Living with mental patients

– Earlier version in Dr. William Glasser’s JOURNAL OF REALITY THERAPY, Spg ’83.
who said it was, ‘…one of the most important papers I have read in a long time’.

– Dr. Garth Wood (The Myth of Neurosis) said it was ‘… wonderfully perceptive …’.

Most people would be surprised to learn what mental (not retarded) patients are like. I started and ran a home for them (men in their 20s and 30s), living with them for two years. It took a lot of time, discussion, and soulsearching to appreciate their characteristics. I concluded they were l0% ‘crazy’ and 90% spoiled, immature, and irresponsible.

Self centered ………………………………….	|	……….. selfish
Past dependence on folks ………………….	|	………… cling to folks
Low self esteem ………………………………	|	………… refuse to take pride.
Unmotivated …………………………………..	|	………… lazy
Rigid, unassertive, overly sensitive, resentful	|	unhygienic

Identity problems, buried emotions, isolated, private logic (the ‘crazy’ part)	| | | } little effort to resolve these
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^	| ^     ^
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(view of professionals)	| (view of non-professionals)

They had little interest in criminal activity; and were basically nonviolent. Their use of soft drugs and alcohol was minor; and, while they abused property, they didn’t steal it.

They were more normal than you’d think. Although they seemed unaware of things, they were. When it looked as if there was going to be a fight in the house or when a historic event appeared on TV, they emerged from the woodwork to watch and later drift off as if nothing had happened.

Many were nice, gentle, even ingratiating, and could have gone far on personality alone.

Many didn’t know how to hang laundry, mow lawns, mop floors, wash dishes, or other chores, and … were not about to learn! If they wouldn’t do these, they wouldn’t do all the other ‘normal’ things [hygiene, grooming, manners, exercise, laundry, money management, hobbies, etc.]. No wonder they were depressed. I see this as the first major clue. It is probably given little notice in the mental health field because of the field’s aversion to ‘judge’. It’s important as it takes some of the mystery out of the work.

Patients felt life was supposed to come to them. When it didn’t, they resented it and spent time twisting their ideas to fill the void. They had far too much time for this. If they had been required to be busy, it would have helped. Work of any kind, in a sheltered workshop or volunteer work, would have been a godsend; but amazingly, their counselors told them they weren’t ‘ready’.

They didn’t think they had much to offer, and thus looked for things to come to them. Thus they thought too much of the staff and not enough of themselves. They would take up the staff’s time with matters they could have solved among themselves. They could be easily dominated and manipulated by the staff; they wouldn’t stick up for themselves.

Some of them and their parents were far too close; you couldn’t get them apart with a crowbar.

To speak negatively about patients is to stick one’s neck out; but most of their behavior was extremely irresponsible. When this came up, social workers had a thousand excuses:
– If a patient didn’t want to get out of bed, he had a ‘problem’ with this.
– If he didn’t wash or bathe, there was a ‘mental’ factor.
– If he didn’t want to do chores ‘authority problem.’
– He wouldn’t go to his day program ‘withdrawal.’
– Nor take his pills ‘rebellion.’
– He was bored ‘lack of stimulating environment.’
– He fidgeted constantly ‘agitated’ (or 20 cups of coffee?).
– He was uncooperative because the staff hadn’t ‘understood,’ been ‘compassionate,’ or been a ‘friend.’
– He wouldn’t cooperate with his parents ‘delusional system.’
(It got so you couldn’t look at him sideways without setting off another ‘neurosis.’)

Once you got past the excuses, you could see patients were irresponsible: One damaged a lawn mower. Was he sorry? No. Was he sorry it happened? No.

Other examples: reading in the front room on Halloween with the house lit and not answering the door when kids knocked; sneezing into the refrigerator; coughing on clean dishes; revolting table manners; never using ‘please, thank you, or excuse me’; and one patient’s dumping a pot of pudding down the drain in front of the rest of us because HE needed the pot. In these ways they ‘walked on’ each other and everything the home stood for. They did these things and wondered why they didn’t have friends. There was no excuse for such behavior if they had pride; but pride or shame meant responsibility.

– I can drive a car (but not make a bed).

– You’re treating me like a kid (though I’m acting like one).

– I’m sorry (but not enough to make up for what I did).

– The hospital, my folks, or my pills caused my troubles. (hardly).

– My Dr. doesn’t want to hear from you. (nonsense).

– I’m 80% disabled. (absurd).

– No one has had it as rough as I. (hardly).

– I am paying to stay here. (The government was paying).

– Too many confrontational house meetings. (too much reality).

– I’m moving (cause I’m out of games).

Their irresponsibility showed in extreme laziness: they sat indoors in perfect weather, turned down rides to the beach, never made anything in the kitchen that took effort, and would open doors, but not close them. Trying to get them to do a half hour of chores was the worst part of the day.

