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The Norwegian Artist Theodor Ketilsson wrote:
"To see the world through a troll’s eye is to discover that everything wrong seems right, and everything right seems wrong. Beware and do not try this!"
He could very well be describing the experience of dealing with the mentally ill. For those who have suddenly found themselves in that situation, it is indeed a troll’s world! Even worse is the lack of guidance or support for those seeking to deal with a mentally ill loved one. One finds himself thrust into a netherworld of insanity and the odd side of the medical profession.
Mental illness is nebulous in its consistency. Unlike physical ailments, it cannot be measured, weighed, or viewed through a microscope. You cannot point to a spot and say, "It hurts here." Mental illness shows symptoms through behavior rather than the body.
There are behavioral symptoms of mental diseases. For example, a symptom of paranoid schizophrenia is hearing nonexistent voices. These are actually in the patient’s subconscious. A symptom of clinical depression is delusions. The more conspicuous symptoms of the various disorders are bizarre behaviors. In the mental realm, they stand out the way blisters, skin inflammation and eye discoloration stand out for physical symptoms.
Each mental illness is different and has a different set of symptomatic behaviors. The bizarre actions look like utter chaos to the layman, but are predictable indicators to the experienced mental health professional. You and I may see unexplainable, wacky episodes which a psychiatrist would recognize schizophrenia, depression or dementia.
For those who must deal with mentally ill persons, the fact that diseases can be diagnosed means that there is help. You do not need to deal with the sick person by yourself. A whole range of mental health professionals are available, and more important, are likely to have successfully handled the same problem many times.
How did you come by the sick person in your life ? Sometimes the person is a long-term case and has been around you for years. This is the case where a parent, child, sibling or other relative has had a long history of mental illness. In the case of older adults, you might have ‘inherited’ the task when their usual caregiver or companion has passed away. This does not mean you know what to do. Mental Illness had such a stigma that many parents purposely shielded their children from it. They concocted a host of excuses to explain away the sick person’s malady. Such stories are misleading. When misunderstanding of an illness is compounded with lies, no matter how well-intentioned, it makes things worse. You would be surprised how well some families conceal and cover for the disease both to outsiders and other family members. Children are taught to believe adult relatives. Though children know that something is going on, they are prone to accept their parents’ lies as truth.
In other cases, the mentally ill person is a more recent addition to your life. He or she may be a friend, in-law, spouse, Kindred – or Coven-mate or other acquaintance. They may be chronic sufferers who have come to you recently. They may be recent people whose outbreaks are sporadic and infrequent. They may also be people who have been in your life for a while, and whose disease developed recently. Whatever the origin of their disease, it is new to you. An episode of insane behavior is shocking because it is unexpected.
Whatever the origin, you find yourself having to deal with someone who is mentally ill. The behavior of the afflicted ones can be described as mercurial, capricious, irrational, illogical, insane, weird and downright bizarre. At this point, you may feel as if you have no resources for handling the problem. Worse, the sick one will frequently try to resist attempts to help.
Mental illness has long had a stigma attached to it. This goes back to the Middle Ages, where the Catholic Church taught that insanity was caused by demonic possession. Another aspect of the stigma came from the Medieval culture, regarding the "village idiot." Mental retardation was lumped in with other mental diseases. As a result, the afflicted were seen as feeble-minded ninnies or demoniacs. None wanted to admit that retardation or evil sprits could abide it their family.
Treatment of the mentally ill was itself callous. They were locked away in horrible conditions, or subjected to violent exorcisms or spurious "treatments." Right into the early 20th century, weird and often painful treatment were concocted in hopes of conquering mental illness.
There were few alternatives. Families were ill-equipped to handle the more extreme forms of mental illness. The afflicted ones were often locked away in large institutions for years at a time. The prospect of curing these diseases was slim. Even the new science of psychiatry had few answers.
The stigma is one of the major factors in hindering a remedy. Affecting both the sick individual and those around him, it keeps people from seeking help. Who wants to admit that a relative or other loved one is crazy? For this very reason, it is essential that those dealing with mental illness get good information. They need to speak with mental health professionals at the earliest convenience. The gossip mill is no place to find answers!
