DIGNITY

AWAKENING TO AN OLD WORLD

As any reader of my blog knows, the outcome of the U. S. presidential election was not what I was hoping for.  When I awoke the  morning after, I felt as if I had awakened to a different world - a familiar place that felt old and tiring.  My anxiety level was very high as I went to bed that Tuesday night, watching the map turn increasingly red, and I awoke during the wee hours of Wednesday morning because I couldn't stop thinking about it to check how things were going only to see that they weren't going well for Mrs. Clinton and the indication was the Mr. Trump would be elected.   

When I officially got out of bed on Wednesday and confirmed that Mr. Trump was now President-elect Trump, I would be lying if I didn't say I was depressed and feeling somewhat disorientated. I couldn't turn on the television.  I didn't want to hear the pundits go through their antics of asking and analyzing their own questions. 

I needed silence to ponder my own questions and the gnawing fear that has been with me since the start of this election season started.  I wasn't motivated to do much that day, and recognizing this, I sat myself down, took a few deep breaths and tried to let reason return to my anxious mind.  By the afternoon, I was able to read and listen to Hillary Clinton's post election speech, which comforted me a great deal as she reminded me and everyone else that President-elect Trump deserved being offered an open mind.  Later, I heard President Obama tell the American people that he sincerely wished Mr. Trump success as our soon to be next president, that we are all rooting for him because we're on the same team.  Mr. Trump also spoke about the divide that exists in this country and his wanting to heal that divide and bring us together.  I hope for all of our sakes and for the sake of the world he does just that.

Those brief dignified moments were missing from a frequently vitriolic and contentious presidential campaign that devolved into labeling whole groups of people; such as, "bad hombres" and "deplorables." Those few post-election acts of dignity calmed me and allowed me the space I needed to process my feelings and gather my thoughts.

Although it is tempting to engage in the great pastime of post-election speculation about the why's, the how's, and the what nows, I will try to avoid doing so. Instead, while the thought of dignity is fresh in my mind, I thought I'd write a post about it.

If you're a regular reader of my posts, you may recall  that I worked in the field of mental health my entire adult life, working 38 years in my state's mental health hospital where, for the last fourteen years before I retired, I was that institution's first Human Rights Specialist.

AN EDUCATION IN DIGNITY

When I became a Human Rights Specialist, I received my best training from the patients I served.  I also had to quickly get up to speed with our state's statutes, federal laws, and the hospital's voluminous policies associated with the issue of human rights.  What is probably found in every states' statutes regarding patient rights is a statute that addresses the issue of dignity.  In my state, the statute read that a "person"  had a right to humane environment that gave them individual dignity, as opposed to other clauses that were prefixed by adjectives like an "appropriate" this or a "reasonable" that.

Being of a philosophical bend, I pondered long and hard on the simple fact that the people we served in our mental hospital had an undefined "RIGHT" to INDIVIDUAL DIGNITY.

The questions that immediately came to mind is who or what determines what an individual's dignity is, if not the individual?  

How do I, as an advocate for a patient suffering from a mental illness, protect that patient's sense of dignity should it be counter to what others working in the hospital consider to be a"common sense" meaning  of dignity?

What I intuitively knew from working in mental health and was quickly validated in this new role is that individual dignity is maintained, first and foremost, by being heard.  I found myself listening, literally for hours at a time, to individuals who were very ill try to explain their needs to me often through expressions of anger, delusion, and illness that often masked sincere and valid concerns which most direct care staff didn't have the time to sift through.

I was not their therapist.  I didn't offer advice on how to cope with their illnesses, but rather to listen through their illness to discern the voice of the person speaking to me.  In finding that voice, what I found (and was also acknowledged by some treatment teams) was that through the patient's experience of being heard, the patient felt better, acted better, and was better able to communicate valid concerns to that individual's treatment team. 

State mental health institutions are a microcosm of the world-at-large.  Almost every social issue that our world faces will pool in a mental health facility.  In my role as an advocate, I dealt with racism, homophobia, sexism, xenophobia, ageism (both old and young versions), and religious rights, along with a host of other issues. We served patients from around the world and so there were also cultural issues that arose from time to time.  All of these concerns and issues revolved around and were effectively resolved when the individual's personal sense of dignity was maintained.

DIGNITY AND SAFETY

As can be expected, safety is the primary concern of every inpatient mental health hospital.  Trying to maintain a safe treatment environment for individuals who are affected by severe mental illness or emotional disturbances that render them unstable and at risk of harming themselves or others is no small task.  The hospital were I worked was very safety-aware. In fact, it was so safety-aware, that the right to individual dignity could and was, at times, overridden by safety concerns or, to be more succinct, the fear, on the part of those in charge of patient care, of the fallout that could happen should a patient do harm to self or others.

