[The Mental Health Film Board presents]
[Full Circle, Comprehensive Community Psychiatry, Series IV]
[Sponsored by the Vocational Rehabilitation Administration]
[Nick:] Why is everybody pushing me?
Why does my wife constantly tell me I've got to get a job, I've got to make a decision?
I mean, after all, you've got to do something you have some pleasure in.
You just can't make up your mind and then do it and not feel that you're interested in it.
You can't be pushed into it.
[Social worker:] Well, that's certainly a problem, knowing what to do with pressures from the outside.
Don't you think so, Miss [inaudible]? You want one thing, and your parents want another, right?
[Psychiatric patient 2:] Yes, but... I don't... I don't...
know exactly how I should react. I'm afraid.
I'm so used to listening to them always and taking their advice.
I don't know how to make decisions on my own.
Should I work? Should I go on...
[Psychiatric patient 3:] Well, one of the ways you go about deciding these sorts of things, it seems to me,
is by setting limited goals for yourself.
Um, you know, for example, when I was drinking so much all the time,
the only way I could really decide to stop was just by cutting down and holding off
for one week at a time, and saying if I'd stay off that week,
I could make it for another week,
and you could do the same thing for a job.
[Social worker:] What do the rest of you think about this, about setting some kind of limited goals for yourself,
something you can accomplish?
[Molly:] I don't think I really know how.
[Social worker:] What is it that you don't know how to do? You can actually go out and look.
[Molly:] Who to see, when to see them, and how to speak to them.
[Psychiatric patient 3:] Have you ever worked before, Molly?
[Molly:] Yes, but many years ago.
[Social worker:] What did you do then? How'd you go after a job?
[Molly:] All recommended.
[Social worker:] The people you knew? [Molly:] Yeah.
[Leslie:] She might be turned down too. That would be an awful hard thing to take.
You know, people that might have helped you before might not help you now.
[Social worker:] Why do you think that might be?
[Leslie:] Well...
[Molly:] You don't have to be afraid to say my age and...
[Leslie:] Sure, I mean, but, you know, it might be difficult for someone to recommend her.
They don't know. Maybe she won't be able to do a good job now.
It's difficult.
Most people don't want to stick their neck out for anybody else.
[Social worker:] Well, how do you feel? I mean, do you think you can do a job now?
[Molly:] I feel that I can if given half a chance.
[Social worker:] How do you feel when she talks? Do you get a sense that she can go out and do a job?
[Leslie:] Yeah, I wish I had her confidence.
[Social worker:] Of course there's living space with that too because at this point, she's not convinced about what she can do.
[Leslie:] Yeah, I really don't anything to even build a...
I have an education, but I can't use any of my education really.
[Social worker:] How's that?
[Leslie:] I don't see how I can.
I'm a teacher, and I can't teach,
and I'm just sitting here, just becoming so upset listening to everything that all of you people have.
I mean, accounting, and they're crying for that sort of thing,
and you can always do something with it.
And you have your drawing,
you have your chemistry, and all these things are really a talent, and I can't do anything.
[Social worker:] Why is it you feel you can't go back to teaching?
[Leslie:] I can't control all those children. I mean, even if they're kindergarten, I mean,
I just can't go in every day and face them, and I can't be a stenographer or anything like that.
I'm here in the hospital, and what can I do, you know, to find a job and everything?
[Social worker, thoughts:] Yes, this is a hospital, and these are patients who meet regularly once a week to talk about jobs,
how to get them, how to hold them.
I'm a trained social worker,
but actually, the members of the group help each other by pooling their experience,
by discussing their problems in simple human terms.
[Narrator:] The work adjustment group is a fairly new program developed for men and women who have suffered from mental illness.
For these are all psychiatric patients in a general hospital in the heart of the big city.
In spite of their appearance, many of them are seriously ill, some with symptoms that were once considered incurable,
but which might have led to a life of isolation and misery in a far-off institution.
Now, by virtue of the modern revolution in the management of mental disease,
they can be treated in their own community in an environment that is comforting and hopeful.
