I 'Flew Over the Cuckoo's Nest': My Involuntary Hospitalization at the Psyche Ward
A few years ago I was involuntarily detained and forcibly placed in a psychiatric hospital in Washington, DC. I can honestly say this has been one of the most traumatic experiences I have ever lived. So while I was detained, I had the mad urge to write to keep sane. The essay that follows was written mid-hospitalization on the back of the papers I was given detailing the 26 major side effects of lithium (the golden drug for bipolar disorder).
I sit on the floor of my hospital room wearing an oversized blue gown. The sounds across the hall are unbearable. She continues to beg for water screaming “Agua! Aguaaaaa!” while slamming violently on the door. I see her sometimes, staring out from the rectangular sliver of a window on her door. She sees me too, and I smile.
I always smile at her.
I need her to know that she is loved. But I must quickly avert my eyes before they see me. The guard outside her door is always vigilant- hawkishly evaluating all passersby. Every so often they open her door and yell at her to shush. I saw her bite her husband once, after he leaned in to embrace her during a visitation. His shock immediately evolved into betrayal and hurt, as he realized his act of love was returned with violence. But from what I am learning, love is scarce in this place.
I was admitted to the psychiatric ward under what is referred to as an “FD12 – SI” (forcible detainment for suicidal ideation), or more explicitly, an involuntary detainment.
One Lie After Lie
Saturday afternoon I walked into my psychiatrist’s office for what I thought was a routine visit. Once again, she confirmed my bipolar diagnosis. Prior to the visit, I had felt distressed. Being diagnosed with one of the most serious mental disorders is naturally cause for distress. I had been crying. I was not entirely lucid. I admitted to her that I had been distracted while driving, and existentially shared that I was not particularly concerned if another vehicle crashed into me. I also admitted (rather stupidly, upon reflection) that there was a handgun in the house.
I sat there, pouring out my heart to this person, trusting her with my most vulnerable torments. After a moment she excused herself, and returned a few moments later looking stern. “Jacqueline, let me tell you what is going to happen. Because you have said some concerning things to me, I want to ask you if it is okay to call an ambulance to take you to the emergency room so that you get evaluated… to make sure you are okay.”
This was not at all how I imagined the remainder of my Saturday going. But I acquiesced, under the condition that I would not be admitted to the psychiatric hospital. Immediately after I nodded, signaling my permission to call the ambulance, five muscular men wearing EMT and police uniforms paraded in through the door. That should have been my first clue that I had lost all agency in matters of my mental health and of my freedom. Clearly her request was a mere courtesy.
My permission was irrelevant.
After what felt like an eternity, the police officers finally escorted me outside the clinic and into their police car. I was seated, safeguarded with a seatbelt, and stripped of all my immediate possessions: purse, phone, keys, and so on. The moment we arrived at the hospital, an officer asked me if I was aware of what an FD12 was. Under paralyzing distress and limited cognitive functioning, I quietly assented. During that moment I could have been asked if I could recite Beethoven’s symphonies from memory and I would have said yes. My “yes” was not a real “yes,” but merely a physical reaction. My mood was less than optimal as my mind swam in thick fog.
I felt a funeral in my head.
After seeing a nurse and going through a screening process, I was escorted through the chaos of the ER. I took off my much-needed glasses so I could avoid seeing all of the immediate despair. The sounds of machines beeping, urgent chatter, and the few but memorable patient groans continue to haunt my thoughts. As I entered the psychiatric emergency unit, I was seated in a room with three other patients, who were monitored by several guards (I have to pause my writing at this point before I get too feverish with it, because I am being watched and evaluated almost constantly, and I cannot show any signs of what they would consider “manic” behavior).
Although the mental health technicians in the ER were personally kind and attentive, the environment was (to say the least) mentally toxic, infecting any remaining thoughts of sanity. The woman next to me, whom I suspect suffered from severe schizophrenia, for hours kept screaming variations of, “Jason, where are you? Jason, are we a family? Jason, I had an abortion. Jason, don’t leave me!” She had also soiled herself.
Another patient had voluntarily committed herself, desperately seeking help for what appeared to be an ongoing battle with depression and anxiety. I remember listening to her conversation with the social worker. The details of her suffering (which I will omit from describing here for the sake of her privacy) will stay with me for many years.
Countless medical professionals made their rounds and checked my name off their endless patient list. The questions were always generic and always the same. Are you having thoughts of suicide? Are you hearing voices? The question that annoyed me the most was, “How are you feeling?” I never knew how genuine their concern was. Did they really want to know? Or was that another clinical question to ask from their boilerplate lists?
