|
8. Emotional Rescue: Managing
Meltdowns
Now that we've covered the main
bases of crisis response, we're going to focus on home plate:
psychological Management: Often, it's the busiest corner of the
whole crisis ball park.
We say that for a couple of reasons.
For one, psychological emergencies involving drugs -- hallucinogens,
stimulants, and marijuana, primarily, but any other drug (or
even no drug at all) will do in a pinch -- probably account for
more crisis problems than physical overdoses and toxic reactions
put together.
For another, although drug-induced psychological crises are rarely
fatal, they can be unpleasant -- and result in toxic memories
and fears that can last a lifetime.
They do, that is, unless an experienced person is around to help
someone on the business end of a drug freak-out or other personal
crisis to re-contextualize his or her fears and re-channel the
experience.
How do you do that? There are a lot of ways. And in this section,
we'll consider some of the best.
Re-Framing Fear
Anxiety is the fuel that most
simple drug emergencies run on. The range of problems that are
powered by panic can include everything from minor caffeine jitters
to full-blown LSD freak-outs.
Fortunately, there are a lot
of things you can do from the outset to help people put themselves
back in their own control and pull the plug on panic:
Begin by establishing a friendly
personal relationship.
Tell who you are, and explain why you're there. Ask for permission
to stay and help.
Be real. Don't try to come across as a mental health worker
if you're not, and don't pretend to have been through similar
experiences if you haven't. Good, old, safe, everyday reality
is the best treatment for panicky unreality. Be who you are.
Relax. Since most psychological emergencies are built
around anxiety, turn yourself into a relaxation role model: Use
body language. Stretch. Yawn. It really is contagious.
Relaxation is to panic what joy
is to anger: You can't have one with the other. So refuse to
be awed by anxiety. Don't ignore it or minimize it, certainly.
But don't unnecessarily reinforce it, either.
Just let the person know that anxious feelings are a common side
effect of over-amping the central nervous system, and let him
or her know that the feelings will change.
Everything does.
Set & Setting
A key element in re-framing panic
in a drug experience involves the notion of "set and setting."
To be effective, you'll need to focus on both.
Set refers to the mind set a user brings to a drug experience.
It includes expectations, previous drug history, physical and
psychological factors, and any emotional baggage a person may
have brought along on the trip. Any one of these factors can
emerge as a major determinant of the quality of the experience.
Setting implies the external environment in which the experience
takes place. "Setting" variables can include physical
factors, such as room temperature or noise level, or interpretive
elements -- whether a place or companions seem cheerful or gloomy,
safe or dangerous, "weird" or "cool."
Pay special attention to setting in the initial assessment of
a psychological crisis.
Variables here are often easier to alter than are elements in
a user's internal world, and sometimes merely changing the setting
is enough to significantly alter the dynamics of the experience.
Optimizing setting variables can at least provide a stable context
for helping further. That's important because most drug-induced
psychological emergencies don't disappear just because we turn
down the stereo. Still, it is a start.
That's when you have to dive down deep into a person's "set"
and hope you come back up with a pearl. And the only way to do
that is to be patient -- and persistent.
Because the simple fact is that the emotional turbulence of a
bad trip can seem overwhelming to the person experiencing it.
And it can be hard to tell, in some cases, if your communication
is even getting across.
Because of the absence of objective standards to measure the
crisis, it's important that you approach psychological emergencies
consistently in terms of both the message you send and the support
you give.
That's why we've put together the following guidelines for helping.
They're a means for reminding crisis victims that they don't
have to stay crisis victims.
Drug-Related
Emotional Crisis Response
Define reality. Remind the person of his/her name and
explain what's going on. Repeat the information, if necessary.
Say, "Your name is _____________ and I'm ________________.
We're sitting in your apartment (or wherever). You've taken a
drug that's affecting the way you think and feel, and I'm going
to stay with you until you come down." Or say something
similar.
Reduce stimuli. Because sensory impressions can seem so vivid
during a trip, users can saturate themselves with stimuli to
the point that they OD on sounds, images, and other input.
