Just finished watching the Christmas M*A*S*H episode with my son, Fred, where the whole camp ends their Christmas celebration by singing Dona Nobis Pacem, after which new casualties are delivered by ambulance and Father Mulcahy says, "When you are moving from one disaster to the next, the trick is to just keep moving."
Although I don't work in a mobile army surgical hospital at the front lines of a war, Father Mulcahy's statement touched me very deeply. I do kind of work at the front lines of human disaster and misery, and some of the things I hear, see, and witness at the suicide clinic are so far down on the rungs of the ladder of "human" behavior that I can hardly believe it. And it seems like we are fighting a war that can't be won, because for every patient we finally send home, another one comes in with more pain, grief, and tragedy in his or her life than I care to think about.
I understand perfectly well that people don't come to our clinic when life is good, and so, of course, we witness the consequences of human depravity at its worst, day after day. And I understand that there is just as much good in this life as there is evil, and probably a lot more good than evil. I have, however, come to understand more clearly than ever before that we ought to make every good deed, every act of kindness and benevolence, every moment of patience, every act of service and unselfishness, every smile, every word of praise -- all the good people do every day -- we need to make them count even more by taking notice of them very actively, by noticing and acknowledging them in our hearts and in our minds and in our responses to those to perform them.
And we need to perform them ourselves.
So we just keep moving. And although we obviously can't win the war against evil, we can win the battle for good. This is not a contradiction in terms.
Dienstag, 22. Dezember 2009
Freitag, 18. Dezember 2009
December 18
Today I saw more patients than on any other day before. The swine flu and the approaching Christmas holidays are taking their toll on our numbers. The approaching holidays are also taking their toll on public mental health. It's painfully ironic: Christmas, the season of love, cooperation, and support, is violently chewing at the emotional roots of many people, but especially those of suicidal people, who, as you might remember from yesterday, don't feel loved, think they are hopelessly incapable of solving their problems, and have a low distress tolerance. Add to that, say, post-traumatic stress disorder, being a political refugee and a woman, and see how much you dig that.
For example: Mrs. X., a refugee from a muslim country. She used to be a special-ed teacher in a big city. She taught sports and social science to handicapped children. Unfortunately, she also had some strange notions about freedom of religion: She felt that people in her country should have it. She studied Buddhism and Christianity, taught yoga classes, and once came up with the hideous idea of letting the girls take off their head-scarf during gym class. She shouldn't have done that. Years of terrible persecution began.
She said to me, "I don't trust anyone anymore. I don't trust the government here, I don't trust the hospital, I don't even trust you." (Smart woman! I wouldn't trust me either. ;-D)
After years of living in constant fear of more pain and torture, guilt for leaving her extended family behind, and a terrible marriage for cultural reasons (which she is maintaining because she is scared witless of her husband), she'd had it. Now she's with us. Not once in the last 15 years of her life did she trust anyone to share her emotional distress, her terrible memories, and her painful life. She kept it bottled up. The only thing she dared do was to quietly cry into her pillow night after night, after her husband had fallen asleep, and then sink into endless nights of endless nightmares.
I looked her straight in the face and said very quietly, "You are important to me. Your feelings are important to me." And despite her lack of trust in me, something in her heart broke loose and she began to cry. It was a strange experience for me because you could tell from the way she cried that she hadn't cried out loud for a long time. It was almost as if she had forgotten how to cry like a human, like a woman. She sounded like a wounded animal. I have never heard anyone cry like that before. All I could do was scoot my chair next to hers, put my arm around her, hold her, and let her cry. For a very, very long time. By the time she was done, Mrs. X's crying finally sounded human.
Every time a patient finally opens his or her heart to me, either in so many or so few words, or through emotions ranging from shouting to crying, I feel that I am treading on holy ground. I sense that I am privileged to witness a sacred event, and I treat it the way I treat other sacred experiences: With quiet awe and deep humility. In a way, it's like witnessing a birth, because once people decide to trust me enough to finally share of their innermost feelings, nothing ever goes back to worse. Healing, no matter how small, finally begins to set in. It's literally the beginning of a new life.
Working with my patients often is like having Christmas and Easter all at once.
