I would like to thank my Relationships Are Hard guest today Robert Wertzler.
This is a story of three people with three relationships. I was one of them. I will call the other two Mary and Jane. Those were not their names. They were clients of the county mental health clinic where I worked, so, even though it was more than twenty years ago, I cannot use their real names. Of the three relationships, two are easy to define. I was Mary’s case manager. Mary and Jane were friends and roommates. The third, as you will see was not so easy to put in a standard category.
Both Mary and Jane were diagnosed with Schizophrenia. Their apparent symptoms were mainly in the
“negative symptoms” category, meaning confusion, difficulty with social interactions, flattened affect and emotional expression, delayed responses, and anxiety. I don’t recall now whether either of them had previously reported hallucinations, intrusive thoughts, or expressed delusions, but neither talked about those when I knew them. They both presented as generally quiet and rather shy, compliant with medications, and not among the “squeaky wheels” in their respective caseloads.
Mary had come into the treatment system after a disastrous pregnancy which ended with her giving birth alone at home and unable to do what was needed for herself or the baby. The baby did not survive. I never heard what sort of relationship resulted in that pregnancy and it was not clear how long before the birth she had begun having symptoms. Jane had graduated as an English major from the local State university at the top of her class, Summa Cum Laude (with highest honor), and continued on to graduate school at the same school. Her psychotic break came in grad school, cutting short what was expected to be a successful, even brilliant, academic career. They met after their hospitalizations as roommates in a local board and care home.
It happened that the county mental health clinic where I worked and one of its residential contractors developed a supported living program in a small apartment building. Mary and Jane were able to get a two bedroom apartment there. They were able to manage their own medications and daily activities reasonably well. Martha Stewart would, I think, not have been impressed with their decor and house keeping, but they did well enough with subsidized rent on their SSI budgets. Given their limitations it is difficult to imagine them having a physically intimate relationship, even had they been so inclined, but they had an effective partnership and a companion whom they trusted.
One day, Jane called me and said in her quiet way, “Mary won’t wake up. Its been three days. Can you come help her?” Of course, I said I would and went to the apartment, fearing the worst. Jane met me at the door and led me to Mary’s room. Her bed was a mattress on the floor (they did not have a lot of furniture)..One of her feet was out of the blankets. I touched it and it was stone cold. She did look as if she was peacefully asleep, but was not breathing. There were no signs that she had suicided, such as empty pill bottles, and no signs that she had struggled or been in pain. She was my first dead person outside of a casket at a funeral.
They didn’t have a phone and this was in the early 90s when cell phones were not common, so I went outside to the pay phone and called my supervisor who said she would send Jane’s case manager right over. Then I called 911, telling them the subject was clearly deceased and asking that they come quietly. Jane’s case manager arrived and took Jane for a walk while the paramedics collected Mary. The Coroner’s office took charge of contacting family and making arrangements. I requested a copy of the Death Certificate. I found in Mary’s records a reference to a preexisting condition of Mitral Valve Prolapse, a condition in which one of the heart valves flips the wrong way, greatly reducing the efficiency of the heart. At this point there was nothing for me to do about Mary’s death but wait for the copy of the Death Certificate and grieve the loss of a gentle, relatively young (30s) woman who had suffered much and endured her mental illness with some good measure of dignity and grace. Little did I know then that it would take fourteen months for me to receive that document. I still don’t know why it took so long, but that fact is important in the next part of the story.
Several weeks later Jane came to see me at the office. I should explain that at that time our clinic office was in an older building with six doors, none of which were locked or guarded during business hours. People could just walk in and wander about. She had probably been there for an appointment and found my office door open and me not with another client. She asked if she could talk to me and I said she could. She said she thought she might have seen Mary somewhere in town, but that it might only have been someone who resembled her. I agreed that it was very likely a look-alike since Mary was not a very unusual looking person. My thinking was this; Jane had certainly been told by her case manager and perhaps also the doctor that Mary was dead. If she had said to either of them what she said to me, they would have tried to correct her, do therapy. If so, it had not worked because she was not ready to accept that her friend was truly gone. She also understood the rules of confidentiality well and so knew that if Mary was alive somewhere and I knew it, I could not tell her without permission. So, I listened without trying to correct or contradict her, but agreeing with any doubt she expressed about seeing Mary. Beyond that, I just listened, giving her my full attention. I continued to do that as she dropped in every few weeks or once a month. I think I made a safe place for her to talk about her suspected sightings and speculations. She never stayed long, was never agitated, and never said she was certain she had seen Mary. Finally, I did receive the copy of Mary’s Death Certificate. I showed it to Jane the next time she came. She read it and said, very softly, “Oh, thank you.” and went on her way. Her body language said a weight had been lifted. For the first time in all those visits she genuinely made eye contact. Like many people with schizophrenia she usually avoided that.
What did that eye contact and what seemed a weight lifted say? What did that document tell her? It wasn’t just that her friend was dead. Her friend had disappeared. In part that document told her the same things it told me. First, that she did not leave by choice. Second, that there was almost certainly nothing any of the three of us could have done to prevent it. Jane could stop asking why Mary left her and had not come back, or sent a message to explain. It said, “You did not do anything wrong.” I think those questions were what had been driving her looking for, or looking out for Mary. And the direct look, I take as speaking of the shared loss and the real relief of finally knowing. Now, she could grieve and move on. Although, in the few years before I left that clinic and moved away, I did see her there occasionally, we did not talk again
There is a reason we have rituals such as memorial services and funerals, and why we want to be at the bedsides of loved ones in their passing. We need those chances to to say goodby. Jane did not get to say goodby to Mary. In a way, I did that day when I found that she had gone, but Jane’s illness did not allow her even that full awareness. She was not invited to any service. She was not told (nor was I) where Mary was laid to rest, and so had no grave to visit. I know what that is. There have been a number of people in my life to whom I did not get to say goodby in those ways and no doubt in years to come there will be more. Sometime we can only do so in our hearts. I hope Jane was able to do that.
I don’t know how to classify that relationship. It was not, by any of the usual models and theories, therapy. It was not part of her official treatment plan. I did not write those visits into the clinical record, in part because there was no billable service code for just listening (there should be). Besides, If she was telling those things to her case manager or the doctor they already knew, and if not that was her choice. On the other hand, it was not exactly friendship either in that clinical context. Somehow it was about the shared loss and I don’t need to give it a name. Whenever it may be that I again spend some time in that town, perhaps, just perhaps I will get a chance to hear her side of our story, probably not, but I would like that. And if that should happen, now it could be as a friend.
Bob is a retired mental health professional, having worked in SMI Case Management, Crisis Services, and Substance Abuse/Addiction Treatment. He retired in 2006 to become the primary care giver for his father who then was then beginning to suffer from dementia until his father died in late 2013. Prior to getting into mental health work he held many different jobs including cab driver, toy maker, welfare case worker, and others. He is an Army veteran of the Vietnam conflict. Looking back on his 70 years he quotes a line from a song,”What a long, strange trip its been.” Looking forward, from another poet, “Where to? What next?”
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