Thursday, January 7, 2010

Regularly scheduled programming

So, back to the hospital. Were any of you wondering when the hell I was going to get around to telling you what happened? Well, that's what I was doing on the unit after my doctor went to Asia, wondering when the hell anyone was going to take over for her, and update me about the possibility of my not being incarcerated for Christmas. Slight tangent: if you think the word incarcerated is too strong, you are incorrect. Dr. Rao used to tell me frequently, "This is not a jail.", but it kinda was. I mean, granted it was a lot more comfortable than I imagine your typical jail is, and they seem to put more effort into ensuring that you don't get the shit beat out of you, and they can't force you to work, but the fact remains; the doors are locked, you can't leave, even for five minutes to smoke a cigarette, and people will tackle you and inject you with things if you try. Admittedly I haven't checked the dictionary, but I'm pretty sure that the definition of "incarcerated" is something similar to that. In fact, in the hospital, you have less access to things like T.V. and phone use than some prisoners do (see the wikipedia entry for protective custody). And if you compare your access to TV, phone use, and even visitors on a psych ward to what you get on pretty much any other unit, the difference is staggering. On any other unit, you have a TV for each person in a room which you can watch whenever the hell you want. On a psych ward, there is one, in a community room and your chances of EVER getting to watch anything you might even be remotely interested in without pissing someone off are slim to none. It is also turned off at 11 PM. And it's not like there's anything else to do between groups (which they don't have on weekends). If you're lucky, you get a ping-pong table. The arts and crafts people often picture in such places are available for maybe two hours a day. If you don't have people you can count on to bring you books, you could end up walking the hall endlessly out of sheer boredom. On any other unit, you have a phone, in your room, which does not require quarters to use. On a psych ward, you get a pay phone, which you use in front of everyone and their mother and God help you if you don't have at least two quarters on you when you lose your marbles. And by on you, I mean like, in your clothes (they take your purse, remember). On most units nowadays, you are allowed to have visitors pretty much whenever you feel like it. At some places they respectfully request that you not visit at three in the morning, but you've usually got a good consecutive 14 hours a day when people can come see you. On some units, husbands and wives or parents can even stay overnight with patients. On the psych ward I was on, and on the one where I later worked, you had about four or five hours on weekdays, usually more on weekends, but still less than ten. This means that if your husband, wife, or parent is , I don't know, say a nurse working a twelve hour shift, you can't see them at all half the time. And these are the same people who constantly tell you how important a good support system is. If and when you get visitors, you must have all conversations with them in front of everyone else as they are not allowed to enter your room, even with the door open. The result for me, was that I felt very exposed and vulnerable andpowerless which are not favorable conditions for mental wellness.

On top of all this, the staff on psych units will often remind you that your hospitalization is an opportunity for growth and healing that you should not squander and that you need to be making the most of it. Let's also not forget that you are expected to pay for this "opportunity". Like, a LOT. Don't get me wrong, if given the choice between prison and the psych ward, (for the same amount of time) I'll take the psych ward any time. But prison does have one, single advantage in my opinion. The people who put you in prison and keep you there don't expect you to be grateful for it.

Wednesday, January 6, 2010

What's in a name?

Recently I discovered a website called bring change 2 mind. Its mission is to fight the stigma that is faced by the mentally ill. While I'm thrilled that anybody cares enough for such a site to even exist, I was dismayed by their approach. It seems to consist mainly of word-tweaking (not using words such as crazy or mental, saying that a person "has schizophrenia" instead of "is schizophrenic") and story sharing without any real advocacy. This is particularly a problem when one reads the stories being shared and realizes that many of them are guilt-ridden confessions of how badly people feel they behaved before they got treatment. In fact, some of them have a sort of amazing grace quality, in which the sufferer of illness is portrayed as a poor sinner type figure and some drug or doctor or other, or a friend who "forced" them to get treatment becomes the sun of salvation. While I respect and support these people's right to tell their truths, I'm not sure that their manner of expression is helping their cause. I am concerned that it will instead confirm the widely held belief that most or all people with mental illness are burdens at best and dangerous at worst and that it is ok and even beatific to make their decisions for them. It also sends the message that one doesn't need to be smart or informed about their treatment, but that everything will work out fine if you just blindly throw yourself into it. To be fair, this approach has worked out for some people and could work out for you. Or, you could end up with Tardive Dyskinesia. This is what I posted on their site.

