Listening for Systems
My first placement, in 1982, was in an inpatient setting in East Harlem as part of a Hispanic outreach unit. Many of our severely mentally ill patients were being "deinstitutionalized" with no viable discharge plan; they were simply returned to the street. So the placement coincided with the beginnings of the homelessness crisis in New York. Our mission was to follow these patients into the community and help them find the supportive services they needed to live securely.
My supervisor, a dedicated, imposing Puerto Rican woman whom we called "La Profesora," made clear that our primary function was to carry hope to our clients. I tried to remember this when I was assigned to a man on the unit who had no I.D. and, therefore, no known name. He spent his hours and days in the corner of the large common room, shouting names and numbers at passersby. "I'm not Governor Carey!" he'd yell. "I'm not Mayor Koch!" Then he'd let loose with a volley of numbers: "Eight four eight two nine seven five six four one!"
I'd never encountered psychosis before, and had no idea how to help this distraught man. But La Profesora instructed me to continue to approach him, introduce myself, offer to help, and then wait. Wait and listen. As I kept vigil with this man one morning, I began to notice a pattern in his shouted numbers. The first three sounded like a New Jersey area code. Then a whole phone number emerged, and when I dialed it, the man's aunt answered. She told me that her nephew was a Vietnam War veteran and a PTSD survivor. This phone conversation led to a reconnection between nephew and aunt, which, in turn, made possible a real discharge plan.
I was stunned, and thrilled, by this outcome. In graduate school, I'd been learning about the importance of context, about listening for the systemic background music in a client's story. Even so, this man was clearly psychotic, making no sense at all to me, and if it hadn't been for La Profesora—"keep paying attention, keep paying attention"—I'd have probably written off his shouted pleas as mere ravings and concluded that we needed to up his meds. Now I'd experienced the power of systems thinking, firsthand. This man, who appeared to be so utterly alone, did have a family, wanted his family, and had communicated that to me as best he could.