Up is Down and Down is Up

An interesting phenomenon, I've noticed, is that the crazier the patients are, the more sane they think they are, and the more sane, the crazier.

I did a group on one of our less acute units today. These patients might be suicidal and/or character disordered, but they don't generally get special messages from the TV. They mostly have homes, families and jobs, and are not usually delusional in the clinical sense. One of the patients, like many others, is a young, bright, college-educated woman, who for some reason becomes suicidal every few months and comes in to the hospital. In today's anxiety management group, she was expressing her frustration at how irretrievably crazy she believes herself to be and exclaimed, "But who gets anxious before parties?!" Well, anyone who has parents, in-laws, or has been to high school.

Contrast this with a patient I had a few weeks ago on the acute unit. Also like many of his cohorts, young, bright and talented. When he doesn't stay on his meds, the voices take charge and he comes into the hospital. Prior to this admission, a bird had died in the yard of his group home and he respectfully buried it out back. Then he came up with the idea that the bird perhaps could be revived. He exhumed it and brought it up to his room. When the group home staff told him he had to get rid of the as-yet-unrevived bird, he, as we like to say, could not be redirected. Right up to his discharge, he insisted that he saw nothing odd about this.

CPR on dead birds: sane. Wigging about social functions: crazy. Keeping carcasses in your bedroom: sane. Avoiding family gatherings: crazy. Sometimes up is down and down is up here in The Nuthatch.

Peace out,

Madeline