Working In an Inpatient Psychiatric Hospital and Not Taking Home The Work

Working In an Inpatient Psychiatric Hospital and Not Taking Home The Work

A couple in love on a beach

I wanted to talk about a day in the life of a Therapist on the Adult Unit at a Psychiatric Hospital.  This time in life would not be as simple or as blissfully happy a period of my life if I was not engaged to the perfect woman.  She was soft and gentle which was a mutually appealing quality we shared.  It was somewhat familiar in that I had a special friend before I met Lynn named Celta.  She was very loving and kind.  I never knew that anyone would feel so captivated or mesmerized by my thoughts and feelings.  Then there was Lynn who was soft-spoken and gentle in all her mannerisms.  I would feel like the world moved just to hold her hand. 

We would cuddle together by the beach as the waves crashed just sitting there together it was like time had stopped and I forgot about everything else.  I wish I still had photos of that time of my life.  She was so amazingly beautiful.  I never thought I could be so happy.  By the time I started working at the Inpatient Psychiatric hospital that is described in this story, I had been through with all the nightmares from the terrifying life I had known in Southington, CT.  I didn't know how terrifying it was until I went away to college in 1984 after high school graduation.  There at the university in the south, I learned the world was a good place filled with flowers, love, and kindness. 

If you saw a photo of me at that time in the 90s after college with Lynn I was in love as was obvious to anyone around us.  Years earlier, we came inside after one night and announced to my two female roommates that Lynn and I were more than friends.  They looked at us and said "duh!"  I said, "well, Lynn brought up the question and that was basically what I said to her but we needed to make it official."  So, they wanted to start taking photos of the perfect couple with the beaming smiles and all the joy and happiness.  My roommates seemed about as full of joy as we were.  One year later we were engaged and shortly after that Lynn's mother bought a house for us to rent from her. 

So, Lynn moved from her parent's retirement home on Wrightsville Beach to Brucemont Ave in Wilmington, NC with her love Bruce.  No, the street name was not named for me.  Her mother just found a nice home there for us.  She wanted her beloved daughter to have a blissful life as a married couple.  Technically, marriage was a problem since Lynn had a genetic disorder and my income could cost her access to medical care.  Still, her mother wasn't hung up on technicalities of official religious ideas about living as husband and wife.  If we were not making love as a married couple her mother would have been disgusted that her daughter was not getting the love she deserved.  We would occasionally, rarely visit my family but Lynn wondered if we should sleep in different beds.  I thought, "that's bizarre, do they have such a limited understanding of the nature of our relationship that they would think we are not for all practical purposes like a married couple?"

Being in this intimate and loving relationship with Lynn was a comfort during any difficult times on the job.  I certainly did not want to see anything but a smile on Lynn's face and the same blissful joy that I felt (some people only noticed our arguments but that is a matter for another story).  Just like on an episode of Criminal Minds, I had to discuss the horrors I might face on the job from time to time.  To be clear, I left many of the details out of the stories that I shared.  Unlike on the show Criminal Minds, Lynn was not in a field that dealt with man's inhumanity to man.  She did do some volunteer work at the rape crisis center hotline and I had been there with her a few times when she was working.  I guess I had that kind of nature to my personality that endeared me to the kind of people that help people in crisis.  This would be crucial in my work, this aspect of my personality would be crucial for a person who is dealing with something horrifying. 

Other than that short work at the rape crisis line, Lynn had no exposure to anything terrifying and I wanted to keep it that way if at all possible.  If I needed to share a tough day on the job I would talk only superficially about what I learned or heard on the job.  Lynn was someone I met in a different part of my life outside my professional path.  I met Lynn through the poetry readings in Wilmington.  That life was all creative and fun.  When we weren't sharing deep and creative ideas we would go canoeing down the Cape Fear River or some tributary of the river.  The beach was more of something where Lynn and I spent time or when her family visited from out of town.  No, my family didn't choose to visit us much but we tried to be friendly to them.  They were just very different than Lynn and me and they were very different than our social circle.

