Print This Article

by Paul Creeden

"I chose the path of humanism, as I understood it then, the path back to psychiatric hospitals where I could prevent these atrocities from happening on my watch.

I consider my practice of humanism and my practice of professional nursing two tightly intertwined strands of my life. Speaking plainly is a skill in caring for people in crisis. Therefore, I explain and understand my humanism less formally, scientifically or academically. I consider myself a plain-speaking humanist. Why nursing? Well, I attended dental school for a while after college in 1970. Nightmares about molars and flapping gums ensued. I had been on track to attend medical school in college, but a traumatic encounter with viciously homophobic physicians during a medical summer job dissuaded me from that course. After teaching secondary school for two years, I found my way to nursing. It was simply a good fit. And, as I have often said, "If it was a good occupation for Walt Whitman, it's good enough for me."

The first ten years of my nursing practice were spent in locked psychiatric facilities, both state-operated and privately owned. I was drawn to psychiatric practice in nursing school. In 1975, when I had my nursing school rotation in a state psychiatric hospital, I was one of very few openly gay nursing students in the United States. I knew this, because I belonged to the first American Gay Nurses' Association at the time. I spoke at nursing schools to advocate for awareness of and sensitivity to gay students and patients. This was another aspect of my humanist practice at that time. During my school rotation in the locked ward of a wretched state facility, I encountered several so-called "chronic" mental patients, who had been incarcerated in the hospital by their families in their adolescence during the 1940s and early 1950s because they were perceived as overtly and criminally homosexual by their families and communities.

When I encountered these men, they had become nearly dysfunctional human beings. They had not been out of the institution for decades. Their social skills were gone. One, Bill, had been lobotomized after several violent escape attempts. I insisted on working with Bill and did a thorough study of his history. I ascertained from his record that his parents had advocated institutional abuse for their son. They had sanctioned the harshest therapies, including electric shock and lobotomy. The Commonwealth of Massachusetts had gladly obliged.

I could not reverse Bill's experiences. I could not save him. I was faced with a crossroads before I had even graduated into my profession. I chose the path of humanism, as I understood it then, the path back to psychiatric hospitals where I could prevent these atrocities from happening on my watch.

Over the following decade, I worked in locked psychiatric units which both tested and strengthened my humanism. In the state institutions, I faced a lack of equipment, sanitation and safety. As well as having to advocate for people unjustly subjected to needless confinement because of their differences from the perceived norms of society, I actually had to advocate for the continued confinement of the institutionalized patients who could no longer fend for themselves independently. Many of the latter group were middle aged people with severe cognitive disabilities, who had been thrown into the psychiatric system for lack of other programs, better suited to their needs.

One of the pivotal experiences of my work in state institutions was over mattresses. A patient, smoking a cigarette secretively in her room, fell asleep and set her mattress afire. Within seconds, the closed ventilation system of the locked unit filled with acrid black smoke. We managed to evacuate the fifty patients onto cold January streets with no major injuries. It came to light that the state had purchased substandard mattresses for its facilities. These mattresses had covers which were highly flammable and released lethally toxic fumes when burned.

When, as the head nurse of the unit, I formally protested the situation, I was told to be quiet by the nursing administration. This was a humanist moment for me. I chose not to be quiet at the risk of my job. In fact, I confronted the Massachusetts Commissioner of Mental Health, in front of a meeting she held to reassure all staff members of the facility that the fire had been no real danger to anyone. I knew this to be a patent lie. I stood up and announced that I would call the press and lead all my patients and staff members onto the streets of Boston in protest of the dangerous mattresses, unless they were replaced by week's end.

I was called to the Commissioner's office after the meeting. I was threatened with being fired and banned from any psychiatric nursing job in future, if I persisted. My humanism dictated persisting further. The Commissioner backed down. The new mattresses were delivered that Friday to cheers from the patients and staff. My bosses never quite got over it.

I tell this story as a way to place humanism, as I see it, in a real-world context. At the time, for a twenty-seven year old, openly gay nurse in a traditional setting, the choices were not written clearly in any book. If I were fired, I recall thinking, I would have lost the opportunity to advocate for those people I was most dedicated to. I would probably have found it hard to secure another nursing job, since this was my first. However, if I retained my job at the risk of life-threatening disaster for the patients and staff, I knew a core part of my own humanity would die. I chose my humanity over my professional goals and financial security. This established a foundation for decision-making in my future personal and professional life.

