Note: This story is based on what actually happened in one instance of psychotherapy. Names and details have been changed to protect identities.
It was 25 years ago. I was a relatively new intern at a busy inner city community health clinic and working at the Oregon State Hospital. I had already had my eyes and heart opened by the many stories of tragedy that surrounded such a place — poverty, racism, sexual assault, child abuse — and above all, the incredible power of the human spirit. I was already learning the limited power of the standard mental health system in addressing such injustices and trauma, and often did not feel up to the task.
Nancy was diagnosed with schizophrenia and major depression. She was incredibly suicidal, heard voices and was on a cocktail of psychiatric drugs. She had been arrested for assault and spent time in the state prison. The prison had quickly seen that she did not belong there and transferred her to the state hospital. I was able to see her first in the hospital and then at the clinic when she was released.
She was a mess. I didn’t know how long I would be working with her before she committed suicide. She had extremely lethal plans for it and was alone and isolated.
Nancy’s sad and violent history was recorded in the large file that came with her. She had a history of being sexually and physically violated by her father, who was, thankfully, on the road much of the time as a truck driver. Nancy’s mother was extremely depressed and unable or unwilling to adequately mother and protect her child. There were hospital records of her many visits to the emergency room starting from age 4. It was and will always be a mystery to me how and why Nancy was left in these circumstances with no intervention from the state.
Nancy trusted no one. She had not ever had a good experience with relationships and was extremely wary of me. It was difficult to get her to talk to me in our early sessions. Slowly, she told me a little of her story, primarily how she had been put in prison for assaulting people on city buses because her voices told her to. Her voices had ruled her life since mid-adolescence, telling her how worthless she was and about the dangers surrounding her. She was cut off from feeling for the most part, so her fear of others manifested as paranoia: Her voices told her others wanted to hurt her and that she had to lash out first or be attacked.
It was at one of these early sessions that Nancy turned her head slightly and seemed to tune me out.
”Are you hearing voices?” I asked.