Marcus is an MHA. M is for miraculous or manly, H is for handsome, A for associate or asshole. We both work at a psychiatric hospital, but our jobs are different. I like his better. There are various units in the hospital all divided by age. He sits on them and monitors behavior, sometimes keeping logs of the patients’ movements once in the rounds the book. He has to do this every 15 minutes, to make sure they haven’t disappeared, or aren’t up to some mischief. That is not the part of the job that sounds fun.
Usually Marcus sits on the boy’s unit, which I imagine is because he is very muscular and boys would find that intimidating, perhaps admirable. You can see it very clearly through his shirt, though I didn’t notice until someone pointed it out. I, on the other hand, work with the adults, who find me intimidating because I am pretty. Adolescents scare me because they don’t find me intimidating at all. I have always been wiser than adults, but a little slower with my own kind. Now that I am adult, though, I’m not sure.
Marcus’s job is not mostly to monitor; it’s to control. My job is to monitor, to report, sometimes to counsel and not mostly to be therapeutic, though my title is therapist. When I meet with patients they always have this reaction like, of surprise. You want to meet, with me? Why? I had this one patient who always asked if I had something for him to sign. On the last day in the hospital he asked me if I was his social worker, as if he had never seen me before.
Their skepticism is contagious. I tell them that I want to meet, “to talk,” because I have yet to develop a more accurate explanation, but I’m pretty sure I’m not very convincing. According to the treatment plans I write I am helping them to identify triggers, to develop coping mechanisms and to determine if medication compliance is resulting in increased reality testing. I suspect I’m not very good at any of these things. I’ve always been bad at agenda setting.
There’s a hierarchy at the hospital, but it might differ depending on who you are. By pay, the MHAs are the lowest, then the therapists, then the nurses and then the doctors. But before I knew this I thought the therapists were higher than the nurses, because it is a psychiatric hospital, after all. This was also before I realized that the difference between psychiatry and therapy is that the one emphasizes discipline and the other love and that you can’t mix the two, because their objectives will cancel each other out. They complement each other though, kind of like your mother and father, the difference being actually that the one requires expertise and the other you are supposed to do just for the pleasure of it, apparently, or therapists would get paid more. Oh, and, the mother is the one who knows what’s going on, but the father always gets to tell the mother what to do. I, myself, do not get paid. In fact, I pay, because I am an intern and need to do this to graduate from school, which puts me in a strange relationship to the hierarchy. The patients can’t tell the difference though.
I met Marcus, my associate, on my first day in the hospital. I had been sitting on one of the units, the one where I am told they put “manic” people, unless they are “sexually acting out” manic people, in which case there are various other places for them to stay. In truth the sexually acting out women are allowed to stay, but the men usually have to go. I was just there to “observe” to “learn” to be a fly on the wall. In fact, I had to be a fly on the wall, lest I do something that required filling out paperwork. My first day I was worried that I would be too snobby and/or pretty to make friends with the MHA’s, that they could sniff it on me, or something. This is how wrong I am about how people react to snobbiness and prettiness. All you really need to do is say Hi.
In fact, the place where I work is not a psychiatric hospital. It’s a behavioral health hospital. Behavioral health, since it is short term, revolves around self-awareness. One has to be aware enough of his/herself to behave according to the rules or society. So the main purpose of the hospital is really to facilitate socialization. One could see how I might be bad at this, for the same reason that it’s easy for me to relate to crazy people, even though, most of the time, I’m not one. On the top of my group notes, under the category of goals, I always put self-awareness, because I know that is the right answer. The patients know it too. When they are self-aware enough to pretend to be sane they get to go.
