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Hearing Voices: Reflections of a Psychology Intern
Hearing Reflections of a Psychology Intern
208 pages, Paperback
First published January 1, 1990
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Displaying 1 - 7 of 7 reviews
October 3, 2010
This work memoir covers a year in the author's life -- after he got his PhD, during his internship of doing psychotherapy under supervision before he could become a real psychologist. He worked at a public, Harvard-affiliated hospital and tried to help some extremely dysfunctional individuals. There are a lot of memoirs out there about the same thing, but I think Dr. Haas's is as good as any of them. He is honest about his failings and his uncertainties, and has real empathy for the dreadful suffering of his patients. And his description of his supervisor's reaction when he was late for a session was absolutely hilarious. Freud would have been proud.
Similar titles are Frederick Covan's Crazy All the Time, Lauren Slater's Welcome to My Country and, more recently, Julie Holland's Weekends at Bellevue.
Similar titles are Frederick Covan's Crazy All the Time, Lauren Slater's Welcome to My Country and, more recently, Julie Holland's Weekends at Bellevue.
August 11, 2009
This is the story of a clinical psychologist’s one-year internship at the Massachusetts Commonwealth Mental Hospital, a state hospital with medical staff and teaching overseen by Harvard Medical School. The author, a would-be novelist (the flysheet says “He recently completed a novel,” and during his internship he ran a creative writing class for the mental patients), writes simply and well, describing the hospital pecking order, the nitty-gritty of hospital routine, and also the terrors and delights of working day-to-day with unpredictable psychotics. A “hurry-up” problem solver, Haas starts out by wanting to cure his patients instantly and is frustrated when he fails; by the end of his internship he’s willing to settle for interacting with them one human to another, like dealing empathically with someone from another culture whose language and ways he doesn’t fully understand. “I no longer want to cure him [his favorite patient, Mr. Plummer:]. First and finally, I want to accept him.” Curiously, one of Haas’s major influences was a college professor who specialized in Third World literature. “Especially important were his efforts to teach me to understand the subjective psychology of the people—their consciousness, their literature, their choices—whose experiences are completely different in all ways from mine. When I am with Mr. Plummer I often think about [that professor:], and I try to give [Plummer:] that same support.” And: “…we must begin to try and imagine the subjective psychological experiences of others when it is impossible to see ourselves in them. I think that this is what Mr. Plummer and I do for each other today.”
There is a touching scene at the end of the book, when Haas meets with Mr. Plummer for the last time. Throughout the year Mr. Plummer has oscillated between megalomaniacal ranting (he has “special magical powers” or is a famous “specialist in pediatric surgery”) and utter silence, with only occasional, brief periods of lucidity. In the awkward final session, after Haas attempts a bit of chit-chat, Mr. Plummer suddenly says, “It’s hard when a reliable therapist leaves. We’ve grown to trust each other, and your leaving is like cutting a flower before it’s had a chance to blossom.”
During the year Haas also works on his own hangups (he starts private therapy), especially his relationship with his father, also a clinical psychologist, and his anxiety about freely expressing himself. He points out how these hangups color his relationships with the widely diverse personalities of his patients and colleagues.
Some of the author’s observations:
I believe that’s an important part of why the mentally ill are quarantined: to know that They are simply more vulnerable to the horrors of existence is intolerable because it means that the horrors, whether real or imagined, are familiar, and it is the reactions to them that vary most. The mentally ill realize this better than any of Us. So we separate Them in order not to be reminded of what We all know to be true: that the world is unsafe, unpredictable in how its cruelties are meted out, indiscriminate about its choice of victims. There is no right or wrong. There is no foundation, no canon of normalcy. Through no fault of their own, children and adolescents emerge as adults having experienced horrors within their families and within their societies and, as a result, they become mentally ill….
My first task is to overcome my fear. [The patients’:] suffering orients them. Their compass is pain. Overwhelmed, they are unable to contain or understand their feelings adequately. As a result, their demons fill a room….
