On Wednesday night I receive a phone call from the Executive Director of a homeless shelter. He asks me if I can pitch in for a simulation training for medical students as an actress. Of course I can. The training is focused on creating realistic opportunities for medical students to interact with people who are living with mental illness, homelessness, and substance use. The students have received training in Motivational Interviewing techniques, de-escalation, and safety skills.
I am asked to play the role of “Francine.” I am given an overview of her immediate situation. She is 42 years old and is tweaking on methamphetamine. Tweaking is the most aggressive stage of meth addiction and refers to a person who has not slept in 3-15 days as a result of taking methamphetamine. My character, Francine, also has a history of trauma and a broken arm. She has been staying at an emergency shelter for three days. She has the perception that she has been hired by the police to seek out alleged crimes in the desert.
She is willing to seek help. Willingness is a critical component. It can be difficult to tap into when the illness part of the brain has overwhelmed a human being who has a much larger story as a whole person. I know this from experience. It is often a kind and compassionate medical provider who can help someone feel she is safe, and compel her to share her story and begin to activate positive changes.
While I have not experienced meth addiction or homelessness, I have experienced various states of mania and depression, delusional thinking, substance use, and trauma. I have a long history of interacting with medical professionals in various states of mind. I am a woman in recovery from co-occurring disorders and this seems like a unique opportunity to be of service to medical professionals.
Recovery from substance use has a very clear line. I am either sober or I am not. But recovery from mental illness proves to be more challenging. It is possible, even when medicated, to slip in and out of recovery. While various states of mania can be highly productive and creative, there is a fine line between functioning at high speeds and spilling over into frenetic chaos that feels like my brain is on fire.
I also have the unusual perspective of understanding both the spirit and techniques of Motivational Interviewing (MI) and de-escalation skills. I have life and work experience with mental illness, substance use, recovery, and therapeutic interventions such as MI.
Prior to the simulation, I conduct some research on meth use and watch 20 YouTube videos of people tweaking. This way, I can better understand how to accurately portray mannerisms and speech patterns.
I approach this assignment with two goals in mind. I am providing an accurate portrayal of mental illness and addiction. I will also be able to respond appropriately based on how the medical students are using the techniques they have been trained in. If the students approach my character with empathy, open-ended questions, and support, I am easier to talk to and more honest about what is really going on. If the students do not use the techniques, I have been instructed to exhibit very challenging behavior.
There are three actors, six medical students, a Crisis Intervention Police Sergeant, a psychiatrist trained in outreach, the executive director of a shelter, and a physician who has developed the curriculum for this new pilot program.
The medical students each have opportunities to interact with Francine for 15-minute segments. A debriefing with trainers follows each segment, a freeze period, and then the students rotate. We do this for one hour and fifteen minutes. It is exhausting and a remarkable opportunity for insight, reflection and new ideas.
I am reminded of how difficult it is to be in a medical office and feel that the doctor does not see who I am as a whole person. I have spent much time in troubled states of mind, convincing medical professionals that I really don’t belong there or that I am incredibly smart, if they could just understand. The experience of feeling judged sparks outrage. The lack of understanding and invalidation can shift me into a place of broken weeping within seconds, if I am not well.
It is remarkable to be in a position of health and awareness and to observe the medical students’ responses to my character’s behavior. It is powerful to experience empathy for medical professionals who at times appear to be frightened by my character’s behavior.
The medical student observes that Francine is picking at her skin. As Francine, I request lotion. The medical student is unwilling to provide lotion despite several requests, after which my character becomes increasingly agitated. It seems to be a simple request, one that is easily managed. Eventually my character slams the chair, shouts, and scrapes her wrists back and forth on the edge of the chalkboard. The medical student states she will leave if Francine does not calm down. At this point Francine transitions to a place of willingness and fear, begging the provider not to leave.
I am struck by the value of this opportunity that offers a space for providers to interact with someone who knows all too well the signatures of experiencing states of mind marked by both mental illness and substance use. This is an opening for human beings to interact with human beings, and an opportunity to practice compassion, empathy, and non-judgment.
I say practice because it seems this is difficult. At one point in the simulation, one of the medical students is uncomfortable and stops the session. As Francine, I tell the medical student that I think she is nice, hoping to elicit some previously unavailable compassion. The student responds in kind and then stops the session. She tells her instructors, “I don’t like her at all.” I am struck by the vehemence in her voice, the fear, and what ultimately I perceive as judgment towards Francine.
The medical student has very little information about Francine beyond the frightened woman who presents aspects of who she is. It is this place that is ultimately dangerous for both patients and medical providers. Everyone, regardless of her diagnoses, is not a walking dysfunction, but rather a whole person with a whole life story that sometimes runs off course.
Check out the "Related Items" to the right of the screen.