January 16th, 2007

Today I completed my orientation at the Buffalo Psychiatric Center. After arriving at the Strozi building, I met with the director of volunteer services, Sue Joffe. She greeted me and we discussed some options regarding my placement within the facility. Then, as part of my orientation, I was asked to watch a series of videos. The first video was an introduction to the BPC. It included some brief information of the hospital’s history, their mission statement, goals for patient therapy, and some guidelines on what to expect as a volunteer. Over all, the facts given were very helpful in my assimilation into the center. The second was on HIPPA, the organization that assists in keeping patients’ records confidential. As a volunteer, I am expected to uphold standards set by HIPPA. Therefore, the video was beneficial in understanding the specifics. At the end of the orientation, I set up an appointment to be interviewed by Dr. Bellus. He is a psychologist in charge of the BRITE I social learning program in the intensive rehabilitation unit, which is where I will be placed.

Hours: 3.5

January, 25th 2007

I met with Dr. Bellus today on the eighth floor. I was excited to actually be introduced to my supervisor and make plans to begin my practicum. We discussed my goals for the future and also what I expect to accomplish at the BPC. It was interesting to hear his experiences as a psychologist working in the field for many years. He briefly described the program I will be working in, which is BRITE I (behavioral rehabilitation and interpersonal treatment environment). He also suggested that I obtain some literature on schizophrenia, since over eighty percent of patients I will be working with have this disorder and many of them have severe forms of it. He gave me a manual to read on the BRITE program as well. I was delighted to hear that as a volunteer, I will be active with the patients and I feel I can learn a lot this way. I also met a man by the name of David Hayes who will be my other supervisor during my time at the BPC. It appears that I will be doing most of work with him and then a tentative schedule was made. Before leaving, I met again with Sue Joffe who provided me with a badge, which I am to wear at all times in the center. I cannot wait to finally get started.

Hours: 1
Total Hours: 4.5

February 8th, 2007

Today, I officially started working at the BPC and interacting with the patients. As I mentioned before, the patients located in the BRITE I unit all have various forms of schizophrenia (such as paranoid, disorganized, catatonic etc.). In view of the fact that I have never had any previous interaction with people who possess this mental disorder, I was somewhat apprehensive on what to expect. Everything I have read in textbooks did not fully prepare me for the reality within the BPC.

I arrived at the center at 7:00am to observe a Thai Chi class that was being held. This class was very rudimentary since many of the patients were not capable of full participation. Afterwards, I was able to interact with a few of the patients as they had their morning coffee. Obviously, because these people have various forms of schizophrenia, some of them were more social than others. It was interesting to observe the signs and symptoms of the disorder firsthand.

The units’ psychologist, Dr. Bellus, has established a token economy system, which supposedly has been very successful. Using this system, patients are always encouraged to engage in positive behaviors, like practicing social skills or taking part in different classes. When they do this, they are able to earn points and, with these, can then “buy” certain desired items, like candy, at various points throughout the day.

For the rest of the morning, I observed the daily routines of the in-patients. Some of the others were allowed to leave the unit to visit outpatient homes. The center encourages these visits in order for the in-patients to realize that they can make efforts in order to be able to live outside of in-patient care. They are also able to make connections with the other patients who live outside the wards. Therefore, if a patient progresses to the point where they can live outside the unit, they may be able to have a support system to help them better acclimate to their new life.

I also sat in on a class with two patients that have lived in the ward for over thirty years. They were given assignments to complete, such as elementary math and reading, which I helped them with. While there is always hope, I believe these two patients have become institutionalized and are comfortable living at the center.

In the evening, I returned to the center to observe a group discussion on each patient’s behavior over the past week. They each received a print out on this, which included their improvements and also what they could work on for the future. After this, there was time to socialize. I decided to play cards with some of the patients while the others read, watched T.V., or wrote letters.

Hours: 6
Total Hours: 10.5

February 13th, 2007

At the center today, I arrived at 9:00am for an exercise class. It was comparative to Thai Chi because the workout was very basic. I joined in the exercises with the patients and worked with those surrounding me to become more motivated. This therefore helped in the amount of tokens they received for that class. Some patients had a very difficult time performing these simple exercises. One reasoning for this could be due to the medication, because some of various forms make the patients drowsy. Music was also being played throughout the duration of the class. To me, it was interesting to see that some of the patients, even those who are usually more antisocial, were energized when listening to the songs that they knew. Many of them danced and sang along with the music.

