My latest podcast episode offers an intimate glimpse into the forgotten world of homelessness, as Zak Mucha, a seasoned social worker and psychoanalyst, joins me, Christina McKelvey, to share powerful narratives of resilience. Zak, also the president of the Chicago Center for Psychoanalysis, illuminates the transformative impact of the Assertive Community Treatment program that he led, their dedication, and connection to the clients. We explore this particularly through the lens of his book "Swimming to the Horizon," where the poignant journey of Charles—a man battling severe psychosis and addiction—is at the forefront of our discussion.
As we navigate the complexities of Charles's story, it becomes clear that the path to recovery is about more than just therapy; it's about meeting basic human needs. Our conversation takes a turn into the critical work of providing emergency housing, food, and a sense of security, bringing Maslow's theory to life in a raw, practical application. Zak's experiences shed light on the often-overlooked importance of secure housing and its profound effect on those under the heavy influence of antipsychotic medications. These stories serve as a testament to the relentless efforts of the ACT team to secure the pillars of stability and dignity for the most vulnerable members of our society.
Wrapping up, Zak and I reflect on the essence of hope and the inherent responsibility we have towards one another. We examine the symbiotic relationship between purpose and hope in the realm of mental health intervention.
About: Zak Mucha, LCSW, is a psychoanalyst in private practice and president of the Chicago Center for Psychoanalysis. He spent seven years working as the supervisor of an Assertive Community Treatment (ACT) program, providing 24/7 services to persons suffering from severe psychosis, substance abuse issues, and homelessness. Mucha has worked as a counselor and consultant for U.S. combat veterans undergoing training for digital forensic investigations in child pornography.
Before going into the clinical field, Mucha has worked as a freelance journalist, truck driver, furniture mover, construction worker, union organizer, staff member at a juvenile DCFS locked unit, and taught briefly at a women’s prison.
He is the author of Emotional Abuse: A Manual for Self-Defense as well as a collection of poetry, Shadow Box (Albireo MKG, 2019), and a novel, The Heavyweight Champion of Nothing (Dockyard Press, 2021). Swimming to the Horizon: Crack, Psychosis, and Street-Corner Social Work (Koehler, 2024), and The Ambulatorium (PWIC, 2024) are coming soon.
Find him here: https://zakmucha.com/
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Disclaimer: The views reflected by any of the guests may not reflect the views of the podcast host. Some topics may be difficult for some viewers, so proceed at your own risk. This podcast does not replace psychotherapy or advice and is for entertainment purposes only.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Christina McKelvy (00:00):
Welcome to Obology.
Stories of hope, healing andresilience.
I'm your host, christinaMcKelvey.
Today we're going to bespeaking with Zach Mucha.
He's a social worker and apsychoanalyst, and also the
president of the Chicago Centerfor Psychoanalysts.
Welcome, how are you doing?
I'm doing good.
Zak Mucha (00:16):
How are you?
Christina McKelvy (00:17):
I'm doing well, thank you.
And I realized that I butcheredthe school's name because I
always butcher psychoanalysts,psychoanalysis I always get
those two confused, and I am apsychotherapist, so you think I
shouldn't, but here we are.
Zak Mucha (00:33):
You should have the words I butcher.
Christina McKelvy (00:36):
So thank you so much for you know coming on
to Hopology.
I looked through your booksSwimming to the Horizon and it's
fascinating, just the differentstories that you share about
you know, working, as you know,the supervisor for your ACT
program in Chicago and I just,you know I found a lot of them
really inspiring, some of themsad, you know, and I just
(00:58):
thought that again, with mypodcast being about hope, it
would be really great to diginto this, and so thank you so
much for coming on and sharingyour story.
So let's start off with justtelling my listeners a little
bit about yourself and a shortsynopsis of your book, swimming
to the Horizon.
Zak Mucha (01:17):
Okay, first synopsis of the book is I ran an ACT team
Assertive Community TreatmentTeam which I don't imagine a lot
of people know what that is.
It's in a community mentalhealth program where the ACT
program is for all of and I'mgoing to go back and forth
(01:38):
between clients and patients,because back then it was clients
and now I use the word patients.
But back then all the clientswere suffering severe psychosis,
substance abuse issues,homelessness, multiple
incarcerations, hospitalizations, extreme poverty, people who
(02:00):
had really been burned or letdown by the mental health system
and also by the society aroundthem, including families.
The people we were working withhad no social supports at all.
So our team really was.
We were 24-7 wraparoundservices.
(02:25):
Idea of a sort of communitytreatment was we'd be like a
hospital unit that ran aroundthe neighborhood because our
patients were not going to becoming in for appointments.
So we were responsible forhelping people get housing
benefits, meds, food, going tocourt, hospitalizing people
every medical issue.
And we had our own psychiatrist, our own nurse, hospitalizing
people every medical issue.
We had our own psychiatrist,our own nurse, our own therapist
(02:49):
, our own case managers, peerspecialists, substance abuse
specialists and everyone had acaseload and a lot of our work
was done outside of the office,which is part of the title of
the book, because a lot of ourwork was done in the street or
in SROs or Flophouse hotels.
(03:09):
What are SROs.
I'm sorry Single residentoccupancy where the rent is just
under what a benefit check forsomeone who would get for their
SSDI.
So you know, back then you'dget $700 a month and the rent
(03:36):
would be $550, $560.
Then you're supposed to liveoff the rest of that, plus
whatever you might get off yourlink card, which is not enough
to live off of.
So a lot of people have tocommit petty crimes just to
survive, and so there was a lotof what we were dealing with and
(03:57):
the neighborhood we're inUptown Edgewater.
In recent years it's gottenvery gentrified.
All this housing hasdisappeared.
I don't know where people havegone to, but it was really.
There were Black House hotelswhich is a non-clinical name for
them all over the neighborhoodand there was one called the
(04:20):
Wilson's Men's Club, which wasliterally like a nine by 12
cubicle with a bare light bulbhanging through the chicken wire
ceiling and it's just a sharedbathroom on every floor.
It's a very dangerous place tolive.
So this is what our team wasdoing, and our job was to keep
(04:43):
people safe in the neighborhood.
Christina McKelvy (04:47):
And was it centered just on that particular
neighborhood or did you go into, you know, other neighborhoods
within Chicago?
Zak Mucha (04:54):
We were mostly in this neighborhood, just because
you know this was our area.
Every once in a while we wouldhave to go out, or I would have
to leave the neighborhood to godo an intake assessment.
Part of my job was going tohospitals and convincing someone
on the unit to work with ourteam.
Christina McKelvy (05:12):
Okay, and I imagine you know, being in the
same neighborhood, you startreally establishing
relationships and seeing thesame individuals and seeing
their growth or demise,depending on what direction they
chose.
And some of the stories and Iknow the names are changed right
and so when I mentioned namesthey're changed.
(05:34):
They're not actual names of thepatient's clients that you saw,
but there's just stories aboutManny Bobby Leonard.
Those were some of the onesthat stuck out, charles, you
know that one was yeah.
So I don't know if you want to,and for I forget that my
audience, my listeners can't seeme, but I, when I mentioned
(05:55):
Charles, I just my heart brokebecause of that story.
So I don't know if there's anyparticular ones you want to kind
of delve into and share.
You know that maybe impactedyou the most, or you know that.
Zak Mucha (06:07):
I'll talk about charles, because he truly was
heartbreaking, yeah, and he wasinfuriating, and you know, and
people really you know trueambivalence loved and hated him
at the same time.
He was a former NGRI client,not guilty by reason of insanity
(06:29):
.
He had committed some realviolence in the past, which he
wasn't a violent person, but bythe time we got him he was you
know, he was throughoutschizophrenic but he was also,
you know, very addicted to crack.
He was hiv positive, he was achronic, chronic shoplifter and
(06:53):
but he was also really brilliantat teaching new staff.
And when I first took over theteam, you know the the original
staff, it was very much meds andmoney.
That was it Because the agencywas the payee for a lot of our
clients because the state haddeemed them too quote unquote
(07:16):
disabled, unable to handle theirown finances, which was not
untrue finances, which is notuntrue.
The state assigned the agencyto be the payee, which meant we
would take care of the rentbills and also have to dole out
that little bit of money thatwas left throughout the week.
(07:36):
Charles had a fierce, fierceaddiction and his money was very
important to him.
The staff that I inherited wasvery much this compliance model,
which is really really ugly,and it is not about, you know,
independence and subjectivity ofa person.
(07:59):
It's you take your meds, youget your money.
Christina McKelvy (08:02):
Not very person-centered either.
It sounds like you take yourmeds, you get your money.
Zak Mucha (08:05):
Not very person-centered either.
It sounds like no, no, it wascompliance.
