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A Day in the Life of a Psychiatrically Hospitalized Clinician (Part 1)

Liat Katz

Editor’s Note: This week Pulse presents the first installment of Liat Katz’s brave and forthright story. The conclusion will appear next week.

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 okay. 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. Okay, 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:


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.”

About the author:

Liat Katz, a licensed clinical social worker, has published personal essays in Lilith and Washingtonian Magazine and has an upcoming fiction piece in Gargoyle Magazine. An alumna of New Directions, a three-year postgraduate writing program offered by the Washington Center for Psychoanalysis, she is also the current editor of their literary magazine. “I write to honor the clients I’ve had the pleasure to work with over many years. They have let me into their lives at their most vulnerable moments and, in turn, have let me into my own life. I write to make sense of the world I see through the lens of a clinician, a patient, a mom and a person just muddling through life.” Liat lives in Rockville, MD, with her wife, two daughters, two cats and two bunnies.

Story editor:

Diane Guernsey


29 thoughts on “A Day in the Life of a Psychiatrically Hospitalized Clinician (Part 1)”

  1. Thank you so much for writing this you have no idea how close it hits to home. I was a child welfare worker or CPS worker for eight years. I was unable to continue my job as a social worker because of bipolar disorder. Being a social worker in a psychiatric hospital as a patient is extremely humbling. I felt many of the same things you did. And this article is the first time I’ve read about somebody who experienced it as a clinician or social worker like I did. I’ve wanted to talk about my experience for years but have not found a professional like me Miss had this experience. Sorry for rambling but I wanted to let you know I really appreciate you sharing this experience

    1. Thank you so much for your comment, not rambling at all. It is both good and sad, of course, to know that there are others who have been there. I am really sorry you weren’t able to continue your job as a social worker, though–especially since you probably had increased empathy for the kids because of what you had to go through. I hope that you can share your experience with others now. Thank you again.

  2. Liat, you have so many people who love and respect you and I wish you could feel that. I am sitting here with tears in my eyes reading this. Hugs.

  3. Thank you for sharing your story. Trust me I feel the same way, some days. Thank you for articulating what depression feels like with such precise prose.

  4. This is a Christmas and Easter story rolled into one. A birth of a perfect reflection of God (when you were born), then a later death and resurrection of your spirit (over and over). I know this sounds dramatic, but your story moves me.

    1. Hopefully I answered this through the second part of my piece, but, yes I am better, for the most part. I am really touched by your (and others’) reactions and inquiries. Thank you.


    reminds me of the fact that we don’t know what many of our patients go through or what they do in their real life. we make assumptions that are not grounded in reality.
    I am often overwhelmed with respect and admiration for what my patients overcome and how well they manage.
    I also hope someone during that hospitalization treated Liat with respect just because she was a human being and therefore deserved to be.
    there but for the grace of God go I.

  6. Liat, Please remain that eloquent voice that needs to be heard by those of us whose job it is to care for others in their time of need. Your writing has given us a different lens with which to view our patients, and a necessary reminder of the invisible but ever present angst that plagues many. I am humbled by your essay. Godspeed.

  7. You brave beautiful perfect soul. Thank u for speaking the truth. I have told my students (phd candidates) that really the only difference bw who inside and off the unit depens on one thing only at any given point. Who has the keys. We are all human afterall. The hummiliation you, I and my pts expetience is wholly unneccassary and certainly not healing. Your writing moved me to tears. I thank you for the biggest gift u can givevthis struggling psychologist right now. The truth. Ening stigma. With warm regards, Susanna New York

  8. Nicely done. However, I might have wished to learn at least one employee at the mental hospital was nice to her. This way piece kind of feeds into the sterotype that workers in mental hospitals are nasty to a fault. More of that One Flew Over the Cuckooes Nest business.

  9. Wow Liat. I had no idea. Amazing insight and raw honesty to write this, with ironic humor, even in the abyss. And what courage to share it. Hugs and support to you – with or without the bra.

