Looney Tunes running the Psych Ward

Isn't that a great image? I see it now. Bugs saying, “what's up doc?” as the Road Runner raids the Ritalin cabinet and Wily has birds flying around his head after getting hit with an injection of Haldol.

Have any of you ever wondered what the ins and outs of a psych ward are? Maybe some had their internships in psych wards, or maybe some of you have just seen family members and friends in psych wards and gone for a visit. Regardless, ever since I was little, I was fascinated and knew that I wanted to know what was going on in there. I remember my family taking me to visit a second cousin in the hospital who was diagnosed with bipolar disorder. It was actually classic because she entered as a Jew and came out a Jew for Jesus. That's recovery. Anyway, there's a certain smell, the white coats, the doctors with the Zyprexa pens, my dad screaming, “WASH YOUR HANDS!”, that stuck with me. And apparently didn't leave as I decided that I wanted to experience the inpatient psych ward. Especially in a big city.

So, about 15 years later, I went to a big city and found out what it was all about. Hired as an intern in a city hospital (that meant we got to accept any freak off the street claiming he was psychotic or going to kill himself- usually he was just our local smart crack dealer who thought it was getting cold out and needed a place to sleep).

Side note about crack dealers. I lived in a neighborhood infested with crack dealers. Now, you might think this was dangerous. Well, actually, living in a crack dealing neighborhood is a win win situation for everyone involved and safer than living anywhere else. First off, crack dealers want to keep White people safe so there are no cops called. If anything happens on your block, crack dealers have to go to a different area. Things were great for me, because I got to know the crack dealers and let me tell you, not only are they good people to know if you ever get into trouble (one of my favorites used to run around with a flat razor in his cheek, “just in case”), but they are some of the smarter people I have ever met. My favorite local crack dealer, Country (he came from North Carolina) was 65 (looked like about 45- something about crack, he said, that preserves the skin) and God rest his soul if he is still around. One time, I was going for a run and Country saw me and yelled, “someone chasing you? Cause I got your back”. He couldn't fathom that anyone was running for the sake of running. But, this guy knew how to take care of himself. He was usually around in the summer time because it was pretty out, unless he got too drunk or agro on crack and got into trouble, but if it was cold in the wintertime, he was rarely out on the streets. And where do you think he went?

While I didn't see Country in my hospital, I saw many a crack dealer “hospital jumping”. Isn't it great to know what we are spending our tax dollars on. Actually, I feel better about spending tax money on giving Country (a character) a warm bed than any number of meth addicts, devoid of emotion and personality. Think about it. Who would you give tax money to? Someone who is able to figure out how to convince everyone they are crazy so they can have a warm bed and hot food and basically a hotel room in a pricey zip-code or a meth addict who repeated his phone number 6 times backwards. I am so mean. The benefit of having friends in the crack industry, is that I would get the scoop from patients. Basically, the key to hospital admission was geographic jumping. Upon being discharged from one hospital (supposedly going to a shelter), they would ask for a ride to a far away area of town where they claimed to have family. Instead, they would show up on the door steps of yet another city hospital which admitted them. And so the cycle went. I used to see clients walk through the doors up to 6 times during my 8 months at the hospital. Clever huh?

What really amazed me was when patients could actually convince staff to change the menu from chicken to roast beef a few times a week (no one else in the hospital got roast beef- serious persuasion). Don't even think those patients weren't running the unit. Obviously drugs and alcohol and cigarettes were banned in the psych ward (c'mon, the least you could do was give the poor people cigarettes). But this didn't deter anyone from smoking or smuggling alcohol, buffalo wings and serious party food in from outside residence visits. I wish I could have seen the night security tapes. Patients weren't sleeping all day because they were drugged up, they were partying all night. At least, that was my theory.