Moving on to the work at an inpatient psychiatric hospital, I want to talk about what I might have shared on a typical day.  I was working at Brynn Marr psychiatric Hospital in Jacksonville, NC.   It was a locked unit so people couldn't just walk out if they were unhappy with treatment and many were there under involuntary commitment orders.  This was near the Camp Lejeune Marine base in Jacksonville.  Being near the military base many of the patients there had insurance through the military or were military families.  Many of them had known combat and so PTSD might have been a reason for admission to the hospital.  

On this particular day, like any normal day (I suppose though each day was unique), I could have talked about my interactions with difficult patients or difficult issues I should say.  I do not mean to imply anything negative about a patient there.  Their treatment of the patients and the lack of respect they showed was a key factor in my decision to resign and find other work at one point though I worried about who would help those patients who might come after I left.  The names in this story are aliases and to be honest I could not remember the hundreds of patients that I treated in that or other settings, much less the hundreds of outpatient clients I have worked with as a Social Worker or in the human services jobs I've had over the years.

There was Vivian a young woman with Anorexia and Borderline Personality Disorder (this has been used by some mental health professionals as a pejorative term, that's why I like Complex-PTSD better as a diagnosis since it points more blame at an unhealthy environment in one's early life).  Just the day before she had said I was just like every other therapist and Social Worker, nurse, and doctor who didn't really care about her.  When she was told by my boss that she "had to attend a group every day" while she was there, she said, "Okay, I will go to Bruce's groups."  We had one other therapist on the adult unit and she was a Clinical Social Worker but she didn't seem as warm and even I was surprised since as a student and in other previous experiences, the Social Workers I knew were so filled with idealistic views about helping the vulnerable in society.

I did have a female Social Work intern who I was supervising, named Tammy.  She was in her last year of a Master's program with an interest in the same career path I had taken along with my colleague on the unit.  Tammy chose to work with me after observing us on the unit with a few patient intakes and a couple of group sessions.  I was surprised that she would choose me for a supervisor since I was clearly shy and nervous in the group settings.  I suppose Tammy was interested in my one on one interactions with others.  I had a sense of confidence that I could help no matter what the problem was.  I didn't think that anyone needed to be drugged and sent home.  Even disorders like Schizophrenia, Bipolar Disorder with psychotic features and all psychotic disorders can be treated with psychotherapy and people can be understood.  To respectfully listen and seek to understand another person can make a big difference.  A gentle effort to encourage a person to keep talking can help a person feel understood for the first time in their life.  

I was meeting with a combat veteran who had PTSD and he was having flashbacks and he wanted them to end.  Tammy was interested in sitting in and was glad that he agreed to try hypnosis.  I remember I had to stop the use of hypnosis because I wasn't sure if he was having flashbacks or if he was afraid he was being followed by some sinister forces in black helicopters.  I wasn't sure if this was a memory from combat that was intruding into his life now or if he feared that he was in danger now and why would he fear this now?  Sometimes he wasn't sure if it was a helicopter he was seeing or some other flying aircraft.  I didn't' know what he feared was happening now or what was the full nature of his fear.  More assessment was required.

None of these topics would be discussed that evening with my loving spouse.  Not the patient who said something to the effect of "I hate you, but don't leave me."   Between Monday and today, I went from just like every other bad therapist and doctor to the only therapist of the two she would speak to.  Nor would I talk about the combat stories that turned to present-day fears in another patient.  I was going to have to talk in some small way, without going into all the explicit details told to me by a rape victim.  I knew Lynn would not want to hear the explicit details that Tammy heard.  I don't know how law enforcement officers interrogate a person who actually harmed a woman.  To listen for hours to a story about rape is painful. 