[Television program playing in background]
So the statistical truth that in a few weeks or a few months,
most of them will be well enough to go home is constantly in the minds of the professional staff who care for them.
Mental illness is now approached without fear or horror,
for it is known that, like other disease, it usually responds to intensive medical care.
Hospitalization is indicated during certain acute stages of many kinds of illness,
but the time comes when most patients can be discharged,
when they should be discharged.
[Social worker:] And this is the goal of all hospital workers, no matter what department they are in.
It's what doctors plan for and nurses work for.
When can the patient go home?
It's on the mind of every occupant of every hospital bed,
in the thoughts of every relative who comes to visit.
And yet, for many, leaving is a problem.
[Wife:] You have to learn to take it easy for a few months.
[Hospital patient 1:] I won't be able to use my left leg for a long time.
[Hospital patient 2:] Do you think they'll give me back my job?
[Narrator:] For psychiatric patients who left a world they could not cope with,
the prospect of going back can be even more terrifying.
It's not just a matter of facing old problems;
It could be the need to relearn old skills or to develop completely new ones.
Occupational therapy is used to help the patient to concentrate on a task,
to turn out a piece of work so that every assignment carried out is a step toward recovery.
Ceramics can be medicine when administered by a skillful therapist.
It is part of the arsenal of modern psychiatry
along with the tranquillizers and the depressants and all the other chemical compounds
that have helped change our ideas about mental illness by radically changing the behavior of patients.
They are no longer the pitiful, frightening human beings of the snake pit.
Most of them are now capable of talking about their troubles, their fears, their hates.
And since, for many patients, the road to cure is simply a question of relearning the meaning and use of their feelings,
psychotherapy is still the principal tool of the psychiatrist.
Although there are many others, like shock therapy,
that are used to treat certain kinds of stubborn symptoms.
[Social worker:] But they all point in one direction: toward going home, toward going back to a job.
The work adjustment program is part of that total plan.
[Psychiatric patient 3:] As a chemist in a... in a man's, uh... field,
it's very difficult to see them get promotions and raises, and all the recognition that I've never gotten as a woman.
[Social worker:] Well, isn't this the kind of problem of what to expect from a job?
What is it you're really looking for from your work?
[Psychiatric patient 3:] Well, I'm looking for one of the things that Nick talked about, and that is satisfaction,
but that does come from a certain amount of recognition of my abilities and my talents.
[Social worker:] Well, but Emma suggested you have other talents and abilities too.
[Psychiatric patient 3:] Well, what do I do with them?
Look, Leslie has other talents and abilities, and she doesn't know what to do with them.
Well, you're pretty and dress well and have a nice personality. Isn't that important to you?
[Psychiatric patient 3:] Yeah, but it doesn't get me anywhere.
[Psychiatric patient 6:] You have... You have things that none of the rest of us have, uh...
I know there was a time when all I wanted to do was finish school.
You have degrees and things, and uh... It seems to me these ought to give you a lot of satisfaction.
[Karen:] It's easy for men to say that, but in the... let's face it, in the business world, it's a man's world.
[Social worker:] This is Karen Graham, 25, unmarried,
a patient in the psychiatric service.
Her story might be a good one to show what can actually happen in a group like this.
She first came into the hospital about five weeks ago in a state of acute depression.
Before then, she had been a successful commercial artist living right here in Uptown Adams,
a few blocks from the hospital, with her parents.
As a matter of fact, it was her mother who had come in with her,
a troubled, puzzled mother who couldn't understand what had suddenly happened to her attractive, talented daughter.
Miserable, withdrawn, Karen couldn't talk. She couldn't even eat.
The mother came in several times those first few days, vainly trying to cheer her up.
But Karen just wanted to be left alone.
She was too tired, too hurt to respond to anyone.
[Narrator:] Dr. Pradi had been assigned to her case when she was admitted,
but in those first interviews, he had not really been able to get through to her.
His questions, his very presence seemed intrusions on her misery.
[...]
[Dr. Pradi:] When did you first start feeling depressed?
