Thursday, August 25, 2011
If you have a serious mental health problem, find a skilled helper!
There are many different kinds of mental health professionals. Often they claim a broad knowledge base and are willing to see anyone who comes through the door. If you have a serious mental health problem, check around. Contact your local mental health association or the local affiliate of the National Alliance for the Mentally Ill, (NAMI). Have a brief phone or face-to-face consult, which should be free. Make sure the person is skilled and knowledgeable. Talk about cost and insurance.
The professional should be helping you set goals and objectives early in the process. Avoid “chit-chat” therapists who don’t have a plan and talk to you like an interested friend. You ought to know where you are going in treatment and how you are going to get there. You should be learning skills and be able to apply them in the real world. Insight is not enough! Change needs to take place. A skilled mental health professional should know about “talk” and “non-talk’ treatments and be open to at least discussing all possibilities. If, after three months, change is not taking place, find another professional.
The smell of gasoline was frightening. It enveloped the entire space. The empty gallon can was next to her on the concrete floor as she sat there sobbing, her hair and clothing covered, soaked with the fuel that was slowly evaporating. In her hand was a shiny zippo lighter. Its reflection sent splashes of light throughout the two car garage. I sat on an overturned five gallon bucket near a side door to the room. The cars were parked in front and I could see the lights of the police cruisers flashing against the leaves of the trees in the early autumn afternoon. She was a thin, small white woman in her mid-forties. Her damp hair may have been blond. Her white sleeveless blouse and grey sweatpants were saturated, her feet were bare. The garage was silent except for the buzz of the florescent bulbs overhead.
The therapist had come running down the hallway waving a folder in her hand about two hours earlier. “Terry, Terry, you’ve got to help me. She’s going to kill herself. This time she’s really going to do it.” I sat her down and had her tell me the whole story. Her client had a long history of depression. She had been seeing her for eight or nine years. Our new psychiatrist had recommended medication for this patient and Diane, the therapist, had not only resisted, but had poisoned the person’s attitude regarding medication. She was an old school therapist who was taken to saying, “People have to work through their issues. Medication is just a short cut, a band aide that doesn’t solve the problem. They need insight and understanding into the reasons they are depressed. They need to take responsibility for their part in their depression.” This particular therapist had a caseload of depressed women who she had been seeing for years and none of them ever seemed to get better. Her notes always indicated that her clients were “gaining insight” or on the verge of having a “breakthrough”.
When we had reviewed this case a few months earlier, we had noted the length of time the patient had been in treatment without real progress. Our recommendation was to begin a trial of Prozac, a medication that had only been available for a short time. I understood the resistance to the older antidepressants, the tricyclics, like Elavil and Imipramine. Those medications were very useful except for a major problem. A month’s supply would kill you. Prescribing the means to end your life to a depressed, suicidal person was risky business and in the thirty years they were in use, these medications killed many. Prozac did not have this problem and was a game changer. Professionals had to be convinced, but many didn’t have an interest in rethinking the way people with serious depression might be helped.
The therapist was rocking back and forth in her chair saying, “Hurry, you’ve got to hurry.” I scanned the folder in front of me and called the sheriff’s dispatcher. The response was: “We’ve got a car out on the lake road. He can meet you and you can follow him out.”
The initial call had come from the woman’s boyfriend. Lenore had been having increasing suicidal thoughts and had been fighting an impulse to kill herself for an entire week. The boyfriend had locked his rifle in the car, hid all the sharp knives and cleaning products and hoped Lenore would make it to her next appointment. That morning they had argued about something minor and he had gone to the store. When he returned, she was in the garage covered with gasoline. “Stay away from me,” she had screamed at him, and he called her therapist. He went to the door of the garage and told her someone was coming out to talk to her and proceeded to the end of the driveway to wait.
I pulled up next to the deputy’s Crown Victoria and briefed him on our call. “Follow me. Stay close,” he said smiling, and then his wheels spit gravel at me as he took off, his big lights flashing. My official county car was perhaps the worst car ever made, the Ford Escort. It was small and cheap and when you stepped on the gas the engine made a roaring noise and the car hardly moved. We had a twelve mile run into the country and even though I repeatedly called on the radio to slow down, the deputy kept us moving at about eighty. The front end shook, the doors rattled, wind made the hood lift slightly as if it would fly into the windshield. We passed semi’s from the salt mine and school buses full of kids and when I realized my life depended on it, I got about six feet behind that cruiser and stayed there.
The boyfriend was leaning against a fence having a smoke when we got there. “I can’t take this crap much longer,” he began, and I had him fill me in on recent events. The deputy said, “I called an ambulance. I’m going to wait out here. If you need me call me.” I replied, “Get the fire department too, and remind them both to approach silently. I don’t want to have to yell over the sirens. And tell them to stay out until I call them.” “You’re the mental health expert!” he responded.
The adrenaline from my drive was beginning to dissipate when I opened the door to enter the garage. The smell was overwhelming. “Lenore?” I asked, as I observed the figure on the floor. “Don’t come near me,” she yelled, flipping open the lighter. “I’m going to stay right here. Do you mind if we talk?” I asked, introducing myself. “I think we met once in the waiting room, can I open the window? The fumes are making me a little dizzy. I’m going to sit on this bucket.” “Ok, but just stay away,” she replied.
“Tell me what’s going on?” I asked. I want people in crisis to tell me their story and she did. It was a sad story, a difficult story, one that had no simple resolution. It included a problematic childhood and the betrayal of friends. She spoke of missed opportunities and unfortunate decisions that created unpleasant consequences she had to live with. There was a sadness that permeated everything.
“I’m so sorry. That sounds awful,” were my responses to the pain she expressed. “Why now, why today?” I asked. “There was nothing special. When I woke up I just felt like I couldn’t deal with it anymore. There is no end in sight and I’m so tired.” She began to cry, first tears running down her face, then sobs that shook her body.
“How about this? Clearly you are overwhelmed and can’t see any resolution to the problems you’ve described, but you’ve also told me about good things in your life. What if we get you some place where you are taken care of, where the worries can be put aside and you can try to focus on the few things that have taken you to this point?” She slid the lighter across the floor to me.
When she was discharged a month later on Prozac, I assigned her to a new therapist. Three months later Diane resigned, wanting to devote herself full time to her private practice.
The stories are my remembrances. Each of them is based on a true event in my work for Tompkins County Mental Health. I have changed the names of every client, patient and co-worker except for Beau Saul, of the Ithaca Police Department, who I was fortunate enough to have as a partner. When confidentiality demanded it, I have changed details. The dialogue is my reconstruction of what was said at the time. I have felt honored to be let into the lives of so many individuals over the years. Their stories are a gift I have been given. Please enjoy them in the spirit with which they were written; to educate and inform.