Thursday, November 02, 2006


You may be right. I may be crazy.

I have been reticent in the retelling of my psychiatric clinical rotation and I know that. It is partially because I do not wish to appear callous to those who do suffer from mental illness, and partially because I have found it to be a much more difficult experience than I had previously expected. Though my first few weeks have been peppered, indeed, with entertaining stories of the “crazies”, I am assured that this is not a clinical area for me, career-wise. I believe, in all honesty, I lack the patience needed to treat patients who are rarely rooted in the reality I rely on. There are fellow students around me that are blessed with this virtue and they will change lives and heal minds. I have a place too; a place I’ll change lives and heal minds, but it’s not in psychiatry.

My clinical rotation occurs in two parts – the second part will be spent in an honest-to-God psychiatric hospital-ward. Because of the high census of geriatric dementia clients, the ward is far more “Golden Girls” than “One Flew Over the Cuckoo’s Nest”, which honestly, is to our chagrin. In the mean time, the first part is two weeks spent in a day-care facility of sorts for schizophrenics and other mood and personality disorders. They are mostly self-sufficient – in the most basic sense of the word, live in group homes or with caretakers and come to this place each day to learn simple job-skills or simply to have a place to be for the day. They are, to the “sane” outsider: odd, illogical, pathological, repetitive, shut off, and strangely insightful at times. They act in ways that would make you stare, or at the very least wonder what the hell was wrong with them. But when you enter this day-facility, you, my friend, are the minority. And after a while, you begin to wonder who, really, the crazy one is.

Tuesday was Halloween, as you know. The facility was hosting a small party for all of the clients. (Oh yeah, in today’s very PR world, you’re not a “patient” anymore. You’re a “client”. It still sounds like you’re ill to some extent, but reminds us all that you are the paying customer.) Soon after I arrived I was asked to move all the chairs in the main room into a circle for the morning meeting. I went about my business and continued small conversations with some of my patients from the last week (one of whom had a “bug” implanted in her head over the weekend that enables everyone to hear her thoughts). (And yeah, I still call them patients.) As I moved chairs, the main lady who runs the joint called over one of the more severe schizophrenics and said, “Would you mind helping Cathy make that into a circle?” Woah, woah, woah! I can manage a “circle”. I have a college degree – and distinctly remember passing the first grade, when shapes were first introduced to me.

Sadly, it was only the first 15 minutes of the day, and bound to get worse.

In preparation for the party we had groups of clients coloring Halloween-themed outlines and then hanging them around the facility as decorations. One client, her diagnosis is paranoid-schizophrenia, was intently coloring a pink bat. I chimed in and said, “Oh, what a great pink bat!” Her head jerked up and she stared at me harshly. “Are you being sarcastic?” I immediately assured her that I wasn’t and she continued to color – but it occurred to me that she may have sensed the slightest tinge of sarcasm in my voice. Maybe I was being sarcastic? It was a great check for me to be more aware of myself here. Because though they may be left of center, they know sarcasm and criticism better than any of us ever will – and even more so, they know how to sniff it out of you.

The party was a success, really. We organized a great party game of Halloween-Hangman. I was elected to be “it” at one point and decided on my holiday-themed word. It was “Pirate Costume”. Because they continued to guess the same, wrong letter over and over, I was making the hangman out to be a pirate until they all caught on. One of the clients who volunteered to be “it” chose an odd 11 letter word to play until we all discovered later (after nearly 10 minutes of guessing…) was not a real word. Very real to him, however. He, incidentally, spent a good 35 minutes later that day telling me about his development of the cure for diabetes – which he will deliver to the world’s population via email soon. So be sure to check your spam folders so you don’t miss it, ok? He comes from quite a lineage as well – his mother, who has been president of nearly every country in the world and is also a four star general, has recently accepted the post of president of the United States. And to talk to him about all of this, he’s very serious. Dead serious. So serious your mind almost strains to make it make sense in your own head.

And that’s when you start feeling a little crazy yourself. Crazy because you appear to be the only one in the room that is finding fault with these nutty ideas. The only one in the room that doesn’t believe that Arnold Schwarzenegger is giving live birth every other day. The only one in the room who doesn’t think that bearded men are inherently untrustworthy. Harmless and talkative, every one, but if one says an idea, they all catch on to it faster than you could catch bird flu. It goes from nuts to gospel in less than a minute.