Anyway, life in the psych unit was fun (I learned some interesting things about how to make crack), it had it's downfalls too. On my third day at work, I remember a scene where 8 police officers were restraining one patient with a taser. The client tried to get away and they pounced – it took 8 cops to hold him down. Psychosis definitely creates superhuman strength. Sad thing is that the dude they restrained was really sick. He wasn't just trying to rebel. At 25, his 6'2 lanky frame would meander up and down the hallway with a goofy smile all day. He had a great hairdo that could have been on a (Jean Paul Gaultier runway) with toilet paper. His MO was to make lewd comments to women and subsequently get nailed with Haldol. When he made a lewd statement to me, I told him he was totally out of line and if he ever wanted me to talk to him again he better apologize and stop saying shit like that. After I put him in line, he was appropriate and even remembered my name. I even got him to go to a community meeting. At the meeting, sitting next to me, he tried to help me scratch my back (this was non-sexual and I was trying to scratch my back). I took his hand and placed it back on his person. The psychiatrists decided that he needed to learn a lesson, though, and injected him with Haldol. While I was initially angry and outraged by this, my outrage was quickly reversed when I found out, that it was protocol to medicate patients if they touched staff. While some of you are thinking, “some protocol Nurse Ratchet”, I felt safe. Even if that guy was harmless, there are other patients who aren't harmless and if they witness a patient getting punished for touching staff, it might deter them from doing so. SAFETY. Plus, apparently Haldol can be a cool drug- just ask the nurses!

So, now you get a good idea of the patient types. The “malingerer” (manipulator needing a place to sleep) and the true psychotic (who needed help and by the way, would stay there for a good 6 months-1 year because there were not community residence beds open. Speaking of tax payer's money).

So, let's talk about the staff. Well, first off, there's me, the crazy intern as you can tell, the two psychiatrists, three medical interns, 4 nurses, a few security people and 2 social workers and one office. My supervisor happened to be the social worker with no teeth (she'd take out her dentures to brush them at team meeting every so often) and she had been at the hospital for 15 years. While she definitely had a vast amount of information to share, she was a bit jaded. She either loved clients, “you pooor thing” or hated them and called them “fucking assholes” in staff meeting. Like I said, this was a breath of fresh air for me who had been stuck in classrooms where teachers found a new synonym every day for African American that was apparently more PC. They spent more time coming up with the synonyms than they did making a point. Therefore it was nice when someone could convey a point in one sentence with, “he is a fucking manipulative piece of shit”. Well, there's one looney tunes for you- in a good way. She was kind of like Tweetie Bird. She even hummed hymns sometimes in the morning- it was cute. Gotta tell you that once again, I tend to respect and learn from the craziest of the bunch. I remember her giving me the most amazing feedback one day after she observed me run group. She said to me, “sometimes, I want to smack you and just tell you to say straight up what you mean instead of going around in circles and trying to be so nice”. This has stuck with me until this day and I think probably contributes to my no bullshit approach to therapy.

So, there you have it. Life on the psych ward. Supervisors with no teeth, doctors sedating patients so they wouldn't bother them, nurses giving each other drugs out of the cabinet and me. The sad thing about psych wards, is that they are actually set up to help the non-crazy who don't want to get better and just drug the patients who really need help. So, in this case, the looney tunes running the hospital works to perpetuate the problem of recidivism and doesn't really help anyone get better. It just serves as the interim for the people who are smart enough to figure out how to access it. The crazy people don't want to be there. But at least the clients aren't actually run the unit. It is made very clear repetitively, that while they clients have their underground life, it is the staff that control what happens on the unit and the fate of the patient. If the patient doesn't cooperate, there are consequences which are enforced. There are also unit rules clearly displayed on the walls and they are clearly referred to during every community meeting. Of course clients complain, that's what community meetings were for. But just because they complained didn't mean that all their complaints were taken to the review board. In other words, the clients didn't run the unit, the staff did. While there was definitely crazy making at this job, at least the purpose and power dynamics were certain and clear.

*[A quick note on my use of the word crazy. I remember seeing an episode of Oprah several years ago on mood disorders. They had a laundry list of ridiculous words for “crazy folks”, which included, “cuckoo, wacky, loony, psycho”... you know. Again, when people label themselves, it's ok (like you can use the word “retarded” in front of a retard, but you can't call a retard “retarded”). But we can't be calling people “you fucking cuckoo psycho” to their faces. It's not nice. So, as far as labels, having worked with people who are less neurotic than I am, I think I'm entitled to throw a little crazy their way, especially because I call myself crazy too. You see, if you are any minority, or any label, it's okay for you to use the label as long as you feel comfortable calling yourself that label. So, it wasn't okay when Don Imus called women basketball players, “nappy headed hos”, but it was okay when Paris Hilton used the “n” word. Wait, what?]

