“Crazy” Outtakes, Part 8: Verbal Abuse, Nursing Homes and Validation

Click here if this is your first time visiting the Crazy Outtakes section of the site.

This was one of the last pieces to be cut from “Crazy.” It seemed overkill to write about validation and empathy in separate chapters, so I went with the latter and decided to deep six this piece. Fortunately, you can still read it if you so choose (for free!):

Years ago, when I worked in the nursing home, I would often try to engage a very angry and disinterested woman in therapy. While no one was required to participate in treatment, I usually made multiple attempts to offer my services to the residents. The treatment was covered (in full) for them, and sometimes after my gentle hounding over a few weeks they would get comfortable and look forward to a visit from me.

This woman, however, was not buying anything I had to sell. Upon entering her room, she would often simply shout, “get the hell out!” On one occasion she threw a bedpan at me and, at another point, threatened to “remove my cock and flush it [down the toilet].” I was younger then and, seemingly, enjoyed being verbally abused, so I would simply smile and say ridiculous platitudes such as “okay, I guess you’re not in the mood to talk right now. Maybe I’ll come back next week!”

The next time I entered the room, the woman (who was bedridden) was already screaming out in pain. “Get me painkillers, someone needs to get me painkillers!” Her voice ebbed and flowed in volume so that, without a medical chart and an adequate history, it was impossible to tell if the woman was experiencing pure pain, withdrawal, a sort of delirium, simply seeking attention from the staff or possibly some combination. Quickly, however, her eyes met with mine and her voice become more coherent and even.

“You. Need to get. Me. Painkillers.”

“I’m sorry,” I said. “I don’t do that. I’m just the Psychologist. I can get a nurse for you.”

“NO!” she said. “You get them now.”

“I can’t do that,” I repeated. “I try to help you through talking, not medicine. That’s not my job.”

“You’re job,” she said, “is to do what I say.”

“No, that isn’t correct, and I’m sorry you feel that way. Let me get a nurse for you.”

As I turned and began walking, I heard, “oh sure, sure,” she said, and waved an arm with many bedsores on it. “You just go, leave me, go home to your perfect life.”

I stopped and thought about my perfect life. At that point in time I was probably 31 years old and had about $376 in the bank. I had just gotten dumped for “not being ambitious enough” by my girlfriend because I wasn’t mentally prepared to begin a full-time private practice. My recent experience with Andy left me feeling like a professional cripple and I was, at the time, on a slow but steady pace toward developing an alcohol problem if I wasn’t careful.

I turned around. “What did you say?”

“I said to go back to your perfect life. You probably have a great wife, a pretty car, kids, everything. I have nothing. Just look at me.”

It would have been foolish to even attempt to quantify our quality of life on a Tale of the Tape. This was a woman who had no family, spent most of her time in a bed in a nursing home, in poor health and had over 80 years of poverty. I came from at least a somewhat intact middle class family, I had a doctorate and a truckload of potential in my professional life. And yet, I was angry. Why?

This woman didn’t truly know who I was or anything about me. Given that she’d never heard a word I ever said (as she was always yelling over me), I could have been a case manager or home health aide making virtually nothing for incredible demeaning labor. Yes, I was younger, but that didn’t guarantee that I was in good health. I could have had no family whatsoever, and I certainly didn’t have a wife, kids or a nice car. In short, she profiled me and was wrong in many ways.

More recently, I had a discussion with a client about the concept of validation. I argued to her that we are hard-wired to need validation when we are experiencing any sort of psychological pain. We need to be told, either by ourselves or others, whether rational or not, that we are entitled to feel what we feel. It’s this message that allows us to look at our problems in a more objective light. I have clients who make well over $500K per year, drive luxury cars, live in mansions, drink the finest wines and have great relationships with their spouses, children and friends. On the surface, they have it all. And yet, something doesn’t feel right. They’ll wonder if they need more money, or they may become anxious about losing their partner to a younger, better-looking rival. Will their children be successful in life, how will I keep my cholesterol at a reasonable level, how can I cut down my hours at work so I may spend more time with my family? The list goes on and on.

Do these people ultimately need to get their cognitions in check if they truly want to live fully? Of course. But pushing that point is skipping an important step, the act of validating. And if you know anything about me, you know that my overarching philosophy on life is that we are all “crazy.” It’s only when a person hears, “these problems are yours, you are allowed to feel how you do, that’s your right,” that he/she can begin to consider, “maybe it’s not so bad?”

