Carry Me Through: Hospitalization for Mental Illness

Guest Post by Hailey Rebecca McNutt

Photo by Nong Vang on Unsplash

Going to a mental hospital can be incredibly scary, both for those who are actually going to be attending therapy services and for those who love someone who is going to be in the hospital. As a social worker who works in both inpatient and outpatient services, I see a wide variety of reactions to being in psychiatric treatment. Some patients are excited to get better; others deny their problems. Some family and friends are supportive, and others blame patients for their condition.

Overall, the main difficulty in receiving psychiatric treatment is the stigma and prejudice our society holds against mental health. I’m here to help you understand what mental health really is, what treatment is, and how to help yourself or your loved ones walk through the journey towards wellness and recovery.

Mental health is being able to find a healthy equilibrium towards what we perceive as positive and negative emotions, difficulty and good times, and day to day activities. Mental illness is generally categorized as behavior and thought processes that augment our ability to perform daily tasks and maintain our life balance and relationships in a healthy fashion. Mental illness can be caused by environmental factors, difficult situations, or a chemical imbalance between the necessary chemicals that keep our minds well and stable.

To help mental health, people can be encouraged to attend therapy sessions. However, if the patient is not well to the point that they are seeing or hearing things or are having suicidal thoughts, it is recommended to bring them to the hospital setting.

An important thing to remember about patients in a hospital setting is that they are not different from individuals who have any other type of illness.

There is debate about the illness model towards mental health as well—some professionals say that maladaptive behaviors are caused by people doing the best they can in traumatic and chaotic situations and learn these thought patterns and behaviors in order to survive. In any circumstance, our culture has taught us that mentally ill individuals are “crazy,” “deranged,” or “beyond help.”

We tend to think that these are people who can’t get better and don’t want to seek treatment, when in actuality our hospitals are filled with people who are open to receiving help and desperately want to get well.

It is imperative when working with mentally ill people to remind them that this is what they are—people.

They are people who are battling something very difficult, not very different from a physical illness. If your friend or family member were in the medical hospital for a life-threatening condition, what would you do? You would probably tell your community members, ask for prayers, send flowers and visit them regularly.

However, this isn’t how psychiatric patients are generally treated. They are seen as a secret, a blemish in the family, to hide until they’re well. This type of mentality from family members doesn’t help the patient feel like a person, which is the most helpful feeling when dealing with a mental illness.

Instead, I encourage friends and family to visit often, remind their loved ones how meaningful and vital they are to their lives, and encourage them that they will feel better and that this is a season you are willing to walk through with them.

I believe that simply changing the language we use about mental illness could really help the patients—saying “you have depression” instead of “you are depressed.”

This identifies patients by their strengths rather than their weaknesses. It shares hope and love instead of scolding or asking why they ended up here. People with mental illness are trying to make sense of the vibrant world that lives inside them, and the best medicine is compassion and empathy.

Once an individual goes through inpatient treatment, they will mostly likely step down to outpatient treatment. This typically looks like attending therapy services for several hours a day and then going back to the patient’s typical home life.

During this time, I encourage family and friends to help the patient get back to a normal lifestyle. Encourage them to exercise, eat well, visit friends and family, and look for a stable place to work if they do not have one.

It is best not to constantly remind them of the hospital but instead tell them how much they’re improving and remind them of the future. This will help them try to put their acute care behind them and feel like a person again, which is so useful to their recovery.

Mental health is a difficult topic for everyone, but it is vital to the wellbeing of caretakers and people who become patients. Overall, it is best to lead with kindness and compassion and help everyone feel respect and dignity. In this place of rest and love, healing thrives.

Lessons from the Bedside: Physical Therapy and Change

"They are NOT getting me out of this bed. They just make my pain worse."

"Whew! That physical therapist worked me too hard."

"I'm just not up for occupational therapy today." (No matter that the patient was also "not up to it" yesterday, or the day before, or the day before that...)

