It has been a year and a half of running my private practice and I'm finally starting to get the hang of this insurance thing. I am a member of CAQH (Council for Affordable Health Care), which holds a large database insurance companies use to enroll clinicians onto their panels. I can now submit electronic claims online. I understand what a CPT code is. I know the code when services are rendered in my office, etc, etc... As a client, there is no need to know what the heck I'm talking about. All you need to know is I can now accept some insurance. I am currently in network with Blue Shield, Aetna and I'm in the pipeline for United Behavioral Health (UBH) and PacifiCare. Their representative said I'd be accepted in their networks by the end of June 2008. I recently applied to Blue Cross, and Value Options. (Unfortunately, Health Net is not accepting new clinicians at this time)
I was very fortunate that I had a thriving practice early on without being on any insurance panels. In fact, my office landlord said she went through over five renters that failed to start a practice, and she was surprised to see me with several clients so quickly. I acquired clients through previous professional relationships, through word of mouth referrals and some through Internet marketing. I could have continued in this direction, without insurance.
Many clinicians choose not to deal with insurance at all. I can see why, what a headache it all can be. In addition, it is very intimidating. Plus, many plans will provide out-of-network reimbursement so the clinician does not have to concerned with submitting claims. I thought about taking that route, especially since dealing with forms and big companies is by far not a strength of mine. However, I decided to take on the challenge. The main reason is I do not want people to spend hundreds of dollars on services that could be provided through their benefits. My goal is to provide excellent services, help people get better, meanwhile not place too much of a financial strain on my clients. Plus, if I did not accept insurance, I'd miss out on working with certain populations I enjoy, such as Stanford students. I value my services and need to cover overhead costs as well, so hopefully I can get even more insurance companies to pay me to work with you!
Thursday, May 22, 2008
Tuesday, April 22, 2008
Starlight Adolescent Center
As the rumors of the community treatment center (CTF) closing became a reality, there have been two articles featured on the front page the San Jose Mercury News exposing some of the problems in Starlight.
http://www.mercurynews.com//ci_8874174?IADID=Search-www.mercurynews.com-www.mercurynews.com
http://www.mercurynews.com/ci_8909940?source=most_emailed
These articles highlight citations from MHAP (mental health advocacy project) including an incident when a staff member accidentally broke a client’s arm.
As a former employee of Starlight, I’d like to comment on the articles.
I worked at Starlight for a year in 2006-2007 as a mental health clinician and rehab therapist. My position at Starlight was my biggest challenge in my career to date, even after working in NYC’s inner city schools and with families struggling with a terminal illness.
While a lot of the information in these articles is true, I don’t believe the public understands just how acute most of the youth in Starlight are. They end up in Starlight after every placement option has been exhausted. This includes foster homes with intensive wraparound services, level 9, 11, 12 and 14 group homes that have increasing levels of staff supervision and structure. They all exhibit severe enough self-harm and/or aggressive behaviors that present a serious safety risk to themselves and others. Regularly the teens try to hang themselves, cut themselves, attack each other, attack staff and set fires. In addition, most everyday objects are contraband because these things are often used as a weapon or to cut on themselves including pens, CD’s, shampoo, jewelry, etc. I had to remember not to staple my papers together or use a paperclip because they are perfect devices for self-cutting. When I did beauty activities with the girls, I had to keep a strict count on every bottle of nail polish. One time, I accidentally left a hand-mirror on the unit and within five minutes, one of the girls smashed it and tried to use the shards to cut herself.
People are often naive to believe that if we are kind enough, respectful enough or tough enough, kids won’t show this type of behavior. While more skilled staff members were able to prevent an incident or de-escalate a client, the behaviors of the youth were difficult to control. It was always interesting to observe a new, more naïve staff member believe that they could “rescue” the kids. The youth usually picked up on the staff’s naiveté and would take advantage of him/her.
However, while the clients presented tremendous challenges, myself and other staff members were able to form strong therapeutic alliances with them. We enjoyed working with them, playing games with them, sharing stories and watching them grow. Despite their extreme behaviors, we had strong empathy for these kids who were suffering from a severe mental illness and/or endured severe trauma. Many of them did make progress and it was fulfilling to see. Also, in my role as a Mental Health Clinician, I had the privilege to work with and get to know many of the parents and families of the youth. (See my previous blog entry “The Day the Voices Stopped” for one example)
Unfortunately, the system beat my coworkers and me down. While we were working with one of the most difficult populations, we were also expected to do the job of 3 people. We were bombarded with mounds of paperwork, treatment team meetings, case management, crisis interventions and responsibility for 3 full days of therapy groups. Even with very good time-management skills, it was unusual to work less than 55 hours. (Keep in mind this is 55 hours of high intensity, not a corporate setting)
Often we were scheduled to be in 2 or 3 places at the same time. Inevitably I got burnt out and so did everyone around me. Countless people were hired for that position and left in under two weeks, wasting company time and training $. I lasted in that position only 6 months and then transferred to a per diem position. While I was better qualified as a clinician and enjoyed that work, I was tired of being set-up to fail so I felt I had had little choice.
