Tag Archives: school

Confidentiality Struggles on Inpatient Psych Units

I’ve found that during my psychiatric hospitalizations working to maintain my confidentiality has been an issue.

I’ve never been hospitalized for non-psychiatric reasons, so I don’t have a perfect comparison. From observing while visiting family in the hospital I can tell that any hospitalization seems to result in some level of decreased confidentiality. When there’s a shared room it’s near impossible to keep everything private. You might not know details, but there is often at least a vague sense of what your roommate’s problem is. Family members who visit, often speak with the doctor without the presence of the patient, creating a risk that information will be communicated that the patient might have not wanted shared.

At my first hospitalization there was some posturing about confidentiality. Cameras including camera phones were banned and the lack of names on doors was emphasized.
I had a terrifying experience of 24 hours in the ER and was refusing to sign the form to be admitted. I wanted to go to a different hospital, but they wouldn’t let me. I asked if I could maybe see the unit first to see that it wasn’t scary. I was told I couldn’t have a tour because of confidentiality issues. This seemed reasonable. Eventually I gave in a signed the form.

A couple of years later I heard from a friend who was considering going inpatient at a different hospital for medication adjustments. He had been given a tour of the unit he would stay on before making his decision. So it appears this rule is not consistent between hospitals.

It seems the most significant confidentiality difference between general medical hospitalizations and psychiatric ones is that for psychiatric admissions patients are specifically encouraged to interact.
In fact, not interacting with other patients will likely be looked upon as a symptom.
Rather than staying in your room in bed all day there are common areas and group activities.

It might seem like that activity group is purely recreational, designed to break up an otherwise empty day. Wrong! In all of my records there are notes of my behavior during those types of activities.
One form for an arts activity group says simply that I attended and comments, “Very quiet- worked with no discussion with peers”. Never mind that I was focused and enjoying that I was doing. All that mattered as a record for that hour was my silence.

The problem of communicating with other patients is that all of a sudden your hospitalization is no longer just a relationship between you and medical professionals, now others are added into the mix. These others have no ethical responsibility to uphold confidentiality.
I know that sometimes outpatient group therapy groups discuss that what is said there should stay confidential, but I’ve never heard any sort of similar comment discussed in an inpatient setting.

Despite this, I have found the unstructured social time of inpatient settings to be one of the few helpful things I have gotten out of my hospitalizations.
I’m so secretive in general that it’s nice to be able to talk without the fear that I will be judged for my ‘crazy’.

But information besides what I choose to disclose also gets revealed. If I was in my room crying all morning, people know. There’s no hiding it. If I go back to one-on-one security, people know my suicide risk was deemed increased.

Sometimes check-in meetings with psychiatrists were conducted in the hallways where anyone could hear. I’d whisper everything and usually reveal less information as a result.

This makes visitors a very anxiety provoking experience. On the one hand it’s nice to get a visitor, on the other hand those visitors are generally my parents. I don’t tell my parents much of anything. They receive the most vague information possible. I worry about another patient blurting out something private about me in their presence.

At the first hospitalization visitors were let onto the unit and were allowed to all the same places I had access to. So much for that “No Tours” rule.
There was no private place to meet. They could go in my room, but I also had a roommate. I was on edge during all the visits, trying to steer them away from anyone I’d communicated with.

The second and third hospitalizations had rooms where visitors and patients could meet for more privacy. The second still allowed family access to the rest of the unit thus compromising confidentiality of anyone there. What if a visitor ran into someone they knew there besides the one they’d come to see? In a general medical hospitalization the chances of noticing someone you know are much less likely unless you were peeking your head into each room.
The third hospitalization restricted visitors movement more, only allowing them in that one room.

Some point in the middle of my first hospitalization my doctor asked me to list the top things bothering me at the moment. One of the top items on this list was the distress my hair pulling was causing me. I later learned that this had been relayed to my Dad. He didn’t understand why I was stressed about my hair (the part about pulling it out got lost it appears). I can’t imagine how that doctor believed that it was appropriate to share this information with my Dad. I was so visibly upset upon learning this that I worry my Dad held back telling me more he might know to keep me from getting further upset. I have no idea if he was told more.
I believe him when he says that he didn’t try to get information out of the doctor and that this was shared more spontaneously. The hospital only had my permission to talk about about logistics (such as arranging affordable outpatient care) with my Dad but still information gets shared that shouldn’t once a line of communication is opened.
My Mom is banned from speaking to any mental health professional of mine, because she tries to manipulate people into giving her information.
I banned her from visiting at all during my second hospitalization and unfortunately it wasn’t very effective because they kept allowing her on until I started to scream that she wasn’t allowed there.

