It's a Long Way Down

Failing, Flying, and the Psych Unit

What is one supposed to wear when going to the psychiatric emergency room?

This was the impossible question I faced on the morning of February 10th. I normally know exactly what to wear to every occasion, and take pride in spending hours putting together the perfect outfit for special events. It took me months to find the right dress and accessories to wear to my rabbinical ordination, just under a year ago. But what happens when the rabbi breaks down? What is the proper attire for that? I chose the comfy orange jumper dress with a striped turtleneck that I bought in Jerusalem. I should have known that it didn’t matter, that as soon as I was brought to the heavily secured psych ED I would be required to strip and don a purple hospital gown, which is what signifies a psychiatric patient in the New York Presbyterian Hospital system. I know that because I was once–and soon again will be–an employee of NYP. Someone who is supposed to provide mental health care, not receive it.

My friend Tanya helps me pack a bag, in anticipation that I will end up an inpatient. I freeze while packing, taking a moment to sit on my bed next to her and think about what absurdity we are planning to do. Is this really what my life has come to? Rabbis aren’t supposed to disintegrate. Amalya is a rabbi. She is supposed to be the one that holds people when they fall apart. She is also very, very sick.

This is supposed to be the part of the story where I look backwards and tell you where this all started. I would love to do that, but even as I deeply hope that I have started to emerge on the ‘other side’ of this terribly dark year, I am still grappling to find an explanation that pinpoints the genesis of my undoing. Was it when the anxiety started to grip my brain in October? Was it when the rejections and deep doubts started flooding in during my last year at JTS? Or was it when I was a small child and had separation anxiety that made going to school every morning a massive battle?

To at least attempt to put things in chronological order, I will say that early last spring was when I began to notice a decline in my mental health. I was in the process of applying for my first rabbinic job, which initially started out as exciting. As the months stretched on and the rejections piled up, I was filled with doubt and worry that I had made a major mistake in choosing this career path. I watched my classmates sign contracts, all while having more and more doors shut in my face.

I did finally get a finalist visit for a pulpit position, but during that weekend I was overcome with anxiety and was found crying in an office by several congregants. It was a terrible moment of realization where it became clear to me that not only was I nowhere near ready to take on a pulpit, but it was also no longer what I wanted. I am someone who has always known exactly what I’ve wanted to do with my life, and the few times that that plan has changed I have jumped right into the next plan. Lacking ultimate direction was devastating and made me feel that I had lost the essence of myself. I was left feeling like I was climbing up a rapidly disintegrating ladder, desperately trying to hold onto what anchors me in this world. I came up short, and was left in free fall.

Sometime around last spring, I began to be plagued by intense intrusive thoughts. The kind that made me stay away from ledges and areas of heavy traffic. What scared me most about staring over a ledge at that time was not that I’d actually jump, but what I would see when I stood there. What will I perceive that will change me in a way that I can never take back? Even though I physically felt safe during this period, I was haunted by the reality that some people experiencing these same thoughts do act on them, and that there is nothing external to myself that is actually stopping me from following suit. I have visions of myself being totally alone in the world, and floating endlessly upwards like a balloon with no string. Or, like Icarus, I could one day fly too close to the burning sun that is my ill brain, and fall crashing back to the earth.

Whether or not I wanted it to, the summer ticked on, and the job applications continued. One of my last rejections was particularly ugly, not because I was so excited about the job, but because I was losing my ability to tolerate the perpetual rejection. I remember telling a friend that there was just no way that I could process this rejection until I had successfully found a job. This was also my era of crying in public, which is highly unlike me and therefore deeply embarrassing. A Yekke through and through, any unregulated displays of emotion or public disheveledness are basically horrifying to me. I couldn’t control my emotions, and I also couldn’t control when the rejections came into my inbox. It happened twice in public libraries; I flung myself out onto 5th Avenue gasping for air, my tears dissolving me into the anonymity of the busiest street in the busiest city in the country.