We often admit to the in-patient unit mentally retarded adults who have decompensated and become psychotic under the stress of frightening experiences. When they become upset by something and don’t understand how the world works, their uncertainty increases to the point that they no longer know what is real and what they have imagined.
Haas speaking to a colleague, a second-year resident in psychiatry: “…when I’m successful with a patient I feel like I’m betraying my dad somehow, like I’m letting him down by not acknowledging that he is the only one who can solve problems. It’s like this: whenever I do a good job, like diagnosing someone correctly, or getting a person involved in therapy, I feel like fucking up just so my dad can step in, rescue me, and take care of me. I think that without him taking care of me, I’ll be alone in the world. I mean he’ll be alone.”
“Him or you?”
“Him, him.”
“That’s not your problem. Too bad for him.”
…when I speak at these meetings [with the other interns and psychiatry residents:] I feel as if the staff looks at me like I’m not making sense. I feel inhibited by them, as if I am behaving inappropriately and only they know it. I feel that they condescend toward me because I am not like them. They act strictly psychological. They interpret behavior while I prefer to try and observe it. I am not as interested as they are in seeing art as sublimation, or love as object relations, or religion as metaphor, or madness as schizophrenia, or misery as depression. I am not as interested as they are in definitions of human behavior or in limits to place upon it. I don't share their convictions in theories about why people behave as they feel they must. I feel that they miss an appreciation for the magical, for the invisible, for the accidental. As James Wells [psychiatry resident:] has said to me about his distaste for rigid, orthodox psychoanalysts, “There are things in heaven and in earth that they have not dreamed of.”
The codes or signs used in schizophrenic language vary from person to person because one schizophrenic is like no other schizophrenic. The diagnosis describes only facets of a huge life. The great mistake is to assume that it describes everything about a human being, rather than a narrow set of expectations and observations, because each schizophrenic requires a different sort of treatment and a unique relationship with the therapist, rather than identical medication and psychotherapy.
At the hospital, we were reined in. Working with the mentally ill does that. It is difficult to show feelings around institutionalized (or semi-institutionalized) people whose emotions are often strange and guarded—it’s like having a meal in front of someone who’s hungry and not offering anything to that person to eat.
All year I tried to be like one of the psychiatrists. I parroted them. They are the ones in absolute authority within a psychiatric hospital. And if you want to succeed in their world it means having to be like them. They want to see someone recognizable when they look at me.
But although there is a tremendous amount about the psychiatric model that I admire and seek to integrate genuinely into my work with patients, the process of integration ought to be a matter of choice rather than one of necessity. Because having to mimic psychiatry also means remaining uncritical of some things about it that are wrong—for example, the standard process of locking people up in order to protect them from acting suicidal or homicidal, or from being unable to take care of themselves, due to mental illness.
Is there another way of making people less miserable?
It is not until the internship ends that I am able to ask myself this most fundamental question.
There is a touching scene at the end of the book, when Haas meets with Mr. Plummer for the last time. Throughout the year Mr. Plummer has oscillated between megalomaniacal ranting (he has “special magical powers” or is a famous “specialist in pediatric surgery”) and utter silence, with only occasional, brief periods of lucidity. In the awkward final session, after Haas attempts a bit of chit-chat, Mr. Plummer suddenly says, “It’s hard when a reliable therapist leaves. We’ve grown to trust each other, and your leaving is like cutting a flower before it’s had a chance to blossom.”
During the year Haas also works on his own hangups (he starts private therapy), especially his relationship with his father, also a clinical psychologist, and his anxiety about freely expressing himself. He points out how these hangups color his relationships with the widely diverse personalities of his patients and colleagues.
Some of the author’s observations:
I believe that’s an important part of why the mentally ill are quarantined: to know that They are simply more vulnerable to the horrors of existence is intolerable because it means that the horrors, whether real or imagined, are familiar, and it is the reactions to them that vary most. The mentally ill realize this better than any of Us. So we separate Them in order not to be reminded of what We all know to be true: that the world is unsafe, unpredictable in how its cruelties are meted out, indiscriminate about its choice of victims. There is no right or wrong. There is no foundation, no canon of normalcy. Through no fault of their own, children and adolescents emerge as adults having experienced horrors within their families and within their societies and, as a result, they become mentally ill….
