Wednesday, May 27, 2009

My Mother Doesn't Write..

Mr. Borsch is back. He is not leaving the prison system, the stuff I got through the mail was wrong. So here is his story.

He is 19, and on his second bit in the prison system. His family was vaguely functional for years. His father stayed at home, for some medical reason I am still unclear about, and his mother worked. He was the youngest of five. His father didn’t really take care of the home as much as he required the children to clean and mow and cook to support the mother that worked. Then when Mr. Borsch was 11, he died. Gone. Not much in some ways when he was around, but he created order out of chaos.

The mom continued to work, but she couldn’t make chaos order. Things began to fall apart. Mr. Borsch stepped up to the plate and began to cook and clean as a pre-adolescent. He explains to me his older brothers were already leaving, and his sisters were, “being girls.” He kept the house running and then at 14 began to bring money into the household. He told his mother he was working construction. Actually, he was selling drugs. She was so desperate she decided to pretend to believe him.

School started to get out of control. His older brothers had set the tone through their violence and misbehavior. He described himself as being peripheral, and then beginning to be a force of fear in his small town school. He labels himself as a, “bully.” But as I push into this, he was, in part, protecting the geeks and freaks of which he was one. Preppy and Jocks were his targets.

So, at 12, he gets slapped into an alternative school. If he doesn’t get his homework done, he does three days in juvie. When he got pissed at somebody and flung a pencil at him, he was in juvie for three weeks over Christmas. He had just made enough money to bond his older brother out of jail for the holidays.

This last bit was Uttering and Publishing. He found signed, unwritten checks. He wrote them out enough to have the pseudo-father he was living with, his fiancé, and his mother and sisters had a mind bobbling Christmas, and then he came back to prison.

When they brought him into prison, his mother and fiancé were frustrated and angry. In the past months, his fiancé has taken up with another man. His mother made up with him in the jail, but now it has been four months since he has heard from her.

He explains when he lived with his girl, or lived with his mother, he made different decisions. To have somebody who cares and expects something from him helps him not to make stupid decisions. I can see this is a role I might be able to take on. In some ways it soothes me.

After vomiting this entire story to me over most of an hour he shares with me his current custody status. Some group, which he won’t give me details about, has betrayed him; they have, “stabbed me in the back.” He wants to know why people he cares about do this to him. We talk a bit, but I know that he is asking me if I will do the same. Promises are useless. Time is the issue.

He should go now, count is coming, and I excuse him. He doesn’t stand up. He has three pending tickets which is news to me. If they are all found true, he hits the point level where he rides up to a higher level of incarceration: he leaves.

Crap. Again. How do I keep getting involved with this story? He is so young. He has started to be less skeptical of where I come from, and now he announces his imminent doom. It is too early in the relationship for me to tell him that he needs to stay with me. I think we go there, but he is fragile and easily spooked. But I have no option. I stop to think how to phrase it. He watches me and tells me to just spit it out. So I do.

“if you come into therapy with me, I’ve learned over the year I’ve been here, the only way I can help you is to care about you.” I check him and he is following. “So if I do this, and you do something to get yourself ridden out, it causes me a huge amount of sadness. I can’t keep doing that. If you want to work with me, you need to stop collecting tickets.”

I watch him cross over from wary to becoming one of my guys. Can he stay with me? The moment of electricity sits. It is close to count and he has to go across most of the yard in the next ten minutes. I start to shoo him out and ask if there are more questions.

“If your son was in prison, and you were angry, but talked with him about it in jail and said you would write… what would keep you from ever writing him?”

Monday, May 11, 2009

Monday Blues, Part 1

It’s one of those days I’m just not sure I can tolerate the grief anymore. In the “Real World,” people leave treatment in a number of ways. The most common is they fade away when the acuity has passed, or they never return after the second or third session. Once in a great while somebody just disappears in the middle of something intense, but this is rare. I also don’t usually suffer from the feeling they are wandering off into the wild with no support or expectation of it.

I haven’t written about Mr. Stark in the past few weeks as I’ve just been too sad. He was granted parole, and we had a few days before he transferred out to prepare for this transition. This was in the middle of a huge art extravaganza at our studio, involving 20-50 people daily for two weeks. It was also in the middle of my father being diagnosed with inoperable brain cancer and a limited number of months left to live (we are still waiting for confirmation of this opinion). I received the paperwork on a Monday morning, first thing, and my heart sank.

