“Don’t commit suicide!”

 At the end of March 2001, I was hospitalized for deep depression and suicidality, and released about two weeks later, coming out of the psych ward of the local hospital in Indianapolis to face homelessness and no job.  That afternoon I took refuge in a fundamentalist Christian "rescue mission," which was my home for the next four months, until I became eligible for SSDI, or disability income.  In September 2001 I became successfully employed, by the end of 2004 had shed off my curse of massive recurring depression, and now, over 21 years since my last psychiatric hospitalization, am in absolutely no danger of being re-hospitalized for psychiatric reasons again.  Below is a poetic fictional description of my discharge, with the cheery psychiatrist wishing me on with well wishes and good speed as I went out into the world facing emptiness, poverty, and despair.  Though the account of my departure from the hospital is fictional, the circumstances limned were all too real, and so, this is definitely a poem based on real life as I had lived it then--GF 

“Don’t commit suicide!”

So said the psychiatrist

as I was about to be released

from the hospital,

the one-size-fits-all pleasantness

of the stiff smile plastered

on his face

appearing as though

it had been painted

on an otherwise lifeless

mannequin.

“Go out and face the challenges of life

boldly and positively,

now with your new, healthy attitude.”

 

He forgot to add,

“Go out and face positively

the crummy, low-paying,

dead-end job you have,

the one that doesn’t pay you enough

to live on. (If you still have a job,

as your job is so low-skill

and you so obviously ‘overqualified’

for it with your college degree

you could be replaced

by a chimpanzee,

if a chimpanzee

could be trained

to punch a time clock.)

 

“Go out and return

to your apartment

and pack your belongings,

as you’ve been evicted

and have to get your stuff

out of there by mid-afternoon.

 

“Go forth and accept

boldly and realistically

your homelessness,

or perhaps staving

off that absolute

homelessness

by scrounging up

a bed in the local mission,

where you will be subjected

to mandatory fundamentalist

God-preaching,

despite your atheism.”

 

“Go out and meet those challenges,”

the psychiatrist

admonished,

just as the therapist before,

the one who’d

personally denigrated me

said to do those few years ago,

when he said that

personally degrading

and insulting me

was designed to

help me “meet the challenge

of living on $7.00 an hour.”

 

“Go out and positively

meet and greet

the challenges of your

worthless,

poverty-ridden

life,

that life

bereft of hope,

possibility of change,

friendship,

support

and love.

 

“By all means,

don’t commit suicide!

You have so much to live for,

can’t you see?”

 

No irony in the

psychiatrist’s voice

at all,

just the same

one-size-fits-all pleasantness

as though the mannequin

had a recording

embedded in it

that played automatically.

 

“By the way,

one last thing,”

the psychiatrist added.

“Before you leave,

be sure to

check in with

the receptionist

and sign the papers

for indigent relief

so that we all get paid.”

Dear Psychiatrist/Psychotherapist: Admonitions and Suggestions from a Mental Health Consumer

 

Psychotherapy and dispensing psychiatric advice are easily as much arts as they are sciences, hard science or otherwise, as recently demonstrated by new books by leading psychiatric publisher Guilford Press, which lists three recent books on how to be a better psychotherapist—which basically come down to but one suggestion: listen, really listen, to your client.  That sums it up well, psychiatrist/psychotherapist:  you are, first and foremost, not there to dispense unsolicited advice, much less bark mandatory orders, but to listen, really listen, to that troubled human being sitting across from you; that troubled human being who’s most likely have gone through life’s wringer in ways, and to an extent, you can neither fathom from your own experience, or find automatic guidance for in any standard psychiatric textbook!

 

So, first of all, listen, really listen, to your client, and put this first.  Before dispensing advice or telling the patient who’s before you what to do.  Phrase things such as suggestions and admonitions in an interrogatory way; ask, not tell, your client directly, preface your remarks with, “Have you considered that…” or “Have you thought about…,” for example. And elicit honest feedback from your client!   If your client is unsure of what you are suggesting, if the client has doubts, or thinks what you offer won’t work, and above all, if what you suggest makes your client feel uneasy or uncomfortable, you not only want, but you need, to know about it!  Enforced pseudo-certainly through engineered silence only hurts both you and your client, and detracts from, undermines, the therapy relationship.

 

Second, ask questions of your client and his/her background.  You, therapist, can’t automatically know everything you need to know about your client, not even from the most extensive psychiatric interview, but you need to find out, because as you and the client go along, ofttimes the must unanticipated, the most unexpected, will make their way to the fore.  And remember always, therapist, there is no such thing as an obvious question, or an obvious answer, so don’t ever assume there are.  What you don’t know, what you are unaware of, you are just ignorant or unaware of, period.  Further, questions to the client also show you are directly concerned about him/her, and not just play the role of an authoritative “expert” who always knows everything.  Because such, even if inadvertent, can seriously not just undermine, but also directly jeopardize, the therapy relationship.

 

Remember always, psychiatrist/psychotherapist, your first duty in therapy or dispensing psychiatric advice is to help the client help him/herself, not transform the client into an obliging robot.  You are a guide, not an automatic “expert” who knows all the answers.  Realize also, psychiatry is forever evolving, new knowledge and techniques of practice are always coming along, so it is important to not only be abreast of these, but to communicate to your client that you, too, are a fellow human being also searching for answers, not some automatically infallible guru.  For even the best of us can make mistakes, mistakes that seriously rouse anger and doubt about efficacy in the minds of the clients.  Such as the psychiatrist who asked me in all sincere honesty, “What did you do to make your parents abuse you?”  (Emphases as they were originally in the psychiatrist’s phrasing.)  The “correct” answer is, of course, “Nothing.”  (I did not answer his question this way, though I felt it.)  I can no more cause someone, even a parent, to abuse me any more than, as a woman supposedly having too much to drink or wearing too short a skirt, cause a man to rape me!  Same way with my most recent therapist, who alleged I was not “subtle” enough in understanding my father who called me “sissy” and “n****r-lover” repeatedly at the top of his lungs when I was a child and adolescent!  These two examples show conclusively that, even if inadvertently, the failure to make good word choices can unravel therapy relations!  For, in both these cases, things were never, ever, the same between me and the therapist.

 

That all sums it up.  These are things I’ve wanted to convey for a long time as a mental health consumer to my “professional healers,” and these are things I think are absolutely vital to a good, constructive therapy relationship.  Summarizing, they are three in number, and are an absolutely needed and vital three:  Listen, Ask Questions, Elicit Feedback.  Remember, your client is an autonomous human being, not just an empty vessel for you to pour into whatever you wish.  For therapy to work, it must be an exchange between two people.  Yes, psychiatrist/psychotherapist, you are “first among the two equals here;” but you are neither a god nor and infallible guru, and your expertise needs always to be tempered with a sense of humility, and awareness of just how fallible you really are. Remember, psychiatrist/psychotherapist, you also make mistakes.