This post is part of the Same Situations, Different Faces series. Normal posting resumes in April.
Alright, this is the last post of the Same Situations, Different Faces series. I thought of what would be a good or useful thing to talk about and it seems I’ve glossed over a topic that is pretty important: hospitalization. Your therapist can diagnose you with DID (or just being on the Dissociative spectrum (Dissociative Disorder, Dissocative Amnesia, Dissocative Identity Disorder, Dissociative Fugue)) but being at an actual trauma/dissocative disorders program is where you can really start to get properly diagnosed and treated with a specialized treatment plan. However, hospitals that are top in treating this are few. In the US, there is Sheppard Pratt’s Trauma Disorders program (Which is why it’s very weird Korean drama Heal Me, Kill Me very much did not mention it, but Hopkins instead, which is more for physical ailments.) If you want better than Sheppard Pratt, you’re going to have to go to the United Kingdom to the Clinc for Dissociative Studies. The US has good trauma disorders programs but dissociative spectrum disorders need a lot more attention than chucking pills at the problem. Medication is useful but treatment has to be therapy-heavy for these disorders, especially since there is no medication that can directly manage dissociative spectrum disorders, just the symptoms such as depression and anxiety. The UK tends to use therapy as the primary stop of mental care before going to meds, the US does the exact opposite.
Going to a hospital actually isn’t that scary. Some parts will definitely make you feel like you’ve very much have lost your mind – I think just the realization of being in an actual mental institution kinda does that all on its own – but really, most of your stay will be unbelieveably quiet and boring. It is nothing like Arkham Asylum, there are no strait jackets and most hospitals have phased out their padded rooms (there’s getting the spike and the safety burrito, now. I’ll cover those two later). Mental hospitals and psych wards (the psychological conditions ward of a regular hospital) tend to resemble incredibly quiet hospital waiting rooms with halls that are lined with doors to bedrooms. The windows are stronger than police riot shields and very soundproof, you can barely hear a thunderstorm.
Getting into a trauma program is pretty tough because of the history of sane people being sent to mental hospitals for terrible reasons with relative ease. You can’t pick up a phone, say “I’m like the dude from Split, please come get me,” and there you go. That would skip the mountains of paperwork that needs to be collected!
Before you go, it’s paperwork city. The first day is also paperwork city. In addition, you’re explained your rights, sort of tested to make sure you can understand that you have rights (or are simply cognizant that you’re in a hospital) and more paperwork. Depending on hospital or state, you will also be told the gun laws in your state…because awareness. Your vitals are taken (blood pressure, temperature, etc). If you don’t like needles, you are gonna hate having your blood taken. And the nursing staff will try to take it every day, which will make you think you’re surrounded by vampires. Oh, and the taking of your vitals daily, this is to ensure you’re actually taking your meds if you have any. You will also have to fill out a bunch of tests as well to see if you just have PTSD, if you’re on the dissociative spectrum or simply misdiagnosed. Here is a sample of what a Dissociative test looks like and no, you can not fake the answers to look less dissocative. I’ve tried. Besides, even if you successfully fooled the test, you’re under 24/7 observation. Someone will notice something.
Speaking of dealing with the staff during intake, your stuff is examined with more thoroughness than TSA. This is to make sure you’re not sneaking anything in that could be dangerous, counterproductive to treatment or harmful. If you bring body wash, it must be transparent, both gel and bottle. Otherwise, it’s getting seized because you can sneak stuff in it. If you have cleanser for your face, it’s getting seized because there is alcohol content in the ingredients. If you have a loofah, not a regular sponge, it will be taken because you can unravel it and attempt to hang yourself with it. Unfortunately, people have come up with some super creative ways to hurt themselves or try to kill themselves and that’s what implements changes in the rules. If you have wireless headphones, you can bring in music, as long as you have a super short cord (3″ or less) to charge them with, in view of staff. If your electrical devices can access internet and/or have a camera on them, it’s getting seized. This obviously means no cell phones. The reason is to protect everyone’s privacy. That and there’s a metric crap ton of triggering content on the internet…as well as distractions that could impede your focus on treatment, which is why you’re there. Should you bring books, they can not be of the horror or murder variety. If you bring comics, anything worse than Archie comics will most likely get taken. The nurses do look through the content to see what is in it, unless the title is a dead giveaway, like “Deadpool”. E-readers can not be brought in either unless they are the 1st gen “no access to internet whatsoever” kind. You will be living mainly as a Luddite, basically. A bored one at that. Your clothes will be checked and if there are any drawstrings, they’re gone. Shoelaces, gone. Heavy shoes or thick soled shoes (such as platforms), also gone. If you have any shirts or pants with religious, violent or disturbing art, it’s a no-go. For example, you can bring a Linkin Park shirt and, as long as the checking nurse doesn’t know LP’s songs that well (I love ’em but the song “Given Up” is distinctly about wanting to kill yourself) you can bring their albums but you can’t bring in P.O.D. anything because A) Religious iconography B) P.O.D. stands for “Payable on Death”, which is a banking term but the staff only cares about the “Death” part. I’m sure bringing any The Prodigy is fine (They are responsible for the title of this piece, after all. P.O.D. for the series’ name). Everything taken is securely bagged up and kept in Security until it’s time to leave for home. If you don’t have any sufficient clothes to wear, you’re given either hospital clothes (which is like a cross between paper and cloth) or “safety sweats”, which is just sweatpants and sweatshirt that have no drawstrings. And grippy socks that may or may not have do not have heels.
