Lifestyle Choices

Hospital may be advised or needed in cases of black or white depression. If you or a friend are likely to be admitted, it is worthwhile considering the advantages and disadvantages.

Advantages

Hospital provides a refuge, a place of asylum. Although the concept of asylum has had rather a bad press in recent years, for someone who is desperate, a period of rest can be a life-saver. Hospital provides a break from all the pressure of the outside world and a place where most basic needs are taken care of. For someone in the very depths of hopelessness, a period of asylum can break the vicious circle of trying to perform, failing, feeling worse, feeling the pressure mount higher, trying again with even less hope, failing, and so on. Asylum does not necessarily need to be a hospital, but the reality is that there are few places that are willing or able to deal with very severely depressed people.

Your family or friends may look after you for some time if you are not capable of looking after yourself. However, it can be extremely difficult and exasperating to care for someone who is severely depressed. When these feelings are apparent in those who are looking after you, you are likely to feel even more guilty and may be relieved to have previously unknown professionals taking care of you.

Sometimes, it may be easier and safer to administer treatment in hospital, particularly ECT or the beginning of lithium therapy. Some treatments cannot be done on an out-patient basis (for instance, combined tricyclic and MAOI anti-depressants) because they need the careful monitoring available in hospital.

Admission to hospital will be necessary if you are a danger to yourself or others. Although it is very rare for a depressed person to be dangerous to others, it can occur in white depression when you believe you are doing loved ones a favour by helping them out of this world. Every year there are tragedies of psychotically depressed mothers killing their children. Much more commonly, you may be a danger to yourself and the hospital may provide some protectionagainst suicide. It is not the answer for most suicidal people, who need guidance and counselling, but may provide interim protection for some.

Some psychiatric hospitals have a “therapeutic community” in which selected patients are encouraged to work together and help each other. This can provide useful feedback from people not (initially) emotionally involved with •you, and a chance to be useful and regain some feeling of self-worth. Group psychotherapy is used to facilitate these processes.

Disadvantages

The drawback of hospitals, apart from their enormous expense, is that they tend to encourage abdication of responsibility. There are times when this is appropriate and useful (for instance, in white depression), but for some the possibility of being looked after encourages passivity. Since publicity about the effects of institutionalization, hospitals have in general tried to provide an atmosphere in which patients have more of a sense of individuality (for instance, wearing their 41. own night-clothes and having their personal possessions around them). Hospitals have also tried to encourage more self-reliance, by offering half-way houses between the hospital and the outside world, and by encouraging earlier discharge and more day-patient and out-patient care.

The problem is that however much the hospital offers and provides in terms of promoting more patient responsibility, it is still the hospital that is doing the encouraging. There is a temptation, however well the hospital is run, to use it as an easy escape route. A patient who said she saw an elephant sitting on a lamp post later told her psychiatrist that she just wanted to get back to hospital again — she had had enough. When I worked in psychiatric hospitals, I was saddened to see how many people would get better temporarily and then be readmitted. For some people, part of this was due to the fact that they very clearly did not want to look at why they had become ill or at the ways in which they might have some responsibility for their condition; nor did they want to think about ways in which they might improve themselves or their situations so that a recurrence was less likely. Instead, their basic attitude was to seek the pills or treatment for their condition in such a passive way that it seemed that their condition had nothing to do with them. They would then go back to exactly the same situation, which might well precipitate another crisis. Sometimes it was hard to know how much this passivity created depressive episodes and how much the passivity was part of the depressive process. Either way, the hospital has the very difficult task of being required to look after those who have become incapable, and yet at the same time to try to encourage more self-reliance.

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