2. Your condition may be too serious to be treated appropriately on an outpatient basis. If you are no longer in touch with reality, are unable to communicate coherently, are hallucinating or have delusions, you cannot be relied on to take care of yourself. If you are psychotic, your behavior may hurt others or yourself. If you are suffering from a major, incapacitating depression, you may become suicidal. Finally, if you are unable to control an addiction to drugs or alcohol, inpatient care is more likely to be effective.
You may, of course, have reasons to resist hospitalization. Most likely, your resistance will be based on fear—of the unknown, of the later stigma of having been hospitalized for a psychiatric condition, or of the inner stigma: that you must have been terribly ill (or "weak") to justify hospitalization. Furthermore, if you have been hospitalized before, you may recall that the hospital's supportive environment encouraged you to feel dependent on it and to resist returning to normal living, and you may fear falling prey to this again.
All of these are good reasons to proceed cautiously. Only the first fear can be reasoned with in an objective way, by understanding what psychiatric hospitalization is really like, something this chapter will help you to do. Certainly, the other fears also may have some basis.
Discrimination does still exist against former psychiatric hospital patients. They may find it difficult, for example, to enter military service or serve in an important political capacity.
The inner stigma can be even more damaging, if you are a highly self-blaming person. If you are going to hold hospitalization as yet another black mark against yourself, then you may want to avoid hospitalization unless it means you are withholding treatment from yourself that really is essential to your well-being.
If you have been hospitalized before for psychiatric care, the last reason is very likely the most important one for you to weigh carefully. In the light of your past dependency needs, you must decide whether the problems you now face are serious enough to motivate you to walk into a situation that in the past you found difficult to leave.
Most hospital admissions for psychiatric conditions today are voluntary. Usually, either your own judgment leads you to accept hospitalization, or you are persuaded by family, friends, family doctor, minister, or psychiatrist that doing so is in your own best interest. Involuntary hospitalization is legally difficult and occurs primarily in cases in which, over a period of time, there is evidence that a person's behavior is not responsible, that he cannot take care of himself, or that he may injure himself or others.
WHAT HOSPITALIZATION IS LIKE
Several kinds of hospitalization are available to individuals who are emotionally troubled: