First of all, let me send a giant THANK YOU to Lydia Kang (http://lydiakang.blogspot.com/), talented doctor, up and coming blogger, poet, and historical YA fiction writer for coming up with this idea. We will be collaborating and answering your writerly questions about medical issues and psychiatric issues.
Of course, in order to get this off the ground, we need your help. Please click the link to Lydia’s blog for details on how you can send us a question! She’s set up an e-mail address to house all your thoughtful questions.
DISCLAIMER: The information we offer is NOT to be considered treatment or medical advice. It is SOLELY for the purpose of writing.
What we ask for in return is for you to follow our blogs and link to us on your blog. We will link back to yours, of course. Caveat: WordPress doesn’t have a “follower function” per se, so I have attached a button to be followed on NetworkBlogs hosted by Facebook.
Lydia has already come up with some wonderful mental health questions and I’ll do my best to answer them here:
Okay, now imagine Frasier’s voice: “I’m listening.”
Question #1: What does the word lunatic come from?
Answer (as adapted from Wikipedia): The word lunatic is based on the Latin word “lunacus.” It stems from the term, “luna” (moon), which denotes the traditional link made in folklore between mental illness and the phases of the moon. Though it may seem that people act unusual during the full moon, there is no evidence substantiating any causal link between phases of the moon and psychiatric symptoms.
Question #2: What really happens inside a psychiatrist’s office? Does it really have the reclining chair?
Answer: Great question. There’s a bit of mystery surrounding therapy and there’s a fair bit of stereotyping done by the media and entertainment industry. Suffice it to say, the set up of a therapist’s office varies. In psychoanalysis (the Freudian stuff), the room is set up with a couch for the patient to recline on and the psychiatrist’s chair is behind the patient. In this way, the patient is able to “free associate” (say anything and everything that comes to mind, regardless of the topic, subject, or relation to anything else they say) without the therapist being in their line of sight. In other therapies (there are countless types, actually), the patient and therapist both sit together, usually at a 45 degree angle (to prevent direct “staring” at one another, with a table off to the side to hold tissues and maybe a lamp. Classically, decoration is to be kept minimal and non-provoking. The general rule is for the therapist to be as much of a blank slate as possible so that the session becomes and remains about the patient. The more personal information a patient knows about their therapist, the more muddied therapy becomes. That being said, each therapist has their own style, their own set up, and their own ideas about how rigid to “follow” the rules.
Question #3: If you had to get “put away” because your parents [or a loved one] thought you were going crazy, what does that entail?
Answer: This one is tricky to answer, because each state has its own laws regarding how someone is committed to a psychiatric hospital. In New York State, someone can be admitted to a mental health unit on a voluntary status (preferred because it retains the individual’s autonomy more), or on an involuntary status (called an emergency admission). That means the person is presenting as an imminent danger to themselves, others, or both. So, that covers someone who is going to or has recently tried to commit suicide, someone who is planning on harming another person, or someone who is so ill (psychotic, manic, or severely depressed) that they are no longer taking care of themselves or are incapable of doing so.
Under an emergency admission, a psychiatrist can complete the paperwork documenting the reasons why the person is unsafe to leave the hospital and the treating team had 14 days to “keep” the person there. In a majority of cases, with treatment, a patient is discharged from the hospital within 7-10 days. That time can be shorter, or it can be longer, depending on the severity of their symptoms and how well they respond to treatment.
To extend the emergency admission, there is something called the two physician certificate (which actually takes three people to fill out). This can be initiated by anyone (really, anyone, clinician or not) and must be supported by two physicians. The 2PC extends the time of admission to up to 60 days. (Again, this can be extended as well).
The length of stay for a voluntary admission does not have such time restrictions.
In contrast to New York’s system, the next state over, Vermont, does not have such laws, and any person presenting to the hospital with suicidal thoughts or severe symptoms cannot be held “against their will.” The doctor must let them go if they don’t want to stay, even if they are not of sound mind to make that decision for themselves.
Question #4: If you had a character that heard voices or saw strange things (think urban fantasy) and other people thought she was going “crazy”…well, what exactly does a real psychotic person hear or see? And how would this person know she wasn’t actually crazy? Or would she?
Answer: As with the question above, I could probably write a whole book on this topic. The quick and dirty answer is: It depends. Each person “hears” and “sees” something different. There are some generalizations that can be made. For example, people high or withdrawing from drugs or in a delirium tend to have visual hallucinations–think pink elephants–whereas those with schizophrenia or depression with psychosis tend to have auditory hallucinations. Frequently, the content of what the voices say is in context to how the person feels. If depressed, the person hears things like, “you’re no good,” “you’re evil,” “you’re worthless,” “why not just kill yourself and get it over with.” If paranoid, the person may hear, “I’m gonna get you,” “I’m following you,” etc.
For the most part, when people are actively experiencing these symptoms, they believe what they’re seeing and hearing are real. Those who’ve had a long run in the mental health system may be savvy enough to try to hide their symptoms, but if the person is ill enough, they may react to the voices or visions anyway. When the symptoms abate, the person can recognize that they weren’t real, but not in all cases.
Okay, well I hope that answers your questions. Perhaps more questions have been triggered just by going through this exercise. I’d be glad to any that come up!