If you're a nurse, you have no doubt witnessed these scenarios. Though it's easy for me to discount patients' complaints and reluctance to work with PT/OT, I have to admit, I have a lot in common with their attitude—especially when it comes to change.

Currently, I'm in the midst of quite a bit of change. I'm shifting careers, learning new skills in the writing world, and trying to keep up with an ever-changing healthcare system, all on the coattails of moving from Cambodia back to the United States and working through reentry. Change, like physical therapy, is difficult. As I've observed my patients in the hospital over the years, here's what I've learned about both change and physical therapy:

1. It's painful.

Some patients won't move their feet off the bed for PT/OT until they've had their pain medication. I don't really blame them. Retraining your body to stretch and move and function in a new way can be very, very painful. Change and transition can be the same: a season of retraining our bodies, minds, and spirits to try new things, form new habits, and leave the comfort zone of our beds (or homes, or jobs, or cities). Yet just like with therapy, increasing our activity in these uncomfortable areas only increases our strength and ability to thrive in new ways. It may be painful, but it's worth it.

Adobe stock photo

2. It's scary.

"Don't let me fall!!" patients will exclaim when they transfer to the chair or the bedside commode for the first time. Their legs are weak and shaky, or their balance causes them to sway. Yet the therapist is always there, providing support and holding onto them, a trustworthy safeguard even when patients doubt their abilities. Similarly, in times of transition I too am fearful, and I do my fair share of crying out to God, warning Him I'm losing my balance and am going down, fast! How often I forget He is there, holding onto me, supporting me, even if I don't believe He's strong enough to catch me. It can be terrifying to walk when we're weak because there is always the possibility we will fall, but when we take wobbly steps forward, we arrive to new and important places (like the bedside commode! Just kidding. Kind of.). It's scary, but it's worth it.

3. You'll want to quit.

To be honest, sometimes I have a hard time not judging patients for "being babies" about PT/OT.

"I can't go any farther," they state. Or, "I just can't go anymore. I just want to go back to the bed."

As the patient healthcare professionals they are, our physical and occupational therapists encourage the patients to keep going. They remind them of the benefits of therapy, and they point out how far the patients have already come. Still, some patients refuse to keep moving.

Unfortunately, with all my judging of patients, I am the same way when it comes to anything new. New location, new method of transportation, new routine, new job—anything new throws me for a loop, and like a grumpy old woman who's stuck in her ways, I sit and pout and complain that I can't go back to the way things were before. Even if "before" meant I was bed-bound and my muscles were atrophying.

Like most people, I enjoy comfort. Neither getting out of bed to retrain muscles to walk nor getting out of old routines to form new, healthier habits is comfortable. It's hard, and we'll want to quit, but it's worth it.

4. It's a process, and it takes perseverance.

I wish physical therapy only took one session to accomplish all its goals. I wish one day of accepting change completely reformatted my brain to eliminate all anxiety and stress about new things. However, both physical therapy and change involve growth, and growth is a process. Processes require time, and time requires perseverance.

Little by little, cell by cell, muscle fiber by muscle fiber and neuron pathway by neuron pathway, as we persevere our bodies and brains shift.  The old, unusable junk is broken down and rebuilt into a new, healthier, stronger version of ourselves. Over time, we find ourselves able to jump higher and run faster than we did before knee surgery; we find ourselves utilizing stronger character traits of leadership, servanthood, and compassion as we relate to and lead those around us. It doesn't happen overnight; it's a process, and it takes perseverance, but it's worth it.

5. It's possible.

Though I witness many people who, like me, grudgingly swing their legs out of bed to start therapy, I also watch incredibly motivated patients work day in and day out to regain their strength. These patients focus on the positive and rarely complain. Nothing can deter them from finding something to be grateful for—including the opportunity to participate in occupational and physical therapy. Each time a therapist knocks on the door, they never refuse to get up or tell the therapist to come back later. They are willing to move forward in their healing.