"I almost feel like we're fighting the wrong battle here. I checked out the "get involved" portion of this site and I'm not sure I agree with the bit about watching your language. I mean, it didn't seem to work very well for the cause against racial prejudice. We went through about a million different acceptable terms for describing dark skin tone and one by one each of them became viewed as derogatory because the underlying mindset hadn't changed. The problem as I see it isn't that people call us crazy, anymore than it's a problem that people with diabetes are called diabetic. The problem is that people think that means we are bad or scary, or that our character is somehow otherwise flawed.
Which brings me to another point. I am deeply saddened that so many people on this site have been made to feel that they need to apologize for their illness. No one here chose this for themselves, and I'll be really shocked if anyone here hasn't suffered just as badly as the people around them. It's also not your own fault if the people around you get stressed out and bail. It's really stressful being close to people with terminal cancer too, but no one blames them when they're abandoned by their loved ones. If you feel that you want or need to apologize for your actions that were within your control, that's commendable, but apologizing for aspects of your illness is like having tuberculosis and saying your sorry for coughing blood on the carpet. We're not bad people, our illness doesn't make us bad, and if we want other people to believe that, we're going to have to at least try to believe it ourselves."

Granted, it's really hard to not feel guilty and think everything's your fault when your self-esteem is in toilet, but I really think that apologizing for being ill is just as damaging as calling yourself or someone else crazy. But what do I know, I'm just a nutter.

Wednesday, July 29, 2009

Breaking news

I've been prevented from writing for a few days due to illness and travel. In that time, I experienced something I've heard about, but never encountered first-hand in the land of mental health treatment. I've had therapists that will give you false hope, that will continue treatment that is going no where with you for years but never one who simply gives up. Maybe that's because this is the first therapist I've seen while on Medicaid, so they have no money to lose, or maybe I'm just being cynical. If you asked her, my therapist would tell you I'm wrong, that she has no intention of giving up on me. I don't care what words she thinks would be appropriate, that's what happened.
Up til now, our therapy sessions have consisted of this woman trying to sell me on the benefits of giving up being angry and sad. This is really like watching a commercial for the show you're currently watching. I wanted to scream "I'm HERE, Lady! I'm in the building, I'm AT THERAPY! I've already reached the conclusion that what I'm doing is not working or I'd be on line to see the Mighty Boosh right now." But I didn't do that. Instead I asked her how; how do I give up negative emotions? What do I actually do? What skills can I practice? Because as most people who've been in love would know I think, you can't just will yourself not to feel. I mean, the harder you try not to think about a pink hippopotamus, the more pink hippos become your internal screen saver. And yet that was her only suggestion. "You just have to try, Joanna." Ignoring the fact that this completely invalidated eight years of very hard work, of poisoning myself with medications, of answering absurd questions, of sharing every detail about myself with complete strangers, I simply told her that I was trying. The bitch told me to try harder. Try what? I asked, Tell me what to do, and I'll do it! She had no specific ideas for me. She just continued to tell me to try. I asked what she thought I was doing, if I wasn't trying. She suggested that maybe I was malingering, or seeking attention. After all, she said, that's what she had done when she had been depressed.
And just like that, I came up against what I believe to be the most common problem with mental health professionals. They think they fucking know. Either because of personal experience with mental illness or because of their education, they think they know what's going on with you, sometimes just from reading your chart, before they even talk to you. You have a very small window of time before they decide who you are, and what your problem is and then stop hearing you. In my case, this therapist had had experience with depression, and alcoholism in her family and decided based on these similarities that I was a "mini-her", and that since she had enjoyed the attention it got her, that must be what was going on with me. She stopped trying to help me, and started trying to help her idea of me, someone who doesn't really exist. And since I'm the crazy one, she'll never have a reason to consider that maybe her opinion needs revising because everything I say is suspect. I watched it happen. And there's not a damn thing I can do about it.

