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
Samstag, 12. Dezember 2009
December 12
First of all I would like to thank so many of you who have been giving me feedback on the Foxblog. I appreciate all your emails and text messages and I'm glad that some of you have been helped or even inspired, if only in small ways, by some of the stuff they've read on Foxblog.
Let me mention a couple of things about depression. According to statistics published by the World Health Organization,
Mood disorders are much more than just feeling sad. They affect the entire body and cause changes in the body, especially in brain functioning, so that you can't change your mood by sheer willpower. As I've mentioned before, you can't just snap out of depression. Depression always affects our brain chemistry and therefore our thinking, eating, sleeping, concentrating, and just about every other area of our daily life.
There are basically two main flavors of mood disorders: unipolar and bipolar. Unipolar disorders are associated with feeling only sad and empty. Hence, they are called unipolar. Bipolar disorders usually alternate between mania and depression, hence they are called bipolar.
Today I'll describe unipolar depression. Common symptoms are:
* Persistently feeling sad, anxious, empty, worthless.
* Persistently feeling guilty.
* Feeling hopeless.
* You can't feel any joy or pleasure.
* You experience loss of energy and drive (and that would include your sex drive, folks).
* You find it hard to concentrate, remember stuff or make decisions.
* You're restless and irritable.
* You can't sleep well, wake up early in the morning, feel like shit, oversleep and find it hard to wake up.
* Your appetite changes (overeating, undereating).
* Other physical symptoms may include headaches, stomach aches, digestive disorders, or just feeling pain all over.
* You think about death or dying a lot, or even attempt to commit suicide.
In short: Sounds a lot like menopause, huh, girls??? Just kidding.
If you experience many of these symptoms for longer than a couple of weeks, you may be depressed (or menopausal, or both ;-D)
Go get help from a medical doctor or contact your Fox. *grin*
Tomorrow we'll talk about bipolar depression.
Let me mention a couple of things about depression. According to statistics published by the World Health Organization,
- Major depressive disorder is the leading cause of disability in the U.S. for ages 15-44.
- Clinical or major depression is the top cause of disability throughout the world for persons 5 and over.
Mood disorders are much more than just feeling sad. They affect the entire body and cause changes in the body, especially in brain functioning, so that you can't change your mood by sheer willpower. As I've mentioned before, you can't just snap out of depression. Depression always affects our brain chemistry and therefore our thinking, eating, sleeping, concentrating, and just about every other area of our daily life.
There are basically two main flavors of mood disorders: unipolar and bipolar. Unipolar disorders are associated with feeling only sad and empty. Hence, they are called unipolar. Bipolar disorders usually alternate between mania and depression, hence they are called bipolar.
Today I'll describe unipolar depression. Common symptoms are:
* Persistently feeling sad, anxious, empty, worthless.
* Persistently feeling guilty.
* Feeling hopeless.
* You can't feel any joy or pleasure.
* You experience loss of energy and drive (and that would include your sex drive, folks).
* You find it hard to concentrate, remember stuff or make decisions.
* You're restless and irritable.
* You can't sleep well, wake up early in the morning, feel like shit, oversleep and find it hard to wake up.
* Your appetite changes (overeating, undereating).
* Other physical symptoms may include headaches, stomach aches, digestive disorders, or just feeling pain all over.
* You think about death or dying a lot, or even attempt to commit suicide.
In short: Sounds a lot like menopause, huh, girls??? Just kidding.
If you experience many of these symptoms for longer than a couple of weeks, you may be depressed (or menopausal, or both ;-D)
Go get help from a medical doctor or contact your Fox. *grin*
Tomorrow we'll talk about bipolar depression.
Freitag, 11. Dezember 2009
December 11
THE LAW OF THE HARVEST
Herr N., my dear German suicide-victim-gone-artist, left the clinic for an extended stay at at health resort. He took his drawings with him. As a small good-bye gift I gave him a pack of oil pastels and a sketching pad to take to the spa so he would feel encouraged to keep on drawing to access more of his deeply buried feelings. My colleague, M., was so impressed with the rainbow drawing that he asked Herr M.'s permission to scan it and use it for a research paper. Herr M. gladly granted his permission. I also got a copy, which is now hanging in my office. Last week I said that everytime I would walk along train tracks in the future I would think of crowbars. I would like to rigorously amend that statement: Everytime I walk along train tracks I will think of rainbows. If I don't, I will have failed Herr N. -- and the purpose of Christ's Atonement.
Translucent Frau L. was rather happy today. She asked for permission to leave overnight and stay with her boyfriend, which I happily granted her. Since she seemed quite approachable today I pulled out my own pastels, having barely taken them away from Herr N., and set the box in front of her. About 25 different colors.
I tacitly assumed that this might be just as painful for her as it was for me the first time my therapist set a box of colors in front of me. Just the thought of having to choose a color as an expression of my emotional state that very minute had nearly given me a nervous breakdown and I got so upset with my therapist for forcing me into such a self-revealing decision that I quietly started crying, which completely mortified me and I almost ran away in shame and fear.
