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I. First Entry, First Day

This page is an idea that I’ve had for a while now. Too many people have notions about what mental health is, how it impacts those afflicted, and what it’s like to try to help someone that has struggles. I hope to help dispel some of these ideas, and give a real perspective from the trenches. I must admit, that this may actually be a therapeutic process for me too. But I hope that in venting my frustrations, and telling the stories of those the community ignores (out of sight, out of mind), the positivity outweighs that therapeutic process which some may feel is selfish.

I welcome you to read- if you want- and see how the thousands of individuals in your community live, how they function, and how they struggle. Maybe you know someone that is mentally ill. Maybe you are mentally ill and want to know you’re not alone. I hope to change some minds on the matter, maybe answer some questions, and maybe even inspire you to be kinder and judge less. We tend to be afraid of that which we don’t understand, and that’s okay. This blog is my effort to make a small impact on that understanding (and I mean very small). With that being said, I’d like to share a story of my first day meeting a man diagnosed with Schizoaffective Disorder (this link could help you understand what that entails: https://goo.gl/R5XKxF Thank you, Google!). Little did I know he would be one of the most frustrating individuals I have ever met. Yet, working with him led me to grow in ways I didn’t know I could; as I learned the value of the human spirit, and how each of us have worth, regardless of appearances and perceptions.

When I first began working in community mental health, I had no idea what it really meant. I had some thoughts based on TV shows and movies (I know, right?) and quickly learned how wrong I was. Community mental health is not meant to replace counseling or psychiatry, it is meant to work alongside these in the home and in the community itself. You see, the clients are the most severely mentally ill individuals in the community; in YOUR communities. So severe in fact, that they required up to a dozen hours of one on one help a week to maintain some stability, and work to have the quality of life all of us deserve.

My first visit with Peter (clearly a pseudonym, as all names will be, HIPPAA and all) involved and argument, being bossed around, air deodorizer, and a drink afterwards to process what in the hell I had just experienced. I arrived at his home in a semi-bad neighborhood and knocked on the door. A man that some may describe as a little thug-ish came to the door.

“Hey, uh, is Peter in?” I was a little nervous.

“Who are you?”, he wasn’t Peter.

“I’m his worker?” I answered in question form, okay, I was really nervous- so nervous in fact, I forgot my job.

“Oh, how are you doing man? I’m Joe (Not Joe).” He shook my hand, “Come in.”

He shut the door and yelled for Peter to come down. The home appeared to once be a nice place to live. Now it was what appeared to be the site of a tornado. I was astonished at the condition of the house as I followed Not-Joe to the living room, stepping over trash, beer cans and God-knows-what else. Peter came in from the kitchen, eating a large bowl of plain spaghetti noodles. I later found out he ate bowls of noodles regularly, partly because he apparently loved noodles, partly because they were a cheap meal. I introduced myself.

“Yeah”, he responded.

Shit, I thought, this is going to go well.

Once “introductions” were made, we sat down- he comfortably, me cautiously- and simply begun to speak. He was very hesitant, I was trying my damndest to treat him the way I would treat anyone. Our conversation bounced from topic to topic, he trying to both, impress me and throw me off, and me trying to build rapport. When I got my job, my dad told me to “treat them like people”. My father has an ability to be friendly and build relationships with anyone- something I admired since I was a young’un, as they say. I tried my best with Peter. I had some difficulties for various reasons, including judgement. The first thing anyone notices about him is his disheveled appearance, and the malodor he can exude- things I judged him for. Why couldn’t he just make an effort to help himself? Now, this was something we often battled about because he had the ability and the access to a shower; he just didn’t give a shit. I didn’t understand.

Now, I didn’t address his hygiene on the first day, or the first month for that matter, because I was attempting to apply the core principle my father thought would be essential: the relationship, a surprisingly helpful tip. Our first conversation lasted little over an hour, and he first began with explaining that he was in the Army, and a Paramedic. Neither true. We also discussed his interests- he cited exercise, movies, music. All true! All surprisingly normal. I liked movies, music and exercising too! That was my in. I would use these activities as therapeutic tools and relationship builders. I didn’t know how we would progress, or how I would truly help him. That came later.

- RMV

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II. The Saga Continues

Hello everyone. Hopefully you enjoyed last week’s post! This is a continuation on that case.

