Eulogies and Bedtime Stories: Reflections on My State Mental Hospital Service

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RUMINATIONS OF A PSYCHIATRIST

I was trained in psychoanalytic psychotherapy but found myself working as a staff psychiatrist on a locked unit of a state mental hospital. Talk therapy was not practiced here, so I had to learn about my patients-all chronically and seriously mentally ill long-term residents-by reading their records. Of course, that is not the same thing as getting to know them. And I wanted them to get to know me, I wanted them to feel safe with me and to accept me, a stranger, as their doctor. So I came up with this idea. What better way to show them who I am than by showing them who they are in my eyes?

From time to time during quiet moments and in public spaces, I would stand with the occasional patient and, in the course of conversation, casually re-tell their story as I understood it. I did this in terms not of their illness and its progression and the treatments and their effects, but in terms of their ordeal and strengths. The retelling was not about accounting for their disorganized and psychotic thinking or their obvious inadequacies and failures, but rather about their grit and endurance in the face of such trauma and adversity.

I commented on the stamina called for surviving. I acknowledged the effort it must take for them to endure the disorganization of thoughts and isolation as well as the fear driven by voices. I was hoping in this acknowledgment of their humanity and their battered integrity that was buried deep in the chaos of their lives-and by giving that chaos names-to demonstrate my respect for them and, through this, earn their trust.

I quickly gained confidence in this strategy, a confidence earned not by my patient’s rapt attention to my words but by the rapt attention of the inevitable cluster of patients who would discretely gather within ear-shot to eavesdrop and listen to these stories. I was confident that it was not boredom or nosiness that brought them close-up, but rather it was their thirst for healing. While not directed towards a patient’s recovery or progress (and certainly not their insight or self-awareness), my secret wish was that this story-telling might provide a quiet moment, a moment of peace that comes with feeling you are, at that moment, seen, heard, and cared about. At least that.

Looking back, I am reminded of small children at bedtime. How, alone and in the dark, they can sometimes be overheard speaking aloud to themselves, re-capping what they did and saw that day, as if to hold onto that experience in memory and re-experience the wonder and satisfaction of it. After all, for a child who has never been to a zoo, let alone absorb and process so many sights, movements, smells, and noise, it is not just the animals that make up this accomplishment. It is the surviving the loss of the familiar and holding course while encountering the exciting unknown.

It is no wonder that small children listen attentively to bedtime stories-confirmed by their correcting reader mistakes-as a parent walks them through their day in the safety and comfort of their bed or just reads them a children’s story. No surprise that they beg for that bedtime story. It is not to avoid sleep, it is to be prepared for sleep. By recalling how you mastered a first-of-its-kind experience, faced it and were thrilled by it, or by re-visiting it vicariously through that rabbit or bear in the story who is going through their uncannily similar adventures, you render the chaos and novelty of life’s surprises. The world makes sense. It is safe and there is a place in it for you. That is the real story. Then, they relax, and sleep comes. (Same for adults.)

It was with this in mind that in the years that followed, it became my practice to take a moment to ask patients suffering severe and chronic mental illness this question: “If someone were to write a book about your life, living with your illness, and all you have seen and suffered and survived, what might be a good title for that book?” Their answers were always rich with poignant honesty. For that moment we were both on the same page. We were people together, trying to make sense of what is going on and what went on, both around us as and inside of us. And they were reminded that they were not alien, evil, or crazy, and that things that confuse, frighten, and hurt have names. After all, don’t we all spend our lives trying to make sense of the world and our place in it, too?

Those asylums, our state hospitals, have long since closed and their staffs and patients have moved on. I like to think of those personal stories that I re-told as eulogies, in-as-much as they were genuine hero stories. I would also like to think, for those suffering people who may have enjoyed a momentary of peace, that the peace-of-mind was portable. I would like to think that, in the days (even years) that followed, at the end of the day, lying in bed in the dark, they might have re-told themselves their story as I told it and experienced again a peace-of-mind moment.

Disclosures:

Dr Climo is the author of Psychiatrist on the Road: Encounters in Healing and Healthcare, an account of his Locum Tenens experience.