> I know a lot of people who have been in mental hospitals. I have not met anyone who unambiguously benefited, and I have met half a dozen people who were seriously harmed in ways that made their lives worse for months or years.
I had an unambiguously good experience at a mental hospital, but I know that was a fluke. It was in a small city, which I think helped. I had been trying to tell the people around me to take me to take me to the hospital for hours but wasn't able to communicate clearly enough. Getting to the ER was an enormous relief. I was barely able to sign myself in voluntarily but they were super patient with me. I needed to be put on new medication so once I was checked in to the psych ward they basically just started giving it to me and watched me stabilize for four days, much of which was spent sleeping. The whole thing was triggered by a meditation retreat, and when I refused to go to their mindfulness class they didn't give me any flack. I was pretty confused and trippy the entire time so I didn't feel bored or restless. They gave me vegan food. It just seemed like a really nice hospital.
I was terrified by what happened to me so I was really happy to be safely institutionalized and I thought they could fix me. Had I gone for depression it would have been different, I'm sure.
Thank you for writing this. I have somewhat-mild obsessive-compulsive disorder, and back when I was in therapy for it, I'd avoid mentioning certain thoughts regarding suicide and depression. This was out of an abundance of caution for avoiding being committed. I even made a plan for how to get help/protect myself outside of the normal mental health system if I become dangerously suicidal.
Was all of this stuff unlikely to happen and something I shouldn't worry about? Maybe; after all, the symptoms of the mental illness I was trying to get help with include unwarranted fears and doing questionably-useful things to stave off things that won't happen anyway. But I still did avoid talking about those things with my therapist, and probably wouldn't have if the system were set up differently.
As someone who works in the inpatient setting, my view is that this state of affairs -- which seems so absurd, why would anyone design it like this! -- is the result of thousands of iterations of minimizing “risk” and “liability.” Anyone attempts any kind of self-harm within hospital grounds, anyone tries to elope, anyone sneaks in drugs, anyone violates privacy, patient goes on leave and does something, hospital finds ways of reducing the chances of that happening again. I’ve been in these administration meetings & the people running the hospitals care nothing about patient dignity and comfort. They only care that they don’t get sued, or don’t get dinged for whatever quality metrics government had set. You repeat this process again & again & again, and the result is a system barely different from the prison.
> because it seems like a functional person won’t do that.
I think "won't" should be "would".
> I know a lot of people who have been hospitalized.
I would clarify that this refers to mental hospitalization rather than regular. (Since the previous sentence was talking about regular hospitals, the sudden context-switch is disorienting.)
This was really interesting, thank you. Are there any countries that are doing a significantly better job in mental health provision for people who are severely depressed? I was just wondering if there are places where your suggested reforms (or something similar) have been implemented. I tried googling this but didn't get very far.
When I worked at a suicide hotline I was surprised by how many callers had positive things to say about psych wards. I'd heard almost entirely horror stories (including my friend who nearly bled to death at the best post-partum mental hospital in the state), but I want to say it was about 50:50 at the hotline? Big error bars on that, it's been a long time and I didn't keep a strict count, but there was a definite contingent of people who found it helpful.
There's probably an incentive problem in there somewhere, similar to the ones with regular hospitals (or public schools, for that matter); I'm not aware of patients being able to choose which mental hospital they're sent to, and so there's no competitive pressure* to make them any better. This is definitely an argument from ignorance, though, so salt accordingly.
*Other forms of pressure still exist, which is why they're not just oubliettes.
> I do think the existence of mental hospitals has substantially decreased the chance that I’ll attempt suicide. It’s the swift and certain punishment thing. I know that if I survive a suicide attempt I will go to jail, so I don’t attempt suicide.
Why attempt suicide in a way that might fail? Especially in the US, where one can just buy a gun, I don't understand why people "attempt" suicide rather than succeeding, unless they actually don't want to die and are just doing it for attention.
> I know a lot of people who have been in mental hospitals. I have not met anyone who unambiguously benefited, and I have met half a dozen people who were seriously harmed in ways that made their lives worse for months or years.
