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“The places no one likes to talk about”: A Stanford resident reflects on the psych ward

The first time you visit a psych ward, it sticks with you, for the same reasons Stanford psychiatry resident Nathaniel Morris, MD, discusses in a thoughtful essay in the Washington Post. The locked doors can be scary, and rules that exclude shoe laces, for example, seem strange, off-putting.

And the people inside? Yes, they are sick. Sometimes violently, obviously ill. But most have family and friends, outside lives and loves. They spend their time reading, talking, eating together, tackling jigsaw puzzles -- just like many other hospital patients. And:

These are places where patients put their lives back together, picking up the pieces torn apart by such illnesses as depression, bipolar disorder and schizophrenia. Caregivers from doctors and nurses, to social workers and psychologists work to heal the sick, to guide patients out of the abyss. Families often reconcile with loved ones. Patients may find hope in one another, opening up in groups, sharing meals, discovering the comfort of shared experiences.

It can get ugly, Morris admits: "There are moments when patients rave in the grips of psychosis, scream at the locked doors, throw chairs, harm themselves or threaten staff members. Indeed, there are moments when I’m afraid."

Our culture has made much of these moments and of the dark history of psychiatric confinement. But even though psych wards are now primarily places of healing and refuge, they remain undiscussed, despite increasing demand. Morris explains:

Psychiatric units continue to be the hidden corners of hospitals, the secluded floors that many hope to avoid. Patients openly chat with friends and family about trips to emergency departments, primary-care clinics and even operating rooms, but this isn’t so for stays on inpatient psychiatric units. These are the places that no one likes to talk about.

In recent years, inpatient psychiatric units have been in steep decline. According to data collected by the Organization for Economic Cooperation and Development, the number of psychiatric hospital beds in the United States fell from an estimated 153,517 in 1991 to 67,707 in 2014. As a result, distressed patients often languish in emergency departments, find themselves in jails or wander the streets, unable to get the care they need.

Morris argues that the stigma, and the silence, are part of the problem.

"I wish people could see the kind of good that can be done for patients on psychiatric units. Will we ever see psychiatry units not as places of shadows and terror but as places of beauty and strength?" Morris asks.

Previously: Medical students, suicides and mental health, Mental health in medical school: A resident calls for reforms and A Stanford resident explains why he asks every mental health patient about guns
Photo by freddie marriage

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