Thursday, August 10, 2006

they stuck me in an institution, said it was the only solution

every week, we have 90 day conferences with patients on their progress. mostly, their only statements on record are some form of "get me the hell out of here".

ms. x is different. she has been at the psych hospital for a few years, and wants nothing more than to stay there. she is a schizophrenic, paranoid type, but because of her meds is completely lucid and engaging. she is different from most of the other patients: college-educated, articulate, the product of an average middle american family and a "great childhood". she has a work assignment, is an ideal employee and looks forward to being visited by her family.

the problem is, they have little reason to keep her at the hospital because she is doing so well. so the hospital and ms. x have a little game: they see she's doing well and talk about sending her to the step-down board and care, and she starts acting loopy. she's smart enough to know what she needs to do to stay there and does it.

at her last conference, she laid it all out for us on why she wanted to stay. ms. x is about the same age as my parents (mid fifties), and i can really see the 1960s ideals in her. she was always expected to have the same life as her parents: get married, have kids, have the house, etc. but she didn't want that life and acted out. she was homeless for periods and took drugs. she committed crimes, got arrested and sent to the hospital because of her mental illness. now that she's here, she has everything she needs. she gets the structure of having all her needs met, having a job that gives her peace and a sense of accomplishment, and feels that she is in a safe place. the outside world, including the step-down place, doesn't have those guarantees. she cannot imagine going back to it now.

my attending argues that she has such great potential and would have a much better life outside, but i disagree. she dropped out of society for a reason, and by her own admission, there is nothing out there that would be better than where she is now. our rewarding lives out here mean nothing to her, and trying to sell her on it is a waste of time. but the law is the law, so she very well might find herself essentially kicked out. i reckon she'll do something to get back in, maybe for good. i'm hoping that won't be the case, as some of the people in the conference were able to guide her into saying what she needed to say in order to keep her "mentally disordered offender" status and stay there for at least the next 3 months. but will there always be someone willing to help her stay there?

as hard as it is to believe, there are people who are better off in institutions. i don't want to get into a rant about california kicking patients out of state run mental hospitals starting in the 1970s and decreasing funding to both those hospitals or the community-based programs that were supposed to take their place for the ousted patients (maybe next time). the point is, we can't always put our values on our patients. we also can't assume that they will do the same in society as they do in the hospital. some people may fit the state's criteria for being released and self-sufficient, but if they don't feel ready themselves, they are destined to come back. they will do whatever they can to get back in there. and you can imagine what types of crimes would keep you in a state hospital for life.