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The nurses have to deal with some of it, since they’re the front-line people who have to forcibly inject patients with medication, and they have gotten burned a couple of times.

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For example: “My boss said if I miss one more day of work, I’ll lose my job, and then I’ll have no way to support my family.” Or: “My rent payment is due tomorrow, if I miss it I’ll be evicted and all of my stuff will go to the landfill, and there’s no way I can handle this through Internet or telephone or asking a friend to help.” I assume 90% of these stories are false, but the 10% that are true are still bad enough to more than outbalance any good we can do.) After that, my reaction to these people was “Yes, you may be angry now, but you will thank us later.” This is true of many people, including some of the most histrionically upset.

But I’ve since learned that it’s probably not true of the majority.

But my last time on call, somebody also had a seizure, and I sort of strolled in half-asleep, ordered the necessary tests and consultations and supportive care, then strolled out and went back to bed.

And then there are the little things, like learning to tune out a psychotic guy banging on the window and yelling threats at you. It’s interesting that psychiatric hospitals are used as a cliche for “a situation of total chaos” – I think I’ve already mentioned the time when the director of a psych hospital I worked at told us, apparently without conscious awareness or irony, that if Obamacare passed our hospital would have too many patients and “the place would turn into a madhouse”.

With very few exceptions, there is nobody so mentally ill that calmness authority the implied threat of burly security guards won’t get them to grumble under their breath but generally comply with your requests, reasonable or otherwise. I’d like to say I’ve taken advantage of this to go mad with power.

But it’s actually a really crappy situation for everyone involved.

The Shrink Rap blog surveyed former psychiatric inpatients and found that 62% said their experience was not helpful and they were “the same or worse at discharge”.

I’d like to dismiss this as people just carrying a grudge for having to be there at all, but the same survey finds that a very similar 56% of voluntarily admitted patients said the same thing (although not all “voluntary” admissions are as voluntary as the name expects).

There’s a similar idiom around “Bedlam”, which comes from London’s old Bethlehem psychiatric hospital.

In fact, psych hospitals are much more orderly than you would think.

To the degree that it is all security theater, it’s really hard to give an honest answer to a patient asking why they have to stay in hospital.

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