As nurses were taught to think clinically, to maintain a level of objectivity and professionalism. If we arent careful, we can become so distant that we forget we are working with fellow human beings, with people who think and feel.
I worked with Alice for many of the past 18 years in my position as a nurse at a psychiatric clinic. Alice, who suffers from a major mental illness with periods of mania, depression and auditory hallucinations, is seen by a physician whose clients I follow. In this role, I am her first contact if something comes up regarding medications or their side effects.
Alice and her physician recently decided she might benefit from supportive therapy, which would be a different experience from the intensive therapy — such as cognitive-behavioral therapy — she had years ago. Shortly after we began working together, there were two occasions when Alice made me aware of the importance of our work in helping to sustain someone until they are able to sustain themselves.
My first lesson came when we decided to walk during our session, which I viewed as a way to help Alice get into the habit of exercising. As we walked, she became more and more at ease. There were no walls to confine her and no clock to remind her of the sessions time limit. She spoke from her heart as if talking to a friend. She wasnt caught up in the notion of having to say the right thing to fit into some clinical, sterilized idea of who she was.
During those moments, Alice let me in to see her as a person. She described dark times when, in the throes of her illness, she attempted to end her life. She spoke of the several medications she had been prescribed over decades in a desperate search for something to ease her symptoms; after many trials, with the help of her physician, she found one that helped alleviate some of her symptoms. She was grateful for her freedom from the voices and from suffering the ruinous consequences of extreme mood swings.
The second pivotal moment for me came many months later. By now Alice had developed a comfort with our visits, and the skyline wasnt needed for her to speak more openly. The antipsychotic she had been taking, although helpful in alleviating her symptoms, left her tired and without energy. Her psychiatrist started a new medication as an adjuvant therapy. Alice described her reluctance when she first began taking it. She noticed energy she had associated only with bouts of hypomania in the past, and although it felt good she did not trust it.
She was testing the waters, scared but excited. What she felt now was different. This new energy was focused — not unbridled like the symptoms of hypomania that in the past left her feeling tortured and sometimes suicidal.
She became excited at the prospect of using this new energy as a means of creating direction and opportunity. For the first time she could remember, she viewed her life in terms of rich possibilities. Although she was afraid, she had decided to use her newfound health to create a meaningful existence.
After her musings, there was a pause. Her head was bent low as she looked down at her folded hands and said with heartfelt appreciation, “Hes a god .” She was referring to her psychiatrist, whose visits she never misses. She quickly rescinded, possibly fearing Id think her thoughts had become distorted. “He never gave up on me,” she went on to say. “Even when I gave up, he never gave up on me. He saved me.” In that moment I sensed the enormity of the power of hope.
Providing hope offers patients a life boat until we find a better way to prevent and cure mental illness. People often cant begin to imagine what it would be like to be free of symptoms until they have had that experience. Hope may be the single most important tool we have in helping people brave the countless hurdles before them until effective treatment arrives and relief can be found. •
Carrie Sacco, RN, BSN, is a staff nurse at a mental health outpatient clinic in western Massachusetts. The patients name was changed for this article.