I then participated in a session of patients getting ready to be interviewed for outpatient living. I want to clarify when I use the term “outpatient,” because I am referring to communities of supervised living. Some of these homes are on the BPC grounds, but not in a locked ward. Living in these communities, like RCCA, enables the patients to be more responsible for their own daily lives. They have more control and are more integrated into the surrounding community. The man in charge of this meeting was actually a staff member with a mental illness himself. The patients seemed to respond well to him, maybe because they can better relate to a person who faced similar experiences. He had a list of questions and responses that he went over with the patients in order for them to perform well in their upcoming interviews. Among these questions were “do you have any support systems in you life?” and “do you know what medications you are on and why?” It was interesting to observe that some patients were more aware of their illness and what steps they needed to take to regulate and control their symptoms. Others, like one man in particular, could not visualize a path to achieve his goal of leaving the ward. He had a stroke approximately a year ago and it was mentioned to me that he was “playing this card” as an excuse for a variety of behavioral issues.

I returned to the BPC later in the day to sit in on one of the teacher’s (Laurie) classes. Because tomorrow is Valentine’s Day, some of the patients were excited for the holiday. They wanted to do Valentine’s Day themed learning, such as coloring hearts etc. It is interesting to see that different patients have higher levels of intelligence than expected if they want to apply themselves. Want being the operative word. I mainly talked with the patients during this time and corrected some of their papers. I also helped the teacher make copies and write out valentines for the patients. However, it wasn’t as exciting as usual.

Hours: 4
Total Hours: 14.5

February 22nd, 2007

I worked with the teacher at the BPC for a while today. Many of the patients "bought out" (with their tokens) so only a few participated in the activities. (I am beginning to form an opinion on the token system in regards to "buying out." Although I may be incorrect, I do not believe patients who have earned a lot of tokens should be allowed to buy out every time. Some of the programs are helpful and are a much better alternative than sleeping through the day or watching TV. How are you supposed to teach the importance of things like education or exercise when if patients are “good” they can buy out of these daily activities?). I helped various patients form their origami animals. Separate instructional sheets were handed out to each person, but it seemed that most of them worked best when you showed them how to fold by example. It is difficult to help them all at once because most of them needed individual assistance at the same time. The teacher informed me that I should not worry about helping them all, but, to me, I could see how frustrating it must be to the patients that were trying but just needed a little guidance.

After class, a staff meeting was held in the teacher’s room. I did not join, but I used this time to socialize with several of the patients. One of the patients, who is usually happy to see me, was questioning why I was there. He wanted to know what my qualifications were and what my purpose was for talking to them. He obviously was experiencing some sort of paranoid delusion accompanied by pervasive sweat all over his face. It was definitely interesting, yet my time was cut short when another patient in the same room began exposing himself to everyone. I left shortly after this incident.

Hours: 3
Total Hours: 17.5

February 27th, 2007

I, again, spent most of my day in the teacher’s classroom working with the patients. The variability between patients is extraordinary. Some have the hardest time concentrating and their work suffers because of it. Some have the capability for success, but are not motivated to try. Other patients perform well on their own, while there are several people that need assistance to accomplish the assignments. Lastly, there are a few who do well on their own, but will ask for help from time to time. When they receive this assistance, they then have a tendency to rely solely on it.

The teacher will sometimes do work at her desk, leaving me to assist the patients and correct assignments. I really enjoy doing this because I can learn each individual’s capacity for retaining and acquiring knowledge. Much of the work the patients do is beyond simple. I am always curious to how these adults will react to “coloring in the lines” and other assignments I did in elementary school. Though, it is apparent their mental disorders exclude many of them from rational thinking.

Although, I do not imagine that my small contributions to working with the patients make much of a difference, I like providing the ward with a different viewpoint. Because most of the staff working at the BPC is very much desensitized to the patient’s symptoms, I feel like student volunteers offer helpful stimulation to break the monotony of their routine.

Hours: 4
Total Hours: 21.5

March 1st, 2007

Since I was only at the BPC for an hour, I attended the class that usually is in session from 9:00 - 11:00. When I arrived, class already began and the patients were engaged in an activity. Therefore, I quickly made some copies for the teacher and then assisted the patients when I was needed.

Hours: 1
Total Hours: 22.5

March 15th, 2007

When I arrived at the center, it was somewhat slow considering the teacher was not in and she conducts most of the afternoon activities. Again, it amazes me that the patients have so much free time. When I walked into the day room, my supervisor was encouraging many of them to read magazines, write letters, or socialize. But of course, many of them took this time to sleep or watch TV. I handed out several magazines to persuade some of the patients to read and then started some conversations about what they saw. It was interesting to see that many of the patients were awakened and delighted by pictures of animals and homes. Others, especially the ones that have been in the BPC for years, showed shock at the sight of magazines like “Rolling Stone.” At this point, I wondered how much the world had changed, from when they were basically cut off from it, at their entrance into the institution.

