Psyched Out

I loved it, captivating prose and a rollicking gothic plot. It was largely about the love of reading itself and what it means to be a reader. One of the best things about eighteenth and nineteenth century novels is that in addition to the plot working itself out there is usually an accompanying examination of the human condition. _Pride and Prejudice_ examines personal honor. _Jane Eyre_ examines the line between originality and insanity. _The Idiot_ examines humanity and divinity. This novel has that quality. If you want to read a contemporary author who resembles older writers, Diane Setterfield is your woman.

I'm joining a book club this week, and I had never heard of _The Thirteenth Tale_ because I'm very ignorant about contemporary writers. I know there ARE writers now who are every bit as good as Jane Austen or George Eliot, I just don't know who they are or how to find out about them. So I'm joining a pair of book clubs.

In addition to the introduction to contemporary authors the clubs will provide, joining will revive two aspects of MY life that have lain dormant for about seven years. As you can imagine, baby and toddler and preschool twins take up a lot of time. They are time vampires. I'm only just beginning to have time to read again. Also, the move to Michigan means I have no friends who are mine alone. My husband's friends are wonderful people and I love them, but none of them is a friend that I made on my own. I'm hoping to become friends with some of my book club peers. Even if that doesn't happen, I will at least be socializing with people who have a common interest, which is no bad thing.

So this week I started working full time again. My body is unhappy with getting up hours before the usual time, but not as unhappy as I'd dreaded. This week I have been going to bed mostly on time. Except when I was reading _The Thirteenth Tale_ and I could barely pull myself away. More about that in the next post.

I had some concern that I wouldn't have enough to do to fill forty hours a week. I had forgotten how much busier mornings are than afternoons. In addition, people who were not giving me afternoon work before are now doing it because I'm more likely to be able to schedule something at six hours' notice than at one hour's notice. With a whole day available it is much simpler to fit things in, because many tasks are flexible in their timing.

But the highlight of the week was puking in a patient's yard while helping her pack for inpatient care. I have never puked outdoors before, because I don't get alcohol poisoning now and didn't get it in college either. Since I was not intoxicated, I was aware of the social milieu and therefore profoundly embarrassed. To use a social work word, it was "inappropriate." The patient was so nice about it that I was doubly ashamed of myself. She said something about rain being in the forecast and being sure it would be gone by the time she got home. Isn't it funny how some people while ill are gracious even when they feel irritable, and some people are uncivil when they are at the height of health?

My twins brought Mother's Day presents home from school today. This is the first time since they are in kindergarten this year. The gifts were in white lunch bags with flowers drawn on them and attached was a list of words and phrases they wrote about me.

My daughter's says "MOM: Mom love me, hug,kiss me, lic me, MOM." I am not sure if she meant like or lick by "lic", but this is a disclaimer that I do not lick my children on a regular basis. Occasionally we play puppies and there is a positive history of licking involved, I admit. I have no dignity while playing. My son's says, "MOM: loves me, soft, happ, lisins, MOM." Notice the adorable use of the double p in place of a y.

Inside were cardboard picture frames with bean seeds pasted on (they are growing beans at school) and pictures of the kids in them. And chunky handmade bowls about the diameter of a pop can. They have all kinds of plans for what I am to put in these bowls, and they're so proud of their work in making them.

I have never seen works of art so beautiful to my heart.

Kim commented on the post Bounty Hunting asking if I run into scary or violent situations as a psychiatric social worker. I encounter scary situations from fairly often, but violent situations much less frequently. The neighborhoods I go to are often violent ones, but by avoiding after school hours, not making eye contact and so on I manage. If I'm really uncomfortable with where I'm going or who I'm seeing, I find someone else to go with me, and I always carry my phone. The social workers who end up dead usually work for Child Protective Services. After all, the adults they encounter are usually violent against children in the first place. And people get very angry and very dangerous over custody issues.

I'd like to emphasize that although people with paranoia can become violent, they are more often too terrified of other people even to defend themselves properly from the violence they encounter (on the streets when homeless, for example). Usually if I go out "bounty hunting" and a person is paranoid they hide and don't answer the door. And those people who are having violent or homicidal inclinations are typically not directing them at social workers. Usually their feelings are focused on individuals who play a bigger role in their lives. People with violent ideation are generally hospitalized rapidly before things get out of hand. Even patients who are potentially violent most often have disorganized thinking too severe to plan and carry out crimes. Not every violent person with a mental illness commits violence due to their illness, but that is another post for another time.

The time I encounter violent tendencies is when I am assessing someone for hospitalization, and we do that in pairs if a person has any assaultive history. I've encountered a fist raised at me, a person advancing on me looking dangerous and talked people down from homicide while other staff kept watch on me. But typically I get what I need for a petition (for involuntary hospitalization) before things get actually risky. The law has protections for patients in case we make a mistake in assessing someone's risk level. Every petitioned patient has a hearing where staff have to prove to a judge that the person really needs to be in a locked psychiatric unit.