And this is where I believe was the biggest problem of Starlight Adolescent Center and most of the child-welfare system. Workers are set-up to do the job of the impossible with unmanageable workloads. Staff who choose not to leave often go into “survival mode” to keep up with the demands placed on them both physically and emotionally. Because of the difficulty to retain staff, there was almost always a shortage of manpower, which would force even higher workloads on those who were left. Also, youth counselors, the front-line workers, were often forced to work overtime in this high-stress environment. While most staff entered their job with good intentions, it is near impossible to be present and handle the most difficult youth of the state of California under such conditions. How could the company claim they provided excellent service if this is how workers felt? There were exceptional staff at Starlight that were able to handle circumstances that most people couldn’t dream of. I felt frustrated when I observed them to be unacknowledged and then given more work until they were forced to leave.
Starlight is closing due to state budget cuts and is now under scrutiny from the media. However, it took on a challenge most organizations could never do. While Starlight had some major holes in its management, the cases and circumstances were all extremely challenging. I hope the youth still there will find a placement that will lead to healing and at the very least, safety. Caring for these youth is no simple task. Social workers and others work very hard swimming upstream in a system that makes it challenging to do more that put little band-aids on a large open sore.
http://www.mercurynews.com//ci_8874174?IADID=Search-www.mercurynews.com-www.mercurynews.com
http://www.mercurynews.com/ci_8909940?source=most_emailed
These articles highlight citations from MHAP (mental health advocacy project) including an incident when a staff member accidentally broke a client’s arm.
As a former employee of Starlight, I’d like to comment on the articles.
I worked at Starlight for a year in 2006-2007 as a mental health clinician and rehab therapist. My position at Starlight was my biggest challenge in my career to date, even after working in NYC’s inner city schools and with families struggling with a terminal illness.
While a lot of the information in these articles is true, I don’t believe the public understands just how acute most of the youth in Starlight are. They end up in Starlight after every placement option has been exhausted. This includes foster homes with intensive wraparound services, level 9, 11, 12 and 14 group homes that have increasing levels of staff supervision and structure. They all exhibit severe enough self-harm and/or aggressive behaviors that present a serious safety risk to themselves and others. Regularly the teens try to hang themselves, cut themselves, attack each other, attack staff and set fires. In addition, most everyday objects are contraband because these things are often used as a weapon or to cut on themselves including pens, CD’s, shampoo, jewelry, etc. I had to remember not to staple my papers together or use a paperclip because they are perfect devices for self-cutting. When I did beauty activities with the girls, I had to keep a strict count on every bottle of nail polish. One time, I accidentally left a hand-mirror on the unit and within five minutes, one of the girls smashed it and tried to use the shards to cut herself.
People are often naive to believe that if we are kind enough, respectful enough or tough enough, kids won’t show this type of behavior. While more skilled staff members were able to prevent an incident or de-escalate a client, the behaviors of the youth were difficult to control. It was always interesting to observe a new, more naïve staff member believe that they could “rescue” the kids. The youth usually picked up on the staff’s naiveté and would take advantage of him/her.
However, while the clients presented tremendous challenges, myself and other staff members were able to form strong therapeutic alliances with them. We enjoyed working with them, playing games with them, sharing stories and watching them grow. Despite their extreme behaviors, we had strong empathy for these kids who were suffering from a severe mental illness and/or endured severe trauma. Many of them did make progress and it was fulfilling to see. Also, in my role as a Mental Health Clinician, I had the privilege to work with and get to know many of the parents and families of the youth. (See my previous blog entry “The Day the Voices Stopped” for one example)
Unfortunately, the system beat my coworkers and me down. While we were working with one of the most difficult populations, we were also expected to do the job of 3 people. We were bombarded with mounds of paperwork, treatment team meetings, case management, crisis interventions and responsibility for 3 full days of therapy groups. Even with very good time-management skills, it was unusual to work less than 55 hours. (Keep in mind this is 55 hours of high intensity, not a corporate setting)
Often we were scheduled to be in 2 or 3 places at the same time. Inevitably I got burnt out and so did everyone around me. Countless people were hired for that position and left in under two weeks, wasting company time and training $. I lasted in that position only 6 months and then transferred to a per diem position. While I was better qualified as a clinician and enjoyed that work, I was tired of being set-up to fail so I felt I had had little choice.
