I gave the following brief remarks this afternoon to a class of a dozen student nurses at an acute care psychiatric facility:
We rotated four of you for each of three group sessions today. I would like to thank you for coming, and for attending carefully to what as going on. This group was in the highest level of detention, observation and treatment. Those on initial 72-hour psychiatric holds still are decompensating; those on extended 14-day holds are here for a reason, which is that they remain a danger to self, danger to others, or gravely disabled. In either case, all of them were acting out, or are psychotic, some of them flagrantly so. They have psychomotor agitation, speak incoherently, end up in conversational dead-ends, and may even seem to be, or are, violent. In today’s group, for example, one person got up and started wandering around the room, touching people individually, which easily could be interpreted as threatening. These are not your typical groups like you will find in discussions of group therapy by authors whom you may have studied, such as Irvin Yalom.
One of the group participants asked why several of you were in the room and, as frequently happens, this theme quickly spread to other group members. In response, a couple of you sensed group hostility, and left the room during the second session. What I would like to tell you is that none of this was directed against you personally. It is a normal part of dealing with this segment of the psychiatric inpatient population. Nurses continually monitor the proceedings to see if anything violent is taking place, and are in a position to respond instantly to danger to staff. You may find it surprising, but at the third group session, several members of the group asked where the missing nurses went. Their seemingly challenging behavior during the second group really was nothing more than an artifact of their own subjective psychological processes.
These experiences that some of you had lead to a broader issue, which is what it is like to work in an acute care psychiatric facility. In a way, it’s like working in an emergency room, but instead of treating accident victims or gunshot wounds (for example) you’re dealing with people in acute psychological distress. It’s their minds that are injured, and the mind is part of the body just like an arm or a leg. There’s more to it than that, but this is the place to start.
If you’re at all interested in how the mind works, or the relationship between the mind and the body, then I encourage you to consider acute care clinical psychology as a career option. It’s always interesting, and I never cease to be amazed at the sheer variety of human experience. Pathological human experience in turn sheds the best light on the mechanics and dynamics of non-pathological human functioning, and how we are attuned to our being in the world. Thanks again for your help today, and I hope to see you again, soon.