The academy award winning film “One Flew Over The Cuckoo’s Nest” is what I imagine most people think of when they envision a psychiatric hospital. And, although it’s somewhat dated, it’s not too far off from reality. We still have locked doors, still have the occasional need for restraints when patients get violent. One thing we don’t do is lobotomies anymore, at least not in the physical sense. However, we psychiatrists have to be utmost careful that we don’t ‘lobotomize’ our patients’ spirit, their zest for life. A psychiatric hospital is a universe unto itself. Most psychiatrists don’t want to work in such a place, instead preferring the calm of an office or the prestige of academic research. Psychiatric hospitals are a sea of chaos and the potential for a violent outburst is always crouching at the door. For myself, this universe is a daily privilege to observe the journey of life, to try to help those who are suffering so that they can ultimately help themselves. But - this universe is not always so gentle. And therefore I have to always be aware to keep my wits about me and watch my back. And so it was on a seemingly innocuous Tuesday morning that I was making my rounds. Bill, a very tall and strong patient, was clearly manic. We talked. I told him that I would like him to try Lithium, the gold standard for mania. He said he didn’t want to - he didn’t yell about this, he didn’t threaten, he spoke softy. I told him that I would order it anyway and he could choose to take it or not. As I exited his room and started down the hallway, I heard a soft moan which soon became a loud roar. Bill suddenly came bounding down the hall, yelling and screaming, his arms flailing. I was caught by surprise and didn’t have time to defend myself or escape. Bill punched me, hard, in the face. I put my head down and blood was pouring out. As Bill was getting ready to punch me again, there was suddenly Divine Intervention. Another patient, Frank, who was even bigger and stronger, grabbed Bill from behind and restrained him. That gave time for the mental health assistants to get to the scene and put Bill in restraints. There I was, a bloody mess. in a state of shock. And so were all the patients who were now losing it emotionally. I gathered them all together and I must say the scene was pretty comical. There I was, holding a blood soaked towel by my nose, and telling them that there is nothing to worry about, that everything is definitely under control. As I continued to bleed, I repeated myself and assured them that all is ok. One thing to understand in the world of a psychiatric hospital is that the psychiatrist becomes somewhat of a ‘father figure’ to these patients, especially those who are psychotic, or with weak ego strengths, or with intellectual disabilities. And some of these patients have never had a father who was present in their lives. So they look to me as the father they never had - even if I may be bleeding at the moment. I didn’t ask for this; it just happens. What happened next was incredibly beautiful and touching. In the subsequent days, the patients continuously asked me how I felt, am I getting better, offering me words of care and encouragement. You must understand - these patients have so many of their own intense struggles and pains, and yet they were able to step out of themselves and give me strength. It renewed my belief in the human spirit, our ability to go beyond ourselves and care for others. As for Frank, my savior, I thanked him profusely for coming to my rescue. And, true to form, he responded: “Really, it was nothing. I’d do anything for you, Doc.”
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"Ramblings on the Psych Ward"
”Would you know my name,
If I saw you in heaven?”
(Musician Eric Clapton, after the passing of his four year old son)
Paul, a 48 year old man, walked to the woods with a bottle of whiskey and his gun. He sat alone there and cried, with full intent to end his life - but Divinity intervened: Paul fell asleep, intoxicated. And when he awoke he found himself in the psychiatric hospital. When I first met Paul he was weeping intensely and grief stricken. He shared with me the worst psychic pain imaginable: the sudden and tragic death of his 25 year old son. Paul was sobbing now, talking nonstop through his tears and repeating himself: “My son, my son. Why? I could have helped him. Now I have nothing left. Please doctor, just let me die”. Paul desperately wanted to hold his son. He couldn’t stop himself from crying. He told me about his son, about the night of his son’s passing. And he told me about him again. And again, every day. Death is a mystery. To understand death we need to understand what life is. Our true self is that we each have a soul, a soul that never dies. If you’ve ever been in the room upon one’s passing, you can feel their soul, hovering there. Upon death, the soul is no longer ‘restricted’ to the body and begins it’s journey upwards. With the passing of a loved one, we have the opportunity to examine our own lives: What is our purpose? Why are we here? Some people will get a burst of energy in the midst of their grief, determined to carry on the legacy of their loved one. They may create charities in their memory. Or inspire others by recounting their loved one’s stories. I shared none of these thoughts with Paul. For Paul, the passing of his son was too recent and raw. Because death, especially the death of a child, is simply beyond human comprehension. There really is nothing one can say to explain away the pain of grieving. After all the attempts to make some sense of it all, the heart still cries. As it should. Every day with Paul, we sat together and talked. Sometimes there was silence. But often there were tears. And brief moments of smiles. I learned a lot about Paul’s son. But mostly I learned about Paul himself, his intense love and strength. His vulnerability.
He allowed me enter his world, to be present, to console, and to weep with him.
“Doc, I’m God” Joe was 30 years old. He had been diagnosed with Schizophrenia at the age of 19. For the past eleven years, due to good psychiatric treatment and a supportive family, Joe had been doing well. Until now. Someone had called the police. There was noise, lots of it, at a cemetery. A man had trespassed there in the middle of the night. Crying, yelling, talking nonsensically. Digging up a burial plot. The police took him to the psychiatric hospital and he was admitted. I met Joe the next day. Our first words went something like this: “Hello, I’m Dr. Guterson; nice to meet you. What’s your name?”
"God” “Tell me why you’re here.” Joe started crying. He said that his big brother Frank was all he had left in the world. And Frank died. “Yes, Doc, he died, why did he have to die. And I wasn’t able to go to the funeral, my family wouldn’t let me, because they say I have Schizophrenia, but Frank and I used to play videos and sing and ride the bus all day together and Frank took me to baseball games and bought me ice cream and hotdogs, and doc , I miss him so much, and they kept me away from the funeral and I can bring Frank back , yes I can. I know I can, Doc. I’ve got this power. I’m God”. Joe was weeping now. I looked right at Joe. He was real; he was earnest. So sure of who he was: God, with godlike powers. Adoring of his big brother. And heart broken. So - I’m the psychiatrist - what should I do? Joe’s not hurting anyone, nor himself. He’s been stable for eleven years. He’s loving his brother, grieving his brother, wants to revive his brother. He thinks he’s God - so? So what? Joe says he’s God! Is it my place to “fix” his presenting symptoms? The days went on and I got to know Joe more and more. Before long, I could see that I was in the presence of someone with unshakable honesty, innocence, joy, and love. A palpable soul. And I was humbled. I then found myself wishing that I could have some of what Joe has - and then realized that we all do. We have a soul, a spark, a yearning for transcendence , an inner voice. It is the essence of who we are. The problem is that we get distracted. But not Joe. The days went on, and Joe slowly accepted that digging up a cemetery was not a good idea. We talked more about his brother. We cried and laughed together. Me the psychiatrist, and Joe as God. I never challenged him on his name, never tried to convince him otherwise. Sometimes it seems best to just let things be.