And this is where I believe was the biggest problem of Starlight Adolescent Center and most of the child-welfare system. Workers are set-up to do the job of the impossible with unmanageable workloads. Staff who choose not to leave often go into “survival mode” to keep up with the demands placed on them both physically and emotionally. Because of the difficulty to retain staff, there was almost always a shortage of manpower, which would force even higher workloads on those who were left. Also, youth counselors, the front-line workers, were often forced to work overtime in this high-stress environment. While most staff entered their job with good intentions, it is near impossible to be present and handle the most difficult youth of the state of California under such conditions. How could the company claim they provided excellent service if this is how workers felt? There were exceptional staff at Starlight that were able to handle circumstances that most people couldn’t dream of. I felt frustrated when I observed them to be unacknowledged and then given more work until they were forced to leave.
Starlight is closing due to state budget cuts and is now under scrutiny from the media. However, it took on a challenge most organizations could never do. While Starlight had some major holes in its management, the cases and circumstances were all extremely challenging. I hope the youth still there will find a placement that will lead to healing and at the very least, safety. Caring for these youth is no simple task. Social workers and others work very hard swimming upstream in a system that makes it challenging to do more that put little band-aids on a large open sore.
Tuesday, April 1, 2008
Fountain of Youth group excercise
Every week I facillitate a drama therapy group in an outpatient program for mentally ill adults. I endeavour to come up with creative ideas to help people connect and process issues experientially. This week I invited the clients to "drink" from a “fountain of youth” and embody their 10-year-old selves.
My idea was inspired by a movie called “The Kid”. In this movie Bruce Willis plays an emotionally stunted man about to celebrate his 40th birthday. Then his 8-year old self comes to visit him and changes his perspective on life. Initially he is angry and mean to his younger self, telling the boy what a loser and an embarrassment he is. The feelings are reciprocated when the boy sees his 40-year-old self and is upset with the choices he has made. For example, despite his tremendous wealth and status, his younger self is disappointed the grown self does not have a cool dog and a significant relationship.
Over time, his adult self learns to accept his younger self and appreciate him. He recognizes that his younger ego is there to teach him self-acceptance. Then he had a chance to go back in time to the playground and stand up to some bullies. He also comforted his child-self when he learned his mother had terminal cancer. His adult self consoled the child after his father yelled and criticized the child. He hugged the child and said ”Dad is just yelling because he is scared and doesn’t know how to raise you by himself.”
I found this scene touching and thought about my own life and what I would tell my younger self while I was going through difficult things while growing up. And I was inspired to translate this concept into a drama therapy activity…
This morning I shared with the group my inspiration and thoughts about how we can help and teach ourselves or learn from our past selves. I let the clients know that they are free to not participate in the activity at any time if the activity brings up any overwhelming feelings or trauma. It is important when working in such a powerful medium such as psychodrama that the clients feel safe to do what is comfortable. In addition, I have had the opportunity to work with these clients for several weeks and build a rapport. Finally, this program emphasizes community and the connection among the clients is strong and allows for an emotionally safe environment to participate in a potentially vulnerable activity.
I began the session with a guided imagery. Asking the clients to close their eyes and imagine themselves when they were 10 years old. I invited them to think about what was happening in their lives, with their family and who their friends were at time. Who was their best friend? How were they socially? Were they shy? Outgoing? How old were their brothers and sisters at that time? Were their parents alive? Together? Apart? I asked them to think about what they liked to do. What toys did they play with? What games did they play? I had them imagine themselves in their 10-year-old body and remember how that felt. I also asked them to think about what their worries were at that time and to remember how they handled their feelings. Did they allow themselves to cry for example? I asked them about what their hopes and dreams were at that time. What did they want to be when they grow up? How did they imagine their future family?
After the guided imagery I had the clients open their eyes and I passed out [pretend] cups filled with water from the fountain of youth. Once they drank the water [miming] they would embody their 10-year-old selves and mingle with each other as 10-year-olds.
The clients embraced the activity and took on the inflection of their voices and body language of their 10-year old selves. They talked about their parents, brothers and sisters and pets they had. They talked about getting in trouble and hating school. The girls thought the boys were gross. Some were shy and some were very bouncy and outgoing. They talked about their parents not being home sometimes and feeling lonely. They also talked about the fun things they did with their family like going shopping. One talked about what a brat her younger brother is and another talked about how old her teenage sister is.
I interacted with the group as an adult talking to children and they respected me as “the teacher”. After about 20 minutes in character, I gave the group new glasses of [pretend] water to drink to bring them back to their adult selves.
Then we discussed the experience and how it felt to embody their younger selves. They expressed mixed emotions. One client stated she got in touch with the sadness she felt at that time. She remembered not being able to express her emotions and hiding when she cried. Another client talked about a similar theme of pretending to be happy even when feeling sad and lonely. They discussed the cultural differences between themselves and their parents and their attitude towards therapy and showing feelings. Some only began to learn to accept feelings later in their life. Another client talked about how she enjoyed being 10 again, she “didn’t have a worry in the world” at that time. While as an adult, she is usually very shy and reserved, when she embodied her 10-year-old self; she was more talkative and playful. Some clients stated they had difficulty at first remembering being 10, but with the guided imagery, they were able to get in touch with that part of themselves and were surprised with what they remembered and felt.
