Tuesday, January 10, 2012

Illness can take control!

                There are times when everyone who is involved in mental health treatment tries their best to resolve problems.  The patients work as hard as they can to feel better and to do better.  The helpers, both family and professionals, use every resource available to make things work.  The illness, however, can conquer all.


The Story 

“There’s nothing up here. It’s really dusty and from what I can see nothing is disturbed.” The young cop was on a step ladder, his hat off, his upper body squeezed through a small square hole in the celing of the closet of my client’s bedroom. “The attic is really well insulated.” he said as he carefully made his way down the ladder, adding his flashlight to the gear on his belt. His partner gave him back his hat and they both stepped into the small bedroom. “I suppose there could have been squirrels, but I don’t think so. I didn’t see any light from outside and they have to have some way to get in.”
Gwen looked at me and softly said, “They were here.  I’m not lying to you. They really were here.”
I walked the cops to the door. “Thanks guys, I really appreciate you coming. You’ve been a big help.” The older cop rolled his eyes at me and said, “Give me a call when you’re done.” I closed the door and returned to the living room. Gwen was sitting on her sofa. Her tall thin body was swallowed by the soft cushions. Her graying brown hair was matted. The sweat pants and tee shirt that served as pajamas were wrinkled. She stared at her hands folded in her lap. I’d only seen her neat and prim in nice clothes and makeup. She looked up at me, eyes pleading.
“They were here. They really were here. I don’t know how they do it and I don’t know how they get in, but they were here.”
She was referring to the aliens that had been visiting her on a regular basis for a month or more. Her therapist had brought it up in one of our regular clinic staff meetings a few weeks earlier.
Alicia, her therapist, told us, “This is new. She’s had delusional materiel before, but nothing like this. It came up almost as an aside in a discussion about other problems that she’s had with neighbors in the building, loud noise and stuff like that. She said that aliens have been in her room at night. The first time was in the last few weeks. Two or three of them just stood at the end of her bed. When she first told me about them, they were unformed, a presence. As time has gone on they have become more substantive. They look like TV or movie aliens, a child’s height with light bulb shaped heads, their bodies a greenish color.”
The room gave a collective sigh. Gwen was a favorite. She was a woman in her forties who had returned to Ithaca last year after many years in and out of mental hospitals throughout the country. She’d grown up here and had a strong and supportive family who were willing to assist in any way possible without being intrusive. They’d helped her find an apartment and scoured garage sales and second hand stores to furnish it. More than twenty years earlier Gwen had left Ithaca to go to college in the Midwest. She’d earned an undergraduate degree in English literature and had started a doctorate program. Then she became symptomatic with signs of schizophrenia. After a few hospitalizations she hit the road trying to escape the various demons that made up her illness. She’d tried cities: Denver, Austin, and Portland Oregon. She’d tried rural: southern Ohio, eastern New Mexico, even Lancaster Pennsylvania in hopes that the Amish lifestyle would somehow rub off on her. Illness combined with poverty always led her to hospitalizations. I’d looked at her record a number of times and saw the all too familiar patterns.
“Have her make an appointment to see me,” her psychiatrist said. “Maybe we can find a way to resolve this before it becomes too bad. Squeeze her in after lunch tomorrow.”
Gwen would only agree to a minor medication adjustment when she met with the doctor. She’d been given a variety of medications over the years, but we all knew that many of our clients did not take medication as prescribed and at times the medications did not work. When Gwen came to our clinic, accompanied by a cousin, we’d been impressed by her knowledge of her illness and her level of commitment.
“I am sick of that life!” she told us when she arrived a year earlier. “A young person can wander the country and do all sorts of crazy things. I’m not a young person anymore.”
She was the kind of individual who continued to be very well read, often showing up at appointments with arms filled with books from the library. She went to the library every day, spending hours reading papers and magazines. She often engaged other clients in the clinic waiting room with discussions of current events or politics. Her employment history was the counterpoint to her hospitalizations. She presented very well, and according to her and family members, she’d been able to support herself waiting tables, stocking shelves, answering phones and with every other entry level job imaginable. When she moved home, she needed public assistance to survive and the Department of Social Services looked at her record and insisted she apply for disability. Even with more than twenty hospitalizations, Gwen did not view herself as disabled. Soon after she was settled, she began to volunteer at the soup kitchen.
