One long-term ward I worked on for two years was a drab and old building that was known to have the most docile patients. The Bed Manager sent patients there who the treating teams believed to be more docile but even for the more lively patients, the environment sucked the life out of them. They became zombies from their sedating medication as well as the building that seemed to suck the life out of them.
Newer wards are zombifying patients in different ways. They tend to have artwork and jazzy furniture but still the same sedating medicine. For the lively, aggressive or annoying patients, there is a lazy tendency to encourage patients to take additional medication. This is sometimes totally justified and the appropriate nursing or physician practice but should be done only after non-pharmaceutical coping strategies are explained and encouraged.

Staff may believe that it is quicker to dispense a pro re nata (PRN) medication but this takes time to get from the cabinet, administer and then document in medical records. Encouraging positive coping strategies can be immediately faster and also reduce similar needs for the patient in the future but overmedicating psych ward patients is seen as the default means for creating a more manageable patient load.

Patients are rewarded for acting in ways that are easier and cheaper to manage. Ward privileges and earlier discharge from hospital are rewards for patient compliance with ward routines, taking medications as instructed and deliberately masking signs they are more energetic or interesting than the norm. Clinicians have set templates for what a well person looks like and rarely actually know what each patient is like when they are at their normal baseline.

Intense side effects, especially sedation, weight gain and movement disorders, are allowed to develop and persist to achieve the zombie state. Zombies are easy to distract and to outwit. Those who shake off some of these disabling side effects are then trialled on other medications until they are seen as manageable or better aligned with societal norms. Medications are still saving lives and reducing dreadful symptoms but intensity and duration of side effects is way beyond what any reasonable human being could consider humane.

While their patients become zombies due to low stimulus environments and sedating medication, there is a parallel process of psych ward staff becoming numb like zombies. Zombies are focused on slowly pursuing their target without critical thought. Staff mindlessly and gradually wander towards the brains of their patients -to devour the illness that plagues their mind. As a new brain wanders by, they get distracted with that one and fail to properly work together to really achieve what everyone wants.

Staff are overworked and overloaded with vicarious trauma and compassion fatigue. Few have the energy for systemic change and many deplete the empathy and compassion that led them into the caring professions. Jadedness and numbness are protective and a natural mechanism to survive in a career where you often cannot tell the difference between treating patients and mistreating patients.

The neoliberal hospital lobotomizes staff and patients so they possess the false belief that all problems are because there is not enough funding. They perpetuate the myth that real change is impossible. Sedated patients realise that compliance is their ticket to discharge and worn out staff realise that career progression relies on perpetuating the unhealthy health system.

Next Madness Post: Ex-Patient (Peer) Workers