I told him to wait for me by the lobby. When I finally got the doctor on the phone, the doctor tells me to call PESP. I go find him and he is not in the lobby like I asked him to be. I look for him throughout the department, I can’t find him. I think I know where to find him, outside the hospital building. As I search the campus I locate him with his head down, long uncombed hair, glistening under the bright sun. I know he is hot, he looks sweaty, his hoodie is zipped, I fear he will get sick since the Risperdol does not react well with the heat. I call his name…

“Tolis, I got the doctor on the phone, he wants to see you, you need to come with me. How are you feeling? You look really hot! You got too much clothing on with this heat, the medication does not react well with heat and all that clothing you got on! I am afraid that you will get sick, come inside!”

As we are walking back into the unit, I get Tolis a cup of cold water and he says to me…

“I don’t have Uranium in my brain anymore! The FBI, CIA, NSA wants me to go to another hospital…”

“How does the FBI, CIA,and NSA communicate with you?” I ask.

“Through your thoughts, Cristina!” (makes a facial expression as inquiring why I do not understand).

“Tolis, that went over my head!” And he proceeds to flash me his winning smile as we enter the cool open hallway leading into the unit.

Security is already there waiting for us. Heavy-hearted, I instruct Tolis to go into the vacant room. He knows, he told me earlier that he does not want to go inpatient. He is afraid. For he has been told by so many people that he is sick and that only the inpatient unit and medication will make him well.

I know he can distinguish between his thoughts and the socially contracted reality, but, I need to follow the doctor’s orders and proceed to make my third final call. To my dismay, I know that once they evaluate him, his fears will materialize when the loud clanking sound of those heavy metal doors closes behind him…

This is an unfortunate reality fabricated by an authoritative and paternalistic system of experts who feel that hospitalization and increasing the dose of numbing cerebral molecules is a solution! Obviously, Tolis is not cured…he is misunderstood and told what they think he is… mentally ill.

I do not want to seem minimalistic of this situation, but during the few times I have called PESP, Metallica’s Welcome Home comes to mind. It is such a potent ballad, full of angry, desperate, and raging energy, that portrays what an involuntary patient may feel once those heavy metal doors close loudly behind him.

Welcome Home

Correlating the lyrics of Metallica’s Welcome Home (Sanatorium) with the Current Psychiatric Medical Model

trenton_state_hospital_nh002 — Trenton State Hospital

Welcome to where time stands still

No one leaves and no one will

The moon is full, never seems to change

Just labeled mentally deranged

I see our freedom in my sight

No locked doors, no windows barred

No things to make my brain seem scarred (Metallica, Master of Puppets, 1986)

When an individual, such as Tolis, displays any type of non-conformist behavior and/or thought pattern, he is immediately deemed by his community and the system, either a danger to self or others. Evaluated by a team of mental health experts, trained and abiding to the stipulations and regulations of the DSM5, the potential involuntary patient is pathologized with a powerful diagnosis. This diagnosis is a label that follows the individual for the rest of his life. In Tolis’ case, his presenting thoughts and alleged medication problem, is what has him involuntarily committed (and deemed “mentally deranged”as Metallica states). Cloaked with his given label, Tolis is locked up behind heavy metal doors until the system deems him stable enough to go back into the community.

Welcome: Institutionalization and Medicalization

medications-rethinking-mental-illness — Medicalizing provides ethereal walls, yet, are as confining as the material ones.

Sleep my friend and you will see

That dream is my reality

They keep me locked up in this cage

Can’t they see it’s why my brain says rage

Sanitarium, leave me be

Sanitarium, just leave me alone (Metallica, Master of Puppets, 1986)

As in Tolis’ story and many of those other patients, commitment and lock up in an inpatient psychiatric unit against one’s will is one’s ultimate fear. The pained other’s fear materializes when the evaluating Emergency Room psychiatrist places his or her fear of personal risk and lawsuit before the ethical decision of what is the patient’s best interest (Christensen, 2017). Already isolated due to incongruent social constructs and nightmarish internal realities, the social deviant is locked away to make him well and keep the hospital lawsuit free and the community safe.

