Thursday, September 20, 2007

I see me

Yesterday my bus was 20 minutes late. I walked into class 10 minutes late, and the teacher decided to do a Behavioral Chain Analysis (BCA) on my tardiness.

A BCA is a way for therapists to examine their clients' behavior -- the vulnerabilities and preconditions that lead them to commit a "target behavior" (the focal point of the analysis), and the consequences of that behavior.

In my case, I was late because of the bus, and also because I chose not to take the subway instead of the bus, since my knees woke me up at 4 a.m. screaming in agony. (Taking the subway involves climbing up and down stairs and walking several blocks. It's quicker than the bus, but tougher on the knees.)

I also needed to check my email and read a little news before coming to school; it's a nice little ritual that helps me structure my day -- and that prevented me from getting to school even earlier. So even though I would have been 10 minutes early if the bus hadn't been criminally late, I was still late and it was still my fault.

This wasn't terribly fun, but it wasn't as painful as it could have been. After all, I was in therapy with Albert Ellis, so I'm pretty tough when my behavior's being dissected by professionals. (By my sister -- another story altogether.) And the class has to learn how to do BCA's, so why not subject the narcissist to public scrutiny? I can take it.

It was weird, though, because I had to hold back. I couldn't talk about why it's essential for me to have structure and read my email every morning. People with bipolar need regular routines -- and full-time grad school isn't all that regular. This week was also a big change in my routine, since my internship started -- and depressed people hate change. Moreover, I have a tendency toward terminal insomnia -- but I wasn't going to tell my professor that.

Today my internship supervisor, whom I'll call Melanie (as in Klein), and I met with one of her clients who has a bad hip; he walks with a cane.

"Did your hip start hurting really bad yesterday?" I asked him. "Because my knees sure did."

"It did start hurting really bad yesterday!" he exclaimed. We condoled on how it must be due to some mysterious change in the weather or barometric pressure or something.

On the subway back to the office, Melanie sighed and said that the client is affectionately known as "baby-man" among herself and the other social workers at the agency, since he likes to be coddled by the staff and he really needs to be pushed. "He was supposed to schedule an MRI of his hip and he never did," she said. Implying that nothing's really wrong with it.

I like and respect my Melanie, but I don't think she knows what it' s like to be depressed and in pain. Depression can prevent you from making or keeping appointments, and it magnifies whatever pain you're in. I don't know this client's diagnosis, but it's likely to be bipolar, schizophrenia, or schizoaffective disorder (which is sort of a mash-up of depression or bipolar and schizophrenia) since those are what most of the clients have. It's possible he's mildly depressed right now. Maybe he needs a kick in the pants, and maybe he's in real pain.

Also, not all pain shows up on an MRI. According to my MRI, my knees are fine. (And according to the MRI tech, I'm fine.) Yet I'm frequently in pain. Does that mean I'm relapsing into a depression? Possibly. Malingering? Absolutely not. I feel the pain; it is real. And so is the client's.

I felt the same way during the staff meeting, when the foibles of the clients were discussed and gently mocked. I have to emphasize that I like and respect the people who work at this agency; they do their best to ensure that difficult people are cared for well. And sometimes to blow off steam and keep your sanity, you need to joke about the little things your clients do or say.

But: I've been on the other side of the locked ward door. I've been a client. I've been profoundly sick, and unable to behave as I should. It's entirely possible that clinicians laughed about wacky Ayelet during a staff meeting while I was an inpatient.

I wonder what my professor and colleagues would think if they knew.
Copyright (c) "Ayelet Survivor"

1 comment:

  1. i don't always have "what to say" when i read your blog, but i enjoy reading it so much. thank you for cluing me into it. gmar tov, and an easy fast.