Career Confidential: The Art Therapist With Dangerously Psychotic Patients

I work with patients from all walks of life, from the homeless schizophrenic man you see on the street to the post-collegiate member of the 99 percent who just experienced her first psychotic break.

I work with people who are a danger to themselves or others in a psychiatric hospital in a large East Coast city. As an art therapist (I hold a degree in creative arts therapy) I facilitate group therapy to adults on an in-patient locked unit that deals with people in the most acute state of mental illness. As a city-run facility, the hospital honors the tradition of health care for all. This means I work with patients from all walks of life, from the homeless schizophrenic man you see on the street to the post-collegiate member of the 99 percent who just experienced her first psychotic break.

In these groups, I use art to help process emotions surrounding a relapse, ease anxieties about hospitalization, and help teach coping skills or promote insight to the presenting illness. To enter my unit, patients must undergo a screening process in the ER. There, the multidisciplinary team decides if the patient is a danger to themselves or others.

A danger to the self could be an inability to take care of oneself, like the chronic schizophrenic homeless man who’s been sitting in his own feces, covered in lice, and malnourished because he is paranoid that the food he is receiving is poisoned. Another example is the girl who has been battling depression for quite some time and in experimenting with LSD, believes her family is plotting to murder her.

There was also the good-looking 30-something manic guy, who drove hundreds of miles, went out on the town, drank all night, met a lady, went home with her and decided to “show her the proper way to commit suicide.” The girl found him in her bathroom with double wrist and neck lacerations. He survived to tell the story (to me) and continued to try to take his stitches out (while in the unit) by use of the electrical outlets on the wall. He really liked art, though.

Dangers to others include the paranoid guy on PCP attempting to attack his family to the grandiose manic guy dressed in a dashiki “directing traffic” in the middle of a major street.

Almost all of our patients are involuntarily committed. The patient has the right to petition for release in a
court hearing. This is where the patient presents their case to a judge with representation from a patient advocate and the doctor defends the case to retain the patient for further treatment. Similar actions can occur if a patient refuses medication. Patients will often fight to be released but I have found after court that some patients almost feel more secure and find it easier to comply with treatment.

Though the work is intense, I laugh almost daily. Recently I found myself explaining to a patient that porn is not really a depiction of people in their most intimate of moments but a staged production created for profit. Another psychotic dude was reminiscing about how, when high on drugs, he had “little men crawling up (his) leg.” In his flamboyant Dominican accent he squealed, “Get off my mah legs little men!!” His swatting technique, he demonstrated, was a swift flip of his wrists in a downward motion.

I write a lot of progress notes for my patients that include statements like “she remains resistant to therapeutic intervention and spends most of her day in bed, talking to Jesus” or listen to proclamations like “you know, I was born in 1786 for the 4th time?” “No, I didn’t know that. What is that like?”

The unit staff includes psychiatrists, social workers, nurses and psychiatric nurses aides. An underlying parallel process takes place with people who work in psychiatry. Some can be just as unhinged as our patients perhaps because there was something that brought them to the work in the first place. There is also never a shortage of romantic relationships between staff members. It’s almost like the dysfunction of the population we are caring for fosters poor decision-making with these relationships that are basically set up to fail. But the shared experience of the intensity of the day can be invaluable. Rehashing a day spent in a room filled with psychotics whose thoughts you have to help organize all while making sure the guy that openly despises Regis Philbin doesn’t eat all the drawing paper, or recalling the “take down” that occurred in which a patient got put in four-point restraints becomes difficult dinner conversation for others not in the “biz”.

Being a contract worker, hired out of grad school in the midst of the Great Recession, I do not have health insurance. Yes, I work in a hospital and I do not have health care coverage. With my work, the chance of being assaulted is quite high. I have ducked punches, ran away from patients chasing me because they want to “fuck me up” and the thing that runs through my head in those moments is always the same: “I sure hope I don’t end up in the ER because my student loan bills are high enough!”

I really do love my job, though. I love how art is the common place we can all meet. And if I didn’t work there, I wouldn’t have had the chance to receive the best compliment of my life: “You look like fun!!! You look like kaleidoscopes and rollercoasters!”