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Conjuring Gratitude Out of Nothing
I spend my Saturdays working as a therapist at a behavioral hospital, primarily serving detoxing heroin addicts and suicidal teenagers. I often ask myself what I’m still doing there. It doesn’t pay very well, and it’s not a very tightly-run organization. There’s very little coordination. Staff always try to pass off problems they don’t know how to solve themselves. The patients are always at a low point in life — that’s why they’re there, after all — and a lot of them take their misery out on you. Some days, we practically make the schedule up as we go along. The atmosphere is frequently one of tension, desperation, and fear of what will happen next. Staff overworked and overwhelmed and patients about to snap.
I stay for a few reasons. Inertia, I suppose. The bonds you build with colleagues when you spend long hours in close quarters under stressful circumstances. A little extra cash. Free cafeteria meals with more food groups than whatever I would cook at home. In my more self-congratulatory moments, I like to tell myself I’m also doing something good for people, being there for them through the worst of times. Hoping that while their internal worlds might be torment, and their current surroundings aren’t so pleasant either, the time I spend with them might provide some small comfort or ray of hope.
I also rather enjoy my status at the place. Since I only work one day a week as a PRN employee, I’m not held accountable for much of anything. I never see the bosses. I can essentially show up and leave whenever I want. My coworkers are always happy to see me, not only because of my winning personality, but because anything I do is something off their plate (even if I don’t work very hard). All the real responsibility goes to the full-time staff so, if I encounter anything hard I can just say, “Hmmm, you’d have to ask the weekday therapist about that.” Even if something bad happened and they let me go, it wouldn’t seriously disrupt my life. So despite the stressful setting, there’s an odd sort of freedom about my limited role.
But I digress. What makes my experience there so powerful is that I’m dealing with people who have hit bottom. People who are no longer working to hold it together, who aren’t trying to keep up appearances anymore because there’s no point in that place. People who are miserable but, in the better scenarios, also reaching a new point of self-reflection that had long eluded them: that impetus for real change. Sometimes, people who are starting to bounce back and feel hopeful again for the first time in a long while. For all the dark picture I’ve been painting, some people are absolutely overjoyed to have what feels like a fresh start.
One of my main tasks there is to facilitate therapy groups. Depending on how my colleagues and I split it up, I may end up running the women’s or men’s addictions groups, the children’s group, and/or the adolescent group. In keeping with the chaotic nature of the place, I don’t tend to plan my groups in advance at all. Partly, this is just due to the lack of accountability, that nobody prompts me to plan and I’m not organized enough to do it myself. But it’s also because I simply don’t know what to expect when I walk in. I may have an empty room or a packed one. I may catch people in a state of withdrawal and sedation, or of the optimistic energy that comes when the drugs start leaving your system. I may get a bunch of quiet, reflective older folks, or grandiose younger guys ready to swap war stories, or some combination of the above. With so many variables, planning ahead too much would be futile.
There are a lot of ways to run a therapy group. Playing to my personal strengths of sensitivity, intellect, a listening ear, and a calm demeanor (as well as my aforementioned weakness of disorganization), I usually just introduce a topic which I try to spin into an open, reflective discussion among the patients. This doesn’t always work, and sometimes goes in completely unintended directions, but I’ve found the approach to be more or less successful.
This month, in every group, my topic has been gratitude. Even off-season, this is one of my favorite themes. Experience and research have both taught me gratitude is a key ingredient in navigating life’s challenges. It pulls people out of the negativity that so often besets their lives. As I explain in my opening monologues, there will always be problems. If we wait for our problems to be over to be happy, we’ll never be happy. Practicing gratitude is a way to reorient our minds and seek peace in the midst of chaos.
For my part, I feel extremely grateful for the life that I have. But that’s not much of an accomplishment. I’m what the liberals like to call privileged. I haven’t been dealt a bad hand by any stretch of the imagination. Any suffering I’ve been through has been essentially self-inflicted and, thankfully, temporary. It would be absurd for me not to feel gratitude, and even so I have far less of it than I ought.
