My Life In Mental Health: A Nurse’s Story

MY LIFE IN

MENTAL HEALTH

A NURSE’S STORY

JOHN NUGENT, RN

Copyright © 2014, 2015 John Nugent.

All rights reserved. No part of this book may be reproduced, stored, or transmitted by any means—whether auditory, graphic, mechanical, or electronic—without written permission of both publisher and author, except in the case of brief excerpts used in critical articles and reviews. Unauthorized reproduction of any part of this work is illegal and is punishable by law.

ISBN: 978-1-4834-3799-6 (sc)

ISBN: 978-1-4834-3798-9 (e)

Library of Congress Control Number: 2015914849

Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

The names and other identifying information of most persons and places in this book have been changed to protect confidentiality. The opinions and conclusions stated in the book are those of the author and do not necessarily represent those of any other individual, institution or organization.

Any people depicted in stock imagery provided by Thinkstock are models, and such images are being used for illustrative purposes only.

Certain stock imagery © Thinkstock.

Lulu Publishing Services rev. date: 11/03/2015

Contents

1      Meet My Parents

2      How I Survived Childhood

3      Beyond High School

4      Rooftop Decision

5      The 1974 Diary

6      My Career Begins

7      Moving Out

8      Patients’ Rights in the Seventies

9      Tryouts

10      In the Pursuit of Women

11      Time for Therapy

12      Nursing School

13      Husband and Nurse

14      Christmas Memories

15      Community Mental Health

16      Father and Son

17      Social and Economic Influences

18      Management Success and Stress

19      Three Facts Regarding Labor Unions

20      Back to Nursing

21      2002

22      Starting in PACT

23      The Lean Years

24      Pain in the Butt

25      Keeping Perspective

26      Legal Issues

27      Fighting the Stigma of Mental Illness

28      PACT: Journey or Destination

29      Arriving Home

Endnotes

References

Acknowledgements

About the Author

Dedication

This book is dedicated to all those who struggle with serious mental illness. Never lose hope in your recovery. If you lost it, dream, believe, and seek those who can support you.

The author recognizes the work of the National Alliance on Mental Illness. NAMI is dedicated to building better lives for the millions of Americans affected by mental illness. NAMI advocates for access to services, treatment, supports and research and is steadfast in its commitment to raise awareness and build a community for hope for all of those in need.

Introduction

We learn starting in infancy. As babies we discover quickly that crying will bring food if we are hungry. Crying and sucking our thumbs are two of the earliest actions we take to cope with the world. We learn that there are a few people we can trust to fill most of our needs. For most of us, our parents are our first support system.

A few years pass. We are running around the house and out in the great big world. Here we meet many new people – extended family, people we start calling friends, and strangers. Gradually, the number of people we trust increases. We are also faced with many new challenges and tasks to master. Some we figure out quickly, others take more time, and a few will elude us for life.

Later, in school, life gets more complicated. We start comparing ourselves to others. In looking around we notice many differences in how people look and behave. Some seem smarter than us. We want some of the other children to be our friends and others seem mean.

By the time we are in high school we have a better sense of who we are, what we are good at, and what we like. We have a better sense of when we feel safe and happy and are challenged to cope when we don’t. At this time, we are not only comparing ourselves to others, but comparing our family to other families as well. We may find that we use siblings or friends more for support, and use our parents a little less. The knowledge has been acquired that genetics, biochemistry, and environment also affect who we are, how we think, and how we feel. It may suddenly hit us that we are not going to be children forever, and we need to figure out what we want to do for work, and what type of career would be meaningful to us.

I come from a dysfunctional family. That term gets overused; perhaps it is more a matter of degree of dysfunction. What I know is that I was raised by a mother who suffered with anxiety and appeared depressed at times, and by a father who was often angry and may have suffered with post-traumatic stress disorder. By the time I started college I had low self-confidence and thought of ending my life, even if just briefly. Taking a course in psychology helped me get things in better perspective. In my second year of college I started writing a diary. I have kept a diary or journal ever since, and I found writing more beneficial than therapy itself was for me. My interest in psychology, and new supports I made in college, pointed me in the direction of working in the field of mental health. Starting out with a bachelor’s degree in psychology, I would later return to nursing school and continue my professional career in mental health as a registered nurse.