For example: Mrs. X., a refugee from a muslim country. She used to be a special-ed teacher in a big city. She taught sports and social science to handicapped children. Unfortunately, she also had some strange notions about freedom of religion: She felt that people in her country should have it. She studied Buddhism and Christianity, taught yoga classes, and once came up with the hideous idea of letting the girls take off their head-scarf during gym class. She shouldn't have done that. Years of terrible persecution began.
She said to me, "I don't trust anyone anymore. I don't trust the government here, I don't trust the hospital, I don't even trust you." (Smart woman! I wouldn't trust me either. ;-D)
After years of living in constant fear of more pain and torture, guilt for leaving her extended family behind, and a terrible marriage for cultural reasons (which she is maintaining because she is scared witless of her husband), she'd had it. Now she's with us. Not once in the last 15 years of her life did she trust anyone to share her emotional distress, her terrible memories, and her painful life. She kept it bottled up. The only thing she dared do was to quietly cry into her pillow night after night, after her husband had fallen asleep, and then sink into endless nights of endless nightmares.
I looked her straight in the face and said very quietly, "You are important to me. Your feelings are important to me." And despite her lack of trust in me, something in her heart broke loose and she began to cry. It was a strange experience for me because you could tell from the way she cried that she hadn't cried out loud for a long time. It was almost as if she had forgotten how to cry like a human, like a woman. She sounded like a wounded animal. I have never heard anyone cry like that before. All I could do was scoot my chair next to hers, put my arm around her, hold her, and let her cry. For a very, very long time. By the time she was done, Mrs. X's crying finally sounded human.
Every time a patient finally opens his or her heart to me, either in so many or so few words, or through emotions ranging from shouting to crying, I feel that I am treading on holy ground. I sense that I am privileged to witness a sacred event, and I treat it the way I treat other sacred experiences: With quiet awe and deep humility. In a way, it's like witnessing a birth, because once people decide to trust me enough to finally share of their innermost feelings, nothing ever goes back to worse. Healing, no matter how small, finally begins to set in. It's literally the beginning of a new life.
Working with my patients often is like having Christmas and Easter all at once.
Donnerstag, 17. Dezember 2009
December 17
GIVE AND TAKE
I am really tired. Very tired.
Tired of shattered limbs, busted ribs, sprained arms, broken hearts, gunshot wounds, fractured skulls, broken souls, betrayed trust, fear, pre-arranged marriages, mothers emotionally abusing their daughters, fathers selling their daughters off, children finding their mother who hanged herself, incest, parents demanding perfection from their teenage kids, little children refusing to speak because they were half beaten to death by their father for opening their little mouth, mothers silently watching their husbands sexually abuse their daughters, boyfriends beating their girlfriends for taking anti-depressants in an effort to heal, injured legs from beatings with lead pipes, tears of sorrow, grief, guilt, shame, more shame, and even more shame, lots of railroad tracks, ropes, guns, knives, cables, large packs of tranquilizers, more tears, more fear, no hope, little hope.
And then there is Mr. M., a refugee who needs to pass his German test in order to remain eligible for legal immigration. Of the many forms of treatment he was offered here to heal his hopeless heart, none involved getting him some help with his German. Sometimes even head shrinks can be very dense.
Mr. M. is not my patient. I just heard about his plight during morning staff meeting.
Suicidal people struggle with 3 things:
1. They feel unloved.
2. They feel helpless to solve their problems.
3. They have low distress-tolerance.
Again following my feeling, I went up to Mr. M during my lunch break and said, "Grab your grammar book and meet me in the big room."
"???"
"Before my pain turned me into a psychotherapist I used to be a language teacher."
The damn biggest mediterranean smile I've ever seen. His therapist will help him work on his distress tolerance, but love and help in solving problems can come from anyone.
Mr. M owns a grammar book and six swizzle sticks covered with sugar crystals. Don't know what they're called, neither in German, nor English, nor Arabic.
He goes to his room, gets his book and presents me with one of his sugar-coated swizzle sticks, the only wordly possession he can share, and tells me that I should use it to sweeten my cup of tea. I've never liked sugar more.
Suddenly, my fatigue is gone.
I am really tired. Very tired.
