San Francisco Mental Health Center: A Therapist’s Notes

SAN FRANCISCO MENTAL HEALTH CENTER

Therapist’s Notes — Trauma/Grief Group

June 11, 2022

New patient C.B. arrived late — he was delayed apparently by intake forms that needed to be filled out, and his insurance information was out of date. He is no longer covered by the City of San Francisco’s Civil Service Health Insurance, effective since the date of his unsuccessful recall election, when it was explained to him that, because he was no longer the district attorney for San Francisco, his coverage had been reset and he would need to reach his deductible.

Patient C.B. grumbled and complained that there were still forms to fill out, and when the attending therapist offered to lend him one of her pens, he quickly took it and put it into his pocket, afterward using one of the pens from the front office, which he had apparently taken as well.

Patient C.B. was asked to acknowledge that this behavior was what we in the group call “antisocial” and “unmindful” and, in the case of my fountain pen in particular, which was a graduation gift from my parents, “theft.”

Patient C.B. laughed and claimed that it wasn’t a big deal, just taking a small thing, and then he immediately went to the corner of the room, squatted down, and defecated next to the small potted palm that the attending therapist had purchased with her own money.

When asked to cease doing so, patient C.B. shrugged and said that it really wasn’t a big deal and that people seem obsessed with these trivial things, like theft and public defecation, when there are so many more important things to worry about, like climate change and racism.

It was interesting to watch the reaction of the other members of the group. Some asked outright whether this activity — the thefts and the public defecation — was all “okay now” and were told emphatically (though in the case of two former members of the San Francisco Board of Education who had also been recently recalled by voters, this came too late) that it was not. Both had by then contributed to the general feral quality of the session.

After several quiet reflective moments and some deep-breathing exercises — made challenging by the unpleasant piles around the potted palm — the session began with new patient C.B. describing his shock and unresolved trauma following his rejection by the voters of San Francisco. He continues to display hostility to any reconciliation with this event and is caught in a spiral of blame-shifting. His intransigence was amplified by the former members of the San Francisco Board of Education, who backslid into the same attitudes and behaviors, which was especially disappointing to the attending therapist because they had all finally reached a place where they understood that the city’s parents were not “wrong” or “racist” or “fascist” to want their children to attend school, and to learn mathematics while there.

Patient C.B. managed to undo months of progress.

Attending therapist engaged in some role-playing exercises to try to get patient C.B. to empathize with voters who supported his recall. This entailed a lot of group activities simulating the general lawlessness of San Francisco’s streets, with some patients acting the part of the “law-abiders” and some the more unconstrained citizens.

The results were mixed. Patient C.B. began to display a slight awareness of the problems some of his former constituents — including, it must be said, the attending therapist — faced day to day in the city, but these glimpses of progress were short-lived when participants switched roles midway through the exercise. At which point patient C.B. somehow managed to defecate once more by the potted palm (memo to Staff — please have the plant removed as soon as possible from the Session Room) and to take possession of the attending therapist’s Apple Watch 7, which had all of her workout stats on it.

As the session ended it was clear that the pathology that patient C.B. and his former colleagues from the San Francisco Board of Education suffer under arises not just from their reflexive progressive politics, which blind them to the realities around them, but from the clear absence in their lives of anyone — at home, in high school, in like-minded social gatherings, in law school — who told them that stealing is wrong and that you shouldn’t just poop anywhere.

So when confronted by the street realities of the social fraying of San Francisco, patient C.B. and others simply did not see what others saw. What voters saw caused them to say, “Yuck.” What patient C.B. saw caused him to say, “We must continue the struggle against heteronormative capitalism.”

The question for the attending therapist — aside from deciding when, or whether, to replace the potted palm — is whether this dissociative mental illness was the root cause of patient C.B.’s progressive politics or it was the progressive politics that somehow caused the dissociative mental illness.

Much to learn.