-From the journal of Petra, age 15, 1996.

Written while inside a state psychiatric hospital.




A Study of Home Elements Provided in Psychiatric Hospitals for Adolescent Girls

by Jane Schreck

Writing Workshop II: Professor Julia Keefer


New York University

The purpose of this study was to see if psychiatric hospitals/hospital units on Long Island/New York provided elements of home for adolescent girls requiring intermittent inpatient hospitalization, in order to foster feelings of security, comfort and a sense of belonging. A survey was developed to help to define which home elements are perceived as important to adolescents in both home and hospital settings. Surveys were given to ten middle class females, age 13-18, not diagnosed with any psychopathological disorders and thus not requiring psychiatric hospitalization. Psychiatric professionals, a staff member and a parent were interviewed for their opinion on this issue. Most agreed on its relevance and cited quality, i.e. the degree of sensitivity/kindness of all hospital staffing along with family involvement/family therapy as the most important factors in providing nurturing environments. They raised important financial and insurance issues. Four case study subjects were also surveyed, who currently are or previously were hospitalized between the ages 14-18, suffering from various psychopathologies, which necessitated intermittent inpatient care in Long Islands psychiatric hospitals/hospital units. Their experiences and perceptions have provided much insight of the hospital environments, where they received or are receiving treatment. The hospitals were rated based on home element criteria identified in this study. Most of the six hospitals studied were found to be blatantly lacking with some or all of the home elements, especially girls not feeling safe in some of the hospitals. Lack of financial resources, especially in state run facilities was a major factor. Other influences were type/size of facility, location and demographic population. Treating adolescents with adults poses a problem. One unit in a small hospital was found to be an ideal model. The case study subjects all agreed that the amount and quality of psychiatric therapy and activities plus family involvement/therapy provided in the hospitals was of vital importance in conjunction with a nurturing home environment for perceived overall benefit. Conclusion: managed health care is forcing shorter, more focused stays which may influence hospitals to provide intensive, effective programs. This could be an argument for creating a strong nurturing environment. It could also be an argument against with relevance to budget constraints. Sensitivity training programs for all staff members, not just the professionals, could help create the nurturing family atmosphere where it is minimal or absent from hospitals. Further studies are needed to show the efficacy of a model nurturing environment by studying patient outcomes.




At a time in my life when I was frightened and in emotional pain I turned to psychiatry for help. Sometimes things get to be too much for people and they just need a break. This can happen to anyone, it can happen to you. If you cant take a break at home, the only other option in this society the place you go to, to get a little rest, where others will take up the slack for you, care for you a bit - is the hospital, so they tell us. But they lie.

-Shelagh Lynn Supeen, As for the Sky: Falling





But I dont want to go among mad people, Alice remarked.

Oh, you cant help that, said the Cat: were all mad here. Im mad. Youre mad.

How do you know Im mad? said Alice.

You must be, said the Cat, or you wouldnt have come here.


-Alice and the Cheshire Cat, Alice in Wonderland





It was like being Dorothy in the Wizard of Oz. All of a sudden you are completely uprooted and in a weird place. Some of its friendly and supportive. People want to help you find the way. And some of it is as scary as the Witchs castle.


-Kirsten, age 19






Why should a researcher care about whether or not the psychiatric hospitals on Long Island


provide a home environment for teenage girls? The strongest allure for a quest into the unknown


usually stems from a desire to know the truth, fueled by a personal experience, painful and real.


