Psychosis is an abnormal condition of the mind that involves a “loss of contact with reality”. People experiencing psychosis may exhibit personality changes and thought disorder. Depending on its severity, this may be accompanied by unusual or bizarre behavior, as well as difficulty with social interaction and impairment in carrying out daily life activities.
Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home.
– Descriptions of the two major types of mental disorders found in the ward.
There were two types of people on the ward – those suffering from psychosis, and those suffering from depression. They were easy to tell apart. Those who were psychotic either exhibited bizzare behavior, such as glossolalia, hallucinations, or obviously flawed social behavior, or else didn’t by virtue of the fact that they were so heavily medicated as to be hardly more than shells of human beings, shuffling along slowly like movies of their lives played at half speed, and responding in monosyllables when spoken to. No two in the ward were more than vaguely alike, he discovered. His roommate whom he overheard the nursing staff talking about, was admitted for seeing visions. He was so heavily medicated that all he seemed able to do was move slowly from one place to another. He never spoke unless spoken to. There was the wild-haired man who stared intently at everything, as though in deep concentration, his eyes glittering and wide. Polite in a manner that suggested rigid control of every thought, movement, and word, he would nevertheless at times approach a staff member to inquire whether there was someone in the ward trying to steal his beard, or whether his head had fallen off. There was the woman with glossolalia, who had conversations and sometimes arguments with things unseen. She would on occasion break into song, singing hymns in a voice that suggested years spent in a church choir, but could never get more than a few lines before she would struggle to remember what came next and eventually lose the thread of the song altogether. There was the apple-faced man who was charming and friendly, if incoherent, but would without warning explode into violent outbursts of screaming and hitting himself and swearing. There was the seldom seen walker-man who simply seemed dazed and confused by everything, and spent almost all his time in his room.
The depressives formed the other group – his group. Higher functioning by far than the psychotics, they were the ones who attended group activities, were more social, and interacted more. They could carry on conversations and relate to the staff on a more normal level. Mostly they sat around being shell-shocked and dazed because of the events that had brought them to be a threat to self. There was the woman with PTSD, who talked about her husband and the beautiful home they had once shared until a home invasion turned violent had destroyed their dreams. There was the man who was there for losing control during an argument with his family when the pressure became too much. The woman stressed by losing her home and feeling that she was a burden to her family. The man depressed because his health was failing. The woman who was simply sad because she had grown old, and wondered if it was worth going on.
And him of course.
The depressives were largely functional. They wanted to get better, get out, and get home to whatever support system and family they possessed. The psychotics were to varying degrees nonfunctional – they didn’t attend groups or participate in group activities, their behavior was abnormal, and many of them seemed to possess little or no support system or family to go home to (at least one of them was homeless, and the staff was working to find a shelter that would take them). The depressives were able to bond as a group and individuals, have conversations, talk about things, and support one another. The psychotics were in their own individual worlds, largely cut off from everyone else in the ward, including the staff who often struggled to determine what they actually wanted or needed based on their often convoluted statements. The depressives benefited from social interaction, counseling, and therapy. The psychotics benefited from medication and having a roof over their heads instead of being on the street.
The ward was too small for them to separate like oil and water, but little beyond the most basic communication and conviviality passed between the two groups. The depressives simply couldn’t relate to the problems of the psychotics, and the psychotics couldn’t relate to the problems of anyone.
The third group on the ward was the staff. With few exceptions they were dedicated, hard-working, enthusiastic, and positive. With few exceptions they were also in over their heads, working long hours, wearing too many hats, dealing with too many patients with too few resources. If there were failings in the ward, they were not the staff’s failings. If there were those who were not helped in the ward it was not the staff’s fault. The flaws that were there were systemic flaws, and the staff threw themselves at those flaws every day, trying to make up for what was lacking by sheer determination, compassion, and creativity. That they failed sometimes was not their fault, and was not for lack of effort on their part. If sheer grit were enough to make the ward great, to make the ward successful, then the ward would have been a place of profound healing and new beginnings.
He met with his supervising physician, the person who held the metaphorical keys to the locks on the doors. The person who could set him free. They talked for perhaps five minutes. He tried to be unfailingly positive, to present a sane persona – the sort of person you would meet at the supermarket or on a train, not the sort you would meet at a locked facility. The physician seemed friendly enough, if (like everyone else) overworked. “I’ll leave a note for tomorrow’s staff about your release.” the physician said.