I had an unambiguously good experience at a mental hospital, but I know that was a fluke. It was in a small city, which I think helped. I had been trying to tell the people around me to take me to take me to the hospital for hours but wasn't able to communicate clearly enough. Getting to the ER was an enormous relief. I was barely able to sign myself in voluntarily but they were super patient with me. I needed to be put on new medication so once I was checked in to the psych ward they basically just started giving it to me and watched me stabilize for four days, much of which was spent sleeping. The whole thing was triggered by a meditation retreat, and when I refused to go to their mindfulness class they didn't give me any flack. I was pretty confused and trippy the entire time so I didn't feel bored or restless. They gave me vegan food. It just seemed like a really nice hospital.
I was terrified by what happened to me so I was really happy to be safely institutionalized and I thought they could fix me. Had I gone for depression it would have been different, I'm sure.
Thank you for writing this. I have somewhat-mild obsessive-compulsive disorder, and back when I was in therapy for it, I'd avoid mentioning certain thoughts regarding suicide and depression. This was out of an abundance of caution for avoiding being committed. I even made a plan for how to get help/protect myself outside of the normal mental health system if I become dangerously suicidal.
Was all of this stuff unlikely to happen and something I shouldn't worry about? Maybe; after all, the symptoms of the mental illness I was trying to get help with include unwarranted fears and doing questionably-useful things to stave off things that won't happen anyway. But I still did avoid talking about those things with my therapist, and probably wouldn't have if the system were set up differently.
Excellent post and all great point. You may find this recent post of mine to be of interest: https://awaisaftab.substack.com/p/asking-better-questions-about-involuntary
As someone who works in the inpatient setting, my view is that this state of affairs -- which seems so absurd, why would anyone design it like this! -- is the result of thousands of iterations of minimizing “risk” and “liability.” Anyone attempts any kind of self-harm within hospital grounds, anyone tries to elope, anyone sneaks in drugs, anyone violates privacy, patient goes on leave and does something, hospital finds ways of reducing the chances of that happening again. I’ve been in these administration meetings & the people running the hospitals care nothing about patient dignity and comfort. They only care that they don’t get sued, or don’t get dinged for whatever quality metrics government had set. You repeat this process again & again & again, and the result is a system barely different from the prison.
Some typos:
> So there should absolutely nothing to do
Missing the word "be".
> dangling the change to leave
"Change" should be "chance".
> because it seems like a functional person won’t do that.
I think "won't" should be "would".
> I know a lot of people who have been hospitalized.
I would clarify that this refers to mental hospitalization rather than regular. (Since the previous sentence was talking about regular hospitals, the sudden context-switch is disorienting.)
This was really interesting, thank you. Are there any countries that are doing a significantly better job in mental health provision for people who are severely depressed? I was just wondering if there are places where your suggested reforms (or something similar) have been implemented. I tried googling this but didn't get very far.
When I worked at a suicide hotline I was surprised by how many callers had positive things to say about psych wards. I'd heard almost entirely horror stories (including my friend who nearly bled to death at the best post-partum mental hospital in the state), but I want to say it was about 50:50 at the hotline? Big error bars on that, it's been a long time and I didn't keep a strict count, but there was a definite contingent of people who found it helpful.
There's probably an incentive problem in there somewhere, similar to the ones with regular hospitals (or public schools, for that matter); I'm not aware of patients being able to choose which mental hospital they're sent to, and so there's no competitive pressure* to make them any better. This is definitely an argument from ignorance, though, so salt accordingly.
*Other forms of pressure still exist, which is why they're not just oubliettes.
> I do think the existence of mental hospitals has substantially decreased the chance that I’ll attempt suicide. It’s the swift and certain punishment thing. I know that if I survive a suicide attempt I will go to jail, so I don’t attempt suicide.
Why attempt suicide in a way that might fail? Especially in the US, where one can just buy a gun, I don't understand why people "attempt" suicide rather than succeeding, unless they actually don't want to die and are just doing it for attention.