I also participated in the weekly staff meeting with the ward’s psychiatrist, psychologist, rehabilitation therapist, nurse, social worker, and TAs. I enjoyed this very much because it was extremely informative. The staff went over each individual’s weekly progression or decline. They talked about several of the patients in depth, including their struggles, accomplishments, and medicines. When the different types of medication were discussed, the positive effects as well as the side effects were explored, which helped my understanding of them immensely. For me, it is beneficial to be acquainted with these aspects of each patient so I can interact with them accordingly. I also saw cracks within the system when there was a conflict with the social worker and the rest of the staff. The social worker was offended by gentle teasing by some of the other staff members. He actually blew up and walked out of the room, which took me, as well as everyone left sitting, by surprise (to say the least). Of course, the staff meeting continued but this lack of professionalism was noteworthy.

Hours: 5.5
Total Hours: 28

March 20th, 2007

Once more, it was a slightly calm day on the ward. When I arrived, an informal interaction session had begun where the patients are allowed to have free time before engaging in a program. Soon after, I joined in the teacher’s group and the patients involved were given a story to read followed by questions regarding their comprehension. She basically let me take the lead of the class, so I worked with them when any questions arose.

As I sat observing the class, I realized that many of them had a difficult time with this simple task. Out of the six patients, two did not try to participate, two read the story but did not complete any of the questions, one said she had a hard time reading because of vision complications, and lastly one completed the task. However, it took all of them a full hour to accomplish what they did. I have to admit it became a little frustrating when I tried to motivate one man, who usually has the full capacity to complete an assignment of this kind, without success. I would say “I know you can do this, you’re very intelligent” and he would respond by saying he was smart and he would. He then went on to circle the answers without reading the story. I was very patient yet it was difficult to work with someone knowing they could complete the work but, at this time, chose not to.

I also have to record a strange interaction that occurred with a patient who I usually converse with at the center. After working with him throughout the day, he shared his feelings with me that he would like me to leave. When I asked him why, he declared I should “go home and make dinner for my family.” Obviously, this wasn’t a logical answer, but it made me wonder if I was upsetting his routine. I typically have set hours when I work at the center and today I stayed later than usual. Therefore, this might be a possibility to why something upset him (considering he is used to routine for he has lived at the ward for over thirty years).

Hours: 3
Total Hours: 31

March 22nd, 2007

Today at the center, I discovered why the patient became upset with me the last time I was in the ward. Although my hypothesis was that I was disturbing his routine by visiting the center at an unusual time for me, I was wrong. His change in behavior actually had to due with the fact that the ward’s psychiatrist changed his medication. The shift wasn’t as severe as it was on March 20th, but the change in his mannerisms was still apparent. He continually asked me why I told him the other day that I did not like him. Obviously, I never said this, but he believed I did. On his adjustment to this new medication, he also became more violent towards other patients. During the time I was there, he scratched another patient’s arm, drawing blood. He then isolated (“time out”) for a while after this.

Besides this incident, the ward was fairly quiet. I joined in the teacher’s class where we read a story about springtime. I helped them answer the questions drawn from the story. Most of them had a hard time in accomplishing this. I have noticed that many patients I work with in the classroom are more inclined to mathematics than reading or writing. I would be interested to find out if there is a correlation between this and their mental condition.

Hours: 3
Total Hours: 34

March 27th, 2007

The ward was fairly uneventful today. When I arrived, I joined in the class, which was already taking place. Because David, the rehabilitation therapist and my supervisor, took many of the patients out of the building to swim, there were only a couple of them that attended. Many of the others were engaging in informal time in the day room (where they read magazines or played cards). I much rather prefer helping the patients with learning. I handed out a story to be read about Alaska and its’ climate. Like I have mentioned before, reading is not the strongest academic skill of many of the patients, so only one read the entire story. I tried to motivate the others to read by saying it was interesting and they would enjoy it. Afterward, the teacher handed out spring themed crossword puzzles and word searches. Many of the patients are becoming excited for spring and the Easter holiday, so I thought this was appropriate. While they were working, it became apparent that some of them needed my help. Because they all received different worksheets, they were confused with the directions. I mainly worked with two patients the longest because they were having the most difficulty. Both of the patients believed these assignments were too complicated for them, but I reassured them this was not the case. The one patient was working on a word search and could not find any of the words. I helped her find a general location of the first couple words, letting her look and find them for herself. When she did, I complimented her and after a while, she became more confident and needed less help. The other patient was working on a cross word puzzle. He was very confused about the directions. As a result I had to explain them to him several times. Finally, he understood what he should be doing but still needed a little guidance. Because he has poor vision, I sat next to him and, when needed, would read the number of the column or certain words. By doing this, he was able to finish the cross word. After class he actually told the teacher I was a large help and he enjoyed coming to class. He also said if he could have more of this kind of assistance, he would be a “smart man.”

When the class ended, the patients were able to have “token store,” where they traded in their good behavior tokens for special treats. Informal time was then continued and I sat in the day room and talked with a group of patients. Following this, I left for the day.

