Dose #12: Is It Illness Or A Shortage of Hope?
"A leader is a dealer in hope."
~ Napoleon Bonaparte
As an intern in an adolescent group home I was assigned the role of counselor for a disgruntled, irreverent, fifteen-year-old boy. At our first meeting he walked into the small office with an awkward, lumbering stride - oversized, baggy jeans, wrinkled t-shirt, shaved head, tattoos and body language all boredom and disgust.
I had the feeling he was looking through me, sizing me up, waiting for me to say something foolish. With little more than classroom discussions under my belt, I was feeling unsure and knew if it showed, I could lose him on the first day. I would keep my expectations low, a conversation about anything would do. Surely that could happen.
He had other plans. If he could torpedo my efforts, if the meeting failed, any assumption he had of being beyond repair, would prove true. He quickly took charge, sighing, grimacing, asking more than once how far along we were in time. There was a lot of chair-shifting, window-gazing, as little eye contact as possible. Until that minute, until I saw it sitting in the chair opposite mine, "resistance" was an obscure, poorly understood concept I knew nothing about.
Minutes left in the session, feeling rather lost - I pulled out a therapy 'trick' - a paradoxical intervention. I would join the opposition. As he stood up, certain he'd won this round, I said, "What I want you to do this week is - nothing. I don't want you to change a thing. That's the assignment." In that minute, I got what I'd hoped for - a chance to connect. It was there in his eyes, confusion mixed with a flicker of interest. The first full sentences spoken, "What do you mean? I don't understand.", he said. I repeated the assignment and showed him to the door.
By the end of the year, what I saw as solid, measurable improvement in this boy's life, had begun. He was more cooperative with staff, getting along with peers, running a few times a week, doing better in the on-campus classroom. Head still shaved, jeans still baggy, he was able to return to live with his family. The local school that kicked him out agreed to let him enter his sophomore year.
Report in hand, I walked into the year-end treatment review meeting. My supervisor was pleased enough, then suggested there was more I could have done. She said I had 'under-diagnosed' this student, and not getting to the bottom of his "deeper conflicts", problems would resurface in the future. What appeared to be progress was likely superficial, unreliable, probably short-lived.
I went away thinking I might not be suited for this work. I should quit while I'm ahead. Sixth-grade thoughts of being a hard worker, but 'not so smart', came roaring back. In that moment I doubted everything I'd done all year.
I'm trained as a behaviourist, my supervisor was Freudian. Looking back, I speculate discipline differences may explain some of her response. It was 1988, a time when most of psychiatry was still framed through a prism of illness, not wellness. In part, a hold-over from World War II when soldiers returned home, 'shell-shocked'. The urgent need to repair thousands of damaged minds grew the business of psychology into a well-funded government enterprise. Illness driving development.
My program focused entirely on the study of, "CBT", cognitive behavioral therapy. The protocol was in its early stages, not yet widely understood, not always well received. Allowing for a more optimistic view of what makes us human, I believed it was the most rational, reasonable approach, but on that day, my faith was shaken. Traveling home I was filled with remorse and sadness, thinking I'd failed this boy.
I carried the worry about a clinical weakness - that of not getting to the bottom of the
'real problem" - for a long time. Time has taught me otherwise. It's also revealed that some of my best learning happened at home, not in the classroom, and not based on one approach or another.
Family gatherings could be characterized as a group of eccentric ducks getting together to eat, drink, definitely be merry - insult each other from time to time, laugh a lot, argue over politics, money, poetry, food and Ed Sullivan - then hug, leave and come back to do it all over again. It was chaotic. A little crazy. Full of love and warmth, joy and commitment. Most gatherings were hosted by the family matriarch, my grandmother, referred to by my cousin as, "The warden of the big house".
In a single evening so much was worked out. Watching and listening, not wanting to miss a thing, I was learning about conflict, loyalty, acceptance, and forgiveness. I saw that with a little effort, one could - and should - make some small attempt to see the good in others. I learned that having faith in someone's judgment fosters personal responsibility and hardship re-framed as challenge - even adventure - builds resilience.
Today I see armies of experts too willing to, 'over-diagnose'. Too willing to pathologize, medicate prematurely and too long, characterize 4-year-olds as 'disordered', and see eccentricities only as abnormalities. I see too many clients locked in first opinions, rejecting the idea of a second, fearing they'll offend expert #1. I see too few able to trust their instincts, believing someone else's opinion is almost always better than their own. It seems we lean once again, in the direction of illness - on the lookout for malfunction.
I'm not at all sure which discipline would have been better for the boy I met so many years ago. I'm not sure it matters. Whether, clinician, parent, lawyer, banker, friend, sibling, spouse - what matters is that we work in hope. Those who are lost, need hope.
Hope comes in the form of listening - sincere listening. It comes when we help others identify their strengths, when we encourage the idea that a small portion of who they are may not be working while so much works just as it should. Hope comes when the trust we give allows someone to trust themselves.
Hope flourishes when we are wise enough to value those we meet, giving them space to learn to value themselves. Even with their eccentricities. Even with their failings. Even with their self-hatred. When as few as one believes in one other, possibilities show up.
To those who would say this is simplistic, that we must have diagnoses and medicine and urgent care - I know. But, it is sometimes true the most complicated problems are resolved with a least complicated approach. Let us not lose site of the power of acceptance, the magic of having someone believe in us - not squeezing us all into some carefully ordered box called "normality", not as they want us to be, but as we are - wrinkled t-shirts and all.
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