And they all smoke like fiends – and even though they’re smoking outside (sometimes every 10 minutes) the whole insides smells like your favorite college bar on Sunday morning. Interestingly enough, I was told that they were taught to smoke by the staff at their respective state institutions. Not only did it give them something to do and an excuse to be outside, but actual studies show that nicotine quells some of the symptoms of psychosis. So does Vitamin-E, Omega-3 and Omega-6, but, hey, vegetables and fish are more expensive than smokes, eh?

At the same time, however, you can’t help but notice how very sad it all is, really. Grown adults, physically, but very small, helpless children inside. Most of them suffered all manner of abuses, true and real abuses, at the hands of state psychiatric institutions years ago. The stories they told me (the true ones) sent chills down my spine – and I’m afraid the images they gave me might haunt the recesses of my mind forever. Their usual flat or vacant affect turns to paranoia and great fear when they remember those days – and I cannot imagine those horrors myself. To them, this place is heaven. I’m so glad that it is there for them.

I was able to spend time with a woman today – and her love monkeys. If only I was kidding. Since January 21, 1984 (she was so strangely clear on the date), she has been carrying around these two small stuffed monkeys. They don’t eat anything REAL, she told me, they feed on love. And to feed them, you have to rub them all over your face and make squeaky noises. Her monkeys were named “Billy Idol” and “Boy George”. Apparently Billy had a thing for me because she said he was telling her that he wanted me to love him – as she held him towards my face. And with this worn, dirty and misshaped stuffed monkey only a few inches from my face, I declined. Now, if there was a love monkey in her pocket named “George Michael”, I’d be all about it.

There was more to my time here than just extracting the strangest stories of my life. I am first, and foremost, a nursing student here. On the first day there I found myself actually enthusiastically groping my own (clothed) breast at the “Women’s Group” meeting to teach them all how to do self-breast exams. After a few moments I realized they were all staring with a great deal of intensity at my left breast to watch and mimic how I was doing it. Truly, it is just one of those times you couldn’t ever foresee yourself involved in until you’re knee (or breast) deep. Today I gave a presentation on the importance of exercise (seeing as how I’ve come to enjoy the fruits of exercise recently). As I spoke, the whole group of clients sat intently watching my every movement. Except for the lady at the end who was fast asleep and snoring. Occasionally, one or two would get up and walk directly in front of me to go smoke. They would come back a few minutes later (the fastest smokers I ever knew) and sit down again. I asked the group for examples of their favorite forms of exercise – one man raised his hand eagerly. When I called on him, he said with a flurry of fist and arm movements, “Kung-fu.” Yeah. I guess kung-fu is exercise.

My dearest patient was a man in his 60s – who bore a striking resemblance to my own father. He has been diagnosed with severe autism, OCD and schizophrenia, but he is as kind and gentle as a daisy. Jittery and nonsensical, yes, but sweet and talkative. I spent most of my time in this place with him close behind me – eager to help me with whatever task I could assign to him. He was, in fact, the one who started the whole “men with beards can’t be trusted” conversation. Probably because of a strange combination of all of his conditions, we only ever had the same conversation every day that I was there. Everyday I asked him the same questions and he gave me the same answers with the same renewed enthusiasm he had the very first day. I would ask different questions, but he rarely answered them – and then quickly turned back towards his tried and true topics. I was told most of these clients become attached to faces and people there – and so when you leave, especially for good, they ask that you don’t tell them, only because the clients react so strongly. And that was the hardest part about today – leaving him and not telling him I wouldn’t see him again.

Today, shortly before I had to leave, Billy Joel’s “You May Be Right” came on the radio. The other nursing students and I started singing along. And when we sang “but it just may be a luuuuuuuuuuuuunatic you’re looking for….” the whole room laughed as if they were in on the joke. And oddly, it felt as if we were the only ones not in on it.

I feel like I left today with more appreciation of my own sanity – and indeed, the smallest amount of jealousy for their whole lack of it. There’s something very delicious about a world where literally everything is possible, anything can happen and often does.

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