He thought that meant that he was getting out. His 72 hours were at an end, after all, so it made sense. He called his wife to let her know. He started counting down hours.
His wife was visiting, and their time was at an end. They walked to the nursing station to ask about the procedure for release, what time she should be there to pick him up, etc. The nurse, a very nice and professional French woman, let him know that he was now being held under 5250 for up to an additional 14 days – he was not getting out tomorrow. He might not be getting out for awhile. The physician was holding him under “extreme disability” and had written that he was still severely depressed and was still planning suicide.
He felt sheer terror. It was like all the movies about horrible mental institutions were coming true. He was in Bedlam. He was in Arkham. He was in One Flew Over the Cuckoo’s Nest, and wasn’t even Jack Nicholson. It wasn’t simply that he didn’t feel the assessment to be true, and it wasn’t that the physician had misled him (he reviewed the physician’s final words to him over and over and eventually realized that they were absolutely true – just disingenuous). It was that the physician had lied. It had to be lying, because they had never discussed suicidal ideation during their brief meeting. He wasn’t suffering from extreme disability either, he felt (though he wasn’t as sure about what extreme disability meant, he did think he was one of the higher functioning patients in the ward. Maybe all patients thought that, though).
He was potentially facing an additional fourteen days in the ward, and he didn’t feel like he had been even consulted on his wellness, in fact, not even assessed.
The kindly French nurse was quick to point out that the 5250 did not mean that he would necessarily be in the ward for the full fourteen days. He would be let out at the physician’s discretion any time during that period, unlike the 5150 which mandated a 72-hour stay. She was professionally sympathetic – this had to be a situation that the staff dealt with a lot, and they were all smart enough and well-trained enough and empathetic enough to know that it was a truly shattering moment for any patient.
(He would notice throughout the following evening that several staff members went out of their way to check in on him, to talk with him, to even touch him on the shoulder or arm occasionally – which the staff otherwise never did. It was the best they could do to be sympathetic and kind and supportive of him in the face of bad news. Like so many things on the ward, it didn’t help, but it was not for lack of trying on the staff’s part, and he was grateful).
His wife got the physician’s phone number and they decided that he would wait to contact the patient advocate until he had talked to his physician the following day. The risks of causing trouble were simply too great to proceed in any manner but caution. Something had gone seriously wrong somewhere (the form, he thought, something had gone seriously wrong days ago when he filled out that damned form), and stirring things up without first understanding what was happening could potentially make things worse.
His wife left. She had to because visiting hours were over. In the midst of a shattering revelation, he was without her again. The nice French nurse explained that normally they waited until later to discuss these matters with patients. He thought that was a pretty awful way of doing things from the patient’s perspective, and while allowing that it probably made things easier for the staff not to have to deal with potentially belligerent family members while 5250ing a patient, imagined all sorts of unpleasant reactions he might have had if his wife hadn’t been there to help support him during those initial moments of shock.
Fourteen more days.
There was no way to approach that mentally except as a whole. The fact that he was being held longer than his 72 hours for reasons he didn’t understand made it impossible for him to convincingly argue that it would only be another couple of days, not the full two weeks. He no longer felt he understood what was expected of him. He no longer felt that things made sense. He no longer felt that he was dealing with a system that, while potentially flawed, was at heart rational. His physician’s notes made no sense (he’d lied). And the bond of patient-caregiver trust had been shattered (because he LIED!) so there was no longer any assurance that decisions about his care and treatment would be made in ways that were sensible and beneficial.
He lay in bed watching his blood oxygen monitor, greeting the nurses who came in to do bed checks every ten minutes, and to check the monitor every ten minutes, just so they would know he wasn’t asleep. Fuck sleep, he thought, I have to wrap my head around this by morning so I can have my game face on again.
The physician had prescribed a sleep aid for him, but it was at his option whether to take it or not, and he had decided not to that night. In his experience, sleep aids made him groggy all day the day after he took them, and he felt too vulnerable to risk it. Tired was not much better, but it was a little bit better and that was all that was necessary.
There really was no wrapping his head around the problem though – he didn’t have enough information. He didn’t understand what had been done to him or why, and without that knowledge coming to any conclusion that wasn’t pure speculation was impossible. So he played with the blood oxygen monitor, again trying to voluntarily lower his heart rate.
After two hours of trying he wasn’t able to lower it below 81.
No one had asked him why he was depressed.