VIEWS FROM THE INSIDE: A Commentary on Therapy PRESENTED: Japan, August 1997 BY: Marie F. McKenzie WHO AM I? I am a psychologically integrated multiple personality expatient. I have been ONE for 15 years. Dr. Ralph Allison made the diagnosis in 1978, and we completed the integration in 1981. My past history is full of major abuse by my father, stepfather and husband. The abuse was physical, sexual and emotional. Over time I learned that I had to be passive and pleasing in all ways, especially to adult males. I learned early on not to make difficulties or to cause anyone to be unhappy. If I did, I would be punished severely. I also learned to read others' body language and word tone so I could protect myself. I also learned that nobody will ever know what is going on in my family. It was all SECRET and, if I told, I would cause great hann to my family or me, and they would not love me. OBSERVATIONS AS AN INPATIENT - WARD STRUCTURE County Hospital Psychiatric Ward: The building was made of concrete and the windows were barred. The white walls were dirty and smelled of urine. The doors were made of steel. The entire place had no color or warmth. My Reaction: I felt more depressed, defeated, whipped, and tired. I had to get out of there to feel human. Private Hospital Psychiatric Ward: The building had character, color, warmth, and charm. The patient rooms were carefully decorated with soothing colors. There were different areas to be in, both inside and outside. The ward provided an atmosphere of caring. My Reaction: I felt cared for and mothered. I liked the place, but it was too nice. I felt no need or desire to improve. County Hospital Seclusion Room: The room was 10 feet by 6 feet, with a bed bolted to the floor. The walls were cold and painted a dirty yellow. It was an inhuman environment with no toilet, even. Bright lights in the ceiling were left on all the time. The locked steel door had a steel mesh grate as the only window and a slot through which the food tray could be pushed. The place smelled of urine. My Reaction: OH MY GOD!! I was not a human, but abused, cold, defeated, exhausted, in despair, with no hope and no chance of help. State Hospital: The three bed ward had old cement walls with new paint and a locked steel door. My Reaction: I felt controlled. My freedom was gone. I was dismayed and concerned but at least I had time for reflection. NURSING STAFF & PROCEDURES County Hospital Psychiatric Ward: They stripped all patients and injected them with tranquilizers. They left the patients alone, and acted uncaring and unfeeling. It appeared that they just had a job to do, with keeping us quiet being the primary objective. My Reaction: There was no one to talk to. I felt like an animal who was told to stay still and be passive, do what I was told to do. It was more abuse. I felt not worthy - not a human. Private Hospital Psychiatric Ward: Nursing staff interacted with patients, and came to feel that we, the patients, were like staff. The nurses were too nice as helpers and had to make everything comfortable. They had to please everyone. My Reaction: The staff members were pushovers, who had no plans, no direction. They needed for us to be perfect. They were too nice and did what we patients wanted them to do. They wanted to be us, to be taken care of. County Hospital Seclusion Room: Nurses did what the doctor told them to do. They were subservient and pleasing only to the doctor. My Reaction: None. No interaction or talking was allowed. State Hospital: Nursing staff was quiet but interested and left us alone. They stayed away, isolated in the nursing station. My Reaction: I felt alone, separated, but I was glad to have peace and quiet for the short time I was there. PSYCHIATRISTS County Hospital Psychiatric Ward: The doctors did the intake workup and prescribed medication only. My Reaction: They were very distant, offered no conversation. They did not seem to care and acted matter-of-factly. They were too busy to have time for patients. Private Hospital Psychiatric Ward: They saw their patients once a day for 10 to 15 minutes, read nurses notes but did not have the time for therapy. My Reaction: They did not care and were always too busy for any therapy. County Hospital Seclusion Room: They were POWERFUL, UNCARING, CONTROLLING, UNFEELING. My Reaction: I was defective, horrible, at fault, bad. State Hospital: The psychiatrist did the intake workup but had no other contact. My Reaction: None. OBSERVATIONS AS AN OUTPATIENT - OUTPATIENT THERAPY Office Layout Private Office: A large desk was placed in front of the patient, a couch was in the corner, and a chair in front of the desk. My Reaction: The desk was a barrier. It felt cold, impersonal, sterile, and seemed modeled after the psychiatrist's office commonly seen in the movies. County Mental Health Clinic: The desk was next to a wall, with a chair next to the desk. The patient and doctor were sitting at 90 degrees to each other. There was no couch. My Reaction: The layout showed concern, trust, without barriers. I felt connected to the psychiatrist, another human being. THERAPISTS STYLES Freudian Orientation: Psychiatrist felt comfortable with rules and kept answering questions with questions. He felt he had to be in control, safe, and orderly. My Reaction: I was not to ask questions. I was to he superficial, cautious, careful. Honest answers were not wanted. Jungian Orientation: He asked about my "Shadow," telling me I must have one. He kept using words that did not make any sense to me. My Reaction: I did not know what he was telling me. He thought I had something called "The Shadow," That was scary. I thought he was trying to put on airs and show off with his added education. Conversationalist (without hypnosis): He wanted me to talk only about today's problems. He felt comfortable and did not like rules. My Reaction: I was bored talking about the same problems each time. There was no motivation to change. I could just talk without having any goal to reach. Interactive with Hypnosis: He pried into my mind, seeking truthful answers. My Reaction: Here was someone who know what to do. He could also be a friendly human being.