How to survive in a psychiatric hospital without consequences? How do they live in a psychiatric hospital?
Let's say you woke up from an unfamiliar noise in a completely unfamiliar environment. By the look of pajamas on people like you and white coats on people “not like you,” you realize that you are in a hospital. Well, from the look and behavior of your neighbor tied to the bed, you begin to guess that this hospital is psychiatric.
For the sake of experiment, come to the emergency department tomorrow psychiatric hospital and try to pretend to be sick. I assure you, you won't succeed. ( And if it happens, we are not to blame and we were not involved in incitement. approx. editor.) The fact is that in such a science as psychiatry, there are clear criteria for each psychiatric diagnosis. And even if you read about them on the Internet, you are still doomed to failure. I'll explain why. In general somatic medicine, all diseases have three outcomes:
- Recovery
- Chronicity of the disease with improvements and exacerbations
- Death
IN psychiatry To these three, another fourth criterion is added - personality defect. This is what the psychiatrist identifies by comparing your stories with the stories of those who brought you and the clinical picture.
What's happened personality defect? Imagine yourself as an alcoholic who has given up. You can easily identify such a person, even if you are not an HR inspector. Or remember that among your surroundings there are people with “weirdness”. When a doctor interacts with such patients on a daily basis, he intuitively identifies sick people, even if they appear “normal” at the time of examination. So pretend mentally ill almost impossible. ( We are, of course, talking about a normal situation when doctors take their responsibilities seriously. approx. editor) Therefore, think about the question “?” before “downloading your rights.”
Long gone are the days when psychiatry there were dissidents or inconvenient people. Since 1992, Russia has had a law “On psychiatric care and guarantees of citizens’ rights during its provision.” This means that whoever put you here is criminally responsible for it. If you think you are here by mistake, here are some helpful tips.
First. Sooner or later a doctor will come to you or you will be taken to his office. In a calm voice, ask his last name, first name and patronymic, and also inquire about the name of the hospital, number and profile of the department. This will make it clear to the doctor that you do not remember the circumstances of the hospitalization and, accordingly, could not give your consent to this. If the doctor assures that you yourself asked to be “treated” and signed a consent to hospitalization, then ask him to show you this consent. Don't be surprised to see a signature similar to yours on a document. If you are sure that this was not written by you, tell your doctor directly about it. The doctor will ask you questions. Some of them will seem strange, and some will seem offensive. For the sake of example:
What time of year is it now? Day of the week, month? Where are you located? Give the full name of your parents. What do you do, what educational institution did you graduate from and what is your current job? What did you do yesterday? And a week ago? And so on.
This is ideal. In fact, the doctor doesn't care WHAT you say. What matters is HOW you say it and whether your story matches the stories of those who brought you here. Think for yourself - if you don’t work anywhere and drink away your mother’s pension, you smell of fumes, and you are a regular client of the office, then what can we talk to you about? IN psychiatry They don't listen to what you say at all. This science compares your words with your deeds. So I repeat once again, look at yourself and your life critically before “downloading your rights.”
But it also happens differently. In my practice, there was a case when a woman, while doing renovations in her apartment and inhaling paint, “caught” a real psychosis. The hallucinations stopped as soon as the inhalation of the toxic substance stopped. The woman was treated and discharged with a neutral diagnosis the next day.
Second. Patient psychiatric hospital signs two informed consents at the very beginning of his stay there. The first is consent to hospitalization, and the second is consent to treatment. If you think that you are here by mistake, then do not sign any papers. In this case, the doctor will be required to call a judge from the city court to issue a ruling on involuntary hospitalization. The doctor has no more than 72 hours from the moment of hospitalization to do this. When the judge arrives, you will be invited back to the doctor's office. In addition to the doctor you already know, there will be other doctors present. For example, the doctor who “admitted you” or the dispensary doctor who wrote out the referral for hospitalization, the head of the department and the deputy chief physician for medical work. In a calm voice, ask the judge’s name and ask to see his official ID. Tell the judge that you believe your hospitalization was unlawful. Also report staff violence towards you if it occurred. There is no need to suspect the doctor and the judge of collusion. Even if your relatives pay one of the doctors, the judge will not want to risk his salary and official position for the sake of immediate gain. Or do you really value yourself that highly?
Third. If the judge considers that your hospitalization is legal and justified, then prepare for the fact that your stay in the hospital will be long. And even after discharge, it will be almost impossible to prove or challenge anything. But don't despair. Discharge is inevitable in any case. Ask your doctor for a document called a medical history statement. Also ask to be given the opportunity to review the medical records. If it is difficult for you to decipher the doctor’s handwriting, simply take a photo of all the sheets of the “history” or ask for a photocopy of it. If you are denied this, then submit an application addressed to the head physician to the hospital administration. You have the right to do so. With an extract and a “medical history” go to Department of Psychiatry at a medical university. Ask you to be examined and give an opinion about your mental health by people who have an advanced degree. If they consider you sane and do not agree with the diagnosis of the doctors who treated you, then with this conclusion you will go to court with a charge of illegal hospitalization and to the prosecutor's office with a statement against the judge. Let this thought warm your clouded mind, although this has never happened in my practice.
Well, fourthly, I’ll tell you a professional medical secret. Nobody cares about you at all. Starting from nurses and ending with judges and professors. The doctor only thinks about following the examination and treatment protocol. One more sick, one less. Since after this work the doctor goes to work at another hospital, and the next day he goes back to work, and so on. Therefore, no one will detain you against the law. No one wants to be responsible for you. Nurses also think about their sanitary affairs and dream that you won’t kick her in the head when she’s washing the floors next to your bed. The nurses dream of quickly going home and forgetting “this madhouse.” The judge and the professor are thinking, “how not to mess up with you.” So calm down and try to think that maybe you are here not by chance?
