Doing crisis

Picture having an encounter with someone at a hospital – either in the ER, in “psych hold” or on a medical unit, to determine within a few minutes to half-an-hour if the person is suicidal or homicidal or dangerously incompetent. This is the job responsibility of the “emergency services clinician” or “crisis interventionist” or “mobile assessor” or “Rapid Response Team.” I’ve seen – in Ohio, Colorado and Nevada – two species of this job rooted in different agency funding structures, but also in different philosophies, and maybe in different moralities.

One clinician, working at a community levy-funded mental health center, is a traveling crisis therapist. He sees a person at a terrible moment of truth and wants to be the light of help. He wants to be the first eyes that really see her, the first absolutely cleared-out container for her lifelong pain. And he wants to be the giver of encouragement that is based both in the patient’s unique life and in deep psychological knowns. I remember being there. The worst results might be that my empathy is silently laughed at by a patient who only wants to manipulate his way out of the hospital; and the thought that I’m spending a lot of time (and agency money) on someone I’ll probably never see again and who ultimately reduces to a “stay or go” determination. The best results are very, very good: I’ve really helped a skinned, gutted, depressed, lonely, desperate person feel survivable again.

The other clinician, working at a for-profit mental health center, brings to each encounter the goal of psychiatrically hospitalizing as few people as possible, along with the unspoken theme: “Disprove my cynicism.” The worker waits for the tripwire to jiggle when the patient contradicts himself, lies about his drug use or story-tells his overdose (“he actually counted forty-three Xanax and twenty-one Depakotes?!”; “There is the tox screen, you know”), obviously “malingers,” just wants a bed for the weekend, sounds too chatty to be suicidal, agrees too zealously about the importance of therapy and accepting follow-up services. Often the wire is already tripped because the man or woman is a “frequent flyer” ER visitor, a hospital-to-hospital vagabond who knows the system and all the right terms to say. You recognize this individual and you’ve already known he is a more rugged, perverse survivor than you are. A good clinician of this ilk will still, hopefully, detect a different tone this time, a different quality of seriousness, and will this time facilitate a hospitalization. Mostly, though, she feels omniscient enough to dole out thumbs-ups or thumbs-downs efficiently, based on instinct and a simple internalized checklist of factors and dog whistles. It’s amazing the skills a person can become proud of.

My point or grievance is that psychology has become – very paradoxically – almost universally a superficial approach to human life. We believe that the outer adult or adolescent coating is the person. We believe that all the spoken meanderings in his head are substantial – a product of something adult in him – when they are as neurotic and child-stuck as his feelings, his obsessions, his motivations. We witness the toxic spillage of arrested development in all the words of Donald Trump, and we don’t realize this is an infant driving a tractor-trailer. We believe that simple “cognitive” techniques can make a person happy, that we can “choose” who we want to be, how we want to feel.

And at a bedside in the hospital, a master’s or doctoral-level clinician can see distress in the simplest terms. “You’re not going to kill yourself today.” “I’m referring you to our outpatient clinic.” “Your husband and sister-in-law have agreed to stay with you tonight.” “Your parents will be removing all the knives and sharps from the house.” We take this opportunity to sit down, throw away time, and be two people having one of the most important conversations in the human play, and we skip it as if meaning were lint. We don’t see the living or dying beneath the life and death decision.

Hillary explains her email server indiscretion (after being infected with the Psycha virus)

Has any one of you never taken home a square of Post-It Notes or a postage stamp or paper clip from your office? Has anyone here never had negative thoughts about your boss while continuing to work for him or her in a good-natured and productive way?

Is there anyone who could say that their professional character mirror-image reflects their deeper self? That their private reality and inner engine – in its complexity, its rip currents dark and light, mature and regressive, wise and childish, kind and indifferent – is identical to their public persona? Can anyone swear that their psyche is precisely what fairness and civility, social morality and justice, political correctness and perfect health dictate?

No honest person will swear that the most dangerous responsibilities and highest callings – priest or president, CEO or parent – transform the flawed human self that we all are. No one can claim that having an ideal makes us a Platonic ideal, existing other-worldly in perfection. We are the molecular mess, a history of roots grown in darkness and undiscoverable things, of childhood bent by other people’s power and blindness over us. Like you, I am a “molecular” person.

There is one way in which our true self conforms to our career. A depressed woman will be drawn to underemployment. A victimized and angry teenager may choose, without admitting it, a career with intimidating and cruel power. An anxious person may go to a people-pleasing or people-avoiding job. Those of us who enter the ironical world of power altruism, of self-aggrandizing public service (it’s hard to know how to depict humanitarian work whose other face is power, wealth and prestige) probably come out of a childhood that was co-opted by ideas and crusades that were not ours, but instead our parents’ and their neurotic axes to grind. We learned, we became other-focus while our own needs to just be a kid – a loved kid – were ignored. I’ve often talked about my mother’s enduring lesson – sending a little girl out the door to face the bullies on her own. On the surface this was noble and a template for my future. But inside, the cauldron where our life is forged, it was abuse. It was my mother’s detachment, projection, abandonment and warped motivations, distracted and sweetened by her zeal. It was no lesson for a child! – to be ejected from home to a brutal world and made to think and sink or swim like an adult, be her own protector. My father, too, was “tough love” along with his beatings.* He taught me that I – a girl – could do anything, be anything. Except a safe and cherished child.