I have learned much about myself and mental illness, from family experiences, education, mentors, colleagues and from the many people that I have known who have struggled with severe mental illness, such as schizophrenia or bipolar disorder. I want to share what I have learned, in the hope of helping to end the stigma of mental illness. People with severe mental illness have more in common with the general population than many people realize.

What feelings arise in you when you hear the word schizophrenia? Is it anxiety and fear? Disdain and scorn? Do you pity the person struggling with severe mental illness? Or do you feel a desire to understand more about this serious illness? Is there something you can do to help?

Mental illness does not have to be feared, but needs to be understood. Despite a few tragic news stories, the vast majority of people who have severe and persistent mental illness are not dangerous. Many are highly successful at work, and after some periods of illness are generally stable. Others, including most of who I describe in this book, struggle with more persistent symptoms, yet still have much to offer. Many are husbands or wives, brothers or sisters, fathers or mothers, and all are sons or daughters. Many are more challenged in communicating with those around them, yet with the right support and skills they can recover and will appreciate those who have helped along the way.

Daily in our lives, we are confronted with challenges and interactions that affect how we feel and can affect our perceptions as well. I still believe that how we cope, our support system, and finding meaning in life, has more to do with our mental health than genetics or brain chemistry. It is my view that people with severe mental illness have more difficulty in one or more of these areas: coping, support, and finding meaning.

I have long believed that what makes a difference for people is not how simple or clinically sophisticated a treatment is. It matters that the treatment is driven by the individual with the illness, and what appears to make the biggest difference is how we help people in three areas: 1) coping with their stressors, 2) strengthening the support system, and 3) understanding and seeking what gives meaning in their lives.

When I first started working in mental health the focus was on alleviating symptoms. Over the years, I have seen many forms of therapy and treatment for mental illness. Some have come and gone, and some have been far more helpful than others. While symptom management is still an important short term goal, a greater focus now is on the end goal. That being the goal of true recovery.

Chapter 1

Meet My Parents

My brother, sister, and I were raised at an early age to be afraid. My mother’s anxieties contributed to this, and so did my father’s temper. We grew up fearing the dogs on the street. Back then, there was no leash law. We also were led to fear the changing ethnic makeup of the neighborhood. My childhood was also the time of the Cuban missile crisis, when in schools we were taught to go under our desks if there was an air raid. Was that supposed to make us feel safe, or did someone really think the desks would keep us safe from an atomic bomb?

Somehow, we got used to living with our fears. However, at age eight, I wasn’t prepared for what came next.

In 1963 we did not have a television. We got most of our news from the radio, and it usually wasn’t good. The school principal, Sister Margaret Mary, sent my brother, who was in the seventh grade, and me, in the fourth grade, to the corner store to run an errand. While at the store, we heard the fateful news: President Kennedy has been shot in Dallas. My brother and I ran back, and with trembling words, we informed the principal of the news.

I prayed the rosary that night, once with family and several times alone. Although my mother worried about almost everything, she always found comfort in her faith. At that moment, it worked for me too, at least a little. I also swore to God that I was going to be a policeman when I grew up.

We were raised strict Roman Catholics. I could find many positive aspects to this, but there were negatives as well, such as the guilt. A month after the JFK assassination, I knew that I didn’t want to be a policeman. So since I had sworn to God that I would be one, to absolve myself, I swore I would say a rosary every day and say an extra one for every day I missed. After a few more months, the guilt was even worse. If I talked about this in confession, I probably could have gotten off with three Hail Marys and a good Act of Contrition, but that seemed too easy. After all, the president was dead!

My parents were raised in neighborhoods of Boston. They married, bought a house in one of those neighborhoods, and raised three children - my brother Bernie, my sister Mary, and me. I lived the first twenty-three years of my life on the same small street in Jamaica Plain, first in an apartment, and then in the house across the street that my parents bought when I was four. The house held three families. An older couple, Helen and Frank, lived upstairs. We lived on the main floor and my uncle and his aunt lived in the basement apartment.

