You already know I have a profound difficulty with letting things go. So it should not come as any kind of surprise that I feel like writing yet another confused pile of words about my visit to an acute care ward at a hospital that makes a joke of all of Australia’s collective governments’ claims of wanting to take mental healthcare seriously.
I am also going to admit something that also probably does not come as a surprise to anyone. My thought process is, at the best of times, a confused mess. That old pearl of wisdom I refer to occasionally about how our intellect serves our emotions, not the other way around. No better case study in that exists than me. For me, positive emotions and intellectual stimulation are inexorably linked. Anything that gets my brain to do something other than repeat things to itself or attempt to buffer out the drudgery of the world around it can produce visible highs. But certain stressors such as repetition of requests that I cannot possibly continue to comply with also have a visible and dramatic effect upon my affect.
This is why moving from Queensland back to Sydney was such a source of elation in the initial stages. Although I got off to a very bad start, the level of intellectual and emotional stimulation that was offered in the “new” environment made me wish I had come back sooner. I guess it takes a profound and unpleasant revelation to really get some wheels turning. And whilst enough of the local populace persists in dawdling or even coming to a complete halt in the path of thoroughfare to make me snarl at them to go back to Queensland once a day, enough of them do not that it makes a big difference. Do not let ruralists bullshit you. People treating their (and your) time as important enough to get a move on is a good thing.
You know that saying about how time is money? Well, it seems to have been supplanted in our exploited, taken-for-granted present day with the statement “it is only free if your time is not valuable”. I heartily endorse this saying. My moron male parental unit, he not only will go on and on about how you can do anything that you can do in a city like Sydney in the hick bum-fukk village he calls home (you cannot), but he conveniently ignores the fact that for many, even very rudimentary tasks like shopping for groceries are not only more difficult, but incur measurable additional monetary costs in the bargain.
People have tried to straw-man my comparison of modern-day Sydney (especially Central Western Sydney) with Brisbane. They have tried to ignore vital components of it. They have tried to focus on an entirely irrelevant demonstration of how my decision-making process is adversely affected by stress. But the thing they just cannot get past is that not only is Queensland a poor example of how a society treats the little niche of Human-kind that I represent, it is also a poor example of how to treat anyone living on the fringe.
When Prime Minister Julia Gillard finally did something that a person worthy of calling themselves a leader would do… let me start over. Australia as a society, as I have already stated, has the highest level of poverty in its disabled population compared to the rest of the OECD. When you stop to consider that this list contains such “rife with corruption” countries as Mexico, that is just plain shameful. Julia Gillard is the first Prime Minister of Australia who has looked at this shameful situation and deemed it unacceptable. So when she did this, it revealed the true colours of many parts of Australia as a society. Regardless of what party line you vote, if you do not believe that considering 55 million dollars to start rolling out disability insurance among your state’s populace less important than 110 million dollars for horse racing is utterly despicable, then you are utterly despicable.
New South Wales has the distinction of being the first state to say that as far as they are concerned, the National Disability Insurance Scheme (that is, an expansion of Medicare to cover disability) is a done deal. It has now also been passed into Federal law, sure, but New South Wales stepped up to the plate and said they would bring it in, and did so months before the scheme became Federal law. So the next time you want to tell me how nice and wonderful Queensland is, you can shove anything you have to say to me up your arse and pull it out sideways.
However, the problem of disability service reform is more than just money. As I believe the cases of both the mentally ill and the autistic prove, money can do nothing so long as the only people offering the service are simply charlatans with profit as being their only goal. And in today’s conservative, profit-to-the-point-of-madness-driven economy, charities (or “charities”) with profit for their owners/staff as their sole goal are inevitable.
Proponents of the National Disability Insurance Scheme, the organisation known as Every Australian Counts being a good example, are quick to emphasise that the NDIS is not about charity but rather investment. The logic being that if individuals with disabilities that keep them out of society are given more of a welcome in, they will participate more and thus bring more revenue into society. The problem from the point of view of the autistic and the mentally ill being that as groups, we have seen it all before. There is always some Great New Initiative coming around the corner that will change our lives for the better, and when it finally does come, what we tend to end up with is zero change, zero improvement, and just more of the same with a new name.