Hours: 4
Total Hours: 38

April 3rd, 2007

After arriving at the center today, I decided to accompany David Hayes and some of the patients to the swimming pool. I have never been to the pool before and thought it would be interesting to see how the patients interacted in this kind of environment. Before leaving, I notice one patient (who usually likes to swim) in the day room, not getting ready to leave. When I went in to ask her why she was not attending, she told me she had gotten a fine the previous week and lost her privileges. It appeared that she was very upset about this because she has arthritis and the pool helps ease any pain. I was surprised to hear she had gotten any fines, because she is always very well mannered, so I asked her what she had done. Apparently, she forgot to make her bed. It is hard not to feel sympathy for some of these patients from time to time because for example, this woman also has dementia. Therefore, things like remembering to make the bed can be difficult.

It was great to observe patients in the pool. This was a place they could relax and enjoy the water. I also got a chance to talk with David at length about many of the patients and their ailments. He informed me that swimming is a wonderful exercise for many of them, especially the ones whose medications and/or mental illnesses hinder their mobility. The water acts like a cushion for these individuals, giving them a chance to work out. David asked the patients to stay in the water the full hour and a half to receive all their tokens. One patient in particular caught my attention that stayed in the pool in one spot the entire time. He is another man who is always very well behaved and coherent, almost to the point where one questions his illness. I asked David about his demeanor and he responded in saying this patient is too obedient that he almost wishes this man could be less inhibited. He explained this by telling me that he was a WWII solider and some kind of trauma resulted as well as schizophrenia, shortly after he left the military.

Because it was a beautiful day, after leaving the pool, David and I took the patients on a walk around the grounds. To me, it is depressing that all of the patients could not be out enjoying this type of weather, because I believe it is important for their health. However, I realize that this is not possible and at least some are able to benefit from the walk.

Hours: 5
Total Hours: 43

April 5th, 2007

I began my day at the center at 7am and at first, the patients appeared to be more groggy than usual. This was due to the fact that it was still very early and they had just received their medication. I socialized for some time while the patients had their morning coffee. This was followed by an informal interaction period, where they watched TV, read magazines, or played cards in the day room.

I decided to work with the teacher soon after. She dispersed reading material on WWII. It was a fairly large class, about 8 people, and most of them kept up with the assignment. It usually takes many of the patients an hour or more to read the few pages of the story. Therefore, I helped Laurie (the teacher) organize the classroom by sorting paperwork and filing away past completed assignments. After everyone was finished, we went read the story again, as a class, and the patients were expected to answer some simple comprehensive questions.

Later in the day, I attended another staff weekly meeting headed by Dr. Bellus. As always, it was interesting because many of the patients are reviewed in terms of their progress or decline. Over the last week, one patient in particular has been aggressively acting out toward others. She is twenty seven so, among many reasons, this has become a considerable worry due to the fact the majority of the population is much older as well as lower functioning. Their safety has become an issue because of her violent outbreaks. In fact, the majority of her days have been spent in “time out” (a secluded area of the ward). Because of this issue, the staff has been considering many different ideas to bring about a resolution. Medication change has been one suggestion as well as a variety of coping strategies for her to learn when she becomes enraged. Dr. Bellus invited another psychologist, from a different ward, up to present one of her solutions. This psychologist brought with her a large blanket and then invited the patient into the meeting. This blanket was meant for her to find a “safe place” to be in when she becomes angry. She is supposed to wrap it around her in a specific way in order to help her cope with feelings of fury. However, the patient did not believe this would provide any relief for her. It was interesting to see that she was able to make that decision and then suggest other options on how the staff could help her calm down when needed. It made me wonder if anyone had asked her personally, before the meeting, about how she prefers to relax. The meeting then went on as normal to discuss other issues that needed to be addressed.

Hours: 8
Total Hours: 51

April 17th, 2007

I participated in a rehabilitation meeting today for those who are being considered for discharge to another facility or group home etc. I really enjoy attending this group class because it gives me a chance to listen to the patients talk about their illness’ and I become aware of which individuals are more cognitively conscious of their situation. Again, the man who is in charge of this group has a mental illness himself (a peer mentor). He relates to the patients by relaying his own experiences of how he handles his condition so that functioning “normally” in society is possible. Some of the other patients from the BRITE II ward attended along with another student volunteer. This was interesting because I was able to observe other new patients and, because two psychology students were in the room, we were included in discussion much more. The group leader would ask us various questions like “What are your definitions of recovery.” It seemed like the patients really listened and responded well to our answers.

After this, I joined the informal period and played battleship with a newly entered patient. He is much younger than many of the patients in the ward and because of this, he is more active. He also appears to have more control over his illness. This may be for a variety of reasons. As I discussed with the staff, the only foreseen conflict that may arise with his transfer, is the fact he is a considerably younger. There is only one other patient in this ward his age and they believe she will compete with him for attention. I believe this to be a possibility because his personality is extremely outgoing and friendly, while she is more reserved. Upon his first arrival into BRITE I, she did attacked him, deeply scratching his neck. If this continues, there is likelihood that one of them will be transferred to BRITE II. It will be fascinating to observe how they interact in the future.

