A staff member is always on duty in the day area. The duties of the staff member include locking and unlocking things, screening visitors, turning down the television, handing out meal trays, and so on. The staff member sits at a desk inside the door and, depending on the quality of the staff member, patients may sit around the desk and chat with the worker.
Charles, a tall black man pushing fifty, is one of the most genial of workers, having a calm demeanor, quiet attitude, and good sense of humor. He does not like to get upset so he invites the community to be quiet with him. In the real world, he is an elementary school teacher working on his master’s degree; in the mental health world, he is a counselor working evenings and weekends. I needed a low-stress environment, so I spent as much time as I could in the quiet space that surrounded Charles.
In fact, Charles and I discovered that we both had worked for the NYS Office of Mental Health, Central New York Regional Office, during the mid-1980s. Although our offices had been in different buildings, we knew many of the same people so we chatted pleasantly, reminiscing about old times and old friends.
What Mary saw, on that Tuesday evening, was that I spent a lot of time talking to another staff member: I loved somebody else more than I loved her. Consequently, Mary approached me and, without preamble, asked if I was suicidal. “How very odd,” I thought. I had not been suicidal for a moment since being admitted to the hospital. What would prompt her to ask?
One of the things I had learned in the past year was that I am not obligated to spill my guts to anyone or everyone who asks. I now reserve for myself the right to have private thoughts and feelings, therefore, I said to Mary, “Um, that’s something I’ll reserve as confidential, and discuss with my doctor.” Mary considered herself rebuffed, and set out to regain control over me. When she came to work on the unit the next day, Wednesday, she read all the notes my doctor had written since I was admitted. This is something of a joke, since half the time even my doctor can’t read what he’s written. Mary, however, could and did pick out the word “suicide.”
In the year since I had last been discharged from 3-6, my health had failed substantially. In fact, my case manager and social worker had moved me into residence at Loretto (geriatric center), where I was usually in a hospital bed and wheelchair. St. Joseph’s Home Health Care Agency, which provided my daily aides, had me categorized as “Homebound”, whereas the Loretto residence carried me as “Independent.” I was caught in a logical inconsistency. In functional terms, that meant that I had to buy my own groceries but couldn’t go to the grocery store. I was caught between illness that was getting worse and services that were not rising to meet the increased need. I became suicidal and hospitalized. In the hospital, the level of illness and the level of care were sufficiently parallel that I ceased to be suicidal.
I was not suicidal in the hospital but the risk of suicide would continue to exist if I returned home without some change in circumstances, therefore, my doctor and I were working to diagnose the health problems, and the discharge planner and I were working to increase my level of home care. Mary Corbliss had neither the education nor the intelligence to investigate these issues. What she did have was the desire to control my “treatment.” Poor unit management, negligent nursing, and Mary’s manipulativeness enabled her to do so without regard to the real issues.
Mary came to my room and informed me that my chart was “littered” with suicide, implying this litter-ation was in that day’s note, which puzzled me since my doctor and I had not had any major discussion of the subject. Later information revealed that the word suicide only appeared in my doctor’s notes four times in ten days, which is fairly routine for an inpatient on a psychiatric unit.
What Mary communicated was that I had to be kept safe from killing myself, and she was the one to do it—never mind that my psychiatrist had kept me safe through multiple hospitalizations for eight years without her help. Mary took it upon herself to change my treatment plan.
The day before, my doctor—apparently too foolish to know what was good for me—had sent me to another physician for a second opinion. Mary now informed me that I should not have been allowed to leave the unit, no matter the purpose. Mary, who was not privy to any of my private thoughts and did not have any direct discussion with my doctor, decided she knew how to care for me better than did my psychiatrist. And the unit management let her.
My doctor had ordered outside passes for me twice a day. These passes consist of a few patients and a couple of staff members going outside and sitting on a bench for about half an hour. He had ordered them for two reasons: first, most of the window blinds on 3-6 are broken closed, and I have seasonal affective disorder: he ordered me into the light. Second, I have become intolerant of all medication. I—and I alone of all the patients on the unit—had to cope with my emotional disorder without any medication to blunt the pain. Counselor Corbliss announced that I could no longer go on outside passes with the group, never mind my doctor’s order.
The position of mental health counselor is entry-level and requires only a bachelor’s degree, subject irrelevant. One counselor had a degree in art. Now, according to the judgment of mental health counselor Mary Corbliss, I was at too great a risk for killing myself to be allowed to go outside.
In fact, not being allowed outside would increase the probability of suicidal feelings. I was trapped in a prison with no daylight. (To be continued)
For the antidote to inpatient psychiatry, see Dr. Nasri Ghaly at http://annecwoodlen.wordpress.com/2010/12/29/dr-nasri-ghaly-psychiatrist-part-4/