To capture a mood: psychiatric inpatient

Today is my second post in the "To capture a mood" series. In this series of posts I use my collages to illustrate mental states with the goal of increasing awareness of mental illness. See my March 6, 2012 post on mania for details on my "process."


In this entry  I hope to illustrate the experience of being a psychiatric inpatient.


I apologize if this is annoying, but I must begin with some disclaimers:

• Not all experiences as a psychiatric inpatient are negative; Every person's experience is unique and this collage and accompanying discussion illustrates only one perspective. 
• Oftentimes suffering leads to personal growth. Therefore, although the experiences described below may seem harmful, they may lead to improvement in symptoms and general well-being.
• Inpatient treatment can be absolutely necessary to keep people safe and improve their quality of life.

Okay, here it is: "Treatment Compliance"

Treatment Compliance, 2012

To reiterate, this collage depicts the "scary" parts of inpatient treatment, not the positive ones. So as you read keep in mind you are hearing a biased account.


Like in my March post about mania, I will discuss different parts of the collage and why I chose specific images to evoke the mood I was attempting to capture.

Individuals with mental illness are hospitalized when they are deemed a risk to themselves or others. Suicidal and homicidal ideation are obvious examples. Hallucinations, delusions and extreme paranoia can also endanger the safety of the patient and others. Engaging in risky behaviors while manic (see March post for examples) can also justify institutionalization. Regardless of the reason for hospitalization, the experience of being confined is usually unpleasant. If you do not understand the reason(s) for your hospitalization (e.g. due to psychotic symptoms) it will be especially scary. However, even patients who agree that hospitalization is necessary, the feeling of confinement can still be traumatic. A hospital strives to be a place for healing, safety and growth, yet to the mentally ill it can feel like a prison.

Medication can be, and often is, lifesaving for individuals with serious mental illness. However, determining the correct type(s) and dosage(s) of medications can be a long and taxing process.


Hospitalization occurs during the acute stages of illness when symptoms are too severe to safely manage in an outpatient setting. Medication changes are often initiated immediately upon admission, the justification being that the current medication regime is not "doing its job" if the individual requires hospitalization.


The above left image represents the emptiness one may feel when faced with medication changes in the hospital. To me, her expression communicates "here we go again..." She appears resigned to the possibility that her feeling of "self" is likely to be affected by the medication adjustment.


The above right image represents the trust the patient is asked to place in his or her doctor(s). The blindfold symbolizes vulnerability; you often do not fully understand what you are being instructed to ingest, how it will affect your mood and sense of self, and what side effects you may experience. Yet you are expected to take the medication(s) offered without protest and any resistance may be documented as noncompliance.


Judgment is often passed on individuals diagnosed with mental illness who choose not to take medication as prescribed. This judgment, I believe, is the result of not understanding the diverse and far-ranging effects of these medications. Psychotropic drugs often have debilitating side-effects (to name a few: sedation, appetite changes with accompanying weight gain or loss, metabolic changes, tiredness, acquired motor disorders which may become permanent, hair loss, dry mouth, increased sweating, decreased libido, sexual dysfunction, gastrointestinal distress, decreased memory and/or concentration, insomnia, agitation, anxiety, the list goes on and on). Also, although drugs may relieve psychiatric symptoms, the "loss of self" some experience may outweigh the perceived benefit of drug (for the individual taking the drug, not an outsider). I will use the phrase "loss of self" often when discussing the treatment of mental illness. Though I am fiercely confident in my "gut-understanding" of the concept I struggle to articulate it. I welcome your comments as I truly want to describe the internal experience/thought-process that I have labeled "loss of self." For now I will move on to address other images in this collage. "Loss of self" will be discussed further as it relates to other images.

In the hospital you are always being watched. For good reason of course; it's extremely important that your safety and health is monitored and your progress (or lack thereof) is continually documented so as to inform future treatment decisions. Such scrutiny however is very disarming. The left images illustrate the unwanted exposure and privacy-violation one may feel being the subject of such ongoing observation.

