Medical Examiner

Life in a Psychiatric Hospital

Everything pop culture tells you about inpatient treatment is dangerously wrong.

One Flew Over the Cuckoo's Nest
It’s not as bad as One Flew Over the Cuckoo’s Nest makes it out to be.

Film still via Warner Brothers

Growing up with cultural representations of psychiatric hospitals as soul-crushing, prisonlike institutions, my impression of such treatment centers was quite negative. Then I was a patient in one.

When I tell friends I was hospitalized for 19 days, they’re horrified. Generally their reaction has less to do with what they think might have landed me there than with the brutal conditions they assume I must have encountered inside. In their imaginations, I barely escaped without having my frontal lobe scooped out with a spatula.

This wasn’t my experience at all. Instead I found a supportive, nonjudgmental community made up of staff who quickly diagnosed my problem and fellow patients whom I count as friends today. Granted, the hospital at which I stayed, Four Winds Saratoga in upstate New York, is private. Perhaps some public hospitals are so underfunded they amount to detention centers for the mentally ill. Places like Four Winds should be socialized, and the quality of mental health treatment provided there should be made available to everyone.

The film One Flew Over the Cuckoo’s Nest played on television one day and, enjoying the irony, we patients watched it in our housing unit’s common room, laughing frequently with self-awareness. Hoping to share the joke, I told the doctor about it when he next did his rounds. While mildly amused, he said nothing had done more to prevent those who needed help from seeking psychological treatment in general, and electroconvulsive therapy in particular, than that movie. ECT saves lives, he insisted. Indeed, I’d guess that as many as one-quarter of the people on my unit received ECT—voluntarily, it should go without saying. And all spoke positively of its effects.

As far as I was aware, all of the patients in my unit had signed themselves into the facility by choice. This included my roommate, who escaped the locked building before being returned by police! Patients typically stayed between five and seven days. Most wanted significantly more time to recover from what led them to be initially hospitalized. In decades past they would have received it, but increasingly aggressive insurance companies have cut short their treatment.

I was allowed to stay nearly three weeks likely because my intrusive thoughts were horrific enough to freak out even a penny-pinching claims adjustor. But other patients, even those who undoubtedly represented a greater danger to themselves or those around them, were released earlier. There was perhaps no better anecdotal evidence that many patients needed additional time than one young woman I befriended who was discharged at the beginning of my stay and readmitted before I left.

Patients built an incredibly strong intimacy by sharing not just a living space but hours of group therapy per day and a particularly vulnerable period in all of our lives. I remain in contact with many of the friends I made there. I spent no more than a few weeks with any of them. Yet I feel closer to many of those I’m no longer in touch with than some non-patients I’ve known for decades. Together in the hospital we created something like the Island of Misfit Toys, that sanctuary for defective playthings in the television special Rudolph the Red-Nosed Reindeer. Together, we were safe, valued, and understood.

There’s perhaps no better recommendation of the staff’s professionalism than the fact that they diagnosed me almost immediately—after multiple outpatient therapists had failed to do so. Simply put, if I hadn’t entered the hospital, my symptoms might still be a mystery to me. After all, the outpatient therapists I had visited later admitted they had never heard of the specific form of obsessive-compulsive disorder with which I was diagnosed. Nothing did more for my recovery, not antipsychotic or antidepressant drugs, than knowing other people had experienced what I was going through and that despite my unwanted, disturbing thoughts I wasn’t a monster. This realization wouldn’t have been possible without a diagnosis.

As odd as it might sound, I’m often nostalgic for my time in the hospital, specifically for the camaraderie and acceptance I felt there. I will always remember my first karaoke night on the unit, for instance. Psychiatric patients, as anxious as they often are, seem unlikely participants in the activity. But the staff’s relentless enthusiasm overcame most of our reserves. One staff member could belt out “Before He Cheats” with more beauty and vengeful heartbreak than Carrie Underwood. Her impressive skill was intimidating for those of us who could barely hold a tune. However, her staff partner’s flawed—but entirely committed—crooning of soul classics made musical mortals like me feel welcome. We patients took turns singing off-key duets late into the night. We looked and sounded crazy. And that was OK.