Friday, September 29, 2017

Outpatient program, part two

First, please read: Outpatient program part one.

Third Session (Sept. 29, 2017)
Today was better. The first hour of checking in was conducted by a facilitator I'd actually seen before. I've finally made it to the repeats! One woman said she'd had a hard time making a stressful phone call, but she finally did it. She started to say that it had made her feel anxious and afraid, but the facilitator pulled her attention to her success in getting it done. She assured the woman that anyone would have felt anxious in that situation, but she handled it and that's great.

That's the general tone of this program. They don't have time to hold your hand through whatever fear or anger you're feeling. They want to lead you straight to the bright side, the better way to look at it, the possibility of success. I guess this strategy works a lot of the time.

I also got the feeling that the facilitator wanted to normalize the woman's anxiety. Her attitude seemed to be, "You're fine. You're just like everyone else. You're normal."  It's like they're trying to hypnotize us into believing we're not depressed or anxious.

When the facilitator got to me, I told her that I was feeling so-so. She asked why. I told her I was really looking for more group therapy with everyone taking part in a conversation and so far this program hadn't provided that. I said this made me feel disappointed. She said, "You wanted more time to process?" I wasn't sure what that meant, but it sounded about right so I said yes. She said maybe they'd try to do some more of that kind of activity. 

Maybe it was a coincidence, but after the break, we spent the second hour having more of a conversation, and it was led by an actual psychologist. Finally! Dr. B had someone pull a slip of paper from a pile, read aloud the challenge described on it, and say what they'd do in that situation. For instance, one described being at a family reunion and sitting next to a family member who was drunk and talking badly about people with mood disorders. We only had time for about five of these challenges, but each time people said what they'd do, or how they've faced that challenge, or how they're facing it now and don't know what to do. It was almost like group therapy! 

I pulled out a slip that described being on the bus and having someone harass you. I said I'd just ignore them. Dr. B asked if it would invoke any emotions for me. I said, not really because I'm very good at boundaries and I'm very good at not engaging if that's what I've decided. He said, "So this is within your skill set." I said yes, it was. So he turned to the others who said they'd have different responses.

In fact, every challenge we discussed wasn't anything that I'd have trouble with, so while I was glad to finally have some group discussion, I still didn't feel like I was learning any new coping skills.

After lunch (fried fish sandwiches with regular potato chips), Dr. B led the last activity. Not only did the same person lead two exercises on the same day, but it was a psychologist! I was impressed. We had a discussion about how we feel about the stigma attached to having a mental illness, with Dr. B answering our questions about how many people have mental illness and why some psychiatric wards operate as they do. He was a good source of information.

The last part of the morning was a handout. Oh, well. Not having to do any handouts would have been too much to hope for. We wrote down how we'd respond to someone asking about our symptoms/illness in different contexts, such as at a party, in a therapy session, on a first date, in a job interview, at work, with friends. Then we discussed our answers in pairs. It was another exercise that didn't tell me anything new about myself.

At the end a facilitator asked how we thought the day had gone. I said I really appreciated the group interactions and thought the day had gone well. I also said that doing handouts and then reading aloud what we wrote puts people to sleep. Another woman backed me up, saying she thinks filling out worksheets and then reading them doesn't get us anywhere. I tried not to smirk, but had to nod in agreement. Most of the others said the day had gone really well and they liked all the exercises.

So I have a little more hope that I might get some of the group dynamic and emotional support I'm looking for. But the level of skills that this program teaches doesn't feel like the level I need. So far nothing has challenged me (although plenty has challenged my patience). Plus today someone smelled like urine, so I left the room to eat lunch.
The next post is Outpatient program, part three.


Anonymous said...

Well it does sound better. I don't think you were being unkind speaking up about what isn't working for you. We both teach. If we never listened and tried to meet our students needs would we be at all effective teachers? Your one paying of this. You have ever right to get as much as you can out of it.

Anyway glad you spoke up


Regina Rodríguez-Martin said...

Thanks, Sharon!

Rayfield A. Waller said...

"Someday, maybe, there will exist a well-informed, well considered and yet fervent public conviction that the most deadly of all possible sins is the mutilation of a child’s spirit; for such mutilation undercuts the life principle of trust, without which every human act, may it feel ever so good and seem ever so right is prone to perversion by destructive forms of conscientiousness."
-Erik Erikson (Young Man Luther: "A Study in Psychoanalysis and History, 1958)

This might be too much to lay at your door, Sharon, but I am convinced I must say it not just in support of Regina’s fascinatingly understated, even abnaffected narration (a powerful element of her fiction writing, by the way), but because you say you are a teacher. I am also, a fundamentally conflicted teacher, a disturbed teacher, as any ‘teacher’ who is not just performing a role, ought to be. So think of yourself as simply an excuse for me to address some stuff, it’s not personal.

