Sermon prep: storytelling.
Jun. 9th, 2010 09:17 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
rivkaI want to tell you about a guy I used to know. I'll call him Ray.
Ray was a gay man who grew up in one of the rougher neighborhoods of inner-city Baltimore. From his earliest childhood, he told me, his father and brothers rejected and abused him because they saw him as effeminate. He grew up thinking that at the core of his being was a horrible flaw, and - because he was also a devout conservative Christian - an unforgivable sin. When I met Ray, he couldn't ever remember a time that he hadn't thought he was worthless. He didn't want to live. He didn't think he deserved to live.
So, lucky Ray: he wasn't going to live. He was dying of AIDS when I met him.
This was a few years after protease inhibitors were introduced, and there were several effective drugs to treat HIV. Ray had been on all of them. But because he didn't really want to live, he'd taken them halfheartedly - skipping doses, coming on and off his meds. His HIV was resistant to every known treatment. When I met him, his T-cell count was four. (You probably have a T-cell count of more than 1000.) His doctor had run out of options for him, and was focused only on controlling his considerable pain and trying to prevent opportunistic infections. Ray was inevitably on the way to getting his death wish.
Then I came along, and whether that was good or bad luck for Ray becomes a complex question. I was a new intern in clinical psychology. Ray's doctor sent him to me for therapy. I don't think any of us thought it would actually work, but something funny happened: Ray and I clicked, and he kept coming back and coming back. Slowly, imperceptibly, he started getting better. He started to make peace with himself and his past. He started to see himself as a person who had value. And - this is the ironic part - he started wanting to live. Therapy changed him from a dying man who was glad to die to a dying man who didn't want to die. Was that a good thing? Or a bad thing?
An interesting thing happened, as we continued to work. Ray's doctor had given him six months to live, and yet six months passed and Ray lived on. He was weak and frail. He suffered from nerve damage, a toxic effect of old HIV medicines, which was so painful that he had to wear a transdermal patch that delivered narcotics through his skin, 24 hours a day. But somehow he managed to avoid the hundreds of infections that can carry off a person with advanced AIDS. The flesh melted away from his bones, but his eyes remained bright and engaged. And he told me: "I never knew I could feel this way - at peace, and really like myself." Ray lived for almost a year longer than his doctor predicted. Scared, sometimes, as his death approached. A little sad that he hadn't come to this point of loving and accepting himself before it was too late to save his life. But mostly happy and at peace.
Ray asked me once what the point of our therapy was, since he was dying anyway. Why should he work so hard to come to terms with himself? What difference would it make in the end? At that time I didn't have an answer. We struggled to look for one together.
He was a deeply religious man. He had a very literal belief in an afterlife that involved angel wings, golden streets, pearly gates. It helped him to think that therapy was preparing his soul to be better suited to heaven. I couldn't believe in Ray's version of heaven, so it wasn't that easy for me. But I did come to believe that Ray's reconciliation with himself at the end of his life mattered. That the work he did on his heart and mind and spirit was not wasted. That it made a profound difference - to Ray, to the people who knew him, and to the world - for Ray to die with peace and acceptance, not hopelessness and bitterness.
When I met him, Ray would have been a perfect candidate for assisted suicide. Terminal illness, no treatments, significant pain and suffering, no sense that living further would be of the slightest value. And frankly, he was as lousy a candidate for psychotherapy as he was for further medical therapy. It would have been what he wanted. And it would have been a profound loss of his potential, potential that no one could have guessed at.
Ray was a gay man who grew up in one of the rougher neighborhoods of inner-city Baltimore. From his earliest childhood, he told me, his father and brothers rejected and abused him because they saw him as effeminate. He grew up thinking that at the core of his being was a horrible flaw, and - because he was also a devout conservative Christian - an unforgivable sin. When I met Ray, he couldn't ever remember a time that he hadn't thought he was worthless. He didn't want to live. He didn't think he deserved to live.
So, lucky Ray: he wasn't going to live. He was dying of AIDS when I met him.
This was a few years after protease inhibitors were introduced, and there were several effective drugs to treat HIV. Ray had been on all of them. But because he didn't really want to live, he'd taken them halfheartedly - skipping doses, coming on and off his meds. His HIV was resistant to every known treatment. When I met him, his T-cell count was four. (You probably have a T-cell count of more than 1000.) His doctor had run out of options for him, and was focused only on controlling his considerable pain and trying to prevent opportunistic infections. Ray was inevitably on the way to getting his death wish.
Then I came along, and whether that was good or bad luck for Ray becomes a complex question. I was a new intern in clinical psychology. Ray's doctor sent him to me for therapy. I don't think any of us thought it would actually work, but something funny happened: Ray and I clicked, and he kept coming back and coming back. Slowly, imperceptibly, he started getting better. He started to make peace with himself and his past. He started to see himself as a person who had value. And - this is the ironic part - he started wanting to live. Therapy changed him from a dying man who was glad to die to a dying man who didn't want to die. Was that a good thing? Or a bad thing?
An interesting thing happened, as we continued to work. Ray's doctor had given him six months to live, and yet six months passed and Ray lived on. He was weak and frail. He suffered from nerve damage, a toxic effect of old HIV medicines, which was so painful that he had to wear a transdermal patch that delivered narcotics through his skin, 24 hours a day. But somehow he managed to avoid the hundreds of infections that can carry off a person with advanced AIDS. The flesh melted away from his bones, but his eyes remained bright and engaged. And he told me: "I never knew I could feel this way - at peace, and really like myself." Ray lived for almost a year longer than his doctor predicted. Scared, sometimes, as his death approached. A little sad that he hadn't come to this point of loving and accepting himself before it was too late to save his life. But mostly happy and at peace.
Ray asked me once what the point of our therapy was, since he was dying anyway. Why should he work so hard to come to terms with himself? What difference would it make in the end? At that time I didn't have an answer. We struggled to look for one together.
He was a deeply religious man. He had a very literal belief in an afterlife that involved angel wings, golden streets, pearly gates. It helped him to think that therapy was preparing his soul to be better suited to heaven. I couldn't believe in Ray's version of heaven, so it wasn't that easy for me. But I did come to believe that Ray's reconciliation with himself at the end of his life mattered. That the work he did on his heart and mind and spirit was not wasted. That it made a profound difference - to Ray, to the people who knew him, and to the world - for Ray to die with peace and acceptance, not hopelessness and bitterness.
When I met him, Ray would have been a perfect candidate for assisted suicide. Terminal illness, no treatments, significant pain and suffering, no sense that living further would be of the slightest value. And frankly, he was as lousy a candidate for psychotherapy as he was for further medical therapy. It would have been what he wanted. And it would have been a profound loss of his potential, potential that no one could have guessed at.
