The Audacity of Care

As mentioned in the last discussion topic, one of our forum members is currently hospitalized. All things considered, Alan Smithee‘s spirits are as up as much as be hoped. Her sense of humor is more or less intact. Still, there are serious frustrations and (what I would consider) degradations at play.

Pertinent Background: Four times in the last four days, since the day Alan was admitted by her doctor, I’ve gone to what is considered a perhaps better-than-decent teaching hospital in NYC. The first two visits were to the psych emergency room. The second two visits were to the inpatient ward. To be clear and fair, what I’m about to write is my opinion, some of which is derived from what Alan has told me of her experience…which is honestly good enough for me.

Some things that have happened in the last few days:

(1) Alan was first assigned a windowless shoebox of a room, with a sheet-covered bench and minus a clock, and made to wear paper.

(2) Alan has been informed of brand new and ludicrous possible diagnoses by psychiatric residents who’ve studied psychiatry for a fraction of the time Alan has spent dealing with psychiatrists.

(3) One of these new diagnoses was told to her in public. Alan was ambushed in a group session she was told to attend — a group for a disorder no one ever mentioned she may or may not have.

(4) Despite being an incredibly accomplished and intelligent person, Alan has been condescended to repeatedly under what I can only assume is the belief that mental illness makes a person stupid.

(5) Such condescension (I mean “condescension” in the most generous way) has manifest as clapping at her to signal meal time. That’s right, mental illness might also make a person a dog.

(6) This pejorative view of what Alan can and cannot comprehend has also led these newly minted resident doctors to decide that she should be informed of issues concerning her mental health and care on a need-to-know basis, wherein she is completely baffled by whom and how one decides what she needs to know.

(7) Alan’s attempts at (what she swears, and I believe, are calm and rational) voicings of reasonable frustration have been called “unsubstantiated anger” and have led to discussions of another possible diagnosis. I can only deduce then that treating a person with an operational vocabulary and the capacity for reflective critical thought as though they had neither would not anger just about anyone. I can also deduce that there may be no need to apologize if a person feels so disrespected.

(8) And for comic relief: I am glad that the hospital offers meal options that cater to dietary restrictions due to religious belief. Sadly, the hospital staff decided Alan’s relgion without inquiring and spent multiple meals feeding her accordingly, despite her attempts at clarification.

And those are some highlights.

(9) Oh. And she’s been called a liar.

Clearly, Alan’s functioning has been affected to the extent required for hospitalization. For the record, however, so much of what allows her to function throughout her life until this point is very much intact. Still, these frustrations and degradations have nothing to do with levels of functioning. I argue that a basic level of respect and humanity are prerequisite for treatment regardless of functioning or cognitive capacity. Have doctors forgotten the need for establishing trust with their patients in order to further treatment? Have they deluded themselves into thinking that psychiatry and psychiatrists hold any authority greater than that which their patients give them through that developed trust? (Sorry for the repeat question. I admit this is a hot-button issue for me.) Have they forgotten that the healthy development of self-worth is necessary for the treatment of so many mental health disorders and that such unabashed condescension does nothing but erode whatever self-worth is left? Do they fail to realize that this sort of unprofessional behavior only underpins, reinforces, and perpetuates the dehumanizing stigma that continues to keep people from treatment, that it only contributes to the shame-spiral so many suffer?

Lastly, what is an empowered patient to do when no one acknowledges his/her empowerment? 

  1. said:

    Update: Today (Day 5), Alan is being released (discharged). I will let her speak to her experiences further when ready.

  2. Natalie said:

    Really glad to hear the update, ∃. Because my immediate response was to say that an empowered patient should get the fuck out of the hospital if they are in way capable of doing so (this assumes their legal autonomy has not been unduly stripped, and that they have some semblance of support in the real world). Hospitals do not make people well, in fact, they very often make people quite ill. This can be said for both psychiatric wards and non-psychiatric wards alike – nosocomial (hospital-born) infections account for an alarming percentage of what people actually end up being treated for while in hospital, and I think this can be extended to mental health.

    If you treat someone like an idiot who is incapable of thinking, feeling, and acting in their own best interest, if you take away any semblance of human decency, if you constantly condescend and talk about someone rather than with someone about their own state of being, if you do not trust that the person in the body/mind/soul is the ultimate authority on said body/mind/soul…yeah, that will tend to fuck a person up. And if they were already feeling fucked up in the first place, well, seriously not the least bit helpful.

    We desperately need to reform our system of “care”…the first step would be to have a system that actually does. Care, that is.

    Alan – I’m thinking of you, and hope you’re on your way to finding the support and healing you need. I’m so sorry for the crap you’ve had to put up with recently at the hands of people who are supposed to “help.” Take care.

    (∃ – Yeah, this is a HUGE fucking hot-button issue for me too!!! We are people, first and foremost. People who deserve the same respect and dignity as everyone else – *especially* in our most vulnerable moments! And unfortunately, what we so often get is just the opposite.)

  3. erinire said:

    Just circling back round to the blogosphere – I was only hospitalized that one time and, by and large, the level of care I received was second to none. However, the first 12 hours of my internment were spent alone in a windowless room the size of your average bathtub. Twelve hours during which I had almost no human contact, received no medication, and got no sleep whatsoever. If I wasn’t crazy before that, I sure was after! (Haha. ha.) (ha.)

  4. Bee said:

    I know I’m a bit late to this conversation, but this terrifies and sickens me to my very core.

    I’m new to this, I’ve never been hospitalised for mental illness, but I have been for another health issues, and that was terrifying and objectifying enough.

    It sounds like being hospitalised for mental illness can be like being declared a non-citizen, a non-human even. Being stripped of the right to dignity and respect is terrifying. And it all takes place in a locked rooms with no windows where no one can see and advocate for your rights when you might not be in a condition to do so, or when all your attempts to do so are constructed as further signs of mental illness? That’s a sick system. What can be done? Can hospitals be sued for this kind of thing? What recourse is there to protect the rights of patients?

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