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About Our Guest
Gabe Nathan is an author, editor, actor, playwright, director and a lover of commas. He has worked as an Allied Therapist and Developmental Specialist at Montgomery County Emergency Service, Inc., a non-profit crisis psychiatric hospital. While there, he created innovative programs such as a psychiatric visiting nurse program, a suicide prevention collaboration with a regional public transportation authority, and an Inpatient Concert Series that brought professional performing artists to entertain the patients and enrich their inpatient experience. Gabe serves on the Board of Directors of Prevent Suicide PA and the Thornton Wilder Society.
Gabe spreads a message of suicide prevention and awareness with his 1963 Volkswagen Beetle Herbie the Love Bug tribute car. The car, a participant in Prevent Suicide PA’s innovative “Drive Out Suicide” awareness campaign, bears the number for the National Suicide Prevention Lifeline (1-800-273-TALK) on its rear window, and Gabe talks about suicide prevention and mental health wherever he and Herbie travel together. Gabe lives in a suburb of Philadelphia with his wife, twins, Herbie, a basset hound named Tennessee and a long-haired German Shepherd named Sadie.
WORKING IN A PSYCH HOSPITAL SHOW TRANSCRIPT
Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Narrator 1: Welcome to the Psych Central show, where each episode presents an in-depth look at issues from the field of psychology and mental health – with host Gabe Howard and co-host Vincent M. Wales.
Gabe Howard: Hello everyone and welcome to this week’s episode of the Psych Central Show podcast. My name is Gabe Howard and I’m here with my fellow host Vincent M. Wales. And today we have a very, I’m going to go with unique, guest not because he himself is unique, although he’s a rather cool guy, but because his experience is unique to mental health shows. Let me give a little background. Early in the early days of the Psych Central show Vin and I used to do Gabe and Vin only shows. Remember those, Vin, way back when?
Vincent M. Wales: Oh, yeah.
Gabe Howard: And one of the first episodes we did was Vin interviewing me about my experience in a psychiatric hospital. I was in the psych ward of the hospital as a patient and how I felt about it. And then a year or so later with the launch of A Bipolar, a Schizophrenic, and a Podcast, me and Michelle Hammer, who lives with schizophrenia, we both talked about our experiences inpatient. And we got a lot of feedback from a lot of people that said, “Yeah. It was traumatizing being a patient locked away. Everybody was mean to us, and it was just an awful experience.” And Michelle and I said, “Yeah, yeah, it was terrible. We didn’t like any of it.” And then I was talking to my friend Gabe, who I will introduce here in a minute, and he said, “You know, it’s very one sided. You know people who work there, they have an opinion.” And the exact phrase that he used was “psychiatric hospitals are traumatizing for everybody.” There’s nobody that really escapes the trauma of these places they’re just scary places for everyone. And that really is worth investigating more. So without further ado, Gabe Nathan, welcome to the show.
Gabriel Nathan: Hi. Thanks for having me.
Vincent M. Wales: Thank you for being here.
Gabe Howard: Now first, in interest of full disclosure, you currently do not work for a psychiatric hospital, but you worked there for a number of years.
Gabriel Nathan: Yes, I worked in an inpatient crisis psychiatric hospital for five years.
Gabe Howard: And inpatient is people who are admitted there, sometimes voluntarily, sometimes against their will. It’s the locked door, they have to be probated to leave, they sleep there.
Gabriel Nathan: Yeah, there are many locked doors at our facility. It’s a freestanding independent locked crisis psychiatric hospital and the majority of our patients were involuntary, but there were a mix of voluntary and involuntary patients. If you were brought there on an involuntary hold, in Pennsylvania where I worked, it’s called a 302. You are there for up to one hundred and twenty hours. You have a hearing in front of the mental health review officer. Sometimes there are people who testify about your behavior. The treating psychiatrist testifies, you can testify. You have a public defender. If the mental health review officer believes you need more time then add more time. That’s how it goes.
Gabe Howard: And when people think of psychiatric hospitals and psychiatric wards, this fits, right?
Gabriel Nathan: I mean yeah. I can I can give you like a general feel of the facility where I work. You know, it had institutional furniture. You know, the stain resistant industrial vinyl. Very very heavy chairs, because you know sometimes people get angry and like to throw chairs. So we try to mitigate that with you know heavy furniture.
