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Why I love being an inpatient
Posted Monday 25 January 2010
A guest post by Marion Janner, founder of the Star Wards project
Hmm. Perhaps the only uncontroversial words in the heading are those with a character count below 4. That’s 3 of them (I’ve just started ‘tweeting’ on Twitter and am now obsessed with character count as each tweet has to be haiku-like petite, under 140 characters. I usually find it hard to express myself in under 140 minutes).
Anyway, returning to my own character, it’s been totally fucked over in the last seven years by the explosion of borderline personality disorder. BPD is actually as common as schizophrenia but most people have never heard of it. I hadn’t until many months after I became inexplicably hyper-depressed and started, completely bewilderingly, self-harming as a way of managing extreme plunges in mood (I go on and on about this in my website Mentalising). And when my partner of 20 years walked out on me, a month after our civil partnership ceremony and having forgotten to mention her plans to me, the suicidality started.
You might be familiar with OCD-type compulsions – hand-washing, germ-avoidance, safety rituals. My compulsion to kill myself is broadly similar. Although obviously with the opposite intention in terms of life preservation. It’s pretty exhausting (not least for my extensive team of therapists) trying to contain this force and all gets very messy when I decide to take an overdose as a way of flirting with death and simultaneously gaining a sense of being able to control my destiny when I sheepishly land in A&E to get the overdose reversed.
So. The chance of a break from having to internally manage my self-demolition urges is irresistible. Butlins is great, what with all the entertainment, slot machines and good grub, but it’s a lot to ask them to manage my suicidality. Whereas my lovely local, St Ann’s in Tottenham, may not have the slot machines, but they do lock me in and remove all tolerable methods of disposing of myself. Such a relief.
I’m a bit of a regular at St Ann’s, and the familiar staff team greet me with hugs and welcomes, perhaps temporarily forgetting that I’m a nightmare patient for them. For example. I’m 4’9” so not very tall, but while being ‘specialed’ via 1:1 staff with me 24/7, I’ve still managed to unscrew a lightbulb from the ceiling and use it to self-harm. All very David Blaine and presumably infuriating for staff. Yet they manage to respond to my relentless self-destructiveness with patience, understanding, non-judgementalness (?) and to use an old-fashioned term – compassion.
I love it there. I don’t need to worry about work or my weird eating nonsense or looking after my foster sons or (not) answering the phone or writing blogs or going to meetings or acting cheerful. I know from my work running the Star Wards project that St Ann’s is scarcely in the Premier League of hospitals, indeed it’s going to be knocked down and replaced. But it has exactly what I need, and what my friends and family need, to keep me safe and provide a little break from the overwhelming task of keeping it all together. There are very few days when I’d rather be at home than in hospital.
Marion Janner
Marion was awarded an OBE for services to mental health care in the New Year Honours list 2010.
20 Comments
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Maybe its just me, but with the addition of a swear word in the blog, it loses its value. When I was assessed for my mental health problems, I have schizophrenia, and got 'upset' I used to swear, the NHS said "Oh its just part of the condition" and never took any notice of it, no matter how much I felt strongly about the opinion I was trying to express. Now days when I am upset I am able to elaborate on the reasoning and be more professional about how I convey them to others, i.e. the language that I use, etc.
I have previously been detained due to the mental health act and have now re-gained control of my life, aged at 21when speaking of my experiences I have every right, such as yourself, to use bad language but to convey my experiences and faults/positives of this time I find it more appropriate to use formal language.
I once was a regular Mind post reader/donater, and think the general contents of this post is an insight I would read, but I wouldn't share because it shows that people cannot show restraint/professionalism even while posting onto a site such as this.
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Thanks for this feedback. I was once asked by a service-user to swear less in a workshop I was running. My feelings about my mental illness are such that nothing short of a 'shocking' adjective begins to convey just how much I hate it and what it's done to my life. I don't use this highly informal language when writing articles (or letters to funders!) but my sense from reading lots and lots of all sorts of blogs is that this is a space where the blogger can let go a bit and that this uncensored expression of views, feelings etc is one of the reasons people read them.
But I'm sorry you found the f word very off-putting in this blog and that this distracted you from the points I was making about inpatient care.
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I absolutely agree with above. Swearing is not clever and soon as I saw the word I became uncomfortable reading it and, like the above, I wouldn't share this article. Think editing, MIND.
