5 Things Movies Don't Tell You About Mental Institutions
Everyone knows that mental hospitals are horror movie prisons for crazy people, with padded walls, flickering lights, and evil nurses wearing tiny hats. Well, everyone might want to get their head checked, because psychiatric hospitals are nowhere near as exciting as all that. Most look more like college dorms with extra locks on the doors. I should know: I've been in six psychiatric facilities in three states, from the fancy McLean Hospital (aka the Girl, Interrupted place) to crappier state-run facilities. I've been diagnosed and misdiagnosed with everything from major depressive disorder to borderline personality disorder to schizophrenia. But I'm better now, and I swear that all this shit is true.
They Don't Use Straitjackets
It's actually a legal requirement that hospitals use the least restrictive restraints they can. Instead, hospitals use chemical restraints (that's a fun term for drugs, as well as a pretty bitchin' band name) or a four-point cuff system. Those are called leathers, because they've traditionally been made of leather -- it makes them harder to bite through. Leathers are supposed to be impossible to get out of, but I routinely did. The problem was my wrists. Make the restraints too tight and they cut off circulation; make them too loose and I'd get out in seconds. The real trick was hiding my new Houdini-like skills from the doctors.
Once, I was sitting in leathers in the ER, restrained to a hospital bed with a security guard outside my door. I was reading a book, but it was impossible to turn the pages with just one hand. I slipped out one hand to turn the pages, then sneaked back into the cuffs and played dumb when the nurse came in. All innocently: "Could you flip the page for me? I've been stuck on this one for like 10 minutes!"
You can insert your own sinister chuckling.
Once the staff caught on, they still didn't switch to movie-style straitjackets. They just started using leathers and chemical restraints together. Think about it: Which is easier, lacing up an elaborate crazy-girdle on an unwilling participant, or slamming a syringe full of Ativan into a thigh? Option 2, of course. Which was fine with me: Being knocked into dreamworld was much more fun than drawing myself as a tree in art therapy -- again.
Pastels just don't have that characteristic buzz of narcotic-y goodness.
It Isn't Like a Jail
You're allowed to bring your own stuff into a mental hospital. You're not going to be sitting in a hospital gown, barefoot, in a barren room with nothing but your pixie cut and a big Native American dude for warmth. The hospital will give you socks, at least.
Whether you get the Native American dude depends on your HMO.
Virtually every place lets you bring your own clothes, with some restrictions. No belts, shoelaces, drawstrings on hoodies or sweatpants, nothing with violent images. No Manson T-shirts or gang colors. But you can totally wear a suit or cocktail dress if you really want.
You're allowed to have visitors, and they can bring you things like books and edible food (of course, the staff searches the bags first). At the state-run hospital, I was only allowed to have three books at a time, but they kept five books behind at the station I could trade in. That particular hospital also gave me a plastic baggie with a toothbrush, deodorant, and assorted toiletries from random hotels. Nothing says luxury like JW Marriott shampoo next to the biohazard disposal container.
All the comforts of a home with an unusually high risk of biological contamination.
At one private hospital, I could bring my laptop and keep it in my room, cord and all. I'd do my homework and keep up with class assignments with the hospital's free Wi-Fi. I could also order delivery and have it buzzed through to the floor. You're not treated like a criminal, because you're not criminally insane. Movies often lose the distinction between the two -- normal people with mental issues aren't going into some dystopian crazy-prison, because they've done nothing wrong. They're sick, and the whole point is to help.
You Know You Need to Be There
To get into a mental institution, you first go through a psychiatric evaluation at the ER. Then if you pass (or fail?) you're shipped out to a psych-only facility. Sometimes treatment is involuntary at first. The specific laws depend on your area, but most hospitals can hold you for 72 hours for psych-related reasons without your permission. Even if you're truly OK, the hospital needs to ensure that you aren't going to leave and immediately have another episode in the parking lot.
It's for your safety, and the safety of all those easily breakable faces around you.
After three days in a psych ward, you can leave ... if the doctors say you can leave. If there's a disagreement between you and your docs, you go to court. But most people use the third option: voluntarily signing themselves into treatment.
Movie mental hospitals are filled with clearly-just-eccentric people held there against their will, either planning to escape or gaming the system as best they can to get "released." Maybe that was accurate 40 years ago, but shorter stays combined with a better understanding of mental illness means functional people aren't locked up for years.
Hooray for progress! Eventually!
The hospitals I stayed in were filled with people who knew they needed help. One person flew across the country in order to take advantage of the facilities at McLean. We'd compare notes among ourselves about the various hospitals: which had the nicest psychiatrists, the best after-care programs, the worst food, the most affordable payment plans.
During each of my 10-plus stays at six hospitals, I signed myself in voluntarily, and I don't remember hearing about anyone who didn't do the same thing. Mental illness is an illness. Sure, there's the odd nutbar version of Typhoid Mary who just refuses treatment. But most of us sick people just want to not be sick.
If only it were that simple.
