201 Comments Posted by dme

Perhaps this was a hall connecting two wards.

One of Kirkbride's basic principles was that psychiatric hospital should have attractive, pleasant furnishings to facilitate patients' mental health and hopefully lead to their discharge from the facility. That's why he specified gardens, trees, large windows, wide hallways, high ceilings, careful selection of staff, and regular entertainment programs in the auditorium, among many other things. He recognized the problems of having too many patients in one hospital. He advised that patient bedrooms be as large as possible, to give patients "quiet and privacy...provided their dimensions are not so great as to lead to two patients being placed in the same room." State hospitals, in his opinion, "should be made good enough for the highest class of its citizens" because what is good enough for the most well-to-do patient "is none too good for the humblest of the unfortunates who are compelled to look to these institutions for custody and treatment." The attitude underlying all of his recommendations was that "the best hospital, best built, best arranged, and best managed, is always the most economical in the end." But then came far more patients, low salaries, lack of maintenance, little or no staff training...and we know the results. (the quotes are from a book I read recently but I can't remember its name)

You know you're in bad shape when even your underwear isn't your own. :-)

A very trivial question that popped into my head when I saw this--in the old institutions built before electricity, what powered the clocks in the towers? Was there a winding mechanism in the attic?

What are those pipe-looking things near the bottom of the left-hand wall? Were there sinks or toilets on the opposite side in the past? Or maybe radiators? (but wouldn't radiators be on the wall or ceiling in a room with water?) And is that an electrical outlet under the sink on the right? Seems like safety must have been first on the mind of whoever installed that. Perhaps this room used to have another purpose and the outlet was disconnected when the sink was installed. As I think about it, I don't recall ever having been in a bathroom where the electrical outlets weren't above the fixtures.

I've been terrified of the dentist since I was about 8 years old. My regular dentist had a family emergency so his partner was covering his appointments for that day, one of which happened to be mine. I had badly chipped my two front teeth a couple of years earlier in a bike accident, and that icy cold air they used to use, to dry your teeth, I think, before they had the suction device they use today--caused severe fingernails-on-a-chalkboard type pain. My regular dentist knew this and was very careful. This dentist didn't, and when I started to cry he put his hand over my nose and mouth until I stopped crying because I couldn't breathe. I never did tell my parents.

I suppose the reason they tear down old buildings is partially due to a fascination with so-called "new and improved" structures, and also due to a focus on the financial bottom line. Asbestos abatement, lead paint removal, bringing vast plumbing, electrical and HVAC systems up to current code, retrofitting automatic sprinkler systems if the building doesn't already have one, universal design for accessibility, plus our changed ways of living/use of space and changed standards of privacy and patient rights...it probably is cheaper to tear it down and build from scratch. I wonder if they salvage what architectural elements they can before actual demolition. Many of these buildings have a quality of workmanship that cannot be duplicated today.

It's really hard to guess at the writer's meaning when all we have are the words. Just last night I watched a tv program about body language and how we really need to have facial expression, gestures, voice, and the words themselves if we are to make accurate judgments. When one of my children was in junior high, a classmate heard about something her boyfriend had said, and with typical teen-age girl hyperbole said, " I'm gonna just kill him!" An adult overheard the comment, took it way out of context, reported it, and the girl was suspended indefinitely. She was only allowed to return to school two weeks later, after having psychiatric and psychological evaluations to prove she was not dangerous. I know we have to be concerned about violence in schools and elsewhere, but we have to make sure we're paying attention to the right signs, and that those signs really do mean what we think they mean. Perhaps the writer of this note was merely quoting a song s/he liked.

One of the things I learned at the best job I ever had was to never think I was better than any of the people we served. We were expected to treat each person as we would want someone to treat our parent, our sibling, our child, our best friend. We were reminded often that anyone of us could be in an accident that would leave us with a brain injury and in need of constant care. When we were looking for housing for a person with mental illness or mental retardation, our standard was whether or not WE would live there. A person with mental health problems is still a PERSON first, with thoughts and feelings and hopes and dreams just like everyone else--not a "psycho," "insane lunatic" or any other asinine label.

I hope i misunderstood the last comment. Auschwitz was built as a mechanism for genocide. However great the shortcomings of state psychiatric hospitals, they were established for the purpose of restoring people to health.