Fast forward. Now I'm sitting here with Miss Borderline who can barely look into my eyes because she is so scared of life. But she has no problems choosing neon orange to describe her mood right now and it didn't take her longer than 10 seconds and very little prodding from me to grab the neon orange crayon and start drawing some very odd figures. Still, "better than I did after hours of therapy," I said to myself with a very sheepish grin. "And I'm NOT borderline." Okay, my husband and kids would possibly argue that point, but never mind ...
Our time is over. I ask Frau L. if she would like to take the neon orange crayon and the sheet of paper with her over the weekend. She says yes and then suddenly asks for 3 or 4 more empty sheets because she would like to draw more than just one picture, she announces to my surprise. I am dumbfounded (as I have been so often in working with people). So I give her the whole crayon box for the weekend. And another hug. Not to make HER feel good, but to make ME feel good, a token of gratitude, in a way, for my own therapist who "tortured" me into learning to use art as a means of releasing and expressing emotions.
Still, Frau L. appreciated the hug enough and left.
After she closes the door I go to the window and look outside. Gray skies, rain, sleet, mud from the construction site underneath the window. I recall John 4:36:
"And he that reapeth receiveth wages and gathereth fruit unto life eternal: That both he that soweth and he that reapeth may rejoice together."
We just don't know HOW our actions, decisions, and choices will influence other people and maybe generations to come. Which "border line" am I going to cross (or not) and where will it take me and the people around me? What am I teaching others, either consciously, by introducing them to, say, art therapy, or unconsciously, by the way I respond to certain people or situations?
Herr N., my dear German suicide-victim-gone-artist, left the clinic for an extended stay at at health resort. He took his drawings with him. As a small good-bye gift I gave him a pack of oil pastels and a sketching pad to take to the spa so he would feel encouraged to keep on drawing to access more of his deeply buried feelings. My colleague, M., was so impressed with the rainbow drawing that he asked Herr M.'s permission to scan it and use it for a research paper. Herr M. gladly granted his permission. I also got a copy, which is now hanging in my office. Last week I said that everytime I would walk along train tracks in the future I would think of crowbars. I would like to rigorously amend that statement: Everytime I walk along train tracks I will think of rainbows. If I don't, I will have failed Herr N. -- and the purpose of Christ's Atonement.
Translucent Frau L. was rather happy today. She asked for permission to leave overnight and stay with her boyfriend, which I happily granted her. Since she seemed quite approachable today I pulled out my own pastels, having barely taken them away from Herr N., and set the box in front of her. About 25 different colors.
I tacitly assumed that this might be just as painful for her as it was for me the first time my therapist set a box of colors in front of me. Just the thought of having to choose a color as an expression of my emotional state that very minute had nearly given me a nervous breakdown and I got so upset with my therapist for forcing me into such a self-revealing decision that I quietly started crying, which completely mortified me and I almost ran away in shame and fear.
Fast forward. Now I'm sitting here with Miss Borderline who can barely look into my eyes because she is so scared of life. But she has no problems choosing neon orange to describe her mood right now and it didn't take her longer than 10 seconds and very little prodding from me to grab the neon orange crayon and start drawing some very odd figures. Still, "better than I did after hours of therapy," I said to myself with a very sheepish grin. "And I'm NOT borderline." Okay, my husband and kids would possibly argue that point, but never mind ...
Our time is over. I ask Frau L. if she would like to take the neon orange crayon and the sheet of paper with her over the weekend. She says yes and then suddenly asks for 3 or 4 more empty sheets because she would like to draw more than just one picture, she announces to my surprise. I am dumbfounded (as I have been so often in working with people). So I give her the whole crayon box for the weekend. And another hug. Not to make HER feel good, but to make ME feel good, a token of gratitude, in a way, for my own therapist who "tortured" me into learning to use art as a means of releasing and expressing emotions.
Still, Frau L. appreciated the hug enough and left.
After she closes the door I go to the window and look outside. Gray skies, rain, sleet, mud from the construction site underneath the window. I recall John 4:36:
"And he that reapeth receiveth wages and gathereth fruit unto life eternal: That both he that soweth and he that reapeth may rejoice together."
We just don't know HOW our actions, decisions, and choices will influence other people and maybe generations to come. Which "border line" am I going to cross (or not) and where will it take me and the people around me? What am I teaching others, either consciously, by introducing them to, say, art therapy, or unconsciously, by the way I respond to certain people or situations?
Donnerstag, 10. Dezember 2009
December 10
On following your feelings:
Herr N., the German with the so amazingly abusive father, was still not granting anyone (including himself) access to his world of emotions. His sessions were really not going anywhere. On Monday, simply following a hunch, I ran to the car during my lunch break and retrieved my oil pastels and a sketching pad. I gave them to Herr N. and asked him if he would be willing to produce some sort of a visual representation of a life without suicide ideations. To my joy my hunch had not been a dud: Mr. N. became totally excited, telling me that had apprenticed as a painter in his youth and had always enjoyed art in his spare time. In the course of his unhappy life he had forgotten all about it.
