A mental health professional find counsel from his patients...
Hello, My Name Is...
Being obsessive-compulsive myself, it has been my pleasure to work in the mental health field. Although many of the conditions we encounter--I hesitate to use the term "disorders"--are never fully eliminated in patients, most are able to be managed. Often times it is merely accepting the existence of the condition that enables us to manage it. And yes, I say "for us," for it is not unlikely that you, the reader, may exhibit one or more of these many conditions, to a greater or lesser degree.
For my own part, I remain to this day incredibly obsessive-compulsive. For instance, I keep extensive journals, logging the events of my day, however trivial. In those journals, I keep all manner of lists, as well. A particular list--where I went that day, when, and who I met or saw--is especially gratifying to me for some reason. Here is an excerpt from my personal journal:
Today was grocery day, as is every Tuesday. Washing was completed by lunch, and I went to market at 1230.
I took an early dinner at Elle's Diner, where I was surprised and pleased to see Mr, Appleton again. While we have never established a first-name relationship, our friendship feels quite genuine to me; in fact, I rather appreciate the slight distance he keeps by referring to me as Mr. Langenthorn. My evening trip to the 7-11 for cigarettes was uneventful.
(The reader may ask: "A man of compulsive lists and no record of what you bought? Really...?" Don't worry: the receipts are all attached to the back of the journal entry.)
All of this is exposition, of course. The context is that, while I have been keeping these journals and lists for decades, it was not until a mental health professional inspired in me the confidence to recognize the presence of an organic condition and begin to manage its parameters. These lists--the lists predate the journals by many years--were shameful and embarrassing to me. I knew my peers and parents didn't record their schedules fanatically. The thought of someone discovering my box of records was as distressing as the thought of being caught masturbating.
Dr. Lim taught me that the shame came from my own fear of the unknown origin of and reason for my obsessive-compulsive condition. He taught me that once I accepted it as something organic and natural, my condition would be no more embarrassing to me that the slightly above-average amount of hair on the backs of my hands. Dr. Lim taught me to accept myself. Dr. Lim taught me freedom.
And I have spent my life returning that favor (I hope) as a mental health counselor, myself.
However, there are more people to help in this area than those that seek guidance with these conditions; the whole of our population has room to grow and better understand these different facets of the human mind. I offer the following summaries of some of my cases, then, not as humorous anecdotes meant to belittle or embarrass; rather, they are intended to enable you, the reader, to begin to accept these conditions as normal facets of the social world, and to help everyone manage their lives a little better.
(NOTE: Regarding names, I will refer to patients by initials, as in the preceding list where I mentioned "D." This is obviously for the sake of patients' privacy, which I hold sacred.)
That we might manage to make the Human Condition better through Understanding,
Dr. Miles Langenthorne
Silence is Golden
Since I began my own practice, I have conducted interviews with new patients in an unconventional manner. I turn my chair away from where the patient will be sitting (there never has been and never will be a couch in my office). When the client comes in, I conduct the first five minutes of our interview with my patient sight-unseen. This way, I feel I avoid developing biases at first sight. (I thought this was a terribly clever technique; then I saw the hosts do the same thing in a television show called "The Voice." I suppose great minds are bound to happen on the same ideas. Ha!)
One of my patients, R, rather turned the tables on me in this regard. I accept anything my patients have to say...or not say. I heard R come in and sit down. Though I greeted him, there was no reply. When no reply followed my second greeting as well, I allowed R his own time.
Just as the five-minute period was about to end, I heard the patient rise from the chair and leave my office. I was speechless, and it is not common for me to be taken by surprise in my office anymore. As I sat gaping at the open door, I faintly heard R as he spoke to my receptionist down the hall.
"Thank you so much! I feel so much better!"
I never saw R again (or for the first time, for that matter). And although I had every right to, I never billed him for the appointment. Why put a price on someone's five minutes of peace and quiet?
Through a Glass Darkly
LL was a middle-aged woman of average everything--average height, average looks, average weight. She was off the curve of average in one way, that I knew of: she insisted on one-hour-and-fifteen-minute appointments, as opposed to the customary one-hour appointments. She explained that the first five to seven minutes were always catching up, and the last five to seven minutes was setting up the next appointment. She wanted her whole hour. She paid an extra thirty dollars for the extra time. Yet, during her appointments, she spent most of the time looking out the window and sighing.
