Jill Presnell

[The individuals and situations described below are an amalgam of years of encounters and represent common presentations. Potentially identifying information has been removed or changed to protect confidentiality] It’s 5:30 am. I receive a desperate phone call from the unit. Would I be willing to come in “for even a few hours” to cover for a therapist who called in sick. I have a little more flexibility with my hours because I’m currently a per diem therapist. I agree to work from 7am to 1pm. My husband and I planned a date for this afternoon.

Many individuals who come to our floor express feelings of hopelessness. Often, these feelings have a future orientation with the focus being primarily external or internal. The person may be immersed in thoughts about the pressures around them in which they feel trapped and see no viable way past. The future is a continuation of the present. Current circumstances and their consequences are eternal, becoming worse over time.

As a child, I believed that any part of my body that wasn’t under the bed covers would be grabbed and chopped off by the creature that hid under my bed. At times I even caught glimpses of its shadow. I felt the air move when it passed. Several times my mother came in, turned on the light, and made me look under the bed to see that nothing was there. Rather than interpreting this to mean that my fears had no real cause, I “discovered” another characteristic of the monster. It could become transparent when exposed to light. As a result, the hall light remained on at night throughout my early childhood. If this had happened when I was thirty, I might have been called psychotic.

I have one more part to the series on reactive detachment but wanted to pause to discuss this topic. We frequently work with individuals who have had fleeting suicidal thoughts for years. It’s become part of their life. This is the case for most of the members who participated in a recent group I facilitated. The group began as a discussion about secondary gains. The topic of suicidal thoughts came up. We dove in.

I work on an Acute Inpatient Mental Health unit. We provide mental health treatment, not drug and alcohol treatment yet we keep getting folks who are addicted to illegal or prescription drugs. Individuals who are violent and psychotic from using bath salts get dragged to the ER by police and then are dumped on us. Addicts trying to escape going to jail come to the unit claiming that they are depressed and suicidal. People with “chronic pain" whose doctors won’t give them anymore pain meds or who have used up their script early suddenly claim that they feel hopeless or depressed and “can’t take it anymore.” They know that when they’re admitted they will be given more pain meds. Once these people get on the floor, they spend the whole time arguing and drug seeking. If they come to groups, they blame everyone else for their problems and don’t take responsibility for anything. They act like teenagers.