All information about patients or staff has been anonymized and altered as to gender, age, race and history in order to provide anonymity to everyone.
I am entering my sixth month working with people with psychotic disorders--schizophrenia, schizoaffective, a mere bipolar with psychotic symtpoms seems like a walk in the park. I fell into this job--being offered it after being turned down for three others. It is in an awful building physically, he a homeless shelter in it as well as one for sex offenders. The population we serve are severely disabled by their psychosis, impoverished, frequently homeless or hospitalized. I have both male and female patients and some who are gender fluid or in transition. I have people who hear voices and have command hallucinations to hurt themselves, and I have people who are merely delusional and have fixed and unrealistic or bizarre beliefs about their own lives and that of the people they meet. I have paranoid schizophrenics, a whole other ball game. I have professionals (occasionally) who manage their symptoms and lead an ordinary life and people who are nearly catatonic and utterly lack insight.
This work is so new to me that I am frequently reminded of my early days as a new mother--my husband and I would turn to each other and say "can you believe it?" because we could remember the time before. Before needing a babysitter to leave home. Before needing to plan ahead for baby disasters. For me the time before includes being in control of my own time instead of working (like everyone else! how did I miss this!) nine to five, monday through friday. I get up at five thirty, shower, and get on the bus and take myself to a cafe for an hour to make notes to myself about the day ahead, or the day before, or to read for my trauma class (which meets most Monday nights at a nearby university for two and a half hours). Then I get on the subway and head into work aiming to be there by 8:15 and work without a break, or only stolen breaks, until five when they kick us out of the building because it is too dangerous to stay later. If I come in at 8:30 the homeless men and women are leaving the shelter for the day and walking into work through the ugly, basement, door that is assigned to us is like walking through a cloud of smokey zombies. The ones who are my patients greet me happily, the others who are in various stages of sleepy distress or confusion simply ignore me. If I leave early, at four thirty, they are coming back into the shelter and there is a lot of sadness and despair pooling in the hallway and the elevator. I found this daunting at first--and there are other people in the office who tell me that they never take the elevators at all because of anxiety about being attacked or because for an entire summer someone was peeing in the elevator and they never found out who it was.
The significance of the awfulness of the building is this: my "civilian" patients, those who come to us from the outside world that is not defined by poverty and mental illness, have a really hard time accepting that this is their new life. That their new life with their mental illness brings them into close contact with poverty, trauma, grief, homelessness. There is a safety net for our patients--and we are it!--we treat our patients with the utmost love and respect. But the environs are scary and the prognosis is not good. Mental illness such as our patients suffer is no respecter of class or race and even a wealthy, suburban, white family with everything (nominally) going for it can buckle under the weight of the demands that a family member with very resistant mental illness like schizophrenia or psychosis can place on it.
Let me take a moment to praise the people I work with. I can not tell you how beautifully the other social workers and nurse practitioners and doctors that I work with treat our patients. Every patient has someone on staff who just loves them--its almost absurd, some times, the way everyone has their personal angel advocate who will say to you, spontaneously, "I just love X! Such a wonderful person!" Even about people who, at first glance, seem completely unconnected to reality and to their surroundings. I have a patient who I will call Gandalf who has been hearing voices since his teen years--he is now very, very, old. He comes in and sits in my office and we have intermittent conversations while he is dialoguing with his inner voices. When we do speak he is courteous and thoughtful, but what he says is often very bizarre. One of my proudest moments in treatment, in our first session, is when he commented on flowers I had in my office and after listening to what I had to say about the flowers he said, dismissively, that his voices thought "the flowers are not important." I said "I think the flowers are important because they help people recognize the passing of time, as the flower grows from bulb to flower to seed, and also because they beautify the surroundings." After a long, long, long pause he suddenly said "I think I disagree with the voices, I think the flowers are important." Imagine that! I brought this up with one of the other practitioners and they said to me "when I worked with Gandalf he wouldn't come into my office because he thought there were bears in there! He has really come a long way." Their voice as they said this was so full of love and respect for Gandalf, and for the work we are all doing trying to (as we say) "hold" and "contain" these patients--so often lost and disconnected from everyone else in their lives.