My office is uniquely placed. It is in a modest four-story building on the outskirts of "downtown." Looking out my office window, one sees half of the view (the left half) dominated by Lender's Park; the right half of the view is comprised of a sudden new urban development project that screams of the city. The dichotomy of this view has actually been a very useful tool in my work over the years...but I have never found it worth looking at for forty-five minutes at a time, as LL would do.
Every now and then, she would turn to me and quietly speak a sentence or two before turning to look back out the window. She usually looked down at her hands as she spoke.
One day, LL turned from the window suddenly and looked me squarely in the eyes. She spoke for twenty minutes about the cycle of abuse she started while young and chemically dependent. Her children were the victims of violence and mental cruelty, and were eventually removed to foster care. An infant in her care died, and LL went to prison for some time. When she was released, she told me, she was clean and optimistic. But reality was waiting in the wings with terrible news of the consequences of her actions. The damage was done; the cycle was begun.
Her son was now in jail for domestic battery, which stemmed from his own losing battle with addiction. Her daughter had escaped the cycle of addiction and abuse, but was killed while trying to break up a fight between an older man and her foster brother. The man pulled a knife and cut her foster brother quite badly, and then stabbed LL's daughter in the neck almost as an afterthought, the foster brother reported. The man was never identified or found.
LL discovered all of this within a week of being released from prison, and it was then that she sought my help to void a relapse into that horrible lifestyle.
We had been creeping down her road of therapy together for ten months when she finally told me this.
After telling her story, LL looked back out the window. I saw tears on her face; she made no effort to wipe them away. As I considered the best response to this revelation, I realized I had been silently weeping with her, and I didn't feel the need to wipe my face, either. Sometimes tears are for healing.
I tried a few gambits to further this conversation, but LL continued to stare silently out of my window for the rest of her appointment. She did not sigh a single time. As her appointment drew to a close and I began collecting my thoughts on how to proceed with our next appointment, LL turned and looked at me again. She did not drop her eyes, did not even glance at her hands. She held my gaze for what seemed like a long time, although was certainly no more than a minute. Then she spoke to me in a firm, determined strong voice I had never heard from her before, and quite frankly had never expected.
"Good bye," she said with a grave finality. I sensed (one's intuition develops quite keenly in this line of work) this was the last time I would see LL in my office.
"Good bye," I said in return. I found there was nothing more that needed to be said: our mutual tears said it all.
I was right. I never had another appointment with LL. Apparently she had gotten what she needed.
It is surprising to me how much I miss her.
Not every patient finds the guidance they are looking for or the help they need.
LJ came in to see me for about three years. He suffered from a minor depressing condition, and he appeared to me to be on the autistic spectrum, although it was not called that at the time. I suspect now that he was displaying Asperger's syndrome, which was an even more obscure term back then. Without these labels, I only recognized that LJ had a great deal of difficulty connecting with his peers and maintaining those relationships.
He came a long way in the time we worked together. The autistic is unlikely to ever truly understand these social intricacies, but can be incredibly adept at managing them academically and "fitting in" to a high degree with people who have no such pervasive developmental issues. As LJ's ability to form relationships increased, his symptoms of depression decreased. I felt we were on the cusp of a true breakthrough, which is so much more rare than one might imagine that it is nearly maddening.
During this exciting time in our work, LJ simply did not come in one day. While he had never been a savant about his punctuality, I had been able to impress upon him that his timeliness for our appointments had a great deal of impact on me. In fact, my obsessive-compulsive condition is terribly aggravated by "no-call/no-shows." His disregard for our progress by simply not showing up or calling to cancel literally impacted the rest of my day.
As hard as I tried, I could not stop fixating on LJ's lack of consideration. This is, unfortunately, par for the course with me, and only certain techniques help to untangle these feelings. I arrived home that evening in a very negative mood, and wrote for a long time in my journal, listing everything I could think of for that day. Around eight thirty, I felt I had calmed down enough to resume my normal evening routine. Part of that routine is to read the daily paper from front to back, every word--even the sports scores and editorials.