Vincent M. Wales: And you’ve got the ligature free everything.
Gabriel Nathan: Yeah everything is reviewed. So we have what’s called environmental rounds where staff members patrol the hallways and actually look for things. Could this be potentially be a ligature point? Could this be used to harm someone? We had sometimes wicker furniture that people would pick off the pieces of wicker and use that to cut themselves. So, you know, you had to be looking for everything. The art that was on the walls is covered in Plexiglas that is screwed to the wall. Like the frame is screwed to the wall because we have patients rip the artwork off the wall and try to break the Plexiglas to hurt themselves. If you were writing you’d have these little bendy pens that were nearly impossible for you to hurt yourself with and little tiny little golf pencils. So the entire environment is regularly scrutinized and the quote “therapeutic milieu” which is the term that’s used to describe the patient environment, is all designed to keep people safe from themselves or others.
Vincent M. Wales: I have a couple specific questions since I work in the hospital end of things myself here. Did your hospital have a psychiatric E.R.?
Gabriel Nathan: Okay, so this was a psychiatric emergency facility. So we would have cops roll up at 3:00 a.m. with the ambulances. We in fact have one of the only dedicated psychiatric ambulances, it’s based out of our hospital. So when a warrant is issued, it’s an EMT is along with the police serving that warrant so that it’s not the police showing up to the house. It’s not the person being handcuffed and thrown in the back of a patrol car like a criminal, right? It’s more trauma aware. Not to say that it’s not traumatizing to be dragged out of your house at 3:00 a.m., whether it’s by EMT’s or whomever, but it looks a little better to the neighbors.
Vincent M. Wales: Sure. So Gabe what was your position there? What was your job?
Gabriel Nathan: When I was hired in 2010, I was a hybrid of psych tech. So which is really like your lowest rung. Sometimes they’re called psychiatric aides. They’re really the backbone of any psychiatric hospital. They’re doing rounds, they’re checking the bathroom to make sure people are not doing inappropriate things in there, or harming themselves, and they’re checking every single room, they are monitoring the hallways. They’re everywhere, and there’s usually, you know, eight to 10 on duty per shift. So I did that a couple of days a week and then a couple days a week I was what’s called an allied therapist. Basically my job as an allied therapist was to facilitate a wide range of psycho educational and recreational groups for the patients. So at eleven o’clock I could be running coping with anxiety at one o’clock I could be running creative writing or current events and then doing a lot of documentation and conducting like one on one interviews with patients, just to see how they were doing that day. So that was what I did for three years and then I moved up to development and programming. I did that for two years.
Vincent M. Wales: Okay, and one last hospital question. How large was it? How many beds did you have?
Gabriel Nathan: At the time I was working there, we had a 73 bed capacity.
Gabe Howard: So let’s talk about differences between patients and staff. So one of the things that you just talked about is all of these things are done to keep patients safe. What was the word that you used? Therapeutic value?
Gabriel Nathan: Therapeutic milieu
Gabe Howard: Milieu? OK, so milieu.
Gabriel Nathan: Yeah yeah.
Gabe Howard: Speaking purely as a patient, you’re constantly staring at people and trying to see if they’re up to anything, and it appears very infantilizing and you’re talking down to us and you’re constantly treating us like we’re not adults. That’s very much what I felt when I was there. How do you feel about that? Not like why is it done. I think we all understand why it’s done. But how did you, Gabriel Nathan, feel sort of, I’m trying not to say baby sitting adults, but in a way you’re responsible for keeping adults safe who don’t appreciate it. How did that make you feel?
Gabriel Nathan: Sure. We’re responsible for keeping people safe who have demonstrated that they do not possess that ability.
Gabe Howard: Yes, agreed.
Gabriel Nathan: So, unfortunately it’s an unwanted reality. And we were often being confronted with people saying, “F you! You’ve got no right to to be watching over me,” and you know whatever, when they just tried to throw themselves in front of a bus. So there was often a disconnect there. And I tell people the most commonly uttered phrase in the hospital is, “I don’t belong here.”
Vincent M. Wales: OK. Yeah.