The modern mental health system uses several levels of care and a host of professionals. Forget the images of "One Flew Over the Cuckoo’s Nest." The mental health system is much better than that. To be fair, most of the psychiatric staff are too proud to allow lapses in their professionalism. As for the profession, it has made great leaps in recent years. The ability of the psychiatric profession to restore people to life within society is tremendous. In the last 20 years, they have been able to empty the institutions to such a degree that many state psychiatric hospitals have closed.
The first level of mental health work occurs while the sick person is still able to function in society. That includes therapists, nurses and psychiatrists. They may have private offices or might be attached to a larger hospital. Most hospitals have a separate mental health center for "outpatient treatment". (Outpatients are patients who are not hospitalized.)
Of all the staff, the patient will have most contact with the therapist. This is a person who interviews them and discusses their problems. The therapist can be a psychologist or social worker. (The usual degree for therapists is MSW – Master of Social Work. He might otherwise be a PhD in Psychology.) Their work is entirely conversational. Neither has the license to prescribe drugs.
Therapists arrange counseling sessions. There are two common types. A one-on-one session is when the patient talks to the therapist alone. The group session is when a therapist has several of his patients meet and talk together, under his supervision.
There are therapists who work alone, using counseling as their sole tool. Others work in conjunction with a psychiatrist. Their conclusions are passed to the psychiatrist, who then determines appropriate treatment.
Psychiatrists generally do not spend a long time with patients. They determine a course of treatment. This usually includes pharmaceuticals as well as other therapies. A psychiatrist can prescribe drugs. Unlike the Hollywood image, the psychiatrist is not a therapist. He is a fully-licensed medical doctor.
Psychiatrists are the experts at diagnoses. They know what questions to ask and what reactions to note. Their exam is unusual, with several odd questions. However, these things that seem odd to normal folks are good at exposing mental illnesses.
Psychiatric nurses are members of the nursing staff assigned to work with the mentally ill. They normally work in a hospital setting. However, the increased use of nurse practitioners may bring more of them into mental health centers.
In the hierarchy of medicine, the doctor is at the top. Next come nurses, who have more direct contact with patients. A "nurse practitioner’ is a relatively recent thing, being a nurse with limited ability to diagnose and prescribe drugs. Therapists are somewhat outside the loop, since they deal directly with the psychiatrist rather than the nursing staff.
The next level of care is the hospital psychiatric ward. Even among mental health workers, it has such corny nicknames as "the flight deck," "the looney bin" and "the Australian think tank." Almost every hospital has one. The psychiatric ward is where the mentally ill are first placed, should their behavior warrant it. People who are a danger to themselves and others, who are considered a suicide risk and who are otherwise incapacitated by mental illness go to the psychiatric ward. For many with psychiatric ailments, it is the next stop after the emergency room. The psychiatric ward is also used by associated mental health clinics when a patient needs temporary inpatient treatment.
Should your mentally ill person have an episode that needs treatment, they will likely be taken to the emergency room, get evaluated by a member of the psychiatric staff, and then be sent to the psychiatric ward. For most cases, the situation is an emergency rather than planned treatment.
Hospital psychiatric wards are intended for stays from a day up to about two to three weeks.
The hospital psychiatric ward is a "lockup ward." That means that the doors are locked. A person can only enter or exit if permitted by the staff. Without the locks, insane people could wander through the hospital at will. Hospitals do not want people who are a danger to themselves or others to go loose. Many mentally ill people must be contained until an effective treatment is applied.
If a person has attempted suicide or has had to be brought in because of an extreme episode, he will likely qualify for "observation." Most states have a law allowing a person to be held for 72 hours if his mental illness poses an immediate threat to himself or others.
The hospital psychiatric ward has a small staff that includes nurses and attendants. There is one doctor who is in charge, and usually one or more who are available when the main doctor is off duty. The head nurse is the person with most authority, after the doctor. Nurses are like officers, in that they can handle many duties that require a decision. However, their authority is limited. The doctor has few limitations in decision making.
Attendants, or orderlies, are the staffers who handle mundane tasks. They see to the patients’ safety and well-being. Attendants also handle disruption. Experienced attendants are expert in using restraining holds to subdue patients who become violent. Amazingly, they can subdue without doing harm!. The attendants handle things like roll call, getting people together for meals, medication and group meetings, etc.
