I’m an odd duck, and I wouldn’t have it any other way. In an age of specialists, I’m an anti-specialist. These days most people function in tiny specialty boxes. Perhaps you’ve heard the saying, “Think outside the box?” We’ve become such specialists that we need to be reminded that the world is out there. We need to be encouraged to even think of it. Imagine that!
That idea isn’t an issue for me: I LIVE outside the box. Centuries ago, traders made great fortunes doing something very simple. They would bring something cheap and common, say silks in China, to somewhere like Europe where those same silks were exotic treasures. I do something similar: I poke around in lots of specialty boxes, looking for problems and solutions. Often one box has a problem, and another box an easy solution, yet neither box knows about the other. I bridge the gap: problem solved! Specialization is powerful and much good has come of it, but it leaves a need for box-hoppers that I’m rather happy to fill. It’s fun, and the opportunities are endless!
How does one come to such an unusual role? As you might expect, by an unusual path. My life path has included some unexpected, painful detours and potholes. For a long time, I mostly hid these dark times in which I paid my dues. I hid them from everyone else and even from myself. Over time, though, I’ve learned to embrace them instead. There is no better teacher than experience. Sad but true: the worst experiences offer the most powerful lessons.
My first mental health experience came quite by accident the summer after fourth grade. There was a wooded valley in across the street from my house in the mountains of Pittsburgh. I was alone once, I don’t recall why, deep in the woods. I scrambled to a hilltop to see the view and ran into an angry man about twice my size. He said I’d scared away a rabbit he was hunting, so I would “be the rabbit”, as he pulled his hunting bow tautly and aimed at my forehead. The arrowhead, a sharp pointed wedge of steel, was inches away as he spoke, almost too close to let me focus my vision on it. To this day, I have no recollection of what happened next, and I told none about it for years. I do recall making a decision that summer: I would wall myself off, take no chances, become invisible. I never kept fully to that plan, but I didn’t forget it either.
I graduated from high school with an ROTC scholarship from the Air Force and no real sense of my purpose in life. I had earned good grades largely on auto-pilot, driven by the idea that you ”should” do the work, little more. It seemed the safe path somehow, and an easy way to measure safety. I started out at Cornell in engineering, for no more reason than my dad was an engineer and people assumed I’d do it too. Safe path, remember? Of course, I also have a strong aversion to doing what I’m told: soon I got bored, left engineering and ROTC (“do-what-we-say-because” didn’t suit me) to study philosophy and pre-med classes. I had a quaint and outdated country-doc career in mind, but I applied to Harvard Medical School of all places and they accepted me: it seems they positioned me as the community ethics guy if their interview questions were any indication. Everyone around me got excited: Harvard! It didn’t fit my vague plans especially well, but I soon got caught up in all the hoopla, and off I went. I had some sense of purpose by then, but vague and naive, uninformed, untested. Expectations and “shoulds” still ruled. I’d stumbled basically passively and basically accidentally into my second Ivy League college. Life!
I had no problem with the academics: you might see by now that I have some talent for such, and hard work generally helps. I studied harder than ever. Why? I assumed that’s what all medical students do: study harder than ever. All was more or less fine until the depression came. Medical school soon became a series of successes, crises, hospital admissions, regrouping respites, in a repeating loop. Finally I locked myself in my dorm room, lined up a lethal dose of imipramine (I looked it up) – an antidepressant and a rather effective suicide tool – and took them. At that time I was worthless, doomed, finished, worthless: in my mind. Depression lies: it tells you all is lost, that it will never get better, that it’s all your fault, and that you’re worth less alive than dead. Lots of people buy the lies, sadly. I sure did. Depression is extremely talented and convincing, a real demon, so to speak. It kills your confidence in everything except those dark lies. So I took those pills, one by one, faithfully, doing everyone I knew a favor, as I saw it at the time.
I awoke from a series of seizures and unconsciousness 36 hours later, and emerged from my room, confused and a bit bloody here and there. I chipped a tooth and cut my thumb badly enough to leave a scar to this day: I assumed they were related somehow, but who knows: not me. A friend took me to the ER across the street. Why didn’t I go there in the first place for help, just across the street? In a single word, stigma. When a problem seems too shameful to tell anyone, you don’t. So like so many other people in a similar scenario, I didn’t, and it very nearly killed me. I take stigma very seriously as a cause of suffering and death. I know it well. That said, it was time for another admission, and then a ‘year off’ doing an NIMH Research Fellowship at McLean Hospital, ironically enough (it’s Harvard’s primary psych hospital). Such Fellowships were the preferred way for folks like me to regroup respectably, it seems. After some more suffering and debt-building, I finally withdrew mid-third year, hopelessly (it seemed) in debt and without any plan. It felt like I’d surrendered my future. I had, in fact, abandoned the “should” about studying as the only way forward. It took me a long time to find other ways to motivate myself. I was lost.
