The Nightmare known as Psychiatric Care Part One - page 2

by aknottedyarn Guide

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The Nightmare Many years ago there were insane asylums. Some were so bad that we even got a new English word to describe mental illness based on the facility, Bedlam. When I was a child we had State Hospitals. They were... Read More


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    Quote from Sadala
    Physicians, and not just psychiatrists, still try to give women hysteria dx. They just use different semantics. IMO
    True but you have totally different presentations of hysteria from 50 years ago (or from 50 years ago and 100 years ago) than your typical, say, borderline dx.
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    I don't know the answers about the dx of hysteria. Certainly it was common. My gut feeling is that they were seeing peripause, menopause and likely endometriosis and had no good way to dx those things. As the behaviors of crying, mood swings, etc. were confined to women it became a popular dx for anything female. There was such a thing as depression but usally only diagnosed when something close to catatonia developed. We also called Bipolar I "Agitated Depression" and did not recognize B-P II at all.

    Although I did a great deal of psych nursing back in the day I can't claim to be an expert.

    As to the question of what was the nightmare/is the nightmare? I look back and see how horribly we treated people, with the best of intentions. We did the best we could but we were warehousing many and encouraging dependence so people were less able to function in the real world. It was the set up for the blow up of mental health care and the attempt to close down the worst of the places. In the process, as with all good ideas gone wild, too many doors were shut and too many people left homeless or without skills to make it outside.
    Meriwhen likes this.
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    I'm currently in nursing school and work the night shift as a CNA in a psych facility and this article was very interesting to read.
    aknottedyarn likes this.
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    This past sounds unbelievably barbaric to me and HAPPILY a part of the PAST of medicine.

    Lobotomy, asylums, wet sheet treatment - it sounds akin to the backwards use of leeches centuries ago and the use of no anesthetics. These treatments were not scientific - being wet and cold is unhealthy (lowering the body temperature), destroying someone's brain can turn them into vegetables and tamper with their ability to care for themselves (as seen with brain tumors) - and people could be put into asylums who did NOT belong there, as well as be disturbing to live with people who had issues, maybe even making their problems, IF true, worse.

    And even more harmful to the person than without them.

    What a nightmare. I would protest it indefinitely. I'm glad this non-scientific nonsense/ torture is a part of history- where it belongs.

    Quote from aknottedyarn
    The Nightmare

    Many years ago there were insane asylums. Some were so bad that we even got a new English word to describe mental illness based on the facility, Bedlam. When I was a child we had State Hospitals. They were filled with people who did not fit well into society. Some were severely developmentally delayed, they were called retarded, idiots, imbeciles. These were real classifications. Now we see these words as swear words. I am hesitant to even write them. Others in these institutions were alcoholics, usually late stage with what was known as “wet brain”, also known as Korsakoff’s Syndrome or the earlier stage of Wernicke’s. The next category I recall were those who were asocial or had poor social skills. Many were very passive and followed directions well. All they wanted was to be left alone. The most difficult to care for before the mid 1950’s (before my time) were those who had what we traditionally think of as“mental illness”.

    Schizophrenia, especially those with hallucinations, catatonia, depression, paranoia, and associated symptoms were common. There were some very dangerous individuals. My first job included some of these individuals. Most were not dangerous, as is the norm with people with mental illnesses.

    One patient, Mr. C, frequently tried to purchase guns through the mail. We were allowed to stop this mail from going through. He was one with poor impulse control. There was once a bee in the common area. He picked up a solid metal chair to throw and attempt to kill the bee. This chair weighed a great deal but that would not stop this man, even in his 70’s at that time. He could not take any of the “normal”antipsychotics of the day. Mellaril, Thorazine, and Stelazine. Haldol was just coming in at that time. He could take nothing because he had been so heavily medicated in the past his liver was on its final go round.

    Life in the old psych units must have been interesting. I am too young to recall wet sheet treatment except when I was the instructor we, my second year students and I once saw it used for a pregnant woman. It was torture, from my vantage point. Of course when it was used it was one of the few treatments used and found to be somewhat effective.

