Sunday, October 15, 2006

Inside The Asylum

I've been blogging now for about five months. In that time I've covered a lot of topics close to my heart - politics, my dogs, my daughter and childcare in general, beer, and so forth. Today I'm going to write about someone else close to my heart, on a subject that is both difficult and yet immensely important.

First off, let me introduce you to my wife. She's a little younger than me, although she likes to think of it as a lot younger than me. She is a wonderful mother, who puts her child (soon to be children) ahead of anything and everything else in life. However, she is extremely intelligent, articulate, likeable, personable and a very accomplished saleswoman. She is a voracious reader, and is self-educated on a huge range of subjects. She's popular, attractive, funny and often the life of any gathering in which she participates. And she has a serious mental illness.

My wife is bi-polar and suffers from obsessive-compulsive disorder. Currently, she's doing very well, on a medication regime that seeems to be working for her and under the care of arguably the best psychiatrist in Ottawa. However, this post is not about now. This post is to take you back several years, to a time when things were not going so well.

Let's go back to around 2001, when my wife's OCD was largely uncontrolled and her depression was deepening. To give you an idea of what OCD is, and what it does to someone, she was convinced that every surface, every person, every object she touched was contaminated. Her fear of infection practically defined her. She washed her hands constantly, until they bled profusely. She was unable to do laundry, because it terrified her. She couldn't go out socially or meet people. She couldn't be near children because she thought they were all dirty. At the same time as these irrational thoughts controlled her, the same smart, intelligent woman was there underneath. The desperation she felt, in being unable to control these irrational fears and impulses drove her deeper and deeper into depression. Finally, early in 2001, she attempted suicide - her third attempt, in fact, but the first really serious one. She researched online the fatal dose of her medications, and she took more than enough.

From the local ER here, she was transferred to Ottawa's Civic Hospital, where she spent some time in intensive care, then a week in a stepdown unit and finally a few days on a regular ward. It was decided that she might benefit from a prolonged period of hospitalization, and a space was sought for her at the Royal Ottawa Hospital, Ottawa's psychiatric hospital. Indeed, she felt that for her own safety, that's where she should go.

Fast forward to today. A new Royal Ottawa Hospital facility has been constructed and just opened. It includes a Zen garden, light and airy rooms, decor aimed at soothing troubled minds, and so forth. The opening of the new facility has been trumpeted constantly in the local media, most recently in a piece in Saturday's Ottawa Citizen. That article is behind a subscriber wall, but it talks about the ROH changing its name:
"We wanted to remove the term 'hospital' from our facility names because of the association with stigma, discrimination and the dated notion of an insane asylum," said Scott Eaton, board chairman of the Royal Ottawa Health Care Group.

"Our goal is to provide a centre for mental health care, research and education, where health care partners, families and staff can come together in an environment that promotes healing and recovery instead of shame and secrecy."

Health Care Group," said CEO Bruce Swan. "Our new role and mandate means we are providing the majority of our care in the community, working with other partners in the health care system.

"The Ottawa and Brockville campus will represent important hubs in the mental health care system but not as institutional warehouses for people with serious mental illness,"

This is typical of the kind of press the ROH receives and it is typical of the self-congratulatory material they have published ever since we became aware of their existence. But what's behind these fancy words and the new Zen garden? Come with my wife and I, back to 2001...

She was initially admitted to a unit in the Witney building. This, it transpired was not where she would be treated, but was a reception unit, effectively a holding tank. Patients entered here and waited for beds to open up in the appropriate unit. During her time on this unit, she saw no psychiatrist. She received no treatment of any kind, except her medication. Her days were filled with smoking (which she only took up in the ROH) and watching videos. Happily, this only lasted for a little over a week, before she was moved to the Mood Disorders Unit.

This was where she would be treated; where 'health care partners, families and staff would come together to promote healing and recovery'. Right? Wrong.