If you have natural hair, it would be best to get your hair into yarn twists or any other low/no maintenance hair styles if you have any forewarning because, frankly, nearly every black hair care product will not pass the list. Most of them aren’t clear liquids or in clear bottles. Hair picks are automatic no-go, even plastic ones. Satin bonnets and night caps are not likely either. You can probably talk your way into having a satin pillowcase but that probably will be it.
After getting through paperwork city, having your stuff checked and taking your test to see how dissocative you are, that’s when an individualized treatment plan is really hammered out. The meds, the group therapy sessions, triggers (potential and known), things like that. And this is where the boredom begins. The trauma disorder ward is immensely boring. Between groups, there are wide blankets of time where there is nothing to do. You can’t always have the tv in the general living area on, that’s strictly regulated. There are few board games and card games to pick because “safety is important”. If you can possibly choke on it, throw it or attempt to kill yourself with it, it can’t be in the ward. This means you’re stuck with puzzles and coloring books. Tons of them. If you want something of more intellectual stimulation, you’re going to be out of luck. There are books in the trauma disorders ward, but just like every psych ward, the books are completely snowstormed – White writers, White-led story and content. No diversity, nada. If you have a 1950’s housewife’s taste in books, you’ll be well suited. If you’re basically everyone else, you’ll be screwed. Few people donate books and games to mental hospitals so you get little selection. Perhaps you could bring a word search book or a crossword puzzle book. At least two of them.
When you’re in a trauma disorders program, it’s voluntary. That means you can go after a 72 hour hold. This is given that you’re not kicking up a major fuss or showing that you’re very, very unstable. (Sometimes, kicking up a major fuss can get you to go home faster but don’t count on it as the rule, just the exception). Two doctors have to sign your paperwork that says you’re mentally fit enough to leave and not have to be returned via police escort that very night, based on your past 72 hours. The only common exception is when your insurance finally craps out and you have to leave practically on that very day, regardless if you’re well or not. In voluntary, you can refuse meds you don’t want to take (given you’re relatively self-stabilized) and treatments you may not want (like electro-convulsive therapy). Basically, you’re fairly involved in your treatment experience. If you’re in a psych ward involuntarily, it means that you can’t refuse meds or treatments you don’t want to take and you’re more at the mercy of the psych staff. You stay as long as they think you need to stay and you hardly have a say. Basically, you don’t want involuntary because it is the “we’re bringing you in kicking and screaming”. It’s not common to be in the Trauma disorders program as an involuntary, however.
The various groups are therapy groups to teach you and the other patients about your recently diagnosed (or confirmed) disorder, the meds you might be using and methods to help manage it such as Cognitive Behavioral Therapy. Here is a game created by Nicky Case that shows an example about this particular method, titled “Neurotic Neurons“. If you’re not a fan of group therapy, you’re not going to enjoy this. They’re usually quiet, few people want to talk (understandably) and you will sometimes get the sense that the interns, doctors or nurses are taking stabs in the dark about some parts of the disorders. It’s not that they don’t know what they’re talking about but they do sometimes give you a “learned about swimming from reading aplenty but never been in a pool” feel. And by “sometimes”, it will be “almost regularly”. Bringing a journal is strongly suggested because in group, you’ll have activities to do.
