Since, ahem, I’ve been published as a guest blogger on Brevity.Com today, I don’t need to come up with anything new. please check it out at
My coffee this morning is in the “Write Like a Motherfucker” mug that my friend that I’m jealous of got me from the last writer’s conference we went to, before this one. It was a gift and she gave me a gift because she did not know yet what a horrible person I am. I either write like a motherfucker or not at all. Because we are all going to die. But I am getting ahead of myself.
I will spend this morning writing for my blog that nobody reads. See where this is going?
I have been having a small, personal festival over the past week. A pity party we might call it at work. I work with addicts and we toss around phrases like that all the time. Usually I hate them, the phrases that is, I love the addicts. They are my tribe and I can help them with my expertise, my script pad, my humor, my success stories. I am at least competent there. I teach them Cognitive Behavioral Therapy, “CBT”. And like the Paul Simon song “Rewrite” or the Vivian Gornick book about situations and stories, just change your story line, man, and you’ll feel just fine. How’s that going for you, I ask myself. Not so hot, I answer, as the list of complaints against the self rolls merrily along.
“You self actualized too early,” a old boyfriend cited Maslow to me in 1975. He looked just like Woody Allen, I swear, which was pretty cool back then. “It’s a set up.” I didn’t know any better, and my first career as a clay artist came easy, every gallery I approached wanted my stuff, I sold every piece I made, they clamored for more, and I ended up with vases in the permanent collection of American Craft at the Smithsonian. Then I went to a hotshot university for a nursing degree, won awards, got a free Master’s Degree, great jobs doing good work, and as much as I complain now, “poor me I did 45 hours of work in three days…” well that means I get four days off to write! It’s not that I didn’t learn my craft (one morning I threw 500 one-handed bowls, Japanese style, on the potters wheel and would not let myself keep a single one, I suffered harshly through Organic chemistry and worse through Research methods) but at least I was in charge of where it was all going. Even my sobriety came easy. I just stopped drinking. Yeah the withdrawals could have been life-threatening, but I didn’t know it then. I even cold-turkeyed cigarettes after smoking a pack a day of Marlboros since the age of 13. I am a lucky girl. One might say determined. Yes, that too.
So I go to this writer’s conference in Mississippi. Where everyone is charming and I’m anxious because of the red/blue problems, I have preconceived ideas. I remember visiting my aunt in Nashville every summer. I am the daughter of a liberal Jewish very northeastern set of parents, my father a writer whose short story about southern graft got him on Alfred Hitchcock and then a screenplay bastardized into the cult classic Hot Rods to Hell. I remember my aunt and her friends, whenever they were ready to dish mercilessly about someone, would start with… “Well bless her precious little heart….”. At the conference I am very mad at myself for not writing an essay for the Creative Non Fiction contest “Southern Sin,” but then the winner of the contest reads his essay on Friday evening and I am very glad I didn’t even try. He was brilliant. During the conference the friend I am with, talented and young, finds out she won a teaching award. She has just gotten several pieces published. Everyone clamors for her memoir proposal. She reminds me of me, how must it have felt for my friends back when I was winning everything. But I don’t care. I am jealous. Then I get an e-mail that a piece that I’ve just submitted to Rumpus (the Write Like a Motherfucker people) has just been rejected and I can’t sleep. Then Facebook announces that my best friend from nursing school has just gotten an amazing thing (not at liberty to describe) AND she has just developed her own App for patient education. I have done none of those things. I hate myself and everybody else. I am not consoled by my own publication list. I am not consoled by the godfather of the genre of creative non fiction telling me I’m a great writer, the proof being that he selected my piece to go into one of his collections. I am not consoled by listening to the esteemed conference panel discuss the years they put into their success. One panelist reminds us to write because we are going to die. I’m going to die a whole lot sooner than the friend I am jealous of.
But I am buoyed by the charm and sweetness of the southern way, it’s like an immersion into CBT, just being nice, it feels good. And so I bounce along, my horribleness known only to me. Till now. One gentleman who I’d call pretty “red” talks about marbling, the red and the blue, we’re marbles. He literally embraces my conflicted northern self. I want to move down there, maybe I’d become a better person. But it’s muggy most of the year and my mascara and my masquerade would wear thin quickly.
So now you know. And this writing thing, well it is hard. I was set up, as the old boyfriend warned. But there’s no choice. So after a week of heavy partying (pity, that is) and too much TV, I’m still at it, bless my precious little heart.
“What is to give light must endure burning.”
