The Key to the Psych Unit

My grandmother was a caregiver, an artist, and a ruthless bingo player. I always sought to understand how she experienced the world and learn from her. We talked about almost everything. When I came out as bi+/pansexual, we had a conversation. She shared that her sister might be gay and that she just wanted me to be happy. Her love felt strong and unconditional. She had a sweetness to her that was undeniable. I liked being in her presence and enjoyed the time we spent together — sharing, playing cards, and laughing, always laughing.

It was not unusual that I also shared what I was learning in my post-secondary studies, but one time, the conversation was different. It was the late ’90s and as an undergraduate psychology major, I was reading a book on electroconvulsive therapy (ECT). I was horrified to learn psychiatrists still conducted ECT, and I said as much to my grandma. She was quiet. Quieter than usual. She listened, but when I paused, she didn’t respond. I directly asked her, “Can you believe they still do this to people?!?” She shared that she could. She shared that it was done to her.

We had talked about a lot over the years, but I had no idea she lived through that. Perhaps I should have. Our family was no stranger to mental health symptoms and clinical diagnoses. It was not a secret that my grandmother’s sister lived in a psychiatric institution for most of her life, and my uncle spoke freely about how he drank because reading people’s thoughts was too overwhelming for him. Plus, most of the family had been in therapy at some point to deal with depression, abuse, or whatever the diagnosis du jour was at the time.

My grandma explained that she went to a psychiatric hospital in the mid-South a few years prior, and the doctors assured her ECT was safe and the best treatment for her condition. She shared how her generation trusted doctors because they knew best. She went along with their recommendations, already feeling hopeless and helpless, but the ECT didn’t work. She sounded sad when she spoke, not from the depression but from regret.

I was angry at the doctors. Who would do something so violent to my sweet, fragile, artist of a grandma? I was angry that my family let this happen. Who knew about this? How bad were things that it seemed like a reasonable idea? Did anyone try to stop it? I believed her yet was in disbelief.

In the moment, I wished I could take back my words that exacerbated her shame and remorse. I wanted to take away any pain she felt. I wanted to stand up for her and to get her sister out of the psychiatric hospital. I wonder what pressure my grandmother felt to agree to the treatment. Perhaps she felt like the lucky one. She had been mistreated by the psychiatric profession, but she was out. She had her freedom. Her sister did not.

I’ve benefited from their sacrifices and the advocacy work of so many who have come before me. I have had so much freedom and opportunity. I graduated with my associate’s and bachelor’s degrees in psychology, and my master’s in social work. My first job post-graduate studies was as an intake coordinator at a for-profit residential eating disorder clinic. My supervisors constantly told me to ask people who desperately sought help about their insurance before their well-being. I chose to ignore this terrible professional advice. After two weeks, I quit. They happily wished me luck — elsewhere.

My second job was as an Americans with Disabilities Act Coordinator at a state university during the weekdays. At the same time, I worked as a live-in caregiver for someone with quadriplegia, and was an on-call medical social worker and a per diem psychiatric social worker on the nights, weekends, and holidays. I was engulfed in a disabled world. I continued to center humanness and respect in my work regardless of supervisor guidance sometimes to the contrary.

I was not making a ton of money, but it felt like I had ‘made it’. As someone from a fluctuating family income bracket (from low to middle with the invention of credit cards back to low after both parents filed for bankruptcy), I was proud to work at a university, a medical hospital, and a psychiatric hospital. I had a career. It was exhausting working so much, but I knew having these jobs was also a privilege. I constantly worked hard to earn the opportunities and to prove I deserved them.

While I felt like I had made it professionally, I was dealing with symptoms of chronic Post-Traumatic Stress Disorder (PTSD), although it was diagnosed as adjustment disorder at the time to avoid a pre-existing condition label in a pre-Affordable Care Act United States. I journaled, went to therapy, and consumed excessive amounts of cocaine and vodka to deal with the hell I relived regularly.

The patients in the psychiatric hospital were similarly facing their own torment. People were either committed against their will or they voluntarily admitted themselves and were typically released within 72 hours. On my first day, it was surreal when they gave me a key to the unit. I carefully placed it on my hospital lanyard with my employee identification. I remember thinking, Do not lose these. It’s the only proof you have that you are not a patient.

