self mutilating patients

seizetheday · Nov 17, 2011

Sometimes people who have schizophrenia have psychotic episodes where their entire reality is altered. Both the content of their thinking and their thinking process is altered and they are in a whole different reality where something like digging out and eating flesh makes sense. They are living in a 'movie' (sometimes a horror movie) scripted by their psychosis (hallucinations, delusions, paranoia). They have persecutory delusions where they think people are after them and they have to do x or y to pass a test or to appease others or to keep themselves or someone else alive. Sometimes there is still some normalcy also scripted into their movie - so they can have basic conversations or get through ADLs, seemingly normally but if you were able to hear the voices in their head you would realize that they not thinking like you or I.

The other possibility is that the person is not that psychotic and wants to stay in hospital longer and not go back to jail so they are adding another layer of physical injury and psychological problems to try and stay longer. You'd have to be pretty desperate though to eat your own innards.

There is a great deal of untreated or undertreated mental illness in the prison population. The proportion of prisoners with a mental illness is incredibly high. I saw one program where the main focus of intervention was on treating mental helath issues and they continued to focus on mental health after release and the recidivism rate dropped to an incredible low of about 17%.

He is no different in terms of being a 'kind' of person. He is a human being just like you. He has a major mental illness that impairs his ability to think rationally and inserts irrational picture, ideas and thoughts into his thinking and we act based on how we think. I have no idea what his crime was and it may or not be related to his mental illness (e.g. picked up for disorderly conduct because he was psychotic and ranting in public or robbed a bank 5 years ago when well). Treat him with respect, if he is psychotic don't get into conversations about his delusions or his self harming, be factual, keep conversations short, keep his stimulation low, give reassurance that he is safe.

*LadyJane* · Nov 17, 2011

Just remember, this is a human being who is tortured with schizophrenia. It's hard to be him. You don't know what all he has gone through before reaching the point in life where he is now, but you can guess it wasn't good.

Just try to treat him as a person with plenty of troubles in his life, and could use someone seeing his humanity and treating him with some genuine caring. It could make a huge difference (or even a small difference) in how he sees himself, and help him get through the day.

Jane:nurse:

NurseOnAMotorcycle, ASN, RN · Nov 17, 2011

Take a deep breath. Then take another one. :hug:

This sounds like it's really difficult assignment. Do you have a chaplain or a workplace employee assistance program? Get advice from psych nurses on how to deal with this pt?

I hope someone from psych is following the pt so it doesn't happen again.

chevyv, BSN, RN · Nov 17, 2011

I hope the doc orders 1:1, at least restraints for a bit, and some good meds. Poor guy definately needs to be on a treatment program.

I started a working for the county psych hospital and will tell you the same thing they still tell me today....Welcome to County!

nursemichelle80, BSN, RN · Nov 17, 2011

You cannot figure these people out. I work in a prison and see this kind of stuff on a daily basis. As a nurse, it is my job to provide the best medical care to them, regardless of their crime or disease. I may not like them or what they've done but I always adhere to the Nursing Code of Ethics.

chevyv, BSN, RN · Nov 17, 2011

I would also caution you to be on your toes and to be careful, schizophrenic pts sometimes are very paranoid and can be unpredictable and strong. I've seen some pretty serious injuries to staff that come on out of the blue. Good luck!

Kooky Korky, BSN, RN · Nov 17, 2011

Respecting the patient? Why not respect him? He's just a person and a very sick one at that.

Are you thinking he deserves punishment for mutilating a body made by God? Or is it another type of spiritual problem you are having?

I've seen a number of mutilators. It's hard to stomach but I realize they are sick. It's just a sickness, nothing to be judgmental about. it's disgusting, it's scary, but not the person's fault. It's horrifying, it's fascinating, after a while it's almost boring. Not to be harsh or cold. It's just that after you've seen a few of anything and you realize there's no real explanation and no real changing it, you kind of move on.

nightengalegoddess · Nov 17, 2011

Every one of you has really helped me out right now. The truth was just under the mask you guys just gently pulled off. I just had written in another thread about judgment. ha ha.

I had thought about all these things all night, but I couldn't get real and get over myself. I made it, but not advancing much for the better within his world besides caring for the medical side as well as possible. I at least did talk to the docs about psych follow up. It is hard to tell if that could ever go far enough. I guess the measure of damage is relative to the sensitivity of the person too. He's probably a really sensitive guy. I have heard of societies who recognize the "mentally ill" at a young age and teach them shamanism and healing. It is true we do not have that now.

I do hope it gets to where it is boring. I have come to love boring now that I have been a nurse for a while. : )

maelstrom143 · Nov 17, 2011

As both a nurse and family member of people w/mental illness, my heart goes out to you. "Seizetheday" was right on target from a nursing and humanistic perspective, so I am just adding my :twocents: to that.

Schizophrenia is a heartbreaking disorder. Many schizophrenics have really high IQs and imaginations, as well as being very sensitive before the illness manifests itself. It is heartbreaking to see the devastation of mind and soul this illness leaves in its wake, not just for the patient, but for those people around him/her that must deal with it. Not to mention the loss of potential good that they might have offered to their society had not their illness destroyed their futures.

From the few I have cared for, as well as family members' experiences, many schizophrenics live in constant fear, even terror, from the voices and delusions they experience on a daily basis. One of our family members believes she sees things that are not there, that walls bleed, that she is murdered and raped/sodomized on a regular basis. One of my patients heard the wall talking, swore there were radio waves checking on him, and that he was in a government facility where he would be probed to get the truth out of him. He trusted me, and it broke my heart to hear his horrible delusions of persecution and torture.

We have no idea what each individual has to live through, but while we take care of them, giving them dignity, treating them with respect, and ensuring their safety during our shift is paramount. Also, thank God, at the end of the day.

There but for the grace of God...

SweetseRN · Nov 17, 2011

I am sorry you had to experience that. It sounds awful. Big hugs to you.

xtxrn, ASN, RN · Nov 17, 2011

Self-mutilators aren't uncommon. Many are abuse survivors. It's a release of some sort. This is obviously an extreme form in your op.

What are your facilities policies re: protecting from self-harm?