Throw Away the Key

November 30, 2005

One of the main functions of the classes I teach at the hospital is to allow patients a chance to share their experiences. Because, as I point out to them, everyone has a different situation, but many of us share similar experiences and thus, we can learn from one another. So throughout each discussion, I constantly ask for examples from the group from which to work. One person will offer up an example of a situation… another will provide an example of a “bad” solution… and then, together, we work on a better solution. I’ve usually got a list of situations and a list of behaviors associated with each one (because these folks are usually more than willing to share how they’ve messed up in the past). We start at the top of list, and using what we’ve hopefully just learned, we work through each example and come up with a more workable solution.

Usually, they’re quite receptive to learning new ways to handle whatever it is we’re discussing. And you can always tell when a certain topic hits home for a certain person. During a class on dealing with grief, one woman’s eyes never left mine. She never said a word… and she was constantly on the verge of crying. But I could tell she was deeply engrossed in what we were talking about. During a class on guilt (more specifically, during a part dealing with appropriate guilt), another patient could hardly contain herself from asking questions that you could tell were specific to her situation. Eventually, I had to promise to spend some one-on-one time with her after class to discuss her specifically.

I’ve been assigned to work with a group of more acutely ill patients for the next couple of weeks. The groups are smaller and they’re usually shorter - half an hour or so. But the topics of discussion are exactly the same as those covered with the higher functioning group. Two patients in particular tend to skip out on our group classes. They’re both male, both in their 30s, and both have mistakenly decided that intimidation will get them what they want. As it turns out, that doesn’t work. One of them cussed me out after I told him he couldn’t spend the entire day in his room… and then cussed me out to his wife on the phone later. It made me laugh a little.

What wasn’t quite as funny as the long list of four-letter words was the participation these two patients decided to grace us with during a group discussion on anger. I’m not sure if they were upset because I made them come to the group or if they were just trying to be difficult. But either way, it’s the closest I’ve come to loosing my cool since I took this job.

Neither had said a word until we started discussing inappropriate ways to express anger. I asked the group for an example of a destructive way to deal with anger over something someone else says about us. Someone threw out the word “fighting”, and when I asked her to elaborate, she said, “ya know… going over to the person’s house and kicking the crap out of them for talking about you”. Excellent example of a bad way to handle anger, no? I wrote that on the board and then the two guys sitting in corner ignoring me decided to speak up.

They both went into huge spills about how “kicking the crap” out someone was not only appropriate, but it was the best way to vent anger. They played off of one another and actually argued amongst themselves over the best way to actually kick the crap out of someone. Another patient, a nursing student who was observing my class, and myself all tried to redirect them back to the point of the class. But they were insistent on talking about their viewpoints. Far be it from me to deny anyone a say. So I gave them each the opportunity to justify their claims.

Both stories were very similar. Both claimed to have military training… both claimed that beating the shit out of another person was not a loss of control. And both claimed that they felt better after having hurt another person. When the nursing student challenged their assertion, and said that fighting was, in fact, a loss of control, they countered with the idea that beating someone was actually a very, very controlled situation. As one of the guys put it: “I’m completely in control… of myself and of the situation… they’re not going anywhere until I’m done and I’ve got a specific set of things I’m going to do to them”. When the soon-to-be nurse asked them what happened when they lost control, went to far, and killed someone, they both agreed that “that would never happen” because of their military training.

I haven’t been in the military myself. But I know a lot of people who have. My dad is a Vietnam Vet. And while I can’t claim to be an expert on military training, I’m pretty sure the military does NOT teach people to kick the crap out of people in anger. I’m sure they teach you how to fight. But I seriously doubt they teach you to use those skills in a non-combat situation against people who talk smack about you.

By this time, another patient had become so upset over the course the class was taking that she left. So I decided this part of the class was done. I explained that, while they were free to express their opinions, those opinions were not shared with the majority of society or the majority of the people in the group. I also told them that if they wanted to leave the group they could do so… otherwise, they would need to keep their combative opinions to themselves until after the class. Afterwards, we could discuss their views in private.

Neither said anything else… until… we started talking about the consequences of inappropriate expressions of anger. They both spoke up again, talking about spending time in jail… prison… and psychiatric hospitals. Both agreed that none of those consequences was really that bad. In fact, they told me, the hospital I work for was the worst one of all because we actually made them do something while they were there. Neither had been to our facility in the past. Neither wanted to come back because they were forced to come to these groups, clean up after themselves, and were given structure. One of them was actually brought in by the police for a 96 hour hold and psychological evaluation. He said that he’d thought about hitting the police officer who brought him in. He’d done it before, and the only consequence was a 20-hour jail sentence. Which would you pick, he asked me? Here for 96 hours… or 20 hours in jail?

So the way the system works appears to actually encourage people to act violently. If you don’t hit the cop… you spend 96 hours in a hospital and are forced to try to better yourself. If you hit the cop… you spend 20 hours sleeping in jail. Doesn’t make a lot of sense, does it?

But these guys are ok with going to jail. They’re ok with spending a couple of years in prison. What they don’t like is being in a hospital where they’re made to try and learn something. How do you help people like that? The rest of the group agreed that jail/prison time was an undesirable consequence. As I put it, most people don’t like having their personal freedoms stripped, regardless of the time frame. But these guys didn’t agree. They thought a few hours or a few weeks or a few years in prison was an acceptable consequence for beating the crap out of another person.

I think I’ve just met my first “lost causes”. We learned about them in school. But the psychologist in you says ‘no one is a lost cause’. But after the discussion I had with these two men, I’m starting to think a little differently.

Maybe we should make them both happy and just lock them up forever?

Category Posted in Human Nature, Series, Work