The mind is tricky and sometimes it can backfire on you.
When you have to deal with a difficult person, a difficult decision or you're having a tough time parenting, it's essential to think clearly. And who always does, right? In this series, we've been discussing the problem of divorcing a person displaying narcissistic features. And, it's not easy.
So, today I bring a cautionary tale from my life. It's about hubris and stupidity. It's about naïveté and being green behind the ears. But really it's a story about how "healthy" narcissism can get you into trouble. We're often not as in charge as we think.
Deep breath: when dealing with a potentially dangerous person, hubris can backfire. Humility—rather than fear or overconfidence—is key to success in handling a person with a Personality Disorder or a Character Trap. Know thyself is an ancient teaching—and I can't recommend psychotherapy, and knowing thyself more than to a person going through a divorce with a very difficult ex.
A narcissistic ex may be difficult, but you can make it worse by over or under reacting.
Here is my story. It is a small moment in time that taught me a lot.
The setting: When I was a young doctor training in Washington DC, I made an upsetting rookie mistake that taught me a lesson in preparedness which has served me well. I hope that others can learn from my experience.
(Even though its twenty five years later, the details are changed to protect identities.)
The place and time: It was an urban hospital. The time was three in the morning and I was the psychiatric resident on call. I had just admitted a depressed patient who had been abusing Nyquil, of all things. Those were the days when residents worked thirty six straight hours and I was exhausted because it was patient after patient that night—without let up. It didn't matter though, because each case that night was my responsibility. I simply girded myself up for each new visit to the emergency room.
I remember joking around with Officer Johnson, the hospital security chief. You bond with people when working under these conditions. He asked me for a donation to a police charity. No problem. It was a big city ER and we were team mates.
The next admission: Within minutes, we had a new patient presenting to us. He was a 25-year-old young man with disorientation and paranoid features. Officer Johnson asked me where I'd like to conduct the intake interview. I was exhausted and didn't want to be distracted, so I decided to do the interview in a side room adjacent to the bustling emergency department—and out of the way.
Like Yesterday: I remember what follows like it was yesterday.
The patient had a slight built and a passive expression. He had a past history of PCP abuse and multiple psychiatric hospitalizations. He looked completely out of it. I started the interview like I'd done hundreds of times before.
Then, in a split second everything changed.
The psychosis inside made itself evident; his eyes sharpened into a malevolent ferocity and the patient lunged for my neck. Time stood still.
As if in slow motion, a blue blur blocked my field of vision. It was Officer Johnson making a cross body tackle and subduing the patient.
Spared: I was safe, and the patient was spared as well. At least for that night, he simply had a psych admission for drug abuse without an additional assault charge. I walked away shaken and counting my blessings.
Thank you Officer Johnson!
I continued the interview in the ER with three policemen standing behind me. The patient settled down, the interview went well and I learned an important lesson.
That patient was not the first, nor the last person I encountered who could be dangerous. So, from that moment forward, whenever I had the slightest index of suspicion, I called the police down to the ER and interviewed the most difficult patients with equanimity.
Once I was comfortable that I was safe, interviewing was easy. Once the patient knew that he or she had few options to be violent, they settled down as well.
While it may seem obvious to others, I felt like I discovered a great secret—safety counts. This lesson helped me to be a better psychiatrist.
The Lesson: Safety Counts
1. Therapists cannot provide thoughtful therapy if they feel threatened. Period.
2. Bad things can happen when someone is under the influence. I should have been wiser because I put the patient and myself at risk by using a small room where he obviously felt uncomfortable. He was high on PCP; what was I thinking? (That episode put an early end to any physician related omnipotence I may have had.) If your ex is drinking or drugging, you have to recognize that things may spin out of control. Be humble and be safe.
3. Bad things can happen in the blink of an eye. Since I work often with teenagers I've learned the value of trying to prevent a dangerous act before it happens. If an out of control teenage boy hits his mother in a fit of rage, for instance, he can't just take it back. Rage often passes and what's NOT done counts a lot. This is even more profound in divorce. Many violent acts occur when there's been a change in custody or when a court date is approaching. With the spike in stress, more disturbed exes can do dangerous things. So, if you recognize that you may not be able to control a dangerous moment, avoid a confrontation if you can. Be humble and let time pass; sometimes a terrible event need not occur.
4. Working with divorce cases as much as I do, the value of safety is paramount for a more optimistic outcome. Good boundaries are critical. If person with narcissistic or character issues is triggered, for instance, when picking up the kids from the house—which he considers his house—then the kids will have to be picked up in a more neutral setting. If an ex wife is triggered and threatening (which happens), knowing how to use outside help, whether it's a therapist, a lawyer or the police, can keep some cases from spiraling out of control. There is humility in getting the help everyone needs.
5. Finally, we all have blind spots. I was tired that night, and overestimated my skills while underestimating the danger. Officer Johnson knew better—and I was humbled. It's important to remember that we don't always see things the way they really are. Often, someone outside the situation looking in will pick up something important that you're missing.
All therapists, regardless of experience, must be open to supervision and consultation. We cannot be effective if we don't see what's really going on.
That unfortunate patient and Officer Johnson taught me much that day, some twenty five years ago.
They say you learn more from your mistakes than your successes.
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