One of the realities one must face as a clinician in a city psychiatric unit is that many persons do not grow up in the idyllic family. Many of the patient’s issues I was convinced had a biochemical foundation, but there were also many contributing family and social dynamics that also played significant roles. The key to being meaningful in this clinical setting was to not be too dependent on one absolute mode of therapy, and also to ward off personal pessimism and the sense that no one is capable of change.

There were incidents along the way that were filled with humor as well as sadness. Being in California the presence of earthquakes was a constant. One day in the middle of a session I could feel the floor start to tremble and I was keenly aware that we were about to experience an earthquake. One of the members in the group Gary who had a host of issues and rarely spoke immediately leapt from his chair and positioned himself under a doorway. The rest of the group was passive and needed incouragement from me to find an appropriate safe place. When the danger passed I went up to Gary and wished to inforce how appropriate his response was. Speaking in glowing terms and focusing on his specific behavior Gary smiled at my words. He went back to his chair turned to me and said.”I may be crazy but I am not stupid.”

On another occasion a woman in one of the groups started making great strides, and after about seven weeks appeared ready to live in a half-way house. She was bright ,and had new insights into her behavior. I believed that this was a real alteration in learning, and felt optimistic about her future. Before leaving the hospital she asked if I could see her on an outpatient basis. I was happy to see her professionally, and it was a pleasure to witness her progress to the point that she had secured a job, and was visiting her children on a regular basis.

After four sessions I believed that to continue to see her was to some degree a negative issue because I did not want her to become too dependent on me. She understood this rationale ,and at the last session she boldly asked me “Do you think that I am crazy.” I immediately responded with “absolutely not.” She seemed relieved and said” then I will tell you what I have told no one before”. She said when she was first admitted to the hospital she had trouble sleeping, and one night she was in the hallway at a far end in total darkness. She heard a commotion and observed a struggle between some man, one of the patients and a nurse. Presuming it was one of the usual outbreaks on the floor she was confused when one of the men said” where is my money?” A fight broke out and the one man covered the other with a blanket and then she heard what she thought was a gunshot. The noise was followed by silence and becoming fearful she hid behind a sofa. In the next few moments another man entered the hospital and he, the one with the gun, and the nurse wrapped the man in a blanket and took the body to the parking lot. She was petrified and told no one the tale until now.

The possibilities were limitless beginning with it could have been a dream, or her medications caused her to hallucinate so initially I did not think that she had actually witnessed this event. On the other hand this area was known for open drug dealing, and if she as actually awake and conscious she may have seen a murder. I did nothing with her version but after seven weeks of literally interrogating her I began to investigate whether this was even remotely possible. I spoke with her psychiatrist about her medications during the period. He assured me that she had made such progress since her former hospitalization that she was on no medications during that time period. The next step was to check the duty roster log and see which nurse was on duty that early morning.I was surprised to see that the notations from that morning seemed different from other days , and in checking with the nurse who was on duty she became rather aloof and defensive.

Finally I was convinced that she might have seen a murder and made an appointment to visit the San Jose police department. My patient held up beautifully during the rather rough interrogation by two seasoned detectives but it was clear that they thought she was mentally disturbed. Also if she had seen it then it was one last dealer they had to follow in the neighborhood. I was sure when we left that they had a good laugh about the “crazy lady and the naïve shrink.” I may have been wrong, but honestly I believed that it had actually happened.