June 19, 2024

Years of researching health psychology didn’t prepare Alice Black for her own stay in an acute mental health ward.

The Sunday Essay is made possible thanks to the support of Creative New Zealand.

Illustrations by Austin Milne.


Disclaimer: Memory is fallible at the best of times, but my memory of hospital is distorted by the experience of mania. This is what I remember. I cannot guarantee it. 

‘You leave your dignity at the door when you enter a psychiatric hospital or you give birth and pick it up again on the way out.” These were my mum’s words of comfort when I complained about my experience at Te Whare o Matairangi, a 24-hour mental health assessment and treatment service, after being hospitalised for my first manic episode in mid-2023.

I have a MSc in health psychology and a background in mental health research. I thought I knew a little bit about the system. It quickly became apparent, however, that I had no idea just how grim a place an acute mental health ward really is.

In the first ward I was in, my room simply consisted of a mattress on the floor. There were frequent visits by security staff and there was a general climate of fear. After I was moved to another ward, I commented to a staff member that my experience in the previous ward had been worse than being treated like a dog on the street. They justified the mattress on the floor with some vague reference to safety. There was nothing much else to say.

I was initially restrained and given injections by force. I wondered, as I was lying on the ground with my limbs pinned down, how any of this could be legal in Aotearoa in 2023. At one point I had my boots confiscated for kicking the staff while I was being restrained. Unlike most of my memories of the hospital, this one makes me smile.

I’m what people refer to as a “strong woman”. I used those words to describe a relative at her funeral and it was a euphemism for “cruel and borderline psychopathic”. I don’t think I’m either of those things, but I am blunt, and I haven’t genuinely respected authority figures since I was in primary school. But regardless of your personality, I think being trapped in a mental health ward against your will would test anyone’s interest in compliance.

I’m not a violent person, but I do have a Tony Soprano complex, I see Malcolm X as a social justice hero, and I think guerrilla warfare IRA-style is morally sound. Malcolm X once said, “Be peaceful, be courteous, obey the law, respect everyone; but if someone puts his hand on you, send him to the cemetery.” Manic or otherwise, nobody was going to touch me without my consent. Long story short, my psychiatrist eventually gave up on the injections and I got my boots back.

A couple of years ago, I co-authored a paper on men’s experiences of mental health stigma. Suddenly I was having compulsory treatment under the Mental Health Act in the immediate vicinity of my former employer. I don’t think there are many things more stigmatising than being committed in a psychiatric hospital. It was a waking nightmare. Even while I was manic, I was aware of a bitter irony. My former employer published a large review of acute mental health settings and found them to be places of terror and violence. They found service users lacked autonomy and a sense of care, experienced an atmosphere of paternalism and boredom, and felt physical confinement and lack of activities contributed to violence on the ward. I was now one of those service users.

I’ve been back home for a while now, but the power dynamic is ongoing. I have to attend reviews – I’ve been referring to my monthly engagements with the community mental health team as my “parole meetings”. Despite the team’s attempt to build a therapeutic relationship with me I find the meetings, by virtue of their compulsory nature and stressful content, extremely unpleasant and they usually bring my mood down for days afterwards

I’ve been relieved to find I share a common experience with others, but also saddened to find what happened to me is not unique.The He Ara Oranga inquiry of 2018 found the current Mental Health Act to be outdated and coercive.They recommended that the government adopt a human rights-based approach, one that prioritises shared decision-making and minimises coercive treatment. It’s heartening to know that the MHA is under reform, but it’s ultimately not going to make a difference unless the hospital’s physical (custodial) environment also changes. It is a self-fulfilling prophecy to put people in an environment that so closely mirrors a prison and then call security on them when they (so predictably) lash out, as I witnessed numerous times.

After the injection failed and the medication wasn’t working, I was given electroconvulsive therapy (ECT). It was terrifying at the time, but it’s ultimately a pretty standard (and highly effective) procedure and I would have it again if I was experiencing symptoms. However the context in which I received ECT was less than ideal.They initially anaesthetised me on a hospital bed in front of the entire ward and I was surrounded by students. It was humiliating and degrading. I had no idea what was happening and thought I was having an EEG.

When I finally realised what was going on, I was mortified. I told my psychiatrist I didn’t remember giving consent and he said that that was because I didn’t. The opinions of two psychiatrists overrode my say in the matter. I’d never experienced such an abject loss of power. It reminded me of how Janet Frame was almost given a lobotomy before she won a prestigious writing award. Now that I’m doing better, I can see that the severity of my symptoms warranted ECT, but that doesn’t make the complete disregard of my agency any more palatable. Contra Janet Frame’s near miss I think having had ECT will ultimately help with my writing aspirations – I just want to be like Joe Bennett by the time I’m middle aged okay, if that’s delusional then I guess send me back to the ward.