Gabriel Nathan: And that was said by a great number of people. It was said by very wealthy well-to-do individuals who I guess were saying it because they didn’t belong with, you know, kind of the impoverished psychotic individual who was wearing newspaper underwear, right? They felt this kind of righteous indignation of I don’t belong here. But it was said by everyone regardless of their socioeconomic status or whether or not they used illicit substances or what. Nobody belonged there. Even when we were at capacity, no one belonged there.
Vincent M. Wales: Yeah, you have no reason to exist.
Gabriel Nathan: Exactly right. So how did Gabriel Nathan feel in that position? I think uncomfortable is the word. I felt uncomfortable for quite a few reasons. First of all ,I did not have a lot of psychiatric training when I was initially hired for this job and I felt uncomfortable about that where I was feeling like I was a fish out of water.
Gabe Howard: Ok that makes sense.
Gabriel Nathan: So I felt uncomfortable that way. I felt uncomfortable you know being somewhat of relatively slight build, being put in a position where the alarm would go off and, you know, if you’re the first one who’s arriving at whatever emergency it is, like you’ve got to deal with it. And you don’t have a lot of tools at your disposal to deal with issues in an inpatient psychiatric hospital. And so I felt kind of outmuscled and that got uncomfortable several times. And I also felt uncomfortable because the whole environment is . . . it’s bizarre. You really feel like you’re in a bizarro world. You’re with individuals, some of whom are psychotic, some of whom are reality based, some of whom are suicidal, some who have severe depression and anxiety or inability to care for themselves. It is a huge mix of individuals because of the makeup of our hospital. It wasn’t divided into separate units like this is the bipolar unit and this is the schizophrenia unit.
Vincent M. Wales: Right, right.
Gabriel Nathan: And it was just everyone together, so facilitating a let’s say creative writing group when you have individuals who are psychotic and actively responding to internal stimuli and people who are reality based. It was very very difficult and very frustrating at times. And I want to address the point too about it feels like everyone’s watching us. It feels that way for staff too. Don’t forget that we’re on camera also. When you get called up to H.R. You’re feeling it, okay?
Vincent M. Wales: It’s like being called in to the principal’s office.
Gabriel Nathan: Well it’s like being called to the principal’s office, But the stakes are so high. Because unfortunately at the hospital you are going hands on with people. A woman comes out of her room stark naked and there’s three male employees around. You have to manage that situation and that gets very problematic. So we are being watched as well as employees. And I used to run one of the groups. I would run is was called, it was called a safety group and we would talk about the hospital. I would talk very frankly. I would let them know, yeah, you are on camera 24 hours a day. The only places we don’t have cameras are your bedrooms and the bathroom. But other than that you’re being watched all the time so it’s not paranoia. Like I was very frank about it, but I also emphasized we are too. And that is for your safety as well. You’ve got to watch everyone.
Gabe Howard: We’re going to step away for a moment to hear from our sponsor. We’ll be right back.
Narrator 2: This episode is sponsored by BetterHelp.com, secure, convenient and affordable online counselling. All counselors are licensed, accredited professionals. Anything you share is confidential. Schedule secure video or phone sessions, plus chat and text with your therapist whenever you feel it’s needed. A month of online therapy often costs less than a single traditional face-to-face session. Go to BetterHelp.com/PsychCentral and experience seven days of free therapy to see if online counselling is right for you. BetterHelp.com/PsychCentral.
Vincent M. Wales: Welcome back everyone we’re here with Gabriel Nathan talking about what it’s like to work in a psychiatric hospital.
Gabe Howard: Gabriel, when you worked there, did you feel personally scared? Were you ever afraid? I mean you talked about being nervous or being you know worried about HR or feeling watched. But did you ever fear for your own physical self or emotional self while an employee there?
Gabriel Nathan: Yes. You know the first time I ever got punched in the face was at the hospital, that was like a unique experience. And you actually do see stars. I did, like the bursts of light that’s how it is and I was like wow I thought that was just a cartoon. That’s real. I got attacked during what’s called, we call it an “elopement attempt.” I was the only one there and that really sucked and that was a turning point in my time there.
Vincent M. Wales: What happened exactly?
