Friday, January 31, 2014

Tales from the schizophrenia ward - Part IV: It could be worse...

You know, going by the accounts of this series' first three parts you'd probably think that I had a hellish time at the schizophrenia ward, but it really wasn't all that bad. Yeah, the Haldol stories I talked about in parts II and III were pretty damn bad, and the boredom detailed in part I was somewhat bad, well, mostly inconvenient, but as a whole, I didn't have such a bad time, and neither did many of my fellow patients. Sure, none of us had the best time of our lives, that's in the nature of such a place, but there was a good spirit between patients, a spirit of camaraderie and at times - after a while - even friendship. We hung out, talked, had fun, it was pretty nice a lot of the time. So while some aspects of this episode of my life and the lives of those around me at the time were pretty dismal, sometimes you gotta see things positively and think of the less fortunate.

And we did think of the less fortunate, because there was no way around it. That is because half of us - excluding myself - were the less fortunate prior to their joining the ward I was at. This ward was what they call an "open" ward, which means you agreed to come there, you were free to roam the clinic area, and you were free to leave if you should choose to do so. And where there is an open ward there sure enough was a "closed" ward not far away - about 50 meters from our building, the building next door. This was a place where you'd be brought against your will because you were deemed "a danger to yourself or others", and where you could not leave the ward (either entirely or just for a stroll) without express permission of the doctors. Once doctors decided you were no longer a danger to anyone you would be sent to our open ward, mostly to get your meds down and prepare you for release. So a lot of the people I met at my ward were at the closed ward next door prior to my meeting them, and the first-hand accounts I heard from them were truly horrifying.

One big issue is that in most clinics, there are numerous different wards, each with a different focus. When you decide to become an inpatient by yourself, you have your doctor sign you up for the ward that is deemed appropriate for your diagnosis and you wait until there is a free bed. When you are brought to the clinic against your will however they obviously can't keep you in the ambulance for a week until a bed in a ward appropriate for your diagnosis is free, so when one isn't, you are simply redirected to another closed ward with a different focus in which there is a free bed. This is problematic because most patients' diagnoses require a long-term stay at a ward that offers long-term therapy, but because such wards do long-term therapy, rotation is lower and a bed is less likely to be free at any given time. Wards that do have a high rotation and therefore are more likely to have a free bed are those for short term intervention in an acute problem - most commonly detox or suicidal ideation/suicide attempts.

Since I was at a schizophrenia ward, the majority of people there suffered from schizophrenia or related illnesses such as schizoaffective disorder. So most of those who had been in a closed ward prior to their arrival at the open one I was at were committed there as a result of such a heavy psychotic episode that they were deemed a danger to themselves or others. Now most people who have never experienced a psychotic episode or similar phenomena will never quite understand what happens inside these people at the time, and from my own experience I can only relate to the intense paranoia that my diagnosis (obsessive-compulsive disorder) shares with schizophrenia. Now imagine being in a state of intense, overwhelming, unmanageable paranoia and being committed to a mental hospital against your will (which is bad enough), but because there is no free bed in a ward appropriate for your symptoms you end up in one place with 20 Russians on heroin withdrawal or 20 suicidal people who are intent on trying to end their lives any chance they get. To call that counterproductive would be one hell of an understatement.

But let us assume that you do get a place appropriate for your symptoms, a closed schizophrenia ward, as a good number of people I have met did. Here's where the really ugly truth comes to light: Doctors and nurses, no matter how much training they have received and how competent they are assumed to be, do not know how to handle people who are experiencing a heavy psychotic episode other than with mental and physical violence. You read correctly. This is the "enlightened" 21st century and we live in what supposedly is one of the most civilised countries on the planet, and patients at mental hospitals are being treated with violence by the staff. They are not being beaten or anything like that, but the mistreatment that is going on can only be described as violence. I have heard many such examples by a number of patients, but one in particular stuck in my memory the most as one of the most horrifying stories of mental hospital abuse I have heard in my life (so far):

There was this young woman, a bit younger than me. She was experiencing a massive psychotic episode and wanted to go to the clinic. Naturally, she wanted to come to an open ward since it was her choice to come and she was not a danger to herself or others, but there was no free bed, so they wanted to send her home until something opened up. She however was in a horrible state of mind and felt she desperately needed help, so it was arranged that she could go to a closed ward for a time. While there, her psychotic episode got worse and she was freaking out. Not in a way that would endanger herself or others, but in a way that was horrifying to her. Doctors, unwilling to deal with her, had a perfect solution: Trying to give her Haldol. Now she worked in the field so she knew very well what Haldol was, and she was extremely paranoid about it, so she refused. Here's where it gets ugly. The staff's reaction was simply beyond disgusting. They strapped her to a bed, and she knew from her experience in the field that they would want her pants off, so she begged them not to do it because she had been very badly raped. Two nurses, both male, ripped her pants off anyway. They injected her with the Haldol she refused and left her strapped to the bed overnight. They left a bedpan for her to pee in, despite her saying that she can't do that, so she didn't get to pee for, if I recall correctly, over 24 hours. Once they let her loose from the bed she had massive renal colics and spent the next day lying in a bathtub crying in pain. That was Christmas Eve.

I trust her enough to have told the truth when she told me this story. If you don't think something is very fucked about that, you clearly lack a basic sense of humanity. That is the type of stuff that is done to thousands of patients in hundreds of clinics all over Germany. So yeah, what I experienced where I was at was nothing. Fifty meters away in the building next door, things were a lot worse.

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