If you didn’t read it, you can find part one below!

As always, the names and other identifying information has been changed.

 

My experiences in community mental health have led to a lot of emotions. I’ve felt sadness, empathy, frustration, anger and more (sometimes within the same hour). One of the most important takeaways from my work, however, has been personal growth. Peter was the first client that helped me grow both, professionally and personally.

After a few sessions together, we were developing a pattern and rapport. Sometimes I’d meet him at his house (I had grown accustomed to Not-Joe and the disaster site they shared), sometimes he’d be MIA. I would then have to track him down. Some days, he’d be at the office driving the staff crazy, wearing some sort of brace, smelling up the place while telling them all about how he broke his knee or some other limb and/or appendage. At one point, he told everyone he broke his back and had a heart attack! (he never broke his back, nor had a heart attack). This was still early in our relationship, though, and I was still becoming frustrated. But I was also becoming familiar with his behaviors and thought processes. I would open discussions on maintaining our appointments, to which he would reply by telling me “You work for me!” I didn’t take it personally. I was picking up on things at this juncture and learned that responding in kind to these would never get me anywhere. His discussions of surviving injuries were simply ploys to get some positive attention. He yearned for some sort of love or care- he didn’t know what it was like to receive such a thing.

“Be water my friend.” Bruce Lee

Why the corny quote about Bruce Lee? Because it fits perfectly into many areas of life, including working with the severely mentally ill. If I go into a session with a client holding expectations and rigidity, it will be a terrible ordeal- for both of us. This was the first lesson I learned with Peter. When he missed appointments, I didn’t try to force him to meet me how I wanted him to; I learned to meet him how HE needed me to. Sure, when I went into the office to find him, I would be frustrated. Sure, I would also become angry when he told me I was his personal employee. But, I also would feel empathy when I learned how he was being treated everywhere he went; he was a pariah, even at home. His parents abused him as a child. His earliest memory of this was an attempted drowning in the bathtub when he was six years old. He was mistreated his entire life, and learned to live in that space. He was comfortable in poor relationships because they were all he knew.

His roommate(s) often took advantage of him. I would witness them coercing him to use his money for their gains, pay for everyone’s food, and more. Why did he do it? He was getting the attention he never got. Spending all his money, or being taken advantage of was still better than being beaten. He didn’t think he deserved better.

One day, I noticed him struggling more than usual. He was genuinely sad. Peter hid his emotions well, he’d learned to use anger and posturing as defense mechanisms. But he was experiencing some delusions and more intense symptoms. He didn’t refill his medication because he didn’t have the money to pay the one dollar copay- his roommate convinced him to “lend” him the rest of his money to buy beer. He ran out medications some days prior, and he became increasingly confused. His thoughts were convoluted and clouded- I could see the wheels turning too much for someone as intelligent as he was. We had a long session- I spent over five hours with him that day. Finally, after exhausting every avenue, I decided no human being’s life should be so damaged over $1. That evening, I took him to his pharmacy, and paid the copay- even though it was strongly discouraged to pay for any client’s expenses. On the way home, he cried. I didn’t speak, letting him maintain some sort of pride. When we stopped at his house, he thanked me and smiled. It was the first time I felt genuine care for him. Walking up to the front door, he turned around and walked back. I rolled down my window. He leaned in, smiling.

“We should go to CiCi’s pizza tomorrow.”

Even water has limits.

-RMV

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III We joined the Christmas choir! (Jesus help me)

This is the third chapter of Peter’s story.  For the previous sections, see below!.  I promise it’ll make more sense that way. 

My experience with Peter, now a few months in, continued to be one that was best characterized as interesting.  He continued to eat his bowl of plain spaghetti noodles, not bathe, and now was living in a new apartment.  After a while, he and his roommate had a falling out, and he was basically homeless.  With some help from his payee, I was able to help him find an apartment- just in time for winter.  Holidays can be especially difficult for the mentally ill- a reminder of what they want, and often don’t have.  The office staff and administrators came up with the idea of doing a Christmas choir.  It served as a tool for the clients to do something nice for others, while having some sort of purpose themselves.  Peter was very involved in the choir.  In fact, he requested to have a solo.   When I discussed the idea with him, he explained, that he was an amazing singer.  So amazing in fact, he deserved to be the star.  I obviously didn’t think he was telling the truth, but what the hell.  What could go wrong? 

