Did all those fifty-plus hospitalizations for depression do me any good? Almost a decade removed from my last hospitalization, I look back and say “yes,” but not in any way you’d imagine.
In hospital, I was exposed to every kind of therapy. In the 1970’s the big idea was milieu therapy. That meant that you would be stuck in groups and sent out on group activities and that would make you feel better. Apparently the alternative to milieu therapy was sit-in-the-dayroom-and-do-nothing therapy. There was group psychotherapy and individual psychotherapy. Music therapy, art therapy and play therapy. Electroconvulsive therapy (ECT), also known as shock treatment. And, always, pharmacotherapy: take drugs. I had them all.
Milieu therapy probably grew out of three things: (1) people admitted to inpatient psychiatry came from isolation and loneliness; (2) in the 1970’s psychiatrists and their minions were still connected as human beings, and (3) there were very few drugs on the market then.
Group psychotherapy was the best thing. The quality varied according to who was leading the group and who was in the group. At Hutchings Psychiatric Center the group was led by a real honest-to-goodness psychiatrist, but the members of the group were called “low functioning,” which meant that they could find the therapy group room by themselves—on a good day. At Upstate Medical Center the groups were variously led by psychiatrists, psychiatric residents or psychologists, who ranged from good to very good.
At Benjamin Rush Center, a private hospital that later became Four Winds, the group was led by a psychologist who was pretty cool. One day a new patient announced that she was having sex with her dog, which was a real conversation stopper. Experienced group members knew that there were some things you just did not share in group, but the psychologist didn’t bat an eyelash. He welcomed her into the group, made some generic noises of acceptance, and then quietly suggested that some things should be shared with your therapist in a one-on-one situation. Bestiality was definitely one of those things.
Group therapy at St. Joseph’s Hospital all depended on which group you got put into. The highest functioning group got a good social worker with a lot of experience, and it was pretty worthwhile. The lower functioning groups got lower functioning leaders, and I for sure never would have gone to them. Community General didn’t have group psychotherapy and, as previously noted, CPEP does not provide any therapy.
Individual therapy was hit-or-miss. You didn’t get any at Hutchings. At Upstate you got the residents, who had absolutely no experience. Some were talented and would become good after they got some experience; some were complete losers—I am particularly remembering one resident who never made any sense, who was incapable of linear thinking, and who generally made me crazy. And no, dear hearts, you cannot change to a different resident. If you ask to, then you are told either that you are trying to manipulate or control the therapist, or you are trying to avoid dealing with your issues. The system is always right; the patient is always wrong.
Never ever forget for one second that a teaching hospital is run for the benefit of the students, not the patients. They need to practice on you, and you cannot escape a bad resident and try to get a good one. Sometime after I was discharged from Upstate, a staff member explained to me that the resident who was making me crazy, in fact, had schizophrenia. I’m not saying that a psychiatrist with schizophrenia can’t be a good psychiatrist, but I am saying that this one wasn’t. She appeared not to be doing well in therapy.
A few people at St. Joseph’s Hospital get psychotherapy; none at Community General. You must understand the nature of the people who get hospitalized: they are not exactly good candidates for psychotherapy.
Bottom line? Most inpatient therapy is just something to keep you busy while they wait for the drugs to take effect.