Religion and Spirituality in Psychiatry

Psychiatric Care Using Buddhist Principles 325my back.” She said she really didn’t need treatmentbut agreed to work with us for six months.It felt like she was commanding me to listen, notinterrupt, and not to make eye contact or sayanything that would put her on the spot. I compliedwith her “commands,” asked her if it wouldbe OK if I started introducing her to potentialteam members while she was in the hospital,and she said a bit dismissively, “of course.” Shereported no preference for men or women on theteam and “anything else you need to know mymom can tell you. Are we done?” Though she wasoutwardly a bit hostile, I found her quite likable.I could see it was unspeakably difficult being inher situation and thought she did a good job ofgetting to the point and taking care of herself. Ileft with the impression that Julie was terrified,feeling completely vulnerable, and making a tremendouslycourageous effort to try somethingdifferent in her life.From all we could gather in our ensuingassessment, including, importantly, her historyof sanity and success, (2) Julie had grownup quite normally as an energetic, intelligent,athletic, and creative person. She had begun toexperience mood instability late in high school,at times needing to withdraw a bit from her usuallively flow of activity, seeming depressed withlower energy. Once in college, Julie continuedto do well in all areas, but her mood irregularitybecame more pronounced. Sleeping was oftendifficult, and it was harder for her to keep anenergetic schedule. Her art at times became morebrilliant and subtly expressive, but she also didless of it. She tried medications for a brief period,but rapid weight gain and unimpressive resultsconvinced her that they weren’t worth the troubleand she stopped. In the meantime, Beth andJulie’s father were in the midst of a fairly amicabledivorce, which resulted in her father moving outof state and essentially out of her life.After a heroic struggle to stay in school, andwith her life badly deteriorated from how shehad been at the beginning, she finally graduatedfrom college. Shortly after that, Beth visitedher and immediately knew that something wasterribly wrong. Julie was talking in a rapid andpressured way, was very irritable, and was speakingin an urgent manner about what soundedlike Christian mysticism. Her apartment lookedlike someone had ransacked it, and it appearedthat Julie might not have been sleeping for awhilebecause her bed was now under many layers ofoddly arranged artistic creations that appearedto constitute a shrine. When Beth urged her tosee her old psychiatrist again, Julie stormed outof the apartment and recklessly drove off. Shewas picked up later that day by the police andwas taken to the psychiatric hospital on a mentalhealth hold. Thus began the cycle that wouldbecome her life for the next five years: briefperiods of stability interrupted by involuntaryhospitalizations, medications, weight gain, and“stupidity,” sometimes a job that was hard to copewith, no friends, no meaning, “mom worriedabout me all the time,” “wanting my life and freedomback,” and almost dying on two occasionsafter intentionally stepping into traffic.The consensus of the assessment was that Julieneeded a fully developed team and two shifts perday to begin with. This is a lot of contact, whichcould be overwhelming, but we also sensed thatwe needed a very solid structure for her to actuallystabilize and be safe. The shifts would berelatively brief, an hour and a half in the morning,to help her get breakfast and organize theday, and another shift at around 6 to 8 p.m., toget dinner and to make the transition from theday to evening. With the day book-ended in thismanner, it was also designed to get Julie’s sleepcycle stabilized with her being awake during thedaytime. We had worked on this plan as best wecould with her, but she was not interested in thedetails of what we would all do. She just said, “I’lldo whatever for six months.”As with so many of our clients, Julie washighly ambivalent toward psychiatric medications.Windhorse Therapy does not have a policythat dictates or prohibits the use of medications.Rather, we attempt to approach each client’s needsand desires, without pre-judgment, from a place of“taking a fresh look.” From what we heard in Julie’scase, it was reasonably clear that medications hadhelped to settle her moods for brief periods in