How do I work in a mental hospital
MY DAYS WERE IN THE ENVIRONMENT OF PEOPLE WITH SCHIZOPHRENIA, bipolar affective disorder and oligophrenia. I am a medical psychologist at the rehabilitation department of a Moscow psychiatric hospital - and this work is perfect for me.
My future plans changed radically several times: model business, journalism, German, sound engineering - as a result, I received a diploma of higher education with a degree in psychology. I wanted to help people in extreme situations, and work in the Emergencies Ministry - for this it was necessary to unlearn another year. After reviewing the profile programs for the desired specialization, I chose the one offered by the Moscow Institute of Psychoanalysis. They immediately warned about compulsory practice in a psychiatric hospital - a frightening prospect. What did I know about psychiatric hospitals by then? Only what is shown in the movie: aggressive killers, possessed by the devil, half-dead bodies with empty eyes - the classic American horror films flashed before my eyes.
Before the first Saturday practice, I barely slept and several times smoothed a white robe. On that autumn morning, about fifty students gathered at the entrance to the mental hospital. From the checkpoint to the hull I moved almost dashes and tried to keep as close to the others as possible. In the assembly hall, she specially sat in the third row in order to see well what was happening and at the same time not to be too close to the patient she was about to bring. The teacher explained that we must respond to everything that happens as calmly as possible. No comments. Look, listen and take notes.
I was waiting for someone stereotypically "abnormal" who would rush at people, sway, roll on the floor and roll their eyes. And she was completely discouraged when accompanied by a pathopsychologist - a specialist in pathology of thinking - a completely ordinary-looking woman in a robe, thrown over hospital pajamas, entered the hall. Neat, with a pleasant voice. If I had met her in other circumstances, in a subway or a shop, I would never have thought that “something was wrong” with her.
The patient calmly and in detail answered the questions of the pathopsychologist. He asked her about her state of health and asked to perform various tasks that reveal violations of thinking. At times, she was carried into lengthy arguments about the meaning of life - but who does not happen to anyone? The woman talked about her family, admitted that she misses children terribly. When she was taken to the ward, the pathopsychologist said that this was a vivid example of delirium in schizophrenia: everything that the patient was so sincere and detailed about was a hundred-percent fiction. The woman in hospital pajamas, as indicated in her medical history, did not have any close relatives at all.
Life with disease
How do adults live with mental illnesses that I encounter in my work? Their life goes approximately according to this scenario: a state of acute psychosis, hospitalization, discharge, return home, daily medication. The psychiatrist diagnoses and is responsible for drug treatment, the medical psychologist deals with rehabilitation and monitors the human condition. At best, the patient is in remission, but most often after temporary relief, a relapse occurs and the circle closes. During an exacerbation, the patient is in the hospital for an average of three weeks; the rest of the time he is observed in the clinic. A month after starting the practice, they called me to work as a volunteer in one of them.
We talked a lot with patients - they are sorely lacking communication. Sometimes they tell me three times how they arrived at the clinic and what they saw on the street. The most common household conversation with a psychologist for many is salvation and the only opportunity to communicate with another person. I did not notice the slightest aggression - to be afraid of them would be just ridiculous. I saw before me very lonely people with whom the terrible had happened: their own mind refused them and made it impossible to live a full life. Society turned away from them, like lepers. Relatives, friends, with rare exceptions, began to be avoided. Not a drop of support. Total loneliness.
Patients know that “something is wrong” with them, they see that it causes fear and even disgust in others, so they start to consider themselves to be bad. Society imposes a sense of guilt on them and complicates the treatment process itself. In 95% of cases, when a person begins to behave differently, as usual — he considers white insoles in shoes, hears voices, cannot concentrate on a conversation, or speaks illegible, so that others cannot understand him — relatives ignore the problem to the last. The man himself for medical assistance is not addressed. The situation becomes critical. As a result, the patient tries to hurt himself, commit suicide, or cannot get rid of hallucinations and obsessive thoughts. Then he is called an ambulance, which takes him to the hospital in a state of acute psychosis. This is a classic script for schizophrenic patients.
With bipolar affective disorder, everything looks different. I remember well one of the first patients with this diagnosis in my practice. The girl had just experienced a maniacal state, when her mind was so accelerated that she could no longer finish the job or finish one sentence. It tore on the number of ideas, desires, assumptions. In this state, people make huge spontaneous spending, go on unplanned trips, take loans. They turn off the sense of responsibility. The patient with bipolar disorder, which I am talking about, has already taken the first dose of consciousness-retarding drugs, but still remained incredibly “fast”: she rushed to fold origami, draw a sketch for a tattoo, smoke, search for special paper. Often people with bipolar affective disorder miss the manic state, especially when they experience the opposite stage - depression.
Rules of communication
I started working in a psychiatric hospital as a full-time clinical psychologist quite recently, when the annual practice and volunteering ended. My main duty now is diagnostics. I communicate with patients and understand what exactly is a violation of thinking in one or another case, so that the psychiatrist could later make a diagnosis. Plus, I conduct various trainings that help patients to communicate more comfortably with the outside world. Modern psychiatry has come to the conclusion that many diseases that were previously treated exclusively with medication can be partially or even almost completely corrected by therapy.
When dealing with people with mental illness, medical psychologists must follow a few rules. The main ones are: not to discuss their diagnosis with patients, maintain distance and avoid physical contact completely. We cannot be friends or have a close relationship with patients: this makes therapy ineffective. The psychologist must be an authority, otherwise half of those with whom he works, instead of classes, will require to drink tea and cuddle.
One of my patients, for example, is constantly trying to kiss my hands. He has schizophrenia since childhood, he always seems to be different names and constantly hears a childish voice in his head, which swears. If I ever give up the slack in communicating with him, it will be impossible to restore professional relations. It’s also fundamentally not to feel pity and be emotionally stable. I can not afford to drink or not sleep before work, as well as come upset, irritated or feel bad. Patients read all this instantly, and it becomes much more difficult to establish contact with them.
I try to clearly distinguish between professional activity and daily life, so that I do not diagnose everything for myself. For a while I did not notice this, but from senior colleagues I heard that they have problems with going to museums. It is difficult for a professional psychologist or psychiatrist to look at a picture written in a state of acute psychosis, and quietly enjoy the artistic impression without starting to analyze the author’s mental features.
After just a few weeks of volunteering, I abandoned the idea of going to work at the Emergencies Ministry and decided to stay in a psychiatric hospital - it turned out that I was ideally suited for this. Patients are comfortable with me, they quickly open, and I intuitively establish contact. In our business, the main thing is desire and a lot of practice. It is sad that most patients have a chronic condition: they are discharged, but after a while they return to the hospital. Sometimes it seems that there are serious positive changes, and literally in a week the disease wins again.
The head of our rehabilitation department is a real fan of his work. Thanks to him, in the hospital, patients, in addition to compulsory therapy, can engage in painting, modeling, dancing, attending drama school and excursions. These activities are conducted by staff psychologists who understand the specifics of patients and how they perceive reality. But even constant attention and effective therapy can not always guarantee recovery.
The news that I work in a psychiatric hospital, one hundred percent of the interlocutors perceive acutely. For questions like "Are you not afraid of getting infected?" or "Are they even connected there?" I learned to relate philosophically. Light discomfort - nothing in comparison with the buzz every day to help people who really need it.
Photo:invisiblesk - stock.adobe.com, mantinov - stock.adobe.com, zhykova - stock.adobe.com
