As a result of the mania likely developed from anti-seizure medications that the doctors loaded me with, before and after a sudden brain tumor surgery, I suddenly found myself committed to a psychiatric ward.

 

The experience reminded me of my Anthropology and Disability Studies, where I learned about the history of institutions and deinstitutionalisation. Visiting and researching such places as a student would have been impossible, I would never have been allowed to enter a locked ward.  But here I was, in a female-only locked ward in a major psychiatric hospital in Prague, stripped of identity like Ervin Goffman had described in his groundbreaking book Asylums in 1961.

Being transformed into a patient meant being in an institution where inmates get uniform clothing and are stripped down to their basic possessions and values. Clothes make people, their personalities, and their personas. Here in hospital pajamas, we are all equal patients. That is why I loved to wear my summer dresses and colorful clothing in the hospital to feel more human. Unless just after surgery or giving birth, bleeding and hooked up to tubes and machines, I refused to wear the white oversized gown that opens in the back and frequently and unwillingly shows patients’ buttocks.

I assumed that my voluntary psychiatric hospital adventure would take about three days – the doctors would switch my medication, watch me for one or two nights, and I would be ready to go home. Three days turned out to be nearly three weeks and I had to persuade the medical team of my sanity to be discharged early.

When I arrived at Ward 1 Women’s Unit in Bohnice, I was struck by the metal bars on the large windows and a heavy door that shut after me and was locked by a nurse. I spent at least three hours in the admissions office with my Mom by my side, not being able to conceive what I was getting myself into when I signed the voluntary consent form. It was around 7pm, I was hungry, but was told by the staff that dinner time was over, there was no available food and the vending machine downstairs was unavailable to me since the nurses refused to let me go back to the first floor and unlock the door again. Fortunately, a fellow inmate shared the food that she brought home after a weekend homestay. Solidarity, sharing, and mutual help were common among the women in this ward.

I was placed in a room with seven other women. Altogether there were eight beds in one large room with enormous, historic windows with bars on the outside, tall ceilings, and a little metal night table next to each metal bed. There was no privacy. A strict set of rules was posted on a bulletin board in the dark hallway. We were scheduled for 20 minutes each for breakfast, lunch, and dinner. The nurses would unlock the inner bar door and patients had to return from the “eating room” on time. Meals were very basic, with few fresh fruits or vegetables. The menu was posted for the whole week in the hallway.

Visitors were only allowed for a few hours in the afternoon when “therapies” were not in session. I put therapies in quotation marks because the healing effects of some of them were doubtful. Medicine was served by the nurses, hollering, “Come get your medicine!” in the echoing hallway, to which sounds the patients grabbed their plastic cups and formed a line to fill them with readily available weak cold tea. We had the same plastic cups in school cafeterias when I was a child before Communism ended in 1989. “Coffee time” was scheduled right after lunch and at 3 pm – a nurse would boil water and the patients would line up to have the nurse pour it into a cup filled with dry instant coffee.

Showers were only unlocked for 30 minutes in the morning and an hour in the evening. The three showers for a ward of about 30 to 40 women had no curtains and no privacy, but it seemed as if all the inmates were used to this.  There were no shelves or hooks for personal items or towels, only two old metal chairs. It felt to me like this was meant to cause discomfort and inconvenience since several women had virtually no space to put on their dry clothes while they showered. Bedtime was strictly at 10 pm when the nurses would turn off all lights.

Due to lack of staff, heavy medication has frequently been used to handle aggressive patients in many countries around the world, including psychiatric institutions in the Czech Republic. After I was admitted to the hospital, I learned that medication played an essential part in the acute care locked ward. It has become common practice since the elimination of physical restraints such as cage beds or straightjackets. The replacement is to serve Rivotril, a blue calming liquid, to any patient about half an hour before going to bed for a good night’s sleep.

When I took the blue drops for the first time, not knowing what they were and not questioning the nurse authorities, I went to bed to write in my journal. Within 20 minutes, my hand became very heavy and I started writing nonsense words and sentences, my head got dizzy, my eyes closed and I slept like a baby. The following day I asked what the blue water was and was told it “helps you sleep.” I countered that I did not need to take medicine to sleep and explained to the nurses the unwanted effect it had on me. They informed me that I had the right to refuse any medicine. I did not retake it. I only wished I had been told about my right to refuse any medication the very first time they were gave it to me.  Rivotril (Clonazepam) is widely used to treat ADHD, anxiety, depression, schizophrenia, and many other conditions and may lead to memory and concentration problems, and full-blown addiction.

Right after I was admitted to the locked ward, the doctors took my computer and cell phone away with no further explanation except that I “needed to rest.” They followed the advice of my mother and my husband who feared that I was posting extensively and uncontrollably on Facebook and that I was not making sense. It was true that I wrote outstandingly long Facebook posts with updates about my manic condition and my vivid dreams of going to Dubai, in addition to unedited emails that I sent to my former boss and others. However, I needed my Chromebook for my online work.

The doctors decided to only grant access to my cell phone for 30 minutes each day to check my messages and emails. During these 30 minutes, I walked around the locked ward and documented my experience by taking pictures of the rooms, hallways, and toilets.  The toilet doors were covered in quotes, words, and song lyrics (“I hurt myself today, to see if I still feel, I focus on the pain, the only thing that’s real…”). The small toilet room with a window up high with bars served as a smoking room and since about 90% of the female ward smoked, I had to hold my breath or ask them to leave for a few minutes when I needed to use the bathroom.

I later found out the doctors and nurses read what I typed in my text messages to make sure I was making sense in my communication to others and to check on my manic state. However, there are ways around every rule. I realised I could use my roommates’ phones to search the Internet, make phone calls, or communicate with the outside world more than I was allowed. During my limited 30-minute slot with my phone, I wrote down the numbers of my friends, and then I could text them anytime (when the nurses were not looking) from fellow patient’s phones who were once again ready to help.

I have to admit that the rule against cell phone and computer use made sense at the beginning of my illness. People with mania, no matter if it’s caused by the side effects of drugs or not, are more likely to act unreasonably, impulsively, or spend money easily. I did send a few very troublesome and awkward emails, including some to the principal of the school where I was teaching at that time, and the lengthy posts on Facebook were great examples of my wandering mind and unending stream of thoughts. On the money-spending note, I asked a friend to buy a tablet for a fellow inmate whom I had barely met. For me, it was a fraction of my savings while for her, with no extra money to spare and several months of treatment ahead of her on the Wasteland ward, it was a blessing. One of the characteristics of mania is that people tend to spend money impulsively and without planning and if I had access to my bank card or banking, I’m positive I would have spent all my savings during this short period. If the same woman asked me now if I could buy her a tablet, I would not have bought it.

Reflecting on this experience, staying in a major psychiatric hospital in Prague for two and a half weeks, enabled me to observe and experience first-hand the current state of psychiatric treatment of patients with mania and other psycho-social disabilities. From a human standpoint, it was a very degrading encounter; from a student and researcher perspective, it was interesting, eye-opening and valuable. I am happy to share it.

Jitka Nelb Sinecka is a mother, a climber, a special education teacher, a university assistant adjunct professor, a friend, a person unable to rest, a doctor of philosophy, a speaker of 5 languages, and a student.

This is a Sample Article from the Winter 2024 issue of Asylum Magazine.  To read more, Subscribe to Asylum.