So it’s much more powerful for me to hear stories of gratitude from heroin addicts, from the suicidal, from people who are homeless or deep in debt or suffering from extreme incurable physical ailments, who have encountered every imaginable hardship in life. Coming from the patients, any expression of gratitude takes on much greater significance.
People on the tail end of the heroin withdrawal are grateful just to be feeling physically okay. For months or years, they’ve been in a constant state of chasing pills and powder, not always so much to get high as to avoid becoming violently ill; to “get well,” as they put it. From the second they wake up in the morning until they go to bed at night, getting and staying “well” is the sole priority, dodging what feels like an ever-impending crisis. So when they say they’re grateful just to feel physically stable, they know of what they speak.
Many say they’re just grateful to be alive. This sounds cliché, but takes on greater significance considering that many of them had “died” from overdoses, system shutting down and heart stopping, before the paramedics revived them. In some cases, this may have occurred immediately before they entered the hospital, or they have been through it several times. Some have past (in some cases, recent) failed suicide attempts. A man last weekend told me he’d been stabbed twice and survived. These patients have faced their mortality in a very direct way, so when they say they’re thankful for life they speak of something they might easily have lost. Invariably I tell them they’re obviously meant to be here for a reason, believing and hoping that it’s the truth.
Patients say they’re grateful to have family who loves them. Another seemingly typical response, until you consider that many of the addicts have lied, cheated, and stolen from their families, abused their good intentions and manipulated their emotions, in the never-ending quest to “get well.” They’ve burned bridges, rebuilt them, and burned them again. If I were counseling the families, I would probably advise them to cut their addicted relatives off until they could prove they’d made changes. But in my group with the patients, I’m glad they have somebody who’s still there. The mentally ill patients may have been great burdens on their families, and some of the teenagers have turned their parents’ lives into virtual prisons. But despite any harm they’ve caused, they recognize that a loving family is, indeed, something to be grateful for.
Patients say they’re grateful for their children. The women tend to bring this up earlier than the men. And honestly, given my own pro-family bias, I tend to nudge the discussion in that direction if it doesn’t get there on its own. But this is powerful for people. However much they’ve neglected or wronged their children, they recognize that they have something precious. Frequently, they offer absurd justifications for how they could be parents as addicts — “I might have been shooting up but I always made sure my baby had food in her belly,” that sort of thing. On the one hand this evasion of responsibility can seem repugnant, but on the other, it’s striking that they still want to be good parents for their children despite their condition. In their kids, they see joy, purpose, and hope for the future. Given the mess some of them have made of their own lives, that’s no small thing.
An older black man, in poor physical condition, who had been wearing the same set of clothes all week because it was all he had, shared eagerly that he’s grateful to be able to pray every day. That he knows God is there no matter what, and as long as he can talk to Him he’ll be alright. People say they’re grateful for the sun shining. That they ate today. Their pets. Some say coffee and cigarettes; just lesser addictions, perhaps, but also simple pleasures of the sort I always encourage.
Many patients say, “I’m thankful for this hospital.” As you can imagine, given my description of the place, my initial reaction to this is cynical amusement. But I try to fight back that urge and remind myself that, however flawed the institution, we’re serving a real need and it’s good that we’re there to do it. Some tell me, “I’m grateful that you’re here doing this group with us.” I thank them for the sentiments, though at this point I always feel like a bit of a charlatan. Here I am, in a group I didn’t prepare for at all, offering wise-sounding words and reflections, insisting they conjure up gratitude under circumstances in which I’m not at all sure I’d be able to do so myself. But if they’re saying it, I hope it means they’ve benefited from the experience and I played some part in that. So I’m feeling unworthy, but grateful as well.
