What do you do? How do you cope?

[loveoforganic]

Background - I've been volunteering with an OT at a psychiatric hospital for the past few weeks working with kids/adolescents. There's a variety of illnesses and a few pasts involving molestations. Two of the molestations were with young kids - 5/7. While this is obviously sickening, they never truly broke me down. I think this was in part due to their behavior - they behaved mostly like kids having fun (mixing in some inappropriate sexual behavior and whatnot, but yeah).

We got a new patient today. He's already been to two other hospitals. Prior to commitment, he was raped by three adults. Since then, he's had severe anger/violence issues. He does a variety of awful things. I feel an utter lack of hope for him. He's only going to be committed for a few months, and I feel like he's just destined to molest/rape/murder sometime following release, ruining another person's life. I mean, it's not his fault - how can a ****ing child cope with being raped by three adults? How can anyone? I just can't help but feel that it would be better for society and himself if he were to just... die. I cried for the first time in something like six years, following his eval.

The overpowering sense of helplessness/hopelessness has subsided to an extent. This is mostly thanks to just telling my gf about it and having a fun session following his eval in which a kid who'd previously been very withdrawn had some great social experiences. I don't know how I would feel if that had not happened.

So how do you all come to handle these things? I can't think of anything even comparable in other fields of medicine other than maybe early onset Alzheimer's. Even young kids with metastasized cancer at least have the opportunity to live out the remainder of their lives with some degree of normal pleasure.

Edit: Info edited to increase anonymity of patient; just read T4C mod note.

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[kugel]

I'll mention a few of the ways I've seen people cope in a minute, but first let me say this:
None of them work fantastically well.
It is what it is...and it's not supposed to be easy. If it becomes "easy" and you reach a point where it doesn't bother you - it's time to get out.

If you do decide to stay in a field that has such close association to these kinds of tragedies, you WILL find ways to make it tolerable most of the time (like the way you reveled in someone else's victory). But there will be times when it gets to you. Don't think you have to hide those times or discount them or allow anyone to tell you that it's a sign of weakness. Those times when "it gets to us" are the reason we go on. We don't stay in mental health because of the times when it's routine and when the tragedies don't bother us. (If that were the case, we'd do something which doesn't involve exposure to these tragedies).

Also, remember that you will have the opportunity to decide which tragedies and suffering you are willing to tolerate and which victories and rewards you seek - via the ability to chose the exact discipline you pursue and which jobs/facilities/programs you accept. You get a fair amount of choice in all this - so take you volunteering experience very seriously in terms of deciding how you want your career to be structured.

Also, please remember that there is NOTHING wrong in deciding this is not for you. I could not possibly tolerate being an accountant, firefighter, oncologist, cable TV installer, or moderator of an internet discussion forum - but I'm sure glad they exist. So, take your time and deciding and remember that we WANT people in the field who care as deeply as you do.

As for ways people cope, they are many and most people use a number of different ones at different times:
Celebration of the victories that do happen
Dark humor
Getting angry at the abuser
Helping find and prosecute abusers
Comfort and fun with family/friends
Psychotherapy
Religion/worship
Hobbies
Volunteering or contribution to causes which have more concrete victories


There are others that are common, but which I don't recommend:
Cynicism
Alcohol/drugs
Constant anger/disappointment
Retreat into routine and apathy

 

[IAmAUser]

.

 

[Regnvejr]

...So how do you all come to handle these things? ....

You start at that point and work on every little thing you find. If next week is better than this week and next month is better than this month, then you and he win over those who hurt him. You prepare him for therapy with emphasis on getting control over his own emotions and and win back control from those who took it away from him. Direct his anger at them rather than others. Victims of abuse might never live a carefree life, but they certainly can get to the point of not getting in trouble and therefore not have others control their lives, and to the point of being able to assess the positives of each day and move forward. It is important to make them see that the path forward is rewarding.

There are no throw-away people.

 

[erg923]

I would also add that it's situation like the OP described where Im actually thankful that psychiatry and clinical psychology are so terribly poor at predicting future behavior, at least when we base that prediction on "clinical judgement" alone. There is simply no telling how your interaction can affect someones life for the better. I always keep that in mind when I see someone whom I feel is "doomed" never to to get better, or to reoffend, etc.