Today he presented us with 3 pictures. They were mostly happy in nature and showed a positive outlook -- two thirds life, one third death. Two-thirds of a beautiful rainbow originating in a black field. Life arising out of death. And finally Herr N. began to speak about emotions ...
Rule A) Follow your intuition.
Our translucent borderline patient, Frau. L., got a royal yelling-at from the doctor on duty yesterday. She had a dental appointment and failed to return to the hospital after her visit to the dental clinic. Apparently she had been out gallavanting around town. Then the psychologist on duty reprimanded her this morning for the same reason. I got her at 11 a.m. She was even more translucent than usual. By order of der Chef we went over her therapy contract one more time and she started to shake. At the end of our session I followed my feelings and did something highly unusual for an Austrian (and even more unusual in a medical setting): I gave her a big hug. And all of a sudden she became a person of flesh and bones, her translucency giving way to a lively skin color. She whispered "Danke!" in my ear and ran out of the room.
Rule B) Follow your intuition.
Herr N., the German with the so amazingly abusive father, was still not granting anyone (including himself) access to his world of emotions. His sessions were really not going anywhere. On Monday, simply following a hunch, I ran to the car during my lunch break and retrieved my oil pastels and a sketching pad. I gave them to Herr N. and asked him if he would be willing to produce some sort of a visual representation of a life without suicide ideations. To my joy my hunch had not been a dud: Mr. N. became totally excited, telling me that had apprenticed as a painter in his youth and had always enjoyed art in his spare time. In the course of his unhappy life he had forgotten all about it.
Today he presented us with 3 pictures. They were mostly happy in nature and showed a positive outlook -- two thirds life, one third death. Two-thirds of a beautiful rainbow originating in a black field. Life arising out of death. And finally Herr N. began to speak about emotions ...
Rule A) Follow your intuition.
Our translucent borderline patient, Frau. L., got a royal yelling-at from the doctor on duty yesterday. She had a dental appointment and failed to return to the hospital after her visit to the dental clinic. Apparently she had been out gallavanting around town. Then the psychologist on duty reprimanded her this morning for the same reason. I got her at 11 a.m. She was even more translucent than usual. By order of der Chef we went over her therapy contract one more time and she started to shake. At the end of our session I followed my feelings and did something highly unusual for an Austrian (and even more unusual in a medical setting): I gave her a big hug. And all of a sudden she became a person of flesh and bones, her translucency giving way to a lively skin color. She whispered "Danke!" in my ear and ran out of the room.
Rule B) Follow your intuition.
Mittwoch, 9. Dezember 2009
December 9
Another session with Signore M., the sad Italian. He just sat there and cried. And cried some more. And kept crying.
He has absolutely no hope for his depression to ever go away again. And that is one of the disgusting side effects of Signore M.'s kind of depression -- you think you will feel this terrible/despondent/sad/hopeless forever.
Fact is: You won't. No system can maintain feeling THAT shitty for very long.
It's good that Signore M. can cry. Lots of people in his condition can't even cry. That presents a by far tougher challenge to the therapist.
It's good to cry. At times we just have to let ourselves cry. For a couple of minutes. Maybe for half an hour or maybe for a week or a month. But at some point in life it just might be time to cry. To let ourselves be totally depressed -- depressed like snot, as one of my missionary companions once so aptly termed this condition.
At some point in life it might be time to be completely depressed like snot. Let my body and soul grieve. Take a break. Keep quiet. Rest for a while. Accept the fact that I have no energy whatsoever. Not try to force things to get better. We live in hectic times.
In all likelihood this condition will not persist. Things will get better. With adequate help and care from internal and external resources I will regain my strength, physically, mentally, emotionally. But first I have to rest and let myself simply be whatever I am.
Sometimes the illness is the cure.
Buona sera.
He has absolutely no hope for his depression to ever go away again. And that is one of the disgusting side effects of Signore M.'s kind of depression -- you think you will feel this terrible/despondent/sad/hopeless forever.
Fact is: You won't. No system can maintain feeling THAT shitty for very long.
It's good that Signore M. can cry. Lots of people in his condition can't even cry. That presents a by far tougher challenge to the therapist.
It's good to cry. At times we just have to let ourselves cry. For a couple of minutes. Maybe for half an hour or maybe for a week or a month. But at some point in life it just might be time to cry. To let ourselves be totally depressed -- depressed like snot, as one of my missionary companions once so aptly termed this condition.
At some point in life it might be time to be completely depressed like snot. Let my body and soul grieve. Take a break. Keep quiet. Rest for a while. Accept the fact that I have no energy whatsoever. Not try to force things to get better. We live in hectic times.
In all likelihood this condition will not persist. Things will get better. With adequate help and care from internal and external resources I will regain my strength, physically, mentally, emotionally. But first I have to rest and let myself simply be whatever I am.
Sometimes the illness is the cure.
Buona sera.
