Midway through our interview, Anna paused to answer a phone call. After talking so clearly about her experiences in mental health hospitals in Ireland, her change in tone was a jarring reminder of her status as both student and young adult. Speaking to her father, she burst out in excitement over their weekend plans, before saying she was currently busy but would be home for dinner. Hanging up, she asked to be reminded about what she had been saying before the call came. Prompting her that she had been describing her encounters with another particularly unpleasant patient in the day hospital, she smiled and returned to unveiling the often hidden experience of students in mental health facilities throughout Ireland.
Psychiatric hospitals evoke a myriad of images. What’s more, the perception of these facilities is clouded by the unknown. Given only glimpses from media, the reality of mental health hospitals is a far cry from what people believe. Portrayals range from Winona Ryder’s Kaysen in Girl, Interrupted, all the way to Jack Nicholson’s tragic battles with Nurse Ratched. The relevancy of these tales in Ireland is hard to judge. Not only are they grown firmly in American soil, but they are of a bygone era. What are the truths of the so-called “asylum” and how do they affect one’s self-perception?
“The distraught adolescent she described was a world away from the young adult that was now in her seat.”
Anna, a Trinity student, divulged her story as both an in-patient and a day hospital attendee. With an unclear diagnosis initially suspected as epilepsy, she is currently being treated for bipolar disorder. Characterised by the pendulum-like swinging between the debilitating lows of depression and the often-destructive highs of mania, it is often considered one of the most troubling mental illnesses. This does not stop her from attending College – far from it. Clearly intelligent and very articulate, the distraught adolescent she described was a world away from the young adult that was now in her seat. Moreover, her open manner and comfortable banter spoke to her acceptance of her past and where it had brought her. Attending support groups every Wednesday – so long as it doesn’t conflict with her sporting schedule – and taking medication regularly, her troubles seemed under control, if not completely behind her.
Offering background as to how she ended up in hospital, Anna explained: “I had issues my whole life but my parents never paid attention to them.” Sounding matter-of-fact, she continued that after years of intermittent distress including eating disorders and self-harm, her parents felt unable to cope with the reality of being her sole carers. According to Trinity’s Assistant Professor in Child and Adolescent Psychology, Dr Lorraine Swords, this experience is not uncommon. Parents are often faced with the difficulties of trying to assess what is best for their children, and one of the advantages of inpatient care had been the assurance it seemed to offer. “Caregivers noted a sense of relief when their children were admitted as they hoped that they would now get the treatment they needed that they may have been waiting a significant time for. Caregivers also expressed relief that they could take a break from assuming complete responsibility for their child’s illness and safety.”
“I remember that there was a pile of tissue beside me and I destroyed anything that they would put in my hands.”
Seeking help, Anna’s parents found a therapist shortly after her Leaving Certificate. She described this as one of her worst encounters with the healthcare system. “[The therapist] thought I wasn’t aware of how toxic my situation was. I hadn’t cried in a few years and she thought this was a problem and decided to make me cry.” Assessing that Anna was repressing her emotions, she described how laughing was banned in the therapy sessions and would try to induce states of distress to create cathartic crying. Instead, Anna felt as if she had been dragged into “this anxious wreck; a psychotic state”. After a particularly traumatic episode, Anna talked of the episode materialised in her physically: “I was shaking and scratching myself and I was ripping up a lot of tissues. I remember that there was a pile of tissue beside me and I destroyed anything that they would put in my hands. I was freaking out and I tried to jump out of windows. She just got me to talk and I vaguely remember talking about seeing videos of really disturbing things.”.
Concluding that talking therapy was not an appropriate course of action, the therapist recommended she be treated medically and organised for Anna to attend a hospital as an inpatient. “There was a really scary lady in the room I was put in. She was talking to the wall and then talking to me and touching my arm saying ‘they’ll make you better’.” Continuing on, she described it as “a very grim building…[with] no windows and the ones there had bars in front of them”. According to Dr Swords, descriptions such as these were one of the reasons for the disappearance of mental health facilities: “Institutional care was costly for states to provide and issues with underfunding and understaffing sometimes led to poor living conditions and consequently, poor quality of life for patients.” The introduction of psychoactive drugs and alternative care in the community facilitated the deinstitutionalisation in the Western world, providing a more palatable solution to inadequate hospitals.
“I was there for three and a half months the second time. They made jokes that I should teach the classes by the end of it…”
In spite of Anna’s unnerving introduction to mental health care, another hospital with both inpatient and day-patient facilities was suggested. While initially hesitant, she was reassured and reluctantly agreed. “I started in August and I was there until Freshers’ Week. During Freshers’ Week, I’d go in for orientation or anything I had to do in Trinity and then go back to the hospital.” While determined to attend College, Anna became increasingly doubtful of the feasibility of their plan; “I got really depressed. I couldn’t get out of bed. After we had our Christmas break, I couldn’t go back. I tried to once, but I ended up locking myself in the bathroom. It was bad.” Consulting her doctor, it was recommended she return to the hospital as an inpatient, but ultimately was not readmitted for lack of beds. “You’re only meant to be in the day hospital for five weeks, but I was there for three and a half months the second time. They made jokes that I should teach the classes by the end of it.” Letting her tone drop for the first time through the interview, Anna seemed to take a moment to look back at her stay and its impact on her life.
