Conflict and Relationship Triage

Petar's Substack, The Whiteboard Project is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. For 7 years and change I worked as a Program Director of a day treatment program in a pretty large facility. It had 150 inpatient beds, but also had a huge day treatment program. One of the inpatient units was a locked adult unit that had a door leading directly to the rear of the facility, where police and ambulances would bring in people being placed on 72 hour psychiatric 'holds'. In these facilities 'codes' get called, just like in a medical hospital. Sometimes they are medical emergencies, but more often they are of course psychiatric emergencies. These can be threats, fights between clients, assaults on staff, property destruction, AWOL attempts. Sometimes these are big nothings, sometimes actually funny, always heartbreaking, sometimes all of the above. A 'code green' got called one morning, directing staff to the back door of the adult unit likely because of someone being brought into the facility, which was what I found being the first person out of the door when I got there. There was any ambulance, two EMTs, an LCSW and a PhD from our facility already there, with a guy on the ground, screaming incoherently (to most), disrobing his first of many layers of clothing, struggling with a shoe. He was clearly disorganized. Smelled pretty bad. Easily distracted and what we call in the trade 'responding to internal stimuli', among other really awful symptoms. So, I burst out the door having run from another area, and as soon as I did they all looked at me and the guy on the ground started the conversation with yelling at me, 'And who the fuck are you?!?!' Gonna call this guy 'Dave'. 'My name is Petar - what's your name?' 'Dave!' At which point he started talking about satellites and home birthing or whatever. The first four folk seemed not to know what to do with/for Dave. 'What's going on here Dave?' 'SatelliteshomebirthingSpaceNeedleramenorwhateverhesaid.' 'Wow, Dave - that's alot. It looks like you are trying to get your shoe off too. Um, you have lots going on and I'd like to hear it. Whaddaya say I help you get that shoe off or on, I help you up. Seems like these folk would like you to go inside - I'd like to get you a cup of coffee and a cigarette and hear what you have to say.' 'Somethingsomethingmealoafrecipesure…', and Dave takes my outstretched hand, I walked him into the building without any patient wrestling. The people outside it seemed to me, looked at me like I was a wizard. Of course it doesn't always go quite this smoothly, maybe takes a little longer, but here is my sense of the 'moral of the story' and why I am holding you all hostage with it. I skipped a lot of preliminaries. No power struggle. No real directives. Interest in his struggle and comfort first. No fighting with his symptoms. Point is,I treated him like a human before anything else. Humans have a really ineffective, though as most of our behaviors, really understandable proclivity.We treat each other and circumstances as a constellation of symptoms. Another word for 'constellation of symptoms' is disease. Or disorder. Or dysfunction. But the most common word we might use is adiagnosis. In all our relationships and circumstances with one another, there is a heuristic we run that starts with our 'felt sense' of a person's 'diagnosis' (as I'll call it from here for simplicity), and we make decisions based on those inferences. This is my always half-drunk and unpredictable uncle. This is my lazy kid who only cares about his friends and video games. This is my employee who is always late and has an excuse. That sort of thing. Long story longer, but the soul of the thing here is what I consider a better heuristic for what to do when it is all going sideways: Human Stage of development Roles/responsibilities Name Diagnosis