A Moment of Silence

At the President’s suggestion, I attempted to observe a moment of silence in remembrance of the shooting that occurred in Tucson. Six people died and a congresswoman was critically wounded by a gunman who was immediately termed “schizophrenic” by a wave of amateur diagnosticians. I was in the psychiatric assignment office (PAO) at the psych emergency department (ED), between assessments of delusional people, my third and fourth that day when I attempted the moment of silence.

There’s been precious little silence since this shooting. There have been prayers for the recovery of Arizona Representative, Gabrielle Giffords and speculation about Jared Lee Loughner, who shot her. People have expressed the horror over yet another attempted political assassination, outrage over corrosive political discourse, and in admiration for the bravery of the men who wrestled Loughner to the ground and for Dorwan Stoddard, who died covering his wife when he heard the shooting.

And then, during the proscribed moment of silence, even my own brain couldn’t be silent.

I couldn’t help but think: this is going to create a lot of paperwork for me.

We get people like Loughner almost every day in the psych ED. Most are compelled to come and be evaluated by someone in authority. They are suspicious of the government and will tell you in detail of how they have been persecuted. The most dangerous, we admit to the psych ward and force feed medication for a few days until they are released and they go off the medication. In the end, they will count us at the ED as lackeys of the government and distrust us, as well.

“Now I know why postal workers go postal,” one said to me when I told him he would have to stay at the hospital against his will.

“Are you planning on going postal, yourself?”

“I didn’t say that. I just said I know why. I know how it feels.”

“Powerless.”

“No, when I think about going postal, when I think about that gun in my hand, I feel great for once.”

“You feel like you are getting justice?

“No, I feel like I’m getting heard.”

For this man, and for so many others who are less articulate, admitting him to the hospital involuntarily only made him more alienated and bitter. It made him less likely, not more, to seek help in the future. It made him less likely to obtain redress for his grievances against his employer for being fired, allowing them to fester and inflame.

Yet, I had no choice but to admit him, for he not only had grievances, he had a gun and told me he was thinking of using it. I would have been remiss had I not forced him into treatment.

Unfortunately, the treatment, at least the kind of treatment that is most often offered, gets in the way of any long term resolution to his problems.

I know this because I know my own case. Here I am, a suicidal crisis counselor who cannot tell anyone I am suicidal. If I did, I would be hospitalized, maybe in my own hospital, for my own safety. I’d rather die. What would happen when I get released? How could I go back to work here? If I don’t work, what else do I have?

I believe all these people want is for someone to listen to them and take their concerns seriously. There is quite a battle over air time in this world, everyone waiting to get their say and wanting the story to be told their way. For instance, it seems like everyone has been attempting to make this shooting be all about their pet peeve. Loughner shot people because of corrosive political discourse, say some, because Sarah Palin put crosshairs on Giffords’ district. Others say because Loughner was schizophrenic, because Arizona cut funding for mental health care and because guns are more accessible than treatment.

Why does Loughner say he did it?

He doesn’t, directly. I looked at some of the material he posted on the internet. He incoherently complains that his freedom of speech had been taken away. In a legal sense, his freedom of speech does not seem to have been violated. However, he had, for all practical purposes, indeed lost his speech, but for reasons other than how he describes.

I think Loughner shot people because he wasn’t getting heard. He wasn’t getting heard because no one could make sense of what he was trying to say. No one could make sense of him because he was incoherent and people stop listening when someone is incoherent. Listening is quite an investment and few are willing to make that investment when there will be few immediate returns.

Why was he incoherent? It may be that he has a brain disease that scrambles up the connections. But what I think is more likely is that he was incoherent because he hadn’t been in a real conversation with anyone about the things that matter to him. A conversation, a real conversation between people who treat each other as equals.

Incoherence is thwarted by real conversations in which people are free to give feedback and get clarification, and also give each other space to say what they need to say. People get better at saying what they are trying to say when they have real conversations. When they get better at saying what they are trying to say, then they feel heard and have less reason to go postal.

People seldom get real conversations when they approach the community mental health system. Of course they don’t get them when they shoot others, either, but then it’s too late. When people approach either the mental health or the criminal justice system what they get is labeled, and when they get labeled, the conversation is over. When they get labeled, their voice, what was left of it, disappears and in its place is a label: in Loughner’s case, schizophrenic. Once a person is schizophrenic, there is no more that needs to be said about him or her.

Hospital administrators are not immune to this desire to be heard. The more anxious they are, the more they want to be heard. They get very, very anxious; especially when there’s been a shooting. They speak by creating paperwork.

When I talk with a patient in my ED, there appears to be just two of us in the room. In reality, the hospital administrator is there, as well, speaking through his or her paperwork. Only I can hear the voice of the paperwork, although, I guess many patients suspect it is there. It shouts.

The voice of paperwork does not treat either one of us as equals; it has power and control over both of us. It may ask for clarification, but it has a small vocabulary with which to receive it, so that it seldom can grasp the nuances necessary to completely communicate. It gives feedback, but not the gentle feedback that allows the conversation to continue. Its feedback is crude: it takes away your freedom, your livelihood, your good name, or it lets you keep it.

All this is to say that I would be a much better counselor if I didn’t have to answer to anyone but the patient.

What we really need whenever we encounter one another, especially the troubled and incoherent, is a moment of silence. A silence like the silence I heard on the hilltop, or the silence I observe on this screen as I begin to write; silence that invites us to fill it with whatever we have to fill it with.

This silence should be followed by the initial speaker being silent while the first one that was silent speaks, expressing his or her reactions.

Then repeat.

This is the way that conversation happens, a conversation that will keep us all safe.

I’m going to be silent for a while now. I invite you to comment.

Related articles

• How Jared Loughner Fell Through The Mental Health Cracks (huffingtonpost.com)
• Loughner a “textbook” case paranoid schizophrenic (salon.com)
• Fear-Mongering and the Mentally-Ill (swampland.blogs.time.com)