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Thursday, July 21, 2011

7 - Mental Health

Transcript of Mental Health Class
12:03 Introduction
12:07 Concept of Havatar
12:10 Four types of mental health
12:11 person fine/avatar fine
12:15 person fine/avatar suffering
12:31 inside Sl resource
12:33 predators disguised as professionals
12:37 person suffering/avatar suffering
[12:03]  Zenith Sorbet: Now today's class is about dealing with mental health issues. As always our clases are informal and discussion based so if you have a question or comment just do * or raise a hand.
[12:04]  Zenith Sorbet: It is an unfortunate fact of life but some of the people in SL have mental health issues that as Gorean physicians you may encounter and have to deal with.
[12:05]  Zenith Sorbet: A fairly large percentage of the population at large in the real world has or have had or will have some form of mental health issues.
[12:05]  Zenith Sorbet: I think we see a bit more in SL than in RL for a couple of reasons.
[12:06]  Zenith Sorbet: Sometimes people with RL mental health issues can't work and have more time to be in SL.
[12:07]  Zenith Sorbet: Also for some groups, doctors and therapists actively recommend SL to patients as a way to improve themselves. Many of those with autism, for example, find SL extremely beneficial.
[12:07]  Zenith Sorbet: One of the down sides to this is that since we present in rp as physicians, some people come to us expecting "treatment" for their mental health problems.
[12:07]  Zenith Sorbet: This class is about four broad categories of mental health you may encounter as I see them.
[12:07]  Zenith Sorbet: First I would like to introduce the concept of the "havatar".
[12:08]  Zenith Sorbet: The "havatar" was a concept first proposed by Bruce Dalmer and the term was coined by Dr. Richard Gordon and it has to do with the idea that the human running the computer and the avatar are together a functioning unit.
[12:09]  Zenith Sorbet: The human is affected by the avatar and the avatar is affected by the human.
[12:09]  Zenith Sorbet: How many of you have ever felt cold because your avatar was in a cold place for example?
[12:09]  Zenith Sorbet: Or, sexual arousal because your avatar was doing something sexy is another example.
[12:10]  Zenith Sorbet: Anyway it is important to recall that you are always dealing with not just an avatar but a havatar.
[12:10]  Zenith Sorbet: There are generally four broad categories of mental health you will encounter. Please bear in mind sometimes people will overlap between one or the other and these are not fixed. They are just a useful tool to allow you think about and understand what might be going on so you can react appropriately.
[12:11]  Zenith Sorbet: These are:
1) person fine/avatar fine
2) person fine/avatar suffering
3) person suffering/avatar fine
4) person suffering/avatar suffering
[12:11]  Zenith Sorbet: Let's begin with the first, one person fine/avatar fine, because it is the easiest and the most common. Examples of this would be a slave exam.
[12:11]  Zenith Sorbet: or your city had a battle and someone was injured in role play.
[12:11]  Zenith Sorbet: These people come into your infirmary, you treat them, they leave, usually saying thank you.
[12:11]  Zenith Sorbet: We love them. They love us. We're all happy.
[12:12]  Zenith Sorbet: If all our patients were 1) person fine/avatar fine our job would be so easy.
[12:12]  Zenith Sorbet: Unfortunately though they are the majority, they are often not the ones that stand out.
[12:12]  Zenith Sorbet: So let's move to the next category 2) person fine/avatar suffering.
[12:13]  Zenith Sorbet: The person behind the computer is fine mentally but the avatar is having some issues. This is very common when rp is boring and the physician is handy
[12:13]  Zenith Sorbet: It can also be quite common with slaves when the master is neglectful or no one else is around.
[12:14]  Zenith Sorbet: There really is nothing at all wrong with giving an avatar some attention and sending them on their way.
[12:14]  Zenith Sorbet: common things you might see are falls, sprains.
[12:14]  Zenith Sorbet: ate something yucky and got sick
[12:14]  Zenith Sorbet: They are very reasonable and if you don't have time to rp just then you can politely send them on their way.
[12:15]  Zenith Sorbet: I enjoy them actually.
[12:15]  Zenith Sorbet: Better for me than sitting around an empty infirmary sorting inventory.
