Are there any permanent psych hospital patients?

Factual Questions
1

Between advances in medicine and cuts in funding, people who at one time were confined to psychiatric hospitals for years or even for life are able to just get outpatient treatment. I’ve known people with schizophrenia, for instance, who are living reasonably normal lives. I’ve also known people who have been in (for a month or two) and out (for a year or two) of psych wards. Aren’t there some poor folks, however, whose conditions are not treatable and who spend many continuous years in psych hospitals? I haven’t read of any since before state hospitals started emptying out in the Seventies, but of course that doesn’t mean there aren’t any.

Just to be clear, I’m not referring to inmates in psychiatric prison facilities.

2

(emphasis added)

Maybe “poor folks” are, overall, just as treatable as non-poor folks, but just don’t get the treatment that could be helpful, but instead get thrown into cheap-ass institutions or warehouses where they are left, more-or-less, to rot. The same could be said for any number of other serious chronic diseases, not just for psychiatric.

Ironically, such long-term confinement in a hospital, nursing home, etc., could end up costing much more over the long term than decent treatment would have cost in the first place (providing that the condition is reasonably treatable).

3

I don’t believe taffygirl used “poor” in reference to their wealth, or lack of it, but rather as a synonym of “unfortunate”.

4

Okay, I can see it might have been meant that way.

If so, my remarks (with poor as in un-wealthy) still stand, though, even they may thus be not quite responsive to what OP is talking about.

5

Absolutely there are. In Virginia a major problem is the permanent residents fill up most of the spots and more short term patients can’t get into State hospitals and instead spend longer than optimal time I regular hospital psych wards. There are some private psych hospitals as well but they are also usually full up.

Yes, hospitalization may have been emphasized since the 70s but I have no idea why you haven’t heard of anyone being a permanent resident since then. There are many people who have spent 40+ years inside and are not likely to ever be released.

6

According to Robert Whitaker (Anatomy of an Epidemic), the general impression that people have been freed from the ravages of mental illnesses by the excellent pharmaceuticals that started coming out in the 1950s, with each generation bringing better pharmacological remedies, is turning out to be spurious.

While it is true that the permanent hospitalization that was commonly implemented before that era is pretty rare as a modality now, it was largely popular before WW II (says Whitaker) for eugenics reasons (i.e., permanent institutionalization as a means of vastly reducing reproductive opportunities). In a fairly short window between the time when eugenics sentiments became politically incorrect (due to overtones of the Nazis) and the time that thorazine became widespread, approximately 1/3 of patients with even the most serous diagnosis recovered completely in the long run, another 1/3 recovered partially (e.g., living in the community but not fully employed), and 1/3 remained significantly disabled.

Whitaker says (and cites a huge slew of case studies) that all of the efficacy of the psychiatric pharmaceuticals widely used from the 1950s through current era meds falls off to significantly worse than no meds at all when you study long-term efficacy instead of short-term efficacy. In a broad sense, the various drugs do one of four things:

• increases neural receptivity to neurotransmitters of various sorts

• decreases neural receptivity to neurotransmitters of various sorts

• increases speed or efficiency of reuptake of neurotransmitters of various sorts, thus reducing the amount present in the synapses

• decreases reuptake of neurotransmitters of various sorts, thus increasing the amount present in the synapses
In every psych category and pharmaceutical remedy that he examines, Whitaker finds that over time the brain compensates: if receptivity or the amount of neurotransmitter chemicals are increased, the brain reduces the number of receptors to make up for it; if receptivity or the amount of neurotransmitter chemicals are decreased, the brain makes new receptors to compensate in the other direction.

He shows that the optimistic theories about each of the mental illnesses being caused by a “chemical imbalance in the brain”, i.e., specific neurotransmitter chemistry differences setting the mentally ill in each psych diagnosis category apart from the non-ill, were all derived in reverse from assuming that the short term efficacy of the newly-found psychiatric drugs was caused by those drugs addressing an underlying undersupply or oversupply of one or another of the neurotransmitters. And that in every case it has turned out that no such “chemical imbalance” can be demonstrated by the research.

As a consequence, (he concludes / supports with data), we have a burgeoning chronic population diagnosed mentally ill who are NOT recovering at the 1/3-1/3-1/3 pattern rate but instead are overwhelmingly disabled by their mental conditon; the drugs leave people worse off in the long run than if they had not been put on psych meds; their brain chemistries have been modified, not “corrected” or “fixed” by the pharmaceuticals; and although people aren’t being stuck in hospitals on a permanent basis, we have a revolving-door syndrome replacing it.

7

Wow. That is both news to me (I’ve always heard the “Chemical imbalance” theory, too) and very depressing, if true.

