After years of battling depression, anxiety, and chronic pain, my younger son, Alan Ross Jacobs, died on January 10, 2015. Three months later, I attempted suicide by overdosing on pills and alcohol in the hope that I could be with Alan again. As a result of my failed suicide attempt, New York State incarcerated me in a mental institution. For 21 days, I was confined in an environment that was degrading, stultifying, and downright depressing.
Rather than alleviating depression, the physical environment in the geriatric ward where I was confined actually added to my despair. All the walls were grayish-white and devoid of any decoration. Windows were screened with such dense material that little natural light shone through. The furniture was of beige plastic and, wherever possible, bolted to the floor. Bedrooms consisted of two beds, each with a foam mattress on a wooden base. Open shelves were provided for clothing, the only personal possessions patients were permitted to have except for an approved paperback or two. We spent most of our time in the day room, which had a row of bolted-down plastic chairs against one wall, a TV, a refrigerator, and a table with some moveable chairs around it. In the corner stood a pay phone, which we were allowed to use for a couple of hours in the morning and evening (cell phones were forbidden). The TV was always on unless there was some sort of group meeting being held in the room. The only way to change the channel or adjust the volume was to find a staff member, who then had to get the remote control out of the locked nurse’s office adjacent to the day room.
The dining room was as colorless and dim as everything else in the hospital. The food was equally drab and made worse by having to eat everything with a spork—a cross between a spoon and a fork. The dining room also served as the visitors’ room after lunch and dinner. There was always a guard at the door—actually a psychiatric aide (PA)—listening to and watching everything. The first night, my older son, Erik, and his wife came to visit, and the PA asked Erik to empty out the bag of supplies he had brought me. The hardcover books were prohibited; their size and heft meant they would be dangerous if thrown. Later, the drawstrings on my pajama bottoms were removed; my shoelaces had already been taken.
After my visitors left, it was time to go to bed, but I didn’t get any sleep at all because of the noise coming from other rooms, and we were not allowed to shut the door to our own rooms. Too soon—it was barely light outside—there was a pounding on my open door and a loud voice yelling “Vitals!” Patients lined up in the hall to have their blood pressure and temperature taken. Then most of us then sat around in the day room until breakfast at 7 a.m.
At breakfast, I discovered that even though we were in a “geriatric ward,” a number of the patients were women in their early forties; one was in her twenties. Like me, two of the women had been committed following suicide attempts. Fortunately, these women and I became very close. Their support, more than anything else, made the days bearable.
Sadly, some of the other patients suffered from very serious issues. In some cases, those issues manifested in ways that made me feel unsafe. For instance, someone threw a chair in the day room and it passed me too closely for comfort. There was also the time I was washing my hands at the bathroom sink and a woman came out from behind the shower curtain; she must have been watching me as I urinated. It was sometimes very uncomfortable to be in the day room because one male patient didn’t keep his hospital gown closed.
The day room was also the setting for group therapy sessions, but most of the patients stayed in their rooms or sat around the perimeter of the day room without participating. At the start of the sessions, we were handed a clipboard and asked to sign in. Even those who were not participating were asked to sign. We were told that if we did, we would be “given credit” for attending. Toward the end of my hospitalization, I realized that I’d been signing in for an exercise program when the activity being conducted was something else entirely. Apparently the hospital was falsifying records indicating that physical activity was being provided. In truth, the only physical activity was an occasional, supervised group walk on the hospital grounds. That happened only four times in my three-week stay.
During group therapy, we often filled out questionnaires, but there was rarely any discussion of our responses. Often, the questions focused on how to avoid the pitfalls that could lead to a relapse into addiction, which served little purpose for patients suffering from depression or suicide attempts. Art therapy was also offered. Again, there was never any discussion of what we were doing, why we were doing it, or what our artwork might reveal about us. The “therapy” usually involved coloring on worksheets. “Music therapy” consisted of listening to CDs while sitting around a table.
One-on-one therapy would have been far more effective, as it could have been tailored to individual needs. Given the patients’ wide array of problems, it doesn’t seem possible that there could be a one-size-fits-all therapeutic approach. When I discussed this with the social worker in charge of recreational therapy, she told me she agreed but pointed out that there was no budget for more individualized programs. She added that the limited budget didn’t allow for patients with different conditions and different needs to be separated into different facilities or wards. At least I had an answer; most of my questions about hospital conditions or treatments had been met with some variation of “If you question or resist, your stay in the hospital will be longer.”