He has been working hard, making difficult progress and was at the brink of what felt like a turning point: a change in how he was thinking and dealing with his emotions and fears. We both assumed, due to his flurry of tickets earlier in the year, that he would be flopped. He wasn’t. I should have given myself a day to process, but I didn’t. I called him out to tell him the news. It was possible he would be gone in two days, we needed to do some preparation and I had paperwork to complete. It didn’t feel like I could wait. Besides, he would be so excited. I was greedy for the opportunity to tell him myself. Although I was disappointed and worried and the timing could not have been worse, I knew it would balance out with his amazement and anticipation.

He walked into the office, I assumed, wondering why I had called him at such a weird time, or even called him at all. I put on happy face, glowed at him, waggled my eyebrows and reached out the paperwork declaring him free. He sank into the chair, looked balefully at the paper, and told me he already knew.

“I’m not ready, Ms. Mclain. It’s too soon.” His face was still, his body limp, and he wouldn’t look at me. This is a guy who is constantly moving in session. Shifting, hooking his leg over a chair arm, laughing, angry, pacing. No movement. Just an overwhelming despair that flooded then met with my own exhaustion and regret and inundated us both.

I got up and shut the door. He looked at me then, for the first time, “I guess I’m here for a bit?”

I nodded and told him I’d cancelled the remainder of my morning. We had to figure out how to seal off treatment in a way that could hold him safe. What had just happened is the one person he had come to trust and rely on was being precipitously removed from his life, another relationship ending in pain and ashes. We mostly sat for that hour and were sad, talking a bit about what needed to happen, but being quiet most of the time and just sitting with each other.

He does this thing with his arms and hands, where they become completely tense and energy filled. At some point during therapy I finally asked about it, and he told me this was a way he channeled his rage and fear and desperation out of his body: a sign of his emotions overflowing. It is something to do with his arms and hands that didn’t create violence except toward himself. I lost count of how many times this behavior manifested on this Monday.

He rose to leave just before count, and stopped at the doorway as I was looking at my hands trying to wait until he left to vent my own frustration and fear. He stopped in the doorway.

“Ms. Mclain, I probably shouldn’t say this, but I’m leaving.” Silence, I don’t even have the strength to wonder what comes next.

“I really care about you; you’ve become really important to me.”

What do I respond? Where is the boundary? What does he need? What is true and real?

“Me too, Mr. Stark. Otherwise, I wouldn’t be crying.”

“I know that, you didn’t need to tell me.”

And he is gone.

Sunday, May 10, 2009

Good Friday 3

Third Friday experience was Mr. Stewart.

He was in group on Thursday, and became, for the first time enraged at me. He wanted a specific medication we could not give him. I told him again, it wasn’t going to happen. His face shifted from prison dead eye into a full Marquette, and he was actually raising his voice at me which has rarely happened at all in my past year. I do know the difference between somebody yelling in my vicinity and directing it toward me.

In the midst of his tantrum, and before it could be settled, the siren went off for Mobilization. They all retreated to their prospective housing units and we went through the irritating process of 90 minutes of interruption in our work day and sitting in the Muster Room twiddling our thumbs.

So I have this lovely Friday, and Mr. Sotheby has left and I have a bit of my afternoon left for catch up. The sun is shining and a breeze is blowing the papers around on my desk. And Mr. Stewart is suddenly standing in the doorway, clutching a pass and a book I had leant him.

“Uh, do you have a minute? I have a quick question.”

I nod and he pulls the door closed behind him and sits down.

“I was wondering if you changed my meds after we talked yesterday?” and there is no dead eye, let alone a Level 5 glare. He appears vaguely sheepish.

“No, Mr. Stewart, we hadn’t finished the conversation, so I hadn’t talked to the doctor.”

“Well, okay, thanks Ms. Mclain.” And he doesn’t move.

“Mr. Stewart, you didn’t come in here to ask about your meds.”

