The shameless and the damaged
It was the last consultation of a long and tedious day. Shawn presented with chronic headaches. In taking the history, I enquired how long the headaches had been present. Shawn indicated that they had been present since a traumatic time in his life which had occurred five years previously. I asked him to provide some details regarding this ‘traumatic time’. ‘Have you got the time Doc?” enquired Shawn. “Give me the summarized version” I responded. And so Shawn began to relate the details of this ‘traumatic time' of his life. I was astounded by what I was hearing. I requested that Shawn pause in the narrative while I allowed my staff to shut down and leave. I locked the door and requested that Shawn continue with the unabridged version of the narrative.
From the copious notes that I took during that consultation, let me now share Shawn’s story with you.
I was an only child. I have no memory of my father. He left my mom soon after I was born. Our family consisted only of me and my mom. Mom had to work to keep us going. She worked long hours and invariably I spent many hours alone in our small apartment. I had no real friends to talk about. There was a small wooded area near our apartment where I spent a lot of my time. It became my habit to think aloud. Then I was having conversations with myself. Not long after that I began having conversations with imaginary people in my fantasy world. Sometimes I even conversed with the trees.
Soon I began to attend school. I felt very different from the other kids. I kept very much to myself because I didn’t know how to engage with others. From time to time I was the victim of mockery and abuse and on at least one occasion suffered cuts and bruises from being physically abused. This only served to alienate me further. I was very much the loner. My solace was still my conversations with the people of ‘my world’, my fantasy space. I used to share my pain with them and they use to provide solutions to help me deal with the pain of my daily life.
I remained a loner until completing my schooling. At eighteen years of age I was a complete loner without having formed any relationships. I had only ‘my friends’ in the fantasy space. I had however become an avid reader. My favourite author was James Joyce. I got a job as a cashier at the local grocery store. It was here that the fateful moment occurred which was to result in the most extreme of trauma’s. Something which would forever change my life. I was at the back of the store during my lunch break. Thinking that I was alone, I began talking with ‘my friends’. Unbeknown to me, the manager of the store was standing behind me. Suddenly he approached me. “Who the hell are you talking to Shawn?” he asked. I was totally embarrassed. I could only shrug. “Hang on man, you’re sick! You’d better get to see one of them shrinks urgently.” he continued.
Somehow, between the manager and my mom’s involvement I soon found myself face to face with a psychiatrist. “How long have you been hearing these voices?” enquired the doctor. “Ever since I can remember” I responded. “What do they say to you?” he continued. “This and that” I responded. The doctor looked at my mom and then back at me. “Can you please leave us for a moment. We’ll chat with you shortly” requested the psychiatrist. I left the room. A short while later my mom exited the room and joined me in the waiting area. She indicated to me that I would need to attend an assessment the following day at a psychiatric hospital. I had no idea what was going on.
The following day we arrived at the psychiatric facility and were directed to the ‘Interviewing Room’. We were soon joined by three doctors who began questioning me. Once again I was requested to leave the room. After a while I was recalled. I noted that my mom had become very tearful. It was communicated to me that I would need to remain at the facility for ‘further tests’. I remember my mom hugging me and now sobbing. I looked enquiringly at the doctors and again at my mom. There was no explanation forthcoming. I recall shortly thereafter that two burly orderlies arrived and escorted me to ‘my room’. I was surprised that access was restricted by heavy metal doors. But I didn’t think too much of it at the time. I just assumed that it was a feature of the facility.
The room was sparsely furnished with a basic bed, table and chair. There was a window. Again the relevance of the bars across the window escaped me at the time. Soon there appeared a nurse with medication. I enquired what it was for and she responded, “Just something to make you feel a little less anxious.” It is difficult to describe the feeling that overcame me about an hour after taking the medication. I developed tunnel vision and all my thinking slowed down. I also felt no emotion. Movements slowed down and were becoming robotic. I no longer reflected on my surroundings. I felt as though I was walking through thick syrup. The best I can describe this was being wrapped up in a chemical straight-jacket! Soon I was asleep. I was awakened and escorted to a dining area. I had no idea what the time was or how much time had lapsed. In the common dining area I met other people. They all appeared to be moving very slowly. Some needed to be physically placed on chairs and fed. Others were mumbling to themselves and exhibiting repetitive movements. The food was placed in front of me, which I reflexly ate. I had no idea what it was that I ate.
After the meal I was directed to a lounge area where there were old chairs a table or two and a TV. Some of the people were seemingly engaging in some conversation, but the majority appeared to be locked into their own worlds. I sat there numbed, not able to make sense of where I was and what had just transpired in my life. After a period of time I was directed back to my room. Once again I was given medication. I knew it was now night-time since it was dark outside of my window. I soon fell asleep.
I was awakened the next morning. I was completely disorientated. Upon being awakened, I was once again instructed to swallow the medication. I have very little recall for the hours and days that passed. Then one afternoon the burley orderlies escorted me to the ‘Interviewing Room”. Seated there was a doctor. Amongst other things he asked me if I still heard voices. It suddenly dawned on me that I hadn’t engaged in any conversations with ’my friends’ since arriving at the facility. In fact I had had no thoughts that I could recall. “No” I said. “Good’, responded the doctor. “We’re making good progress”.
“Progress in what?” I managed to ask.
“In your illness” he replied.