More than once patients have told me, “I wish I could just do what you’re doing. To get up and go to work every day and feel normal.” This always has an effect on me. It’s not all that glamorous, I want to tell them. It can be stressful or unfulfilling or just plain boring. But I hold my tongue. Because they know better than me. They know what it’s like to live in a constant state of crisis – and they know it can strike again. That they can have a relapse, or an attack of depression or schizophrenia or what have you, at any time. And by contrast, they recognize how precious and how fragile a stable, functional, routine life can be. More than I, they can appreciate the extraordinary value of the ordinary.
So I leave at the end of the day feeling drained, overwhelmed, frustrated, inadequate, discouraged but — for all that — not without feeling grateful.
[Editors’ Note: This post is part of members’ November Group Writing Series on gratitude. Want to see what else is going on on our Member Feed? Join the conversation; first month’s on us.]
Published in Culture
In the dysfunctional family literature (and I believe Al Anon also looks at this), the authors often talk about the fact that the addiction issues usually go back generations. So the present generation says, and rightly so, “I didn’t do that terrible thing to my children” or “I did that thing for my child which was never done for me.” In their minds, that’s a big accomplishment. The children of people with addiction problems often don’t realize the sacrifices and work the most awful seeming parent has made to be better than the parent he or she had.
I really enjoyed this story of your work with these patients. I admire you. Thank you for doing it.
Solar – There’s no eclipsing the extraordinary light you’ve thrown here.
This is one of the most enlightening pieces I’ve encountered on this subject. You’ve taken us into a world that we only know exists from the local papers’ headlines and scattered magazine articles.
Your self-effacing approach – your hard-nosed realism as you describe the people, their shattered lives and the environment within which you try to effect life-saving changes . . it’s all so touching and exponentially increases my admiration for what you do.
Thank you.
Grateful for you! And holding you and your clients/patients in prayer…Thanks for this!
A family is something both to cling to and to stand up for. Thank you, SE.
That is for certain. Normality may be boring, but many would pay great sums for it if they had the money to pay.
Wow. Thank you.
Thank you for this lovely post. I’m grateful for people like you, SE, and for the work that you do. This post has immeasurably brightened my so far dreary, cold and damp Southwest Pennsylvania day, and reminded me that gratitude comes in all sizes, shapes, flavors and colors.
And like the widow’s mite, when it’s shown by the poorest among us, in small amounts, for the simplest and most natural things that many of us take for granted, sometimes that’s when the force multiplies and it means the most, for them and to us.
Your profile says that you write “occasionally.” Please write more.
Have you read any of @ryanm ‘s posts? You and he, it seems, are dealing with many of the same people in one way or another – you tending to their physical and spiritual health, he to dealing with the legal consequences of their actions on their families.
Thank you for sharing. We have our own inpatient unit. People have hit bottom, and some of them turn around, and it always inspiring.
Thanks , SE. What a gift you are to your groups. You give them the gift of being fully present — a rare quality.
I’ve personally witnessed and had to deal with family members who suffer from addiction and/or mental illness. It’s a hell of a cross they have to bear and a hell I can’t even begin to fathom. I thank the good Lord everyday I don’t suffer from these problems.
Thank you for taking us into a world we would never experience otherwise. It helps us to be more grateful for our “ordinary” little lives.
Thank you for sharing this, SE
This seems a wise approach. In my study of Adult education I sat in with an ESL teacher, and he brought in a short text (the one I remember was a call to the doctor to set up an appointment) which he’d write out, read slowly, have volunteers read, and then answer questions. He’d talk about telling time in English with one person, phone etiquette with another, and how to phonetically render the words with another. I initially dismissed it as amateur hour due to the lack of structure, but after some reflection concluded that this was pretty close to ideal given the circumstances: he had no idea who would be showing up in a given class, and the range of competency was very wide. So a focused plan building knowledge week-to-week would have been folly, but presenting a common text which bears questioning on many levels was valuable for everyone who did show up.
Thanks for your contribution!
Great post, I greatly admire your empathy and patience. I for one have a much more dim view and little if any empathy for parents dealing with addictions. The devastating and havoc they create in their children is just too horrible. All I hear is rationalizations so they don’t fully confront the damage they created. What I see are selfish and self absorbed individuals trying to remake the past and make excuses.