Comedy about hospitalisation and mania helps me process the distress I experienced. There’s an episode of Peep Show where Jeremy and Hans try to get Mark sectioned, for example.

I also listened to a lot of Kanye West, the poster boy for bipolar, in hospital. And, of coming out of my manic episode I would simply say, “Bitch I’m back out my coma”. 

Comedy normalises my experience and I’m so grateful to live in an era where bipolar memes and reels are available. 

 

After I got out of hospital, my favourite message came from a good friend and former flatmate. I couldn’t remember what he knew so I just said that I had had a pretty rough few months, but I was getting better.

He replied:

“Oh shit! Sorry to hear about how mental you are! Always thought you were a bit of a lunatic. Just joking…obviously a serious thing. Just wanted to see if you still had your sense of humour?”

It was exactly the response I needed. My friend Áine similarly reflected: “Hard yards make hard cunts.” Humour is the antithesis of trauma. It is my peace.  

Mania is terrifying, by the way. I’ve heard people talk about the “high” as being enjoyable because you can feel confident and charismatic. Well, I normally feel confident and I can be fairly charismatic when required (e.g. shortly after being discharged, I confidently [and insanely] gave Aragorn’s Black Gate Speech at my brother’s wedding). However, at no point when I was manic did I feel “good”. I felt terrified and paranoid and when I was in hospital, I thought I was going to die.  I was caught up in a number of delusions that no one could reason with (see below), and I couldn’t tell what was real or who I could trust. There was no escape.

One of  the symptoms of my mania was that I became completely fixated on a hospitality worker that I had previously simply had a crush on. I normally form crushes on pretty much every barista, bartender, supermarket checkout operator and Bunnings employee that I meet. I love to flirt and I hate to follow through (you can’t be let down if you never actually get to know someone!). 

This particular delusion persisted throughout my stay in hospital and even after I got home it took me a while to put together what had happened and accept it wasn’t real. Having to let go of the reality I built up around this person while I was unwell was more gutting than any “real” break up I’ve ever had. Partly that’s a testament to the mediocre men I’ve dated (not all of you, please don’t message me), but partly it’s just the fact that what was a delusion by DSMV standards was still real to me at the time. It no longer feels sad, I can accept it as a symptom I had no control over. But it does feel mildly embarrassing because regular Alice would never put a man (except one of my many wholesome middle-aged role models) on a pedestal. Regular Alice very quickly writes off almost all the men she encounters and then wonders why she is single.

The worst part of the whole experience was the boredom; being isolated from my friends was a close second. I actually missed work, or more accurately, I missed the 30 coffees a day I have with my friends while at work.  Everyone determined that I was at too great a risk of damaging my reputation so I had my phone and laptop taken away from me and I was given what I can only describe as a “burner phone” with the numbers of five close friends. As a raging extrovert who is in constant communication with all her close friends and family, I found this part unbearable. I also couldn’t listen to comedy (which I can confidently say is my primary coping mechanism). Thank you to Scottish comedian Limmy and my favourite podcast, Uhh Yeah Dude for keeping me “sane” (I’m still mental, just in a more socially acceptable way) when I finally did make it out of hospital.

My family and close friends have been incredibly supportive and caring. I’ve received flowers, coffees, homemade scones, books and magazines, kind messages, visits, a trip to Kapiti Island, and most importantly, unconditional love and support.

There is nothing like a crisis to tell you who your real friends are, however. A few friends distanced themselves from me after I got out of hospital. Two people actually ended an eight-year long friendship and a couple more have stopped talking to me but bizarrely still watch the odd social media story. It would be nice and #wholesome if I could be accepting and forgiving of all of that. But unfortunately, in peace times I am a vindictive bitch. So to the people who peaced out while I was at my most vulnerable, I say what Malcolm Tucker said to his former colleague in The Thick of It:”Sorry you had to go but let’s face it you are a fucking waste of skin.” Mania is something I experienced for the first time at 31. I couldn’t have predicted it and it’s not something I’m going to feel guilty about.

The article by my former employer concludes with a question around whether mental health facilities are places of healing or of custody. I had a great psychiatrist, the support of my family, and eventually the right treatment. But being in an acute mental health ward under the Mental Health Act felt like being in a violent relationship, one I Iegally could not escape. Bring on the reform.

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