There are a number of strategies for how to get through life in a psych ward.
Probably the first and most popular strategy is Outright Defiance. This involves yelling at the staff, demanding to see the doctor, demanding a list of lawyers, screaming all the time about how your rights are being violated, and spending lots of time on the phone arguing with relatives about coming and getting you out. You see this one all the time, especially when people first come in, and some people stick with it the entire time, although eventually they get reconciled to some things, which is another way of saying that they figure out that it’s not worth fighting about everything.
The next strategy is Passive Acceptance. This is when you figure out that no matter how you fight and argue, almost nothing you demand is going to change and the staff don’t really give a fuck anyway, and you just get along through your day: waiting in line for medications, for the snacks at night, for the next mental health worker to become available so you can get a couple towels and some more shampoo for your shower. Sometimes the Passive Acceptors grumble or say things under their breath, but they only rarely confront anyone. This is probably the next most common thing you see.
The next strategy is Trying to Enjoy and Learn from It All. These are the people who attend every group they can and ask serious questions, who go to the gym every day and to the library and the recreation room whenever they can, and who maybe even pick up a book — maybe the Bible itself, or even the Q’ran — and actually read it. They get along with the staff, and there is no interesting power dynamic involved except in the way that the staff loves the softball or difficult questions they ask and how they always parrot back the officially taught answer to any question they have heard discussed in a group.
The next strategy is sort of one you have to either be born with or have developed somehow, which is to Make Art All the Time. There are all kinds of pieces of paper printed with illustrations from coloring books, and there are all the colored pencils and markers and crayons you could want. You can take one of the crocheting books out of the library — there is a big pile of them — and do a little crocheting. I have seen a woman who spent almost all her time in a special armchair, barely moving except to move her crochet needles as quickly as a machine, the piece she was working on held right up to her face while she stared at it closely the whole time. Some people draw. Some people paint in the arts and crafts classes, where they can also do beading or special projects that the mental health workers bring in. Some people cover their doors and their walls with the artwork that they and their friends have done. (I have a wall devoted to it.) Some people sign their names to the bottoms of the pictures they color and dedicate them to people with a special message before giving it to them.
The next strategy is either to Watch TV or to Sleep All the Time — more or less the same thing, I guess. TV Watchers and All-the-Time Sleepers usually don’t make a whole lot of trouble either, although I have seen people who would emerge from the TV room to yell at the staff for a while before going back to watch their favorite show.
The next strategy is to Pace Endlessly. I am an Endless Pacer, even if I also fit into another category that I am going to get to in a moment, a category which is one of the rarest categories of them all. As an Endless Pacer, I can tell you that sixteen hours or more of pacing in a day (I don’t need to sleep all that much) will reduce you to exhaustion. It may be, in a place where the doors and windows are locked and the hallways are the only place where you can really move around to work out your energy, that pacing is the only thing that really makes you tired. Endless Pacers are the people who get themselves a music player and headphones as soon as they can, or who borrow them if someone is either foolishly trusting enough or who knows you well enough to lend you theirs. (It’s not very smart to let anyone you don’t have good reason to trust get their hands on your music player, as it might get broken or simply “disappear” when someone steals from that person.) These people may belong to another category or two as well, such as the Outright Defiance or Passive Acceptance categories — which is not to resemble the DSM too much, I hope. This is not a diagnostic system, after all.
There are other strategies as well, some of them based on who you are. There are what used to be called the “hebephrenic” and who are now called the “disorganized schizophrenics,” although I’m sure there will be a progression of different labels for them in the future as time and psychiatric fashions change. These people tend to deal with everything in a passive way, as avoidant, in a way that is unique to each one of them, but they all tend to do certain things. For instance, I have noticed frequently that when most “disorganized schizophrenics” hang out in a public area, they are always watching something across the room for a moment, then swinging their heads around to stare into space for a while, then staring at something else for a while, and at all times avoiding eye contact with anyone they don’t trust, which may be only one person or maybe even none. They have virtually no social contact with anyone, and this is deliberate. These are the people who have deliberately adopted a strategy of non-engagement, and as a result they avoid all the power dynamics taking place around them. One extremely memorable “disorganized schizophrenic” that I knew pretty well had a way of looking at you for a moment after someone had said or done something, and raising her eyebrows as though in this kind of very meaningful disbelief and then rolling her eyes. She was very funny, once you understood what she was saying. She spoke in disjointed sentences that I realized were a sort of private code, and it occurred to me that she might be a twin, since twins often develop their own code or even their own language. I asked her about it and she said that she was, in fact, a twin.