In both state and private, more civilized, mental hospitals, the settings where I worked were plagued with violence. This aspect of my nursing work posed a special challenge to my humanism, which is founded in a commitment to nonviolence.

I studied psychology and psycho-pharmacology diligently. I also studied my patients with an eye to anticipate and prevent violence whenever possible. Paradoxically, the decision to act in prevention of violence entailed a commitment to using physical force to isolate and even restrain a patient, who otherwise would become uncontrollably violent. Every time I faced these decisions, I struggled within my humanism. The most intense struggles occurred whenever I was physically attacked by a patient. This tested my commitment to nonviolence and allowed me to develop nonviolent skills to deal with being attacked. Gradually, with developed judgment and skill, I became less tentative and more confident in applying clinical judgment in these crises. But, I never allowed myself to become complacent. I learned from watching other clinicians that complacency is the deadly enemy of compassion.

The ongoing challenge to my humanism was balancing my role as an employed and licensed member of a medical, hierarchical structure with my role as a conscious, practical humanist. Most nurses and physicians, I have found, must face this challenge in a capitalist system, where clinical decisions are not always based solely in clinical or moral principles. Insurance companies, pharmaceutical companies, medical equipment companies, boards of directors, all these players in our health care system challenge humanist clinicians constantly.

I chose to leave psychiatric nursing for hospice nursing in 1986. The AIDS epidemic was decimating my community and the movement for human rights for GLBT people. I felt I had to do something. This was a humanist decision to mobilize my life for good, despite my own fears. It entailed choosing between a rather secure lifestyle with comfortable standard of living and a whole new world within my nursing profession. New York City was the epicenter of the epidemic. I chose to move there to learn and do what I could.

In New York, I eventually worked as a home hospice nurse for wealthy people in Manhattan. This experience brought a depth to my humanism which I had not anticipated. I was confronted daily with the inconsequential nature of wealth in the face of sickness and dying. My patients frequently asked me, "How do you do this?" after ascertaining I was a gay man, who had intimate experience with AIDS in my own life. Ultimately, the answer became simply this: I had to do what I was doing to satisfy my sense of my own humanity. That is, I had to do it to feel whole.

My dying patients frequently quizzed me on my humanism. "You can't possibly like what you have to do for me," more than one patient said to me in the nine years of dealing with dying AIDS patients. I was forced to work out for myself where liking, loving and caring fit into my compassion and doing what is consistent with my humanism.

The kernel of my humanist practice became clearer over time. I realized that, for me, being human meant being humanist above all else. In other words, the core of my practice is connecting with and enabling the humanity of others in each circumstance, in each moment of human connection, without regard for social class, gender, race, ethnicity or any other variables. My humanism and my humanity exist in connection with the humanity of others.

An important encounter occurred early in my work at a residential AIDS hospice in Boston where I worked when I returned from New York. Ram Dass, a.k.a. Richard Alpert, a modern philosopher and longtime advocate for hospice work, was affiliated with our hospice. He visited and did a day of training with us. After the formal sessions of the day, I began my usual evening shift, working at the bedside of patients. Ram Dass appeared on my floor of the hospice. I gave him an impromptu tour. Our tour ended in the room of a man who was very close to death. This patient had been someone I had known in the community outside the hospice. We stood at the bedside. I straightened the patient's linens, made sure he was comfortably positioned and fussed, which was my habit. Ram Dass stared at the patient's face with a blissful smile. He ran his hand gently over the patient's brow.

When we left the room, we went to the nurses' station. Ram Dass was quiet as I continued pointing things out. He then said, "Is there anything you would like to ask me?" I was moved by the gentle concern in his voice and the openness in his eyes. I remember my voice cracking as I said, "How can I keep doing this?" He continued looking into my eyes and said quietly, "You must fall in love with each one and then let each one go." It was one of the few times I allowed myself to cry openly on duty. I feel that brief moment significantly deepened my understanding of what it means to be human and a humanist.

The years since then have been personally challenging for me. Through crises of my own, I have had the opportunity to speak plainly to myself on many occasions when I needed stability and concentration. My humanism has weathered the tests of my own difficulties. I have defied the conventional wisdom that there are no atheists in foxholes.

The enduring nature of developing a humanist practice, a daily commitment to humanist ideals and action, has sustained me and brought me into relationships with remarkable people, whose personal humanist practices have enhanced my life and practice. I currently feel very fortunate to participate in the Harvard Humanist community. By choosing to associate with other humanists in community, I experience my own humanity more fully and more happily.