For the most part, the media gets PTSD dangerously wrong.
PTSD does not, generally, make a person violent. A kind, non-violent person will not acquire PTSD and then also the sudden unshakable desire to shoot up a grocery store. Sure, as within any population, you get your violent psychopaths. But psychopathy is a disorder that is distinct from PTSD and not something that comes hand-in-hand.
One thing the media got right though, is that we do have a tendency to get ourselves strapped to hospital beds and put on psychiatric holds.
I have technically only been admitted to the ‘psych ward’ once; last year, after I tried to kill myself I spent about five days in a psych unit. But I have spent numerous evenings with one hand and the opposite foot strapped down to a gurney, waiting for hours until a psychiatric professional condoned my release.
Here are a few things I learned from my experiences on psych hold:
All roads lead to the nurse’s station
I have been held for at least twelve hours on numerous psych floors. I lived for five days on a psych unit. Some were more barbaric than others. The one that was near the Latino neighborhood, where I had been picked up for throwing myself onto the street at night, screaming “Fuck you” to the driver who stopped to help me, and running away without one of my shoes, was especially unkind. Surprise surprise. But what I noticed about all of them, whether they made it obvious that they were medical prisons for the mentally ill or tried to disguise themselves as group homes, was that their hallways were always arranged in a circular pattern. No matter which way you wandered, you would always end up passing the nurse’s station, where medication was dispensed, and check-ups made. There was no escaping the Nurses’ Gaze.
The Nurses’ Gaze is a real thing
So what exactly is the Nurses’ Gaze?
You’ve probably heard of the Male Gaze, yeah? If you haven’t, the Male Gaze is the perspective in media and society belonging to men, which despite all the advances in feminism is still evidenced to be the dominant perspective, and which reduces female figures to icons of sexuality, “birthing goddesses” and passive vessels for male pleasure whether that be utilitarian, sexual, or otherwise. The term was coined by Laura Mulvey in 1975, and specifically referred to cinematic expressions, because in film at that time (and still too often today) men controlled the camera.
Well now Elizabeth Brico is coining a term. It may not be as poignant or universally relevant as Mulvey’s buuuut…it’s just as real.
Nurses rule the psych ward.
Yes, it’s the people with MDs who ultimately prescribe pills and sign off on release or detention forms, but it’s the nurses who dispense and decide. The Nurse’s Gaze rules the psych ward. The head nurse is the monarch on shift, and all of the other nurses are her minions, reporting back every interaction between patients, every off color remark, every phone call request and the contents of the call if granted, every untimely bathroom break; yes, really, even that. If the nurses decide that they see something a certain way, that is what goes in the shift report. They are the writers of history, in the psych ward.
And the Nurse’s Gaze is not kind.
Before a nurse out there gets huffy and says “I always treat my psych patients with respect:” I have encountered the rare kind psych nurse. When I had my five day stay, there was one nurse in particular who would hang out with us inpatients and laugh and listen, and she didn’t feel like a “plant” the way some of the others did. I believe that she was a genuinely good person, and that she saw us as human. She wasn’t a head nurse, and probably never will be.
In the Nurse’s Gaze, psych patients are less than human. We are aberrations. Weird little fleas just on the border of human existence. We are also all dumb; if one of us manages to mutter something intelligent, it is passed off as a fluke. If we dare to speak intelligently on a consistent basis, our intelligence becomes a part of our diagnoses. Under the Nurse’s Gaze we are reduced to statistics and quotations from the DSM-V. We have no identity outside of the ward. We are Inpatients.
I once ran into one of the Psych nurses at the park while I was playing with my daughters. Her Frisbee floated over to us and I returned it. She took it, without looking me in the eye, mumbled an apology, and returned to her friends. It was too much for her, I guess, to see a former patient alive in the sunlight.
The friendships you form in the psych ward do not always translate to the real world
You do make friends in the psych ward.
Not so much while on psychiatric holds. You’re kind of secluded, and distressed, and pumped with uncomfortable drugs, and strapped to a bed…but once in the psych ward, once you have come to terms with the fact that you are there until a doctor or judge says you can go, you begin to socialize.
