Girl Interrupted

[Martha]

Yesterday I visited a friend who is in the psychiatric unit at a local hospital.

I sat and talked with her while she had lunch with other patients. I have never seen so many people who were so visibly struggling with mental illness. It was a difficult and troubling visit. Young women with slashes and burns all over their arms (and who knows where else). Old men bent over and barely able to feed themselves. Incredible pain everywhere.

My friend had a psychiatrist breeze through on rounds at 6:00 am, asking how she was and whether she had any questions. She couldn't think of what to say as she was trying to wake up. Medications were changed and life goes on.

[donheff]

I worked for a year on an acute ward at the Illinois State Psychiatric Institute - primarily populated by teens and twenty-somethings. It is tough to see kids in such pain. Their family histories are often mind blowing.

[saluki9]

Somebody very close to me was hospitalized for an eating disorder. Visiting a psych ward does give you a different perspective on life and what basic things you should appreciate.

When your basic functions of eating, sleeping, getting up and doing things get interrupted it's amazing the new view you have one the world when you get them back.

In my opinion, a certain breed a Psychiatrists and nurses in those hospitals are the equivalent of modern day saints.

[Sam]

It's sad.

A little off topic: Do these psychiatric institutions cure their patients, or just a place for these people to stay and preventing from hurting themselses more. The drugs they take are just "relaxers", correct?

[FinanceDude]

I dated a girl who had some problems and ended up in the local psych ward a few times.

I agree with Martha, those places make nursing homes look bright and cheery..............

[Danny]

Quote:

Originally Posted by donheff I worked for a year on an acute ward at the Illinois State Psychiatric Institute - primarily populated by teens and twenty-somethings. It is tough to see kids in such pain. Their family histories are often mind blowing.

my hat is off to you Don....just out of college almost became a psychiatric social worker in the Illinois system, but chickened out and went to San Francisco with flowers in my hair to become an accountant instead...

[saluki9]

Quote:

Originally Posted by Sam It's sad. A little off topic: Do these psychiatric institutions cure their patients, or just a place for these people to stay and preventing from hurting themselses more. The drugs they take are just "relaxers", correct?

Negative. It used to be that they would just give people drugs like thorazine to keep people calm and let them stay there forever. Nobody has the funding for that anymore.

I have a friend with severe bipolar disorder. Using medication designed for epilepsy (and 18 months of trial and error) his psychiatrist has gotten him back to full function. To say it is an amazing transformation would be an understatement.

[Rich_by_the_Bay]

Psychiatric wards are troubling places for the uninitiated (as they are for the more experienced, though in a different way). It's too easy to criticize the "excessive" use of drugs in such facilities until you have seen what many of these patients were like in the events leading to their hospitalization.

I think most overuse of psychotropic drugs occurs in the outpatient setting where people who are sad are diagnosed as depressed; those who are worried get a label of anxiety disorder; and a few bad nights' sleep gets you a sleeping pill.

In a psychiatric ward, it is all too common that the "zombie" on heavy doses of Haldol was previously a paranoid schizophrenic who was ranting in the streets, seeing nonexistent insects attacking him or her, and possibly disrupting society enormously. Or perhaps a psychotically depressed person found just in time in their garage with the car running. Maybe a manic patient gambling away their family's last dollar or on a dangerous promiscuous series of encounters with strangers. My first psychotic patient was a man who saw water rushing out of his abdomen; he was admitted when he tried to throw himself on a woman at the bus station to staunch the flow.

I wish we had better treatments, and I know that understaffing and other problems are rampant in the system. But until you have dealt with the pre-treatment population of psychotic patients, my experience is that such inpatients are not treated for nothing - they were in big, big trouble.

Either way, the angst is almost overwhelming.

[tangomonster]

I think psych wards, especially in private hospitals and those of today, are
better/more hopeful places than where I did volunteer work (state hospital in NJ) 30 years ago. But can still be dpressing, especially the first time you see one. So much happiness and people not living up to their potential.

