Bent but not broken by Elizabeth Margaret

Nothing is good anymore. Mum doesn’t care. She hates me. I hate me. I hate what I have become. I am sorry, Crystal. Try to forgive me. There is no way out.

Abigail.

CASE FILE #2794 ABIGAIL LEE MANUS D.O.B. 02/04/1998

Consulting psychiatrist:

Dr. Harry Nightingale, B.SC; MD; MRCPsych; FRACS; FRANZCP

INITIAL ENTRY: 09/04/2014

Abigail was admitted to the facility directly from St Bartholomew’s General Hospital following a nearly fatal suicide attempt.

Medical history accompanying her admittance indicates that Abigail is generally physically healthy, though underweight.

Records from St Bartholomew’s General Hospital also indicate evidence of scarring to her upper inner thighs and pubic area. Some of these are fresh, others healed. This is almost certainly an indication self-harming.

Abigail appears to be aware of her surroundings and is responsive to directions. However she seems almost disinterested in where she is, or what has led to her being here. She refuses to answer questions from staff.

I have prescribed anti-depressant and anti-anxiety medications to be taken after the evening meal.

I have assigned her to room 101 with 30 minute suicide checks overnight.

I will begin individual therapy 10/04/2014.

Dr. Harry Nightingale.

CASE FILE #2794 ABIGAIL LEE MANUS D.O.B. 02/04/1998

ENTRY 2: 10/04/2014

I explained to Abigail that our sessions would be recorded and transcribed into her case file notes.

‘Like I care!’ was her angry response.

Abigail displays extreme anger and resistance. She has denied suicide attempt: “Just had a headache” given as explanation. She exhibits a very defensive posture, with her arms across her body and refusing to make eye contact with me. She is unwilling to speak, except to demand that she be “let out” because there is “nothing wrong with me!”

She adopted the same highly antagonistic and defensive position in group therapy session today.

It has been reported by the staff that Abigail has refused to interact with other patients in the ward. She has been seen crying quietly when she thinks she is not being observed. At other times she has seemed almost catatonic in her lack of interest in her surroundings. She has switched extremely quickly from totally lethargic to enraged behaviour, manifesting in verbal abuse and swearing.

She has eaten some food, and so far shows no sign of bulimia.

She has refused to change her clothes or shower, citing lack of privacy as the reason for this disinterest in personal hygiene.

At this stage I cannot tell if Abigail is exhibiting symptoms of bipolar disorder; understandable teenage angst at being in the facility clearly against her will, or signs of post-traumatic stress disorder.

She utterly rejects that there are any issues for her to discuss. I asked her why she thought her mother signed her into the facility.

‘It’s her way of getting rid of me!’ Abigail shouted.

When I asked her about the other members of her family, she spoke positively about her younger sister Crystal.

As she has refused to talk with me, I have offered her the option of writing to her sister. For the first time I saw Abigail look interested. I told her that she would have to do this under supervision in the lounge. I will not facilitate her attempts to further isolate herself by staying in her room during the day.

Dr. Harry Nightingale.

Dear Crystal,

Doctor Hobbit says it will help me if I write to you. I think he’s full of shit. But being stuck here with no phone or internet is driving me mad. Ha! That’s a laugh! This place is crammed with crazies. I know I don’t belong in here. It’s a bloody prison.

All they have are dumbass board games. Even the TV is mounted high on the wall. The nurses control the stupid movies. The pictures on the walls are covered in perspex, not glass. The carpet is that industrial stuff like at school. The lights are those horrible, bright fluorescent ones that flicker and hum. It stinks like a hospital.

I haven’t done anything to deserve this. I hate it here. Can you convince Mum to get me out? I just want to come home.

Abigail

CASE FILE #2794 ABIGAIL LEE MANUS D.O.B. 02/04/1998

ENTRY 3: 11/04/2014

Abigail is even more angry and uncooperative than when she was first admitted. Hostility radiates off her in our individual sessions. She folds herself into the far corner of the couch, as though to maximise the physical distance between us. She speaks as little as possible.

‘Do you know where you are, Abigail?’ I asked.

‘Duh!’ was her angry reply. ‘The loony bin!’ she spat.

