Things patients said to me today:
"Can you explain to me why sometimes the Moon can be seen in daylight?" (I later discovered that he was afraid the Moon was coming too close to Earth and that it could have eventually cause tsunami and all sort of terrible things).
"I’ve seen that psychologist having sex with that trainee while I was hiding inside the doghouse."
"There was this guy, he was a patient here, and the psychiatrist and the nurse have killed him."
"You were sent here to spy on me."
You're too clever for this job.
Me [super serious]:
In the middle of a random chat I was having with the new trainee, she said: “Can I be honest with you?”
"I had a weird feeling when I first met you."
"That’s because I’m weird.”
Today a patient screamed at me and almost attacked me physically because he was convinced I was part of a government cospiracy against him and because, as he said: “You don’t listen to God’s word! You’re a sinner a you don’t even know! You can’t do it!”
I was lucky he didn’t know I’m an atheist.
: In your recent post you alluded to working in the private sector with children as being a toxic environment. I am currently in a school psychology graduate program here in the US. I have finished my course work and am preparing to start my internship in a public school system. For one of my practicum, I worked with a private agency that had a contract with 3 school systems in the area. I am curious as to what you felt the negative aspects of this environment are vs. working in the public sector.
What I meant is that the specific place where I worked was a toxic environment. I don’t think all the private sector is toxic. But I will say more about the negative aspects I’ve seen in that specific place.
But first you should know that before I went there I know almost nothing about learning disabilities and working with children. That wasn’t my field of expertise at all.
The negative aspects that I feel were the most important were this two:
1. Incompetence. They were all psychologists or speech therapists. They used a treatment for dislexya that consists in two books, one contains stories any of which elicit one specific difficulties of reading, the other contains excercises the kids should do to overcome such difficulties. After a while I was there, I tried to understand more about this “treatment”. I discovered that those books were written by a teacher and was aimed for teachers to use, not for psychologists. Basically, using those books wasn’t a treatment at all.
Also, to use those books requires for the child to sit on a chair, to listen, to read and to write. This is all possible in theory. This is easy to theorize if you are a teacher. This is something that almost never happen easely with children with that kind of problems. Those kids are always very anxious about all the things concerning reading and writing, they often feel those things as a torture because those are the exactly the things in which they are inadequate. They don’t want to read and write. They already do that in school, they don’t want to do that even more. So, basically, some kids don’t sit on the chair. This is where being a psychologist should help you. But even being a normally sane and intelligent person would do. Do you know what was the common strategy used to make the reclutant children sit and do what they were required to do? Manipulating the kids saying something like: “If you do that, I’ll let you play with the toy you really like”. With some of the youngest, the used candies. If the kid did what was asked, he was given a candy. Something that reminds me of training a dog.
One time I personally saw a speech therapists hold a kid in a chair by force in a way that was explicitly violent.
This is just one of the many examples I could give of the enormous incompetence I’ve seen in that place.
2. Exploitation. I wasn’t the only trainee there. In fact we were five. We weren’t paid (of course). That was a private center. This means that people paid a lot of money for an hour of therapy. An hour of therapy require at least a trained professional. Many, many times, the director of the center placed one of us trainee to make the work of a trained professional. Alone. Without saying anything to the parents. It’s illegal and unethical and simply wrong in so many ways. This is an exploitation of a the trainee. I was asked to do that, and I have done it the first times I was asked, but after a while I was wise enough to find a way to escape this requests. The other trainees were not wise as me. I can understand why, it’s a difficult situation because in a way you feel flattered, you want to make a good impression, and even if you feel that all the thing is wrong, is hard to say no. I’ve paid for saying no. It is also an exploitation of the children. They wouldn’t dare to do that with adults, because an adult would kick their asses. They do that with children because children are more easy to manipulate.
I don’t think this is what normally happens in the private sector. I think I was very unlucky to end up in that specific place. I had some very negative experiences there, and when I was deciding where to do my second traineeship I absolutely didn’t want to go back there, and I tried to find a place that was different from there as much as possible.
Yet, I need to say that it was also a very fun and educational experience. This is partly because I managed to find a little corner in which all the negative aspects of the place were greately reduced: after I realized what was going on I chose one of the psychologist, and I worked only with her. She was nice, competent and ethical. But it was mostly because of the children. They were wonderful. And thanks to them I was almost always happy (contrary to what is happening in my current traineeship).
I doubt this could be useful to you, but, well, now I’ve written it, so…
: With that said, do you think that there should be a dichotomy between the way children and adults should be treated? Or do you believe there should be some middle ground as far as sensitivity or objectivity in mental health care? Do you find different improvement rates in adults and children because of this treatment?
To talk about improvement rates is really difficult (and maybe impossible) because children with learning disabilities and adults with schizophrenia are really different. The impression is that children I’ve seen improved more than the adults I’m seeing now. But does that mean tha that attitude and kind of treatment was better? I don’t think it’s right to deduce that. In fact (I will expand this in my next post) I think that the psychologists I’m working with right now are far more competent thant those with whom I’ve worked back then.
That said, I don’t thing there should be a dichotomy. As far as it is possible in the clinical practice, I think mental health professionals should aim for objectivity, but this doesn’t mean necessarily detachment. I see detachment as a very natural reaction, a defence mechanism to cope with the awareness that you’re using a huge amount of energy to achieve a very small thing, like a patient that starts saying a few words instead of staying always silent, another that find the strenght to get out of his house for an hour a week, or just a patient that doesn’t deteriorate more.