Halfway down page 5 was a short blurb that brought me up short:
"[LJ] was found dead in the Terrence Hotel basement at approximately 10:30 this morning. Police have ruled the death suicide, concluding that [LJ] shot himself in the temple with a snub-nosed .38 calibre revolver, which was found immediately next to his body."
I still think of LJ often, as I do many of my patients. I am ashamed of my angry reaction toward him that afternoon, and I wonder how I managed to miss signs of this impending disaster. Was it my excitement at what I perceived to be his progress toward further integration in society? I'll never know, but I carry with me the self-blame that I was blinded by my own pride in LJ's apparent success.
Even when we feel we are on the cusp of something truly great, the hard truth remains that the story may not have a happy ending.
Not everyone finds the help they want. Or need.
Turn the Page
O was a scary case to me, as well as a case of redemption. O was definitely autistic, unable to communicate conventionally with anyone, even her parents and siblings. She was referred to me by her Mental Health Assistance Advocate--a sort of day nurse and and personal cheerleader, to drastically understate and oversimplify the wonderful jobs these people do. With my own unusual first-interview approach and tenacity and finding a way to at least discover the problems another person perceives, she though I stood the best chance of reaching O of any mental health professional in our small city.
At first, I found her method of communication with me original and therapeutic. I have even used it as a tool with other patient who were unable or unwilling to communicate conventionally. O would read to me. But she would not read her own words, either creative or factual. She would read to me excerpts from books and poems and, occasionally, song lyrics. She once read to me one of my own favorite passages by Ray Bradbury. I was forced to interpret the prose in a whole new context, and to apply them to someone else's perceptions instead of my own. In this way, O was helpful to me, as well, her method of communication challenging and enlightening.
But it was difficult to have true dialog. She never responded to my questions, not even through quotes. I tried to guess at her context, but I have no idea how successful or accurate I was during those first few weeks. One day I musingly responded to her with a fond quote I had memorized years before, one which was apropos of her own context that day. I said it almost to myself, but O heard it, and her whole face lit up! She was ecstatic and began throwing at me an amalgam of others' words to express her own thoughts and feelings. I was swamped by the challenge of trying to participate in such a circumspect conversation, and I was thankful that O was my last patient of the day.
I saw O twice a month, and during the period of time we worked together, I spent a great deal of my own time reading a vast variety of literature to further our communication. From Shakespeare to Stephen King, how-to to who-dunnit, I read like a man possessed. And it was worth it.
Aside from a plethora of fantastic stories and invaluable knowledge, I was able to learn of O's background. Her parents were very loving, positive people. They doted on O, but they were ultimately unable to break through her shell far enough to care for her. With unspeakable heartbreak, O was turned over to a Catholic adoption agency just before her tenth birthday, and she spent the remainder of her childhood and beginning of her young adulthood there.
What she was able to articulate to me, in her own tortuous way, was that she did understand her parents and their love; she was unable to break out of her own shell to explain her needs and emotions to them. Her face remained blank while her heart broke at the adoption agency. She was able to make me understand her isolation and desperation. I read an excerpt of the lyrics to Metallica's song "One" to her:
I can't remember anything
Can't tell if this is true or dream
Deep down inside I feel the scream
This terrible silence stops me!
She replied with the Who, and I knew our connection was solid:
No one knows what it's like
To be the bad man
To be the sad man...
I was intrigued when she began to read mostly headlines to me. Was she trying to expand her world-view? Was she trying to be emphatic, or assert an understanding of her own importance?
O: Local Man Picks Winning Lotto Number
ML: I am not a number. I am a free man!
O: Man Saves Horses From Barn Fire Single-Handedly
ML: No man is an island, entire of itself...
O: The King Is Dead
One day O startled me badly with an unexpected outburst of frustration and anger.
Rage! Rage against the dying of the light!
Rage! Rage! Rage! RAGE! RAGE!
My receptionist ran in to make sure we were both safe. As soon as O became aware of another person in the room, she became immediately silent, and she remained uncommunicative for the rest of our session.
There followed a series of one-sided conversations with O where I tried all manner of gambits to open her path of communication again. Sadly, none worked. I was afraid--no, terrified--that O had locked herself away again and lost the magical key she had found to release herself from her own silence.
