Have psychiatric wards changed?

[daftandbarmy]

Have psychiatric wards changed?

A 1970s psychologist caused outrage by faking symptoms of mental illness for a study. But have lessons been learnt?

http://www.timesonline.co.uk/tol/life_and_style/health/mental_health/article6726435.ece

If you found yourself locked up against your will in a psychiatric ward, you would probably do your best to get out. But in 1969 a group of people did just the opposite — they tried to get in. A young American psychologist called David Rosenhan persuaded seven friends (two psychologists, a psychiatrist, a doctor, a housewife, a painter and a student) to see whether they could convince doctors that they were mentally ill simply by claiming to hear voices. Now previously unpublished notes from Rosenhan’s private archive reveal what the experience was really like.
Between 1969 and 1972 the team of “pseudo-patients” presented themselves at 12 different US hospitals in five states on the East and West coasts. What would a sane person have to do to convince a doctor they were insane? Not a lot, it seems.
Having claimed to hear words from “thud” and “empty” to “hollow”, words selected because they had never been recorded in psychiatric literature, every pseudo-patient was admitted to hospital for varying lengths of time, from 7 to 52 days. They were given diagnoses of schizophrenia and prescribed a total of 2,100 pills (only two of which were swallowed; in preparation for the study the pseudo-patients had learnt to “cheek” any medication).
Other than giving false names and inventing voices, the patients were to answer all other questions honestly. If they were admitted to hospital they were to say that they felt better and that the voices had disappeared. Not one member of staff suspected them of faking it.

 

[dapaterson]

Are you asking because you're looking for a little get-away, and want to select the best method?

>

 

[Journeyman]

Have psychiatric wards changed?

They don't let me out much, to look at the others, but mine's pretty much unchanged.  :nod:

 

[Staff Weenie]

One of the Brit surgeons in KAF told me that during his psych training module, the crusty old psychiatrist said there was a simple method to sort out the fakers...

Pull the fire alarm in the psych hospital - everybody who runs for the exit is probably okay.

 

[RHFC_piper]

One of the Brit surgeons in KAF told me that during his psych training module, the crusty old psychiatrist said there was a simple method to sort out the fakers...

Pull the fire alarm in the psych hospital - everybody who runs for the exit is probably okay.

I still like the Simpsons method;

Homer: "How do you tell who's insane and who's not insane"

Dr: "It's simple; whoever has this stamp on their hand is insane"

;D

 

[mariomike]

Or the "Catch 22" method:

"There was only one catch and that was Catch-22, which specified that a concern for one's safety in the face of dangers that were real and immediate was the process of a rational mind. Orr was crazy and could be grounded. All he had to do was ask; and as soon as he did, he would no longer be crazy and would have to fly more missions. Orr would be crazy to fly more missions and sane if he didn't, but if he was sane he had to fly them. If he flew them he was crazy and didn't have to; but if he didn't want to he was sane and had to. Yossarian was moved very deeply by the absolute simplicity of this clause of Catch-22 and let out a respectful whistle.
"That's some catch, that Catch-22," Yossarian observed.
"It's the best there is," Doc Daneeka agreed."

 

[Gunner98]

One of the major changes is the use of video cameras and the varying elements of group time by which the counselors and nursing staff can now provide more observations to the seldom seen psychiatrists. Another change is that psychiatric has been replaced by mental health cases which now include all elements of addiction and social dysfunction.  Finally the tremendous boon of anti-psychotic drugs, anti-depression and anti-everything drugs has led to many sedated/tempered people being within the community rather than in the sanatoriums of the past.  If you can ask the question - am I sane, generally you are, or so I have been told by the/my caregivers.

 

[mariomike]

The deinstitutionalization of the mentally ill has lead to much of the vagrancy we now see in our cities.

 

[Blackadder1916]

. . . If you can ask the question - am I sane, generally you are, . . .

