I was spending time on a hospital psyche ward over Christmas one year when I happened to meet a very animated and colorful personality who suffered from schizophrenia.  She would sit and brood while she smoked these long cigarettes, her eyes would smolder under a nest of tangled jet-black hair.  She would gesture grandly and call the place her “Hassle Castle” in a thick Romanian accent, stating with a hiss that she was its queen.  And you know, the name kind of stuck in my mind, for different reasons, of course, it seemed oddly appropriate.  Let me explain. 

            There are many reasons why returning to hospital can be both a very disturbing and unnerving option for bi-polar sufferers when they are in the midst of extreme instability.  This reaction may not be caused by the onset of trauma brought about by horrific memories of past hospitalizations, no, not in the least, it may be because of something entirely different in nature.  They may baulk at hospitalization due to deep-set belief systems about mental illness, their own ideas about the disorder and its direct influences on their emotional health.  Then there are the issues involving the actual hospitalization in general.  The infringements on one’s personal freedoms that may occur, and the loss of homely comforts, can actually cause some people to avoid hospital admittance for as long as they can possibly put it off.  These factors, alone or added together, may in fact cause the hospital to appear more of a “Hassle Castle” than a place of sanctuary.

            Here are some examples of why some bi-polar sufferers may hesitate in returning to hospital.  These are just few, there are many others, you may or may not find one that matches your situation.

1. There are a lot of people who feel like failures when they have to be hospitalized a second or third time.  Most of the time people who have been treated in hospital for mental illness like to believe that each stay on a psyche ward will be the last time they will be in need of such an institution. They fail to realize that their illness is a life long disease and that institutions like psychiatric hospitals may be a form of treatment needed for the rest of their lives.  Albeit, their visits to these institutions may be sporadic, and at times far between, they will have to eventually come to this understanding about their disease and its long term treatment over the span of their lives. They feel that their mental illness is a weakness (and they believe in the stigma of *mental illness) that they should be ashamed of and should hide at all cost, even at the cost of their own well-being.  They don’t realize how much inner strength it actually takes to battle mental instability.  When they have to return it’s like a crushing blow to their self-confidence when they discover they are mentally unstable, out of control, and emotionally needy all over again.  They come back to the hospital begrudgingly, seeing it as a place of failure and disappointment, a place to crawl back too and hide their heads in the sand.  They don’t want the help offered them, the hassle; they are too busy licking their wounds.  

            2. Then there are the people who steadfastly believe that they are not suffering from any illness and deny they have problems beyond their control.  They too have a problem with the whole issue of the *stigma of mental illness, but their most troubling dilemma is the matter of being control addicts. They presume that they can handle their emotional crises on their own without help from medications or other medical therapies because they are not ill.  They treat prior hospitalizations and mental crises as minor hiccups in their personal lives, misunderstandings of teen angst, misdiagnoses of overzealous doctors, and on and on.  They avoid the hospital because they know on the ward they have to admit that they have a disease and that they suffer from problems that may be beyond their ability to properly control.  They have in the past had to give themselves up to the care of hospital staff.  They have even had to allow psychiatric professionals to make decisions on their behalf and have had to give the doctors permission to take a modicum of control away from them psychologically *(environmentally too). 

These patients find situations in which they must sacrifice any degree of personal control to any individual, especially psychiatric professionals, an excruciatingly difficult experience.  It makes therapy a haltingly methodic process.  Many times these people will wait until they are completely handicapped by their illness, and unable to manage on their own, before they will seriously consider another hospitalization.  More often than not, however, these same people become too ill to be able to determine what is beneficial to their mental health, all the while being convinced they are handling their illness effectively on their own.  Sadly, these people are gravely mistaken and misguided about their mental health needs. 

3. There are those who may be suffering from very advanced forms of their illness.  They may not be able to fathom or grasp the idea that at that point their illness may have a suffocating grip around their psyche and they are no longer thinking for themselves in a cohesive manner.  Their behavior becomes increasingly erratic and unhealthy, even dangerous, not only to themselves, but also to those around them.  They eventually need to become institutionalized for their own safety.  Many times these people have interrupted their drug regime convinced that their medications are bad for them in some way, shape, or form. They stop visiting their therapists and other mental health care workers believing they are only there to toy with their minds or waste their time with a lot of useless psycho-babble. 

These people increasingly become too ill to be able to decipher whether or not they should be in hospital.  A lot of the time they become too ill to willingly, of their own free will, readmit themselves to hospital and must be accompanied there by friends or family members, or unfortunately, end up coming in through emergency services.  At this point, these people are so advanced in their illness they are often acutely averse to the idea of institutionalization.  They are oblivious to the ravaging progress their disease has had on their mental health and are unable to rationalize any form of treatment.  Unfortunately, people suffering from such extreme advances of their disease must at times be committed without their consent for their own safety and welfare.  It may be the only way they can receive proper treatment and care.  Sadly, it comes at a cost, the patient has to suffer the pains of returning to the ward unwilling and uncomprehending his/her treatment until he/she is returned to therapeutic medication levels, which could take a number of weeks until he/she is completely stabilized.    

