Editor’s note: Yu Lei is a nurse at a tertiary psychiatric hospital in China’s eastern Jiangsu province with more than 10 years of experience. Her hospital receives patients with various mental health conditions, referred through government and nonprofit relief programs. Between shifts, she shares her “psych ward stories” on social media.

Yu Lei had only been working at the psychiatric hospital a few days when she first heard the “mushroom story.” It tells the tale of a patient who would squat in a corner holding an umbrella and remain completely motionless, refusing to eat or drink, because he believed he was a mushroom. One day, a doctor took an umbrella and joined him. After some time, he convinced the patient that mushrooms can also walk and eat, and gradually the patient began to recover.

Yu found the story touching. She wanted to be like that doctor and “become a mushroom” with her patients, to step into their inner worlds.

Recently, the tertiary psychiatric hospital where Yu works has seen an increase in the number of new patients. She works mainly in the men’s ward and often is so busy she feels her feet barely touch the ground.

Reflecting on her work in recent months, she finds that she spends most of her time either dealing with patients’ various bodily secretions or answering endless questions. She also spends a lot of time washing feet — smelly feet, muddy feet, blistered feet, calloused feet, bleeding feet, all kinds of feet. She says she can probably guess a person’s age and occupation just by looking at their feet.

Newly admitted patients are usually in the acute phase of their illness and experiencing extreme stress. For example, one patient recently greeted Yu by declaring that he wanted to “slaughter her.” Yu inwardly laughs off such remarks, but the hospital’s strict safety protocols required her to restrain him. “Every year, there’s some patient who wants to kill me. I’ve become numb to it,” Yu says with a resigned sigh.

When she was new to the profession, Yu struggled to deal with the negative emotions triggered by threats from patients. A large, heavily tattooed man she was assigned to would attempt to intimidate her every day. “If you don’t XYZ, I’ll XYZ,” was how he would usually phrase his threats. Enduring this day after day took its toll on Yu. One day, in a fit of pique, she screamed back at him: “Just go ahead and kill me!” Around this time, she thought about resigning almost every day, she recalls.

Yu graduated from nursing school in 2010 and took up her position at the psychiatric hospital. Since then, she has dealt with all manner of patients, including a middle-aged schizophrenic who had stabbed a passerby for coughing near him, and a man claiming to be the King of Wuji Kingdom, a character in the Chinese classic “Journey to the West,” who had traveled through time to the present day.

Yu says she will never forget her first day on the job. On the way from the nurses’ office to the ward, the head nurse had comforted her by saying: “The ward may look chaotic, but there’s no need to be afraid.” However, as soon as they reached the doors, Yu was welcomed by the sight of a nurse covered in blood being carried out after an incident with a patient.

From that moment, Yu says she felt a deep sense of reverence for the job. “We must respect psychiatric patients. They are all human; they’re just sick.”

Preventative measures

When gathering information about newly admitted patients, Yu pays special attention to those experiencing auditory hallucinations, as it’s essential to ascertain whether their hallucinations are commanding in nature. For these patients, the voice in their head can act like a radar, constantly scanning the environment for signals it can respond to, which sometimes can lead to anti-social and even criminal behavior.

Yu believes that psychiatric patients have their own closed-loop logic that people who haven’t experienced mental illness cannot comprehend or relate to. All she can do is try her hardest to understand her patients and make the best use of the available medical resources to treat them.

Psychiatric care nurses are required to prevent patients from behaving impulsively, running away, self-harming, and hiding medications. To make sure patients take their medication, the hospital provides only transparent, wide-mouthed drinking cups. Yu personally watches every patient as they take their medication, then meticulously inspects their mouth, cup, hands, and pockets for unswallowed pills.

For Yu, the most challenging patients to care for are those with depression. Although the ward undergoes safety checks every day, some patients still seek any means to harm themselves. Yu recalls a young man diagnosed with bipolar disorder who, in the middle of the night, took advantage of a blind spot in the surveillance system to swallow a whole toothbrush.

Violent outbursts are unfortunately inevitable in a psychiatric hospital. Almost every nurse has had their hair pulled by a patient, sometimes so badly it left a bald patch. Scratches are also common.