After hours of waiting, wondering where Jason was, and refraining from eating (to avoid any involuntarily bowel movements), I finally saw Martin, the social worker. To my eyes, he was the man who would get me closer to a discharge and to my own bed and snuggles with my dogs. In his casual sweatpants and Baltimore Ravens lanyard, he asked those same generic questions, jotting down my responses in a Mead composition book. Once the interrogation concluded, he told me it was likely that I would be discharged soon.
I was so relieved by the news that I would soon be home with my dachshund, that I dropped my bowel guard and proceeded to devour the contents of my Chipotle dinner that had been sitting on my bedside table for the last several hours. As if by some cruel joke, the moment I emptied the mushy bean and rice container, Martin walked in with a solemn expression and announced, “I’m sorry, but I spoke with the psychiatrist on the phone, and he told me you cannot be released until you speak with him tomorrow morning.”
This piece of news crushed any hope I had built up. I was sobered by the severity of my situation. I was no longer a free woman, but a prisoner in a psychiatric ward. You know those lyrics by The Eagles: “Welcome to the Hotel California… You can check-out any time you like, but you can never leave.” Well, I had foolishly checked-in to a psychiatric ward from which I could never leave.
At least that is how I felt then.
And to be honest, how I still feel now, as I write this with a three-inch pencil on the back of the information sheets they gave me, detailing the 26 side effects of lithium, the standard medication for bipolar disorder.
I was unable to keep it together. The news crushed me. I broke down crying, reliving the painful trauma of involuntary detainment I had experienced five years before, after an attempted suicide. I begged Martin to let me go, to advocate for me, to understand that an extended stay in this dreadful place would only damage my already vulnerable psyche. I argued, cried, begged, but all to no avail. Denial is the first step of grief. Acceptance is the last, and I fear this last step will be the most difficult for me to accomplish.
In the Cuckoo's Nest
Due to an error in my paperwork, caused by the chronic incompetence of the hospital, I stayed in the ER for several more hours than I should have. Once the staff brought the wheelchair, I was transported through the labyrinthine hallways of the hospital. It was 2:30 a.m. when I arrived at the psychiatric ward.
Exhausted and about to collapse from stress and lack of sleep, I was seated in a cold room for yet another screening. What is your name? What is your family history? Why are you here? Apparently hospital records, at least in this hospital, do not communicate across departmental boundaries. Once my unnecessary round of screening was over, I was stripped again of my remaining possessions (clothes and shoes, most notably) and forced to wear the oversized blue gown. My swollen red eyes, runny make-up, and unruly hair fittingly complemented my fashionable new outfit.
The image of the mental patient was complete.
I must have slept close to two hours when I was brutally awoken by the beaming brightness of the room’s overhead lighting. “Wake up, it’s vitals time!” All that was missing from this good morning to feel more like a prison was to get poked by a baton. After my rude awakening, I remember being utterly disoriented that morning, while trying to get a clear picture of my situation. Again, those feelings of dread, denial, and the traces of a melancholic resignation overwhelmed me.
Perhaps coffee could help reorient me. This was the moment when I realized that one had to almost beg for food here. To be fair, they do feed us – three times a day. We are given food, but let’s just say that what we eat is questionably edible. I have generally enjoyed hospital food in the past, but this experience has soured my outlook. Our breakfasts generally consist of carbs and more carbs, which doesn’t appeal to me, as I have a mainly vegetarian-based diet. To drink, there is sugar disguised as a fruit juice, milk, and one measly cup of diluted, lukewarm coffee.
This was particularly harsh for me to discover during that first breakfast since I am accustomed to drinking an entire coffeepot every morning. I was caffeine deprived, which could make anyone “crazy”. And apparently, so are the other patients.
Coffee here is the highest priced commodity. “I’ll trade you these pancakes and my fruit for your coffee!” And when there is any leftover coffee (which is rare), we all engage in a “survival of the fittest” run to the tray. I must admit that I jumped at the opportunity on that first day, and perhaps shoved a few of the other patients along my way to the coffee tray. Nothing could stand between me and that cup of diluted-lukewarm coffee.
Perhaps it was because of my anthropology training, or because my body was tuned in to my survival instincts, that I quickly learned the rules of operations in my new prison. No one explained these rules. Instead, when I committed an offense, I was aggressively reprimanded. For example, the first night I tried taking an apple to my room to eat later when my blood sugar was low. Halfway to my room I was yelled at. “Hey you, you cannot take any food to your room! Throw that apple away!” I resented this for many reasons.
Aside from suffering from bipolar disorder, I am also afflicted with a rebellious personality. The next day during breakfast I stashed a bowl of grapes under my gown, snuck it into my room, and hid it under my pajama bottoms. Later that day I also hid a package of honey graham crackers under my towels. They also tried forcing me to wear their socks. I flat out refused. I proudly parade around the corridors with bare feet knowingly irritating the staff.
