During my career, I had the privilege of working with adults living with severe and persistent mental illness in an outpatient program at a local behavioral health center. Although frequently grouped together and labeled as “crazy,” “nuts,” or “dangerous,” this was hardly a homogeneous population. Teenagers, adults, and senior citizens from many different cultural backgrounds were living with varying symptoms and in various stages of the mental illness process—from newly diagnosed to chronic.
Among those I counseled were people with—according to the Diagnostic and Statistical Manual of Mental Disorders—severe depression, anxiety, posttraumatic stress, schizophrenia, and dissociation; some had mixed symptoms of a number of different mental illnesses. Few were employable; many had little, if any, family support; more than half lived in adult congregate living facilities; most survived on Social Security and Medicaid, and many had done so for years.
But then there was the 18-year-old who had been a basketball star at his high school prior to his first psychotic break; the newly married father whose thinking had recently become so disorganized that he found himself unable to keep a job (although he seemed to be functioning adequately as caregiver for his young daughter); the college student recently diagnosed with bipolar and furious with everyone on the treatment team for believing she was behaving at all abnormally; the young woman with suicidal postpartum depression. The people described here are composites based on my actual experiences; real names have not been used to protect confidentiality.
I “cut my teeth” in the counseling profession working with these people, both in group settings and on an individual basis. Theirs is a story of courage and is a testament to the resiliency of the human spirit and to ordinary creativity—the ability to see things in a new light that transforms hopelessness and despair into hope and a reason to keep on living.
Grieving the Loss of Mental Healthcounseling student internship had rolled around. I was having to scramble at the last minute to find a work site, as I had been informed suddenly—a week before the school year was to start—that the program I had been scheduled to work for was no longer available. What to do? The only thing to do was to quickly get into high gear, network, and start making cold calls. The end result—with my start time only delayed by a week—was that I ended up at the behavioral healthcare facility that serves as the setting for the rest of my story.
On the job—outside of sessions, charting, and staff meetings—I began reading the current literature on mental illness. I learned about brain chemistry, psychopharmacology, symptomology, and treatment protocols. I also prepared myself to learn about the human side of mental and emotional distress directly from my clients.
I found a wonderful book that would greatly inform my work with individuals as well as groups. The book is called Grieving Mental Illness, written a year prior to my experience by Virginia Lafond, a Canadian hospital social worker. Rather than speaking in a cold, clinical fashion, the book discusses the impact of mental illness on the individual who directly experiences it—for the first time, the second time, and chronically—from a human perspective. It focuses on the feelings of loss associated with the onset of mental illness for people in therapy, caregivers, and intimates. It covers how to help individuals not only acknowledge and cope with this tremendous sense of loss, but also engender hope for the future and a willingness and desire to go on.
As I got to know people in my sessions on an individual basis, I also became acquainted with the pervasive sense of loss that most of them lived with on an almost perpetual basis. Many were grieving possibilities lost and opportunities never to come to fruition because of an accident of fate, of biochemistry, of environment, or of all of these. Those accidents had attached a seemingly permanent label of “mentally ill,” as though they were doomed to wear a sandwich board while shuffling down the sidewalks of life. To them, that sandwich board read, “Danger—crazy person, looney bin reject, nut job” or whatever the most taunting, hurtful jibe imaginable to them might be.
“What do you mean?” my clinical supervisor queried brusquely in one of our weekly sessions. This person was sharp, knowledgeable, and efficient. She was good at what she did but didn’t have a lot of time to chat.
I said, “I think that many, if not all, of my clients are grieving. I mean that they are grieving the loss of their mental health, having a diagnosis of mental illness, and all of the ambiguous loss that comes along with that. In other words, they’re still here, but in a way they’re not. They know the potential they once had may never be fulfilled. They know there are relationships, jobs, and opportunities they will never have because of their diagnoses. Some of them have never been walked through that grieving process, and it’s stuck to them almost like glue. They feel hopeless. They need to find a reason to go on. I want to work with them on that.”
My supervisor raised a skeptical eyebrow, and we went on to discuss my progress with individual people in my sessions during the previous week. Because I had not been forbidden to do so, I determined to offer grief work to people who wanted help with the process of letting go and moving on.