The main premise for institutionalization is to promote the individual’s rehabilitation back into the community. However, due to Medicare and Medicaid financial cuts to the mental heath system there are no inpatient unit groups to assist reintegration or any other stimulation other than an enclosed television that is set on one channel. Isolation and ostracism from others is compounded by the medicalizalized system adopted by most hospitals to keep the patients as heavily medicated as possible simply because the system deems that their thoughts and behaviors are biochemical and not sustained from psychosocial trauma or spiritual imbalances.

Medication stabilization is the protocol used for patients like Tolis who are diagnosed with schizophrenia. Thorazine, Risperdal, Zyprexa, Seroquel, Geodon, Prolixin, Haldol and other neuroleptics are heavy medications which sedate the brain, numbs the mind, and can cause severe physical sides effects. The majority of patients placed on neuroleptics complain of side effects and the numbing qualities these have on the whole being. If a patient feels any rage, anger, frustration, or any other emotion, the dose is increased to the point that many do not feel anything at all. Many equate this to a chemical lobotomy. The person lies in bed or slumped in a chair. No complaints arise for there are no independent emotions or thoughts. What therapeutic value does this procedure hold other than containment and … to keep whom safe?

Welcome: Stigma and Marginalization

Build my fear of what’s out there

And cannot breathe the open air

Whisper things into my brain

Assuring me that I am insane

They think our heads are in their hands

But violent use brings violent plans

Keep him tied, it makes him well

He’s getting better, can’t you tell? (Metallica, Master of Puppets, 1986)

It only takes five to fifteen minutes for the psychiatric evaluation to determine if a person is mentally ill or “insane”. Medication is the preferred therapeutic protocol used to make the person well. Even with the sedative effects of the medication there is occasional acting out behaviors, especially among the unit newcomers. When this happens a “Dr. Strong” is called throughout the hospital for assistance in the unit.

The following are illustrations of what it looks like:

images-6 — This is an illustration of a Dr. Strong subduing the non compliant patient. Once the patient is secured he or she will be placed on the bed and secured with the 4 point restraint.

The premise of a “Dr. Strong” is to keep the patient safe and secure from self-harm. Yet, witnessing it portrays a total different connotation. The noncompliant patient is corralled by security guards and taken down to the floor. This video portrays a very civilized “Dr. Strong” which does not transpire in real hospital life. On many occasions, unlike the video, the patient is spoken to in a shaming/blaming tone for his behavior. Many outsiders question if this is against the patient’s human rights , but, hospitals claim it is for the good of the patient for since they need to be taken care of from their hell and the hell they cause. Patients’ perspectives are quite different: their narrative is one of feeling degraded, punished, hurt, and humiliated.

Welcome: Pathologizing and Social Control

No more can they keep us in

Listen damn it, we will win

They see it right, they see it well

But they think this saves us from our Hell

Sanitarium, leave me be

Sanitarium, just leave me alone

Sanitarium, just leave me alone

Fear of living on

Natives getting restless now

Mutiny in the air

Got some death to do

Mirror stares back hard

Kill, it’s such a friendly word

Seems the only way

For reaching out again. (Metallica, Master of Puppets, 1986)

It is known that medicine has a paternalistic authoritative mentality and philosophy towards patient care (Christensen, 2017). Unfortunately, it is also the credo for many psychiatric social workers. Deemed mentally ill, as in Tolis’ case, his only option is to go inpatient to get well. Actually, it is the belief that due to his thoughts, unconventional behavior, and appearance he needs to be admitted, even if Tolis believes the contrary and he presents no harm self or others. Many a times, social workers describe a patient, like Tolis as “too sick” or “very ill” or “he needs his medications increased”. With this perspective in mind any displayed behavior, either provoked or reactive, is pathologized, blamed, shamed by the social workers and of course, medicated by the psychiatrist.

This philosophy of an authoritarian, pathologizing, and medicalizing mentality creates a dependency on the system which strips the individual of his sense of agency, and fosters a self fulfilling mentality. This perpetuates the vicious cycle of recidivism. Even if the person is a danger to self and other, is institutionalization the only option? What happened with the coming together of the tribe to empathize with and assist the distressed person?

Our current psychiatric system is reliant on “Big Pharma” to numb behaviors, not cure as they claim or wish. The numbing molecules convert lively humans into dull, numb, dispirited beings! It is so disheartening to witness individuals in the units nodding and wobbling as they are attempting to walk or self-consciously drooling on themselves. I strongly believe that new protocols need to be in place to encompass the whole person and the community for effective treatment, integration, and mutuality.