I asked the group to think about what they would tell their younger self or how they could help their younger self if they could go back in time, just as Bruce Willis helped his younger self stand up to the bullies on the playground and how he comforted his younger self the moment he learned his mother was terminally ill. One of the main themes that came up was self-tolerance and accepting feelings as ok and normal. “I would have told my dad, I have a right to have these feelings”, one client stated.
As I wrapped up, I thanked the clients for trusting me to do this vulnerable exercise.
My idea was inspired by a movie called “The Kid”. In this movie Bruce Willis plays an emotionally stunted man about to celebrate his 40th birthday. Then his 8-year old self comes to visit him and changes his perspective on life. Initially he is angry and mean to his younger self, telling the boy what a loser and an embarrassment he is. The feelings are reciprocated when the boy sees his 40-year-old self and is upset with the choices he has made. For example, despite his tremendous wealth and status, his younger self is disappointed the grown self does not have a cool dog and a significant relationship.
Over time, his adult self learns to accept his younger self and appreciate him. He recognizes that his younger ego is there to teach him self-acceptance. Then he had a chance to go back in time to the playground and stand up to some bullies. He also comforted his child-self when he learned his mother had terminal cancer. His adult self consoled the child after his father yelled and criticized the child. He hugged the child and said ”Dad is just yelling because he is scared and doesn’t know how to raise you by himself.”
I found this scene touching and thought about my own life and what I would tell my younger self while I was going through difficult things while growing up. And I was inspired to translate this concept into a drama therapy activity…
This morning I shared with the group my inspiration and thoughts about how we can help and teach ourselves or learn from our past selves. I let the clients know that they are free to not participate in the activity at any time if the activity brings up any overwhelming feelings or trauma. It is important when working in such a powerful medium such as psychodrama that the clients feel safe to do what is comfortable. In addition, I have had the opportunity to work with these clients for several weeks and build a rapport. Finally, this program emphasizes community and the connection among the clients is strong and allows for an emotionally safe environment to participate in a potentially vulnerable activity.
I began the session with a guided imagery. Asking the clients to close their eyes and imagine themselves when they were 10 years old. I invited them to think about what was happening in their lives, with their family and who their friends were at time. Who was their best friend? How were they socially? Were they shy? Outgoing? How old were their brothers and sisters at that time? Were their parents alive? Together? Apart? I asked them to think about what they liked to do. What toys did they play with? What games did they play? I had them imagine themselves in their 10-year-old body and remember how that felt. I also asked them to think about what their worries were at that time and to remember how they handled their feelings. Did they allow themselves to cry for example? I asked them about what their hopes and dreams were at that time. What did they want to be when they grow up? How did they imagine their future family?
After the guided imagery I had the clients open their eyes and I passed out [pretend] cups filled with water from the fountain of youth. Once they drank the water [miming] they would embody their 10-year-old selves and mingle with each other as 10-year-olds.
The clients embraced the activity and took on the inflection of their voices and body language of their 10-year old selves. They talked about their parents, brothers and sisters and pets they had. They talked about getting in trouble and hating school. The girls thought the boys were gross. Some were shy and some were very bouncy and outgoing. They talked about their parents not being home sometimes and feeling lonely. They also talked about the fun things they did with their family like going shopping. One talked about what a brat her younger brother is and another talked about how old her teenage sister is.
I interacted with the group as an adult talking to children and they respected me as “the teacher”. After about 20 minutes in character, I gave the group new glasses of [pretend] water to drink to bring them back to their adult selves.
Then we discussed the experience and how it felt to embody their younger selves. They expressed mixed emotions. One client stated she got in touch with the sadness she felt at that time. She remembered not being able to express her emotions and hiding when she cried. Another client talked about a similar theme of pretending to be happy even when feeling sad and lonely. They discussed the cultural differences between themselves and their parents and their attitude towards therapy and showing feelings. Some only began to learn to accept feelings later in their life. Another client talked about how she enjoyed being 10 again, she “didn’t have a worry in the world” at that time. While as an adult, she is usually very shy and reserved, when she embodied her 10-year-old self; she was more talkative and playful. Some clients stated they had difficulty at first remembering being 10, but with the guided imagery, they were able to get in touch with that part of themselves and were surprised with what they remembered and felt.
I asked the group to think about what they would tell their younger self or how they could help their younger self if they could go back in time, just as Bruce Willis helped his younger self stand up to the bullies on the playground and how he comforted his younger self the moment he learned his mother was terminally ill. One of the main themes that came up was self-tolerance and accepting feelings as ok and normal. “I would have told my dad, I have a right to have these feelings”, one client stated.
As I wrapped up, I thanked the clients for trusting me to do this vulnerable exercise.
Thursday, November 8, 2007
a poem
My 18-year-old client gave me permission to post his poem here. It inspired me.