Patients did occasionally have private sessions with a psychiatrist and a psychologist, but I only met with the psychiatrist three times and didn’t see the psychologist until I’d been in the hospital more than two weeks. At the first meeting with the psychiatrist, she reviewed the facts of my case—I was 65, lived alone, had lost a son, and my other son lived 900 miles away. Given these four simple facts, she decided that I was suffering from textbook geriatric depression. She never asked me any questions about my life that might have revealed alternatives. She never learned that I was not suffering from irritability, apathy, withdrawal, or changes in appetite, which are among the most common on the checklist of “geriatric depression” symptoms. Nor did she learn that I’d been working at a job I loved, was in a long-term romantic relationship, and was the organizer of a very active women’s group.
The psychiatrist did ask how I had slept and quickly decided to write an order for sleeping pills after she learned I hadn’t been able to sleep because of the noise. She also prescribed several antidepressants and a sedative. I told her that, given the circumstances of my son’s death, I didn’t want to take that many pills. She sighed and agreed to begin with a trial of one antidepressant, Effexor, and the sedative.
That evening and twice a day thereafter I lined up along the hallway walls with the other “inmates” to get our medication. We weren’t allowed to sit down. At night, almost all of us were given sleeping pills. Patients would rush to be at the front of the line in order to get a temporary reprieve from the misery of incarceration.
When a patient arrived at the window where the drugs were dispensed, the technicians would call out the names of the drugs as they put the pills in a little plastic cup. Klonopin, a benzodiazepine used to treat anxiety and schizophrenia, among other ailments, was given to many. This was one of the drugs on which my son Alan had become dependent and that had contributed to his lethal overdose. I had learned that Klonopin is not recommended for those with a history of depression or suicidal thoughts or behavior. It is also considered particularly dangerous for older adults because its sedative effects last longer in older people. So it struck me as odd that this drug was being given to geriatric patients with a history like mine.
When I got to the dispensary window on the second evening of my confinement, I was given four pills instead of the Effexor and sedative I’d expected. I asked what the other two pills were. The dispensing nurse said one was for my GERD (gastroesophageal reflux disease)—although I’d already taken that pill in the morning—and the other was to help me sleep. I didn’t want to risk being considered uncooperative, so I took the pills. The next morning, I felt so drugged that I could barely open my eyes.
Eventually, another nurse in the dispensary told me that the extra pills I had been given were Zyprexa (an antipsychotic sometimes used in conjunction with antidepressants) and Remeron (an antidepressant that is used as a sleeping medication because of its sedative effects). They had been prescribed by the psychiatrist without any discussion or explanation. This dishonest practice violates New York State Office of Mental Health regulations, which require that the purpose, possible side effects, and alternatives to the drugs offered be explained. No one had even discussed the side effects of the one antidepressant drug I’d agreed to take.
When I met with the psychiatrist again, she told me the pills that she had prescribed would help me sleep. I explained that because those pills made me feel like a zombie, I would not take them anymore. I also refused to take increasingly high doses of antidepressants; I’d seen how many negative side effects these drugs can have while watching my son throughout his decades of treatment. Instead of trying to understand my concerns, assuage my fears, or change my medication, the psychiatrist simply labeled me as “resistant to therapy.” Those words would come back to haunt me when my original release date was postponed. My reasons for refusing the pills were not important. After all, I had been committed; how could my judgment be trusted?
No one seemed to notice or care that my drug avoidance was partially a response to my son’s fatal overdose, nor did anyone seem concerned about the possible physiological repercussions of the “pill therapy.” YES, I was—and continue to be—resistant to taking drugs. Given Alan’s history, that shouldn’t have been surprising. I later learned that the hospital records incorrectly stated that my son had died in a motor vehicle accident, so the reasons behind my resistance wouldn’t have crossed their minds.
Excessive restrictions, lack of privacy, lack of exercise, and boredom combined to make my life at the psychiatric hospital miserable. Realizing how unhappy I was and fearing a deterioration in my mental condition, Erik discussed various possibilities with the hospital staff. This led to my being given a marble-covered composition notebook so that I could keep a journal of my experiences. Unfortunately, patients weren’t allowed to have pens. The one pencil I was given had to be frequently sharpened, which meant finding an aide who could take the pencil into the office to sharpen it and then bring it back. What should have been an additional therapeutic avenue turned into yet another source of anxiety and frustration.
Not surprisingly, I only wrote in the journal once, but the seeds of writing about my experiences had been planted and, over the four years following my release, grew into Broken: How the Broken Mental Health System Leads to Broken Lives and Broken Hearts, published by Amazon in 2019. It’s the story of the many ways the mental health system failed my son, largely by relying on drugs to solve his problems. It’s also the story of how my stay in a mental hospital robbed me of autonomy, self-worth, and self-esteem. Nothing about me as an individual was valued or even recognized in that place. How can such treatment possibly foster mental health? Yes, we’ve come a long way from the horrid living conditions and patient abuse in the mental asylums of the early 1900s. But we haven’t come far enough.