Repeat After Me

I was just listening to the Slate Political Gabfest, The “I Expect Loyalty”Edition Live from Denver, Colorado, this evening. One of the guests was Colorado Governor John Hickenlooper, who was at one point in the conversation talking about dealing with people who get very upset for various reasons. He was using the example of getting upset when visiting a restaurant. His take on this, and his espoused method of dealing with it, was to look directly at the person, listen to what they have to say, and then repeat exactly that back to them, multiple times, over and over again. His reasoning was that when the person heard what they were saying reflected back to them many times over, they would fairly quickly come back to their usual, more calm ways of processing things on a more rational basis.

I have had similar experiences in the past, most recently a few weeks ago when I was working my emergency department  telepsychiatry job. I was asked to see a young male who had threatened suicide, who was thought to be very depressed, and who was quite agitated and hostile with the staff who were trying to help him. I introduced myself, we talked, and then we got to the point in the interview when I wanted to get an idea from him what he thought would help him regain control, get better, and be allowed to leave the ED.

Almost immediately he got quite angry and hostile, drew nearer the screen, glared at me with unblinking eyes, and began to shout how he did not want to take any medications, using a few choice words just to make sure I understood his seriousness. I countered with medications that might be better tolerated, that he might get some benefit from, my usual drill. He became more and more hostile, fuming at me and getting more red-faced by the minute.

Then, the “Hickenlooper Principle” hit me. I understood what I should by all rights have picked up on many minutes earlier.

“So, I hear you now, loud and clear. You don’t want to take any medicine.”

“No! No! I don’t want to take any g–d—-d medication!”

“I can hear that now, You really don’t want to take any antidepressants or any other medication.”

“Damn right I don’t. I was stuck in prison for three years and they pumped me full of that crap and I had no choice and I don’t want to take no f—–g medicine!”

“So, I hear you. No medicine. No medicine, okay. ”

Like magic, he visibly relaxed. He sat back from his close encounter with the monitor and camera and cocked his head just the slightest bit at me, like he was hearing a far away, high pitched whine that no one else could hear.

I waited thirty more seconds.

“So, no medication then. Good. Now, what do you think might help you get better enough that you could get out of here and go home?”

A completely different conversation ensued.

I think Governor Hickenlooper is right. Sometime, simply stating and restating what an angry or hostile or upset or frightened person says to you is enough to defuse the situation, just enough so that something more productive can be said.

Have you ever been in one of these confrontational situations?

Might you handle it differently the next time?

 

 

Rage

Image

It was a dark and stormy night.

Inside and out.

He was a big strapping guy with a blood alcohol level north of 400, dressed in a hospital gown like all the rest of the patients in that particular emergency department. The gown looked silly on one so agitated, like a little boy dressed in a tablecloth and trying his best to portray a good Achilles meeting his foes on the plain.

“Listen, buddy,” he began straightaway when the camera came on. “You are going to let me out of this f—–g hospital. That’s what you’re gonna do. Okay? You hear me? Okay? Okay.”

I explained who I was, how I was listening, how I was not his buddy, how the process worked. Standard issue telespeak. He was having none of that.

“Listen!” he belched, and I could smell the alcohol coming out of his pores even through the Polycom screen. If memory serves, Aldous Huxley called them Feelies. I tend to remember them being especially strong and potent during love scenes. There was no love lost here.

“I just had a few too many, I got sh-t-f—d, and now I want to go home and lay on my couch and watch TV and have everybody leave me the f–k alone.”

It only got worse from there.

He was not just mildly inebriated. He was s–t f—d. His words.

He was not just detained for evaluation. In his mind, he was captured. A prisoner.

He was not just mildly annoyed that he could not leave at will. He was enraged.

He was not thinking of using me in a clever or manipulative way to get what he wanted and walk out the door. He wanted to annihilate me.

Oh, nothing personal, mind you. When totally drunk off your ass and whirling like an F-5 tornado, stomping the next available person, whoever they might be, is just fine.

I don’t like losing control.

Do you?

I don’t like that feeling of letting my emotions get the upper hand, letting the anger wash over me like a storm surge topping out at thirty feet above sea level and having nowhere to go but up and out to saturate the landscape and drown everything it covers. I get some of that from from my mother, who was and is a very sweet, gentle, passive woman with a good heart. I get some of it from Dad, who was an engineer, a thinker, a problem-solver. Put those two together and you get a quiet, calm, sometimes over-thought-out look at the world around, with logical Spockian interpretations of stresses and problems and challenges. Sometimes that works just fine. Sometimes it doesn’t.

Back to our hero.

Achilles in his pale blue flowing cotton garment ready to do battle with Hector.

What must it be like to be that angry, I found myself thinking even as I listened to him, trying to catch a thread in the conversation that I could hold on to. What must it be like to be so full of rage that you could snap someone’s neck (physically, in reality) or shoot them or stab them with a knife or poison them slowly, the better to watch them die? (Yes, all true stories I’ve collected over the years) What must it be like to take in enough alcohol to let the tsunami start as a tiny one foot wave, build on itself as it races forward, piling more and more on until finally, it crests, crashing in so fast that very few can escape it, drowning the coastland and flood plain of you-don’t-understand-me.

What must it be like?

I’m quite sure I’ll never know.

How about you?