Care on the part of care providers that is highly motivated and based on a CYA (Cover Your Ass) approach to care delivery is very prone to ignore the person in the patient and the patient's right to individual dignity.  Anyone, in any form of health care, has been trained in the CYA approach by the institutions they work for as a means to avoid litigation.  When I worked in direct care, I certainly well aware of that approach, but as a Human Rights Specialist I saw where this approach could become very counterproductive and, in fact, inadvertently put patients and the hospital at risk.

A MINOR MIGRATION

When I began my career as a Human Rights Specialist, my state was faced with a crisis involving the closing of its juvenile justice's  "training" facility which directly impacted our hospital as it became the depository of a large number of juvenile offenders displaced by the closure of the facility that once housed them.  It was a forced migration that had the hospital's adolescent program scrambling for space and facing a behavior control crisis of its own.

The result was that individuals with behavioral and legal issues had to be blended in with individuals who had extreme emotional and mental health issues because of space and staffing availability. It was a clash of two different institutional cultures being forced to coexist. Behavioral chaos was the result, and soon I was hearing from adolescent patients complaining about a number of issues.

When humanitarian chaos erupts, the individual is easily lost.  The adolescent staff, many of whom were not much older than the adolescent patients in their care were experientially ill equipped to handle such a drastic change to their work environment. The other factor that played a role in the chaos had to do with how the whole adolescent population was viewed.  They were "minors."  

It's an interesting term, minor, in that minors are subject to whole set of law pertaining to their rights at various stages of their age of minority. Just being a minor can curtail the right to individual dignity that pertains to all people regardless of one's age, and minors can find themselves at a loss with how to deal with the adults in their lives who are prone to ignore anything a minor has to say. 

LIFE IN A PETRI DISH



Dignity became a major issue on one adolescent unit in particular when I first started my new role.  With the influx of juvenile offenders from the justice system into our hospital, one unit, in particular was reserved primarily for patients with the most severe emotional problems associated with adolescent mental health.  This made a lot of sense due to the mix of adolescent in the hospital, but given the extreme emotional and mental health issues pooled on this one unit, the level of staff anxiety and fear regarding patient and their own safety consumed them.



My initial exposure to adolescent care started on this unit with a call from one of their patients. Prior to his call, I had worked as a direct care giver in the hospital adult acute care program.   My understanding of the hospital was largely based on my experiences there and was not until this young man's call that I understood that there were actually five different hospitals housed in one facility, each with its own care history and culture; the adolescent program being the most divergent in its approach to patient care from what I was familiar with. 

When I arrived on this unit, I witnessed a literal verbal siege taking place, with staff on their side of the desk lobbing verbal directives to the patients on the other side of the desk, who largely deflected them.  While this was taking place and the patient who called me was being summoned my direction, one staff member told me, "He's the worst patient we have. He's going to be here for the rest of his life." 

The patient was fourteen.

The patient and I were taken to a group room where the staff left the two of us together and closed the door behind them which, given the description of this young man, struck me as perhaps indicating the staff had an agenda in mind.  After introductions, I asked the patient how I could help.  He described an incident that was not in keeping with concept of individual dignity or safety but rather was done, from what I could gather from the patient, out expediency on the part of the unit's staff and would, if found to be factual, violate hospital policy on a number of levels.

About a minute after explaining the incident to me, the patient began a verbal tirade against me, the staff, and the hospital.  He used words and twists of phrases that I thought only sailors would know.  This tirade lasted fifteen minutes.  I know because there was a wall clock behind the patient.  I didn't interrupt his tirade. In fact, I zoned most of it out because it didn't make a lot of sense.  After he seemed to be done, I was able to interject and validate that he had very strong feelings, and then he started in again for another five minute. 

Finally, he got all of his pent up anger out and recognized I was still there listening to him.  As a result of this tumultuous introduction to adolescent care, I was, in very short time, able to find a  number of systemic issues that needed to be addressed; issues that infringed upon the right to individual dignity under the guise of unit safety.

The overt safety concerns of that unit's treatment team created an unrealistic fear that resulted in  invisible walls being built by the use of blue masking tape on the floor to separate certain types of patients from one another.  All patients, at the time, had to take their mattresses off their beds at night and sleep in the hallway in order to be observed by staff who sat in each hallway.  Patients were not permitted off the unit to attend other adolescent activities because of concerns about the juvenile offender presence.  Patients couldn't cross certain blue lines without getting into trouble.  Patients were assigned rooms, but were not allowed in them unless supervised by staff.  All of these efforts became targets and challenges the patients could and did use to get the individual attention they inwardly craved, even if it was negative.

