My View • Psychiatric staffs cope with chaos compassionately
The death of Glenn Shipman Jr., a psychiatric patient at North Portland’s Legacy Emanuel Hospital and Health Center, is a tragedy by any measure. At the same time, the resulting public discussion concerning the nature of inpatient psychiatric care has disturbed me. Many have opined that inpatient psychiatric units are dark places where the staff is primarily concerned with controlling patients, rather than helping them. In my experience, nothing is further from the truth. Inpatient psychiatric units are, by their very nature, studies in controlled chaos. They consist of a mixture of voluntary patients who recognize they need treatment, and involuntary patients held against their will after being deemed dangerous to themselves or others. Patient ages range from 18 to the elderly. Men and women are segregated by room but mix freely in day-to-day interactions and therapy groups. On any given day, the mixture consists of angry and manic individuals, withdrawn and depressed persons, and people suffering from psychotic symptoms and delusions. Occasionally, developmentally disabled adults with psychiatric diagnoses are hospitalized, compounding the already stressful environment. To add to the difficulties, the mixture changes daily as the stressed mental health system attempts to move people out of the hospital as quickly as possible to make room for the growing numbers awaiting admission. Every day, inpatient psychiatric staff members walk into this setting armed only with their experience, training and compassion. It is a rare day when a potentially violent situation isn’t defused solely through the use of those three key elements. Many times, I’ve watched in amazement while staff members stood serenely in the presence of an angry, physically agitated, and often delusional individual, calming him or her merely by remaining connected when the intuitive action would be to retreat to safety. Their willingness to do that every day is what helps the people in their care get better. When others might avoid contact with these patients, the staff members sit quietly and talk with them, meet with them privately, and encourage them to find better ways to deal with their many issues. They promote a sense of community among people who may never have had any sense of belonging in their personal lives. In an almost magical way, that community then provides its members with an alternative social reality where everyone can see that everyone else has problems. It reminds them that they aren’t alone. At that point, the patients begin to help one another recover, which is perhaps the most magical thing of all. Few people ever personally experience this process. Only those whose presence is required or invited are allowed on inpatient units, because psychiatric patients retain their rights to privacy and choice of who they want involved in their lives. If this were not the case, perhaps people would not be so quick to criticize the actions of staff members faced with hundreds of decisions on every shift, any one of which might result in a physically dangerous situation to themselves, the patient or other patients in the environment. I see it in my work on psychiatric wards every day. But I’ve also seen situations where nothing could prevent a person from escalating to violence or self-harm. Because of that, I have to reserve judgment in Shipman’s case — I don’t have all the information. I would encourage others to do the same. I can only say that in my own experience, compassion and dedication to helping people whose mental illness often robs them of the ability to help themselves are the driving emotions behind the vast majority of psychiatric staff I know. Jeff Rogers is a mental health professional in the Portland metropolitan area.