On this unit, things changed. I'll have to let her tell the story, because when she moved here, I became basically excluded from the process, as did her regular doctor. The hospital took over. They did not ask anyone who knew her what was 'normal' for her. They didn't let her keep any part of, or connection to, her life outside. I was never offered information, help, support, or even the time of day by anyone at the ROH. However, that is nothing compared to what was going on inside.

Imagine a ward full of people in various states of mental illness; depression and / or mania. A mixed ward. No problem, because the nursing staff are there to take care of them, they're all being treated by doctors; supervised for their own protection and others; kept busy with therapies and activities... Right? Wrong again.

On this unit, the lucky patients saw a psychiatrist once a day. Others, as little as once a week. The nurses stayed in the nursing station, and closed their door completely outside the hours of 9 to 5. Control of the patients was left to security staff, who basically controlled access to the elevator and little else. Patients were given various privilege levels, seemingly arbritrarily. A kleptomaniac spent her days at the Westgate mall next door, until the mall merchants finally had lost enough merchandise and complained enough to get the hospital's attention. Two known 'cutters' were given razors to go into the shower; both produced bloody and gory results. On the other hand, to earn outside privileges, my wife was forced to use a public payphone in the corridor to call her outside doctor and discuss with him her history of sexual abuse. In public. In front of patients and staff. Forced to do this to earn privileges. In her own words:
an intensely violating and humiliating experience. NO support was offered by either nursing staff or the hospital psychiatrist involved. It was a 'test'....and remains one of the most disturbing things that I underwent; it smacked of sadism and powerplay

Once again, there was nothing to occupy the days, except chain smoking and movies. Well not quite nothing. What do you think a mixed ward of highly vulnerable people under sedation and not necessarily in their own minds is going to lead to? At least two sexual relationships were ongoing while my wife was on the unit; sex in stairwells, in rooms, while on visits outside... The rules were that nobody of the opposite gender was allowed in a patient's room. But the nursing station door would have to have been open for anyone to have noticed.

Nursing staff were burned out, apathetic and had given up. They went through the motions; handed out medication, including patient requested drugs. They talked contemptuously of 'frequent flyers' - meaning patients that came through the system multiple times. So much for respect and working in partnership.

I'll let my wife tell the rest of the story:
Asylum means a 'secure retreat', but secure for whom? The ROH wants to get away from that association, but why? It is a lot more honest and accurate: the function of places like the ROH has not changed, since the motivation of the doctors remains the same... Are they there to keep patients safe, or to make society feel safer? How does a Zen garden help to heal schizophrenia or a personality disorder, or OCD? What communication do they really want to have with the families of patients? Our experience was that they weren't interested in talking to family at all. How is having a greenhouse going to help geriatric patients cope with the sense of having been forcibly removed from everything familiar?

Psychiatry is the easiest specialty in which a foreign trained doctor can qualify, regardless of their original field. Is this the right thing for the most vulnerable sector of society? Or does this somehow imply that psychiatry is a field in which you really can 'do no harm' ? In my experience I felt like I was there to be practised on, an experiment.

The best care and most life saving care I've received has been in the community, from a doctor for whom this is obviously a true vocation and not just a job. I am immensely greatful for this privilege, and only wish that this standard of care was the norm everywhere, including in a hospital setting.

In 1887, the journalist Nellie Bly got herself admitted to an insane asylum and wrote a now famous exposé of the treatment the patients received. Tired of reading puff pieces about the Royal Ottawa Hospital, tired of seeing the doctors pat themselves on the back, tired of being lied to, we think it's time Canada and Ottawa had their own Nellie Bly, and someone really looked at what goes on inside the modern day asylum.

My wife is well today, thanks to a great doctor and mostly thanks to her spirit of determination. She left the ROH a broken individual, with nowhere to go but up. In the weeks that followed she picked herself up, got herself a job, worked hard and began to succeed. It was a long climb back to normality, but she did it herself. I've never been more proud to have known anyone.