Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Introspections   |    
Grassroots Therapy
William Houghton, M.D.
Am J Psychiatry 2005;162:1058-1059. doi:10.1176/appi.ajp.162.6.1058

A modern beige hospital crowns a hill in an affluent suburb. It looks like a pile of sleek boxes with one wing thrust higher. The marquee atop that wing reads "Heart Unit" in bold font. This billboard is lit with floodlights, visible from the highway.

Within, a group of 15–20 people meets every Wednesday. The hospital lets them use a conference room in the basement. The hospital newsletter says: "Support Group (DBSA, Depression and Bipolar Support Alliance), Wednesdays at 7:30 PM, East Conference Room. All are welcome."

The room has a large U-shaped table and functional chairs. It is multipurpose, generic, and anonymous. No refreshments are served.

"Bob," a retired high school teacher, is the calm and steady leader of the meeting. Always present. If a group member misses a meeting, Bob will call that person during the following week and talk on the phone at length. Years of experience have taught Bob to be patient in supporting all the members. His wife, "Anna," sits beside him and offers her experience, too.

"I liked the article and the discussion of hope," one woman says. Others chime in.

For the first 20 minutes, people discuss an article. This time it is a chapter from Kathleen Crowley’s The Day Room(1). Then they go around and tell how they are feeling and what they have done that week. Cross talk is acceptable but brief.

"Now it’s time for sharing," Bob says, "Let’s go around."

A pretty young woman with swollen eyes talks excitedly, as if she is telling a pleasant story. "I’ve been sleeping too much. They’re adjusting my meds. I started Tegretol and I got a headache. The pharmacist said you wouldn’t get one from that, but I found it online. It’s supposed to go away. I was sleeping all the time for days, and then my son Rickie came home from school. I went into the kitchen and saw he had opened a box of cookies. I started yelling at him, I was screaming way too loud—he didn’t deserve that—and he started yelling at me too. We were both yelling and then I broke down crying. Then he started crying and both of us were bawling in each other’s arms. That’s no good for either of us."

Others sympathize about kids, suggest an alarm clock and daily agenda, and recount problems that they have had with medication.

When it is his turn, a stocky guy with a cheerful grin says, "I had a pretty good week. I put in three applications for jobs."

An older woman with a pained expression says, "It’s been a year now since my daughter died of brain cancer. She had it for a year and then she died. Everywhere I go, it’s not the same. I go to the mall and see the world goes on, but nothing is the same."

"It’s never the same," Bob says, drawing on personal experience. Anna nods.

There’s a murmur of "Let go and let God" from no one person in particular.

A handsome fellow in his early 30s with the vigor of an athlete sits at the head of the table and says, "Things are going better for me. I was cut back from a job 6 months ago but now I’ve got another good one. The hours are tough but the pay is good. I’m still working on my bladder problem. There’s pain in the pelvis all day ’cuz of the kidney problem, but I can get along. There’s another round of tests coming, but I’m optimistic they’re going to figure it out. I just hope they can fix it with an operation."

A young man with an intense stare says, "I’m doing pretty well today, but there were some rough times last week. Friday was my birthday. I decided to give a party again, sent out 20 invitations. I was waiting at 8 o’clock, 9 o’clock, 10 o’clock, and nobody came. Not one person came."

There is a long silence.

The man with the bladder problem says, "Not to interfere, Johnny, this is just a suggestion. Next time you send out invitations, you could ask them to RSVP."

Bob says, "Friends are few. True friends are few and far between."

The young man with the stare says, "It wasn’t so bad. I had ordered six dozen buffalo wings, and they were in the oven. At 10:30, I called my friend Jake, who was able to come over and we ate all the buffalo wings." He looks around and adds, "At least I knew I had this group to come to."

Halfway through the meeting, around 8:15 p.m., the hospital above begins to quiet down. A bell chimes and visitors are asked to leave. The hallway lights dim down throughout the building. Even up in the fancy high-tech heart unit wing on the second floor, things slow down. The floodlights on the billboard, however, stay on throughout the night. Here in the basement, the halls grow dark and empty.

A woman who may be 40 but looks much older, as if she were hit by a terrible accident, begins to talk. "I’m tired all the time. I get up for an hour but then I want to go to bed again. I sleep for 14 hours but I’m still tired. I went to the university hospital and asked for a heart transplant, but they don’t want to do it. I’m going to a new doctor next week. I just hope he’ll do something."

"You can hope things will be better next week," Bob says. "At least you were able to get here tonight."

An older fellow with an accent talks about how he went to a flea market and picked up two table-model radios from the 1940s. "I strip them, stain them, and polish them. I got some old tubes, I get ’em running again, and pretty often I can sell them to an antique store for a good price."

The pretty young woman with swollen eyes says to the woman seeking a heart transplant, "Thinking of your situation, Barb, health care for the poor sucks."

Another woman says, "They hear you got Title 19, they’re out the door."

"The mental health center, it’s almost gone."

"Just pray they don’t give you one of those fancy new super drugs. My neighbor lady got one—it cost $500 a month."

A 50-year-old man with a square jaw and an educated style says, "I used to be an urban planner, if anyone knows what that is, until that job gave out. Now I do substitute teaching and I’m thinking of going into horticulture. You look around, there just isn’t any community any more."

The pretty young woman says, "I used to feel alone, until I found this group."

As in the ancient town of Gheel, when money, experts, and resources run out, the adaptable human animal will make the therapy that fits. Every voice strikes the common chord. The total cost of this meeting to the hospital was a fraction of a penny for the electricity.

"I guess that’s it for the night," Bob says. "Everyone’s welcome to come to the diner."

People talk softly to their neighbors, as if reluctant to break the circle. Then the group traipses out through the darkened corridors. Most of them go to the Canterbury diner.

Address correspondence and reprint requests to Dr. Houghton, 2577 N. Downer Ave., Milwaukee, WI 53211; puck1595@worldnet.att.net (e-mail).

Crowley K: The Day Room: A Memoir of Madness and Mending. Los Angeles, Kennedy Carlisle, 1995


Crowley K: The Day Room: A Memoir of Madness and Mending. Los Angeles, Kennedy Carlisle, 1995

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe

Related Content
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 9.  >
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 9.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 9.  >
Topic Collections
Psychiatric News
APA Guidelines