So, in the case of my more recent job, the case was similar, except, as I stated before, the big man was a bottom. When people get mandated to drug treatment, this is sort of intervention. Their PO tells them to go to treatment or go to jail. When they get an assessment, it is decided by the clinician whether they are fit for outpatient or inpatient treatment (we had both within agency). So the problem is that the word, “intervention” was not in our vernacular because it was considered, “too harsh”. So, if you call an addict on their behavior, they will get defensive. But you don't necessarily anticipate other clinicians to defend clients. There are two reasons that clinicians would defend clients. 1. because they are just plain stupid, and I'm really hoping this isn't the case, or 2. They're thinking big picture and have every reason to.

1.The agency loses money if you refer a client out. Most likely, clients who are in your program for a long period of time without progressing continue coming because your program is enabling them to continue their current life style of drinking or using. As long as they stay in treatment, the organization gets paid. As long as “minimal requirements” are met on a monthly review, community providers (PO or child services worker) allow their behavior to continue. Minimal requirements are determined by clinician and obviously vary depending upon clinicians preference and personality. In my opinion, minimum requirements for someone whose been in treatment for a year isn't good enough. Especially if there has been no improvement, it means treatment is not working. So natural inclination tells me to up the ante. So, it's in the agency's best interest never to create any program rules or specify what kind of clients they treat.

[One example of this would be with the “chronic patient”, usually someone diagnosed with Borderline Personality Disorder, with state insurance. This means they latch onto an agency and have services at about 6 different places. While there is a special type of therapy that treats BPD, usually independent agencies are a dream for this client type. So, Borderlines tend to be extremely intelligent (even though they think they can read your mind and know everything you're thinking- often they do hee hee) and know how to get a reaction out of clinicians because they've been in treatment for longer than you've been alive. While they can be frustrating to work with, in the right setting, I love this client, because you can lay down the law with them and watch them throw temper tantrums.

One time I told a BPD that I couldn't see her because she was an hour early, she screamed and I closed the door. She stormed outside the clinic in the rain chain-smoking for an hour and ended up getting a cold. Not my problem. This is called DBT. If you want to do treatment, you follow the rules. You don't make up your own. You already showed where making up your own rules got you- jail, your kid taken away, and 2 years of drug treatment (and a really bad Pat Benatar obsession – has anyone else noticed the connection between Borderline clients and Pat Benatar?)! This may seem harsh, but this is the only way they get better, Evidence Based Practice baby. Now, if it were up to the agency, if you're not with a client, you see the client whenever, because state insurance pays for her unlimited treatment. Regardless of whether she only has one hour a week, never does her homework and comes to group doped out on Thorazine and other sedatives, you let her in the door and bill her. Statistically, Borderline clients are over-served in agencies that continue to enable their attention seeking behavior.]

2.If you piss off a client, you create conflict: what if the client pursues legal action? Well, if the meth addict (very rare, but it does happen) has it together enough to actually follow through with the “identity theft charges” and you are really wrong when you assume they are using because they refuse to stop working graveyard (also a rare occurrence), and keeps it together for long enough to file suit against the agency, good for them! That would be a great tv movie starring Meredith Baxter Birney, Judith Light and Alan Thicke. If it does happen, recourse is to blame the person making noise about the issue.

3.Why make more work for anyone? Making rules and following them takes work. Plus, enforcing them is a whole other issue. Instead, just wait until something happens and leave it upon the clinicians to handle it. Then, you'll figure it out.

So, what does this mean? Well a couple implications. First, if supervisors are trying to avoid conflict with clients and avoid change (to avoid work), it's easier to undermine different clinicians. When supervisors believe clients over their clinicians, addict behavior is enabled. It's awesome how a meth addict can get into 5 car accidents a week on her way to treatment, have no dents on her car and even more interesting how a supervisor buys into it! So, as it is enforced that we are to take clients words as the gospel, the result is that addicts end up running the treatment center! Just like looney tunes ends up running the psych ward. So, here we are, a drug treatment center, enabling drug behavior.

As I may have mentioned before, the one thing that made me remove myself from the agency was a friend/mentor, person outside of the profession, who told me that I sounded like an abused woman. Get out while you can. This was a person in recovery from alcohol for numerous years. She called this situation codependent. The codependent works to enable addict behavior.

On a larger level, the addict was the agency. Everyday, I came to work wondering what to expect. Some days, I felt confident, only to have reality crash down the next when someone undermines your efforts, and reinforces the clients behaviors (trust in the client because they are always right).