Viktor Frankl 1905-1997
It is National Nurse’s Week and I am preparing a presentation for our nursing staff on the phenomenon of vicarious traumatization, the subject I tackled in my last blog and most recent essay “Don’t Touch the Mustard; Notes on Being in Lockdown With my Daughter.”
Vicarious trauma is a contagion, it is what happens to nurses and other caregivers who spend time helping others move through illness and crisis. We absorb the pain that surrounds us. Its sister, compassion fatigue, is the “debilitating weariness brought about by the repetitive, empathic responses to the pain and suffering of others” (LaRowe 2005) and “very much the landscape for today’s professional” (Showalter 2010).
My hypothesis for this presentation is this-If we look at trauma differently, will we respond differently? I am briefly commenting on this in honor of nurses everywhere who risk burnout, fatal weariness, and with concern for our healthcare system which suffers from the turnover that this fatigue costs all of us.
Trauma Informed Care
“A thorough understanding of the profound neurological, biological, psychological and social effects of trauma and violence on the individual” (Jennings 2004).
“Trauma is a disease of disconnection.”
Bessel van de Kolk Lecture, October 2011
Traditional treatment demands “compliance,” how would it be different to ask for “collaboration?” Would a change in a power differential actually ease the burden on the caregiver? Or is the potential for connection threatening? This is a question begging far more time and energy than is possible for this caregiver and blogger right now.
Can symptoms be looked at as adaptive rather than destructive? Normal responses to abnormal experiences?
For traumatized patients, all behaviors were directed towards survival. Over time they may have become “dysfunctional” with high incidence of substance abuse, psychiatric symptoms, and repetition compulsion. If we intervene with a clear understanding that these symptoms were lifesaving behaviors, we can respectfully help suggest alternatives. The same alternatives that might help any one of us.
Should we say- what happened to the patient rather than what is wrong with the patient? If we practice this with others, might it be easier to look at ourselves with more compassion?
Viktor Frankl also suggests that we honestly assess whether in the same situation might we do the same thing that we see our patients doing? This would go far in reducing the ‘us and them’ mentality that often gets in our way.
And then there is humor. Wish I had more time. Suffice to say it is the rare situation, with patient or colleague, that doesn’t get a whole lot better with humor. Or food. Another subject for another blog.
I need to get this on Powerpoint. In the spirit of collaboration, I will use more questions than answers. And bring lunch.
My reminder list remains static. I seem to always have the same things on it: Find bills in mess, pay bills. Bring in wood. Treadmill. Write something new. Submit something old. Write up evaluations. Vacuum. Holiday cards. Birthday cards. Throw shit out. Vacuum. Deal with book proposal. Get ready for whatever conference. Throw shit out. Treadmill. Vacuum.
Slowed down this week, moving underwater. Vicarious trauma is insidious and when you realize you have it, it feels shameful. Nothing really happened to me. My daughter in Boston is fine. What right do I have to take up space with my imaginary flashbacks and histrionic PTSD? All the while preparing to do a training at work for staff on Compassion Fatigue, of which Vicarious Trauma is a cornerstone. I’ll try to schedule it for Nurse’s Week. Compartmentalization of affect works up to a point, I will tell them. Acknowledging how hard the job you do is, how other’s trauma leaks into your unconscious. Into the collective unconscious. Damn, maybe we are just all walking around sodden with each other’s pain.
Write something new. An excerpt follows.
“Don’t Touch the Mustard, Notes on Being in Lockdown with my Daughter“
Would it be cheating on my sobriety to take an eighth of a Klonopin? Of course it would. I’m an addictions specialist, recovering alcoholic 34 years sober, and a psychiatric nurse practitioner. I have a prescription for the popular benzodiazepine, a compound which has toppled many a recovering addict, but I also have a longstanding anxiety disorder and use my prescription PRN public speaking only. A dose that is considered placebo. I have a fresh batch from my PCP specifically for my presentations at conferences about addictions, which I otherwise would not be able to do without some GABA enhancement. So I know better. And it’s been two weeks already since my daughter walked through the finish line at the Boston Marathon on her way to work at 2:40 and one week since I was in lockdown with her in Watertown.
But for the last two days I find myself crying at the very thought of her. My heart is racing, pounding really, my blood pressure was sky high yesterday, I thought about quitting my job where I treat dually-diagnosed addicts in a rehab facility, after an idiotic argument with a valued colleague the day before. Today I can’t breathe.
So many patients have PTSD, either full blown or a sub-clinical variant. I’m great with them, I don’t prescribe Klonopin, too risky in its potential for abuse, but I use a lot of mindfulness, supportive exploration, and Abilify when I can get it covered by insurance. Do I know about delayed symptoms? Do I know about vicarious traumatization? Fuck yeah. I’ve been in the business for almost three decades. You bet I know about it. And I treat it so I’m immune.