Just like every person is a universe, it felt like every potential job also contained a whole world. Despite my best efforts, it was impossible to not fantasize about what my life would look like in each position. I imagined building a life in Washington D.C. near my grandfather, or moving to Westchester and getting to have a car again. With each successive rejection, I was not only saying goodbye to a potential job, but to a piece of myself. To a piece of everything I had hoped my future would be. Every time someone asked me to articulate my dream job it felt like I was losing my command of my native language. My friend Malka very astutely described it as feeling like “when you say a word so many times that it no longer sounds like a word”. Simply put, I was beginning to feel like a stranger was taking up residence in my body.

This feeling of self-alienation was unfortunately just beginning. In September, it seemed that my long and terrible job search had finally come to an end. I was given the remaining spot in New York Presbyterian’s chaplaincy residency at Brooklyn Methodist Hospital in Park Slope. What I didn’t know then was that I would only get a few weeks’ reprieve from my mental health woes before a much more serious crisis would take shape. I began my residency filled with hope and excitement, but only a week later it was as if a demon had flipped a switch within me.

This brings me to the part of this whole story that I am still trying to understand. Almost overnight, my body was in the vice grip of severe physical anxiety. I felt its heat climbing up my back and neck, and a tension came over my stomach that was so bad it took me hours to finish a single waffle. I shook and cried almost constantly. While I had dealt with a cognitive form of anxiety in the past, I had never experienced anything like this before. Each day the physical symptoms got worse, and on what would end up being my last day of work, I only made it there because a friend dragged me to the hospital. Even though I couldn’t imagine how, I figured that I’d work through the anxiety eventually. Instead, I was pulled into a meeting with my supervisors where it was suggested that I take a leave of absence. The next day it was recommended that I resign.

Everything I worked for was gone, and I barely got the chance to wrap my fingers around it. Not only was the job itself gone, but also any semblance of a plan or future. If the job search had felt like freefall, this was freefall into a pit of quicksand. I saw before me an endless stretch of days with no organization and no concrete hope for the future. No longer anchored to a student schedule and academic calendar, there were no answers or guidance as to what I was supposed to do with my life now.

Slowly, somehow, things started to get better. My friends deserve so much credit here, showing up in ways both big and small. Rabbi Guy patiently sat with me while I sobbed incoherently in his office, and Malka came in from Baltimore to deep clean my apartment. Shalhevet offered to fly me out to Miami to stay with her. Roni let me slump on his couch and called potential therapy programs on my behalf. Devorah force-fed me oatmeal and made me take a shower while she stood watch. Lisa held my hand while I had panic attacks in shul. Yael rubbed my back and let me cuddle her baby. Sarah Beth dragged me out into the snow so we could dance like fools in front of my apartment. People from shul set up a meal train and brought me food and company. My story of mental illness is so thankfully one of deep care and friendship, in addition to the suffering.

At some point I realized that despite losing so much, I never lost my call towards chaplaincy. When I left my job in November, I had no idea what my career plan was or if I even wanted to be a rabbi anymore. But eventually, I noticed that I couldn’t walk past a hospital or hear an ambulance without feeling a deep sense of longing. This sense of purpose kept me going, enough so that I decided to enroll in a part-time CPE unit and re-apply to NYP’s residency program at the Columbia campus. Miraculously, I was admitted back into the program and will return to full-time work in August. A second chance at chaplaincy that I hope I come to deserve.

Before I could continue moving forward, though, I had to get a lot sicker. I unfortunately had no clinical mental health support during this time, because I lost my insurance when I lost my job, and it took months to wade through the hellswamp that is applying for Medicaid. Due to some combination of messing with my meds and knowing that my new unit of CPE was about to start, the anxiety returned in full force. I quickly turned into a shaking leaf that bore very little resemblance to the “real” Amalya. I cried nearly constantly, and in very embarrassing public situations. I stopped eating again, and no one knew how to help me. Being in groups was too much but so was being alone. I couldn’t exist anywhere, including my own skin.

