I have mentored 10 or 12 graduate social work interns over the years and always gave them the same advice: try and spend at least a few years working in an inpatient psychiatric hospital. This is where you get to see mental health diagnoses in their most acute and serious stages, which helps you to gain a better understanding of the full spectrum of disorders.
I have worked in a state hospital, private hospital and a psych unit of a general hospital. This story is about my experience at Chestnut Lodge, a former private psychiatric hospital in Rockville, Maryland. This was my first job after getting my Mental Health Associate degree from Montgomery College. It was 1977 and I was 21 years old. I was working the evening shift as a psychiatric technician. This allowed me to continue to go to school full time at University of Maryland, while working full time — not the best recipe for attending college but since I was paying for school myself, I didn’t have much choice. And I figured that if I was going to have a job it would be best for me to have one in my field.
Chestnut Lodge was an interesting place, known for the site of the book and movie “I Never Promised You a Rose Garden,” an autobiographical account of a patient’s experience there and “Lilith” starring Warren Beatty. In its heyday, it was an internationally well-respected psychoanalytic hospital and the home of Frieda Fromm-Reichmann, an internationally known German psychoanalyst, who not only was on the staff but also lived there. “The Lodge” was known for treating patients with 5 days a week psychoanalysis and for the non-use of medications, even at a time when the understanding of schizophrenia and brain chemistry was changing our previously held beliefs about how to treat these disorders.
Since I worked the evening shift I had a lot of time to spend with the patients. We escorted them to dinner and afterwards we talked, played music and spent a lot of down-time with them. I was fortunate to see firsthand what non-medicated schizophrenia, bipolar disorder, delusional disorder and other conditions I had only read about in abnormal psychology textbooks REALLY looked like. Trust me, it was not always pretty. And oftentimes it was downright dangerous.
It was not uncommon for a patient to become irritated, enraged and sometimes violent. It was the job of the staff to manage this, without the use of medication. We were trained in “packing” patients in ice cold sheets. There were usually three or four of us that apprehended them (sometimes 8-10, depending on how big and out of control they were), and maneuvered them over to a bed where sheets that had been “on ice” were unfolded and they were wrapped in them like mummies. They were usually quite resistant and often violent and our #1 job was to make sure we didn’t get hurt and our #2 job was to make sure that the patient didn’t get hurt. Trying to prevent someone from hurting themselves while they are simultaneously trying to harm you was not always the easiest job. Once it was clear that they couldn’t move they usually settled down. Between that and the freezing cold, “being packed” had an amazingly instantaneous effect of calming the patient. Not unlike a shot of Thorazine but much more natural. A hot water bottle was placed at the top of their head and at the bottom of their feet. Someone always had to stay with them the entire time and they usually stayed in this position for a couple of hours. Even though this sounds torturous, many patients often asked to be packed because they liked the feeling of safety and security that it gave them. It was not uncommon for patients to receive psychoanalysis while they were wrapped in the sheets.
The staff who trained me were mostly ex-military, Vietnam vets. Great guys, but they often were dealing with their own PTSD issues. While it was extremely reassuring to know that these guys always had my back, and I certainly had theirs, there were some moments where the patients had to be protected from the staff, not many, but it did keep you on your toes. I am sure they saw me as this young “do-good hippie” that wanted to connect with patients and maybe wasn’t as always as fearful of the patients as they were. I made a connection with a patient who was a professional golfer and part of my job was to take him and another patient to play 18 holes of golf every week at the course on Falls Road. The site of these two guys with unkempt beards and long hair on the golf course and me as their “chaperone” often resulted in open-mouthed stares from the other golfers.
Even though I was only there for two years, one of my big successes was organizing a dinner out at a local restaurant for the whole unit of 24 patients. The staff did not back me on this, they thought it was insane. I reminded them that we did, after all, work in an insane asylum, so what was the big deal? Fortunately, the Unit Psychiatrist, Dr. Rappaport, a very kind man, backed me and we somehow pulled it off. Just think about the boat trip scene from “One Flew Over the Cuckoo’s Nest” and notch it down a bit, and that was our evening. I remember to this day a crotchety old patient who had been at The Lodge for years, who I never saw smile. But he couldn’t help himself that night and smiled through the whole evening. THAT made all of the trouble we had to go through to make this happen even more worth it.
There were many things I learned from this brief stint in my career but the words of Carl Jung summed up these lessons the best: “Know all the theories, master all the techniques, but as you touch a human soul, be just another human soul.”