Crazy Days at Metropolitan State Hospital — Internal Stimuli

One day, a new patient was brought to our ward. This is unusual primarily in that most of our patients were long-term, and there wasn’t a whole lot of turnover. People didn’t often get out or leave, so seeing new faces was unusual unless it was for an extremely-rare family visit or new recruits joining the visiting Christians. The new guy was an older man, who looked like an old southern gentleman, with shoulder-length grey hair and a chin-puff beard. I don’t know if he had a southern accent, as he didn’t speak.

Paranoid schizophrenics don’t all appreciate or understand eye contact and a hearty handshake, so I left him alone. He didn’t speak, and mostly paced back and forth along the day hall, a ritual I wasn’t about to interrupt.

Our largely-Haitian custodial staff (and some MHA’s) were in the obnoxious and dangerous habit of speaking French to each other on the ward. A normal person not fluent in French might have suspicions that they are being talked about. To a paranoid schizophrenic, this is not only an absolute certainty, but it provides proof of a conspiracy against them, feeding into any number of delusions and agitating them beyond belief. For this reason, the hospital had a strict English-only policy. The policy was sometimes just ignored, with the predictable result that French-speaking Haitians tended to get attacked at an alarming rate.

On more than one occasion, I found myself rescuing one or more Haitian rejects. It pissed me off and I wrote them up. Knowing the patient was set off unnecessarily may have led me to be even more gentle when I restrained a patient, even though I might want to punch the jerk who should have known better. I never did, of course, though I’ll admit being pretty slow on the draw if the patient wasn’t in danger of getting hurt.

Sometimes, though, a patient would be set off by nothing in particular. More accurately, nothing external, as schizophrenics often had a disjointed internal dialog that could upset them or tell them to do things. This was referred to as “responding to internal stimuli,” and would appear on incident reports where a patient would appear to go off for no discernible reason. Even with medication, some patients were subject to bouts with their internal demons, so on the ward, one’s guard was never entirely down.

As I sat in the day hall chatting to a patient about one of their problems, the new guy walked back-and-forth, back-and-forth in front of us. Nobody paid much attention, though I tried to keep an eye on “the Colonel,” as I thought of him, without it seeming obvious that I was keeping an eye on him, which can be a trigger for an episode. So mostly, I listened to his feet, and didn’t look at all.

The footsteps halted abruptly near enough where I could see his feet, even looking down. A lot happened at once — he reared back, and his foot came up. With a small measure of pride, I can say that my first thought was how I could keep the Colonel from hurting himself. With a larger measure of embarrassment, my second thought was “here comes a foot right for my FACE,” and since I didn’t want to knock the guy onto the concrete, I decided to lean back to minimize the blow and get kicked in the face. Decided is probably far too strong a word, as ruling out more potentially-harmful-to-the-patient options as his leg was in motion left me with very few choices of action, most of which involved a facially-visible shoe print.

Agitation breeds agitation, so a lot of the patients started yelling and getting upset. The Colonel lost his balance with the initial blow, his fists balled with rage, body shaking, face strangely impassive. I grabbed him and we fell to the ground together. “It’s okay,” I said calmly, “I won’t hurt you.”

Other MHA’s showed up and they walked him down to the restraint room. Since I’d been kicked, I was instead sent to the nurse, who looked at the tread on my face and said, “those look like Converse All-Stars.”

As they struggled to restrain him, the MHA’s noticed dollar bills on the floor of the restraint room, which had fallen out of the Colonel’s many pockets as he tried to wrestle free. He’d apparently had nearly $500 in small denominations crumpled and stuffed all over his person, which was inventoried and placed in safekeeping to be returned to him upon his release.

I didn’t see him for a while after that, but while I was sitting on the day porch, he marched out and fixed me with a wild-eyed look. I was wary, but not openly defensive. After a moment, he sat down next to me.

“Sorry about kicking you,” he said with a sigh. “Money just makes me so crazy.”