Monday, June 18, 2018

After Things Go Wrong Sometimes Amazing Things Happen

After Things Go Wrong Sometimes Amazing Things Happen
Book Review by Carl Blumenthal
Some Stories Have No Ending

How many of us could survive one day in New York City’s notorious Rikers Island Jail, given we have behavioral health issues? Wouldn’t admission to a psychiatric hospital be safer and more therapeutic? 

Until recently I worked as a peer counselor in the psychiatric ER of Brooklyn’s Kings County Medical Center. I admit that I approached with caution what the police call “emotionally disturbed individuals” (EDI’s) charged with crimes. Even with one wrist handcuffed to a gurney, they were liable to react aggressively. Unfortunately, the sooner they calmed down and went to Rikers, the sooner our staff could focus on less agitated patients.

Having “done time” on psychiatric units as a non-forensic inpatient, I expected a lot more heartbreak than hope in psychiatrist Elizabeth Ford’s Sometimes Amazing Things Happen: Heartbreak and Hope on Bellevue Hospital’s Psychiatric Prison Ward (2017). I was surprised to discover a role model who all mental health providers should copy. 

Due to the revolving door between Bellevue and Rikers—the hospital has 68 beds to treat the most distressed of 5,000 inmates with mental illness—she admits, “I have come to see my success as a doctor not by how well I treat mental illness but by how well I respect and honor my patients’ humanity, no matter where they are or what they have done.” 

Ford shines a light not just on the jail’s insufferable conditions but also on prisoners’ lives that are too often defined in psychiatric and legal terms. The list of their challenges—addiction, homelessness, poverty, illiteracy, racism, etc—is as long as an indictment. To paraphrase African American psychologist, Amos Wilson, these men have learned to be the best at doing the worst. 

Ford proves one wo(man) can make a difference by never giving up on her patients even when society has cast them aside. And they do their part merely by surviving. As one peer tells another in group therapy, “You are worth it, man. You got mad courage. You just hang on and keep going one day at a time. That’s all you got to do.” 

Elizabeth Ford may never have taken a course in conflict resolution, but she’s a natural at calming potentially (self-) abusive patients and keeping the peace among staff—mental health providers and corrections officers alike. Even as she climbs the career ladder, there is always someone telling her what to (and not to) do. Yet she’s not afraid to speak truth to power. 

Her calling is to assume more and more responsibility for events others consider beyond their control, in the end becoming the current head psychiatrist of the city’s correctional health services. She prefers the intensity of working with psychiatric inmates than other populations in other settings. 

For example, Ford is in her glory (or God’s), when, like a modern-day Noah, she evacuates the prisoners to an upstate hospital during super storm Sandy and finds refuge elsewhere for those re-housed on Rikers Island, where she discovers just how poorly those with mental illness and substance abuse are treated.

Is Elizabeth Ford too good to be true? Except for a few moments of self-congratulation, burnout seems to be her only shortcoming, but that’s because she cares too much. Her family and therapist keep her on an even keel; she recognizes her racial, social, and economic privileges. And there are events out of her control, such as the beatings, murders, suicides, and escapes she learns about second-hand. 

Ford’s memoir has the pace of a well-directed movie with enough drama to satisfy the most avid consumer of stories about abuses at mental hospitals. Her prose is straight-forward. Her eye for detail demonstrates the mindfulness necessary to survive amidst daily trials and tribulations. She enables us to witness what others can’t or refuse to see.    

Thus, it’s the small blessings that give her and us hope: A phone call home by a scared teenager, a grungy prisoner’s unexpected shower, proper clothes for a court appearance, a sing-along in community meeting, ping-pong on a makeshift table, and a patient forgiving a doctor’s mistake. 

She concludes Sometimes Amazing Things Happen with these words: “A story without an ending is still a story worth telling.” Meaning these are snapshots of lives—sometimes like our lives—that we must honor, no matter how difficult to appreciate. 

Yet, much as she treats our peers humanely, Ford doesn’t hesitate to use both diagnostic labels and psychiatric medication for what she believes is our own good.

Based on my experience in the psychiatric department at Kings County, I now see the language is a shorthand and the meds are shortcuts to get people out of the hospital as quickly as possible. (After all, who wants to be confined in a mental hospital?) It may be only with long-term community services that peers have a better chance to educate clinicians.

I volunteer for the American Friends (Quaker) Service Committee’s Prison Watch to end solitary confinement, which causes and worsens mental illness. Agencies such as CASES, the Fortune Society, and the Osborne Association now rely on peer specialists to connect with ex-prisoners living with behavioral health challenges. I recommend that readers of City Voices get involved in these efforts if not doing so already.

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