It's great if Regina is deriving something (anything) good from her outpatient experiences, which I’m sometimes feeling horrified by and sometimes finding to be simply amusing as I’m reading her narration, but I'm left very disturbed by the therapeutic element of the experiences she has been describing. The psychological 'health care' regime is fond of 'normalizing' patient feelings and experiences (at least discursively, that is, in the actual discourse they deploy clinically) in a way that can often discard true therapeutic value, or so I think, in its patronizing, infantilizing attempt to 'make the hurt stop hurting' in a sense (whether in safe-making action or in drug induced calm), as in jettisoning the threatening or dangerous social and political context that lay at the root of all our neuroses, and when the hurt is often both a major symptom of great underlying pain, and often a residue of the patient’s natural response to a social system that is irrational, anti-human, and harmful (B.F. Skinner—Beyond Freedom and Dignity, Maslow’s “hierarchy of needs”, Eric Fromm—The Fear of Freedom).

This pattern or response is antithetical, often, to our simple childhood realization that something in the world around us is terribly wrong. This woman who had anxiety over a phone call is clearly not 'normal' but is struggling with deep seated unease that may be part of the root of her depression. Psychological regimes such as hospitals, therapy programs, and so-called group therapy often seek to plaster over these symptoms with happy talk, 'encouragement', positivism, and the act of normalization. I myself do not have anxiety about making even difficult phone calls, at least not to the point that I would hesitate or put them off, because I would not be effective at achieve my own hierarchy of needs if I did. I might in fact be suffering from depression.

Rayfield A. Waller said...

"Outpatint Program" Comment 2

My brother, now dead, was profoundly mentally ill, and to a great extent, he was badly served by this aspect of his treatment. When not over medicating him with drugs they were happy talking him into greater comfort about his depression and underlying schizophrenia. The depression at least, was as much a social response to his genius being punished by the post segregation, racist, and economically inferior primary education system he was trapped within (that same system labeled me ‘retarded’ due to my dyslexia when I was a boy, and ignored the severe emotional illness one of my sisters suffered from, as well as ignoring her pedagogical needs arriving in a classroom within a severely violent part of the city we lived in, in poverty).

I remember the constant reiteration of teachers, “you’re ok, its going to be ok,” which I ignored for the idiocy it clearly was, but which my brother and sister suffered because of, perhaps because they got caught up in wanting it to be true. I remember that I resented that placebo, and sought alternative mental hiding places from it. The severe emotional abuse Regina suffered as a young girl and her tactic of managing and enforcing boundaries is similar to my own tactic of finding camouflage and mental hiding places, mostly using techniques such as mirroring back at teachers, and lying to them or using irony and outlandish responses that I noticed they seems to believe.

The bourgeois, infantilizing responses of the therapist in Regina's group has a mirror image in the physical (as opposed to psychological) therapeutic technique of doctors and teachers. Doctors tend to NOT tell their physically ill patients that what they are going through is ‘normal’, but in fact that they are abnormal and must regain normality, usually it is said or implied, through an act of WILL— the advocating of self-abnegation and self-denial, the ascetic sense that medical professionals themselves seem often to be products of (there is an irrational suborning, isolation, self-denial, and physical and cultural removal from society that make so many doctors so pale, spindly, and soft handed, medical education and training that make doctors so often unaware of and disconnected from social and political realities that impact, shape, and even dominate their patients’ lives, choices, weaknesses, and are even the sources of their illnesses) .

Your commendable but otherwise typically positivist response to the strange activities Regina has gone through in her program is dissatisfying. And when I say typical I don’t mean you or Regina but everyone. Regina’s experience represents I think a large number of Americans, such as my little Brother Reginald, the one who was essentially destroyed by his teachers, who lived half his life under medical authority (he was an asthmatic and a schizophrenic, who died prematurely of an asthma attack at a young age, in his twenties). As a teacher myself (university professor) I recognize what is wrong with medical regimes, medical professionals, and ‘healthcare’; doctors, like professors, must live with a savage contradiction if they practice in America, particularly in large, post-industrial, urban setting with large, disproportionately poor, Black, and Latino populations, where financial and medical inequality are the norm, such as Chicago, Detroit, Los Angeles, NYC, Philadelphia, etc.

