Early Reflections During My First Few Months of Community Mental Health Work

[From early 2013, several months into my practicum/internship.]

So, this is what I’m thinking today. It’s different than last week and I will have a different view on Wednesday evening of next week. “She” refers to most of my client base.

I’ve been trying to describe what it’s like to drive the nine miles to work and to provide some measure of the real distance that I travel between here and there. Many of my clients have problems that cluster around labels that you’re probably familiar with: severe mental illness, homelessness (or virtually so), substance dependence, and severe (underscore severe) childhood and adult trauma. Pick any three (or four) of these four issues and imagine them in a single person. That’s pretty much the core of my client base.

I drive to work (technically my practicum) to meet with people that I’m certain that I could not have met in any other way, in any other place, as though both of our worlds were intentionally designed to provide no common foyer. Against all odds, we meet in a room that feels and smells to me like a coat closet or elevator. She says that this room feels like the elephant on her chest. It was hard for her to get here and it’s harder for her to stay. I’m not comfortable here, either. I encourage her to go where she is comfortable, precisely the places where I’m less familiar and most uncomfortable, but I assure her that I am a “professional” and that I will follow her. I strongly imply that I will be able to help her.

The first thing that I notice as she describes her world is that everything in sight feels cramped, as though it was all built when people were shorter, desired less open space to heat, and had a lot less to store or carry. Part of it is the vintage architecture and part of it is the stuff tossed everywhere… I was going to say “stacked,” but “tossed off” is better. Much of my difficulty in following her comes from my impatience at the way all the things that she is carrying bumps against all the other things tossed against walls and onto tables. She will not put anything down, because the things she carries are the things that she cannot afford to leave unattended. She does not live in the best neighborhood. Things get taken from her all the time when left unattended and too often when they are attended. She has come to see me specifically to help her with these things she carries. I am following her into her world, because I am looking for some safe place—any place really—to set some of it down long enough for her to catch her breath… to get out of this crisis. I’m still looking.

When I return to my world, everyone says that I’m mistaken… that I just went down the road, that everyone is pretty much the same, that we share the same inheritance, the same sky, and that all of the smallest of our shared streams flow into our common ocean. They explain my sense of dislocation in terms of politics, simple socio-ethnic differences, listed DSM criteria, or my own limited exposure in our shared world. I have a profound sense, however that I’m travelling into another world. Yes, that other world has a lot of the things that our world has, just replicated into a lot less space. There are subtle language and conceptual differences, as though her version of Wheel of Fortune is exactly like mine, but her Vanna keeps turning over word, after word, after word that is almost familiar… and none of them found in any of my dictionaries. It’s incredibly frustrating. It’s clearly frustrating for her, too. My company is something, but not enough. Will she even come back tomorrow?

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