Dehumanization

Most of you know about my lifelong struggles with depression. While my case has been classified as “chronic,” “severe,” and “treatment-resistant,” I’ve been lucky enough to only have been hospitalized for it once. It was a terrible experience. It’s been on my mind lately, so I decided to write out my thoughts.

This was three or four years ago, during the summer. It started as a run-of-the-mill episode, but I couldn’t shake it. As weeks went on it grew more intense. My psychiatrist at the time, who I hadn’t been seeing very long, decided to up one of the two antidepressants I was on (Wellbutrin XL, for the informed) to the elephant dosage. It seems that in some cases that does the trick, and in others it increases the symptomatology (especially suicidal thoughts). I’ll let you guess which happened to me.

This culminated in me not being able to get out of bed the day of our neighborhood block party. I called the psychiatrist, who wasn’t available (he wouldn’t return my call until six hours later). In desperation I called my old therapist, who knew my condition and history better than anyone. She recommended I get to the ER. Off to Resurrection Hospital I went. I figured I’d meet with a resident psychiatrist, get my meds adjusted, and be sent on my way. Not so much. It turned out that Res doesn’t have an inpatient psychiatric wing. I dealt with an ER doc, who felt like I was beyond her capabilities to deal with. They needed to transfer me to a more dedicated facility. Down came the social worker to set things up.

Now, it’s worth mentioning that depression is an entire self-reported condition. It can’t be diagnosed by measuring blood pressure or reading an EKG. Any veteran of the mental-health-care system knows the battery of questions they ask to assess you. The wily patient knows exactly how to answer those questions to achieve one’s desired outcome (a quick shrink visit, a medication adjustment, etc.). The primary no-no is NEVER answer “yes” to any of the suicide-related questions. Mental-health professionals take those very seriously.

So when the social worker was interviewing me, I made sure to say that I wasn’t immediately suicidal. Sure, I’d had a few suicidal thoughts over the previous weeks (hence needing a med adjustment), but I didn’t need anything more than that. I even used the term “suicidal ideation” to show I knew what I was talking about. So when she asked one of the standard questions, “Do you have a plan?,” I smartly answered no. But then she one-upped me: “But hypothetically, if you were going to do it, have you thought about how you would?” I slipped up and gave too many details.

(Fun aside, I’d had a Costco poppyseed muffin for breakfast that morning — either lemon or almond. The social worker was quite concerned about the trace amounts of narcotics in my bloodwork. I lived the Seinfeld episode.)

You see where this is going. Everyone involved felt I needed to transfer to an inpatient facility. For all my machinations, at that point I really wanted to feel better so I acquiesced. Hell, the dedicated attention would do me good, right? A psychiatrist continually monitoring my meds, regular access to a therapist, all that good stuff. An ambulance whisked me away to Alexian Brothers Behavioral Health Hospital.

Here’s where the story really starts. I thankfully have no experience with any correctional institutions, but I proofread a book on the subject early in my book-publishing career. The author described the persistent processes of dehumanizing prisoners, starting with intake and continuing throughout the prisoner’s sentence. The parallels with what I experienced are disturbing.

Remember that every patient undergoing intake into a mental-health facility, not just me, is in an extremely vulnerable state. I was still in a hospital gown. They collected a bag from the original hospital with all my stuff — clothes, phone, wallet, everything. What was the first thing the smiling, friendly young man who greeted me did? Asked a few routine administrative questions and strip-searched me and went through all my stuff. He went so far as to go through the contents of my wallet card by card. I understand the need for security, but really? Was this necessary? Even after my possessions had been evaluated, the only items returned to me were my clothes. No shoes (laces were a suicide hazard), no belt (same reason), no phone (contact with the outside world was discouraged so patients could focus on treatment). Taking my belt away was an issue because I have a 37″ waist so I wear 38″ pants. My shorts perpetually felt like they were about to fall down my ankles.

Needless to say, I felt very uncomfortable with what I felt was a gross invasion of my privacy. When I asked whether I could rescind my admission and return home, I was told no. I’d signed the paper committing myself and only they could decide when I was fit to leave. Institution 2, Don’s freedom 0. So again I told myself that the benefits would outweigh the costs. It was late, and once I met with the necessary professionals in the morning I’d be on the road to recovery.