Peter had some difficulties with performance anxiety.  He really wanted to earn others’ praise and respect, but had a difficult time with actually performing.  This was rooted in a lifetime of wanting to belong but always being ostracized.  Being a part of a company that was there for him seemed to give him the courage and support he needed to actually take the risk.  I felt he needed to try; for his own sake.  I proposed the idea.  This was a contested point.  Especially against it was the leader of the choir- an employee who felt their calling was music and now had their “big shot”!  There are various types of stereotypes in office and professional environments.  This particular employee- we shall refer to them as Jackson- took the task too seriously (he was that employee, we all know them).   He didn’t think Peter would able to perform his solo- I argued he could.  I have to be honest, in retrospect, I feel embarrassed to admit that, I, too, didn’t think he’d be able to perform all that well, yet seeing Peter openly wish for a moment of glory, praise and respect made me be his advocate (plus I enjoyed making Jackson stressed).   

All week long, I encouraged Peter to practice.  “I got this” he’d say.  The time for the first concert came.  We were to go sing at a local mental health hospital, spread some cheer to the patients in dire need.  We met there, each employee with their client, and the concert began.  “Do you hear what I hear?” A cacophony of out of tune singing, screaming, whispering and lip-synching.  Solo time.  Peter stepped up.  I was standing behind him, proudly.  He froze.  He didn’t make a sound.  He simply looked down at his paper, periodically shutting his eyes tightly, never looking up.  Holding his music sheets in one hand, the other hand pointing out, fingers outstretched, each moving one by one- thumb to pinky and back again.  Jackson stared at me annoyed.  I simply shrugged. 

After the singing, we were walking back to my car, not speaking.  He still couldn’t look at me.  I just said, “It’s okay.  Maybe next time.”  He didn’t respond.  Any time I’d bring it up, he’d shut down in shame.

Peter never returned to choir.

RMV

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IV A Difficult End

Hello!

This is the fourth and final piece on Peter.  The previous three chapters are below.  Enjoy, and thank you!

 

Spending a large amount of time with anyone leads to a relationship and a bond.  It’s unavoidable to become attached to our clients; although we are expected to maintain a boundary (if we don’t, the client may have a difficult time working with another clinician).  Peter and myself developed a good rhythm: resistance, frustration, resistance, progress.  We knew each other well.  We had been meeting nine to ten hours a week, for six months. 

Our sessions involved various patterns.  We’d sometimes go to the YMCA where he could get some exercise and I would convince him to shower.  Sometimes CiCi’s, where he’d get rewarded for his efforts with colossal amounts of pizza.  Other times, we’d meet with his payee, where he was confronted for spending his money on pot, beer or whatever.  We’d go grocery shopping to argue about buying other things besides noodles.  We’d go to meet his Probation Officer, who just shook his head every single time; sometimes in disbelief and sometimes in frustration.  Good effort to make some progress.  I enjoyed our work.  Regardless of how infuriating (very) he could be at times (a lot).

I was informed, six months in, that I would be transferring. 

When discussing a change in services with a client, it’s important to be delicate.  I was very nervous to approach the subject with Peter, because on several occasions, he had mentioned feeling abandoned by previous clinicians.  I knew his reaction would be a difficult one; he would be hurt.  The conversation needed to take place at least a couple of weeks before our final session.  I took him to get lunch.  I told him I was being transferred. 

“I don’t give a shit” he responded.

 I was surprised, “You sure? We can talk about it.  We should talk about it.”

He looked at me defiantly “No, it’s fine.”

I took him at his word (a mistake) and we finished the session.  The next two weeks, our meetings weren’t consistent.  Finally, I was able to track him down, hoping to have one last session before my transfer.  He wanted to go to the YMCA.  We did.  On our way back to his house he barely spoke.  I pulled up to drop him off.  He wouldn’t talk, he just kept looking down.  Finally, he looked at me.  He was crying. 

I was surprised.  But now realized his response two weeks before was another defense mechanism.  I asked him about what he was thinking.

“I really liked going to YMCA and CiCi’s” he said.

 “Me too buddy.” 

-RMV

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