How Do We Help Someone Through a Dark Night of the Soul?
Are we any good at it?
TW: Discussions of suicide, prisons, and inpatient psychiatric facilities.
Sometimes, I have a secret feeling that I am out of my depths when writing about a subject. And that applies to this piece.
I have never sought inpatient psychiatric care because I have, luckily enough, never needed to. I do not have first-person experience of being committed, and hopefully, I never will. But as someone who has struggled with various mental health co-morbidities associated with autism, like depression, anxiety, and C-PTSD, I know what it is like to struggle with suicidal ideation only occasionally. Because of the brave truth-tellers who have come forward to express what their experience was like for them — some of these individuals being part of what’s known as the Psychiatric Survivors Movement, I would be hard-pressed to reach out for inpatient psychiatric services even if I thought I needed it.
First, I’m not inherently antagonistic to psychiatry per se. Prescribed medications have been very effective for me in many instances, and the same has been confirmed for well-known autistics like Temple Grandin. I do not think the profession of psychiatry is evil, and although it is rough around the edges and it’s not an exact science because risks naturally form when one tries out a new medication, it can help. I have significantly benefited from my meds.
How do we help those in need?
My objection to the inpatient involuntary commitment of some individuals is that it can resemble incarceration and can sometimes even involve less due process than the criminal legal system. For example, any jail is supposed to allow a person the opportunity to make a phone call. Yet, as of 2016, only 21 states required allowing the person a phone call in inpatient psychiatric settings. In 2016, only 26 states mandated that a person could consult with an attorney in these settings. While different medical facilities may say phone calls act as a distraction to treatment and that the patient is entitled to privacy under HIPAA or that the patient may be hiding from an abusive family, that patient should be able to speak with whom they want to in a truly safe space.
Given all of the first-person accounts I have read about the process, I conclude that asking for help can make one feel like a criminal because of the treatment the patients sometimes receive. Patients might go through strip searches while staff can look at their anal cavities, as would happen in jail or prison, to ostensibly cover the facility’s liability regarding contraband.
According to Crystal Nelson:
Inpatient psychiatry is not a place of psychological healing; it is devoid of compassion and full of human rights abuses. Those trapped there due to their emotions, thoughts, and behaviors are controlled by pharmaceutical Americans and their cultish mindset hailing drugs at the expense of everything else. The conditions are prison-like, human rights nonexistent, and intimate friendships banned. Due to the presence of cutting-edge, next generation drugs and electric shock machines, though, psychiatrists have faith that these are places of psychological healing.
People can arrive at these facilities for a whole host of reasons. They can arrive in an acute paranoid state and then subject themselves to being video monitored 24/7, which, as Crystal Nelson says, ensures their worst fears are coming true. They can be homeless individuals, and the trend of psychiatrically “treating” these people (as espoused by one political campaign in particular) in tent cities is alarming to me and portends a dystopian future. These patients can be forcibly injected until symptoms subside. Many times, if one does not “agree” to the medication being prescribed, they risk a longer stay. Patients often feel that they are severely restricted in their autonomy, forcing them to adapt and comply lest they risk being disciplined. In essence, many patients feel they have lost their dignity. Freedom of movement and to associate with whom one chooses is often limited in these settings due to house rules. Nurses and staff vary in their view of these rules; some view them as necessary, while others see them as humiliating to patients.
To the extent that a Psychiatric Advance Directive is necessary and helpful, it may be something one should consider.
According to Plunkett and Kelly (2021):
Dignity and humane treatment in psychiatric settings is not only a moral claim but also a human right (Gostin, 2001). Patients, however, commonly report that their dignity is not always protected in mental health services (Kogstad, 2009). Patient experience of coercion and restrictive practices in psychiatric settings have been the subjects of systematic review (Chieze, Hurst, Kaiser, & Sentissi, 2019; Hotzy & Jaeger, 2016), but dignity among psychiatric inpatients remains understudied. Although a ‘Patient Dignity Inventory’ (PDI) was developed for palliative care settings (Chochinov et al., 2008) and has been validated in the psychiatric inpatient setting (Di Lorenzo et al., 2017), there is still a paucity of literature on this topic.
Many people have argued that while these inpatient psychiatric facilities laudably try to stabilize individuals who are a threat to themselves or others, their real motivation rests with making money. According to a former patient who was involuntarily committed:
Another annoying part of the involuntary commitment was being badgered about not having health insurance. I am a believer in having private health insurance and had it all my life until I was fired at 25 years old. I had gone without it during the decade I couldn’t find a job and was too prideful to sign up for Obamacare when I had the opportunity. I had even taken to doing light therapy outdoors for my last lichen planus outbreaks, which was free, instead of taking steroid treatments. It actually worked better and wreaked less havoc on my body with no side effects. Eventually, I agreed to sign up for medical-coverage public assistance to pay for the $100,000+ hospital bills for being committed for nearly two months.