Gabriel Nathan: I will tell the story exactly as I can tell it. It was September 17th, 2012, and you don’t you just don’t forget this stuff. It was a Monday morning and I worked every other weekend when I was on the unit and this was my weekend off. So it’s coming in on Monday fresh. You didn’t know the patients who had been admitted over the weekend, morning report had not happened yet. So I didn’t get the skinny on who was who and I was preparing the paperwork for the allied therapy department. It was a lot of paperwork from the weekend that I just have to get together and put in every patient’s chart and everything. You have to make photocopies. So the photocopies are used for Morning Report and the originals are put in the charts. So the copier in the chart room was broken. It was always broken. It was a pain in the ass. So I had to take all the originals and go out to the crisis lobby. They had a photocopier. So I go out of the chart room and there was a young man in his early 20s, white guy, T-shirt, shorts standing by the door to the crisis lobby and there’s a red and white lines you know square by the door to signal like stand outside of this box like you’re not allowed to stand inside the box. And he was standing inside the box and I was like. “Oh great. You know, first thing in the morning I’m going to have to tell this guy you can’t stand by the door. It’s going to be a confrontation.” But as I was walking towards him he moved outside of the box, but still like near the door. But I was like Oh OK. He did the right thing. I don’t have to say anything to him. I nodded my head and I said good morning. He looked at me and I put my key in the door and I opened the door and I felt him right behind me and I turned around and had my keys in my hand and the papers and I said, “No.” And he said, “Let me in there,” and he shoved against the door and I was shoving back trying to close the door on him and I was standing on a mat like that wipe your feet. I’m on the mat with it sliding back on the floor. And I was like I’m going to lose it. He shoved his way through and he bear hugged me and pushed me up against the wall. And I’m thinking, just stay on your feet. All you have to do is stay on your feet and in 20 seconds there’s gonna be 10 guys in here, right? So I’m wrestling with him and I had a hoodie on. Which if you ever work in a psychiatric hospital don’t wear a hoodie.
Vincent M. Wales: OK.
Gabe Howard: OK.
Gabriel Nathan: And I never ever did. This was the very day. So I had this stupid hoodie on he reaches over the back of me and pulls the hoodie over my head. So now I can’t see anything. I hear screaming and someone hits the psych alarm and I can hear the bell. And then the next thing I know I’m on the floor and I can feel on top of me and I’m like, “Oh great. They took him to the floor and we’re all on the floor together and they’re going to pull him off me and it’s all gonna be over.” Well, what I didn’t realize until I watched the video was when he had pulled my hoodie over me and someone activated the alarm, it was actually a patient who hit the alarm. He immediately got off me when the other staff came in and staff took me to the floor, not him. And he faded back and was just watching with the other patients and a nurse came in with a trilogy, which is a needle with Haldol, Benadryl, and Ativan to give to me. And I was face down on the floor with my head covered with the hoodie, and she looked at me and said, “Oh my God! He’s got a belt on. Why does he have a belt on? How am I going to give him the needle?” Because obviously when you come into a psych hospital, they take your belt.
Gabe Howard: Right.
Gabriel Nathan: So the guy who’s on top of me pulled my hoodie up and he said, “Gabe?” And I was on the floor staring at one of my colleagues and he said, “What is going on?” And I said young guy, white T-shirt, gray shorts. And they found the guy and put him in restraints and gave him the trilogy. That’s how that incident went down and that sucked. And after they brought me up and after I had explained what happened, all my co-workers are standing around and they’re trying to comfort me or whatever. And you just see me I take my glasses off and I throw them against the wall as hard as I can. And I took that stupid hoodie off and I throw it against the wall. And I was just so incensed that I didn’t get saved. Like it didn’t go down the way it was supposed to. You know?
Vincent M. Wales: Right, yeah.
Gabriel Nathan: Not the way I had been there for colleagues, it didn’t pan out for me. I want to make it very clear there are colleagues who have been hurt way, way worse. You know I went and ran a group the next hour, and I should not have, but I did. We’ve had people who’ve had their shoulders broken, who’ve had concussions, who’ve had their jaws busted. I mean all kinds of stuff. So I don’t want this to be like, “Oh my God!” You know, it happens to a lot of people. A lot of people. So the short answer to your question is yes, I have been scared. And I had been preparing for something like that to happen since the day I started working there.
Gabe Howard: Yeah I think that anybody can understand why being attacked at work is traumatizing. And I think that there’s a lot of us who can really relate to the idea that you thought you were safe. You thought that there was all of these protocols that would keep you safe and they failed you.