Thursday, July 16, 2009

The myth of the big guns (Part 3)

So, I had decided to try and make the best out of a very troubling situation. At crack o' dawn on Monday morning some poor lab vampire came up and drew my blood for the lithium level. And I met with Dr. Rao for about ten minutes every day so she could assess my progress. At least, I believed she was assessing my progress. I found out differently on Wednesday. I asked, during our meeting if she planned to discharge me that day as she had suggested was possible a few days ago. She replied that my lithium level was too low. Not that she believed me to be a danger to myself or anyone else for that matter. Not that anything she had "assessed" lead her to think I might be unable to function outside. Just that a certain salt in my blood did not meet certain standardized parameters. I wondered what the point of our meetings had been if that was going to be the deciding factor in whether or not I was going home. Or, for that matter, what had been the point of her going to medical school. Hell, I wasn't even a nurse yet and I could read blood test results. One of the first things they teach you as a nurse is to look at the person, not the machines. If the heart monitor says V-tach and the patient is drinking coffee and complaining about the T.V. reception, you do not approach them with defibrillator paddles, you realize that they were moving around and the monitor was screwy. Apparently, they don't share this little hypothetical with soon-to-be doctors. Dr. Rao then added as sort of an after thought that certain staff members had also shared with her that they believed me to be "still emotionally unstable". Funny thing, that, because I had behaved spectacularly on the unit. And when I later asked the nurses and aids their opinion on my stability they told me that I seemed stable enough to them. One even went so far as to roll her eyes and say "Doctors sometimes say things like that." So unless housekeeping had had a heart to heart with Dr. Rao regarding my sanity, she had lied. That wasn't her only lie either. My mother requested a meeting with her to discuss why I was still at the hospital and when she thought I might be able to leave. Dr. Raos' answer was "It takes a week at least to stabilize a patient." Aside from being completely arbitrary and inconsiderate of individual needs, this minimum of Dr. Rao's revealed her "maybe wednesday" statement to be complete bullshit. So now I wasn't just being held against my will, I was being held against my will by someone I couldn't trust. And the real kicker was that this woman's master plan consisted of doing exactly the same thing as was being done on the outside. Her single goal was to get my lithim levels up. That was it. No big guns. Except maybe electro convulsive therapy and I didn't meet the criteria for that. The cherry on top of this marvelous sunday was that about a week into my treatment Dr. Rao left the country. She just went back to India. And she wasn't gonna tell me either. I asked her about it after overhearing her talking with staff. So I was still locked up, and the doctor in charge of letting me out was in another time zone. Now what the fuck was I supposed to do?

The myth of the big guns (Part 2)

