Working with Crazy People
"You'll be interning at XYZ Therapy with people experiencing severe mental illnesses". Wait, what!? Prior to that moment, I listed the populations I wanted to intern with and I defintiely, did not write I wanted to work with people with severe mental illnesses so I followed up with my graduate school program director immediately: Hey Dr. J, I just received your email but I didn't choose this population so would you be able to select another site for me?
“Sorry Vaughn, that's all we have.”
“Heeell no! We gon' find a way.”
I scoped the area of this new internship site using Google's Street view. The more I see in the neighborhood, the more reasons I find to avoid interning with people who had severe mental illnesses. I click the map, which shows me further down the block. "Nope, this looks like the house the Albany, Young Jeezy would trap out of". I click the map again... "I might get robbed and kidnapped in front of this house". Honestly, those two clicks were all I needed to see before reaching out to my program director again. "Hey Dr. J… So being a Black, man growing up in Harlem…" I was about to deploy every single tactic I had to avoid interning at this site I was assigned, "…I was traumautized… A LOT!" I basically said the neighborhood was too dangerous, too triggering and going there would give me anxiety, disorienting me from doing efficient work with the clients I would be so fortunate to work with and I'm even experiencing flashbacks as I think of my old environment while crafting the email I was sending. He responded with the same courteous gratitude employers give you before saying they're not hiring you, except his "We regret to inform you" was basically followed with: You are definitely going to that site! I briefly thought about transferring schools.
The truth was, I was scared. Severe mental illness?! Schizophrenia? Bipolar disorder!? Multiple-personality disorder? I just knew as soon as I walked into the site I was going to see people in straight-jackets bouncing off walls, the strong ones who managed to rip through their straitjackets would probably be swinging on fans and performing different aerial attacks on me, people drooling on their selves, walking in circles while talking to their selves or entities that I couldn't observe, throwing feces on me and all types of stuff. Nah. I was gonna tell Dr. J the truth. It wasn't the neighborhood, it wasn't past trauma, I was scared.
…Naaaah. I'm not about to tell nobody, I'm scared. I imagined overhearing Dr. J in a staff meeting unable to control his laughter as he told the other professors "Yeah! He said he was scared (crying laughing)! He's 6'6 and says he's from Harlem" and the entire room going in an uproar of stomach-aching laughter, with some of them dropping to the floor from their seats, slapping the floor and crying literal tears because I confessed I was scared. A few weeks later, I anxiously and begrudgingly head to the site of my new internship.
Immediately, I receive a warm reception from clients standing outside the program. They ask me a few questions and welcome me. I'm liking this so far. Then, I go inside. "Hi, I'm the new intern. Is Madison here?" Madison was my supervisor at the program. Now, a small crowd of the program's participants is gathering around me and I'm feeling like the new substitute that seems cool but inevitably has to be tested. The crowd of clients asks me questions, I answer the questions, a few clients of the program advocate for me and say, "He just got here, and y'all are asking him all these questions. Leave him alone." The supervisor greets me and speaks to the clients as if they're normal human beings. I see more professional therapists interact with the clients like they would with anyone else outside of work. I shadow other clinicians to observe how therapy groups operate and I recognize figures I see in any group. This person is the comedian in the group, that person is the trouble-maker, this person is the kiss-ass, that person really doesn't want to be here and is going to let it be known, that's the person everyone thinks is cool and so on. As the day progresses, the realization creeps up on me: The participants in this program are normal people. This is my first day and I'm not entirely free of prejudices but I'm no longer scared. I'm also a little less ignorant. The hours I had anticipated dreading as an intern at this site quickly became hours I knew I would enjoy, at least most of the time.
An internship is about applying what you learn in school, but also learning as much as you can from that experience. My internship was one of the richest educational experiences I have had, to date. I remember walking to my office one day, past a defeated-looking client who was sitting with my classmate/fellow intern and a staff member for support. I think I hear the client said say "I'm going to kill myself" with the softest voice. WTF did I just hear?! They couldn't have said that. I turned around and stopped in case I heard what I thought I heard and I needed to be around to offer something. I had no idea what to do. In fact, I'm not even sure they said what I think they said. After more dialogue between the client and an experienced clinician, the client yelled, "Nooo! I am going to kill myself!". I did hear what I thought I heard. Immediately, I was asked to inform my supervisor, Madison, that the staff and client needed support so I beelined to my supervisor's office. I got to Madison, closed the door behind me and told her what happened. I must have forgotten the client's name in a panic and the supervisor asked what they looked like. I described the client and the supervisor nonchalantly said, "Oh, that sounds like Jordan" and proceeded to continue typing. Hold up. Why aren't we reacting more urgently Madison? As if she read my mind, Madison explains, this was a coping strategy for the client, Jordan. She proceeds to finish her typing and then goes to speak with Jordan. I remember Madison being extremely zen-like, speaking to the client respectfully and with the utmost sincerity. Every time I experienced someone with visible mental health challenges in the past, they were either spoken to condescendingly or ignored, so the interaction took me aback. Madison spoke with Jordan in the manner she did because that's how people are supposed to speak with each other. Later, Madison would explain to me that Jordan's life experiences led them to understand that using threats to harm themselves and/or kill themselves would lead to them receiving consolation. My supervisor's ability to tend to Jordan came from her expertise as a mental health professional. If you hear someone say they want to kill themselves or harm themselves, please take what they're saying at face value and seek support so they do not proceed with harming themselves or anyone else. Resources include but are not limited to the Suicide and Crisis Hotline, phone number 988, 911 for emergency services and mental health providers the client may be working with already.
