Religion and Spirituality in Psychiatry

Psychiatric Care Using Buddhist Principles 327flavor, but you could see that she really caredabout what she was saying. We all liked her andsensed she had been, and continued to be, in aterrible life predicament.The team meetings were held at her house.These were generally not very comfortable, a difficultvariation on a basic attendance shift, withJulie needing to keep the relationships at a safedistance. The house meetings, also held at thehome, were more comfortable and productive asthey focused on details of running the home withDonna.Julie continued showing up for every shift,but as time passed, she was beginning to let it beknown that we were all nice enough people butquite useless as therapists. Especially John. Therewere many sessions where they would just sitwith a lot of silence. A little teaching would happen,and then Julie would tell John what a wasteof time therapy was. She didn’t need therapy, andJohn was a lousy therapist anyway.One morning Julie didn’t want to get outof bed. Her polite demeanor had been slowlychanging over the last month, and she stoppedteaching. This morning she looked withdrawnand terrified, like she was really suffering, asif it were difficult for her to breathe. She spentthe morning in bed but seemed to appreciatethe quiet company of the basic attender,who brought her tea and food and read a bookwhile Julie lay in bed, not wanting to talk. Laterin the day she had a therapy session with John,and strangely, she seemed interested in seeinghim. At the beginning of the therapy session shewas quiet, but it had a completely different feelingabout it. Instead of angry and guarded, sheappeared completely vulnerable and fearful, veryuneasy. Finally in a quiet tone she said, “I can’tbelieve this is who I am.” Then in a steady andmeasured flow of words, she described how horribleit had been over the last five years to see lifeas she thought it would be, completely washeddown the drain. She couldn’t count on herself,and nobody else could count on her, except todo something crazy, destructive, and stupid. Shehad wanted to ignore it, but the mania kept comingback. She wanted to leave everything, but thepolice kept bringing her back. Now she was hereand having more awareness than she wanted andJohn, after having survived so much of her anger,felt like the safest person to be with. At least forright now. Caught between the depression, whichmade her feel like a hopeless and utterly bad,worthless person, and the insight of what she hadlost, and without having any sense of a way outof this horror, she saw no realistic option but tokill herself. She had no immediate plan, but shepromised that if she tried again, it would be successful.It was clear that she meant it.John quietly listened to her. When sheappeared to be done, he said that he was glad shecame in that day. The simplicity of him just beingthere listening to all this horror and then genuinelycommunicating that he was glad to be withher, spoke straight to the level of her experiencewhere she felt utterly lonely and unlovable, cutoff from everyone, unspeakably afraid and outof control in a world without allies. She cried formost of the rest of the session until John took herhome. Once there, Sandy, the team leader, joinedJulie and John to talk about what was going on.After believably agreeing not to hurt herself, theyall felt it would be best to increase her shift supportfor at least the next week. Because we hadexpected her to get depressed at some point andthought this was likely to be a positive development,no medication changes were indicated.Waking up to who you are and how your lifehas been is a critical part of the recovery process.This dramatic shift in Julie’s awareness was verysudden, which is a dangerous place for a lot ofpeople to be. It can be extremely difficult to toleratehow it feels to be suddenly that aware. Often,a person needs to diminish awareness throughcultivating psychosis again, finding other waysof being defended, or killing oneself. But Juliewas able to tolerate this experience and use it asa reference point throughout the rest of her timewith the team. It was very striking to her that theteam did not shy away from the painful intensityof her emotional state, but actually seemedto appreciate her all the more in her vulnerabilityand for being genuine. Julie’s awakening wasa dramatic example of an island of clarity , an