Noncompliance, however, in this environment is done at your own risk. They tell us that we have the right to refuse medication, group time, food, sleep, etc. And technically we do. But such a decision comes with repercussions. If you refuse any of the aforementioned actions, you WILL prolong your stay.
Aside from refusing to engage in these activities, many other factors contribute to the length of your stay. I learned this the hard way. While here, it is crucial to quickly learn the unspoken rules. But before I venture down that rabbit hole, I would like to paint a picture of the day-to-day activities.
Early in the morning, as I discussed above, we are awoken by a technician to gauge our blood pressure. This is immediately followed by breakfast time, group session, medications, lunch, another group session, “siesta” (or as the staff call it, “Happy Hour” for them), dinner, visitation, a final group session, and lights out. The day is packed with mind-numbing busy work.
For an introvert like me, this regimented schedule is a hellish nightmare.
There are a total of roughly six daily groups facilitated by different professionals (i.e. nurses, social workers, or technicians). Though the content of each group may vary, the facilitation approach is similar across most of them– preachy, infantilizing, and insultingly basic. “Hi everyone, today we are going to talk about why it is bad to take drugs. You should not take drugs because they are bad for you.”
Sometimes I get smart during groups, to the dismay of the facilitator.
For example, one of the social workers assertively declared that the top three reasons why patients return to the hospital are 1) refusal to medicate, 2) substance abuse, and 3) insufficient support. As someone who works with data for a living, I could not resist asking, “When you say these are the top reasons, where did you get this information? Are these anecdotal observations? Or did you conduct an extensive literature review?” I doubt this was appreciated.
On another occasion, we were asked what we had accomplished during the day. So I told them that I had learned about defecation practices in India (which is true, I have a National Geographic magazine with me). This accomplishment was met with a roll of the eyes and a facetious “Okaaaay.” I think my “strangeness” (which I like to think of as my charm) here is often interpreted as a manifestation of my “crazy”.
At the end of the morning and evening groups, we are asked to rate our mood on a scale of one through 10, with one being awful and 10 being phenomenal. Some of us here are being held against our will. Naturally, our mood plummets into the negatives. But rating oneself positively is of significant importance. These daily self-ratings are reported to the psychiatrist, more colloquially known as “the decision-maker”. So if one wishes to be discharged sooner, it is crucial to lie.
So what is my current mood? Honestly?
Let me see– I am nauseated from the medication, constipated from the stress, annoyed with the nurses’ announcement of “group time”, and angry at our country’s mental healthcare system.
So my mood is subpar.
But of course this is something I cannot openly admit. Instead, I will announce that I am feeling “great” and that my mood is between an eight and a nine. As a professional evaluator, I know how frustrating not picking a whole number from a scale can be for the staff. My instigation and small acts of rebelliousness, I know, affect my discharge, but this is the only way I feel like I retain some control over anything.
In this place I have generally had two goals:
1) to get discharged, and
2) to maintain my sanity as much as possible in the process.
Lithium, the Key to Escape
The first night in the ER, I was promised I would see a psychiatrist early morning on Sunday. Depending on his evaluation, he could potentially discharge me. I was hopeful that I would walk out of this place on Sunday. But I did not see a psychiatrist that day. Instead, I was screened by social workers, nurses, and phlebotomists. At the end of Sunday, I met with a nurse practitioner. We talked, reviewed my case, and she printed sheets of information about bipolar medication, on which I am now writing this story. Then I asked if I could be released that day. I was already regularly meeting with a therapist, was going to a support group, had started the psychiatric process, was reading all of the literature, and was strengthening my support system.
She simply said, “Absolutely not, I cannot authorize your discharge.”
I told her that if I was not released by Monday, I would miss my flight on Tuesday to see my family in Mexico, to which she responded, “In matters of psychiatry, you just never know.” She said that the only way she would consider my discharge was if I took my medication.
Again, I was crushed by the uncertainty of my situation. I realized I would never leave this place unless I played by their rules and acquiesced to all I was told.
So I stared down at the 20-something side effects of lithium listed on the page she had handed me, and with bitter resignation I said, “Okay, let’s start on lithium then.”
My decision to start taking lithium has weighed heavily on me since then.
On the one hand, I could have waited to start a medication plan until after my release and after several consultations with a psychiatrist to talk about my options. What would be the most conservative approach to treat my bipolar disorder? But refusing this medication at the time it was suggested would have been detrimental to my release. I cannot with certainty say how much longer they would have held me here, but I am sure that my extended stay would have felt like an eternity.
I know one thing for certain, though, and that is that this is not the way in which I wanted to start a medication plan.