My first task is to overcome my fear. [The patients’:] suffering orients them. Their compass is pain. Overwhelmed, they are unable to contain or understand their feelings adequately. As a result, their demons fill a room….
We often admit to the in-patient unit mentally retarded adults who have decompensated and become psychotic under the stress of frightening experiences. When they become upset by something and don’t understand how the world works, their uncertainty increases to the point that they no longer know what is real and what they have imagined.
Haas speaking to a colleague, a second-year resident in psychiatry: “…when I’m successful with a patient I feel like I’m betraying my dad somehow, like I’m letting him down by not acknowledging that he is the only one who can solve problems. It’s like this: whenever I do a good job, like diagnosing someone correctly, or getting a person involved in therapy, I feel like fucking up just so my dad can step in, rescue me, and take care of me. I think that without him taking care of me, I’ll be alone in the world. I mean he’ll be alone.”
“Him or you?”
“Him, him.”
“That’s not your problem. Too bad for him.”
…when I speak at these meetings [with the other interns and psychiatry residents:] I feel as if the staff looks at me like I’m not making sense. I feel inhibited by them, as if I am behaving inappropriately and only they know it. I feel that they condescend toward me because I am not like them. They act strictly psychological. They interpret behavior while I prefer to try and observe it. I am not as interested as they are in seeing art as sublimation, or love as object relations, or religion as metaphor, or madness as schizophrenia, or misery as depression. I am not as interested as they are in definitions of human behavior or in limits to place upon it. I don't share their convictions in theories about why people behave as they feel they must. I feel that they miss an appreciation for the magical, for the invisible, for the accidental. As James Wells [psychiatry resident:] has said to me about his distaste for rigid, orthodox psychoanalysts, “There are things in heaven and in earth that they have not dreamed of.”
The codes or signs used in schizophrenic language vary from person to person because one schizophrenic is like no other schizophrenic. The diagnosis describes only facets of a huge life. The great mistake is to assume that it describes everything about a human being, rather than a narrow set of expectations and observations, because each schizophrenic requires a different sort of treatment and a unique relationship with the therapist, rather than identical medication and psychotherapy.
At the hospital, we were reined in. Working with the mentally ill does that. It is difficult to show feelings around institutionalized (or semi-institutionalized) people whose emotions are often strange and guarded—it’s like having a meal in front of someone who’s hungry and not offering anything to that person to eat.
All year I tried to be like one of the psychiatrists. I parroted them. They are the ones in absolute authority within a psychiatric hospital. And if you want to succeed in their world it means having to be like them. They want to see someone recognizable when they look at me.
But although there is a tremendous amount about the psychiatric model that I admire and seek to integrate genuinely into my work with patients, the process of integration ought to be a matter of choice rather than one of necessity. Because having to mimic psychiatry also means remaining uncritical of some things about it that are wrong—for example, the standard process of locking people up in order to protect them from acting suicidal or homicidal, or from being unable to take care of themselves, due to mental illness.
Is there another way of making people less miserable?
It is not until the internship ends that I am able to ask myself this most fundamental question.
August 31, 2025
5 out of 10. This is as much about the author's psyche as it is about his patients'. I found some of it insightful, but the narrative's structure was scattered, the writing at times odd, even sloppy. The psychological and psychiatric theories and approaches he shared seemed so scattershot -- this patient might have this condition, but then again might not. No doubt these field have come a long way in the past 35 years, but for it being from the late 1980s I was surprised at how much guesswork there was in this prestigious mental hospital.
September 28, 2011
A year in the life of a psycho ward intern. Straightforward, brave and honest and full of introspection that makes
atavistic, mishegas, solipsistic
Mr Plummer (a patient) prefers to say nothing. When he talks, his monologues are about his powers of mind-reading, telekinesis, visions of the future, all things magical. When I ask him if he feels his medication is robbing him of his powers, he smiles back and says, "Yes!"