But I can’t focus through the flying limbs in my minds eye.
Sirens all night, cold air mattress, needing to leave to register at the conference downtown by 7:00, oh yeah add to the list public transportation anxiety. So I was awake, the hypnogogic vision of limbs replaced by my patient’s ashen face. Oh shit.
The roommate startles me. “You can’t go anywhere,” she tells me in the dark as I’m slowly heaving myself off the floor to the bathroom. “Oh, honey, I’m going to that conference downtown,” I say, moving towards pure denial at this point. “You can’t, the MBTA is shut down,” “OK well I’ll just drive in,” and I’m thinking about the 40.00 parking rate for a whole freakin day and whether I can bill it to my employer.
Ginny, the roommate, is a lovely and polite young woman. She repeats evenly, “You can’t go anywhere. I’ve been on Twitter all night. The bomber is right here in Watertown.”
I tell her that Twitter is an unreliable source of information, she tells me that Watertown is on high alert, I tell her to turn on the TV, whereupon my daughter yells at us from her room that we are being too noisy, WTF Mom, and so begins a day of lockdown with my daughter.
Our house sitter, only a year out of college himself, Facebooks from Vermont, that no college age kid can adjust easily from thinking she only has to be okay for twelve hours with a parent in her apartment, to realizing she has to spend another few hours with said parent, much less in lockdown indefinitely. This saves me, dare I even say it, from downing the whole bottle of Klonopin.
End note: I believe, if I interpret myself accurately, my point is that for me, creativity saves me. My ability to laugh, to write, I write an essay and the symptoms start to abate. It’s OK if we don’t get through our To Do lists. Our world feels crazy when we know so much and we should be evolving. We are all just walking underwater. Most of us are doing our best.
Probably in the not so long ago past, I would have had the ritual of stuffing crisp pages in to a new manila 8 x 10 envelope, actually signing my name with a hesitant flourish to the bottom of my cover letter, discussed it with the postmistress in my tiny town post office as I bought the appropriate number of stamps, and walked home in the fresh air, feeling a sense of accomplishment.
My proposal is ready and I just can’t seem to hit the SEND button.
That’s it? Just hit SEND and we’re done for now? And then what?
I’ve lived with this thing for so long. This proposal, this albatross of my own making. No one is making me do this. From the moment that I got the idea for this book, DUMPED: Women Unfriending Women, from the moment that the first group of people I presented it to showed me such enthusiasm, from the moment that I took the photograph of the dumpster in my yard and made the pretend book cover, I was smitten. Then my writer’s group and a few friends kept the passion alive. And then I found myself with the non-fiction counterpart to DUMPED, my novel Marginal Living, fiction loosely set in a similar situation, all done and no agent biting. I hired a consultant and reviewed my options. I wanted to publish something of my own, yes it’s great that I have pieces in other’s anthologies, but I wanted my own. My consultant looked at the novel, at my collection of micro-fiction (beautiful, but seriously not a commercial option) and then at DUMPED and said, “This could sell.”
Then my consultant hooked me up with a fabulous woman in the business who then hooked me up with an agent who is still waiting to see the proposal. How lucky is that?
Writing the proposal was supposed to be as easy as filling in the blanks and the book is almost written, said one friend who sent me the template that has always worked for her. Ha. The first clue should have been when my consultant said it was normal for a proposal to run about forty pages. I originally had three. It is now thirty-seven. And that includes my own essay, Simple Geometry, the essay it took five decades to percolate and a week to write. The original three pages? That was so many months ago. These thirty-seven pages have been my focus, through this semester of teaching, through the hours at my job, my mantra every morning of “Oh shit it’s five-thirty AM and my proposal isn’t done,” my excuse for not sending out holiday cards or birthday cards or sympathy cards or exercising or cleaning. A pathetic conversation starter, “Oh, I’m working on a book proposal.” And it’s expensive! Consultant fees, writer conference expenses, website development. Now I’m just poor, fat and anxious. And what if nothing comes of it?
Up at five- thirty again this morning, I am still finding typos and awkward phrases, still have no “big name authors” totally committing to submit, still not sure how I will handle hitting “SEND” and having it out of my control. And writing this blog entry instead while I hum the Bacharach tune from the 70’s. Originally sung by Dusty Springfield, who figures into Simple Geometry in odd synchrony. “I Just Don’t Know What to Do With Myself.” Which is totally untrue. Once I hit SEND I have to pack for the Harvard Masters Psychopharmacology Conference. Yes, there is plenty of real world awaiting me as I live life after hitting SEND.
