One of my responsibilities as a psych nurse is patient education. I help my patients learn coping skills, teach them about their medications and how they work, and help them find ways to change the thoughts and attitudes that keep defeating them. It’s not a one-way street, though; my patients teach me, too. They show me new ways to look at the world; they teach me honesty and transparency, and about the resilience of the human soul. Once in a while, one comes along who teaches me more than I have to offer in return.
Jerry* was one of those. He had a mental illness that included psychotic symptoms, and was back in the hospital for a medication tune-up. He was very interested in the new medications the doctor wanted to try, and what their effects would be, so we were going over his medications together. One of them, naturally, was an antipsychotic. When I explained that it would help to diminish the voices, Jerry looked alarmed. “Oh, I don’t want the voices to go,” he told me. “It’s too lonely without them!”
I’m sure I seemed surprised, since that’s not how most of my patients feel about their voices. Jerry began to explain to me how, in the beginning, the voices had been horrible, nagging, taunting, threatening things; much more typical of the voices many psychotic patients experience. But Jerry had found a way to deal with them. “You have to get right with yourself,” he told me. “Every little thing you’ve ever said or done that you feel bad about, anything you don’t like about yourself, all the things that have happened to you that you still think about. Those are handles they can hold on to you with.” He talked about how he had searched out, one by one, every bit of the past he had been holding on to, and had worked through each thing in whatever way he needed to in order to finally come to terms with it, make peace, and let it go. He had dealt with his own flaws and shortcomings the same way, learning to accept himself in spite of them. “You have to just get over it,” he explained, “that way you get rid of all the handles for them to grab on to, and they can’t hurt you any more.”
But that hadn’t been the end of it, for Jerry. Once the voices had nothing left to taunt him with, they changed tactics and began to threaten him. “I was afraid all the time,” he told me. “They were always telling me horrible things they were going to do to me. It was a nightmare.” He paused for a moment, then continued. “But then I realized they never actually did anything. They just talked about it. So one day I had enough, and I sat down on the ground and told them, ‘Okay, if you’re going to do something to me, then do it! Right now!’” He waited for a long time, he said, but nothing happened, and so he knew the voices couldn’t really hurt him. After that he wasn’t afraid of them any more.
“So then they started changing,” he told me. “They would say things to help me, or to make me laugh. Now they’re like my friends. I’m okay with them, and they’re nice to me, and when they’re not there, it’s just…it’s so quiet, and lonely. I’m used to having them around now; I don’t want them to go away.”
We all have “voices” in our heads, audible or not…voices of self-criticism, doubt, guilt, and fear; voices of the people in our lives who have wounded us, hurtful things we save in our memories and replay over and over to make ourselves miserable. While for most of us the voices are silent and imaginary, for people like Jerry they are audible and real. Yet he was able, despite that much greater challenge, to come to terms with his own failings and learn to accept himself for who he was, to let go of the past and its hurts and failures, and choose to move forward. Once he had made peace with himself, he then faced and conquered his worst fears, even though they were much more tangible and real than most of us can even imagine.
I came away from that encounter both awed and humbled. For someone who is really pretty severely mentally ill, Jerry showed an amazing amount of insight, not to mention plain old common sense. Even those of us fortunate enough to have healthy brains and fairly normal lives could stand to learn a thing or two from him, I think.
* The patient’s name and other identifying details have been altered to protect their privacy.