Where are the times and places where the Cookoo's Next comparison is more apt?

In 1992, some of my friends broke another friend out of a mental hospital.

Mind you, they were all teenagers, and I'm not willing to state unequivocatably that teenagers make the best possible choices, especially when potentially exciting adventures are possible.

Either horrible families cause mental disorders, mental disorders cause horrible families,

Best evidence is that both are true. Mental disorders are both environmental and genetic.

I recommend Theodore Dalrymple's Romancing the Opiates -- it's not that even alcohol withdrawal is dangerous, it's that it's distinctively dangerous among all forms of withdrawal.

The lying liars who think the hospital is a great place to stay -- sigh. I've heard of them before. What is really needed is a good liar detector that scans your brain for what sections activate, because they've found lying and telling the truth use different skills. But that's more suited for SF than hope at the moment.

Actually, what's needed is some sort of other livable option. . . they're acting rationally, because there is nothing else they can do to stay alive.

A great many of them could do a great many other things -- except that would entail their having to spend money on rent and the like. One woman I know who worked in a homeless shelter estimated that 75% of them are homeless because they prefer spending their money on drugs to rent.

Nor -- and this is where the book comes in -- is giving up drugs the wrenching experience that they claim it is. They are just looking for excuse to not give it up.

Even giving up tower defense games is pretty hard! An archetypical addict's life is made almost entirely of "Hey, drug time now" triggers, sucks enough that the temptation to seek relief in drugs is enormous, and has no support of any kind for quitting. Do you honestly think most people could ride it out, while in the throes of physical and psychological withdrawal? You can handcuff yourself to the heater for three weeks, but you can't stay that way for eighteen months.

Many people have given up drugs -- permanently -- without support.

Though it's one of those "the lightbulb really has to want to change" things -- which does mean it's foolish to throw money at helping them because it won't change their desires.

Yes, having drug treatment options available would help. Kicking a drug habit is clearly one of the toughest things a person can do, and certainly, without help being available, it's just not going to happen.

People routinely quit drugs without any assistance whatsoever.

Really? How many people have you known who've tried to quit drugs and succeeded without help?

See, that is a remarkable statement. It goes against every study I've read; it goes against the personal experience of every person I know. I'd love to know WHERE you got that from, since it flies in the face of observation and science.

I've heard of people kicking cold turkey on their own, but it's VERY rare -- almost statistically insignificant. And, as squid314 pointed out, it can kill you dead.

I already told you. Romancing the Opiates. An account of opiate addiction by a doctor who worked in the slums and as a prison doctor for decades, and whose knowledge of addicts is extensive.

And what exactly did those studies study?

Recidivism within populations who had decided to give up opiates, and different methods.

Okay, I've been looking up Theodore Dalrymple, and I can't find anyone who's actually been looking at his claims scientifically. Looking at his ovure, he looks like the kind of person who loves just claiming whatever the opposite of whatever everyone else claims, and I can't find anyone who's actually studying what he's claiming. The best I found was a discussion of the book between him and another person, which just turned into "Nuh-unh!" "Yeah hunh!" real fast.

It's an interesting thesis, but I find myself skeptical of a person whose other books are all "Western Society is doomed!" "Emotions make us all wimps!" and stuff like that. I'm not yet willing to throw out everything I've learned on the basis of one book by one guy who wants everybody to throw out everything they've learned about EVERYTHING.

You should try reading the book. He debunks a number of those studies and gives other that support his view.

Or you could take refuge in name-calling to avoid it.

"I recommend Theodore Dalrymple's Romancing the Opiates -- it's not that even alcohol withdrawal is dangerous, it's that it's distinctively dangerous among all forms of withdrawal."

Sorry, that was poorly phrased. I meant that I would have naively believed that alcohol withdrawal would be less dangerous than cocaine or heroin or something because it's legal. Yes, counterfactual me is an idiot.

It's a common view, no doubt -- not exactly helped the hoopla about opiate addict and withdrawal that's current. . . .

Ten years ago I attempted suicide, and then drove me to the hospital, who then transferred me to a psychiatric hospital for a week. I am still convinced that psychiatric hospitals are intentionally boring as hell so that you either decide to quit trying to hurt yourself, or at least make a better attempt the next time.

(For the record, I got out of the hospital, left my husband, and have never been suicidal since. Depressed, yes. Suicidal, no.)

I was concerned about the lack of things to do/read at the hospital where I worked, so I brought in a dozen or so books. The books disappeared within the week, just as other staff told me they would.

I like to think that for the $1 each book cost me from the thrift store, someone got at least that much relief/enjoyment out of them.

