Living in three worlds

By Alan Bodnar Ph.D.
March 23rd, 2020

depressionThe man is smiling now, released from the grip of the terrible depression that brought him to the hospital so many years ago. He smiles often as he anticipates his next trip to a restaurant in the city with his social worker. Movement from the locked hospital setting to the community is slow.

Evaluations for safety must be completed, tribunals of experts convinced, judges brought on board, permissions given, obstacles anticipated, solutions planned, and steps taken, one at a time, into the wider world.

He has run the course of illness and recovery, guilt and forgiveness, and has begun the journey back to a better version of the life he left behind. And so he speaks first of the world into which he is moving, the one he shares with his therapist, hospital staff, and his family.

This is the world described daily in newspapers, television, and internet news outlets. This is the world of divisive politics, border walls, isolationism, and now, the coronavirus that has already claimed over 15,000 lives.

Most of the victims come from the other side of the globe, but the experts warn that we are next if a cure or a vaccine cannot be found soon enough.

The man keeps up with the news and is well aware of the dangers that he faces. He knows too that we face them together. Microbes do not distinguish between the mentally ill and the mentally well, staff and patients, even former patients. They do not distinguish between citizens and immigrants.

From this perspective, the hospital can almost seem like a safe haven. The illusion of safety evaporates in the sound of screams in the corridor outside the office. The words are unintelligible and are soon joined by other words spoken by deeper voices, calm at first, then firmer, answered now by more angry screaming. The man, unfazed, continues to talk about the state of the wider world and his upcoming excursion into one of its small corners.

Staff rush by the office windows, blurs of motion and adrenalin pushing a bed on wheels toward the sound of the screams. Soon they are rushing back with their human cargo to a safer place where reassuring words, medication, a comforting presence, and time will restore the person to himself.

With time, treatment, kindness, and understanding, that self will become stronger, more capable of withstanding storms of emotion, and better able to navigate the world of the hospital and the wider world beyond its locked doors.

The drama playing out on the other side of the glass is a serious situation. Placing a person in restraints is an intervention of last resort done only to prevent physical harm to that person or others. Psychological harm almost always follows as a consequence of being placed in restraints. It is, unfortunately, a case of the lesser of two evils, and staff routinely debrief the patient and others involved in a restraint situation to address the residual effects and identify alternatives to prevent a recurrence.

Later that same day, psychologists will gather in a conference room for their annual training in relapse prevention strategies and de-escalation techniques to help people maintain control in the face of strong emotion. If all else fails and restraints are needed, they will learn how to use these techniques in a safe, humane, and caring way.

But now there is an elephant in the room or, more precisely, in the corridor outside the room,  and the therapist must direct the patient’s attention to events in the world of the hospital. The man knows the screaming patient. He has tried to help him in calmer times and has been rebuffed. He has a theory about why this person cannot function in any of the worlds he inhabits and shares it freely. It is a theory based on one element of his own personal experience, but that doesn’t stop him from applying it across the board to the behavior of all of his most annoying peers.

Perhaps he is right, the therapist offers, but there are other possible explanations for the wide range of irritating or frankly disruptive behaviors observed in a state hospital. Mental illness can erase a lifetime of good habits in a fog of delusion and self-hatred. Good treatment and time can lift the fog to reveal the person’s better self. The man remembers that something like that happened to him. His voice softens, his tone becomes less judgmental, and his better self repeats something he has been saying for years. It is something about how hard it is to live in this world. It is not just hard for him. It is hard for us all – for him, for the screaming patient, for his annoying peers, for the staff who carry the burdens of their own worlds.

There are worlds within worlds – the one we share in our common humanity, the one where we work and live every day, and the one that carries the freight of our personal histories and private struggles. It is not an easy task to live in three places at once, but that is exactly what we are called upon to do. It helps to know that we are not alone.

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