Dienstag, 8. Dezember 2009
December 8
Today is a holiday in Austria and I didn't have to go to work. However, after having spoken to a number of people, I will respond to their requests to mention a couple of things about mental illness. I might do that on weekends as well.
Understanding mental illness more accurately can help reduce suffering because a lack of understanding increases suffering by victims of mental illness as well as by their loved ones. Even the term mental illness continues to scare people. The term itself can refer to many different kinds of problems, most of which have to do with a certain degree of the brain's ability to function as it should. It's obvious to most folks that a stroke (as a result of a clogged blood vessel in the brain) can reduce the brain's ability to function properly, for example, by causing loss of speech or control over one's motor functions.
But the brain also runs our emotions and thoughts and it processes every bit of information we take in. The causes of mental illness are highly complex and are a consequence of interacting biological, psychological/emotional and environmental factors. Sometimes these causes are genetic, sometimes they are caused by illness or injury, sometimes by stress and trauma, and sometimes the body just doesn't produce enough neurotransmitters to keep the brain functioning properly, or the neurotransmitters are reabsorbed too quickly. I'll talk more about that next time.
The most important thing I would like to mention today is that people who suffer from mental illness can't just "snap out of it." Telling someone with, for example, chronic depression to "snap out of it" is just as ridiculous as telling someone with thyroid malfunction or diabetes to "snap out of it."
The second thing I would like to mention is that there is no need to be scared of taking medication as a part of treatment for mental illness. As mentioned above, if the brain chemistry (regulating neurotransmitter functioning) is a problem, then taking meds to regulate neurotransmitter functioning is like taking insulin if you suffer from diabetes or thyroid hormones for thyroid malfunction. Who in their right mind would think of not taking insulin if the body needs it to stay alive?
Would anyone laugh at a diabetic for taking insulin? Would you stigamatize a diabetic for taking insulin? If my brain needs meds to function properly -- then what is wrong with having that diagnosed and taking the meds to make me feel okay so I can function properly?
Think about it.
Understanding mental illness more accurately can help reduce suffering because a lack of understanding increases suffering by victims of mental illness as well as by their loved ones. Even the term mental illness continues to scare people. The term itself can refer to many different kinds of problems, most of which have to do with a certain degree of the brain's ability to function as it should. It's obvious to most folks that a stroke (as a result of a clogged blood vessel in the brain) can reduce the brain's ability to function properly, for example, by causing loss of speech or control over one's motor functions.
But the brain also runs our emotions and thoughts and it processes every bit of information we take in. The causes of mental illness are highly complex and are a consequence of interacting biological, psychological/emotional and environmental factors. Sometimes these causes are genetic, sometimes they are caused by illness or injury, sometimes by stress and trauma, and sometimes the body just doesn't produce enough neurotransmitters to keep the brain functioning properly, or the neurotransmitters are reabsorbed too quickly. I'll talk more about that next time.
The most important thing I would like to mention today is that people who suffer from mental illness can't just "snap out of it." Telling someone with, for example, chronic depression to "snap out of it" is just as ridiculous as telling someone with thyroid malfunction or diabetes to "snap out of it."
The second thing I would like to mention is that there is no need to be scared of taking medication as a part of treatment for mental illness. As mentioned above, if the brain chemistry (regulating neurotransmitter functioning) is a problem, then taking meds to regulate neurotransmitter functioning is like taking insulin if you suffer from diabetes or thyroid hormones for thyroid malfunction. Who in their right mind would think of not taking insulin if the body needs it to stay alive?
Would anyone laugh at a diabetic for taking insulin? Would you stigamatize a diabetic for taking insulin? If my brain needs meds to function properly -- then what is wrong with having that diagnosed and taking the meds to make me feel okay so I can function properly?
Think about it.
Montag, 7. Dezember 2009
December 7
A full day. Tomorrow's a holiday and so several of my colleagues aren't coming in today as well, leaving the rest of us with their workload. Kind of makes for a more relaxed atmosphere, though. Der Chef and Alpha Female aren't in today as well. Morning staff meeting offered everyone the chance to use two chairs (one for your feet, except Austrian decorum would never allow for that).
Only one new patient came in over the weekend. The saddest of all sad things to observe: A despondent Italian. Lots of tears and paper tissues. No O Sole Mio, no spaghetti carbonara, no Firenze, Milano, Roma, e Napoli. No Luciano Pavarotti, Andrea Celentano, prosciutto di Parma ... just lots of tears and wailing. Oh, it's all so sad. Signore M., way past middle age, the former owner of several of the finest Italian restaurants in town. Many colorful guests ... politicians, actors, movie stars, automobile champions. Now, just tears and more tears. E molto terribile. No, he doesn't want to go spend time at a mental health resort to regain his emotional stamina, he just wants to be able to calm down here at the clinic and also be around la famiglia, his beautiful wife, his so very handsome and successful son, his intelligent and absolutely gorgeous daughter with a law degree, the brothers and nephews who are now doing so well after having switched over from Italian cooking to car selling ... mangiare e macchine. Santa Maria! How could he possibly leave them?