The average person does more in a day than they did in a month. They were ‘nervous, but had no energy’. They had big plans, but did nothing. None read a book, few watched TV, most had no hobbies, few looked for work, and most never exercised. They spoiled themselves with coffee, cigarettes, food, sweets, selfanalysis, pleasure, entertainment, and favors. They spent l0l6 hours a day in bed as an escape. None had an alarm clock. They didn’t own or use a deodorant, nor shower daily. Some didn’t change their underwear or socks and slept in their clothes. They would have lived in filth, if permitted. Fresh air had to be let in continually, which ran up the utilities. Allowing smoking inside would have been the kiss of death. They talked of becoming independent of their folks, but went home at the slightest excuse. Some even moved back home where everything was done for them and they ‘slept’ all day.

Many acted like they were the only person on earth, the only one to have problems, or the one whose problems came before everyone else’s. Their conversation always came back to themselves. ‘I, me, mine, and my’ were sacred pronouns. Two people would be talking and from out of the blue, a patient would interrupt with something about himself.

There were house meetings to discuss these problems. Such meetings gave them some of the attention they craved by spending time on their problems, but also showed they had to sit through someone else’s problems. They resented this. They resented things that didn’t go their way, efforts to help them, or suggestions they observe basic courtesy or table manners. (Sometimes you wondered if they resented the sun coming up.)

Most had one or more emotion deeply buried and eating away. Many didn’t know where they fit with their families or society. As they lived in their private worlds, they were the world’s loneliest people their own Robinson Crusoes. One got so lonely at home, he called wrong numbers just to talk to someone.

One believed the TV could read his mind, another believed everyone was trying to run him off the road, and others thought they were in touch with spirits. These mental factors are the stuff of Hollywood; but, while often touching and important in some ways, they were a minor part of their behavior. This is important to keep this in mind as too often mental illness is viewed as total craziness. It’s not; after one gets to know them and their subtleties, their behavior is fairly understandable. The craziness is minor; most of their behavior is depressed and withdrawn.

On a deeper level, some seemed to unconsciously induce craziness when it suited them. One went into a state of agitation when social workers were present, threatening a brain seizure if he didn’t get his way. I had never seen him like this. Another time, according to an operator of another home, ‘out of control’ patients ‘regained’ control when the police arrived.

These are reasons for keeping good records and collaborating, but at this level neither existed. At higher levels professionals didn’t read records because they didn’t want to be ‘prejudiced’.

Each day of nothingness was excruciatingly boring for patients, but it was easy  exactly what they wanted, no matter the price. One, who recovered and started her own home, would tell patients, ‘It’s easy to be crazy, stop playing the ‘sick’ game’.

They weren’t devious, they just didn’t want to grow up. One on TV said he was as afraid of getting well as staying sick. Another said, ‘Being this way lets me do the things I want.’
The public assumes they want to get well. Most didn’t, and the incredible games (religious and otherwise) their minds came up with was testimony to the power of the mind. In their ways, each had moved a mountain.

They didn’t want to hear most of their behavior was spoiled, immature and irresponsible. Their relatives didn’t want to hear it, and professionals didn’t want to hear it. It was too simple an explanation for something they had had so much training for. Everyone wanted mental illness to be technical, chemical, biological, or hereditary, which only perpetuated the mysteriousness and hopelessness of it all.

Others who ran homes for patients agreed with this, and even patients agreed. This should be researched, starting with patients and nonprofessionals. Such a bottom-up approach would offer more hope (and put holes in the insanity plea).

It would show patients are dying to be stood up to. But in my experience no one would; inexcusable behavior was continually excused with theories. Round and round it went  a buck passer’s paradise for professionals, a snake pit for the rest. (Who was crazier, patients or staff?) Add to this the empty existence of patients, and a suicide should surprise no one.

The field needs to get down to basics: traditional values (accountability, hygiene, manners, chores, etc.), confrontation, sheltered workshops, and competitive employment. It’s pointless to counsel patients on big responsibilities while ignoring small ones.

My observations fit Dr. William Glasser’s (author of REALITY THERAPY): If there is no organic cause of a patient’s problem, his condition comes from trying to fill his needs irresponsibly. He can only get better by becoming more responsible. He is not to be treated as ‘ill’, but confronted with reality through group therapy and taught better behavior. He is also to work (which most programs virtually ignore).

The following (untested) could be developed.

1-2 poor 3-4 adequate 5-6 very good

short term memory ___ long term memory ___ atten. span _____

good judgment ___ common sense ___ alert ___ aware ___

manages $ well ___ in touch with feelings____

assertive ___ realistic ___ flexible ___ responsible ___

confident ___ moderate ___ active ___ positive ___

openminded ___ pride ___ empathy ___ humor ___

foresight ___ contributes ____

work habits ___ selfdiscipline ___ honesty ___

hygiene ___ attire ___ grooming ___

general manners ___ table manners ___

takes care of room and belongings ____

___knows chores ____ does chores

deluded ___ hostile ___ compulsive ___ confused ___

withdrawn ___ preoccupied ___ tense ___ hyper ___

frustrated ___ adverse to physical contact ___

sexual problems ___ gets lost ____

childish ___ spoiled ___ selfish ___ stubborn ___

craves attention ___ wants magical relationships ___ clings to folks ___

expresses feelings inappropriately _____

lazy ___ bored ___ spoils self ___

plays head games ___ postpones _____

defensive ___ resentful ___ uses others ___