When They Say “Danger” and Mean “Inconvenience”

Quite often, I’ve heard doctors and nurses here use the words “safety” and “danger” when really they seemed to mean “quietness” and “inconvenience”. An example is when the doctor told me about the time-out policy and said she wanted to talk about safety. While there’d been one safety incident a few days before the policy was introduced – that I’d stood still in the middle of a road -, the reasons why nurses would segregate me, are things like my slamming doors. Well, what’s so dangerous about that?

It is understandable, given the behaviors that I have exhibited, that there’s a time-out policy in place for me. Not that time-out would’ve made any sense at any of the times when I exhibited dangerous behavior – simply because the danger had already passed when a nurse found out about the behavior or when we reached a time-out room -, but at least some of my behavior would’ve warranted time-out.

But there is something else, that involves the question how necessary time-out really is. The nurses say I haven’t freaked out since the policy was introduced. Well, I have, at least two times. The difference was that now they all need to send me to my room first before placing me in time-out, and it’s very rare that I am so unreachable that I cannot follow this command – it happens, and at that point, time-out is often an appropriate measure. Previously, some nurses would send me to my room, but some would not. Besides, the time-out policy was introduced after an incident in which I did freak out, but did exactly what the nurse told me to do, so there would’ve been no reason for time-out.

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Next Treatment Plan Discussion

Had my next treatment plan discussion on Thursday, and it was horrible. There is a new ward psychiatrist, who knows nothing about me. Furthermore, the recreactional therapist neither the sports therapist were present. There was a nice nurse – not one of my primary care nurses, cause one is on vacation and the other didn’t work that day -, but that’s about it. The doctor started off glorifying the time-out policy, because I’d not freaked out majorly since it’d been introduced, and, hence, haven’t been in time-out so far. Hmmm, if I had been in time-out often, she’d likely have said that it was a useful tool.

The psychologist had a lot of questions that were poorly answered, said that there needed to come a functional behavior analysis, and wants me to live on another psych ward until I have enough control of my freaking out behavior. As for the FBA: I recommend it to parents of children with behavioral difficulties, when there is conflict or disagreement about which approach to use with the child. In itself, it is a useful tool. Mind you, the psychologist probably doesn’t know the difference, but I prefer a functional behavior assessment, which means that people around the person with the problem behavior observe carefully what occurs before, during and after the behavior, in order to determine its function. A really simple example is when a child (it’s usually about children) asks for a cookie, doesn’t get it, then tantrums and the mother gives them the cookie anyway. When this happens often, you might conclude that the function of the tantruming is to gain cookies. An actual functional behavior analysis is what I’d call “experiment around until you got what you want”, because it involves manipulating the environment to see what happens to the behavior. My main problem with having a functional assessment of my inappropriate behavior, besides the unlikelihood that it happens carefully on a busy ward, is that it’s a very passive process for the person with the problem behavior: I’m not supposed to participate actively in the process. And the doctor’s conclusions may’ve been right – as far as she could draw any conclusions about the cause/function of my behavior, I agreed with her -, but she never asked me.

And as for moving to another psych ward, it pretty much confirms the conclusion that I can only be in society provided that I meet other people’s standards of appropriate behavior. And if only it were about the actual dangers involved when I freak out – for example, that I might stand still in the middle of a busy road. But it’s not about that: it’s about screaming and door slamming. When I grunted at this to a nurse and the social worker today, they both asked whether I want to unlearn to scream and slam doors. Well, first, it depends on what the goal actually is: if it’s sismply that I stop screaming and slamming doors, no, but if it’s that I learn more appropriate alternatives to fulfill the function of my screaming and door slamming, absolutely yes. And second, even though I want to learn to change my behavior, this doesn’t necessarily mean that I need to be on a psychiatric ward as long as I display this behavior. By the way, after I qualify to move out of the psychiatric hospital, the psychologist wants me to live at Werkenrode. The reason is that he says I have a problem accepting my blindness and the people at Werkenrode can subtly handle that. Well, I have no problem accepting my blindness – yes, I’m laconic about it, but that doesn’t necessarily mean I have a problem accepting it -, and Werkenrode is an organization for the physically impaired.

There was a lot of debate about my possibly getting an UMTS card to connect to the Internet. That is very expensive, but the social worker says I can get funding for it because it’s an essential communication tool. Oh my, that sounds ridiculous! I told her that I won’t buy the card until I know where I can get funding.

The nurse was the only person who spoke directly to me – all the others spoke to each other. She actually had a pretty good contribution. Of course, quite a bit about the freaking out, standing on the road, pouring boiling water over my hand, etc., but she didn’t draw stupid conclusions. Then, my contribution was read to “the team”, but no-one commented and it seems no-one listened. There was some discussion about the fact – well, idea, it’s false – that I didn’t exhibit dangerous behavior (like the boiling water thing) before my last treatment plan discussion and did it now, about the accepting blindness stuff, and the new shrink asked why I was committed. My doctor used the simple word “danger” for it. Well, in the entire week of my crisis, there were only two dangerous acts of mine, and one, the doctor doesn’t even know about – the fact that I stood in the middle of a road on the afternoon of my commitment. The other is of course the fact that I made a suicidal threat, but my doctor used examples like my wandering – well, what’s dangerous about that? – or getting involved with the police – well, simply walking while blind can get you involved with them. The psychologist also asked why I was here, and got the standard answer that I’m just here to stay. Oh, and the doctor said that I thought I wasn’t doing well, but “the team” thought I was, thanks to the time-out.