Hours: 4
Total Hours: 55

April 23rd, 2007

I spent most of my day in the teacher’s classroom in a learning environment. The first class session was spent reading a story on different climates and seasons. As usual, it took several of the patients a while to read the three pages before them. I tried to motivate those who were distracted or too tiered to focus. I also took a copy of the story and began reading and completing the comprehensive assignment that followed, hoping to stimulate the group as well as become familiar with the information. When I saw that most had moved on to the questions, I went around to each patient trying to notice if anyone needed assistance. While it is difficult to help each of them at once, I was able to assist one man in particular. He is a patient that has more cognitive ability than many, so I found it distressing when I did not see him working. I pointed to the words of each question and read the answers for him to choose until he could do this on his own. Surprisingly, he answered every question correctly. Before the class ended, we went over the answers as a class and he seemed delighted that he could participate. It felt great when the teacher congratulated him on how well he did. He responded by saying that I had helped him considerably and he was grateful to have received this assistance.

After lunch, class resumed. There were only a few patients that attended in the afternoon. We studied math and the class was given worksheets to finish. One of the patients, who I have mentioned several times previously, was excited to work on his assignment. He performs better when dealing with numbers instead of reading. I think this is his preference because he has the capability, but prefers to do well on assignments he enjoys. Again, I went around the class to see if my assistance was needed and to correct their worksheets. I take pleasure in working with them in this way because I have noticed that much of the full-time staff can become overwhelmed from time to time and many of the patients benefit from the personal attention.

Hours: 4
Total Hours: 59

April 24th, 2007

I had an interesting conversation with a patient today. She has wanted to talk to me personally for a while. During informal time, we sat in the day room and had an extensive conversation about her life. Similar to this individual, most of the patients acquired schizophrenia during young adulthood (which is common for this disease). Unlike many of the patients in this ward, she was able to secure a professional career and have a family, while being dually diagnosed with a bipolar disorder and as a schizophrenic. I was grateful that she was so open about her mental illnesses and her life. The unfortunate aspect of her state is that recently she has showed signs of early dementia. We discussed her latest trip to ECMC where she saw a neurologist to assess her condition. It is difficult not to feel sorrow for this woman because I have gotten to know her fairly well during my stay at the BPC and she tries exceedingly hard to do her best. The rest of the staff agrees that she appears to be a very kind person and it is sad to know she has little contact with her immediate family. To me, it is surprising how many patients have lost contact with their families or whose families do not choose to be involved with them. This patient is soon to be discharged and we also discussed how freighting it is for her to leave the facility she lives in now. I told her that that was a valid concern but reassured her that this step would improve her life immensely. After this discussion, she thanked me for listening and I then went on to have several other conversations with the surrounding patients.

For the rest of my visit, I mainly just chatted with the patients, played cards with “the team,” and trouble. The teacher had left early, so I did not participate in any class sessions. Although it was a relaxing day, I did get a chance to learn a lot more about many of the patients, as well as the new patient who I talked with for a while. He also was eager to discuss his life with me, which was nice because I benefit from listening.

Hours: 5.5
Total Hours: 64.5

April 30th, 2007

Unfortunately, today was rather uneventful. Most of the staff was out of the ward taking a required seminar on how to calm and/or restrain patients when necessary. Because of this, none of the scheduled programs were running, like the academic or the rehabilitation skills class etc. Basically, the patients had a free day, so they watched TV, read, played cards, listened to music, or fell asleep. I used this time to socialize and get to know the patients better.

It was the newest patient’s birthday, which I have mentioned previously, and he was very excited about his family visiting in the evening. He received a present before I arrived, from the day nurse, which was a card deck. Playing cards is a hobby of his and he decided to teach me how to play spades. This game is extremely popular with the staff and patients in this ward. It is commonly played during the informal period. Although it took a while, he was a good teacher and I eventually caught on. After a couple of games, I asked two other patients to join us and we continued playing for quite some time. It surprised me that most of the patients could concentrate for as long as we played, but I have learned through attending the teacher’s classes that many people do astonishingly well with skills they enjoy (which makes sense).

After our game ended, we watched the news for a while and I asked the patients questions about what they thought about what was on TV. During the news, the new patient received a phone call from his father. He came back into the room crying. He said that his stepmother was yelling at his father for making her talk to him. I couldn’t imagine how this would feel and I tried to calm him. I suggested certain coping strategies, such as deep breathing or adjusting the way he thought about the situation. Eventually, after talking to him for a while the nurse called him to the desk and she gave him a CD player so he could listen to music. This definitely helped him settle down.

Before leaving, I met the new patient’s family and they showed me the gifts they gave him for his birthday. I began to think how nice it was that he did have a support system that truly cared for him. Most of the patient’s in this ward outlived their families or never became close with them, so no one comes to visit. It actually is quite sad when I think about it.

