Psych Clinical Orientation

I oriented to my new Psych clinical rotation on Friday. I wondered why my clinical group only had 3 people in it, including myself. (That's less than half the normal size of a group) Turns out my placement is on a very small unit - only about 8 patients - inpatient, locked unit. The patients have severe OCD, Schizophrenia, and substance addictions. The best thing about our unit is that it's a research unit, which means that the patients are inpatient voluntarily and that they get paid to participate. The worst is that facility is state funded, which we all know means that they're broke. The facilty has inpatient, outpatient, and walk-up services.

I was the first one there for the orientation and had to sit in the lobby by myself for 30 minutes because everyone else was late. It was...interesting. Many, many black folks, and consequently many, many young men trying to "get to know me." I met two black men who rapped out loud to themselves the whole time. They weren't paying any attention to me, but I was listening to them. I have always been fascinated by what I presume to be a very thin line between psychosis and sanity. Everything they said made sense, and that was my worse fear for this rotation. What does it mean if psychotic people make perfectly good sense to me? There was a lot of conspiracy theory in their rhymes, but I believe in a few so-called conspiracy theories myself. I'm not saying that I can't recognize the difference between me, a non-psychotic person, and them. However, I think we have gravely underestimated the psychological trauma related to racism in this country and so I can't help but wonder how many of these people used to be just fine (or borderline, like we all are) and then they just snapped under the reality of this life?

Our professor gave an example of an African American married man who had to work two full time jobs to make ends meet for his family; one day he woke up and decided that he just couldn't do it anymore and he went into a severely depressive & suicidal state and had to be instituionalized. I must say I CAN imagine. The goal is to get the person to remove their stressor, to put things into perspective, to change. How do you tell someone not to work as much? Are you going to supplement his income? How does a person without very many marketable skills find a job that pays so well that he will be able to work one job? If he could find it, wouldn't he already have it? Who chooses to work two full time jobs for their entire life? The point is, what if the event that leads to psychosis is just life. What if you are being crushed under the weight of a circumstance that isn't going to change?

There were many other examples, and a good friend of mine asked about the intersection of race and mental health. (We're getting much better at taking turns!) The professor referred anyone who was interested to the works of another person. Now, I am all for providing students with the resources that allow them to investigate something for themselves, but why is it that the impact of race on the psyche is not also a topic that up for discussion in the classroom? If we aren't going to discuss it, then what is the relevance of including the race of the person in the case study examples? And I find it wholly inappropriate to spout statistics that help to set up the minority/unhealthy vs. non-minority/healthy/normal dichotomy without dicussing race at all.

I realize I'm ranting at 2 am Eastern and no one's listening. But the other day I realized that I pay over $1,000 PER WEEK to this place! I refuse to pay AND be invisible. We are reading a novel for this course in order to write a paper on mental health. We write all about the character's mental disease, so it's stuff like The Bell Jar (Plath)(deals with depression) and She's Come Undone (Lamb)(deals with Obesity, PTSD, and depression). I submitted a proposal to read a novel by a black woman because I have reached the point where I refuse to pay and not get what I want. I learned this from my colleagues. These people are vicious climbers, demanders of what they came for - and the only way to not fall victim to getting what's left over because they didn't want it, is to be right there fighting for what you want. It's the game in every sense of the word. I chose 72 Hour Hold by Bebe Moore Campbell (Bipolar mania). What does this have to do with the whole "grad school is a game" theory? It occured to me that the only reason they get what they want is because they have the audacity to demand it.