Compliance always crumbles.
If we had an audience in frontof us, I would ask, raise your
hand if you like being told whatto do.
And Charles was brilliant.
I remember when I started hiringmy own staff, a young woman was
learning and I was telling herdo not tie meds to money.
(08:27):
Just throughout the team,throughout the years, if someone
takes their meds, that's not asimportant as building a
relationship with that patient.
And we had to build arelationship.
They had to be able to trust usrelationship.
They had to be able to trust us.
We had to be able to do what wesay we're going to do and it
(08:53):
was.
That was the only way anyonemight have a reason to listen to
anything.
You have to say, as a therapistor case manager, that you had
earned that trust.
I know we could say we couldnever say trust me because that
doesn't do anything.
Therapist or case manager, thatyou had earned that trust.
I know we could never say trustme because that doesn't do
anything.
It's just another instruction.
But this young clinician wasworking with Charles.
(09:15):
Charles was incredibly streetsmart, he was brilliant and you
know she's saying oh, take yourmeds and I'll give you your
money.
Christina McKelvy (09:27):
He says no One thing.
You told her not to do.
Zak Mucha (09:29):
Yeah.
And he said, no, give me mymoney, then I'll take my meds.
And she said, no, it's theother way around.
And they went back and forthlike Bugs Bunny and Elmer Fudd
until he finally said I haveAIDS, you're withholding my
medication, you're killing me.
And of course she, you know,crumbled right there and you
(09:52):
know he walked out.
It was very much a power playand he knew how to switch it
around on her.
But Charles, I mean, he was anamazing survivor.
Christina McKelvy (10:09):
Those skills.
Like you mentioned, he was verystreet smart.
How did he?
What kind of growth did you see?
Cause when I was reading astory, it sounded like there was
a lot of ebbs and flows withwith his growth.
Zak Mucha (10:26):
Sure, I know a lot of Sure, a lot of our clients.
We weren't going to be sendingpeople to college.
We were really trying to keeppeople housed.
We had to track progress With alot of people.
We could say, okay, this personwas hospitalized less this year
(10:48):
than he was last year and youknow he only got evicted once
this year, rather than threetimes last year.
And progress would be, you know, having some stability, some
safety in the community.
Christina McKelvy (11:08):
Progress would be building relationships
yeah, you say in chapter 22,that act was designed to be a
campaign of full press,intensive services aimed at
clients who faced steep recoverychallenges and were almost
certain to progress slowly if atall yeah yeah, and and even
(11:32):
even the bureaucratical of ACT.
Zak Mucha (11:36):
You know just the full fidelity ACT, because we'd
be audited every year.
You know the requirements, evensaid you know one clinician
should not be seeing the sameclient every day, Like, if
Charles is a client, I would seehim on Monday, this person see
(11:57):
him on Tuesday, this person seehim on Tuesday, Another person
see him on Wednesday.
And the official reasoning fromthe state was that well, we
don't want them to get attachedto anyone.
Christina McKelvy (12:12):
And.
Zak Mucha (12:13):
I disagre.
You know we really built a teamso that, like if you were a
clinician, you would have acaseload of you know four, five,
six, seven, eight people thatyou were their connection to the
world.
You were the person they had torely on.
You were the person they sawevery day, and because they they
(12:38):
, you know we have to have thoserelationships.
I mean, it's this is where youknow what we're doing was very
psychodynamic.
The relationship is everything.
I mean that that's the onlything that that was.
Christina McKelvy (12:53):
That was where we saw progress, when
someone actually, you know, wasable to start making
relationships and thatrelationship, and I'm trying to
I had a mark, but for charles itsounded like it was that he, he
acknowledged his.
There was a.
(13:13):
There's a part where it saysthat like he was talking to
someone, that's when he realizedhe was dying.
And I don't know if thatrealization came because of that
relationship.
I'm trying to find thisparticular I had it marked scene
.
Um, do you I don't know if yourecall, or of course you do you
(13:34):
wrote the book, but um, therewas a part where it says and
then he realized he was dyingand that support he got from his
clinician and the team wasprobably huge, especially during
that time, and didn't he also?
He also moved from the streetto jail in the last part of his
life.
Zak Mucha (13:55):
Yeah, it was real, it was a real shame.
I mean, it was everything theguy had done.
A judge got him for justchronic shoplifting.
He had so many shopliftingarrests and he was, he was very
sick when he went into, when hewent into jail.
But even before that he was ina hospital, a medical hospital,
(14:19):
a medical unit which, unlike thepsychiatric unit, you have a
phone at your bed.
So Charles was calling ouroffice every two minutes, ten
minutes, and you could just seethe phones lighting up around
the room, with him calling anddemanding a beef sandwich or a
combo fries, and someone had tobring him something sounds like
(14:39):
he was trying to connect in someway in his turn.
Yeah, yeah, and it wasinfuriating, but this was.
Christina McKelvy (14:46):
This was also how he connected yeah, like you
said at the beginning, yourwork with an act was infuriating
but also, you know, inspiring.
You know I don't think that'sthe word you used, but it was
both of those points it was.
Zak Mucha (15:03):
I mean we talk about hope.
I mean it was always stunningto me how much people do want to
live right, how much.
I mean there are very fewsuicides, which was amazing.
Christina McKelvy (15:20):
Yeah.
Zak Mucha (15:22):
And that people.
It's amazing what we can sufferthrough with.
You know the idea of all right.
There's something I want on theother side of this.
I had some brilliant clinicianson the team.
(15:55):
One guy was more than him, butthere are some people who are so
amazingly dedicated and when webuilt this team, we created a
lot of stuff just because theagency wasn't really too
concerned about what we weredoing.
We were making money for them.
Act reimburses at a high rate.
(16:16):
I'm sorry, go on oh oh no, I wassaying so they weren't
concerned, but they were in away yeah yeah but, you know,
thank you, they gave us room todo, to create a lot and we had,
okay, we had our own clothingcloset, we had a food pantry, we
had, you know, one therapistactually convinced the city gym
in the neighborhood to give freememberships to his caseload and
(16:41):
he was.
He was marching his guys upBroadway into the gym.
You know, it was great and ittook months and months, and
months but we actually truly sawa difference and, just you know
, people were able to.
You know, you know what theThorazine shuffle is, just the
sort of disconnection to yourown body, part of meds and part
(17:03):
of symptoms.
He was able to actually startcombating that.
We could see guys walking verymuch with a purpose and walking
with an awareness of theirbodies.
It was amazing and we had that.
We had, you know, we created, uh, emergency apartments because
we were dealing with a lot ofhomelessness and I convinced,
(17:25):
you know, one landlord if Icould raise the money for two
apartments for a year, just givethem to me, let me use them,
I'll move people in as I need toand you don't do any background
checks that are going to takethree to five days.
If I'm pulling someone off thestreet?
Where am I going to put themwhile we're waiting for a
(17:48):
background check?
And we needed a place wherethey wouldn't have to pay rent
for the first couple monthswhile we get their benefits
started and all that.
So I told the landlord and wethrew parties and raised the
money.
I told the landlord I thought Iwas being really magnanimous.
I told him I promise you nomurders.
(18:09):
And he said I don't care aboutthat, I don't want any arsonists
.
That's a good point.
Christina McKelvy (18:18):
That's a landlord point, but that's a way
, that's a that's a landlord.
Okay, yeah, our, yeah,arsonists wouldn't, you know,
would not be a good thing forsure.
Um, you know, speaking ofhousing, I was as I was reading
this book and I even had it.
I have a note next to it.
Food and housing come first,and I put maslow's.
I'm curious how does Maslow'shierarchy of needs play into the
(18:42):
work you did, or you know?
Did it?
You know, did you see the?
You know how?
What Maslow spoke about likewhat you need as the base and
moving on up, did you see thatworking in action?
Or you know what did that looklike?
Zak Mucha (18:56):
Oh, totally, I mean mean housing.
That was why we had theemergency apartment and housing
housing comes first.
It's impossible to do anythingif someone does not feel safe.
You know, just it's like the,the homeless shelters.
It's really a dangerous thingif you're being prescribed heavy
anti-psychotic meds.
It's really a dangerous thingIf you're being prescribed heavy
(19:17):
antipsychotic meds.
It's really a dangerous thing togo to a homeless shelter
Because those meds, if you takethem, they're going to knock you
out.
You're near unconscious.
If you do that in a homelessshelter you're going to wake up
with all your stuff gone at thevery best.
So you know, safe housing issuch an important thing it still
(19:41):
is.
So that was.
You know, that was always afight to have housing for our
people.
And you know, I remember whenwe had one man who was a cab
driver.
We had one man who was a cabdriver but his symptoms, his
hallucinations, delusions, wereso severe.
