Happy To Be Here

May 21, 2015 3:29 PM

The first thing you need to know about secure psychiatric facilities is that their bathrooms smell strongly of pee. What does it feel like to suffer from a mental illness? How can you explain that unique pain? I don't know how to explain it but this post hits a few points in a profound way.
posted by Another Fine Product From The Nonsense Factory (23 comments total)

I love this:

I couldn't get through this if I couldn't laugh at myself and at the absurdity of it all.

I first recognized this because of golf pencils. You're encouraged to write to loved ones when you're hospitalized. But pens are potential weapons, so they give you the short, stubby pencils that you'd use to score miniature golf. These induce hand cramps but are highly ineffective for suicide. Once a day they'd ask me to sign a promise not to hurt myself, or others. When they asked that they gave me a pen. An oath written with a golf pencil is of mickle might; nobody expects your word to be binding unless it's written with, at a minimum, a Bic. After you sign the no-harm promise they take the pen back, and give you back the golf pencil. One day the cosmic ridiculousness of this struck me so hard that I started to laugh until tears rolled down my face. I do not recommend this as a strategy to get out of a mental institution more promptly.

The whole piece was nice. Thank you for posting it!
posted by jaguar at 3:52 PM on May 21, 2015 [11 favorites]

Really great.
posted by Divine_Wino at 4:00 PM on May 21, 2015

The bit about self-reliance being a trap when you're depressed is so damn true.
posted by nebulawindphone at 4:50 PM on May 21, 2015 [4 favorites]

Ken White is a great writer about a lot of legal topics. He also, it turns out, is a great writer about a-legal topics.
posted by Lemurrhea at 5:37 PM on May 21, 2015 [2 favorites]

While working in mental health, I've found that the facility in which it's only the bathroom that reeks of pee is a rare one. Usually, it's the entire unit. Jails and prisons have an unfortunate potpourri of the scents human desperation of which urine is but one note. Every time I start externship in a new place, I make an internal judgement of the facility based on the intensity of pee smell. In my estimation, urine confined to just the bathroom would indicate comparitive luxury.
posted by batbat at 6:10 PM on May 21, 2015 [4 favorites]

Ken White is a national treasure.
posted by Mr. Justice at 6:35 PM on May 21, 2015

I would like to tell you, we visited a friend in a locked mental ward when we had a six-month-old baby, and we took our six-month-old baby, and he was the total celebrity of the locked ward, and he brightened everyone's day just by playing with his stacking toy on the floor in the visitors' room. Everybody was extremely nice and it was extremely safe and everyone but us was wearing just socks, no shoes. Take your babies to visit friends and family who are having a rough time! Babies make people feel better!

Babies do not know it's awkward to visit a locked ward, or that their friend is struggling with mental health and you have to talk delicately about it. They just know that their friend can build a tower over and over and it is HILARIOUS to knock it down.
posted by Eyebrows McGee at 6:59 PM on May 21, 2015 [32 favorites]

I had the sort of day that illuminates the distinction between "I've fought depression for sixteen years" and "I've successfully fought depression for sixteen years." It turns out the difference matters.

Holy shit does that ring true. (I've joked with my neighbour about putting a sign on my door that says ____* Days Since Last Suicide Attempt).

And, wow, reading this--and a couple of the comments here--has shown me that maybe I've been pretty privileged in terms of psychiatric wards (2) and hospitals (1 hospital, 2 locations) that I've been in. The kind of lockdown mentioned--cages around toilets, no shoes allowed, etc--in my experience here is reserved for the really acute wards, where people are e.g. dealing with active and/or unmedicated psychosis, severe violence issues, etc. (Or, at CAMH's main campus, the wards that house people who are intersecting with the justice system.) Hell, even last year when I had to be admitted and stomach pumped and was in restraints, I was on a totally not-locked-down ward. (Actually, if my extremely foggy bc Reasons memory serves, I was just in a regular ward, not even on the psych ward.)

