It’s interesting that psychiatric hospitals are used as a cliche for “a situation of total chaos” – I think I’ve already mentioned the time when the director of a psych hospital I worked at told us, apparently without conscious awareness or irony, that if Obamacare passed our hospital would have too many patients and “the place would turn into a madhouse”. There’s a similar idiom around “Bedlam”, which comes from London’s old Bethlehem psychiatric hospital.
In fact, psych hospitals are much more orderly than you would think. Maybe 80% of the patients are pretty ‘with it’ – depressed people, very anxious people, people with anger issues who aren’t angry at the moment, people coming off of heroin or something. The remaining 20% of people who are very psychotic mostly just stay in their rooms or pace back and forth talking to themselves and not bothering anyone else. The only people you really have to worry about most of the time are the manic ones and occasionally severe autistics, and even they’re usually okay.
For a place where two dozen not-very-stable people are locked up in a small area against their will, violence is impressively rare. The nurses have to deal with some of it, since they’re the front-line people who have to forcibly inject patients with medication, and they have gotten burned a couple of times. And we doctors are certainly trained to assess for it, defuse it, and if worst comes to worst hold our own until someone can get help.
Yet in the two years I’ve worked at Our Lady Of An Undisclosed Location, years when each doctor has talked to each of their patients at least once a day, usually alone in an office, usually telling them things they really don’t want to hear like “No, you can’t go home today” – during all that time, not one doctor has been attacked. Not so much as a slap or a poke.
I am constantly impressed with how deeply the civilizing instinct has penetrated. When I go out of the workroom and tell Bob, “I’m sorry, but you’re disturbing people, you’re going to have to stop banging on the window and shouting threats, let’s go back to your room,” then as long as I use a calm, quiet, and authoritative voice, that is what he does. With very few exceptions, there is nobody so mentally ill that calmness + authority + the implied threat of burly security guards won’t get them to grumble under their breath but generally comply with your requests, reasonable or otherwise.
Scott Alexander, “Reflections From The Halfway Point”, Slate Star Codex, 2015-06-29.
June 26, 2017
QotD: Psychiatric hospitals
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