Friday, August 15, 2008

Issues in psychiatric treatment of psychosis

I was trying to read the rest of the book, The Center Cannot Hold, by Elyn Saks today. I could not finish it, because of my blurry vision (which I will have to address with my old eye doctor sometime soon). However, I did get near the end. I like the book, but there are some issues it brings up which warrant discussion, I think. For example, Saks states in this book that restraints, while commonly used on psychiatric patients in hospitals around the United States, have not been used in England for some 200 years. She argues that, when she was severely psychotic, and thought to be a danger to herself or others, she should not have been put in restraints because this is an inhumane, degrading practice.

On some level, I agree with Saks. Obviously, nobody wants to be tied down to a gurney or a bed, unable to move, losing the most basic human rights of freedom simply because they have a mental illness. It is also rather odd, since I have spent so much time in psychiatric hospitals myself over the years, for me to imagine a hospital where nobody was ever restrained, even when they got out of control. I do think restraints and forced medication are used too frequently. I know they were used on me, and that it was not remotely helpful at the time, but I've kind of always thought, in retrospect, that there must have been some reason why I was put through that kind of treatment. It must have, somehow, been warranted.

But what if it wasn't? I recall, clearly, seeing other people put in restraints and shot up with medication, while there seemed to be no logical reason for this to be happening. I remember seeing a woman, who was my roommate, named Patrice, in New Jersey at one hospital I was in who got injected by the team of psych techs and nurses because she was yelling and aggravating them too much. She did not appear to be psychotic (but then, I clearly was psychotic so my judgement may have been lacking at the time), and I recall telling the staff that they should not be treating her this way (at which time, I was told to go away).

I recall banging on the door of the seclusion room, when I was in another New Jersey hospital, begging and pleading with the staff to let the screaming woman locked inside that room out. She screamed in Spanish, and she did it frequently. They locked her up. I only knew, on a deep level, that no one should be locked up for the fact that they were upset and yelling. It was unfair, and I did not like it in the least. I tried to talk to her through the door, to calm her down. That said, I, myself, at that time, believed I was pregnant with a baby implanted inside me, that I was in a concentration camp and not a hospital, and that I was in some movie being made by my friends and Ani Difranco. I was not exactly thinking clearly or logically. Does that mean I had no idea how to judge right from wrong? I am not sure, but I don't think it does mean that.

I think Saks makes a good point in her book, foreign though this line of thinking is to me, as I have been on the receiving end of psychiatric treatment for so long I don't always question the things about psychiatry that may be questionable. I disagree, however, with the idea that people should not ever be forced to take medication. Saks leans toward this concept, and I know that there are many people, including all the brain-washed Scientologists of the world, who think that people should never be medicated at all.

I know that medication saved my life, and that I was unable to keep myself on that medication before the medication worked well enough for me to know that I needed to take it. Therefore, being forced to take it, actually, saved my life. So I don't agree that people should never be forced to take medication. I was forced, and I am quite glad about that today. If I had never been forced into the hospital, forced to take medication, and told point-blank what my diagnosis was, I surely never would have regained a healthy level of functioning in the world, because I would have continued to roam around thinking meds were a poison that could never help me, and I would have continued to be floridly, horribly psychotic, and probably killed myself as well.

I do think, however, that it the idea of whether or not people should or should not be forced to take medication when they're psychotic is certainly worthy of discussion. Saks, who is in the legal profession herself, as a professor, seems to think that people have the right to refuse medication. I tend to agree, however this is a complicated topic for me because I know that being forced to take medication really helped me more than anything else ever did. I was lucky, in that medication worked for me, finally, when I was kept on it for months. For many years before that I was in and out of hospitals, never remaining on medication for long after I was sent home, and never correctly diagnosed, and never knowing that I was psychotic. So I lived a very painful, difficult existence during those years, which I would not wish on my worst enemy. To be living in an unreal world is no pleasure trip. It is a heinous nightmare from hell. For a person in that state, in my opinion, giving medication is more an act of mercy and care than a violation of their human right to remain lost in the nightmare of psychosis indefinitely.

So, at the end of the day, I think I disagree with Saks on this point. I tend to agree more with the arguments of E. Fuller Torrey, psychiatrist, and author of Surviving Schizophrenia, which is a bible for this illness, though, of course, he cannot speak about the illness in the first person as he, himself, has never been through it.

Also, Elyn Saks is, of course, a bit of an anomaly. She went through Oxford while suffering from Schizophrenia, then completed Yale Law School, then became a tenured professor at the University of Southern California and a published author. Many people with this illness struggle to complete the most basic tasks of daily living every day, and making such accomplishments in academia as Saks has made is really not possible. I think her story provides hope for those of us who are struggling to finish college or make our way in the world of work, but it should not be mistaken for a common story, because it is not one. Perhaps, if those of us who have lived through this illness continue to discuss it, and open a dialogue with others about mental illness and the importance of necessary research and treatment that works, eventually, we will have more useful treatments available, and maybe, someday, there will be no more restraints in hospitals, no supposed need for them, and no more Haldol shots either. One can hope.


  1. Whew, tough issue! I've seen both sides of it years ago as a psychiatric technician. I have seen the emotional frustration of people in restraints. I have also seen the side effects of Thorazine and similar drugs used to chemically restrain people. Both have their supporters, but I personally prefer the chemical method of restraining on a very limited basis, perhaps in conjunction with a padded cell to help prevent self injury. To me that is the most humane method of restraint we currently have available. It is not perfect but I like it better than straitjackets or tying people down to a bed with wrist cuffs.

  2. You have a good point, Ken. The more I think about it, the more it seems inhumane to tie people to beds. Perhaps medication is a little less inhumane. It is a tough issue to sort out.

  3. I really like her book a lot! I read it a few months ago, and I thought it was extremely well written. I understand about the restraints, too. At the hospital I worked at, we had strict guidelines of how long we could keep someone in restraints. Definetly no more than 30 minutes without a re-evaluate of their status. It was a level 6 facility, so the hospital that adolescents went to when they weren't getting better and other hospitals. I think we have come a long way (at least in some hospitals) from the straight jackets, as Ken says, but I know, for one, that the state mental hospitals in GA are completely whacked. The AJC did an article on those hospitals a few years ago, and it was appalling!

    Anyway, I know this is an old entry for you, but I keep jumping around, haha, and clicked on a "popular post" button and wound up here.

    Take care,

  4. Dear Jen,

    My name is Dinah and I'm one of the psychiatrists who blogs at Shrink Rap. I'd like to ask you a question in a more private forum. Would you be willing to drop me an email at shrinkrapblog at gmail dot com? I will respond to you from my personal email address and maybe we could have a quick conversation? I'm enjoying your blog.
    Thanks so much,


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