And I’m back to the blog after another hiatus. Real life can stop sucking at any time now. Back, with the second guest post from med school! This is the story I asked ladystardust19 if I could repost in the first place, because I think it’s a beautiful example of cultural competency in mental health practice.
A lot of people assume these days that if they hear someone is “Christian”, they know what that entails. That they have a reasonable idea of what practices the religion involves. However, Christianity is not a single monolithic religion—I know I’m blaspheming against ecumenism here, but I’m not sure if I’d call it a single religion at all anymore, so much as a spectrum of many religions with a shared set of core texts, from a practical standpoint if not a theological one. Christianity is so diverse these days that two Christians who have both been immersed in their faith for decades can meet and scarcely recognize each other’s lived experiences. If you want to be culturally competent where religion comes, you cannot assume that “Christian” is the free square on your bingo card. You have to your research.
There’s a lot more I could say about why it’s important for us to be culturally competent around Christianity—whether about the domination of social services in many areas by Christian groups, Christian thought’s effects on psychological theories and practices, or Christianity’s messy struggle to combine religion and childrearing, and its aftermath. At some point, I probably will. But today, let’s go on to the story.
The Woman Who Heard God
On my very first day of rotations, when I’d just taken a board exam after months of study, when I’d never seen a real patient in my life, when I was convinced that I would further mess up every last patient in the world simply by existing, much to my horror, my attending and I saw a patient.
We actually saw several patients, but after my attending introduced herself, established this was indeed my first rotation, and suggested I observe her with a few patients and take blood pressures and stuff while I got my bearings, we saw one particular patient.
She was new to the practice, so I got to see take her vitals and see her intake appointment. This patient and I connected as soon as we screwed up our courage to make mutually terrified, but empathetic eye contact. My hand shook uncontrollably as I positioned the blood pressure cuff, and my heart felt like it was about to beat up my esophagus, out my mouth, and run hysterically over the stack of paperwork on my attending’s desk. My patient nearly jumped out of her skin and muscles and internal organs every time my short white coat, stiff with being bleached and ironed the night before, shushed as I moved.
We must’ve made quite the pair, shaking with nerves and getting in each other’s and our own ways while desperately trying to get a simple blood pressure reading, but my attending didn’t even blink.
I was so scared I was moving wrong or sitting wrong or breathing wrong and thus angering my new attending or upsetting our patient that I caught very few things during her appointment. One was that this patient was anxious to the point that she could not live a normal life. Another was that, decades ago, there was a botched surgery on her back which left her with searing pain. She became convinced the pain in her back was due to demons who were punishing her for turning her back on God’s healing power. She reported she’d heard the demons at one point, but denied hearing them anymore, and said the pain had resolved after corrective surgery.
She was prescribed a mood stabilizing medication that also has some antipsychotic properties, as these meds sometimes do. Since she seemed to like me, my attending had me call her a couple of days later to see how she was doing. Our patient seemed pleased I called, reported she was doing well, and scheduled an appointment for the last day of my rotation.
In the blur of learning everything I could about Psych, I actually managed to forget about her appointment until I went to get her from the waiting room. I’d come far enough in the intervening weeks that my attending let me do my own interviews with consenting patients, and this patient said she’d be happy to talk to me.
She’d stopped taking her meds because of some breakthrough anxiety soon after I’d called her, which isn’t uncommon. Psych meds can have terrible side effects, and breakthrough anxiety is one of them. I explained that fact to her, assured her my attending would not be angry at her for discontinuing the meds, said we would explore other options, and continued with the interview.
I asked her about the demons she’d heard. “Oh, I haven’t heard them for years,” she confirmed. “I do hear the voice of God, and sometimes…Well,” she looked a little embarrassed, but continued, “I know He’s in my head, but He takes over my vocal chords and I start to speak the language of God.”
Here’s a factoid about me: I’m an atheist. I’ve been an atheist basically my whole life, even when I didn’t know what atheists were.
I also come from a Southern family on my mother’s side. I am lucky enough to like and respect as well as love the vast majority of my legion of relatives, and most of these folks are deeply religious.