Vermont is at the forefront of a war between traditional treatment of mental illness- medications and acute hospitalization (when one can even find a bed in a hospital) versus what they consider new talk therapies and either no medication or minimal medication. Where does that leave practitioners such as myself, comitted to easing symptoms, keeping people safe, and trying to work ethically within such a broken system now fraught with disagreements between providers about the very things we once agreed on? I wrote this essay, an excerpt follows, as part memoir, part public service announcement, and part in response to what I see as a potentially dangerous trend in psychiatry. Or maybe progress? So far, The Sun Magazine (I challenge them in the essay), 7 Days (a local alternative paper following this issue), and a couple essay contests have rejected the essay. I sent a copy to Robert Whitaker, whose Anatomy of an Epidemic, Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, 2010, Broadway Paperbacks, New York, was a pivotal point in all this, but he didn’t respond. As we blame mental illness in our national discourse on gun control, as we blame our broken system for mental illness in the first place, we should place understanding of biology and treatment in the forefront of our dialogue.
“If you feel like you’re in a whirlpool
You feel like going home
You feel like talking to someone
Who knows the difference between right and wrong”
Talking Heads, What a Day that Was
When I was seven or eight, I met a friend of my father’s at the beach. His name was Red Litvak. His once red hair, hence the nickname “Red,” was bleached out by age and endless walking. He was a big man, and very childlike. He followed my family around that day and was happy for the custard we bought him, hinting that he wanted us to buy him dinner as well. Red had been a wild, unmanageable child, my father explained. “He burned too bright.” He became dangerous as he got bigger, with rages and crazy talk. My father went on to explain that there wasn’t much else to do but lobotomize him or lock him up. It was the forties when Red was at his worst, they didn’t even have Thorazine yet, which he probably wouldn’t taken anyway. My father said, what was better? Eating a custard at the beach or being in lock-down somewhere? I couldn’t imagine this gentle man hurting anybody. I also couldn’t get my young mind around the fact that people’s brains got poked open. I watched Red lumber off and have never forgotten his lonely slow motion down the busy street away from the beach. This is dedicated to Red Litvak.
And dedicated to my father’s second cousin Margie, who we never thought of as having schizophrenia, or anything else. We just took care of her after her parents died. When she died, her estranged children thanked us for helping their “schizophrenic mom.” Schizophrenic? She had been too close to us to label. Once, after I became an advanced practice nurse, she called me one day, sounding a little strange, but Margie was always strange. She asked me if I thought she should take her medication. I thought she was talking about pneumonia. I told her “of course.”
Author note: I have deleted some examples here, unsure if relatives of these people are fully aware of how they died
When I was 36 I graduated from nursing school. I decided to specialize in psychiatric nursing at the University of Rochester, where George Engel’s bio-psycho-social model was still in full swing, and where John Romano’s “to each his farthest star” was the way we learned to provide respectful and hopeful care. We had access to brilliant psychopharmacologists who only strengthened the bio. I would never have anticipated struggling with today’s backlash.
Over the next few years, working inpatient and especially in the ER, there were moments before the Haldol/Ativan cocktails kicked in, that my life was endangered by flying furniture, bites and ambushes from behind. These patients, often “responding to internal stimuli” as we described it, were tremendously remorseful and only too happy to stabilize on meds. On other days I observed in the ECT room the life changing effects “shock treatment” has on intractable depression. I soon obtained my masters degree in Psych-Mental Health nursing and became a Clinical Nurse Specialist, educator, therapist, substance abuse specialist, and now a prescriber of psychotropic medications. My personal and professional catalogue could go on and on.
They say, do what you love and write about what you know. In my 25 year career I have heard “Thank you for saving my life” a few too many times to let our current trend of anti-psychiatric sentiment go unchallenged. It would be unethical of me. And yet, I wonder about it all.
A few years back the director of a graduate program in psychology asked me if I ever heard the phrase “do no harm?” We were on break during a conference, the presenter was a psychiatrist who claimed to have schizophrenia but did not use medications or even like to prescribe them. I had just told the director of the graduate program that I prescribed a full gamut of psychotropic meds. No one prepared me for the venom that would follow that day as I, the only prescriber in the audience, or at least the only one admitting to being a prescriber, challenged the presenter’s words and the program director’s philosophy. I was used to the complaints that there was such an inadaquate response to mental illness, not enough of us in the field to provide the necesary resources to help people remain safe. By safe, I mean both the community and the patients. I was unprepared to be challenged on actually being available to provide treatment.
