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A Day in the Life of a Psychiatrically Hospitalized Clinician (Part 2)

Editor’s Note: This is the conclusion of Liat Katz’s remarkable story. Part 1 was published last week.

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 okay 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 okay with living a life that requires me to occasionally have to ask for shampoo.

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.


13 thoughts on “A Day in the Life of a Psychiatrically Hospitalized Clinician (Part 2)”

  1. As a fellow social worker that often battles with mental health challenges, thank you for writing this – it’s raw, it’s beautiful and it inspires hope. Sending warm thoughts your way.

  2. I just wanted to say thank you so much for writing this, Liat. I, too, am a social worker, and was hospitalized last month for suicide watch. It was an incredible struggle for me – the depression is the obvious struggle, compounded by the struggle of feeling like I’m failing the children for whom I am a therapist. Who the f*** am I to be working to help kids deal with their feelings when this is the way I deal with mine? Your story spoke to me on a beautifully human level, as I’m sure it did to many others (even those who don’t share the obvious similarities). Thank you.

  3. Well written and so honest.

    My wife and I both have bipolar, As I mentioned in a reply further down, she too is a social worker who has spent a lot of time in the psych hospital. She thinks it helps her a lot in understanding her clients. She does disclose her mental illness. It’s actually been a benefit at all but one place of employment.

    We’ve both been in the hospital more times than we can count (I mean that literally, we really can’t keep track, it’s been so many). I’ve been lucky and have always been treated with respect and kindness by most of the staff at the two hospitals I’ve been in (I have some real issues with them, but at least I was treated well), she hasn’t been so lucky, especially in the years before we met.

    I really get what you are saying about the monastery like atmosphere and the benefit of writing. I usually write a lot when I’m in, mostly for my journal, but sometimes other people see it, at least in part..

  4. I, too, have been a patient on psych unit (several times) as well as part of a healthcare team treating patients. I have also been the parent of a child with Asperger’s who also spent a lot of time on psych units as well as 18 months in a residential treatment facility. I am not shy about sharing my story, especially because in 2004 I underwent 11 ECTs and in 2007 I had a VNS (vagus nerve stimulator) implanted, and people are surprised to see that the ECTs did not turn me into a vegetable and that I can walk and talk and hold a job. I hate that my VNS had to be turned off (dead battery) and the insurance companies won’t cover the cost of its replacement because it was truly the best thing that ever happened to me. I hate that I am holding on, barely, by my fingernails. I hate even more that my boys each exhibit similar traits of my depression.

    1. Interesting, my wife (also a social worker who’s been in the psych hospital many time (she discloses)) has a VNS as well. It’s been over 8 years and the battery is still going. We know that can’t continue much longer. We’re scared to death of what will happen when it dies, it has been a total life saver for her.. Your post makes me even more worried…

  5. Thank you for sharing your experience. I too am a mental health professional, and you’ve given me lots of insights on how to do a better job. But the real benefit for me is that you articulated some things I’ve experienced as a human being. I have struggled with chronic depression over the years, and your memoir reminds me that I am not alone, that I have much to be grateful for, and also that good things can come from mental illness.

  6. Profoundly moving and incredibly real – thank you for your bravery and honesty. You have described person-centred care in a way I believe in.
    Sincere best wishes to you and to all those that you love. Susan B.

  7. Henry Schneiderman

    Liat, this is so valuable and so brave, as Marianne said. Thank you for pulling yourself up in the time and setting where it is hardest of all to do so; and for using the lists, born of your own experience, as part of your work to help others use writing to regain a footing amidst the quicksand.
    I also love that you have built something to help others even more effectively, out of your own pain. That is profoundly healing for you and for them: tikkun olam, healing the world, turning your own hurt into a path to help another person.
    Wishing all the best to you, your wife and daughters, and to the cats and bunnies (and the animals are not silly or peripheral, to give love and to receive love from a non-human creature runs very deep and speaks to empathy that is not entirely word/language-dependent).
    Henry S.

  8. Liat
    After reading your inspiring piece, I now know why I write and started writing as a young woman (girl actually). I am now almost 70 and still write. Your words are healing and enlighting. How fortunate your patients are. Thank you for writing this and sharing it. All my best to you & yours.

  9. These installments have been beautifully and honestly written. In my first year out of grad school as a clinical psychologist, my best friend committed suicide just as my husband to be was headed for Vietnam. Other stressors, too. Long story short, I had my first and thankfully, my last clinical depression and went voluntarily into a psychiatric unit for two weeks. The personal care was horrid. No therapy. No interest. Making pot holders was the treatment. If I refused, the nurse threatened to report me for insubordination. Several years later I found my niche running programs on units. My experience helped me set up model programs that were praised by both the patients and accreditation committees alike. All was not for naught.

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