R.C. Blenis

The Thread You Follow

The woman on the subway platform picks her scalp with methodical violence. I see blood under her fingernails. She's maybe forty, wearing office clothes from another decade. Other passengers have formed a subtle clearing around her, that practiced New York circumference of avoidance. She mutters something about bugs, about infiltration. A teenager films her. What I see, I've seen before. Enough times to name it without looking: mental illness, probably schizophrenia, possibly meth. The city has taught me this taxonomy of distance. 

Then her phone rings: normal phone, normal ringtone. She answers with disarming composure: "Hi honey. Yes... the neurologist. The new med is making my skin crawl. Like bugs under—" She catches herself, breathes. "Tell him Mommy will read him two stories tonight to make up for being late."

The teenager lowers his phone. The clearing collapses. We're all leaning forward now, as if her explanation has given us permission to be near. The blood under her nails is still blood, but now it's different. Not crazed. Not contagious. Medical. Legitimate.

I work as a charge nurse in a pediatric psychiatric unit. Most of my job is translation: deciding what behavior means, what intervention fits, what story makes sense of distress.

This is what I've come to understand: we are all translators, constantly rendering the foreign familiar, the incomprehensible into sense. But some translations change more than meaning; they change what we see. 

#

An eight-year-old enters my unit on all fours. She's barking; not playfully, but with a desperate insistence that makes the intake staff step back. Her fingernails scratch against the linoleum as she circles the common area. A newer staff member mutters about attention-seeking. Another suggests we ignore the behavior until she's ready to "use her words."

As the charge nurse, I could intervene— redirect staff or enforce a protocol. Instead, I sit on the floor. Not close. She needs space, but low enough to enter her peripheral vision. I wait. The barking continues, but something in its pitch shifts, becomes more questioning than declarative.

"It's scary here," I say to the air between us. "New places are scary." The barking stops. She's still on all fours, but her head turns slightly toward me.

"Sometimes when things are too scary, we need to be something else for a while." She crawls closer. Inches. Makes a smaller sound, almost a whimper.

It takes three hours. Three hours of careful approach, of offering crayons and paper at dog-height, of talking about how even brave dogs get frightened sometimes. Finally, she whispers, still crouched but human again, "They said I had to be a good dog to get food."

The story comes in fragments. She was the biological daughter of parents who'd taken in foster children for the paychecks. A swimming pool. Dinner thrown to the deep end. A foster brother who couldn't swim, thrashing toward it. Her parents laughing. Punishments that involved barking on command. Two days ago, both parents were sentenced to prison. Her first foster placement lasted exactly forty-eight hours before she broke down.

The other staff are watching now, understanding dawning on their faces. She isn't seeking attention. She's showing us, the only way her body knows how, what home taught her safety looked like: humanity is something you have to earn; being human is dangerous; sometimes safety is becoming something else.

#

In 2003, three researchers at Yale conducted an experiment. They gave people descriptions of strangers exhibiting troubling behaviors: insomnia, anger, and social withdrawal. Then they simply connected symptoms with explanations: insomnia from work stress, anger from chronic pain, withdrawal after a death.

With each causal connection, something shifted in how participants saw these strangers. The behaviors remained exactly the same, but the people seemed more normal. Not cured, not fixed, but recognizably human in their distress.

The researchers called this "the understanding makes normal" effect. They discovered clinical psychologists showed the tendency more strongly than laypeople, perhaps because their training is in the art of translation: more ways to render distress comprehensible.

But not all explanations worked equally. Brain abnormality explanations like “problems in the reticular formation” left people unmoved. The translation only worked when it connected to something people could imaginatively inhabit: stress, loss, pain. Stories they could see themselves living.

I came across the study in graduate school as part of a course on cognitive biases, filed it away as interesting. But it didn’t become necessary until months later, when I watched staff debate whether a patient’s behavior was ‘manipulative’ or ‘trauma response.’ The moment someone named the context, the room shifted. Same behavior, suddenly comprehensible. I pulled up the study again, realized I’d been watching it unfold in real time, and posted it in the breakroom. 

#

The boy's group home called it "excessive screen time." Six, seven, eight hours a day. Aggressive when staff tried to enforce limits. Particularly hostile toward female staff. Classic oppositional defiance, heading toward conduct disorder.

But watching him hold that controller, the way his fingers move with absolute precision, like a pianist who's memorized not just the notes but the breathing between them. This isn't gaming. This is communion.

"Who do you play with?" I ask.

His whole body changes. "My dad. We build worlds together."

The explanation comes slowly. His father, diagnosed with early-onset dementia two years ago. The real world is increasingly foreign to him, but somehow, in the pixel-realm of Minecraft, still present. Still capable. They meet there every evening, father and son, building elaborate structures that exist nowhere else. The Xbox is the last church where his father still remembers him.

"And your mom?" I venture.

His face closes. Later, much later, I'll learn about her hands, about the very specific ways a mother can break a child. About why women in authority trigger something primal in his body, a remembering that happens below thought.

The group home still needs to set some limits. The boy still needs to learn to navigate a world that won't always understand his grief. But now they know: they're not dealing with defiance. They're dealing with someone trying to hold onto the last threads of connection to a father who's disappearing one neuron at a time.