Such is the poignant draw for this researcher. A teenage girl, very close to me, is currently


hospitalized in one of Long Islands psychiatric hospitals. The symptoms of her psychiatric


illness are no longer manageable with outpatient care and she has been confined in this facility


for the last five months, as of the date of this research report. She is severely homesick, misses


her family and wonders why is she being punished? I wonder why she feels she is being


punished, why she can only be visited by one parent for a couple of hours once a week, and why


there doesnt seem to be a nurturing/homelike environment? This question has led me on the


path of this research project. Are most psychiatric hospitals on Long Island like this, or just this


one? What constitutes a homelike/nurturing environment? Is providing a nurturing environment


necessary or irrelevant to the ultimate healing of psychopathological disorders? How do


professionals feel about providing a home in the hospital? How do the teenagers hospitalized


feel about this question? I wanted to address these questions through my research. And although


this study is inspired by the painful experience of a loved one, I nonetheless approach the task


of looking for home in the hospital with objectivity and a commitment to seek the truth.




The concept of providing elements of home in the hospital for adolescent girls is not one


explored in great depth. My rigorous search for case studies and information seemed fruitless at


times, yet is not a concept completely ignored. Some psychiatric nurses recognize ill effects of


non-nurturing environments. They prescribe supportive and home-like hospital environments


to lessen the effect of stress on the psychological stability of an adolescent. An important


factor for our teenage girl who is hospitalized for her psychological instability. Nurturing


environments provide deep, healing, positive experiences for adolescents (Shoen Johnson, 1995).


Conversely we could say if the environment is non-nurturing it would be a deeply negative


experience for our teenage girl who is already suffering. The environment sends powerful


messages that influence behavior, it can nurture coping skills and socialization, or promote


feelings of isolation and depersonalization (Olds, 1978, Pischeria, Bragg, & Alvaraz, 1982). We


can see the value in considering the environment as an important factor in the healing process


because of its influence on behavior.


In this study, I define elements of home as anything that creates a nurturing


environment to promote feelings of security, comfort and a sense of belonging for the adolescent


female inpatient requiring intermittent hospital stays. Intermittent is defined as a one to five


month stay for each individual, possibly repeated over a course of one to five years.


Security means feeling safe from harm, from self, staff or other patients. It implies not


feeling anxious or fearful, the ability to relax in the surroundings and not feel physically,


mentally or emotionally vulnerable. Safety should be an issue in considering hospital


environments. Most psychiatric patients have confused thoughts and unchecked emotions, so


they could present harm to themselves or others (Berger & Vuckivic, 1994). Teenage girls with


suicidal thoughts or violent behavior patterns would fit in this category of self harm/harm to


others. I can imagine the difficulty for a teenager trying to heal from a psychiatric illness if she


feels physically threatened or feels further emotional insecurity from an indifferent, cold staff.


Since I consider homes as contributing to a model for hospitals, it is important to


acknowledge that some home environments of girls are not safe and secure, and are in


fact the contributing causes of psychopathological disorders. Physical, sexual and emotional,


abuse and neglect prevail in many homes. Home environments are routinely


assessed to uncover harmful/abusive vs. loving/supportive aspects (Schoen Johnson, 1995).


I look for an overall ideal of a secure home rather than the dysfunctional one to


apply to the hospital setting. I surveyed teenage girls for their concepts of home, who were from


relatively safe, secure homes, to serve as my control group. The girls in my case studies, who


have psychopathological disorders, may or may not have come from safe, secure homes, but


were also surveyed to carefully consider their viewpoint.

Comfort is defined as that which soothes, makes life easy, and promotes feelings of


contentment. Comfort encompasses issues of privacy, personal space and familiar surroundings.


Hospital design should reflect comfort in the furniture, space and allowance for personalization


(Shoen Johnson, 1995). Being comfortable involves not being uncomfortable, or feeling the


environment is cold, impersonal or physically unpleasant. Studies show that cleanliness,


attractive dcor and quality of food are important considerations in hospital settings for patient


satisfaction and comfort (Squire, Stout & Reuben, 1993). Comfort is an essential element in the


home to create a sense of peace. As stated by Witold Rybczynski in his book, Home: A Short


History of an Idea, Comfort was meant to be undramatic and calming. Most of us desire a


comfortable place to heal our mental and physical wounds in. I know I certainly do.


Sense of belonging signifies relationships, family atmosphere and involvement in activities.