I wish you health, survivors, not only physically, but also mentally!
16:00, 02.11.2017
There are two extremes in society's attitude towards mental illness. The first is marginalization. Like, dangerous, scary psychos. The second is romanticization. Like, I’m such a subtle romantic with a bipolar personality. Both are far from reality. Mental illnesses are primarily illnesses that need to be treated. The sooner the better. And it’s better to stay in a psychiatric hospital once than to poison your whole life with madness.
Luna talked to people who once ended up in a mental hospital and spent some time there. They shared their experiences and told their impressions about the conditions, the treatment process, and interesting neighbors. The neighbors here are indeed often interesting. Treatment helps, but not always. And the conditions, judging by the stories, are slowly but surely getting a little better from year to year.
Take care of yourself and your mental health. Our new text is about this.
We have changed some names.
Dzhokhar:
I was diagnosed with bipolar in 2017. The atmosphere is very boring, there is nothing to do. Okay, you can read the book.
The neighbors have left to varying degrees. One of them hid my pony so it wouldn't be stolen. The treatment process consisted of selecting competent therapy in the form of distributed tablets.
I remember the orderly who forced the same grandfather to clean every day. 70% of his effort spent cleaning consisted of indulging his own nervous tics. Really: in order to take a step, he turned his head, stuck his tongue in and out, shrugged his shoulders and swayed from side to side. After a short dialogue with the orderly, it turned out that the grandfather was being removed because of the orderly’s great love for the work of David Lynch.
Valentina:
This was last year. It all started with the fact that the psychiatrist from the mental hospital told me that all she could do for me was to call the orderlies and send me to a mental hospital right on the spot, and I was in no condition to refuse. On the spot I was allowed to make one call, after which they took all my things, gave me pajamas, gave me phenazepam, and I don’t remember the next three days.
The first memory is how I stand near the toilet and sob, not daring to go in there, because all the doors are open, privacy is impossible, and near one of the toilets there is a naked woman chewing bread. She was spanked for this because she asked everyone for bread and crumbled it on the floor. The nurse persuades me to either decide to go to the toilet or go into the room and cry.
It was hard for smokers - cigarettes were given out for socially useful work such as washing the floor, working in the canteen and the like.
My book was stolen! Moreover, they chose a collection of Estonian short stories, which, according to the deeply interested person, no one reads at all (deeply depressing stories about the villagers of the Estonian swamps). This revealed the real target audience!
Visitors could come twice a week and bring delicious food (from the list of permitted ones). One day they brought me several pieces of meat and a thermos of coffee (generally prohibited, but apparently not too strictly), and I managed to smuggle them to a woman whom no one was visiting, and therefore she was not allowed into the meeting room. She began to cry and said that she had not seen fried meat for two years. She told the story of her life in another mental hospital, from which it was clear that I was incredibly lucky.
Really lucky actually. I admire the patience of the nurses, who generally behaved quite correctly towards the patients. There is a clinic on the hospital premises, where all patients underwent a bunch of different examinations and tests (hurray, I don’t have HIV or anything else). In the end, I didn’t want to throw myself from the twenty-fifth floor and wanted to live.
Evgenia:
My treatment for major depressive disorder began late last year. My relationship with my husband was upset, one of my best friends abandoned me, I had surgery, everyone around me was dying. Everything was very bad, and when I persuaded a specialist at a psychiatric center in Moscow to admit me - it was the end of the year, crazy queues, there were no places, I just called from the food court and screamed into the phone, choking with tears, that the new year was coming, the time when the number of suicides is growing and that I will definitely do something about myself.
I thought that everything would be like this: we’ll chat now, I’ll cry on the couch, they’ll prescribe me pills and I’ll go to her for a conversation for 3,500 about once every two or three weeks, and everything will be fine. Not so.
After listening to me, they asked me a lot of general questions about my condition, and then, very puzzled, they retired to the next office, from where the psychiatrist came out with a referral to the crisis center at the 20th Yeramishantsev City Clinical Hospital. I had read about the CC before on Meduza, and, of course, I didn’t think that I would ever end up there as a patient.
The next morning I went there in some kind of torn sweater, without combing my hair, without putting on makeup, completely crying. A smiling doctor met me, talked to me and suggested hospitalization.
Once in the hospital, I immediately noticed the oppressive situation. My bed was signed, the windows had no handles - only the nurses had handles, and the windows were opened only during ventilation on request. I was also thinking how ironic it was that the psychiatric ward was on the highest floor of the hospital.
There were bars on the windows in the toilet. Toilets are without latches. Shower room too. While the young man and I were waiting for me to be processed, periodically from different corners of the department the melody “Don't worry be happy” was heard - this is a notification that one of the patients needs the help of a nurse - well, the IV ran out, for example, or something else -That.
I was put in the same room with a young girl, her parents were fussing around her. When they left, we started talking, got to know each other better and told each other our stories. The girl's boyfriend committed suicide, and, of course, she blamed herself for everything.
One vile publication wrote about this story. In addition to the experiences associated with the death of a loved one, bullying began. The girl tried to commit suicide, they pumped her out, sent her to a mental hospital for a while, but she did not get better there, and it was decided to send her to the CC.
At first, the girl often cried on my shoulder, we sat hugging each other, she told many pleasant and funny stories about her dead boyfriend and inevitably broke down into hysterics, I ran for medical help so that the girl could be given medicine or potion.
At the CC you were allowed to take whatever you wanted with you - a book, a laptop, a phone, even an easel. I took a couple of books, downloaded Twin Peaks on my mobile phone, and took drawing tools with me.
