January 1st, 2014

At the turning of the year

A gentle rain is falling outside the upstairs window as I write these words at the turning of another year. The holiday season is upon us with Thanksgiving, Hanukah, Christmas and New Year’s Day stacked up on the runway poised to take off, one after another, until the tarmac stands empty except perhaps for the snow. The season prompts gratitude and hope, gratitude for the many good things that have happened to us over the past year, hope that we will find the good we seek in whatever the new year brings.

It is easy to overlook our everyday blessings because they often come mixed with trials and challenges that we would rather not have interfering with our lives and making a mockery of our plans. Nowhere is this more evident than on the treatment units of a state mental hospital. This place is where people come when their stories start to write themselves and the would-be authors stand in shock before what has become of their carefully plotted lives. Some are here because they suddenly disappeared from their productive routines when voices told them to act on delusional beliefs that they were the sons and daughters of kings or the heirs of great fortunes.

In the hospital, they may learn that there is no way to trade the challenges in their lives, including the challenge of mental illness, for a fantasy that cannot withstand the harsh judgment of reality. For that they may be grateful and better prepared to return to the hard work of pursuing their goals, knowing now what they must do to stay on track.

Others never even get a chance to start working toward their goals and come to the hospital feeling like a failure in the eyes of more successful friends and family. It doesn’t matter what people think, a group member told us one day, it’s how you feel about yourself in here that counts. He pointed to his heart to illustrate the core of his self-regard and his wisdom was a gift worthy of gratitude.

Sometimes mental illness tips the delicate balance of impulse and control and people come to the hospital by way of the criminal justice system. The lucky ones, when the voices and frightening delusions stop, look back and see that whatever damage they may have caused need not have lasting consequences. Others are not so fortunate and struggle to forgive themselves and rebuild their lives from the rubble. For what do they have to be grateful? There are no easy answers here and, like any of us faced with extreme situations, they seek consolation in everyday routines. Working in the hospital canteen or greenhouse, sharing with others in therapy groups, exchanging words and small acts of kindness with peers and staff, staying in touch with loyal family and friends – these are the humble threads given to be woven into a new life. It may not seem like much compared to what has been lost, but it’s a start, and maybe even a reason for thanks.

If even the most meager circumstances give us some reason to be grateful, an orientation toward the future requires hope that, no matter what happens, we will find some good in the outcome. Ideally, we will find the good we have sought from the beginning and, having such a goal, we will be better able to muster the will, energy and perseverance to do what we must in order to achieve it. As the American Gospel song goes, “Keep your eyes on the prize.” The turning of the year is a formal, socially institutionalized invitation to take stock of where we stand in relation to our goals and to adjust our course as needed.

Our response to this invitation can fall anywhere along a spectrum from hastily conceived New Year’s resolutions at one pole to a deeply felt commitment to fundamental change on the other. It is for good reason that psychologists try to measure and encourage hope in clinical settings. Answer true or false, you know the drill, “I might as well give up because there is nothing I can do to make things better for myself.” Sustaining hope requires effort, the effort of both positive thinking and active engagement with our circumstances no matter how challenging they may be. Hope without effort is mere fantasy. Effort without hope cannot endure for the long haul.

Psychologists in clinical practice have the responsibility of nurturing hope not only for our patients but for ourselves as well. As in so many areas of our work, it is crucial to be aware of our own feelings and attitudes, so they do not distort the expectations we have for others. The recovery philosophy reminds us to encourage hope and to support our patients in achieving their goals but what do you say to the man still in the grip of delusions who says he will be satisfied with nothing less than becoming a multi-millionaire? How do you respond to the woman who sees her life as a failure because her symptoms have prevented her from accomplishing what she has set out to do? To what extent do you settle for acceptance as a viable alternative to achievement? These are the questions we ask ourselves every day and, along the way, we find the answers, not all of them, but enough to keep us going.

Alan Bodnar, Ph.D. is a psychologist at Worcester State Hospital and a consultant in the field of leadership development.

By Alan Bodnar Ph.D.

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