At the Heart of the Bend

Still in her novelty nun costume, the activity therapist stuffs her oversized cross into her pocket to better hold her clipboard, as she asks her patients her usual round of orienting questions: “Do you know where you are?” “Do you know what the date is?” “Do you remember why you’re here?”

It’s morning and sunlight has just begun to peek out across the river bend hugging the psychiatric hospital that sits beneath the shadow of Lookout Mountain in Chattanooga, Tennessee. Some of the patients answer the activity therapist’s questions with smiles saying, “We’re at Moccasin Bend and it’s Halloween,” while some of the patients say nothing and continue to shift their gaze across the different faces in the room. They are male and female, ranging in age from 18 to 65, dressed in clothes they either brought with them to the hospital or clothes the activity therapists gave them. They are all interested in the ambient Halloween music playing in the room. As the activity therapist continues speaking, the rest of the staff behind her hold up the boombox. The sounds of rattling chains and screams are just as cartoonish as their costumes and grinning faces. I’m the only one among them not dressed up. Ryan, the lead activity therapist, who wears a macabre scarecrow mask, tells me he would have reminded me to dress up with the rest of the staff, but forgot that my job shadowing schedule had recently shifted to include Halloween.

“Wouldn’t I freak them out if I was in costume?” I ask.

“No, the patients absolutely get a kick out of this,” Ryan says. He reaches to turn up the boombox. “It’s something exciting and new for them in the ward. Everyone loves celebrating Halloween.”

That’s an activity therapist’s primary mission at Moccasin Bend Mental Health Institute (MBMHI): to make sure patients have something to look forward to every day as they recover.  


With only 150 beds available for the 52 counties the psychiatric hospital serves, admittance to Moccasin Bend is a revolving door and the ward is constantly full. The goal of the staff is to help patients bounce back as fast as possible so they can return to their homes and more beds can open up. The Hollywood horror movie trope of being locked up in a straitjacket inside a white room alone forever simply doesn’t exist here. Patients spend most of the day walking around freely in their units until they’re led to an activity that is planned by Ryan’s team. As long as the patients show they are maintaining a stable state, they can take part in activities ranging from painting, to planting a garden, to cooking peach cobbler, to even taking a supervised walk on the hospital grounds. Most of the afternoons when I shadow the activity therapists, we sit on a couch with the patients and learn a new card game together. The majority of the activity therapists, including Markia Johnson, say this is their favorite part of the job.

“I get to meet different people, and I love seeing the change; how we can help someone. We have a different way of treating people here at MBMHI. I think it’s our Southern hospitality. We have a lot of love in our hearts for our patients,” Johnson says. “When I got my bachelor’s degree at University of Tennessee at Knoxville, my major was kind of taken as a joke by some people. They’d say, what are you studying? And when I’d say, recreational therapy, they’d say, what’s that—playing games?”

“It is sorta like playing games, but what most people don’t understand is there’s a therapeutic side to play,” explains Johnson, “We take our patients’ leisure interests and we use them to turn those activities into a coping mechanism they can take with them once they leave the hospital.”

The activities Johnson  and her co-workers create also teach patients daily skills they can use outside of the hospital to maintain a healthy, independent lifestyle. The cooking classes in particular are the most popular among the patients. When I help an activity therapist conduct an early morning lesson on how to cook a low-calorie breakfast quiche, there’s a wide range of energy and emotions in each of the patients’ faces.

Most of the patients just want to savor the smell of the ingredients, which we pass around in a bowl for each of them to help mix, while others are eager to help measure the correct amount of spinach and bacon bits. Some of their hands shake. A few sit in the corner, fighting to keep their eyes open. Their medications can have that lethargic effect in the morning, but we encourage them to push through so they can get a taste of the finished quiche.

At one point, the plastic butter knife we’re using to cut things goes missing. For a brief moment I panic, but sure enough the activity therapist ends up being correct when she assures me we just left the knife in a weird spot.


“In some psychiatric hospitals the staff treat the patients like they’re in trouble or untrustworthy,” Johnson tells me, “but at MBMHI we give our patients privileges in exchange for their good behavior, and they get to earn trust; we have a reward system that facilitates good behavior. This is important for when they go back into their original community and have to learn a way to regain any trust they may have originally broken with their peers.”

The emphasis on trust at MBMHI comes to my mind whenever my friends ask me if I feel safe at the hospital as a woman. Have any of the male patients threatened me? Have they thrown things at me? Have they tried to grab me? These are the questions I constantly get, but can answer no to.

“When it comes to patients who may come at me, call out my name, or try to intimidate me, I just remember that I’m a Southern girl,” Johnson says. “I’m from Atlanta, Georgia. I was a server growing up and a waitress for five years at Cracker Barrel. I have a lot of patience and understanding, but I also don’t put up with that kind of bullying. It’s my Southern hospitality. I have a lot of love in my heart, but I also won’t tolerate any harassment.”

Overall, Johnson says being a woman at MBMHI doesn’t affect her like some may think it would.

“I’ve dealt with family who’ve had mental illnesses. I actually started this job to learn how I can help out more at home,” she says. “We’re all human and we all have different struggles we’re going through.”

With all the stigmas surrounding mental health, Markia and the other activity therapists feel it’s important for the patients to have a positive experience at MBMHI. Recently, to better help their patients retain positive memories of the psychiatric hospital, the activity therapist staff proposed an idea to have care bags available for every patient when they leave the hospital. The care bags will have the MBMHI logo, as well as a list of the patient’s medication and favorite coping skills and activities they learned with the staff.

“Working at Moccasin Bend is probably one of the lowest paying job in my field, but it’s my favorite because we have so much freedom to pilot new things, like the care bags, with our wide variety of patients,” says Johnson. “Our patients need help with stress management and we put together our creativity, knowledge, and skills to help them find way to cope.”

Jessica Ann York is a Creative Writing Master’s candidate at the University of Tennessee whose debut short story is forthcoming in the Autumn 2019 issue of Vastarien: A Literary Journal. Her business articles and profiles have appeared in Little PINK Book, Business Trend, and Floor Focus Magazine.