The idea of restraint upsets normal folks until they understand what it is, and how it is done. Some patients become unruly to the point of being dangerous, either harming themselves or others. The attendants need to stop them. If the person cannot be stopped with words, physical force has to be used. Be aware that medical use of force is different from that of the police. Medical people do not seek to arrest or retaliate or punish. They realize they are dealing with a sick people whose actions are symptoms of disease. The person is a patient, not a prisoner.
The attendants have a small battery of tricks borrowed from wrestling and jujitsu that allow them to safely restrain a person. These are simple holds and locks that do not damage the person. They incapacitate him only as long as they are applied, giving the other staff time to react. A common technique is to inject the restrained person with a sedative that makes him tractable.
There is usually one room in the ward for isolation. It has restraints, which are belts and cuffs. A person who is extremely violent might have to be prevented from moving temporarily. They can be strapped to a bed, much like a patient in an ambulance. Other restraints are applied via cuffs to the wrists and ankles. They prevent a patient from harming himself via clawing, striking, etc. They can also be used to immmobilize a patient.
Restraint is not used to punish or change behavior. It is used to prevent an irrational person from doing damage. Understand that while it sounds barbaric at the outset, it is actually the only reasonable alterative for an unreasonable and violent patient. Restraint is only used temporarily.
Except when the 72 hour rule applies, a patient can sign himself out of a hospital any time he wants. If he does so against the doctor’s advice, it is a case of "a.m.a." or "against medical advice." (That can be an issue with insurance.) The only ways a hospital can keep a person against his will are the 72 hour rule and commitment.
To be "committed" means that a person can be held against his will. It requires a psychiatrist and a judge. The doctor has to make a determination that the person is such a danger to himself or others that he must be contained. This must be presented to a judge, who is the only one with the authority to have a person committed. Because this law had been abused in the past by scheming relatives and hucksters, judges are very careful that this is done correctly.
A person who is committed can be released if they have regained the ability to function. Most hospitals want to get patients back on the streets as soon as possible. Commitment is a tool and a last resort.
Larger institutions such as state and county hospitals are for those who cannot be helped in the local psychiatric ward. There are also private institutions for those who can afford them. The function of these places is to care for people who require a longer term of treatment. They are the ones with the scary reputations.
Because of advances in psychiatry in the last twenty years, these places are dwindling. Those who go there now are people with very difficult ailments and / or those requiring long-term inpatient treatment..
If you visit a larger institution, there is one rule: always make sure staff knows where you are. They will usually assign an attendant to accompany you if you visit someone on a ward. Stay with him. These places are big and you can get lost.
There are lock-up wards where the entire building is locked. Visitors are assigned an attendant who must open each door, let them pass, and close that door behind him. Security is tight because the inmates cannot be allowed to go loose, lest they harm themselves.
A visit to a big institution can be scary. However, these places exist because there are extreme cases that need to be handled this way.
If you are visiting a hospitalized relative or friend, you might need to bring some supplies. Ask the nurse what they need. If you are new to this, let the nurse know. Even the best sometimes forget how new and different this is for a first-time visitor.
People who are going to be hospitalized for even a few days need a change of clothes and perhaps some toiletries. Hospitals can usually provide toothbrushes, soap, etc. However, there are things like combs, brushes, and such that are not provided.
Clothing is important. You will likely need to bring underwear, socks, comfortable pants and shirts. Avoid clothing that has belts or laces. Also, try to find clothing that looks presentable in public. Even though they are in a lock up ward, people are in the company of others and feel better if they look presentable. Sick people are embarrassed enough, and do not need to feel worse about themselves.
How much clothing? Find out how long your loved one is likely to stay, and plan accordingly. Remember that hospitals do the laundry for patients. This is usually done weekly. You do not have to plan the way you would for a long vacation. When in doubt, ask one of the nurses.
Whatever you bring, pack it in a plastic bag rather than a valise. The staff has to check everything, and that means it all has to come out. Besides, psychiatric wards have no place to store a suitcase or duffel bag.
Things that are harmless to you might be banned on a psychiatric ward. Rat tail combs, anything with a hint of a sharp edge, shoelaces, string, and belts are usually restricted, if not entirely prohibited. Many patients are a danger to themselves and others, and will use whatever they can get to do damage. While your loved one might be relatively harmless, others can be dangerous. They would think nothing of stealing a potential weapon from someone else.