Gabriel Nathan: I never, I never thought I was safe really.
Gabe Howard: Okay. So the whole time you were there, you just didn’t feel safe at work. But you did this work for how long?
Gabriel Nathan: I was on the unit every day for three years.
Gabe Howard: And then after three years you went to work and didn’t feel safe. And as you know people like me, people like Michelle Hammer, people that we interview on other shows, we’re there three four or five days and we don’t feel safe and we carry a lot of whether you call it anger whether you call it misunderstanding trauma whatever toward the hospital and staff. I am listening to what you say and I’m thinking My God I would never want to work there but there’s still that part of me that’s just like you were still mean to me.
Gabriel Nathan: But there should be. There should be that part of you and I don’t begrudge that anger at all. Not at all. And I would never pretend to say I understand it because I don’t. Look, I’m a mental health consumer. I go to therapy. but that’s not the same thing. And I would never pretend that being an employee who has keys that jingle jangle at 3:00 o’clock and I’m out of here is the same thing. But what I will tell you is that I was traumatized long before the assault. I mean I was. I had to take, I took a patient down my first hour on the unit. The first hour I was sitting ,I was sitting on the acute unit with my trainer. You have a trainer or preceptor for I don’t know what it is two weeks maybe. You’re his shadow, you know for every hour you’re on the unit. The first hour I’m sitting there with him. And just like what happened to me, a staff member put his key in the door to go out and a patient followed him and cold cocked him. Hit him right in the back of the head. Immediately, my trainer and I jumped up I had to the midsection he had the top. Took the patient to the ground. He was a Hispanic young man. Waited until three or four more other staff members got there. Picked him up, put him on a bed, putting him in restraints. That’s traumatizing for everybody in the room.
Vincent M. Wales: I can imagine.
Gabriel Nathan: Everyone. So that to me even with the words coming out of my mouth and I know it’s true it sounds disingenuous because you’re like How dare you? Staff members say that you’re traumatized? You’re not the one being put in full leathers. You’re not the one being, you know, exposed in this way. No, but you’re perpetrating an act that is it seems so draconian it seems like very 12th century. To be restraining somebody to a bed, it seems very vulgar and very violent and it is. It’s an act of violence. So what you’re whether you’re on the receiving end of that or the perpetrating act, that’s traumatizing.
Gabe Howard: I think that there’s a lot of analogies that would probably fit this situation and I hate that the one that keeps coming to mind has to do with infants. Since we’re talking about feeling infantilized as a patient, but it just sort of reminds me of a parent taking their 2 year old to the doctor to get a shot and the 2 year old understands that this is going to hurt and the parent understands that it’s going to hurt and the doctor understand it’s going to hurt. But there’s that little bit of disconnect from the 2 year old. It’s like why are you allowing this to happen, Mom? Why why won’t you take me out of here, Dad? And the parent is always holding the child down while you know that the treatment is being given, the vaccination or whatever it is. And how can you not be affected by that? You just held your kid down when your kid asked you not to do it. Does that resonate with you? I mean from my perspective, when I was there, you all looked like you were enjoying yourselves, which I now know is ridiculous. Nobody enjoys themselves there. But at the time it felt like that. Where’s the bridge for that? Obviously like you said, we can’t sit people down and say listen it’s going to look like the staff is having a good time because they may whistle or they get to go home or they’re going to laugh or tell a joke but really we’re all traumatized too. Because that doesn’t really make a patient feel safe either.
Gabriel Nathan: Right.
Gabe Howard: What’s the goal here? Everybody’s miserable.
Gabriel Nathan: Well here’s the thing, everybody isn’t miserable. So the patients aren’t miserable 24 hours a day. Like you will go, you will hear patients laughing and joking with each other and having a good time in the activities room or watching a movie. Let’s not sell each other a bill of goods on either end, that like it’s a completely horrendous experience for the patient. It’s not.
Gabe Howard: That’s true. I got better I got better. It saved my life.