Putting My Treatment Plan Into Practice
On a particular Monday morning, I came prepared with a new activity for my Mental Illness Awareness group. The first half of the group was spent in open and honest discussion of everyone’s feelings about their mental and emotional difficulties, about the losses they had experienced as a result of those problems, about being labeled mentally ill and misunderstood, and about the stigma of mental illness in the media and in society at large.
They expressed anger, rage, disbelief, sadness, confusion, emptiness, numbness, loss, and grief. They laughed, cried, whispered, and shouted. I sat silently and listened, and eventually I said, “Yes, I get it. You have a right to your feelings. They are normal. You each have experienced a tremendous loss. We will work through this together, and we’ll figure out how to make sense of what has happened to you, what about it you need to accept, and what you can change. And we’ll figure out how to move on from here.”
For the second half of the group, I brought paper and writing instruments. I told them, “Now is an opportunity for you to remember, to identify, and to celebrate all of the parts of you—the complete human being. Yes, you each have a diagnosis, but there is much more to each of you than simply a list of symptoms conveniently labeled so that medical professionals can talk about you in a kind of psychiatric shorthand.”
I continued, “So, here goes. Draw a picture that represents you in the center of your paper. You can draw a face, or a stick person, or whatever suits you, or just write your name. Okay, now I want you to identify as many facets of you as you can think of. Draw something that represents each part of your life somewhere on the paper. Identify each part. Then, connect the parts to the center and to each other. When you’re done, you’ll have a complete picture of yourself.”
After some clarification of what sort of “parts” I was talking about (in other words, not arms, legs, eyes, and ears) they set about drawing. They drew representations of families, friends, pets, favorite foods, flowers, hobbies, talents, interests, support systems, schools, churches, and many other aspects of normal, everyday life that most of us take for granted. These parts were crucial for them to remember if they were to reconstruct coherent personal narratives that would provide meaning for their present situations and hope for the future.
We discussed the drawings and debriefed the exercise. “What did this activity make you think of?” I asked.
“That I am not just a person people think is crazy.”
“It reminded me that there are other sides to me besides what I think about most of the time.”
“That I am special.”
“That I am good at some things.”
“That I can draw.”
“That I can still play basketball.”
“That I am a whole person!”
More responses expressed similar themes.
The remainder of the group discussion focused on each participant picking one forgotten or neglected aspect of themselves that they would focus on during the week. John would go out on the patio and shoot some hoops. Maria said she’d take a long walk with her roommate, stopping to smell the flowers along the way. Lorenzo vowed to remember to watch his favorite show on the comedy channel. Becky planned to play a board game with her sister and her family. Jorge would call the church and ask to have the van pick him up so that he could attend Sunday services. On leaving, it seemed that the mood of each of the participants was brighter, and I noticed some even seemed to be walking taller.
Was this an instant cure for their grief? No, but for some it was a start. Was I a Messiah for having introduced the concept of grieving mental health to a center designated for the treatment of mental illness? No, of course not. As I worked my way through the program, I found the greater part of the staff to be sensitive, supporting, and caring. Self-awareness and self-esteem groups were already in progress, providing great opportunities both for exploring the grief process and for developing creativity and resiliency as coping skills. I was given the opportunity to provide an in-service training to the staff on guiding people in therapy through the process of grieving mental health.
Best of all, the experience provided me with a wonderful opportunity to witness the ability of individuals—sometimes even in dire circumstances—to harness ordinary creativity. Grief temporarily blocks creativity because the person experiencing it has no energy to devote to anything other than just getting by. The simple act of drawing I just described—and the creative connections it spawned—were fledgling acts of defiance against settling for living a life of submission to mental illness.
I believe the philosopher Paul Tillich refers to both ordinary creativity and resilience in his wonderful book The Courage to Be. According to Tillich, even when we can’t see the purpose, the reason for existence, or the reason to go on, we go on anyway—and in going on, we find meaning and purpose. That is the gift of understanding ordinary creativity that I received from people in my sessions during that internship experience. I will thank them eternally.
- Lafond, V. (2002). Grieving mental illness a guide for patients and their caregivers (2nd ed.). Toronto: University of Toronto Press.
- Tillich, P. (1952). The courage to be. New Haven, CT: Yale University Press.
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