"My Only Confession"
Life is tough, just ask me why...
Things are complicated, and then you die...
Reality is, most people don't care...
They mock, they laugh, they just point and stare...
But things don't always stay that way...
I'll~try and live life day by day...
There's plenty of times I've been happy...
If being stoned wasn't fun, then fuckin smack me...
I really wanna let people know...
I want a good life, does that not show?
I want a woman with beauty IN heart...
Accept me who I am, part for part...
I'm not crazy, I just want to live...
To grow old with someone and maybe have kids...
Get me a job and work my way higher...
Lay down with my love when I get tired...
Why should I hide my face from success...
I'm gonna take failure and put him to rest...
I'll chop off his head and bury him deep...
Then me and my future can get a good night's sleep.
"My Only Confession"
Life is tough, just ask me why...
Things are complicated, and then you die...
Reality is, most people don't care...
They mock, they laugh, they just point and stare...
But things don't always stay that way...
I'll~try and live life day by day...
There's plenty of times I've been happy...
If being stoned wasn't fun, then fuckin smack me...
I really wanna let people know...
I want a good life, does that not show?
I want a woman with beauty IN heart...
Accept me who I am, part for part...
I'm not crazy, I just want to live...
To grow old with someone and maybe have kids...
Get me a job and work my way higher...
Lay down with my love when I get tired...
Why should I hide my face from success...
I'm gonna take failure and put him to rest...
I'll chop off his head and bury him deep...
Then me and my future can get a good night's sleep.
Wednesday, October 17, 2007
feelings soup
I currently work part-time at a day treatment program for mentally ill adults. Every Monday, I lead a drama group where I lead activities and self-expression through drama. This group has been a stretch for many of the clients, as a lot of them carry a lot of anxiety, particularly social anxiety. Also, no one had done a group like this before at the program so it was new to everyone. Nevertheless, they have taken many risks and had fun. When we processed how the group was going, it was difficult for people to articulate, but I still sensed a lot of anxiety. I went home that night, thinking about how I could address this ongoing issue that causes people to isolate. That’s when I thought of the “feelings soup”.
The next week, I asked the group to think of a feeling they had that morning. About 80% of the group said they were feeling some form of anxiety, although one said he’s feeling hopeful and another said he’s feeling optimistic. I instructed the group to take that feeling and hold it in their laps. It now had a physical shape and form and they had to hold it accordingly. For example if it was really big, or really hot, it needed to be held that way. Some people’s feelings were liquidy and needed a container, one person’s feeling took the shape of a little turtle that he could carry on his shoulder, and one feeling was prickly and sharp. I asked people what they wanted to do with their feeling and most said they wanted to put it in the trash or stomp on it. I did not encourage that, as they have to live with their feelings and manage them. But I did have them pass their feelings around so others could hold their group members’ feelings. They passed them around until they eventually got their feeling back. Some people expressed their feelings were starting to change shape.
After that, I placed an imaginary magic bowl in the middle of the room and one by one each group member placed their feeling in the bowl. One person had a pretend spoon available and she mixed the feelings together. Then I had each group member take out a part of the “soup” that they chose without further instruction or prompting. Each group member spontaneously took out a positive emotion; they took the hope and optimism that was in the mix. As they described their reformed emotions, they expressed feeling connected to others in the group. One group member took out “happy”. I asked her to think of what her happy looks like if it could take a shape or form. She answered by saying she is not good at these things. However, in actuality, she had a wonderful visualization for her “happy”. She described a helmet that helps protect and shield against overwhelming problems and helps her manage them. Other people in the group expressed they wished they had a “happy helmet” too. At the end, they each had their part of the soup and they now could carry it with them. I concluded the group by having the client with her helmet give each of her group members a helmet of their own to wear. This was particularly inspiring because this client often does not recognize her tremendous value. Meanwhile, her great idea was validated and the group appreciated receiving a helmet to help them manage their negative feelings.
This was an activity I had thought of on my own and had not done before with another group. I was impressed by the spontaneity of the clients. I had no plan that the group would find all of that hope and happiness in the soup. I was amazed and inspired by the power of the group process to help people feel connected with each other around similar feelings.
The next week, I asked the group to think of a feeling they had that morning. About 80% of the group said they were feeling some form of anxiety, although one said he’s feeling hopeful and another said he’s feeling optimistic. I instructed the group to take that feeling and hold it in their laps. It now had a physical shape and form and they had to hold it accordingly. For example if it was really big, or really hot, it needed to be held that way. Some people’s feelings were liquidy and needed a container, one person’s feeling took the shape of a little turtle that he could carry on his shoulder, and one feeling was prickly and sharp. I asked people what they wanted to do with their feeling and most said they wanted to put it in the trash or stomp on it. I did not encourage that, as they have to live with their feelings and manage them. But I did have them pass their feelings around so others could hold their group members’ feelings. They passed them around until they eventually got their feeling back. Some people expressed their feelings were starting to change shape.