Change and growth, whether physical, mental, emotional or spiritual, inevitably involve pain, fear, exasperation, and teeth-gritting perseverance. Change is all of these things, but it's possible. And it's worth it.

"Do not conform to the pattern of this world, but be transformed by the renewing of your mind. Then you will be able to test and approve what God’s will is—his good, pleasing and perfect will." Romans 12:2 (NIV, bolding mine)

Why I Quit Full Time Nursing—And What I Learned From It

A year ago today I worked my last shift as a full time registered nurse in Waco. I resigned so I could move to Cambodia for a few months to teach English and work with a church, which was one of the best decisions I could have made.

When I returned to the States, I decided not to go back to full time nursing, which was also one of the best decisions I’ve made but one that surprised quite a few people around me. Currently, I’m PRN (as needed), and I love it. Here’s what I’ve learned since quitting full time nursing.

                                                          PRN

It seems crazy.

It seems crazy to quit a full time nursing job for a variety of reasons: my education is specialized and specific to nursing, nurses make a fair amount of money, and the schedule is, for the most part, convenient and flexible. Plus, nursing school was a lot of work.

At times I feel pressure from others and society in general to work full time. But if I’m being honest, most often the pressure I feel comes from within. “I’m young, healthy and able to work,” I tell myself. “I’m lazy for not working at the hospital more.” When I think these things, I have to walk myself through the steps I took to decide not to work full time. Step one is remembering:

Nursing drains me.

After a long shift a couple weeks ago, I came home and told my roommate that nursing drains me not just physically but also emotionally and even spiritually. Part of this is due to the nature of nursing—the emotional and spiritual components to caring for people—but part is also due to the way nursing plays to some of my greatest weaknesses.

For example, when I’m at work, I’m the point of contact for my patients’ care, and my patients are constantly changing. Being the point person for anything (or anyone) isn’t my natural bent, and neither is investing in short-term relationships with patients. Though these things are easily overcome with a little extra energy and effort, all the “little extra’s” start to add up.

However, since I quit working full time, I’m getting to live out my dream jobs, and that fills me up.

A couple months ago when a coworker asked what my dream job would be, I was excited and surprised to tell her, “I’m living them out now: working with at-risk students and writing." I paused before adding, "Nursing wasn’t ever part of my dream, but it finances what I really want to do.”

I regularly spend time writing and volunteering with students each week, and though they don't pay the bills, these activities are more than rewarding. They help fill me back up, and when I show up at the hospital I have a surplus, not a deficit.

This makes me a better nurse and a better coworker.

When I started back at the hospital after returning from Cambodia, I found the time away had allowed me to recover from burnout. I was less cynical, more compassionate, and could maintain my sense of humor even on poopy days (literal and figurative). I had the energy to help coworkers if they need a hand, which I’m extra glad I could do because I work with some of the best nurses out there! Though I still have rough days at work, I’ve found having a few extra days in between shifts keeps the burnout at bay. When I’m not burned out, I’m closer to being the nurse I want to be, the coworker I want to be, and the person I want to be.

Overall, I’m less stressed working PRN.

I’m less stressed when I’m at work. I like that it’s my choice to sign up for a shift instead of having to show up a certain number of times a week and work certain weekends. It helps me not dread going to work and not blame the workplace if I have a bad day—because I chose to go in that day. Nobody forced me.

I’m also less anxious when I’m not at work. Fewer shifts and more time to do what I love means less stress. I’m learning a season with a slower pace of life is perhaps the healthiest thing for me right now—physically, mentally, emotionally and spiritually.

Because of what I've experienced, I'm redefining success.

I've struggled with guilt over not having a full-time job, and I've questioned my work ethic and my sanity. I've had to decide what success would be to me. Success could be the numbers in my bank account, the letters after my name, the hours on my time card, and the reputation as a hard-working employee. Or it could be who I am and how I am.

It's worth it.