Rayfield A. Waller said...

"Outpatient Program" Comment 3

The contradiction is that the healthcare industry is not making profit from ‘health’ but from sickness. The meaning of the word ‘industry’ is tied to profit and corporate capitalism (which owns the hospital and medical regime in America) is about SUPER profit. The educational industry likewise is an ignorance regime, not an education regime, in which the teacher’s task is to indoctrinate and normalize, not educate young people who are growing ever more obviously damaged by the social arrangement we must train them to fit into instead of what we ourselves were trained by our profession to do: educate them to be critical and analytical enough to overthrow the social arrangement through revolution and evolution, through resistance.

Doctors, like professors, must practice within a system that they themselves are implicated by, that leaves them powerless politically, often exploited financially unless they fully submit to the system and milk it for wages off the backs of their students/patients; they must somehow rationalize this distortion of the profession they spent their youth assimilating, training for, and studying theoretically only to see the social theory they learned thrown out the window by their employers and masters in favor of a need to conform. One of my best friends, a psychotherapist who works at a large hospital in Miami, who treats victims of brain trauma, is also politically active in opposing social, economic, and political injustice in Florida. As a result he is held suspect by his employers and colleagues, who expect his to do what doctors do: disregard root causality, context, and political reality in order to justify the huge amounts of money he and the hospital make off the illnesses of his patients. Too much consciousness, living ‘too much in the outside world’ (the world outside the hospital, where the patients come from) is antithetical to the Platonic, idealized, ‘therapeutic’ retreat that is the hospital (like a node, or a nodule a fractal world that features all the same inequalities and malignancies of the outside world, but as a subset of that world, a pinched off place of removal and so imagined to be a kind of resort).

To rationalize this, mental health professionals learn to patronize patients by happy talking them and seeking to ‘normalize ‘ their pain, to influence them toward conformity and functionalism, while physical health care providers patronize as well but in the opposite direction-- driven to blame their patients for NOT being ‘normal’ enough in their (sic) ‘choices’.

They say it, that the patient is abnormal by choice, but even those who don't say so, communicate this bias constantly and forcefully in their prescriptions, diagnoses, prognoses, and even in their silences. The better ones are unaware of this, but the worst ones proclaim it directly. White, male, heterosexist, conservative, Judeo-Christian doctors are sometimes capable of rising above it, but it is most often they who say it most clearly and deliberately: everything you suffer, that brings you to this room with me, is a result of your own bad choices. Though on some level true, this sort of ideology quickly degenerates into diagnostic solipsism. Who, for example, rationally wishes to survive a nuclear war? The living shall envy the dead. As an African American my will to survive is socially suspect, particularly in the capitalist, Western, post-modern sense (individual survival). The survival of African Americans has been and still is, historically, a choice of the individual to sacrifice herself or himself, not to turn blind eye and deaf ear to the sufferings of the family and the community around her or him, a ‘choice’ that leads to financial stress, emotional stress, danger, risk, and the constant siphoning of resources from the individual for the benefit of the ‘community’.

Rayfield A. Waller said...

Outpatient Program" Comment 4

I was particularly disturbed by the game Regina describes of pulling scenarios from a collection of slips of paper (what possible correspondence could there by in those slips of paper to my life for instance among family most of whom have no college education like me, need constant help from me to pay their bills and to keep there homes, have little or no financial resources as I do, and are being preyed upon by the police, by crime, by drugs both legal and illegal, and are being devastated by unemployment and malnutrition? The medical ideology and discourse says ‘nothing will ‘be alright until you isolate yourself from the world, exert your own individual separation from your community, and be an individual in the Western, masculist, competitive capitalist sense”.

Some of the amusing or perhaps insulting categories Regina saw in the paperwork she did in one of her sessions in which she was asked what her ‘values’ are, were ‘Family” (Latin family, I wonder?) ‘Community’ (is the Black community even definable as a community under the hospital regime of isolation from true community?) and “recreation” (Say WHAAT?).
The African American individual (say an ivy league graduate, former tenure track professor, world travelled, former worker for the ANC, published author, who has sold screenplays, published n=books, been a truck driver as well as a journalist and editor, and who has just sold a novel to a publisher and is taking courses at Harvard University online) is not ever going to be both sane AND an ‘individual’. Mental illness for an African American consists of trying to actually imagine a role in America as an ‘individual’.