Do you remember at all when it started?
[...]
Had you been enjoying your job?
[Karen:] Yeah.
[...]
[Dr. Pradi:] Did your family know that you were depressed?
[...]
[Karen:] I don't know.
[Narrator:] Karen didn't seem to want a pleasant, kindly person trying to help her.
She wanted to be left alone to suffer.
These hands, these clever hands, they were useless now.
At least they couldn't get her into trouble anymore.
She seemed to want to be hurt, to be punished, perhaps even to die.
But she didn't want to die, either.
[Mr. Burns:] That was the day I saw her for the first time.
It was quite apparent that she was in no shape to talk to me,
although I usually interview the patients soon after their admission, as soon as possible, that is,
because psychiatrists now believe in starting rehabilitation as soon as a case is diagnosed.
And that's my job. I work for the state.
I'm a vocational rehabilitation counselor permanently assigned to the hospital.
I'm not a doctor, of course, but I work closely with them,
and I keep my own records on the patients from the beginning.
This beginning was a gloomy one.
[Dr. Pradi:] Miss Graham is really very depressed.
[Nurse:] Do you think she's suicidal, doctor? [Dr. Pradi:] I don't know yet.
She hasn't really been verbalizing anything to me.
[Miss Meltzer:] She doesn't speak easily with me either.
[Dr. Pradi:] Have you found out anything about the family?
[Miss Meltzer:] Well, she has a very overprotective mother, um,
but I think there's something more significant going on between the patient and her father.
[Dr. Pradi:] Have you noticed anything during the visiting hour?
[Nurse:] Well, she sort of ignored her mother completely,
but then, just before the mother left,
she put her hand out and touched her.
[Dr. Pradi:] Okay, I want you to encourage her to get out of the room.
In a few days, I'll send her down to OT.
Are there any questions now at this point?
[Therapeutic team:] No. Nothing.
[Dr. Pradi:] Okay, we'll talk later on about her.
[Mr. Burns:] Sometimes, the therapeutic team can only wait.
Sometimes, the patient isn't ready to be helped.
In Karen's case, it wasn't a long wait.
Within a few weeks, she had shown remarkable progress.
She had responded to medication and psychotherapy.
But it was her work in OT that dramatically reflected her improvement.
The fingers were working again,
and so were the imagination and the eyes behind them.
She looked forward to her weekly participation in the work adjustment program.
Unlike many of the other patients, this girl would not need long weeks of retraining before she could take up her career again.
I agreed with Miss Bruce, the occupational therapist.
Karen had real talent that had not been affected by her illness.
The work she had been doing in OT was quite free
but could obviously be adapted to commercial applications.
I thought it was time for me to get moving.
[Social worker:] At the next staff conference,
Mr. Burns reported that he, Miss Bruce, and Miss Meltzer felt that Karen was ready for reemployment,
but I thought they were pushing things.
I admitted Karen was greatly improved, but I definitely against sending her back to her family.
Dr. Pradi agreed but didn't think that this was a good reason for keeping her hospitalized.
If a job could be found, if living quarters of her own could be arranged, it might all be for the best, he said.
[Mr. Burns:] The next step was a serious discussion with Karen.
What did she want to do?
I was surprised to learn that she was not so eager to start looking for a job.
She felt much better and was pleased with how well her painting was going, but...
the "but" was a job in an office, any office where there were many employeeslike a magazine or a newspaper.
She said she didn't feel she could face a lot of people every day.
When I suggested a freelance job, one in which she could work alone at home, she showed more interest.
She felt at least she would like to try it.
[Social worker:] In the meantime, the therapy went on, but it was not all smooth sailing.
Some days, Karen seemed to slip back into her withdrawn, despondent moods, but the staff expected this.
[Woman playing guitar:] Karen? Do you know this? ♪ "Oh Lord I want to be in that number" ♪
Recreational therapists knew that she constantly needed encouragement.
[Woman:] On this one, Karen, why don't you sing along with the rest of us on this next one. "When the revelation comes."