#

I'm teaching a poetry group on the unit. We're reading Stafford's "The Way It Is." I've written it on the whiteboard: There's a thread you follow. It goes among things that change. But it doesn't change.

"What's your thread?" I ask. These groups often start in silence.

A woman who's been here three times this year speaks first: "Checking. I check the locks seventeen times. The stove twenty-three times. Everyone thinks I'm crazy. But if I don't..." She trails off.

"But it is hard for others to see," someone else reads from the board.

"What happens if you don't check?" I ask gently.

"My daughter died in a house fire when I was nineteen. I was at work. The babysitter left a candle burning." She says it matter-of-factly, like she's reading ingredients. "So I check. It's my thread. The one that says maybe if I'm vigilant enough, nothing else will burn."

The room shifts. Another patient, a young man who's been silent for three sessions, suddenly speaks: "I check my mirrors. Hundreds of times a day, even when I'm not driving. Store windows, bathroom mirrors, my phone's black screen. Everyone thinks it's vanity. But my girlfriend died when I reached for my phone while driving. Didn't check my blind spot, didn't see the truck. One second. Now I check everything, I can’t miss anything again.”

While you hold it, you can't get lost, another patient reads aloud. Tragedies happen; people get hurt or die; and you suffer and get old. Nothing you do can stop time's unfolding.

"But we don't let go," the woman with the checking says. "Even when they tell us it's a compulsion, a symptom, a disorder. It's still our thread."

They begin to see it then; how each of their "symptoms" is actually a thread connecting them to something essential: a loss that must be honored, a fear that makes sense in context, a love that persists past reason. The checking isn't just checking. The phone isn't just a phone. These are rituals of remembrance, of penance, of connection to what's been lost.

You don't ever let go of the thread.

One by one, they share their threads. The man who won't eat meat because his brother choked to death at a barbecue. The teenager who cuts because physical pain is the only thing that feels as real as her emotional pain after the assault. Each thread, examined closely, leads back to something human, something that makes terrible sense.

#

There's a danger here I need to name. Understanding can slide into excusing. Explanation can become exoneration. That’s why the researchers considered it a potential reasoning “fallacy.” The psychologist Paul Meehl, who first noted the phenomenon, worried exactly this: that understanding a patient’s behaviors would lead therapists to minimize their severity. A man kills his wife; understanding why doesn’t make the act normal or acceptable.

I think of those parents, the pool, the dinner, the drowning boy. Understanding their own histories of trauma doesn't excuse what they did. The eight-year-old girl crawling on my unit floor is still crawling, still barking, still carrying wounds that may never fully heal.

But I wonder if Meehl missed something about what normalization actually means in practice. Understanding doesn't undo damage. It doesn't eliminate the need for treatment, for accountability, for change.

What it does is something more subtle and maybe more radical: it returns people to the human community. It says that their distress, however extreme, exists on a continuum we all inhabit. That the border between normal and abnormal is more porous than we imagine. In my years of watching this translation happen, I’ve never seen understanding erase pain, but I have seen it make pain speakable.

#

Months later, I'm in Tops grocery, by the bananas. I hear my name. Well, not quite my name, but close enough. It's the boy from the unit, same Curious George shirt, cleaner. His hug is so complete I briefly vanish, held by someone who remembers being seen.

We separate. He shows me his basket: good bananas, a fresh coloring book with blank pages. We talk briefly. His father is in a facility now, but they still meet online sometimes, when his dad remembers how. The grief is still there, but it has a shape, borders that contain without constraining. He hasn’t let go.

We nod, return to our shopping. Both of us still here, both still holding our threads, still choosing what to fill our carts with.

#

The eight-year-old girl left our unit walking upright. Not cured. You don't cure that kind of trauma in a few weeks. But translated back into a form the world could recognize. She went to a therapeutic foster home, people who understood that her fear might sometimes make her small, make her other than human, and that this was not manipulation but memory.

I still think about her sometimes, wonder if she remembers the afternoon we spent drawing together on the floor, neither of us using words, just making marks on paper until the marks became a story, and the story became a bridge back to speech.

#

I'm back on the subway platform, different day, same station. A man is shouting at someone who isn't there, wild-eyed, gesticulating. The crowd parts around him. I feel the familiar impulse to diagnose, to distance, but also to translate.

The man's shouting resolves into words: "You said you'd be here. You promised you'd be here." He's holding a funeral program. The translation doesn't make his distress disappear. But now I can see him as someone grieving. The distinction matters— not for him, necessarily, but for how I move through the world and engage with others' pain. Madness, as Leslie Jamison wrote, is often just "grief with nowhere to go."

This is what understanding does: it shortens the distance between us and them, between normal and not. It reminds us that the thread dividing the comprehensible from the incomprehensible runs not between people but through each of us, shifting with context, with explanation, with the quality of attention we bring to looking.

We are all one story away from being strangers to each other. We are all one translation away from being recognized.

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Image by Daniel Queiroz from Unsplash

R.C. Blenis is a writer and nurse from Atlanta, Georgia. Their writing is influenced by fifteen years of experience in emergency and psychiatric settings. They hold degrees in Nursing from Emory University and Psychology from Georgia Tech. They are currently working on their first manuscript, Listen for Water, which explores the intersections of somatic knowledge with systems of care and neglect in American healthcare.

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