During my time at Willowbrook Residential Center, I had the unique experience of coming face-to-face with people suffering from severe mental disorders. It was a surreal experience, to be sure, as I tried to reconcile living with mental illness as a more or less permanent part of one’s identity. I attended my placement, all the while feeling distinctly disconnected from the clients I was supposedly there to assist.
The most difficult issue to face in this field is, in my opinion, working with those clients who may never get better. There is definite stress and sadness associated with working with those for whom their mental illness is, quite simply, a way of life, and will be until they die. How do you cope with such a bleak prognosis—both as a client and as a clinician? I am left wondering if this was the source of that disconnect—was I afraid of the disappointment, of the futility of trying to aid in a hopeless cause? It felt like befriending someone who you know has terminal cancer. How do you get around the undeniable fact that they will never get better?
This is a question I grappled with during my time at Willowbrook, particularly in the times I was called to work with a particular patient, who we will here refer to as Steven. Steven has severe symptoms of obsessive-compulsive disorder, as well as schizophrenia, to the point where he uncontrollably collects trash and junk in his room, and is virtually incapable of parting with it without strict guidance. When I first became acquainted with Steven’s case, I was told much about how intelligent he was. How he, despite his illness, frequently went to community college classes and thrived there as an engaged and enthusiastic student. I was encouraged, believing that he would have a lot of insight into his disorder, and that it would be easy to communicate with him.
However, when I finally met Steven, I was met with the reality of the situation: that he was barely communicative, not at all aware of the facts of his illness, and it seemed impossible to get anything through to him. Steven’s coordinator informed me that he had been working with Steven for a long time, and had tried everything he could think of. He also confided that, though I had been brought into the case as a sort of last-ditch effort to prevent Steven from being evicted from Willowbrook due to his unsanitary habits, he (the coordinator) didn’t really believe there was any hope that there would be any actual improvement.
This was a bit of a harsh reality check—why was I even there, then? What was I hoping to accomplish with a client who had cycled around in the mental health system for literally as long as I’ve been alive? It felt like such a futile effort, and I began to wonder whether anything we were doing here—indeed, in the mental health system at all—was worth all the time and money that’s being poured into it, if there are so many clients, like Steven, who never experience relief from their illness?
I spoke to my supervisor, bringing to her some of these concerns. I was confident that, given her years in the field and close contact with the clients, she would have some insight. I was correct; not only had she grappled with the same sorts of questions, but she also had some interesting light to shed on the situation, and by the end of our conversation, I had come to some conclusions.
The cold hard truth is that some clients never do get better. This is a very basic fact that clinicians must learn to accept. While some more fortunate clients can be counseled through rough patches in their illness and eventually rejoin the community, for other clients, all we can do is maintain them at baseline. We—and they—must learn to accept the illness, much as a cancer patient must accept the cancer. We can try treating it, sure, but at a certain point it becomes unavoidable to realize that it may be futile.
It requires a certain amount of realism to accept that some people may be in this position for the rest of their lives. In discussing this with my supervisor, I found myself reflecting that I am much more of an idealist—I like to believe that, eventually, everyone gets better, if they put in the required effort. Hearing her say that one must be realistic rather than idealistic, therefore, made me a little nervous. Does becoming a so-called realist mean I have to become jaded?
But my supervisor had something to say to this too. Being a realist is not to say we are giving up on our clients; on the contrary, they require even more commitment—more effort and time—than their more fortunate peers, because the goal for them is to develop an environment that as closely approximates a happy, healthy home as possible. Willowbrook—and places like it—create a stable community, a more compassionate and therapeutic version of the real world, so that these people can live as close to a normal life as possible while still being cared for and treated for their illness.
As for becoming jaded, I learned something that was encouraging. Of course it’s true that, in my own experience with clinicians, I have seen plenty of those who seem to not care at all, who don’t connect with their clients as people, but only take notes and spout out textbook phrases and coping skills. These people have truly frightened me, and I find myself wondering if this is my future. Am I doomed to become a cold, impassive therapist, building a wall around myself to avoid the heartache of failed interventions? My supervisor doesn’t think so.
I’m learning that the most important thing is to avoid burnout at all costs. It is so easy to slip into complacency where you find yourself just going through the motions, not actually invested in their welfare or their future, just doing your job to get through the day. But it is possible to avoid this future, with constant effort and reflection on why you got involved in the field. It is so crucial to never let human beings become merely names and diagnoses. They are more than their symptoms, more than their illness. There is a reason we no longer refer to them as “schizophrenics”; they are people—real human beings—with a mental illness. To cease to see them as human beings means to not care whether they get better or not. And if you don’t care about your efforts actually being successful, why are you in this job to begin with?
The point is that we must do everything we can do ensure we are getting the best possible treatment for people. Always question yourself, always confer with others—get a reality check so you don’t become isolated in your own limited worldview, with a perspective of apathy and disengagement. Be making every attempt to help them get better, but at the same time find a way to accept that they may not be able to get better. Therefore, in addition to providing them the best care we can, we must also give them a healthy community, with healthy connections, because only with those things can people truly thrive.
