Thursday, October 19, 2017

Outpatient program, part six

Presence St. Joseph Hospital in Chicago, Illinois USA
You might start with Outpatient program for depression and anxiety, Part One.

Ninth Session (Oct. 13, 2017)
There's one man who consistently dozes in group and I feel for him because it sounds like he's on too strong a sleeping pill prescription. But he's not allowed to stop (or start) any prescription without talking to his doctor and his appointment isn't until next month.

Poor guy! He's struggling to reach a normal level of wakefulness. It's bullshit that he can't get in to see his doctor for weeks and bullshit that he can't reduce his sleeping medication when he nods off every day and bullshit that today he said he had to take an energy pill just to stay awake.

Mental health services have been so drastically cut in Chicago -- and Illinois has such a crisis of too few psychiatrists -- that of course we end up having to figure out our own treatment. There are few professionals we can get in to see without having to wait one or four months, even if your health insurance is top notch. American mental health falls way behind that of other countries and it's infuriating.

But on to the program. At one point today, when the facilitator asked a general question about safe spaces, I made the following comment, "It really feels different in here when it's just us, as opposed to when therapists are in the room. So I'm wondering if I could ask, I mean, this is just a friendly suggestion, but would it be possible for therapists and interns and observers to leave the room as quickly as possible during breaks and lunch?"

He said he'd have to clear that with the director of the program, and I said, "Oh, sure. Then could you please pass that along to them?" He said he would.

During lunch (once we were alone) three women told me they were glad I said that and a couple of men sort of nodded. We agreed that it's really nice to just relax and talk among ourselves and not have a facilitator asking questions or a medical student observer peering blankly at us. (Speaking of the med students who observe us, they are so stone-faced! It's like they they're not allowed to look sympathetic or engaged in any way. I've looked them dead in the face while talking and they give no indication they even understand my words.)

As we ate (hamburgers and Sun Chips), one person said she notices when I don't attend IOP (we only go three days a week, so it's not always the same people there). She said they might be in the middle of a discussion and she'll think something like, "I wish Regina were here to make one of her comments right now." This kind of attention makes me uncomfortable. I told her, "When you think things like that, then YOU do it!"

As we all chatted up the place, I asked why people clam up when the facilitators ask questions. A couple of people said sometimes it's because they ask very specific questions and they don't have an answer. I also noticed today that when called on to speak, three people basically said that from listening to others they learn that they aren't alone and they get ideas for what to do the next time they feel bad. Listening seems to help them understand themselves. I guess maybe some people benefit from listening to us loudmouths and that's all they need.

This is consistent with remarks people made today about how IOP has helped them: they said it helped them be more honest with themselves. I guess either talking or listening in IOP has helped many people learn what really motivates them and what they're really feeling.

The second hour we had a group discussion about what we do to get through bad days, what coping skills we've learned in IOP and how we've changed since we started the program. Many others have gotten much more out of this program than I have. One man called the facilitators "incredible" and other people testified to how much they've learned and how much better they now cope. 

In the third hour people talked about how this program has changed or even saved their lives. I heard more stories of how people have benefited from it and how much the facilitators and Dr. B helped them get through bad times. It made me realize I've been a big, impatient snob because I've spent almost three decades learning the coping skills and self-scrutiny others learned in IOP for the first time. Much of my criticism and attitude has been unfair. I'm obviously not typical of their usual clientele.

So today I learned that even though this program hasn't given me what I came here for, I mustn't talk badly of it because it helps a lot of people who haven't spent almost 30 years figuring out all their mechanisms, building their boundaries and coping strategies, and tirelessly examining every single crack in their brains. That's just me.

Tenth Session (Oct. 16, 2017)
After today, just two more sessions and I'm done! By the way, the director told me last week that he had been reading my blog, which is good because I can tell that a few things have improved. The facilitators don't talk to us as much in the happy, chirpy voice, and when we're doing check-ins, they sometimes say, "I don't mean to seem like I'm being unsympathetic, but we have a lot of people today and sometimes I might have to cut you off so we can get to the next person." I appreciate that. And, of course, we've never done as many worksheets as we did that first week. I'm very impressed by how good this director is at receiving and responding to feedback, even when it comes through as informal (and obnoxious) a medium as a public blog.

