Rave-Off

Help is not a shower you can just stand under.

Joe Romanowski, RN, Concord, NH

In vaudeville (and burlesque, and English music hall) there was a comic bit known as a rave-off. The most familiar example from my childhood was "Niagara Falls! Slowly I turned..." by the 3 Stooges. They used the bit several times, and there are other versions on YouTube, including one by Lou Costello and Sid Fields.


In the British versions, the upset person was more likely to do something silly than to get violent, such as stand in a bucket. Monty Python used this a few times.

Many of us have lines like this, that If I hear anyone say just one more time... we fear what we might do next. I have many, especially at work, but one main one. "I just want him to get help."

We admitted a young man Wednesday, typical for us: polysubstance abuse; a bully to his family; history of head trauma from abuse, fights, and risky behavior; kicked out of school, fired from all jobs. His girlfriend broke up with him and later that day he started texting his mother that he was suicidal, but not answering her calls. She sent the police, who eventually found him and brought him to the ER, where he played cat-and-mouse games about whether he was still suicidal or not. They sent him to us. These guys are always outraged to have been sent to the "loony-bin," and contemptuous of the other patients. Their narcissism does not allow them to admit they are anything like them, and they declare they would rather be in jail.

All this, as I said, quite typical. But notable here is that after his interview I said ruefully to the rest of the team. "I'll call mom. I can predict exactly what she will say." And I was right. Yet it occurred to me that I knew this empirically, from having seen it so many times, but didn't have a clear explanation why the mothers of thes men always say the same things.

She told me he couldn't return home because he had shoved his sister. I agreed with her. She described how he had threatened suicide and been enraged in front ot the grandchildren (who of course also live there), so he couldn't live there. I told her we supported this. She described incidents over the years how he had been abusive and threatening with other family members, that was why he couldn't return home. I stressed that I agreed with this.

She wanted to tell me his history, so that we would understand him better. I'll bet you can guess. His father had been an alcoholic, and had abused his mother. He had abused her in front of him. Why, one time...and then another time...and he even... he eventually abandoned the family, and has nothing to do with them. Except he keeps popping back into the story as it unfolds.

But her boy, now, sometimes he was the sweetest boy you could ever know. Very helpful, very generous. But he had gotten mixed up with the wrong crowd (always that phrase), using drugs. This girlfriend of his, she's no good. She plays head games (always that phrase) with him and it gets him all upset.

So, I tell her we likely won't be holding him long, only until the crisis is past. We've found that long hospitalizations don't tend to help much, and often even make things worse. This amazes her. After all she went through to finally get him some help, we're going to put him out on the street. (Always that phrase.) Several other themes consistently recur: we should find him a group home of some kind. I always ask innocently "Do you mean an unlocked facility? Do you think he would stay? Or would he go out and drink and use drugs...or the girlfriend come over..." Oh no, then, this would be someplace he had to stay. We'd have to make him stay and "get therapy." (Always this phrase).

Well, I ask her what she means about him getting therapy. Does she mean group therapy, or a job coach, or coping skills, or substance counseling... No of course she doesn't mean those, she means therapy, and she is amazed that I don't know what she's talking about. She means talking with a counselor so that he can get all this anger out. (Always this phrase.) I suspect the reasoning, such as it is, goes something like - you think about something that happened to you that is sad, and you cry about it, then you feel better. A good therapist, doing real therapy, helps you find other sad things you may not have thought about, including the key sad thing that is ruining your life. Then you cry about that and feel better, and you have this breakthrough. This is why people say that therapy is very, very, hard and call it work - because you get sad and you cry. Or something. Maybe it isn't even that well thought out.

Some observations:
1. Mom wants someone to take charge of her son's life and make him do what is good for him. This is a pretty understandable fantasy, which most parents have when their children go awry. It happens in the movies and on testimony Sunday all the time. That the son has no interest in anyone taking charge of his life doesn't get factored in.

2. Mom has a permeable boundary between her own anger at the boy's father, and the anger she thinks he should feel toward him. Which he probably does already, but somehow that breakthrough hasn't happened.

3. The first step is to stop using drugs, which the son isn't interested in. But Mom often defends his need for prescribed abusable substances - especially if they are the ones she herself is taking - which in exactly the right doses, if we would only invest the time in figuring out by keeping him in the hospital, will remove his need to take street drugs.

4. She will have him back home. In fact, she will probably even pick him up, because the hospital has so mistreated and misunderstood him that she has no choice now.