Tired of shattered limbs, busted ribs, sprained arms, broken hearts, gunshot wounds, fractured skulls, broken souls, betrayed trust, fear, pre-arranged marriages, mothers emotionally abusing their daughters, fathers selling their daughters off, children finding their mother who hanged herself, incest, parents demanding perfection from their teenage kids, little children refusing to speak because they were half beaten to death by their father for opening their little mouth, mothers silently watching their husbands sexually abuse their daughters, boyfriends beating their girlfriends for taking anti-depressants in an effort to heal, injured legs from beatings with lead pipes, tears of sorrow, grief, guilt, shame, more shame, and even more shame, lots of railroad tracks, ropes, guns, knives, cables, large packs of tranquilizers, more tears, more fear, no hope, little hope.
And then there is Mr. M., a refugee who needs to pass his German test in order to remain eligible for legal immigration. Of the many forms of treatment he was offered here to heal his hopeless heart, none involved getting him some help with his German. Sometimes even head shrinks can be very dense.
Mr. M. is not my patient. I just heard about his plight during morning staff meeting.
Suicidal people struggle with 3 things:
1. They feel unloved.
2. They feel helpless to solve their problems.
3. They have low distress-tolerance.
Again following my feeling, I went up to Mr. M during my lunch break and said, "Grab your grammar book and meet me in the big room."
"???"
"Before my pain turned me into a psychotherapist I used to be a language teacher."
The damn biggest mediterranean smile I've ever seen. His therapist will help him work on his distress tolerance, but love and help in solving problems can come from anyone.
Mr. M owns a grammar book and six swizzle sticks covered with sugar crystals. Don't know what they're called, neither in German, nor English, nor Arabic.
He goes to his room, gets his book and presents me with one of his sugar-coated swizzle sticks, the only wordly possession he can share, and tells me that I should use it to sweeten my cup of tea. I've never liked sugar more.
Suddenly, my fatigue is gone.
Mittwoch, 16. Dezember 2009
December 16
Today, "la brava dottora" got her English patient. Anthony Minghella, eat your heart out.
I have never seen a more insecure and truly frightened young man than P, age 19, who came in during the night. He's from an English-speaking country and moved here not too long ago with mommy and daddy. His German is near perfect as is the rest of him. He is amazing. Perfect. An explanation for everything. A bundle of fear and insecurities like I didn't even think could exist in a person. He is guilty of feeling guilty for not being perfect every second of his life.His biography makes me sick, sick, sick.
The train tracks. The scars on his wrists from another suicide attempt.
It's not fun to stay alive if mommy and daddy want a perfect son.
This is how he begins nearly everything he says (in a very quiet tone of voice, of course):
"This might be a dumb question, but ..."
"I hope it's appropriate for me to say this ..."
"This might not be important ..."
"I hope I'm not annoying you ..."
He's assigned to me because I speak English. As soon as he can speak English he begins to relax a bit. One less opportunity to not have to "perform" and be perfect at it.
"P., you don't have to do anything right for me, okay? I'm your therapist, not your mother. I'll take care of you to the utmost of my ability while you're here with us. There are no dumb questions with me. Everything you want to say to me is appropriate. Everything you want to tell me is important to me. You can't annoy me. It is simply not possible for you to annoy me. I don't give grades and I don't hit."
A silent, incredulous stare.
"Really???"
"Really!"
By now I am really angry. Angry at parents. His, mine, the rest of all the other patients' parents here at the clinic. For a damn good reason.
At the end of the session I ask P. if it's okay if I give him a hug because I love giving hugs to teenage boys. No, I'm not some pervert. I'm a mom when I'm not posing as a psychotherapist.
"Really???"
"Really!"
"I'd love to get a hug from you."
"Really???" Now it's me asking.
"Really."
I have a son exactly P.'s age. His name is Robert, and he's dead. I would have loved to raise him.
Really.
After P. leaves I put my head on the table and cry.
I have never seen a more insecure and truly frightened young man than P, age 19, who came in during the night. He's from an English-speaking country and moved here not too long ago with mommy and daddy. His German is near perfect as is the rest of him. He is amazing. Perfect. An explanation for everything. A bundle of fear and insecurities like I didn't even think could exist in a person. He is guilty of feeling guilty for not being perfect every second of his life.His biography makes me sick, sick, sick.
The train tracks. The scars on his wrists from another suicide attempt.
It's not fun to stay alive if mommy and daddy want a perfect son.
