The inpatient unit where I work is not unlike any other clinic or health facility, set with decades old white washed walls and colorless decor. Walking in, I hurry my pace and refrain from inhaling the burning aroma of disinfectant. Antiseptics and sparkling clean floors should, intuitively, bring about a sense of safety in reminding us that disease and bacteria cannot live here and yet, I’m not convinced humans can either. Having side-stepped my own brief internal shock to the smell, I make contact with the only people required to live for longer than 12 hours in such a place. An interaction or two with one of these shoeless, robed and wide-eyed patients are what I am here for, what everyone is here for, but I don’t have time. I must stick to the schedule, I must start my therapy groups soon. The nurses remind me of the old gauntlet drill we’d run during lacrosse practices – head down and determined not to be thrown off course by obstacles. They’re racing to stay on schedule and nothing will stop them. Their obstacles are scattered throughout the unit as some wander, some talk excessively and rapidly to no one in particular, most sleep and others form a line to receive their medication.
In 1958, Rollo May warned against the danger of psychotherapy and all therapeutic techniques that served to diminish the significance of a human life. He saw that there was a great risk to treating someone without using a holistic approach. He noticed that dividing the human experience into several parts and their associated functions, all to be diagnosed and treated, was problematic. May believed in the treatment of the whole being and predicted that if the fragmentation of people continued than “psychotherapy in general will become part of the neurosis of our day rather than part of the cure (p.35).” As I rush through the halls of one of our 21st century inpatient facilities, I see that May had reason to be concerned.
Medication is the primary mode and most highly valued psychotherapy amongst the staff. If not medicated, the people won’t work. If not medicated, the talk therapy won’t work. If not medicated, the hospital just won’t function. Where once straightjackets and padded rooms controlled the untamable, now we rest assure that large doses of anti-psychotics, mood stabilizers and other numerous combinations of pills and injections, make them manageable. Managed though the medications also induce weight gain, glucose and lipid problems, cardiac problems, deep sedation, hypotension, hypertension and sexual dysfunction (among others).
Now, don’t get me wrong, I am thankful for medications. In fact, I’m certain that a strong defensive line of antibiotics has kept me alive and breathing on more than one occasion. This past September was my most recent encounter with health issues that sent me to the emergency room on two occasions. Running a temperature of over 100 degrees for five consecutive days left me dehydrated, delirious and quite worried about my ability to endure much longer. Medications were absolutely necessary and I’m thankful that I had access to them. However, I do not consider medication to have been my saving grace, it was not the primary mode of stabilization, recovery and return to health. I give that credit to my relationships; to my mother who called on several occasions to check in on me, to my closest friend that kept me “in his prayers” and to my wife that rolled the cool side of the washcloth against my forehead and reminded me that she loved me.
In a unit where the medicalization of psychotherapy is primary and the hailed structure of a system comes before relationship building, empathy and compassion, it is no surprise to find the sick getting sicker and the staff becoming drained and tired. Like much of the country, the mental health system is suffocating from a lack of resources and money. However, the resources that are available in this setting are being used to introduce and implement robot doctors, whose heads stream live televised faces of their physicians that will take the place of live psychiatrists (yes – it’s happening). In addition, an increase in medications are taking the place of empathic listening and a whitened, disinfected environment is substitution for a kind someone to turn the washcloth and remind them that survival is possible and desirable.
One may argue that the diagnostic, scientific approach is the best we have to offer. In fact, it saves lives. I do concede that I am breathing today because of a cold and fragmented approach to illness and recovery. However, I cannot say that recovery would be worth it if my life was without meaning, was without people to provide hope. The inpatient population on my unit has been locked up, bound and held because they are ready to end their lives or someone else’s. Because they have ended their search for existential significance, value and worth. Life has become, for them, in these moments, as cold and useless as the fragmented, dehumanizing approaches the hospital utilizes with the best of intentions. The patients are hospitalized in order to extend their lives and so the meaningless void is also dragged-out. As the void occupies and tortures the psyche of someone with major depression or schizophrenia, we keep them breathing in the hope that something will change, that meaning will take hold once again. Attempts at increasing life value and meaning is what we call psychotherapy. And it seems that if professional healers don’t allow themselves to slow down, to be authentic human beings and to extend deep and consistent compassion within these disinfected spaces, than therapy will fail to become part of the cure. We will fail to become part of the cure and will instead produce as much hope and vitality as is cultivated by the white-washed and colorless decor within which we detain the most ill among us.
Photo in slider from here.