Under the Table in the Psychiatric Unit
By VT Pricilla Minkin, CPE
As a chaplain for a community hospital, I am often called to visit patients on the inpatient psychiatric unit. It did not start out this way. I began working in January and before this, the hospital had been without a chaplain for almost two years.
Hospital staff was skeptical of the need for spiritual care, inpatient psych even more skeptical as it is a closed unit with 15 beds, and they are protective of their patients and space. I made a habit of dropping by to say hello on a weekly basis and to chat with the receptionist and anyone else behind the desk. Members of the medical team were polite and distant.
One day I received a request to visit a patient, a young woman with anorexia and paranoia. She was refusing medication and food and was an involuntary admission due to a suicide attempt. I was asked to check in with her care team after my visit.
As I talked about the patient’s feelings of abandonment by God, her unworthiness, and the way I used story to guide me and to help her connect to and name her fear and pain the team’s skepticism of spiritual care began to soften.
I wish I could say stories and connection were it all it took for this patient to heal. Instead, she cycled for two months between inpatient psych and ICU for hydration. There was talk of force- feeding and an ethics consult was called, there were issues of autonomy and decisional capacity. Seeing such a beautiful, articulate young woman refusing food, refusing medication, refusing to leave her room and the fear in her eyes was unsettling to staff, to volunteers, to me.
Patients experiencing paranoia or depression, I have discovered, often express feelings of unworthiness and a fear of being judged and rejected by God.
Relationships are broken; delusions of paranoia real, conversations can be circular and self -reflection difficult. This is where stories guide me with patients unable to self-reflect, patients experiencing paranoia, or patients believing they have no value or worth can relate to stories.
I am especially fond of the stories of the Chasidic rabbis. The rabbis have a story for every human situation and they are not afraid to argue with God, challenge God, and reimagine what it means to be worthy.
Hebrew scripture is rich with stories of struggle. The story of the Israelites on the banks of the Reed Sea feeling trapped between the sea and the Egyptian army closing in on them as they are asked by Moses to step in to the waters, to step in to the uncertainty of what lies ahead can be helpful to patients feeling trapped, feeling uncertain and frightened of the future.
The 23rd Psalm speaks to patients experiencing depression and/or suicidal ideation, “Even though I walk through a valley of deepest darkness.” A valley of deep darkness feels very real to these patients. Then there is the story of Jesus in the garden before his crucifixion asking for his suffering to be taken from him.
Jesus crucified on Friday and resurrected on Sunday. Jesus in a dark place waiting for resurrection, patients connecting and finding comfort in knowing Jesus, the Psalmist and others have been in dark places too.
For a time I was the only person this young woman with anorexia and paranoid delusion would allow willingly in to her room. At the end of each visit, I would ask how I could be a support to her in the days ahead and she would respond, “Please, could you tell me one more story before you leave, they help me get through the week.”
The ethics committee after reading my notes and medical staff notes on this patient requested that I see her consistently. Slowly building trust between the medical staff and spiritual care.
Seeing that spiritual care is so much more than a prayer, that spiritual care can be instrumental in helping patients name their pain, move through their pain, move through the valley of deepest darkness.
Spiritual care notes that are detailed in naming the patient’s understanding of God; their spiritual distress; and offering interventions that can speak to what a clinically trained chaplain can offer to patients and the medical team has been helpful in gaining respect from nurses, social workers, and physicians.
The patients in the psychiatric unit are very challenging. Their despair can seem overwhelming at times. I am challenged to stay present, to let go of judgment, to stay connected heart to heart in the moment, to not only hear but to listen.
There is one story I do not share with patients; it is a story that guides me in my work. It is a story from Rabbi Nachman of Bratzlav, the story of the Turkey Prince. In this story, the king’s son believes he is a turkey and he refuses to come out from under the king’s banquet table where he is naked and pecking at oats on the floor.
The king calls all the physicians from the land and yet no one can heal his son. Finally, a wise man comes and says he can heal the prince. The wise man undresses and crawls beneath the table where he also begins to act like a turkey pecking at oats.
This goes on for a long time until finally the wise man says to the prince, “I think even a turkey can wear a shirt.” Eventually, “even a turkey can wear trousers,” and finally, “even a turkey can come out from under the table and behave like a human.”
Under the table with patients, seeking to be present with them in their reality, hoping and praying for peace and healing.
After completing four units of CPE training at Dartmouth Hitchcock Medical Center and Fletcher Allen Healthcare in Burlington, VT Priscilla Minkin began working as the out -patient hospice chaplain for a local nonprofit hospice.
In January of this year she began working for Central VT Medical Center as a member of the Palliative Care Team and the Spiritual Care Counselor for the hospital. Priscilla has travelled through many religious traditions, has a MA in Theology and a MEd and currently found her spiritual home in Judaism. She has been swimming laps 3 times weekly for twenty eight years, loves books, people and catching the stories of all the patients, family members and others she meets.
Minkin, Priscilla. Under the Table in a Psychiatric Unit. PlainViews. 8/20/14. Vol.11 No 15HealthCare Chaplaincy Network. Web. http://www.plainviews.org.