(20:03):
He would be driving, driving acab, but he would hear someone
saying horrible things about himand he thought it would be the
fair in the backseat.
Christina McKelvy (20:16):
And he would pull over and get violent.
Zak Mucha (20:18):
Something terrible was going to happen.
But he had these very realdelusions that there was
literally someone fused to hisback, coming out of his back and
yelling at him and excoriatingthis really ugly, ugly
commentary about him just 24-7.
And he couldn't keep driving acab.
(20:39):
He was going to hurt someone.
Christina McKelvy (20:43):
Yeah, yeah.
Zak Mucha (20:45):
So you know, when we had petty cash and subsidies for
not apartments but hotel rooms,I made a deal with him that
we'll get you, because he wassleeping in the alley behind the
cab stand.
He had nowhere to stay and Isaid, all right, I'll put you in
(21:07):
in a room, I'll get you a place, your own bed, your own
bathroom.
But you know, like like any,like any apartment, I need down,
I need a deposit.
You'll get it back when youhave your own place.
He gave up his cabbie licenseas a deposit on his apartment,
(21:28):
which is great, which meant hewasn't going to kill someone
driving, and this is weird, itwas a lot of on the fly problem
solving well, it sounds go on ohsorry, I was just gonna say it
sounds like the shelter was moreimportant than the income for
him at that moment, and thatkind of proves maslow's needs
(21:51):
yeah, the income was not doinganything for him.
Yeah, he needed.
Christina McKelvy (21:55):
He needed to be somewhere where he could rest
, sleeping in the alleys it'snot good for psychotic symptoms
and did you notice that once theyou know the base need of, you
know food, water, shelter, likewhen that was met, were they
able to climb the rung to thenext need, and then so forth?
Zak Mucha (22:22):
Yeah, but the rungs were very close together.
I mean it wasn't huge progress.
I know there was progress, butit was hard.
It was a lot of.
These are people who had beenyears and years without real
intense care, without anysupport systems.
(22:44):
Some of the staff I don't knowif you remember the case of
LaFleur, but the case managerthat was working with him.
I had to show him how to washhis feet, how to you know it was
.
I mean you talk about?
(23:04):
You know a lot of talk aboutChristianity, I mean and I don't
I'm not religious in that waybut this was truly compassionate
work this therapist was doing.
I mean going there showing himhow to clean the toilet, how to
clean the tub, how to wash yourfeet and just stuff that this
man had not done in years andyears and years.
(23:26):
There are several points wherewe would have to go to Home
Depot and buy full-on disposablehazmat suits just to clean
someone's room, disposablehazmat suits just to clean
someone's room when we startwith them, because it would just
horribly horrible and just inhuman conditions people are
living in and that that would beoften.
Christina McKelvy (23:56):
I mean, I can imagine that can kind of do
something, that one's beliefs orum outlook like how, how would
a clinician, um case manager,social worker, like how, how,
what would you recommend thatyou know, especially those that
might be working in act programs, can?
(24:19):
Where do they find theirstrength?
I guess it's the question youknow, and how to move forward
and see the hope in their work.
Zak Mucha (24:26):
Yeah, well, it's like the, the title of the book
itself, right swimming to thehorizon.
If you give it a thought for amoment, it's not a hope, not
even a hopeful vision, right?
I'm swimming to the horizon,we're not going to make it that
makes sense, yeah yeah, and andit's from a conversation I had
(24:48):
with a really amazing therapistwho was she was was working too
hard and, you know, justliterally staying way too late
typing up notes long aftereveryone's gone.
And we were, we were on call 24seven, but still, you know, I
think at one point I literallydid have to threaten to unplug
her computer while she wastyping, she wouldn't go home.
(25:10):
And she was very upset becausethere was always always more to
do.
I mean, every day you come inthere'd be something else that
fell apart.
Someone else who was in trouble, someone else, you know, threw
their meds out, someone gotarrested, you know, whatever
there was always, you know,always something new to take
(25:30):
care of.
And I was telling her she wasvery upset.
You know, in my office I said weare not going to cure psychosis
.
I mean, we are swimming to thehorizon.
Our job is to help our patients, you know, move their lives
forward in these little littlebits, lives forward in these
(25:53):
little little bits.
And I think the valuable partwas for the staff who did, who
were energized by the work, werethe ones who valued the
relationship themselves.
(26:17):
One thing this is a little bitof a sidebar, but not terribly.
You know, when we're firstsetting up in our offices I had
a buddy paint a big banner forthe team and it said if you
can't be counted on, you can'tbe counted in you can't be
counted on, cannot be counted in.
Yeah, like we are a unit, wehave to support each other.
As you know, as co-workers,this wasn't, you know, it was a
(26:41):
big team office.
Everyone had to be able tosupport each other.
Everyone had to be able to backsomeone else up.
If I'm hospitalizing someone, Ineed someone.
I may need someone to come withor at least someone to watch my
back while it's happening.
You know we were in a lot ofnot safe situations, yeah, or
just you know we had to.
(27:02):
If someone couldn't get topatient mary for her doctor's
appointment, someone else had tograb it and take care of mary
you know, we had to support eachother in supporting our
patients, and the banner was agood litmus test, because if a
staff member was annoyed by thatthought, it told me a lot about
them.
That they didn't want to becounted on and didn't care about
(27:27):
being counted in.
But with this, I mean, and thosealso often were not the
clinicians who were energized byor valued the relationship with
the client.
I mean, it was hard, hard work,and I wasn't thinking of this
(28:03):
back then because I didn't knowof Emmanuel Levinas, the
philosopher who lost his entirefamily in the Holocaust.
And I think of his work, aboutour irreducible responsibility
to the other, that we have to.
We have to be responsible.
Basic rule to not to not killthe other person.
(28:23):
And you know so.
You know that we have theresponsibility to not look away
from the sort of devastation.
We have to acknowledge it.
We have to step in and dosomething.
And I think the people on theteam who really love this work,
I think they just inherently hadthat sense that we just have an
(28:47):
inherent duty to other people.
Christina McKelvy (28:54):
Yeah, the humanist, yeah, humans, Mm-hmm
yeah.
Zak Mucha (29:03):
And just stepping in because we were dealing with,
you know, severe psychosis.
It's very scary.
It's scary to you know.
Try to figure out what is thisperson talking about and over
time we would see that, allright, a lot of these symptoms
were about their traumahistories.
I mean, we could rarely getlike a full intake out of
(29:25):
someone, a full, you know, fullsocial history, just because the
disorganization was so great.
But over time we would see, allright, the narrative of the
symptoms would hold a lot ofpieces of very traumatic past,
traumatic childhood and atraumatic adulthood, and one guy
(29:47):
who I really, you know, reallylove this guy.
The only way he would work withme was if I could step into sort
of half a delusion he had thatwe were like cops working
together in a buddy movie and Idon't know if you remember him
from the book.
But during the intake interviewhe would do nothing but scream
(30:08):
at me I'm Stephen Scull, you'reBruce Willis, remember when I
kicked you the gun when theykidnapped your daughter?
And you know it was all thisvery hyper-masculine stuff.
But okay, there's something heneeds to prove in this and I
can't.
Well, it's a point of realityif I say my job is to get him
housed and safe in theneighborhood.
So you know we'd have to drivearound the neighborhood.
(30:31):
He got evicted from places alot.
He was deeply offensive andthreatening to a lot of people
but he was able to work with mebecause I wasn't challenging him
.
It's like all right, I didn'tsay I was Bruce Willis, but I
just went on and said all right,this is what we have to do, and
(30:55):
that was the way he couldconceptualize the relationship
so it was acceptable to him.
Yeah, and, and you know, wekept him safe in the
neighborhood as much as we could.
Christina McKelvy (31:19):
Yeah, there's , there's so many, you know just
lovely like and I'm using theterm lovely stories, even though
it was hard and hard work andgrueling work, and I highlighted
this part.
I did, however, understand thetherapeutic aspects of work.
(31:40):
Some of us are like dogs.
We need responsibility,something to do, something to
define our value and purpose.
But not all job searches weretherapeutic, especially when the
odds of success werefrustratingly minimal.
And I'm connecting that to likewith the houses you know you
mentioned.
You know he were getting himhousing and he continued to get
evicted, getting individualsjobs and maybe they were
(32:02):
continuing to lose those jobs.
But the big thing is that theyneeded to have value and purpose
and that's what you're alsohelping and I know that.
Again, back to Maslow's needs.
That's like I don't have itpulled up, but I think it's like
three or four, you know, but Iactually kind of think it runs
up and down the side of thetriangle.