The Punishments Are Way Tamer (Just More Annoying)
Chemical restraints and leathers, as cinematically interesting as they may be, are generally only used in exceptional situations (like if you attack a staff member or try to escape from the facility). But everyone has checks. Every half hour, a staff member will find you and make sure you're OK. If you're in the shower, he'll knock until you shout your own name. If you're asleep or in group or reading, he'll just write it down and be on his way. They generally don't show that in films, because your protagonist being lightly annoyed every 30 minutes by her own personal Navi does not make for a thrilling narrative.
It's the human-being version of a straitjacket.
But if you've been obnoxious or disruptive, those checks are every 15 minutes. Or 10. And the worst folks have a 1:1 rule placed on them, which means they need a staff member within 10 feet of them at all times. The staff doesn't touch you or harass you -- they're just around. They make sure you don't hurt anyone or yourself, or lack for a tennis partner should a mandatory game situation ever arise (it never has).
The places I went were pretty understanding, especially when I punched a dude in the face. He deserved it. He was young, maybe 19, and creepy as hell with his unwavering stares. He took it a step further by whispering stuff like "I'm going to come into your room at night and rape you" every time he passed a woman. And of course, none of our rooms had locks.
And they'd confiscated my wheelgun at the door.
One day, I was reading in my room and he barged in, which is a huge taboo. Patients are never allowed in each other's rooms. I told him to get the fuck out, shoved him backward, and used the door to force him out of my room. But each of our doors had a little Plexiglas window (for those frequent checks) and he kept staring at me through the window.
So I opened the door. He didn't move. I pulled back my fist and looked at him. He still didn't move, so I punched him square in the face. I took the book I was reading (one of the last Harry Potter ones, a big, fat, pre-weaponized hardcover) and chased him, screaming and beating him with the book while he tried to run away down a 20-foot hallway. Not a lot of places to hide in a psych hospital.
And no places to hide from this big bastard.
Staff members pulled us apart. He got put on 1:1s, but I just got a warning ("Please don't punch anyone else"). It probably had something to do with the fact that, as a rape survivor, I don't respond well to rape threats or assholes barging into my room. So yeah, gonna go with "He deserved it."
You Don't Usually Know What's Wrong
When someone in a film has a mental disorder, it's always clear exactly what's wrong. It takes a movie doctor 12 seconds to lower his glasses and throw out a diagnosis of schizophrenia. But one of the most frustrating things about a serious mental illness is that you almost can't know exactly what's going on.
"Shit, let's just call it a headfuck cocktail."
It took me more than a decade to go from my first therapy session to knowing what I had. I started with a diagnosis of major depressive disorder, but after my first episode of mania, it turned into bipolar disorder, then bipolar with psychotic features, and finally schizoaffective disorder, bipolar subtype (and no, there's no fun little acronym for that one because it would be SAD-BS). Your brain changes as you age, so it's possible for your disorders to evolve like terrible crippling Pokemon. I started therapy at 13, but I didn't have a full-on delusion until I was 21. It was not very effective.
Since the doctors can't be 100 percent sure what's wrong, they can't be sure that the treatment is going to work. It could even make you worse. If you're secretly bipolar, but have only outwardly shown signs of depression, then antidepressants could throw you into your first mania. That's besides all the normal risks and side effects of medication. If you only get dizzy, sleepy, nauseated, or jittery, consider yourself lucky. Bad side effects include fainting, dangerously low blood pressure, seizures, the beginnings of Stevens-Johnson syndrome, and muscle stiffness to the point where you can't stand up. And those were only the side effects I personally experienced.
Others were rather more severe.
Delusions are pretty confusing, too. One Friday night I came home and instantly knew my boyfriend had been replaced by an alien doppelganger. He looked the same ... but somehow off. I knew it was impossible and screwed up and wrong. That's one of the things about mental illness they don't show you: You can know what you're thinking is abnormal as you're thinking it. Here's the other thing about mental illness: That doesn't help one fucking bit.
If you suddenly hear a voice telling you that your neighbor is Satan, you don't go "Well, golly gee, time to kill him with a screwdriver, I guess." You'll fight it and disbelieve it, until you start seeing Satan in everything your neighbor does. By the time you confront him, you have tons of evidence. The evidence doesn't make sense to anyone else, but your brain makes it make sense to you. So when your neighbor ignores your hello, it's clearly because he's Satan and not because he didn't hear you.
Those damn horns he keeps wearing sure don't help.
And my alien delusion? How would I disprove that? My boyfriend would say he wasn't an alien, but that's exactly what an alien would say. Eventually, I got over it ... by ignoring it. My thought process went something like this: "If he is an alien and I blow his cover, he might beam me up to the mothership right now and whisk me away. If he's not an alien, he'll get upset that we're having this argument again. If I act normal until the alien leaves, I'll be fine."
The only way to fight your delusions is to ignore them. Not that this is a comfortable thing, since my brain is now convinced that I've had sex with an alien.
Hymn Herself has written a novella about her time spent inpatient in McLean Hospital. It's called House Full of Insects, and you'll buy it if you're cool.
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