It's kind of counter-intuitive to think of people getting sicker in a hospital. But it happens every day. People who come in for surgeries wind up with pneumonia, people who come in with pneumonia get bed sores. And, if my experience is any indication, people who come in with psychological problems just keep accumulating more psychological problems. I arrived on Krembs-3, the less acute psych unit at Binghamton General Hospital escorted by two people wearing badges that read "volunteer". Why anyone would volunteer to ride elevators with crying people at the crack of dawn was and still is beyond me. I was quite distraught, as may be imagined. On top of how I had been feeling before I came to the ER, I was feeling totally powerless and helpless in the face of my surprise admission, and my nerves were frayed from two hours of being badgered by Jen, and I hadn't slept in the past twenty-four hours. In addition, I was wondering at the back of my mind what the hell I was going to tell my professors if I was still stuck here come Monday. I was, I hope understandably, having some difficulty maintaining my composure. I wept through my tour of the unit and my intake interview with the nurse. "I don't understand." I kept saying, "I haven't seen a doctor." At last, my psychiatrist appeared on the unit. She was a tiny woman from India called Dr. Rao. The first thing she did after introducing herself was offer me drugs. No, I would not like some ativan, thank you, I would like to discuss your reasons for admitting me. Yes, I understand that I seem upset, but I am upset for a legitimate reason and that isn't what Ativan is for. No, I would not like some vistaril either. Keep in mind that when I say I was upset, it wasn't like I had thrown a chair. I wasn't even yelling. I was just crying. Crying hard and messily, no doubt, but that was the extent of my "out of control behavior". Finally I agreed to take a Benadryl simply so we could move on to other things. She gave me a physical exam which consisted of a cursory listen to my heart and lungs. I expressed concern about missing my upcoming finals. She dismissed these out of hand. If she had been listening, she might have taken into consideration that people who are in imminent danger of suicide aren't generally thinking about what's going to happen next week because they don't plan on having a next week. She might have taken this as a positive sign, and dare I say, made an assessment that required some insight on her part. Instead she gave me the patent answer that I get everytime I show reluctance to drop what I'm doing in my life and do whatever I'm told: "Your mental health comes first." She told me she would do a blood test to see what my lithium levels were like and we'd go from there. "Just a few days" she had said. "I will discharge you, maybe on Wednesday." But I still felt as though I didn't need to be there. Yes, admittedly, I had thought of suicide, I had even thought of a plan. But I hadn't done anything about it. Not even close. I hadn't gone into the station and gotten a box-cutter and stood in the bathroom, poised on the edge. Instead, I had done exactly what you are "supposed" to do. I thought, (and I still think) that showed I wanted to live. And besides, I had support outside. I had people that I could count on not to leave me alone. I said so. She said that I was clearly emotionally unstable, why, look at me, I practically couldn't speak for crying. But you can't say that you admitted me because I'm hysterical when I'm hysterical because you admitted me. Or at least, I thought you couldn't. Apparently, you can. In any case, I realized I was going to have to suck it up, and fast, if I wanted to go home. So, I went to groups, I took the meds they gave me. I requested Benadryl when I was homesick or angry at my situation because I didn't want them to have any reason to question my judgement (or to see me teary again). And I started to think, that second day there, that maybe this wasn't such a bad thing. So I hadn't really needed to be hospitalized, maybe it would do me good anyway. Maybe this was my chance to really get out the big guns and blast away those awful feelings. So, they're a little trigger happy with admissions, at least they'll pay attention. They'll make sure they get to the root of the problem. At least I'm in a situation where something will have to change. Yep. That's what I thought, all right.

Monday, July 13, 2009

The myth of the big guns (Part 1)

I very nearly made it through college without ending up on the wrong end of a nurse-patient relationship. Then came finals week of my first semester of senior year. We were doing a radio play very late at night when the fear and hopelessness hit me. I stepped out of the station to try and get myself under control. And as I sat on the couch in the new union basement and tried not to cry, I had to face the fact that what I was doing was not working. And I started to look ahead at life. I saw no relief. I saw this monster just regrowing head after head after head and I felt desperate. There was an unused bathroom just feet away and a drawer full of box-cutters in the radio station. It would have been very easy. But, I was a student nurse, and it had been drilled into my head that people who are feeling suicidal need to go to the ER. So, I asked my boyfriend to drive me. At the ER, I tearfully admitted to the triage nurse that I was feeling suicidal. She asked about my insurance, took my purse (although thankfully not my clothes as I've seen done in other hospitals), and brought me to a room where I waited to be evaluated.

