DRAFT: This module has unpublished changes.

An Introduction: An Indoctrination

 

Indulge me, if you will, in a sweeping generalization.

 

I hadn’t realized just how necessary it was for my school’s academic advisement center to send people off with folders that held small packets of information together until I started working in places that didn’t have as immediate access to folders. My clients were content to take the information I’d lovingly pieced together for them and just sort of jam it into their bags or backpacks. Eventually, I stopped asking “Can I get you a folder?” and started wrapping up conversations with “let me get you a folder.” From then on, people would lovingly use that folder to keep track of all their paperwork.

 

People who were meeting me for the first time, however, were a different story. They’d slap a mess of papers down at my desk and shuffle through them for a while before locating class schedules and proof of criminal justice involvement. I’d slide an empty, glossy folder near the mountain of documents and they’d take the hint – or they wouldn’t – but rarely did students leave my office without me at least offering some sort of organizational tool. I am a firm believer in the old adage that a cluttered desk means a cluttered mind. If I could ease that physical and mental clutter in any sort of way, I would.

 

I am thinking about my past clients when I meet Saul, a WASP-y looking youngish person clutching a stack of papers to him throughout the duration of the group therapy session we are both participating in. Meeting Saul marks my first day at Bellevue and the first time I will meet someone who is experiencing serious psychosis.

 

I wonder if I could find him a folder, I muse, while also trying to listen to the other patients speak about what brought them to the hospital. From my furtive glances at the pile, he has dog-eared single-paged sheets on the “rules” that are given to each patient once they come to the hospital. One of the last pages in the packet gives information in a number of languages on patient rights. I recognize the nomenclature as something proudly displayed next to all the elevator banks – not once has Bellevue tried to hide the fact that there are certain things guaranteed to patients. I imagine that he holds them close to his chest for comfort, or for reference, and suddenly it’s his turn to speak.

 

“I grew up in France,” he tells us. His accent is decidedly American but this quickly checks out as he explains that he moved to the States pretty quickly and spent most of his adolescence in boarding schools. I’m imagining him in pressed uniforms standing near the Alps when he reveals he has a background in journalism. This doesn’t faze me much. People from all occupations come to Bellevue.

 

He references his notes often. My memory of Saul is melty and imperfect. In my mind’s eye I see him shuffling his papers and speaking about his childhood, and I remember my supervisor on one side of me and an occupational therapist intern on the other, but around him are watercolor swirls of yellow walls and blue-green chairs. I don’t remember if he told us he wasn’t supposed to be there, but I remember his franticness in trying to communicate the atrocities of the hospital.

 

“We have rights,” he emphasizes, waving the papers at us. “I’m going to write all about this when I leave. I work for the government. They’re going to hear about the fact that you deny people their rights.”

 

My supervisor asks him what he feels as though he is being denied, and he tells us that he is trapped here. This, I find out soon enough, is a common feeling that runs through any patient at any hospital, particularly if they are being housed on a psychiatric unit. People rarely check in and check out the next day, especially if it was something particularly egregious that brought them in.

 

Saul gives the impression that he is high up in his government position and I start to see through the picture he has painted. I am no longer picturing a small French boy with golden hair and a gray jacket with a little phoenix emblem. I picture Saul at eleven years old, sitting in the back of a New York City public school classroom. My supervisor calms Saul down, who—despite how fired up he seems—has not raised his voice to any alarming or even concern-inducing decibel throughout the confrontation. He sits quietly and listens to the other people speak, sometimes going back to his papers with hooded eyes. He produces a little pen from nowhere and writes, watching the rest of the group intensely. I wonder what he is writing down, and if he will be able to make it out later with his papers tattered the way that they are.

 

Coming out of the unit, I debate to ask about the journalist-turned-government-worker because I am unsure if I should know better or not. A delusion that someone is a high-up government official is a little too on the nose to be made up, isn’t it? I also can’t shake the thought of the Rosenhan experiment, which I’d first read about in eighth grade (pretty quickly after I’d decided that I was going to be a clinician) I’d determined that I would never ever let myself let someone sit in a hospital that wasn’t truly unwell or wasn’t being helped (as if I’d have much control over that).

 

I have to ask. It’s like the most persistent itch I’ve ever had.

 

“Was, was he – did he really work for the government?”

 

My team stops walking and I suddenly feel very small, but excited to learn more about the man I have just met.

 

“Who, Saul?” The occupational therapist asks, then smiles. “No,” she says softly, and I nod. There is no animosity in her voice, no pity, no malice, no laughter. She is simply explaining that this man is unwell, and I then and there decide that this—this compassion—is the Bellevue that I want to represent. This is the Bellevue that lets people like Saul ask about rights, and the Bellevue that delivers while keeping them safe.

 

Oh, I thought. I guess television got some stuff right.

 

For all the work that I had done so far, no one had really explained to me what it was like to listen to someone with a persistent delusion. Considering where I’d worked before, this seems normal. When I was on Rikers I worked in the schools, and students who went to school had to be well enough to go to school. In the same way that I wouldn’t meet someone with a broken leg or a high fever, I wouldn’t meet someone living with grandiose delusions. My clients at the Department of Probation—though I was asked to offer my opinion on best options for treatment—sat far away from me in lofty courtrooms, shrouded by their Legal Aid representative. Their presenting problems were discussed far away from them; we decided their futures with a manila envelope and a narrative presented by someone else.

