Her parents brought her in. Voluntary admission. Marie was seventeen, thin and pale. She looked more like a ten-year-old. Her clothes were not what you’d expect of a teenager. Short skirts and short coats were all the rage. Marie’s coat was unfashionably long. A baggy jumper attempted to hide an underweight frame. Her parents were smartly attired but mute. What was there to say? She was ‘under’ the professionals now and they felt they’d done the right thing by bringing her here. So, they didn’t say anything, at least, not when I was there.
Their address had suggested that they came from a side of town that was reputed to be quite well-to-do. They seemed to be consumed by concern. Frowning. Hovering anxiously… but did I notice that their daughter flinched ever so slightly, almost imperceptibly when her father attempted to put his arm around her shoulders?
I was not privy to what the parents had said, nor did I learn any words of wisdom from the psychiatrist’s intervention. We were told in a handover, during which information was given about patients, before staff changed shift, that she was self-harming (cutting criss crosses on her wrists) and hearing voices which were threatening her, as well as telling her to perform even more injurious behaviours on herself.
Hearing voices? The psychiatrist had diagnosed schizophrenia. Inevitably, the drugs that would quieten her were prescribed and zealously administered. The Charge Nurse liked a peaceful, orderly ward. He was ‘paternalistic’ but could be strict and stern with a ‘no-nonsense’ approach. The Charge Nurse had simply said,
‘She’s a troubled girl,’ but I privately wondered if that should have been ‘She’s a girl in trouble?’
Patients, however, were ‘zombified’ before they had a chance of opening their mouths. At least, that’s how I saw it. Some would say that the medication calmed and soothed them.
Psychiatrists focused on the behaviours. I always wanted to know what was behind them. Bit of a race against time. Could I build the trust and enable the client to talk?
Unfortunately, I had one week’s holiday booked. I could be almost certain that she’d still be there when I returned but in what state of mind?
When I was next on shift, she was cowering in a small room that was reserved for private interviews. ‘Handover’ in which between shifts, nursing staff updated incoming staff about their charges, had not been promising. Much ‘attention-seeking behaviour’ (often expressed with scorn) had been in evidence. What kind of ‘attention-seeing behaviour’ was rarely specified. The use of the phrase was enough to elicit least concern from nurses and doctors alike. She was on ‘Constant obs’ (suicide watch). I believed ‘attention-seeking behaviour’ was a disguised, often silent cry for help.
Even as this information was being delivered, there was a loud bang from the dayroom and screaming could be heard from some of the female patients. When we raced there, she was semi-conscious on the floor. She’d launched herself at the reinforced glass window in an attempt to kill herself. We were three floors up in the Psychiatric part of a gloomy, old Victorian Hospital, the larger part of which was given over to the General Side. She was very bruised after falling back into the room onto the wooden arms of two chairs and had cut her head open on the corner of a table. These injuries necessitated a stay on the General side of the hospital, accompanied by a nurse or nurses who’d carry on the ‘specialing’ (another name for suicide watch). It didn’t involve me because I was a student in my first year of training.
I have to mention here that this was one of three ‘acute’ wards which received patients who, for the most part were frantically distressed, given to self-harming behaviours and frequently on a Section 2. This meant that they could be detained up to 28 days in order to be risk-assessed before deciding what their treatment should be. Marie, however, was ‘voluntary’, although who had volunteered her was questionable. She was limp and dejected, appearing to have no volition at all. The ‘acting out’ of ‘paranoid behaviour’ was blamed on her diagnosed illness. Trained nurses were quite matter-of-fact about this. Would I respond in that way after my training? I doubted it somehow. I was viscerally shaken. Qualified staff on the other hand, seemed to accept unquestioningly, that her actions could be explained by the schizophrenia diagnosis.
When she returned, the heavy drug regime had taken hold. Her eyes were glazed, her speech monosyllabic. But she was ‘compliant.’ So much so, that over the weekend, it was proposed she should be allowed home leave. Before this, I’d tried to talk to her. She’d told me how worthless she felt and said that the voices were telling her to kill herself.
‘I’m no good,’ she kept saying, repeatedly. By then, she seemed resigned and hopeless. Sadly, I feared she was beyond counselling. Her mind was fogged by the medication.
‘I don’t think she should go on home leave,’ I’d said at handover, towards the end of the week.
She’s very low in mood and self-esteem. I think she’s at risk of harming herself. Did you see her flinch when her dad tried to put his arm around her?’
No one else had. My concerns were voted down. Trained staff thought it would do her good to go home and be in ‘normal surroundings.’ The psychiatrist was guided by the trained staff’s view, so my objections to this were overruled and when I wasn’t on duty, she was ‘let out.’ I was only a first-year student after all.
I never saw her again. That weekend, she became another statistic when she hurled herself over the local railway bridge as a train was passing through.
It was her mother who came to the ward to collect her few possessions. I gave her my heartfelt condolences. She smiled sadly and said:
‘My husband couldn’t come. She was “Daddy’s little girl.” He loved her too much.’
EMOTIONAL ALCHEMY
I have held the hands of broken souls whose lives disintegrated
I have stemmed the blood from self-inflicted wounds
paced miles with those on ‘constant obs’ – down endless corridors
and countered suicidal arguments with gentlest persuasion.
Played useless games of draughts and dominoes in soulless dayrooms
passing time and hoping drugs would heal their pain.
I have sought to help them regain strength
to engage in the battle of life once more and live it to the full.
Walked with them through ‘the shadowy valley’
shared grief and rage in pastel painted rooms
Listened to their stories, borne witness to their suffering
until they could emerge with courage and determination
find self-belief in power that would sustain them
Helped them help themselves through tribulations
we all must face and must survive or die.
Hope is the balm and antidote for despair
Most powerful medicine of all.
Editor’s note: this post is an excerpt from Shut Up and Keep Taking the Pills! by Hazel Amanda Jones. You can get a copy of the book here