Gabriel Nathan: The staff isn’t miserable 24 hours a day either. We like each other, we love each other. There is an incredible bond that happens with employees who are kind of in a first responder environment. And within the confines of a closed psychiatric hospital, you are the first responders. So you know, you are the ones running down the hall when there’s an emergency. You are the ones leaning on each other. We’re hugging in the chart room, we’re crying with each other. We get mad and yell at each other. It sounds so cliche, but it is very much like a family. We’re not walking around 24 hours a day crying about how horrible it is. We’re just not. Because first of all, we wouldn’t be able to function. We would not be able to do our job if that’s how we acted.
Gabe Howard: That’s true.
Gabriel Nathan: It’s totally ineffective for the patients and for each other.
Gabe Howard: No.
Gabriel Nathan: We depended on each other for support and to be able to get through hard incidents and a lot of that was done through humor and very very black humor, as I think you’ll find in all hospital environments and first responder environments. The gallows humor, it gets you through. So yeah, I think people are traumatized. But you deal with that in lots of different ways. You know, whether it’s through humor, whether it’s through a variety of coping mechanisms. Some of them are healthy, some of them are not.
Gabe Howard: I understand what you’re saying. I really really do. That’s really beautiful. Gabe, thank you for being so open and so honest with all of your stories. We really appreciate it. So I know that you no longer work at the psychiatric hospital and you went on to another job, but it still involves a lot of mental health advocacy and empowering people through telling their stories and making movies. Can you talk about the job that you have now and tell people where to find that site?
Gabriel Nathan: While I no longer work there, I am still back there every other month or so. It seems like there’s always some kind of reason where I’m back there, and that’s nice actually. It’s kind of nice not to have the cord and completely separate. But where I work now it is still involved in mental health. It’s just not the trenches anymore. I’m the editor in chief of a mental health publication called OC87 Recovery Diaries. We’re at OC87RecoveryDiaries.org. We’re on Facebook, Twitter, Instagram, all over the place. And we publish mental health personal essays and do original mental health documentary films. We have a new essay every week and a new film every month that just really highlighting stories of mental health empowerment and change.
Gabe Howard: I want to blow your horn a little bit, Gabe. Because you know sometimes people hear you know we’re a web site and we make little movies every month. These aren’t little movies, these are very high end well thought out. They’re incredible mini documentaries about various people and things and they’re really quite amazing.
Gabriel Nathan: Well I love what we do and I love how we do it and the production company that we work with for the films calls it giving mental health stories the red carpet treatment. It gives to them to give mental health storytellers the respect and dignity of having a professional editor and laying their story out correctly. And same thing with the films. If we’re going to profile you, we’re gonna do it right.
Gabe Howard: Well excellent. Thank you so much everybody. Check that out over at Oc87RecoveryDiaries.org. Thank you again.
Vincent M. Wales: It was great having you.
Gabriel Nathan: Thanks. Thank you, Vince.
Gabe Howard: Thank you for putting up with both of us and thank you everyone for tuning in. And remember you can get one week of free, convenient, affordable, private online counselling anytime anywhere by visiting BetterHelp.com/PsychCentral. We’ll see everybody next week.
Narrator 1: Thank you for listening to the Psych Central Show. Please rate, review, and subscribe on iTunes or wherever you found this podcast. We encourage you to share our show on social media and with friends and family. Previous episodes can be found at PsychCentral.com/show. PsychCentral.com is the internet’s oldest and largest independent mental health website. Psych Central is overseen by Dr. John Grohol, a mental health expert and one of the pioneering leaders in online mental health. Our host, Gabe Howard, is an award-winning writer and speaker who travels nationally. You can find more information on Gabe at GabeHoward.com. Our co-host, Vincent M. Wales, is a trained suicide prevention crisis counselor and author of several award-winning speculative fiction novels. You can learn more about Vincent at VincentMWales.com. If you have feedback about the show, please email [email protected].
About The Psych Central Show Podcast Hosts
Gabe Howard is an award-winning writer and speaker who lives with bipolar and anxiety disorders. He is also one of the co-hosts of the popular show, A Bipolar, a Schizophrenic, and a Podcast. As a speaker, he travels nationally and is available to make your event stand out. To work with Gabe, please visit his website, gabehoward.com.
Vincent M. Wales is a former suicide prevention counselor who lives with persistent depressive disorder. He is also the author of several award-winning novels and creator of the costumed hero, Dynamistress. Visit his websites at www.vincentmwales.com and www.dynamistress.com.