Today during the second hour, we did a handout on protective factors. These are things that can help you maintain emotional balance and are basically what can help you deal with general suckiness of life. Listed were social support, coping skills, physical health, sense of purpose, self-esteem and healthy thinking. 

The facilitator had us rate how strong each of these factors is in our life and then we discussed it. One thing she asked was, "So, why do you think it's hard to be honest with ourselves about our strengths and weaknesses?" Predictably, people didn't say much and soon we had silence again. I spoke up.

"I also wonder why it's hard for people to be honest with themselves. People were talking last Friday about how IOP has helped them be honest with themselves and I'm wondering, so why weren't you honest with yourselves before?"

Another pause, then someone answered me in part by saying something like, "You say you're all aware of stuff and totally honest with yourself, but what about sugar? If you're honest with yourself and have discipline you should be able to handle that."

I said, "I have the honesty but not the discipline."

He said, "I think they go hand in hand."

He seemed to push back against my bewilderment about why people wouldn't be honest with themselves, and he sounded a little defensive, like I was judging them. Maybe I could have taken that opportunity to say that while my mental health has been a priority for me for 28 years, I don't think I'm better than anyone else the program and I regret coming off that way. Even with all my skills, I still get just as depressed as anyone else. It's just that what this program happens to teach, I happen to have already learned from countless professionals, books, videos, support groups and fellow wackos. 

Basically, while normal people spent decades getting married, having children, establishing careers, buying homes and spending time with family, I have spent decades being focused on me, me, me. I've spent the past almost 30 years learning my inner mechanisms, motivations, emotions and triggers. I know myself very well. While others have lived full lives, I've lived alone and focused on my own emotional health. For 28 years. Sad, but true.

Anyway, at this point Dr. B happened to be in the room and he picked up on the question of why it's hard for people to be honest with themselves. He explained to me that sometimes it's not that people are actively not being honest, but that they don't have the self-view to be able to perceive what's going on with them. He used the example of the color blind test, which is impossible for people who don't have the biology to perceive certain colors. Likewise, people who haven't learned to distinguish between motivations might just be unable to know what's really going on with them. That made sense.

I wanted to turn back to the facilitator who had originally asked the question and said, "See? Your question was too hard for us. Dr. B was the only one who could answer it. Work on your questioning skills." The facilitators often ask questions that we can't answer because we don't understand what they're asking. Most of them need work on how to ask good discussion questions. Then again, we patients need to speak up when we don't know what they're talking about. Unfortunately, most people just sit in confused silence and then things go nowhere.

This leads me to the question: why can't Dr. B spend more time with us? He's great. We need a lot more of Dr. B and less of facilitators who don't seem to have spent much time leading support groups. I think most of them are psychology students or interns and I know that means that of course they don't have a lot of experience, but we deserve better than that. It's another indicator of the state of American mental health care. I imagine St. Joseph IOP can't afford to have a psychologist like Dr. B dedicated to the 9-12:30 daily group, but man if we could, it would be so much better.

After lunch (chicken wraps and Fritos), we had a group discussion about what courage is and what kindness is. It wasn't bad. It was interesting. We talked about how courage can include still feeling afraid and how kindness includes respect for others. It was ironic to me that we were talking about kindness, when I've seen these facilitators not be too kind. I'm talking about one outpatient who tends to talk out of turn and not stay on topic who's a little difficult to manage. A couple of other facilitators ignore his mutterings or they call on him and let him speak, but when he starts rambling on, they turn away and call on someone else. Singularly, the facilitator who led this discussion on courage and kindness listens to him and responds to what he says and treats him with respect. And guess what? He doesn't talk out of turn as much! Yeah, this man is annoying and takes a lot of patience, but come on. Let's be respectful and kind.

I continued to talk about the depression support group I'm starting on Oct. 23rd and one person said he's definitely coming. Besides that, there are 20 people on Meetup.com who have signed up to come! I know they won't all be there, but other brand new Meetups often get around 10 people (or fewer) signed up at their first meeting. The only other Meetup I've personally seen get such a big response from the beginning is a recovery support group. Clearly Chicago needs emotional support groups!

And here's the final part of this series, part seven.

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