But I couldn’t do anything: the atmosphere in the hospital and the medications are very tiring, you constantly want to sleep or lie around. I didn’t even have the strength to be stupid on social networks or scroll through stupid memes, I instantly passed out.
Three weeks in the hospital were not in vain. I left refreshed, a little more joyful, and I was happy to check out of this oppressive atmosphere and live freely. About two weeks later, I quit my job and went to St. Petersburg, from there I left for my hometown, because I realized that I was still very tired. I began to continue treatment at home.
Some time ago I again became a patient in a mental hospital. I went there with a scandal: my mother has a rather stigmatized attitude towards mental illness, and we had a big fight on this basis.
My mother accused me of abandoning my colleagues by going on sick leave, that I was letting everyone down, that I didn’t want to work, and that I had been undergoing treatment for almost a year and there was no result - as if it was my fault. It was good in the mental hospital, however, I spent only a few days there this time: I was depressed that I was here, and my mother was angry with me, that I was lying in the ward alone on a drip, and my colleagues were working hard - I couldn’t get rid of feelings of guilt and somewhere on the fourth day of my stay there, I checked out.
I was lying quite comfortably: they had chosen the perfect menu for me, taking into account my allergies, there was no one else in my room, in the department there were all sorts of cool little things like a sensory room - you could draw all sorts of different things in the sand, look at holographic images, walk on some... then tiles with different textures and roll around in big bean bags.
Moreover, there is a real cockatiel living in the department, he chirps cheerfully, and when in the morning the nurse makes her rounds with a blood pressure monitor and thermometer, the birds fly after her, lifting everyone’s spirits. I regret that I interrupted the treatment and hope to complete it in the foreseeable future.
Now I continue outpatient treatment, sometimes it scares me that it can last for years. But it’s better to take pills than to die.
Olga:
I went to the hospital in the fall of '15. I had anxiety, suicidal thoughts, apathy and who knows what else. At some point, my family became worried and rushed me to a psychiatrist.
They conducted a series of standard tests on me and decided that everything was sad and should be put away, because this would be the most effective solution. I was upset about this because I didn’t want to live away from home, but the hospital itself didn’t terrify me.
At the reception, the head of the department talked to me and told me honestly that I would not commit suicide. They immediately prescribed me pills, and on the first evening I managed to catch rotavirus, so I vomited all night.
Then, against the background of this, hysteria occurred, which, perhaps, they began to relieve with tranquilizers, or maybe they gave them to me even before. In short, the combination of tranquilizers and rotavirus is just that.
For the first three or five days, I felt what it was like to be almost physically unable to stay awake: the whole room brought me up for lunch; how I didn’t spill anything in the dining room, I still don’t understand. According to eyewitnesses, it looked scary.
When a young man came, I just very contentedly went out to sleep on his shoulder in the corridor.
No, I tried to talk, but it didn’t last long. The day was divided into: “Hurray, I’ll sleep well!” and “They will disturb my sleep again!” And then I moved away and began to join in.
I ended up in a fairly toothless version of a mental hospital, there was no one there who looked like a caricatured psycho: there was no violent ward, no one with delusions. The conditions are also mild: visits every day, after the first week you could go for a walk (getting to Nevsky, drinking coffee and returning was no problem), so a couple of my neighbors somehow even managed to drink alcohol.
The most important quest of a mental hospital is to find out what exactly is wrong with you. Patients are not given diagnoses as much as possible, so I and many around me clung to any scrap of information.
We were told the names of the pills, so every time the prescription changed, the person began frantically Googling how what was prescribed to him worked and WHAT IS IT FOR? Sometimes I managed to hear something about a friend near the doctor’s office, when someone’s relative came, for example.
About the pills. Everything is fun with the pills, because, as far as I know, the system is like this: diagnosing a disease accurately is expensive, so they make something like an approximate diagnosis, based on a not very large number of tests and what the person himself says, and then they just go through pills, trying to figure out which ones help.
As a result, a person receives a set of pills with which he can live. In this regard, I was once lucky: another combination of pills caused me uncontrollable muscle tone (this is what I felt, and not a term, if that).
What it looked like: I was sitting, talking, feeling that something was wrong with my facial expressions. I go up to my sister and say: “See this grin? And I don’t do anything to make it appear.”
My sister said that everything was ok and went to give me Morozov drops. Then I noticed that my posture was like that of a ballerina. “I’ve always dreamed,” I tell my sister, “of good posture. But I think there’s something wrong here.” The nurse told me to go to the room. Going to the ward turned out to be even more fun, because my back began to bend unnaturally back, and as a bonus, my jaw began to squint. Down and sideways. All the patients were impressed by the fact that the nurses were trying to give herbal drops to a man who was slowly but surely being folded in half across his back.
I would have laughed at the comical nature of the situation, but I had no time for it; my jaw arched so much that it began to ache noticeably. I tried to put it back in place with my hand to give the muscles a rest, but it didn’t help much. As a result, the doctor on duty called me to his office, they took me away and sat me in front of him.
— Has this happened before?
— Were you worried today?
-Are you worried now?
- Well, yes, a little. My jaw is tearing open and my back is so arched that it is difficult for me to look straight. Only up. - I would have said, but I had a jaw, it was difficult for me to talk, so I tried to make the doctor understand the same thing with my appearance.
- In general, young lady, now we will give you an injection.
“If it doesn’t work, we’ll take you to another hospital.”
“There will no longer be any visitors there and in general everything will be stricter.”
As a result, they injected me with phenozepam, and I was cleared. Why they scared me with another hospital and where this hospital is - I don’t know.