One thing many people do not know is that at the end of a prison sentence, involuntary commitment is an option that some states and the federal government have at their disposal if they think you *may* commit another crime. Note that the standard is not that you did commit another crime but that you may. This is a form of “precogs” being unsuccessfully deployed trying to predict the future, as in Minority Report. In essence, it is preventative detention under the guise of psychiatry.
Why am I worried?
My antenna around these issues is very sensitive right now in the era we may be close to ushering in, where, as earlier stated, tent cities are already being built for the psychiatric “care” of the homeless, where being homeless is criminalized, where attempting to help the homeless is a crime (that’s the state’s job), and where conservatorships threaten the autonomy of disabled people. It seems like being anyone other than a cis-male individual without any mental health issues or a developmental disability makes one a target these days. We are overcorrecting from the days of deinstitutionalization by trying to swing the pendulum the other way in this era of radical extremism that aims for a purified society. When one of the candidates for president of the United States spoke about certain people “poisoning the blood” of the country, every marginalized person in this country stopped in their tracks. They knew exactly what it meant.
Psychiatry should not be allowed to be co-opted in this endeavor with the power of the state behind it. The conditions of our jails, prisons, and inpatient facilities are already beyond the point of being disgraceful. But this new layer of otherizing that is being embraced by some factions in our country is a hair-raising trigger threatening to curb freedoms for individuals in society who are ‘not deemed to fit in properly.’
I very much doubt that psychiatric inpatient facilities could adequately serve the needs of autistic people. Forced social groups with a lack of guidance by nurse practitioners or doctors and with little knowledge or expertise in autism somehow do not seem like it would be that effective for autistic people. In our other primary custodial settings in this country, jails and prisons have notoriously failed to serve the needs of autistic people. There are no screening tools to identify autistic people in custodial settings. Is that any surprise? If it takes autistic people years and years to get an assessment on the outside for a diagnosis, why would it be any easier to get assessed at taxpayer expense? Well, I say it should be. Classification and placement in these settings can be the difference between life and death for autistic people, and I am not being hyperbolic.
Even if you think that what you read above is simply “woke,” what should bother all of us is this: Our culture says that it values life but simultaneously dehumanizes and humiliates those who are thinking about taking their lives at the most inopportune moments. It is a bit like when George Carlin said that certain people in our country are concerned about you up until nine months in utero, but after that, they don’t want to know you. As a little kid, I always thought that if people were suicidal, they would be taken into a hospital setting where the staff continually affirms their existence and even pampers them a little. It seems like this is the opposite of the truth.
I know these places are often short-staffed, which is a systemic failure. Many facilities reject patients due to staff shortages, overcrowding, and lack of training. Sometimes, autistic individuals wait in the ER for weeks before they get a bed in the psychiatric unit. And I also know sometimes patients have to be restrained for their own safety and the safety of others. However, patient neglect and abuse are still all too common, even excusing the environmental circumstances under which employees are placed. We need better oversight to ensure the psychiatric patient Bill of Rights is correctly implemented and those facilities that do not meet this standard are removed from accreditation or licensure.
I believe that asking for help when one is at their lowest is one of the bravest things a person can do. But how we respond to individuals in this state defines the essence of who we are collectively. Like Dostoyevsky said, just as the nature of civilization in any society can be determined by entering its prisons, so too can the same be said of the places where brave souls go when they ask for help. And we are failing that test.
Conclusion
I will end with what you have probably heard from others: If you have made it this far in life, you are a badass. You have defied expectations again and again and are still here. Circumstances that seem insurmountable can change when you least expect it. Those catalytic moments will come, but you can’t force them, just like you can’t force water to boil quicker by watching it.
I won’t tell you that you are here for a purpose and all that new-age bullshit. But I will say that I believe you are loved. And even though you may not vicerally feel it in your bones, I suspect others have noticed your perservance. But even if they haven’t, you know you have persevered. And you know what? That makes you a badass! No one can take that away from you.
Whatever time you can enjoy away from the pressures of conspicuous capitalism and the daily grind it is taking on your life, do so when you can. Take a walk in nature and just enjoy being surrounded by the trees, animals, and the scents of the flowers in springtime. Listen to music or poetry that speaks to you. Find a community that values you and your voice.
Carpe diem.