    As a young grad I saw those who had been through the lobotomy treatment. Zombies might not quite be the right word. One could not control his body temperature so every once in a while he would spike a temp of106 degrees. Another, who was non-verbal, common with our post lobotomy patients, would regularly take off all his clothes and bless his manly parts. I was young at the time and shocked.

    People recognized how dysfunctional these human warehouses were and eventually they disappeared. The thought was that many people in there did not need to be hospitalized. They were capable of self care. At around the same time the Vietnam War was ending. We saw many veterans returning with many psychiatric illnesses, most not seen in the VA system because the old VA system was not user friendly at all. I know there are still long waits and appeals are difficult but in the old days, soldiers did not have mental illness. We still see that attitude in some military areas even today.

    So we had an influx of veterans back to the states at a time when the war was not very well accepted. Protests were common. It was the first televised war. Our veterans, who had a new kind of fighting to deal with, who had seen too much, been led by people who did not understand the enemy came home to a place that rejected them. “Fragging” an officer was not uncommon so many of these returning had multiple layers of pain that became toxic, some called it PTSD. At the same time drug culture was gaining new converts. The war on drugs started and every person with a lick of oppositional behaviors tried drugs and many became hooked. Before this time drug use was more limited to certain jobs, cultures,and classes. Soldiers in search of relief from their PTSD symptoms started to use these same chemicals.

    This is a bit of the history of mental illness treatment. Next installment of my nightmare will consider more modern ways of dealing with mental illness.
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    Don't be fooled by the reality of changes in care for those with mental illness. The stigma is still there. Funding is pitiful for the chronic menally ill.

    But part of that is for the next installment.

    In the time before it comes out think for yourself how you respond to hearing that __________ has ben diagnosed with ____ mental illness.


    Thank you all for your comments. Please keep them coming. As we become more able to discuss what was and how we see that we become more determined to make the future better so no one writes about the nightmare of the early 21st century.
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    Interesting read, looking forward to the next installment. I work on an inpatient acute care unit, and will hopefully be starting for my PMHNP in the next year.
    aknottedyarn likes this.
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    Great article, AKY!! Can't wait for the next installment Learned a lot about "wet sheet therapy" on youtube..haha. Sad state of affairs, our mental health system in this country. I'd even go as far as to say it's tragic. And I've been lucky enough to be a patient at the #1 inpatient psychiatric hospital in the country. The only place I felt that I got help. The other places were nightmares and a joke.
    aknottedyarn likes this.
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    Advances have been made; more should be coming!
    aknottedyarn likes this.
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    I am a second year nursing student and I find this article very interesting. I had my psych rotation this past semester and saw how frustated the patients get by being ignored by the medical staff (I was on the depression wing side) I understand they have to follow a structure (times), but simple questiones they had, such as :can I talk to my social worker? And they would be rudely told "you need to go to your room, later your nurse will talk to you" other patient would say I am in pain can you give something?, " go to you room, we will be there later" . I am only a student and I dont know much about mental health facilities, and if you need to treat patients like that, but the patients were not aggresive or being rude to be treated rudely by the staff. Patients would mention in the "community meetings" on how staff would ignore their questions by saying they will go talk to them in their rooms and they just didnt come see them at all and how they felt as being "treated as being in prision". One of the only two nurses is so jaded and she was very rude to us, we would talk to her and she would completely ignore we were there (even though we were doing the vital signs on ALL of the patients on the floor, wich other person would appreciate the help. I guess it is challenging to work in mental health facility, but if your that bitter, just change specialty.
    malamud69 and aknottedyarn like this.
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    Each specialty requires different abilities of a nurse. I could never work in the OR. I have the patience of a saint when it comes to students and people with dementia, go figure, but hav no patience with many other areas.

    Psychiatric nursing requires a certain set of skills. If you don't have those skills bitterness is the result, same as it is in all areas. If you find you like psych you can be a person who helps bring about change. Simple role modeling of thanking students for their help is noticed by patients. It always will be the non-verbals that either grant you entrance or cause you pain.
    student forever likes this.


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