The Nightmare known as Psychiatric Care Part One

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    The nightmare is a review care provided to those who suffer mental illness. Some of the past is important to give a hint of why we continue to see mental health care as a nightmare. It is, in part, a history of the care I delivered as a new graduate. Times change but the nightmare continues.

    The Nightmare known as Psychiatric Care  Part One

    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.
    Last edit by Joe V on Dec 19, '12
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  3. by   RubberDuckie
    Looking forward to reading the next installment. Mental health is still in its infancy compared to other systems-- it's all so fascinating
  4. by   hecallsmeDuchess
    Thank you for this article, I'll be staying tuned for the next one(s).
  5. by   dirtyhippiegirl
    I've been hospitalized with a few geri patients who had lobotomies 40-50 years ago. Interesting affects, to say the least.

    Did you ever run into any patients with a hysteria dx...or was that too long ago? That's been a pet interest of mine for a while.

    Also, there's been a lot of academic debate on the schizophrenia label and how the dx of schizophrenia has changed since even the 1970s. Literature wise at least, decades ago it seemed like there was a lot more true schizophrenic catatonia, and conversion disorders were a lot more common. Have you noticed anything like that in your practice over the years?
    Very interesting article, aknottedyarn. I look forward to the next installment.
  7. by   Sadala
    Quote from dirtyhippiegirl
    Did you ever run into any patients with a hysteria dx...or was that too long ago? That's been a pet interest of mine for a while.
    Physicians, and not just psychiatrists, still try to give women hysteria dx. They just use different semantics. IMO
  8. by   onthejourney
    An interesting read, thanks for the post. I've never heard of the wet sheet treatment before.
  9. by   morte
    apparently the wet sheet therapy is still being least as of 3 years ago...check out nih
  10. by   Joaquin49
    In California, we can thank Gov. Ronald Reagan, andl his grand wisdom in the early 1960's for closing and discharging many mentally ill pt's from the state hospitals out into communities that were ill equipped to handle or care for them. As a nurse that has in the past worked in state hospitals as well as prvt. and county institutions for the mentally insane it really was quite challenging.
    Last edit by Joaquin49 on Dec 19, '12 : Reason: Structure
  11. by   classicdame
    OP - what part of this article is "your nightmare"?
  12. by   dirtyhippiegirl
    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.
  13. by   TopazLover
    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.
  14. by   Cali_Nurse_209
    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.