Response to Sandy Hook Shooting

Along the rest of the nation I have spent the past week attempting to grapple with the horrific tragedy that plagued the community of Newtown, Connecticut a week ago.  When events like this happen our own life experiences play into how we comprehend such a senseless act and on which aspects of the tragedy we tend to focus.  For instance, a colleague's Facebook status in the days following stated that she was going to focus on the children and heros rather than the evil that walked into the school in all her conversations for the day about the event.  She is from Connecticut and, I assume, needing to honor her community and focus on its good.

First and foremost, I process these events from the lens of someone who has had first hand experience with a similar event that also made national news some 13 years ago.  Sadly, the numbers of individuals who also have this kind of first hand experience is growing exponentially as events such as this one continue to occur with some regularity.  Even so, though we may have experienced similar events each of our reactions can be quite different based on our previous life experiences and general dispositions.  For instance, I have noticed, beginning with the shooters at my own school, that I tend to find compassion, empathy, and some understanding for the killers.  I have curiosity for what leaves an individual to feel so isolated that they feel the need to take their anger out on innocent children.  Even prior to having gone through my own school shooting, I had always been attracted to the underdog, the children that were isolated from their peers. I suppose that is what led me to wanting to work in mental health and foster care, the interest in the psychology behind people's behaviors and helping out the underdog.

My role as a mental health professional also plays into how I processed the event.  I was at work when I heard the news.  As such, I put my guard up, and refused to take it in so I would not break down emotionally.  I subconsciously desensitize myself to such events and as such refused to focus on the stories of the victims as my Connecticut colleague did.  As the week went on, I was able to slowly let it in as the topic came up with patients.  One patient was visibly distressed and preoccupied and had been talking to me about being abused by his peers when he was an adolescent.  The event being at the forefront of my own mind I specifically asked him about thoughts of hurting others as had been done at the elementary school.   He too displayed confusion and disbelief over the event and could not understand how someone could do something like that either.

Several patients have come in the last few days with anxiety about the holiday coming up.  They verbalize feeling isolated and alone during the holidays.  One guy I talked to yesterday talked about compounded stressors, one of which he identified as making him have homicidal thoughts.  He stated, "That's not me, I'm a good person."  He came to the hospital for help.  These are the individuals that want help, the ones with a moral compass that don't want to have these bad thoughts.  But what about all of those people out there that are sitting at home in isolation that don't desire or don't know how to reach out for help?  How do we identify them and provide services for them in order to protect the rest of us?

As a mental health professional and a foster parent I work with individuals that have been through some pretty tough shit.  Many of the kids in the foster care system have endured unspeakable trauma at the hands of their own parents.  If anybody should have a vendetta against the world, a reason to want to shoot up a school, it should be them.  Yet, the shooters tend to be privileged, white, young men who have lived in the lap of luxury in seemingly stable home environments.  My curious side wants to autopsy all their brains and do brain scans of them playing violent video games.  What's missing for them?  Why do they lack value for human life?

Lastly, I process the event through the eyes of teacher and caregiver.  The first classroom I did practicum work in for undergrad was a first grade classroom.  I can't help but picture the many primary schools I have worked in, subbed in, volunteered in.... and imagined how it would have happened.  Would I have been willing to give my life attempting to protect my students?  What about the principal and school psychologist, they could have hidden away in the office and saved themselves?  Did they die for no reason, should they have just stayed put?  Would they support the NRA's suggestion, if there had been a firearm in a safe in the principal's office, could she have done more to stop him?

I think about how all those kids were sitting ducks in all of the classrooms.  Drawn shades, locked doors, and hiding spots in cubbies was not going to stop a man with a gun.  In addition to lock down drills, shouldn't we have evacuation plans for when the danger is in the building as well?  Those 6 kids that slipped out of the second classroom while their teacher and classmates were shot down, they just ran with nowhere to go.  What if there were some kind of safe house to run to?  

But taking in the magnitude of all those little lives that were lost is hardest for me.  Last night, I babysat the 5 year old boy that I was a primary caregiver for when he had been an infant.  It was so hard watching him play and imagining little children like him taken so tragically.  Such joy and interest in life ripped away from their parents and this world.  I imagine all the parents weeping in their child's bedroom having thought they were just sending them off to school like any other day.  Then I'm taken back full circle to having been through the aftermath myself 13 years ago; the suicides, the bomb threats, the media that follow such a senseless act of hatred.  My heart weeps for Newtown and the long road ahead!

