Positive Seclusion

My phone rang at 2 AM:

“Dr. Guterson, this patient Duane got totally out of control; he started threatening us and then got violent. It took six of us to get him into seclusion and 4-point restraints. And he’s still wild, yelling and spitting on us. Please, doc, we gotta give him something.”

“Gotcha”, I responded. “Give him a shot of Haldol 10 milligrams and Ativan 2 milligrams, both IM (intramuscularly). That should settle him down quickly and once he’s calmed down, get him out of seclusion and those restraints as soon as you can.”

The next morning I saw Duane and he was out of those restraints and out of seclusion, happily dancing about the ward. After first unleashing a few expletives at me, he smiled and said that the alone time forced him to think about himself, something he hadn’t done in years. “Thank you, Doc!”

Duane’s positive spirit reminded me of a comical scene in the 1980 movie “Stir Crazy.” There, the actor Gene Wilder is in prison and as he is placed in solitary confinement, the guard says to him: “Get in there….and I’ll see you in about five days if you make it.”

Five days pass. The security guard opens the door, Wilder pokes his head out and says:

“One more day. Please, one more; I was just beginning to get into myself.”

We all desire time alone, time for solitude, time for ‘seclusion’ (ideally not in a psych ward or a prison). The truth is that even when we feel alone, we really are not alone. This is because we all have a piece of divinity inside us and therefore we are all intrinsically connected to each other. We just need to shed all the grime that hides this. And once we access our own divine source, we subsequently are able to recognize it in others. And then we can light up the world.

Our Locked Doors

Our Locked Doors “These walls are funny…first you hate them. Then you get used to them. After time passes, you get so you depend on them.” These words, stated by ‘Red’ (played by Morgan Freeman) in the iconic film, Shawshank Redemption, are from a man who has been in prison for decades. He has no more fighting spirit left, nothing to live for: “Let me tell you something, my friend. Hope is a dangerous thing. Hope can drive a man insane. You better get used to that idea.” Losing hope. It is what I have felt and seen, deeply, in the eyes of my patients in the psychiatric hospital. They, too, are behind a locked door: walls surround them and envelope them. We try to help but, sadly, some simply see no way out. And, dare I say, this is tragically what can happen to many of us in our everyday life. For us, our locked door may be slower and more subtle. As time goes on, we lose our passion, our curiosity, our fight. Bereft of meaning, we give up and resort to escapism, distraction, and way too much comfort. Never, never give up. Midway in the movie, a fellow prisoner, ‘Andy’ (played by Tim Robbins), says: “there are places in the world that are not made out of stone. There’s something inside that they (the prison system) cannot touch…..hope.” Andy’s words echo the insights of the great psychiatrist, Victor Frankl, author of “Man’s Search for Meaning”, who survived the holocaust. Frankl said that those who fared best during the holocaust were those who had a sense of tomorrow, something tangible to look forward to, something to dream about. People who never gave up hope. People who still had passion and a purpose that no one else could touch or take away. One of the more powerful blessings of life is that we never know what lies next around the corner. And that’s what makes life so intriguing. So yes, we should always keep dreaming, dreaming about the unique chapter that we can write, the difference that we can make. As the film comes to a close, Andy’s words are poignant: “I guess it comes down to a simple choice. Get busy living, or get busy dying.”

Finding Home

“Homeward bound, I wish I was….” (Paul Simon) His name was Brian and he was homeless - or was he? In years past, whenever I did night shifts in the psychiatric emergency room, there was always a certain nervousness, an excitement inside me. You never knew who was going to show up. And so one night I met Brian. He was sent in by a psychiatrist who was doing research on the homeless. I was informed that this psychiatrist wanted him admitted to the hospital to help him find a home. It turned out that Brian was a very likable and engaging fellow: “I love my life, doctor. I love sleeping outside, being on my own. No one to tell me what to do. Look at you, with all your paperwork. Not the life for me. Please, doc, please, just let me go. Let me go home.” Brian was an intriguing young man. I should say that he did appear to have schizophrenia, as he would hear voices and had some delusional thoughts; he was also quite malodorous and disheveled. However, in my overall evaluation he came across as a more ‘sophisticated’ type of schizophrenic. He had been previously well educated and still had a good residue of world knowledge, still had moments where he could look outside himself. Brian also had sparkling blue eyes, a big beautiful scraggly beard and a perennial smile on his face. He told me he reads the Bible and prays everyday; that G-d wants him to be homeless, that he has a mission to help others who are homeless, that he is a coach for them. So what was I to do? The research psychiatrist wanted him admitted to the hospital but there appeared to be no criteria to justify this. Except for his hygiene, Brian passed his medical workup with flying colors. His tox screen showed no evidence of usage of drugs or alcohol. There were no issues of self-harm, no legal issues, no aggression, no suicidality, no homocidality. Unlike many of the homeless that I have met over the years, Brian was unique; he was undoubtedly home within himself. I realized that night that I was in the presence of a man, a soul, that clearly beat to a different drummer. We are all searchers, craving connection, looking for that place deep inside. It seemed that Brian, in his own way, had found it. As we wound up our conversation, Brian told me that no matter what I decide, he will always be free: “No one can take that away from anyone….not even you doctor.” He then asked me if I felt free. And then, once again, he asked me to please send him home. To his home. And that’s exactly what I did.