Friday, July 10, 2009
Susan's When You're Going Through Hell Keep Going blog comments on a Newark (NJ) Star-Ledger item that reports:
"Beginning today, smoking will be banned in all areas of the Greystone Park and Ancora psychiatric hospitals, with similar bans to follow at three other state psychiatric facilities ..."
Smoking is already prohibited inside all state psychiatric hospitals in New Jersey. Says Susan:
"I would like to know what genius convinced Governor Corzine this is a good thing. They sure as hell didn't ask me. I have been in private and public hospitals - and what do you do in them? You smoke."
Susan goes on to say:
The last time I was in a hospital, the smokers were going off the wall, craving their cigarettes. The nurses were giving them patches, but the thing is about a patch, you want something to hold in your fingers, to put in your mouth, to shake into an ashtray, to grind the butt down. It's not just the process of lighting the cigarette, putting it to your lips and inhaling, it's everything.
Take it away from people in psychiatric hospitals, what do you get? A bunch of unhappy smokers who are forced against their will to wear patches and crave a cigarette. They get unhappy. They snap at the doctors, and nurses. They are miserable, crabby, and just not pleasant to be around.
According to the Star-Ledger article, the ban was instituted in the name of "wellness and recovery." According to an official, quoted in the article: "Our intent is to increase the life-spans of our patients, not to shorten them."
Ahem. Excuse me. I have a friend here in California. Last year, hospital staff picked a fight with her brother, Jeffrey, age 25, over whether he could have a cigarette break. Staff decided to show him who was boss. He was placed in five-point restraints, belly down, where he died.
Earth to psychiatry: Let patients smoke.
Individuals are admitted to psychiatric facilities in a state of crisis, generally in extreme agitation and often traumatized by a very recent event. They find themselves - usually against their will - in a strange environment that they rightly perceive as threatening.
Locked units with buzzing doors, strange people, police walking in and out, uniformed security, burly men poised for a takedown ...
So what do authorities do? They take away the patient's one comfort, the one thing that may help them settle into their new environment.
Psychiatric hospitals exist to take an individual out of crisis and move him or her into a state of conditional stability before sending them back out into the street, typically disoriented and confused. Patients don't get "well" in these settings. But they need all the help in the world getting them through the experience.
How misguided is psychiatry? The same profession that purports to be concerned about the patient's long term health when it comes to nicotine is the same profession that puts them on meds that demonstrably shorten their life spans over the long term.
Sorry for raving, but this hypocrisy bugs the hell out of me.
Last year I was in New Jersey, giving a ground rounds lecture at a private psychiatric facility in Princeton. No Smoking signs were all over the grounds. My talk was on meds compliance, and part of my prepared message included the fact that as opposed to the low compliance rates for meds over the long term (because they leave an awful lot to be desired), tobacco has a 100 percent compliance rate (because it works).
One reason that most people with schizophrenia and bipolar crave cigarettes is because for the brief time a cloud is in their lungs, their head clears up. People with schizophrenia in particular have difficulty filtering out distractions, which interferes with their ability to think. This changes when nicotine molecules lock onto the neuron's alpha-7 nicotinic receptors.
In the drug development pipeline are nicotinic agonists.
Patients are sending a message loud and clear, I told the psychiatrists and therapists in the audience. They will take a drug that works, even one with the worst side effects profile in the world.
I happened to jokingly add that maybe they should be prescribing cigarettes to their patients. I also called them out over the No Smoking signs I saw on the hospital grounds.
My audience showed their appreciation by emptying the room as soon as my lips stopped moving.
Psychiatrists I have talked to in private also don't get it. They have been conditioned to believe that smoking is a bad thing - which it is - that should not be encouraged. They forget that there is a crucial distinction between short-term and long-term treatment. Getting a person out of crisis is not the time to be worrying about what may or may not occur a quarter century from now. That's why doctors overmedicate with drugs that are blatant metabolic and diabetes risks. That's why patients should be allowed to smoke.
You don't facilitate getting a patient through a crisis and moving toward stability by taking their one security blanket from them.
(Recovery Innovations, based in Arizona, seems to be the one exception. At the emergency facility they operate in Phoenix, they have a policy of zero restraints. Significantly, they allow patients to smoke.)
Long-term care is a different kettle of fish. You leave the patient on high side effects meds only if you have to. You promote good diet, exercise, and all the rest. If the patient is smoking, you encourage various smoking-cessation regimens, when the patient is ready.
Sorry for raving on. I never smoked. I hate idiots who think they have a First Amendment right to blow fumes in my face. But what I hate worse is innocent people dying alone in five-point restraints, all because of an argument over a cigarette.
If Jeffrey had been allowed to have his smoke, he would be alive right now.