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?

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.

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.

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.

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!!!

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.