...
We try to listen like Saul the adviser, like Theodore Reik, author of The Third Ear, whose humor and childlike amazement informed his ability to remain interested in people like an artist, not to classify or even try and cure, but rather to understand and in this process come to love them precisely for their contradictions and suffering. Saul's acceptance is like an embrace.
...
"You a psychologist?" asked a gnomelike man who walked in with complaints that red, white and blue bugs planted in his teeth by the CIA or FBI were devouring his nasal passages and making it impossible for him to breathe.
"That's right" I replied.
"Read my mind!" he shouted gleefully.
...
The malingerers and the mentally ill I meet at Eastmark share the intensity that come from being alone in the world. Embracing their feelings makes me aware of my own loneliness. When I am able to imagine their suffering, and their dignity in the face of it, I feel hounded, too, and disliked, and cut off from society's enterprise. I think that's why the Them and Us mentality prevails in the the mental health professions. By cutting Them off, we create the illusion that They are not like Us, and that We do not harbor the thoughts and feelings that they embody.
If we view madness on a continuum, however, we have become aware of those features of our souls that we would rather pretend do not exist. The constant shuttle of patients through Eastmark confronts the commotion inside the clinician who observes as if from a distance. But in the end, there is no faraway pain, and there is nothing remote about their suffering. Their misery and their madness are fundamental human experiences.
I believe that's an important part of why the mentally ill are quarantined; to know that They are simply more vulnerable to the horrors of existence is intolerable because it means that the horrors, whether real or imagined, are familiar, and that it is the reactions to them that vary the most. The mentally ill realize this better than any of Us. So We separate Them in order
atavistic, mishegas, solipsistic
Mr Plummer (a patient) prefers to say nothing. When he talks, his monologues are about his powers of mind-reading, telekinesis, visions of the future, all things magical. When I ask him if he feels his medication is robbing him of his powers, he smiles back and says, "Yes!"
...
We try to listen like Saul the adviser, like Theodore Reik, author of The Third Ear, whose humor and childlike amazement informed his ability to remain interested in people like an artist, not to classify or even try and cure, but rather to understand and in this process come to love them precisely for their contradictions and suffering. Saul's acceptance is like an embrace.
...
"You a psychologist?" asked a gnomelike man who walked in with complaints that red, white and blue bugs planted in his teeth by the CIA or FBI were devouring his nasal passages and making it impossible for him to breathe.
"That's right" I replied.
"Read my mind!" he shouted gleefully.
...
The malingerers and the mentally ill I meet at Eastmark share the intensity that come from being alone in the world. Embracing their feelings makes me aware of my own loneliness. When I am able to imagine their suffering, and their dignity in the face of it, I feel hounded, too, and disliked, and cut off from society's enterprise. I think that's why the Them and Us mentality prevails in the the mental health professions. By cutting Them off, we create the illusion that They are not like Us, and that We do not harbor the thoughts and feelings that they embody.
If we view madness on a continuum, however, we have become aware of those features of our souls that we would rather pretend do not exist. The constant shuttle of patients through Eastmark confronts the commotion inside the clinician who observes as if from a distance. But in the end, there is no faraway pain, and there is nothing remote about their suffering. Their misery and their madness are fundamental human experiences.
I believe that's an important part of why the mentally ill are quarantined; to know that They are simply more vulnerable to the horrors of existence is intolerable because it means that the horrors, whether real or imagined, are familiar, and that it is the reactions to them that vary the most. The mentally ill realize this better than any of Us. So We separate Them in order
August 25, 2012
Fascinating, quick read! Several times I found myself rooting for the characters in this book and saddened that these scenarios are true. The writer has a real talent for drawing you in, allowing you to really connect with the characters.
February 11, 2013
This was not good. The guy who wrote it had a condescending tone, and pretty much seemed like a jerk. He did not seem to care about the patients he worked with.
March 30, 2017
At times sarcastic, very witty, and truly realistic of what goes through a trainee's mind while dealing with patients in a locked-up psych unit
Displaying 1 - 7 of 7 reviews