"Of all God's creatures, there is only one that cannot be made slave of the lash. That one is the cat. If man could be crossed with the cat it would improve the man, but it would deteriorate the cat." - Mark Twain

Wednesday, May 4, 2011

Life in the State Mental Hospital

As promised, I'm going to write a bit about my time in the state mental hospital. I have also spent a little time in a couple of private mental hospitals but, except for some specific things that I'll mention later, it was not much different. This has been very difficult for me to remember and reflect on so I hope that you'll bear with me as I write this.

First, remember that when I came into this hospital, I was coming to it straight from a prison cell. One week of solitary confinement in jail was enough to drive me deeper into my broken mental state and there was not a single moment of time that I did not hear the myriad voices in my head arguing amongst themselves. I was unwashed and had not eaten properly in a week. I was cut off from all my friends and family. I sang songs to myself to try to hold on to my memories and my humanity since I had almost no conversation with anyone and had been given only one small book (a religious one) to read the entire time. I sang songs to try to block out the sounds of those voices that had taken over my mind and, I felt, driven me to this state.

Now I was taken, handcuffed, in a patrol car to the state mental hospital. The staff was extremely courteous and assured me that they wanted to help. They didn't seem to look down on me or judge me harshly for my condition. They wanted to make sure I was well taken care of.

My first interview was with my new psychiatrist, some nurses, and a couple of social workers. They asked a lot of questions and it was hard for me to answer them. I felt very self-conscious and afraid. It's always difficult to explain "hearing voices" to psychiatric staff because they never really seem to understand. They are used to schizophrenics and psychotics who hear voices from the outside. My voices always come from within. It's been that way since I was in grade school and it's both embarrassing and frustrating to try to discuss because it doesn't fit into the neat framework of any particular diagnosis. Of course, they also asked me about any physical or sexual abuse I'd encountered. I dislike talking about all that and I'm afraid that whatever answers I gave were probably very incomplete and unhelpful.

The staff made sure I was bathed and fed after the interview and then came the part I'd been dreading - the blood draw. I simply cannot get out of a hospital of any kind, it seems, without them sticking a needle in my arm. This was frightening and painful for me and I spent most of the rest of the day sitting on the couch shivering and staring straight ahead like a zombie.

The state hospital, like the others of my acquaintance, had a "day room" or two where they encouraged patients to congregate and watch TV, play games, or read. My last private hospital forced us to do this by locking us out of our rooms all day. The state hospital allowed us to go to our rooms during free time as long as we didn't abuse the privilege. I only knew of one girl who was locked out of her room during the day and she simply moved her blanket and pillow to the couch instead. I spent most of my free time reading classics that I'd just never gotten around to reading in my regular life so I could block out the disjointed conversation of the patients around me and I would not have to look at those poor women who sat there and just stared at the wall as if they were in a trance. It was not uncommon for one of the paranoid schizophrenics (there were several there) to suddenly look up and accuse someone of talking about them. You'd think that this would be frightening at first and then I'd get used to it but it actually worked the other way around. As time went by and this happened more often, I became unnerved by the behavior. Eventually, one patient ended up throwing her books across the room. Another time while we were in the medication line, a severely disturbed patient jumped another patient standing right by me and the aggressor had to be carried down to the padded room. I felt like the staff wanted to keep us safe but that someone might attack me at any minute for absolutely no reason. I never had any real reason to fear, however, for the most that happened to me was that a patient crept into my room one night and started whispering to me. The nurses found her quickly and rushed her out. I had 200 mg of Seroquel running through me that made me not really give a damn.

We had classes at appointed times throughout the day and night to help keep us on a structured schedule. Sometimes we learned more about our illnesses (though, to be honest, the information was very elementary and not of much interest to me) and sometimes we were allowed to talk about our experiences. However, the psychologist who led some of these classes did not like to waste time in this manner. He felt that by talking about our experiences, we were simply rehashing them and using them as excuses not to address our underlying problems. I thought this was terribly harsh at first but, as I listened to the women around me and then to myself, I realized he was right. All too often, we would recount something, not to learn from it, but rather to wallow in self-pity and get the sympathy of the other patients. It was one big circlejerk and he had no interest in hearing it. I listened to that skeptical psychologist more closely after that and I observed his style of listening critically and then asking the tough questions. I did that with myself and I did not like the answers I was getting. One day he seemed to be quite frustrated after listening to someone dance in circles around her issue and he said something like, "You know, 99% of you are not going to learn a thing in this this class. You're gonna go right back out there, make the same mistakes, end up right back in here, and then wonder how you got here again."

His point became very evident because of the band system we used. When a patient first comes into the hospital, she gets a white armband. While on a white band, the patient must wear scrubs and is very limited in where she can go and what she can do. She can have no visitors.  It's an assessment phase that generally lasts for 24-48 hours. Once the patient shows she is responsible and stable enough, she gets a yellow band. Those on yellow band can wear their own clothes with a few restrictions and can have visitors. They are allowed to go to the gym or to any special events. A patient may stay on a yellow band for quite a while depending on how they are managing their illness and how well they are responding to medication. Those patients who are responding well and have shown consistent good behavior as well as taking responsibility for meeting classes, grooming, and such get a green band. These patients get full privileges, may stay up late on the weekend, and can even go home on a short pass if the doctor approves. These patients are very close to being able to go back home permanently. A patient who is non-compliant, starts fights, self-injures, or does anything like that gets a red band and is on full restriction. No one wants a red band.