(32:24):
You know, for those of you thatdon't know, maslow's hierarchy
of needs is a triangle and youknow there's the basis food,
water and shelter, but shelter,but having that value and
purpose and hope, I think goesback and forth and when you have
that hope you have that purposeand value.
You want to move forward and itsounds like that's what you
(32:46):
guys were doing, despite knowingthis individual may not hold
this job for long or may nothave this house for long, but
we're going to keep getting themthose resources yeah, and I I
totally agree with you.
Zak Mucha (32:58):
The idea of having a purpose is a life-saving thing,
whether you're at this level ofyou know severe mental illness
or, you know, any patient whocomes into your office.
I mean you could see that sortof without a sense of real
purpose in the world, howdepressing and disheartening it
(33:21):
could be.
And yeah, that even you knowbecause it defines us right Even
to have a terrible job.
I mean I've done it before.
I went to social work school alittle later and much later in
life.
So I had a lot of rough jobsthat I did not like, but I can
(33:43):
at least define myself by sayingI hate this job.
This is not what I want to dofor the rest of my life, and
that defines us as much as a jobwe love.
So, and that's also a big partof the work and it was a part of
, you know, buildingrelationships with patients,
(34:03):
because you know we were having,you know we did have the
50-minute hours with ourpatients and this crowd was
deserving of therapy as anyoneelse, and therapy should not be
only for middle class and up andjust to have that.
(34:24):
One thing we would talk aboutis what any patient, no matter
who or where they were in theteam everyone needed to feel
safe and be heard.
Christina McKelvy (34:43):
They needed you know, actually have what
they're saying be taken in.
Zak Mucha (34:46):
Yeah, be safe and be heard, even when there was, even
when there was violence in theoffice and I would have to
intervene.
I remember having someone andwe ended up on the floor, but I
remember telling him no one hereis going to hurt you and I'm
not going to allow you to hurtanyone else either.
(35:08):
And that was like the basicrule for when people are in the
office.
Christina McKelvy (35:14):
Yeah, I'm not not gonna let anyone hurt you
either, because a lot of times,individuals are fighting because
they're feeling threatened andthey're not feeling safe totally
sharing them yeah it was.
Zak Mucha (35:26):
It was all affective violence rather than predatory
violence right affectiveviolence is just.
Just, you know, get away fromme so I don't hurt.
Hurt anyone to in order to feelsafe yeah, oh well.
Christina McKelvy (35:43):
well, zach, we're gonna um switch to the
instagram live portion, uh, butbefore we do, I want to, just in
case it doesn't transfer over,because I'm going to try and
somehow record the Instagramlive session.
But I wanted to ask, before weswitch over I ask this question
to everybody that's on my showwhat brings you hope?
(36:04):
What gives you hope?
Zak Mucha (36:05):
What brings me hope is I think that I've you know
back then doing that work andnow you know I'm a therapist in
private practice.
I mean just, I have seen peopledo amazing things, make real
(36:28):
changes.
I have seen people just sort ofcome to life.
I have seen people just sort ofcome to life and just
personally.
Stuff that gives me hope ispoetry.
It's just such an amazing thingreading books.
Books are always hopeful.
I'm never going to get througheverything I want to read in
(36:49):
life, I mean and I think I'vesaid this to you before you know
.
And also one thing that's beenvery hopeful for me is and this
is totally counterintuitive andparadoxical, but that's how it
is but like Zen Buddhism, I'mpracticing Zen Buddhism, which
(37:11):
is the only thing I've gottenout of all of that is to see
that, to see that my ownthoughts are not that important.
Everything I worry about it'sme doing it to myself, and it's
just this very strange way tofind hope in how horrible
(37:31):
everything is, even like we weretalking about today.
You know, before we started, wewere talking about the weather
and I'm in Chicago and it's theend of February and it's 70
degrees, which is not how it'ssupposed to be in Chicago in
February.
This is supposed to be whenwe're all depressed and
miserable and it's a lovely day,but it's also a horrible sign
(37:56):
for the climate.
It's like we're taking out apayday loan on the planet and
it's about this awfulness at thesame time as it's also lovely.
And there was a lot of likeyou're describing in the book.
It's not, you know, it's a tonof very sad, sad stories, but
(38:20):
there's also a lot of joy inthose little bits of
interactions.
Some of these people had anamazing you know clients and
staff an amazing sense ofgallows humor that got us
through this.
Remember I was training a newstaffer at one point and we're
(38:40):
working with a man who hadreally severe delusions and
hallucinations and I'm trying toteach a young staffer how to
respond differently betweendelusions or hallucinations.
Hallucinations you could realitycheck.
Delusions you do not want tochallenge because you end up
part of the conspiracy and wesee that with you know American
(39:03):
politics right now.
So this man is being chased byan entire family that are
delusional and we're in a roomsomewhere and he's saying I
could hear they're pounding onthe door.
Right now it's yelling.
And I said you know respondingto the delusion, something like
(39:27):
you don't get a moment's rest.
These people are always afteryou.
You can never relax.
He said that's right.
I said but I got to tell you Idon't hear anyone pounding on
the door.
What do you think that means?
And he said well, it means oneof us is fucked up, and all
(39:48):
right.
He had a little bit ofawareness there it was good,
yeah, hmm, it's that.
Christina McKelvy (39:57):
it's that hope within the darkness yes,
that's exactly.
He summarized me going onendlessly perfectly well, zach,
let's, um, you know, switch toinstagram live, and I'm gonna
pause okay, okay, all right.
(40:18):
Well, I don't know if I'm goingto have this in the podcast or
not, but we tried to go live andit didn't work, but that's okay
.
So I'm going to ask thequestions to you.
That, but we tried to go liveand it didn't work, but that's
(40:39):
okay.
So I'm going to ask thequestions for you, um to you.
That I was going to ask liveand, of course, if anyone has
questions for Zach, if you werelike, oh you, we can't, you, I
didn't get to meet you live,that's okay, cause in the um
under my podcast on Spotify, youcan provide feedback.
You can send an email, sendZach an email through Instagram.
(41:00):
You know, contact us if youhave any questions or feedback,
and I'll also put that in thelittle sorry note on Instagram
that um.
So one of the other questions Ihad was what did your
experience and this might be theonly question to ask actually
(41:20):
working in that team, teach youabout resilience and healing?
Zak Mucha (41:30):
I think the one thing I really did about resilience
and healing was that workingwith ACT, I saw that I had so
much more to learn.
Was that working with ACT, I sawthat I had so much more to
learn, and it's why I ended up,I believe, why I ended up a
psychoanalyst and there was somuch happening that I could not
(41:56):
understand, and you know that'sjust about symptoms, symptoms,
and that people were soresilient I think it was, you
know, there was so much that Iwas not trained in.
I mean, there was nopsychoanalytic training, there's
barely any supervision at all,anyway.
But I realized, all right,there's so much I don't know,
there's so much happening herethat I had a sense of something
(42:20):
that.
But I really had to go learn,and you know, and I started.
You know, I started going tolectures at the Chicago center
for psychoanalysis.
The first lecture I went to wasa Lacanian lecture.
I didn't even know who Lacanwas and I walked out of there so
(42:40):
angry because I couldn'tunderstand a damn thing that was
said.
But it sort of set me to allright, this, this is this was
like taking over the act team.
I had no clue what I was doing,I had no business probably
doing it, but there wasliterally no one else who wanted
to run that team.
I mean, I was promoted intosupervising that team when I was
(43:03):
maybe a few months out ofsocial work school.
It wasn't because anyonerecognized this amazing talent I
had, it was that no one wantedto do this filthy, violent, you
know, thankless job.
But I was willing.
I was willing to because partlybecause I didn't know any
better, and but that that alwaysfascinated me, that, all right,
(43:26):
there's walk into this thingwhere it was a total mystery and
a total mess and, I think,going from act into
psychoanalysis and very much atotal shift in, you know,
perception of my ownresponsibilities.
But in all of it, the samething that is there and it's the
(43:48):
thing that keeps me hopefuljust how resilient people are
you know and how much potentialthere is, or for people to you
know, keep growing.
It's an amazing thing to findout.
All right, I could do much morethan I thought I could.
I am much more than I thought Iwas.
Christina McKelvy (44:08):
Yeah, I am much more than I thought I was.
I love that and that's thathope.
Hope breeds resilience orhealing.
It ties into each other.
When you have hope, you canhave that resilience.
Hope breeds resilience orhealing.
It ties into each other.
When you have hope, you canhave that resilience and then
you can heal.
Zak Mucha (44:25):
Actually I think it's for me at least.
I sort of see it the other wayaround that resilience sort of
breeds hope Okay.
Christina McKelvy (44:32):
I like that.
Zak Mucha (44:34):
Say holy shit, I just survived this.