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Swearing? Get real. The only place in this country that swearing does not occur is on the TV soaps.
The addition of a strong adjective or two has the effect of bringing to life the article. Its use is hardly a reason not to refer to the article in context. If you are so prudish as to bridle at the use of one descriptive word in an excellent article and refuse thereafter to use it for educative purposes, then maybe you should edit out the word with a small 'censored' label.
I found the post both entertaining and informative and will be referring to it in the future in my work with our Forum.
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Certainly some heated replies here!
Personally I hate no problem with swearing in itself - it is such a common part of The language we experience all around us that it has lost a lot of its taboo. Also I know that almost everyone I know swears, from every walk of life.
However, when you are writing something that is to be published on the official website of a charity or company you have to choose your words more carefully so as not to offend what is not really "your" audience, if that makes sense?
So basically, when writing for others be aware of The different audience and your position as a guest, but on your own blog you should absolutely feel free to say what you like! I know I hate unleashed more than the occasional string of obscenities on mine ;)Welcome to Twitter by the way :)
Oh, and respect to MIND for not censoring this article but allowing an open discussion regarding the matter :)
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Thank you for your reply and sorry for my lateness within replying back, I have been in work all morning.
I agree with what another user has said above, on your personal blog, swearing would be an acceptable language, if you so wish to use it - after all, that is your viewpoint, your interpretation and most properly most importantly read by people who like that approach to writing.
Before I became ill I was studying to become a journalist and had a part time job within my local paper, I have never read any of the columnist etc. once swear within an article because though used within everyday life, and may be the persons personal prospective, they know that in the world we live in today, it wouldn't be allowed.
I have done several things within the past couple of years, giving my personal prospective to friends, who work within the mental health sector, and I know if I went around swearing my ideas towards them they wouldn't listen to me - such as what I assume this post may do to readers who are sitting at home thinking, "I want empowerment and people to listen to my viewpoint to create better services etc. but while there is someone out there saying your [insert whatever word you like] - were not going to get there"
Mind, as a professional site, I agree with you publishing it - but as swear words are classed as offensive, you have broken your own bloging rules. I would have thought you would have had a talk with the bloger and ask them nicely to reword that little bit, because otherwise in my opinion, it is a great article, just a shame that professionalism wasn't throughout the whole thing.
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I agree with Richard, the f-word is a part of what Marion has written as an expression of her thoughts and experiences. It's not just thrown in for the sake of it, and the piece is not peppered with expletives to make a point. Sometimes saying something is f-ed up is the only way to describe it; messed up, bothersome, bad etc just don't convey the same message.
I think this is a brilliant post and it's honesty is very refreshing. More like this please!
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The only thing I found offensive on this page was the rather 'holier-than-thou' attitude from most of the people commenting. What a pompous, and rather superficial reaction to Janner's honest expression.
'Concerned' reader? I am thinking more 'petty' than concerned - it was akin to you being in the audience during an impassioned, gut-wrenching speech, and the only thing you come away with is the need to criticize the speaker's style of dress, the color of her shoes. Petty.
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I'm not bothered by the use of 'f***' at all it doesn't offend me, what I do struggle with is the notion that inpatient care is that great. That's not to say that all inpatient care is bad, of course not, but on the whole it's not a wonderful picture according to the CCQ's report, from what many service users say and from units I've visited where there is no patient-staff contact other than at medication/mealtimes, where close observation seems to be an alternative to interaction. I struggle to make sense of Marions joy at being in hospital but that is her personal experience so I can't pass judgement on it no matter how hard I find to understand, but I would like to know out of all the wards Marion has visited for Star Wards has any of them ever been less than wonderful?
Perhaps she could visit some of the units I have and find what's wonderful about them. -
Thanks for the post Marion. BPD is horrible, and often feels relentless. It colours every aspect of life when its bad.
I agree with Summer29's comments, by the way
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I respect that hospital is seen as a positive experience (as in this post) that takes the pressure off and is containing when in a bad, dangerous place. Its good to hear if things do work to the benefit of those using services - and save lives.