Hours: 5.5
Total Hours: 70

May 1st, 2007

When I first arrived, I participated in the rehabilitation class with a peer mentor in training who was running the group. He seemed very nervous, so the organization of the class was very scattered. He told us that he has schizoaffective disorder, but he learned to control his symptoms. What I found interesting was that one of the patients that attended from BRITE II ward had a problem with anxiety. A staff member told me it was partly attributed to the medication he was on. The senior peer mentor made a deal with this patient that was if he could stay in the class for fifteen minutes, he would receive all his tokens. It took a great effort on the patient’s part and after getting up several times to fill his water glass, he made the fifteen minutes needed.

Later on in the day I joined the teacher’s class. Most of the patients were completing math assignments. What I found to be extremely interesting is that one of the patients, who is very low functioning, completed his problems flawlessly. These problems were somewhat difficult as well. It made me realize that mental illnesses are very complex for this man can barely remember names of people but can finish these kinds of math assignments without error. How can this be?

What I have learned from this is that no one can predict this kind of population. If you do, there is no doubt you will at some point be very surprised.

Hours: 7
Total Hours: 77

May 2nd, 2007

I arrived fairly early to the center and brought in coffee to have while some of the residents were having theirs. It is interesting to note that whenever something is brought in from outside of the center, such as a drink, it is almost as if you get swarmed walking in. Most of the patients surrounded me asking what I had and if they could have some. This has happened on several occasions. In the day room, I then began to socialize with various patients while they watched the news. This is especially hard to do in the morning because so many of them are so tiered.

In the afternoon, the entire ward went down to the basement, which is basically like a recreational room. There is an exercise room, pool tables, a basketball hoop, and a fenced patio so the patients can go outside. I really believe that they enjoy journeying away from the ward from time to time and relaxing in this kind of environment. They can also play cards, do homework (because the teacher brings work down), and watch TV. This is nice because it gives them a variety of choices of activities to engage in.

It was a moderately warm day so I decided to walk outside on the patio with one patient. I actually was not prepared for his upcoming behavior because he started to pretend he was falling by flailing his arms and tipping to the side. I repeatedly told him that he would be fine and he would stop for a moment and then replicate his actions. I was unsure of how he would continue to behave, so I suggested we both go inside were he could calm down. While inside, he pronounced that he was going to fall again, but I reassured him he was not and this behavior soon subsided. For the rest of my duration in the basement, I played spades with two patients and my supervisor, which was entertaining.

One last observation from today was that I have noticed during my time at the center that many of the patients like to follow me as well as some of the staff members around the ward. This has happened in the past and again today while talking to a staff member in the visitor’s room. This room is locked to the patients. But after a while I looked up and at the window, in the door, a couple patients were staring at us. Sometimes I feel that while I am here to observe the patients and learn more about their behaviors, they are curious about others as well.

Hours: 4
Total Hours: 81

May 8th, 2007

Today was fairly uneventful. I arrived at the center in the early afternoon and some of the staff members had taken a half-day. Therefore, many of the programs usually scheduled were canceled. Because of this, I mostly socialized with the patients on a one on one basis. I benefit from listening to what they have to say about their lives.

One patient discussed with me the medications he was currently taking. Unlike many other patients, he was able to tell me the names of the drugs and how they modified his behavior. I enjoyed listening to him because I am very interested in how certain medications are used for various mental illnesses. While conversing about this topic, it was surprising to me when a few of the other patients joined in the discussion. They compared their experiences with similar and dissimilar medications. I found it fascinating that some of the same medications affected each patient differently. I’m sure it can become wearisome at times for the physiatrists and nurses to administer the right medication for each patient. It seems that medications are almost trial and error process for each individual. They may work for one patient but not another even if they both have the same diagnosis. Side effects are also a large consideration. One medication may be effective for a mental illness, yet the side effects may be too detrimental for the patient so it is necessary for it to be changed. What also is regularly done is that patients will take other medications to avoid the side effect of one drug. This, in turn, has left the patient with a cocktail of pills. It makes me wonder how much we do not realized about mental illnesses and how much research still needs to be preformed to perfect our modern medicines.

For the rest of my time here this day I played spades and then rummy with a group of patients. It was a lot of fun and I was able to interact with some other patients who usually prefer sleep to social interaction.

Hours: 4
Total Hours: 85

May 9th, 2007

Again, today was a quiet day at the center. Upon arrival, a group of patients was going over to the swimming pool. A lot of the other patients were at the rehabilitation group in the Butler building or involved in other programs. I decided to join the swimming group instead of staying in the ward with the few patients that were left. We walked over to the pool and the patients changed into their bathing suits. I sat on the side with my supervisor and the lifeguard. I really believe this is a wonderful form of exercise for the patients. Many of them, especially the ones who are overweight, profit greatly from this. It also seems to serve a stress reliever in combination of all the known wonderful benefits of exercise. I observed the patients as they swam and also conversed with my supervisor about my experiences at the center since they are soon ending.