I tend to think what works and what is best are very nearly the same thing, particularly on an individual level. If being a theist works for you, I think that’s great. If being an atheist works for you, I think that’s great. I’m married to a theist. I certainly don’t mind if my patients are theists.
I’m also from a culture where things like God taking over your vocal chords isn’t unheard of, so when she reported this behavior, I just said, “…You speak in tongues?”
Another factoid about me is that my family built a Primitive Baptist church on our family land, pre-US Civil War, as part of a pact my many-times great-grandfather made with his God regarding the safe delivery of his daughter. His wife gave birth to my one-less-many-times great-grandmother two hours after he made this pact, and so the church was built, and my Primitive Baptist family has worshipped there ever since.
In our tradition, “Primitive” is meant something like “Old-School”. From what we can tell, we are one of the earliest Baptist splinters that happened in the history of Baptists, and in how my family tells it, we split from the rest of the Baptists over the issue of Humility. So, while we do suppose that some folks do indeed truly speak in tongues, we are far too humble to claim this talent for ourselves.
Nope. Not us. We are Primitive Baptists, and we Know Our Place In The Scheme Of Things.
But speaking in tongues is not at all a foreign or even strange concept to me. Some people speak in tongues. Some people believe that a cracker and wine is the literal flesh and blood of Christ. It seems like it takes all sorts to worship all y’all’s God, and that’s fine with me.
“Oh, you know what it is!” My patient smiled brightly and looked pleased. “Do you speak in tongues, as well?”
Most USians do not trust atheists, so I’m reluctant to disclose my religious affiliation in a professional setting. As I often do in tricky-to-navigate social situations, I channeled one of my great-aunts, who were Southern Ladies, forces of nature, and brilliant conversationalists.
“Oh, I would not presume to be so blessed!” I demurred.
“Do you go to a church where they do?” my patient asked.
“You know, I feel that I am being called to medicine, these days,” Atheist Me replied, channeling no fewer than three of my great-aunts as I considered my words. “I’ve been spending much more time with my medical textbooks than I have with the Bible, but I feel that is where my path lies, at the moment. I rest easy, knowing I am doing what I am called to do.”
“Oh, certainly, certainly,” she agreed. “How wonderful, that you’re following your calling!”
“Does speaking in tongues disrupt your life?” I asked.
It didn’t–she reported she only does it at home, or sometimes at her church. The voice of God made her feel comforted and cared for, and that she was blessed and loved. It didn’t make her feel anxious, or tell her negative things about herself, or tell her to do anything destructive.
I snagged my attending before I passed her off. “So…She’s started speaking in tongues, lately,” I began.
My attending, being an immigrant from a very different religious tradition, had no clue what that was.
After I explained it, we had a brief discussion about how to address this development. I brought up that our patient is from a region where speaking in tongues is not terribly uncommon and attends a church where it isn’t, either. We may think it’s a delusion, but it’s one from her culture, and it didn’t seem to be bothering her.
“Didn’t she hear demons for a while, though?” My attending asked after a moment’s consideration.
“Yes, though she reports she hasn’t heard them in years,” I answered.
“This might be a continuation of that psychosis,” my attending suggested. “And she needs a mood stabilizer, regardless, and those can have antipsychotic properties…”
“…So we’re not going to tell her it might make the voice of God go away?” I asked.
“We need to get her less anxious. Her anxiety is hurting her,” my attending pointed out. “She can’t function with her anxiety as it is, so…No, I don’t think we will.”
Her anxiety is hurting her, and it does keep her from functioning, and she did come to us looking for help with her anxiety after the usual (and some less-usual) anxiolytics and antidepressants didn’t help. This is the drug class that is most likely to help her with her severe anxiety, but I’m not sure either of us were entirely happy about that potential side effect.
My attending dodged the speaking in tongues issue, instead choosing to verify that the voice our patient was hearing was not a belligerent one, and making a note to follow up to be sure the voice does not become so. We put the patient on another mood stabilizer that, like the first med and like other meds in its class, may also have some antipsychotic properties.
Call me the weirdest atheist ever, but I hope it doesn’t take away the voice of God for her. She’s such sweet lady. She deserves to feel comforted, cared for, blessed, and loved, and I hope the meds that may alleviate her anxiety will not also “free” her from the voice of her kind, loving God.