Typically, when one goes to the emergency room, one expects sooner or later to see a doctor, or a nurse practitioner; someone who is licensed to diagnose and treat illnesses. This is apparently not the case when you are a psych patient who shows up at five in the morning on a sunday. 24 hour emergency care by a physician is not deemed necessary for you. I saw a counselor. Her name was Jen. I told her my symptoms and she seemed decidedly unimpressed. She pushed, and pushed for some sort of circumstantial reason why I was feeling this bad, but nothing I told her seemed satisfactory. The tone of her questioning was almost skeptical, as if she suspected I was somehow faking. When she asked about my previous diagnoses and I told her that they didn't really know, she became irritated. I just wanted to be out of that room and away from that woman who made me feel so insignificant and so small. After demanding for forty-five minutes that I explain myself, as though I were a misbehaving child, she asked if I wanted to be admitted. The simple answer was "of course not". Of course I did not want to locked up with limited access to my support system, no control over what and when I ate, and strangers judging my every move. No, I did not WANT to be admitted. But I didn't want to be turned away without so much as an assessment by a doctor either. I didn't no what to say. I just sobbed. She stared at me for a while and then said "Why don't we talk to the psychiatrist and see what she says?" "We", she said, as if I'd be involved. "Yes", I said, "Please, I would love to see a psychiatrist." She left the room. She was gone for a long time. I waited. I thought when the psychiatrist came in, we would talk for a few minutes and she would give me some new medication and maybe a referral for a follow up appointment and I would assure her that I would call somebody before trying to kill myself and that would be that. Only, the psychiatrist never came in. Jen returned after about a half an hour and said "We're gonna go ahead and admit you." I was confused. "What happened to the psychiatrist?" I asked. "I just spoke to her on the phone." Jen said. So I was not to see a doctor after all. "Could we, actually not admit me?" I asked, beginning to feel that this had been a very, very, bad idea. She shook her head. "We already have the order to admit you." I thought, How could that be? This doctor hadn't seen me, hadn't asked me a single question, and had just taken away my freedom. She had made her assessment (and I use the term very loosely) solely based on the opinions of someone else. It's not as if Jen had had a set of medical facts to report to the doctor, like the size and drainage from a wound which would be the same observations no matter who was making them. I know from my experience on the other side of psychiatry that all the information she gave to the doctor would have been subjective observations that might have been interpreted very differently by a medical professional with supposedly more experience and training. "That's just the way we do things", she said. And that was it. Nothing I said after that point mattered, it was just a question of whether I was going to walk up to the unit or be physically forced. So I walked.

Friday, July 10, 2009

The temptation to decompensate

As I continued to take my meds and talk to Bill with little to no effect I began to feel more and more hopeless. I also began to feel angry. I was doing everything I was supposed to be doing, I was quite literally sacrificing my body in an attempt to heal my mind (my liver has still not recovered from the drugs I've been on) and things were not getting better. And nobody seemed particularly bothered by that fact. That's when I started thinking seriously about hurting myself, both as a way to express my anger and as a potential way out. I mentioned this to a psychiatrist that I was seeing in NYC between college semesters. He took notice. Keep in mind I had never (and have still never) actually tried to end my life. At the time I had not even hurt myself (since then I have done so once). He suggested a partial hospitalization program in addition to the medication I was taking. And I applaud him for that. His name was Sander Marks and he took me seriously without panicking and overreacting. Partial, as it is called, consisted of meeting with your doctor and attending two groups daily. Unfortunately, the groups were a lot of diffuse talking about how much everyone wasn't enjoying their lives with little discernible goal. Still, it was getting me out of the house, and out of my own thoughts and that was something. I could only go for three weeks before I had to return to school but I figured at least I had a consistent place to go during breaks and summer. I was wrong. When I later tried to return I was informed that this would be impossible. That I had had my chance and it was "someone else's turn". And I became aware of another theme in mental health care, which is that if you dare to try and function like a normal human being; if you want to go away to college, or even hold down a day job you just don't need help badly enough. I was not willing to put my life on hold and sever all the relationships I had with people at school and therefore I had to resign myself to care that was way more fragmented than it had to be. I ran into the same theme again over and over with different agencies who referred me to therapy groups that were "just perfect for me" but which met smack in the middle of the work day without exception. The message I got was that if I wanted help, I had to give up everything else. Ironically it was those relationships at school, that prospect of finally being a real nurse, the hope of moving out of my mom's house and getting a permanent job that made me want help, that made me want to stay alive. I was clinging so desperately to the little I got out of life that I couldn't let it go for the possibility that something might work eventually if I just gave it unlimited time. Part of me though, began to wish I could. If I could just stop hoping, stop fighting, that part thought, maybe I could get some help. The question is, would there have been anything left to help?