The patient is removed to the third floor, and four-point. Dr. Megna told me he hated putting people in four-point. Certainly people hated being put in four-point, nevertheless, the system designed and built a special room for four-point. It is not a kind of needlepoint or a geographical heading or a place in the band. It means being tied hand-and-foot to the bed. Call it four-point. Pretend reality is not what it is. This is a psychiatric ward.
Tied-hand-and-foot is not reserved for six-foot hulks who are violent and frighten everybody; it is matter-of-factly used on 98-pound Polly.
It is just this year that they have installed the tied-hand-and-foot room. It is not a remnant of prehistoric psychiatry; it is state of the art. Why is the system regressing? What’s next? Being chained to the wall in a dungeon? Call it stellar cellar therapy.
A comprehensive study showed that facilities that believe restraints should be used finds it necessary to use them; if the facility does not believe in restraints then it never finds them necessary. Benjamin Rush Center, a private psychiatric hospital, believed that if they had to use restraints then it was an indication that they had failed to do their job. Physical restraints come, not from physical need, but from a philosophy that says it’s okay to tie up people. Compassionate restraint comes from the quality and quantity of staff members available to provide care.
Hutchings had one aide on the floor for every twelve people. If that aide was called away from the floor then two floors were combined with one aide “providing care.” She was, of course, not providing care; she was simply locking and unlocking things, and hiding in the office.
Alarms come in the night, usually on the evening shift. Each unit has an emergency alarm that is a small, beeper-like box worn on the waistband of the staff member. In case of emergency‑‑which is usually a euphemism for a patient getting violent–the alarm is pressed. That simultaneously triggers a shrieking sound and a light on the call box indicating where the alarm is. All staff members immediately drop everything and run fast to the aid of their endangered colleague.
If you are one of the workers, it must be a comfort to know that you can summon your colleagues anytime, anywhere. If you are an institution, it enables you to cover many patients with few workers, which is budgetarily desirable if not therapeutically. If you are a patient, it is demeaning and humiliating to know that another human being will not stay with you without that mad siren at hand. We are not the wild-eyed enemy; we are your children, in pain.
One night during the Olympics, an alarm siren went off, triggering the flight response in the staff, only to discover that it was not the emergency alarm but the fire alarm. Fire doors were quickly unlocked and we were hustled down the stairs, I with my cast and crutches. We were ushered out of our building and into the day room of the next building. Imagine fifty psychiatric patients in one twenty-by-twenty room!
Kathy entertained us. She was a little woman from the locked third floor. Clad only in a hospital gown, she danced and jumped and cavorted, singing and hollering and jabbering her manic gibberish. Kathy had caused the emergency alarm to go off one night when she attacked the television with a desk chair.
This night we shift restlessly from one foot to another for half an hour then the Fire Department gives us the all-clear signal and we return to our bed and board.
Maintenance has to be called from a far country to manually bring the elevator back into operation. I am still on the first floor waiting for it when a tall angular woman sails in and identifies herself as the AOC–Administrator On Call. She snaps orders. She wants interviews with the nurse, the aide, the patient–oh, it’s going to be a long night of report writing.
A patient on three had got matches and set fire to her mattress. She was forthwith removed to the jail and charged with arson. It is important that the system make a clear distinction: arson is a crime against society; it is not a mental health aberration. People should be tried for crimes in a court of law with a competent defense attorney, not railroaded into the psychiatric system. If a crime was committed then the person has the responsibility to answer for it, psychiatric complications not withstanding.
I discover her one morning sitting in a shaft of sunlight (or perhaps being the shaft of sunlight) in the sunroom: early twenties, long brown hair, and tentative expression. She is doing a survey for a class at the university. I sit in the elevator lobby and watch her.
She sits opposite one of the higher functioning (hey, simply functioning) human beings and explains her mission, then they talk for a long time. A civilian to talk to: I want in on this. When the chair opposite her is empty, I swing forward on my crutches and take a seat. Suzy Sunshine introduces herself then explains the game. She will ask about my level of satisfaction with various things and I will rate them either excellent, good, fair or no contact. Okay, I can play this game.
We start with the admitting unit and how I was treated there then continue through doctors, nurses, recreation workers, food, smoking rules and how my guests are treated. I wax poetic; she writes intently. It is a thoughtful conversation and I am deeply grateful for it.
Afterward I make it my business to bring her additional people to interview. The staff is sending her only the most alert and verbal patients; I try to send her simply everybody. I lift the sheets from the bodies on the floor and seek out the silent forms hunched in the sunroom. “It’s about whether we’re satisfied here,” I tell them. Almost all of them leave their solitude long enough to answer the questions. I have a delightful morning. I have purpose. (To be continued)