NOVEMBER 2012 • CLINICAL PSYCHIATRY NEWS
It’s becoming the exception for a psychiatrist to spend more than 15 minutes speaking face-to-face with patients. This is the unfortunate concomitant of a medical culture that reimburses us more for 15minute medication reviews than for talking to patients for an hour.
Yet, we know that connecting with patients at some heartfelt level is critical to doing our work. It is the relationship that inspires their trust and encourages them to dare to imagine that they can create new endings to their old stories. It turns out that listening at that level can actually happen in a short time if you are truly present and paying attention.
I recently participated in a community mental health clinic in the streets of Iquitos, Peru, where I went with Dr. Patch Adams, the world’s most recognized humanitarian clown. One hundred clowns from all over the world participated in a collaborative preventive health project in a desperately impoverished section of town called Belén. They are performers, musicians, artists, teachers, students, entrepreneurs, students, and health workers.
We conducted workshops for children (percussion, hip-hop dance, acrobatics, juggling, puppetry, photography); painted homes and public murals; clowned in hospitals, prisons, and shelters; and supported local health organizations.
Ideal Place for Community Psychiatry
For the last 3 years, I’ve worked with Amazon Promise, a nonsectarian, nonprofit organization founded by activist Patty Webster that provides health and dental care to the indigenous people in the Amazon Basin of Peru.
This year, what is thought to be the worst flooding in recorded history struck the region. Inhabitants were forced to leave their homes by the thousands, and malaria, pneumonia, and leptospirosis were escalating problems. Add to these the problems that accompany extreme poverty (crime, violence, drug abuse, alcoholism, sexually transmitted diseases), and you find an ideal place to conduct a mental health clinic.
I was the first psychiatrist willing to see patients in an open public space, without privacy or psychiatric drugs. I had a remarkable translator who wove my words into her own meaningful story that touched patients. People waited in line without shame, talking about their problems in full view of their neighbors. We discovered in these sessions that good things can happen – even in 20 minutes.
Among this year’s clown group were 20 clinical health professionals (psychologists, counselors, nurses, doctors, social workers, and body workers). We set up four half-day clinics in the streets of Belén, where we knew people would be gathering. We printed fliers that said health professionals who could offer help would be available for people who were experiencing problems at home (with spouses, children, or parents), couldn’t sleep, or had aches in their body.
Preparing the Medical Team
Before the first clinic, I met with the clinicians and told them about my experiences over the last several years. In those meetings, the clinicians were in an open setting with no privacy, hearing stories that would make their hearts bleed (abuse, abandonment, sexual trauma), and they would wonder how anything in their training could help them deal with such overwhelming problems. I assured them that, in addition to the symptomatic manifestations of such grinding poverty, they would see a remarkable people with extraordinary resilience.
Perhaps the most significant thing we could do was simply listen to their stories: For many patients, 20 minutes with a compassionate listener was an exceptional event. If, in addition, they could help patients identify some strengths, offer some advice, or inspire hope, that would be an additional dividend.
We had no psychiatric drugs, so at the end of the sessions, we would give them vitamins for themselves and their children. I brought along some neck laces with a small silver medallion of the Virgin of Guadalupe that had been blessed by Huichol and Navajo shamans. I suggested to the clinicians that, if they saw patients who might benefit from having this reminder of their time together, they could share these special amulets with a blessing of their own. … “Whatever your heart prompts you to say at the moment.”
We did not dress up in our usual clown regalia – only our clown noses identified us. We set up in a schoolyard, loading dock, and empty rooms. Upon arriving, we passed out the fliers and announced our presence through loudspeakers.
Clinicians were paired up and each team huddled in a tight circle with their patient(s) so they could hear above the clamor. Clowns playing with children, veterinarians sterilizing dogs and cats, and laboratory technicians taking blood from kids surrounded the teams – all while the community casually strolled by.
Clinicians saw 200 people over 4 days; they listened to the breadth and depth of the human experience. Twenty minutes is a blink of an eyelash when measured against the length of one’s life, but it’s enough time to feel the pain of another and to reach out to touch them with compassion.
It is those moments, when we are reminded of our shared humanity, that make all suffering bearable. In a short time, in a public place, without privacy, not making diagnoses or prescribing drugs, patients and clinicians connected in a heartfelt way that had a positive impact on both. When we surveyed patients who had visited the clinic, they told Rosa, our interpreter, that they would indeed come back.
We are psychiatrists. We listen to patients. We reflect and enlighten. And if we really pay attention – even for only 20 minutes – we would be reminded of what we like doing best, and we can magnify our therapeutic efficacy, and prescribe fewer drugs.
DR. HAMMERSCHLAG, a leading proponent of psychoneuroimmunology (mind-body-spirit medicine), is chief of community mental health at the Gesundheit! Institute in Hillsboro, W.Va. He also is affiliated with the Arizona Health Sciences Center at the University of Arizona, Phoenix. In addition, Dr. Hammerschlag is a professional keynote speaker and author of numerous books on healing, spirituality, and other topics. To get in touch with him, e-mail him at firstname.lastname@example.org. For those interested in the work of Gesundheit! and clown trips, go to www.patchadams.org. Residents and medical students who are interested in the February 2013 3-week expedition sponsored by the University of Michigan Medical School Global Reach Program are urged to contact email@example.com.
Medical professionals were paired up, and each team huddled with individual patients so they could hear above the clamor.
Clinicians saw more than 200 patients over 4 days. For many patients, 20 minutes with a compassionate listener was an exceptional event.
Some patients benefited from body work, a combination of therapies aimed at restoring health and balance to the entire person.