♪ Oh when the revelation comes, ♪
♪ Oh when the revelation comes, ♪
♪ Oh Lord I want to be in that number, ♪
♪ Oh, when the revelation comes. ♪
[Woman:] And when the saints...
♪ Oh when the saints (oh when the saints) go marching in (go marching in), Oh when the saints go marching in... ♪
[Mr. Burns:] But step one was the job, and I wasn't having much luck.
When some people hear the words "mental illness,"
they act as though they were living in the Middle Ages.
I sometimes wonder how we stopped witch-burning.
You never know when you'll meet up with prejudice and plain downright ignorance.
[Miss Meltzer:] I had the difficult task of winning the cooperation of Karen's mother.
Living at home might not be the best thing for a 25-year-old girl, I ventured.
You've told me yourself that your husband picks on her all the time about her dates.
And now that his illness keeps him in the apartment during the day,
it doesn't seem the best place for her to work, does it?
Whatever we arrange would only be an experiment.
[Mr. Burns:] By now, Karen had started to make the rounds.
She would often leave the hospital for a few hours in the morning to keep the appointments I had set up
or follow leads of her own that turned up in the course of interviews.
She was perfectly capable of doing the legwork that any kind of job hunting entails.
[Social worker:] But she had her preferences and she stuck to them.
One small publisher offered her a children's book to illustrate, a good job that involved big fees,
but she had a definite aversion to the prospective employer.
And that was that.
[...]
She never mentioned these feelings at the work adjustment group.
[Mr. Burns:] I was reaching the end of my list of publishers
when it suddenly occurred to me that the department store where I'd placed a number of people as salesgirls
might also use fashion artists.
I called Mrs. Kellen, the head of personnel.
She listened to my story and indicated some interest.
She would arrange an appointment for Karen to bring in some of her sketches to Mrs. Blake, the fashion coordinator.
[Miss Meltzer:] There was still the question of where Karen would live.
Mrs. Graham was clinging to the hope that she could take care of her daughter when she left the hospital.
But then, I threw the ball right back to her. Sure, she could help!
Why didn't she find the apartment for Karen herself?
Then, when Karen needed her, she would be on hand,
or Karen might drop in at home once in a while.
That would make the new arrangement easy for everyone.
Delighted at the prospect of having Karen within walking distance,
Mrs. Graham plunged into the work of apartment hunting.
This was how she could do her share, even though the musts were many.
The place would have to be light so that Karen could work in it.
It had to be in a radius of four or five blocks of her own home,
and of course, it had to be inexpensive.
Karen was insisting that she still wanted to make some contribution at home, even if she were on her own.
It wasn't an easy set of requirements,
but Mrs. Graham too made the rounds without complaining.
[...]
[Mr. Burns:] Karen had a few days to get a portfolio ready,
and then she came in for her first interview with Mrs. Blake.
Naturally, she was more than a little nervous.
You can never be sure of pleasing everyone, and Mrs. Blake was obviously a person of sharp likes and dislikes.
Fashion coordinators are like that.
But right in the beginning, she responded favorably to Karen's work.
The drawings were extraordinary for a person who had not had much fashion experience.
She would have plenty of work for this kind of talent.
Right now, she needed some black-and-white sketches for a summer promotion.
She pointed out the new necklines, the new sleeves, and some of the other special details.
It seemed that Mrs. Blake had a new artist, and Karen had a job.
Yesterday, when I met Karen in the corridor as she was leaving the hospital, she seemed all set:
a job, an apartment, an eagerness to face the world anew.
Quite a change in five weeks.
[...]
[Miss Meltzer:] The little flat is just perfect for her needs.
Not too big so that there's a lot of housework and not too small for a little studio setup.
What's more, she's surprised to find how happy she is at being on her own.
At first, the idea had been a little frightening, but now it seems just wonderful.
She can come and go when she wants to, work or not work as she chooses.
She had been sure a month ago that she'd never feel like smiling again, but here she is.
[Mr. Burns:] Back in her neighborhood again, back in familiar streets.
