Carol O’Dell: I enjoyed reading your excellent, Pushcart Prize nominated essay Smoke Break. You are a practicing psychiatrist and you’re working on a creative nonfiction manuscript based on your experiences as a doctor. Do you find that you feel a responsibility to tell the stories of individuals who are so marginalized in our society—or is there another reason to feel compelled to write about them?

James Damiani: My mother suffered from depression, and I have always had a special spot in my heart for people who suffer from mental illness. People with mental illness often lack the ability to access the things they need to heal. For example it is often difficult for them to connect to others and to live in a supportive environment. So yes, I do feel a need to be a voice for them in that sense. But at another level, I also discovered telling their story was telling my story. Many of the problems they experience are mine magnified. Protecting them is protecting me, understanding them shows me how to understand myself, and ultimately helping them helps me. I would add one more thing, I believe we are all at least a little mentally ill and that’s okay.

 
CO’D: You write stories about elderly men who have lived their whole lives in the mental health system.  In one sense, there is no recovery for them. How do you offer the men—and the reader—a sense of hope, or do you?

JD: Recovery is a hot topic in mental health circles right now. Some people do fully recover from mental illness, some individuals might say they have even grown from the experience. When that happens, sharing hope is easy. But you are right, my patients are in a group who generally never return to their full functioning. In fact their story is most often a progressive decline in abilities and health. What I have learned is that there is still hope within that journey and also so much life. I have seen the men experience joy and perform spontaneous acts of kindness. When a person can give in some way, it is good for his soul, good for the soul of the world and cause for hope.

 
CO’D: In the midst of this rather bleak world, there are surprising and refreshing humorous stories, like Smoke Break (Your line, “Is that your urine?”). I also understand that in a story/scenario such as this it has to be handled with, let’s say, a certain amount of delicacy/diplomacy. I would think that humor becomes a shield to protect yourself. Do you grapple with cynicism or apathy (two of my favorite coping mechanisms)? Or do you grapple with that fine line of creating a story your readers will engage with and knowing how far to take it?

JD: Great questions.  I do use humor to help soften the stark painfulness reality hands us, and in that sense it shields me.  I believe humor can be used to reveal our pain in a tolerable way. Ironically I have found the more I am able to bear the pain of life the more I can laugh, and the more I laugh,  the more pain I am able to bear.  One thing I don’t want is for the humor to be gratuitous.  I want any funny thing I write to have a purpose, to soften the ugliness.  But I would not want my humor to come at the expense of another’s pain. One litmus test I use is to ask myself if I am laughing at or with.  When I am laughing with others it’s usually a good thing. When I am laughing at others I have to be careful. As far as crossing the line or going too far, my family would say I do that a lot. But my motivation is to help,  and it is done with a spirit of acceptance and joy. I count on that to cover me when I go too far.  I belong to a writer’s group and they also help let me know when things are too raw or off the mark.

CO’D: You seem to spend a good amount of your day with individuals who have various types of delusions, fits of rage, confusion, probably outright belligerence. Does that ever get to you? Do you have a way/a ritual that allows you to emotionally separate (in a good way) while still preserving a sense of balance ? What does—get to you—and how do you deal?

JD: In a way, because these people are so ill, it is easier to forgive them than say someone close to me who I see as having at least some control of their choices.  But I can’t deny that their words still hurt and they have frightened me at times. I believe the angry psychotic man is often actually frightened, either of me or themselves. On my better days I am able to let the patient know that I can handle their anger, and that he or she is safe and does not have to be afraid of me.  My ritual, if I have one, is to look on the person with affection and tell them I want them to be safe and peaceful.  At the state hospital it is a very controlled environment and though no place is 100% secure we have a lot of tools to keep individuals from causing or receiving harm. Still I have to admit there have been times where being taller, faster and younger than my older patients has been handy.  What does get to me, on some days more than others, is the unending parade of inane problems my work can produce.  Also, although there is hope there is also a large dose of futility when working with geriatric patients who do not get better. The frustration can add up, especially when there aren’t some tangible successes.