[12:15]  Zenith Sorbet: So now category 3) person suffering/avatar fine
[12:15]  Zenith Sorbet: This one can be quite tricky.
[12:15]  Zenith Sorbet: You often get other avatars bringing an avatar in for care, with comments "she's crying for no reason" "she has never acted this way before.
[12:17]  Zenith Sorbet: Sometimes, behind the scenes, you get someone who has been coping very well and then gets their meds changed. Suddenly they come unglued.
[12:18]  Zenith Sorbet: Or you get someone who was severely sexually abused in their past and they came into Gor unconsciously seeking to work through that and are suddenly flooded with memories they didn't expect to deal with.
[12:18]  Zenith Sorbet: Or you get a character whose been fine in rp all along and suddenly they are biting people's heads off or acting irrationally.
[12:18]  Zenith Sorbet: These ones are best dealt with OOC in private IM quietly.
[12:19]  Zenith Sorbet: "Are you okay?"
[12:19]  Zenith Sorbet: "Is something going on in your life right now?"
[12:19]  Zenith Sorbet: "Can I help?"
[12:19]  Zenith Sorbet: Sometimes you can just listen and that's all they need. Sometimes you suddenly find yourself in way over your head and the person is considering committing suicide.
[12:20]  Zenith Sorbet: I recall one Gorean "physician" tell me she had a situation where a slave girl came asking for herbs for inducing abortion.
[12:21]  Zenith Sorbet: It took a bit for her to know what was going on but she discovered she was actually dealing with a 13 year old girl who had snuck into SL was being sexually abused by her father and was pregnant by him.
[12:22]  Zenith Sorbet: Yes so what do you do then?
[12:22]  Zenith Sorbet: Well first of all if you are dealing with a situation like that you DO NOT try to treat it yourself.
[12:23]  Zenith Sorbet: You're a pretend physician in a pretend role play world and you have no training.
[12:23]  Zenith Sorbet: Even a RL clinical psychologist, can't really start treating an unknown avatar.
[12:25]  Zenith Sorbet: So the avatar walks in seeming perfectly normal and then you discover the person behind the avatar is very messed up.
[12:25]  Zenith Sorbet: Now in those situation DO NOT treat.
[12:26]  Zenith Sorbet: See if you can get a location for the person, a city or a state.
[12:26]  Zenith Sorbet: And then you use your webrowser and you find them professional help in their location.
[12:26]  Zenith Sorbet: Every major city has, for example a suicide prevention hotline. A kids phone helpline.
[12:27]  Zenith Sorbet: You ask them to get up while their avatar is still functioning and talking to you, get the phone and call for help.
[12:28]  Zenith Sorbet: In the case of the abused girl, the Gorean physician had the girl call 911 and police came and the girl was rescued.
[12:28]  Zenith Sorbet: Never ever ever try to to handle these situations on your own.
[12:28]  Zenith Sorbet: You'd think I wouldn't have to tell you this.
[12:28]  Zenith Sorbet: You'd think it would be obvious, but it isn't.
[12:29]  Zenith Sorbet: However they come to you for help and you want to help, so you do what you can.
[12:29]  Zenith Sorbet: Just try to react as if you just were chatting in a supermarket line and someone said that. What would you do?
[12:29]  Zenith Sorbet: You might just save a life.
Inserted valuable commentary from later in class
[13:04]  visiting physician: if it happens to you, try not to get too involved. fact is in over 90% of the cases you won't be able to find out anything about the person you're speaking to.
[13:04]  Zenith Sorbet: yes
[13:04]  visiting physician: it's very difficult to get them to seek rl help
[13:04]  Zenith Sorbet: How true sadly
[13:05]  visiting physician: sl is so much easier because anyone can stay totally anonymous
[13:05]  Zenith Sorbet: And people often work up to asking for help in stages so even if it seems like you got nowhere this time, the next person might.
[13:06]  Zenith Sorbet: I agree, you have to let some things go.
[13:06]  visiting physician: so don't feel it's your fault if you can't do anything. it's not. usually someone who doesn't have an exact plan how and where to do it the suicidality is questionable. ppl who really plan to kill themselves usually stay quiet
[13:06]  Zenith Sorbet: nods
[13:07]  visiting physician: I don't want to get too far into it. just saying that it's likely the person will log out at some point and you never hear from them again
[13:07]  visiting physician: it's not your fault if that happens.