Later they gave me more haloperidol than I needed. It's hard to describe, you have to feel it. Imagine your brain being sick. Introduced? So, I also went to read scientific literature about the Serbs. According to internal sensations, the brain slows down all the time, but at the same time it wants to do something. And I had to live with this for three days, because they assigned me this case on Friday, and the doctor insisted on the weekend. Everything was very difficult.
Overall, I can’t say that I was in a bad institution. For the most part, the nurses were adequate, the doctors were ordinary Russian delayed doctors, who at that time still had an additional burden. I still take some pills, specifically carbamazepine, and I still communicate with some of my neighbors from there.
Anna:
I lay down several times. First in the department of borderline conditions with anorexia and bulimia, then with the same in psychiatry in the women's department. Then I was in psychiatry, again with bipolar disorder, then with a personality disorder and a history of self-harm.
The first time lying down was quite interesting and scary. People who are talking to no one knows who, a woman who jumped from the third floor.
What saved me was that I met my friend there, and it was more fun with her. That was the first time I hit a woman many years older than me. It was night, she started hitting me with a towel and calling me a child of the devil. I had to hit it. The nurses, by the way, weren’t against it. They tied her up later. But by then I was already sleeping under sleeping pills.
Music also saved me. Sitting in the smoking room and singing songs, telling stories - all this helped to take my mind off the hospital walls and pills that caused nausea.
For cigarettes they had to work and help the nurses - wash toilets, wards, and make dirty beds.
Sometimes it was sad that the young girls, lying there with deep emotions, could not get out of it all and simply went even more crazy.
These pills are all evil in their purest form. You completely lose yourself, everything becomes sideways, and this only makes it worse. Because you don't recognize yourself. And I don’t want to live. And I don’t want to do anything.
In the end, I wouldn’t say that everything went smoothly. I still have a manic attachment to certain things. Well, self-harm.
Although it has already become a little better, because I no longer care about others and problems. Now I think about everything easier. There is no time to worry.
Anatoly:
I was in an institution with yellow walls for three weeks, 9 years ago. He went to bed at will. I was in the state of a vegetable under drugs, but I remember that no one particularly stood out there, except for two - one was a natural monkey, yelling, screaming, scratching himself.
And the other one, from the neighboring women's department, was completely out of this world and often asked everyone something, but it was impossible to make out what exactly. The department was paid, but the food there was the most disgusting in my life. I remember this well. Well, I remember how all the doctors walked around with their hands in their coat pockets. There they held the handles on the doors to the department - it was impossible to just get out of there.
I was treated for OCD, but in the end it turned out that the diagnosis was completely different. But this is much later and in a private clinic. Then things got better, remission lasted until 2012.
Elena:
It was 2004, Volgograd. When I got there for the first time in 8th grade, the psychiatrist was so incompetent that she decided on her own that I was being beaten at home, and decided to “show off” my guardian, telling her that I told about it (and I found out about this only after extracts). Because of this, after my discharge, they began to despise me at home, that I had lied and slandered my aunt, constant daily poking at this and psychological bullying began, which led me to a second breakdown and hospitalization.
During our stay, I really liked one nurse who sat at the door of our sixth ward and watched us so that no one left. I sat at the threshold, we talked with her and solved scanword puzzles. After a week of stay, it was only thanks to her that I began to speak, because the doctor herself seemed aggressive and inadequate to me.
I only started eating so that they wouldn’t give me IVs, they would do it roughly and painfully - they tied me to the bed, all my arms were bruised, they poked me with a needle until they got into a vein (there were also terrible bruises and bumps at the injection site).
It was interesting to take all sorts of tests; the girl practicing there took them once a day for about an hour.
Thanks to the drugs they gave, it was easy to lie there all day and night, almost motionless and looking at the ceiling, until that nurse was there. A girl of about 20 years old was lying constantly tied nearby; there was a constant smell of urine in the room, because she was urinating, and no one changed her underwear all day. And the mattress probably wouldn’t let that smell go away.
After the sixth ward, you could go out during the day to “walk” on a balcony measuring about 3x3 people of 10 each; after dinner, until lights out, the TV was turned on in the rest room, you couldn’t change channels, and you only had to watch Russian TV series about birches and fields.
Yes, and upon admission I was forced into a dark shower under cold water and forced to wash my hair with laundry soap. Considering that I could barely stand, I was constantly nauseous and my vision was getting dark. Because of this, my long and curly hair was terribly tangled, and there was no comb. And they just took them and chopped them up for me with huge scissors. That's probably all.
Alexander Pelevin
Frames from the film “One Flew Over the Cuckoo’s Nest” were used in the text design.
On the cover is an episode from the film “Planet Ka-Pax”
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Mikhail Kosenko was one of the first detainees in the Bolotnaya case. He could have been pardoned at the end of last year if not for his health. The Serbsky Institute conducted a psychiatric examination and declared Mikhail insane at the time of the crime. Therefore, prosecutors did not ask for a prison term for him, but compulsory treatment in a psychiatric hospital. To await the court's decision, Kosenko went from the Medvedkovo pre-trial detention center to the hospital at Butyrskaya prison.
A year and a half later, the court agreed with the conclusions of the Serbsky Institute and, after an appeal, in March 2014 sent Kosenko for indefinite treatment to closed psychiatric hospital No. 5 in the Chekhovsky district of the Moscow region. Then no one knew how long he would have to stay in compulsory treatment. Many human rights activists assumed that Kosenko would be released later than other convicts in the Bolotnaya case. But after two and a half months, Mikhail was released on an outpatient basis. The Village met with Mikhail Kosenko and found out how “punitive psychiatry” works in modern Russia.