Javier, the older, Hispanic MHA (skinny, irritable, focused, coherent), made sure to introduce himself in a way that let me know I should have introduced myself. So I apologized profusely. I wanted to say, I’m sorry, its not that I am snobby and pretty, it’s just that I’m disorganized and petrified. I think my tone may have made that clear. He introduced the first group for the day. “Today is June 27th, the weather is 90F and sunny.” He wrote it on the board. You might think this is patronizing, but for people with nothing to schedule and no access to the outside world, it is just, in fact, a courtesy. Or perhaps it is patronizing since this information is really irrelevant here and the fact that it’s hot and sunny in Chicago, just a tease. Or perhaps it is meant to be both. In this hospital courtesy and condescension are sometimes the same thing.
Marcus, on the other hand, was sitting in a corner playing spades with the patients. They were having some argument about the rules. “Well that’s not how they play it where I come from.” He remained neutral. He invited me over. This is how on my first day at work I learned to play spades.
I immediately liked Marcus for his mild manners and because Heather declared that he was the only staff she could trust. Often, I find, you can trust a crazy person’s judgment of character better than most. Heather, herself, had become famous in the hospital. When in orientation you could hear someone screaming from the 2nd floor, we were informed that this was Heather. When staff popped their head in to say “Hi,” they would say something funny like, “Oh, I have just been fired by Heather,” or “Oh, Heather just gave me a raise.” So when I finally met Heather (impulsive, psychotic, focused, agitated, labile) and she welcomed me to the hospital and told me that I better respect her because if I don’t she’ll fire me, I was honored. But when she asked me if she could take my seat next to Marcus I said No. I forgot to mention that patients are at the bottom of the hierarchy.
Honestly though, I see why Heather was famous, because I haven’t found a patient quite as lively since. They could use her to advertise the place, “Where crazy people come for a crazy time.” Her feelings quickly turned against Marcus, whom she accused of sexually harassing her the next day, proving once again the old adage, that being nice to crazy people doesn’t pay. Sane people are, however, just as simple, as evidenced by the fact that after this day both Marcus and Javier developed crushes on me. Discipline, mixed with a little condescension, always leads to love. Love is in fact the only thing that kills desire and this is why love is the social worker’s job. Nobody wants it.
This cycle, discipline, condescension, love, does not lead to increased reality testing. In fact, people in the psychiatric hospital who refuse to take their meds often get worse. It’s not good for the staff either. Marcus, for example, also seemed to suffer, sometimes ignoring me and other times asking me out. Perhaps he thought that this would provoke my desire, but for me it doesn’t work like that. Maybe this is why I’m a social worker, because I am emotionally incapable of playing a roll in the cycle. That’s why I don’t date much. It, however, took my cointern Daryl to point out that Marcus has control issues. I still don’t quite get it, but in some vague way it makes sense. He also pointed out that Marcus doesn’t seem like my type. “A ripped black man with you?” he exclaimed. “Well, who seems more like my type in this hospital?” I countered. I was jealous that every woman in the hospital seemed like Daryl’s type and no man, or woman, seemed like mine.
During this conversation Marcus walked by my table twice. He sat behind me, with his back turned, not saying a word, apparently absorbed in the work of monitoring the boys while they ate. I asked Daryl if he thought this was strange and he said it was probably because I was sitting with a dude, which to me seemed even stranger. In these sorts of circumstances I always want to break the awkwardness. My inclination was to turn around and make some sort of conversation, to put Marcus at ease, but I guess this is my own form of condescension and besides my approach, which was to smile, have lively conversation and ignore the situation worked, because later Marcus left a message on my phone.
The problem with me is that I can see some things, like depressed mood, confusion, anxiety, vulnerability, pride, but not others. I don’t know what those other things are, but I get the feelings they are supposed to be the things that I respond to if what I am looking for is behavioral health. I’m still not sure what to do with Marcus, if I should ask him on a date, or respond when he asks me on one, or if he’ll keep on asking if I ignore him. It seems like I am supposed to be the one doling out the discipline and he the condescension. I am pretty sure that for him I feel a certain amount of love, but as far as behavioral health goes, it’s not worth it if it makes me crazy.