The psychiatric hospital becomes the new temporary home. Doctors, nurses and all staff


members become the surrogate family. Feelings of being loved, cared about and supported


constitute a healthy home and thus should be the goal of the hospital. This is a therapeutic


environment: a team approach between empathetic, caring therapists, staff, family members and


the patients. As in the home, the hospital should provide the adolescent with structured daily


activities, rules, positive reinforcement for good behavior, the continuation of school work along


with individual, group and family therapies. (Shoen Johnson, 1995). An adolescent girl in the


psychiatric hospital filled with a sense of belonging, is less likely to feel isolated, lonely or


homesick. Besides avoiding these negative feelings, it is important to promote a family home-


like world to help build self esteem through support and approval. (Gelard & Gelard, 1999). A


home/familial setting in the hospital could help the suffering teenager develop a positive self


image. A sense of belonging means giving her personal space with individual touches to


promote self identity. It promotes open relationships with the staff and a positive sense of group


identity. (Lennard & Gralnick, 1986)


Elements of home in the hospital creates a therapeutic community as A. Gralnick, in


Humanizing the Psychiatric Hospital, beautifully describes:


Anything that makes life easier and more comfortable is thought of as a mark of the therapeutic communityAny place that gives the patient little cause for complaint is the therapeutic community. Any hospital that is like home is the therapeutic community. An environment that is peaceful and permits leisure time, pleasure and freedom from pressure is the therapeutic community. Particularly, anything akin to the humane approach is considered therapeutic. (p.72)



Home is our connectedness with people, a unique place, a past anchored with memories and a


future for dreams and hopes. (Altman & Werner, 1985) A lovely sentiment, but as Clare Cooper


Marcus aptly put it in her book, House as a Mirror of Self: Home can mean different things to


different people. This is true for the teenage girl whose subjective choices are persuaded by


junk values of a mass culture, as described at length in Dr. Mary Piphers book Reviving


Ophelia. Open any magazine or look at television to see the media bombardment of carefully


marketed products targeted at teens. Popular culture themes affect their tastes and preferences.


Additionally the teenage girls concept of home is influenced by family/parental choices and


controls. But whatever the influence, her concept of home as a nurturing, welcome place requires


exploration to provide a paradigm for the psychiatric hospital environment. It is important to


solicit the opinion of the adolescent girl if we are to help her. She should be involved in the


process of her treatment because she is at an age when she needs to be listened to with


understanding and acceptance (Shoen Johnson, 1995). If we can find out what her needs are, we


can use this to influence her behavior, especially self destructive behaviors, like suicide attempts,


drug abuse, violent behavior, self-mutilation or eating disorders. The adolescent girl, like all


humans, have learned behavior which is affected by gratification through pay-offs. For


example if there is a positive pay-off for doing homework or chores, she is likely to repeat the


behavior. If wearing certain clothes or teasing a friend rewards her with compliments or


laughter, again she is likely to repeat the behavior. She learns from feedback she gets after the


behavior, thats why adolescence is a time of experimentation and risk. (Boyd-Franklin & Bry,


2000). If we find out the whats in it for me values of the teenage girl, we can determine


criteria for providing a nurturing, therapeutic environment for her.


I developed a survey to help define which elements of home were of importance to teenage


girls. I asked a Nurse Clinician at Mount Sinai Hospital and a member of a psychology honor


society to review the survey for their input and critique. (See attachment 1 for a sample survey.)


Keeping in mind the whats in it for me factor, I spent forty dollars on mini-perfume bottles as


a look what you get for doing this survey reward. Armed with my fragrant enticements,


dressed in floral decorated jeans and a t-shirt that said Girls Rule, my glitter decorated eyes


and I ventured out into the world where teenagers congregate. I went to the mall. I set out to


find ten middle class girls, age 13-18, who had never been hospitalized or diagnosed with any


psychopathological disorders. I wanted them to serve as my control group against the four case


studies, whose homes may have had negative influences. I approached a group of girls and one


said, Cool eye shadow. I was accepted, however I only netted three surveys that day. The


remainder I solicited through adults who had daughters willing to take the survey.


