For People in Psychiatric Hospitals, Dignity Can Be Life-Saving
In August 2014, the actor Robin Williams died by suicide. Like Robin Williams, my friend Emily took her own life. I met Emily in a psychiatric hospital where I was “incarcerated” for 21 days following my suicide attempt. Our experiences in the hospital were not helpful: The hospital was degrading, dehumanizing and downright depressing. Still, I have not made another attempt on my life in six years. Why were our outcomes so different? At least part of the reason can be found in what psychologists refer to as “self-determination theory.”
According to this theory, people’s need for competence, connection and autonomy must be fulfilled if they are to grow and change. These three needs were utterly unmet in the psychiatric hospital. First and perhaps foremost, institutionalization stripped us of autonomy. In the hospital, our every move was dictated by the staff — when and where we slept and ate, the clothes we wore, the toiletries we used, the books we read, even if we could open a window.
In addition to taking away our autonomy, hospital policies suggested that we were not competent to make any decisions for ourselves. If we sought explanations — particularly explanations about the drugs we were given — we were told that non-compliance would lead to increased time in the hospital. Emily already had feelings of incompetence. During her early school years, she had struggled to succeed because of dyslexia. That early struggle had left her feeling inept. On the other hand, I’d had a good deal of academic and professional success throughout my life which gave me a strong sense of my own competence even while the hospital made me feel as if I was incapable of taking care of myself.
Furthermore, my hospitalization can be seen as resulting from a loss of connection. My younger son’s fatal accidental overdose had left me reeling from the loss of a vital connection. I was fortunate that my feelings of connection to my family increased during my hospitalization. My son flew up from Atlanta and visited every day. My sister, niece, nephew and boyfriend called constantly. Emily didn’t have a sense of connection to her family. She was divorced, and her husband was in jail. Her parents were also divorced and lived far away as did her brother. They never visited and rarely called. Emily expressed to me her fear of being alone when she returned home. Surrounded by people and noise day after day, she was going to return to a silent, empty house.
Discharged patients are, in a sense, “set adrift” and lose the sense of “connectedness.” Sometimes the patient interprets the return of emotional distress even after being treated in a hospital as a sign that there is no help to be had, no hope for recovery or improvement. At least in my case, Erik would be staying with me for a few days after my discharge.
Sadly a year or so after our discharge, Emily died. Apparently, hospitalization is not an effective suicide deterrent. What can be done? Many mental health professionals today are calling for treatment that “prioritizes autonomy, empowerment and respect for the person receiving services.”
All of these tactics satisfy the three needs found in self-determination theory. In addition, CBT (cognitive behavioral therapy) is a highly regarded treatment. When used for patients who have attempted suicide, CBT focuses on enhancing coping skills, minimizing social isolation, increasing adherence to treatment and implementing emergency safety plans. Another promising treatment, dialectical behavior therapy (DBT) combines CBT with humanistic elements and mindfulness, the practice of being fully aware of and present in the moment. It also involves teaching people how to tolerate distress rather than attempt to change it, and how to develop interpersonal effectiveness and regulate emotions.
To help patients find a way to go on living, therapeutic approaches must give patients a sense of their value by giving them respect and treating them with dignity. Hospitals must also give the patients some autonomy so that they learn to live in and deal with each moment that comes.
Dignity and respect can’t be found in a pill.
Isolation from the world doesn’t breed coping skills.
It’s time for hospitals to turn to a new way of preventing repeat suicide attempts.
Read more about my experiences in “Broken: How the Broken Mental Health System Leads to Broken Lives and Broken Hearts” available on Amazon.
Photo by Emiliano Vittoriosi on Unsplash