Life On The Psyche Ward

The Inside Scoop

Very few people have been on a psyche ward, for any reason. Most have only seen them as depicted in Hollywood films with evil nurses, austere looking doctors, white-coated security staff running around clubbing patients into submission, and scary looking janitors with thick glasses lurking around every corner emanating their deadpan stares, adding to the widespread psychosis and paranoia. Although there is some truth interwoven into these films and their scripts, wild scenes of terror and skullduggery are not the norm.

I’ve never been a patient on a psychiatric ward. My time spent on them was either to visit a sick friend or, more commonly, to attend to one of my psychiatric clients as part of my job duties.

During my decades-long career in the field of mental health and addictions, visits to the psyche ward were commonplace. Occasionally I was the one responsible for clients being admitted in the first place, but often projected the blame onto the psychiatrist. (Keeping good therapeutic relations with clients was a tricky business, and scapegoating the doctor came in handy when working through delicate situations.) My perspective of life on the psyche ward, therefore, is mostly through a vocational lens, watching colleagues work their magic in maintaining a calm, hospitable atmosphere for patients seeking relief from psychiatric symptoms too unbearable to manage on their own. It’s not easy work.

The most exciting time of day on the ward occurs upon arrival of new patients, especially those under police escort. It can get interesting. All heads turn with intense, curious stares directed at the only entrance to the compound. Televisions, board games, crossword puzzles, and other distractions are set aside, being no match for the real-life excitement that could unfold during intake. A big bulky security guard conspicuously and purposefully makes his way toward the newly assembled welcoming committee gathered around the plexiglass-encased front desk. Nurses scribble copious notes that will later be typed neatly onto computer screens. The patient’s personal items are collected and held under lock and key until the moment of discharge. Signatures are required by most everyone involved, especially the patient, unless too ill to do so. In that case, it can wait until later when the medication kicks in, or the narcotics wear off...one or the other. Perhaps the patient is unable to cope with this administrative ordeal and is simply led to his room (the one closest to the nursing station to ensure maximum scrutiny during that first night) after being given a dose of something to ensure a good night’s sleep.

Patients with violent histories, or currently presenting with aggressive speech or behavior, are apt to be temporarily held in a room closely monitored by the big bulky guy. A so-called “rubber room” is available for extremely violent patients who pose a risk to themselves or others. All this is contained within a secure section of the ward far from the patients’ common area to ensure their well-being, both physical and mental. Well, that’s the plan, anyway. But things can go south very quickly on the psyche ward.

The serene atmosphere can be disrupted without warning. Verbal outbursts, overturned tables, security guards in full gallop, these are all possible, and staff are always cognizant that difficulties can arise suddenly and with fury, like an unexpected tempest at sea. Involuntary injections may be required not only to restore order and de-escalate the situation, but also to keep the unruly patient safe from further harm. Someone may have to “stop the bleeding”, so to speak…and fast.

Fortunately, I’ve not witnessed much of this firsthand, but have heard many varied tales of tumult and violence from seasoned psyche nurses who, mixed with much dark humour, can recall these events as if they happened yesterday - and sometimes they did.

One of the goals of those staffing the psyche ward is to create and maintain a physical setting and atmosphere that reflects a normal, healthy living environment. This is done not only for the comfort of the patients, but to give doctors and nurses the opportunity to observe individuals in normal or near normal social settings. On this ward, there are no high-tech electronic monitoring devises for staff to depend on. They must rely on their eyes, ears, intuition, education, training and experience to decipher what is going on in the mind of the patient. These are indispensable tools of the trade employed to accurately identify psychiatric symptoms and come up with the best possible course of treatment.

The psyche ward is not where friends and families of patients want to be. First-time visitors are often still plagued by scenes of Jack Nicholson being wheeled around on a gurney in a comatose state, a la “One Flew Over The Cuckoo’s Nest”. But after a while, they will realize that the ward is a warm and welcoming place in which to spend time with their loved ones. The staff will be just far enough away to provide adequate privacy, yet close enough to react to any troublesome episode which may arise. Psyche nurses know their jobs are fraught with potential danger but are highly skilled at keeping that inner tension hidden in order to cultivate a relaxed ambience for visitors and patients alike.

For some reason, food provided to psyche ward patients is not the typical hospital fare. I know this, having enjoyed many hardy and delicious meals while visiting with clients or friends. Sometimes I deliberately timed the encounter to enjoy this yummy cuisine. Well, not exactly cuisine, but tasty just the same, and certainly not the unappetizing gruel other hospital patients endure.

I can’t give enough praise to members of the psyche ward nursing staff, wherever they may be. Their humanity, love, compassion and understanding permeate the air within the walls of the ward. Even those in the “hard-to-love” category find acceptance and genuine concern given to them without expectations of reciprocation. Psyche nurses are truly unsung heroes.

And now we turn our attention to the unpredictable world of patient-to-patient relations. (Not to be confused with patient-on-patient relations. Ahem. Those types of relations are, of course, never permitted, but can occasionally be missed by sleepy night shift workers. Stuff happens.)

One thing I know for sure is that patients on the psyche ward, and psychiatric outpatients, are each other’s best mental health clinicians. They may or may not have the book smarts and technical training a professional psychotherapist has, but they have the inside scoop on what it is to live with mental illness. That’s the advantage. Without even recognizing it, they are well schooled in the art of comforting others by looking into the hearts of their peers and swapping war stories. Through common suffering, they can give comfort and relief to each other in ways the so-called experts cannot. In no way am I diminishing the value of those in the human services field, just pointing out the important part patient-to-patient relationships play on the path to sound mental health. Spend time with psychiatric patients and you will witness these healing interactions. Infliction of pain onto others is a rare event on the ward, but staff know not to let their guard down.

My mental health training was not restricted to the tedious but necessary task of becoming familiar with the DSM-V (Diagnostic and Statistical Manual of Mental Disorders). My classmates and I were fortunate enough to have an instructor willing to teach us about the human beings at the center of our studies, the ones with whom we’d interact over the course of our careers. That was what drew me to the field in the first place.

People living with serious and persistent mental illness are usually experts in judging others and identifying any ulterior motives being disguised. Their intuitive, sometimes overactive, self-defense skills enable them to sift the good from the bad, and these abilities somehow remain in good working order despite their active psychiatric symptoms. This is especially true with those suffering from various forms of psychosis, in whom delusional thoughts and/or hallucinations are present. They seem always on high alert when it comes to sizing up others. This is the tension going on within those suffering from psychosis. If untreated, the stress commonly leads to an early death either by suicide, or other health issues. The lifespan in this population is shorter than average. I hope these stats are improving. Mental illness can be deadly.

I was once told a story of a client who was asked to pinpoint the most important trait or skill a mental health professional could possess. The answer? “Be real”. If you’re thinking of entering the field of psychiatry, don’t waste your time trying to fool clients into believing you are genuine, just be genuine. If you really don’t care about people or in it for just the money, your clients will detect it long before anyone else, and all your education and training will be useless. If the clients don’t trust you and let you in, you’re out.

My own struggles with mental illness made me a natural fit in the field of psychiatry and enabled me to have the required compassion for my fellow sufferers. I’ve come to know that my difficulties were not without purpose.

Hopefully, you are more comfortable with the thought of being on a psyche ward, for whatever reason, than before reading this.

Daniel (Murphy) Kennedy