The result was that patients on this unit developed a behavioral economy they controlled.  Good behaviors did not get patients anywhere, "bad" behavior did.  If your behaviors were bad enough, chaotic enough, you could get privacy by being detained in seclusion.  If you and your comrades-in-arms worked together and managed to fill all the seclusion rooms, you could get transferred, even if temporarily, to another unit because one's friends were occupying that unit's seclusion areas. In one case, it led to a patient being permanently transferred to a different unit.

Unit rules changed about every day to address anything viewed as some sort of infraction of conduct.  They were literally handwritten and taped to the wall behind the nurse's station. These dysfunctional approaches to treatment would have been obvious to most, but the staff on the unit were not seeing it.  They were too close to it, too obsessed with putting out fires with the very things that were actually fueling and fanning them. They simply were unable to see a way out of the corner they painted themselves into.

Ironically, the ones who saw it for what it was were the patients who, in fact, told me exactly how "their" system worked.   Metaphorically, the unit became a plugged septic system of dysfunctional behavior.  Even psychiatrists were oblivious to the obvious because of the "minor" status of the patients who had bettered them.

Eventually, things changed when, under new unit management, the unit's protocols were refined and limited to necessities.  Patients were allowed off the unit to participate in adolescent activities with other units. Patients were eventually allowed to have off unit jobs that not only allowed them to earn some money, but increased their sense of self worth. The unit's treatment team developed a fail-safe treatment agenda that extinguished the potency of bad behavior and facilitated safe patient privacy which underscored the importance of individual dignity.   Eventually, behavioral incidents became the exception not the rule on that unit.

HEALING WOUNDS THAT DIVIDE US WITH THE BALM OF HUMAN DIGNITY

My point in sharing this experience is that what happened in the microcosmic petri dish of that adolescent psychiatric unit some sixteen years ago appears relevant to the macrocosmic chaos being played out in today's world. 

I had a choice on how to respond to that fourteen year old's tirade, I was almost old enough to be his grandfather and his language certainly reflected what the staff on his unit described him as, but I chose to hear him out and not become offended by his language or his attitude towards me at the moment.  I learned on that adolescent unit that people live up to the expectations others have of them, especially if there is no way to change the expectation others have. This is particularly true of children and I believe it is true for humans in general.

The result was that this fourteen year old never used inappropriate language with me. He was polite, respectful, and was eventually discharged from the hospital as an adolescent.  I never addressed how patients talked to me during my time as a Human Rights Specialist, but rather I sought to get their message. Just getting the message frequently, if not invariably,  resulted in a change for the better.  I think most adults know this, but it seems to be knowledge that isn't being applied on a regular basis. We have grown impatient with one another and patience is not only a virtue but a necessity on everyone's parts in moving forward.

I think one can see the applicability of my hospital experience to the world we live and the challenges we face in the United States, post-election.  There are stressors that have affected global and national perspectives based on the migration of whole populations across borders - individuals seeking a better life - seeking life due to economic hardship, terroristic violence, and warfare.  There is fear created by the unpredictable behavior of lone wolves of every kind who take it upon themselves to wreak havoc on the public square.  There are large numbers of people who have seen their quality of life decrease with a sluggish job market where pay hasn't caught up to the pre-recession level.  All of these things helped bring about the election results that we have in the hope that they will be meaningfully and peacefully addressed.

Unfortunately, the vitriolic, labeling language of this election has given rise to expressions of hate towards individuals based on their race or religious beliefs or sexual orientation by extremist groups; in particular, white nationalist extremists in the West. There is clearly a lot of work to do to relieve the fear that creates such hate.  Listening to the voice of fear and hate is hard to do, but necessary to understand the underlying dysfunction that causes it.  Moving past entrenched ideological beliefs that foments anger which functions much the same way chronic anger masks delusions and paranoia found in mental health is vital in exposing the person behind the ideological mask. 

A determined ear does much to soften the hardened heart.

One of the most dignified acts that recently occurred after the election was demonstrated by our vice-president elect, Mr. Pence. After attending the musical "Hamilton," the cast respectfully addressed Mr. Pence in order to make an appeal for the incoming administration to respect the diversity that makes this nation great.  Mr. Pence respectfully turned to listen to their appeal before exiting the theatre.

That was a healing moment that did much to reassure a great many people that night.    Mr. Pence made it clear he did not feel bullied and was not offended by the cast's comments.  His calm created calm, if for a brief but enlightening moment.

Listening sets the stage for being heard. Treating the individual on the stage or on the street with the balm of dignity has a way of penetrating deeply to heal the wounds that divide us.  We don't have to agree in order to be respectful or treat others with dignity. Sincerity is conveyed through respecting the dignity of the other by listening patiently before exiting. There are many voices in world wanting to be heard.  Listening to them and seeking the true message will create a calmer more peaceful world.

   "There is a balm in Gilead to make the wounded whole."

                     From an African-American spiritual.

Until next time, stay faithful.