People you meet…in the psych ward: part 1 – “how do you think I am?” & the wish sandwich

I’ve been meaning to write a post about interesting experiences I’ve had while being admitted inpatient to the psych ward. I’ve been procrastinating because perfectionism & lack of spoons. So I’ve decided to break it into chunks & offer vignettes in several posts about people I’ve met.

The first person I’ll tell you about is someone I met when I was involuntarily hospitalized inappropriately. The inpatient psychiatrist didn’t think I needed to be there at all but ER had pink-slipped me so I was stuck. He did thankfully let me out of a lot of the forced activities. But I did spend some time hanging in the common areas when I was bored.

Now something that happens during downtime in inpatient is that there are still counselors available to talk to & check in on you. They often have titles that are something like “milieu counselor”. Now this hospital had a milieu counselor who kept checking in on those of us hanging out in common room every 15 minutes or so. One of the guys in the room had been sort of antsy & she kept especially paying attention to him. And eventually he lost it and went on a glorious rant. Glorious because these places are designed to pathologize perfectly reasonable responses to bad situations & patients being agitated is definitely used against us to deny “privileges” etc.

Anyway apparently what was happening was this guy’s insurance was refusing to cover his hospital stay going forward so they were kicking him out. But he’d been having housing & family issues & had nowhere to go after discharge. Him and social worker I think had been looking for alternatives all day like group homes etc but he was clearly really anxious about this whole thing. Because who the hell wouldn’t be?

When he finally lost it at the milieu counselor, it’s because he said I’m being denied treatment & have nowhere else to go. Of course I’m stressed out. You keep asking me how I feel & if I’m ok. Of course I’m not ok! & you asking me over & over is not helping!

After hearing his rant, I knew I liked this guy. I’m not particularly a fan of the “snitch” like role of milieu folks & how patient triggers aren’t necessarily respected.

Later that day, I went to get a snack from the common kitchen which was very sparse. So a few of us, including the dude above, were hunting around for stuff & joking about the weird food combos we were contemplating. And we started to play a game of something like what’s the weirdest meal you’ve eaten when the fridge/pantry is sparse. That’s where I learned another thing that made me like this patient. Some of us talked about ketchup or Mayo sandwiches. But he told us about a “wish sandwich”. So a wish sandwich is when you’re out of any viable sandwich fillings so you take two pieces of bread, close your eyes, picture what you wish was in the sandwich & eat it.

Now I will say I had disliked other group therapy etc settings before this because it was hard to relate to other patients as many of these are structured to be educational & clearly not designed for nerds. [Side note: I’ve yet to find a group therapy setting where they’re actually ok with having a proper discussion including patients pointing out logical flaws with the approach]. I think the reason I liked this person was both because I learned something about classist barriers to accessing healthcare but also because his frustration with the medical system was very relatable & he was very direct about his grievances regarding social circumstances’ impact on psych symptoms and how that was being handled.

In hindsight I also realize that the coercive nature of these places means that it’s difficult to actually speak up in group settings. So while initially what didn’t jive with me was the oversimplification in group therapy & folks going along with it so what I really liked about the above encounter was seeing people getting really “real” & that helping me unlearn my own elitist bias re group settings not being as relatable with non-nerd patients (though that still helps), I now also realize how much the coercive nature of these spaces harms the group dynamic. Like people can’t be open and honest because of both the group rules put in places & the threat of being labeled disruptive and non-compliant hanging over your head. I understand the concerns about triggering other patients with certain stuff but I can’t say I find the current system helpful when it’s swung so far the other way in stifling patients being able to share what’s actually bothering them & getting support because it contradicts the toxic positivity, victim blamey, gaslighty stuff often peddled as “therapy”.

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