Exploring if her experience in the hospital was helpful, Anna was adamant in its healing potential. “The person who comes in and the person who leaves, they seem like a totally different person. I think that’s incredible. Your whole face changes. You look different…It’s really powerful.” What’s more, she talked about the benefits of observing the experiences of others. Speaking of another woman with particular fondness, she described the patient’s initial irrelevant stories during group therapy. “As she got better, she stopped doing that and we realised it was her anxious rambling. She had all of these thoughts in her head and she needed to get them out. By the end, she was really funny and coherent. It’s almost as if the disorder buries the person.”
Dr Swords agreed that the hospital environment could be nourishing: “From a review of the literature on this topic it seems that some young people saw the inpatient unit as a safe and supportive place, sheltered from everyday pressures, that allowed them the time and space they needed to focus on recovery.” With that said, reports from the other side of the fence also existed, “some young people also talked about losing connection with the outside world, particularly with family, friends, and school, which can lead to feelings of isolation. Others described the time in the unit as a ‘suspension of real-life’ or experienced a sense of life stagnating while others on the outside moved on. That is understandable but concerning.”
“She just said it would be good for diagnosis to find the ‘unmasked disorder’ which wasn’t pleasant.”
Moving onto her situation and her feelings on medication, Anna explained that it was a long journey to arrive at her current treatment plan, although substantially shorter than many others: “I had been prescribed Valium (anti-anxiety medication) by my GP, but I didn’t take the Lexapro (an antidepressant) because my parents wanted to wait until I got into the hospital and get their opinion.” There, her psychiatrist recommended she attend College without medication and observe her progress before deciding on a suitable course of action. “I do understand the hospital’s concerns with that, but she wanted to observe me without medications. She just said it would be good for diagnosis to find the ‘unmasked disorder’ which wasn’t pleasant, at all.” While Anna appreciated the hospital’s hesitance, she felt it hugely hindered the psychotherapeutic work that she carried out with the staff. “It meant I couldn’t really access the help they were trying to give me. When you’re in that state, you need both.”
After a particularly trying episode, Anna’s mother contacted the hospital. “I hadn’t left my room in five days and my mum had to stay with me all the time. She said, ‘This isn’t feasible, she needs medication’. So she called the hospital and told them she was going to give me something and they could either approve it or not.” From there, she started on a course of antidepressants which soon led her into a heightened state. “I went so high. Everyone was so confused because I came in for depression, and I was running around. The other patients were scared of me and would ask what they should do when I’m like that. I got up and ran out of the canteen and ran around the whole hospital. My speech would get so rapid I couldn’t get it out. I was literally bouncing around.”
Despite her manic reaction, her psychiatrist continued with her treatment without using a label, and even avoided associated terms: “She’s never used the words depression and mania to me, she uses low mood and hyperactivity, or energetic bursts.” Dr Swords offered an explanation for the reasoning behind this: “During adolescence, a young person’s developing sense of self or identity formation can be shaped by receiving a mental illness diagnosis – if it is included in the answer he or she gives to the question ‘Who am I?’ If a young person thinks that a mental illness defines them in some way, it can cast long shadows forward into their adulthood in terms of their confidence, willingness to take on challenges and try new experiences.” Equally, however she comments, the individual may feel that there is a clearer plan of treatment and path to recovery. While it may be casting the individual in a box, it can also offer a sense of validation for those distressed.
“The hyper-bubbly, excitable, affectionate – I’d always associated that as myself.”
During her primary psychiatrist’s holiday leave, Anna saw a different consultant. Upon looking over her file, the consultant remarked it was fortunate that bipolar disorder was her speciality. While Anna had never formally been told she had the disorder, the acting consultant treated her as if she had, adjusting her medication plan to be more in line with a bipolar diagnosis. “[They] were a lot more blunt, and went onto explain a lot more about the disorder and how it works.” Explaining that the bipolar diagnosis describes much of her behaviour, she commented: “In general, I’d be a walking contradiction.” She distinguishes this from her personality, “it’s obviously a very big part of me, but when I was put on mood stabilisers I was really scared because I wasn’t ready to let go of mania. The hyper-bubbly, excitable, affectionate – I’d always associated that as myself. I thought of that as me when I’m better because I didn’t identify as bipolar. So I didn’t know who I was then.” Talking of the plethora of famous figures who suffered from bipolar disorder, Anna clearly recognised some of the socially desirable traits associated with the disorder. She even commented that her mother suggested she channel the mania to finish essays. Deliberating on the subject, her excitable tone shifted to contemplation: “They can medicate it, but the cycles will still be there. A lot of bipolar people interviewed on if there was a proper cure, where you could take a pill and both sides would be gone forever, they wouldn’t.” And if she would? “I don’t know. Are the highs worth the lows? I don’t know. Would you be satisfied in the middle? It’s very hard to tell. The answer should be yes, but it’s not.”