When I was an undergrad at Boston University, I took a course in the department of sociology in “medical administration.”  I was compelled to understand the social context of medical practice, for whatever reason.  I remember little of the course itself.  There was a very attractive older woman sitting next to me who amused herself by “adopting” me, which she thought gave her a right to criticize my then overweight figure and poor clothes.

I remember more about her than I do about the professor, a wacky guy the university had seen fit to import from New Zealand.  He had published a couple of relevant papers down there, but was still pretty new to the American health care system.  He told us that New Zealand had lots of sheep and was a big wool producer.  He talked about this great wool magnate who had this neat wool mill — a big one — and how it was he actually became quite wealthy. This was someone who knew about the tremendously loud machines that were used to process the wool.  The wool mill owner decided to hire only deaf people.  They asked for little; generally, they had problems finding jobs.  They were really happy and thankful to be able to work, so they worked hard.  They did not have any kind of a problem with the very loud machines.

That struck me so much then that I remember the story now, 50 years later.  Even then, I already felt that I would be in some kind of a management position as a physician and could do something that clever, becoming as rich and powerful as that New Zealand guy.  The professor had said something about Americans not thinking that way. The opportunity has not really presented itself.

Probably the closest I ever came was when I was running the day treatment center at the Veterans Affairs Medical Center in Oklahoma.  I had a lot of schizophrenic gentlemen who were not rich in social skills, but many of whom liked computers better than people.  Certainly, they related to computers better than they related to people.  I tried to get them computers, maybe even a little training. Read more on How to Employ an Individual with Asperger’s…

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I heaved a sigh, realizing I was going to relive a scenario I had lived too many times.  I would take too much time, I would be behind my schedule, but I was going to do this thing.  I was going to figure out why he had gone off his medication.  Frankly, I did not think anyone else could or would take the time, so I would do it.

He was a schizophrenic who had been without medication, maybe a month or so.  He had come in wanting some because his misery was indescribable.  He could barely speak and he had a downcast gaze, fixed at his toes and the floor. He sat stiffly in a chair. I slithered down on the floor, on my back, and tried to insinuate my eyes into his line of gaze.  He screamed.  “You are too strong.  You are going to annihilate me.” I could only answer “sorry” and get back to my seat. He started saying a lot of things about the importance of being Christian and following Christianity.  It did not matter what I knew or thought I knew about Christianity.  It only mattered that I could fit into whatever he thought Christianity was, right or wrong.  I could make little sense of his thoughts.  I have a standard way of dealing with this.

“Look,” I said, “I am not Christian and I am not going to pretend to be Christian.”  I am a Jewish lady psychiatrist, I am fully qualified and licensed in the state of California.  I am also a full blooded descendant of the House of David. If you think that the God you believe in is able to work through me, then I am going to help you the best I can.  If you do not believe that God can work through me, and you want a Christian doctor or some other doctor, we will try to figure out what you need and get you to the right person.”
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He was 35 and tall and thin, with beige hair and a rare grin he claimed only I could elicit.  He enjoyed seeing me. He always came with a knapsack, because he didn’t really trust the other people in the residence where he lived.  He probably had reason to feel that way, for things had been stolen from him before.  Things like medications.  He reported these things to the pharmacy involved.  Both they and I believed him.  After all, these things happen.  He had not abused anything known to us.  Besides, medications are frequently stolen.

The diagnosis was schizophrenia, that too-often debilitating disease that hits at least about 1% of the population and that is still generally considered manageable but incurable.  He was actually doing pretty well, living in a residence and “stable” after countless hospitalizations.  I asked him about his plans for the future.  He told me he had been attending information sessions about an interesting course at a local college.  Now I knew that local colleges, this one in particular, were famous for providing “practical” education.  I had even heard of a bachelor’s degree in auto body work. He told me he wanted to learn to make guns.  I tried not to appear nervous here, but I was impressed that he could read my emotions well enough to tell I was worried.

“Don’t worry, Dr. G.  I am not going to hurt anybody and I don’t want to kill myself.  You must worry a lot about that because you ask me every time.” Good — he was smart about that.  But what could happen if his medicines were stolen before I could replace them?  In his distant past, he had some real troubles with “false beliefs,” worrying that criminals were out to get him.  What if he believed that, and tried to shoot someone?  I could not ask him that, I knew he would tell me it would never happen – but I knew it could.  “I really like hunting animals.  Little ones, not bears or anything.  Squirrels, but that was a long time ago.  There are lots of squirrels and things like that around here.”  He went on.  He was exhibiting more insight and understanding than I had ever heard from him.

“I like the insides of the gun and how it works and I want to learn how to make them.  I did like the feeling of shooting a little animal, because it meant I was smarter than he was.”

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