Because of my and my family’s experiences, I presented and experienced the hospital differently than most of the employees. When I interacted with patients, I saw my grandmother, my uncle, myself. A few days in, I sat across from a young man the same age as me. He was found by police passed out from drug use in a pharmacy parking lot. He had lived through childhood abuse and was facing his own symptoms of PTSD. I listened intently as he spoke. I nodded and easily empathized. I was stunned at how our circumstances mirrored each other. If I took a left and he took a right, we would Freaky Friday switch places, and he would have the key and employee ID.

I went from holding my lanyard to grasping it. I had to remind myself I could leave at the end of the day. I touched the paperwork and clicked my pen to orient myself. I tried to validate his experiences and listen to what he wanted for treatment.

There was such a range of individuals who came through the unit. I certainly did not relate to everyone. An affluent white woman was brought in one night by the police. She drank liquor to deposit a large quantity of Xanax in her stomach and then shared this with her personal trainer who in turn called the police. When she woke in the hospital the next morning, she was panicked.

With urgency she explained, “I have to get out of here. I don’t belong here.” I thought, Who belongs here?! She assumed I shared her worldview because we had similar levels of melanin. I told her she would be released, but she had to wait her turn.

My boss overheard our exchange. She raced over with the woman’s chart in hand and said, “I completely understand. Let’s get your paperwork taken care of, and you can be on your way.” I heard this. The patients heard this. The staff heard but seemed unfazed by the exchange. Being affluent and white is the key to the psych unit.

The same supervisor told me my case notes were written as if I conducted outpatient treatment. She meant I humanized the patients too much. She wanted the notes to read, “Patient alive, attended group, ate at X time, went to bed at Y time.” Instead, I wrote with admiration about patients’ strengths and insights to honor their uniqueness.

Writing about who they were as individuals was an act of resistance. It was a way to center their personhood. My notes were always completed on time regardless of length and prose, and they would be accepted for billing so there was no legitimate complaint. When I asked my supervisor to explain her concerns, she said, “That’s just not how we do things.” She suggested I put more effort into fitting into the workplace culture.

I avoided the staff. The pervasive ableism was palpable. They referred to patients who entered the ward repeatedly, often when they were at risk of death due to debilitating psychiatric symptoms, as frequent flyers. The tenth visit should have been free then. In administrative meetings, healthcare professionals focused on insurance rather than illness to determine treatment, and I learned that the hospital had been bought by a for-profit hospital chain. Putting profits before well-being is the key to the psych unit.

That is hard to do when you can relate to the people who are being devalued. The line between us and them was a requirement, but whose team was I on, anyway? Do I choose my family and myself or my new profession? I regretted my degree. As a bi+/pansexual, I prefer not to choose.

I spent as much time as I could with the patients. We talked about their fears, movies, and the lousy food. We spoke to each other as human beings. We joked, and we laughed. I loved adding the sound of laughter to the unit. It was both mundane and remarkable given the context. I could feel the stares from the staff. I did not fit their workplace culture.

With my family history of mental illness, my own diagnosis, and my incessant desire to poke the bee’s nest, it became clear that I was toeing a very precarious line working in a psychiatric hospital. I knew how tenuous my perceived sanity was. I eventually quit and moved on to outpatient settings where my dissertation-style case notes were welcomed, and the doors were unlocked during treatment hours.

When I left, many of the hospital staff seemed satisfied that they were right, I couldn’t hack it, but little did they know I still had the key to the psych unit. Not metaphorically. I took the fucking key. When I did my exit paperwork in Human Resources, no one asked for it so the key seemed rightfully mine. It was like a trophy symbolizing my family’s victory over the mental health system. I conned them and got away with it. I kept the key on its hospital lanyard in the middle console of my car to ensure that anyone who stole it would know where to use it.

Looking back, I cannot help but laugh at the irony of feeling like I made it when I got to the psych unit. My great-aunt would have surely questioned my sanity. Now I tend to agree. Most days, I still do my part to create spaces where patients are treated with dignity, and professionals who can personally relate to mental health challenges can be their full authentic selves. But some days, like my grandmother, I’m just glad to be out.