As I have hinted elsewhere, it is not a coincidence that I told one of my mother’s younger brothers that I would have rather have spent the prior eight to ten years in prison than Queensland. There are many factors that drive this feeling, the attitude citizenry have towards both themselves and people outside of their social group being a big one. But the biggest problem for me when I returned to Sydney was going from one place of knowing neglect to a place of unknowing neglect.
Having a case of what I sometimes term “the terminal sads” does not go away over time. It stays with one for a long time, especially when there are other complicating factors involved.
I have said a number of times that it takes quite a lot to piss me off to the point where I will no longer recognise an individual’s Humanity. The Wright family, the bastards leading the charge to have every autistic individual on the planet murdered, would be one example of that. In spite of how mad I might have felt at different times at different people during my hospital visit, I do not think I ever really found myself absolutely voiding their Humanity.
This is not to say that I was completely relaxed or comfortable all or even a large amount of the time. In fact, I had to distract myself from where I was using any and all means that I could.
I am not going to wax lyrical about the failings or trappings of the mental health care system as it exists this time around. Instead, what I am going to do is provide a few hints concerning how to survive a short stay in an acute care facility. Note that there are a lot of ifs and buts with each point on the list, and it is written entirely with my own neurology in mind. Your perspective may vary. But if you are among the fifth of a fifth who, for one reason or other, finds themselves a resident in a mental hospital for any length of time, these pointers will really make a difference in your experience.
- Make sure people you can trust know where you are.
I cannot emphasise this point enough. Even if you are like me and only have family that you can hardly stand the sight of, or friends that make you cry in frustration, make sure they know where you are. You do not have to give the doctor(s) consent to talk to these people, but having people out the outside whom you trust to arrange things for you know where you are is a big plus.
- Bring (or get) changes of clothing.
One reason to have people you can trust to arrange things for you know where you are is so that you can have access to things outside of the ward that you may need. Clothing is one of those things.
It might come as a surprise unless you have been to a mental health care facility before, but they can be rather dirty places. And I do not mean in terms of how they are maintained. Rather, I mean that some patients will have rather low standards of personal hygiene or the maintenence thereof. You just never know when one might throw up on you (or worse if you are not vigilant about keeping your distance).
Everyone has times when they wish they had a spare set of pants or a spare shirt with them. In a mental health care facility, the chance of one of those times occurring goes up dramatically.
- Communication is an essential skill.
Communication is a subject of both controversy and study among many different professions. In The Hitchhiker’s Guide To The Galaxy (the real one, I mean), the narrator finishes an entry on the Babelfish with a statement that by removing all barriers to communication, it has caused more and bloodier wars than anything else in the history of the universe.
I love conversations. No, that is not merely a quote from the Cadaveria song Atypical Suggestions By A Dead Artist. But the qualifier to that statement is that I love conversations with people whom I respect, admire, or in a handful of cases want to play hide the stump with. What I do not love is conversations with people I do not respect, look down upon, or feel angry at.
Even when we are sitting perfectly quiet and still, we communicate something to observers. Recall in the introductory scene of The Silence Of The Lambs where Starling’s boss is instructing her about her mission to interview Lecter. If Lecter refuses to talk to her, he says, observe what he does. If he is drawing sketches, what is he sketching, is the example that springs to mind. Professional psychologists and psychiatrists are trained in this skill, of inferring things from observation. However, when it comes to inferring the right things, observation comes a very distant second to direct communication.
The question also exists of exactly what to communicate to which professionals. Nurses will listen to what you have to say to them, especially when they are on guard duty and need something to break up the boredom. I must admit that I admire their ability to maintain an intelligent conversation with someone like myself and watch the myriad of concerning behaviours that the patients enact. But if you tell them something that will make a doctor rather concerned, chances are they will report it to the doctor in control of your case.