Afterward, I returned to the Strozi building and to the ward. After the patients had token store we had an informal period. At first I talked with one patient about his approaching discharge. Although nothing was set in stone, he was being considered for a probable candidate to leave the BPC. He seemed to be very excited about this possibility and was making a calendar to track the days in terms of his progress. Because he was having some difficulty, I helped him with the creation of his calendar and we made three months together. He said this would assist him in monitoring his behavior every day making sure he could accomplish his weekly goal to be obedient. I thought this was a great idea and told him that these small steps are like stepping stones, which could lead him to his ultimate goal.

Later, I set up a group to play a series of “battleship” games. To encourage friendly competition and social interaction, the rule was whomever won game would challenge the next player waiting. This went on for a couple of games and some patients became involved whom I never expected to. It was nice to see that this stimulated a few and hopefully this will motivate them to play more on their own without any outside encouragement.

Hours: 5
Total Hours: 90

May 11th, 2007

When I entered the ward today, the programs had already begun and I participated in the teacher’s class. She handed out a story about REM sleep and asked the patients to read it and comprehend what they had read. Because she had another assignment planned, she only gave them fifteen minutes to read the two-page article. This would be a simple task for many, but none of the patients had completed it entirely during the allotted time. This may have been why some of the patients struggled to answer the questions following the narrative. However, this was a story that many of them did seem truly interested in which was probably the reason for their attentiveness.

Half way through the class, I was invited to join a group going the bowling alley in the Butler building. I had never been before so I assumed this would be a new learning experience. One of the patients that came along was very low functioning and almost never left the ward. I was excited to have him along and surprised at his success while bowling. He actually became very active and scored extremely well on his game. I have observed him before and have come to realize that he only performs well on the things he enjoys doing. For example in the teacher’s class, he prefers math to reading. Naturally, he performs better on his math problems and will not even read the stories when assigned. In terms of exercise, he will make excuses to why he is not capable to participate in swimming, but will joyfully partake in bowling and, as a result, do quite well. Bowling was also an interesting experience because I was given the chance to interact with other patients on different wards and I saw how the patients interacted with each other.

In the afternoon, as usual, token store took place. Afterward, it was time for the informal period. I had brought my laptop to the ward with the purpose of playing a few songs to one of the patients. He is lower functioning and has been in psychiatric hospitals for over thirty years. I had downloaded various Beatles songs because he is known to be a huge fan. In fact, all throughout the day, he will draw on papers that include song titles and lyrics from this band. What I have learned is that many, if not all of the patients in this ward enjoy music and their reactions to it are very powerful. When I sat next to him, I told him I had brought some songs with me and asked him if he would mind hearing them. He did not and of course I started to play a few. After a while, he asked me if he would like me to sing and I responded by saying I did not mind. During one of the songs, he actually started to form tears in his eyes. I am obviously not sure why, but I am glad to have been able to provide this music for him. Other patients took part as well by singing along and asking me if they could retrieve CD’s for me to play. The effect music has on this population shows me that it can stimulate, calm, and bring pleasure. If I could make one suggestion, it would be incorporate music more into the patients’ daily lives. To do this may not be just for pure enjoyment, but as a therapeutic method for relaxation and/or release.

For the rest of the time, I socialized with the patients further by playing “two headed” spades and the infamous game “Trouble.”

Hours: 8
Total Hours: 98

May 14th, 2007

It is my last week at the BPC. I want to use this time to really engage with the patients further and take in everything I can before I leave. Today was interesting because I got to see a side of one patient that I have been warned about but never observed first hand. Although many of the patients are very low functioning, like I have stated previously, they’re few located in this ward that become violent or act out. She is one of these few. While at lunch she decided to throw her tray across the floor, which ended up spilling on surrounding patients. She did this because she wanted a condiment that was not included in her diet. After this, when some of the patients became upset by her actions, she started to physically assault a man who was twice her age. I was actually grateful that I was present during this scene because I believe I can be somewhat naïve to the fact these individuals are very unstable in terms of behavior. If prior incidents did not teach me, this event really set in stone that these patients are unpredictable and while around them, I should never lower my guard.

I also participated in the teacher’s class where we mostly worked on math problems. Mostly, the patients that enjoyed math attended this class. As usual I provided my assistance when anyone needed his or her papers corrected or were stuck on a problem. One thing I have noticed over time is that assisting with teaching the patients and motivating them can be psychologically draining. This may be why turnover can be high in careers that involve health and mental illness. I believe it takes a unique individual to give their all everyday in efforts to aid in patient recovery.
After class, I mainly observed and talked with various patients. I also started a card game with the usually players. It is remarkable to see that patients who are engaged in an activity outside of the designated times can receive better treatment from the staff. In other words, they are rewarded for their positive behavior. However, I do not believe these patients realize that social behavior is promoted and can help them receive special treatment. If they do know this, some cannot control their occasional fits long enough to see the benefits of good behavior. It can be quite sad.

