I am a licensed clinical social worker. And, occasionally, a mental patient. Today, as I eat breakfast in an inpatient psychiatric unit, I am definitely more patient than social worker
It is Monday morning, and I am eating breakfast across from 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.
My table mate is an odiferous, rebel-flag-T-shirt-wearing, hairy-eared, phlegm-spitting 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 he 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. 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 as a gown and another as an undergarment or sash.
In yesterday’s therapy group, I heard my table mate 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 murky-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 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.
The stigma of an intimate relationship with depression means that you can’t reach out for help until it’s too late. My Paul Bunyanesque table mate couldn’t get out of bed anymore to go to his mechanic’s job, nor to maintain a relationship with his girlfriend; I couldn’t get out of bed anymore to work at my Adult Protective Services social-worker job, nor to parent my 3- and 5-year-old daughters.
So what good are we?
After breakfast, 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 of “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,” one patient 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.
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. I feel exhausted just thinking about it, but I request soap, shampoo and a towel from the 20-something 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, reclothed, emerge defeated from the bathroom. I ask a nurse how to use it.
“Oh, honey,” she says with a slight laugh, “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; anyone could walk in at any time. I feel so tremendously vulnerable, exposed and alone.
Was it worth all this to keep me from killing myself? Really?
This is perhaps my 15th hospitalization, the first being an 18-month stint as an adolescent, after suffering severe abuse at home. But I hadn’t been hospitalized in more than 13 years.
I thought I’d gotten my life together. I have a family, I got through grad school with a 4.0 GPA (after finishing the 10-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.
It crept on me gradually. Over several months, my ability to do paperwork for my job began to dwindle. I’d call people and not remember whom I’d called. One day 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.
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 after I wrote them 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, lifelong reality that their mother had killed herself.
I knew that I had to be in a safe place that would protect me from me, so I sucked it up and headed to the ER. After spending 16 hours lying on a gurney by the nurse’s station, I was brought to the psych floor.
Yet today, after my sad breakfast and lonely shower, 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 will work on getting healthy enough to go home.
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.”
Katz, a licensed clinical social worker, is a graduate of New Directions, a three-year postgraduate writing program offered by the Washington Center for Psychoanalysis, and editor of its literary magazine. She lives in Rockville with her wife, two daughters, two cats and two bunnies. This article first appeared in the online magazine Pulse — Voices From the Heart of Medicine.