Taking the route of “disorganized schizophrenia” is not the only personal strategy, of course, but simply an example.
As it turned out, over the course of a couple of extended admissions I ended up developing my own personal strategy, which one would simply call Unceasing Persistence. There were many aspects to this strategy, and the rest of this essay is going to be a discussion of them, because in the end what they result in is Getting to Run the Psych Ward.
I was so successful in this role that by the time I was released from one admission after four months, a couple of the other patients had begun to refer to me as “The Mayor” and “The Big Man” because of the way I could get things done for people, like getting them the extra food that they needed or maybe some help letting the staff know that they needed the Colase not only because neuroleptics constipate you but because the kitchen staff cooks the living hell out of every scrap of starchy or potentially fiber-containing material they give you, which only makes the constipation worse, and which is exactly what happens to a lot of people — and I mean a lot of the older people especially. (Those boiled green beans are meant to be easy to get down, but they plug you up.) Anyway, I could help people out because of the way I had gotten the staff — trained them, essentially — to do basically anything I wanted them to do as soon as I wanted them to do it.
The strategy of Unceasing Persistence is actually a subcategory of Outright Defiance. In my experience it starts out just like Outright Defiance, but soon one learns to use a group of very consistent and thoroughly annoying techniques of demanding what you want and getting it every single time. It gets so that the staff just sort of learns to give in and just do whatever you’re asking for, because if they try to ignore you it will take them so much more time and effort to get rid of you than it would to simply give in and immediately respond to your needs and desires in the way that you want them to that they learn to just do it, regardless of how they might feel about it. After a while, a new sort of working relationship is created in which the mental health workers, nurses, doctors and other staff just sort of start to see your point of view and learn to go with it.
My case started out as a case of Outright Defiance, but with this exception: all the features were magnified.
From the hospital admission itself, where I insisted on reading every single document from beginning to end and making notes and demanding copies of the laws involved, to calling the first young resident doctor I talked to a “collaborator,” I took the strategy of Harassing the Staff to a new level. I filled out at least five different dietary preferences sheets, changing my diet, until I found one that suited me, and I demanded meetings with the dietician as well. I would bring my request forms to the nurses’ station and demand that they be signed and dated (by the doctor if possible) and then photocopied and distributed to every party concerned, whether that was the dietician or the complaints investigator or the chief administrator of the hospital itself, as well as a copy added to my medical record, and I did this with every document that passed between us.
When I first arrived, we lost ten minutes of gym time every time we went to the gym because the staff never called the groups on time and it took ten minutes to round everyone up even after the staff finally did call the groups. When you only get thirty minutes at a time to use the gym, that ten minutes is a lot of lost time. After I arrived, the trains ran on time. I would show up at the nurses’ station five minutes before every gym group and I would remind the staff to call the group. I did this time after time after time until they learned to call the gym groups on time. If a “patient” was screwing around, they got left behind. The staff basically learned that unless they wanted to see me standing there while they listened to yet another lecture on how they were depriving us of our legally mandated exercise, they learned that they’d better call the group on time and leave for the group when we should.
As part of the Unceasing Persistence strategy, there were areas in which I was the most extreme of Outright Defiance and areas in which I was Unmovable Resistance. Examples of each deserve mention.
In the Outright Defiance strategy, I had a way of going up to the counter of the nurses’ station and pounding on it for hours while lecturing people at the top of my lungs. The nurses’ station was built like a machine gun nest, with the counter there in front to keep the “patients” at arm’s length, with the desk behind it and then behind all of that there was the doorway back to the nurses’ actual working area, including the medication room and a big conference room where they could eat their lunch or sit and bullshit with each other for a while as they punched data into a laptop. I don’t know which aspect of this technique was worse for the staff. The counter was hollow wood — essentially, a big drum — and the way I would pound on it would go straight into the eardrums of anyone within twenty feet, and the way I would do it for hours if necessary was enough to break down the wills of a group of people whose wills are not easy to break. Also, yelling at the top of your lungs to the nurse at the workstation in the conference room to come give you what you needed, instead of going through a mental health worker and having to wait fifteen minutes to receive any help, while always demanding the charge nurse if possible so that it got to the point that the charge nurse always came out and gave me what I wanted, to the point where I once again broke their wills, turned out to be a very successful way to go about things. This was the first of my two main strategies.