She still comes to the hospital every Tuesday evening for the work adjustment group,
and Dr. Pradi is still her doctor, going right on with his plan of treatment.
I had heard about how well things were going from Mrs. Kellen.
I like to keep in touch with the situation when I place people.
This was a happy placement, happy, that is, for just a little over three weeks.
[Narrator:] And then, came the explosion!
[Karen:] Mrs. Blake, I'm going to have to leave. I just want to let you know.
[Mrs. Blake:] Karen, what's the matter?
[Karen:] There's nothing the matter.
[Narrator:] Karen in tears, Karen in trouble again and on the heels of a promotion.
She had been assigned to work directly with a Mr. Anderson in the Publications department.
They'd only had three meetings, and this was the result.
Mrs. Blake is sympathetic. She offers to find something else for Karen to do, but...
[Karen:] It doesn't make any difference about the job. It's me. I just can't do it.
[Crying]
[Social worker:] Dr. Pradi doesn't think that Karen needs to be readmitted to the hospital,
but he wants her to go on in the work adjustment program.
Can you tell us what happened?
[Karen:] There's not very much to tell.
This man in the office, Mr. Anderson, um...
he wants to go out with me. Everything I did, you know, he says "This is great, this is wonderful..."
But uh... he's not really, you know, accepting it.
He's just, you know, he just wants me to go out on a date, and that's the only reason he's doing it.
[Molly:] So why didn't you try it?
[Karen:] What does it prove going out with him?
I mean, this is just why I quit my job. I don't want to go out with him.
[Dick:] You know, Karen, I was wondering, could it be, like, are you seductive to him?
I mean, did you lead him on, you know, without knowing it to the point where he would ask you out so that you could quit the job?
[Karen:] Me?
[Dick:] Yeah, you! It could be more you instead of him.
And it could be that you liked him. [Karen:] Well, if I am, I'm not aware of it.
[Social worker:] Well, do you think you might be interested in going out with him if it weren't mixed up with the job situation?
[inaudible]
How do you separate out why he's interested in you?
[Karen:] I think he's interested in me because...
you know, I'm in the job, and I'm there, and he can take advantage of the situation.
[Psychiatric patient 4:] Well, that's not taking advantage.
[Karen:] I think it's taking advantage. [Dick:] I don't.
[Karen:] Why, Dick?
[Dick:] Because I feel if your work is satisfactory and you really believe it is, then you can honestly say...
[Karen:] But he's not accepting it that way. He wants to go out.
[Dick:] You don't know that. You're projecting it that way.
[Psychiatric patient 4:] Have you gone out with other men?
[Karen:] Certainly.
[Psychiatric patient 4:] Often?
[Karen:] No.
[Dick:] And this problem comes up every time?
[Karen:] They're all after the same thing.
[Dick:] All right, now you're making a generalization, right?
[Karen:] No, it's a fact!
[Dick:] You're dissatisfied with that. You're dissatisfied.
[Social worker:] Well, does everybody feel that's as a fact?
[Dick:] No.
[Group:] No, of course not. It's anger. [Karen:] See, he's agreeing.
[Dick:] I do! But I still think...
[Psychiatric patient 4:] You're including him in this generalization.
[Karen:] That's right, and he's agreeing with me.
[Dick:] The interest of [inaudible], but I don't think that's the crux of the problem. I know it's you. It goes right back to you.
[Psychiatric patient 4:] Well, look at Herb. He's your friend for how long?
[Dick:] Well, Herb is married. I'm not, so he's got...
[Psychiatric patient 4:] But he's still a man. [Dick:] Well, he's still got a wife.
[Psychiatric patient 4:] Well?
[Herb:] I don't agree with you on that at all. I don't think all men are the same. I don't think all people are the same.
I think there's a lot, there are a lot of differences.
[Karen:] This happens all the time. It's just not, you know, it's not just me.
[Psychiatric patient 4:] Then who is it?
[Karen:] I mean, this happens in every area. Men are always after what they want.
[Dick:] What's wrong with what men want? Women want it too, you know.
