The Silent Treatment

Frances Smalkowski

Last year, while enjoying a two-week tour of the cultural capitals of China, I was amazed by how at home I felt. Searching my memory for the reasons behind this unexpected state of mind, I suddenly remembered Mr. Loy.

We met more than forty years ago. I was in my third year as a nursing student, doing a semester-long rotation in a large psychiatric hospital. Each student was assigned a patient for the semester, and Mr. Loy was mine. 

We were expected to forge a therapeutic relationship with our patients. This was a tall order; most of our patients were diagnosed with some form of persistent schizophrenia, and few spoke in any coherent fashion, if they spoke at all. 

Mr. Loy was no exception. A short man in his late sixties with raggedly balding hair, he made frequent references to “the machine on my head.” His bald spots marked his attempts to remove the machine. The machine, he said, had commanded him to kill his son. Because he’d actually tried to do so, using a large knife, he’d been hospitalized as criminally insane. 

Before our first meeting, I read Mr. Loy’s medical history. Thanks to the psychiatric nursing education I’d received, I understood about hallucinations and delusions, and on a basic level I felt prepared to talk with him. I made a tentative plan to ask him about his life story while accepting in some way his regular references to the machine. In this fashion, I hoped that I could uncover and affirm some positive aspects of his life and make our time together a beneficial experience for him.

But I wasn’t prepared for the fear that struck me during our first encounter–not fear of someone who’d been labeled as criminally insane but fear of a Chinese person. The neighborhood I’d grown up in, Jamaica, New York, was fairly diverse in race, color and creed, but no Asian people lived there. My images of Asians came from the television shows I’d seen, in which they were depicted, in the usual stereotypical way, as sinister bad guys.

This fear made it hard for me to relate to my new patient, although this probably wouldn’t have been noticeable to anyone else. Someone looking at us would have seen Mr. Loy and me sitting side by side in silence. Occasionally I’d make attempts at conversation. Most of the the topics I broached–his work, his home and family–sparked barely any response.

These long periods of silence, as it turned out, were therapeutic–for me. 

Being outgoing by nature, I found sitting with Mr. Loy difficult, even painful. But, sitting beside him, I could see how irrational my fears were. Unlike the Asians on TV, Mr. Loy projected nothing sinister at all. (I viewed his psychiatric diagnosis as a separate issue entirely.) 

I took comfort that he seemed very accepting of my presence. Even early on, when I would come to the unit for a session, he would stay seated next to me instead of getting up and pacing, and soon he began to smile when he saw me come in. 

His acceptance of me, and my self-awareness, combined to allow me to see what my issues were. Little by little, I felt my fear peel away.

Then, one day when we were planning a St. Patrick’s Day party for the patients, I had a major breakthrough with Mr. Loy.

“Do you have a favorite song?” I asked him.

To my surprise and delight, he answered!

“Yes,” he said.

“What is it?” I asked.

” ‘How Much Is That Doggie In The Window?’ ” he replied. (I was so pleased that he’d spoken that I didn’t think to ask him how this particular tune had become his favorite.)

The day of the party arrived. 

Strumming my guitar, I led the singing–beginning with Mr. Loy’s favorite. He beamed from ear to ear, and I marveled at how little it took to touch his heart.

This seemingly small connection made all the difference. From that time forward, Mr. Loy began to talk more in our one-on-one sessions. He also became noticeably protective of me. During fire drills, for instance, if he saw another patient acting disrespecfully to me, or anywhere nearby, he would frown at the person or point in the time-honored “get lost” gesture.

For me, the highlight of our relationship occurred when my turn came to lead the small-group session. 

We students dreaded this experience. Under our teacher’s eye, we’d sit in a circle with seven or eight patients and do our best to get them to speak about their thoughts and feelings–a nerve-wracking challenge. Halting initiatives by the student were met with awkward silences; and after a few minutes, one by one, our patients would get up and wander off. 

Soon after I opened the session, Mr. Loy stood up. Going to each patient in turn, he pointed and said, “You!” 

To my thrilled astonishment, many of them responded, in words ranging from “You” or “My baby” to “Leave me alone,” “Get out of here” and “Shut up.” The exchanges were brief–and yet, it was the most active group I’d seen in all of my time at the hospital. 

Afterwards, my psychiatric nursing professor was very congratulatory–and at semester’s end, she recommended me for a National Institute of Mental Health traineeship.

It was a sad day for me when, after weeks of preparation, I had to terminate my therapeutic relationship with Mr. Loy. 

I approached him gingerly.

“As I’ve told you before,” I said, “I’m only a student so I only get to stay here a short time–and today is my last day.”

He looked at me and I looked at him, not knowing what else to say–sensing our bond, knowing that he had so little company, if any, and feeling guilty that I was deserting an old friend.

To this day, I have him to thank for helping me through the opening stages of my successful thirty-five-year psychiatric nursing career as a clinical specialist and private-practice therapist. 

Visiting Mr. Loy’s homeland, I felt his spirit with me in a special way, and I had a sense that he understood the gratitude I’ve felt to him all these years.

It made me realize that we didn’t say goodbye, only so long. Such treasured encounters are never really forgotten. Their imprints in our hearts and minds remain, a testament to the powerful–and mutual–bonds that form between ourselves and our patients whenever healing takes place.

About the author:

S. Frances Smalkowski is director of pastoral care at Pope John Paul II Care and Rehabilitation Center in Danbury, CT, and maintains a part-time private practice in Monroe. “I’ve always enjoyed writing, but my Catholic University of America freshman English teacher, Lt. Col. Howard T. Wickert, got me interested in being more serious about it. My only regret was that when I published my poetry book, Panning For Gold, in 2005, he had already died. As a member of a religious congregation, Sisters of the Holy Family of Nazareth, since 1960, I’m often involved in writing for our publications.”

Story editor:

Diane Guernsey