 

I’m sitting back in my supervisor’s office and he goes to pull up Saul’s medical record. An obligatory warning of “ACCESS TO RECORDS MUST BE FOR MEDICAL USE” flashes across the screen—the first thing they taught me in my HIPAA training was that the Bellevue workers who slyly accessed the Ebola patient’s record were shown the door—and he clicks on Saul’s name.

 

“Hm.” My supervisor is leaning over the screen.

I scoot next to him. “Hm?”

“He’s got a French last name,” my supervisor says, scrolling quickly through the evaluation one of the social workers conducted. “Maybe some of that stuff was true.”

 

According to Saul’s chart, his story has not wavered much from person to person. I imagine that there are some people who latch onto several different delusions at once, but my patients tended to pick one thing and stick to it. Saul left his mark as my first patient with schizophrenia but there were many, many others.

 

“This is good,” my supervisor says, pleased that he had been offering the same story to people. “What you need to do,” he says, turning to me suddenly, “is focus on the themes.”

“The themes,” I repeat. I knew themes in English term papers and classical movements.

“The themes,” he presses. “He makes himself out to be important. His life is interesting, and by saying he is trapped here he doesn’t have to admit that he needs help. What does that sound like to you?”

“Feelings of inadequacy,” I say slowly. “And resistance to treatment.”

 

“Not resistance to treatment, Anna. He came to group. He participated. He listened. He is actively participating in his treatment. He may be unwilling to admit he needs help, but he wants to get better.”

 

I nodded and considered the other patients I’d met that during that initial session. There was the woman with clear presentation of Borderline Personality Disorder, who laughed easily until she laughed oddly. She held up a blank wrist to one of the behavioral health staff members, indicating she wasn’t wearing her identification bracelet—a middle finger would have been just as clear of a gesture—and oscillated between insisting she could leave at any time and fearing for the moment the treatment team would “kick [her] out.” It was hard to keep up with her. She wants to get better, though.

 

There was the man with logorrhea who made my heart hurt, because all he wanted to do was tell me, a new audience member, his story. I could understand about half of what he said—the way he held his mouth didn’t allow for much diction—and I would have listened for an hour straight if my supervisor didn’t cut him off. He was clearly upset to be cut off (and said as much, citing the unfairness that everyone else got to talk) but he stayed for the rest of the meeting. Even when feeling slighted, he is committed to getting better.

 

There are the patients who don’t say anything, but sit and watch. They are not active participants, but they are learning what that means. They want to be better, too.

I practiced. For the rest of my time at Bellevue (and for the rest of my days on earth) I looked for the themes in peoples’ monologues. Some were easier to identify than others. It takes some practice, and it takes listening. If I was going to listen for the themes, I couldn’t concentrate solely on what I was going to say next. Because I was so dedicated to listening I had deeply organic conversations and genuine reactions. This made people comfortable with me.

 

A year later I am sitting in a public library and half-heartedly studying for the GRE. New York City has recently taken to touting the campaign that “libraries are for everyone,” which led to an uptick in people who would otherwise be sitting on the street. I am focused on learning to solve quantitative comparison questions, so it takes me a bit of time before I tune in to the older woman sitting a few feet away from me. Her back is turned to me and she is speaking to no one in particular.

 

“My family’s fortune,” she says. I missed the first moment of her speech but I am sure that she will come back around to it. I put my pen down.

 

“My father worked for the royals. My sister is there in Europe. We have roots. We had secrets.” Secrets. My notebook shuts with a quiet slap.

 

It’s hard to make out what she is saying. I keep in mind that I am in a public place, not a well-regulated hospital, and that it would be uncool at best to physically get up and ask her about her family secrets.

 

“The painting in the attic,” she says, a little louder now. No one has lifted their eyes to her monologue—even I politely keep my eyes cast down—so I imagine she is feeling braver, or that her initial cry for help was unsuccessful. “It’s of all of us. The eyes are black. Do you hear me? The eyes in the painting are black.”

 

No fucking way. Why are they black? What happened to your family? What happened to you? I am straining to hear her but an employee gets to her first.

 

“Ma’am,” he says, keeping his distance (I smirk a little at his apprehension), “is everything okay?”

 

I’m fully watching now. I don’t know if this library has a “we call cops” policy or what and there are a number of vulnerable people in this space. I’m ready for anything.

 

She glares at him with open hostility, but she is also a frail old woman, so the stare is not as menacing as she would likely hope. “I’m not talking to you,” she says. “I don’t need you.”

 

He is grateful for the dismissal. I am still watching her as she leaves her things in her chair and walks out to smoke a cigarette with no coat on despite the frigid chill of the March air. What are the themes? Familial discrepancy, quite possibly resentment towards them. Are they in Europe? Is her sister still alive? When was the last time she spoke with her? A need for respect. Black eyes – why does she see them as black? She is talking outside – to herself, to the void. I can hear the blur of her voice on the window but not her words.

 

Do you remember how I’d said I left my bones at Bellevue? Sometimes I feel like I am walking around as a complete skeleton and then things like this happen. What does this story represent: a clinician on the rise; a nosy millennial; a person who can’t let go? What are the themes in my monologue? What are the delusions I hold?

DRAFT: This module has unpublished changes.