Maybe it’s inevitable that children and adults are treated differently, but I really don’t want to think that.
As you know, I’m doing a traineeship.
I autonomously decided that at the Mental Health Center, Friday is Casual Friday, and so I dress a lot less professional-me and more me-me.
Today I was wearing a Darth Vader t-shirt.
The nurse looked at me and asked: “what’s written on your t-shirt?”
I answered: “I’m your daddy”. She did not understand the joke and left.
A patient looked at me and said: “COOL! I LOVE STAR WARS!”
Patients are the best.
At the Mental Health Center on monday morning they have a staff meeting to assign cases.
There are basically 4 possibilities:
- a case can be assigned to one of the psychiatrists;
- a case can be assigne to one of the psychologists;
- a case can be sent to another health department;
- a case can be put on a waiting list.
Yesterday there was several interesting cases, yet one made me think more than the others.
The nurse told us about this woman that came to the MHC with is father. The father was talking for all the time so that the nurse thought he was the one who was asking for help. Instead it was his daughter. When the nurse realized that, she asked the father to live so that his daughter could have some privacy a speak more freely. He left the room but only after he was asked to several times
And so the story was that this woman left his husband because she has an affair with another woman. She’s not economically independent so she has came back to her family, but they took the whole lesbian affair very badly, so that they took her phone, they forbidden her to see her lover again and there were always fights and whatever. And then she came to the MHC because she’s felling: “stressed, depressed, anxious…”. Guess why?…
Now, to whom was assigned this case? To one of the psychiatrists.
And that’s when I thought: what the hell?!
This isn’t a psychiatric patient.
Someone should have go to her father and gave him a kick in the ass and say to him: “Stop being a moron! Support your daughter and don’t force her to a Mental Health Center!”.
Knowing that I will probably post more about my experiences during my traineeship, I think I need to clarify some things.
In Italy (where I live) psychiatric hospitals have been closed in 1978 and they have been replaced by community mental health services. Right now the National Health Service have Departments of Mental Health that are responsible for specialist mental health care in a regional community. Within these DMHs there are various facilities: Community Mental Health Centers, Day Care Facilities, General Hospital Psychiatric Units and Residential Facilities.
I’m doing my traineeship half in a Mental Health Center, half in a Day Care Facility.
The work in the Mental Health Center is both with new patients with no history of previous psychiatric treatment, as with patients with a long history of psychiatry illness. The actual work involves: clinical psychiatrists’ activity, forensic psychiatric assessment, psychological assessment, psychotherapeutic treatment, a bunch of nurses’ activities (like nurse’s home visit or administering psychotropic drugs) and social support activity provided by social workers. The patients treated in a Mental Health Center are usually very ill. All the patient I have seen have psychotic disorders.
The work in the Day Care Facility is very different. The patients arrive to a Day Care Facility usually after a long history of psychiatric treatment; they probably have lived for some time in a Residential Facilities. They all have a serious mental illness, but they managed to have a certain autonomy in their lives. In a DCF are done all kind of rehabilitative and socializing activities like: interpersonal and social skills training, occupational activities, leisure and socializing activities, psychomotor and creative therapy, outpatient contact with rehabilitation therapist, sheltered employment activities, individual and group psychotherapy.
In my case (there are different rules in different organizations, and even in the same organization rules change between different tutors) traineeship means that I can assist during some activities, but I can’t do anything alone.
The things are a little more flexible in the DCF. There, patients arrives even without an appointment, maybe drink a coffee, talk with a nurse or a psychologist about anything, read a newspaper, stay some time, and then leave. Of course there are also more structured activities, but the fact that it’s a more free space, makes easier for me to interact with patients, usually in an informal way (although I find that most of them usually end up talking about their problems). These conversations are, for now, the more interesting part of my traineeship, but they are, I want to underline this, simple conversations. This means I can talk about whatever I want, without having in mind a therapeutic goal, being these conversation part of the socializing activities, the therapeutic goal is achieved in the conversation itself.
Why am I saying all this stuff?
One reason is for some of the comments I received on this post, comments like: ”Is that wise?" or "that doesn’t seem like a very good approach…”.
It would be probably not wise and definitely wouldn’t be a good approach if it was my patient and we were talking in a therapeutic setting, but it wasn’t that the case. As I explained, in that situation we were just two persons having a conversation. My point of view is that I’m entitled of talking about anything I like (but I should say I don’t usually start conversations, so most of the times is the patient who choose the subject) unless it’s clearly an upsetting topic.
The other reason I’m saying this is this message (and other comments alike).
“Could you explain why you feel the need to talk about Schizophrenics like they’re an alien race?”
The person who sent this message must be a new reader of this blog. I think it’s clear to anyone who have taken the time to read some of the stuff I write from time to time, what is my position about mental illness.
For example, I never refer to someone as schizophrenic, or depressed, or bipolar or whatever. I always (always, really) say something like: a patient with paranoid schizophrenia, a person with anxiety disorder, etc. This is because I really think that having a mental illness doesn’t define your whole identity, it’s just part of your identity.
Trust me when I say I have difficulty even in saying “patients”.
The fact that after talking to a patient I think about what happened, that I reflect on both his and mine behavior, that I write about that trying to analyze it, and even that I find the irony in having a conversation so similar to some I have here on this blog in an environment so different, it’s part of my “job” and it definitely doesn’t mean I “need to talk about Schizophrenics like they’re an alien race?”.