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.