This is how he begins nearly everything he says (in a very quiet tone of voice, of course):
"This might be a dumb question, but ..."
"I hope it's appropriate for me to say this ..."
"This might not be important ..."
"I hope I'm not annoying you ..."
He's assigned to me because I speak English. As soon as he can speak English he begins to relax a bit. One less opportunity to not have to "perform" and be perfect at it.
"P., you don't have to do anything right for me, okay? I'm your therapist, not your mother. I'll take care of you to the utmost of my ability while you're here with us. There are no dumb questions with me. Everything you want to say to me is appropriate. Everything you want to tell me is important to me. You can't annoy me. It is simply not possible for you to annoy me. I don't give grades and I don't hit."
A silent, incredulous stare.
"Really???"
"Really!"
By now I am really angry. Angry at parents. His, mine, the rest of all the other patients' parents here at the clinic. For a damn good reason.
At the end of the session I ask P. if it's okay if I give him a hug because I love giving hugs to teenage boys. No, I'm not some pervert. I'm a mom when I'm not posing as a psychotherapist.
"Really???"
"Really!"
"I'd love to get a hug from you."
"Really???" Now it's me asking.
"Really."
I have a son exactly P.'s age. His name is Robert, and he's dead. I would have loved to raise him.
Really.
After P. leaves I put my head on the table and cry.
Dienstag, 15. Dezember 2009
December 15
Thanks to those of you who wished me better health. I have it. The same to you. Gesundheit.
Once again following a hunch, I've decided to try a different approach with Signore L., our dear sad Italian. My colleague R. and I are going to do a double session (two therapists). We sense severe anger and fear in the man, and I think I know exactly what is bothering the past middle-age guy, but he just can't let it out. So, we are going to try a harmless version of the good cop/bad cop criminal interrogation approach to finally get to the core of all this Italian sadness. My colleague R. is excited to try it because it's so unlike him, personality-wise. It's a crazy-Judith-idea, but it is in complete harmony with the tenets of his training as existential analyst and theologian. Usually women are the good guys, right?, but today I'm going to be the bad cop and suprise Signore L., which will hopefully throw him for an even bigger loop because he thinks I'm such a nice, gentle, sweet, understanding, honest, decent person - la brava dottora, as he likes to refer to me.
So, R. and I listen to another 20 minutes of more quiet tears and sadness -- listless, aimless, colorless sadness, all drawn out to amazingly great lengths -- the exact opposite of your stereotypical Italian who'll jabber at you about food, wine, and amore at 200 miles per hour. No, listening to Signore M. is like watching an entire funeral service in slow-motion. Now, R. gives him all the empathic action Signore M. is used to from our sessions while I kind of just sit there the entire time, seemingly paying more attention to the construction work outside the office window than to the session.
Then the following scene takes place at a very rapid pace, almost like firing a machine-gun:
Very suddenly and completely unexpectedly for the poor guy I nearly shove my nose in Signore M.'s face and ask in a very sharp tone of voice, "WHAT EXACTLY IS IT THAT YOU ARE SO SCARED OF, SIGNORE M.???"
He doesn't miss a beat.
"EVERYTHING!!!!", he yells.
Bullshit.
"IT'S DEATH, RIGHT?", I yell back.
"YES, DEATH!!!!" Signore M. shouts back at me, exploding in pain and tears.
Bingo.
Buona sera.
Once again following a hunch, I've decided to try a different approach with Signore L., our dear sad Italian. My colleague R. and I are going to do a double session (two therapists). We sense severe anger and fear in the man, and I think I know exactly what is bothering the past middle-age guy, but he just can't let it out. So, we are going to try a harmless version of the good cop/bad cop criminal interrogation approach to finally get to the core of all this Italian sadness. My colleague R. is excited to try it because it's so unlike him, personality-wise. It's a crazy-Judith-idea, but it is in complete harmony with the tenets of his training as existential analyst and theologian. Usually women are the good guys, right?, but today I'm going to be the bad cop and suprise Signore L., which will hopefully throw him for an even bigger loop because he thinks I'm such a nice, gentle, sweet, understanding, honest, decent person - la brava dottora, as he likes to refer to me.