I guess what I'm saying is that 'locked ward' probably has a much greater variance in how they're operated and designed than most people who've never been in one might think. In my experience, much closer to a really ordinary hospital ward with a few special rules than to the Silence of the Lambs-style lockdown that gets more attention and media play. And, for me, I find some of the rules really dehumanizing. I mean, I understand why so many of them are there, there's a necessity, and at the same time it's almost... paternalistic? Patronizing? "We know you've come here to get help, ps you can't be trusted with a pen." And, yeah, they have to go for the lowest common denominator of safety; there's just not enough money to really fine tune safety levels in wards. It's a tough bind to be in. Perhaps I wish there were enough money to distinguish wards of people who are admitted entirely voluntarily and (probably?) at less risk of self-harm, and those for people who have been admitted against their will.

Perhaps there's a philosophical difference? I'm inclined to believe there's two things at play: first, that there's just not a lot of money for mental health services anywhere, and probably even less (as an average; I'm not talking about fancy private places) in the USA, meaning the lowest common denominator has to be really low; and second, that the more extreme versions of lockdown are much more interesting. In kinda the same way that we see more media (both fiction and nonfiction) around places like Alcatraz or Rikers or your friendly neighbourhood Supermax than we do about the six-cell county jail down the road.

Or perhaps my experience has been coloured/privileged by 1) not being in a state of psychosis, and 2) not exhibiting any violence towards anyone but myself. And, maybe, 3) living in a country where healthcare is provided by society, so the dregs we get in mental healthcare are a step or two up from the dregs given in the USA. Small steps, probably. What I mean is... the publicly funded system in the USA gets the shit end of the stick anyway, and mental healthcare comes at the bottom of the list both here and there.

(Funny side note: the first time I was ever admitted for psychiatric care was when I was a teenager, so I went to Sick Kids. The psychiatrist was telling me about the safety protocols, and that they'd recently had to have a big rethink after one kid went into the supposedly safe common room, and then handed them a list of dozens of ways he could have seriously harmed himself in there. Us people with the head gremlins can be ingenius!)

Eyebrows, to your point about your baby, when I was in a locked ward a couple years ago (similarly 'voluntarily;' my initial admit was voluntary, they would have held onto me if I'd tried to leave, at least for the first week or so) the absolute high point of the week was when the therapy dog would show up. Everyone would be playing with it and chilling out. Dog was in doggy heaven, a whole bunch of people who wanted nothing more than to give it head scritches and belly rubs.

Don't get me wrong; that was absolutely a locked ward (though most of us, after a while, had in/out privileges at certain times of day). Still, we could keep footwear (not with laces, of course), snacks in our rooms, etc. Across the hall was a rather more severely locked-down ward for people in much more extreme states of distress.

I seem to be rambling and have lost the point of what I was saying somewhere.

And since it bears repeating from the article:

The National Suicide Prevention Lifeline at 1-800-273-TALK (8255) is available 24/7. The National Institute of Mental Health has links to many other resources for people in pain and their loved ones. So does the Suicide Prevention Resource Center.

Those are for the USA. For Canada, if you're a youth (under 25) contact 1.800.668.6868 or see here. Other international listings.

* 421
posted by feckless fecal fear mongering at 8:17 PM on May 21, 2015 [13 favorites]

And, wow, reading this--and a couple of the comments here--has shown me that maybe I've been pretty privileged in terms of psychiatric wards (2) and hospitals (1 hospital, 2 locations) that I've been in. The kind of lockdown mentioned--cages around toilets, no shoes allowed, etc--in my experience here is reserved for the really acute wards, where people are e.g. dealing with active and/or unmedicated psychosis, severe violence issues, etc.

In the locked facility where I sometimes work, where we treat people with psychotic disorders who are conserved (that is, they're acute enough to be considered unable to provide for their own food and shelter due to their mental illness), shoes are actively encouraged but many of the residents seem resistant to putting them on. I know in hospital wards serving clients with suicidal ideation, shoelaces and such are taken away, and I think there are legal requirements that facilities provide those slipper-socks with textured soles, but I think a lot of people in various locked wards/facilities are shoe-less by choice.

And double-triple-quadruple agree on therapy dogs. If anyone has a super-friendly laidback dog and wants to do some volunteer work, getting your dog certified as a Therapy Dog and visiting institutions would be a lovely way to do so.
posted by jaguar at 8:45 PM on May 21, 2015 [2 favorites]

Thank you for this post. Having repeatedy lived this for 15 or so years, it is empowering and gratifying to hear from another who's survived such in/voluntary institutionalization with such grace and, ultimately, healing. It is a huge gift to be able to so nakedly share these experiences and insights, both as solidarity and as a hope-narrative for those of us who have/do suffer/ed these psychiatric wards , and as a valuable voice to the rest of society, which far too often hears about mental hospitals--if at all--from (well-meaning of course!) professionals and the media, instead of from those for whom, at least nominally, the places/experiences are meant to exist.