Yes, I imagine many ordinary folks’ reaction would be, “You can’t be sincerely grateful, because if you were, you wouldn’t have gotten yourself into this kind of trouble in the first place.” Heavens knows it’s always tempting to blame others’ failure to cope well on their ingratitude.
@midge I don’t deny them their feelings of gratitude. Redemption is hard and gratitude is integral to that process. What I am referring to is the denial and obfuscation many addicts have as to the depth of destruction they wrought. It is when an individual sincerely admits to themselves and others how truly awful their actions have been that I have seen real forgiveness and healing.
That’s a very understandable reaction. I don’t see it as my job to judge the patients – but that doesn’t mean there’s nothing to judge. Moral indignation would be the natural response to much of what they talk about. Maybe the people they’ve hurt need to express the pain they’ve been through, or maybe they need a long-term individual therapist or spiritual advisor to help them face themselves.
I do have empathy for them though. People outside this world can easily see addicts as selfish degenerates who are entirely responsible for all their own problems. People on the inside frame addiction as a disease, emphasize the genetic and biological element of it, and offer explanations that seem to relieve them of accountability.
The truth, I think, is somewhere in between. I refuse to absolve people of personal responsibility for their actions. But at the same time, once the addiction takes hold of people it really does twist them into something other than themselves…
(cont’d)
…consider that all of us have character flaws and moments of weaknesses, times where we do things we shouldn’t have, or fail to do things we should. Lash out in anger because it’s more satisfying than not, eat too much, sleep in when we have things to do, avoid people who irritate us even when they would enjoy the company, etc.
So take whatever selfish impulses you already have, and multiply them by 1000. Addiction interferes with cognitive functioning, offers heights of pleasure, and threatens depths of pain far beyond what most of us experience in daily life. This doesn’t excuse people’s actions, but it does put them in a new light.
Of course, you can always say they’re responsible for having become addicted in the first place. But people don’t become heroin junkies overnight, but rather gradually slide down the slippery slope, an accumulation of poor decisions that are much less consequential, even understandable, if taken individually. And of course, there’s nearly always a sad story behind every addiction that predates the addiction itself.
So I can suspend my moral judgement in the context of the hospital, because it’s not really needed there. But I can definitely see how some people might find it difficult.
Most people, are doing the best they can each day.
I know I am always fighting against being the Pharisee.
@solareclipse I agree with what you have expressed. The origin of most addictions are psychological and spiritual. I know intimately how devastating the wounds can be. What I do not have much empathy with is the excuses. I understand the causes but do not yield to the excuses or justifications.
One of the fascinating things to emerge from various aspects of brain science is an appreciation for how much habitual thoughts shape our brain’s activity.
My stepfather A”H was a psychiatrist whose medical practice began towards the end of WWII. He used to tell me about a study that the Army, or maybe the VA had done. They assembled a group of men who had been wounded and who had been given morphine in the course of their treatment for long enough to make addiction a real possibility. Some had gone on to be addicts, some had not. They interviewed them, and found that there had indeed been a point at which they realized that they were becoming addicted. The men had gone two ways: “I realized I was becoming addicted, so of course I had to quit” and “I realized I was becoming addicted, so of course there was nothing I could do.”
That points to a habit of thought that preceded the narcotic exposure. It used to be common to refer to drug addiction as a “habit.” This was useful. Current thinking is to medicalize it. That’s useful too.
One thing it certainly is is timebound; literally “chronic.” It shares something with chronic illness when the sufferer is unrealistic, either unrealistically hopeless and ungrateful, or unrealistically hopeful and ungrateful.
[continued]
I once had a patient. This individual had been living a pretty fast life, working as waitstaff in a very trendy place, lots of money in tips, and lots of money spent on drugs and alcohol, burning the candle not just at both ends but in the middle too.