Okay, I didn't think I would.
Christina McKelvy (44:39):
Okay.
Zak Mucha (44:40):
That changes my own boundaries as a person, that
changes my own self-definition.
I can survive a thing that Idid not think I could before
yeah, I like that reframe.
Christina McKelvy (44:55):
Yes, yeah, that makes sense too.
Well, zach, thank you so muchfor you know being on my podcast
and you know your flexibilityis trying to figure out the
instagram live, but I will golive on instagram in a minute
and apologize to my three, threefollowers.
Um, but, zach, where can peoplefind you if they want to learn
(45:15):
more about you and where canthey find the book, if they
would like to buy the book?
Swimming to the horizon?
Zak Mucha (45:20):
uh, I'm very easy to find at my name zachmuchacom
z-a-k-m-u-c-a-jcom.
Uh, I'm easy to contact.
My information is there.
The book is.
Wherever you buy books, you canget a copy of it all right well
yeah, nice well, thank you ah,thank you.
(45:42):
This was fun and all right.
We tried instagram.
It didn't work big deal.
If half the things I triedworked out, things would be very
different.
Christina McKelvy (45:51):
This is great yes, yeah, no, it it was.
It was really fun.
I definitely definitely enjoyedit.
And to everyone listening outthere no-transcript.
Welcome to Obology.
Stories of hope, healing andresilience.
I'm your host, christinaMcKelvey.
Today we're going to bespeaking with Zach Mucha.
He's a social worker and apsychoanalyst, and also the
president of the Chicago Centerfor Psychoanalysts.
Welcome, how are you doing?
I'm doing good.
Zak Mucha (00:16):
How are you?
Christina McKelvy (00:17):
I'm doing well, thank you.
And I realized that I butcheredthe school's name because I
always butcher psychoanalysts,psychoanalysis I always get
those two confused, and I am apsychotherapist, so you think I
shouldn't, but here we are.
Zak Mucha (00:33):
You should have the words I butcher.
Christina McKelvy (00:36):
So thank you so much for you know coming on
to Hopology.
I looked through your booksSwimming to the Horizon and it's
fascinating, just the differentstories that you share about
you know, working, as you know,the supervisor for your ACT
program in Chicago and I just,you know I found a lot of them
really inspiring, some of themsad, you know, and I just
(00:58):
thought that again, with mypodcast being about hope, it
would be really great to diginto this, and so thank you so
much for coming on and sharingyour story.
So let's start off with justtelling my listeners a little
bit about yourself and a shortsynopsis of your book, swimming
to the Horizon.
Zak Mucha (01:17):
Okay, first synopsis of the book is I ran an ACT team
Assertive Community TreatmentTeam which I don't imagine a lot
of people know what that is.
It's in a community mentalhealth program where the ACT
program is for all of and I'mgoing to go back and forth
(01:38):
between clients and patients,because back then it was clients
and now I use the word patients.
But back then all the clientswere suffering severe psychosis,
substance abuse issues,homelessness, multiple
incarcerations, hospitalizations, extreme poverty, people who
(02:00):
had really been burned or letdown by the mental health system
and also by the society aroundthem, including families.
The people we were working withhad no social supports at all.
So our team really was.
We were 24-7 wraparoundservices.
(02:25):
Idea of a sort of communitytreatment was we'd be like a
hospital unit that ran aroundthe neighborhood because our
patients were not going to becoming in for appointments.
So we were responsible forhelping people get housing
benefits, meds, food, going tocourt, hospitalizing people
every medical issue.
And we had our own psychiatrist, our own nurse, hospitalizing
people every medical issue.
We had our own psychiatrist,our own nurse, our own therapist
(02:49):
, our own case managers, peerspecialists, substance abuse
specialists and everyone had acaseload and a lot of our work
was done outside of the office,which is part of the title of
the book, because a lot of ourwork was done in the street or
in SROs or Flophouse hotels.
(03:09):
What are SROs.
I'm sorry Single residentoccupancy where the rent is just
under what a benefit check forsomeone who would get for their
SSDI.
So you know, back then you'dget $700 a month and the rent
(03:36):
would be $550, $560.
Then you're supposed to liveoff the rest of that, plus
whatever you might get off yourlink card, which is not enough
to live off of.
So a lot of people have tocommit petty crimes just to
survive, and so there was a lotof what we were dealing with and
(03:57):
the neighborhood we're inUptown Edgewater.
In recent years it's gottenvery gentrified.
All this housing hasdisappeared.
I don't know where people havegone to, but it was really.
There were Black House hotelswhich is a non-clinical name for
them all over the neighborhoodand there was one called the
(04:20):
Wilson's Men's Club, which wasliterally like a nine by 12
cubicle with a bare light bulbhanging through the chicken wire
ceiling and it's just a sharedbathroom on every floor.
It's a very dangerous place tolive.
So this is what our team wasdoing, and our job was to keep
(04:43):
people safe in the neighborhood.
Christina McKelvy (04:47):
And was it centered just on that particular
neighborhood or did you go into, you know, other neighborhoods
within Chicago?
Zak Mucha (04:54):
We were mostly in this neighborhood, just because
you know this was our area.
Every once in a while we wouldhave to go out, or I would have
to leave the neighborhood to godo an intake assessment.
Part of my job was going tohospitals and convincing someone
on the unit to work with ourteam.
Christina McKelvy (05:12):
Okay, and I imagine you know, being in the
same neighborhood, you startreally establishing
relationships and seeing thesame individuals and seeing
their growth or demise,depending on what direction they
chose.
And some of the stories and Iknow the names are changed right
and so when I mentioned namesthey're changed.
(05:34):
They're not actual names of thepatient's clients that you saw,
but there's just stories aboutManny Bobby Leonard.
Those were some of the onesthat stuck out, charles, you
know that one was yeah.
So I don't know if you want to,and for I forget that my
audience, my listeners can't seeme, but I, when I mentioned
(05:55):
Charles, I just my heart brokebecause of that story.
So I don't know if there's anyparticular ones you want to kind
of delve into and share.
You know that maybe impactedyou the most, or you know that.
Zak Mucha (06:07):
I'll talk about charles, because he truly was
heartbreaking, yeah, and he wasinfuriating, and you know, and
people really you know trueambivalence loved and hated him
at the same time.
He was a former NGRI client,not guilty by reason of insanity
(06:29):
.
He had committed some realviolence in the past, which he
wasn't a violent person, but bythe time we got him he was you
know, he was throughoutschizophrenic but he was also,
you know, very addicted to crack.
He was hiv positive, he was achronic, chronic shoplifter and
(06:53):
but he was also really brilliantat teaching new staff.
And when I first took over theteam, you know the the original
staff, it was very much meds andmoney.
That was it Because the agencywas the payee for a lot of our
clients because the state haddeemed them too quote unquote
(07:16):
disabled, unable to handle theirown finances, which was not
untrue finances, which is notuntrue.
The state assigned the agencyto be the payee, which meant we
would take care of the rentbills and also have to dole out
that little bit of money thatwas left throughout the week.
(07:36):
Charles had a fierce, fierceaddiction and his money was very
important to him.
The staff that I inherited wasvery much this compliance model,
which is really really ugly,and it is not about, you know,
independence and subjectivity ofa person.
(07:59):
It's you take your meds, youget your money.
Christina McKelvy (08:02):
Not very person-centered either.
It sounds like you take yourmeds, you get your money.
Zak Mucha (08:05):
Not very person-centered either.
It sounds like no, no, it wascompliance.
Compliance always crumbles.
If we had an audience in frontof us, I would ask, raise your
hand if you like being told whatto do.
And Charles was brilliant.
I remember when I started hiringmy own staff, a young woman was
learning and I was telling herdo not tie meds to money.
(08:27):
Just throughout the team,throughout the years, if someone
takes their meds, that's not asimportant as building a
relationship with that patient.
And we had to build arelationship.
They had to be able to trust usrelationship.
They had to be able to trust us.
We had to be able to do what wesay we're going to do and it
(08:53):
was.
That was the only way anyonemight have a reason to listen to
anything.
You have to say, as a therapistor case manager, that you had
earned that trust.
I know we could say we couldnever say trust me because that
doesn't do anything.
Therapist or case manager, thatyou had earned that trust.
I know we could never say trustme because that doesn't do
anything.
It's just another instruction.
But this young clinician wasworking with Charles.
(09:15):
Charles was incredibly streetsmart, he was brilliant and you
know she's saying oh, take yourmeds and I'll give you your
money.
Christina McKelvy (09:27):
He says no One thing.
You told her not to do.
Zak Mucha (09:29):
Yeah.
And he said, no, give me mymoney, then I'll take my meds.
And she said, no, it's theother way around.