Mikhail Kosenko
39 years old
Group II disabled person, unemployed.
In June 2012 was detained on suspicion of participation in mass riots during the May 6 protest.
In October 2013 he was found guilty and sentenced to compulsory treatment in a “closed psychiatric hospital.”
In June 2014 the court allowed him to be released for outpatient treatment.
Disease
When we start the conversation, Mikhail seems to be dissatisfied with something. He explains: he doesn’t want to talk about personal things and tell the story of his illness, let’s just talk about the hospital. But he still says that he got sick before the army. He was drafted anyway: there was no normal psychiatric examination at the military registration and enlistment office. During the service, the illness worsened, but not as a result of concussion, as they write in the certificates about Kosenko.
Mikhail’s diagnosis is terrible - “schizophrenia”. Although, according to the president of the Independent Psychiatric Association of Russia, Yuri Savenko, in the West the diagnosis would sound differently - “schizotypal personality disorder.” Kosenko has a second disability group. “It’s hard to live with an illness, but I’m trying to cope somehow,” Kosenko shares. He has to take medication every day.
The disease distinguished Kosenko from other “swamp dwellers”. The Serbsky Institute, based on a twenty-five-minute conversation with the patient, according to records in the medical record from the dispensary and the materials of the criminal case, recognized Kosenko as insane and prone to dissimulation - downplaying his own illness. A person declared insane at the time of committing a crime is usually exempt from criminal liability. After the examination, Kosenko was transferred from a regular pre-trial detention center to a hospital at Butyrskaya prison. There he spent a year and a half.
"Cat's House"
This place is called “Cat House”, “KD”, “Cat” or “Cat”. Previously, there was a Butyrka building for women, who in this world are called “cats”. Then a separate pre-trial detention center was built for them, but the name remained.
"KD" has five floors. The first is for staff. The second group includes seriously ill patients. On the third are “transit workers”, those who are constantly transported to the Serbsky Institute and back. The fourth group includes defendants who were declared insane at the time of the crime. The fifth floor has recently been renovated. There is a “medical and social rehabilitation department” where drug addicts are kept. According to Kosenko, the conditions there are the best: comfortable beds and even a gym. Residents of other floors are not allowed there.
On all other floors the conditions are the same as in the prison. Instead of chambers there are cells. Doctors don’t show up regularly; they don’t even do rounds every morning. Patients' requests are treated indifferently - they may be satisfied, or they may simply be forgotten. Medicines appear and disappear. Mikhail, who was mainly kept on the fourth floor, was brought tablets by his sister Ksenia. If they ran out, you had to wait a week or two for her to deliver them again.
The cells house between two and eight people. The daily routine is prison. Getting up at six in the morning, but it is optional. If you wish, you can sleep longer. Next is breakfast. The food in the prison hospital is disgusting. The food supply is limited; everyone relies on gifts from relatives or what they give to fellow inmates. The food in the local hospital differs from prison food only in that they occasionally provide eggs, butter and milk.
Nurses and orderlies are almost never visible, Moreover, even those orderlies that exist are prisoners, those remaining will serve time in prison
Walk once a day. There is no infrastructure for sports exercises. Nurses and orderlies are almost never seen, and even those orderlies that exist are prisoners left to serve time in prison. Order is maintained by guards who are not assigned to the hospital. They also work in the main part of the pre-trial detention center. No one here has the task of curing patients. Patients are treated as temporary residents who will soon leave the hospital. There is essentially no access to a psychologist. You need to make an appointment with him, and then, if you’re lucky, he’ll call you. In prisons, a psychologist often simply comes to the cell, opens the window and tries to talk with the person in front of the other inmates. Prisoners refuse to share their problems in such conditions.
“The hospital feels more like a prison than a hospital,” recalls Kosenko. If someone feels bad, you need to knock on the cell door so that the guards call a doctor. Often no one reacts. “In my presence, one such patient was handcuffed to the bed so that he would not make noise,” said Mikhail. They say that sometimes people who are particularly violent or who have attempted suicide are put on restraints and held for several days. The hospital management, of course, denies such facts.
There is a version that suicides or suicide attempts occur more often in a prison hospital than in a regular prison. Of course, other patients are not told about them, but rumors spread quickly. A man whose neighbor had committed suicide was once transferred to Kosenko’s cell. The most common ways to die are hanging and cutting veins.
At the same time, according to Mikhail, most patients are adequate, sane people. Everyone communicates with each other and jokes. For many, the diagnoses are not true. There are people who got there on falsified cases. They committed a variety of crimes: theft, murder, and smuggling. In the cell next to Kosenko sat Sergei Gordeev, who shot the students of Moscow School No. 263 in February. But there was nothing special about it.
Some patients are allegedly given haloperidol as punishment. Injections of this medicine cause muscle cramps, pain, and stiffness. Many people feel twisted: it is physically impossible to be in a normal position after the injection. Also, the injection is often given randomly to show that at least some kind of treatment is underway. The consequences of its use are extremely serious. Haloperidol suppresses the will. Those who use it will not perform unnecessary actions.
One warden told Mikhail, that in the 1990s there were all patients kept naked without bedding
For violating the rules or insulting employees, patients can be sent to a punishment cell, or to the “elastic cell”. It is called so because the glue with which the sponge is glued to the walls smells like rubber, protecting patients from self-torture. There is nothing inside the cold room, not even a bench. Usually the offender is kept there for a day, but for a serious offense they can be kept for three days. At the same time, all the clothes are removed from the person so that he does not hang himself with them. Before imprisonment, an injection of haloperidol or aminazine is given.
However, it used to be even worse in the “Cat House”. One guard told Mikhail that in the 1990s all patients there were kept naked without bedding.
