Friday, March 9, 2007

The following is based on an experience I had while working as a counselor/human rights officer on a locked psychiatric unit in western Massachusetts in the 1990s.

What do you like to be called? That was one of the first questions I asked of the patients I worked with. Nobody told me to do this; it didn’t come up during my orientation to the unit. But all things considered, it seemed to me to be a pretty good idea.

I’d just made a career change. I’d been an advertising copywriter before landing a job in mental health. The advertising business is thick with confident, hail fellow well met types who approach you with a foot wide smile and an outstretched hand. There was no shortage of sociopathic charm in the thickly carpeted corridors of the ad agencies where I worked.

How different can two places be? An ad agency. A locked psych unit. On the unit “ clients “ rarely approached me wearing a smile. Offering a hand? Forget about it.

Most of them were depressed. A lot of them didn’t wish to be touched. They’d been touched too many times, in all the wrong places.

I usually made the first move. Said my name is Terry, then asked, “ What do you like to be called? “ The response I got told me much about a new patient’s state of mind. If he or she said hello and gave me the name they liked people to use – well, that was a good start, an auspicious beginning to the patient, caregiver relationship.

If I got a blank stare, or an angry glare, that was another story. If my gambit was greeted with silence, that was a bad sign. On a locked unit, silence can be an alarm. I preferred “ Screw You “ and “ You can go straight to hell, “ to the silence.

Silence meant they were keeping it in. You don’t have to be Freud to realize that’s not a good thing. Keeping it in meant they’d be letting it out. In some way, shape or form that was bound to be dangerous.

So. If I could get them to tell me their name, the name they wished to be called – let the treatment begin.

I was frequently annoyed by colleagues who didn’t recognize the importance of names. I heard nurses refer to Humberto as Roberto. Gina as Tina. I wondered: Is this their way of distancing themselves from the patients? Is this one of the ways they cope with the frustration of working with the mentally ill?

Did getting to know them too well result in feeling their pain too much?

Consider the opening line of what many consider to be the greatest novel of all time. Of all the first thoughts Herman Melville could have had his character utter, this is the one he chose:

“ Call me Ishmael. “

From the very beginning, we know something important about the man with whom we are about to set sail. He is a man who knows who he is, a man whom we can trust and feel safe as our fragile vessel makes its way out to sea.

Melville knew the power of names.

Mispronouncing a patient’s name. Getting his or her name wrong. Forgetting a name. Those who did that were, in a way, reminding patients of the power they held over them. It was like wearing the key on the wrist. Each of us had a key that unlocked the locked doors on the unit. I kept mine hidden away in my pocket. But others wore the keys like jewelry, attached to rubber bracelets they pulled onto their wrists.

It was like saying, “ I can get out of here whenever I want. “

The implicit message being:

And you can’t.

One morning, just after I started my shift, the charge nurse informed me that there was a new patient she wanted me to check on. He’d been admitted during the night. Been assigned to my treatment team.

“ He’s still in bed, “ the charge nurse said. “ See if he wants some breakfast. “
I walked down the hall and into his room. He was in bed, but he wasn’t sleeping. I introduced myself. Said, “ My name is Terry. “


“ I’m the counselor on your treatment team. You hungry? “


“ OK, “ I said. “ If you need anything, if I can help you with anything. My name is Terry. “
Then I walked out of the room.

A few minutes later, the new patient appeared at the nurses station. He was getting into it with the charge nurse. His voice was loud, his speech pressured. He was trying to explain the government conspiracy, the web into which he and his family had been lured.

“ I’m not going to talk to you when you’re this angry, “ the charge nurse said.

“ C’mon, “ I said. “ Let’s walk back to your room. “

He grudgingly followed me down the hall. Just as we were about to turn into his room, he took a few steps back, then came at me. Punched me hard in the face. I bent over and saw my broken glasses on the corridor carpet. I saw blood dripping onto the glasses and blood puddling around the glasses. Then I saw him back off again, four,five, six or seven steps. Then he came at me again, this time using his feet. I’d been punched. Now I was being kicked.

Throughout this whole process, he didn’t say a word. And neither did I. Just another quiet morning on a locked psych unit in western Massachusetts.

Me being assaulted. That was the bad news. The good news? The assault took place right outside the clinical psychologist’s office. The psychologist was a good guy; I liked him. But his star on the unit was hardly rising. There was, since I started working on the unit in 1991, a tug of war being waged. On one end of the rope were the shrinks who represented the medical model of psychiatric treatment. They believed pills were the answer. On the opposite end of the rope were people like the psychologist. People who thought talk therapy was the answer.

The psychologist had seen the writing on the wall. His days were numbered, and he spent most of them hidden away in his office. I’d walk by his office and peer in. There he’d be, at his computer, staring into the screen. Pounding the keys.

Every time I saw him doing this I thought of the writer Jack Torrence, that character in the Stephen King novel, “ The Shining. “ Jack Torrence. Remember him? He was played in the Stanley Kubrick movie version of “ The Shining “ by Jack Nicholson. Remember that scene where Jack’s wife discovers what Jack has been writing all those long winter months stuck in that old hotel?

All work and no play makes Jack a dull boy. Over and over again, that one sentence. Three or fours months work and the result is one sentence.

Confined to that room, sentenced to that office. That was how I saw that psychologist, who came to my rescue. He was in his office. Of course he was in his office. He was always in his office and thank God he was.

Right after I got kicked, the door opened and the psychologist beckoned me in. I dove into his office and he closed the door. Then locked it.

The irony is not lost on me. I was rescued from a man bent on killing me. The man said nothing as he came at me again and again. Then there I was, sitting in a psychologist's office, bleeding profusely. The psychologist pulled out a handkerchief and wiped the blood from my face. He said nothing. I said nothing. We did not talk, but he saved me.

I remember everything that happened that day. I remember the number of stitches the ER doc sewed into my face. I remember a nurse I worked with coming down to the ER and holding my hand. The one thing I don’t remember is…

The name of the guy who assaulted me. I don't remember his name.

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