What I learned in my year in the Mental Institution

About a month and a half ago, I finished my doctoral internship at a psychiatric hospital. It was a year of highs, and a year of lows. I saw great successes, and had my heart broken by failure and tragedy. What I saw at the hospital taught me very crucial lessons about the human condition, lessons that often go unseen and unlearned in our society:

1) We are all crazy, just some of us are better at it than others. Think about any person or group of people that annoys you. Think about all the reasons you think they are not attached to reality, not rational, self-contradictory or hypocritical, but still walking around. Now take that same critical eye and turn it in on yourself. We live in a world filled with logical fallacy, black/white dichotomous thinking, and detachment from reality. The main difference between the people inside the hospital, and those outside the hospital is how well they can function in society with what can often be described as symptoms of mental illness. Some struggle in society, while other thrive, turning these differences into unique strengths. Some lives are disrupted by difficulties, while other difficulties seem to hide in the background. How often do we ask what the difference is between the artist and the patient, or those who champion tragedy while others seem to fall apart? More often, we ignore the question, and isolate ourselves and others.

2) We need to listen more. We have a society that is built on the concept of speech, and this is not a bad thing. Our empowerment of every man’s right to speak helps us to ensure a conversation that can lead us to higher truths. The problem, however, is that speaking is only half the process. In our constant struggle to be heard, we have forgotten to listen, and so the conversation suffers, if it really happens at all. As a result, we have became a species of constant and meaningless chatter and shouting matches. As a result, our relationships fall apart, isolating people in pain and suffering until the damage is too far gone to repair.

One of the reasons we have failed so horribly when it comes to listening is that we’ve confused it with “hearing.” I watched it happen many times. “Fine, I’ll listen” is said, but decisions are already made. If there is a difference of opinion, or information contrary given, there was no attempt to resolve the conflict, merely a shouting out or silent dismissal. Many times there was no opportunity given for people to speak, and then their lack of speech was assumed as meaning they having nothing to say.  I did not just see this in how staff treated patients, though this is where I saw it the most. I saw it in how staff treated staff, admin treated staff, and how people treated each other in more social relationships.

Listening entails making the effort to understand what the person is trying or wanting to say, not merely allowing the vibrations to reach your eardrum. Listening is the antithesis of the shouting battle, it’s taking in what’s being said from the speaker’s perspective, and looking for what wants to be said. Listening involves eliciting a response and giving people permission to speak. Listening does not mean always agreeing, but it does mean acknowledging. What I often saw going wrong in this process is that people were so scared of what could be said, that they found subtle ways to take away people’s ability to talk. Fearful of what may be said or how they might be challenged by the words of the other, they denied the other the right to speech.

3) The more we label people, the less we understand them. We like to label things, because it makes them easier to understand. The problem is that people shouldn’t be treated as things. In psychology and psychiatry, we rely heavily on diagnosis. When used properly, it is a tool that allows us to understand what we may see in the presentation  of the patient, and what needs to be focused on in treatment. It is not always used that way, however, and instead the diagnosis is used to dismiss rather than understand. I’ve watched professional ignore real needs in a patient through creative diagnosis. I’ve seen people throw up jargon and ignore human understandings of situations.

We need categories to understand things in the world. These categories, however, need to be tailored to the individual. But we often cut out the latter part of the process. The more we use jargon, intellectualized terminology, and other pigeon-holing labels, the less we actually understand about the person before us. Instead, it separates us, building a shield of cold categories that isolates people from each other. Instead of understanding how the trauma of war, or the brutality of an accident or car wreck has caused doubts in the person’s world, we label them as anxious. Instead of engaging in the conversation of grief and loss, we label them as depressed. At the hospital, the diagnosis told me what to look for, but my success came when I pushed past the diagnosis and asked them about their world.

4) Our assumptions create self-fulfilling prophecies. I was often regarded as a naive and green student who wasted my time listening and paying attention to the individual patients. Usually it was because as patients, they were supposed to be crazy, disorganized, and generally unreliable. I also was frequently complimented on the progress of my patients and the information I could bring to the table.  It amazed me how people could not see the connection between the two. Even more confusing was how often signs of growth and healing were pathologized. It’s been 38 years since the famous Rosenhan experiment, and we are still showing we can’t distinguish health from pathology. Prosocial interactions became pathological cabals, attempts as self-soothing behaviors were demonized, and demands to be treated fairly and professionally were dismissed as psychotic agitation. Once given the label of insanity, everything a person does gets viewed according to that definition. But the problem is that because we pathologize health, we end up smothering the healing process and prolonging the illness.

Once again, this is not a problem exclusive to mental hospitals. We are often challenged in life to understand new information from unexpected sources. It’s how we learn, and how we grow. If we could predict where the next great lesson would come from, we would be seeking it out on our own. But sometimes that information, or even that source, is so alien that it not only challenges what we know, but how we see ourselves. At such a challenge, we have two choices: we can volunteer to change how we see ourselves and others, or we can ignore the source by denigrating it. Sadly, there are powerful forces towards the latter such as tendencies towards confirmation bias, and attribution. As a result, we end up hurting both ourselves and others, stifling our own growth, and tearing down others.

5) We don’t often think about how we hurt others. When you think about the history of mental institutions, you may have a hint of how horribly we’ve treated patients. Popular movies show very clean cruelties like padded rooms, isolation, water baths, restraints, electroconvulsive therapy and and the scars from lobotomies. The truth is a lot more disturbing. Think beatings, think surgical mutilation without anesthesia, ice pick lobotomies done through the eyes. The actual history is more disturbing than our fictions portray. The most frightening thing about this is that historically, we haven’t stopped the cruelty because we saw it as cruel, but because we found easier techniques. Lobotomies, for instance, didn’t end because someone pointed out the horror, but because major tranquilizers were discovered. It was only when we looked back did we admit our sins.

Ironically, this history of horror has made us complacent. Rather than learn from history, we seek vindication from it. When we look back on the sins of those before us, we seem to say “look at how much better we are than them,” and fail to ask “what are the cruelties am I committing today that the future generations will know?”

Ghandi, Truman, Churchill, and many other great leaders often spoke about how the test of a society lies in the it treatment of the weakest and most vulnerable. In my year working in the psychiatric hospital, I saw that connection. They are not only homes to house individuals with mental illness, but have also come to house the symptoms of the illnesses of society. In the end, I have come to wonder that if we had taken more time to treat and heal how we relate to one another, would we have fewer residents at the hospital? I wonder if that were we to spend more time listening to and truly relating better to each other as a whole, would more people find the strength to live with their illnesses, and would they find the support to recover quicker? And it is from these questions that I have gained my lessens from the mental  institution, and hope the world soon learns these lessons as well.

Looking back on the tone of this post, I also need to mention those who taught me to understand these lessons by both sitting with me in acknowledging the problems, and actively taking stands against them. I did not just find conflict at the hospital, but support, allies, and friends. The supervisors, interns,  therapists, and floor staff who helped me to see the issues from both sides may have been in the minority, but they were there. And maybe this needs to be the final lesson:

6) No matter how bad the world gets, there are always people willing to stop, listen, and work with you to find solutions. They may not always be easy to see, but they are there.

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