So, R. and I listen to another 20 minutes of more quiet tears and sadness -- listless, aimless, colorless sadness, all drawn out to amazingly great lengths -- the exact opposite of your stereotypical Italian who'll jabber at you about food, wine, and amore at 200 miles per hour. No, listening to Signore M. is like watching an entire funeral service in slow-motion. Now, R. gives him all the empathic action Signore M. is used to from our sessions while I kind of just sit there the entire time, seemingly paying more attention to the construction work outside the office window than to the session.
Then the following scene takes place at a very rapid pace, almost like firing a machine-gun:
Very suddenly and completely unexpectedly for the poor guy I nearly shove my nose in Signore M.'s face and ask in a very sharp tone of voice, "WHAT EXACTLY IS IT THAT YOU ARE SO SCARED OF, SIGNORE M.???"
He doesn't miss a beat.
"EVERYTHING!!!!", he yells.
Bullshit.
"IT'S DEATH, RIGHT?", I yell back.
"YES, DEATH!!!!" Signore M. shouts back at me, exploding in pain and tears.
Bingo.
Buona sera.
Montag, 14. Dezember 2009
December 14
It's very cold outside today. I have a headache the size of Texas and I'm coughing like a camel on crack. And because I'm an idiot, I forgot my bottle of Ibuprofen, my scarf, and my gloves at home. By the time I get to work I wish someone would run a Sherman tank across my body from the chest upwards to make the wheezing in my lungs and the pounding in my head stop.
Three patients and two staff meetings separate me from my lunch break. My despondent Italian, who's been feeling a bit more positive. Still, he's worried that feeling halfway good today will just make a bad tomorrow feel even worse. I wonder if this whole friggin' country of Austria doesn't run on this principle.
Then there's Herr H., who is planning on going home for Christmas. Finally. He tried to take his life in August and has been with us ever since, coming up with a new reason once a week to feel miserable so he can stay yet another week. Why? Probably because: See last sentence last paragraph.
Then there is Frau L., my translucent borderline friend whom I left with a box of crayons for the weekend. I open the ring binder she brings to our session and now it's time to gasp: Translucent Frau L., whose entire appearance is so colorless and pale that she might as well be her own ghost, drew two of the most amazingly bright pictures, just playing with the crayons, and she chose the brightest colors you can imagine: neon bright shades of green, purple, blue, yellow, red, and orange. It almost blinds and even kind of hurts me to look at the pictures. Plus she gave the picture a totally cool texture by rubbing the color on the paper surface with her finger. I am shocked. Unfortunately, our session is over, so I don't have time to talk to her about interpreting her drawings, but I ask her permission to show them at our staff meeting. She can hardly believe that I would want to show her pictures to anyone, but she gives me her consent. Later, when I show the pictures and tell my colleagues who drew them, they all sit there in utter shock, quietly mumbling words of disbelief -- especially those who had "handled" Frau L. during her past stays and who had informed me that there wasn't a damn thing we could do to get her to come alive a bit.
Conclusion: NEVER be fooled by a ghost.
Three patients and two staff meetings separate me from my lunch break. My despondent Italian, who's been feeling a bit more positive. Still, he's worried that feeling halfway good today will just make a bad tomorrow feel even worse. I wonder if this whole friggin' country of Austria doesn't run on this principle.
Then there's Herr H., who is planning on going home for Christmas. Finally. He tried to take his life in August and has been with us ever since, coming up with a new reason once a week to feel miserable so he can stay yet another week. Why? Probably because: See last sentence last paragraph.
Then there is Frau L., my translucent borderline friend whom I left with a box of crayons for the weekend. I open the ring binder she brings to our session and now it's time to gasp: Translucent Frau L., whose entire appearance is so colorless and pale that she might as well be her own ghost, drew two of the most amazingly bright pictures, just playing with the crayons, and she chose the brightest colors you can imagine: neon bright shades of green, purple, blue, yellow, red, and orange. It almost blinds and even kind of hurts me to look at the pictures. Plus she gave the picture a totally cool texture by rubbing the color on the paper surface with her finger. I am shocked. Unfortunately, our session is over, so I don't have time to talk to her about interpreting her drawings, but I ask her permission to show them at our staff meeting. She can hardly believe that I would want to show her pictures to anyone, but she gives me her consent. Later, when I show the pictures and tell my colleagues who drew them, they all sit there in utter shock, quietly mumbling words of disbelief -- especially those who had "handled" Frau L. during her past stays and who had informed me that there wasn't a damn thing we could do to get her to come alive a bit.
