I spent two years in a locked psychiatric unit during my days at seminary. As a part-time “psych tech” in a secular hospital my role was to support the nursing staff in patient care. The real life of most of our patients was often heart-breaking: in some measure all were broken and hurting. We did what we could through the medicines and interventions at hand and sometimes seemed to make some headway. Yet in too many cases the patients we helped and released were readmitted after just a few weeks or months.
Let me take a pair of insights from those days to reflect on the real life we find outside such a unit. The first is that our world itself is “crazy”; and, with that, that one of our common solutions to brokenness is misguided and can only lead to patient recidivism—and to the regular recycling of problems that most people experience in any setting.
Before I say more let me note that I don’t mean for this post to be a wholesale indictment of what our unit offered: on occasions the interventions we used led to substantial and lasting relief. I praise God for that. But much more is needed, namely a cure that speaks to all our deep needs and that lasts forever.
That said, I came away from my two years there with deep concerns about the problems of real life found both inside and outside the unit. Let me start with our most common intervention, and then turn to the underlying problem itself.
The common cure for dealing with patients whose conduct was out of bounds—too extreme for those around them—was to apply behavioral modification programs. That is, many of our patients had attitudes and behaviors that were labeled “dysfunctional” by the staff. We then confronted those issues with a variety of pressures to get them to change.
Typically the staff would begin the care program by defining behavioral standards: coaching a given patient in what was and what was not acceptable. The next challenge was to link the care plan to some form of leverage that had enough power to change the patient’s behaviors. If, for instance, patients were smokers the staff would withhold cigarettes until they behaved, and then parcel them out as rewards. Or if patients prized opportunities to go for a daily walk outside the hospital with staff escorts that permission was used as a lever for change. The greatest reward, of course, was the promise of eventual discharge from the unit: “behave and be released” was an implicit and sometimes explicit message being offered every day. Pavlov and Skinner, two of the great behavioralists, would have been proud of us!
So much for the common cure. What about the problems we were addressing? First let me offer two examples of the sort of issues we faced.
One woman was in the unit for her deep episodes of depression. As a psych tech I was expected to engage patients in conversations about their issues, then to write up anything significant in their chart for others on staff to read. In one conversation this woman mentioned that she didn’t trust men, her husband included. Why not? I asked. She answered that all the men she knew were driven by sexual ambitions and while she was always willing to offer herself she still felt unloved and unlovely—with the exception of just one of her male counselors who had ended his own involvement with her “for my sake”—so, she concluded, with this one exception, men are never to be trusted!
In a second case a young woman had been unable to invest herself in any meaningful relationships and was wildly impulsive in her behaviors. The male staff were asked not to have any substantial interactions with her over the course of her three-week hospitalization. This was only reversed on the day before her discharge so she could have some re-socialization time with men.
My sense of a much bigger problem that stands behind these more immediate episodes—the problem of a crazy world—was reinforced by the way these two encounters went forward, and illustrates what I found in many other cases.
After the first conversation—with the promiscuous wife—I returned to the staff office to check through the patient’s chart to see if her multiple male relations and expressed loss-of-trust issue had ever been reported. Nothing was noted. But before writing up the exchange I mentioned her comments to one of our experienced nurses.
“Do you mean to include that in her chart?” she asked.
“Well, yes.” I responded.
“I’m not sure why you would,” my colleague, went on, “since it’s not all that significant.”
Only then did it dawn on me that this married colleague was, herself, freely active in her sexual partnerships—as would slip out to others during meal breaks. And she wasn’t alone on staff in that pattern. I was, she seemed to be saying, the one who was living by a different behavioral standard. And, in her view, the patient’s problem with depression could scarcely be related in any way to her sexual activities.
In the second case I had my only conversation with the young woman. It began with a basic question.
“What’s your biggest ambition in life after you leave us tomorrow?”
“Huh?” she responded. “What do you mean?”
“Oh, just that all of us operate with a variety of goals and ambitions in life—the things that set up our priorities for how we spend our time and resources. ‘Hope’ is a label for that, and hope is what orients us in life. All of us have some sort of hope that helps us figure out what we want to do. So I’m curious about what you hope for in life.”
All this seemed like a brand new concept to her and she asked a couple of follow-up questions that I answered. What surprised me, though, is that she was getting more and more animated in the process. Finally she was clearly angry with me!
“I don’t get it!” she said, “I’ve been here for three weeks and what you’re saying is the first thing that makes any sense to me and it’s only coming after my three weeks here and just before I get out!”
In both cases, of course, I was spilling out my Christian faith in a world that didn’t share that faith. So the values I was applying were sometimes very different from the values that were guiding others on our staff. This is not unusual for many of us. In a mostly post-Christian culture we often see the “real world” in very different terms: and each side of this divide is increasingly viewing the other side as socially and morally dysfunctional, and even crazy on some counts.
With that in mind let me return to the favorite cure used on our unit: behavioral modification. For a biblical Christian it represents a crazy approach. It seeks to change people from the “outside-in” rather than from the “inside-out”. It dismisses the point that helped launch the Protestant Reformation when Luther insisted, contrary to the model of virtue ethics common in his day, that we do not become righteous by practicing righteous behaviors, but we practice righteous behaviors only after we’ve entered into the righteousness of Christ’s work in us [thesis 40 in his Disputation Against Scholastic Theology, 1517]. Real change in real (that is, eternal) life always starts with a heart change.
Our hearts, the Bible tells us, are the ultimate fount of all our behaviors: we were made by God, in his image, as lovers. We were made to be other-centered; to be holy and blameless in our devotion to God; and to engage in a life of faith, hope, and love.
The patient I spoke to who had her many men was looking for love in all the wrong ways. In that dysfunction—call it “sin”—she revealed a heart longing for what real sexual love offers: to engage in God’s plan for a devoted and singular commitment with just one partner for all of life, mutually bonded in an enduring trust and delight. To live otherwise is to enter into a world upside-down to God’s design.
The young woman—driven by the huge waves of impulsiveness—was hungry for an anchor in life: for meaning. And only through hope and a sense of meaning, with the worth and nobility that comes through a hope in Christ, would she find a basis for real stability in life. I’m afraid that all our unit offered her while she was with us—until our encounter—may have been some behavioral seasick pills.
So the question for today is this: are we presently living a true “real life”? Or are we living within sin while using short term behavioral pills to minimize the pain? The only way to guard our hearts is to give our hearts fully and freely to all that God offers us. Then and there we find an abundant life. The world needs us and our cure!