Hospital in Chekhovsky district
Mikhail managed to leave the “Cat House” after the verdict was passed. The court agreed with the conclusions of the Serbsky Institute and sent Kosenko for compulsory treatment to closed psychiatric hospital No. 5 in the Chekhov district of the Moscow region. The two-story brick buildings, built before the revolution, are not a prison hospital. But its main guests are people declared insane at the time of the crime. Even if they have recovered from their inadequate state after this, they will still be sent for treatment. Therefore, almost everyone with whom Mikhail interacted were normal people. There are also ordinary patients in the hospital, not criminals, but Mikhail did not interact with them.
In total, the Chekhov hospital has 30 departments. They differ in the modes of keeping patients: general or special - for more severe cases. Other hospitals also have a special intensive care unit. In the Chekhov hospital, its function is actually performed by the 12th department. People end up there for various offenses. People there are kept locked in two-person boxes. Sometimes they get into the 12th department not too deservedly. One of Mikhail’s acquaintances was placed there because he helped other patients write complaints. The doctors considered him a “negative leader” and decided to teach him a lesson.
In special intensive care units, under strict supervision, the most seriously ill patients are kept, who pose a serious danger to themselves and others. Patients are injected with many drugs, including haloperidol. They carefully check whether the person took the pills or not. They say that sometimes from heavy doses of drugs people lose consciousness, fall on the concrete floor and break their heads, and some simply die.
The will of patients is suppressed so that they are not capable of crime or suicide. If the patient leaves the hospital and commits a crime again, his attending physician will be accused of unprofessionalism. “I wasn’t in the special intensive care units, but I talked to the patients who came out of there,” Kosenko said. “These are not some degraded people, but they would all prefer not to end up there.”
The will of the patients is suppressed, so that they are not capable for crime or suicide
Kosenko himself was in the general department. The atmosphere there is much better than in a prison hospital. Instead of cells there are chambers from which you can leave. True, there are 15-20 people in each, and there is only one toilet per department. But normal beds, more humane attitude of the staff. There are no guards - instead there are orderlies and nurses. Addressed by name. The guards, whose help you sometimes have to resort to, are also not from the FSIN system. The main thing is confusing: none of the patients in this hospital know when they will be able to leave it.
Kosenko did not complain about the food in the Chekhov hospital. According to him, it is quite good and definitely better than the prison one. In addition, food can be obtained from relatives.
The daily routine in the hospital is strict, but even with strict discipline and supervision, people feel freer than in prison. After breakfast there is a mandatory round. The doctors are quite distant. Usually patients tell them that everything is fine with them. If there are any questions or complaints, doctors or their assistants carefully write everything down.
They are allowed out for walks twice a day at certain hours under the supervision of orderlies. In summer, walks are long - up to three hours. In the exercise yard there is a table tennis table and a volleyball court. But there was no one to play it, so it fell into disrepair. Mikhail saw them playing in the neighboring yard, but patients in his department were not allowed access there. It was possible to talk to them only through the mesh enclosing the yard.
It is officially prohibited to engage in physical exercise or do push-ups in the hospital. The reason is very strange - by doing this you can suppress other patients and also use your skills to escape. The staff treats push-ups leniently, but sometimes stops them. But in the department there are the same games as in prison: backgammon, dominoes, checkers and chess. Cards are prohibited.
Computers and cell phones are also prohibited. You can have a player without a voice recorder, a radio, an e-reader, or a Tetris-type toy. But they must be rented out at night. Patients learn about what is happening in the world from newspapers brought by relatives and from the TV installed in the dining room. In the wards, unlike in the prison, there are no television receivers. What to watch is chosen by the patients themselves. Usually it's news, movies or sports. In exceptional cases, they allow you to watch TV after lights out.
Paper books can be given to patients. But not all. “I recommended John Kehoe’s book “The Subconscious Can Do Anything” to my friend, but it was not allowed,” Kosenko is surprised. “Apparently, they considered it harmful.”
Doctors also check letters. As they explained to Mikhail, patients were repeatedly sent an escape plan. In prison, letters were edited - they crossed out with a pen or felt-tip pen what the censor did not like. In the letters sent to Kosenko, email addresses, nicknames and passages against the authorities were crossed out.
Patients were allowed to shave twice a week. Once a week - shower. In the heat, you could ask to wash during the day. There was no such luxury in prison. But in prison you can keep a razor with you, but in the hospital it is taken away in order to stop a suicide attempt.
You should also not keep cigarettes on you. At Kosenko’s department they were given out ten of them a day. They bring out a box with signed packs - everyone takes one and goes to the toilet to smoke. Many people loved walking because of this: there is a box there all the time and you can smoke as much as you like.
Visits are allowed every day. But only relatives are allowed in, and one of the staff listens to the conversation. One day, Mikhail’s sister came to see him with a friend. The friend was not allowed in. But once there was a concert in the hospital. The visiting artists read poems dedicated to the First World War and sang songs from films. Patients from all departments were invited to the event, but not all of them wanted to attend. According to Kosenko, such events take place in the hospital once every few months.
You should also not keep cigarettes on you. They were issued at the Kosenko department ten pieces a day
If a person commits some serious offense, he is transferred to another department. If the staff does not listen, keeps tea or cigarettes, shows aggression, fights, even as a joke, they are transferred to the supervisory ward. This is a room with several beds, no bedside tables. You can't get out of it. The clothes of its inhabitants differ from the uniform of other patients, so that it is immediately clear who is who. They are only allowed out of the room for a walk and to go to the toilet. Sometimes they are released into the canteen, but more often the food is brought directly to the supervisory ward. It's unpleasant to be in.