“I’m not ill.” I replied. Something had now triggered a raw nerve. It had been a while since I had taken my medication that day and so some faculties were functioning. I continued, “In fact I don’t wish to stay here any longer. I demand to be released. It’s my right.”
“You have no rights in this place. You are an inmate of a psychiatric facility where the medical staff are mandated to ensure your safety and the safety of others” he declared.
I was shocked at this realization. I was a prisoner. For some reason beyond my comprehension I had been labelled as ‘ill’ and removed from my daily life.
“How long am I to be kept here?” I asked.
“As long as it takes to effectively treat your problem”, he answered.
Something deep within me was suddenly triggered. I was alone, powerless, and helpless. Frustration morphed into anger and then rage. Immediately the orderlies were summoned. I was man-handled and strapped to a gurney. Next came the needle and I was injected with some mighty substance. I felt a buzzing feeling and then everything melted into oblivion.
A far off noise. A slow emergence. I found myself in a foreign place. I was in a cell-like room, on a bunk. There was a high ceiling with a single light. In the one corner there was a toilet and basin. The walls were padded with a canvas-type material. It slowly dawned on me that I was alone in a padded cell. I was fed through a slot in the door. I was given no utensils. I ate with my hands. My medication was now much stronger. I have very little recollection of that time. I have no idea how long I was kept in that cell. Each moment melded into the next. There was no day and no night.
At some stage I was moved back to my room. Numbed and devoid of thought and emotion I existed as a living, breathing zombie. There was only a vague awareness of others. Some time later an idea emerged from the depths of the fog. I would feign taking my medication so that I could regain my living faculties. And so I freed myself of the chemical chains. But with emergence returned the same frustration, helplessness and rage. I spontaneously erupted one day at mealtime. Again the ‘burley twins’ were quick to subdue me and strap me to a gurney. This time there was no needle. Much worse was to come. I was wheeled to a clinical section and kept in a waiting area for what seemed like hours. I was then wheeled into an OR. I was told that I was to receive electro-convulsive therapy – they were going to anesthetize me and pass an electric current through my brain to stabilize me for ‘my own good’. And so it was.
I awoke in a bed. It wasn’t my bed nor my room. It was a big room with other beds. It took me hours to begin to piece together who I was. Fragments of old memories were the first to emerge. And then, over days I began to recall ‘this place’ in which I was imprisoned. A therapist arrived at some stage to help me out of the bed. But I had extreme difficulty with standing and walking. The disorientation caused me to feel as though I was walking horizontally along a wall!
And then at some stage I was returned to my room. I was no longer ‘self’ . I was a ‘thing’ beyond definition or context. There was no longer a past or a future. There was only floating fragments of sound, color and a body on auto-pilot.
One day I was escorted to the ‘Interviewing Room’ again. There was a new doctor, a woman. She seemed to be genuinely interested in how I was feeling. Perhaps as a result of the connection, some emotion was triggered. I began to cry. And through the tears I told her that a great injustice had been perpetrated against me. That I was just a loner, engaging with my own world. I was holding down a job and had harmed no one. And yet the powers that be had reduced me to a functionless zombie.
Her response was sincerely empathic .“You were diagnosed as being a paranoid schizophrenic by three of my psychiatric colleagues. You were admitted to this facility to stabilize you and ensure that when you are released, you will not be a danger to yourself and others. On two occasions you had become so violent that you needed to be subdued and isolated on the first occasion and and on the second, you required electro-convulsive therapy.”
“My rage was as a direct result of my frustration and sense of helplessness at being locked up in this place, without explanation or hope” I responded.
She gazed at me for a while and then said,” Ok, I will personally take an interest in your situation and recall you to a consultation in a month’s time. If you indeed are assessed as having become stabilized, I will motivate for a release with follow-up treatment as an out-patient.”
And so began the period of probation. I behaved as a model zombie. I took my medication on cue and co-operated with all the staff.
One month later I was escorted back to the ‘Interviewing Room’. There were several doctors present, including the woman psychiatrist. There were also senior nursing personnel present. I was interviewed at length. I was mentally sharp and appropriately responsive.
On gaining some confidence I made my definitive statement, the one that I had practiced so many times before, for this moment. “I want to state to this committee that I have been wrongly incarcerated in this facility. This is clearly apparent by my exemplary and appropriate behavior over the past month.”
One of the older psychiatrists in the committee fired back, “ But that’s because of the medication that we’ve kept you on.”
I stood up and dug my hands deep into my pockets and produced all the medication that I was supposed to have taken over the full month! I had feigned swallowing the tablets and kept the accumulated collection in a concealed space in my room. Jaws dropped and eyes looked to each other and to the floor. The following morning I was recalled to the ‘Interviewing Room’. There were doctors present as well as two non-medical individuals who I was introduced to as representing the Department of Health and the Department of Justice. It was put to me that if I signed a document absolving the respective departments of wrongly incarcerating me in a psychiatric facility and undertaking never to litigate against the said departments, I would be immediately released.
I signed the documents and was released. I was not referred to any out-patient psychiatric clinic nor prescribed any medication.
The law in our country at the time that this drama played out was that the signature of three independent psychiatrists was sufficient to institutionalize a psychiatric patient. The length of time of incarceration was at the discretion of the attending psychiatrist. Through my professional connections I was able to verify that Shawn had been incarcerated for a period of eight months. There were no further records following his release and most notably, there were no follow-up medical recommendations.