Being an in-patient

I have been a psychiatric in-patient on quite a few occasions. I am also the psychiatrist on an in-patient ward. There are differences: I work with people with addictions, whereas my times as a patient have been on general psychiatric wards with severe depression. But there are also similarities, and most of my admissions were to this self-same hospital, to a ward just across the carpark from where I work now.

People have said to me that I’m brave to have done what I’ve done. I find that odd, because I had little choice, really. If I wanted to work in medicine again, after two and a half years absence, and in the specialty of my choice, I needed to be stubborn and pig-headed. It didn’t feel much like valour to me. But it was very, very difficult, and I think a lot of that was down to the complete exposure I experienced as an in-patient. My picture of myself and how others saw me – all had been stripped from me.

I was first admitted to that hospital on a Monday when I was five months pregnant. I was bewildered. Up until the previous week I had been working as a GP trainee – albeit struggling, and with support – and now I was told that I must be admitted to a psychiatric hospital. I don’t really know why I acquiesced, but I was terribly afraid of being detained, and that was something that coloured all my admissions. I had had one overnight admission earlier in the pregnancy in a different area – and I can still hear the words on that occasion threatening detention, and knowing that I had no choice. I firmly believed that I would be unable to work as a doctor, and definitely not as a psychiatrist, were this to happen. I still think that I was actually told this when in medical school, and I wasn’t one to question in those younger days.

I have read others’ accounts of what is sometimes referred to as de facto detention, and I think it’s a very difficult position, for both sides. As a psychiatrist, I really don’t want to detain people and deprive them of their freedom, never mind add that blot to their records – but neither do I want to take away their rights. Nor do people want to be detained, because it’s hugely traumatising, and sometimes they may think that it’s better to agree to admission, despite the consequent loss of any rights of appeal. But it’s very hard for a psychiatrist to say, “I’m sorry, even though you’re agreeing to come in, I don’t really believe you, so I’m going to detain you anyway.” Loss of liberty occurs in many odd ways, but this can be a difficult one to argue, especially when distressed; it’s also difficult for a doctor to impose, and can have far-reaching consequences for both. 

It’s no accident that I work in a specialty where detentions are few and far between – although if I’m going to try to be really honest, that can cause problems too. The rules for who gets detained and who doesn’t are complex and sensitively thought through – but are inevitably grounded in preconceptions, given the long history of our culture and of medicine.

My experience of being an in-patient was, like many, imbued with boredom. There is nothing to do. Sometimes I just lay in bed, and this was facilitated by sedative medication. At other times I paced, I don’t really know why. My background social ineptitude made speaking with fellow patients very hard, and I also felt acutely embarrassed that I was a doctor, a privileged person. Staff were never unkind to me that I can remember, but neither can I remember ever forming any relationships with them. The nurses were too busy, and the doctors too infrequent. Sometimes I look back and think – why was I admitted, what was the point of it all? I assume it was largely to keep me safe, and it probably did fulfil that function. I also had ECT during many of my admissions, but I’ve subsequently had that as an out-patient. This was probably better for me – but if I’m being really truthful, it might have been better for my family had I been an in-patient, at least at the start.

No-one wants to be in hospital, away from family and friends – unless, of course, that is a worse option, or they have no home. Being in a psychiatric hospital is no home from home, yet neither is it like being in a “normal” hospital. Much of the treatment given could easily be given at home, except the protection (of both self and others), and the loss of liberty. 

For me, I see hospital as no potential safe haven. I cannot imagine ever again being admitted without the threat of detention – partly because I would not agree, but the situation is now compounded by reduced bed numbers for psychiatric patients across the country. To me, one form of hell would be detention in a hospital far from home, with no-one I knew.

The stigma of being an in-patient was, for me, enormous. Other than brief medical student attachments, it was my introduction to psychiatry, and I was on the opposite side to where I had thought I would be. The bridge across was vertiginous and frightening, although I seem to be better equipped when I cross it now (or maybe I just can’t see as well). I felt both exposed and misunderstood, and that I would never be seen as normal again. Everything – my sleeping, my eating, my bathing, and more – was open to scrutiny and no longer belonged to me. I looked at those who had secrets, and envied them.

In a strange way, though, working where I had also been an in-patient helped me. Initially it was terrible, I could hardly enter the building without trembling, but avoidance was not an option.  And I realised, later, that it no longer had to define me, that it was an experience, better or worse, just one of many.

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