 

[masterofmonkeys]

I recommend pessimism.

People say pessimists have it all wrong. I think we get it right.

Because I'm a pessimist, I'm pleasanty surprised on a regular basis when people aren't total douchebags, when patients really do get better, etc.

As a consequence, while I may sound all doom and gloom, everything always seems to turn out better than I could have imagined.

 

[erg923]

I recommend pessimism.

People say pessimists have it all wrong. I think we get it right.

Because I'm a pessimist, I'm pleasanty surprised on a regular basis when people aren't total douchebags, when patients really do get better, etc.

As a consequence, while I may sound all doom and gloom, everything always seems to turn out better than I could have imagined.

Thats funny because just the other day, after a long day of dealing with crowds at a large outdoor concert, my wife turned to me and said in her sweet little mousy voice: "Honey, how come we are so cool and everyone else is such douchebags?" God I love her!

 

[Therapist4Chnge]

I do a good deal of trauma work (individual and group), so I've definitely questioned humanity on a regular basis. Here are a few things that I've found helpful:

1. Try and do more good things than bad. I can't control what others do, but I can control what I do and if I make a positive contribution or not.

2. See a professional (psychologist/counselor/etc) regularly so that there is space/time to process thoughts/feelings that inevitably come up as part of the grind. We are there for our clients/patients, though often we do not give ourselves the same opportunity for someone to be there for us.

3. Try and leave work at work.

4. Mix up your schedule so you don't get beaten over the head with trauma cases. I'm not sure what other options you have in your department, but it may be worth checking out.

5. Surround yourself and your life with good people and positive experiences.


*MOD NOTE: While your descriptions aren't explicitly identifying, you should probably remove a few things as the "gist" of your post would still be intact without having additional information out there.*

 

[OldPsychDoc]

All of the above, but one that hasn't been mentioned yet is work with a team. A good team can validate the reactions you're feeling and help to diffuse (and de-fuse) the outrage. We can also look out for each other, and lend a hand when someone's having a tougher time than most. I agree that if you stop feeling outraged at stuff like this, you've become less human--and that's not a good thing. My unit SW and I play a lot of these off each other, debrief each other. We fortunately don't get acute child trauma like this--though we frequently get the sequelae many years later. We did have a mom admitted whose toddler had been abused to death by her boyfriend (an all- too-common story ) and that was particularly hard on many.

Stay human, rejoice in the small successes. Your young patient may never be "intact", but as Regnvejr said, you can help him get ready for the next step forward.

(MoM--totally agree with the pessimism angle...keeps life from being too disappointing...)

And one last thing, loveoforganic, my first response on reading your post was that you should think about rephrasing "how can a ****ing child cope with being raped by three adults?" to "how can a child cope with being raped by three ****ing adults?". Because we know who really deserves the epithets in this situation...

 

[Neurotica]

have to agree with the Masterofmonkeys...so many of these depressed patients have faltered in life because things didn't live up to their expectations. it's infinitely better to be pleasantly surprised when things go right and you were expecting the worst, than to face the fall when things don't turn out as stunningly as you had hoped or expected.

 

[loveoforganic]

Thank you all for taking the time to write out your replies. You all have the perfect mix of bluntness, sincerity, and good advice, and you helped remarkably

 

[erg923]

Is your avatar the "marching hammers" from Pink Floyd's-The Wall?

 

[loveoforganic]

Yes

 

[OldPsychDoc]

I recommend pessimism.

People say pessimists have it all wrong. I think we get it right.

Because I'm a pessimist, I'm pleasanty surprised on a regular basis when people aren't total douchebags, when patients really do get better, etc.

As a consequence, while I may sound all doom and gloom, everything always seems to turn out better than I could have imagined.

Re: the "black humor as coping mechanism" thread--this is posted on my office door.

 

[loveoforganic]

Antimotivationals are great.

 

[Solideliquid]

Playstation 3, Xbox 360, my iPhone and lots of music/apps from the iTunes store, and my dogs.

 

[Regnvejr]

Playstation 3, Xbox 360, my iPhone and lots of music/apps from the iTunes store, and my dogs.

Runescape it the end-all and be-all