7: Romeo and Juliet: Outcomes
Now let me say something about the participants’ later behavior. I’m not saying that being in the group caused favorable outcomes. There were lots of other factors. I’m just observing parallels.
I mentioned already the man I gave the part of Tybalt to. Another male also had the problem of temper tantrums, threats, and occasionally striking out at someone. He joked with me about Tybalt, calling me by that name, for example. I did my best to play-act the part. His behavior improved and he had a stable discharge.
One group member was a woman who usually speaks so indistinctly and quickly that it is difficult to make out what she is saying. One night nobody wanted to play Romeo--the guy who’d done a great job the week before refused to come out of his room. This woman volunteered, to my alarm. But no, she read Romeo’s lines clearly and with feeling. She fell into her usual way of speaking only if Romeo had a speech longer than 3 or 4 lines. Fortunately I had edited down many of them. She said later that she’d been in plays in high school (thirty years earlier). She showed quite a bit of interest in literature and art for several months. After a session on art, for example, she could name her favorite painting by Leonardo da Vinci for weeks.
Another woman read so slowly that the man whose lines came next got bored and started playing solitaire. Predictably, when his turn came he couldn’t find his place. He blamed me and stormed out of the room. But he was back the next week, thoroughly enjoying his role as Mercutio. He himself liked to speak in riddles and flights of fancy, which he didn’t bother to distinguish from reality. He, too, was interested in art and literature for a while—he especially liked Van Gogh. For whatever reason, his speech and thinking improved dramatically over the next few months. I hypothesize that reading Mercutio might have helped him to form a separation between himself and his own cryptic and imaginative remarks, which now came from a character he was creating rather than himself as the actor. He had a stable discharge.
Perhaps the most encouraging follow-up is that of a group member who had a long history of cutting on herself and self-neglect. After hearing Romeo’s predicament in the first scene, she talked to me privately about her own depression, of her husband dying and that there was no hope of anyone replacing him, she was so now fat and ugly. She did a lot of processing of this with other staff as well. Later she agreed to read “just a few lines” of Juliet, but in fact finished the scene. Afterwards she told staff, “I enjoyed it, and I’m just a patient.” She also asked me, “Am I Juliet?” She meant it literally, Juliet as opposed to the person she actually was. I think there was a metaphorical component as well. Later she said, “I took Juliet personally.” She also asked the psychiatrist if he could give her “a lethal dose.” I assured the treatment team that we did not read the suicide scenes, or anything about the poison Romeo got, although I did summarize the ending and discuss alternatives. She probably knew the play already, he said. Yet she never tried to cut on herself again. Moreover, she started a special relationship with a male resident of the facility—-a rather dramatic example of the “principle of opposite action” in dealing with depression and negative self-talk. Her mood improved, and she had a stable discharge. Ending the relationship did not seem to bother her.
The most valuable thing about using the play was that besides being fun and non-threatening, it provided a bridge between the theory they learned in DBT and the times in their life they needed it, when they were overwhelmed by strong emotion. Even learning concrete skills is just theory until you incorporate them into your life.
There is such a thing as “state-dependent learning.” That is, when you’re in a certain emotional situation, you remember what you learned in that same emotional situation earlier. If you learned DBT in a non-stressful discussion, you probably won’t remember it when you’re in the grips of an emotion. You will remember it later when you are processing the incident, but that, too, is a time when you’re not in the emotion’s grips, and so equally problematic for the future. But when you play the part of someone in the grips of that emotion, then you are partly in that emotional state yourself, and perhaps you will remember what else was going on at that time. That to me is the value of reading scenes like those in Romeo and Juliet.
Let me add that watching a video of the same scenes is not at all the same thing. In hopes of further reinforcement of the lessons learned, I played the same scenes in the de Caprio video of the play. The class was all totally “numbed out,” not able to move toward a discussion of what they saw at all. All they wanted to do was keep watching! That taught me something, too. It might have been the same if they had been watching other people perform the scenes.
Finally, let me caution that putting on plays with the severely mentally ill is not something to undertake without knowing the individuals first and doing a lot of follow-up afterwards. It is not something to do once a week and then leave. Integrating the material is hard. It's sometimes hard for participants to disengage from the characters, and even to know that they are not them in real life. Emotional situations in the past will come up, great material to help them process but hard to contain if it is not processed well. There may even be trouble with the management team responsible for their care. There are risks, but with proper awareness they are well worth the benefit that may come out of it.