CO’D: I loved the line, “Taking care of the mentally ill seemed to be where I fit best,” but of all the jobs in the healthcare field for a practicing psychiatrist—many are far more glamorous than the one you’ve chosen—what drew you–and sustained you to do this work?

JD: Yes we at the state hospital are not at the top of the heap. In fact, we are more like the dungeon of psychiatry, maybe of society.  I never planned to come and stay at the state hospital. I ended up here because of my own spiritual and emotional crises.  But I am grateful I came. Was there a God directing me here, or was it sheer dumb luck?  Who really knows? I am sustained here because it is good work and gives me a way to connect with others. This job maximizes what I do well and minimizes my flaws and weaknesses. It also pays the bills.

CO’D: I loved that smoking is what bonded you with your patients and perhaps one of the few motivators you and the staff have, but I’m guessing that with the current changes in the law that smoking at a government building is no longer an option. I’ve noticed that it’s helpful to step down (if that’s the proper term), when it comes to addictions, (drinking, drugs, etc.) and that smoking has a calming effect and may be the lesser of evils, to use a cliché. Do you think we should have some medical considerations?

JD: I went from being completely anti smoking, to seeing the benefits of it in our setting, to surrendering to the realities of the situation.  For example we are now smoke free and it is logical that the state cannot be purchasing cigarettes, which cause cancer, for people whose health they are responsible for. As for how smoking fits in with stepping down and rehab for addictions I can’t really tease all that out in a paragraph.  And there is the broader question of mood altering agents for our patients.  Should our patients be given Caffeine? Sugar? Alcohol? Marijuana? For what reason and where do we draw the line on our restrictions?  This much I do know, my smoke breaks with the men were a place of sharing, a time for normal interaction, and often served as a way to affirm and support one another.  The patients and I needed those times of communion and having a mildly mood altering agent seemed to help, especially in appropriate amounts.

 
CO’D: There’s one line that seems to capture the essence of this story and that’s when you wrote, “It did me good to value him.” How did you come to this place, of knowing and honoring each soul that comes your way–however angry, delusional, or incontinent they may be?

JD: I came from a place of woundedness and fragmentation where I could not value myself or others.  It has been a long journey leaving that place. Being able to do a good work and finding love were essential pieces to finding my way out.  Eventually there came a point in my life where I understood how precious life and people are.  It isn’t really an achievement as much as it was my being able to keep my eyes open without my own pains and fears blinding me. The more whole and healed I become, the more natural I have found it is to see the value of others. The chance to honor the life my patient’s have been given and the lives they have lead, is a gift.

CO’D: Are there some patients you simply cannot reach? I guess I’m asking, are some folks…unreachable? How do you reconcile yourself to that?

JD: If by unreachable we mean a situation when an interaction produces no effect on the other, especially no visible benefit, then there are plenty of those times. But I believe in the invisible.  I know something always happens in human interchanges, even with my patients.  I try to embody openness and acceptance. Usually the small exchanges accumulate and produce effects, in the other person and in me.  It is like water on rock.  But I have to admit, I have seen the light go out before anything healed or moved.  I have been rejected and felt quite impotent to help some people.  The folks with rampant psychosis and progressive dementia in particular come to mind, but still I believe even at those times nothing is ever wasted.  The attempt to connect at least moves me, and who knows maybe it even reaches across time and death sometimes.  So, no, I do not see anyone as unreachable, though some people are not reached in any way I can discern.

Carol O’Dell is the author of Mothering Mother: A Daughter’s Humorous and Heartbreaking Memoir. Carol is a professional blogger, contributing editor at Caring.com, a Pushcart Prize nominee, and the founder of Chats Noir Writers Circles. Carol’s fiction and non-fiction have appeared in Deep South, Atlanta Magazine, and the International Short Story Collection. Visit her on the web at www.caroldodell.com.