“When I leave here, I wish I could have a friend like you.”
This is what MH* longed for as he prepared to be discharged from his long hospitalization at an inpatient psychiatric facility for the severe and chronically mentally ill. I had worked with MH for many years and I had seen him change from an impulsive, id driven, instant gratification seeking, aggressive person who developmentally was stuck in a teenager’s mind to a caring, slower version of himself, facing old age and infirmity with regret and a desire to live out the rest of his years “doing things right.” It had not surprised me to hear that he desired a friend like me, because in his words, he had never known someone to care for him without wanting something in return. He would say, “I don’t have friends, I have associates, who I trust as much as I can pick up your truck and throw it.” In the years we had worked together, I had slowly earned his trust. I had let him down many times, as had he, yet we had enough respect for one another to admit our transgressions and to continue to show up to therapy even when angry or disappointed with one another. And now, as our therapy came to an end, he longed for friendship, someone to trust, and someone he could depend on to care for him even when he failed to be perfect.
When I first met MH, he longed for many things, but friendship was not on that list. “Friendship was for wimps,” he announced and stated that he would do anything to not be seen as a pushover. He longed to get high and proudly reminisced about the many times he had sneaked in drugs to the locked forensic facility he was previously at without getting caught. He longed to smoke cigarettes, and constantly looked for opportunities to sneak in a drag in the bathroom or in a dorm room; even though cigarettes were deemed contraband and getting caught smoking could set him back in his progress towards discharge. He craved to assault the many individuals who daily disrespected him and acknowledged that the impulse to act on his urges was at times more than he could bear. He desired sexual release, and constantly looked for a willing companion to sneak into a closet for a few moments of heavy petting or sex if time allowed. He craved to feel something, anything. But most of the time, he felt very little, he felt empty. He described how the urge to act out impulsively overtook him and for those brief moments when he stopped thinking about consequences, he felt something. He stated that the feelings he felt were no longer good feelings, no longer a rush, just different enough from feeling nothing that he settled for them, despite the risks acting on his impulses often entailed.
I sought a lot of peer supervision in the years I worked with this client. I often became frustrated at his slow progress and self-sabotaging behaviors. I became his biggest cheerleader and when he had setbacks, I couldn’t help but feel the impact as a personal defeat. I wanted him to thrive and I saw so much potential, so I could not understand why he would often succumb to immediately gratifying a need, when in the long term the gain felt so insignificant. Why give in to a craving, when the future holds so many more opportunities for real happiness and longer lasting pleasures? Although I tried to understand him, I often failed to really empathize with his reality. How did he know that the future was going to be any better? He had never known genuine love, happiness, or friendship. He had never experienced the joy of hope, unconditional understanding, and a belief that he could truly change.
I don’t know when he started to believe that it was possible to change. I don’t recall an instance or time when his self-perception shifted, and yet the person sitting in front of me was not the same person I had met all those years back. He had adopted the idea that there were other things to look forward to out there. My partner once told me “Craving is trying to fill a void with whatever your environment has to offer.” This made sense to me. If MH’s environment offered cigarettes, drugs, and thrills, he would try to fill his void, his emptiness, with those pleasures. It would work for some time, until even those things lacked to bring him any real satisfaction. Once I understood that I was no different than MH, that I also craved to feel pleasure, then I became better equipped to help him strive to seek different joyous experiences. Luckily, my environment afforded me different ways to feel fulfilled, and thankfully I never felt quite as empty as he chronically felt. But at our core, we were the same. Two individuals wanting to feel understood, feel connected, feel fulfilled.
*Names and other identifying details have been changed
Author: Gladys Valdez