My Time Working on a Psych Unit

When I first heard I was going to be assigned to work on a Psychiatric Unit at a hospital as a unit therapist, my mind went straight to three things

• One flew over the cuckoo's nest

• Shutter Island

• Straight Jackets/White Coats and drooling patients

I was wrong, and here was my experience. I am writing this to show, bring light and give a little perspective on what truly goes on behind closed doors of psychiatric units. Some stories might be sad, funny, or hard to wrap your head around truly, but I promise everything I am writing happened and is 100% true. ,(I, of course, haven’t said all the stories, some too gruesome or inappropriate)

I was genuinely terrified about the thought of working with the severely mentally ill population, but at the same time thrilled and had a rush of adrenaline. I was getting prepped for my first day, mentally and physically. My supervisor told me to wear a tie to look professional on the unit while I worked there. I walked into the hospital, made my way up to the unit, and was standing at the front door of the unit. Getting buzzed in was interesting, feeling like I was going into a jail, locked in and locked out. The primary doctor ran over to me and grabbed my tie and said: “Do you want to be chocked to death, take that off.” I was shocked. It didn’t even occur to me how the smallest things can become dangerous (I learned the hard way about that...Ill talk about that later).

So, little by little, I met the team, and they were super friendly, super close, and very warm to me. They were accepting me as one of their own. I was hesitant, holding back and was very warry about talking to, looking at, and being near any patient. I was scared about doing the wrong thing, saying the wrong thing, and behaving in a way that could trigger one of them to hurt me, maybe. I was rigid and paralyzed. I felt like I was sneaking by each patient, hoping they wouldn’t notice me, see me or talk to me. If I messed up and did something wrong, how would I handle it?

I had my first meeting with the team to interview my first patient. The room was packed with doctors, residents, and myself and my supervisor. The patient went into detail about how she wanted to kill herself. I was in shock, and I had to control myself from having my jaw hit the floor and stare. When the interview was over, I said to my supervisor, “how come no one else reacted?” She looked at me with the clearest voice and most honest answer, “Eli, you get used to it, and it makes you numb.” How sad! How upsetting that by hearing the same stories, you lose touch with the human side of them.

At that moment, I changed. At that moment, I made an active and conscious decision that I would NEVER lose touch with my humanity when it came to any patient and person I work with. At that moment, I realized who I was and going to be as a therapist...always be human.

Now, as the months went on with my training and learning curve changed. It became very apparent to me that I had to be strong and tough to be in this business.

Here are a few stories that taught me to be tough, strong, and changed my perspective on a lot of things in regards to mental health:

• I remember coming in one day to see a man squatted in front of the Medical Residents’ office and was pooping on the floor and wrote a handwritten letter to let them know his feelings about it. Yes, it may sound humorous, but it was my job to speak with this patient with care, strength, and focus without cracking and joking about what he just did.

• I had clients touching themselves sexually in the main hang out area with no shame or care.

• I had one patient that was very flirty and liked to be inappropriate with me throughout his time on the unit. He was a “frequent flyer” in the psych hospital. Overtime working with him, I learned a way to be jokey with him yet stern, so he understood something very important…boundaries. When pt left, he asked if I could adopt him, he looked me straight in the eyes and said, “Don’t worry Eli, I am house trained. I don’t bite...but I nibble”. Through his stay, he was always pushing the limit on his boundaries of what he can get out of me.

• There was once a patient who wanted to shave, but he had a past of suicidal ideations and intentions. He begged his family to fight for his behalf. They came into the unit to talk with myself and the doctor and gave their loved one a packaged and sealed meal. Within minutes, the patient searched through the salad and pulled out a razor in which his family snuck into the unit, and the patient ran out and pushed himself into the hallways and began to cut himself, it was one of the scariest moments of my time there. But it did teach me how fast things can change and how blind some families are to the severe issues their loved ones can be going through.

• I dealt with a lot of yelling at me, calling me names, antisemitic remarks, and extreme defensiveness throughout my time there. When people are put into a corner, they will act in ways that will surprise you.

One of the scariest moments while being on the unit, I was working with a man in his 40’s for about 4 months. He was extremely kind and sweet. We had a very good relationship and spoke 2-3 times a week. One day, he got some bad news about his family and future housing, which hit a very hard nerve. Within seconds, he jumped onto me, threw me against the wall and began to hit me. No matter how nice someone is, no matter your connection, all it takes is a small change to impact someone’s mood and general behavior in a massive way. I remember vividly walking away from this scary scene and going to the office and taking a breathe and continue to work because that’s what needed to be done. It only hit me when I got home and cried to my wife because I could have been seriously injured. It did impact the way I interacted with the other client’s going froward until I became more comfortable with myself and how I was around them.

There were a lot of scary, sad, and funny moments during my time there. But the constant was that the key to their mental health and recovery is treating them like they are human as best as you can. I would say 8 out of 10 of them wanted to be talked to like things were “normal” and not talked to like they are dumb, “crazy,” or stupid. Whether we like it or not, or whether we want to admit it, people are people with stories and are complicated, no matter if they have a mental illness or not. They deserve to be treated with love, care, and patience. It’s not always easy or enjoyable, but they need it just like anyone else.

One of the sad truths I found out over the 9 months of working on the unit, I realized how the system works. How of a machine the hospital work is. Intake and Discharge, stabilize and let go, and I was just a small cog in this ongoing process. Clients would come in distress, emotional, traumatized, and in a lot of pain, and the main goal of the psych unit was to stabilize and pass them on for further long term treatment. It serves a purpose, but it was hard for me to watch and see. Sometimes people were over-medicated just to get them out. The saddest part was a lot of the decisions were being dictated by insurance coverage, and what they deemed was the “perfect” amount of time for a person to become stable and better to go back into society as a functioning person. I noticed a considerable amount of homelessness and poverty among the majority of people I worked with, really opening my eyes to some systemic issues with the world and how it trickles down to impacting mental health and overall functioning. So within this sadness and system that was build, I tried my hardest to be a light. To be someone, the patients could rely on and depend on in their time of need and not treat them as just “another patient” but as individuals. I hope and pray that I was able to give my patients a sense of normalcy during their rough and hard stay in the unit.

One of the biggest keys for me working on the unit was the sense of family with the other staff members. We had such a tough job, day in day out dealing with vulnerable and challenging patients who were sometimes a pleasure to work with but also extremely difficult at times. We were there for each other if something funny happened and even at the lowest points. When my colleagues and I were attacked at different points over the 9 months, we always became closer and had each other back. We didn’t always get along, but we came together when we needed each other. That, to me, was the most enjoyable part. Seeing a group of strangers is there for one another daily. We bonded and connected on such deep levels, and we became friends over time. We were interested in birthdays, family, and each other lives outside of the unit. We became stronger as a team and one united front.

So, in the end, when I look back at the time, I miss it. I miss the thrill, the rush, and the excitement of everyday work. But I also miss the impact one person can make on others.

As a social worker and going through school, I had a very myopic view of what “therapy” meant. I needed an office with nice chairs and a specific population to be successful. This showed me that therapy could happen anywhere, with anyone. We aren’t bound by an office to be successful. Real therapy is the ability to reach across to someone, show them love, support, and care, and have them know you are there for them. The ability to change and give hope to someone no matter what the scenario or set up, that is the true meaning of therapy.

So did it change me… YES!

I’ll forever be grateful to all the patients and staff for changing my view on what it truly means to be a successful therapist and human.