I often imagined the elegance that this Mansard Victorian must have shown at a previous point in time. When we moved in, however, the division of the three apartments was awkward. Stepping into the house, you entered into the outside hall. On the left was the staircase going to the upstairs apartment. On the right was a short hallway with a door midway down and a door at the end. We always entered our apartment through the end door. This took you to the inside hall. Just inside this hall, a doorway on the right took you into my parents’ bedroom. At the far end of the hall were my sister’s bedroom and a doorway on the right, leading into the kitchen. My brother and I shared the bedroom at the far side of the kitchen. You could also leave the kitchen out the back door or back into my parents’ bedroom.

The most awkward part of the house was that to get to the living room, you had to go through my parents’ bedroom. Mom and Dad had a folding door (more like a plastic curtain) between the bedroom and the kitchen. They never had any real privacy while the kids were in the house. I am sure, at one time, the house was a single-family home and the outside hall was a foyer. You would have entered the door on the right directly into the living room, and what was my parent’s bedroom was likely a dining room.

Because my parents did not like to change much, they never tried to change the layout of the house. Even in our cellar, there were old pieces of furniture, boxes, scraps of wood and toys from a previous generation that had been there when we moved in and were still there when I moved out. Change always seemed inconvenient to my parents.

My mother did not like to inconvenience anyone, especially someone outside the family. For most of my years in the family home, there were five of us living there. Upstairs were Helen and Frank in an apartment that was one room larger than ours. As much as Bernie and I pleaded our case, to have our own room, my parents never pursued swapping apartments, even though they owned the house.

My parents lived through the Great Depression. This, no doubt, contributed to their resistance to change. What we had when I was a child was much more than they had when they were children. They were grateful for the house as it was; they didn’t need more.

The house had potential, however. When my father retired in the early 80’s, the house was sold for less than $30,000. Looking back, I am sure my parents, siblings, and I were all just too naïve and taken advantage of. The house was converted into condominiums. In 2008, the basement condo was being sold and listed for $299,000. The house, still looking the same outside as when we sold it, had become a million-dollar property.

It was Monday, August 30, 1965. I know that not because what happened that day was so traumatic, but because it revolved around my mother sending my father to take me for a new pair of shoes to go back to school with. Most of the time, my father’s days off were Sunday and Monday. Stores weren’t open on Sundays back then, and I was about to start the sixth grade.

The main shopping area in Jamaica Plain was referred to as Jamaica; at least that’s what my family called it. Going up Centre Street was another way it was referred to. It was about a third of a mile to Centre Street from our house and about two thirds of a mile up Centre Street.

I was looking forward to the trip. There never seemed to be enough times to do something pleasant with just my father. Trips to Jamaica would not just involve shopping; lunch would also be part of the outing. Dad worked hard, and since neither parent drove, the trip to work took him about an hour each way. He often came home tired and would nod off watching the evening news. I played more sports in the backyard with Frank, our upstairs neighbor, than with Dad.

The weather was sunny and cool. The walk was comfortable. I vaguely recall eating first at the local deli. The conversation must have covered the short day trips we made that summer and about not wanting school to start.

I remember most the time at Hanlon’s Shoe Store. The interaction started out fine. Could my son try on a pair of those Hush Puppies? Dad asked the sales clerk.

Of course he can. Let’s just measure his feet first, the sales clerk responded. After measuring my feet, he headed off to the back room, saying, Let’s see what we have in stock.

My memory is that the clerk returned fairly quickly with shoes, but then something happened. Goddamn it! My father started one of his tirades.

The sales clerk must have started to help someone else while I was trying on the shoes. I can’t say for sure. I cannot remember everything that was said, but I know a few obscenities snuck in. What I remember most that day was my father’s anger and my embarrassment. When my father had one of these outbursts, his voice got very loud. Everyone else in the store got very quiet. I remember his face going red, the angry scowl on his face, and his clenched fist.

Dad, calm down, I tried.

Be quiet. Do you want the shoes or not? he responded angrily to me, although not as angrily as at the salesman.