Family meetings seem to be encouraged, again creating the risk that something will be said that I wanted private.

My third hospitalization was the worst with regards to confidentiality. The central issue became my efforts to protect my privacy.

First they told me they were going to contact my school to let them know I was there. I strongly refused.
Anyone who’s been reading this blog regularly knows that letting my school know about my psychological issues is a touchy subject.
‘But it’s our policy’, they said. ‘We have an agreement with the local schools’
I called my lawyer and they called theirs.
After creating a huge amount of panic and stress for me they backed down realizing they had no leg to stand on.

While this was still being sorted out I noticed some student nurses were visiting the unit. I spotted a name tag. My college’s name was on it.
I fled the room. Had they seen me, had anyone recognized me?
Student nurses from my school came twice a week. No one had thought to mention this to me.
It happened too fast for me to spot any faces. Did I know any of them?
I spent the morning hiding in my room.
“Isn’t their being here putting my confidentiality at risk? I don’t want them to know I’m here. Can’t they leave?”
I go to a small school. People know each other.
No one seemed concerned.
I spoke to the apathetic Human Rights Officer.
I wasn’t allowed to ban them from the unit, but I could ban them from any activities I wanted to attend.
But I couldn’t attend the activities, I couldn’t walk down the hallway to get to the activities room without risking being seen.
The only way to prevent them from knowing I was there was to hide while they were on the unit.

When got out of the hospital I sent an anonymous email to the heads of the nursing department to let them know what had happened.

Here’s the email I sent:

“I am writing to inform you about an issue I had recently relating to the *college* nursing department. I do not believe that anyone at *college* was at fault in this problem, but I hope that by bringing this to your attention perhaps something can be done to fix it.
I am a student at *college* and I was recently a patient on the inpatient psychiatric unit at *hospital*.
My confidentiality is very important to me, as I have previously had my confidentiality broken and suffered discrimination as a result of this. I understand that not everyone will react the same way others have, but because of these problems, keeping my psychological issues separate from my education is very important to me.
One day while on the unit I spotted someone wearing an ID saying ‘*college*’. I bolted from the room to speak with a staff member and learned that a number of nursing students from *college* would be there that morning. The staff knew where I go to school, no one thought to warn me of their arrival. I didn’t want to be seen by them. The staff informed me that they couldn’t be kicked off the unit or restricted to a less central location and that my only option was to hide in my room(or the isolation room) all morning. So I was stuck doing that. The stress of hiding there and the isolation it involved were not things I needed piled on top of the reasons why I was already a patient there.
The staff I spoke with (including the human rights officer) were fairly apathetic towards this problem, citing that they have an agreement with the school to allow the students on the unit. I argued that allowing peers of mine to see that I am there is a breach of my confidentiality because them seeing me there involves receiving information that I don’t want disclosed.
I understand that the students themselves are sworn to confidentiality. (Though from my experience when people break confidentiality it is hard to prove and they end up getting away with it), Were I to run into one of these students in a social or academic situation at *college* the interaction would be colored by their knowledge, knowledge that I didn’t want them to have in the first place.
I feel that as a patient my needs, particularly my rights to privacy, should be taking priority over the educational needs of the nursing students, because there is the option for the school to find an alternate assignment for the students in this sort of situation, but I don’t have the option of being in an alternate psych ward for the morning.
I can’t imagine that I’m the first person to run into this problem. And I understand that having the students not be there when someone from their school is a patient there who objects may not be a reasonable option.
I understand that the teaching hospital is a very successful concept, but that doesn’t mean it can not be improved. The current way that it is being implemented at *hospital* is taking too casual of an attitude towards privacy. I do not know if this experience is representative of other hospitals.
At the very least, if you could help me out by giving me a list of all hospitals where *college* students are on the psychiatric units, I would appreciate it. So I can know to avoid them. Because at this point I feel that if I am in need of inpatient psych care I am unable to get it because I fear a confidentiality violation.
Thank you for taking the time to read this. ”

I now have a note behind my ID in my wallet listing 8 hospitals I can’t go to because my confidentiality would be at risk. Basically I would have to travel fairly far to get to a hospital free of my school’s nursing students. Even further if I wanted to get to a reputable hospital.