What is Whitakers conclusion or alternative? (Or did he only collect the data?) Given that Freudian treatment has a success ratio of only about 1/3, from what I remember, with 1/3 of patients getting better without any treatment, what other options are left? Electroshocks are being used for a very select few cases where they actually seem to help (but it still sounds rather barbaric).

If the brain adapts and the cause was not an imbalance to start with - why do some people seem to be born psychopathic/ sociopaths/ develop schizophrenia? Is something wrong with their brain electrically instead of chemically? (Does this mean lobotomy would be good treatment? Hopefully not!)

I always thought the theory about neurotransmitter imbalances was based on better diagnostics and actually measuring the amount of neurotransmitters in the body! I’m appalled that it was worked out backwards.

Is there mainstream support for his ideas/ conclusions?

8

It wasn’t news to me so much, because I’ve been in the psychiatric inmates’ liberation movement since 1980 and most of these conclusions were being touted all throughout that time, but most of the research I was familiar with was thin and very far out of date until Whitaker published. This is much more solid empirical support for these claims, as well as solid documentation for what we only sort of suspected which was that the etiological theories of the causes of the mental illnesses were worked out backwards from the chemical treatments.

Whitaker, I should hasten to say, does believe there are mental illnesses and he believes we know them categorically, that there is a specific ailment called schizophrenia and a different specific ailment called bipolar disorder and so on and so forth. I (and many others in the movement) are far less convinced of that as well; I believe the mind (anyone’s mind), under the right kind of stress, becomes “schizophrenic” (using the word as a descriptive adjective) or “bipolar” etc etc, although some people’s minds, for whatever reasons, are more inclined to go that direction under the same stressful conditions than other people’s minds. I don’t think they are best thought of as “illnesses” so much as “conditions” or “mental/emotional states”.

As for ideal treatments, good god NO, there’s no evidence that putting someone face-up on a couch and listening wordlessly for an hour while they free-associate or ruminate about their potty training in infancy does a damn thing to sort out their thinking and feeling. Freudian psychoanalysis is garbage and there’s no reason to posit any kind of either/or of Freudianism versus the medical model of mental illness.

There’s a lot we don’t know. It is sad that so much energy money and policy initiatives have gone into a model that doesn’t appear to be viable, but perhaps more disturbing is that acknowledging this going to mean recognizing that we’re right back where we started from, with no magic cures.

What we do know works at least better than no treatment at all: mutual support. People who have been diagnosed with mental illnesses helping others get through their crises. Also, reducing coercive interventions, treating the phenomenon in as matter-of-fact a way as possible, allowing people to BE “nuts” and work it out instead of trying to make the symptoms go away. It is theorized that the incoherent and inappropriate thoughts and feelings are part of a process that is very unpleasant, usually, but if left to run its course is decently likely to to do. Only where there is actual violence and destructiveness does coercive intervention seem unavoidable.

But I’m not going to sugarcoat it and pretend that everyone will make it through if left to their own devices, even with support networks.

9

AHunter3, what’s your take on cognitive behavioral therapy?

The stuff I’ve seen seems to show that it’s very effective for problems in the depression/anxiety/OCD range, at least, although I’ve not seen any info on problems like schizophrenia or bipolar.

I haven’t gotten hold of actual studies, but summaries have said it is at least as, if not more, effective than the accepted medications. Some studies even document changes in actual brain activity. When I started hearing about this stuff, it reminded me of something from a long time ago.

I remember seeing a guy on some talk show (Carson, I think) many years ago, who was a counselor/advocate/whatchamacallum for mental patients who had been de-institutionalized. His method was to discuss with his clients the appropriate/inappropriate times and places for acting crazy, which basically boiled down to “Don’t act crazy at work, you need your job. Do whatever you want the rest of the time.” According to him, it worked quite well for most of his people. They could maintain “normal” at work as long as they were able to be themselves elsewhere. I remember him talking about the transition he’d seen clients go through as they approached their workplace and visibly changed modes.

Not sure how similar those things are, but for some reason they struck me so.

Any rate, thanks for the reference, I’m going to have to get a copy of that.

10

To some extent it may be, but our understanding of what neurotransmitters do is still in a pretty primitive state, and drugs are, by their nature, a blunt instrument for correcting problems with them. It is undoubtedly the case that what matters about neurotransmitters is not so much how much of each is in the brain, but precisely where (and when) they are released in the brain (on a fine grained scale, both spatially and temporally). Drugs can’t do much more than modulate the gross amounts available.

I don’t know if things are truly as bad as AHunter3 says, but I would not rule it out. I have close friend who has been on antipsychotics for something like 30 years now, after a schizophrenic break. In a sense he functions ok in society, but he is not “better,” and has had to live on disability ever since his breakdown. He is probably considered one of the success stories of drug treatment for schizophrenia.