I knew my efforts were useless, and all I could do was stand in fear, embarrassed and praying that the fist didn’t go anywhere. It didn’t. It never did. As far as I can remember my father would go off like this a couple of times each year. I never saw him hit anyone, but there was always that fear.

My father saw himself as the breadwinner and protector of the family. Things did not always work out right, but he tried to fill these roles. He worked for the electric company, Boston Edison, as an assistant substation operator. I was most proud of my father when the company he had been with for twenty years was bracing for a long strike. Dad quickly sought temporary work, showing initiative I rarely saw from him, because providing for the family was what he was supposed to do.

My father’s anger came out quickly when anyone entered our property who didn’t belong there. He was, after all, the protector. It did not matter if they were kids whose game took them through our yard or an elderly man who paused to rest on our front steps. They were not asked politely to leave. They were yelled at, reminded it wasn’t their property, and told to Get the hell out of here.

Dad fought in World War II, and like so many who fought in the Great War, he did not like to talk about it. Could some of his anger and moodiness reflect post-traumatic stress disorder untreated all those years? Most of the anger we saw with my father seemed to reflect frustration with either some perceived disrespect (as was probably the case with the shoe salesman) or with the cards life had dealt him.

My father never seemed happy with his job. After two days off, we always saw that unhappiness on the night before he was going back. Different from the anger we saw with his tirades, and when protecting the property, my father showed this quieter, seething anger before returning to work. The rest of us would be watching TV in the living room, and he would be in the bedroom getting his clothes out for the next day. There were the slamming of drawers and a few curses. Dad seemed to have this penchant for getting mad at any floor lamp, or table lamp, that was either out of position or somehow got in his way. The lamp would get the brunt of his anger those nights; maybe that was a good thing. We all tried to talk to him about it, about work, but it never got anywhere. At best you were politely told, I don’t want to talk about it. Other times you were angrily told to Shut up and mind your own business.

My father was not a happy man, nor was he a strong role model. I say this not because he was unhappy so much, but because he rarely showed that he was trying to find a way to make things better for himself.

I never thought of my father as a bad man, but some who read this will disagree. I recently discussed childhood memories with my sister. Mary remembered an incident that I had previously blocked out. It was a time my father went too far.

She recalls the day my father had his hands around my mother’s neck. My sister was thirteen at the time, a year younger than me. After talking with my sister, I can partially remember the incident taking place. However, I never saw my father with his hands around my mother’s neck, or perhaps I have permanently blocked that vision.

My brother, who was eighteen at the time, pulled my father off. When my mother then went for the phone, my father grabbed it away, threatening, If you get anyone coming to this house, I’ll kill them too.

My mother and sister went for a walk. My brother told my father how ridiculous and out of control he was being. Bernie was six inches taller than our father. My sister recalls, when she and Mom returned, my father was apologetic to them, offering my sister a dollar. The apology was all too similar to the remorseful phase common of many abusers and batterers. This loss of control was not common with my father, but his rage often made us fear it would occur.

Although never deserving the threats and abuse, my mother had her faults. From an early age, my siblings and I could see how my mother would set my father off.

As surprising as it may seem, my mother was the boss of the family. There may be some details about growing up that my siblings and I disagree on, but we are all in agreement that my mother was in charge.

My mother sought to be in control, and she got it by force, appeal to the church, or whatever worked at any given time. I got threatened by hair brushes, paddles, and belts. I never remember getting hit by my father, but I remember my mother hitting me. Neither my siblings nor I felt we were physically abused. In the sixties that was how most parents, who we knew, disciplined their kids.

My family rarely went to church together. Usually, my siblings and I went early with my mother, and later my father would go to mass alone (this even occurred sometimes on Christmas). After church on Sundays, my mother frequently stayed around to talk with various nuns and priests. My siblings and I were often asked to wait out of earshot. Sometimes we were close enough to hear our mother complain about Dad.

At different times, my mother was critical of my father, the children, and even herself. A common expression of my mother, when one or more of us were complaining, or having some fun in public, was Everyone is looking at you. This statement often worked in shaming us to quiet down.

Some statements my mother made probably did not have the