Anita is 37 with blonde, wild, disheveled hair. She is overweight, has bad teeth, wears too much make-up, and is severely depressed — sometimes psychotic. She tells me she often hears voices. And she constantly complains that the medicine she gets from our clinic (and she gets a lot), does not take the edge off her feelings. She has severe anger and is in an anger-management group at our offices. Each ...

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James is a tall, lanky Caucasian man, well into his 40s. He has brown curly hair and is not a bad looking fellow except for the vacant look in his large brown eyes. He is a pacer, which is a manifestation of his illness, and a consumer of excessive amounts of water. You have to talk right at James to be understood. I try to make eye contact. Sometimes he doesn't ...

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Mr. Fine is in for the eleventh time in less than a week. I work as a social worker in a hospital emergency psych unit. Mr. Fine is suicidal again. It is kind of late in the evening when I see him, although it is my first time, I am the only social worker on tonight. This is the usual situation, one social worker per shift. The psychiatrist takes me aside, quietly ...

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I'd known Ellis for years — he once hired me for a social work job. Yet when I think of Ellis Ledger, I remember him best the night I encountered him outside of his apartment building. I was out late walking my dog. Ellis stopped to talk. He clearly was drunk, not falling-down-drunk (he never was), but feeling no pain, as they say, and he was upset about something important ...

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Mary Beth is a female in her early 30s, quite obese and mildly mentally repaired, as well as suffering from schizophrenia. She lives in a housing authority apartment, which is not a great place. But being highly subsidized, it is cheap! Her apartment is in a perfectly dismal condition. She lives in absolute squalor with garbage strewn around, and I am unable to figure out what to do about it. ...

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I first became John Dolan’s social worker following his colon surgery, surgery for removal of a very large cancerous tumor, the largest the experienced surgeon said he had ever seen.  John was told he had about three months to live. So much for predictions!  He lived another 16 months. To the chagrin of his very large Catholic family, he was one of thirteen children; he was all the time rejecting their ...

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Jacob is just past 30 by a year or two. He is, as I like to describe him, a little boy trapped inside a man's body and very much mentally ill. He started off with fetal alcohol syndrome, which means his mother drank heavily when she was pregnant. I am not sure I believe that diagnosis is correct, by the way. Fetal alcohol syndrome is a much more complicated condition ...

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Marijuana use today is not limited to the poor, the marginalized among us; nor is it kept in the inner city, as it pretty much was when I was a kid.  Now it is widespread, even legal in some states.  One might even make the argument it has become a substantial part of the life of the elite, the affluent of America.  And when we think of elite and powerful ...

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I am a bit of a coin collector, and recently I visited my favorite coin shop in downtown Louisville.  I was met with this news: A coin dealer I know in Austin, Indiana had been killed recently, murdered in his own coin shop, shot in the head by robbers.  Four persons were later arrested when coins belonging to this elderly man were found in their possession.  Austin, Indiana is, by ...

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Jerry once killed a man, his best friend.  He told me about it, unemotionally, but as if it had just happened. He wandered the street like a refugee in a war-torn country, except he was in mid-America: Louisville, Kentucky, as it were.  He was homeless.  I've known him for five years, anyway.  He's approaching fifty, a rough-looking man, large, with thick gray hair, which is quite long now.  He has lost ...

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After having an echocardiogram recently, I saw a cardiologist, which seemed the prudent thing to do.  I was not symptomatic, and I think the echo was pretty much unremarkable -- to use a bit of doctor's lingo.  I saw the word "mild" here and there in the report describing processes of my heart's functions.  When you're over seventy-three, "mild" sounds pretty all right.  Better than the word "acute," I figure.  ...

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Well, decision time was here and it looked as if Bill would choose surgery, and why not, with the doctors liberally throwing around the word "cure.'" The various tests Bill endured, breathing tests, echocardiogram and MRI of the brain, were all within tolerable ranges, we were told.  The oncologist noted some marks in the brain that suggested mini-strokes, but Bill didn't hear this or it didn't register with him, or ...

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I am often struck that those I work with who have enormous reasons to be depressed -- they may be poor, physically ill, uneducated, and very crazy -- are not depressed, not at least as I describe depression, a state of melancholy and dejection.  In my view, there is a terrible, terrible hopelessness in these situations and in these lives.  And then, there is William Jenkins. With William, I find I ...

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shutterstock_89752360 I went to the doctor yesterday, my semi-annual visit, as it were. These days I see a nurse practitioner, a woman. Recently, she and the practice she is a part of moved into a renovated building, state-of-the-art, they are calling it. It almost sparkles in its newness. The practice is owned by one of the large hospital corporations in our city. See ...

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I never thought it would go on for so long -- seeing Donald Wyatt, I mean. I certainly didn't plan it this way. More than six years ago, I retired at age sixty-six from my social work job at a mental-health agency. Donald had been my client there for about eight years. As I was cleaning out my office, his mother called. She explained how Donald's father had left when Donald was ...

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On my voice mail is a message from Donald Wyatt. He doesn't often call, but every Monday morning he comes to see me at the Louisville, Kentucky, mental health clinic where I'm a social worker. His message is brief: "I'm not feeling well, and I am planning a trip to either St. Louis or Elizabethtown." I smile, wondering at the odd pairing. Elizabethtown is a small city of 50,000 people. And, well, ...

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