It was not the woman in the bed’s job to validate my personal issues, far from it. However, she made premature decisions about me and used them against me. I didn’t have a chance to respond to her because a nurse came in and began attending to her needs, and every subsequent effort by me was met with a dismissive hand. This is one of the biggest regrets in my career. We could have used this experience to help her see that not everyone who seems to be successful and put together is, in fact, like that. I would have self-disclosed some aspects of my life to her. Would that have helped? We’ll never know. But it’s truly unfortunate that the woman rejected me, permanently, on variables that were not only false, but ones that we could have discussed to bring her perspective on how everyone suffers in their own way.

I suppose I can only hope someone else was able to get that message through to her.

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5 Responses to ““Crazy” Outtakes, Part 8: Verbal Abuse, Nursing Homes and Validation”

  1. Tippy says:

    Just because someone is old, doesn’t make them cute & cuddly, huh?

    Old people can be mean, too.

    Recently, I was talking to my doctor about worrying. This particular worry was tied to not having anything put away for retirement and I felt like a stupid irresponsible idiot because of it.

    He asked me if I thought he had money put away. I told him
    ” Yes, you’re a smart doctor with a family. ” and he shook his head, indicating he did not.

    (I had profiled him and been way off, just as this woman had with you.)

    And accordingly, I felt less like such a failure in that area. If someone as smart and educated as my doctor hasn’t any money stashed away for old age, maybe I’m not a such an irresponsible idiot- because he isn’t.

    This disclosure also showed me that my perceptions are not as keen as I like to think( I tend to believe that I know what everyone is thinking about me ), which also made me feel better. If I was wrong about that, I could wrong about a lot of things.

    I want to be wrong about a lot of things- as many things as possible, actually.

    Looking frwd to June ..or July..no, June. Thanks for adding this one, Dr. Rob 🙂

  2. Emmy says:

    Great post. It’s amazing how a near stranger can cut to the quick, isn’t it? My rather uneducated opinion is that this woman was far beyond help in the form of a social lesson – maybe it would have been useful for a moment. But what people like that really need, is family, friends and a life beyond being bedridden. It’s like that post I read on all the therapists trying to help people after a natural disaster. Yeah, they’re traumatized, but maybe they don’t want to talk and instead would like some food, water, clean clothes and a shower.

    I know validation is useful – in my own experience, all else being equal, if someone “has it all” and is still depressed, one very useful thing is to travel for a month with zero amenities and many physical challenges. Where a hot meal and a cold glass of water seems like the best fortune ever.

  3. BL1Y says:

    Perhaps the need for validation is the result of our society’s quick backlash against anyone who dares complain about anything. We have an instinct to assume that when someone says something in their life is going poorly that they’re also saying it isn’t their fault, and someone else should fix it for them, when much of the time that’s not at all what they mean.

    This happens a lot lately with law. Recent grads will mention the lack of jobs, or how the jobs that do exist aren’t actual legal work (ie: doc review), and then older generations will tell them to shut the fuck up because their complaining doesn’t solve anything, and besides, a job is a privilege, not a right, and you don’t have one probably because you spend so much time bitching.

    Of course, law’s not unique. Any objective statement that anything is tough is met with a slap in the face. I’m sure there are plenty of people who you could say “Sometimes it’s really hard to spend all day listening to people’s problems” to, and be met with “No one is forcing you to be a psychologist, so why don’t you quit if you hate it so much, and besides, you’re paid really well to just sit in a chair, so shut the fuck up.”

    If Obama were giving an interview and very candidly discussed that the job is stressful, there’d be an army of talking heads telling him to just shut up and deal with it.

    It would be good practice for us, when someone complains about something, to simply acknowledge that it does indeed suck, and then not say anything else until the other person gives further context for their complaint.

  4. Boz says:

    I would have to imagine that the nursing home could be just a huge impediment to therapy to begin with. So many people have such deep-seated anxieties liking them with death and hopelessness. Is that the opposite of a therapeutic milieau? Anyway, I know that not all nursing homes are like that, but that seemed like a job for Sisyphus, not Rob.

  5. Juice says:

    I liked the post. I do agree with you that validation is important, but I feel -in my limited experience- that for some people it’s not enough. Some people need to know that their problem, situation, life etc. is worse than everyone else’s. I think that some people believe that they’re ‘better’ than you or someone else because what they’re going through is worse, if not absolutely then relatively.

    I’m not sure, but I’ve definitely seen it. Maybe its the ego trying to grasp for straws?