The psychic dissonance involved in such a conceit would be crushing, debilitating, or otherwise a source of terrible narcissism and arrogance of the same type as the doctor who greets the individual upon his arrival in the resort of the hospital space and somehow can successfully disregard the death, suffering, stress, injustice, and ugliness outside the resort/hospital that he or she just walked in from. In other words, this medical ideology fixes one of American society’s most offensive monstrosities—the Black bourgeoisie—as the ideal. The Black parent, the Black patriarch or matriarch, and the most effective members of a Black family are a tradition left over from the first period of segregation which continues to ensure collective survival in the current period of neo segregation and current destruction of Black lives:

My body is not some 'individual' nexus, it is the COLLECTIVE property of my own family, and of my community. It is not so crucial here that this affords me the right or the privilege to disregard rational diagnoses offered by my carefully chosen doctor (she will be female, she will be Black or Jewish, she will be at least outwardly non heterosexist and non classist, because I will chose her for those reasons), but rather, the important point here is that if she cannot raise in the discourse between us her recognition of all that I must overcome to even begin to attend to my own wellness, and cannot offer me realistic support for my accomplishments (which the medical regime might ignore as not ‘pragmatic’ enough, as my own wrong ‘choices’), then she might be suffering from an inability to confront her own implication in the system that had conspired to make me ill in the first place.

Rayfield A. Waller said...

"Outpatient Program" Comment 5

That will be a problem between us. A BIG problem. My conformity may be necessary to save my life, but my conformity must be understood to be a sacrifice, a necessary one, yes, but not an inevitable and socially, politically neutral sacrifice—it is something that occurs in the midst of injustice, not one that should be seen as ‘pragmatic’ or as ‘wisdom’. Who wants to survive a nuclear war? The only humane and rational reason to want to survive a nuclear war is so that one can help to ease the suffering of the other survivors as well as be there to retell the lost history the war has destroyed.
I have suffered through this intensely as a pre-diabetic and hypertensive for four years now, (I was first diagnosed three years ago and engaged in the physical, mental, and psychological struggle of my lifetime to become more well), I suffered at the hands of medical professionals. Their gross displays of bias and ignorance are so clear, I suppose because they encounter me, my very existence, as symptomatic-- as a negative entity, a source of all social ills-- a Black male subject/object of their diagnoses and prognoses, as a resident of a city with a 70% illiteracy rate and a growing, atrocious poverty rate and a third world profile of illness (feudal and medieval illnesses like consumption, hepatitis, syphilis, gross malnutrition, etc.) Things that should not even exist in the county’s first mass industrial city, the remains of which (the ruins lay all around us) show that the city was once the most technologically, industrially, and infra-structurally advanced city in America if not the world—the city once called ‘the arsenal of democracy’ for having mass produced the guns, tanks, jeeps, meals ready to eat (MREs) and other materiel that defeated the Axis Powers in WWII.

There is also the reality, that I have in four years never heard a physician mention to me, that in order to change my eating habits (which I have, significantly) it is required that I live a life of self-denial that is preposterous, because the corporate food industry that now dominates our lives has spiked all pre prepared foods in our environment with salt and refined sugar. All Americans are now essentially pre diabetic (with the exception of the blind luck of those born with a certain metabolic and genetic predisposition toward resistance to the chemicals killing us all). Massive numbers of ordinary Americans are obese, massive numbers of them are hypertensive, and stress has caused multiple proliferations of countless ‘illnesses’ that are to a great extent merely medicalized labels for a population suffering delayed stress syndrome, trauma, and mental response to social abuse (fear, stress, ego reduction, self esteem reduction, and self hatred, all of which are constantly broadcast at us by the loud, relentless media saturation we are subjected to daily). These labels include ‘restless leg syndrome,’ chronic stress induced migraine, esophageal reflux and distress, acid reflux, bulimia, hyperactivity (treated by addiction of and the psychological damaging of an entire generation to Ritalin—the result of which I contend with in my students), and sex addiction, just to name a few.

For four years now, I have learned to often disregard what I am being told by my doctors and health care providers in terms of the do-ability or even rationality of their prescriptions (the ruinous prices of their pharmaceutical prescriptions is another story) , which I mostly find unhelpful, and even insulting and disempowering, even when their diagnoses are medically correct. As a professor in an urban center, I have learned to not, in an oracular voice, tell my students what they ought to do (however ‘correct’ my oracular instruction might objectively be).

