More than a Diagnosis


On the course of our spiritual and life journeys, we are sometimes asked to travel a path we would not ordinarily or voluntarily choose if we knew what was going to be asked of us. This path changes us deeply, emotionally, mentally, sometimes physically, and most certainly spiritually. It is one that we can only travel by faith, because everything we have learned up to this point can provide only a basic roadmap for the journey. It isn’t enough to sustain us through the difficult turns and unexpected twists. We must dig deeper. One such choice was offered to me while on a temporary assignment at a mental health clinic.

The clinic is one of two agencies in the area serving the most severely mentally ill population in the county. The most common diagnoses among our clients were delusional or paranoid schizophrenia, followed closely by bipolar disorder. We also specialized in serving those with complications from homelessness and drug or alcohol addiction. Our clients were the people other agencies could not or would not serve—those whom other people typically didn’t want to be around. Ours were the type of clients you occasionally read about in the newspaper, usually at the wrong or violent end of police intervention.

I was hired as a temporary replacement for an administrative assistant on leave. My job was to process paperwork, take notes at meetings, schedule appointments, and fill in for the front desk receptionist when she was at lunch, on a break, or otherwise out of the office. As my luck would have it, she was out sick my first three days on the job and for a large portion of the next month.

Talk about culture shock and a trial-by-fire initiation. I have known people who suffered from mental illness. I myself suffered from severe depression when I was in my 20s. But nothing in my experience prepared me for my first week at this job. A number of our clients distrusted strangers and hated change, and to them, I embodied both of these triggers. During the brief training, I was told to set expectations about service and boundaries regarding acceptable behavior in the lobby. It was obvious that many of the people who came in didn’t like being told they had to wait to see a nurse or clinician by someone they didn’t know or trust. I tried to be warm and welcoming. They regarded me with suspicion. My “other” name during those first three days became “f——in’ b——,” and clients were not shy about saying it to my face. The staff comforted me and told me that things would get better as the clients got to know me. The situation improved a little in the second week, but a number of the more suspicious clients still showed signs of distrust. As a comedian might have described it, they were a tough crowd.

I knew the situation could not continue as it was. I needed to find a way to reach our clients and become more comfortable with them, or else I would not survive the assignment. I also knew I could not change the situation alone. George Fox advised Friends: “Be patterns, be examples in all countries, places, islands, nations, wherever you come; that your carriage and life may preach among all sorts of people, and to them; then you will come to walk cheerfully over the world, answering that of God in everyone.” The Alternatives to Violence Project (AVP) believes there is a power for peace and good in everyone, qualities which can transform our relationships. I considered Fox’s advice and AVP’s philosophy and made a decision: I would look for that of God in all our clients, regardless of how they treated me.

This was a hard choice and commitment to make given our rocky start. I had to be willing to surrender myself to the potential for transformation. An even more frightening prospect was being vulnerable enough to open my heart to them as part of the transformation, allowing that of God to show itself in them and me without fear of reprisal or backlash. The changes came gradually over a period of weeks and then months. I’m not sure who changed first or most: the clients or me. I reminded myself to look for their kindness, warmth, humanity.

For some of the clients, the opening came easily. For others, I had to look deeply and many times before I saw the glimmer. I reminded myself over and over to look underneath and beyond the behavior, anger, and hard words. I had to confront and release my tendency of responding to anger with anger. I practiced deep listening and all the mediation and conflict-resolution skills I’d ever learned. The most difficult clients slowly started to release their distrust and talk with me. We shared, human being to human being. One of the women who gave me my “other” name allowed me to call her by her first and real name, rather than her alias, alter-ego name. A man who had previously been banned from the building because of his violent and uncontrollable rages sat quietly smiling in the waiting room with other clients while I sat watching from the front desk. The woman who screamed and raged when she didn’t get her own way was willing to be reassured. The man who threw the phone receiver in anger apologized because it bounced in my direction—he hadn’t intended me harm. The man who frightened other clients with his glowering, menacing stares eventually began to speak more than one- or two-word sentences to me. When I mentioned how much I missed his beautiful smile, his scowl dissolved into a full-toothed grin. Another shared how he would get embarrassed when offered apples for a snack because he had no teeth. We grew to like and become fond of one another.

These improvements may seem like a natural progression of relationship as people become more familiar with each other. But other administrative staff members did not have the same experiences with the clients. Fights and behavioral issues still occurred, but rarely while I was at the desk. Clients would argue strongly and sometimes physically with the other administrative staff over the rules and what was expected from them. They argued about rules and expectations with me also, but we always seemed to be able to resolve the problem through talking. They sometimes lied to me, perhaps out of habit or maybe as part of their illness. We both knew when it was happening, and there was a willingness to acknowledge it. Not everyone liked me. One woman considered me the devil incarnate and told me so, although she never told me why. Another disliked that I set strong boundaries around her behavior. I recognized that I did not carry the same accumulated anger toward the clients that some of the other staff held in check. Maybe if I had worked there longer or maybe if I had the same experiences as other staff members, my openness to being transformed might have been less or the transformation harder. I just know I was firm in the commitment I had made to see that of God in them.

As time progressed, the clinic hired a new receptionist, and I spent less time on the front desk. When I did see our clients, some would ask when I would be back there full-time. They wanted to be greeted by the “nice woman” again. Then, as all temporary assignments do, my time at the clinic came to an end. I said goodbye to as many of our clients as I could. On my last day, I told one of the women who had given me my “other” name. She stood in shock and said how much she wanted me to stay. In a tone of amazement, one of the clinicians later informed me that she had left the clinic in tears that day. He had never seen her cry before.

Looking back at the experience, I realize that what our clients wanted most was to be seen and treated as human beings. They wanted dignity, respect, patience, and acceptance. They wanted to be treated like normal people. As one woman put it, she knew she was mentally ill, but she wanted “to be seen as more than my diagnosis.” Fox’s advice and AVP’s philosophy challenged me to open my heart, look past surface appearances, reach beyond my preconceived notions, and become a pattern and example of what’s possible, both in my life and in theirs. While I did not always approve of their words, behavior, and actions, I learned to appreciate them as human beings. They are, after all, children of God. I still hold memories of our most difficult clients fondly in my mind, maybe because reaching the place where we saw each other as human was a long and heart-warming journey. I may have touched their lives for only a short period of time, but their presence made a huge and lasting change in mine.

About a year after my assignment, a query posed during worship sharing caused me to reflect once again on my time at the clinic. I spoke of my experience and the transformation I went through as part of my relationship with our clients. Afterward, a man came up to me. He was excited about what I had said and asked me to share my story at a small conference for mental health professionals. He wanted me to reinforce the message that the mentally ill really do want dignity, respect, patience, and acceptance. They want to be treated as whole human beings. He felt my experience was a pattern and example for others of what good relationships with the severely mentally ill could be.

How we treat those who are radically different from us does matter. Matthew 25:40, an oft quoted verse, tells us: “Truly I tell you, whatever you did for one of the least of the brothers and sisters of mine, you did for me.” I have no illusions. Seeking that of God in people like the clients I worked with will not solve all of their issues related to mental illness. Boundaries around expectations and acceptable behavior are needed for a reason. But if we believe in the power of peace and good in everyone, we are opening ourselves to the possibility that our relationships can be transformed for the better. If the mentally ill are held from a place of love and acceptance, and treated as though they are more than their diagnosis, we can create an opportunity for them to become just that: more than a diagnosis.

Pam Melick

Pam Melick came to Quakerism in 2000 and is a long-time attender. She currently attends both Detroit and Birmingham Meetings in Michigan.

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