[12:29]  Zenith Sorbet: Any questions on that one?
[12:29]  Student #2: raises her hand
[12:30]  Zenith Sorbet: yes?
[12:30]  Student #2: does it happen very often ?
[12:30]  Zenith Sorbet: No. Fortunately not.
[12:30]  Zenith Sorbet: I have encountered it myself only once.
[12:30]  Zenith Sorbet: In my case a slave was rping she was having nightmares of being sexually abused by Earth men. I was able to refer her to appropriate outside help.
[12:31]  Zenith Sorbet: Now there is an inside SL resource you should be aware of.
[12:32]  Zenith Sorbet: This is to Avalon Birk's mental wellness center.
[12:32]  Zenith Sorbet: They are professionals here, they can offer professional health.
[12:32]  Zenith Sorbet: They have a proper intake process and they couple in SL help with real out of SL help.
[12:32] I will now add two cautionary notes. First I have met one physician who had someone pretend to be ready to commit suicide as a joke. He called in police and they arrived to find a prankster on the other end. Some people have a sick sense of humor.
[12:33]  Zenith Sorbet: Second cautionary note: There is one other type of professional in SL you may encounter and if you do go into full red alert and run like hell.
[12:33]  Zenith Sorbet: This is someone who is running around Gor and they tell you they are RL mental health professionals in here to help slave girls.
[12:33]  Zenith Sorbet: 99% of them are predators.
[12:34]  Zenith Sorbet: RL professionals DO NOT come into SL Gor looking for clients.
[12:34]  Zenith Sorbet: At best a RL professional will say they are such a person and can refer to outside help. However they do not seek clients in SL.
[12:35]  Zenith Sorbet: Some predators like to pass themselves off as Green, look for messed up people and mess them up even more. So you have been warned.
[12:37]  Zenith Sorbet: Another thing that happens is you may encounter what I think of as a do gooder, someone who isn't predatory just in over their depth, trying to "help" a girl by being a friend.
[12:37]  Zenith Sorbet: Those ones you help by helping them understand somethings are best left to a professional.
[12:37]  Zenith Sorbet: I will now move to the final type.
[12:38]  Zenith Sorbet: 4) person suffering/avatar suffering
[12:38]  Zenith Sorbet: You can spot them because you will see the following things popping up.
[12:38]  Zenith Sorbet: extremely demanding, highly critical, whining, demanding to be taken seriously, going from physician to physician
[12:38]  Zenith Sorbet: They have accident after accident, you can't do anything right
[12:39]  Zenith Sorbet: everyone hates their avatar and avoids them and you can't get through to them OOC.
[12:39]  Zenith Sorbet: Now before you write them off as mental cases just recall one other thing it could be.
[12:40]  Zenith Sorbet: People come into SL with different motivations.
[12:40]  Zenith Sorbet: Some people are very serious and some are less serious.
[12:40]  Zenith Sorbet: So I don't mind if someone says to me "Hey, I have to get my kids to school, can we set your broken ankle tomorrow?
[12:41]  Zenith Sorbet: I am a role player storyliner type.
[12:41]  Zenith Sorbet: Some people in here are so intrinsically involved in their role play that they can't step back easily and detach so to them you're insulting their role play, you are bad game player.
[12:41]  Zenith Sorbet: Why can't you understand how important it is to them?
[12:42]  Zenith Sorbet: I don't think those ones are really mentally ill as in my fourth category.
[12:42]  Zenith Sorbet: In that case you have to try to sense it and rp your way out.
[12:42]  Zenith Sorbet: You also get to know who in your city that might be.
[12:43]  Zenith Sorbet: So you rp "I have to deal with a warrior injured in sparring! I'll send my apprentice." and you leave fast, instead of saying your kids need to be picked up from school."
[12:43]  Zenith Sorbet: but 4) person messed up/avatar messed up
[12:44]  Zenith Sorbet: usually you ask them about if they are okay OOC and they come back and reply "Well my psychiatrist already has me on meds".
