When I'm on my day job, I am a psychologist working in a psychiatric ward treating severely socially challenged patients with schizophrenia or similar psychiatric disorder. All of them have at some point of their life commited crimes of serious violence. The rest of the time, though, they are some of the kindest people on Earth.
Being a psychologist, mental health is of course of the utmost importance to me - and especially that those people perhaps most in need of help get this second chance. It's a very challenging job, not just for me personally, but for all my colleagues, as well. How do you help someone so far removed from knowing how to help themselves?
For centuries, the answer has been "professional acumen". The health professional, armed with books and years of experience, would know better than the patient what their needs were. At the end of the day, however, this has amounted to little more than personal opinion or peer consensus. There is this word, "science". Back in the day, the practice of blasting patients with cold water to cleanse their weakmindedness, was deemed as quite scientific. I will agree that science has come a long way since its beginnings, but these days, science is not much more of a help, with most scientific evidence showing uncertain results and a depressing average outcome for patients such as those with whom I work.
One problem has been to focus a lot on the ways in which the psychiatric personnel can control their patients. Controlling their body with belts and beds, by controlling their minds with (1st generation) anti-psychotic medication. Both have terrible side-effects in loss in quality of life and ability of life as well, but would "stabilise" the patients and lower violence and rebellion.
There's this idea, these days, to do the opposite. To let people go free. To trust that, though unrestrained and taking just the minimum necessary amount of medication, these are still people wanting a second chance. Ideally, though the patients of our ward have sentences to undergo psychiatric treatment, the doors are unlocked. They are asked to tell us if they want to go for a walk or go shopping. We can call the police if they do not return. But most usually, they do.
Not that this is not an approach without challenges. Drugs keep getting smuggled in. Cannabis, sure, we can accept that. Hard drugs are almost okay too, though they are detrimental to treatment outcomes. However, there is a close relationship between drug use and violence.
Where other parts of the psychiatry enforce strict regulation and might restrain or force tranquilising medicine onto patients that are behaving aggressively, we instead try to de-escalate dangerous situations. Not that this is not an approach without challenges. We keep hoping for the best, that this will work, that they might be able to compromise to stay in their room. It takes a lot of coordination, teamwork, manpower. It is dangerous. And it is taxing on our mental health.
About 48 hours ago, I ended up in a violent situation. No violence occured, but it easily could have. It was prolonged, took place in a remote, unknown location after dark, far away from the ward and from any other personel.
I held, in my hands alone, the responsibility of protecting my patient from his own increasing anger, of protecting passers-by from him, and of figuring a way to leave the situation without escalating the problem. I had the utmost trust in him, and even as he shouting loudly threatened to kill a colleague of mine, a third-party as well as the whole psychiatric staff (which would logically include me) with graphic detail, I did not feel so much afraid as deeply despairing at the difficulty of finding a solution to the situation.
For those forty-five minutes or so, I stood in a state just before panic, of crystaline concentration and raised reflexes. At any moment, the precarious situation might tip and become dangerous.
Returning to the ward, I was taken care of by my colleagues, offering me support as well as sending me back home (with a colleague to keep me company). As ridicolous as it seems, that I was given a sleeping pill with the strength to (I imagine) take out an elephant, I see as a symbol of the care they offered me. They forced me to take sick leave. It was probably for the best.
Yesterday, I was a bit shaken. Today, I felt much better, but then after the debriefing about the event, I once more feel slightly shaken. It is pretty difficult to explain. Yesterday morning, before the sun rose, I woke with a start at hearing a cough outside, realising the door was unlocked. Usually I do not care much if I forget, but this morning, it took me a minute or more just to assure myself enough to dare to stand up and leave the room to lock the door. Also, at different points of time throughout the day, tears would come to my eyes.
Overall, right now, my mental health is at an 8 out of 10, I'd say, which is better than it has been at several points of my life. Nonetheless, I know that, if left to my own devices, I would have returned to work even yesterday, quickly burdening my fragile defences and who knows what would have happened.
How do you help someone so far removed from knowing how to help themselves?
A lot of reactions occur in those situations, some of them quite strange. I have been deeply worried for my colleague who had the most direct threat raised against her. A sort of shame at not reacting to this threat (though I know that reacting would be a terrible idea). An unexplainable feeling that the threat itself - which she did not hear - would cause her suffering. Also I worried for her safety, though less so, because I knew she would be safe as long as she did not, as I did, stand alone with this patient several miles from the ward. As staff, we are safe as long as we have coordination, teamwork and manpower. Talking to her today, that was what she said.
Just now, I am starting to put together the full picture of what happened that night. I have no reason to believe I will suffer any long term symptoms from this altercation. However, this is only for certain because of the way I was taken care of.
The truth is, however perverse, that this was a great piece of work. The situation was defused. Nobody was hurt. The patient, too, suffered no ill consequences, no force was used, no extra medication, no means of limiting their freedom. No trauma. I do not quite know how to continue our therapeutic relationship when I am back from sick leave, but I think both of us are willing to resume it.
So that's the moral of this post. That the world is complex, and good and bad stand close side-by-side. That mental health is important both for those treated and those who treat.
If you see somebody shouting into the night and another, perhaps more professional-looking person nearby, know they are doing their best, and the person shouting should be respected, not subdued.
I choose to write this post here, so different from everything else on this blog, because my first instinct was to keep quiet, but mental health should never be taboo. Because above all else, mental health is important.
