Behind the doors of psychiatric treatment centers (20 Nov. 2015)

McLean hospital

 Exterior of McLean Hospital, the institution referenced in Girl, Interrupted (photo by John Phelan)

 “Is it going to be like ‘Girl, Interrupted’?” I cautiously asked my husband before being taken to the psychiatric wing of our local hospital. He assured me it wouldn’t and, in unfortunate ways, he was right.

I spent less than four hours under the hospital’s care, but what I saw I did not like. I was wheeled on to the locked floor by two security guards, past patients that didn’t look like me; they seemed overwhelmingly middle aged and male. I passed people in hospital gowns and people who were not high functioning. I was terrified.

I was condescended to as I tried to explain why I thought this was a higher level of care than I needed. I had signed away my autonomy at check in and was now in the unenviable position of trying to convince the psychiatric nursing staff that I was sane. Though I knew how it would look, I couldn’t help myself from sobbing out the words, “I’m not crazy.” In the end, they let me go that night. As scared as I felt in the hospital, the truth was I did need that level of care and had for months.

I should note that this, the first and briefest, hospitalization was to be followed by two additional trips, each substantially better than the last. The subsequent hospitalizations were both critical for my safety. Moreover, I count my stay at the last hospital among the most important experiences of my life.

There is so much misunderstanding and stigmatization surrounding mental health, and this is pushed to the extreme with hospitalization. Because people feel ashamed to share their experiences, and understandably so, the only picture the general public often has of a psychiatric hospital is from popular culture. Psychiatric hospitals are the light-on-patient’s-rights, long-term care units of Girl, Interrupted. They are places where unruly men are lobotomized in One Flew Over the Cuckoo’s Nest. They are insane asylums filled with deranged patients of American Horror Story’s or Modern Family’s gross misrepresentation of modern inpatient care. As a gleaming exception to the rule, It’s Kind of a Funny Story provides a modern account of psychiatric hospitalization that felt close to my experiences. It’s because of the paucity of the later example, and a profusion of the former, that I choose to share my experiences.

“Whenever you’re planning suicide,” my fellow patient answered. I had asked her when she knew it was time to seek hospitalization. During the year surrounding my hospitalizations, I frequently wondered when it was time to go in. Her answer draws a bright (and appropriate) line separating inpatient from outpatient services. In practice, I can tell you it’s much muddier. If every day is progressively a little worse than the last, it’s hard to identify the tipping point. In my second two hospitalizations someone else had to make me see that we had already moved well beyond the line that indicated it was time to turn to enhanced care.

hospital hallwayModern psychiatric wings may look like a standard hospital hallway

When I was hospitalized the second time at the local hospital it was Valentine’s Day and I wasn’t supposed to be there. Let me clarify, I very much wanted to be at a hospital, but because of my lingering fear of the local options, I had been scheduled to be admitted to a private institution in Connecticut. That morning we heard that I would need to wait through another weekend until a bed would be free for me. I couldn’t handle the small extension and it was back to the local, public hospital we went. I had strongly diametric feelings about going to a private versus a public hospital. I didn’t want steak and risotto for dinner, I just wanted to feel safe with other patients that wanted to heal. New York’s public hospitals include people who are there voluntarily and involuntarily and they take all patients. They both need to and should accept all patients because every person deserves care, irrespective of level of function or financial status. It does, however, mean that the care they provide needs to meet a wide level of needs. Necessarily, safety is prioritized above deep healing.

In some ways the local hospital was like you might imagine. Yes, the doors are locked, they take away your belts and shoelaces, and depending on the nurse, the staff might make you open your mouth after taking a pill to confirm that you actually swallowed your medications. We had the option of meeting daily for group psychotherapy and occupational therapy, which could be helpful or just a way to pass the weighty hours between other activities depending on the day.

On the whole, by keeping me safe from myself, I was able to stabilize at the hospital, but not for lack of a few major missteps. I focused on processing feelings on my own and in frequent meetings with an intern psychologist. I learned new coping skills from the occupational therapist. My meds were rapidly changed as we settled on a new cocktail to which I better responded. I was often treated with respect by the nursing staff, though that was not absolute. Interactions with rotating students and some of the other patients were less helpful. After hearing about my good marriage and successful research pursuits a med student told me he didn’t understand why I was depressed, and went on to ask me what I thought I would get out of suicide. I experienced friction from a few religious patients who strongly suggested that I talk to a priest, or vocally expressed their displeasure at my atheism. A psychotic male patient, and I mean that in the clinical sense of the word, physically threatened some female patients with sexual assault and made me fear for my safety until he was transferred to a different unit. Despite these complications, my first true hospitalization was both needed and successful in my stabilization.

Four Winds

The grounds of Four Winds Hospital, the site of my last hospitalization

My experience at Four Winds Hospital eight months later was so very different. From the intake procedures, which included a visual inspection of your body for any signs of physical harm, it was clear the doctors and staff were there to care for your whole being. Unlike my first experience, Four Winds provided programming throughout the entire day to build coping skills. This programming was offered in addition to regular meetings with a therapist and psychiatrist. Breaks to let the mind rest from the emotionally intense work of healing included walks around the autumnal, tree-lined campus, or art therapy with more media than I could get into in my 10-day stay.

At Four Winds I worked on deep emotional issues with a fabulous therapist, a bulldog of a psychiatrist, a convention-busting art therapist, and a whole host of supportive and encouraging nurses. I was introduced to the powerful system of Dialectical Behavioral Therapy. I wrote prose and poetry. I poured out the pain of my core into paintings and sculptures. I laughed with fellow patients at the absurdity of what mental illness had put us through. I worked hard. And I healed.

The two hospitals could not have been more different in many ways, but at their hearts, they were both needed to keep me safe and alive. Despite a multifarious system of caregivers we assembled who ensured I was never alone “on the outside,” both times I was admitted I needed more care than my unofficial team could provide. Both hospitals were instrumental in my ultimate healing. Unfortunately, the more depressive episodes someone has, the more likely they are to have another major episode. Because of this I can’t say that I am “cured” and will never need to be hospitalized again, but knowing that facilities like Four Winds exist heartens me that, should I again need inpatient care, there are good facilities that provide true healing.

My greatest hope for this brief post is that it grants insight to the locked facilities that are psychiatric hospitals. They are not the places portrayed in mainstream media. They vary in quality and clientele. They are chronically underfunded and overstretched. And they are crucial to the healing and survival of so many.


 

As a Biology Ph.D. candidate, Liz Droge-Young studies the incredibly promiscuous red flour beetle. When not watching beetles mate, she covers the latest science news on campus for Syracuse University’s College of Arts & Sciences communication department. She is also a mental health advocate, a voracious consumer of movies, and a lover of cheese.

 

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