In the eyes of a money-chasing, corporate-ladder-climbing society, my lifestyle makes no sense. But to me? My lifestyle is wildly successful. Life probably won’t always allow me work PRN, but for now, I’m so grateful for the chance to live my dreams.

To me, quitting full time nursing is worth it. It’s worth it to get to follow my passions and serve students. It's worth it to allow myself time and space to reevaluate what career fits my talents and gifts. It’s worth it to be a better nurse and a better coworker. It’s worth it because I’m convinced my choice to quit full time nursing is helping me become the person I was made to be.

Beyond the Smiles (Part II)

(For Part I, click here.) 

I remember him laying there. The bare white mattress in the Emergency Ward. The blanket stained with sweat and dirt wrapped around his waist. His ribs protruding from his thin, malnourished frame.

I remember him turning onto his side, obviously in pain. I remember his mother standing at the bedside, anxiety and fear written clearly across her face.

A group of American healthcare workers, part of a medical mission team I was working with, flocked around him and hooked up an ancient ECG machine to confirm a diagnosis of pericarditis—a diagnosis for which nothing more could be done in this rural Cambodian hospital. 

As they gathered around the bed adjusting ECG leads and talking among themselves, I stood in the back. Listening, observing, and praying.

I took in a deep breath, and I let it out. This young man was dying. There was nothing we could do about it. With all our knowledge, with all our experience, with all our compassion and good intentions, there was nothing we could do to prevent this man’s suffering and death. 

There was a time when seeing a patient like this young man broke me. It led me on a journey of desperate brokenness and incredible healing. It led me to face truths concerning what I believed about God and myself. Ultimately, it led me to rest in knowing I don’t have to be enough.

This time, as I stood near the patient's bed, everything was different. Outwardly, I was surrounded by Americans, and I was grateful to be with so many whose education and experience exceeded mine. Things had shifted inwardly, too; I found I had courage to reach out to this patient in a way I was too timid to do before but was incredibly important.

When I close my eyes, I am back in the hot, humid, Cambodian Emergency Ward. I breathe in deep, and I choose to rest in this truth: I don’t have to be enough, for Christ is enough. When I stop worrying about how much I can’t do because I am not enough, I hear Jesus’ quiet invitation to sit in His presence, even in the midst of such deep suffering. And I accept. 

I sit in His presence and bring this young man to Him, praying he would know the peace of Jesus’ presence, too. I sit in His presence and bring myself and my broken heart to Him, finding space to grieve and freedom to be sad because when I’m with Jesus, the lie that “I have to be the strong one” crumbles. Jesus is the strong one. I never have to act like I have it all together—because I don’t. Jesus knows this. He's okay with this.

The Americans clear out, and it’s just my dad and me left. With the help of our friend and translator, Dad explains why the American team is there, to teach and work with the local doctors. The patient’s mother looks up tearfully and asks if her son will live.

All our knowledge, all our diagnostic powers, all our education and good intentions—it means nothing in this moment. We have nothing to offer this woman and her son. Nothing except Jesus. So we ask if we can pray, and I reach out my hand to touch this patient’s dirt-smeared blanket and lift him up to Jesus.

And I know in all our heartbreak, in all their heartbreak, Jesus is enough, and He is with us. 

His presence is so strong. It always is, if we'll just acknowledge it. If we'll just accept His invitation and stop our striving to be everything, fix everything, and know everything. Perhaps this is the most important thing I’ve learned about poverty in the past few years. Poverty and suffering highlight our sense of helplessness, and so often our response is to push this uncomfortable feeling down and ignore it or to grit our teeth and take it upon ourselves to eliminate disparities. Yet I’ve found no freedom there. 

No, freedom is found in Jesus' presence, in trust. It's found in trusting God is enough, trusting He cares and is big enough for all the hurts in the world and my grief over poverty and suffering and death, and trusting God is, indeed, good.

He is good. Even when everything around us seems to be wrong and impossible and heart-wrenching and clouded with evil. He is, indeed, good, and He is enough.