The first few paragraphs from my in-progress memoir on the 20-odd years I spent working on a locked inpatient Psych Unit in Portland Oregon:
“You never knew what you’d get on 5L. The randomness fried your nerves. Each shift was a blind date with 25 pacing, bored insomniacs. As with any psych unit literally anywhere, patient mix made all the difference. Every day, as I keyed the restricted access elevator, as the lift vibrated upwards, I shrank and narrowed. Nurses got punched in the face. Glass got broken. Chairs got thrown, as did thick orange pee—from full urinals–and shit. Now and then there were angry, psychotic people who needed to be tackled and strapped down on the floors of isolation rooms, or given injections in the butt, against their will. We’d huddle in the nurse’s station watching on live feeds as they struggled against soft restraints (which used to be made of leather) then slowly, minute by minute, drifted off into drugged quiescence. I thought of dogs being put to sleep. It amazed me how meds knocked people out so swiftly. They were asleep, technically, but it seemed like a dying. It was oddly mathematical. Yet once they woke up, it started again. It wasn’t about curing anyone, it was almost never about curing anyone. It was about control. 5L was a “crisis unit.” The idea was to make the crisis stop. It didn’t. It got discharged.
5L smelled. Not a window opened. The odor was hard to specify: bad over-microwaved decaf coffee (there was no regular), bad over-medicated breath, sagging adult diaper urine, BO, the residue of bad meals, shit stained sheets dumped in hampers spread around the unit and emptied maybe once per day, if that. There were five things people always wanted to do. Smoke (it wasn’t allowed). Shave (it was, with staff standby). Shower. Make a free call. Watch “Fried Green Tomatoes” on the VCR in the day room. Rarely, people asked to read their chart. This always caused commotion. They would be told they couldn’t. They would insist, it was their chart, they had a right. The doctor would be called. They would be told no again. Maybe once or twice in 20 years a patient prevailed—the chart, in a sky blue plastic binder, was given to them. It wasn’t what they bargained for. Most likely, it was boring. It caused no disquiet. The words meant nothing. They couldn’t see themselves in the words.
The term you heard more than any other was “inappropriate.” People coughed inappropriately. They microwaved inappropriately. They changed the channels on the TV inappropriately. They listened to music on their headphones inappropriately loudly. They loitered around the nurse’s station inappropriately. They put lipstick on inappropriately. This was a land of inappropriateness. People weren’t so much ill. They were naughty—or so they were led to believe. They were bad. What they were missing, what was absent from them, was shame. They had no “governor.”