Yet he won't go to Italy for Christmas. Too much stress. La famiglia down there is way too much for his nervous system. He just wants peace and quiet at the suicide clinic so he won't want to commit suicide anymore. But why does he want to do himself in in the first place?
H., the psychiatrist and I, who are assigned to the case, are somewhat puzzled. This guy shouldn't even be here. Santa Maria! We consult with our colleague, R. "Oh, Signore M. is back!!!!" R. knows Signore M. He's been in before. He was shipped over from the closed ward and the forensic ward after some serious violence issues. But now? I have a spontaneous hunch. This guy is seeking protection. Female intuition? Or have I been hanging around this place for too long already and I should check out the ICD to diagnose myself?
So, R. fills us in about Signore M.'s case history from his last stay.
The beautiful wife, Signora M., she IS beautiful, unlike hubby. And he beats her in fits of jealousy.
The so very handsome and successful son -- not much in control of his Italian temper as well. Not on good terms at all with Papa. In kahutz with Mama. Wanted to keep Papa in the closed ward last time. Threatened the clinic staff.
The intelligent and absolutely gorgeous daughter with a law degree: Keeps herself completely aloof from everything. Didn't come in once last time to visit Papa.
What happened to the famous restaurant? The car-selling nephews? "Don't ask me", R. says. "I don't even want to know. Last time I talked to one of Signore M.s relatives the dude said that things were going to be settled the Italian way." Nudge, nudge, wink, wink, say no more.
There is truth to the old adage that goes: People ALWAYS lie to their priest, their lawyer, and their psychotherapist.
Santa Maria!!!
Only one new patient came in over the weekend. The saddest of all sad things to observe: A despondent Italian. Lots of tears and paper tissues. No O Sole Mio, no spaghetti carbonara, no Firenze, Milano, Roma, e Napoli. No Luciano Pavarotti, Andrea Celentano, prosciutto di Parma ... just lots of tears and wailing. Oh, it's all so sad. Signore M., way past middle age, the former owner of several of the finest Italian restaurants in town. Many colorful guests ... politicians, actors, movie stars, automobile champions. Now, just tears and more tears. E molto terribile. No, he doesn't want to go spend time at a mental health resort to regain his emotional stamina, he just wants to be able to calm down here at the clinic and also be around la famiglia, his beautiful wife, his so very handsome and successful son, his intelligent and absolutely gorgeous daughter with a law degree, the brothers and nephews who are now doing so well after having switched over from Italian cooking to car selling ... mangiare e macchine. Santa Maria! How could he possibly leave them?
Yet he won't go to Italy for Christmas. Too much stress. La famiglia down there is way too much for his nervous system. He just wants peace and quiet at the suicide clinic so he won't want to commit suicide anymore. But why does he want to do himself in in the first place?
H., the psychiatrist and I, who are assigned to the case, are somewhat puzzled. This guy shouldn't even be here. Santa Maria! We consult with our colleague, R. "Oh, Signore M. is back!!!!" R. knows Signore M. He's been in before. He was shipped over from the closed ward and the forensic ward after some serious violence issues. But now? I have a spontaneous hunch. This guy is seeking protection. Female intuition? Or have I been hanging around this place for too long already and I should check out the ICD to diagnose myself?
So, R. fills us in about Signore M.'s case history from his last stay.
The beautiful wife, Signora M., she IS beautiful, unlike hubby. And he beats her in fits of jealousy.
The so very handsome and successful son -- not much in control of his Italian temper as well. Not on good terms at all with Papa. In kahutz with Mama. Wanted to keep Papa in the closed ward last time. Threatened the clinic staff.
The intelligent and absolutely gorgeous daughter with a law degree: Keeps herself completely aloof from everything. Didn't come in once last time to visit Papa.
What happened to the famous restaurant? The car-selling nephews? "Don't ask me", R. says. "I don't even want to know. Last time I talked to one of Signore M.s relatives the dude said that things were going to be settled the Italian way." Nudge, nudge, wink, wink, say no more.
There is truth to the old adage that goes: People ALWAYS lie to their priest, their lawyer, and their psychotherapist.
Santa Maria!!!
Freitag, 4. Dezember 2009
December 4
Today I got out of rounds. Instead, someone (who?) was kind enough to surprisingly schedule supervision for me. I hate rounds. It's one of those remnants of European feudal societies, I figure, that help make sure we all know who's the boss and who's not. Not only the patients. It helps you remember which border lines are not meant for crossing.
Every morning the psychiatrists, psychologists, psychotherapists and members of the nursing staff follow the alpha female, Dr. A., from room to room and bed to bed. (In Austrian hospitals there are more than just 1 or 2 beds per room.). You greet the patient with a handshake and a firm "Guten Morgen" and ask him or her inane questions that get quite personal at times. In the course of all this many personal border lines get crossed ...
... with a whole slew of people listening in, including your roomies. Some patients choose to hide in the bathroom instead of making themselves available for rounds. In that case, one unfortunate member of the nursing staff gets to drag the equally unfortunate victim out of the shower, or wherever. More border lines get crossed. Don't you dare upset routines!
