Feeling Coerced Into Psychiatric Care

Editor’s Note: This article previously appeared in a different format as part of The Atlantic’s Notes section, retired in 2021.

This next reader had a horrible time as an inpatient, and her feelings ranged from lonely boredom to the fear of sexual assault:

I can’t tell if the timing of Eva’s letter is great or awful for me, because I’ve been in an inpatient psych ward twice in my life—and due to various circumstances, I recently began to wonder if I’ll soon be forced into a third. Eva mentions that her experiences have been a mixed bag, and I guess I’d categorize my experiences similarly, overall. But the negative moments have been so horrendous that more than once I’ve caught myself thinking it’s not worth saving my life if I have to be trapped in one of those places again.

I’ve only been in psychiatric wards in the U.S., and they’re pretty uneventful. The most notable thing about them is the widespread boredom. Sure, there are group therapy sessions and arts and crafts and meals, but all of those occupy at most 30 percent of the time. The rest of the day I spent lying in bed, staring at the ceiling and crying, or sitting in the community room watching whatever soap opera was on TV that day. You were not allowed access to any electronics—not even a cheap MP3 player to help soothe yourself—for the entire stay, and there were no locks on any of the interior doors.

The other inpatients were rather benign. (The only issue I had in that regard was an older man who either seemed to want to be my drug dealer or my sugar daddy, I’m still not sure which. Maybe both.) What elevated dull hospital stays into “Never Again” is the widespread incompetence and cruelty of the doctors who “recommended” my hospitalization and controlled my fate once I was there.

***

The first time I was an inpatient I was 16. I had been depressed since I was 11, and my illness had recently progressed into self-harm with scissors. When my psychiatrist found out, he forbade me from cutting myself and threatened hospitalization. Of course, because I was 16, I agreed out loud but in my head told him to go screw himself. I kept cutting.

At my followup appointment a couple weeks later, he asked me if I was still doing it. I didn’t take his threat seriously, so I admitted, yes, I had. He gave this long, exaggerated sigh and said he had no choice: He had to admit me to a psych hospital.

In Michigan, where I live, involuntary psych hospitalizations, even for minors, can only be administered by a court if the patient is an immediate threat to themselves or others [more details here]. I was not suicidal at the time, but my psychiatrist found a loophole: He said I could refuse to admit myself to a hospital, but if I did, he would call social services and have me removed from my home. And oh, he says, looking at the clock on the wall, “You need to make a decision quickly, because I have another patient in 20 minutes.” His reaction to seeing a 16-year-old girl in so much pain that she felt compelled to hurt herself was to rip her from the only sense of safety she had left.

So my parents admitted me to the hospital, where I stayed a week. When I had my intake exam, the nurse tutted, “These scars are nothing”—but they kept me anyway. For the first two days, I slept fully clothed and didn’t shower, out of fear that one of the random men coming to check on me in the middle of the night would assault me.

While I was there, the doctor on-call adjusted my medication. “How are you feeling?” she asked me the next morning. When I said I was just as miserable, she actually seemed confused, but anti-depressants take weeks to work. If even the doctors didn’t know that, why the hell was I even here?

The one bright spot came when a nurse took pity on me and showed me her clipboard. She let me know that someone was always watching us, and that they kept track of whether we took part in group therapy, whether we talked to other patients, whether we ate and how much. She said that little checklist was how they determined who had to stay and who got to go. She didn’t say it in so many words, but the subtext was clear: Fake it. So that’s what I did.

During my final interview with the on-staff psychiatrist, he asked me if I thought I’d ever cut again. And like a seasoned pro, I said, “No, because I don’t want to end up here again.” He smiled and nodded his head. “Good,” he said. “That’s why the doctor put you here in the first place.” That one statement was so repulsive to me—wasn’t the point of psychiatric care to heal people, not just scare them into compliance?—that I promised I’d never go back. That I would be so selective of what I shared with everyone, but especially medical professionals, that they’d have no reason to suggest it.

***

Four years later, the mask slipped, but my therapist pointed out that because I was an adult and the stay would be voluntary, I could leave at any time. I fell for it, only to arrive at a hospital where they said if I decided to leave, they’d just send me to another hospital that had no illusion of choice at all, and that hospital could keep me as long as it wanted.

I am not against inpatient hospitalizations, either voluntary or involuntary, in theory. But in practice, I can say with complete certainty that they have done far more harm to me than good.

Update from our reader, responding to my thanks for sharing such a personal and powerful story:

You’re welcome. I always feel a bit uneasy about sharing my negative experiences because I don’t want to outright discourage someone seeking help, but informed consent is important. Not all intervention is good intervention.

Another slap in the face I forgot to mention: being coerced into the hospital, having it not work, and having my parents get a bill in the mail for over $2000. Fun times.