Unit 3-6, the inpatient psychiatric unit in St. Joseph’s Hospital, is laid out in a T formation. The locked door off the main hospital corridor is at the base of the T. At the head of the T there is another locked door because the rooms located across the head of the T are for “seclusion,” that is, solitary confinement. There are about ten rooms back there and some of them are bare except for a mattress on the floor. This is how they house some patients. I recall, in particular, Christie.
In the old days, we used to have women hospitalized for “empty nest” syndrome. Their personal identify was wholly involved with being a mother. When their youngest child got his driver’s license, Mom would collapse. She was no longer needed. She had no purpose in life, no identity. One of the side effects of the feminist movement is that it put a stop to women identifying themselves solely as somebody’s mother. I haven’t seen anyone in the empty-nest category on inpatient psychiatry in years. Beaver’s mom got a job and an individual identity.
The empty nesters are being replaced by a new group that has evolved as a result of the absence of restraints on teenage sexuality. Christie is typical of the new group in which the parents are teenagers from different races, religions, or status. In short, neither family wants the offspring. After birth, the baby is originally taken to be raised in the home of the maternal grandmother. When Grandma gets tired of that, the baby is removed to the home of the paternal grandmother. When the grandparents refuse to take the child, or are found incompetent to parent, or are engaging in criminal neglect, then the child goes into foster care. When the mother and father come of age, they take their turns at yanking the child around.
After spending ten or fifteen years being torn back and forth between the homes of two parents, four grandparents—often divorced—and countless foster care placements, the kid is now so messed up that s/he is being placed in group homes for problem kids. (Christie relates that when she was thirteen, she got kicked out by her mother. The next day, when she came out of school, her mother was there to pick her up. Mom said, “I need your Welfare money.”)
By the time these children are technically adults, they are in psychiatric care. They never have had any stable relationships. They cannot bond with others. They have no capacity for trust, or the ability to make discrete judgments about whom to trust. They have learned various inappropriate attention-seeking behaviors. They are irresponsible, and frequently panic-stricken in a world in which they have no control. They set records for low self-esteem.
Christie was typical of the new damaged class. She engaged in instant intimacy with strangers. She would variously laugh or cry, then quickly escalate into hysteria. And she swallowed things: coins, nail polish remover, the spring from a ballpoint pen, her hair barrettes, the cross and chair she wore around her neck—the list was endless. Finally, the decision was made to strip her down to Day One and start over.
She was remanded to seclusion, where she was given a hospital gown and a bare mattress—that was all. Dietary was told to send her a special tray containing only finger food. As days turned into weeks, Christie was gradually re-introduced to plastic utensils and more clothes. She was not allowed to have anything that would be stimulating, i.e., books, toys or music. She was to learn how to calm herself and behave appropriately. After a month or so, she was allowed out for an hour or two a day. She really was a very sweet kid but she’d been so messed up by the adults in her life that she hadn’t stood a chance.
As a result of the back-room behavior management treatment, her conduct improved substantially. The most dangerous consequence that I saw was that she became totally in thrall to the inpatient psychiatrist because he, and he alone, saw her every day while she was in seclusion. All her emotional ties became fixed on him. The horrific danger of this is that inpatient psychiatrists on 3-6 came and went with about the same frequency as the patients—and after discharge an outpatient could not be followed by the inpatient psychiatrist. The psychiatrist didn’t stay on the unit long, and I don’t know what the long term consequences were for Christie.
So Christie was locked up in back, as were people who were violent, self-destructive, disoriented or so disruptive that the staff couldn’t stand to have them out front in the general population. The rooms in front were all doubles; the rooms in back were all singles, so there also was maintained in the seclusion section a fully furnished single room for the occasional nun or priest who went bonkers. It was a Catholic hospital and they got special privileges. (To be continued)