I hear the words, the thoughts, the feeling tones, the personal meaning, even the meaning that is below the conscious intent of the speaker. Sometimes too in a message which superficially is not very important, I hear a deep human cry that lies buried and unknown far below the surface of the person.

So I have learned to ask myself, can I hear the sounds and sense the shape of this other person’s inner world? Can I resonate to what he is saying so deeply that I can sense the meanings he is afraid of, yet would like to communicate, as well as those he knows?

Carl Rogers, Experiences in Communication

Jenny’s shoulders slumped a little.  It was almost imperceptible but I was sure of the movement.  I scanned the room to see if it registered with anyone else.  Nothing.  I couldn’t read their faces.  It’s times like this when the business at hand fades into the background and my attention wanders.  Did I imagine what I saw?  How many other subtle changes have I failed to notice?  Is there a way to confirm what I thought I saw?  Are her fidgeting hands congruent with slumping shoulders? When did the fidgeting start?  Should I be looking for a frown?  Downcast eyes?  This change in her posture wasn’t as dramatic as the time she placed her elbows on the table, lowered her head and covered her eyes with her hands.  That movement was unambiguous and it was clear she knew what to do.  She needed to hide.  Or there was the time when her quiet sobs pierced the somber room and the review panel members responded to the task at hand.  “Do you need tissues?”  “Do you want a break?”  Tears call out for absorption, but how does one comfort slumping shoulders?  I canvas the possibilities in my mind but before I can settle on an answer my attention is summoned to her deep sigh.

The sigh’s sound was familiar and its meaning was on the periphery of my awareness.  It was not impatience.  It did not signal tiredness.  It was almost apologetic.  I looked at Jenny and saw the sadness that had invaded her eyes.  I recognized the resignation.  I asked the hospital presenter to repeat what he just said.  “… her child was taken from her at an early age …”  The effect of these words was unmistakable.  Or was it the culmination of the earlier spoken words – “manipulative”, “grandiose”, “unreliable historian”, “whiny”, “resists treatment recommendations”, “no insight”, “refuses to listen to professionals”, “poor money management”, “suspiciousness”, “impulsive”, “superficially pleasant”, “dismissive”, “preoccupation with spirituality”, “unable to maintain a relationship” …?

Like all of us, Jenny came intact with hopes, desires, coping mechanisms, fears, personalities, emotions, fantasies, ideas, ego, images of self, prejudices, memories of family and losses.  Like all of us, Jenny was formed over time, chiseled from a lifetime of experiences, thoughts and emotions.  Unfortunately, the distinctive, purposefully multilayered Jenny has increasingly faded into the background, blurred by the interventions of a mental health system whose impulse to help is tethered to the imperatives of the DSM V, the psychiatric diagnostic manual.

Her journey began with a life-affirming act: she relied on her courage to carry her beyond her fear, embarrassment and confusion to the mental health system, where she asked for refuge from the torment and anguish she was experiencing. This journey has since deteriorated into recurrent acts of broken trust and loss of personal autonomy. Since the diagnoses entered her life, a fundamental battle has waged over which perspective will gain supremacy in determining how she views herself and how others will relate to her.  Will it be a clinical view that focuses on illness or one that embraces the mysterious complexities of life?  The victor will determine what about her life is normal and what is abnormal.  If she doesn’t submit to their description of her, then they control the rules and say she has no insight.  If she wins she will regain some sanity.  This struggle has gone on for over two decades.

Jenny’s experience of the mental health system, sometimes willingly, sometimes against her will, is that the integrity of her array of behaviors, personal values, and belief systems are sacrificed in the clinical search for identifiable symptoms that can be squeezed into a diagnosis.  Genuine curiosity by others about her dynamic and contradictory life forces comes to a full stop.  A constructed map replaces the territory of her life. Succinct terms such as “paranoid”, “delusional”, “personality disordered”, “manic”, and “depressed” become attractive, cavalier shorthand for the depth and breadth of her human nature and experience.  She doesn’t recognize herself in the language of brain disease, chemical imbalance and malfunctioning neurotransmitters.  Imagination and understanding is replaced with labels and judgments masquerading as knowledge of who she is.

I’ve come to understand the separation and alienation Jenny feels from the various agency and mental health interventions that have taken up residence in her life.  It’s ironic that Jenny, who is longing to be seen and understood, is caught in a system that relates to her primarily by highlighting and rejecting the abnormal.  As her legal advocate, I am entrusted with giving voice to Jenny’s concerns, with normalizing the abnormal and bridging the gulf of misconceptions about her.  I value my role and enjoy great personal satisfaction from my job.

It’s easy for me to wear the garments of justice and fairness and say that I am not like the others who create separation from Jenny.  But is this true? What would the light that constantly shines into my clients’ lives illuminate if it was turned on me?  Would I be honest to conclude that my actions are always connected to caring?  In what ways have I contributed to their feelings of separation?  To what extent does my fear or uncomfortableness inform my interactions with my clients?  How much of an open-heart do I bring into our relationship?  Does my professionalism create connection or separation with them?  The answers to these questions may have a bigger impact on my clients’ lives than whether they get decertified by the review panel.

Some days Jenny is victorious in her desire to control the interpretation of her life’s journey.  Some days the complex, mysterious, wet, rich texture of her life penetrates the narrow, rational, dry, shallow categories that haunt her.  Today is not one of those days. Today she will not be heard. Today her personhood is narrowed and diminished.  Today I appreciate her resilience in trying to emerge from under the layers of non-recognition.