When in treatment, mentally ill people are not more violent than the general population. Of course you can't force medication into a patient's body against their will unless they are court ordered for hospitalization. My agency can only put people back in the hospital, we ourselves can't compel treatment. Outpatient people can always refuse.

The only time I was actually attacked involved an autistic adult, not a mentally ill person. That was bad. He bit through the nerves of one finger but didn't manage to sever it, and I got bites over my scalp, hands and chest. My hand with the bitten finger grew to about double its size with infection and I had to have surgery to save the hand. Human bites are much worse than animal bites, all the nurses and doctors assured me. I was something of a hospital superstar. Random staff would encounter me and say, "So you're the one with the HUMAN BITES, huh? How did that happen?" It happened while with another staff I was trying to cushion his head from banging against the wall, and being autistic once he started biting he couldn't stop. The other staff person locked me in the room with him while she called 911, which didn't help. Fifteen years with mentally ill people, no problem. One month with an autistic adult - BAM! I'm sure most autistic adults are safe as well, this is just my experience.

Thing One has been at work interior decorating for us again. I noticed that our printer has been written on in red eighteen hour lipstick. You know, the kind that is more or less a dye for your lips. I know it is Thing One, despite Thing Two's name being the content of the graffiti, because Thing One has a record of being devious. She has actually left notes stating, "Thing Two Did This" on some of her more creative enterprises. Sadly for her, she leaves a trail of evidence during her shady pursuits. That, and Thing Two is something of a tattler. A very happy tattler with endless opportunities to tattle because his sister is mischievous. We're hoping that these outlaw activities are an early sign of scientific genius or something, pathetic as that is. And maybe Thing Two will be an intrepid reporter. Maybe.

Anyway, if anyone out there knows of a good makeup remover that is printer safe and effective on eighteen hour lipstick, please put it in the comments. I always just let ithe lipstick wear off.

Today I was pulled aside by the head of HR and given a choice of continuing to work part time in an administrative position and working full time in my current position. They are eliminating the part time position I work in so as to concentrate the hours now worked by various people into one full time position. I've liked working part time since last October, when I was offered this position. I've been able to spend time with my kids in the morning before their afternoon kindergarten starts.

The part time administrative position would be at the same wage, and would still include client contact as I would be helping people sign up for benefits. But it just wouldn't be the same as real clinical contact. And I'm fairly sure I'd dislike it. I don't especially enjoy filling out forms or playing phone tag with hostile Medicaid and SSDI bureaucrats. I don't want to BE a bureaucrat.

I love Love LOVE my current job, generally helping out and finding people who need treatment but aren't coming in. It's clinical without having the quadrupled work load that the case management job acquired last fall. I don't have a case load. I might have to borrow one if somebody goes on maternity or disability leave, but it wouldn't stay mine for more than a couple of months at the outside.

This offer has made me realize just how much I value the job I'm doing now. Enough to go back to full time.

So I have two neighbors who for different reasons invoke a social work reaction outside of my job.

One is, as far as I can judge with a practiced eye, involved in substance abuse of unknown breadth. He came to our door at 3 AM recently and told a spectacular, rambling and obvious lie in order to get beer money. He certainly has issues with alcohol, and let's just say his parties draw a crowd that is kinda questionable. Last summer someone at one of his parties shat a gun at someone else right outside our house. No, actually he shOt a gun, but the typo gave me such a vivid and hilarious mental image that I decided to share. Anyhow, we have not been accustomed to gunfire in our neighborhood and don't want to become accustomed to it.


The other has been struggling with debilitating muscle atrophy for over a year and has recently been diagnosed with ALS (Lou Gherig Disease), which I would not wish on my worst enemy, let alone my lovable and kind neighbor. Through the past year she has gradually lost strength and function, but she has never asked for help. When I found out, I spent a whole day scouring the internet for resources she could use and passed them on immediately. She is self employed and has no insurance, and the only drug to treat ALS is $1000 a month. I looked for patient assistance programs, but found none. ALS is an "orphan" disease and the medication is therefore expensive because few people need it.

The point is that I get impatient and dismissive with neighbor #1, but I'm willing to spend half my weekend helping neighbor #2. I genuinely believe that substance abuse is a medically treatable and blameless condition, which causes much suffering for users and their families. I treat people with substance abuse all the time at work. Yet in my personal life I am biased, it appears. I'm more willing to help the sick neighbor I like better. I wonder if this off the clock double standard is a luxury that I should even permit myself. I have always prided myself in being able to separate home from work, to give myself the mental rest that helps me face the work week. Why am I now making an exception?