For example, string seems safe. To a suicidal person, string presents an opportunity to hang himself. The world of the insane is a troll’s word where even the safest of things becomes a tool of harm.
Be careful about bringing food. Hospitals try to control diet, as it plays an important role in healing. Several foods are banned on the psychiatric ward.
When you visit a psychiatric ward, close your psychic senses. Shield and screen yourself. If necessary, take a friend who can help you shield and screen. This is a bizarre environment for a person with finely-tuned senses. Emotions among patients are intense and twisted. They are projecting stuff all over the place. If you must, take along a protective amulet or other magickal device.
If you have brought anything for your friend or relative, show it to the nurses first. Some things just cannot be allowed in a psychiatric ward. (For instance, some foods are banned because they conflict with medication.)
You will see people doing odd things. Some might even approach you. Let the attendants handle them. Your only thing is to visit your loved one. If a patient becomes a problem for any reason, call an attendant. He will handle it. Remember that these people are in the ward because they are insane. They are saying and doing things they do not mean.
Many people will seem docile and passive. A common practice among psychiatrists is to "snow" patients with sedatives when they first arrive, to make them manageable. After a day or two the "snowing" stops to allow other treatment. A few patients may be active, roaming about, interacting with others, dancing to unheard melodies, etc. Rarely will you see anything extreme.
Remember that these people are insane, but not stupid. Just because someone is sick does not mean they are also dumb. Psychiatric patients can be cunning and surprisingly smart.
When you talk to your friend, focus on them. If the environment is intense, it helps to have a friend come along. The friend can screen out psychic interference while you concentrate on your loved one.
If possible, talk to the nurse before you leave. Find out if there are any things that your loved one needs. Nurses have a lot of contact with the patients and can tell you how well your friend is doing.
A good plan of action is to arrange to talk with the psychiatrist, too.
If possible, find out from staff the symptoms of the disease and characteristic behavior. This helps differentiate between when your loved one is being himself, and when his disease is in charge.
In a psychiatric ward, you might notice attendants checking off a sheet on a clipboard every so often. They take a head count of all inmates frequently, especially during visiting hours.
Each mental health facility differs. When seeking information about your loved one, it can be difficult to get the right person. For instance, psychiatrists, therapists and social workers tend to work day hours. It is hard to get to them off-hours. In some cases, a nurse or social worker is the point of contact, through whom you must go to contact the psychiatrist and other significant staff. If you are dealing with a hospital, call and ask for the psychiatric ward. Ask the nurse about whom you should contact. Then, it can be a waiting game. Most therapists and doctors associated with psychiatric wards are busy because of odd situations. These events are episodes common to the unpredictable nature of the mentally ill. They may take a while to get back to you.
Be aware that medical personnel can only give medical information to family. If you are not a relative, the staff will not discuss the patient’s disease with you. The best you can do in that circumstance is to visit your friend during visiting hours. You can often get a little more information in person.
Should you have to call for immediate help, tell the operator that the problem is a psychiatric episode. Many areas have special ambulance crews who deal with psychiatric emergencies.
If you have time, look to the hospital you use for your medical concerns. Call and ask for their mental health center. Tell them the situation and be ready to follow directions. They may want you to set up an appointment for evaluation or therapy. They might want their psychiatrist to take a look and decide if the person needs hospitalization or outpatient care. Of course, you may be told to bring the person to the hospital immediately, or arrange for an ambulance. If the person initially seems manageable but gets worse, call again and inform the staff of the changes. They might recommend a change in plans, and that could include an immediate trip to the hospital.
In case of a suicide attempt, head for the hospital. This goes double if they have hurt themselves or ingested any substances. They may lie about how much they took. Also, some substances are not wiped out just by making the person vomit them up. In fact, some should not by regurgitated because they are caustic. A medical emergency room is needed to deal with them. Whenever a substance has been ingested, whether it has been vomited out or not, call the hospital immediately!
Let us be blunt here. You are facing a problem that you do not understand. The mental health professionals do understand it. It is a good thing to keep in mind that they know the problem, and you do not. Trust them to know what to do, and follow their directions. This is not "One Flew Over the Cuckoo’s Nest." It is a real medical solution with trained professionals who have a high success rate in handling these diseases. If there is any doubt, consider that most of the old mental hospitals have closed because the modern remedies are so effective and humane.
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