Doctors are also a bit of a puzzle in terms of communication. I was merely lucky in that I was assigned one who understood that I have a peculiar, roundabout way of getting my point across. But it is important to know how to get the best results out of discussions with any staff member in a mental health care facility. First, know what you feel is important for them to know. For me, it was vitally important for the good doctor to know that I have been subjected to a long period of mistreatment, that I am averse to medications as a result of that, that I have diabetes, and that the overemphasis of that fact annoys the hell out of me. Oh yeah, and that I am autistic.
Another point to bear in mind with doctors is that the more information you give them, the better informed their decisions are. No medical practitioner likes to have their job thought of as being easy, and being as informative as you possibly can goes a long way. If a person whom they are speaking with about your care (for example a spouse, another doctor, or a relative) bothers you and makes you feel concerned, explain why.
One thing to remember during a stay in any mental health care facility, especially when you are being told you cannot simply leave when you wish, is that it is very easy to talk your way into the facility. Talking forms a major component of the manner in which one can get out.
- Try to have some form of method to keep yourself amused.
Ninety-nine percent of conflicts between patients, or incidents of patients acting in a manner that disrupts the ward’s harmony, can be traced back to one deceptively simple thing. Namely, boredom. It should come as no surprise to anyone familiar with the public health system that public mental health care facilities are very threadbare and generally do not keep many forms of entertainment available for the patients’ use.
I had three major devices with me during my stay in the acute care ward. A mobile phone (more on this in a moment), an e-reader, and an iPood. Reading multiple George Orwell novels in a mental health care facility has a certain ring of irony to it, but it at least keeps the mind from going into overdrive in the absence of stimulation.
I think it is redundant to say that being talked into ingesting a pair of medications that have effects on the neurochemistry changes the manner in which one enjoys reading or listening to music. Or rather, the effect that the medications in question have on one’s neurochemistry changes the manner in which one enjoys reading or listening to music.
(At this point, some kudos are due to Apple for the iPood Classic. This little music box with its 140-some gigabyte capacity can store enough music that one can continuously listen for more than two weeks and still not hear the same song twice. Favourites during my stay on the ward included Battle Of Mice, Agoraphobic Nosebleed, and Slayer. Go figure (at least in the latter two cases).)
Being able to sit and chat with another resident on the ward is also a good thing, but do not count on it. That saying about how it takes all types does not apply when it comes to passing the time through social interaction. When you need to pass large chunks of the day by conversing with another person, you really need to make sure you can at least listen to them for a while.
- A word about mobile ‘phones.
Just about everyone and their dog has a mobile telephone device these days. The devices themselves have their good and bad points, of course. One of those bad things is their insistence on trying to do everything that their designers can fit into them, and in so doing, doing none of them especially well. A stunning example of this is the mobile ‘phone camera.
It may come as a surprise to particularly dense individuals out there. But cameras of any kind are a no-no at mental health care facilities. I do hope that nobody is surprised when I say this, but the most difficult thing for the autistic and the mentally ill to deal with is the ignorance of outsiders.
Hence, it should not come as a surprise that few, if any, patients in any kind of mental health care facility would want to be photographed in there. There are positive prejudices (yes, I know how that sounds), and there are negative prejudices. The prejudice that normies have against the autistic and mentally ill goes beyond negative and goes several light years into irrational, confused, and dishonest. Small wonder, then, that not only would a lot of patients prefer to keep their visits to hospitals to themselves, the administrators of the facilities would rather ban all photographic devices from the grounds.
Hence, if you reveal to the staff during the admission process that you have a mobile telephony device with you, they are going to want to know a few things about it. Especially if it includes photographic functionality. And if it does, they are going to want to take it from you and lock it away in a place where making use of it will not be possible. You will get it back when you are discharged, but that will not help if you need to communicate something to someone outside in a hurry.
Fortunately, there are mobile telephony devices still available that do not have cameras wedged into them. And if I may be frank, manufacturers, I hope that continues to be the case going forward. When I want to take photographs, I will use my Nikon D5100 for the job, thanks very much. As Anton Chigurh says so well, you pick the one right tool for the job. So once my uncle was able to take me home for a couple of hours to get clothes, I also got him to take me to acquire a camera-free mobile ‘phone. Thus, I was able to have a textual conversation with one of the few people left in the world that I wanted to be out of the ward for.
