I am a licensed clinical social worker. And, occasionally, a mental patient. Today, in this inpatient psychiatric unit, I am more a patient than a social worker.
It is Monday morning, and I am eating breakfast across from Owen, a muscular, flannel-clad, Paul Bunyan-looking patient. Little pieces of his scrambled eggs keep landing on his copper-colored beard. I sort of want to motion with my hand at where the eggs are on his face, but I’m too tired, and I don’t really care. About anything.
Owen is an odiferous, rebel-flag-t-shirt-wearing, phlegm-spitting, hairy-eared mechanic who, to be honest, would not normally be part of my social sphere. In my professional life, he could be my client. But right now, unshowered and unkempt, I’m looking pretty rough around the edges myself.
At least, Owen is wearing real clothes. Like several others here, I am on suicide watch, so I’m required to wear a hospital gown. I’ve been stripped of my clothes, my ID badge, my degree and my dignity. The staff have even confiscated my bra, explaining that it might be used to hurt myself or others. Don’t they know that I need all the support I can get in life? I think. As if “death by bra” were a common occurrence from which I need protection. Other patients have made the best of our clothing situation, showing runway-worthy ingenuity: Some wear the gown as a robe, others use it as a dress, or use one gown as a gown and another as an undergarment or sash.
In yesterday’s therapy group I heard Owen describe his experience with depression. Now it’s as if we share a secret lover — for to know depression is to make love to the manipulative beast, to learn all of her intimate quirks. Depression draws you to her with such power, making you feel that you’re a willing participant. As she leans in, she whispers in your ear that you are nothing, an incapable nobody, and she gives you shit-colored glasses to see through as a daily reminder. She says that she will stay with you and be your only confidant. She sits on your chest to make getting out of bed difficult. She hangs her full weight off of your shoulders, so that even showering or walking feels like an Olympic event.
Depression helps you forget anything positive about your life and insists that you sabotage any attempt at living without her. She whispers that the only way out is to die, then reminds you subtly, every day, that you can’t even do that successfully.
Owen and I know that once depression got her claws into us, we were doomed — we had to submit to our locked doors and toiletries-behind-the-counter hospitalization, because we’re in it deep with her. It’s our penance for not pulling up our bootstraps strongly enough to resist her.
The stigma of our relationship with depression means that we can’t reach out for help until it’s too late.Besides, we think, we don’t deserve any better than this. Owen couldn’t get out of bed anymore to go to his mechanic’s job, nor to maintain a relationship with his girlfriend, and I couldn’t get out of bed anymore to work at my Adult Protective Services (APS) social worker job, nor to parent my three- and five-year-old daughters, so what good are we?
Too exhausted to speak much, we sit in intimate, silent conversation about our shared lover, making the morning bearable. He wipes his beard with a napkin and musters a brief smile at me as I eat my bagel.
Later, when I’m done with my third nap of the day, I wander into the “day room.” To make the time pass, I try to guess people’s diagnoses. I think of all the resources and support systems I could set up for my fellow patients. Do they know about that new mental-health housing program? That guy could probably use his VA benefits to pay for his psych meds. Clearly that woman is not ready for discharge — and yet, there she goes. I keep it in my head; that’s not my role here. Social worker, heal thyself (first).
A couple of fellow patients and I play the dangerous, ever-popular game, “What you could use in this place if you really wanted to kill yourself.”
“You could stab yourself with a pencil,” I offer, knowing I’ll get no points for that one — too boring.
“Bundle your sheets together and use them to hang from … from … from something,” Owen remarks. As we all look around the room for something to hang from, I instantly regret playing this game. What if someone’s not kidding? I think. How irresponsible of me to join in.
“You could just eat the food they bring us,” I say, trying to lighten the mood. I look around. Mood definitely not lightened.
Moving on, I join another patient in assembling a small jigsaw puzzle of kittens in a basket. There are pieces missing, so we can’t complete it.
In the hospital, even the simplest tasks become an exercise in humility. I decide that for my major activity of the day, I will shower. It’s late, and I feel exhausted just thinking about it, but I request soap, shampoo and a towel from the twentysomething psych tech.
“You’ll just have to WAIT,” she snaps, as if admonishing a whiny child. I hadn’t noticed that she was doing anything; she’s just standing there. I’m twice her age, I think to myself. At home I don’t have to ask permission to get shampoo; I must be really screwed up to need that.
She stalks to the supply closet and comes back. “Here!” she shouts, shoving a bottle at me.
“Can I have a towel too, please?” I ask in my humblest Oliver Twist manner. (I don’t bother asking for soap; I’ll use the shampoo.) Meanwhile, I’m thinking, Usually, lady, I’m on the other side of the desk from you, looking at my clients’ charts when I’m here checking on them or consulting.
She rolls her eyes and brings me a towel. It is only big enough to cover my left nostril.
The shower in my room has no curtain and no handle, just a bare, stripped knob. I try turning it right or left, but I can’t get it to move. I figure maybe its operation is part of my mini-mental cognitive exam, so I’m determined to figure out how to use it. Surely I can master a shower handle. I summon my years of education and of putting together furniture and toddler toys, but, alas, I just cannot do it. I add this to my list of failures in life and, re-clothed, emerge defeated from the bathroom. I ask a nurse how to use it.