And they went back and forthlike Bugs Bunny and Elmer Fudd
until he finally said I haveAIDS, you're withholding my
medication, you're killing me.
And of course she, you know,crumbled right there and you
(09:52):
know he walked out.
It was very much a power playand he knew how to switch it
around on her.
But Charles, I mean, he was anamazing survivor.
Christina McKelvy (10:09):
Those skills.
Like you mentioned, he was verystreet smart.
How did he?
What kind of growth did you see?
Cause when I was reading astory, it sounded like there was
a lot of ebbs and flows withwith his growth.
Zak Mucha (10:26):
Sure, I know a lot of Sure, a lot of our clients.
We weren't going to be sendingpeople to college.
We were really trying to keeppeople housed.
We had to track progress With alot of people.
We could say, okay, this personwas hospitalized less this year
(10:48):
than he was last year and youknow he only got evicted once
this year, rather than threetimes last year.
And progress would be, you know, having some stability, some
safety in the community.
Christina McKelvy (11:08):
Progress would be building relationships
yeah, you say in chapter 22,that act was designed to be a
campaign of full press,intensive services aimed at
clients who faced steep recoverychallenges and were almost
certain to progress slowly if atall yeah yeah, and and even
(11:32):
even the bureaucratical of ACT.
Zak Mucha (11:36):
You know just the full fidelity ACT, because we'd
be audited every year.
You know the requirements, evensaid you know one clinician
should not be seeing the sameclient every day, Like, if
Charles is a client, I would seehim on Monday, this person see
(11:57):
him on Tuesday, this person seehim on Tuesday, Another person
see him on Wednesday.
And the official reasoning fromthe state was that well, we
don't want them to get attachedto anyone.
Christina McKelvy (12:12):
And.
Zak Mucha (12:13):
I disagre.
You know we really built a teamso that, like if you were a
clinician, you would have acaseload of you know four, five,
six, seven, eight people thatyou were their connection to the
world.
You were the person they had torely on.
You were the person they sawevery day, and because they they
(12:38):
, you know we have to have thoserelationships.
I mean, it's this is where youknow what we're doing was very
psychodynamic.
The relationship is everything.
I mean that that's the onlything that that was.
Christina McKelvy (12:53):
That was where we saw progress, when
someone actually, you know, wasable to start making
relationships and thatrelationship, and I'm trying to
I had a mark, but for charles itsounded like it was that he, he
acknowledged his.
There was a.
(13:13):
There's a part where it saysthat like he was talking to
someone, that's when he realizedhe was dying.
And I don't know if thatrealization came because of that
relationship.
I'm trying to find thisparticular I had it marked scene
.
Um, do you I don't know if yourecall, or of course you do you
(13:34):
wrote the book, but um, therewas a part where it says and
then he realized he was dyingand that support he got from his
clinician and the team wasprobably huge, especially during
that time, and didn't he also?
He also moved from the streetto jail in the last part of his
life.
Zak Mucha (13:55):
Yeah, it was real, it was a real shame.
I mean, it was everything theguy had done.
A judge got him for justchronic shoplifting.
He had so many shopliftingarrests and he was, he was very
sick when he went into, when hewent into jail.
But even before that he was ina hospital, a medical hospital,
(14:19):
a medical unit which, unlike thepsychiatric unit, you have a
phone at your bed.
So Charles was calling ouroffice every two minutes, ten
minutes, and you could just seethe phones lighting up around
the room, with him calling anddemanding a beef sandwich or a
combo fries, and someone had tobring him something sounds like
(14:39):
he was trying to connect in someway in his turn.
Yeah, yeah, and it wasinfuriating, but this was.
Christina McKelvy (14:46):
This was also how he connected yeah, like you
said at the beginning, yourwork with an act was infuriating
but also, you know, inspiring.
You know I don't think that'sthe word you used, but it was
both of those points it was.
Zak Mucha (15:03):
I mean we talk about hope.
I mean it was always stunningto me how much people do want to
live right, how much.
I mean there are very fewsuicides, which was amazing.
Christina McKelvy (15:20):
Yeah.
Zak Mucha (15:22):
And that people.
It's amazing what we can sufferthrough with.
You know the idea of all right.
There's something I want on theother side of this.
I had some brilliant clinicianson the team.
(15:55):
One guy was more than him, butthere are some people who are so
amazingly dedicated and when webuilt this team, we created a
lot of stuff just because theagency wasn't really too
concerned about what we weredoing.
We were making money for them.
Act reimburses at a high rate.
(16:16):
I'm sorry, go on oh oh no, I wassaying so they weren't
concerned, but they were in away yeah yeah but, you know,
thank you, they gave us room todo, to create a lot and we had,
okay, we had our own clothingcloset, we had a food pantry, we
had, you know, one therapistactually convinced the city gym
in the neighborhood to give freememberships to his caseload and
(16:41):
he was.
He was marching his guys upBroadway into the gym.
You know, it was great and ittook months and months, and
months but we actually truly sawa difference and, just you know
, people were able to.
You know, you know what theThorazine shuffle is, just the
sort of disconnection to yourown body, part of meds and part
(17:03):
of symptoms.
He was able to actually startcombating that.
We could see guys walking verymuch with a purpose and walking
with an awareness of theirbodies.
It was amazing and we had that.
We had, you know, we created, uh, emergency apartments because
we were dealing with a lot ofhomelessness and I convinced,
(17:25):
you know, one landlord if Icould raise the money for two
apartments for a year, just givethem to me, let me use them,
I'll move people in as I need toand you don't do any background
checks that are going to takethree to five days.
If I'm pulling someone off thestreet?
Where am I going to put themwhile we're waiting for a
(17:48):
background check?
And we needed a place wherethey wouldn't have to pay rent
for the first couple monthswhile we get their benefits
started and all that.
So I told the landlord and wethrew parties and raised the
money.
I told the landlord I thought Iwas being really magnanimous.
I told him I promise you nomurders.
(18:09):
And he said I don't care aboutthat, I don't want any arsonists
.
That's a good point.
Christina McKelvy (18:18):
That's a landlord point, but that's a way
, that's a that's a landlord.
Okay, yeah, our, yeah,arsonists wouldn't, you know,
would not be a good thing forsure.
Um, you know, speaking ofhousing, I was as I was reading
this book and I even had it.
I have a note next to it.
Food and housing come first,and I put maslow's.
I'm curious how does Maslow'shierarchy of needs play into the
(18:42):
work you did, or you know?
Did it?
You know, did you see the?
You know how?
What Maslow spoke about likewhat you need as the base and
moving on up, did you see thatworking in action?
Or you know what did that looklike?
Zak Mucha (18:56):
Oh, totally, I mean mean housing.
That was why we had theemergency apartment and housing
housing comes first.
It's impossible to do anythingif someone does not feel safe.
You know, just it's like the,the homeless shelters.
It's really a dangerous thingif you're being prescribed heavy
anti-psychotic meds.
It's really a dangerous thingIf you're being prescribed heavy
(19:17):
antipsychotic meds.
It's really a dangerous thing togo to a homeless shelter
Because those meds, if you takethem, they're going to knock you
out.
You're near unconscious.
If you do that in a homelessshelter you're going to wake up
with all your stuff gone at thevery best.
So you know, safe housing issuch an important thing it still
(19:41):
is.
So that was.
You know, that was always afight to have housing for our
people.
And you know, I remember whenwe had one man who was a cab
driver.
We had one man who was a cabdriver but his symptoms, his
hallucinations, delusions, wereso severe.
(20:03):
He would be driving, driving acab, but he would hear someone
saying horrible things about himand he thought it would be the
fair in the backseat.
Christina McKelvy (20:16):
And he would pull over and get violent.
Zak Mucha (20:18):
Something terrible was going to happen.
But he had these very realdelusions that there was
literally someone fused to hisback, coming out of his back and
yelling at him and excoriatingthis really ugly, ugly
commentary about him just 24-7.
And he couldn't keep driving acab.
(20:39):
He was going to hurt someone.
Christina McKelvy (20:43):
Yeah, yeah.
Zak Mucha (20:45):
So you know, when we had petty cash and subsidies for
not apartments but hotel rooms,I made a deal with him that
we'll get you, because he wassleeping in the alley behind the
cab stand.
He had nowhere to stay and Isaid, all right, I'll put you in
(21:07):
in a room, I'll get you a place, your own bed, your own
bathroom.
But you know, like like any,like any apartment, I need down,
I need a deposit.
You'll get it back when youhave your own place.
He gave up his cabbie licenseas a deposit on his apartment,
(21:28):
which is great, which meant hewasn't going to kill someone
driving, and this is weird, itwas a lot of on the fly problem
solving well, it sounds go on ohsorry, I was just gonna say it
sounds like the shelter was moreimportant than the income for
him at that moment, and thatkind of proves maslow's needs
(21:51):
yeah, the income was not doinganything for him.