I got a couple of more sympathetic, “We’re taking this seriously” emails in reply, but basically the end result is still that I can’t go to those hospitals.

Confidentiality should not need be one of my primary worries when hospitalized, but it has to be because I have to protect myself.

Adderall and Ritalin

As you can tell from my post about food, I am very particular about what goes into my body.

It was an ordeal for my parents to get me to take any kind of medicine as a child. Any occasion where I took medicine was a rarity. I had no understanding of the cause and effect. The idea that something I ingest would alter how I felt (possibly in a positive way) was hard for me to understand.

My freshman year of high school my parents decided they wanted me to begin taking Adderall. I refused initially. I wasn’t worried about potential risks of the drug. Taking a doctor prescribed drug as directed seemed harmless. I knew cognitively about the idea of side effects, but had no personal experience and therefore was not concerned. My reason for objecting was taste.
I’ve never learned to swallow pills. I have to place them in food. The bitter taste is inescapable.
My parents offered to pay me to take the Adderall. I forget how much. It was a one time payment in exchange for taking the drug indefinitely. I’m not much of negotiator, I probably could have gotten a better deal, but I accepted it.

I began the Adderall.
I have no memory of ever being told by a doctor what side effects to look our for. My parents were told, but I wasn’t.
So when I stopped needing to eat or sleep much I didn’t connect this to the new drug. I just thought I didn’t need these things anymore.

I’d sneak over to the computer at night and play games online. Go to bed at 3 am wake up at 7:30 am? No problem!
I loved my alone time at night. I had free reign of the house, provided I was quiet.
Why would I tell my parents? They’d just get mad at me for sneaking out of bed.

I didn’t need lunch anymore. I’d save my lunch money for various odds and ends.
Couldn’t tell my parents that either, they’d get mad.

Classes were boring. I’d look around the room going pondering the different ways I could kill myself before the class ended. Could I jump out the window? Hang myself with the flagpole? It was half serious and half a game.

I exploded at a friend at school. She asked where my boyfriend and I were going on our date. I accused her of trying to follow us. I never repaired that friendship following this incident.

I started self-injury during this time. Was it something that was bound to happen even without the Adderall? I have no way of knowing.

Based on how long standing my problems have been and my family history I believe I’d still have had difficulties without ever taking Adderall. I think they may have just been accelerated.

During this time I feel something in me broke. I’ve spent the rest of my life trying to fix it, but I never get back to where I was. I have times when I think I am fixed, but a little bump makes me fall apart again.

My fabulous, amazing godfather commented that I looked drugged. And he would know, what with all the time in the 80s he spent being punk rocker, hanging around the east village.

There were a lot of dramatic, loud arguments with my Mom. One resulted in my running into a snow storm in only a t-shirt and jeans. I figured I’d freeze myself to death in the snow. I hid in the backyard, then I got cold, so I decided to live.

I re-entered my home. My dad was on the phone with a local psych unit. Had I stayed outside a few more minutes I’d have been dragged to the hospital.
This was my first threat of psych hospitalization. It began a series of nightmares I had for years about being forcibly hospitalized. (This is a topic for another post)

I wonder sometimes how things might be different had I been hospitalized that day. If some type of intervention had been made earlier would things be less severe today? My parents were and still are for the most part clueless about how bad my problems are. It was a year until I began regular therapy and it wasn’t due to a specific mental health diagnosis except for a little about my ADD. It was primarily for dealing with conflict between my mom and I.

After the snow storm incident, my parents finally realized the Adderall was not the best idea for me and I was taken off it.

Life improved after quitting the Adderall, but never quite to where it was before. The self injury tapered off, to the point where I thought I was done with it forever. There was almost a year where things felt close to normal. A rough patch during my junior year brought everything back. It was much easier to fall apart the second time.

You’d think this would have scared me away from stimulants for good, wouldn’t you?
It did for awhile. It scared me away from all drugs.

Out of desperation, my freshman year of college, I tried some other psych drugs for my anxiety and depression. (This is a topic for another post) This loosened up my fear somewhat. I’m still very distrustful of drugs, but if desperate enough I’m willing to look into the option, occasionally.