A sense of humor and perspective are also necessary for working in the mental health field. You have to be able to separate the person from their illness and the "bad" or dangerous behavior it can cause. One co-worker was severely injured when a delusional patient came into the building and swung a large hammer at his head. Another was hospitalized for a couple of days when a patient sprayed a toxic chemical in her eyes (he didn't understand that it was ok to use it for cleaning floors, but not for squirting people). Another patient brought a gun into the building, and one of the doctors disarmed him without violence. After these incidents, we made our building more secure, more Plexiglass windows and locked doors, so that there would be a little more time to defuse a situation before it reached the point of personal injury, and we made sure we were monitoring signs and symptoms more closely. No one wants patients to have to get into a crisis before they get the help they need. I've learned that virtually anything can be used as a weapon. I recall an enraged man running down the hall at staff, swinging his three-foot bowling trophy. If you take all of these things too seriously, you can't last in the field. You have to keep reminding yourself that this is why you are here. If the people didn't have problems, they wouldn't be where they are, so sometimes you have to suppress what would be a natural reaction in most settings, and just go on loving them and doing the best you can. Probably the funniest episode (again, in a gallows humor kind of way) was when two large, very strong, and very angry young adult male patients got into a fight. The secretary was so flustered that instead of using our standard code for calling for help, she got on the intercom and yelled "We need MEN on the third floor!"

Another factor that made workers' jobs so difficult at state hospitals is that the patients there were placed there because there was NO other place for them. If they had strong family support, if they had insurance, if they had money, they saw a private psychiatrist in a nice office and went to a private psychiatric hospital if the need for hospitalization arose.

I've worked with more than a few people who preferred to spend the hottest weeks of summer in a recently-constructed, air conditioned state hospital rather than stuck in their stifling, run-down, tiny apartment in a high crime area. Most people with serious, chronic mental health issues do not have the job skills to be gainfully employed, and SSI checks do not buy much in the way of decent housing. The community is often not very welcoming, either. I recall one incident where I was working with a young man, teaching him how to go to the drugstore to pick up and pay for his prescription medications. Reading and counting were difficult for him, but he could do both. The insensitive clerk looked at him disdainfully when he was slow to hand over his money and said, very loudly, "What's wrong with you? Can't you even read?" (We called the store later and spoke to the manager.) On another occasion, several staff and group home residents walked to a neighborhood ice cream shop for a treat on a summer evening. One of the residents used a wheelchair. Her wheelchair would not fit through the door, and the owner refused to unlock the other door so that she could enter the store. He said he didn't want "those people" in his store anyway. (We filed a formal complaint with the human rights commission, which sent out a very professionally-dressed lawyer to investigate the possible violation of the Americans with Disabilities Act. He also used a wheelchair, and had the same experience as our resident did, so there were legal consequences for the business.)

I think the "S" after the room number stands for "south."

I've worked with many individuals who lived much of their lives institutions where the patient population included people with mental retardation as well as people with mental illness. Nearly all of them had what we called "institutional behaviors" that stemmed from their experiences in the hospital. There was a preoccupation with coffee and cigarettes, as those two items provided a good deal of the structure of the hospital day, and because there were staff who used the next coffee break or smoke break to control a patient's behavior ("you have to get dressed before you can have coffee," for example, or "calm down if you want your next cigarette"). Except in very rare and specific cases, in community placements we could not use cigarettes as a reinforcer for behavior plans. We had to try every other reinforcer first. Of course we encouraged people to quit smoking, but for many it was a decades-long habit. There has also been some research which showed that patients with schizophrenia may be self-medicating when they smoke, because there is apparently something in nicotine that acts on the parts of the brain affected by the illness. Other institutional behaviors included eating very rapidly and eating with one arm wrapped around one's plate, both done to protect the individual from those at the table who would otherwise steal their food. We also saw people who would carry their most valuable possessions (often coffee, cigarettes, sugar) with them everywhere they went because that was the only way they could be sure someone wouldn't take them while they were out of the room. Some people wore many layers of clothing even in the summer for the same reason. Other behaviors came from the large doses of antipsychotic medications they had been given, such as the "Haldol" shuffle and tardive dyskensia.