Yeah, he needed.
Christina McKelvy (21:55):
He needed to be somewhere where he could rest
, sleeping in the alleys it'snot good for psychotic symptoms
and did you notice that once theyou know the base need of, you
know food, water, shelter, likewhen that was met, were they
able to climb the rung to thenext need, and then so forth?
Zak Mucha (22:22):
Yeah, but the rungs were very close together.
I mean it wasn't huge progress.
I know there was progress, butit was hard.
It was a lot of.
These are people who had beenyears and years without real
intense care, without anysupport systems.
(22:44):
Some of the staff I don't knowif you remember the case of
LaFleur, but the case managerthat was working with him.
I had to show him how to washhis feet, how to you know it was
.
I mean you talk about?
(23:04):
You know a lot of talk aboutChristianity, I mean and I don't
I'm not religious in that waybut this was truly compassionate
work this therapist was doing.
I mean going there showing himhow to clean the toilet, how to
clean the tub, how to wash yourfeet and just stuff that this
man had not done in years andyears and years.
(23:26):
There are several points wherewe would have to go to Home
Depot and buy full-on disposablehazmat suits just to clean
someone's room, disposablehazmat suits just to clean
someone's room when we startwith them, because it would just
horribly horrible and just inhuman conditions people are
living in and that that would beoften.
Christina McKelvy (23:56):
I mean, I can imagine that can kind of do
something, that one's beliefs orum outlook like how, how would
a clinician, um case manager,social worker, like how, how,
what would you recommend thatyou know, especially those that
might be working in act programs, can?
(24:19):
Where do they find theirstrength?
I guess it's the question youknow, and how to move forward
and see the hope in their work.
Zak Mucha (24:26):
Yeah, well, it's like the, the title of the book
itself, right swimming to thehorizon.
If you give it a thought for amoment, it's not a hope, not
even a hopeful vision, right?
I'm swimming to the horizon,we're not going to make it that
makes sense, yeah yeah, and andit's from a conversation I had
(24:48):
with a really amazing therapistwho was she was was working too
hard and, you know, justliterally staying way too late
typing up notes long aftereveryone's gone.
And we were, we were on call 24seven, but still, you know, I
think at one point I literallydid have to threaten to unplug
her computer while she wastyping, she wouldn't go home.
(25:10):
And she was very upset becausethere was always always more to
do.
I mean, every day you come inthere'd be something else that
fell apart.
Someone else who was in trouble, someone else, you know, threw
their meds out, someone gotarrested, you know, whatever
there was always, you know,always something new to take
(25:30):
care of.
And I was telling her she wasvery upset.
You know, in my office I said weare not going to cure psychosis
.
I mean, we are swimming to thehorizon.
Our job is to help our patients, you know, move their lives
forward in these little littlebits, lives forward in these
(25:53):
little little bits.
And I think the valuable partwas for the staff who did, who
were energized by the work, werethe ones who valued the
relationship themselves.
(26:17):
One thing this is a little bitof a sidebar, but not terribly.
You know, when we're firstsetting up in our offices I had
a buddy paint a big banner forthe team and it said if you
can't be counted on, you can'tbe counted in you can't be
counted on, cannot be counted in.
Yeah, like we are a unit, wehave to support each other.
As you know, as co-workers,this wasn't, you know, it was a
(26:41):
big team office.
Everyone had to be able tosupport each other.
Everyone had to be able to backsomeone else up.
If I'm hospitalizing someone, Ineed someone.
I may need someone to come withor at least someone to watch my
back while it's happening.
You know we were in a lot ofnot safe situations, yeah, or
just you know we had to.
(27:02):
If someone couldn't get topatient mary for her doctor's
appointment, someone else had tograb it and take care of mary
you know, we had to support eachother in supporting our
patients, and the banner was agood litmus test, because if a
staff member was annoyed by thatthought, it told me a lot about
them.
That they didn't want to becounted on and didn't care about
(27:27):
being counted in.
But with this, I mean, and thosealso often were not the
clinicians who were energized byor valued the relationship with
the client.
I mean, it was hard, hard work,and I wasn't thinking of this
(28:03):
back then because I didn't knowof Emmanuel Levinas, the
philosopher who lost his entirefamily in the Holocaust.
And I think of his work, aboutour irreducible responsibility
to the other, that we have to.
We have to be responsible.
Basic rule to not to not killthe other person.
(28:23):
And you know so.
You know that we have theresponsibility to not look away
from the sort of devastation.
We have to acknowledge it.
We have to step in and dosomething.
And I think the people on theteam who really love this work,
I think they just inherently hadthat sense that we just have an
(28:47):
inherent duty to other people.
Christina McKelvy (28:54):
Yeah, the humanist, yeah, humans, Mm-hmm
yeah.
Zak Mucha (29:03):
And just stepping in because we were dealing with,
you know, severe psychosis.
It's very scary.
It's scary to you know.
Try to figure out what is thisperson talking about and over
time we would see that, allright, a lot of these symptoms
were about their traumahistories.
I mean, we could rarely getlike a full intake out of
(29:25):
someone, a full, you know, fullsocial history, just because the
disorganization was so great.
But over time we would see, allright, the narrative of the
symptoms would hold a lot ofpieces of very traumatic past,
traumatic childhood and atraumatic adulthood, and one guy
(29:47):
who I really, you know, reallylove this guy.
The only way he would work withme was if I could step into sort
of half a delusion he had thatwe were like cops working
together in a buddy movie and Idon't know if you remember him
from the book.
But during the intake interviewhe would do nothing but scream
(30:08):
at me I'm Stephen Scull, you'reBruce Willis, remember when I
kicked you the gun when theykidnapped your daughter?
And you know it was all thisvery hyper-masculine stuff.
But okay, there's something heneeds to prove in this and I
can't.
Well, it's a point of realityif I say my job is to get him
housed and safe in theneighborhood.
So you know we'd have to drivearound the neighborhood.
(30:31):
He got evicted from places alot.
He was deeply offensive andthreatening to a lot of people
but he was able to work with mebecause I wasn't challenging him
.
It's like all right, I didn'tsay I was Bruce Willis, but I
just went on and said all right,this is what we have to do, and
(30:55):
that was the way he couldconceptualize the relationship
so it was acceptable to him.
Yeah, and, and you know, wekept him safe in the
neighborhood as much as we could.
Christina McKelvy (31:19):
Yeah, there's , there's so many, you know just
lovely like and I'm using theterm lovely stories, even though
it was hard and hard work andgrueling work, and I highlighted
this part.
I did, however, understand thetherapeutic aspects of work.
(31:40):
Some of us are like dogs.
We need responsibility,something to do, something to
define our value and purpose.
But not all job searches weretherapeutic, especially when the
odds of success werefrustratingly minimal.
And I'm connecting that to likewith the houses you know you
mentioned.
You know he were getting himhousing and he continued to get
evicted, getting individualsjobs and maybe they were
(32:02):
continuing to lose those jobs.
But the big thing is that theyneeded to have value and purpose
and that's what you're alsohelping and I know that.
Again, back to Maslow's needs.
That's like I don't have itpulled up, but I think it's like
three or four, you know, but Iactually kind of think it runs
up and down the side of thetriangle.
(32:24):
You know, for those of you thatdon't know, maslow's hierarchy
of needs is a triangle and youknow there's the basis food,
water and shelter, but shelter,but having that value and
purpose and hope, I think goesback and forth and when you have
that hope you have that purposeand value.
You want to move forward and itsounds like that's what you
(32:46):
guys were doing, despite knowingthis individual may not hold
this job for long or may nothave this house for long, but
we're going to keep getting themthose resources yeah, and I I
totally agree with you.
Zak Mucha (32:58):
The idea of having a purpose is a life-saving thing,
whether you're at this level ofyou know severe mental illness
or, you know, any patient whocomes into your office.
I mean you could see that sortof without a sense of real
purpose in the world, howdepressing and disheartening it
(33:21):
could be.
And yeah, that even you knowbecause it defines us right Even
to have a terrible job.
I mean I've done it before.
I went to social work school alittle later and much later in
life.
So I had a lot of rough jobsthat I did not like, but I can
(33:43):
at least define myself by sayingI hate this job.
This is not what I want to dofor the rest of my life, and
that defines us as much as a jobwe love.
So, and that's also a big partof the work and it was a part of
, you know, buildingrelationships with patients,
(34:03):
because you know we were having,you know we did have the
50-minute hours with ourpatients and this crowd was
deserving of therapy as anyoneelse, and therapy should not be
only for middle class and up andjust to have that.