All of this was, of course, also characterized by Unceasing Persistence. I simply didn’t quit. I broke people down.
In the pure Unceasing Persistence strategy, there’s how I got melted margarine so I could eat my eggs. I’ve always hated scrambled eggs, which you get served as often as two or three times a week, and I have to soak them in melted butter and douse them with lots of pepper and salt to get them down. Once I discovered that there was a huge block of margarine kept in the fridge in the room where the employees kept things like crackers and yoghurt and bread and peanut butter and jelly, I would show up at the door of the room and wait until I spied a free mental health worker and shanghai them into cutting a big chunk of the margarine off into a dish and melting it in the microwave for me. Now, securing a mental health worker at meal time was not an easy thing to accomplish, but I would wait, patient as a stone, for however long it took for a mental health worker to become free and to get me my melted butter. After a while, mental health workers would spot me, lingering in the background, waiting to pounce as soon as they had a moment of breath from whatever they’d been doing, and they’d immediately turn and go get me my melted margarine. Now, you might not see the significance of this, but giving someone a small dish of boiling-hot melted margarine is like handing someone a weapon that could be thrown in someone’s face, but after a while they gave it to me every single time I asked.
This is probably the height of Unceasing Persistence, and it breaks down even the most active resistors, the ones who just can’t stand your face until they learn that it will never go away, not until they give in, not until they learn to agree with it, not until you are either Running the Psych Ward or — even better — finally Escaping this Place and Resuming Your Freedom, which is, after all, only what they deserve, for they are the ones who are holding your freedom away from you in the first place.
Probably my greatest triumph in the Unceasing Persistence category, though, was when I got the Tea Garden opened up for patients again.
In the middle of my usual psychiatric prison, around which everything else was built and radiated out, there was a large courtyard called the Tea Garden. When I had been there ten years before for a very brief time, it was actually a genuinely Japanese-style tea garden, with all kinds of carefully groomed plants everywhere and footpaths to wander through it all and a beautifully constructed tea house made out of these immense pieces of timber. It was a place to look at, not to do any sort of recreation in, and as such I suppose it was sort of relaxing. Ten years later, however, it had been transformed. Many of the plants were gone, though the tea house remained. There were now sections of lawn where people could sit on the grass or in lawn chairs and soak up the sun. You could, I suppose, have played a game like hacky sack or even frisbee, although it was still a fairly limited space. Lots of people used the walkway that ran around the whole thing as a sort of walking track, getting their exercise for the day.
When I arrived those ten years later, the Tea Garden was always closed so that the prisoners with “building privileges” couldn’t use it whenever they wanted to. I was told that this was because they had been doing construction in the garden or on its surrounding structures and so they had locked the Tea Garden so that the prisoners wouldn’t try to escape through the small fence that looked out of one side of the Tea Garden. Months after finishing construction, they still hadn’t opened the Tea Garden again. Once I had “building privileges” and saw how I was being denied the opportunity to go outside, I resolved that this was a situation that was going to change.
The first day, at precisely 9 a.m., the policewoman I confronted in the lobby (the state police maintain a presence in the prison in the form of a few officers, a sergeant, and a lieutenant) simply stared at me when I asked her when the Tea Garden was opening since it was supposed to be open at 9 a.m. sharp, at which point she dismissed me in a rather hostile fashion, saying that the officers had other things to do. But my message had been sent. The second day, at precisely 9 a.m., I checked the Tea Garden, found it locked, and moments later was standing in front of the police dispatchers’ office window, asking when the Tea Garden would be open. I was once again treated dismissively, but I still took the time to remind the dispatcher that the Tea Garden was supposed to be open at nine a.m. and that it was probably mandated by actual statute if not by policy. The third day, again at precisely 9 a.m., I checked the Tea Garden and then was at the dispatcher’s office again, and this time after reiterating my complaint in the most courteous way possible (I was always courteous with the police) I asked that my request for the Tea Garden to be open at 9 a.m. be sent to the real person in charge: the lieutenant himself. On the fourth day, as I crossed the lobby, coming from the locked Tea Garden just after 9 a.m., the lieutenant himself came out of his office to talk to me in the most pleasant way possible, and after that the Tea Garden was open at 9 a.m. sharp every single day. All it took was four days and a little dose of Unceasing Persistence.
Being in a psychiatric prison is about power, and it should be treated that way.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.