[12:44]  Zenith Sorbet: So you know this person is already "in care".
[12:45]  Student #2 where should we put drama monsters? Is it mentally ill person ?
[12:45]  Zenith Sorbet: well drama monsters who are not mentally ill can be handled by an OOC "Um you are using too much of the infirmary resources." or a direct confrontation, or you have to rp your way out.
[12:46]  Zenith Sorbet: A drama monster may or may not be mentally ill. They may be just nasty people.
[12:46]  Student #3: come across a few of them
[12:46]  Zenith Sorbet: Sometimes people don't fit nicely into my little 4X4 card categories. The situtations and types over lap.
[12:46]  Zenith Sorbet: You're not really sure what you are dealing with.
[12:47]  Zenith Sorbet: Again, it is not your job to fix the drama queen or to fix the mentally ill person.
[12:47]  Zenith Sorbet: Your job is to provide good rp and rp care in the infirmary.
[12:47]  Zenith Sorbet: You have a right to a life, you have a right to leave your computer to go pick up your kids
[12:48]  Zenith Sorbet: You have a right to say enough is enough.
[12:48]  Zenith Sorbet: It is your infirmary and you can set a limit.
[12:48]  Zenith Sorbet: If you are dealing with 4) person suffering/avatar suffering you have to set limits.
[12:49]  Zenith Sorbet: These can be whatever you are comfortable with. It can be so extreme that you ask them to leave the infirmary.
[12:49]  Zenith Sorbet: You can say they can only come for treatment by appointment.
[12:49]  Zenith Sorbet: Or only when no one else is being treated.
[12:49]  Zenith Sorbet: Or no treatment while I am teaching a class.
[12:50]  Zenith Sorbet: You soon get to know the drama monsters and can spot them coming.
[12:50]  Zenith Sorbet: You get the sensation of a large football hitting your gut when they walk in the door.
[12:51]  Zenith Sorbet: Now you have a right as a physician to call on a warrior to escort someone out of the infirmary.
[12:51]  Zenith Sorbet: I have done that.
[12:52]  Zenith Sorbet: The woman was so difficult she refused to go and the warrior ended up drawing his sword, capping her and dragging her away bound. That worked.
[much laughter in class]
[12:52]  Zenith Sorbet: Obviously you don't go straight to calling a warrior.
[12:52]  Zenith Sorbet: You work up to it slowly. Stepwise, use common sense.
[12:53]  Zenith Sorbet: The other thing you can do is stop all their fun dead in its tracks by calling for a moderator.
[12:53]  Zenith Sorbet: Say this rp is out of control. I want a moderator.
[12:54]  Zenith Sorbet: Then when the moderator arrives you can say "Look I treated this woman's broken ankle last week, the week before that, the week before that and today she just fell again and broke her ankle again. I think this rp stinks.
[12:54]  Zenith Sorbet: We have several who are moderators. Someone is always on who is a moderator. You can go to the citizens and property and ask IM for whoever the moderator is who is on.
[12:55]  Zenith Sorbet: The important point is when you are dealing with highly difficult people you have rights and you have tools.
[12:55]  Zenith Sorbet: If you have tried every way possible to be reasonable and they are simply NOT reasonable you have the right to set limits.
[12:55]  Zenith Sorbet: I'll give you one example. I had a delivery with a difficult patient. I had rp'd everything was normal. The difficult patient came in a few hours later and said she had a fever.
[12:56]  Zenith Sorbet: I replied right back "You do not have a fever, you feel like you have a fever due to hormonal fluctuations."
[12:56]  visiting physician: brilliant
[12:56]  Zenith Sorbet: "There is nothing wrong with you. Please excuse me while I attend the injured warrior."
[12:57]  Zenith Sorbet: This approach spares them the issue of a confrontation but defuses their rp entirely.
[12:57]  Zenith Sorbet: They very soon get to know you and they go away and never come back to you.
[12:57]  Zenith Sorbet: I am very unpopular with drama monsters and hypochondriacs.
[12:58]  Zenith Sorbet: Okay so we can pause now and ask for questions before we close.
[13:01]  Zenith Sorbet: Practical for this class is you treat one of these difficult demanding types and show me a transcript or give me a report.

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