Archive for September 26, 2015

Survival by Negotiation

The first fascinating thing about the 60-year old woman we met in the family medicine clinic this week was her coherent curiosity about the visual hallucination she described to us in her hoarse voice.  “I’m only telling you this because my doctor promised me you won’t lock me up,” she said in a playful but urgent whisper.  Her good looks and long hair parted in the middle reminded me of the singer Judy Collins, but her pear-shaped body and the strain in her voice told of a tough life.  Over the previous nine days she had seen in multiple settings the same vivid image of young boy with a Beatles haircut looking up at her, his hands turned palms upward, as she showed us, in a pleading gesture.  She pursued him several times but he always seemed to vanish, and others with her at the time confirmed that only she had seen him.

She and we could not readily attribute this new, organized, and persistent hallucination to the otherwise likely culprits on her lengthy problem list: her stable but partially-treated bipolar disorder, her pulmonary hypertension, her shortness of breath on mild exertion, her list of 16 medications with no recent changes, the timing of the cold remedies she had tried for her upper respiratory infection.  So we ordered a bunch of tests and asked for her patience.

The second fascinating thing about her emerged when she told us that for several months she had been sleeping on the couch of a middle-aged single gay guy.  He took her in after he found her living in her car in the lot behind his apartment building.  “I’m the second of ten kids,” she told us with a wry smile, “but this stranger took me in.”  We never heard why none of her family is available to her now; nor were they in 2009 when she was first hospitalized after losing her house, her job, and her husband to divorce within one year.

So how could such a clever, attractive, feisty woman have burned her bridges with every one of nine siblings and the rest of the extended family to end up homeless and jobless at 60?  Of the many paths to homelessness the one that intrigues me is the inability to negotiate, even when the stakes are high.

Most of us don’t think about negotiation as a skill to be mastered.  Have you ever seen or taken a course on negotiation skills?  How many high schools offer training in negotiation, and yet, which is more crucial for your child as she leaves home for college or the military or a job: integral calculus or negotiating a rental agreement with a slippery landlord, fluency in a second language or negotiating a job offer with a pushy employer?

I provide psychiatric services in a primary care clinic at the Cincinnati VA.  The woman with the hallucination reminds me of some of the men and women I see at the VA who end up at the bottom of the socioeconomic heap after repeated failures to negotiate.  These are the dangerously disconnected.  They can’t negotiate a treatment plan with me or their primary care doctors.  They can’t negotiate a job dispute with their bosses, a disagreement with their spouses, a rental contract with their landlords, or a loan with a bank.   The VA’s social workers try to negotiate some of these for them.  This persistent inability to negotiate is expensive for these vets and for the VA and, therefore, for you and your taxes.  For a few of them, the inability to negotiate is literally lethal.  They die because they can’t negotiate with their caregivers.

How many of our society’s big problems would be reduced if we trained everyone to be competent negotiators?  What if, in addition to proving he could swim across a pool, every high school graduate had to prove he could negotiate a job offer or an encounter with a police officer?  If every high school student in the state of Ohio graduated as a “competent negotiator,” what would happen to our state’s rates of unemployment, homelessness, crime, divorce, domestic violence, bankruptcy?  No one knows because it has not been tried.  But surely a 5% drop in any one of these areas would save big money and much grief.

The Program on Negotiation, a consortium of teams at Harvard, MIT and Tufts, has proven that negotiation skills are teachable and competence can be assessed.  Their programs aim mostly at college students and above: business executives, government leaders, and administrators.  Better business outcomes, more political harmony, and less global war are worthy goals.  But it’s time to develop a negotiation curriculum for high school students, especially high risk students, a curriculum that produces better employment outcomes, more domestic harmony, and less street war.

What do we need our students and this 60-year old homeless woman to know about negotiation in everyday life?  More on that next time.