Yeah, I can see how that would happen, especially if you're not a huge extravert. I understand they don't want anything that can be used as a weapon (which is pretty much anything; I've been hearing horrifying things about the killing power of a sock with a bar of soap in it) but I still feel like they could bolt some computers down somewhere.

About dementia patients trying the door because why not, and therefore wandering off --

My favorite way that a nursing home has dealt with that problem: they built a fake bus stop in front of the hospital, well within sight of the reception desk. A dementia patient walks out, sees the bus stop, and figures, "Oh! I must be here because I'm waiting for a bus to go somewhere!" So they sit down at the bus stop to wait. The receptionist sends out a caretaker, who comes out, asks what the person is doing, tells them that the bus isn't coming for, like, another hour, and why don't they come inside for a cup of tea while they're waiting?

The dementia patient thinks this is a good idea, comes back inside to the recreation room, has a cup of tea, and forgets they ever tried to escape. Completely non-traumatic for everybody.

how well-organized!

I must think it works better in regions where a lot of people take the bus all the time before dementia hits.

Yeah, I believe it was in Scandinavia somewhere.

Germany, actually, though maybe the idea has spread since: http://www.telegraph.co.uk/news/newstopics/howaboutthat/2069467/Wayward-Alzheimers-patients-foiled-by-fake-bus-stop.html

This matches my experience pretty well, except for the part where the hospital wants patients out fast to save money. I suspect the bad stuff happens more in hospitals that don't aim for high turnover.

This happened at the first (private) hospital I was at but is less common at the current (state) hospital. No one is exerting specific pressure here but everyone realizes that there's a limited number of beds and they can't just let people stay forever.

I used to work in a nursing home, and yeah, approximately none of this applies in a situation where the expectation is that people are there 'till they die.

My experience and what I've told also confirms that nursing homes are sometimes (often?) horrible. I always interpreted it as having more to do with some other factors, including intensity of care required, quality/training of staff, and elderly people who look different and talk different and sometimes lack basic functions activating fewer of the staff's natural sympathies than mentally ill people who mostly look and act like everyone else.

Seems pretty plausible.

(I do note that not everyone who tends not to activate others' natural sympathies is currently institutionalized, though, so the question of what happens to us in facilities like yours is still rather up in the air from my perspective. But that's me being pushy; I'll stop now.)

Yeah, a friend's daughter was committed for about a year. Recently she went back for a couple of weeks because outside life was too stressful, and he says the doctors were happy to have her because she's such a nice girl.

Everything you're saying lines up with what my friend has been telling me, including the hookups - they had to run interference between her and some drug addicted kid who got himself interned to the same hospital to be close to her.

Really? If she was in for a year that sounds like one of the long-term places, which I know nothing about and which I have received slightly more sinister vibes from. I'm glad to know they're not (always) true.

That 'always' would be better as a 'necessarily'; Stockholm Syndrome is a thing that exists and could easily be relevant, among other issues.

Hm, I can't recall right now but she might've been moved to a different hospital at one point half way through the year. I gather the delay was in getting the medication dosage just right, as she kept lapsing back to delusions and persecutory manias. I don't think they ever really nailed down what was wrong with her, the most definitive diagnosis I heard was PTSD - the family emigrated to Europe from Argentina and then the parents divorced.

Ok, I asked, she was in two places (Three really, but the first was the same hospital which moved locations during treatment). The first hospital was a dedicated mental facility for acute cases, an "old style" asylum, far from the city, surrounded by countryside. Later on she was moved to a medium-stay facility which was just the psychiatry wing of a general hospital.

We had two patients who had sex and both claimed it was unconsensual. Not sure how the human rights officer dealt with that one.

My favorite episode with the burly men:
http://jdwise.blogspot.com/2011/11/love.html

Edited at 2012-08-31 06:31 pm (UTC)

I somehow failed to connect you to the Julia who I already knew was a social worker. Now I'm going to have to read that blog.

Since you seem to be another person who blogs about your experiences in a psych hospital, do you know if there are any commonly-agreed-to standards on how exactly the patient confidentiality works? Okay if there are no names? Okay if no one could possibly recognize the case? Never okay? Or what?

My husband's been prodding me for months to read your blog, and I'm enjoying it very much now that I've started.

I got criticized at one point by a reader for giving details that would be identifiable by the person I was writing about, and possibly by their family. After that, I decided to disguise details enough that not even the subject would recognize themselves. But I haven't gone back and disguised things I've already written, which I probably should. Because I use my full name on the blog, I assume some patients/clients will find it someday.