This was what led up to the ER visit that opened this piece of writing. It was a horrible experience, but still ultimately the right choice. Everything about receiving institutional psychiatric care is incredibly dehumanizing, even though as a provider myself I know it must be this way for everyone’s safety. If receiving physical medical care often requires baring the body, getting mental health care means baring your soul. And if you’re in a psych ER, you’ll be doing it repeatedly and out in the open. There is something oddly equalizing about having to give over all of the details of your private illness in earshot of every other patient in the ER, a public confessional to a group of fellow travelers on this most unwanted of pilgrimages.

I think the lowest part of this entire year was when I put in a chaplaincy consult for myself while in the ER. The hospital I was at is the same hospital of which I’ll be an employee in a few months, meaning that the chaplain I saw will soon be my coworker. It’s not supposed to be like this, I thought. This is all wrong–I should be on the other side of this encounter. I felt like a tiny speck of purple swallowed up and anonymized by a giant hospital. Even in that narrowness I thought of my future patients, and how I hope to restore a little bit of personhood through my presence. Tanya stayed with me the entire time, cradling my head while I sobbed in fear and advocating to the medical staff when I struggled to speak clearly.

I was very sick, and also not sick enough. Not experiencing psychosis or active suicidality (for which I am obviously extremely thankful) disqualified me from receiving any impatient treatment. This is the unfortunate reality that meets the millions of Americans who live with chronic mental illness, even the ones with class privilege and good insurance. The reality is that if you are not an imminent danger to yourself or others, there will very likely be no care available for you other than weekly therapy and monthly psychiatric visits. Sure, I wasn’t a danger to myself in the sense of active plans to end my life, but it could hardly be argued that my mind or body were safe places to inhabit. I had stopped eating and showering, and lived for days in the same pajamas. I kept telling my friends and clinical caregivers that while I didn’t feel that I was a danger to my body, my brain felt like a profoundly unsafe place to be.

I’ve thought a lot since then about how we define danger in the context of mental illness. I refuse to accept that merely staying alive is an indication of success or sanity. Of course the most severe patients will be triaged to care first, but the offerings we as a society have for people living with deep psychic suffering are shamefully inadequate. Statistics can tell a lot, but they cannot tell human stories with any level of justice. Numbers may show how many mentally ill people end their own lives, for example, but they do little to tell us what life looks like in the absence of appropriate care and community. How much potential is wasted in the brains of people who are healthy enough to stay alive, but too sick to live? I feel stuck in the inbetween, between Susan Sontag’s kingdoms of the sick and the well.

I am quite fond of metaphor, and it was during this time that I told everyone that it felt like I was host to an alien brain parasite. If I were a much better artist, I would draw a picture of an octopus sitting atop my brain, slithering its tentacles deep into my gyri. It made me understand why people in psychosis often excise their own body parts, desperate to remove the source of the haunting.

Like a lot of people living with mental illness, the past year has been filled with worry that I will never get better. One could call this an anxiety thought, and perhaps the level of intensity would fit under that umbrella, but the fear came from the very real knowledge that some people experience psychiatric breaks from which they will never recover. All who go crazy do not return. Mental decay is unfortunately a one-way street for too many people, and even access to money, psychoeducation, and abundant quality healthcare don’t guarantee a functional brain.

My brain is my instrument, and is what carried me through a childhood where my physicality was awkward and clumsy. I have always experienced the descent into episodes of mental illness as a deep betrayal by my neurons. As humans we are inherently sense-seeking creatures, and we want to tell ourselves stories that put us firmly in the bucket of people who are worthy, and to whom unexplainable tragedy does not happen. Tragedy that defies our understanding of the place in the universe is more than just suffering. It tears at the very fabric of our souls, and permanently alters our sense of the world. There is absolutely nothing that guarantees that I will always bounce back from my episodes, and living with that reality completely terrifies me.

Despite my checkered past of mental health episodes, it always leaves me breathless just how quickly a previously healthy brain can cannibalize itself. Which is exactly how the sharp descent into mental illness feels–my brain setting itself on fire and using itself as fuel in a last-ditch effort to survive. I still worry about what happens if my brain runs out of energy, and what it will look like to build a public rabbinic career that contains that fear.