  10. Joseph Fennelly mdj

    Man. A prodound thank you. In your future work and personal live if you do nothing more than your former service to others your courage and insight will have enlightened ontold others. Thank you for your bravery, for your keen sense of irony and humor, for your steadfastness in being present to our sad ability to hurt others, yet your genius in using it as material for teaching us. I am deeply moved. Joseph

  11. Liat, I am moved by your honesty and artistic expression. I cannot wait for the next installment. Thank you for being so open and for allowing us a glimpse of the stark reality of mental health. There is no magic involved in working in the field. People are just that, “people”, and at the end of the day people are not perfect.
    “You’ll just have to WAIT,” she snaps, as if admonishing a whiny child.” “A nurse, chewing gum and not looking up from her paperwork, declares, “Nine o’clock. Lights out, Katz. Go to bed.”…….Just like that. “People”. Not Perfect.

  12. Depression has woven itself into the fabric of my life since childhood. I was hospitalized once on suicide watch, and years later checked into a psychiatric unit to protect myself from myself. I am a retired teacher, mother, grandmother, hospice volunteer. Depression is a disease that can hit anyone. Liat, your piece goes a long way to reduce the stigma attached to this disease, and to help people understand its impact. Thank you.

  13. Liat,
    Thank you for sharing this very personal and moving experience. Your writing is an incredible gift which I hope you will continue to share. I look forward to reading the next installment. I send you my love and I wish you continuing strength in your fight against depression.

  14. WOW!
    You have a gift. Many brave souls with stories don’t have the ability you have to write them. Many writers are not brave enough to tell their true stories. Stay. Please stay and share your gifts!

  15. An incredible piece beautifully and skillfully written which gave me such first person insight into the experience of depression. Thank you. I can only hope you are in a better place able to enjoy your gifts.

  16. Two words sum up this piece for me. They’re not “strikingly brave” or “nakedly raw”, but those apply as well. The most telling part of this tale, for me, the two words that speak the most to your intelligence, your perseverance, your uniqueness, intelligence, rarified empathy:
    Left nostril.

    The world is a better place with you in it, Liat.

  17. Brave, wise, and funny. When you can laugh at yourself, you’ve won half the war. There are many more of us who sit on that side of the desk, and who have sat on their side, where the patients sit. Bravo, Liat. I already knew you to be a fine social worker. Now I know some of the better things as well. Beautiful story, beautiful person. Thank you.

  18. Oh Liat!

    This is beautiful. And I know just about every comment will say how brave you are, but I have to say it anyway. The hardest and bravest thing can be to ask for help. Especially for the helpers. Which makes it even more brave for you to continue to do the work, and to write this piece. It shows that somewhere inside, you know you have nothing to be ashamed of, or embarrassed about. You are an amazing woman.

  19. Very brave! An unusual crack through the public facade clinicians feel required to maintain. I admire you so much for exposing your vulnerability- many more of us should follow in your footsteps!

  20. What incredible inner strength and courage it must have taken to write, let alone publish, this unflinchingly raw and poignant firsthand account of what it means for all of us to be human and at times sick and vulnerable. No doubt your clients benefit from your insight and compassion gained from personal experience because yes, you really do know what it’s like. I am amazed, can’t wait to read the second installment. Thank you for sharing.

  21. Henry Schneiderman

    This is a very brave first person account. I thank Ms Katz for writing it, displaying great skill as both clinician–in that hardest of assessments, self-assessment–and author. One knows that the reassurance of others does not mitigate the harsh self-abasement amidst depression, but how wrong are those times when Liat Katz thinks herself unworthy; nor, of course, is her worth onlly because of these skills, it is intrinsic to her human essence, her personhood.
    I would wish that every person who has depression, or who ever looks after any person with depression, could not only read this but also hold its essence, raw and real, uncompromising, in mind and heart.

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