“Oh, honey,” she says with a slight snicker, “that one’s broken. Didn’t someone tell you? Use the one in the hall.”
I find the hall shower and maneuver the handle to produce a tiny stream of ice-cold water. This shower also has no curtain or lock on the door. The shower epitomizes all of my hospitalizations, really — each one a cold experience rendering me tremendously vulnerable, exposed and alone.
Was it worth all this to keep me from killing myself? Really?
I stand naked in an unlocked room in the main hallway with no curtain. Anyone could walk in at any time. Sinking to the floor and sobbing, the ice-cold water dripping onto my unliked, large, naked body, I immerse myself in a single stream of humiliation and punishment for being such a failure in life. What have I become?
The water splashes off my head as I think about what landed me here. This is perhaps my fifteenth hospitalization, the first being an eighteen-month stint in Chestnut Lodge as an adolescent, after suffering severe abuse at home. But I haven’t been hospitalized in more than thirteen years. I feel completely caught off guard.
I thought I’d gotten my shit together. I have a family, I got through grad school with a 4.0 GPA (after finishing the ten-year, depressed-undergraduate plan), and I have a job. I’d thought that if I worked hard in therapy and in life, and took my medicine, I’d be immune to depression and hospitalization.
I was wrong.
I’ve been working in my county’s Adult Protective Services (APS) department, investigating allegations of abuse, neglect, and exploitation of vulnerable adults. Over several months’ time, my ability to do my paperwork has been dwindling. I’d call people and not remember whom I’d called. One time I drove to the store in a neighborhood I’ve frequented for years, and I suddenly didn’t know where I was, how I’d gotten there or how to get to where I was going. I pulled over and cried; I could not remember a time when the world was OK. I was fat and ugly and stupid and incompetent — always had been and always would be. My kids were asking why I was in bed so much.
Another day, I became disoriented and fell down a whole flight of stairs at home. Bruised and battered, I lay in a heap at the bottom for hours, sobbing. That night, I wrote goodbye notes to my children.
Reading the notes aloud gave me pause, and a chance to regroup: Even if I couldn’t deal with life, I realized that I wanted to be there for my kids; those lovelies did not deserve to experience a disturbing, life-long reality that their mother had killed herself. I knew that I needed to be in a safe place to protect me from me, so I sucked it up and headed to the ER. After spending sixteen hours lying on a gurney by the nurse’s station, I was brought here to the psych floor.
When the shower is over, I dry my left nostril with the washcloth/towel, get dressed and walk out into the hall. I feel like I don’t belong here. OK, I realize that I’m just as worthy of being here as anyone else, but I don’t want to belong here.
I want to garner some respect — to loudly proclaim my credentials:
“I AM A SKILLED CLINICIAN. I AM ABLE TO NEGOTIATE COMPLEX CLINICAL PRESENTATIONS, CAREFULLY ESTABLISHING RAPPORT, AND I HAVE DEFTLY CONDUCTED INDIVIDUAL AND GROUP THERAPIES. I AM AWARE OF THE PSYCHOLOGICAL FORCES THAT UNDERLIE HUMAN BEHAVIOR AND EMOTIONS, AND HOW THESE FORCES RELATE TO EARLY EXPERIENCE. I AM CAPABLE OF GREAT INSIGHT, AND I HAVE HELPED OTHERS TO ACHIEVE INSIGHT AS WELL.”
Instead, I just glance over at the staff at the nursing station.
A nurse, chewing gum and not looking up from her paperwork, declares, “Nine o’clock. Lights out, Katz. Go to bed.”
Lying here on this hard bed on the psych floor, staring at the white walls and ceiling, I think of my clients — and I don’t feel so alone. Their everyday experience is not so different from my short-lived experience here at the hospital. Often, they endure a whole day’s wait in the dirty Social Security and social-services offices, only to be treated patronizingly and have their needs go unmet.
I think about the conversations my Adult Protective Services (APS) coworkers and I have about our hoarding clients, whom we all want to help, but all want to avoid at the same time. We wonder: “How could that man live in that house so long with all the stuff piled up, with the flies and the trash and the smell?”
I smile, because now, more than ever, I get how coping with a difficult life can make your reality — no matter how bizarre or unpleasant — seem like the empirical truth. Is the world really shit? Am I really worthless? Or is it the depression talking?
In my work, I’ve understood that psychotic clients have experiences that are real to them, but not to anyone else. But I never thought this applied to me — until now.
I’ve operated under the assumption that when you meet people from the Land of Psychosis, you have to learn their language and respect their culture so that you can communicate. You’re entering their world, and you must let them show you around. So I’ve always asked detailed questions about their inner world and hallucinations.
Recalling this, I’m flooded with self-pity. I wish that someone would ask me detailed questions about my depression, as if they were interested in knowing my experience, not just my symptomatology.