On Wednesdays, and only on Wednesdays, the psychiatrists, psychologists, psychotherapists and members of the nursing staff follow the alpha female, Dr. A., who follows the department head, Dr. F., "der Chef." It reminds me of roll call. The male patients must feel the same way because as a matter of course they get out of bed, barely suppressing an urge to stand at attendance. Every morning I wait for someone to spontaneously salute. It never happens, though. And: Why no taps? Surely someone could play taps? This is Austria, after all, with the sound of music wherever you go ...
Another young adult came in during the night. E., age 25. She tried to kill her herself because the women's shelter won't keep her. The shelter is for abused women. Period. Not for abused women with a borderline personality disorder. And E. is "TOTALLY borderline", as my colleague C. says with a professional smirk. "The works."
After her suicide attempt the women's shelter sent E. right across the border to a mental hospital in Bavaria. She crossed the border line. Not funny. The Bavarians didn't want her because they are not equipped to handle suicidal patients. So they sent E. across the border line back into Austria to our hospital where she spent the night in the closed psychiatric ward.
Now she's with us at the suicide clinic. E. comes from a former communist country in the East. Her German is okay. We can communicate. Her father, a refugee, is not a nice man. Actually, he is physically and emotionally abusive. But now she wants to go back home. Across the border line. From a safe room in the hospital to her abusive father. That's very borderline.
E. is very pale. On top of that her complexion is unusually light and she looks surreal, almost translucent. You can't tell where her body ends and her Self begins. Her responses are, well, borderline. Dr. F., the psychiatrist on duty, knows her from two former stays at the suicide clinic. He warns us. "You can't believe half the stuff she says."
We tell her she has to stay at least for a week. She needs meds to stabilize her, she needs therapy, and we have to get in touch with her parents and find an emergency solution for her where she can seek help and stay in case her father becomes abusive again. She has no way of living alone. Someone has to tell E. what to do. She needs a warm environment of care and love that will help keep her within certain boundaries so she can be safe. Structure. Lots of structure and routine. Structure and routine. Structure and routine. Structure and routine. No crossing border lines ...
Somewhere in the back of my head a trumpet is playing taps.
Every morning the psychiatrists, psychologists, psychotherapists and members of the nursing staff follow the alpha female, Dr. A., from room to room and bed to bed. (In Austrian hospitals there are more than just 1 or 2 beds per room.). You greet the patient with a handshake and a firm "Guten Morgen" and ask him or her inane questions that get quite personal at times. In the course of all this many personal border lines get crossed ...
... with a whole slew of people listening in, including your roomies. Some patients choose to hide in the bathroom instead of making themselves available for rounds. In that case, one unfortunate member of the nursing staff gets to drag the equally unfortunate victim out of the shower, or wherever. More border lines get crossed. Don't you dare upset routines!
On Wednesdays, and only on Wednesdays, the psychiatrists, psychologists, psychotherapists and members of the nursing staff follow the alpha female, Dr. A., who follows the department head, Dr. F., "der Chef." It reminds me of roll call. The male patients must feel the same way because as a matter of course they get out of bed, barely suppressing an urge to stand at attendance. Every morning I wait for someone to spontaneously salute. It never happens, though. And: Why no taps? Surely someone could play taps? This is Austria, after all, with the sound of music wherever you go ...
Another young adult came in during the night. E., age 25. She tried to kill her herself because the women's shelter won't keep her. The shelter is for abused women. Period. Not for abused women with a borderline personality disorder. And E. is "TOTALLY borderline", as my colleague C. says with a professional smirk. "The works."
After her suicide attempt the women's shelter sent E. right across the border to a mental hospital in Bavaria. She crossed the border line. Not funny. The Bavarians didn't want her because they are not equipped to handle suicidal patients. So they sent E. across the border line back into Austria to our hospital where she spent the night in the closed psychiatric ward.
Now she's with us at the suicide clinic. E. comes from a former communist country in the East. Her German is okay. We can communicate. Her father, a refugee, is not a nice man. Actually, he is physically and emotionally abusive. But now she wants to go back home. Across the border line. From a safe room in the hospital to her abusive father. That's very borderline.
E. is very pale. On top of that her complexion is unusually light and she looks surreal, almost translucent. You can't tell where her body ends and her Self begins. Her responses are, well, borderline. Dr. F., the psychiatrist on duty, knows her from two former stays at the suicide clinic. He warns us. "You can't believe half the stuff she says."
We tell her she has to stay at least for a week. She needs meds to stabilize her, she needs therapy, and we have to get in touch with her parents and find an emergency solution for her where she can seek help and stay in case her father becomes abusive again. She has no way of living alone. Someone has to tell E. what to do. She needs a warm environment of care and love that will help keep her within certain boundaries so she can be safe. Structure. Lots of structure and routine. Structure and routine. Structure and routine. Structure and routine. No crossing border lines ...
Somewhere in the back of my head a trumpet is playing taps.
