Reasons for coming in.

A lot of folks are understandably curious about what brings people into a psychiatric hospital. I was just reviewing a stack of my notes from first meetings with patients, checking on the reasons they came in. Typically, hospital admission notes include a “Chief Complaint”, or “CC”. Docs differ in how they record the C.C.-- some summarize and editorialize (e.g., “Industrial accident with likely left lower extremity fractures”), while others utilize a direct quotation from the patient (such as, “I mashed my leg in a machine”). Personally, I like the direct approach, which I think helps illustrate the situation better. So, usually, I just ask people why they’ve come, and record whatever they say next. Here is a fairly comprehensive list of the answers I’ve had over the last year, in random order (and with all possible identifiers removed, of course). I think, together, they shed some light on the pathos involved in this work.

Q: “Why are you here at the hospital?”

A:

• “I don’t want to talk about it anymore.”
• “My life’s f----ed.”
• “Well, they pulled another fast one on me.”
• “Dr ___ wanted me to come in.”
• “My friend was f—ing that guy out on the porch.”
• “I asked to go to Canada. I am supposed to be there now. There were going to adapt me to their country and provide what you can’t.”
• “The staff over there were terrible to me.”
• “I don’t know why they sent me here.”
• “I was hearing voices.”
• “Someone pointed a high-power laser scope on me.”
• “I’m here for an evaluation.”
• “I really have no idea what’s going on.”
• “I got depressed and I overdosed.”
• “I’ve been doing some work for the CIA—it’s been very taxing.”
• “Dr. ___ wants to play little toys-in-the-attic games.”
• “They say I need long-term treatment.”
• “I was thinking about killing myself.”
• “I was kidnapped by the government!”
• “I got screwed—they put me in against my will—it’s a hell-hole.”
• “I want to commit myself—I’m almost coming down with a nervous breakdown.”
• “Thank you so much for smiling—it is so lovely to see you.”
• “I need something right away—I’m having a panic attack.”
• “I thought my brother was out to get me.”
• “Someone sent an email that they were concerned about me, but it was all a mistake.”
• “I’m so sleepy I can’t even talk.”
• “They said I hit her, but I don’t remember!”
• “I can take whatever they’re going to dish out!”
• “I told them 4000 times that I wasn’t safe to leave—and sure enough, when I got home, within an hour I had locked myself in the bathroom and was cutting with a razor.”
• “I wasn’t safe.”
• “I had a s---load of trouble.”
• “I own this hospital and I’m leaving.”
• “The voices were getting bad.”
• “My case worker was getting on my nerves.”
• “My mother came at me with a newspaper.”
• “My knee is out of place.”
• “Too many van rides—wore me out.”
• “I don’t want to talk to you.”
• “I said goodbye to the people at [other hospital]. I get better treatment here.”
• “I had to get the hell out of the house.”
• “I’m sorry I ran away”
• “They told me the police were going to come if I don’t go to the hospital.”
• “I signed myself over to the United States of America.”
• “I can’t sleep no more—I see blood and guts.”
• “I didn’t light the fire like they said I did.”
• “They said I had to come here because they weren’t able to help me.”
• “You’re not going to be able to keep me safe.”
• “I don’t want to go to hell!”
• “Rough night in that brain damage.”
• “49 years, no sleep.”
• “They told me I need a group home.”
• “I didn’t like it at that other place.”
• “I don’t like your looks. I don’t care who you are.”
• “They were afraid I was going to kill myself.”
• “I guess I have a demonic problem.”
• “President Clinton says I have a house.”
• “Someone upstairs was insisting that I cook them an omelet.”
• “I was going to blow my brains out.”
• “The cops came in through the window because I was working on particle interfaces.”
• “I was thinking about suicide.”
• “I don’t need to be here. I’d be fine at home.”
• “The Lord told me to destroy the apartment.”
• “Turn off the light, I’m sick.”
• “I got a little wound up yesterday.”
• “I need long-term treatment.”
• “I had an argument with my mother so she put me back in the hospital.”
• “Don’t need any help.”
• “All I need is a cigarette. I’m getting outa this place.”
• “All I need is a social worker to find me a cabin in the woods with a refrigerator and freezer stocked with food.”
• “I had a lot of problems in prison—I flipped out.”
• “They say I’m severely depressed.”
• “I feel like my brain has melted.”
• “There’s nothing wrong really.”
• “Racing thoughts… not myself”
• “My legs and arms have something wrong with them.”
• “I’m going to rip your f---ing a---hole and tear your f---ing Jew c--k off you f---ing lesbian p---k!”
• “They had me on the wrong medications, and my apartment was too high up.”
• “I tore up my apartment.”
• “I’ll be fine when I get my book about my magical bear.”
• “I was feeling suicidal. They discharged me too soon.”
• “I started hearing voices again.”
• “I stopped my medications and was depressed.”