We become blind adults driven by old poisons, believing we are doing the driving and that the poisons are principles. We drive our way to sleek offices and grand titles, to power and good works. We’d love to think we are this person. But instead, we are real, and our private self – the volcanic forces beneath the island – still plays inside us. It has always needed what was never given: Quiet and peaceful silence, safe privacy, freedom to finally be our self apart from the seeing, shaming, expecting world. Probably it needs secrecy. Enjoyment. To be loved and accepted for who we are especially when we are bad. Time in nature and alone without pressure. We all have this inside us – the trapped latent child – and no calling or dream can ever stop it. We also have the absurdity that feels others must do their job and fulfill their obligations in exemplary fashion, while we can be imperfect.

I kept my emails to myself. It felt private and safe, something for me that was not in the glare of the bad parents of the world, that was not of the programmed “good” adult my mother and father prematurely cultivated. The server was discovered. And now the vital energy behind it will go back into hiding and become like everyone else who is a real soul, with needs for peace and privacy, beneath their cover.

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* See http://www.nytimes.com/2015/07/20/us/politics/hillary-clinton-draws-scrappy-determination-from-a-tough-combative-father.html?_r=0.

A world that is not important

Can you see, or feel, the difference between the way reality hit you when you were a kid, and the way everything hits us now, as adults? I’m talking about an entirely different kind of living, of experience. This is almost impossible, or unworthy, to describe if we can indeed remember that “lost horizon.” There was immediate meaning: the experience itself. There was no ego or self-consciousness to get in the way of it. Waking up on a Saturday; saddle-soaping that new baseball glove; seeing and catching crayfish in the ripply stream; hearing your parents laughing together; going on vacation; walking in a summer night choreographed by lightning bugs; sitting down to a peanut butter and jelly sandwich after Sunday School. Even the smell of new school supplies; that girl or boy you like smiling at you in fourth grade class.

One thing to notice is – the moments of pure meaning, there was no ego in it. And when self and self-consciousness started to come into play, we were already becoming lost.

It is time to condemn Peter Pan for his psychological sickness thanks to J. M. Barrie. He who should have been a nature boy was already ego-consumed, needing to see his glory in everything:

“Perhaps I should have ironed it,” Wendy said thoughtfully, but Peter, boylike, was indifferent to appearances, and he was now jumping about in the wildest glee. Alas, he had already forgotten that he owed his bliss to Wendy. He thought he had attached the shadow himself. ‘How clever I am!’ he crowed rapturously, ‘oh, the cleverness of me!’

“It is humiliating to have to confess that this conceit of Peter was one of his most fascinating qualities. To put it with brutal frankness, there never was a cockier boy.

“But for the moment Wendy was shocked. ‘You conceit [braggart],’ she exclaimed, with frightful sarcasm; ‘of course I did nothing!’

“’You did a little,’ Peter said carelessly, and continued to dance.” (At Project Gutenberg – https://www.gutenberg.org/files/16/16-h/16-h.htm.)

Of course, we have to be self-aware, though I wonder about it. Is there a place – some different plane of reality – where children never have to think if they are good or bad, good enough or inadequate, important or unimportant? Where fine, they are simply into things because of interest?

I think these are valuable (though very abstract) speculations because I believe that this worry dimension – the child’s introspection, anticipatory anxiety, self-reference – has, over the course of history, crystallized into a world that is in fact not important, populated by false meanings. Why do we care about movie stars? Why do we engage in and listen to micro-polemics about the various religions? Why do we “deconstruct” literature and produce exegeses about twentieth century irony and care about theories of Aesthetics? How do we come to write eleven-hundred-page stimulus bills, twelve-hundred-page climate bills, thirteen-hundred-page health plans?* There is a big difference between a child’s or a scientist’s peering at slides under a microscope or stars in a telescope for hours, and news commentators parsing the boring angels and pinheads of politicians’ behaviors ad infinitum.

We have grown a world that does not have real meaning to us. It is, using Freud’s term, a “screen”** world. Picture a boy’s super attention to a praying mantis fiddling with its caterpillar lunch, or a girl’s absorption in a book on tyrannosaurus rex or in an Indiana Jones movie. These are not occupations where in a gray haze they will blink, yawn, get up and shuffle away: It’s almost criminal to interrupt such engagement. Yet how many adult pursuits would allow this zombie walking away? We are clock-watchers on the job, spouses who sit through evenings of reruns and commercials, young people who “choose” a job or line of work rather than fall into a passion. If we take a further step back, we might see an entire world lived behind a screen of falseness, where instead of things that matter we see ideas, “beliefs,” thoughts about life not life itself. We live in a dimension of attitudinal eyes and furrowed brows, slowed and agitated by some distance from quiddity, from essence. We have heard of intellectuals who “love ideas” or “love words,” for whom books are more important than breathing.*** I can hardly picture a sicker philosophy clothed as ardor.

There is no crusade here, where I’d like people to return to the best childhood kind of living. It’s enough to point out that we are astray, and to remind people of the right part of their childhood. Because what we’ve lost is the root of all the psychological ills we suffer. We’re touching nothing but the thought of pain and true love. We need to touch the reality.

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* http://www.slate.com/articles/news_and_politics/explainer/2009/08/paper_weight.html.

** Definition via online article -- http://www.psychoanalytischeperspectieven.be/wp-content/uploads/2012/10/screen-memories.pdf. “Freud used the term ‘screen memory’ to denote any memory which functions to hide (and to derivatively express) another, typically unconscious, mental content.”

*** Well-known Erasmus (1466-1536) quotation: “When I have a little money, I buy books; and if I have any left, I buy food and clothes.”