Donnerstag, 3. Dezember 2009
December 3
Mr. N., who grew up under the Communist regime in the former German Democratic Republic, quite past middle age, likes to talk. Not so much that you feel like stopping him all the time because he'll just talk all alone through the entire therapy session, but talk he does. In his thick Saxonian accent he talks about himself. Mr. N. speaks mostly in generalizations and cliches.
Mostly. You better pay attention, because camouflaged in his cascade of words within a description of how he walks home along the railroad tracks after work, like a slurr, almost, he will tell you how easy it would be to just step onto the tracks at the right time.
That gets a rise out of the therapist, who almost got caught in the snare. "Why would you do that?"
"For the same reason I stick my hand in boiling water."
Mr. N feels guilty. Very guilty. We all feel guilty at times. For things we didn't do. Failed to do. Did do. Didn't do well enough. Watched and didn't react. For being or not being.
Mr. N's father used to hit him. He referred to it as "disciplining his son." He hit him time and time again. Mr. N endured it. Being hit by his father. Time and time again. Week after week. Year after year.
With a crow bar.
One day, as a teenager, Mr. N decided that he no longer wanted to be nearly killed by his father, week after week, year after year.
He grabbed a pitch fork and nearly killed his father.
Ever since then, Mr. N has been punishing himself. He hurts himself. In many different ways. Like sticking his hand in boiling water.
A couple of weeks ago, Mr. N's own son got killed in a freak automobile accident. Mr. N tried to kill himself, but was saved. Now he's here with us.
"Why is it not good to hurt oneself, Mr. N?"
Silence, followed by many generalizations but no answer to the question. I sit there and watch him fidgeting around with the zipper of his sweater. More generalizations. More silence. After having been pressed for an answer several times and multiple reminders to please stick to the original question, Mr. N finally says:
"It doesn't solve the real problem, does it?"
I exhale audibly. Finally. Even if he doesn't believe it, at least he was finally able to formulate an answer he can LIVE with.
We then work on a helpful statement he can remember and repeat to himself when he feels like hurting himself -- like stepping in front of a train or sticking his hand in boiling water.
I will never be able to walk along railroad tracks again without thinking of crowbars.
Mostly. You better pay attention, because camouflaged in his cascade of words within a description of how he walks home along the railroad tracks after work, like a slurr, almost, he will tell you how easy it would be to just step onto the tracks at the right time.
That gets a rise out of the therapist, who almost got caught in the snare. "Why would you do that?"
"For the same reason I stick my hand in boiling water."
Mr. N feels guilty. Very guilty. We all feel guilty at times. For things we didn't do. Failed to do. Did do. Didn't do well enough. Watched and didn't react. For being or not being.
Mr. N's father used to hit him. He referred to it as "disciplining his son." He hit him time and time again. Mr. N endured it. Being hit by his father. Time and time again. Week after week. Year after year.
With a crow bar.
One day, as a teenager, Mr. N decided that he no longer wanted to be nearly killed by his father, week after week, year after year.
He grabbed a pitch fork and nearly killed his father.
Ever since then, Mr. N has been punishing himself. He hurts himself. In many different ways. Like sticking his hand in boiling water.
A couple of weeks ago, Mr. N's own son got killed in a freak automobile accident. Mr. N tried to kill himself, but was saved. Now he's here with us.
"Why is it not good to hurt oneself, Mr. N?"
Silence, followed by many generalizations but no answer to the question. I sit there and watch him fidgeting around with the zipper of his sweater. More generalizations. More silence. After having been pressed for an answer several times and multiple reminders to please stick to the original question, Mr. N finally says:
"It doesn't solve the real problem, does it?"
I exhale audibly. Finally. Even if he doesn't believe it, at least he was finally able to formulate an answer he can LIVE with.
We then work on a helpful statement he can remember and repeat to himself when he feels like hurting himself -- like stepping in front of a train or sticking his hand in boiling water.
I will never be able to walk along railroad tracks again without thinking of crowbars.
Mittwoch, 2. Dezember 2009
December 2
D., age 22. A very handsome and articulate young man. His facial features remind me of my son. His father is a psychiatrist, he says. He doesn't mention his mother.
D. had problems in elementary school, in secondary school. He went to a school for children with special ed needs, but he didn't want to be there. He begged his parents every day to let him go to a regular secondary school. They promised him, but they never did it. Then his parents moved to a different country. He refused to go with them and spent a lot of his time with his grandmother. Currently he is working as a cook. His coworkers annoy him. His boss has a habit of rubbing the palms of his hands together in very annoying way. D.'s father is a psychiatrist. He doesn't mention his mother.
On D.'s nightstand: Books by Goethe, Nietzsche, Schopenhauer. He brings a book on Leonardo da Vinci to our session. And his journal. A nicely bound leather journal one of his former therapists gave him. It contains quotes by Schopenhauer. In rather faulty spelling by D. He wants to be an artist, like Leonardo. He wants to go to college. His father is a psychiatrist. He doesn't mention his mother.
