"Untitled," Jackson Pollack, 1943. Guggenheim Museum, NY"Howard" was my patient for many months, many years ago, his name and identifying details have been changed.Howard came to us when his sister dropped him off at our Behavioral Health Emergency Room. “He’s only been here two days, but he’s dangerous, unpredictable…I’m afraid he’ll hurt my kids,” is what his sister said to the intake worker. Then she left; leaving Howard with us for treatment with only these, the condemnatory benediction of the last member of his family willing to care for him and the clothes on his back.
Howard was twenty–five years old. His wild curly, black hair stuck out all around his head and reached half way down his back. The dirty, unkempt beard on his face was matted and wet; the wetness a result of the constant stream of drool that poured out of his mouth. The steady stream was a side effect of one of the meds he was taking for his schizophrenia. Sadly, for Howard, this med, a sort of drug of last resort for schizophrenia seemed to do little to relieve his suffering, leaving him to contend with this indignity and some other much more dangerous side effects. One more assault to the dignity of a young man for whom such a basic human need was already a rare commodity.
As we came to know Howard slowly over the ensuing months, we learned quickly that his sister’s “diagnosis” was, if not compassionate, correct. Howard was dangerous and unpredictable. When the voices and hallucinations became more than he could tolerate, Howard became violent. He sent two mental health counselors to the ER and broke several chairs and tables before the doctor discovered a combination of medications, which enabled him to control his behavior.
Though they never visited again, Howard’s family did call the unit occasionally. Most often to call was a brother from Arkansas where Howard grew up. It was this brother who, unable to care for Howard himself, had put him on a bus to the sister in the Chicago suburbs. According to his brother, Howard was, “scaring the neighbors” and had to be sent away before the neighbors turned violently against Howard. It was from this brother that we learned more about Howard’s story.
Howard was diagnosed with learning and emotional disabilities in grade school. He was always in special classes, according to his brother. Because of this, he had difficulty fitting in with the other children at school and, though he tried very hard to make friends, never found them.
By junior high the other kids, especially the boys, loved to taunt Howard. They would pretend to be his friend only to take advantage of him. As they grew older the taunting became more physical, with school yard beatings a daily occurrence. By high school the other boys were feeding Howard hallucinogenic drugs so they could watch “the retard go crazy.” Sadly, all the while, Howard sought only their friendship. In those days, Howard was the victim of the ignorant violence.
By the time we came to know Howard, it was impossible to tell mental illness and disabilities from the brain damage that resulted from the repeated head traumas of the beatings he sustained at the hands of others and his long-term use of hallucinogenic drugs which he became addicted to by those same hands.
Once his behavior was under control, Howard was integrated into the unit milieu which was dedicated to treating people struggling with psychotic illnesses. A part of that treatment included daily participation the in Spirituality Groups I led. These groups focused not so much on great spiritual or theological truths, but rather more on enhancing the patient’s self-esteem, encouraging patients to value themselves and their miraculous abilities to live in hope that treatment would bring them relief. We would focus too on the courage they manifested daily vis-Ã -vis their years of suffering and anguish, from both their diseases and our meager and often harrowing attempts at ameliorating their pain.
Howard came to Spirituality Group, day after day, and I wondered how much of the group content he was taking in. Whenever it came to be Howard’s turn, he would sit and stare seemingly unhearing, with that at once pained and flat, preoccupied look schizophrenics often have on their faces. Or he would answer in his own uniquely disorganized speech, which seemed to combine elements of what is termed clanging and word salad: “Jesus loves me this I know for the Bible tells me so, I pledge allegiance to the flag and to the republic for which it stands, ABCDEFGHIJ, I love to tell the story of Jesus and his glory…”
Clearly, from these nonsense sentences, Howard had been “churched” by someone at some time in his life. But it was impossible to tell just what that meant for him. And I anguished over how to respond to him. For me, the most important part of the group experience was being able to offer a place where the patients could feel, if only for a moment, valued in their humanity; a place where maybe, in that moment, we could glimpse together the beauty of their inherent dignity before God. That, I think can do more for healing than any group program or content. If Howard had had an experience in church that in any way resembled his school experiences, I was hesitant to affirm his religious ramblings. On the other hand, Howard kept coming back to the group. Group was not mandatory, but was offered and strongly encouraged, as were all groups, every day.
One day, with much fear and trembling , I responded to him, “Howard, Jesus loves you.” The bottom dropped out of my stomach as I held my breath waiting for some pained or angered response. None came. In fact his affect never changed. I tried it again the next day, “Howard, Jesus loves you.” Still no change in affect and Howard kept coming back to group. This soon became our day ritual in Spirituality Group.
1:1’s followed a similar pattern. Howard would seek me on the unit and approach me to talk. His sense of social distance for discourse was about six inches from my nose, so every encounter began with my reminding him that I needed my space while gently placing my arm around him and establishing an appropriate distance by turning us both slightly sideways. Sometimes in our 1:1’s there was silence between us and at others he would talk a blue streak in that distinct style of his, “Jesus loves me this I know for the Bible tells me so, I pledge allegiance to the flag and to the republic for which it stands, ABCDEFGHIJ, I love to tell the story of Jesus and his glory…” Always I would respond, “Howard, Jesus loves you.”
Howard was hospitalized with us for about six months before he was transferred to the State Hospital. Not long before his transfer, Howard stopped me in the hall one day, again establishing himself no more than six inches from my nose. As I put my arm around him to establish a more appropriate distance between us, I noticed something different about Howard. In that moment he was standing straighter, his face no longer bore that pained-flat, preoccupied schizophrenic affect and the flow of drool had stopped. Howard gently reached out and touched my shoulder, looked me square in the eye and said, “Bless you.” Then he turned and walked away.
I wanted to cry. To beg Jesus to cast his demons into swine that would hurl themselves out our third floor unit windows*. When I regained my composure, I looked to Howard who was then sitting in his favorite chair by the nursing station. The flow of drool had returned, as had the pained-flat, preoccupied schizophrenic affect. Howard was once again as he had been. I would never be in this ministry in quite the same way again.
*Mark 5:1- 13