For the rest of the evening I contemplated whether or not I should take this pill. I asked other patients and my loved ones for advice. The consensus was that I should take the medication, if I wanted to leave. The goal at the time was for me to get home.
When the clock struck 9:00 p.m., it was time for medication. I was nervous, unsure of my decision. When my name was called, I approached the counter. The nurse handed me a bottle of water and a small clear cup with one pill– lithium. This was the pill that could change everything I once understood about myself. For me this was a life altering moment. And I was overwhelmed. I quietly asked the nurse if I could take a minute to process this. She replied, “No, you must take this pill in front of me now, because there are other patients behind you. Afterward, you can sit all you want.”
Resigned and utterly deflated, I mustered all my courage and swallowed the little white pill along with my fears, dignity, and human agency.
That night I somberly walked to my room. I hid in the small crevice of what once was a closet and quietly wept. I wept for all that I had lost since I learned of my disorder. I wept for the life I had left behind. And I wept in fear of what this degenerative mental disorder would do to me.
Bipolar is for life.
It can be managed but not cured, and with time this disorder worsens. Yet, I could only weep for a moment. I could not show any signs of distress, and I could not be out of sight for too long. Later that night, however, I broke down again. This time I asked to speak with one of the few kind technicians. Her words were the sobering advice I needed to hear: “Jacqueline, you need to stop trying to control the things you cannot.”
Finding the Light in the Tunnel
This entire experience has been almost unbearable. The hostility of this place, the constant misinformation and broken promises, the mocking and dehumanization of patients by the staff, and the loss of freedom is often too much for to me to manage.
This is toxic.
At least that is how I feel. So it is crucial that any trace of sanity be maintained. The little things one can do to hold on to normalcy are important. For example, I decided to make my bed every morning. Showering is a necessity. I’ve learned to play Sudoku. I ensure I keep reading my magazine articles (i.e. The Atlantic and National Geographic). Yet probably the most beneficial thing I could have done was engage with the other patients.
One must be careful here when approaching other patients. We are discouraged from fraternizing. In fact, one of the nurses told one of my new friends, “You should not be talking to them (us). They are not professionals and cannot benefit you.” While it is true that we are not professionals, I resent this statement. The camaraderie that I have developed with the other patients is what makes this experience tolerable.
We openly and shamelessly share our stories with one another.
So why are you here?
What’s your diagnosis?
What do the voices tell you?
Why do you want to kill yourself?
We lightheartedly joke about our disorders even though we are very well aware of their severity. With them I feel free. I can freely talk about my issues or ask about their issues without fear of judgment. And from them I have learned the severity of an FD12 and how to behave if I am to be switched to voluntary, rather than involuntary, detainment.
Our Broken Minds, Our Broken System
Throughout these last several days I have been deeply reflecting on my experience and those of the other patients, on our broken system, and on how as a larger society we still struggle with how we perceive mental illness and how we treat those who suffer from it.
While I understand that my story may not be a reflection of the average mental health patient, I am sure there are parts of it that do reflect the struggles of others inflicted with a mental disorder.
Regardless of the diagnosis and its severity, once the hospital wristband goes on, the label “crazy” sticks.
This is the same label that makes it legal to strip us of our freedom, but most unfortunately, strip us of our dignity.
I feel so powerless here.
Today the director of the psychiatric ward and another important-looking person paid the ward a visit. As they were leaving, I courageously approached them and told them that from a patient’s perspective, this place does not hold our mental health needs as a priority.
They were polite, but I had the feeling that because I was wearing the blue gown, my words sounded like gibberish to them.
One of the difficult challenges that derives from being diagnosed with a mental illness is losing credibility as a respectable and functioning member of society, even if we are that and more. Our actions, words, and thoughts will always be subject to scrutiny by others but also, perhaps most unfortunately, by ourselves.
Where does the bipolar disorder end, and where do I begin?
In a way, being an FD12 patient is a mark of honor and “street cred” in a psychiatric ward. Out in the real world an FD12 can be a badge of shame, or one of bravery and survival.
It all depends on the story we choose to tell.
The Ins and Outs of OWN IT: A Blog on How to Show Bipolar Who's the Boss
A blog for people with mental illness written by an unstable, unpredictable, and uninhibited woman diagnosed with bipolar disorder
Covers all topics including relationships, coping mechanisms, entertainment, and everyday resources
Updated and shared irregularly (like my moods), news and updates available on Instagram @jackie_loweree, and if you don't have an Instagram, no problem, just check my site - all posts will be here
Disclaimer: OWN IT is a first-hand account of bipolar disorder designed to orient those diagnosed with mental illness. It by no means intends to offer medical advice. If you are diagnosed with an illness, or think you may suffer from one, please seek professional help. Otherwise, take my words lightly and have fun reading!