NARRATOR: Ronke is a young woman
who enrolled in a coordinated
specialty care program about a month ago.
Last week, her primary clinician and psychiatrist met
to discuss a dilemma they have encountered in her care.
- Ronke said she was unhappy
with the medication she was prescribed in the hospital,
that she was thinking about stopping them,
that she didn't feel like herself,
that she felt disconnected, lost.
- I wonder if she sees this as a spiritual experience.
- What do you mean?
- She was upset that the hospital staff
took her Bible away,
so I contacted the inpatient unit.
They found it,
and I gave it back to her at our last session
and her face just lit up.
Then I asked her how she feels about what
she's been going through, but she came back
with a question I didn't quite expect.
- Do you believe in God?
Then how can you understand what I'm going through
if you don't believe in God?
- I think we need to keep encouraging her
to share her perspective with us.
When I see Ronke, I'd like to discuss
what she meant by feeling lost, and explore what matters to her.
- I'm gonna keep exploring her cultural formulation
and what role religion plays in her life,
but I think it's important that I answer her question
about my own spirituality.
This could be our sliding door moment.
It may be just what she needs to hear.
RONKE: What I'm experiencing is not psychosis.
It's a spiritual experience.
DR. JOHNSON: I don't think you're going through
a spiritual experience, Ronke.
This is all a part of your illness.
- So, how was your session with Ronke yesterday?
- We talked about what matters most to her.
- I mean, I like fashion and designing, sewing.
PSYCHIATRIST: I asked if there was anything else
that was important to her.
- My faith.
My faith is important to me.
- I asked if these were things she wanted to pursue.
She didn't know, but she smiled.
- Okay.
I think I'm starting to understand her concerns
around the medication.
I told her that I am a spiritual person.
- Good.
Did she say anything more about how she sees things?
- She did.
- It's a spiritual experience.
A positive, spiritual experience,
and I don't think it was psychosis
or any other mental illness.
- She said, "It's a spiritual experience.
It's not psychosis."
But when she shared this with the psychiatrist
at the hospital, she felt totally invalidated by her.
- So, Dr. Johnson, I was feeling some type of way
and there's one verse that really spoke to me
and I just got this burst of energy,
this immense energy, and it made it so clear.
What I'm experiencing is not psychosis.
It's a spiritual experience.
DR. JOHNSON: I don't think you're going through
a spiritual experience, Ronke.
- What do you think it is?
DR. JOHNSON: This is all a part of your illness.
This is religious, grandiose thinking.
Right now, you're experiencing delusions,
and you're in denial.
PSYCHIATRIST: Wow, that's awful.
I'll need to focus on gaining her trust.
Did she say anything else?
- Well, she said why she didn't like taking the meds.
They're making her lose her connection to God
and finding her purpose more difficult.
- That would make sense
if her faith is so important to her.
- Then she looked scared and she said...
- You don't believe me, do you?
PSYCHIATRIST: What did you say?
- I said, "Ronke, I believe what you're telling me,
that you feel you're having a spiritual experience,
and to me, that is your truth, but in my opinion,
you are also experiencing some mental health issues."
I don't see it as an either-or situation.
It could be both.
- So where did you leave things with her?
- Well, she doesn't agree with the word "psychosis"
but she's open to talking about the meds.
She just wants to feel better and to find her purpose.
- That's great.
- I asked her if she'd be comfortable
talking to you about this.
She said she would as long as I was there, too.
- Okay. Let's meet with her
and think about what each of us can do
to help her support her goals.
- Yeah, we need to make it clear
that we respect her religious experience.
We may disagree on the psychosis
but we just wanna help her feel better
and to find her purpose.
- We can use a couple of engagement tools
to help her think about
how medications can support her goals
and think about the pros and cons
of staying on, changing, or going off medications.
- And maybe remind her
that our supported education and employment specialist
can connect her to resources.
- I'm so glad we had a chance to talk about Ronke's concerns.
- Yeah, me, too.
[video fades out]