I`m one of six full-time psychiatric staff people and 10 trained volunteers who work on the crisis hotline. We`re the only 24-hour psychiatric emergency service in the North Shore area. But our phone calls come from all over Chicago and the suburbs. Callers are about 70 percent female to 30 percent male. More callers are single. In 1987 11 percent of the callers were between age 13 and 17; 52 percent were between 25 and 41; 26 percent were between 18 and 24; 8 percent were between 45 and 59; and 3 percent were 60 and above.
About one-third of my job is spent on the phone, one-third in the emergency room and one-third doing counseling. Those I counsel on the phone are either in a crisis situation or emergencies. Twenty percent of the people who come directly into the emergency room or do so after phoning us are suicidal.
People who are suicidal often have tunnel vision. They only see one way to go, one option, one solution-which is to kill themselves. On the phone, I have to determine what`s an emergency and what`s not. If someone has a gun to his head, I obviously have to take emergency procedures, which means working quickly to get that person into an emergency room. Usually we use the police.
To tell how serious callers are about suicide, I ask, ”How would you do it?” People who are really intent on suicide will have thought about it and will almost always have a specific plan and actually be prepared to go through with it. If they talk about pills, I ask: ”Do you have pills? Where are they?” If they say, ”They`re sitting in front of me,” that`s potentially lethal.
I get calls from people who have already taken the pills, then change their minds. One gentleman who called had recently been separated from his wife and had lost his job. He had no money. He had actually gone to the train tracks to jump. Then he decided to call us. Why the ambivalence? Part of them wants to die, and another part wants to live. They`re calling me to help them balance the teeter-totter. You can`t argue with them. You have to be empathetic. I`ll say things like: ”I`m really glad you called. It sounds like even though you`ve thought of suicide, you want some help.” What I`m doing is allying myself with the person and appealing to that part of him that does want to go on and wants to live.
The teens who call usually talk about pressure. Or they`re having problems with their parents. Kids like that do turn around and kill themselves. Want to hear an alarming statistic? From 1960 to 1980 there was a 237-percent increase in adolescent suicides.
Old people call who feel desperate. Their lives are often sad. Most of their friends have died. Their families can be spread all over the country, and they`re lonely. They have nobody to talk to, no one to share anything with. Sometimes it`s just a matter of helping them connect with community resources, getting them to do some volunteer work or get involved with the senior-citizen center in Evanston. I just recently learned that nationally, white males, age 85 and over, have the highest suicide rate of any age group. It`s 12 times as high as it is for men in middle age.
It`s busy before the holidays. But it`s right now, from after the holidays until spring, that it gets really busy. There`s all the buildup to Christmas and to being with family. And then the weather turns cold, and people aren`t able to get out and be active.
When I`m on the phone speaking with callers and listening to them talk about harming themselves, I keep monitoring myself. Sometimes I feel a physical reaction. It`s almost like a light goes on inside of me telling me about the seriousness of the situation. I ask myself: ”Did I ask the right thing? Am I doing the right thing?”
When it`s not an emergency and people don`t have to come in, I can counsel them on the telephone. A typical nonsuicidal caller might say: ”I`m having a difficult time with the kids. I never have any time for myself.” I may talk with her about how she can schedule in time with her husband or a way to make time for some pleasurable things to do.
I may get somebody who`s recently lost a family member through death. She`s getting all kinds of symptoms and says she thinks she`s going crazy. I tell her she`s not going crazy. It`s a normal reaction to what`s happened. Sometimes that assurance is all a person needs to hear.
The people I usually see in the emergency room are in acute situations. In addition to possibly being suicidal, they may have intense anxiety symptoms. Women may have been raped or battered. Those are the cases that are really the most difficult for me to deal with. As a woman, I identify with their situation. They come with their bones broken. I worked with one woman whose husband had thrown her against a wall. She was covered with cuts and bruises. We help find them housing and get them the resources to make decisions about leaving their home. We never refuse to counsel anybody based on lack of money. If they`re from Evanston, we have a sliding fee scale.
In counseling I help people deal with things differently than they have in the past. Even if clients are going right back into the same situation that caused their problems, I suggest different modes of coping with difficult situations. I deal with here-and-now problems, although there are instances where I do have to go back to their history to shed light on what`s going on in the present. Usually by the time I`ve seen clients six to seven times, they`re functioning a little bit better. That`s not to say that they`re problem-free. Then I either finish counseling them or schedule them for longer-term counseling.
I see a lot of single mothers, burned-out ladies who have no time and energy. They`re working, running the home, taking care of children. Financially they`re having a hard time. They`re stretched in so many directions. I`m thinking of one young, single mother who was recently separated from her husband. She was in a Catch-22 situation, with no job but wanting to work. Yet she didn`t have money to pay for day care for her 3-year- old so that she could look for a job. We paid for two months of her child`s day care so that she could find a job. When she began working, she paid us back.
Often there`s been some major life change that makes it difficult for a client to function. Take one college student I treated who was having such a hard time leaving her family that she was suicidal. We began by talking about what it`s like to establish your independence. Since with an adolescent it`s important to see the family, her family flew in, and we did some family discussions. For her, it was really like saying ”goodbye” to her family and letting her hear them say, ”It`s all right that you left home.” After about six months of counseling she was able to get back on track with what she should have been doing: dating guys and forming peer relationships.
Really difficult cases, like counseling an abused woman, can be very emotionally draining for me, especially when the women go home to the same situation that got them to us. The battered woman whose husband threw her against the wall went back to him because she didn`t feel financially able to be on her own. When I have particularly perturbing cases like that, we have a psychiatric consultant that I can talk to. Another way that I deal with all that stress is by talking with our whole team at our three weekly meetings.
I think I`ll be staying at this job for a while. There`s still an awful lot of work to be done.
