"Hell, no"

Jeff was 24 years, a huge guy, strong and foreboding. But he could not stop using alcohol. He had been to rehab three times but each time, within a week after rehab, the cravings would take over. Not able to control his addiction, he was a slave to alcohol. This time when Jeff drank he was seen roaming aimlessly along the Pennsylvania turnpike. A state trooper was contacted and next thing, he was sent to my psychiatric hospital. When we met, Jeff was one angry fellow. Withdrawing from alcohol can be intense and he demanded that I discharge him immediately. I tried to assure him that we could give him medication to help with his withdrawal and then figure out what to do next. But Jeff wouldn’t hear any of it. He started yelling all sorts of expletives my way: “F… you! ; who the hell are you? I’m leaving now.” But he couldn’t leave, of course. Psych wards are locked and, besides, he was there on a commitment. Some days go better than others. Jeff upped the ante. He started coming at me, with his six foot five frame and his biceps. I did what any experienced psychiatrist would do: I ran! I ran like a scared kid trying to escape a bully on the playground. Frantically, I yelled out ‘CODE STRONG’, and before you knew it, ten staff members came running in. Jeff started swinging now, randomly, at everyone, swearing and spitting, yelling racial and religious slurs. Thankfully, our experienced staff was able to contain him but due to his continued aggression, we had to put him in restraints. I ordered shots of Zyprexa, Ativan, and Benadryl - and soon Jeff was sleeping. The next day, I was forewarned that Jeff was threatening to come after me again. And so, I ‘armed’ myself with three security guards by my side as Jeff barked at me: “What the hell are you doing, Guterson! You know there’s nothing wrong with me. I’ll drink whatever I want once I get out of this damn place. Go f… yourself!” I wish I could say that Jeff’s time in the hospital evolved into a happily-ever-after. Jeff was so used to intimidating others that he couldn’t stop and look at himself. We tried giving Jeff options, tried to help him see his patterns, but he had no interest to take that journey. He did stop threatening me and others, but that was only because Jeff realized that ‘acting nice’ was his ticket out. What can I say? Not every patient admitted to the psych hospital comes out ‘cured’ or necessarily better. But you never know. The journey we take in life has stops and starts, and today’s seeming failures may well be the stepping stones to a brighter tomorrow.

Jeff and I shook hands a week later when he left. I told him that our door is always open, that we are always here if he changes his tune in the future. Jeff smiled and said, “hell, no.”

"I'm Getting Triggered"

“I’m getting triggered” It’s a phrase I hear nearly every day in the microcosm of the psychiatric hospital. On any given day, at any given moment, a loud psychotic female will start screaming - or a sociopathic fellow will start threatening violence. And then, before you know it, most of the other patients are suddenly crying and yelling, stressing out, and freaking out. Getting triggered.

Did I say 'freaking out'? Sorry, that’s what we used to call it back in my era, in the good old baby boomer days. Getting triggered is very real; real because we all have stuff buried in our past. Buried but far from gone. It’s hiding in our neurons, in our psyche. And when a certain jolt happens, we can start spiraling emotionally. We get stressed, freaked; we get triggered.

Certainly some people spiral more easily than others: like those who have suffered horrific sexual or physical abuse. Or those who simply have a less resilient nature. And we psychiatrists, indeed all of us, certainly need to be sensitive to their plight. But also know that every jolt, every trigger, holds within it immense opportunity. Sadly, people may say “I’m getting triggered “ too often. They have to be careful. Careful that they may use 'trigger' as an excuse to fall into a victim mindset and not take responsibility for their lives. "I'm getting triggered" has become the 'go to' phrase for our younger folks. The 21st century replacement for "I'm stressed out". Nothing wrong with it - except when it is used as an abdication of responsibility. Life is difficult. Whether you're a baby boomer, a millennial, or part of generation Z, it's important to know this. We all have triggers, some big and some small, each and every day. It’s how we meet those challenges, how we turn those seeming obstacles into opportunities, that makes all the difference. When we can do that, then it's sort of a funny twist - because then life ceases to be so difficult. Last fall I was walking down the street and saw the following simple, yet profound words posted on a fence: “ ‘Stressed’ spelled backwards is ‘Desserts’. Coincidence?, I think not!” What can I say? I love that quote!

The Wisdom Of Oz

I always wondered why, near the end of the epic movie, ‘The Wizard of Oz’, Dorothy whispers to the Scarecrow: “I think I’ll miss you most of all.” I mean why would she single out the Scarecrow like that? After all, the Tin Man and the Cowardly Lion were also an integral part of Dorothy’s difficult journey back home. They, too, placed their lives in danger and would do anything for Dorothy. Why the Scarecrow? It wasn’t until years later that I figured this out, years after medical school, years after my psychiatric residency, and after years of psychiatric work. The answer lies in an essential approach to life‘s big decisions: your head should ultimately lead your heart. In my work, I have seen too many anguished souls who followed their heart. This does not mean that we ignore our feelings, G-d forbid! No, we must be aware of our feelings, that’s certainly the first stage. But then make sure you understand your feelings - in other words, use your head (your brain) - before you act. I am certain that this is what Dorothy was telling us.…the Wisdom of Oz!