After that, I placed an imaginary magic bowl in the middle of the room and one by one each group member placed their feeling in the bowl. One person had a pretend spoon available and she mixed the feelings together. Then I had each group member take out a part of the “soup” that they chose without further instruction or prompting. Each group member spontaneously took out a positive emotion; they took the hope and optimism that was in the mix. As they described their reformed emotions, they expressed feeling connected to others in the group. One group member took out “happy”. I asked her to think of what her happy looks like if it could take a shape or form. She answered by saying she is not good at these things. However, in actuality, she had a wonderful visualization for her “happy”. She described a helmet that helps protect and shield against overwhelming problems and helps her manage them. Other people in the group expressed they wished they had a “happy helmet” too. At the end, they each had their part of the soup and they now could carry it with them. I concluded the group by having the client with her helmet give each of her group members a helmet of their own to wear. This was particularly inspiring because this client often does not recognize her tremendous value. Meanwhile, her great idea was validated and the group appreciated receiving a helmet to help them manage their negative feelings.
This was an activity I had thought of on my own and had not done before with another group. I was impressed by the spontaneity of the clients. I had no plan that the group would find all of that hope and happiness in the soup. I was amazed and inspired by the power of the group process to help people feel connected with each other around similar feelings.
Wednesday, September 26, 2007
The Day The Voices Stopped
I spent much of this weekend quietly reading the book “The Day the Voices Stopped…” by Ken Steele. In two days, I read the 200 pages cover to cover. It is a memoir of a man who suffered from Schizophrenia for 30 years. His voices began talking to him at age 14 through his radio. They terrorized him, told him he was worthless and regularly gave him ideas and strategies to kill himself. However, with the proper therapy and medication, he became an inspiring advocate for people with mental illness. As a mental health professional that does not have schizophrenia, his story helped me have a glimpse of the worldview of someone suffering from this illness. The book included the specific terrorizing words the voices said to Ken everyday. It described several near death experiences (some were directed by his voices), a brutal rape and prostitution. He also wrote about the many state hospitals he was involuntarily committed to in different cities including New York City, Hawaii, San Francisco and Chicago. He listed the routine of meeting with the different doctors, social workers and being watched closely by the orderlies. He described the restraints, the seclusion rooms, and the wrong medications which caused him to drool or appear catatonic. Very often, he would stabilize, be discharged to a program, start working, but when things appeared to go well, it was too much pressure, the voices would get louder and he would run away and revert to his homeless lifestyle.
Mr. Steele also talked about his ‘institutionalization’. He had been in so many hospitals and halfway houses, he could write a national directory, he once joked in his book. He wrote about knowing the script to get hospitalized, and knowing the correct behaviors to earn privileges. He discussed his needed “toughness” to manage around other patients in these unsafe settings. Also, he wrote about his fears of getting better after being in the sick role for so many years. Finally, talked about his lack of much needed support from his family and how social support was one of the key factors to his eventual stability.
As I was reading, I was thinking of clients I’ve had the privilege to get to know at a locked residential treatment center for emotionally disturbed adolescents. The book gave me an insider’s perspective on some of the behavior I observed including running away, cheeking meds, manipulation of rules and other institutionalized behavior. I thought about the secret voices they hear and the pressure they have to “be normal” when they are seeing and hearing delusions. Because Mr. Steele narrated his story with both reality and voices, it helped me get a better picture of what someone who appears to be talking to themselves might be experiencing. As I was reading Ken Steele’s story, I had tremendous empathy for him, just as I felt strongly connected to several of my clients.
I began to think of one client in particular who graduated from the adolescent treatment center I used to work at. She was a resident at the facility for over a year. She struggled with a severe drug addiction, delusions and paranoia. In fact, her symptoms were so severe; she had to be spoon-fed when she first entered the program. However with treatment and medication, she evolved into a role model for other residents and positively influenced several other younger girls. She was a staff favorite due to her positive outlook and genuine kindness.
In addition, I was always moved by the support this client’s family provided. She and her family struggled through tremendous hardships. Her mother had difficulty parenting due to her own addictions and mental illness. She and her sisters were placed in foster care and had to be independent at young ages. However, her aunt was always available and attended her treatment team meetings and her sister took her out on passes regularly. At her graduation, I was very moved and inspired by her family’s strength and loyalty to one another. She and her family were special. I felt honored to know them and work with them.
Shortly after Ken Steele finished his book, he died in October 2000 at age 52. In the few short years he found peace from his voices, he had become a strong advocate for mental health patients’ rights, a support for the mentally ill and their families and a spokesperson for Schizophrenia. I went online and read what people who knew him had to say, and how he touched them. (http://www.newyorkcityvoices.org/ken.html) I could never know him, but the book he left behind made a difference for me by emphasizing hope and giving me new appreciation for my clients who struggle with Schizophrenia.