Speaking of dealing with doctors and nurses who may not have first hand experience with dissocative spectrum disorders, you’re going to have to advocate for yourself or they will get something wrong. Mistakes happen and constantly. Misunderstandings are regular, especially if you are not with a lot of social privileges and the staff is not very diverse. Since I’m Pagan, I’ve had to explain a host of times that don’t have schizophrenic or psychosis disorders simply because I believe in occultism, magick and spirits. It’s part of my religion. I’ve had to do the same about being Black and creative as well. Chances are your program was subconsciously designed for middle class White people who are usually hailing from Christian-leaning backgrounds. For example, the ward will have a priest and maybe a rabbi but no imam.The less known or more stigmatized your religion is to the Western world, the more likely it will be read as a psychosis disorder by the average mental health professional handling your chart. Hooray.
Now, I previously said that mental institutions have done away with strait jackets and padded rooms for the most part. If anything, you have complete freedom to be visited, use the phone (they have one for open use during the ward when groups are not happening) and even get care packages. It’s not a prison, frankly. However, if you start acting out, such as pulling the fire alarm, acting over belligerently, cause harm to yourself or another person, there are repercussions. The nurses will try to talk you down as much as possible, offer you meds, etc. If you’re not calming down, the nurses will eventually call for security, which is “code green” (think “hulk”) – actually, there are several color codes – and things are going to be a lot more complicated. There will be several security guards and they will also try to talk you down. If you’re not cooperating still, more doctors will also be called because they have to administer what is kind of known as “the spike” as the security restrains you. “The spike” is usually three needles but you only feel the first one. This cocktail is to calm you down and make you super sleepy, thus easier to be placed in “solitary”. Solitary is either an empty room with a mattress and pillow or a bed with four point restraints (to restrain your wrists and ankles), depending on hospital. Most folks don’t remember being placed on the four point bed after getting the spike, they just wake up there and staring at a host of doctors, nurses and security crowded around their bed asking them if they’re going to be more cooperative. If you’re not incredibly aggressive enough to warrant the spike, there’s the safety burrito! The safety burrito is two thick blankets laid out for you to be placed upon and swaddled firmly into a burrito. You’re usually in either the Solitary room or in your room. It can be comforting or depressing, depending on how much you think about all the things you have accomplished in life and how now you’re holed up in a mental institution laying on the floor or on a bed wrapped up in heavy blankets like a infant. It’s definitely better than getting the spike buuuuut it’s not a million times better.
I mentioned that there are color codes these hospitals. The color codes are:
Code Green – Aggressive patient, need security
Code Green, All Male – Aggressive patient that is too violent for regular orderlies, need stronger people (yes, this is a pretty sexist name for a code that basically means “Please come if you’re really strong”)
Code Silver – Patient has a weapon (regardless of the weapon. The patient could be wielding blue, bamboo knitting needles, it’s still “code silver”)
Code Blue – Physcian needed, patient is going through severe physical ailment episode
Code Red – Fire
Now, hearing all this, again, I want to reiterate that mental hospitals are not like Arkham Asylum. It’s not very common for people to get to the point of getting the spike or get into a safety burrito. It definitely does happen, it certainly is not rare but it’s not a wild house where everything and anything happens. If it is like that, try to find the patient advocate and get out.
Lastly, being at a trauma ward will be expensive so if you weren’t a fan of the Affordable Healthcare Act (ACA, Obamacare) then, you will be when you find the bill for a three week stay is over $27,000. And the suggested stay time is six weeks. The ACA is how I actually have never seen the bill. Speaking of insurance, you should read the fine print of your insurance to see if it accepts milieu care/milieu therapy (basically, you’re housed in a supervised, dorm-like atmosphere) because that is what your experience will be. If you have medicare, it’s automatically covered. Otherwise, your healthcare provider will try to weasel out of paying that hefty bill or cut your stay really short. Or both. Because American healthcare.
In short, being hospitalized is definitely no vacation. It’s strictly for treatment and that’s what your experience will be geared towards. It isn’t a halloween terror ride, either. Trauma wards take great pains to make sure you don’t have additional trauma. It isn’t perfect but it’s certainly not 100% like the movies. It’s much more boring.
This finishes the Same Situtation, Different Faces series. This last piece was surprisingly tough to write and make sense of so if there is any need of clarification or just plain questions, please feel free to say something.