“Yeah, I was really angry yesterday…”

“Do you know why?” (This may seem to be a simple question, but it is the essence of both insight and cognitive therapy. The standard answer is to stay right on the suface, acuse us of malpractice and simply being stupid, stubborn State employees, lacking in compassion and common sense. This attitude allows him to fire his rage and excuses him from any responsibility. This has been Mr. Stewart’s standard approach for the balance of his life.)

“Yeah, I think so. What do you think?” He is looking at the pass in his hands, turning it over and around.

This is a bit of a cheat to ask me to answer the question, but he came on his own to straighten it out and I’m tired.

“Why I think or what you think.”

“What you think,” and he looks up.

“You felt we were withholding treatment, which in fact proved that we don’t care about you and everything up to this point was a farce.”

He nods and his face doesn’t even flicker, so he had figured it out on his own. It was probably important that I cared enough to have thought it through also.


“And I came to make sure you weren’t angry at me,” and he holds eye contact and watches carefully.

And this is one of those moments where it all comes together for me. He not only processed what had happened to him, but he was brave enough to try and resolve the potential rejection before the weekend so he didn’t have to stress about it. He knew it would bother him and potentially wind him up, but he took control and did something healthy.

“And you said you thought I might need a little anti-psychotic, like you’d decided I was fucking crazy or something. I’m afraid the more you get to know me, the crazier you’ll think I am. I worry about that a lot. I mean we have a pretty good relationship, you know a therapist fucking client relationship and I don’t want to fuck that up.”

He swears an amazing amount when he is feeling emotional.

It’s nice to know he also thinks we have a pretty good therapist fucking client relationship. I agree.

Good Friday 2

Second afternoon appointment was, as usual with Mr. Sotheby. He walked down the hallway with me in front of his buddies getting store. I have this new little ritual. My office opens directly into the hallway now, instead of being part of a suite. When I leave it, of course it needs to be locked. I had a couple of days where three of my guys objected to the fact that I was opening the door for them. It wasn’t right, me holding the door for a man.

So now, I unlock it and take two steps back. Most of them get it right away, and most of them hold the door for me rather than going in first. Mr. Sotheby is familiar with this ritual, and he got to perform in in front of a myriad of people from the neighboring unit getting their store in the hallway. I hope it was a positive perception rather than one of me dominating him. I’m pretty sure it was the later.

As we were walking toward my office I caught him fiddling in his pants. As you might imagine, this can be a sign of something totally inappropriate. I was a bit surprised and gave him the horrid older sister raised eyebrows.

He opens the door for me, and rearranges his pants. He has a tape in them. A song he wants to play for me. It’s an underground rap group from Detroit, and the song is the one most close to how he feels about his mother. I should have written the title and artist down. I’ll try to remember to do it and add it into the blog.

Anyway, it is brutal and sad. His mother’s birthday has just passed. He is thinking of her. He askes me how my weekend was, and I hesitate. As always, he immediately picks up any sense of something hidden, maybe a lie, a betrayal. I tell him we just got the news that my father is dying, sooner than later. As I stare out the door, I talk about the timing of this event. My sister was in town, and we were having a weekend long music event on our farm. I talked about receiving the news and the fact that my friends, whom I loved just passed me around from one to the other all weekend. Even though they could not change the news, or take back the future, they helped me hold my grief and bear it better. The same reason I wanted him to trust me with some of his pain.

Offering up this much of yourself is controversial. It is standard practice to keep yourself totally separate from your patients, offering a virtually blank slate. This doesn’t seem to work with these guys. They need something of you to connect to, to trust. So I jumped off of this cliff. When I turned back to him he was holding his head, wiping his eyes and looking at me. The first serious sense that I had reached through to him since the day he said he needed to talk about his emotions.

Good Friday 1

Friday was amazing. Three emotional scores in a row, and I came home on a therapy high.

The first was a young man from a small town. He has been in the juvenile and now adult system since about the age of 11. He is on his B prefix at 19, and sat rigid and sad in my chair. He kept ma’aming me until I started to feel about 90 and asked him to back off it a bit. I did my orientation spiel, including the my few weak, ubt usually effective comedy lines. All I got was ma’amed. About 20 minutes into the hour I couldn’t stand it any longer.

