How Can You Mend a Broken Heart?

As RobinMSW so poignantly tells us, these patients can sure break your heart.

Sometimes you're broken-hearted for the patient -- like Robin's patient Joseph, or my patient Gloria, from a recent post. Patients who are so whacked, they can't really grasp their situations, and no matter how what you do, you just can't protect them from themselves. And they're too addled to be broken-hearted themselves, so you have to do the bleeding for them.

Other patients you're broken-hearted with. Often these patients come across as pretty organized and together. They basically do and say the same things you do, feel the things you feel, think about the things you think about, worry about the things you worry about -- the only thing that really makes them crazy is that they do, say, feel, think and worry just like you -- only to a degree that just crosses a line.

Take Anthony. A nerdy 40-something guy, balding, thick glasses, mild-mannered. He wanted to hang himself because he found out the beauty queen he prayed would love him was married to someone else. The wish for this particular Miss America has both sustained and tortured him for years. Now that he knows it will never come true, he tells me how foolish he feels for ever even hoping that a woman like her could ever love a man like him. He knows he never really a chance with her, he tells me, but he couldn't help it -- who wouldn't love her? He tells me how painful it is for him to believe that he won't ever find someone to love who will love him back. I can't bear the thought of the rest of my life alone, he says to me quietly, chin trembling.

Sure, he's delusional -- this Miss America certainly has no recollection of the tenuous connection between them as children, and prayer was probably not the most effective way to her heart even if she had.

But that's the only part of it that's crazy. And my chin starts to tremble as well, as Anthony finishes telling me my own story.

Guest Blogger: RobinMSW on Heartbreak in The Nuthatch

Topic: The two most dreaded words...State Hospital.

No matter how much you dislike a patient, how annoying he is, how much he follows you around, how many times he asks to be discharged, how long it takes him to get a sentence out, or how many times he repeats the same word or phrase, everyone hates telling a patient the hospital is filing for commitment to transfer them to a state hospital.

Enter Joseph. He is all of the above, and more. Mention his name to any staff member at the hospital, and they will each give you the same smirk and eye roll...because they all know who you're talking about. Today, I was left with the dreaded task of telling Joseph he either had to sign a paper agreeing to be transferred to a state hospital, not signing it and going to court for commitment, or being discharged with services from Department of Mental Health with Program of Assertive Community Treatment. Most people would choose DMH and PACT. Most people also do not have delusions about the government conspiring against them and thinking staff at the hospital are actually FBI agents. (Allow me to clarify-most people outside of the world of mental illness don't think these things. We get our fair share at the hospital.) So if you do have these fixed delusions, there's no way in hell you're agreeing to receive services from the State.

React Joseph. Plead Joseph. Beg Joseph. Deny Joseph. Delude Joseph. Panic Joseph. Blame Joseph. Heartbreak social workers.