I have no problem asking the question or even giving myself a reasonably sensible answer - it's the other voices that confuse the situation - they won't shut up and interrupt at the most inconvenient moments.

 

[medicineman]

Not so much being able to ask the question "Am I sane?", but not losing the argument with yourself/selves over said question should be the benchmark.

MM

 

[noob_leech]

Finally the tremendous boon of anti-psychotic drugs, anti-depression and anti-everything drugs has led to many sedated/tempered people being within the community rather than in the sanatoriums of the past.

... although the side effects from these medications aren't very friendly either: weight gain (~50 lb or so) resulting to obesity/diabetes, sexual dysfunction, sheer stupidity...  To those without insurance or disability/welfare coverage, the costs of these meds aren't cheap either.

Although the mental health community is now dedicated to fight against social stigma of mental illness in the mainstream society, stigma within the community is still a big issue.  Clients carrying the diagnostic label "borderline personality disorder" are sometimes rejected from treatment simply because of the archaic assumption that these clients are untreatable.

If you can ask the question - am I sane, generally you are, or so I have been told by the/my caregivers.

It really sounds easy.  However, it probably will require me a lifetime to practise this mindfulness skill - step back from my crazy thoughts, feelings, behaviours and physical sensations through my breathing; observe my insanity as it is; and respond to my surroundings in a (hopefully) saner manner.

 

[Gunner98]

Finding the right generic brand drug with the least physiological and neurological alterations isn't easy.  Sometimes the cure is worse than the ailment - psychosis, lethargy, impotence.  However, a good balance of physical fitness, diet and rest will work wonders for everyone.  I did not say the sane question was an easy one...years of cognitive behavioural therapy with a good psychologist/therapist can work wonders for a chronic depressive, socially-stigmatized, moderately-functional adult. Keeping a marriage and career on track is only possible with some understanding enablers.

 

[40below]

The deinstitutionalization of the mentally ill has lead to much of the vagrancy we now see in our cities.

This. Over the last 10 years or so, the in-patient population of Kingston Psych has gone from more than 3,000 to just a few hundred, and it's not because they cured mental illness. In this city, you become pretty used to listening to dishevelled people having involved conversations with God on streetcorners.

 

[Gunner98]

This has a lot to do with government cuts to funding of beds, a distinct disproportionate number of specialist health care providers and the humane right to check-out against medical advice after the minimum stay unless you are a danger (not nuisance) to yourself or others.

 

[OldSolduer]

This has a lot to do with government cuts to funding of beds, a distinct disproportionate number of specialist health care providers and the humane right to check-out against medical advice after the minimum stay unless you are a danger (not nuisance) to yourself or others.

Do you know where they end up? The end up in our jails and pens across Canada.

We have two full units of what we call MDOs - Mentally Deficient Offenders. We do what we can with what we have, but it ain't ideal.
The governments have downloaded the mentally ill, in some cases, to the justice system.

 

[The Bread Guy]

One of the Brit surgeons in KAF told me that during his psych training module, the crusty old psychiatrist said there was a simple method to sort out the fakers...

Pull the fire alarm in the psych hospital - everybody who runs for the exit is probably okay.

At least until this was posted in public, right?  ;D

While treatment has improved over time, I have to agree with the "Hosts" in corrections who see it first-hand - one of the senior staff at the District Jail here said in public ~10 years ago that easily one in five of his guests needed psychiatric attention, not imprisonment.  That was around the time the Lakehead Psychiatric Hospital, in the midst of shutting down, was housing ~150 patients (down from its peak of ~1,100 in the hey-day).

Should as many people be out of hospital as possible if they're getting the right help?  Yes.  Methinks this wasn't the best way to do it, though - just like the rest of the health system, closing beds saves money fast, spending money on group homes and home-based care doesn't make for shiny headlines.

Thanks, deinstitutionalization...

 

[Nemo888]

This. Over the last 10 years or so, the in-patient population of Kingston Psych has gone from more than 3,000 to just a few hundred, and it's not because they cured mental illness. In this city, you become pretty used to listening to dishevelled people having involved conversations with God on streetcorners.