‘Why do you call it that?’ I followed up.

‘Because everyone here is crazy!’ she shouted.

‘Does this mean that you think you are crazy?’ I asked.

‘Of course I’m not crazy!’ was her furious reply. ‘I shouldn’t be here!’ she yelled.

When a teenager is yelling at me, I lower the volume of my voice to a whisper.

‘Do you know how you got here?’ I asked quietly.

‘Not really,’ she said.

‘Do you remember being in the hospital?’ I asked.

‘Not all of it,’ she said thoughtfully. ‘It’s a bit of a blur,’ she expanded.

‘That’s understandable, Abigail. You had some time in the ICU, where you were being treated for a suicide attempt,’ I explained.

With this, Abigail went off like a cracker.

‘I did not try to kill myself!’ she screamed. ‘I just had a headache!’

After this explosive response she clamped her mouth shut. Her arms were across her chest. She had a cushion clasped as further protection. She spent the rest of our individual session glaring at me. Clearly she views me as the enemy — or at least a representation of all her enemies. It’s a good thing that I have my patented teenage-proof cloak, or I would have been impaled by her stare.

Abigail steadfastly refuses to speak in group sessions. It is definitely a form of resistance, possibly hiding a sense of denial. She maintains her defensive posture and is shrouding her anger with silence.

The staff report that she has maintained her isolationist behaviour, and consistently rebuffs all attempts to involve her in conversation and activities. She is, however, eating more at mealtimes and taking her medication with little complaint.

I will continue with the 30 minute suicide watch over the weekend. I will review this after input from staff at Monday’s meeting.

Dr. Harry Nightingale.

Dear Crystal,

Every time I think I know what’s going on they change the rules. They have rules for everything. When you can sleep. When you can shower. And they watch me eat and then they have an orderly on me for two hours after every meal to make sure I don’t chuck up. I feel like a bug under a microscope. Can you please please, please get me out of here?

Abigail

Dear Crystal,

It’s the weekend and there’s nothing to do. I suppose that’s why I lost my shit. Being in a locked ward with a bunch of crazies I reckon it was sure to happen. There’s a really snotty anorexic girl here who thinks she’s so special. She talks absolute rubbish and never shuts up. She goes on and on about how her family loves her, and this is their way of showing it. I mean, really? She’s nuts. I told her to shut it. It’s not my fault she didn’t take the hint. So I slugged her. She went down like a pile of dirty laundry. Before I knew what was happening I was in an arm lock and marched to my room. I don’t care. She’s a stupid bitch who got what was coming to her.

Abigail

CASE FILE #2794 ABIGAIL LEE MANUS D.O.B. 02/04/1998

ENTRY 4: 14/04/2014

Abigail continues to resist all attempts to engage with me in individual sessions. It does not appear that the anti-depressant or anti-anxiety medications are having any appreciable effect as yet.

The staff reported that during the weekend Abigail maintained her frosty demeanour towards them.

Seemingly without provocation, Abigail violently attacked another patient on Saturday afternoon. She was confined to her room until the staff felt she was sufficiently calm to be returned to the lounge.

It has been reported that she has eaten well at each meal, and has not shown any signs of bulimia. Abigail does appear to be better nourished. Her skin has improved because she has filled out a little, and her hair looks in better condition.

On Sunday night Abigail had a shower, cleaned her teeth and changed her clothes. All of which is an improvement from when she was first admitted. I believe that this is an indication that she is becoming more reconciled to being in the ward.

Her persistent silence throughout group sessions is displaying a passive- aggressive attitude. This is counterproductive both for her recovery, and for the other patients. Thus far, they have not commented about this in the group setting — but two have indicated in their individual sessions that they are angry that Abigail has resisted all their attempts to befriend her and include her in the daily activities of the ward.

I will not remove the suicide watch overnight, as her mood swings and behaviours are volatile and extreme.

I will leave her in room 101 until she shows signs of being prepared to talk with me. I want her to be able to discuss her actions that caused her admittance to the facility. The staff will continue to watch her closely to monitor her attitude and behaviour to staff and the other patients.

Dr. Harry Nightingale.

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