Judy was a petite African-American woman in her late 20s who came in with a blank expression and a stiff posture.  Tammy had said, "Bruce, can help you."  I know I wanted to give her some sense of relief.  My heart went out to her and she seemed so vulnerable and afraid.  It never even occurred to me that she would fear to tell her rape story to a man though that might seem like common sense.  I am pretty sure that Tammy would have reassured her if that came up.  I know Tammy had been impressed by the techniques I had learned for bringing relief to trauma survivors.  I had learned these techniques in another psychiatric inpatient setting starting when I was an intern.  Inpatient stays were short even then but the safety of an inpatient setting with medications available by doctors and nurses could make it a useful container setting for processing the most extreme forms of trauma where a person doesn't have to worry about going home after a grueling session of digging up a nightmare.  

TV shows and movies can never convey the horror of being raped.  So, Judy sat down and suggested she might be more comfortable alone with me.  I said that sometimes it helps to be able to grab onto the hand of a therapist to stay grounded during the session.  "Since this is a sexual trauma it is important that you do not interpret my gesture of support in any sexual way.  If it is okay, having Tammy here might make us both feel more comfortable with the way things happen.  She will sit to the side, okay."  Judy agreed.  I knew that if she reached out and grabbed my hand as in other sessions this could be confusing.  In my own experiences where I was afraid I wanted to reach out for human contact but I always felt guilty and ashamed when I did this.  Later, I learned other ways to do this that titrate the exposure to the trauma so it can be done in an outpatient setting.

In this session, she began with something of a flat and monotonous voice almost matter of factly describing what happened.  I didn't have to push her to go on and get into the darkness of her story.  It seemed to hit her like a flood that surprised her.  It seemed that she was not expecting to actually confront this.  I liked the words from Milton Erickson's book "And my voice will go with you."  That seemed to help her.  She reached across and grabbed my hand on the chair beside her, and I just said, "It's okay."  She didn't look up but described all the details.  I had been through something like that myself in my own therapy ( at that time in my life I had never been a victim of sexual assault only physical and psychological horrors).  In my memories, where I heard Lynn's voice saying something like "It's okay" as she held me in bed or by the beach, the words would echo through my mind almost like a chant - a soothing and repetitious chant or the words that a person using meditation might use for focus or mindfulness.  

When we moved past the traumatic details she looked visibly different to me.  She had a smile on her face.  She knew something was different.  To be honest, I never patted myself on the back and said, "that's fixed for her.  She is all done with the trauma of being raped."  I would let her savor the peace she had found and let her feel the joy she now felt for the first time.  She was overly thankful and totally animated, not like outgoing and happy but just normal while still soft-spoken.  She might have left the room still a meek young woman but she was now alive.  For that, we would leave her with that joy.  I don't know what I felt because it is not about me when I help someone.  I don't do it because it makes me feel good. 

I do know she was very surprised and she said she didn't know she could feel this way before now.  Was that ever in her life?  I heard she was an incest survivor too.   I know that recently I tried to explain to my therapist that I had something like that in the session before last.  In my last session, I couldn't quite put it into words to my therapist what I had felt in the previous session.  I just hope I can feel it again.  What did I share with Lynn if it wasn't only about this one particular hour or longer with one of many patients with whom I had worked that day?  I probably shared enough of what I shared here as I never in this story went into any details about the rape. 

It seems almost repulsive to go into details unless you are the victim and you want to tell your therapist exactly how terrifying the experience was.  It is not just safety that you need to feel.  You need to know the person listening will be able to stay with you every step of the way no matter what!  Mutual trust and shared strength are key.  We lend a bit of our strength to our patients and clients.  There is a scene in Buffy the Vampire Slayer where Willow needs extra strength in her battle with the forces of evil.  In one scene, instead of grabbing Buffy who has supernatural strength she grabs another woman who ends up becoming depleted like a battery.  Willow tries to apologize but the young woman says she cannot talk she needs rest.  

Lynn gave me just enough strength to come home each and every day and put aside the horrors and put on the same blissful smile that you would see in any photo of me from the 90s.