- If you feel unsafe, threatened, or uncomfortable, do not hesitate to talk to staff about it.
Whilst I say that the prejudice mainstream society has against the autistic and mentally ill is based on irrationality and ignorance, that does not mean there are not patients around who act in the manner that normies are so afraid of. There are. In one previous writing, I spoke of one who seemed to have his mind destroyed by drugs. There was also one individual who, I heard one person proclaim, was on the ward as an alternative to prison.
This gentleman picked fights with just about everybody, but with one real qualifier. The people in question were usually significantly smaller than him. And by significantly, I mean he towered over them and usually had a hundred-pound weight advantage. One individual who was on the receiving end of this behaviour was an elderly-looking man whom this aggressor kept shouting out was a pedophile.
Unfortunately, in a ward where there are at most ten nurses and thirty-some patients, segregating the patients from one another is difficult at best. The nurses have to adopt, and remain in, an emergency-basis stance. So patients generally have to do their level best to avoid people who bother them, except in one circumstance.
Generally, if one patient goes to a staff member and says something like “this asshole is bothering me so much that I want to kill them”, they will react accordingly. Indeed, they tend to “profile” the patients. They brief one another on who the ones most likely to cause difficulties are, and whom the recipients of difficulty are most likely to be. I would have loved to have been a fly on the wall when I was being discussed. All kidding aside, however, enduring distress in silence is never a good idea in any mental health care facility.
In fact, you could even say it defeats the purpose.
- Above all else, keep a sense of humour.
This is a tricky subject. There were times during my stay on the ward where I would simply end up giggling like I was high on illegal substances. There are serious aspects to any stay on this kind of ward. For instance, it is always a good idea to remember that attacking a nurse will get you carried off to a more secure ward where nurses consider it standard protocol to restrain you by bending you into uncomfortable positions.
This is not to say that I did not lose my temper with and shout at one or two nurses. I did that. But having a sit-down and thinking about why I lost my temper usually cleared everything up for me. It was not that I regretted the manner in which I behaved. When you take a person like me out of their normal routine, dysfunctional as it might be, and by the force of police at that, you forfeit any right to complain about what I do.
That said, joking about one’s situation can also help expedite one’s release a little. As weird as this sounds, the staff in units such as these constantly write little observations concerning the behaviour of patients on the ward. It cannot possibly have gone unnoticed that I was going from excitedly giggly to downright sad at the drop of a hat. But during times when I was more giggly and excited, I was also more pleasant for all concerned to deal with. (The way I noticed this is that they, in turn, were more pleasant towards me. Funny how that one works.)
- This might seem silly, but try to avoid giving the staff the impression that you are going to attempt escape.
Mental health care facilities are not fun places to be, even for people with twisted senses of humour. And being told you are not going to be allowed to leave when you expect, or even at all for the immediate future, can be rather frightening.
I am going to relate two stories to illustrate the point here. One happened whilst I was on the ward. The other is an anecdote I was told by another patient. I will start with the latter first.
This fellow patient, whom I had frequent conversations with, told me of a time when he was on the same ward years ago. Another patient attempted to climb a known weak point in the fence that segregates the ward’s exercise yard from the rest of the hospital grounds. Although the weak point in question is climbable if you are fit or can rustle up the right aid (generally, pulling up a chair), I do not advise trying. The nurses know of this weak point, and although they do not watch over it like treasure, getting over the fence at this point before they notice you trying would be quite a feat. Anyway, the anecdotal patient attempted this, was quickly brought down from the fence, and had to do some explaining to the doctor. The funny part is that, according to the patient relating this story to me, the anecdotal patient was told he was definitely going to be released the next day.
As the patient telling me the story put it, he had effectively added another week to his “sentence”.
The other story involved another patient who was on the ward at the same time as I. Now, this patient, she seemed somewhat more intelligent than most of the rest of the pack. But when told she was not going to be let out when she desired (in most patients’ cases, “when desired” usually means more or less right now), she began to stare intently at this part of the fence, from a distance of approximately ten feet.
