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What Interning at a Psychiatric Hospital Taught Me About My Own Mental Health

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Editor's Note

If you struggle with self-harm or experience suicidal thoughts, the following post could be potentially triggering. You can contact the Crisis Text Line by texting “START” to 741741. For a list of ways to cope with self-harm urges, visit this resource.

The first week of my grad school program in dance/movement therapy and counseling, I found myself at an inpatient psychiatric hospital, holding a set of keys that would get me onto all of the locked units. I was considered a student extern, meaning I did not work for the hospital but was there as a student to shadow my supervisor, an established and accomplished dance/movement therapist.

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The first 20 weeks of the program, you spend at your first practicum site and you attend twice a week, initially shadowing and then eventually leading certain parts of the session. In the beginning, you literally follow your supervisor around, participate in sessions and get to know the clients.

The program randomly assigns you to the placement and when I found out I was going to be in a hospital, I was scared and unsure what to expect. During new employee orientation, they scare you with all the worst-case scenarios. By the time I got to my first day, I was terrified of everyone and afraid I would do things to trigger people in the hospital. While I am very familiar with some diagnoses, I had never met someone with schizophrenia or any other type of psychotic disorder and had no idea what to expect.

Looking back, I’m frustrated with the organization for not talking about clients like real people who are going through a really hard time. My school didn’t do a good job at preparing those of us who were placed in hospitals with what to expect. To top it all off, I have my own mental health diagnosis that made it really hard to not identify with the clients, particularly in the beginning when I was literally just a group participant and observer.

I distinctly remember being handed my keys and my supervisor going over the protocol with me; never put them down unless you stick them in your bag and put it under your chair. Wear pants with pockets so you can keep them safe. The biggest thing I remember was when she told me to try not to jingle them when I walked because many of the clients have spent time in prison and jangling keys can be a trigger because guards tend to jangle keys to demonstrate power. That’s when I became hyperaware of all of my movements, afraid I might “set someone off.”

I remember walking down the hall with my supervisor on one of the units when she said hello to someone and asked how they were doing. I remember thinking, “why would you ask someone in here that? Of course they’re doing horribly!” My hackles were up and I was afraid to get too close to anyone, especially the bigger men.

The main emotion I felt at the end of the day was not fear, but anger. Anger at the injustice of the system. Anger that there are people out there who need to be in the hospital and anger I was fear-conditioned to work in this environment. Yes, you need to be careful and not leave anything around that could be used in a suicide attempt, or lose your keys on the unit, but first and foremost you need to treat the people on the other side of those doors as people.

The fact of the matter is, we’re all just one bad incident away from being on the other side of those doors. This is why it’s important to treat everyone the way you would want your brother or your mother or yourself to be treated. As someone who has a diagnosis, I always had a sense it wouldn’t take much to put me on the other side of the door, this time without keys.

The hardest part of working in the hospital was the countertransference, which is the emotional response that the therapist has in response to the client. I had it on both sides; I saw myself in many patients and I also saw family members. Working with the older adults at one of my hospital jobs was hard because I worked with men my dad’s age who, like my dad, were Vietnam vets. I worked with suicidal older adults who were isolated, many who were widows or widowers. I worked with younger clients who had experienced trauma and were battling with self-harm and the diagnosis I have.

In the end, my skin wasn’t thick enough. I couldn’t ward off the way that working with these people made me feel. The system is so unfair and many times people were kept in the hospital either way too long against their will or for too short a time for us to make a difference. The saddest part would be when a client would return a few days later after a suicide attempt or breakdown.

One of the hospitals where I worked had an administrator who didn’t understand why a behavioral health hospital needed therapists. There was a lack of support and it’s really hard to keep going when you’re not valued by the head of the hospital or members of the treatment team.

I went through an incident that forced me to leave my job at the hospital two years ago. I have bipolar disorder and for years, I had kept it under control with therapy and medication, but the year leading up to this incident, I had been neglecting self-care and ignoring the way the hospital was affecting me emotionally and psychologically. My mood had become unstable and I was unpredictable, irritable and unhappy.

One day, when I was getting ready for work, I was so overcome with dread at the thought of setting foot in the hospital that harmed myself. It was a few days before Christmas and I had already planned on being away later that week, so I told my boss that something happened, I was unwell and unable to make it in. The weeks that followed were hard and scary, with several more incidents and engagements in self-harm.

I’m pretty sure I didn’t end up in the hospital through the sheer will of my family, my husband, my therapist and my psychiatrist. We upped my meds. I was never left alone. I stopped working. I went to therapy. And yet, it continued.

After six months, I thought I was better and went back to work at the hospital where I had done my first student externship as a full-time dance/movement therapist. The first week there, I started having what we later learned was stress-induced migraines, which for me look like dizziness, light-headedness and falling down. I took two trips to the ER within a week of each other because we didn’t know what was wrong and it kept happening at work. I lasted maybe a month.

I decided that, maybe, my problem was that I couldn’t handle all the responsibilities of working as a full-time employee in the hospital, but maybe I would have a better time of it if I was part-time. I started working at a different hospital on weekends and on a per diem basis, and after just a few short months the migraines were back and I was unable to handle it.

The first self-harm incident and realization that my mood was unstable happened two years ago. After I stopped working in the hospital, things got better for a little while. Then, a year ago, it flared up again. Now, a year later, I feel in control and stronger than I have in several years. But I’m still aware that, just like always, I’m one bad incident away from being on the other side of those doors.

I decided to share this part of my story because I think it’s important to talk about mental health, but it’s important to note it’s only one part. I want to take the shame out of having a diagnosis or needing help.

I’ve only been on one side of those hospital doors, privileged enough to hold keys, but like I’ve said multiple times in this post I am acutely aware that I am just one incident away from being on the other side. We all are. Treat yourself with kindness and compassion and know it’s OK to need help. Many of the people helping have been where you are.

Photo by John Tuesday on Unsplash

Originally published: September 2, 2019
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