Mr. Steele also talked about his ‘institutionalization’. He had been in so many hospitals and halfway houses, he could write a national directory, he once joked in his book. He wrote about knowing the script to get hospitalized, and knowing the correct behaviors to earn privileges. He discussed his needed “toughness” to manage around other patients in these unsafe settings. Also, he wrote about his fears of getting better after being in the sick role for so many years. Finally, talked about his lack of much needed support from his family and how social support was one of the key factors to his eventual stability.
As I was reading, I was thinking of clients I’ve had the privilege to get to know at a locked residential treatment center for emotionally disturbed adolescents. The book gave me an insider’s perspective on some of the behavior I observed including running away, cheeking meds, manipulation of rules and other institutionalized behavior. I thought about the secret voices they hear and the pressure they have to “be normal” when they are seeing and hearing delusions. Because Mr. Steele narrated his story with both reality and voices, it helped me get a better picture of what someone who appears to be talking to themselves might be experiencing. As I was reading Ken Steele’s story, I had tremendous empathy for him, just as I felt strongly connected to several of my clients.
I began to think of one client in particular who graduated from the adolescent treatment center I used to work at. She was a resident at the facility for over a year. She struggled with a severe drug addiction, delusions and paranoia. In fact, her symptoms were so severe; she had to be spoon-fed when she first entered the program. However with treatment and medication, she evolved into a role model for other residents and positively influenced several other younger girls. She was a staff favorite due to her positive outlook and genuine kindness.
In addition, I was always moved by the support this client’s family provided. She and her family struggled through tremendous hardships. Her mother had difficulty parenting due to her own addictions and mental illness. She and her sisters were placed in foster care and had to be independent at young ages. However, her aunt was always available and attended her treatment team meetings and her sister took her out on passes regularly. At her graduation, I was very moved and inspired by her family’s strength and loyalty to one another. She and her family were special. I felt honored to know them and work with them.
Shortly after Ken Steele finished his book, he died in October 2000 at age 52. In the few short years he found peace from his voices, he had become a strong advocate for mental health patients’ rights, a support for the mentally ill and their families and a spokesperson for Schizophrenia. I went online and read what people who knew him had to say, and how he touched them. (http://www.newyorkcityvoices.org/ken.html) I could never know him, but the book he left behind made a difference for me by emphasizing hope and giving me new appreciation for my clients who struggle with Schizophrenia.
Monday, September 10, 2007
September 11, 2001
As the 6th anniversary approaches, I wanted to share some of my personal and professional memories around September 11th. Every New Yorker has their story about where they were when it happened. This is mine: In 2001, my office was eight blocks away from the World Trade Center. Although, as a social worker, I did home visits and Tuesdays were my day out “in the field”. I was lucky to be on my way to the Bronx that morning and was about one mile away from the Twin Towers when the subway system shut down. I came above ground among the chaos and I vividly remember my view of the buildings falling. I remember the sounds of the people screaming around me and the ambulance sirens. I won't forget the crowds gathered around cars with their radios blasting the news, the long lines at pay phones and the smell and taste of the smoke and dust that covered lower Manhattan. I walked uptown with the massive crowd up to my cousin’s apartment through Times Square where they broadcasted the image of the buildings collapse on the large screens over and over again. I rode the subway back home to Brooklyn the next day, everyone was quiet, solemn and in shock. I was still numb.
It wasn’t until a few weeks later that I noticed how the trauma affected me. I felt myself dip into a semi-depressive state in October. I didn’t need to turn on the news; I had reminders in my daily life that New York City was recovering from a deep wound. The subway did not stop near my office anymore so I had to walk an extra 10 blocks, which let me know my world had been seriously disrupted. Plus, everyday to get to work, I needed to show ID to get past a blockade. Helicopters were constantly flying overhead. I looked down the street and there was a clear view of the twisted metal of what used to be the Twin Towers. The media let the country know that it still may be under attack and NYC was a prime target. People were walking around with gas masks on, as if it were normal. The distinct smell of the smoke was overpowering. It was smoldering for months and I could feel it in my throat. There were bomb threats regularly and we were told Anthrax was going to poison all of us. There were signs posted all over the city by loved ones hoping to find their missing friend or family member. Memorials were everywhere large and small. Whenever a fireman’s body was retrieved, there was a large ceremony and more of the neighborhood was blockaded. Every subway train now had an American flag on it. Signs with little slogans such as “These Colors Don’t Run” were posted all over. Even the rescue dogs were commemorated with dog statues in front of select fire stations. Meanwhile, Rudi Giuliani was king of the world announcing how strong and resilient New Yorkers were. However, I was struggling among most New Yorkers trying to make sense of my environment and what I was feeling.