But an inpatient stay is a very short term solution and for a set purpose (eg needing a place of safety or some people having meds changed/having to go back on them sometimes unwillingly). A stay may not feel long enough as its hard to know when you feel ready to leave again. Each time in hospital its difficult to come out and pick up the pieces, though you have to. Not all ward staff may be clued up on BPD in the same way they see other conditions eg psychosis.
I think that when someone has a diagnosis of BPD one approach by psychiatrists is not to admit to acute wards, or not for very long, as this doesn't in itself effect change and sometimes is believed to make things worse (though they may act to keep people safe where on this verge of self harm). But many users want that choice and to be listened to when in crisis thats out of all control.
While the mention of BPD helps as it isnt written about very often - I wish it was too - , some people may want access to wards but not be given that option or even other badly needed services.
The hardest and most significant work of living with symptoms of BPD is outside wards, life is extremely hard, painful and rocky. The distress is there every moment though we have to see things over time. We are expected to find our own solutions (and in a service that promotes recovery throughout the system) but also need support to do that and change life for the better.
I worry here about the reference of 'flirting' with death through overdoses, as its the most risky, potentially lethal or long term disabling form of self harm there could be. So do take care with references (and actions) just for that reason - I say that with all due care and respect.
I hope Mind continues to show blogs and they cover a whole range of opinions - we need these real lived experience and comment that says how it is, and to get responses where they spark ideas and hopefully understanding. -
Thanks to everyone for your responses. I agree with most of the comments about hospital stays and BPD, including those which challenge what I said! I'm bursting with contradictions and conflicts and, like everyone else, just try to keep enough balance to keep it all together.
To pick up the issue of consistency of inpatient services. Hallevai! (Yiddish for 'if only!') I'd be astonished if any other NHS service had such vast discrepancy in quality of services. In response to Mindreader, predictably I only get invited to visit wards which are pretty confident about the service they provide and most of them are indeed awesome. I've seen several NHS wards which are far superior to private wards I've visited and one I stayed on.
But Star Wards' whole approach is to find what is working well and validate and publicise this. It is questionable whether purely 'attacking' campaigns have any effect other than to further demoralise staff and reduce motivation, energy and quality. So even when I've occasionally visited wards which don't fill me with joy, I have always found some aspect of care which is impressive, and have acknowledged this.
There was a superb article, Not Rocket Science, by Louise Pembroke in Nov/Dec's OpenMind magazine: "Find Something Positive. A nurse once praised me for finding a creative dressing for a wound that she would never have thought of, and said I'd made a good job of it. She managed to find one positive thing about me in negative circumstances. In doing so she returned to me a shred of dignity."
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Personally I have no problems with the inclusion of a swear word in the post. We're all adults here, and if it's what you chuffing well mean, then you should flipping well say so. ;)
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I thought this was a brilliant post. It's so good when feeling depressed to read about other peoples' experiences. We can all help each other.
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Hi i have read the in patient care article and found it un-offensive, i cannot comment on in patient care as yet but its all relevant one way or the other - regarding the article itself i found it well written, i have only started using the MIND site today, i have had issues/self harm for years now almost double figures, and my CPN, Care co ordinator and GP have all been what i need and continue to be so - so my point is that as a new user it is refreshing to read something that has not been fiddled with or edited - we are all adults and should in my opinion handle it appropriately its just a case of when is ok and not - i do point out that i disagree fairly strongly that anyone dismiss a whole piece of work/effort because of a word - it is real life after all no white bunnies here.
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Thank you for this blog post, Marion - I found it both honest and interesting.
I was particularly drawn to it because there have been times, during the darkest days of my depression, when I have wished someone would take me away to such a place, a place where, as you say: "I don’t need to worry about work ... or looking after my ... [husband] ... or (not) answering the phone or writing blogs or going to meetings or acting cheerful."
I am, in my happier moments, intensely grateful that I have never yet actually reached that point when I needed to be hospitalised, but I am SO aware of the lure of that relative freedom that you describe ... for when one is exhausted from the constant battles in one's own head, a place of zero responsibility sounds like heaven!
However, I am pleased to say that I am currently fighting my way back from the pit of despair and, although the road is as rocky and steep and treacherous as usual, I am optimistic that I will soon see the summit!
Thank you again (and by the way, I think focusing on one highly descriptive f-word in such a useful piece of writing is, frankly, a bit silly - there is so much more of use and value in this post).