“A "codependent" is loosely defined as someone who exhibits too much, and often inappropriate, caring for persons who depend on him or her. A "codependent" is one side of a relationship between mutually needy people.” Wikipedia

So, at first, I was reluctant to accept that I was actually the enabler. Wait, I'm not doing anything for this agency. My supervisor even told me in so many words at the end of my employment that she valued, not my person, but my work (nice isn't it?). How did I enable an agency that I fought tooth and nail? Well, I stayed for a year and half, continuing to overwork, and take on the responsibilities of a faltering program and other people not doing their jobs. While my supervisor sat in her back office, surfing the web about diets and eating whole meatball and cheese Subway sandwiches (which Jared did not eat, honey, sorry to inform you), I busted out double the numbers and double the money (individuals and groups) compared to both my supervisor and the other clinician in our setting. Now, if it's an anxious person that promotes trying harder when they are not recognized, then I don't think that' a bad trait. In fact, I think it's a good one because in a normal world, and always before in my life, it has worked and people acknowledge that you did a good job. Then you feel good and you don't have to work as hard to prove yourself over and over.

So, why didn't I leave? Instead of complaining, why didn't I get out before crashing to the ground. I'm sure this question is getting repetitive, but I keep asking myself everyday. One has to know, persay, “when to fold 'em”. While I was wondering what was wrong with the agency, no one else around me seemed to see anything wrong with it (or if they did as I noted, they left). And the last place you'd expect to find codependence is in an substance abuse program that's supposedly trying to reduce social problems related to drug and alcohol addictions. This is great because it's just what codependents do. They get sucked in and if they stand up against the crazy making, they are blamed and labelled the crazy one. Isn't it ironic? Dont'cha think?
Sorry Alanis.

More from Wikipedia:
“The dependent, or obviously needy party(s) may have emotional, physical, financial difficulties, or addictions they seemingly are unable to surmount.”

Oprah recently talked about the “vampire” or energy sucking person- a good description of both my supervisor and the agency and another reason to talk about Oprah. Obviously, an agency that isn't functioning properly creates emotional turmoil. We didn't have good office space, I was isolated from everyone else and we didn't have an appropriate setting to be treating the population we were treating. Moreover, of course they were having financial difficulties, which is where I came in because I was the highest grossing product in that portion of the agency.

Last, addictions to old behaviors- addict behaviors. You know the term dry drunk? People who are clean and sober, but continue to display addict behaviors, like hanging out at bars, spending all their money, working graveyard shift... Well, my supervisor would say things like, “oh I think you're being too hard on her. Give them another chance”. Me give them another chance? They're already here on the their last! They were thrown out of their house, arrested and their PO says go to treatment or go to jail, and I am supposed to give them another chance? This is classic enabling. Which means preventing recovery at a recovery agency! HAHAHAH. It gets even funnier!

“The "codependent" party exhibits behaviour which controls, makes excuses for, pities, and takes other actions to perpetuate the obviously needy party's condition, because of their desire to be needed and fear of doing anything that would change the relationship.”

That's me. I controlled because no one else would- did twice the work. I made excuses for the agency at home when my partner told me the job was affecting our relationship. Check- I took action to perpetuate the needy party's condition, even though my intentions were to do the opposite. I wanted to be recognized because I put so much energy into my work. Doing the work was difficult and highly emotional for me and I needed reinforcement, telling me I did a good job. I also wanted to get what I needed- my actions were self driven. I needed to finish my training hours to get an license. I was headed towards a goal. Too bad that my intentions accomplished exactly the opposite of my goal.

One of my friends said to me that the only way that social workers would be able to really change is if they all realize that this is a problem and refuse to engage in it. Problem is, that if we got ourselves into this god forsaken profession, we have to pay our bills. Maybe we should go on strike like the writers and refuse to come into work until they agree to make a change in administration. Problem here is that most social workers are the martyr type and would feel guilty about leaving their clients out to dry. Oh that's so sweet! Your husband is yelling at you that you're ruining your relationship and you have no personal or social life, but your clients need you. Get a life guys! If you want to believe this, you are just as bad as the corporate American businessman, think Michael Douglas Wall Street, who has no regard for the personal. Everything is business. Just cause we try to help people does not make it any better that we spend all our time and energy doing it at the sacrifice of everything else in our lives.