I mentioned already the man I gave the part of Tybalt to. Another male also had the problem of temper tantrums, threats, and occasionally striking out at someone. He joked with me about Tybalt, calling me by that name, for example. I did my best to play-act the part. His behavior improved and he had a stable discharge.
One group member was a woman who usually speaks so indistinctly and quickly that it is difficult to make out what she is saying. One night nobody wanted to play Romeo--the guy who’d done a great job the week before refused to come out of his room. This woman volunteered, to my alarm. But no, she read Romeo’s lines clearly and with feeling. She fell into her usual way of speaking only if Romeo had a speech longer than 3 or 4 lines. Fortunately I had edited down many of them. She said later that she’d been in plays in high school (thirty years earlier). She showed quite a bit of interest in literature and art for several months. After a session on art, for example, she could name her favorite painting by Leonardo da Vinci for weeks.
Another woman read so slowly that the man whose lines came next got bored and started playing solitaire. Predictably, when his turn came he couldn’t find his place. He blamed me and stormed out of the room. But he was back the next week, thoroughly enjoying his role as Mercutio. He himself liked to speak in riddles and flights of fancy, which he didn’t bother to distinguish from reality. He, too, was interested in art and literature for a while—he especially liked Van Gogh. For whatever reason, his speech and thinking improved dramatically over the next few months. I hypothesize that reading Mercutio might have helped him to form a separation between himself and his own cryptic and imaginative remarks, which now came from a character he was creating rather than himself as the actor. He had a stable discharge.
Perhaps the most encouraging follow-up is that of a group member who had a long history of cutting on herself and self-neglect. After hearing Romeo’s predicament in the first scene, she talked to me privately about her own depression, of her husband dying and that there was no hope of anyone replacing him, she was so now fat and ugly. She did a lot of processing of this with other staff as well. Later she agreed to read “just a few lines” of Juliet, but in fact finished the scene. Afterwards she told staff, “I enjoyed it, and I’m just a patient.” She also asked me, “Am I Juliet?” She meant it literally, Juliet as opposed to the person she actually was. I think there was a metaphorical component as well. Later she said, “I took Juliet personally.” She also asked the psychiatrist if he could give her “a lethal dose.” I assured the treatment team that we did not read the suicide scenes, or anything about the poison Romeo got, although I did summarize the ending and discuss alternatives. She probably knew the play already, he said. Yet she never tried to cut on herself again. Moreover, she started a special relationship with a male resident of the facility—-a rather dramatic example of the “principle of opposite action” in dealing with depression and negative self-talk. Her mood improved, and she had a stable discharge. Ending the relationship did not seem to bother her.
The most valuable thing about using the play was that besides being fun and non-threatening, it provided a bridge between the theory they learned in DBT and the times in their life they needed it, when they were overwhelmed by strong emotion. Even learning concrete skills is just theory until you incorporate them into your life.
There is such a thing as “state-dependent learning.” That is, when you’re in a certain emotional situation, you remember what you learned in that same emotional situation earlier. If you learned DBT in a non-stressful discussion, you probably won’t remember it when you’re in the grips of an emotion. You will remember it later when you are processing the incident, but that, too, is a time when you’re not in the emotion’s grips, and so equally problematic for the future. But when you play the part of someone in the grips of that emotion, then you are partly in that emotional state yourself, and perhaps you will remember what else was going on at that time. That to me is the value of reading scenes like those in Romeo and Juliet.
Let me add that watching a video of the same scenes is not at all the same thing. In hopes of further reinforcement of the lessons learned, I played the same scenes in the de Caprio video of the play. The class was all totally “numbed out,” not able to move toward a discussion of what they saw at all. All they wanted to do was keep watching! That taught me something, too. It might have been the same if they had been watching other people perform the scenes.
Finally, let me caution that putting on plays with the severely mentally ill is not something to undertake without knowing the individuals first and doing a lot of follow-up afterwards. It is not something to do once a week and then leave. Integrating the material is hard. It's sometimes hard for participants to disengage from the characters, and even to know that they are not them in real life. Emotional situations in the past will come up, great material to help them process but hard to contain if it is not processed well. There may even be trouble with the management team responsible for their care. There are risks, but with proper awareness they are well worth the benefit that may come out of it.
posted by Michael S Howard at 3:07 PM
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