All patients pass through the observation ward. Immediately after arrival they are placed there. They may be transferred to normal the next day, or they may be detained for a long time. Mikhail had to spend several weeks there, since there were no places in other wards.
There are three observation modes for patients. On one, notes about the patient are made every day. On the other - once a week, on the third - once a month. The entries are sometimes very strange: “I looked out the window and thought about escaping” or “I ate gingerbread brutally.”
Previously, patients worked in occupational therapy workshops. But a few years ago they were closed. Now, instead of them, there are mandatory cleaning duties for the wards, corridor and dining room. Mikhail doesn't know if this is allowed. In the dining room - it is definitely prohibited by sanitary and epidemiological standards. However, the hospital turns a blind eye to violations. Doctors say it's occupational therapy. In addition, many patients get hired to clean other rooms and the catering department. There are no cleaners on the hospital staff - everything is done by the patients themselves. Nobody forces them, but those who work are discharged faster. At the discharge committee, one patient was asked: “What are you doing in the hospital?” He replied: “I’m playing.” - “Well, keep playing.”
Treatment in the Chekhov hospital is the same as everywhere else: injections, pills. True, one of these medications made Mikhail’s hands tremble. He got rid of tremor after switching to outpatient treatment. The only procedure they do is an encephalogram - they check for any abnormalities in the functioning of the brain. This procedure is called "capping" because multiple electrodes are attached to the scalp.
Extract
On average, patients spend from two and a half to four and a half years in the Chekhov hospital. But there are people who are kept there almost for life. Nobody is obliged to discharge you. If the person continues to pose a threat to himself or others, he will be kept in hospital. This is the fundamental difference between a hospital and a camp. A prisoner can shirk work or disobey - he will not receive additional time for this. In extreme cases, they will not be released on parole.
But Mikhail was a “special patient,” as one of the doctors immediately told him. Everyone around knew that Kosenko was involved in a high-profile political case. According to him, this had almost no effect on the living conditions and attitudes of other patients. Moreover, the doctors still considered him sick.
Kosenko’s peculiar situation was most clearly manifested on his first discharge committee. It takes place once every six months for each patient, and includes the attending physician and other hospital doctors. Usually no one is discharged for the first time; Mikhail was only told about one such case. Therefore, the doctor was not even interested in Kosenko’s health condition. Instead, she discussed politics with him in an attempt to defend Russian power.
After such a commission, Mikhail, of course, did not expect release. But unexpectedly he was called to an extended commission. Usually the patient asks for it if he believes that the regular commission was carried out with violations. Mikhail didn’t ask for anything like that. At the expanded commission, politics was no longer discussed. The commission members promised to release Mikhail in a few months. And indeed, the court soon decided to transfer Kosenko to outpatient treatment.
Mikhail himself is sure that he was released due to the resonance around the political case. He is convinced that the decision to release him was not made at the hospital.
What is he doing now?
Now Mikhail is an outpatient. Once a month he needs to visit a psychiatric clinic in the Southern District of Moscow, see a doctor and receive a prescription for medications. If he commits an offense or misses an appointment, he could end up back in hospital. With him in the hospital was a patient who one day did not come to the doctor due to illness, for which he was again sent to the hospital.
“I don’t feel broken, but life is hard,” says Kosenko. - Many doctors believe that schizophrenia has a stronger impact on quality of life than other diseases. There is not enough energy for anything. It’s hard to come into contact with things and objects.” There is still no cure for schizophrenia. Medicines only help not to go completely crazy. “In our country, patients with schizophrenia are in the shadows,” Kosenko complains. Although, according to doctors, about 1% of Russians are susceptible to this disease. The World Health Organization estimates that by 2020, schizophrenia will become the fifth most common disease in the world.
Photos: Gleb Leonov
But let me tell you, friends, a story about how I was in a real psychiatric hospital. Oh, there was a time)
It all started with the fact that from a dashing and carefree childhood I had several scars left on my arms. Nothing special, ordinary scars, many people have them, but the psychiatrist at the military registration and enlistment office, a mustachioed guy with a sly squint, doubted my words that I got the scars by accident. “We’ve seen you like this. At first the scars are accidental, then you shoot your fellow soldiers after lights out!” he said. Two weeks have passed and now I, along with a dozen of the same pseudo-suicidal people, are heading to the regional psychiatric clinic for a final examination.
At the entrance to the hospital, we were subjected to a formal search, all our personal belongings were shaken and all the prohibited items that were found were taken away (stabs, laces/belts, alcohol). They left the cigarettes and thank you for that. Our department consisted of two parts. In one there were conscripts, in the other there were prisoners, mowing down from responsibility. It's such a neighborhood, isn't it? We almost never crossed paths with prisoners, and the most colorful character among us was a hefty Tatar in a Nirvana T-shirt, to whom the nickname “sex” almost immediately stuck. “Sex” was a wonderful, but harmless guy and loved to have a tasty jerk before going to bed. Moreover, he didn’t care about the jokes, requests to stop and direct threats. Without jerking off, “Sex” didn’t fall asleep.
The hospital toilet deserves special mention. The two unfenced toilets were clearly the same age as the pre-revolutionary building itself. But the worst thing was that the toilet was constantly crowded with smoking people. Here you could discuss bark, try to shoot a cigarette, make fun of the psychos from the third floor. Yes, there were real psychos above us and we could have a real rage over them, shouting at each other through the bars on the windows. It was extremely difficult to light a cigarette, because from complete idleness everyone was constantly smoking and tobacco stocks were melting before our eyes, and there was nowhere to replenish them. There was absolutely nothing to do, and when we were kicked out for a cleanup day, everyone was extremely happy. Cleanup work in a psychiatric hospital is a holiday, because on other days they were not allowed to go outside. Oh yes, the toilet. It was extremely difficult to satisfy natural needs, due to the same smokers. Do you think anyone came out? Yeah, right now. Over time, of course, everything settled down, they introduced a schedule and religiously followed it, but in the first days it was completely brutal. Those who were simpler climbed onto the toilets right in front of the smokers, the rest heroically endured and waited for the night.