I talk to him about his love of books. He hasn't read even one of them. The last piece of printed matter he read was a comic book. D.'s father is a medical doctor, a psychiatrist, whose son couldn't get through elementary school without repeating a school year. Today, he can't even remember the number of his hospital room. "I have a problem with my memory. I guess I won't be going to college." Yesterday at work he announced that he was going to buy a rope and hang himself. His father is a psychiatrist. He doesn't mention his mother.
D. knows the term "borderline." He heard it from his father. He doesn't mention his mother.
D. knows some things about "being borderline."
Apparently, he doesn't know a thing about the word "mother."
We can't help him. D. is going to a different department to be put back on meds. He grabs his belongings, takes his books. Schopenhauer, Goethe, Leonardo ..., holding on to them ever so tightly as I gently squeeze his arm good-bye. I look in his handsome face, notice his blonde hair that he wants to dye black. His facial features remind me of my son. D. turns around and leaves. My two male colleagues glance at each other and silently walk down the hall to their offices.
I go to the ladies restroom so they can't see me cry.
D. had problems in elementary school, in secondary school. He went to a school for children with special ed needs, but he didn't want to be there. He begged his parents every day to let him go to a regular secondary school. They promised him, but they never did it. Then his parents moved to a different country. He refused to go with them and spent a lot of his time with his grandmother. Currently he is working as a cook. His coworkers annoy him. His boss has a habit of rubbing the palms of his hands together in very annoying way. D.'s father is a psychiatrist. He doesn't mention his mother.
On D.'s nightstand: Books by Goethe, Nietzsche, Schopenhauer. He brings a book on Leonardo da Vinci to our session. And his journal. A nicely bound leather journal one of his former therapists gave him. It contains quotes by Schopenhauer. In rather faulty spelling by D. He wants to be an artist, like Leonardo. He wants to go to college. His father is a psychiatrist. He doesn't mention his mother.
I talk to him about his love of books. He hasn't read even one of them. The last piece of printed matter he read was a comic book. D.'s father is a medical doctor, a psychiatrist, whose son couldn't get through elementary school without repeating a school year. Today, he can't even remember the number of his hospital room. "I have a problem with my memory. I guess I won't be going to college." Yesterday at work he announced that he was going to buy a rope and hang himself. His father is a psychiatrist. He doesn't mention his mother.
D. knows the term "borderline." He heard it from his father. He doesn't mention his mother.
D. knows some things about "being borderline."
Apparently, he doesn't know a thing about the word "mother."
We can't help him. D. is going to a different department to be put back on meds. He grabs his belongings, takes his books. Schopenhauer, Goethe, Leonardo ..., holding on to them ever so tightly as I gently squeeze his arm good-bye. I look in his handsome face, notice his blonde hair that he wants to dye black. His facial features remind me of my son. D. turns around and leaves. My two male colleagues glance at each other and silently walk down the hall to their offices.
I go to the ladies restroom so they can't see me cry.
Dienstag, 1. Dezember 2009
December 1
If you look at your typical in-patients or out-patients at a suicide clinic you would probably be surprised at how normal they look. They smile, carry on conversations, don't look scruffy or weird. They didn't and don't wear a sign on their back that says, "I FEEL SO TERRIBLY HOPELESS THAT I WANT TO KILL MYSELF."
Go to, say, a mall and look at the many people there. Some of them, many of them, carry heavy burdens. Their burdens make them so hopeless. They feel unloved, helpless, out of control, and they feel that they just cannot handle it anymore.
Maybe you are one of them.
How about a friendly smile or a kind word to a stranger?
Christmas is such a good time to get into the habit of love. Feeling loved. Loving.
Try to love someone. Try to help someone. Try to look through someone's happy smile and well-adjusted behavior.
How are we dealing with burdens? Our burdens. Someone else's burdens.
Maybe it's time for you to get help.
Maybe it's time for you to help someone get help.
Maybe it's time to look at ourself and ask some questions. Hard ones, easy ones. But ask we must ...
Never assume that a well-dressed, clean looking and stylishly groomed and smiling person is only that. Just because I function flawlessly does not mean that I don't want to kill myself.
Look deep.
Go to, say, a mall and look at the many people there. Some of them, many of them, carry heavy burdens. Their burdens make them so hopeless. They feel unloved, helpless, out of control, and they feel that they just cannot handle it anymore.
Maybe you are one of them.
How about a friendly smile or a kind word to a stranger?
Christmas is such a good time to get into the habit of love. Feeling loved. Loving.
Try to love someone. Try to help someone. Try to look through someone's happy smile and well-adjusted behavior.
How are we dealing with burdens? Our burdens. Someone else's burdens.
Maybe it's time for you to get help.
Maybe it's time for you to help someone get help.
Maybe it's time to look at ourself and ask some questions. Hard ones, easy ones. But ask we must ...
Never assume that a well-dressed, clean looking and stylishly groomed and smiling person is only that. Just because I function flawlessly does not mean that I don't want to kill myself.
Look deep.
Abonnieren
Kommentare (Atom)