11

I don’t have a lot of firsthand experience with various therapies but what you’re describing sounds a whole lot like how I came to terms with things myself. I did not much care for the experience of being binned so I learned to be very pragmatic in how I interact with others without relinquishing my own attitudes, beliefs, and so on.

12

I did in fact mean “unfortunate,” and that would have been a better word choice.

I’m learning a lot from this threadAHunter3’s posts were especially informative, if somewhat dispiriting. There was an article in Newsweek in (I think) early 2010 on anti-depressants that said that, basically, the percentage of patients who report an easing of their symptoms on meds is substantially lower than we’d been led to believe. Add in the unpleasant side effects, and you have to wonder if it wouldn’t be better to forgo meds in more cases.

The “blunt instrument” remark also resonated with me. As I understand it, antidepressants, for instance , must be used for 2-3 weeks before patients experience any easing of symptoms, and it’s 6 weeks before they become fully effective. Not experiencing relief? Increase the dose and wait another 3 weeks to see if it helps. Still no help? Switch meds and wait another 6 weeks. The schizophrenics I’ve known have been admitted as in-patients while doctors have put them on a medication, then got the levels adjusted, so I assume there’s a waiting-increasing-waiting process there, too.That’s a long time for someone who’s miserable.

Of the 4 schizophrenics I’ve known, 3 have gone off their meds because of untoward side effects. The slower thought processes seemed the most distressing; one woman said it felt like her brain was immersed in molasses. All four experienced weight gains of over 50 pounds. And from AHunter3’s posts, the drugs aren’t even effective and may be deleterious long-term. Yet I must say, none of those same 3 women functioned well off the meds–if by functioning well, you mean “able to care for their children and themselves.” The 4th woman, by the way, lives a fully functional life as long as she’s not stressed. She has no children and lives with family members. I’ve always wondered how much stress had to do with the more severe symptoms of the other 3, who were all moms.

It seems the brain’s functioning is infinitely more intricate, delicate, and nuanced than we thought.

Of the permanent residents in psych hospitals, what are the diagnoses that keep them there?

13

Well those who think that they are patients of psych hospitals and would not take their meds are looking to stay there for keeps.

I have a friend who worked as a nurse in one of those facilities and based from her stories, it is a tough job to be in there. You always expose yourself to a lot of dangers which could also include catching the mental illness.

It basically is mind over matter

14

Minnesota still operates a State Hospital at Moose Lake with a sizable psycho-geriatric ward, treating elderly psychiatric patients from statewide who are too dangerous (to themself or to others) to go to regular nursing homes.

These are patients in their 80’s and 90’s, whose mental illness is still uncontrolled. Many of them have been under treatment for decades, with no improvement, and are likely to be there until they die.

15

John Hinckley

16

My husband is a nurse at a state mental hospital. Many of his patients are what he calls “frequent flyers” - they’ll be admitted in crisis, stay until they are stabilized and their meds adjusted, get released and stay on their meds for a while. Then they’ll decide they’re ok, they don’t need the meds anymore so they’ll stop taking them. They’ll be admitted in crisis…lather, rinse, repeat. The frequency varies from 3 months to a couple of years between admissions.

A lot of the traffic at the hospital comes from the jail; some prisioners have learned to work the system and get credit for time in the hospital which is a bit more comfortable than jail.

Probably the largest percentage of the patients still have some support system; they have a place to go when they are released. Some don’t, and then the social workers have to scramble to find a place for them. It’s difficult to do, there are far more patients than there are beds for them.

Sometimes the support system has had enough - one too many times off their meds and getting violent or stealing everything your family owns and they have to say “He can’t come back here.”

I know we have some posters who are strongly against meds for mental illnesses. I just don’t know another solution. Jail? What do you do with someone who is mentally ill and violent?

17

I’d like to point out that while these people may be a very visible segment of the mentally ill population, they are not a very large segment. A large portion of mentally ill folks may be a danger to themselves. But few are a danger to others.

When the situation does arise, I’d say jail is sometimes the right solution. Otherwise, you have to force somebody to take mind altering drugs.

18

…

I didn’t know mental illness was infectious, in a medical, not symbolic sense. I presume you’re joking.

19

I suspect what the poster meant was that when one works in an environment as stressful and chaotic as a psychiatric institute, one is at greater risk of suffering from mental ailments brought on by stress and chaos.

I disagree with the statement about mind over matter, though. Strenuously.

20

No, they’re not a large segment. But warehousing them in jail is, IMO, worse than warehousing them in a hospital setting.

The “mentally ill but not violent” are the ones who end up homeless. They aren’t a large segment of the population, have no one to speak for them, and often slip though the cracks of the system. It’s very sad.