Needless to say, this resulted in the nurses having a bit of a camp-out near her. Several hours passed like this, with my conversation partner and I occasionally stopping to discuss whatever progress in the situation became apparent to us from across the yard. She was eventually brought back in, but her desired release from the ward would have been further away than ever.
Then there is the little matter of where one is going to go if they should succeed in escaping from the hospital entirely. (Note that this entails more than just getting out of the ward. It takes a good fifteen minutes to walk from that ward’s doors to the usual entry point that ambulances use. More time is entailed by getting to the nearby park or any useful point of transport. The train station would take at least half an hour’s walk from the aforementioned entry point.) Going home might do for a spell, but that is the first place the police are going to come looking for you.
Yes, escape is a thought that occurs to most individuals at least once per week-plus stay. But it is a poor option compared to making an articulate case for an officially-sanctioned release.
- Finally, be aware of your rights.
You would be amazed at how often the doctors in a mental health care facility hear patients make threats regarding legal consequences for the manner in which they are treated. Doctors, and to some extent nurses, find this funny not because they do not take threats from patients seriously, but rather because they already know what the outcome of a legal challenge would be. Contrary to the delusions that Scientologists maintain, it is difficult from their perspective to get a patient placed in a mental health facility on an involuntary basis.
In fact, it involves a sizeable amount of paperwork, a lot of back and forth with other doctors, and a lot of general arse-covering. If this is a genuine surprise to you, well, welcome to the real, litigious, under constant survelliance world. If you think in a world gone mad with everyone being a turnkey and looking up one another’s blockholes, a badly-understood profession like mental health care can just do whatever it pleases, then I have some beach-front property in Blacktown I would like to sell you.
Get your doctor to explain everything to you, even if you think you already understand it. Get them to explain why you are there, and why you cannot just up and leave when you want. Although the paper trail is a hard slog, there are patients who can tell stories of coming into the ward on a voluntary basis, only to be told the doctor has filled out the forms and it is now all involuntary.
(That, by the way, is a sore spot with nurses and patients alike. Whilst there are reasons for doctors to have the ability to do this, I will agree with some patient advocacy groups that the process needs a lot of improvement. When a lot of first-time patients come in thinking that they are there voluntarily, only to be told what translates to them as the doctor has changed their minds and you are now here involuntarily, it frightens them. Hell, it frightens people who need more than both hands to count the number of times they have been admitted. Hearings, or at minimum conferences with impartial parties present, should be involved.)
Remember something in all of this. The nurses are just working stiffs who have a work routine that is barely a step above that of a prison guard. Getting angry with any display of ignorance on their part is fine, but a line should be drawn at making it personal.
The doctors, for their part, have a specific goal with each and every one of their patients. And it is the same goal as doctors in every other part of every other hospital. To make their patient “well” again. How the patient definies well and how the doctor defines well might end up being different things, but by maintaining an adversarial relationship with your doctor, you only accomplish extensions of your stay.
(At this point, it is worth talking about the doctor-patient relationship between Doctor Peter Teleborian and Lisbeth Salander as written in Luftslottet som sprängdes, and the Swedish television adaptation thereof. Understand that the events described in this fiction, whilst based on things that may indeed have happened (and did happen all too often in an earlier time, as touched upon in the film Changeling), are such an extreme case of the system being abused that the chances of it happening to you are one in a number comparable to the distance between your present position and Proxima Centaurii. That is, somewhere around 401,134,972,037,426 kilometres. If you do find yourself being brought to the lock-up ward by the police, try to stay calm, remember these odds, and above all be nice to your doctor.)
***
In conclusion, my stay in an acute care ward of one hospital that is treated like the cousin nobody wants to admit to was at all times revealing, interesting, and enlightening. Whilst there are only a small handful of people I would wish it upon, I met none of them during my actual stay.
To the people I did cross paths with during my visit to this ward, I have one thing to say here. Just keep on going. Keep trying, keep living your life your way, and keep on being what you are. Even if you are not as active and vocal about it as I am, together we are the fist in the face of normalism.
I Still Find It So Hard... 