4. One of the reasons why some former patients may baulk at the thought of hospitalization is the thought of having to go through the hoopla of the admittance process, and then being turned away.  Everyone knows what an emergency ward admittance process can be like.  Well, consider having to go through it whilst experiencing severe mental instability. The long waits in over crowded waiting rooms, having to repeat yourself over and over again to complete strangers, the possibility of not receiving treatment because all the psyche beds are full.

-“ I once had to spend five hours in an emergency ward only to be told all the beds were full on the psyche ward of that particular hospital.  I was suicidal.  They told me if I spent the night in the emergency ward I had a small chance I might be able to get a bed.  So I did, I took my chances.  I spent the night in a room that was full of cupboards marked “scalpels”, etc., with a guy sitting in the doorway watching me the whole time.  It was an emotionally painful experience, I didn’t get much sleep, but I got my bed.  I wouldn’t want to do it again any time soon.”-

 You may be fortunate enough to have a doctor who refers his patients to a nearby hospital psyche ward, some people do, and some people don’t.  Unfortunately, when one goes through emergency a person really runs the risk of chance, it’s a coin toss really.  Sometimes you are lucky, and you are admitted, and then sometimes you are turned away.  It is truly very difficult to go through all of that admittance hoopla, especially when a person is emotionally sick, but sadly it is a necessary evil to get the help you need.  If there is no room in the psyche ward of the hospital you have attempted to admit too, ask if there are any free beds at another one nearby.  Sometimes they can refer a person on to another hospital and hold a bed for you there.  If you are given the option of waiting for a bed to open, if for a night, or a few hours, take it, it may be your best chance to get the help you need, especially if you are suicidal.  The way I look at it is at least you are in a hospital, be it in the emergency ward or in the psyche ward, get any help where you can get it.  It may sound glib, but suicidal tendencies are something to be taken very seriously and help should be sought through every avenue.

5.  Another hardship bi-polar sufferers come up against when facing a potential admittance to hospital is the knowledge that they must separate from their family for an extended period of time.  This can be extremely difficult for mothers/fathers of young children, teenagers, or spouses whose relationships are new and/or are perhaps in some sort of jeopardy.  The person, whatever the relationships they leave behind at home, feels separation anxiety.  They feel they will abandon their loved ones emotionally and physically, which is very hard for them to reckon with when they do not know how long they will be away.  When these people do submit themselves to hospitalization they often are wracked with guilt and a sense of helplessness.  They feel helplessness since they are unable to provide any parental/spousal care they believe they are responsible to impart because they are physically separated from their family’s situation.  What I mean by this is, they are not able to be physically present if there is a family event such as, a school concert or something as simple as kissing a child after they hurt themselves on their bike. They also experience guilt that they are not emotionally available to their family on a daily basis.  This separation anxiety can wear down a person’s resolve, it can tear apart a person’s sense of well being.

Often a patient will become so wrapped up in what might be happening at home without them that it will begin to affect the integrity of their treatments in hospital.  These people will often ignore the advice of their doctor’s and will push for an early discharge believing it to be the best for their family.  Many times these patients end up leaving the hospital before the proper time has passed for their treatment to be effective.  Some patients don’t even make it as far as the admittance process, they refuse to abandon their family.  What they don’t realize is that they are doing their family more of a disservice by staying home and becoming more of a burden by becoming increasingly more ill, than if they had just gone to the hospital, stayed the proper allotted time of treatment and gotten better. 

            In conclusion, whatever your reason for not admitting yourself into hospital, even if it isn’t in the list above, please reconsider it carefully.  There are a lot of things that can make hospitalization seem like a painful and emotionally distressful process, and I am not denying it can be very disturbing.  If, however, hospitalization is what your doctor recommends, or you are suicidal, please go and get the help you need.  Nothing can be worse than being severely emotionally unstable and not getting the help you need.  If you stay at home it only hurts the ones you love, they don’t know how to properly care for you, they can’t give you the therapy you need.  Your family sees someone who is no longer their loved one but someone else who has taken over their sister/brother/spouse mother/father/ mind. They only see someone who is terrifying and confusing. Therapy for some ailments may need more than just simple psychotherapy treatments once every two or three weeks.  A patient may have progressed in their illness to the point where they need to be immersed in a therapeutic environment for an extended period of time.  In these cases a hospital environment is the only and necessary option. There is a use for hospitals, use them to your advantage, when you need them.

• What I mean by environmental is the actual ward itself.  The confinements and rules one must submit oneself to when staying on a psyche ward.          
• The stigma of mental illness- To many people mental illness means: terror, dark deeds, babbling speech, loud yelling, jerky motions, menacing movements, glaring and mean smiling, sniveling, creepy, continual crying, losing touch with the world around you, suicide, murder, etc.  All these things are cruel and bad descriptions.   People see those suffering from mental illness not as ones to pity, but to avoid.  They view them as if they are not human, but less than human; somehow only appearing as human in body, but not in spirit, and so not deserving to be treated as one.  They know only what they have seen in films, television, or read in books.  All of these mediums portraying mentally unstable pitiful souls as loathsome or pitiful characters with less than scrupulous traits.