Finally I had all ten surveys, plus four additional from the girls who were hospitalized.


The first part of the survey consisted of twenty open ended questions designed to get the


subjects to reflect deeply on home and personal values. This prepared them for a list of thirty


home items that they were to put in order of importance. They were asked to repeat this


process to consider home elements they would desire if they were staying in a hospital for a few


months. This last part was the most crucial for this study and is what will be analyzed.


It was expected that their answers would be very different but that collective themes would


emerge. I rated their answers as: essential, very important, moderately important and least


important. When examining home elements in hospitals, I will consider the girls essential and


very important choices. They are listed on the following chart in order of priority:



Very Important

Moderately Important

Least Important


Spending time with family

Having someone to confide in

Spending time with girlfriends

Feeling safe/secure

Having privacy

Spending time w/a boyfriend

Wearing cosmetics*


Eating home cooked meals

Taking a warm bath or shower

Listening to CD's

Talking on the telephone

Feeling of belonging/fitting in


Watching television/videos

Having leisure time

Having the freedom to go out

Sleeping in a comfortable bed

Having art/decorations

Playing with pets

Having personal "stuff" from rooms

Having exercise/sports equipment

Playing on the computer

Wearing favorite clothes

Having a cozy chair/couch


Reading favorite books

Having plants/flowers/garden

Celebrating birthdays/holidays

Having drawer/closet space

Eating junk food

Playing video games

Studying at ones own desk

Wearing cosmetics*

Fig. 1 *This is listed twice because all four hospitalized girls ranked this in their top five while the entire control

group listed it as their last priority! This was the only element that had such a marked difference, so I felt it worthwhile to note it here.


Spending time with family was the number one value. It ranked in the top three for all girls,


except for one of the girls hospitalized for anorexia. A possible explanation for this


would be that she felt she did not have a good relationship with her mother. She perceived this


as part of the cause of her illness and did not value spending time with her family. Families are


at the core of the home and the girls value this above all. This is a strong argument for family


involvement and family therapy in the treatment plan.

Having someone to confide in ranked as the second most important element and was a top three


choice for the four hospital patients. Girls want to unburden their souls to a person they trust.


This could explain the high ranking for spending time with girlfriends and spending time with a


boyfriend, for the few that had steady boyfriends. Therapists, nurses and staff have to create that


umbilical cord of trust so crucial in helping their teenage patients open up.


Feeling safe/secure was essential to all four case study girls and most of the control group, as


was having privacy. Most complained about not having privacy in their own homes. Privacy is


difficult to have in a public setting, especially a hospital. In order to provide safety/security for


the teenagers in the hospital, individual privacy has to be compromised. Still, where it is


feasible, privacy issues for bathrooms, showers, personal space could be considered to cater to


this need. Privacy associated with the stigma of being hospitalized is taken very seriously by


hospitals. Most try to protect outsiders from gaining any information about a patient.


Wearing cosmetics appears in both essential and least important categories. This


was a curious division among the hospital patients and control group. I attempt a possible reason


for this: sometimes teens tend to want what they cant have. Some of the first things taken


away from teenagers upon admission into a psychiatric hospital are their cosmetics. It is part of


standard hospital procedure to confiscate anything that can be broken into sharp objects to use in


suicide attempts, self-mutilation or as a weapon. The case study group may have changed their


priority on this, if they were told their cosmetics would be confiscated for a few months.


Allowing for cosmetic packaging made of unbreakable soft plastic could be a solution if such


products exist. If not, this perhaps is yet another untapped market for cosmetic companies!