So there you have it, my perspective of the Sandy Hook shooting as student, mental health professional, foster parent, teacher, and caregiver.  Through it all I must find trust in the general goodness of mankind.  Though it is challenging, I must not let fear get the best of me (I have not been to a movie theatre since before the shooting over the summer and have found myself scanning crowded places since last weeks shooting).  I must have hope that what I do through all of my roles makes some kind of difference and helps to prevent things like this from happening again.  How about you, which of these perspectives do you most identify with?  What draws your attention when such a senseless act of violence occurs?

Schizophrenia

My exposure to Schizophrenia prior to moving to Chicago was very limited.  Perhaps, once again, only from movies like A Beautiful Mind.  Then I moved to a big city and started taking public transportation.  I did what every other person on the train did and looked away and ignored the homeless people who were conversing with people not there.  Then there were the advertisements looking for individuals for research studies, "Are you between the ages of 18 and 45 with a diagnosis of Schizophrenia?"

I became intrigued.  Are there really that many people meeting the criteria and receptive enough to respond to an advertisement like that?  I learned more about the illness in my Psychopathology class and began watching for the symptoms I learned about in class while on the train during my commute to and from school.  The people on the train with visible signs and symptoms of psychosis started feeling less foreign to me.  Instead of having feelings of discomfort and fear upon seeing them, I began feeling compassion and understanding.

My heart truly breaks for individuals with schizophrenia.  Can you imagine having experienced a normal childhood, having hopes and dreams for your future, and then having your entire plan shattered after having your first psychotic break during young adulthood?  Granted, it does not have to be debilitating.  There are plenty of people that can function in the world with schizophrenia thanks to a lot of great medications.  But for many of the people I work with everyday at the hospital, those with chronic acute mental illness, it is debilitating.  They often don't stay on their medications or their illness is so severe that the medications can't quite do enough.

Working with my patients has taught me a great deal about Schizophrenia.  I have learned that the illness can manifest in many different forms.  It is as different from one person to the next as we are individuals and all different presenting with our own personalities.  It is an interesting and complicated illness involving our brain, our defense mechanisms, our self-esteem....

My hope is that by writing this now, others can have as much compassion and empathy for those with the illness as I do now.  I want to humanize and educate about the symptoms they experience. The following are some of the possible symptoms an individual with schizophrenia might have.  However, not every person with schizophrenia experiences the same symptoms to the same degree.

• Hallucinations - these can be visual, auditory, tactile, or olfactory in nature.  The individual sees, hears, feels, or smells things that are not really there.  Can you imagine the negative thoughts about ourselves that we all have manifesting into voices constantly reminding us of our short fallings?  Voices telling you that your worthless, good for nothing, that you should commit suicide...
• Delusions - these are false beliefs that an individual has.  For instance a woman might think she is the daughter of a famous person.  A man might think he is pregnant.  An individual might believe he or she came to the earth from another planet.  Many times I have come across individuals with delusions of grandeur and wondered if those false beliefs are their brain's way of protecting them from reality.  As an outsider, this would be the best of the symptoms to have, to really truly believe that you are an important and famous person who has accomplished much in their lifetime.
• Disorganized Thoughts - have you ever woken up from a dream in a stupor, not able to figure out what was reality and what was part of the dream?  Have you ever tried to figure out the answer to a problem in the space between conscious thought and dreamland?  Imagine being in that space in your waking life as well.

What are your thoughts?  Has this been helpful?  What are your experiences with Schizophrenia?

Please check out A Burden to be Well, a NPR piece I heard a few months ago about the siblings of those with Schizophrenia.

Deinstitutionalization

We are all well aware that the two systems within which I work are broken.  Mental health/Medicaid system as well as the child welfare system have definite deficits.  Through my process of working in them, I've wondered how they've gotten this way.  What happened to the lunatic asylums and the orphanages that used to house our mentally ill adults and despondent children?

From my internet research I don't find any clear law or act that got rid of those kinds of institutions all at once.  It was all pretty gradual, perhaps first initiated with the Social Security Act in 1935.  And in the 1950s psychotropics came out and greatly reduced the symptoms of mental illness.  In 1963 Kennedy was able to pass the Community Mental Health Centers Act.  He had a special concern with those with mental illness because his own sister had been lobotomized in her early twenties.  Also in the 1960s, the Federal Aid for Families with Dependent Children legislation provided funding and services for preserving biological families and preventing children from being placed in orphanages.  The premise of these two legislative measures was on track, provide services for individuals needing care within the community rather than locking them away in institutions.

Those of you educators out there know the common phrase, "least restrictive environment."  That was our hope with deinstitutionalization, provide environments that were less restrictive and envelop those with disabilities into the community at large.  But somehow, we've let individuals fall between the cracks and are not providing those environments for them.  There are people with mental illness not receiving the proper after-care services, floundering in the broken system.  There are children in the welfare system jumping from one home to another in our efforts to provide them a less restrictive home environment setting.  Though we may have gotten rid of a lot of the evil institutions, it doesn't mean that the people that were in them no longer exist.  They still need our help.