O's MHAA confided in me that O had regressed significantly for about three months. Hygiene, eating, everything seemed to have been unlearned. I could not speak to Linda, the MHAA, about O's silence, but I was very worried about the pattern of regression and introversion that was developing.
Then, On an early spring day, O arrived at her appointment with a keen, attentive look to her--the look of someone who has something to say. I was encouraged, and used a new "trick" to open our dialog: "ladies and gentlemen, our first guest is: [O]!"
O looked at me with that grim, single-minded determination in silence.
I was afraid my observations of her physical demeanor were mistaken until she began speaking in a monotone voice, devoid of inflection or punctuation. This was not something she was reading, either. THis was not a collection of other people's words that she was assembling on the spot as communication. This had been memorized for just this occasion. It was eerie: her face was intense and focussed, but her voice was as flat as a robot's. One can only imagine the level of frustration inside O!
"Patricia M (nee Ryan) age 82 of Glendale beloved wide devoted mother Cleon Colstrom of longtree preceded by wife Lila Allen M Sue 80 survived by her brother Jack..."
She was reciting the obituaries! O was visibly trembling, almost shaking, and her hands were clenched so tightly on the arms of the chair in which she sat that the entire backs of her hands were white.
I pressed a rarely-used hidden button under the edge of my desk. This button immediately and silently dialed 911. I was sweating myself, hoping that O would stay in my office until help was able to arrive, that she would stay here, in a safe place, reciting to me. Reciting her suicide note.
I have never had the opportunity to actively intervene on a suicide since. I hope my guidance keeps these thoughts far from patients, but I can never be absolutely sure. As I painfully learned with LJ, I can never be sure.
With O, I later found out, I not only intervened but prevented her suicide. I learned that her birth parents had heard about O's admission into Patience Memorial Hospital--through Linda, no doubt--and chose to re-enter O's life...armed with our new language of 200 years of words already spoken. They had never really been far from O, I learned; as much as they could, they kept up-to-date on her care and conditions. I hear she is maintaining, now, doing about as well as one might hope she could. I am glad for her, and I remember her for how much instruction she gave me in return: learning a new language, rediscovering classic literature and discovering many new worlds for the first time, and reacting in an instant--based on instinct--solely for another's well-being.
She sent me a card when she was released from the hospital (or more likely caused it to be sent by her MHAA). It was sublimey unique to O. It was blank on the cover, back, and inside, except for one line where Hallmark would usually leave a sodden, sugary verse. It looked to have been written with great effort, for it was a firm but somehow uncertain printing. It read:
Rage! Rage against the dying of the light!
It was her way of saying thank you.
I understood from her card that she had never wanted to commit suicide, as is too often the case. But she was growing increasingly desperate and helpless to stop the self-destructive ideation. By reading those obituaries to me that bright spring day, she was screaming for me to help, she was raging against the dying of the only light she had ever been able to see. And I heard her.
At the Close of Day
While this little essay has ended up being longer than I had expected (almost a short memoir), I have been unable to articulate half of what I had hoped. None of us are complete--that is our universal condition. It is what keeps us reading, looking for that phrase or verse that finally brings it all together. It's why we stare out the window hoping to find courage and peace; why a moment of silence in pleasant company can make everything alright again.
But it is not enough to know this academically. It must be intuited, acted upon, reinvented daily. It must be lived! The light is always fading and always dying. We must rage!
~ @ ~
I have just finished breakfast, and I go into a new day with routine and expectation as my lead. But i look to my brief charges throughout the day to guide me: to teach me new ways to manage my own conditions, exciting new ways to communicate with all of the people around me, important new ways to impact the world we all build.
I invite you to join me in mind and spirit, to accept the self that greets you in the mirror each morning, and to manage to find a way to accommodate his or her conditions into the course of each of your days.
Ready? It's time to go to work...
I have quit smoking today. I have a lot of fear because of this. But I have a lot of hope, too, because I have a surprising wealth of unexpected support. Mr. Appleton is a former smoker, and he has offered to be an ear for venting any time, day or night. Lela gave me a veritable tome of brochures for products and services to help stop smoking. Even Aziz gave me a high five.
Life is full of defeats and victories. I am thankful every day to remember that.