The next morning I woke up and showered (no door on the bathroom, mind you). I had to put yesterday’s clothes back on, but that was OK because my wife would come soon with fresh clothes. I walked down the hall and saw there was some presentation about medications. I figured I didn’t need it and I wasn’t really feeling in the mood for interacting with people anyway. I was politely informed (by both staff and fellow inmates) that if I didn’t engage and participate in their programming, I wasn’t going home. They didn’t want people wallowing in misery by themselves. I dragged myself to the presentation. It was the furthest thing from helpful or insightful– especially since the presenter talked to the patients as though we were idiots, children, or both. I was to learn she wasn’t the only staff member with that attitude.

Luckily my wife would be coming to visit soon. She’d bring fresh clothes and a couple of books to alleviate what had become some rather intense boredom. I then noticed there was no phone in my room. I asked about that at the desk and was pointed to the phones. There were two phones in the common area, both intentionally within earshot of the staff manning the desk and anyone else who happened to walk by. These people really were continually finding new and inventive ways to remove my privacy. Even if I’d been in an emotional place to accept the calls I’d received from family and friends, I felt less than comfortable talking to people close to me in that circumstance. I also learned that my wife could only visit at a specific time of day (around noon, I think) and only for a very limited time (20 or 30 minutes, I forget exactly). Again, this was ostensibly so patients could focus on getting well rather than any family-derived problems. It only made me feel like more of an inmate cut off from the outside world.

My first visit with the chief psychiatrist was around the time of my wife’s visit. I was looking forward to this, as the staff talked about this guy like he walked on water. Plus I hoped I could voice some of my concerns to an involved party, as no one else had engaged me at all one on one. The guy seemed smart, but very clinical. No warmth at all. When I talked about my discomfort and how the experience was very different from what I’d envisioned, I was told, “You mean you’d rather just lie around in bed all day?” Great. I felt so much better then. I should mention the one major positive of the whole experience occurred then — he pulled back the Wellbutrin dosage and instead put me on Abilify, a Wellbutrin augmenter. That, along with the Cymbalta I’d been on, proved to be the silver antidepressant bullet I’d been searching for for years. After meeting with me, he met separately with my wife. He mentioned that my blood pressure was extremely high (170/100 or thereabouts). Shocking, isn’t it, given the warm, nurturing atmosphere of the place?

At least my wife brought me a backpack with clothes and books. Of course it was confiscated from her upon entry.  The guy at the desk told me I could have it as soon as they went through it (naturally). At this point it was around 1 in the afternoon or so, and remember I was still in the clothes I’d put on the previous morning. And I still had no books or any other way to occupy myself. I expressed that to Desk Guy and was told gruffly that he’d get to it when he got to it. I think I finally got it around 5 or 6 that evening.

I spent the next day telling everyone within earshot how much I wanted to go home and becoming increasingly annoyed and frustrated with the moronic, useless presentations and lack of freedom. My blood pressure remained sky-high. Finally the shrink caved. He acknowledged his ingenious prison of a hospital wasn’t conducive to me getting well. He sent me home with instructions to monitor the new medications’ effects. I can’t tell you how beautiful it was to walk out of that hell-hole.

You already know the epilogue. The new med cocktail worked like a charm, I found a new psychiatrist to manage my meds, and since then has been the most episode-free period in my life (with a few blips here and there, of course — that bastard depression never really leaves). But I still wouldn’t wish that experience on anyone. I’ve been told my current psychiatrist and the therapist I subsequently saw that my experience wasn’t the norm, but barring something very extreme you know I’ll be answering those diagnostic questions a lot more carefully in the future.

 

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~ by chewie93 on January 5, 2014.

2 Responses to “Dehumanization”

  1. While I hate hearing that this happened to you, I am not at all surprised. I’ve visited a couple of friends in similar institutions in college. As much as people think mental health professionals in the US are top notch, it is in fact, quite the opposite. I’ve had my own problems with depression and anxiety. My blood pressure is through the roof. I am taking meds for that now. But, it’s too early, my doctor says. No, it’s been a long time coming. My life, for the most part was and still is hell. I’m surprised I’m still alive and haven’t had a heart attack yet given the amount of stress I’ve been through. I hope one day I can bitch about it on this site. I’d love to blog, but lately bitching just comes more naturally than blogging.

  2. Here’s an example of how other countries are approaching addiction, for instance, and why it works.

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