I know what you mean about inadequate funding.  I can't even guarantee the sterility of the OR instrumentation I am sending to the OR. I can't  get 14,000$ for a hand washing station. 8,000 Canadians die every year from hospital acquired infections. Purell is not sufficient when you are handling implants. Now we are not allowed to replace staff who call in sick for two months, quality of work is suffering as work loads increase.

But back to psych. Most of my psych experience is holding down the patient while they restrain the patient physically or chemically. I did know one who faked his illness. He didn't like working and wanted permanent long term disability. He chose Multiple Personality Disorder. He had his shrink totally fooled. She even wanted to do research paper on him. One of the alters he chose just to push her buttons as she was very Catholic. It was a naughty nun. How he loved to string this woman along. You can see why scientists make fun of psychologists.

 

[mariomike]

Most of my psych experience is holding down the patient while they restrain the patient physically or chemically. I did know one who faked his illness.

When I was young, they sent us to a house to pick up a "Form 1" going to one of our well known local psychiatric hospitals. The guy's wife told us he hadn't spoken in a long time. At least, nothing that made any sense. That's all. He wasn't really bothering anyone that I could see. However, I am sure the doctor knew best, because he signed his ticket and called us. Our usual bribes of cigarettes, candy and tales of pretty nurses didn't entice him, so we had to use restraints. When we got to the hospital, they told us to wheel him into a "treatment" room. That's when we saw the electro-shock machine. That was a surprise, for me at least.
Anyway,...just as soon as he came out of his convulsion, he became violent, AND became profanely eloquent! I don't know if he had been faking, or if their machine had cured him.
I sort of regretted not untying him and letting him run at a traffic light on the way over, because it was the first time I had seen them shock anyone. On the other hand, I guess it was for his own good?
 

 

[noob_leech]

When we got to the hospital, they told us to wheel him into a "treatment" room. That's when we saw the electro-shock machine. That was a surprise, for me at least.
Anyway,...just as soon as he came out of his convulsion, he became violent, AND became profanely eloquent! I don't know if he had been faking, or if their machine had cured him.
I sort of regretted not untying him and letting him run at a traffic light on the way over, because it was the first time I had seen them shock anyone. On the other hand, I guess it was for his own good?

ECT sounds scary indeed.  However, consider this scenario:  My whole body had been funk for so long that I didn't feel like I deserved to live - in fact, I couldn't feel anything unless I cut myself.  My pdoc prescribed me 6 to 7 medications; however, they either made me a fat boy, or made me acutely suicidal, or caused seizures, or ... etc.  After several trials of meds and I still felt this funk, ECT *was* a godsend for me - even better than those pleasure toys purchased from sex shops.

Nevertheless, YMMV always applies for any treatment.  I remember when I was living at the nuthouse last year, the guy next door became interestingly happy (albeit easily irritated) while he was having his series of rTMS treatment.  I still don't know whether hypomania was induced or not.

This kind of random YMMV thing can certainly frustrates a lot of people.  With the advance of diagnostic techniques using brain SPECT scans such as those used at Amen Clinics, clinicians can hopefully formulate individualized and more specific treatment plans in the future.

years of cognitive behavioural therapy with a good psychologist/therapist can work wonders for a chronic depressive, socially-stigmatized, moderately-functional adult.

... although there seems to be a general trend (esp. in the US) where pdocs no longer do therapy.  They might do a 15-minute medication checkup every 3 months, and refer one to a tdoc for therapy.  Unless the tdoc is working at a hospital or community clinic (or s/he is a GP), his/her service probably won't be covered by provincial health plan.  That puts further strain on the limited income of a moderate-to-low-functioning adult. 

 

[mariomike]

However, consider this scenario:  My whole body had been funk for so long that I didn't feel like I deserved to live - in fact, I couldn't feel anything unless I cut myself. 

Please don't do that.