Also, nthing therapy pet visits! :)
posted by riverlife at 9:30 PM on May 21, 2015 [2 favorites]

Yes, fffm, I think, even for most well-intentioned members of this healing community, your "paternalistic...[p]atronizing" really does capture the core of the matter, as does much of TFA. I would add infantilizing. We will do better as people's lived experiences are heard and valued, instead of just repeatedly committed/sedated away.
posted by riverlife at 9:45 PM on May 21, 2015

Last thing and I'm out...my above throws some shade at mental health professionals, and I regret that when celebrating the experiences/perspective of the legally-committed ill individual I subtly threw stones at an entire healing community, without many members of which I would not be living a happy, productive, blessed, and healthy life today. It's just so beautiful and refreshing to hear from one of those in it directly, I got a little carried away and failed to distinguish between the healing doctors, therapists, nurses, and staff, and the very sick system in which they are obliged to work. And of course in which we are obliged to heal.
posted by riverlife at 10:01 PM on May 21, 2015 [5 favorites]

As a healing professional in the sick system: There are a lot of people working in that system who let the sick system make them sick. There are respectful ways of interacting with people in pain, even while leaning toward the over-protective side (because as a practitioner in the system, you're not only worried about the client in front of you but about all the clients in the facility, so you have to work within policies that protect the most vulnerable, even if they may not be applicable to everyone), and then there's the kindergarten-teacher-sing-songy-voiced "professionals" who forget they're dealing with adults worthy of respect and start treating everyone like a three-year-old.
posted by jaguar at 10:13 PM on May 21, 2015 [6 favorites]

Wow, thanks for posting, I really needed to read this, especially this bit: "But down in my lizard brain, where I whisper my failings to myself, I told myself if you go to a mental hospital, that's it. You're not a parent and a law firm partner and a citizen any more. You're a Crazy Person." Not that I am a parent or a law firm partner at all, and am also not in need of going to a mental hospital. But it remains one of my worst-case scenarios, like "you will have completely failed without the ability to recover if you ever get so f-ed up that you wind up in the looney bin". Which clearly is not true. And then it made me think about some of the other thoughts that have run through my head recently that are also clearly not true. So that's good.

Also the pencil bit just killed me. (See what I did there? Too much? Nah.)
posted by Athanassiel at 12:24 AM on May 22, 2015 [2 favorites]

hey, here's the thing I want to say about this article. I'm tired, so I'll be blunt, and I hope you can empathize in the gaps.

type A, law firm partner dude? I am really, really glad you get to write this narrative of opening up to people and asking for and receiving generous support and have it be true. I'm glad the rest of your life that's not your illness is fairly stable. I don't imagine you've got it all good - nothing's perfect.

but some of us don't have that. your story is the depression narrative I've read over and over again. speak out, get help. it helps some people. that's good. but. this is a big but. some - many - of us don't have that work for us. we speak out and our friends (I have some, many don't) feel our pain but don't know what to do. we look at the support structures around us (like jobs, healthcare, social services, education) to try to draw on them and find they're toxic and oppressive.

this isn't depressive bias for us; this is real.

mental illness can be, very often is, the result of living in a world that in real terms crushes you daily. we're poor, or we're not white, or we're disabled, queer, immigrant, trans, undereducated, abused, on and on. our lives are real and outside the Great Depression Narratives.

we've seriously got to acknowledge that many people really don't have access to the factors of success and "recovery" that rich white men do. and you know, maybe that means platforming our stories? we're not "other". this is a shared struggle. talking about how we survive is more useful to the class who normally gets to tell their stories than their stories are to us.

and honestly, I'd like to hear about how in the end we don't survive, too. because so many of us don't.
posted by lokta at 3:27 AM on May 22, 2015 [14 favorites]

NB there's a reason I'm saying this here and not TO KEN. his post is about his pain, his experience and his journey. please think about that when responding to me, if you're going to. I appreciated hearing from him.
posted by lokta at 3:33 AM on May 22, 2015

This was great.