It couldn’t last, and it didn’t. An awkward movement carrying a tray, something gave way. By the time this person came to me, the Worker’s Compensation case was on appeal. A rib had partly separated from its costal cartilage and the costovertebral joint was also injured; severe chronic pain was the result.
The quality of the tissues on this young person’s back was awful. Palpating them was like palpating the paraspinal muscles of an elderly man I once saw who had been on Prednisone for years for arthritis.
We made some modest progress. Better nutrition and lifestyle changes were important. Things began to stabilize. There began to be talk of wrapping up the work comp case. At that point, my patient was in an auto accident. The car he/she was driving was stopped at the stop sign at the end of a freeway offramp, and was hit from behind at over 40 mph.
New injuries. Exacerbation of old injuries. The defendant’s car insurance tried to blame everything on the work injury, the work comp carrier tried to blame everything on the auto accident.
[continued]
Back to what I said previously about hope and hopelessness:
At one point in my own journey (it came after the patient I’m describing) I realized that all my efforts to cure, or even arrest, the autoimmune arthritis had failed. But I had begun to learn something: the difference between being injured and the kind of pain that comes from making progress. Of course, one can’t always tell in the moment, and if you’ve been young and athletic you have a different idea of injury.
Many years later an athletic trainer taught me that the essence of athleticism wasn’t being a highly accomplished athlete; it was the application of will and intelligence to move beyond what had up until now been the best you could physically do. The pivotal realization came slowly: I might be in pain the rest of my life. If I can apply myself so that for the same price of pain paid I have greater capacity, I can do more now and later, as I get older and decline. I’ll have bought myself some headroom. I’m sure I’ll see this place again, but maybe that’ll be later. And if I can’t get any better, then I’ll know that, too and I can make realistic plans.
Figuring out what’s real is important. Someone close to me keeps saying “that’s just today, maybe tomorrow it’ll be better and then I can…”
Sometimes tomorrow never comes.
Yes, but it’s possible even that may reach the point of diminishing returns. Rumination is supposed to be bad for you, or so I hear, and one way to think of rumination is that it’s trying to figure stuff out beyond the point at which figuring has reached diminishing returns.
“What if all that applying myself just made things worse?” is not the greatest place to be, and when that question becomes a serious possibility, rather than a frivolous excuse…
True. And sometimes resting and waiting for tomorrow is the more sensible approach.
All of these questions go both ways, and while conservatives favor the way that rewards individual effort and punishes sloth, that’s not always reality’s way, either. I mean, assuming we can know reality’s way on all these matters, which I suspect we can’t this side of Heaven.
That’s what I called unrealistic hope. It evades reality, and in that way resembles what addicts do. It is also, like addiction, destructive to people who have habituated themselves to such thinking and to their families.
Unrealistic hopelessness is also paralyzing; “I’ll never….” becomes a self-fulfilling prophecy. Obviously biohemistry can contribute to that; but as the success of cognitive behavioral approaches for depression have shown, habits of thought are also involved, and imaging has shown that CBT produces changes resembling those produced by antidepressants, but that last longer.
Back to my patient.
The work we had been doing had, by the time of the accident, piqued my patient’s interest, and he/she had begun to study massage.
At this point, my patient came to me and said: “I think I want to settle my case. I’m not sure this will pay for everything I’ll need to get better. My lawyers tell me I can almost certainly get more money. But I realized that in order to do that I’ll have to keep proving how injured and disabled I am for another year or two. I don’t want to do that. I want to think of myself as healthy instead. I’m going to take the settlement, finish my training and start a practice.”
Definitely not fully recovered as if the injuries had never happened. Definitely not “cured.” But not drinking and drugging. Wanting to help others. What would you call it? Healed?
At least mentally or spiritually.
Not when you do it for years. That’s more like ruminating.
“It hurts but I’m making measurable progress” is true. ”
We’ve done what’s humanly possible to change things. Nothing got better (or maybe it’s still getting worse.) That’s not in my hands. What is in my hands is what I can do with what I still have or can still learn” is true.
“It hurts but doing something for myself helps me do more for myself and others”