I definitely think psychotropic drugs have their place. My concern/criticism is that many private psych hospitals have been documented to retain patients right up until the insurance runs out---and once it does, then the patient is deemed to be ready for D/C. Funny how psychiatric illnesses are in sync with allowable hospitalization periods---must be a similar phenomenon to women's menstrual cycles getting in sync when they work or live together!

[Martha]

I did not want to imply that I thought anyone was improperly medicated, including my friend. I am just wishing for better solutions and better lives for people in such pain. Rich has it right when he said the angst is almost overwhelming.

[donheff]

Quote:

Originally Posted by DanTien my hat is off to you Don....just out of college almost became a psychiatric social worker in the Illinois system, but chickened out and went to San Francisco with flowers in my hair to become an accountant instead...

I was traveling in the other direction. I left San Francisco to come back to start at ISPI while several of my friends kept driving east to go to Woodstock. ISPI was actually a lot better than Chicago State and other hospitals in the Illinois system. We were not a warehouse operation - purely acute care for a matter of weeks, a few months at the most. Since it was a teaching hospital the docs were young and eager. Quite a few of the staff were COs who were pretty decent. I was just a Psych student checking out what clinical practice might entail. I did not go on for my Masters or PHD :-)

[Orchidflower]

Had a girlfriend in college who cut herself. I was, naturally, blown away when she told me she did that as I had never heard of it before. She said she did it because "it felt SO good when she stopped" cutting. Huh?
But guess what degree she was going for? A Ph.D. in Psychology! She was at the Masters level at that time, and we met in a class. Go figure, eh?

[52andout]

I spent most of my working career on psych units as a nurse. I loved it but it did burn me out.
I am surprised at the negative comments about insurance companies and medications because that was not my experience at all.
I worked at one of the biggest VA's, many ex POW's, lots of Post traumatic stress (can you imagine it now with this war), some bipolar and schizophrenia. The number one goal was keeping staff and patients safe, and unfortunately even with a great staff medication is needed sometimes. Certainly, some people cannot function without their lithium or antidepressants. Chemical imbalances need to be corrected. We got people cleaned up, anti-loused and some good food in their body. You cannot keep people against their will if they are not a danger to themselves or others so once stabilized many just want back out on the streets. The legal system protects peoples rights in this way, even if it is not in their best interests in your or my mind.
I also worked in a private hospital, with an eating disorder, chemical dependency, childrens and acute adult unit. We gave really good care and I to this day am in contact with my old coworkers. The eating disorder were the toughest. I loved the adult unit, and if you weren't a caring and patient you would not last there.
As bad as the big psych hospitals were, they did keep many people off the street, fed and clothed. Now that I no longer work I volunteer at a local city soup kitchen. I would say at least 25% are clearly psych patients and no one is looking out for them now.

[donheff]

Quote:

Originally Posted by 52andout As bad as the big psych hospitals were, they did keep many people off the street, fed and clothed. Now that I no longer work I volunteer at a local city soup kitchen. I would say at least 25% are clearly psych patients and no one is looking out for them now.

In the sixties we emptied the hospitals and made it much more difficult to hold people in psych wards against their will. The change made sense in the context of the neighborhood mental health system promised to replace the hospitals -- but the later never materialized. Many of those disgorged patients and their modern day counterparts are living out of shopping carts.

[52andout]

and many are in prison. Most of my friends are nurses and one works in the local prison so I have first hand accounts.
You are right Donheff, there are many community based programs, for instance the group homes that nobody wants in their neighborhoods. But those people you see sleeping under bridges or pushing a shopping cart around could very well be mentally ill. The most worthless people in the eyes of our society are often forgotten in the rush to accumulate personal riches.

[Moemg]

Quote:

Originally Posted by 52andout I spent most of my working career on psych units as a nurse. I loved it but it did burn me out.