Conclusion: NEVER be fooled by a ghost.
Sonntag, 13. Dezember 2009
December 13
Yesterday I mentioned mania as part of bipolar depression. Here we go:
Common symptoms of mania may include:
* Abnormal/excessively high or euphoric feelings
* Extreme irritability or distractability
* Decreased need for sleep
* A marked increase in energy/activity
* Rapid or pressured speech
* Racing thoughts or a feeling that you can't slow down your mind
* You have troubles concentrating or you are easily distracted
* Signs of poor judgment, risk taking, or other bizarre behavior
* An exaggerated belief in one's own abilities or characteristics
* Increased sex drive
* Little or no insight into behavior changes
* In severe manic episodes, you can even have delusions and hallucinations. (But then you're probably hitting schizophrenia or some other psychotic disorder.)
Sounds like fun, huh? Well, it's not.
Bipolar mood disorder (some people still refer to it as manic-depressive illness) is an illness of the brain that afflicts about 1 percent of all people. This mood disorder is caused by extreme mood swings that go beyond the ups and downs of normal moods. It is treatable and manageable, but two-thirds of those with bipolar mood disorder go undiagnosed, folks, and therefore untreated. Why? Because when we go see the doc only when we're depressed, the doc may miss the high episodes.
So, you kind of got to force people to see a doctor during a high episode because people don't have insight into their own behavior and even enjoy their manic phases (reckless shopping, impulsive business decisions, scary driving, lots of sex -- who would not enjoy that? ;-D)
If BMD goes untreated, these folks tend to abuse drugs and alc and they have a much higher suicide risk. Believe me. I see it at work every day. They don't recognize that their emotional problems have a treatable mental illness as their cause. With proper treatment, people with BMD can live a pretty normal and productive life.
So, what else? Symptoms usually start in young adults between the ages seventeen and twenty-five, but they can start any time in life. Even some younger kids have BMD. It's a chronic condition with recurring episodes and requires ongoing treatment. If you don't treat it, it tends to get worse.
More suicide shop talk: About half of all people with bipolar disorder attempt suicide.
Any questions? Ask the Fox. ;-D
Common symptoms of mania may include:
* Abnormal/excessively high or euphoric feelings
* Extreme irritability or distractability
* Decreased need for sleep
* A marked increase in energy/activity
* Rapid or pressured speech
* Racing thoughts or a feeling that you can't slow down your mind
* You have troubles concentrating or you are easily distracted
* Signs of poor judgment, risk taking, or other bizarre behavior
* An exaggerated belief in one's own abilities or characteristics
* Increased sex drive
* Little or no insight into behavior changes
* In severe manic episodes, you can even have delusions and hallucinations. (But then you're probably hitting schizophrenia or some other psychotic disorder.)
Sounds like fun, huh? Well, it's not.
Bipolar mood disorder (some people still refer to it as manic-depressive illness) is an illness of the brain that afflicts about 1 percent of all people. This mood disorder is caused by extreme mood swings that go beyond the ups and downs of normal moods. It is treatable and manageable, but two-thirds of those with bipolar mood disorder go undiagnosed, folks, and therefore untreated. Why? Because when we go see the doc only when we're depressed, the doc may miss the high episodes.
So, you kind of got to force people to see a doctor during a high episode because people don't have insight into their own behavior and even enjoy their manic phases (reckless shopping, impulsive business decisions, scary driving, lots of sex -- who would not enjoy that? ;-D)
If BMD goes untreated, these folks tend to abuse drugs and alc and they have a much higher suicide risk. Believe me. I see it at work every day. They don't recognize that their emotional problems have a treatable mental illness as their cause. With proper treatment, people with BMD can live a pretty normal and productive life.
So, what else? Symptoms usually start in young adults between the ages seventeen and twenty-five, but they can start any time in life. Even some younger kids have BMD. It's a chronic condition with recurring episodes and requires ongoing treatment. If you don't treat it, it tends to get worse.
More suicide shop talk: About half of all people with bipolar disorder attempt suicide.
Any questions? Ask the Fox. ;-D
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