But nothing lasts forever, our examination period ended and we left the not-so-comfortable walls of the psychiatric hospital. Few of the guys were drafted into the army after that; most were diagnosed with “Personality Disorder,” which greatly ruined their lives in the future. So much for random childhood scars...
“One day he hit me so hard that he broke my cheekbone.”
It all started when I was 17. I fell in love - as it turned out much later, with a manipulator and sociopath. Our toxic, as it is now fashionable to say, relationship lasted nine years. Over the years, I had two abortions, we tried to break up countless times - the reason was his infidelity, spree, even beatings. One day he hit me so hard that he broke my cheekbone. I left, but came back - I don’t know why.
That's how we lived. I latently understood that this was unhealthy and not healthy, and at some point I decided to turn to a psychologist.
This was my first experience, I went to the appointment in full confidence that they would help me.
But at the reception, this lady (I can’t call her a doctor), having learned that I work in a sex shop, immediately switched to “you”, then advised me to change jobs, “drove” over my mother and, as a cherry on the cake, stated that men like me only want to “fuck and throw away.”
“I decided that everything was to blame for my laziness, stupidity and worthlessness”
I no longer tried to go to psychologists. I just ran away - to another city, to Kyiv. For a year and a half I felt very good - every awakening brought happiness, even when outside the window the revolutionaries began to seize the prosecutor's office. Then I had to return - to St. Petersburg and to my evil genius. We began to live together - calmly, with classic borscht and movies on weekends. I was a freelancer, I didn’t need a job. To friends too - during the “emigration” the circle of friends narrowed from the size of the equator to three people who started families. The ground was slowly disappearing from under my feet, and I almost didn’t notice it - I wasn’t upset that in February of this year he finally left, we broke up. And I wasn’t happy. It seems like I stopped feeling emotions altogether.
My average day began to be spent in bed. I woke up, turned on the TV and ordered food to take home. Not because I wanted to eat - I didn’t feel hungry. I simply stuffed everything into myself (twice as much as usual) under the pictures flashing on the screen - their meaning did not reach me, nor did the taste of the food. There were tumbleweeds of dust flying around the house - I didn’t care. It was as if I was being crushed by a concrete slab, I physically couldn’t get up - well, except to go to the toilet, and only when it was really hot.
From time to time, friends still dragged me to some parties, concerts - I agreed and went, but there was no effect. Nothing made me happy, although I used to like both music and company.
Of course, I tried to find the reason, and, as it seemed to me, I found it: I decided that everything was to blame for my laziness, weakness of will, stupidity, uselessness, and the list goes on. Here it is - a trap cleverly set by depression. You convince yourself of your own worthlessness, which makes you lose the last remnants of the will to live. There is no point in getting off the couch anymore.
By the end of the summer, my memory and attention began to fail: I could not even concentrate on washing one plate. I wasn’t scared - this is also an emotion, and I no longer had them. But my friend was scared - after seeing how I lived, she did not tell me that I needed to “get ready and go for a walk” and give other “useful” advice. She also took a course of antidepressants, so she simply sent me to a psychiatrist.
“I was ashamed: a young healthy girl turned into a vegetable”
In the psychoneurological department, the very first question from the doctor put me into a stupor. “What do you even care about”? Nothing! It was very embarrassing to describe my condition - a young healthy girl turned into a vegetable. And then we started talking about Kyiv, about my damned man - and I burst into tears. I talked about familiar things for an hour and a half, choking on tears. At the end of the conversation, the doctor said: “Well, what can I tell you?” “Go to work and don’t give people brains,” I mentally continued for him. And she turned out to be wrong. I was sent to a day hospital at the Skvortsov-Stepanov psychiatric hospital with a diagnosis of adaptation disorder.
For two months I went there as if for work: electrosleep, antidepressants, various types of psychotherapy. The effect appeared immediately, but not from the treatment: being among real crazy people invigorated me, of course. An unforgettable feeling when you sit in line for fluorography among comrades in straitjackets, and then on rounds you listen to stories like “everything is fine today, the voices have disappeared.”
“During art therapy, I realized that I didn’t just need support. I can strangle this support.”
After a couple of weeks, the therapy began to take effect. I was amazed by the body-oriented one: it’s amazing how performing, at first glance, idiotic tasks like “imagine that you are a grain” or “image a dog” can open your eyes to your own behavior patterns. I realized that it was with great difficulty that I began to make contact, and that I was simply hiding “in the house” from solving problems. During art therapy they asked me to mold myself in the form of a plant - I molded a bindweed, and then it turned out that I not only need constant support and support, but I can strangle this support - a good version, it actually explains a lot.
There were also individual sessions with a psychotherapist. Thanks to this magical woman: having started to work through my suffering on the subject of a forced move and a nine-year love epic, she eventually unearthed a huge number of things that had always prevented me from living. Thanks to her, I learned to say “no”, not to create illusions, to appreciate and listen to myself. After classes, I no longer wanted to bury myself in the blanket; I began to want to do something. The concrete slab has disappeared. I realized that for two years now I haven’t woken up not only in a good, but in a normal mood, without self-hatred! And suddenly she began to smile inside and out. Once a passer-by even said: “Girl, you are so happy, stay like that always.” But nothing special happened, I just became myself again.
