Lisa, I was told, had a long history of self cutting her wrists and her thighs.
So as I approached her room on the psych ward, I gingerly opened her door and introduced myself. “Get out”, she yelled.
And I complied.
The next day I had a female nurse accompany me. And once again, now with more anger, “Get away from me, you asshole.”
I complied again.
This exchange continued for the next couple days. We did bring her food because she flatly refused to come out of her room. I instructed the staff to let her be. We were not going to get into a battle with Lisa, a young woman who clearly was in pain.
The next day, as I opened Lisa’s door, I let go of my usual introduction and instead immediately asked her: “Were you adopted?”, to which she responded: “How did you know?”, quickly followed with “Now get the fuck out”….
….One day later I was nicely surprised when Lisa spoke with me. She said she was adopted at two months of age, that she had never met her biological parents. She then opened up a bit more, sharing that she has had a series of tumultuous relationships, her eyes now streaming with tears. She asked if she could trust me.
Later, I found myself thinking quite a bit about Lisa - about an infant who did not have her mother to hold her, embrace her. About the severe imprint, an imprint of abandonment, that continues to be part of her until this day.
So the next morning, having finally made some inroads with Lisa, I was looking forward to continuing our conversation. As I opened her door, she blurted out: “Dr. Asshole, get the hell out of here!”
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"Ramblings on the Psych Ward"
Pete was a wreck. A happily married fellow with three young children, he would traditionally came to my office every six months to get his Zoloft for his severe OCD. He enjoyed telling me about his family, his work, his love of sports. Things were all pretty routine - until they weren’t. Pete shared that he had met a woman at the gym. At first they would joke around, but soon the flirting started and in short order, Pete was infatuated. It got to the point where the two of them would text each other so they could rendezvous at the gym at the same time. Pete was feeling increasingly weird and anxious about all this, keeping a secret from his wife, but he couldn’t help himself, couldn’t stop himself. Seduction had taken over. And then, the woman invited him to her place. Pete asked me what he should do. "I’m a married man, Dr. Guterson, and I want to stay married, and I’ve got three children. But I can’t get this other woman out of my mind.” Pete was shaking now. He clearly wasn’t himself. He was lost. His mind had been taken over. In the world of spiritual mental health, Pete had entered the realm of what the sages call ‘temporary insanity’. No, he wasn’t psychotic; he wasn’t schizophrenic or manic. But his passions were so intense that he had lost his way. I turned close to Pete and said, in no uncertain terms, “You have to end this, completely and totally. You cannot even be friends with her because your infatuation won’t let you. Text her that the relationship is over, that you are devoted to your wife. And then block all her numbers and emails. Erase all texts. Destroy any gifts. And never return to that gym again.” I added, “If this relationship with her goes on, it will ruin your marriage, your family, yourself.” I imagine there are those in the mental health profession who would disagree with this directive approach.
In most places of work, including my psychiatric hospital, certain unique phrases become part of the daily parlance. Phrases like “The Dewey Cocktail “. Twenty nine year old Chuck Dewey was a manipulative fellow with little regard for others. For Chuck, people were simply pawns for him to use. But now he found himself behind the walls of the locked psychiatric ward and therefore he was not in control. It didn’t take long for Chuck to start slamming doors and threatening other patients half his size. He stood 6 feet 5 inches and with his muscular frame, he was one scary fellow. “Get me out of this hell hole”, he screamed, and when the staff attempted to defuse his posturings, he started flailing his arms and punching fiercely at everyone. It took eleven staff members, two of whom were now bleeding, to finally pull Chuck down to the ground….. ….“Haldol 15 milligrams”, I yelled to the nurse; “and Benadryl 50 milligrams and also Ativan 2 milligrams; give them all IM (intramuscularly) right now!” Within moments, this trio of meds - an antipsychotic, an antihistamine, and a benzodiazepine - were shot into the upper arm of Chuck, and in short order he had calmed down and was well on his way to sleep. The staff loved the quick effects of this confluence of medications - and so named it, “The Dewey Cocktail.” But I didn’t feel so good about all this. I wanted to reach Chuck, not just knock him out. I tried and tried, but couldn’t get anywhere. Chuck persisted in seeing the world as his playground and he was incapable of expressing any apology or remorse. Anger and narcissism blinded him. More violent outbursts followed and unfortunately, the newly coined Dewey Cocktail had to be delivered twice more, both times again with quick success. The sages say that the strongest of persons are those who can control themselves. When we respond with rage, when we allow our limbic system to take over, we have then become slaves to our passions and lose our chance to learn from the situation. If this rage turns to physical violence, there is no time to waste, and a band-aid cure becomes necessary, a band-aid like the Dewey Cocktail. When Chuck finally was discharged from the hospital, he turned to me and said: “f… you, Guterson, you’re a good guy, but f… you.” I thanked him actually and said that I learned a few things from him. And I told him that I hope he will look in the mirror someday. …..two days later, a fresh patient got totally out of control. Every effort was made to soften the patient by verbally trying to calm him down, but to no avail. As his violence escalated and fears of others getting hurt intensified, the nurse turned to me and whispered, “Dr. Guterson, time for ‘The Dewey Cocktail’?” Indeed it was, as it has been many a time in our little psychiatric universe, but it still remains a mere band-aid at best.