When I transfered schools I was terrified about how I would do academically.

During my second hospitalization I asked my doctor if he could prescribe an ADD medication besides Adderall. I thought it would be a good idea to try it while there so if I had a bad reaction I would be in a safe place.
The doctor said no. He had a theory that I was bipolar type 3 (didn’t seem to care that this diagnosis doesn’t exist) and thought it would make me manic.
In art therapy I spaced out while the directions were being explained. I dedicated my piece of colorful scribbles to him and called it “My therapist won’t give me ADD drugs, so I spaced out during the directions”. In typical art therapy fashion the facilitators talked about how even though I’d not heard the directions, my scribbles somehow related to the assigned topic.

During my 3rd hospitalization I asked again. They put me on Ritalin. Was the only helpful thing to come out of that hospitalization. Originally they had me take it every day. I wasn’t comfortable with that.
Now I take Ritalin just on days I want to. I like being able to compare how I feel on the drug versus off it. It has worked out very well.

Everything in my brain organizes itself better. I don’t stare at a blank screen for hours trying to start a paper.

It’s not perfect. I’ve had horrible mood swings when it wears off. I learned this happens when I skip a meal. I make sure to eat (even if I’m not hungry) and things are fine.

Careful self-monitoring is important.

Ritalin is shorter acting than Adderall. I find this helpful. I can’t go for weeks accidentally depriving myself of sleep and food like I did on Adderall.

Part of my Adderall problem was that I wasn’t informed about anything. I was 14. I was young, but old enough that I should have had a more active role in my health decisions. Someone should have let me know that my body still needed food and sleep even if it was saying otherwise.

It won’t go away

The 3 year anniversary of when I was kicked out of school is a bit over a month away.
It’s been so much, time but it is still an incredibly touchy subject.

I can speak about suicide, self-injury, hair pulling etc in a detached, emotionless voice. When talking about my forced medical leave I struggle to get out a sentence at a time without being interrupted by crying. When upset, my verbal ability plummets.

I spoke with a researcher who is studying people who have been forced out of their school or asked to leave due to mental health issues. I’m glad someone is working to get awareness for the issue. I don’t feel I did a good job of communicating the long term difficulties I have as a result of the forced leave, but at least I did something.

School is the most important thing to me. As you can see from this blog’s name my major is a important part of my identity. Before this mess I was a different major. I defined myself by that major too. I’ve lost a part of who I am. That old identity is tainted by these happenings. I try to push that old part of my identity away and people keep throwing it back at me.

I feel so isolated about it. There are support groups for so many things. Except this one thing I could really use a support group for. I need not only someone in the same situation, but someone who also has long term problems from it.

There’s a message board I’ve been going to for support of a more general nature for nearly 5 years. Using a message board for support is tough. I spend so much time trying to give background information that I don’t feel the ability to vent freely that I really need. What I really need is a best friend and I use the Internet as a poor substitute. My most recent thread, several weeks ago, related to ways this still impacts my life. I felt very misunderstood. Feeling misunderstood feels like an attack. I tried to put on a strong front in my replies, while alternating between tearful keystrokes and slicing open my leg. I wanted to clarify and understand how I can better explain myself. I am extremely touchy about this issue.
I don’t need people to tell me to move on from it. I know I’ve been hanging onto this a long amount of time. It’s easy to tell a person to get over it and not understand why the issue is still hanging around.

Let’s look at this through Compromise Formation Theory which admittedly I don’t know a ton about, but the little I know leads me to feel it is particularly applicable here. I wouldn’t be doing something if it didn’t provide some benefit.

The negative part of this compromise is that I am still hanging onto this thing that happened nearly 3 years ago and have incredible emotional sensitivity to it.

On the other hand, hanging on to this issue is the only way I know how to feel some security. Letting it go feels like opening myself up to the possibility of it happening again. I would be too vulnerable.

My hyper-vigilance is both damaging and protective.

Periodically I do a very stupid thing and google the therapist who got me kicked out.
He’s developing quite the web presence or so he appears to think.
Up until recently, he thought it was a good idea, and not at all reminiscent of tacky 1990s websites, to include a hit counter on his blog.
I’ve taken a lot of pleasure in knowing how small his web audience is.
Yes, it’s petty, but it helps me.

