The trouble with institutions, Part II

Modern science, according to German writer Hermann Hesse, is in the Stone Age compared to the teachings of ancient Indian mythology. I’m sure he’s right.

Dr. Vandemaele, Chris’s psychiatrist at the time, felt that Chris was on the upturn and would be ready to be released from the hospital in early March, 2004. Based on Chris’s reported symptoms and the doctor’s clinical observations, Dr. Vandemaele was of the opinion that Chris had schizophrenia, with a secondary depression, the two together not uncommon in the first presentation of the illness. Dr. Vandemaele assured us that there are effective treatments for both conditions and we could expect Chris to continue to improve with the initiation of the antidepressant. I did not disagree with Dr. Vandemaele’s assessment that Chris had schizophrenia and was also depressed, but to me it was situational depression, prompted by being forced to drop out of university while residing in a mental hospital. To Dr. Vandemaele, depression was a medical thing that could be treated with drugs.

To a doctor working in a psychiatric institution effective treatments mean medication. The institutional doctor does not convincingly project to the patient or the relatives a belief that the patient will eventually be capable of functioning in normal society, probably because the doctor does not work with normal society. His belief system comes from a conservative medical training and what he sees on the psychiatric wards. He only sees the breakdown within the walls of the institution.

For decades, psychotherapy has been downgraded as an effective treatment for schizophrenia in favor of drug treatment. Many people did not benefit from this treatment because it was considered of little therapeutic value when it came to schizophrenia. Dr. Vandemaele spoke of effective medications and did not speak of psychotherapy except to turn that job over to Chris’s priest.

R.D. Laing was one psychiatrist who understood. “Madness need not be all breakdown. It may also be break-through. It is potential liberation and renewal as well as enslavement and existential death.” This sentiment may have been echoed by Dr. Vandemaele, but if it was, he never shared it with me. I could have used the encouragement and the hope in this very dark period. Instead, the language of the institution and the staff was psychosis, comorbid symptoms, prodromal symptoms, effexor, respiradone, etc. These words are terrifying.

The trouble with institutions, Part I

In late January 2004, when Chris was first hospitalized, Chris’s treating psychiatrist wrote that although Chris had a good initial response to the treatment, his condition had worsened over the past week to the point that he was in danger of harming himself. Chris had become disoriented while on a pass with a group of people and had returned to the hospital an hour later. Although no physical harm had befallen him, with the temperature outside hovering around –30ºC, he would not be going out again without one-on-one nursing support. Given the state his mind was in and the need for supervision, Chris was formally asked to withdraw from his university courses. This prompted his rapid descent into a deep depression. He stopped eating and drinking, believing that the world was going to end and resigning himself to his fate.

According to his doctor, his nihilistic beliefs had reached the point that he did not grasp that he had an illness that could be treated. The hospital made him an involuntary patient and deemed him incapable to make treatment decisions. He asked that either Ian or I be the decision-maker for treatment decisions, although Chris had a right to appeal these decisions. Chris had become preoccupied with a number of religious and existential themes and the doctor believed that he could benefit from speaking with his college priest since they had shared a strong relationship in the past. He added that Chris was challenging the finding of his incapacity to make decisions, so no new treatment could be initiated until a hearing took place, which could be as early as the following week.

Years later, reflecting on the psychiatrist’s request to bring in a priest, it occurred to me that this psychiatrist or another psychiatrist should have been the logical first person with whom Chris could discuss his religious and existential themes. What the heck was he a psychiatrist for, if not to deal with a patient’s religious and existential themes? What had become of the psychiatric couch and the empathetic psychiatrist well versed in religion, mythology and psychoanalysis? In Thomas Szasz’s view, he has become the prescription writer for the state. Unfortunately, in a psychiatric institution, the patient and his family give up freedom of choice. The institution operates on a one-size-fits-all mentality. If we wanted something tailored to our specifications, we would have to search for it outside the walls of an institution.