Rayfield A. Waller said...

"Outpatient Program" Comment 6

Instead, so as not to depress and oppress them, discourage hope (see Paulo Freire’s books Pedagogy of the Oppressed, and Pedagogy of Hope), and drive them away from me, I talk to and listen to them, and in class discussion encourage them to talk to and listen to each other, in order to help them to discover for themselves what they feel they CAN do, in what order, and to what degree, as well as how it will benefit them not just as individuals bent on individual ‘survival’ and ‘success’, but benefit the world they must live in, the families they come from, and the communities they know as their own.

I have a keen awareness of the injustice, exploitation, and dehumanization they go through at the hands of the very same institutions I work for, and I remain aware of my implication in the systems of political and social constraint and violence they must navigate daily. I am aware of how the simplest suggestions I give them in terms of directing them toward achievement can quickly snowball into crushing, wounding, and emotionally damaging experiences of defeat and confrontation with a wall of impossibility that dominates their lives though I might have overcome those impediments and those feelings twenty to thirty years ago when I was their age. What good is a prescription that the student cannot afford? What good is my advice, if the student must create an unrealistic, alienated space within his or her family and community just to implement?

And what good am I if I cannot at least see, admit, and take into my discourse the fact that this is the reality my students live with daily, and if I cannot simply listen to what the student has to say about it? However conscientious or correct are the prognoses and prescriptions of the teacher, the doctor, the lawyer, and the psychologist, we must remain conscious of context, or else ours can become what Erikson called “destructive forms of conscientiousness “. In essence, the teacher, doctor, lawyer, and all the other professions, born in the enlightenment, arose out of deliberate rebellion against monarchy and injustice, against inequality and unjust power, to create a middle class and to create literacy and democracy. An unfortunate possibility might be that we were created by deliberate rebellion against all of the forces that we now train our constituencies to obey and conform to, rather than question.

Why aren’t the members of the "outpatient program" being encouraged more deliberately to talk to one another and to have their depression better contextualized with their own individual lives by actively exchanging experiences with one another, rather than being given an orange and told positivist bromides, such as ‘you did the best thing!’ or ‘you handled that well!’?

I’m just asking.

Rayfield A. Waller said...

"Outpatient Program" Comment 7

Finally, there is the peculiar sense one often gets when interacting with the medical institutions both mental and physical, that entering into the clinical and therapeutic space is to enter into a time warp in which one is dispossessed of psyche and insight, regressed back to the unknowing state of childhood (this is an experience far more pronounced when one enters, as I often have, from an urban, Colored, even illiterate and impoverished environment). As a Black male, my every social interaction with police, doctors, employers, and even with students, is marked by the same sorts of assumptions, unconscious biases, patriarchy, and prejudices that women in America experience.

This may be unavoidable. However that is where discourse, curiosity, cultural literacy, and the ability to listen without happy talk in response, is incumbent upon the doctor.therapist.teacher; to be aware of their implication in the oppression of and at least financial exploitation of the patient/student, to listen to or at least notice, the apparent past experience, education, and ongoing struggles of the person they encounter, and to be listening for the echo of their own unconscious bias, which if they are paying attention, will appear in the faces of those to whom they speak.

It is not possible for a doctor to have no unconscious bias, as it is not possible for me, the patient to be without bias. The power relation between my doctor and myself however is large, entailing even the power of life and death for me. My doctor will miss truly seeing or understanding me, or will tax me to have to 'explain' myself to exhaustion if I must take all the responsibility for communication between us, if her imagination and judgement cannot encompass my Ivy League education, my successes as a parent, my knowledge of science and technology, my familiarity even with the jargon of her profession, my experiences in Paris, Rome, Lagos, Capetown, and my knowledge of Madagascar, Mozambique, England, and my fondness of the café bar at Cafe Les Deux Magots in Saint-Germain-des-Pres, as well as my time spent at Sylvia's in Harlem, my love in my life, of Black women, Italian American women, Puerto Rican women (my daughter is half Puerto Rican) and Anglo women, all of whom I have had relationships with, and my identification with Anglophone as well as African and native American cultures (my mother was half Choctaw Indian).

The medical regime deliberately reduces us to deracinated blank slates because allopathic medicine sees us as a canvas upon which it paints wellness, rather than a topology that medicine must exert itself to read the text of us, translate, deconstruct, and break a sweat.

I am a life sprung from many other lives, not merely a diagnosis waiting to be pronounced.