In my more recent googling I learned he is publishing a book, set to come out this year.
It has a cutesy name, the same as his blog, and is about taking a trendy psychology concept and adapting it for
a young urbanite audience.
A blog I can deal with, a book is a different issue. It has the ability to reach a large audience. The thought of all these people reading his book and possibly thinking he is a great guy upsets me.
I wish I were brave enough to publicly tell everything, write my own book, so people could know the rest of the story about him.

I have these horrible images in my head of spotting his book in one of my professor’s offices. I need to keep my old world separate from my new one. A book on the wrong bookshelf would signify an invasion. The fear is almost as bad as if it were to really happen.

In reaction to this I did the only thing I could. I used my Internet knowledge for a tiny piece of vengeance, while not violating any laws.
I reported his domains to ICANN. He had blatantly false Whois info (I highly doubt his phone number is (999) 999-9999).
I got one of his domains suspended for a few days.
Again, petty, I know, but it put a smile on my face for a little bit.

I wonder if he knows I did it. Probably not.

I’m sure I’m much less on his mind than he is on mine. This is part of the problem. It hurts to see him achieving any level of success, when I still have a day to day struggle over what he did.

Within the past week, a blog post of his was featured on the front page of a highly trafficked pop-psychology website. I wonder how many people I know read his article, having no clue about our association.

I want to scream out to the world ‘Hey look what he did!’, but I can’t because what he did left me too scared.

Are psychology majors crazy?

crazypsychThe above image shows some search terms people have used to find this blog.  This tells me two things.

1. People want to know if psychology majors are crazy.

2. There are people who don’t realize a “?” is unnecessary for a search engine.

This post will focus on the first observation, rather than the second. Though I do think the second is also important.

Please note: This post is purely conjecture. I have not met every single psychology major in the world or interviewed a sufficiently sized random sample. I can’t draw real conclusions about an entire group. Everything I am saying is just based on personal experience.

The title of my blog is intended to be a little tongue in cheek. I’m a psychology major and I might half-jokingly refer to myself as “crazy” so it seemed like a good blog title. Humor is a useful defense.

So are psychology majors crazier than the average person?

I think everyone is a little crazy, just in different ways and in varying amounts.

It takes a certain amount of sanity to be able to be in college. I think a better question is “Are psychology majors crazier than the average college student?”

I can’t really answer that. I don’t think anyone can.

I believe that I am probably crazier than the average psychology major as well as the average college student.

I know a lot of “crazy” psychology majors. But I just in general associate myself with fellow crazy people. Some of them just happen to be psychology majors. The majority are not.

Looking at my peers in class they don’t seem particularly crazy. They could perhaps be excellent at hiding it. People have many different motivations for an interest in psychology. Personal experience is just one of them.

A psychology major who happens to also be “crazy” likely has greater insight into their problems. I believe that insight helps a person function better and thus makes them less crazy. It blows me away how little some non-psychology majors know about the problems they are suffering from. Knowledge is very beneficial.

A non-psychology major who I know was recently diagnosed with social anxiety. When I first met her, I assumed she already had been diagnosed with it, because it seemed obvious to me. Last semester she was struggling with her classes. A large part of the problem was her fear of talking in class for oral presentations (she’d skip class when she had one or put off doing the assignment) and she skipped appointments she made to talk to the professor for help because she’d get too anxious. Eventually she went to the school counseling center where she was diagnosed with social anxiety. She hadn’t had a clue there were treatment options for her problem and is now getting help.

A psychology major might not have needed to wait so long to realize there were options available for help.

Hypothetically, if psychology majors are psychologically different from other majors this would pose a problem for some research being conducted at universities. Many psychology classes at colleges offer small amounts of extra credit for participating in one of the school’s research studies. While many psychological studies do have specific inclusion and exclusion criteria, often (at least at my school and others I have heard of) the ones available for extra credit are open to all. If psychology  students are “crazier” this could potentially be hurting the results of the study and making them less able to be generalized to the whole population.

In conclusion, I don’t have evidence to say whether or not psychology majors are crazier than the average college student. I just think those that are, are more aware of their personal crazy. This might cause them to be more vocal about it and maybe seem more crazy, but in the end the additional insight they have is able to help them.

What do you think?