And it’s actually pretty cool. Because, as Lewis Carroll wrote, “We’re all mad here.”
Those awkward social conventions fly away in the psych ward. You don’t have to worry about seeming too weird or fucked up; that information is already on display via your hospital band, lack of makeup, and the fact that you have to request basic conveniences like a telephone or shaving razor.
I made several friends in the psych ward.
One of them, Gordy, actually picked me out. Gordy had been on the psych ward the longest out of any of us. Something like six months. He was overweight (but what could you expect when he was being pumped with pills for six months and allowed no better exercise than to pace the circle and use the nurse’s station as his lap marker), pale (again, what could you expect) and had the tendency to stare at you without blinking (that was all him). He looked no older than sixteen to me, but this was an adult ward. I think he developed an instant crush on me. I guess he couldn’t really be blamed for that either. The other two women on the ward were my sixty year old roommate with a skin-picking problem, and another teenage looking girl who was sweet, but had the awkward habit of touching her genitalia in the midst of a conversation.
Gordy made me uncomfortable at first. I don’t like eye-contact and he insisted upon it. But then I learned that he was autistic, and a heroin addict, and I became interested. Turned out he was pretty nice and caring, and though there was a demanding nature to him that normally would have turned me off, my options for friendships were quite limited.
He now has my number and social media accounts blocked.
He was going to submit a monologue to my theatrical production on addiction, but when I called him “honey bunch” in response to his aggressive demands to meet with him at his specified times, he flipped out. His aggression and my responsive condescension fit with the dynamic of the psych ward, but not the real world.
Then there is DJ Parade. DJ Parade was my savior in the psych ward. They are transgendered and have dissociative identity disorder, so “they” is, in fact, the correct pronoun, not just me forgetting my grammar. In the psych ward, we were practically inseparable. We sat together for meals. They helped me navigate the meal ordering system so that I actually received vegan food that I could eat and was no longer starving. We had more than one midnight crayon-coloring session. They let me vent about the problems I was having with my husband, who was furious with me for attempting suicide.
Now, don’t get me wrong. I love DJ Parade. I still care very much about this person, and appreciate their help in the ward. I still wish them the best. I still follow their life on Facebook and send them healing energy when they need it. I still hope to see them again someday.
But the one time we hung out outside of the psych ward was a shitshow. Their intense, bouncing energy brought much needed lift to the droll, circular psych ward. Their aggressive ability to speak their mind-no matter what was on their mind-was refreshing among a battalion of tight lipped nurses and depressed inpatients. But when they came over for lunch with my family, their wild energy frightened my girls and stressed me out. In the real world, where everything is too fast already, their hyperactivity became one more thing to work through.
There is always someone more screwed up than you
I spent the early part of today at a Family Court Services evaluation, during which I had to recount some of the worst instances of my abuse in an effort to save my nine year old autistic son from his sociopathic biological father. I spent a lot of the interview shaking and cold with fear. When the interviewer walked me out, there was a look of shame on his face, as though he were sorry for having forced such horrific information out of me.
Despite the disturbing scope of my abuse, however, in the psych ward, there is always someone who’s had it worse.
My roommate, for example, was marred by a terrible skin-picking problem, and also unable to admit that she was addicted to opiates. When my daughters visited me, the nurses had to force her to leave the window, where she had been hovering with an enormous smile on her face, tears in her eyes, begging to hold my baby, because her own infant had died.
Gordy recounted some pretty terrible instances of childhood abuse, and also that he had witnessed his girlfriend die by heroin overdose.
DJ Parade spoke with boisterous authority about decades of ongoing abuse.
The nineteen year old who had a tendency to touch herself revealed that even at her young age she had lived through multiple heart attacks.
Then there were the people whose stories I never heard. The elderly Japanese woman who paced the ward on loop, raising and lowering her arms day and night to keep the blood circulation flowing. The African man with the gawking smile plastered to his face in perpetuity. The young man who never changed out of his blood spattered hospital gown. The gay tweaker with the thick scar across his throat; an aftereffect of a suicide attempt.