But not finished, of course. Persistence and time can overcome and/or adapt to most anything: that’s the most human strength of all, adaptability. I’ve suffered from depression now and again since then, but less and less often, especially once I finally figured out my medications and came to terms with my past. They still sting a bit, but they feel more like detours instead of catastrophes: better. Life doesn’t give us meaning: it gives us events. We provide the meaning; it’s part of our power to shape our own story. I’ve learned that from experience. It helps, and it matters.
Back to my tale. I still liked the idea of clinical work, so I got a job in a group home, working with people who had been State Hospital patients for decades. The pay was awful, the job thankless and stressful: one January, a new resident burnt the house to the ground. Lots of stories there: such an education! I learned people skills far better than I could have in any hospital setting, because we usually worked alone, with no security, no locked doors, no force allowed, just your words, your wits and personality, YOU. Most counselors lasted under a year: I stayed for three.
I chose nursing for all the options it offers – the pay didn’t hurt either – and earned an MSN as an Adult/Geriatric NP. To this day, I remain a nurse with no undergraduate nursing degree or certificate of any kind. Masters only – odd duck! At the time, the job market was weak, and I knew psychiatric work inside and out, so I got a staff nurse job at McLean. I’d been a patient there, actually – twice – but no one seemed to notice. Imagine that! When I finally got an NP job at another local hospital, I got tripped up by union politics: nurses who didn’t do their work would claim I’d told them it was OK to avoid trouble. The doctor who hired and supervised me (so he said) suddenly left under a cloud of alcohol and et cetera, and the doctor who officially supervised me (no one told me that detail until it was far too late) had my credentialing rejected. So once more, I returned to McLean. I haven’t left since, although I’ve worked one way or another on all of the inpatient psychiatric units at McLean and the ECT service. I’ve also taught CPR, MALS (nursing practice during codes and other medical emergencies), and clinical placements for various nursing schools. I’ve come far, and I’m still figuring out my path. Life is good.
At some point, I noticed that I had some unusual advantages over my nursing colleagues. I deeply understood depression, suicidality, and the inpatient patient experience. Also, I had been trained by physicians, and by the social workers who ran the group home agency, and by nurses. I knew how to manage agitated patients without meds or force. My mental toolbox was unusually rich and diverse. Odd duckdom has its advantages: I’m one overeducated odd duck!
Thus, my curriculum Golden Rule Care was born. As I encountered clinical problems at work, I researched solutions, built on my experiences and instincts. I practiced new clinical approaches, learning and refining them repeatedly, based on the results. Eventually, I started teaching others about it and gave it a name. More recently I began blogging at what has become Big Red Carpet Nursing and writing. As I write and you read, I’m working on a book about it.
Odd, unusual, atypical, a bit accidental. Such a life path offers great resources, once you get comfortable with it. Being unusual can be quite liberating and informative if you let yourself see it that way. It can also offer lots of fun! So many of us live on a narrow path set for us by others. There’s so much great stuff, great living, off these narrow paths! I’ve often jokingly called it living off the rails: no longer stuck on one path set for you by others in cold steel, you can go anywhere you like. Anywhere! There’s more risk off the rails, but far more opportunities, freedom, and adventure. Life!
You give it all the meaning you choose, remember. It makes all the difference in the world!
I generally counsel people to take great care in offering their stories about mental illness. Trust me, stigma is very real, it has teeth, and once you tell people stuff you can never take it back. Still, it’s liberating to own your dark secrets openly: no one can reveal what you’ve already made public. Also, I find that stigma thrives on secrecy, and it hurts and even kills many people. It hates the light of day, stigma does: it can’t survive it. So I offer my story, as have many others to some extent or another, to make the topic more commonplace and common. I hope and imagine that every bit of open discussion weakens stigma that much more and thus does everyone a bit of service. Whenever you feel tempted to shun or deride anyone with a mental illness, you do the opposite. Trust me: stigma hurt sand even kills people every day. If you help keep stigma alive, you cause much pain and death.
Why would you want to do that? Do the right thing, why don’t you: learn about mental illnesses and do right by them. You might just save some lives that way. You just might.