Personal anecdote time: I recently ended up in this type of facility. I had a similar experience to the author where a seemingly-never-ending crisis got the better of me and my resulting attitude was, "fuck it, so what?" That was quickly replaced though with gratitude that I was surrounded by people trying to help me. And I think there's also that same sense of "well, it's only up from here."

I hope no one reading this has occasion to use this advice, but if you ever wind up in a psych ward, one way to deal with silly rules about pens and toilets and shoes it to treat it like you're in the military, and the mission is to get better. So ignore that crap and try to remember everyone else in there with you is also a human being. And take an interest in the people looking after you, they get affected by the same set of ridiculous tacit and explicit rules about being in psych wards as much as you.

That was harder to write than I expected.
posted by iffthen at 4:13 AM on May 22, 2015 [6 favorites]

they'd recently had to have a big rethink after one kid went into the supposedly safe common room, and then handed them a list of dozens of ways he could have seriously harmed himself in there

Oh god, this made me laugh. A few years ago I was in a ward that turned out to have private rooms, and in those rooms, the beds were like actual hospital beds, all adjustable, which I didn't expect. I was in a bad way (obvs) and so when I found that the bed had little sharp screw-things on the underneath that could be taken off and, well, used as sharp objects, I found myself snottily telling my burly nurse how easily I could die right there in that very room. The nurse sighed, rolled his eyes, and proceeded to explain to me that if I decided to go through with that bit of drama, I'd have to be transferred over to the state facility. I'd been an outpatient there, and yick, so that was actually pretty effective motivation to quit it. Although I still had to sign about five million contracts saying I wouldn't hurt myself. (Nobody laughed when I asked if they were going to sue me if I died. Nobody ever laughs at that joke.)
posted by mittens at 4:39 AM on May 22, 2015 [4 favorites]

That was a great read. Similar to Ken I had such respect for people who did anything to make themselves better and didn't fault any of them a bit. I envied them in many ways for their strength and the help they often received. At the same time I just knew that something would be very wrong with me if I had to do the same thing. I've now learned that this is because I was and am being told explicitly exactly that by people close to me. I hear "don't ever talk about it. what will people think?" and "you need to keep that part of your life separate from work and church and neighbors for your own good" The day I started getting better is the day I gave up on that bullshit. Almost immediately I learned that I'm not strange (debatable, but not uniquely so) and many other people know exactly what goes on in my head. And amazingly there are a bunch of people who want to help me (and I can often help others in small ways too) - though some are pure evil and I'm glad I can usually tell the difference quickly. Now I find great strength in admitting that I wasn't ok. I don't shout from the mountaintops, but I also don't care who knows what about me as long as it's true. I wish there was a good way to tell people it's ok to not be ok and they're not alone, but I don't know what that is. I hope Ken's post finds someone who will get some spark of that from it.
posted by Clinging to the Wreckage at 7:55 AM on May 22, 2015 [2 favorites]

Nobody ever laughs at that joke.

I just did, mittens.
posted by emumimic at 9:17 AM on May 22, 2015 [1 favorite]

If you run into a neighbor in the grocery store, ask them if they know where they knife aisle is. If they twitch, then they know.

Oooh. This is brilliant.
posted by Sophie1 at 9:57 AM on May 22, 2015 [2 favorites]

This is making me weep. My health insurance got screwed by by a combination of insurer error, post office inability to forward my mail, and my own inability to cope with life and saying screw it. So, no zoloft = I'm not as depressed as I'd have thought, but I cry easily. lokta, here's another piece - being chronically depressed makes you less likely to be employed, healthy, etc. I'm sorry it's been so hard for you. Little by little, it's a little bit better, much of the time. Obamacare means that a lot of people have access to health insurance that includes mental health care. Obamacare is notably imperfect, but no Obamacare is way more so. Hugs to all y'all in this thread.
posted by theora55 at 10:41 AM on May 22, 2015 [2 favorites]

I found myself nodding in agreement at the italicized part about anxiety, having recently come through over a year of near-crippling anxiety, the worst ever in a lifetime spent doing the depression-and-anxiety shuffle. I did like the article and I think it needed to be written. But for me, it didn't "get" the actual feeling of depression as well as the deservedly well-known Hyperbole and a Half piece. Too much trouble to link on my phone, but I urge anyone who's not familiar with it to look it up on the Goog.
posted by scratch at 11:19 AM on May 22, 2015