Mirror Mind
“I had the dream again last night. I’m in this room with a sink and toilet and bed, no doors, no privacy. There’s one mirror, and I can’t stop looking at that mirror because there’s a picture reflected in the mirror. I can’t turn around and look directly at the picture. I can’t never figure out what that damn picture is. Sometimes it’s a horse turned in different directions, sometimes it’s a flower made out of LEGOs, sometimes it’s nothing but paint that looks like scars, sometimes it looks like a skinned deer ….”
She shifted a little in the man-sized, uncomfortable office chair, trying not to signal her next question.
Too late, though. James Adkins paused, sensing what she was going to say. James was a tense, skinny 35-year-old recovering addict from Kentucky, his arms covered in tattoos. He sat bent over as he perched on a chair opposite Missy Taylor, his elbows leaning on his knees. His lower arms were a minefield of bruises and collapsed veins. He had been in and out of recovery programs and the mental health care system for most of his life.
He looked up at young Missy, expectantly. She pressed her knees together in a demure angle, and felt self-conscious. “Uh, so, what kinds of feelings do you have when you think about those things, like a ‘ LEGO flower,’ or a ‘skinned deer.’
James Adkins grinned.
Missy dampened a little burst of annoyance and impatience. Don’t let him control this session…. She studiously glanced over James’ shoulder, through the glass wall of their small office cubicle. Beyond was the nurses’ station of the Adult Unit of the Psychiatric Hospital, and on the other side of the nurses’ station, lined up along the wall, were another six patients, awaiting their thirty minutes of therapy with Missy Taylor, not-quite-LPC.
James laughed in a quiet, grunting way. “You know, them nurses are not giving me my Ativan when I ask for it. I’m on the protocol, and they should give me my Ativan and Haldol every two hours, if I need it.”
“I’m sure, James, that they know what they are doing. You need to discuss your medication problems with the psychiatrist. I can’t do anything about it.” Missy glanced at her watch, and realized James Adkins had once again successfully redirected her, not the other way around.
Later that afternoon, after Missy Taylor had finished with her last patient, she attended a treatment team meeting in the conference room next to the nurses’ station. Besides herself, there were two nurses, the psychiatrist on duty, a case worker, and an administrator of the hospital present. She absently drew a LEGO flower in the margin of her notes, then sketched a cubistic horse and something resembling a wounded deer while the psychiatrist, Dr. Spano, said what he usually said each week at these meetings.
“Some of these patients are manipulators of the highest order. Don’t forget that. There is nothing more we can do for them. They are med-seeking. They are junkies and drunks and know what to say and what to do to get what they want. They’ve been part of the system for so many years, they know exactly what to say, how to act, how far they can push staff.”
Missy still wanted to believe that she, they, were doing some good. That men like James Adkins appreciated all their work, and that she had helped James Adkins, even if a little bit. “I think you are generalizing,” she said aloud to Dr. Spano, like she often did. “You can’t ever really know a patient’s mind. You only see a reflection of that mind, and you can’t ever see the truth of what is really going on. Every substance abuse patient is a dual-diagnosis, every one of them needs help. You can’t always presume your patient is lying to you and manipulating you.”
The nurses laughed, the administrator smirked, the doctor snorted. And he said, as he always said when Missy protested, “You’ll learn the hard way, Missy. You haven’t been dealing with these people as long as we have. The addictive personality is above all narcissistic, only interested in self-preservation.”
Missy did not press the argument, she never did. She stretched her mouth into a smile, nodded mechanically, and looked down at her notes. She glanced again at her doodles; the LEGO daisy, the flayed deer, the cubistic stick horse. Unconditional positive regard, unconditional positive regard, unconditional positive regard … she repeated to herself, the mantra of the Rogerian.
Nicolas Papaconstantinou
Wonderfully written piece, Rivka. Lots going on, in that it gives you something to think about – though in the later passages our sympathy is with Missy’s point of view, her session with James Adkins would tend to point to impending disillusionment, or a long life of frustration.
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Rivka Jacobs
Thanks for the response to “Mirror Mind.” I just saw this Recent Comments section. Sorry for not answering sooner!
You are entirely correct about where the sympathy lies. But this is a real argument, that I’ve had both working as a counselor and as a psych nurse. Counselors in particular are taught that we should NEVER judge clients, and give them unconditional positive regard, and presume everyone is capable of some growth and change. On the other hand, when working with substance abuse clients, it is so hard to not become cynical. There is a certain validity to the other point of view. But no mental health professional should give up the POSSIBILITY that a client can be helped, even in the smallest way, by the therapist, doctor, support group, etc.
Thanks again for the response!
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Paty Cockrum
then again… brick walls are brick walls and beating your head against them only give you a bloody forhead and a headache.
I think… having worked minimally in a psychiactric hospital and having been exposed to it all my young life by my mother who ws, for years, a social worker with all kinds of mentally handicapped people, and who would sometimes discuss a case with me just to get another point of view, which I freely gave and which, sometimes, helped her to come at a problem from another angle… that each case has to be looked at separately… and that the ability to judge what is likely to be the outcome of therapy only comes with a lot of time and practice and mondo bloody foreheads and headaches.
I thoroughly admire the hearty souls who can do this and not burn out rapidly. it seems to be a thankless and endless job, rife with frustration… which is probably why some get very jaded and cynical… and not so much with the mentally deficient… but with drug users and addicts who have chosen to be as they are and would willingly, in many cases, go back to it until death did them part from their drug of choice.
One wonders if there are addict ghosts…
Paty
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