Trauma can’t be ranked by the higherarchy of believability that we so often place on other people’s stories. Trauma is trauma; the measure of a severity derives from an inward scale. It can’t be quantified based on outside guidelines. In any case, there is always someone more tragic, more dissociated, more haunted by memories. No matter how screwed up you are, in the psych ward, there’s always someone who is doing worse.
You are insane
If you are in the psych ward, you are insane. In all aspects. Nothing you say is true or believed. When I was sent to the hospital after attempting suicide, my husband was extremely angry at me, and he expressed it in ways that I considered immature and unfair. I won’t go into all the details, but I broke down into tears more than once. And got diagnosed by a student doctor with Borderline Personality Disorder because of it. It never crossed his mind that I could have had a legitimate reason to be that upset. I was insane.
This was common treatment. I watched other inpatients go to the nurses with legitimate complaints, get ignored or condescended to until they became reasonably angry, and then punished or medicated for it. None of us were taken seriously. Our hospital bracelets were the only things that spoke for us; our voices did not matter.
And this carries out into the real world. Once it’s in your record that you have been to a psych ward, people take you less seriously. Being labeled as “crazy” is one of the worst things that can happen to someone with PTSD. Yes, sometimes the magnitude of my trauma causes me to break down and become suicidal, or behave in a way that seems erratic and without logic to people who don’t understand that I am experiencing a flashback to a real event when such behavior would have been expected or at least accepted. That does not mean I am a nut-job. It means that I have survived experiences which are far beyond the borders of normal human experience, and my mind and body are having difficulty integrating them into a continued, cohesive life pattern. The PTSD stigma is real, and it is damaging.
You are not free
This is the biggest takeaway from my visits to the psych units. Whether it’s a 12 hour hold, a 72 hour hold, or something longer, once you are deemed incompetent to care for yourself, you are not free until someone returns your competency status to you. If you shout, or even argue passionately for your freedom, you will be strapped to a bed. It is supposed to be a security measure, to ensure your own safety and the safety of others on the ward, but the reality is that it is used as a punitive measure when people are annoying. I never behaved violently or threatened anyone when I was on a hold. But I did ask, sometimes tearfully, sometimes loudly, to do things like use the phone, the bathroom, or to go home. And that got me strapped down. Because I bugged the nurses. Because I wasn’t docile. Because I rebelled against imprisonment.
When I was admitted after my suicide attempt, I made it clear that the attempt had been a reaction to a specific trigger which had passed (my birthday, which was the anniversary of an especially atrocious assault). I demonstrated that I was not suicidal by planning for the future, pumping breastmilk so that I would not lose my supply, and visiting with my family. I even behaved well. Still, doctors would not agree to release me unless my husband said he was okay with me coming home. My husband had control over my freedom. The doctors (all male) had control over my freedom. A bunch of men had control over my freedom. It was an infuriating and triggering experience.
Make no mistake: The psych ward is a prison. If you send someone you love there, know that. Know you are sending her to prison.
The American mental health system has undergone a number of changes in the past decades, some good, some bad. It still needs a lot of improvement. My experiences on psych wards were dehumanizing and overall re-traumatizing. The biggest and most solid piece of advice I can give after sharing the big lessons I learned in there, is to really examine a loved one’s distress before having a psychiatric hold put on her. We have been socialized to immediately discredit a person if she is sobbing too loudly, talking too quickly, or dressed in a disheveled manner. Sometimes these are signs that what she is saying is true, rather than the opposite. Psych wards will release people if they are not an immediate threat to themselves or others, but make sure that you really, honestly believe that a person is dangerous before sending them away, because even a few hours on a psych unit can be traumatizing.
Next week, we will hear from someone who worked in a facility that was very different from the ones I visited. Subscribe on the sidebar (or beneath the post on mobile view) if you want to make sure not miss a description of a positive mental illness treatment facility.
Do you have any experiences on a psych unit? What did you learn?
If not, what did you takeaway from my lessons? Was any of this information new? Let me know in the comments!
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