Usually, I get the paperwork done, and then work on the engagement. But he was so sad. He had been on the unit for two days, hanging in his cube, avoiding interacting with anybody else. He had not “checked” me out, and didn’t know what to expect.

He had gone into his local mental health about six months before he caught this last bit. He needed to talk. Instead they threw some medication at him and sent him back into the street. He sold the medication, and remained isolated and full of pain. Another betrayal by the system.

He talked with me a little bit. As soon as they threw him into the County jail system, his fiancé and his mother both stopped communicating with him. He has been with the fiancé since he was 14. She is apparently now with some guy named Dave. We’ve made a beginning. I hope I can find a way to help.

A Journey

I have a guy, Mr. Inato (previously Mr. I) who was taken off of the unit, probably long after medical should have been involved, to the local hospital. His labs indicated that he was at the edge of death. He was in one of my groups, and two weeks went by without him. I was only able to look at a modicum of information about his physical status, and was completely sure he was dead.

In group, they asked, and I told them to pray to whatever god they held dear. I couldn’t give them additional information as it was confidential. Mr. Stewart, who lives across the hall from him offered up he was completely incapacitated when they took him out and pissing blood.

The next day, he is in a wheel chair in Control. I see him an inelegantly blurt out, “you’re not dead!”

He wasn’t, but was still very weak, and needed a wheelchair to get around. This means he needs to have one of the other guys push him to meals and med line and so forth. And it’s not like this other guy just stands around like a butler waiting on the whim of Mr. Inato to cart him around. I needed to speak with him about his meds and didn’t want to go through the whole production of dragging him. I could leave a massage with custody, but I don’t want them responsible for communicating medication issues. Besides, I could just walk down the hall, into his unit and tell him.

So I waited in my office for somebody in a uniform to walk by so I could snag him as an escort. It didn’t take long, and one of the Sergeants stuck his head in my office. I asked to accompany me, explained what I wanted and we went briskly down the hallway chatting, into the unit, past the unit officer, and to the very end of the second hallway. I was pleased I hadn’t dragged him out as he couldn’t have been further away from me unless he had been in a totally different building.

I knocked, went in, crouched down to the bottom bunk, gave him my message and talked for a moment. All’s well, he understood and wasn’t upset or otherwise put out. I stand up, the Sergeant guarding my back smiles and we turn to leave. And the passage is blocked by the bigwig custody in charge of the building and the unit officer, with about four of my guys lurking not-so-innocently in the background. Her eyes are bugging out of her head and her eyebrows are waggling madly around on her forehead. Apparently she had decided there was some kind of emergency; apparently related to the noise I made as I walked down the hallway with my heals (I am always noisy, so I don’t get it), and the fact that I had unit command with me. Her passage in turn had set the whole unit buzzing, and I had to soothe all my guys as I made my retreat, carefully not laughing at her misplaced excitement.

Thursday, May 7, 2009

Gay is gay

Crappy day today. I suspect I’m beginning my PMS cycle. But the guys were incredibly irritating, needy and whiney. My regular Thursday group is struggling with a new member who has been overtly gay and is now using Christianity to “fix” himself. I find this concept repulsive and distressing. My belief is gay is gay. It is what you are. For us to judge somebody on this proclivity is tantamount to judging somebody for the color of their skin. I have a little bit more flexibility for judging on what you’ve done.

Ms. H points out that many of these guys have been sexually abused by men. This fact makes their tolerance very low. Perhaps those who have been sexually abused by women have the same intolerance, but I doubt it. Teaching tolerance is what she suggests, and what I attempted today. I must admit, of the seven, only two were virulently anti-gay. Two were trying to help me process and two stayed out of it. I just cannot tolerate that kind of hate in the group. It belongs in the yard. I can’t possibly kick the gay guy out; but that leaves me with kicking the intolerants out. Again, a decision without a clear right choice. I guess I just continue forward.

This guy has experienced years of this kind of response, and he is totally capable of fending it off and keeping himself cocooned and safe. It’s not like this makes me happy. It breaks my heart. So today is a breaking my heart day. One guy left early as he could not tolerate the conversation. Do I delve into their own abuse, do we need to go that deep?? Is this group dying and I need to make some change?? Crap.

How do I fix everybody? How do I keep them all safe?

Young@Heart plays at a Hamshire County Jail