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Thank you for this post Marion i have been going through a major bout of depression lately and hit rock bottom yesterday with tiredness, and was desperate to get my family to section me i was so tired, the on going battle i have every day to keep myself alive is time consuming, the doctor thought with support from my family i was ok to pop home have a cup of tea and take this bag full of tablets he gave me :( i would have given anything to be admitted....
This wasn't a selfish act on my part but more a protective role to save my family another few days aggro x
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Marion what if you didn't find a good point to a ward you visited? Would you scrap the barrell to find one for the sake of finding one?
Sometimes telling people it IS crap is a wake up call. I once sat on a judging panel which decided that NO entrants were worthy of shortlisting and that gave the entrants a clear message, no we ain't gonna put foward something for the sake of it. I've visited wards in London which have made me feel ill as a visitor there is no way I could muster anything jolly to say about those wards and I'm no pessimist because when I do come across a decent service I'll happily write to the service manager and tell them it's good and why it's good. I just don't think it can be all carrots [or all sticks], but I've never heard you say a bad word about inpatient care and it's hard to swallow as a service user, visitor and having friends who are nurses who will say themselves that inpatient care is dire. -
Brilliant post! Very insightful. I find it bizarre that initially people chose to focus more on one word than the whole content!
I did wonder though where you say:
"There are very few days when I’d rather be at home than in hospital."
Have you found that perhaps being treated as you were in hospital has impacted on your ability to cope at home or in the community? How did you deal with the transition between the sanctuary- as it were- provided by inpatient setting and returning to a less supported environment?
It seems as though there may be a thin line between providing an environment that is safe and non-judgemental in which people have their needs met yet which still promotes true recovery in that people want to and feel supported and able to return home. Hospital shouldn't be a punishment or an awful that people dread going but I neither think that it is productuctive for it to be seen as a better alternative to living in the community when someone is no longer in crisis.I am interested on your thoughts on this. I would also like to add that it is refreshing to hear someone have a positive take on the care provided in inpatient settings!
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Hi again Mindreader. Andrew at Mind has asked me to write a blog about what I find difficult about being an inpatient, and despite my love of being locked up, there's still plenty about the experience which drives me nuts. Watch this space for my tales of barricading myself in my room, sending Help Me emails to the national mental health czar etc! This partially answers your questions, Truant, about whether my ward is too comfortable. Believe me (or others who use my local hospital), it definitely isn't!!
To respond slightly tangentially, I had lunch today with an old mate/ boss, from the days when we managed group homes for people with learning disabilities who'd moved from one of the inherently vile, old long-stay hospitals. These 'total institutions' (as Goffman describes them in the classic book Asylums) were almost systematically abusive given their size, funding, location, culture etc. Running residential care services is hyper-stressful and the starting point is always about getting the rota covered. This is unbelievably difficult in itself (if one doesn't want to resort to using agency staff) and I remain deeply appreciative not only that I no longer have this responsibility, but also of ward managers who do. And of every member of staff who turns up for each under-paid, over-pressurised, under-validated shift, at all times of day and night, including heroically through the extreme weather this winter when many public services just shut down.
Thanks also to you, Truant, for your post. I've asked staff this question, about what motivates patients to leave, when I've visited hospitals which are stunningly wonderful. Well, sort of shouted this question as the security staff politely escort me off the premises, with me waving my toothbrush and begging to be allowed to check-in, if only for a mere 6 months. :)
Only joking with the last bit. Staff reply in a way which so reflects why they're running such a brilliant service. They've explained that an important part of their work is to support patients to set up or at least plan improvements to their life back at home which help them feel motivated to leave the security and pleasurable aspects of being in hospital. And part of this is for patients to feel more confident about themselves and their ability to create a life which is definitely preferable to the limitations and stresses of even the loveliest ward.
Which brings me back to the issue of self-esteem. I've had hundreds of therapy sessions (many thanks to all of you tax-payers!!) and the core issue is always the battering that my mental illness gives my self-esteem. This makes me feel a strong connection with others who are wrestling with the paralysing effects of feeling one's doing a terrible job, whether of responding to our own mental illness or to a ward with 20 people who are. Relentless criticism males things worse. Acknowledging staff's genuine efforts and skills and providing constructive suggestions for improving what's not going well makes things better.
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