Part IV: Transitioning Into My Professional World
So, I’ve shared my personal story and insight into the life path that I’ve taken. My family issues and experiences with mental illness began at an early age and definitively led me, initially, into various psychotherapists offices. Later, as my desire to gain some type of understanding of psychiatric illnesses and treatment was replaced by a deeper wish to help people with these conditions, I entered the Masters of Social Work program at San Diego State University. My emphasis was in Clinical Mental Health. I found lots of personal healing in gaining, at first, a beginning amount of information and increased empathy for the level of internal struggles that those with these illnesses endure. Later, my formal education grew and, equally as impactful, so did my experiences working with adults of both genders who were struggling with various psychiatric illnesses.
I’d like to segue at this point into various thoughts that I have experienced, observed, and / or taught others while employed at Napa State Hospital. Each year, through my work with a great team of professionals and numerous trainings brought into the facility, my skill level became more effective and I felt that I continued to make a greater impact on those I was treating and caring for. Being real and expressing genuine empathy and respect went a long way in building true clinical trusting relationships!! The ability to work with these adults provided me with a deeper, more meaningful awareness from minor personal nuances to explicit symptoms that have been experienced. This took a great deal of vulnerability as people bared their souls in hopes of gaining the capacity to manage their symptoms more effectively than they had previously.
I also had the privilege of working with the loved ones and significant others of my patients in ways that my family could only dream about when my brother was in psychiatric hospitals. This is true especially with regards to psycho-education and an increased awareness of how their loved one was progressing in treatment and overall, as long as valid signed releases of information were in place. I remember that it was always so painful for loved ones when the patient was unwilling or unable to consent for this open communication. One wishes to be able to provide information to all their loved ones feeling understandably anxious, but are legally bound not to do so. Thankfully, this was more rare than common as the trust level was high, and most of our adults wanted the staff to inform their loved ones of how well they were doing and to help them better understand their illnesses, the forensic psychiatric system, rules of the hospital, and other questions.
This leads me to what I believe is one of the biggest issues and quite the long-standing dilemma within the field of psychiatric treatment and care. How does a mental health professional convince another adult that they are having trouble managing a mental illness (diagnosis) that they don’t believe exists let alone realize is actually happening to them and distorting their understanding of reality? This is especially true, I believe, with two significant symptoms regardless of the diagnosis – delusional thinking and mania. In both situations, a person tends to embrace the intensity of the feelings they experience and the “bigger than life” identity that often emerges in the midst of an elevated and grandiose sense of oneself. These adults report a heightened state of energy, a looseness of cognitive associations, and a grandeur within their thought process. In fact, it seems to me, that it also serves as a coping skill and therefore a defense against negative feelings of low self-esteem, insecurities, and a state of diminished assertiveness socially. I firmly believe that each person who is learning that they have a mental illness reacts differently although, overall, generally not much different than being told one has cancer. There is going to be a period of shock and denial similar to learning about any other serious health condition. Some stay in this state of denial, unfortunately, for a very long time, which can cause further complications. A model of grief and loss, established by Elizabeth Kubler-Ross and accepted internationally, explains that each person goes through five stages of grief / loss leading to a state of acceptance. The first stage is Denial, and then Anger as one begins to move beyond the shock and is overwhelmed by strong emotions. Often, in the third stage, there is a period of Bargaining. (What if I…? Is my illness real? Should I trust what the doctor told me?) The fourth stage is Depression as the reality of what is going on begins to really settle internally. And, finally, one hopefully achieves Acceptance where they can then move forward again. The difficulty, as I see it, is that the majority of the time, a medical / healthcare professional informs one of an illness, they get past the shock and other two stages, and then become more knowledgable as to how they can best help in the management of their illness. With these illnesses, that typical question is not readily available. I believe that if a diagnosis that includes psychosis came along with physical pain like an abscess in one’s mouth, adults would be running to their psychiatrists as fast as they would run to their dentists!! I don’t wish this type of pain to trigger awareness, of course. However, I can’t help but distinguish the reason for so many not being willing, especially initially, to accept what their psychiatrist and / or general medical doctor is informing them. These are tricky illnesses and, yet, I fully believe that the more that we embrace a delivery of care that is rooted in dignity and respect, and promote the values of non-shaming and anti-stigmatizing experiences, the more adults will be more likely to reach their own personal acceptance sooner rather than later.
Lastly, and not to sound too harsh, however I cannot deny my own experiences. Many criminal acts, which sadly included victims, could truly have been avoided if the denial of that person regarding the severity of their mental illness was broken through sooner. I spent almost 20 years working with adults who overwhelmingly did not have criminal-mindedness nor criminal histories prior to committing a felony crime behind their psychosis and / or manic behaviors. My own brother chased my father around the house with a knife one day when he perceived our father in some type of a demonic manner and felt threatened by his presence. Instead of waiting to be harmed as he, and MANY folks that I worked with did, they take an offensive position although they believe they are defending in some fashion and in a righteous way. My brother was unable to catch my father on that almost fateful day. However, too many of the adults I spent years working with had not be as fortunate. They completed some felonious act and then needed to face that full reality once in a clearer state of mind on appropriate and helpful psychiatric medications and receiving treatment. Too often this included a loved one taking the life of another family member, friend, known acquaintance, or possibly even a stranger. Every patient in these situations wishes they had the clarity they now had prior to the tragic event. This scenario exists in our society each and every day. Very nice, beautifully-minded people under the strains of these illnesses can harm those they care the most about and not realize it during the moment. I want to see a major shift in how we communicate the need for early diagnosing and treatment, and to ensure that the services, regardless of financial ability, is readily available for all!!!