[Karen:] All right, but there's a time and place for everything.
[Dick:] That's right. I'm sure you'd want it on the coffee break. [Laughter]
[Karen:] Well, that was a cute remark.
[Dick:] Well, he said cocktails and dinner. You're always going to go home after that.
[Leslie:] I think she wants him to be interested in him.
[Karen:] You think I what?
[Leslie:] I think you want him to be interested in you, not that he is really interested in you.
You see him that way, but...
[Dick:] Mm-hmm.
Sounds as if he were a sore spot, sore spot. [Karen:] Now what's that for?
What do you mean?
[Dick:] Think about it. You started pouting. You put your head down. Look at the outfit you wear. Look at the outfit you're...
[Karen:] What's wrong with my outfit?
[Dick:] Look at the way you wear your hair, your [inaudible] dress. [Karen:] It's an ordinary dress. My hair is ordinary hair.
[Molly:] I think I'd put it back and let's be less attractive.
[Dick:] Put braces on your teeth. Cross your eyes, and then he won't see anything.
[Karen:] Why don't I just go and hide somewhere?
[Dick:] That's just what you do when you quit your job. You run in a hole and hide.
[Social worker:] The group can be direct, more direct than any therapist whose words carry authority might dare to be.
But Karen is able to take the onslaught.
These are her peers, people who know her as well as she knows them.
It is hard not to hear what they're saying,
hard not to face the impact of their arguments when you're honestly working to find a solution to your problem.
[Karen:] I just couldn't understand at the session yesterday because everyone was just...seemed to be blaming me.
I don't know. Maybe it is me.
[...]
[Dr. Pradi:] What was the difference between this man and the ones you met in the hospital?
[...]
[Karen:] I don't...I don't know.
[Dr. Pradi:] You like Mr. Shore and Mr. Kennedy, the other men in the group.
Even your feelings towards me, they weren't very frightening.
Did you feel different towards this man?
[Karen:] Yeah, I thought he was a very nice man.
[...]
[Dr. Pradi:] Aren't you afraid of liking him too much?
[Karen:] I don't know.
[...]
[Dr. Pradi:] How do you really feel about him, Karen?
[...]
[Karen:] I like him very much.
[Dr. Pradi:] Is that so bad, liking him?
[...]
You're really frightened by your feelings, aren't you?
[...]
Don't you think that you and I ought to talk about this,
why it's so frightening to you to have these feelings,
that you just put them onto the other person, that you run away from situations like this?
[Narrator:] Now, four weeks after Karen has left the hospital,
she is just beginning to attack the deeper problems that have been the source of her troubles.
Now, she can begin to do something about the conflicting feelings that have made her want to withdraw from the world.
Now, at last, she is beginning to move on the difficult road toward mental health.
Karen still circulates in the neighborhood she never left through all her ups and downs.
She's returned to her original job with Mrs. Blake, and she's earning her own living while her therapy continues,
but she's a long way from being completely well.
But instead of being shut up and shut off from the world, she's part of it.
Her friends and neighbors can contribute to her recovery.
She can use their warmth and their support in achieving her rehabilitation.
Just as she has used the other services of community psychiatry,
the short local hospitalization,
the work adjustment group,
the social service staff,
the vocational program,
the outpatient clinic.
[...]
Rehabilitated patient:
The end result of many methods of approach, many skills, many efforts,
all available when and where they were needed.
And they're still there, only a few blocks away.
[...]
[Written and directed by Irving Jacoby]
[Photographed by Roger Barlow, Edited by Peter E. Hansen, Music by Edward Bland]
Psychiatric Consultant Harvey J. Tompkins, M.D., Project Officer Alberta Jacoby, An Affiliated Film Production]
[Grateful appreciation is due to the staff of the Reiss Pavilion, St. Vincent's Hospital and Medical Center of New York]
[for their skillful reenactment of all parts except that of Karen who is played by Rosemary Moody]
[Full Circle was made in cooperation with The Mental Health Authorities of Connecticut, Puerto Rico, Indiana, South Carolina]
[The End]