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.

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.

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.

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.

The eve before Foxblog 1

No problem facing clinicians is more urgent than suicidal behavior. Suicide remains one of the leading causes of death in the younger population. And it is on the increase.

"Denn die einen sind im Dunkeln
Und die andern sind im Licht.
Und man siehet die im Lichte
die im Dunkeln sieht  man nicht."

Bertolt Brecht: Dreigroschenoper

Watch out for Judith's Foxblog as of December 1, 2009.