Gwen had lived in a variety of rooms, apartments, motels and shelters over the years.  She had nothing of value. At different times over the years she’d return to her residence to find her few belongings stolen. Her current apartment was in a building on the edge of college town, where at least ten thousand students and hangers on lived. Most people felt physically safe, but break-ins were common, with practiced local thieves looking for laptops, jewelry and other easily fenced items.
The first few times she’d called the police, it was to report strange noises or possible intruders. The officers had responded quickly and professionally, making sure that doors and windows were secure, writing detailed reports. A crime prevention officer had even come during the day and helped her make an assessment of risk. I was made aware of the calls by the Records Sargent and stopped by Gwen’s on a regular follow up visit. We had only met once before at the clinic and she was polite, but not forthcoming.
Later in the day, after the inspection of the attic, I went to the police department to follow up on the older officer’s request.
It was near the end of the day shift and the officer had that careworn look that cops get when retirement is near but not close. He had a couple of years left.
“Terry, she is clearly a code 88,” he said, referring to the designation police give to mental health calls. Since I couldn’t talk with him about her case, I went to a general discussion.
“When these sorts of things happen, we try to add medication and keep close track of what’s going on.”
The officer knew the limits of our discussion, but added, “When we first got there, she said the aliens “probed” her. I asked what that meant and she got sort of angry and said that they looked inside her. I didn’t bring it up at her house because she had calmed down and I didn’t want her to get upset again and I knew I’d talk to you today.”
I called Alicia and let her know about the “probing”. Working with clients that are often the victims of crime, we felt the need to rule out sexual assault as a possibility.
Alicia called me into her office later that week. Gwen was sitting across from her. As I sat Gwen looked at me, silent for a moment as she tried to gather herself and control her anger before she spoke. “Look, I was probed, not raped. I’ve been raped before, once in Denver and once when I was hitch-hiking. What happened in my apartment was not rape. There was nothing violent or sexual about it. Somehow they controlled my mind. They made it so I couldn’t move. Then they poked and prodded and looked inside. And not just my private parts. They looked in my ears and mouth and even my nose. See what they did?”  She leaned towards me and touched a sore on the bottom of her nose. “They did that! They pulled too hard on the nostril and it tore a little.”
“That sounds really unpleasant,” I said
“You don’t believe me! You people act like you’re trying to help and when I really need help, you don’t help.”
“I was there with the cops when they looked in the attic. When you call, we respond. It doesn’t make any difference whether I believe the specifics or not. I believe that you are upset and I’m trying to help.”
She shook her head and mumbled, “No one believes me, and they think I’m crazy. It’s getting bad, really bad.”
“Would you like to go to the hospital for a few days? You’ll be safe there. No one will bother you. You can catch up on sleep then decide what you want to do. Alicia can meet with you there to sort things out,” I suggested.
Gwen gathered her coat and purse and slowly stood up. “I know you think I’m crazy, or I’m lying, but I’m not. This is really happening. I don’t want to talk about it anymore. I’ve got to meet somebody for coffee.”
After she left, Alicia and I reviewed our very limited options. Fortunately, she didn’t leave while she was angry. We felt there were still opportunities for help.
It was two nights later, about one in the morning when I was called to Gwen’s apartment. I could see the flashing lights as I came down the hill to her street. The fire trucks filled the space in front of the house, ladder lifts on either side of the house. Hoses were directed at the roof where a few flames were still licking at the sides of a large hole. A small crowd of residents and neighbors gathered across the street. Beyond the firefighters was a police car. Gwen was in the back seat.
“I’ll sign the papers for the hospital,” I told the cop sitting in the front seat.
He lowered the driver’s side back window a few inches so Gwen and I could talk.
She was wrapped in a soft white blanket, quietly crying. “They came to take me with them. I heard them in the attic talking and I didn’t know what to do. So I rolled up a newspaper and set it on fire and pushed it through the attic hole to drive them out.”
“I’m glad you’re safe,” I said as the officer rolled up the window and put the car in gear.

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