The Golden Ratio

Here's a quote from Wikipedia: "In mathematics and the arts, two quantities are in the golden ratio if the ratio of the sum of the quantities to the larger quantity is equal to (=) the ratio of the larger quantity to the smaller one."


In inpatient psychiatry, your group is in the golden ratio if the ratio of sociopaths/narcissists/help-rejecting complainers to everyone else in your group is 1:4 or smaller. (Sociopath, narcissist, and help-rejecting complainer are not mutually exclusive categories, so the math here would entail counting the number of individuals in which one or more of any of those features are in evidence. By narcissism, I'm meaning the inability to contemplate the existence of any perspective than one's own, by the way.) I've been working on this calculation for years now, over hundreds of groups on psychiatric units, and I believe that I have finally found the answer. I'm thinking about writing a scholarly paper, and maybe getting something named after me -- Piaget's Stages of Cognitive Development, Prochaska and DiClemente's Stages of Change Model, Freudian slip, the Francesca Principle of Why All Your Groups Sucked Today and You Feel Like the Very Life Has Been Beaten Out of You. It's catchy; I like it.

Now I'm not saying that sociopaths, narcissists and help-rejecting complainers don't belong in nuthatches -- sometimes they do. I'm also not saying that they're not just as deserving of compassionate, competent mental health care as anyone else. Of course they do. I am saying that they can be darned tough to deal with in groups, particularly if there isn't enough of everyone else to neutralize the toxic effects.

It can be particularly tough for me because I'm only working in this hospital one Saturday every other week. The average length of stay is only eleven days, so I don't know most of the patients and they don't know me. I have no fund of good will upon which to draw, and I don't know ahead of time who's going to take up which kind of role in group. More importantly, the S/N/HRC's tend to see me as someone new to test, deride, or manipulate. Usually it's fine -- I've been through it many, many times before, and they don't often come up with much that I haven't heard before.

It's generally stuff along the lines of "the doctors/nurses/social workers/milieu staff/maintenance/food/groups, etc., in this hellhole suck and I'm going to keep interrupting you and/or talk to my neighbor about it, making this group suck, and then I will complain about that, too." Or "my problems are so very, very different/more important/more interesting/more complex/more painful than you or anyone else in this room, heck, the universe! can possibly understand, so how, oh how, can you expect me to divert my own or anyone else's attention away from all my misery for even a moment when I'm in such misery." Or "I'm feigning some mental health crisis in order to avoid jail/being fired/kicked out of my house, and if I can convince you that I really am sick and not malingering, I think I can get you to take pity on me and call my probation officer/boss/girlfriend and get them to take pity on me also." None of which will generally have anything to do with what the group is actually about, so if you're in the Golden Ratio, you can engage EE who's actually interested in your group, and the S/N/HRC's will either be quiet, play along or leave.

If you're not, the S/N/HRC's will join forces and gang up on you and EE will either be cowed into silence or leave themselves.

For some reason today, the S/N/HRC:EE ratio in my groups was unusually high, and the more the groups derail, and the more attention they can grab, the more gratifying it is for them and the more it sucks for everyone else. I didn't have a very good day. The rest of the staff seemed stressed out and disgruntled also, so I'm guessing the Francesca Principle doesn't apply just to groups. I'm glad to be home finally.

And that's the point to remember -- it's fairly obvious, but I suppose it bears saying. I get to go home, and I have a home to go to. And I have many other things to amuse me besides torturing social workers, nurses, milieu staff -- and by the way, other psychiatric patients -- with my BS shenanigans.