Saturday, September 16, 2006

Just another day in the mental health realm...

…or for those of you not familiar with this area, welcome to a day in the life of an individual working with the severely mentally ill…

Jim and Edna were both patients in a mental hospital. One day while they were walking past the hospital swimming pool, Jim suddenly jumped into the deep end. He sank to the bottom of the pool and stayed there. Edna promptly jumped in to save him. She swam to the bottom and pulled Jim out.

When the director of nursing became aware of Edna’s heroic act, she considered her to be mentally stable. When she went to tell Edna the news she said, “Edna, I have good news and bad news. The good news is you’re being discharged since you were able to rationally respond to a crisis by jumping in and saving the life of another patient. I have concluded that your act displays sound mind-ness. The bad news is that Jim, the patient you saved, hung himself in his bathroom with the belt to his robe right after you saved him. I am sorry, but he’s dead.”

Edna replied, “He didn’t hang himself. I put him there to dry. How soon can I go home?”

I thought the above story was funny. I got it from a friend in an email. And though it might not be exactly how things tend to go in a mental hospital setting (because we restrict use to pools nowadays…HA), it really isn’t too far off from how some of our client interactions go.

My most recent experience was a group therapy session…

Time out (this is for those schooled in the mental health realm): imagine doing a group session with two major depressive clients (MDD), one bipolar client (BD), and three schizoaffective clients (SAD). We are talking some people with GAF scores under 50. Some of which, when they first entered the unit, were in the 30s.

Okay, so group begins with one individual (a SAD) who is experiencing grandiose delusions and introduces himself to the group as ______ Trump. He believed he was Donald Trump’s son. Immediately following group the participants’ name introductions, “Mr. Trump” decided to begin by begging on behalf of himself and another of the group member’s urges to have a cigarette.

In our locked-unit, obviously none of the clients are allowed to leave to go to a smoke area, and there is no smoking on our unit. So since this gentleman had been in the unit for about 3 days at this point he was experiencing some extreme withdrawal symptoms; though from the “show” he put on about it, I think more of it was a psychological addiction than as much of it being a physical/chemical addiction. Yes, I don’t doubt the man smokes at LEAST a pack a day, so I’m sure his body was chemically addicted so after having to stop cold-turkey for three days straight I’m sure he was experiencing some withdrawal symptoms, but his response was fun to watch, especially since my supervisor was running the group, so I just got to sit back and watch.

This gentleman who is SAD and was having grandiose delusions began to throw a temper-tantrum that we would not allow him to go have a smoke break. He proceeded to inform us about how he graduated first in his class from West Point; fought on the front lines in Iraq for our country, and so the LEAST we could do is give him a cigarette to show our appreciation for what he has done for our country.

Wow…I had no idea Donald Trump’s son was so involved in supporting our country! ;)

Now this gentleman was getting rather out of control because of his desire to get a cigarette. My supervisor did a great job to keep from escalating as the client was, and she was able to get him to calm down and focus his thoughts off of his nicotine craving and onto the topic at hand for the group.

I’ll be honest. This client was rather intimidating at times. When I first met him and he was following me and my supervisor around the unit as we gathered people for group session he introduced himself to me, and then asked what I do. I told him I help Christine, my supervisor, and then we proceeded to move on to another room. He then asked me, “What do you do? Just follow her around?” And I said “no, I help her out.” He said, “You are like her little elf! You’re her little elf! HA HA HA HA HA HA HA HA HA!”

He proceeded to crack up at himself and repeatedly say “you’re her little elf” and then crack up again. I just smiled and walked on. I had no intentions of arguing with such a tall gentleman who is following me around the LOCKED unit. I have NO problem being an elf at that point in time! HA!

Not only did he have the characteristic laugh that some schizophrenics have, but he also had the stare. He would just stare with an uncomfortable stare at people—uncomfortable for the person on the other end of the stare. It looks like a threatening stare, though I want to clarify that many times the stares are not with threatening intentions, they just come off that way.

SAD (schizoaffective disorder) is an interesting mental illness to work with. For those unfamiliar with the mental health terminology, schizoaffective disorder is when an individual has schizophrenia and a mood disorder, which could be major depressive disorder or bipolar, for instance. Many times it is schizophrenia and bipolar that we have on our unit. That can be a difficult circumstance for the individual as well as those working with them. Either disorder is difficult enough to live with, but having both can be overwhelming at times.

So there you have it. A week with a VERY interesting group session! You can have REAL fun things come out of group session when you are working with such low functioning individuals.

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