Hospital: Everything in Therapy; Therapy in Everything

January 12, 2017

As mentioned in my previous hospital post, I had to wait a few weeks to continue tapering off the Jatrosom/Parnate (MAOI) before starting the Ketamine treatment.

After I got situated in my room and had a tour of the facilities, a nurse brought me my schedule. A couple of my co-patients, who spoke English, sat with me to translate it. I jotted down, briefly, the gist of the activity directly on the schedule, as seen below.

Schedule

First schedule.

At first glance it was shocking. A schedule so full. I couldn’t even comprehend this level of activity. The only thing to do was roll with it.

Apart from visits with my doctor and the Oberarztvisite (Chief head doctor), there were countless activities I was required to participate in. Some medical, most therapeutic – explicitly or implicitly so.

Mondays and Fridays were individual meetings with my psychiatrist (Einzelvisite). Wednesday and Saturday mornings were group visits (Gruppenvisite) – all patients, both psychiatrists and a nurse gathered around the dining table for quick check-ins. It was here I learned how to say how I felt and how my sleeping has been, in German. The first time I did so, entirely in German, everyone in the room erupted in applause and smiles.

Tuesday mornings we had the Oberarztvizite. Each patient would be appointed a time slot to meet with the head of the unit, along with the two psychiatrists, several nurses on staff, the therapists and occasionally an intern or two.

The staff were seated amongst tables in a circle, like a makeshift board meeting, albeit in our patient lounge. I’d only speak directly with the head of the unit, while others took notes. It was perfunctory at first and then became more individualized as time went on with my treatment.

Our (my co-patients and I) other activities were personally assigned. In the schedule above, the red items were required for me, while the others were not, or were voluntary.

The key group therapies for me were as follows:

  • Bewgungstherapie (movement): Various light physical exercises interacting with each other to get our bodies moving again. This also included swimming group exercises. Even if we never felt like doing them, the forced movement and interaction ended up being really nice. Swimming was especially great, for many.
  • Depressionsbewälltigung (coping with depression): Open group facilitated by a psychotherapist on understanding depression, how to cope, how to recognize symptoms, personally, before the illness progresses in severity. Each meeting, new topics to explore and discuss based on the latest research.
  • Ergotherapie (organizational therapy): I don’t know that there is a direct translation into English but that is my best guess. Here, several of us would meet in a studio with any number of creative activities and crafts to explore. People made sculptures, prints, patterned scarves, paintings, etc. I stayed to drawing in my sketchbook but felt more inhibited with everyone around and listening to music with headphones was frowned upon. I probably should have stuck with crafts I’d never otherwise have done. The therapist/instructor offered tea each time and was also the person behind the baking therapy.
  • Genußgruppe (enjoyment): I did not understand at the outset, of course. The purpose of the group was to inform, educate and enable the sensation of feeling joy. Many, if not all, of us were unable to feel joy or experience pleasure of any kind. There is a medical term for this: Anhedonia. Thus, the focus of this group was to learn the most basic of feelings again, via our senses – sight, hearing, taste, etc. I’d never know it til much later, but this would be one of my most favourite experiences in all the therapies.
  • Entspannungliegend (relaxation lying down): This consisted of visualisation exercises for relaxation. Everyone would lie down on yoga-type mats and the facilitator would talk through various visualisations. I hate this kind of thing. I’ve practiced Vipassana and Zen meditation before. Also, a longtime fan of Ashtanga Yoga. I’d have much preferred something like that. As luck would I have it, I wasn’t required to go due to the language challenge.
  • Patientplenum (patient planning): Here we go, the crux of implicit therapy. We all (or most) had chores to do which changed weekly. These included: setting the food, dishes, table for daily meals, cleaning out the refrigerator, providing a tour to new patients, purchasing/managing flowers in the common spaces (dining, lounge rooms), etc. This meeting was for assigning tasks. The thing here was that most tasks were assigned in either pairs or small groups. This meant coordination among people was required. This meant communication, planning was required – something all of us had become unaccustomed to at this stage. It was part of therapy – communicating and dealing with others. In real life.
  • Blitzlichtvisite (quick visit): Translated literally, “lightening visit”. Everyone gathers around the dining room table with the doctors and nurses. We go around and each person says quickly how they are, how their sleep is and if they need to speak with their doctor privately.
  • PMR Entspannung (Progressive Muscle Relaxation): More relaxation techniques, this type I could get into. Facilitated through the constriction and relaxation of bodily muscles with deep breath. Nice.
  • Kaffeetafel (Coffee & Cake): Every Friday afternoon we’d have a ‘Kaffetafel’. Just sit around the table in the dining room and have some cake and coffee or tea. The doctors and nurses joined. It was mandatory for all. The best thing about this was that a couple cakes were baked that day by the patients. Baking was part of the tasks/assignments we had as patients. Earlier in the week on Tuesdays, there was ‘Backplanung’ for the planning. The two people who volunteered would work with the facilitator to decide on what to bake. Thus, baking therapy. Weekly and with excellent results, always. The Germans have baking in their DNA.