If interested, find out more about:
A legislator whose "reforms" he worked on worsened his son's life (excerpt of this article also published in Washington Post) by Paul Gionfriddo, author of blog entitled, Health Policy

the high concentration of people with mental illness in the Uptown area of Chicago, and

the rise and demise of the American orphanage

My 9-5 Job

In everyday life, I don't often talk to people about my work.  It just feels complicated, like it's too hard to explain and people would never really understand.  Going into graduate school I never pictured myself in the setting in which I currently work, in fact, I don't even think I knew it existed.  I'd mentioned my motivation for going to grad school in an earlier post: I wanted to help children who were having emotional/behavioral problems due to abuse and neglect.  Once getting to grad school I realized that the majority of the entry level positions for expressive therapists in the Chicagoland area were in inpatient psych (psychiatric) settings.  So after graduating and struggling to find work in the field for a year, that's where I found myself, inpatient psych.  It's been almost a year since I started working as a therapist at a small neighborhood hospital which provides health services to low-income families.  I work on the hospital's small (24 bed and 12 bed) inpatient psych units, adult and geriatric, no pediatric psych unit at my hospital.

If you all are anything like I was prior to entering the field, most of your understanding of "mental institutions" has been through Hollywood and movies.  You know One Flew Over the Cuckoo's Nest and Girl, Interrupted, etc.  There are definitely aspects of those movies that are somewhat reminiscent of what my job is like.  There is always at least one extremely interesting character on the unit that keeps things highly entertaining.  There are occasionally restraints, but there are no straight jackets and we try to keep them restrained as short a time as possible.  People don't exactly line up at a window to get their medications, however the reality is that medications are pushed and most people spend the first couple of days of their hospital stay in a daze as they adjust to their meds.  And yes, there are psychotherapy groups where the patients sit around talking and confronting one another on their stuff but those are usually pretty rare and hard to facilitate.

Gone are the days of people being carted off to the insane asylum when they have some kind of mental break.  Psych hospitalizations are typically only five to seven days at my hospital.  People have barely enough time to be minimally stabilized on medications before being discharged back into the community.  And as I said before, the first 3 days of that week long stay is spent sleeping and the next 3 days is spent counting the hours till they can get out of there.

People come into our hospital for all different reasons and there are people of all different functioning levels, backgrounds, and race.  In order to be admitted, they must have a psychiatric diagnosis though often just  for labelling and insurance compensation purposes.  We have people ranging from our "frequent fliers," those that come in often with whom we are well acquainted, to first timers who have never experienced a setting anything like this.  We have people that are homeless knowing all the right things to say to get them a bed and 3 meals for the week.  We have individuals that are drug addicts who used all their public assistance money on substances and need medications to curb the withdrawal symptoms until they get their next check (also knowing the right things to say to get hospitalized).  We have patients that are severely depressed and have attempted suicide.  We have all ranges of schizophrenia, from people with acute psychosis who are in catatonic states to high functioning individuals who have auditory hallucinations that they can tell you about rationally.  We have people with bi-polar disorder, severe anxiety, delusions, and paranoia.  We have sex offenders, ex-cons, prostitutes, people that have been shot in the head, and people like you and me.  All individuals with individual life stories and individual problems.  My job is to hear, understand, and have compassion for those stories.

As you can imagine, there's not a whole lot of therapy that can happen in a week long hospital stay.  We as therapists, meet with each of the patients to do their assessment within the first 72 hours of their hospital stay.  Meanwhile, the patients also meet briefly with their psychiatrist, their nurses monitor their medications, the social worker meets with them to discuss their discharge plan, and we have Mental Health Counselors on the floor who provide for their daily needs.  Often times, they refuse to meet with us therapists and have no interest in any kind of therapy.  So that may be the only interaction I have with a patient. 

My primary role is leading groups.  I have to take all those people who have completely different problems and come from completely different walks of life and somehow make them a cohesive group.  We try and do at least one talk/process/psychotherapy group a day where we discuss what brought them into the hospital, how they can stay out of the hospital, and encourage them to seek therapy after they get out.  But getting a bunch of people so different to connect means we must be creative with our therapeutic methods.  We utilize music, art, and if I'm lucky, dance and movement to help patients understand and connect with one another.  Then I go sit behind a computer and chart about it.

So that's my job in a nutshell.  I lead groups, I occasionally meet with individual patients, I chart on my interactions, I go to meetings, try to get along with all my crazy coworkers, and hope that at the end of the day that I have made at least one small snippet of difference in at least one patient's life.


Check out some movies about mental illness.