Decaf, OK? Part 2


12 comments   |   Anger, Blog

Thanks to all of you for giving an answer.  Each suggestion shows how many choices we make, every day, every minute, even every second in the way we treat our patients, and each other.  One small change, one small difference, can have a huge effect.
Here is what I decided to do in part 2 of “Decaf, OK?”

I walked over, a brisk but controlled pace the ten steps to cross the room, not running, not giving a hint of urgency or a mote of exigency.  I arrived to the side of Dan and the nurse where they both could see me.

“Hey Dan.  Want a cup of coffee?”

The non sequitur made Dan pause.  The nurse startled, a plea in her eye but without a voice.  The other staff, ready to take control of the situation looked at me in astonishment as if to ask who was the crazy one here?  This guy was about to beat the crap out of a nurse with a chair.

Dan looked toward me, the chair still poised high above his head, a feather of ferocity wielded by a very sick and angry man.  But he was my patient so I went on.

“Decaf, OK?”

A grin crossed his face, and he put down the chair.  “Cream?”

“Sounds like a plan.  Let’s go and talk.”  As the nurse let down her protective arms, as the staff remained within a reasonable distance in case Dan’s mood changed again, my patient and I walked to the kitchen area for a cup of Decaf.

Dan was 35 and had been in a state hospital for sixteen years.  He had not responded to a multitude of antipsychotic medications, remaining in a world of delusion and paranoia, fearful and feared as he was a big, a very big and very psychotic man.  He had been moved out of the State Hospital as the first step towards a transition into the community.  Not because he was particularly ready or better or more able to manage reality.  Throughout the country the aid for the mentally ill was drying up, and who did these people crippled by mental illness have as their champion?  How were these severely incapacitated people meant to organize and lobby for themselves?  The societal fear of mental illness continues to place a moral overlay on behavior that was on occasion erratic and unpredictable, creating anxiety in a community, and a resulting ostracizing rather than understanding of the inner world of these most remarkable of individuals.

So Dan had become my patient in a University based hospital after surviving for two days post-discharge from his sixteen year sanctuary.


I’ll tell you what I did after the next twenty comments.     Dr. Joe

  • Debbie Hall

    Allow him talk about himself so he feel like a important part of our society. Give him suggestions or alternatives about how he feels or thinks, (You know, Dr. Shrand, how you guide people through the process, like you have done many times before.) Allow him to have a voice on his own treatment, within reason.

  • Maryrondeau

    Help him discover/ remember activities he enjoys; help him rediscover his strengths, visibly enjoy our time and listen. As Dr. Joe says, “there is always a kernel of truth in all” psychotic thoughts. I would also want to talk with family member(s.) -I assume I don’t have to comment on the meds;)

    This is a great supervision model-BTW. Will you do a dual diagnosis next PLEASE or even just a single substance abuser (alcohol.) Thanks!


  • Jen Cantwell

    I would slowly ease him up to caffeinated coffee, you can achieve this by adding a little bit more every day to his decaf.
    (Loving you website & blog & twitter & facebook – you’re a social media pro!)
    -Jen Cantwell

  • Jim Cooke

    I’m not a doctor although I have played doctors. Dan might respond to meditation or Tai Chi. Is there a possibility of a swimming program? Water often has a calming effect. Walking and talking can have a benefit, too.

  • laura

    Do solution focused work with him and ask him the miracle question, ask him if all his problems that brought him into the hospital went away while he was sleeping but he didn’t know, what would be different about his life….

    Elicit, Amplify, Reinforce, Scale!

  • Mel

    In spite of Dan’s mental illness, based on the grin in the story it sounds like he got the subtle (?) humor. Humor can probablly be a very effective treatment tool, but can it also backfire?

  • curious george

    I would introduce a puppy into your next sit down.

  • Coneflower

    I’d try to get Dan outside, into a natural environment, for a while. The vastness of the ocean, or a night sky full of stars, or a forest, a desert, a mountain, can help any of us get into a more balanced perspective. It’s just harder to hang onto the delusions of the Ego when one is confronted with the eternal and objective reality of Nature. And, if a puppy happened to turn up, so much the better!

  • Ediemooers

    I like the puppy idea, but I would go for a trained therapy dog because this guy is unstable. I think dogs can really break through into the empathy instinct.

  • guest

    Is the patient well enough to work with the grounds crew at the hospital? I have no medical background but gardening can be very therapeutic.


    I would invite him to church, but that’s my answer for everything.


    I really like the concept of not getting angry at people that treat you with respect. It works for eveyone except the *#@$^% cop that gave me aa ticket yesterday.