I think of Will, one of my all-time favorite clients, who has lived with schizophrenia for over thirty years. He has coped with his disease by writing poetry — a language where delusions and hallucinations are welcome. His struggle with symptoms, and his desire to express his angst creatively, feel familiar to me. He’s unable to communicate verbally about his internal experience, but there, on the page, his fear and paranoia dance in rhythmic lines, describing a conflicted life that I intuitively understand.
Then it hits me: To make sense of my experience, I need to write. After begging for a pencil and pad of paper from a psych tech, I scribble feverishly into the night.
I write about the shower knob. I write about the smell of antiseptic and the yellow-stained walls. And about my failures in life — a subject close to the surface: “Why aren’t you home parenting, cooking and working like the normals out there?”
Page four is stained by tears: “Conversations with My Daughters: If you get depressed, this is what I want you to know …” God, I hope they don’t struggle like this.
I haven’t felt up to writing for a long, long time. I realize that the act of writing alone is making me feel better.
Pages six through eight write themselves. They are about the beauty of my daughters, and about where I want my life to be. Even when I pause to think, my hand keeps writing, as if possessed.
I write a list of places I’d rather be, and I imagine myself in each place: on a Tibetan mountaintop, in med school, painting a mural with my daughters, on a remote writing retreat by clear blue waters.
Maybe I’m not such a failure in life, I think. Because, in a sense, these places aren’t really so different from where I am now.
Like a Buddhist monastery or a temple, this place frees me of outside possessions and obligations. Granted, they don’t lock you up at a temple, nor does staying there bring the same stigma. And I have no idea what the showers are like. Still, without the distractions of the daily grind or toddlers underfoot, I finally have time to think and write and ask myself hard questions. It’s strangely exhilarating.
I realize that, as odd as it seems, I’ve been given an opportunity.
The lack of empathy and warmth here can be overlooked, if I can see this place as a jumping-off point for a philosophical journey — a search for a deeper understanding of my depression. Starting a philosophical journey feels much less pathologizing than being hospitalized for a mental illness.
I look over at my sleeping roommate, and I’m momentarily surprised that she hasn’t been jolted awake by all this catharsis. Finally, I get to the meat of my writing, my journey, and ask myself the hard questions:What do I do to perpetuate my own depression? And How do I plan to get out?
Page nine starts, “It takes a village to raise a sane person,” followed by the names of people in my life that I need to reach out to for support: My wife, Lisa, who’s had to be like a single mom at times, and remains steadfast beside me. The friends and relatives I’ve pushed away when I got depressed, then wondered where they went when I felt better.
Page ten. Here, seven pages after listing my failures, I realize that I need something positive to launch from, to start anew. Another list appears: “The uniqueness of me.” The items range from my ability to empathize with others to my love of wearing funky earrings, my impromptu air-guitar dance parties with my kids, and my writing.
If I can hold on to these parts of myself during my depressed times as well as my non-depressed times, I think, I can maybe pull through life with less suffering.
I shake out my aching hands and finally stop writing. I look at this pad of paper, which is a hot mess with no beginning, middle or end. I think of writer Anne Lamott’s insistence on having a “shitty first draft.” In a hazy mix of energized writing and tears, I feel ripe and ready for revision.
A week or so after my admission date, suicide does not feel so viable — and my health insurance is demanding discharge. I leave the hospital armed with my edited first draft of this piece, a bit of clarity, increased hope and new medication.
After discharge, I continue to write. I go to therapy. I try not to internalize all the world’s problems. I don’t let fear of depression keep me from working hard or staying present for the demanding parts of my life.
In addition to going back to my APS job, I create a therapeutic writing group at the local domestic-violence shelter so that I can share the healing power of writing with other women who are struggling. I have them start by writing lists, my lists — “The uniqueness of me” and “Who are the people in my village?” — and then have them write, write, write their shitty first drafts. They laugh and cry and support each other as they share and revise the difficult parts of their lives that have found a voice on the page.
In surviving hospitalization, I’ve become a better social worker. I feel even closer to my clients, because I get how it is to be a patient — the disempowerment, the struggle to figure out whether something is real or the illness, the misery and degradation of fighting bureaucracies and dealing with patronizing systems and people.
A few months after I return to work, a client of mine needs to be psychiatrically hospitalized. I make sure that she’s part of every decision possible, and I acknowledge how horrible hospitals can be. As we wait in the ER, I make her a top, skirt and scarf from her hospital gowns, so she won’t feel exposed, and so we can laugh together. I hold her hand and stay with her until she’s settled in her room on the psych floor. I know how lonely that waiting can be.
Now, more than ever, I know that real healing doesn’t necessarily come from someone with deep clinical knowledge; real healing comes from making a human connection with another person.
For now, my own strengths, my clients, my writing and my “village” sustain me.
I’m OK with being a wife, a mother, a licensed clinical social worker and, occasionally, a mental patient. My work informs my life, and my life (in or out of mental hospitals) informs my work.
And I’m OK with living a life that requires me to occasionally have to ask for shampoo.
Liat Katz is a social worker. This piece was originally published in Pulse — voices from the heart of medicine.
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