I take the phrase “first do no harm” to heart. Eat custard on the beach or be in lock-down somewhere? All these years I have opted to guide people through whatever means available-medications, psychotherapy, 12 step, hospitalization, rehab, sometimes nothing- in the direction of the custard. Maybe there’s some sweetness, somewhere, I would suggest.
To do or not to do
“Crash on the levee mama,
water’s gonna overflow”
Bob Dylan, Down in the Flood
I recently attended a lecture by Robert Whitaker, author of the best selling Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Ilness in America (2010). Whitaker’s research for this book “follows the science” (lecture, Springfield College, May 2012) to suggest that the process of medicating mental illness may alter the basic function of the brain, resetting the numbers of affected neurons, resulting in amplification of the affected receptor sites rather than diminuation. Meaning maybe more symptoms and less chance for recovery.
It was at Whitaker’s lecture where, during another break, someone actually asked me, as a prescriber of psychotropic medications, “are you afraid you’ll become obsolete? ” I told her I only wish that could be the case.
Wishing away mental illness, renaming it, not treating it…none of those things will make it go away. If only.
But now a question arises: Is it our attention or our inattention that does the most harm?
The weekly newspaper, The Herald of Randolph, is housed in an old building in “downtown” Randolph, Vermont. It smells of ink and newsprint and old metal type. Like my father’s weekly in Rochester, NY, The Labor News, when I was young. My father was the editor of the AFL-CIO newspaper, until Mario Cuomo bestowed upon him the title of Deputy Commissioner of Labor for New York State. When I walk into the Herald I fall back 55 years, just for a second, but then get on with the business of self promotion and I’m a writer or an artist or an innkeeper or costuming the local children’s summer musical, curating a local art show, and looking for free advertising, which the Herald is always so generous to provide. I stopped in on Friday with the press release and glossy flyer for I Wasn’t Strong Like This When I Started Out, Stories of Becoming a Nurse, the Creative Non Fiction anthology that comes out next week. I have a piece in the collection. It’s a big deal. As many of you know from my constant complaining, life in Vermont has not been easy for me, Vermont has not been what I expected it to be when I dragged my family here in 2001. But then again, is anything? The point is, big deals are very big deals to me, here in my self-involved, angst-driven little essayist’s head.
In the window at the Herald office was a display with the book A Mim’s-Eye View: from the heart of Vermont. “Mim” Herwig, an essayist, also writes a small blurb in the Herald every week about what’s going on at the tiny crossroads of Randolph Center. Randolph Center, on the old Boston-Montreal stagecoach road is also the home of Vermont Technical College, but Mim usually leaves those goings-on up to them to discuss. Mim is all about ‘who came to call’ and who might be ill, what might be blooming, what might have been served at tea. You might as well be reading from seventy five years ago. And indeed, Mim started writing about her life in her teens. She is now 89. The snapshot of her taken in 1948 on the steps of the Herald could be today. The steps have not changed. On Friday, I skittered up those same steps, flyer in hand. I had always meant to read Mim’s book, just because her little updates in the newspaper have always given me some odd comfort. Like, there’s just plain niceness out there, so I picked it up, opened to her rich and detailed descriptions, had to dab my eyes right there in front of the receptionist. On some level I was deeply moved by my ability to resonate with this degree of non-snarkeyness. My favorite essay so far is “Memories of Randolph Center in 1950.” I trust the Fair Use Act covers me in quoting: “The town was bristling with old people-my age now-….Yet it was not a retirement community, but rather a village of people who were growing old where they had lived all their adult lives.” She describes in this essay a sunny morning baking cookies with a rolling pin she had received 50 years prior from her father-in-law, tagged with a note to “handle with care.” She recalls a neighbor, the local blacksmith, “who made a rolling pin for each local girl when she got married. Lewis and his wife Eva, had no children, but held the offspring of the whole community in warm regard.”
A catch in my throat as I read this. Is this what I had expected from Vermont? The last paragraphs: “Across from the store lived Will and Anna Bolin. He had been the town paper hanger and painter, whose name was painted up inside the church belfry. She would appear in time of sickness to lend a hand washing dishes or some other helpful deed. Beside her lived Lettie Pike, a retired teacher whose hands created beautiful dried arrangements and tended a lovely garden. They were not on speaking terms.”
AH, much better. I bought two copies.
A Mim’s-Eye View: from the heart of Vermont, The Public Press, can be ordered by contacting http://www.ourherald.com . I would highly recommend it.