Or does she? As I said, the psychologist's words became clear to me through the band system. It was quite common to see people on a yellow band do very well, get their green band and word that they could go home soon, and then start a fight or have a complete breakdown in order to get back on red band. I wondered whether these patients did this on purpose so they wouldn't have to leave or whether the idea of going back home was so awful and frightening that they couldn't stand it. It's hard for me to say. I saw one woman seemingly work through her issues, become a leader in our little group, take in new patients and help them get situated, talk about her plans for when she left and how she was going to really change her life. And when she got that green band and they told her she was going home, she lost it. First, she talked about how she was going to kill the men who had attacked her. Then she took to her bed and stayed in it almost around the clock doing nothing but screaming and crying. I can't rightly judge her or any of the others but I felt a great deal of compassion for them and, even now, I wonder where they are.

It's hard to say how helpful the hospital is overall. The regimented schedule really helps people who are struggling with mental illness but it is not sustainable unless the patient wishes to and is able to continue it once she goes home. At the hospital, patients are forced to take all medication - anyone who refused was held down and injected (so you better believe I took every single pill they told me to). But once a patient gets home, who sees to it that she takes her meds? Certainly a patient should be responsible and take meds but not every illness makes that easy or even possible. I think the hospital is good at bandaging up the worst bits but, even with social workers and doctors following up, it's just impossible for them to make changes where they are needed most - at home. I hope that as we learn more about mental illness, these providers will be able to optimize the care they give. However, I think our economic and social problems are going to make this extremely difficult and it may make little difference.

Most (and by most I mean well over 90%) of the patients did not have a good home life. Some came straight off the streets or out of homeless shelters. Others came out of jail because they'd been locked up for doing something dangerous. My roommate was a very sweet little old Pentecostal lady who happened to be a paranoid schizophrenic. She had pulled a gun on her neighbors because she thought they'd come over to steal her money. Regardless of where they came from, however, few of them got any supportive phone calls and fewer still ever had visitors. I was regarded as the most popular patient in the hospital because I had so many friends and family members who called daily and visited when they could. I had a tremendous support system that these other women could only dream of. This was especially driven home the day I heard a patient tell a nurse how badly she wanted to go home and the nurse replied, "I'm sorry, sweetie, but your parents don't want you back. They can't take care of you any more."

That's the crux of it really. No matter how good of a job the hospital does, real life is still waiting to chew these women up and spit them right back out. And so the real lessons I learned from my time at the mental hospital is that: (1) life is exceptionally hard for most patients, (2) society generally doesn't give a shit as long as they don't have to see us and deal with us, (3) even the best family and friends can only do so much, (4) most hospital staff do the best they can, and (5) patients who want to break the cycle are going to have a tough time doing it.

That's my overall view of the time I spent there. If anyone has more specific questions, please ask. I'm sure I left out a ton of things I meant to say because I ended up rambling about some things I didn't mean to get off on. But, hopefully, I've given you a glimpse of what it was like both physically and emotionally. I never want to go back there again but it's a possibility that I face. Ultimately, it's up to me.


  1. I'm wondering if that would be Whitfield, which was a hellhole when I lived in the area, but it was the only state hospital in Mississippi. I visited the one at Mandeville, LA, once, and liked it so much that I would have stayed if they would have let me. By contrast, Whitfield looked like something out of a horror flick. You know, perhaps, of an experiment in which it was determined that mental hospital staff couldn't tell a real patient from a researcher who faked illness to get in, where the patients themselves could. Then, when the experiment was published, the hospital cried foul, so they were sent word that a new crop of pretenders was going to attempt to be committed, and so the hospital determined to figure out who they were. No such pretenders were ever sent, but that didn't stop the hospital from finding them. This study was described in the most recent issue of "The Brain."

  2. I've heard this same story again and again, and from friends and family members, too (not just professionally or reading it in the news papers). Person A is stable on their medication. Person A decides that they are better and stops said medication. Then disaster strikes. Tragic.

  3. I've been in the hospital once and I don't remember much of getting there, actually I remember nothing about it. I do remember waking up in the morning and totally freaking out. I was there for less than 18 hours, while the staff was wonderful I was in too much of a panicked state to realize it at the time. That night is what led me to be diagnosed with bipolar II so I guess it was a very good, although scary, thing.

  4. Thanks very much for taking the time to describe what life is like inside a mental hospital. My brother is paranoid schizophrenic and has spent time in mental hospitals. I always wondered what it was like but it's difficult for him to tell me. I learned a lot.

    Thanks - Mitch.

  5. Thanks for writing this post. My sister (42) is currently in a mental hospital now. God Bless You.

  6. Thank you for sharing. A loved one will soon be transferred to Whitfield, they are currently in a local hospital, as this person is very suicidal and depressed and it seems that the condition has worsened since arriving at this hospital, I am afraid that when the transition takes place the condition will get worse, also it will be very hard as thus facility is about 5-6 hours away. I have heard horror stories about Whitfield.

  7. This was an extremely good article. And you are absolutely right. In the end, the main problem is having to deal with reality, because mental illness makes that very hard to do. I am bipolar, and I also have panic/anxiety disorder and some right brain compromise. The ordinary details of life: holding a job, handling money, organizing my time, dealing with people, having relationships- are very hard for me. Right now I am waiting for a Disability hearing, as I have been turned down twice. I do not know what I will do if I cannot get Disability. I do not need to be hospitalized, but neither can I work enough hours to earn a living.

  8. As to Whitfield, I grew up in Mississippi in the '50s and '60s, and used to pick up the occasional corpse from there when I worked for various funeral homes. It was one weird experience to go there late at night (always at night) to pick up a body from its dungeon like autopsy room. I half expected to see Mr. Hyde.