I give you a lot of credit .Psych is a hard place to work .I only worked it briefly as a student in the late 60's .It was like one flew over the coocoo's nest.

[TromboneAl]

I have a relative who is an intelligent woman, now 33, who went to Stanford for one year, and then her bipolar disorder went wild, and has been hospitalized several times. When she's on her meds, she's an intelligent, rational person. If not, she can descend into being a totally insane being.

Here's a letter that I wrote concerning her.

March 5, 1999


Western Institutional Review Board (WIRB)
3735 7th Avenue SW
Olympia, WA 98502


Dear Sir or Madam:


I am writing to report a severe breach of medical ethics. This concerns the following study:
WIRB/ABBOTT/980311/04-24-98/jj/hk
mod 5-18-98/jtw
12-08-98/mg
1-12-99/am Protocol Number: M97-696 WIRB 980311A
Overview

L suffers from bipolar disorder. On approximately February 11, she was hospitalized following episodes of psychotic behavior. On February 13, I discovered that L had been entered into the above-mentioned study based on her signature on a consent form. As I describe below, L was not capable of giving informed consent at that time. She was totally incapable of understanding what the study was about or what benefit it held for her.
Chronology

L was diagnosed with bipolar disorder several years ago. Although she has been hospitalized because of this disease several times, her condition is well-controlled with medication. She functions as a normal member of society, and holds a paying job.


At the end of January or early February, her new doctor ,<deleted>, began reducing her medication. On February 10th or 11th, she caused a disturbance at a local store and was taken by ambulance to <deleted> hospital in Berkeley. I had a hard time finding out what was happening, since she was incapable of signing release forms that allowed the doctors to talk with me. She was also incapable of signing forms authorizing medications. I was able to find that she was incontinent of bowel and bladder, and had thrown her food tray across the room.


She was transferred to <deleted> Hospital on Feb 12th, and placed under the care of Dr. <deleted>. On Feb 13, she signed the above-mentioned form consenting to take part in a study of a new form of Depakote. At that time, she was transferred to the care of Dr. <deleted>. The study involved a washout period during which she received no medication, followed by a period during which she would receive the new drug or a placebo.


The doctors made no attempt to discuss the study with L's mother or me.
I found out about the study, and on Feb 14, I was able to talk to L on the phone on her ward. It was clear that she was not coherent. I asked her about the study, and its benefits to her. Here are my notes which paraphrase her response:


2/14/99 2:40 PM
L told me that she understood that she was currently a voluntary patient, and that if she didn't agree to be in the study, she would either have to leave the hospital or become an involuntary patient.
I asked L how the study would benefit her, and she replied that she would get $50 and that she could use that $50 however she wanted, or give it back if she wanted. She said that the study would pay for the hospitalization. When I told her that I thought her insurance covered the hospitalization, she explained that the money would go into some account with the government, and that she would be able to draw on it later. I asked her whether the doctors told her that, and she said, no, she just figured it out herself.


My subsequent visits with L confirmed that she was incapable of making an informed decision about the study. Her mother, <deleted>, <deleted>; and her friend and landlord, <deleted>, can all confirm her confused mental state at this time.


I've also attached a written indication of L's mental state. The attached pages include the signature pages of the consent form. [It shows mostly squiggles over the entire page]. L tells me that when the doctor asked her to sign it, she, instead of signing her own name, copied the signature of Dr. <deleted>. She was told that she had to cross it out and sign her own name. Thus, on page 9 of the form, you can see that Dr. <deleted>' signature was copied and then crossed out.


At 3:25 PM on Feb. 14th, I was finally able to reach Dr. <deleted>, and told her that we did not want L in the study. L was removed from the study, returned to the care of Dr. <deleted>, and started receiving medication that night.