Jordan and my supervisor came to some type of resolution because the client, thankfully, did not kill themselves. After that experience, it stuck with me how the behavior Jordan exhibited could be a symptom of a few mental health diagnoses (I won't identify the diagnoses to prevent anyone who isn't a mental health professional from self-diagnosing or assuming that a symptom defines the diagnosis). That day, I learned first-hand what the diagnosis could look like and my school education went from being 1-dimensional on paper to being a visceral experience that sticks with me to this day.
I'm not going to create some bubblegum, happily ever after revelation and say all this time I was the crazy one. The truth is, I was a victim of propaganda. When I consumed media about things people with mental health diagnoses committing violent crimes, I generalized the behavior of one person to an entire demographic, believing everyone with mental health issues (I probably didn't even know what a mental health diagnosis was back then) would be an unstable, dangerous criminal. People with mental health diagnoses are often misrepresented, sensationalized, and overrepresented in the media. My perception of people with mental health diagnoses as unstable, dangerous, and violent criminals came from the media. Thankfully, I was able to reduce my stigma of mental health through education and confronting my fears, even if I was forced to do so.
The overwhelming majority of people with mental health diagnoses learn to manage a complication in their life (i.e. the mental health diagnosis) just like people without mental health diagnoses manage complications in their lives. For the people with mental health diagnoses, their ability to seek treatment speaks volumes about their willingness to identify and tend to a challenge, whereas some of us without diagnoses are doing everything we can to avoid identifying a problem we know is present and consequently, avoiding potential solutions. I know it sounds generic but I say this with the utmost sincerity: seeking help is a courageous act.
Today, when I tell people I'm a therapist and people almost reflexively say "you work with the crazies", it's easy to get offended. But whether the comment is made in jest or not, I get prideful. I get prideful advocating for people like Jordan, who is not crazy but instead has a diagnosis based on being abandoned as a child. I get prideful advocating for people like Melissa, who isn't "bat-shit" but is living with an overreactive mental alarm system telling her she is constantly in danger… I get prideful in advocating for Joe who doesn't have loose screws but is… actually, I don't know what's wrong with Joe, cause he was running down my block in the winter coat in the middle of the summer saying "backdoor, backdoor!" but the point is, there is some reason Joe is doing that, that I don't understand. Maybe Joe stopped taking medication which has side effects but mislabeling him as any crazy trivializes his experience and generalizes him with a group of people that don't exist (e.g. "crazies"), which I will not be able to understand unless I am informed by a knowledgeable source of Joe's experience. Reducing him or anyone else to "crazy" is reducing him to a word that has zero value in the mental health profession because it encompasses nothing (e.g. no definitions, no explanation of symptoms, nothing). I probably won't run after Joe, asking him what's wrong but it's likely there's some diagnosis and/or research that normalizes his experience and provides treatment. I had the good fortune of an internship, which forced me to confront my ignorance. With useless labels such as crazy, any Joe may experience shame and isolation, possibly exacerbating the very symptoms that they're already ashamed of. If you're committed to combating stigma around mental health, I encourage you to research different diagnoses. These may be diagnoses you've heard about but do not fully understand, a diagnosis you saw depicted in media, a diagnosis you find interesting and so on. With understanding comes empathy. For people deemed "crazy" to understand they are not crazy usually brings them back to humanity, humanizing them from a place of shame and hiding that they never deserved to be in the first place, especially because there are mental health professionals who can offer help. Together, let's challenge the ignorance that is more dangerous than any mental health diagnosis and destigmatize mental health.
How Can Therapy Help?
Therapy can help you:
Receive guidance for symptoms/challenges you’re experiencing.
Offer support in moments of not having definitive solutions and navigating challenges.
Equip you with tools and/or psychoeducation for navigating challenges/diagnoses.
Reduce the stigma so taking care of yourself feels natural and not shameful.
Destigmatize mental health. Your success in therapy is likely to inspire your family, friends and associates to do the same.
Create a safe space providing you with space to feel less alone, speak freely and without judgment.
Normalize language and knowledge about mental health.
Challenge old beliefs that may have kept you out of therapy and contributed to shame for mental health challenges.
Support others experiencing mental health challenges with more empathy.
Inspire hope that circumstances will get better.