Being a psychologist, mental health is of course of the utmost importance to me - and especially that those people perhaps most in need of help get this second chance. It's a very challenging job, not just for me personally, but for all my colleagues, as well. How do you help someone so far removed from knowing how to help themselves?
For centuries, the answer has been "professional acumen". The health professional, armed with books and years of experience, would know better than the patient what their needs were. At the end of the day, however, this has amounted to little more than personal opinion or peer consensus. There is this word, "science". Back in the day, the practice of blasting patients with cold water to cleanse their weakmindedness, was deemed as quite scientific. I will agree that science has come a long way since its beginnings, but these days, science is not much more of a help, with most scientific evidence showing uncertain results and a depressing average outcome for patients such as those with whom I work.
One problem has been to focus a lot on the ways in which the psychiatric personnel can control their patients. Controlling their body with belts and beds, by controlling their minds with (1st generation) anti-psychotic medication. Both have terrible side-effects in loss in quality of life and ability of life as well, but would "stabilise" the patients and lower violence and rebellion.
There's this idea, these days, to do the opposite. To let people go free. To trust that, though unrestrained and taking just the minimum necessary amount of medication, these are still people wanting a second chance. Ideally, though the patients of our ward have sentences to undergo psychiatric treatment, the doors are unlocked. They are asked to tell us if they want to go for a walk or go shopping. We can call the police if they do not return. But most usually, they do.
Not that this is not an approach without challenges. Drugs keep getting smuggled in. Cannabis, sure, we can accept that. Hard drugs are almost okay too, though they are detrimental to treatment outcomes. However, there is a close relationship between drug use and violence.
Where other parts of the psychiatry enforce strict regulation and might restrain or force tranquilising medicine onto patients that are behaving aggressively, we instead try to de-escalate dangerous situations. Not that this is not an approach without challenges. We keep hoping for the best, that this will work, that they might be able to compromise to stay in their room. It takes a lot of coordination, teamwork, manpower. It is dangerous. And it is taxing on our mental health.
About 48 hours ago, I ended up in a violent situation. No violence occured, but it easily could have. It was prolonged, took place in a remote, unknown location after dark, far away from the ward and from any other personel.
I held, in my hands alone, the responsibility of protecting my patient from his own increasing anger, of protecting passers-by from him, and of figuring a way to leave the situation without escalating the problem. I had the utmost trust in him, and even as he shouting loudly threatened to kill a colleague of mine, a third-party as well as the whole psychiatric staff (which would logically include me) with graphic detail, I did not feel so much afraid as deeply despairing at the difficulty of finding a solution to the situation.
For those forty-five minutes or so, I stood in a state just before panic, of crystaline concentration and raised reflexes. At any moment, the precarious situation might tip and become dangerous.
Returning to the ward, I was taken care of by my colleagues, offering me support as well as sending me back home (with a colleague to keep me company). As ridicolous as it seems, that I was given a sleeping pill with the strength to (I imagine) take out an elephant, I see as a symbol of the care they offered me. They forced me to take sick leave. It was probably for the best.
Yesterday, I was a bit shaken. Today, I felt much better, but then after the debriefing about the event, I once more feel slightly shaken. It is pretty difficult to explain. Yesterday morning, before the sun rose, I woke with a start at hearing a cough outside, realising the door was unlocked. Usually I do not care much if I forget, but this morning, it took me a minute or more just to assure myself enough to dare to stand up and leave the room to lock the door. Also, at different points of time throughout the day, tears would come to my eyes.
Overall, right now, my mental health is at an 8 out of 10, I'd say, which is better than it has been at several points of my life. Nonetheless, I know that, if left to my own devices, I would have returned to work even yesterday, quickly burdening my fragile defences and who knows what would have happened.
How do you help someone so far removed from knowing how to help themselves?
A lot of reactions occur in those situations, some of them quite strange. I have been deeply worried for my colleague who had the most direct threat raised against her. A sort of shame at not reacting to this threat (though I know that reacting would be a terrible idea). An unexplainable feeling that the threat itself - which she did not hear - would cause her suffering. Also I worried for her safety, though less so, because I knew she would be safe as long as she did not, as I did, stand alone with this patient several miles from the ward. As staff, we are safe as long as we have coordination, teamwork and manpower. Talking to her today, that was what she said.
Just now, I am starting to put together the full picture of what happened that night. I have no reason to believe I will suffer any long term symptoms from this altercation. However, this is only for certain because of the way I was taken care of.
The truth is, however perverse, that this was a great piece of work. The situation was defused. Nobody was hurt. The patient, too, suffered no ill consequences, no force was used, no extra medication, no means of limiting their freedom. No trauma. I do not quite know how to continue our therapeutic relationship when I am back from sick leave, but I think both of us are willing to resume it.
So that's the moral of this post. That the world is complex, and good and bad stand close side-by-side. That mental health is important both for those treated and those who treat.
If you see somebody shouting into the night and another, perhaps more professional-looking person nearby, know they are doing their best, and the person shouting should be respected, not subdued.
I choose to write this post here, so different from everything else on this blog, because my first instinct was to keep quiet, but mental health should never be taboo. Because above all else, mental health is important.
Thanks for sharing, this was quite powerful. I'm glad your okay, and I admire your strength in dealing with such situations, I'm pretty sure I could not place myself so intensely in another person's thoughts in such a stressful situation.
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