The days were packed. Dinner was very early. Exhaustion has been a core symptom for me so I’d simply retire to my room early. Maybe watch something on my laptop, or the TV thing above my bed or read if I could concentrate long enough. Though I read and researched voraciously before, by the time I got to the hospital I was unable to focus long enough to read anything beyond a sentence or two.

The language challenge was enormous. In such a psychological state, there are already layers of separation between oneself and other people. To add a language barrier in a therapeutic environment was very difficult.

Though I was in Berlin, an international city by all accounts, the department was not entirely ready for English speakers. We received paper materials related to depression information but there were no copies in English. In Turkish, yes. English, a surprising afterthought.

Given this, I feel fortunate my doctor spoke English, as did the Oberarzt (he even practised at San Francisco’s UCSF). However, the day to day was a Herculean effort with regards to language. It was also among the first things discussed in therapy regarding my integration into Berlin/Germany.

It may sound obvious to learn the language, to foreigners,  but it’s really not so easy to learn German in Berlin. When you can cobble together some words into something resembling a sentence Germans will reply in English. Interestingly, immigrants, whether Turkish, Arab, Vietnamese, etc., will respond in German. Nonetheless, everyone appreciates the effort.

At any rate, I was immersed in the language whether I liked it or not. The beginning was the most rough of all. My fellow patients knew I didn’t speak the language but the really tough part for me was all the group sessions – either therapy, meals, or just random conversations in the lounge or hallway. I simply could not participate. I felt this distance removed a layer of therapy that was intended.

I made the most of communicating with people I could, learning the language on the fly, and real-time translation via friends or staff. In group sessions, I’d take notes, verbatim, as the facilitator wrote on the whiteboard and later translate each word in my sketchbook.

About a third of the way through my stay it became clear the whole program was not accessible to me because of language. So, a psych intern from Frei Universität Berlin, who was already part of the department, sat in our group sessions next to me and translated, whispering into my ear, in real time. This made a world of difference. After some time passed we’d also collaborate on communicating my experience, comments and questions to the group.

Of course, if I haven’t already stated, I am eternally grateful for the English speakers who helped me along the way.

A really nice thing was that we were entering Spring. I arrived at the hospital just after Easter. Little by little the sun would make an appearance and we’d go out to sit on the lawn out front to take in the rays when we had time between various activities.

Also, we weren’t restricted to the hospital. At first, yes, until your doctor got to know you. Once this happened, we were allowed to leave the hospital campus, first for a few hours, then a full day, then overnight at home on a weekend. That made a big difference in the therapy, for me, in my opinion. The openness and responsiveness to everyone’s particular proclivities.

A few weeks in, after fully tapering off the MAOI, I’d begin the ketamine treatments.

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