Hours: 8
Total Hours: 106

May 16th, 2007

Because it was a beautiful day, some patients were able to go outside for a walk. Like many people, I assume the patients look forward to the warm, sunny summer weather. I defiantly believe going outside can be beneficial because it relieves the patients from their sterile cold environment inside the BPC.

After a stroll around the grounds, the group was taken to the bowling alley in the recreation building. I like to observe the patients in different atmospheres outside of their ward. It is also interesting to watch them socialize with other patients who they do not usually see. An older patient who does not usually participate in-group outside of the BRITE ward went along today. His personality is pretty unique and because of this, many patients knew him and said “hello.” I believe most of the time he enjoys this attention. It was nice to see him get out and share in an activity he seemed to take pleasure in. I have discussed him before and he does very well at things he enjoys doing (visa versa). Obviously, he really likes to bowl because he scored very high. Many other patients were cheering him on and I could clearly see that this made him pleased.

Later that day I took part in a game of spades. I basically can expect to play several games of spades each visit to the BPC for it has recently been made a routine for me by a couple of the patients within the ward. It gives them something to look forward to as well as it encourages social interaction. There has also been a visiting patient from a ward on a lower level who loves to play gin rummy. I have been playing this with him also which breaks the monotony of spades every now and again. This also gives me a chance to get to know another patient.

Hours: 5
Total Hours: 111

May 17th, 2007

Upon arrival, a patient who was having a dilemma involving his family greeted me. He is fairly new to the BPC and is also very young. Obviously, because we are close in age, I have found that I can relate to him better. Along with this, I also feel some empathy toward him because he is so young I image what his life could be like without a mental illness. I also hear stories from staff members who have known patients since they were his age and, unfortunately, these people are still located within the ward. This is why I have been trying to have conversations with him trying to instill that fact that recovery is possible. Unlike many of the older residents, he still believes in a life outside the BPC. He was extremely upset because his stepmother did not want his father to visit him. In the past, he has shared with me similar stories, which clearly show some dysfunction within his family. He is fortunate though because he still has loved ones who care about him, which is what I tried to convey. I have sat with him through similar situations and observed his coping strategies when facing stress. In efforts to console him now, I suggested some of these approaches such as asking him to play a game with me or seeing if he wanted to listen to music. We actually did both and soon he had calmed down. After an hour or so he used the phone to talk with his father again and this time he became so upset that he had to take a dose of medication to return to normal functioning. It is not easy to observe such a process within an individual.

Later this day, during informal, I was able to talk with a patient who usually is sleeping throughout the course of the day. Although the conversation did go in and out in terms of her cognitive awareness, I was able to learn more about her, which is something I enjoy. I discovered she was from a different country, had a few children, was previously married, and, most importantly, had goals for her future. I benefit from learning more about each patient. It is interesting because so many of these patients come from different backgrounds, ethnic origins, and economic statuses. It helps me realize, as I have said before, that mental illnesses do not discriminate.

After our conversation I joined together the “team” of card players and we battled through a game of spades.

Hours: 6
Total Hours: 117

May 18th, 2007

Today was my last day at the center. To be honest, I did feel a sense of relief but it was slightly mixed with sorrow. Although I have learned it is necessary to keep emotions out of relationships with patients, I became fond of many of them as well as the staff of the BPC. Therefore, it seemed unusual that I would not be interacting with them on a weekly basis as I have been since January. Some of the patients told me that they were sad that I was departing and asked me if I would come back to visit. Because of this, I spent all of my time socializing with the patients this day. Generally, a few patients seem to demand more of my attention but today, I separated from these individuals to have conversations with those who I do not associate with as much. However, I did spend quite some time with one patient who I usually talk with and we played various games for a while, such as cards and “battleship.” This patient seemed very upset that I was leaving, but unlike many patients within the ward, I told him he had many other people to spend time with after I left, like his family. This is why I believe volunteering is important. Volunteers can have a positive influence on those patients who are not visited by family or friends and have no positive support systems outside of the BPC. I have seen that the few who do have connections outside of the BPC grounds are more open to the possibility of recovery and are more motivated to achieve this goal than those who do not.

In the afternoon, all of the patients assembled in the day room to watch a biography movie on Elvis. They seemed to really enjoy this and it was fun to watch some of them sing along to the songs they knew. Because much of the time the general attitude of the average patient is fairly somber, it is nice to see them take pleasure in an activity.
Soon after this documentary ended, I said my goodbyes and turned in my badge.

Overall, I feel this experience did help me broaden my knowledge of people with mental illnesses, in particular schizophrenia. I feel that this has been a positive aspect of my college career and I appreciate that I was given this opportunity.

Hours: 3
Total Hours: 120

JamiRadtke
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