L improved rapidly from that point on, and was released on approximately Feb. 25. I have seen her and she is her normal self and has returned to work.
Summary

When L's mother, first told me about what she thought was happening, I said "No, that's not possible, there are very strict ethics rules in medicine." I have worked in research, and have seen the measures that need to be taken to insure that the patient understands the risks and benefits of a scientific study. Apparently something went wrong in this case.


I'm sure you can appreciate the seriousness of my charge. L signed away her access to the medicine that would make her sane without knowledge of what she was doing. Had we not intervened, she might have spend several weeks in the hospital on a placebo. Although we are not currently considering legal action, I want to make sure that this event is investigated.


Sincerely,

<deleted>


-----------------

I never heard anything more about this.

[52andout]

Quote:

Originally Posted by Moemg I give you a lot of credit .Psych is a hard place to work .I only worked it briefly as a student in the late 60's .It was like one flew over the coocoo's nest.

The VA where I worked, in Palo Alto/Menlo park was coincidentally where Ken Kesey wrote that book. It was his writing project at Stanford. Fortunately things had greatly improved. They were not doing shock treatment however that is still done around the country but very selectively and now under anesthesia. At the time (late 80's) they were doing a lot of HIV/Aids research and were known to be leaders in cardiac research as well.
When I left the area and moved there were no openings at the local VA due to budget cuts so I did not continue my VA career. I am not sure how long I would have been able to last and do an effective job due to burnout though.

The first day I went to work there I was driving in and a naked man was walking down the street. I stopped at the main building and told a security guard. Without a pause he said into his radio "________ seen walking naked towards the entrance." Should have been my first clue as to what would lie ahead.

edited to correct timeframe- I have moved so many times I forget sometimes dates of when I was where.

[thefed]

interesting i find this post today. my grandfather, 73 yrs old, was hospitalized the other day for excessive depression/mental breakdown

WHY?

FINANCES! I cam here asking for some advice because he was ovewhelmed by the possibility of retiring....its been a declining battle and finally he lost it. Coudnt get him out of the car the other day , he proclaimed "Theyre gonna take my car! I just put a full tank of gas in this thing! Gas is too expensive for them to take this from me. Then if they get the house, im gonna get stuck somewhere without air conditioning....that wont be good etc etc" Keep in mind he will be bringing in 50k during retirement and has a nice little nest egg to supplement. I think the sudden change of scenery (forced to stop working due to back probs...the vicodin they had him on began this spiral downward) really got to him

[Sue J]

My mother has lifelong depression. I've visited her in quite a few psychiatric hospitals. It affects me right down to my core. The locked doors, the despair of the patients, the plexiglas over the glass windows, the stuffiness of the air. Gives me the shivers just to think about it.

But I also remember admiring the staff who work there. I've found most of them to be respectful of the patients and understanding of their circumstances. None of them want to be there, but for many of them they know it's for their own good. They have tried to hurt themselves or have sunk to depths they didn't know they had.

The last time for my mom was in 2005. Some patients were being medicated but for many the last resort was ECT (Electroconvulsive Therapy aka Shock Therapy). They do it differently now and for her it was helpful to see others going through the same thing she was going through and seeing people in her circumstances getting help, seeing a little glimpse of light at the end of the tunnel.

It's been a very long, hard road for her, for my Dad, for all of us. Seeing what she's had to deal with makes me realize how lucky I am that I didn't inherit whatever it is that has cursed her with this. I am one of those people who wakes up every day just happy that I'm alive and that I get to do the ordinary things that make up a day.

In one of her extended periods (about 15 years on Tofranil) of relief from her depression she could explain what depression was like. She said she always had a dark cloud around her and couldn't understand how everyone else could feel happiness and joy all the time. Properly medicated she could finally feel happiness like everyone else. But after years it stopped working, she tried other medications and nothing worked very well or had intolerable side effects. So ECT was her last option.

It's interesting that I can remember every visit to every hospital that she's been in. But due to the ECT she doesn't remember specifics, she knows she was hospitalized but doesn't remember how long, who was there, what went on. I guess for her that's a good thing.