Once, Yu was working with a tall, transgendered woman when she was kicked in the chest, knocking her back against the wall. Other patients can be verbally abusive. A few years ago, Yu’s ward admitted a man who often exposed himself and made obscene remarks to female nurses. On one occasion, his behavior was so upsetting that Yu locked herself in a bathroom to cry.

Working in the psychiatric ward means guarding not only against physical and verbal assaults, but also against patients’ romantic and sexual advances.

Yu’s supervisor was onRce pursued by a patient to the point where she had to leave work secretly through the fire escape, and several female doctors have been pinned down by patients during night shifts. Male doctors have also been pursued by female patients. One woman was so infatuated with a male doctor on the ward that she voluntarily readmitted herself after being discharged.

Yu jokes with her colleagues that psychiatric nurses can’t afford to look too attractive. Senior nurses will also teach younger carers strategies to fend off advances, such as telling every patient that you’re 40 years old and have two children, regardless of your true age.

For this reason, throughout her decade-long career in the psychiatric hospital, Yu’s persona has always been that of a middle-aged woman with children. At the same time, her real-life identity has gradually caught up — she is now a 30-something mother with a child in primary school.

Whenever Yu is asked to reflect on her career, one word comes to mind: “Exhausted.” During her breaks, she goes to a coffee shop and makes a special order: “Give me an espresso that’s even more bitter than my life.”

To let off steam, Yu jumps rope on her balcony every night, usually 3,000 to 5,000 reps. When the weather is warm, she also goes jogging.

Highs and lows

Yu says she often looks to the “mushroom story” to seek inspiration. For a start, she believes what her patients tell her. Many people are initially unwilling to talk about their experiences with mental illness; they may have opened up to others in the past, but had their feelings dismissed or ignored. It is important they feel heard, Yu says.

She is also as straight with them as possible. For instance, when a patient refuses to take their medication, she will tell them: “If the psychiatric hospital was utopia and you wanted to live here forever, you could get away with not taking your meds. But society is different. Society has rules.”

Yu’s time in the ward has also brought some heartwarming moments. One day, a young man who graduated from a Shanghai university wrote the word “banknote” on the edge of a piece of paper, tore it off, and handed it to her, explaining that holding the piece of paper would bring her wealth — he was sure because “the heavens had told him so.”

Two years ago, Yu began sharing her experiences from the ward and personal reflections on social media, attracting many curious readers. She hopes that her blog can not only stimulate fans’ curiosity, but also help remove the stigma associated with mental illness. After all, everyone has their problems.

Yu’s patients are referred to her hospital through various mental health relief initiatives. Many are homeless, and self-harm is common. Yu often uses mindfulness techniques to help people in crisis. “I always tell them: ‘You must learn to control yourself. The medical staff in the psychiatric hospital will give you a hand when you’re on the cliff’s edge, but you have to climb up with your own willpower. Please, don’t let yourself fall into the abyss.’”

During the treatment of one patient, a Ph.D. scholar from a prestigious university who experienced severe depression after graduation and attempted suicide several times, Yu noticed that he liked to draw. When he was eventually deemed healthy enough to be discharged, Yu asked him to send her one of his artworks. Since then, she’s received a sketch from him once a week.

When Yu encounters patients who are contemplating suicide, she tells them: “When you lose your reason for living, you can find a new one. When you can’t find the meaning of life, just focus on surviving and leave the rest to time.”

Not long ago, one of Yu’s patients committed suicide just a month after being discharged from hospital, causing her to question the value of her profession. Later, the head nurse comforted her by saying that not all sickness can be cured, and not everyone can be saved.

Over her years in the psychiatric ward, Yu has cared for many people who have survived catastrophes. Some have made a full recovery, while others continue with their struggle to survive. “All we can do is respond to their suffering,” she says.

Recently, a publishing house contacted Yu to discuss compiling her experiences into a book. When the editor asked her to suggest a title for the book, she gave it much consideration before she finally answered: “I Nurture Mushrooms in a Psychiatric Hospital.”

Reported by Zhang Jing.

(Due to privacy concerns, Yu Lei is a pseudonym.)

A version of this article originally appeared in Oh!Youth. It has been translated and edited for brevity and clarity, and is republished here with permission.

Translator: Carrie Davies; contributions: Strapko Nastassia; editors: Xue Ni and Hao Qibao.

(Header image: A psychiatric ward in Heihe, Heilongjiang province, 2021. Qiu Qilong/VCG)