Even though I am blessed to have a strong social network, it is impossible to overstate just how alone I have felt during all of this. I live without roommates by choice, but that reality became very difficult in the midst of deep mental illness. Waking up alone and coming home to an empty apartment felt suffocating, like entering a black hole where I was alone with my thoughts. I experienced heightened grief over not being partnered, which continues to be a challenge when things get hard. It is an inherent part of the human condition that we cannot be inside of each other’s brains, and just finding the language to explain my experience was exhausting and is why it’s taken until now for me to write about all of this.

I’ve suffered a lot, and at the same time I also know that I have barely scratched the surface of how bad mental illness can be. I have never felt at risk of physically harming myself, and I have never experienced psychosis. It scares me to know how much worse things could possibly get, and I worry I won’t be strong enough if that ever happens. I also think about how many stories don’t get told about people who spend most of their lives somewhere in between stability and mental illness that is severe enough to warrant intensive treatment. As a writer and a chaplain, stories are my lifeblood. Our perception of mental illness is deeply shaped by the stories we tell about it and the language we use. There is still a lot that is unknown about psychiatric illness, including how to define the boundaries between different diagnoses and whether the labels we use are wholly accurate. I think that we are lacking narratives that illustrate just how many people are living lives of only barely adequately functioning due to mental illness. So many people are carrying deep suffering just below the surface, and spend the entirety of their lives treading water. I want better for all of us, and I suppose that has to start with honest storytelling.

I recently told my therapist that I’m frustrated that I’m still getting acquainted with my own brain at this age. I worked so hard in my twenties to find the right labels, coping skills, and medications, and yet I still feel like a stranger in my own head. Where did Amalya go? Will I find her again? What if she never comes back? Though I am much better than I was a few months ago, I am still engaged in the process of rebuilding myself. I spent so long perfecting my mental filing system and learning the programming language of my brain, and I still find myself pushing back against the necessity of doing any psychological rearranging.

My therapist and I talk about how the entirety of my identity is located in my brain, with my body playing a supporting role at the very most. You could probably swap my body out with that of somebody else and I wouldn’t notice. My brain is the start and end of who I am, and somewhat surprisingly given my lifelong history of mental illness, it has always been my safe space. She asks me who I would be if I lost my mind, and I tell her that I’d cease to exist at all.

When I was interviewing to be accepted into residency again, I was asked “what would you like us to know about you?”. All of the people on the interview committee already knew me, either from JTS or from my brief stint at Brooklyn Methodist. I answer with something similar to this: “I want you to know that I am resilient, and that I have come back from worse before. For better or for worse, I seem to specialize in making comebacks. Please know that I want this more than anything, and please know that I am strong”. I guess that's what I want the world to know, and why I am writing this piece in the first place.

So here we are in May 2025, less than two weeks before my 30th birthday, and I am finally working as a chaplain. I have been working part-time at Lincoln Hospital in the South Bronx since March. I recently saw my first mental health patient, which was a deeply meaningful reversal of the place I found myself in just three months ago. Miraculously, I no longer feel anxiety leading up to the work day, and head off to the subway with little fanfare or struggle. Contrast this to the fall, when even thinking about getting on the train would magnetize me to the couch. I am a lot better, but everything still feels incredibly fragile. I am, and always will be, far too aware of just how fast things can disintegrate. I am also really tired, and I don’t think there is enough sleep I can get to make up for everything that has happened in the past year-and-a-half.

I don’t know where my story goes from here, and I remain terrified of the anxiety coming back and failing at residency again. I am still coming to terms with how different my life looks now from what I expected, and I don’t really know where that grief is supposed to be held. I worry about a lot of things, including that pushing publish on this piece will somehow cause the anxiety symptoms to rush back in. I was hoping that I could put off writing all of this until I arrived at some imagined place of complete healing. I’m not sure if I’ll ever give up the fantasy of showing up in that place, but here I am in this imperfect place, cautiously hopeful.