If you’ve read too many depression memoirs, as I have, you might feel a little disillusioned when you enter an NHS psychiatric ward.
In Darkness Visible, William Styron’s hospital offers peace, tranquillity and art therapy. In Shoot the Damn Dog, Sally Brampton’s ward has yoga instructors and group talking treatments. The hospital in Girl, Interrupted is portrayed as some kind of high-security Butlins.
Here’s the thing: the people who write depression memoirs tend to go private.
There was no yoga on my NHS psychiatric ward, although there were people in fixed, uncomfortable postures, like the girl who sat in the corridor each day with her knees under her chin; or Maxine, who lay morosely across a couch in the sitting room that was too narrow for her wide body. It wasn’t yoga, but you got the sense that these postures were thousands of years old.
There was no art therapy there. There was a ‘games and craft room’, which had a bookcase holding half a dozen Jeffrey Archer novels and a copy of the Psalms with a burn mark on the bottom. The room boasted three adult colouring books and a shelf of incomplete, boxed board games. I managed a couple of games of Scrabble with a lady called Felicity. We pooled the few remaining tiles that we found in three separate copies of the game, which meant that some letters were disproportionately represented. We had an abundance of Es and Os. They kept appearing in every pick until my whole tile rack resembled an agonised wail. We could rarely get words that were longer than four letters, and this made the resulting board look cramped and tightly clenched, like a fist.
Hospital, in other words, is not a haven. It’s upsetting. It’s noisy twenty four seven. It would no doubt make some depressed people worse. So why do so many people ask to be admitted? What does it have to offer?
Letting it be
If you volunteer to go into hospital, you are making a choice. You are choosing to sacrifice freedom of movement, freedom to decide when and where and what to eat, and freedom to define your own mental wellbeing, in exchange for the one freedom denied to you in the real world: the freedom to let the mask slip. It’s okay to not be okay in hospital. It’s expected. This can be an almighty relief.
A psychiatric ward is not a place of healing or inspiration. First and foremost, it is a place of holding, where nurses wait for the passion of suicidal zeal to simmer down into stable, stagnant unhappiness. The psychiatrists who treat you and the nurses you are assigned do not work towards the eradication of depression, or complete wellness or a total reversal of fortunes, but towards stability. In hospital, constancy and routine are the furthest reaches of ambition. If regularity and order have been lost from your life, it is a good place to be.
Poor mental health is an epidemic, and in the community, I felt as if I had to compete with other sufferers for support. My requests for help more often than not resulted in my file being passed endlessly between the GP, Crisis Team and Community Mental Health Team – less a record of a patient, more a weapon in the ongoing tribal warfare between the three.
It’s a different story in hospital. Help is concentrated there. I had a physical health check-up and the offer of debt help from a specialist, who could also advise on benefits. I was assigned a nurse who was available to sit with me and talk. I had a care plan on discharge. Getting into a psychiatric ward can be as difficult in the 21st Century as getting out of one was in the 19th, but if you feel you are being dismissed by care providers in the community, securing a bed may be worth the fight.
Access to the good pills
When I was admitted, I hadn’t slept properly in weeks. Zopiclone, a powerful sleep aid which is guarded like the crown jewels by GPs, was given to me each night without question. It didn’t so much lull me to sleep as wrestle my head to the ground and hurl it over a cliff into unconsciousness. At that stage of insomnia, you have to use force.
I was also able to discuss medication with a specialist who understood it. My psychiatrist was kind enough, but singularly interested in the effects and side effects of what she prescribed. When she asked, ‘How are you?’ she meant, ‘How is Aripiprazole affecting your neurotransmitters?’ When I replied, ‘I’ve felt better,’ I meant, ‘Aripiprazole makes me so insatiably hungry I ate a kilogram of chocolate and then felt sick from over eating and utterly ravenous at the same time.’
I began to feel like a stew on a hob, passively allowing her to adjust the seasoning of my mind to taste. My contact with her was therefore somewhat dehumanising, but I never felt that she intended it to be so. Dehumanisation was simply another unwanted side-effect of treatment. Other psychiatrists, it seemed, quite consciously treated patients as if they were less than human. One patient claimed she had been told that, ‘If you want to commit suicide you should just do it.’ Psychiatrists can help, but they specialise in chemistry, not empathy.
I went into hospital naively hoping to be transformed. I came out with new medication, a few scrabble victories under my belt and a desire to never, ever set foot inside such a place again. These things, in themselves, were much less than I had sought, but they formed a part of the patchwork that made up my recovery.