In many ways, while hospitalized, you are treated as a child. You are nagged when you don't eat enough and chastised for substandard personal hygiene. You are not allowed to have sharp objects and your bedtime is strictly enforced. Again, such practices are for the benefit of patients. Keeping a regular schedule and knowing what to expect of one's environment helps with many forms of mental illness. The downside of such treatment may be that it can result in a self-fulfilling prophecy; being treated as a child leads one to behave as a child. If you are cognizant of this shift you may feel ashamed and discouraged. Regardless of one's self-awareness the regression to childlike behavior may result in a decrease in one's sense of personal responsibility for one's health and decreased ability to self-regulate following discharge.

On a psychiatric ward the television is one of your only entertainment options. Sadly, usually the programs being shown are not particularly enriching (but what would you expect of daytime programming?). However, for lack of other amusement, or simply to seek some form of distraction, many patients find themselves glued to the screen, regardless of whatever trashy reality show may be airing. Even if catatonia is not one of your presenting symptoms, your television exposure may cause you to look and/or feel catatonic!

The One-Way sign in the image to the right represents the lack of choices one has while hospitalized. Upon admission to the hospital you relinquish many of your rights, granting the institution legal permission to make decisions regarding your treatment. Again, the reason is to keep you safe; someone who is psychotic or suicidal is unlikely to make good decisions. However, feelings of powerlessness still arise. To me, the image of the man being swallowed by the fish is symbolic of the way one may feel after being admitted to a psychiatric unit; There's no going back, struggling will not make it better, and you are under the control of a more powerful entity.

In this last image I want to revisit the concept of "loss of self." To me, this image is a skeleton, devoid of substance. I'm not sure what type of structure it was, or was meant to be in the future. Simply put, it is empty of purpose.


Using the phrase "loss of self" is my attempt to communicate the process of feeling like you are losing sight of the "essence" of your personhood, which leads to feelings of emptiness. This process can occur for many reasons during mental health treatment.


First, sterile psychiatric wards have strict regulations regarding what you may wear and what possessions you make keep. Consequently, one route of expressing and remembering your identity is restricted.


Next, the side effects of psychiatric medications have far-ranging effects. Not every patient is aware of the multitude of ways medications affect their interaction with the world, but those who do gain insight may intensely grieve the loss of their former, pre-medicated self. Many medications used in inpatient settings have sedating effects (outpatient settings too, but more frequently in inpatient settings due to the higher severity of symptoms).You may feel "zombie-like," drained of energy and vitality. Combined with the impoverished hospital environment, apathy and/or depression often result. Medications can also affect the way you interact with others and your ability to engage in activities previously enjoyed (due to many of the side effects mentioned earlier).


Most saddening, in my opinion, is the personality changes one may observe or experience following the addition or change of a medication. For example, some report that their psychiatric medications sap their creativity, spontaneity and ambition.


I must comment that I believe medications are life-saving in many situations, but I also feel that it is important to report the full story. That is, medications can do much good, but they have a dark side as well.


To summarize, the elements of the psychiatric inpatient experience I wished to illustrate in my collage and in this discussion are: confinement, medication, scrutiny, infantile treatment, impoverished environment, powerlessness, emptiness, and the feeling of "losing oneself."


A few final words:
Sorry if I get preachy . . .

• Spread awareness about mental illness- we need to stop shaming and hiding those who suffer!
• Empathy- if you make an effort to consider a new perspective you may touch lives in a positive way without even knowing it!
• Healthcare trends- What historically used techniques and practices are still valid today? What new approaches can we take? How can we continue to evolve as healthcare providers?
• Recommended reading: "Girl Interrupted" by Susanna Kaysen. The movie is great but the book is AMAZING. 

Confession: These posts about mental illness are very difficult for me to write. Sharing my collages makes me feel vulnerable and the subject matter makes me depressed. But I am passionate about helping the mentally ill and I hope my little blog can spread awareness, even if I only have 3 readers :)


Thank you so much for reading and, as always, I welcome your stories, comments and questions.