Nevertheless, I was working hard as a social worker, listening to client stories and trying to help others. I did groups with children, answered their questions and helped them feel safe. I met with my clients and helped them process their emotions around the event. I also began working with a few select families who lost a family member in The World Trade Center. One of the most difficult sessions I had was when a man described his experience searching for his sister’s DNA in a pile of body parts. He told the horrific story with little emotion while I listened and absorbed the feelings that were difficult for him to express. I remember having a terrible headache that night. 9/11 happened to all of us: the whole city, the whole country so it was difficult for me to stay in touch with my personal experience. I was simply grateful to be alive and unharmed. I didn’t recognize how I was affected.
I experienced several emotions that year. I was relieved and grateful, I was scared and vulnerable, and I was sad and depressed. But one major emotion I experienced was anger. I was angry with all the people profiting from tragedy. I walked down Church Street and observed vendors selling booklets with 9/11 photos. They were also selling images of the Twin Towers and NYPD/NYFD hats and T-shirts. Every time I saw a “United We Stand” T-shirt I was irritated. They were even selling banners with the names of the deceased on it. I remember their laptop computers scrolling images of the day with the Jewel song “My Hands” playing in the background so they can sell their merchandise. That made me angry also. And I couldn’t believe the crowd…people were coming from all over the country to get a peek at “Ground Zero”. For months it was a mob scene until the city built a wooden viewing platform. Also, a store actually framed their products with the white dust on it and it became a tourist attraction. I felt angry, angry that it was so sensationalized, angry that it became a source of profit for people, simply angry.
Over time, I was able to let go of some of my anger and come to acceptance. I moved out of New York City in September 2003 and being away from New York has been both difficult and a relief. I miss being around others who were a part of the community I was in, while it was good for me to have some distance from it. Six years later, I have been able to heal and I will forever carry with me the empathy I gained from being so close to a large national disaster.
It wasn’t until a few weeks later that I noticed how the trauma affected me. I felt myself dip into a semi-depressive state in October. I didn’t need to turn on the news; I had reminders in my daily life that New York City was recovering from a deep wound. The subway did not stop near my office anymore so I had to walk an extra 10 blocks, which let me know my world had been seriously disrupted. Plus, everyday to get to work, I needed to show ID to get past a blockade. Helicopters were constantly flying overhead. I looked down the street and there was a clear view of the twisted metal of what used to be the Twin Towers. The media let the country know that it still may be under attack and NYC was a prime target. People were walking around with gas masks on, as if it were normal. The distinct smell of the smoke was overpowering. It was smoldering for months and I could feel it in my throat. There were bomb threats regularly and we were told Anthrax was going to poison all of us. There were signs posted all over the city by loved ones hoping to find their missing friend or family member. Memorials were everywhere large and small. Whenever a fireman’s body was retrieved, there was a large ceremony and more of the neighborhood was blockaded. Every subway train now had an American flag on it. Signs with little slogans such as “These Colors Don’t Run” were posted all over. Even the rescue dogs were commemorated with dog statues in front of select fire stations. Meanwhile, Rudi Giuliani was king of the world announcing how strong and resilient New Yorkers were. However, I was struggling among most New Yorkers trying to make sense of my environment and what I was feeling.
Nevertheless, I was working hard as a social worker, listening to client stories and trying to help others. I did groups with children, answered their questions and helped them feel safe. I met with my clients and helped them process their emotions around the event. I also began working with a few select families who lost a family member in The World Trade Center. One of the most difficult sessions I had was when a man described his experience searching for his sister’s DNA in a pile of body parts. He told the horrific story with little emotion while I listened and absorbed the feelings that were difficult for him to express. I remember having a terrible headache that night. 9/11 happened to all of us: the whole city, the whole country so it was difficult for me to stay in touch with my personal experience. I was simply grateful to be alive and unharmed. I didn’t recognize how I was affected.
I experienced several emotions that year. I was relieved and grateful, I was scared and vulnerable, and I was sad and depressed. But one major emotion I experienced was anger. I was angry with all the people profiting from tragedy. I walked down Church Street and observed vendors selling booklets with 9/11 photos. They were also selling images of the Twin Towers and NYPD/NYFD hats and T-shirts. Every time I saw a “United We Stand” T-shirt I was irritated. They were even selling banners with the names of the deceased on it. I remember their laptop computers scrolling images of the day with the Jewel song “My Hands” playing in the background so they can sell their merchandise. That made me angry also. And I couldn’t believe the crowd…people were coming from all over the country to get a peek at “Ground Zero”. For months it was a mob scene until the city built a wooden viewing platform. Also, a store actually framed their products with the white dust on it and it became a tourist attraction. I felt angry, angry that it was so sensationalized, angry that it became a source of profit for people, simply angry.
Over time, I was able to let go of some of my anger and come to acceptance. I moved out of New York City in September 2003 and being away from New York has been both difficult and a relief. I miss being around others who were a part of the community I was in, while it was good for me to have some distance from it. Six years later, I have been able to heal and I will forever carry with me the empathy I gained from being so close to a large national disaster.
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