Turn down or turn off unnecessary audio or video equipment, too-bright
lights, etc. Similarly, make any adjustments in room temperature
or ambiance that you think will make the person more comfortable.
Reassure. Emphasize that the effects the person is experiencing
are by-products of a drug that will wear off.
Use suggestibility. Make verbal suggestion carry some
of the load in a crisis. If someone is experiencing panic, let
them know that panic attacks usually subside within 60-90 minutes.
Plant the seed for the end in the beginning or middle of a crisis.
Similarly, if a person hasn't eaten in a while, you might suggest
drinking a glass of milk or juice to bring up blood-sugar levels,
which will also tend to improve mood.*
Use "alternative-focus" activities. Sometimes adverse
drug reactions derive from simply focusing attention on oneself
too long. Help throw the switch on unhealthy self-consciousness
by suggesting activities that create an external focus or help
bring about a more integrated sense of well-being. Possibilities:
Taking a bath or shower. A bath has soothing mental associations
for all of us. The sensory experience also helps re-establish
the psychic connection between body and mind.
Going for a walk. Simply moving can change the setting
enough to enhance the qualitative content of a trip. And a long
walk may increase endorphin production to physically improve
mood.
Eating. Food can re-balance blood-sugar equilibrium and
speed up biotransformation and excretion of drugs. Keep it simple,
though: An orange or an apple will do -- and they can also enhance
the esthetic component of a trip.
Listening to music or watching
a favorite TV show. This
is the opposite of reducing stimuli. If there are no stimuli,
turn some on. There's nothing wrong with a little "cocooning"
under the circumstances.
The list of alternative-focus
activities is limited only by imagination.
Still, avoid activities that
are dangerous or otherwise inappropriate. Even our first suggestion
-- taking a bath -- could be a problem for some people in some
situations.
Otherwise, do whatever works.
Non-Drug-Related Emotional
Emergencies
Even if drugs don't figure into
an emotional crisis, the same basic rules apply that pertain
to re-framing fear. The only difference between a psychological
emergency involving drugs and an emergency that doesn't involve
drugs is the subjective distractions of the drugs themselves.
The feelings -- the fear and sadness and anger and pain -- are
the same, and need to be handled the same.
Begin by applying the same helper's skills that we discussed
in Chapter 3. Stay calm. Don't impose your values and point of
view. Communicate honestly. Be sensitive to any behavioral or
situational cues the person might present.
And remember: In dealing with people in psychological crisis,
you're dealing with people with great vulnerability -- and often,
great motivation to change.
Don't even try to "solve" their problems. Your
role is to provide interpersonal space in which to experience
their feelings with someone else present and the personal perspective
to create new possibilities for themselves.
Important skills in this process
include:
Listening. Don't say what you think so much as reflect
what you hear. If there's pain or uncertainty in a communication,
reflect and acknowledge it. Don't try to minimize it -- or make
it go away. Just get it out in the open.
Giving support. Don't be drawn into the web of helplessness
at the center of the person's problem. Reassure the person that
they're the source of their experience and have the personal
resources to turn it around.
Generating alternatives. Often emotional crises revolve around
"stuck" problem-solving. If a personal problem is the
basis of an emergency, suggest other ways to view or approach
the problem. But don't try to "fix" things or resolve
everything then and there. Simply point out alternative ways
of thinking and acting.
Keeping it here and now. Try to keep things focused in the
present as much as possible. You're not there to psychoanalyze.
You're there to assess and support. Keep the focus on what a
person can do now to re-contextualize his or her situation or
problem.
Other Emotions & Problems
Anxiety and panic aren't the
only emotions that come up in a crisis, but they are common,
and they can unleash other intense emotions.
Anger, depression, even aggression and rage can ride in their
wake, spilling out when normal behavioral controls are impaired.
Fall back on the same basic approach regardless of the emotion
powering the crisis. And remember that the same rules apply:
You're there to create a safe environment and provide emotional
support until the person is able to resume emotional control.
If there's any doubt about whether the person will be able to
resume emotional control, don't hesitate to call EMS or other
emergency services for back-up. People always resume emotional
control, at least to some degree.
But sometimes, they need time and professional help to do it.
|