At one point, I got my first nosebleed in ages and walked out crying. The reason was not just the treatment plan, but the fact that I’d half expected to finally be listened to at the discussion – after being very ill-involved with my treatment/stay here -, and I wasn’t. “The team” will have a new discussion about me sometime in February. I don’t want that – nothing about me without me -, but I likely have no choice.

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Got an Official Time-Out Policy

I’ve been in the psychiatric hospital for over two months and am getting more and more convinced that I shold never have let this hospitalization happen. On Wednesday, I was given more privileges: I used to be able to go off the ward only with someone else, and then could go out alone for up to fifteen minutes. However, on Tuesday, while being outside with a nurse, I freaked out and stood still in the middle of the road. The psychiatrist didn’t learn about this till Thursday, and when she found out, immediately took away my privileges again. But that’s not the worst thing. The worst is that she granted the nurses permission to put me in time-out – something nurses apparently can’t do without a doctor’s approval.

The time-out room, politically correctly often called “quiet room” in English, is not as bad as I used to think it was, as I wrote a while back. At least, the one on this ward. Still, I don’t expect it to be anywhere near quiet in there. After all, I tend to get stressed out by noise on the ward when I’m in my room, and this same noise will stress me out if the room I’m in has a locked door and no-one can hear me state my distress. Then, of course, there is the reason why it’s called “quiet”: the so-called low-stimulation environment, in that there are fewer objects in the room, and obviously you don’t have your own things when you’re there. The stories I’ve heard from psychiatric survivors (most of which are autistics as well), don’t make me optimistic, but theoretically, a low-stimulation environment could do me well in soem cases of overload. But this is not what causes the majority of my meltdowns these days: mostly, it’s my own thoughts that overwhelm me. And in this case, I’d like to call the “quiet room” a low-distraction environment – which is likely to work contraproductively.

There’s this other thing, of course, that involves the reasons for time-out. The only other patient on my ward with a time-out plicy, was placed in the room because she made an unquiet impression and kept asking the nurses to let her out and go to some punishment place she’d made up in her depressed mind with psychotic tendencies. When I’m distressed, I keep asking the nurses to let me out, too. There is nothing dangerous about asking a question, even if it’s annoying to the nurse when I ask the same question over and over again. Still, this will probably be what I’ll be placed in time-out for first – because it was what happened on Wednesday as one of the nurses called my doctor, too, which was likely what led to my time-out policy. In this case, it’s hard to believe that time-out is supposedly not meant as punishment. The nurses’ flawed logic about calming down, makes absolutely no sense. In fact, the doctor’s fortunately a lot more straightforward explanation that it’s about managing my disrupting the ward, is questionnable: that other patient with a time-out policy rarely bothered anyone on the ward, and a patient who insults fellow patients on a daily basis but apparently doesn’t annoy the nurses enough, doesn’t have a time-out policy.

In the meantime, I’m still officially here just to wait to go to something else, and in fact, the only two other times that I spoke with my doctor since my treatment pland iscussion, she both claimed that I’d magically do better when we have more clarity about where I will be moving to – even though she should know that I’ve always had meltdowns. So, I’m here because all my issues will magically disappear when I’ll go somewhere else, yet the nurses get sick of me anyway so they can put me in time-out. And, by the way, my doctor nor the nurses are listening to anything that suggests that they change something. For one thing, I’ve reported at least five times that 10mg oxazepam isn’t working as a calming drug, and it’s still prescribed PRN (I refuse to take it). For another, I and others have communicated that I want weekly scheduels at least ten times, yet I cannot create one completely on my own, and it’s still not there. So really, I’m going to find the magic key to not having any more meltdowns or I’ll be locked up in time-out.

I’m tempted to ask to be released more than I ever was, but at the same time, I fear it more than I ever did. My doctor (not the same as the psychiatirst, by the way) scared me yesterday when she talked about the fact that I’m now committed voluntarily, but if this or that, they might consult an emergency doctor to see if I need to be committed involuntarily. I don’t know what they could be doing to me if I were committed involuntarily that they cannot do to me now – especially now that they already have time-out permission (which isn’t needed if someone is committed involunatarily) -, but maybe the doctor meant that I’d need to be seen if I wanted to get out of here. I’m pretty sure I’ll be committed involuntarily if I make it a point for an emergency doctor, at least if I continue to be hoenst about how it’s going with me. I guess it’s about time that I learn to lie about my mental state. Maybe if I learn to lie to others, I’ll learn to hide my feelings from myself again, and I might even survive at home. I’m pretty much convinced that I won’t ever find the right placement anyway – and that placement doesn’t have a “quiet room”, I might hope.

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