(34:24):
One thing we would talk aboutis what any patient, no matter
who or where they were in theteam everyone needed to feel
safe and be heard.
Christina McKelvy (34:43):
They needed you know, actually have what
they're saying be taken in.
Zak Mucha (34:46):
Yeah, be safe and be heard, even when there was, even
when there was violence in theoffice and I would have to
intervene.
I remember having someone andwe ended up on the floor, but I
remember telling him no one hereis going to hurt you and I'm
not going to allow you to hurtanyone else either.
(35:08):
And that was like the basicrule for when people are in the
office.
Christina McKelvy (35:14):
Yeah, I'm not not gonna let anyone hurt you
either, because a lot of times,individuals are fighting because
they're feeling threatened andthey're not feeling safe totally
sharing them yeah it was.
Zak Mucha (35:26):
It was all affective violence rather than predatory
violence right affectiveviolence is just.
Just, you know, get away fromme so I don't hurt.
Hurt anyone to in order to feelsafe yeah, oh well.
Christina McKelvy (35:43):
well, zach, we're gonna um switch to the
instagram live portion, uh, butbefore we do, I want to, just in
case it doesn't transfer over,because I'm going to try and
somehow record the Instagramlive session.
But I wanted to ask, before weswitch over I ask this question
to everybody that's on my showwhat brings you hope?
(36:04):
What gives you hope?
Zak Mucha (36:05):
What brings me hope is I think that I've you know
back then doing that work andnow you know I'm a therapist in
private practice.
I mean just, I have seen peopledo amazing things, make real
(36:28):
changes.
I have seen people just sort ofcome to life.
I have seen people just sort ofcome to life and just
personally.
Stuff that gives me hope ispoetry.
It's just such an amazing thingreading books.
Books are always hopeful.
I'm never going to get througheverything I want to read in
(36:49):
life, I mean and I think I'vesaid this to you before you know
.
And also one thing that's beenvery hopeful for me is and this
is totally counterintuitive andparadoxical, but that's how it
is but like Zen Buddhism, I'mpracticing Zen Buddhism, which
(37:11):
is the only thing I've gottenout of all of that is to see
that, to see that my ownthoughts are not that important.
Everything I worry about it'sme doing it to myself, and it's
just this very strange way tofind hope in how horrible
(37:31):
everything is, even like we weretalking about today.
You know, before we started, wewere talking about the weather
and I'm in Chicago and it's theend of February and it's 70
degrees, which is not how it'ssupposed to be in Chicago in
February.
This is supposed to be whenwe're all depressed and
miserable and it's a lovely day,but it's also a horrible sign
(37:56):
for the climate.
It's like we're taking out apayday loan on the planet and
it's about this awfulness at thesame time as it's also lovely.
And there was a lot of likeyou're describing in the book.
It's not, you know, it's a tonof very sad, sad stories, but
(38:20):
there's also a lot of joy inthose little bits of
interactions.
Some of these people had anamazing you know clients and
staff an amazing sense ofgallows humor that got us
through this.
Remember I was training a newstaffer at one point and we're
(38:40):
working with a man who hadreally severe delusions and
hallucinations and I'm trying toteach a young staffer how to
respond differently betweendelusions or hallucinations.
Hallucinations you could realitycheck.
Delusions you do not want tochallenge because you end up
part of the conspiracy and wesee that with you know American
(39:03):
politics right now.
So this man is being chased byan entire family that are
delusional and we're in a roomsomewhere and he's saying I
could hear they're pounding onthe door.
Right now it's yelling.
And I said you know respondingto the delusion, something like
(39:27):
you don't get a moment's rest.
These people are always afteryou.
You can never relax.
He said that's right.
I said but I got to tell you Idon't hear anyone pounding on
the door.
What do you think that means?
And he said well, it means oneof us is fucked up, and all
(39:48):
right.
He had a little bit ofawareness there it was good,
yeah, hmm, it's that.
Christina McKelvy (39:57):
it's that hope within the darkness yes,
that's exactly.
He summarized me going onendlessly perfectly well, zach,
let's, um, you know, switch toinstagram live, and I'm gonna
pause okay, okay, all right.
(40:18):
Well, I don't know if I'm goingto have this in the podcast or
not, but we tried to go live andit didn't work, but that's okay
.
So I'm going to ask thequestions to you.
That, but we tried to go liveand it didn't work, but that's
(40:39):
okay.
So I'm going to ask thequestions for you, um to you.
That I was going to ask liveand, of course, if anyone has
questions for Zach, if you werelike, oh you, we can't, you, I
didn't get to meet you live,that's okay, cause in the um
under my podcast on Spotify, youcan provide feedback.
You can send an email, sendZach an email through Instagram.
(41:00):
You know, contact us if youhave any questions or feedback,
and I'll also put that in thelittle sorry note on Instagram
that um.
So one of the other questions Ihad was what did your
experience and this might be theonly question to ask actually
(41:20):
working in that team, teach youabout resilience and healing?
Zak Mucha (41:30):
I think the one thing I really did about resilience
and healing was that workingwith ACT, I saw that I had so
much more to learn.
Was that working with ACT, I sawthat I had so much more to
learn, and it's why I ended up,I believe, why I ended up a
psychoanalyst and there was somuch happening that I could not
(41:56):
understand, and you know that'sjust about symptoms, symptoms,
and that people were soresilient I think it was, you
know, there was so much that Iwas not trained in.
I mean, there was nopsychoanalytic training, there's
barely any supervision at all,anyway.
But I realized, all right,there's so much I don't know,
there's so much happening herethat I had a sense of something
(42:20):
that.
But I really had to go learn,and you know, and I started.
You know, I started going tolectures at the Chicago center
for psychoanalysis.
The first lecture I went to wasa Lacanian lecture.
I didn't even know who Lacanwas and I walked out of there so
(42:40):
angry because I couldn'tunderstand a damn thing that was
said.
But it sort of set me to allright, this, this is this was
like taking over the act team.
I had no clue what I was doing,I had no business probably
doing it, but there wasliterally no one else who wanted
to run that team.
I mean, I was promoted intosupervising that team when I was
(43:03):
maybe a few months out ofsocial work school.
It wasn't because anyonerecognized this amazing talent I
had, it was that no one wantedto do this filthy, violent, you
know, thankless job.
But I was willing.
I was willing to because partlybecause I didn't know any
better, and but that that alwaysfascinated me, that, all right,
(43:26):
there's walk into this thingwhere it was a total mystery and
a total mess and, I think,going from act into
psychoanalysis and very much atotal shift in, you know,
perception of my ownresponsibilities.
But in all of it, the samething that is there and it's the
(43:48):
thing that keeps me hopefuljust how resilient people are
you know and how much potentialthere is, or for people to you
know, keep growing.
It's an amazing thing to findout.
All right, I could do much morethan I thought I could.
I am much more than I thought Iwas.
Christina McKelvy (44:08):
Yeah, I am much more than I thought I was.
I love that and that's thathope.
Hope breeds resilience orhealing.
It ties into each other.
When you have hope, you canhave that resilience.
Hope breeds resilience orhealing.
It ties into each other.
When you have hope, you canhave that resilience and then
you can heal.
Zak Mucha (44:25):
Actually I think it's for me at least.
I sort of see it the other wayaround that resilience sort of
breeds hope Okay.
Christina McKelvy (44:32):
I like that.
Zak Mucha (44:34):
Say holy shit, I just survived this.
Okay, I didn't think I would.
Christina McKelvy (44:39):
Okay.
Zak Mucha (44:40):
That changes my own boundaries as a person, that
changes my own self-definition.
I can survive a thing that Idid not think I could before
yeah, I like that reframe.
Christina McKelvy (44:55):
Yes, yeah, that makes sense too.
Well, zach, thank you so muchfor you know being on my podcast
and you know your flexibilityis trying to figure out the
instagram live, but I will golive on instagram in a minute
and apologize to my three, threefollowers.
Um, but, zach, where can peoplefind you if they want to learn
(45:15):
more about you and where canthey find the book, if they
would like to buy the book?
Swimming to the horizon?
Zak Mucha (45:20):
uh, I'm very easy to find at my name zachmuchacom
z-a-k-m-u-c-a-jcom.
Uh, I'm easy to contact.
My information is there.
The book is.
Wherever you buy books, you canget a copy of it all right well
yeah, nice well, thank you ah,thank you.
(45:42):
This was fun and all right.
We tried instagram.
It didn't work big deal.
If half the things I triedworked out, things would be very
different.
Christina McKelvy (45:51):
This is great yes, yeah, no, it it was.
It was really fun.
I definitely definitely enjoyedit.
And to everyone listening outthere no-transcript.
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