When You Don't Know Where to Turn / A Self-Diagnosing Guide to Counseling and Therapy

by Steven J. Bartlett

Staff members with whom you would have the most personal contact are members of the psychiatric nursing staff. Often, when former patients are asked who helped them while in the hospital, instead of mentioning the therapist, they name a member of the nursing staff. Psychiatric nurses have received special training in psychiatry and often are a major source of human warmth and caring.

Depending on your progress, you may be encouraged to return home during the day, or overnight, or for a weekend. As it becomes clear that you are improving, these periods may be lengthened to see how you handle the transition from the hospital, before being discharged.

Although hospitals expect patients to choose to remain until they are discharged, few hospitals actively confine voluntary psychiatric patients to prevent them from leaving early—and then generally only in cases judged to be very serious. The only restrictions and rules you would likely encounter are those of any hospital: to respect the rights of others, to be considerate, to refrain from taking drugs unless they are prescribed, to smoke only in smoking areas, and to maintain socially acceptable behavior.

Inpatient hospital programs specializing in stress management, depression, eating disorders, and so on, are normally intended for one- to two-week stays. Residential treatment centers for problems requiring longer treatment—e.g., drug and alcohol rehabilitation programs—are less formal than hospitals. Often, residential treatment centers are located in the country and may consist of a cluster of cottage-like buildings. The program is usually under the direction of a psychiatrist.

Hospital care and residential treatment are very expensive. Most health insurance programs cover most of the costs of inpatient psychiatric hospitalization, for several weeks or months. Public psychiatric hospitals must be relied on by many people for longer stays, unless they bear the costs of private hospital treatment themselves. Physical conditions at state psychiatric hospitals have in general improved in recent years but still tend to fall short of private facilities, for lack of adequate public funding.

LEAVING

Probably the most difficult experience if you are hospitalized for a psychiatric condition is leaving, not entering, the hospital. There is frequently a sense of relief and comfort that comes once you have made the decision to enter a hospital. You have a "legitimate" reason for leaving your normal responsibilities; you may feel "rescued" from family or work situations you could no longer cope with. Once you have begun to feel more at home in the hospital setting, you begin to relax, to participate in activities with less restraint or reluctance. Then, as you improve, thanks in great part to the concentrated attention and care you are receiving, you realize that you must begin to think of reentering life "outside."

Returning to your familiar life can be frightening. It is usual to wonder whether it will, perhaps again, prove to be too much of a strain. Leaving the hospital frequently means returning home or going back to work, to shoulder the same burdens again, trying to pick up where you left off.

Hospitalization is often a positive, reassuring experience. Patients become aware that others do care and that, if life becomes especially stressful, there are sources of professional help and encouragement available to fall back on. Most hospitals encourage former patients to maintain contact through follow-up services of some kind. Leaving the hospital is made easier for many people, for example, knowing that the psychologist or psychiatrist is still there and that they will be seen on an outpatient basis. To help former hospital patients ease back into more normal lives, groups that were formed in the hospital sometimes will also continue to meet on an outpatient basis for a time.

The decision to be hospitalized is difficult for anyone. Hospital care may help turn your life around and put you back on your feet. Or it can, if you are your own worst critic, give you another burden to carry. It is important to try not to block potentially helpful treatment with excessive pride and to try to listen to people who care about you. If they are in favor of the decision, their convictions should be considered. If your doctor or minister agrees, this adds weight to their advice. Once you have listened, try to make your decision your own, not anyone else's.