You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Anthony was a large white man, tall and broad, who often tried to hide his height through a hunched-over gait. His large form wasn't fully appreciated until he struggled to situate his frame into the small confines of the clinic's furniture. Anthony had come to our publicly funded community mental health clinic because he lived in almost complete isolation. He had no friends, and spent much of his free time on the Internet looking up conspiracy theories. Living in a tenuous housing situation in a public housing complex, Anthony survived on the minimal welfare check provided by the county. The housing program provided a social worker and the welfare agency brought in a case manager.
Anthony's stature dominated my first impression. He seemed adrift, disconnected, lost in his own thoughts. His eyes wandered, rarely making contact with me, and he talked in a slow, monotone voice, with no use for pauses or silence. His methodical tone drained the life out of the room and out of me. I found myself bored and tired during our hour together, and our work moved slowly. Sessions felt confusing and disparate, and topics became fixed on two points: bland descriptions of daily tasks and lunch spots, or violent fantasies and conspiracy theories. The chasm between these topics was confounded by the speed at which Anthony shifted between them. He became much more animated when discussing his violent stories, and I struggled to recalibrate to the difference in tone and affect. It often felt as if I were listening to a TV show. If I could fight through the fog and offer a comment or thought, he would respond by shrugging it off, as if I were a fly buzzing around his ear that he needed to swat away.
As our work continued, I found brief pathways into his emotional world, but I had to learn how to be an effective fly, buzzing near him at the right time to avoid his swats. The dull stories of everyday life gradually took up less room, while his violent fantasies began to expand, containing