Eating home cooked meals was very important to all of the girls except our anorexic patient


for obvious reasons. Based on the comments the hospitalized girls made, providing quality food


is/was overlooked in most of the hospitals, not surprising for any of us who have had the


pleasure of being served institutional food. One girl said the food in Dragmont Hospital was


literally thrown together and barely edible. An interesting point is that all girls rated junk food as


least important, a fact that would please most parents. Food is strongly associated with home. In


the survey, all the girls describe different home cooking smells as what they like about home.


I believe providing quality, well prepared food is part of the therapy.


A true mark of the passage from childhood to adolescence is the desire to take baths and


showers without parents asking! The proof is in the girls rating this as very important. Also


important was listening to CDs and talking on the telephone, which are not surprising


choices, and are considered perks as part of step up programs in most hospitals. Lastly, the girls


want to feel like they belong and fit in, they dont want to feel alienated. I suggest creating the


home in the hospital to help foster those feelings.


This survey provides insights into what girls value and need for healing. Applied to a hospital


setting, the staff must be nurturing and create heartfelt bonds with the girls in addition to


allowing frequent visits from family and close friends. They need to be aware of privacy and


safety issues and become the confidante for these girls and help them feel like they belong.


Good food, a pleasant place to take a hot shower, allowing music and telephone privileges


are adolescent priorities. Stewart D. Govig (1994), describes a pleasant inpatient environment


as having a corps of aides, nurses and others who stay with patients around the clock to


provide food, comfort and security. (p. 29)




Anxious to get the opinion of professionals regarding this study, I obtained interviews with


Dr. Selma Goddard, Dr. Harry Tonla, Janet Cooper R.N. and Kathleen Switzer, parent to a


hospitalized teenager. Two of the interviews transpired briefly in person, two by telephone. I


changed all names as requested. I am grateful to all for taking time from their busy


schedules to work with a budding researcher. I asked if they thought this was a relevant


issue and what their insights were.


Dr. Selma Goddard, Behavioral Therapist


The idea of creating a nurturing environment is absolutely relevant. I have three words that describe what can make a home environment: staff, staff, staff. Having a cold, impersonal staff when kids are already scared to death, exacerbates the situation. The staff should create as much warmth as possible to aide well being. They have to give individualistic kindness and treatment. But, I must say, this is very difficult to do when they are short staffed and they have to follow hospital rules and regulations. Or a hospital may have a great program in theory but the nurses are overwhelmed and overburdened. There are aides that help out, but if they are not English speaking, they are not going be able to communicate. And communication is key! Every patient needs an advocate to protect their patient bill of rights, even high level places.

There are many, many philosophies in psychiatry. I am an eclectic therapist, I like to draw from many sources to provide a plan A, a plan B and so forth for my clients. I look for an individual by individual approach. I am aligned to the fact that patients are people. Professionals need to really, truly care about the person and have kindness. Creating the home environment depends on whether or not the staff and therapist are there for the teenagers. Its a vital point. They categorically must be there for the patient. Home is security, caring, loving. Staff has to be aware and want to help.

The teens rooms are their private spots, they should be allowed some personal items. Their own blanket, wearing their own clothes instead of hospital gowns. They should wake up and see drawings, pictures theyve made. Stereo and CDs are so important to kids. Take all the sterile crap out of the hospital, the teen should not be a statistic.

Some hospitals give the illusion they are there for the patient, but its a lie!


Dr. Harry Tonla, Psychiatrist


Of course, this is a relevant issue. Most hospitals are not known for their comfortable atmosphere. I have worked with many adolescents in psychotherapy. They could definitely benefit from this kind of home-like environment, but what is feasible? You have to remember hospitals are businesses. Are they in the business of healing people? Yes, but secondarily. They are in the business of making money first. And this is the biggest problem all medical doctors have who work in hospitals. You are fighting for money for your unit, your programs. You are dealing with an administration as complex as the diseases we treat. But Im am not saying it shouldnt be tried, in fact some hospitals do have very good programs for teenagers, but there is always room for improvement. I bring the issue of finance to the table because this is real life.

The other enemy to good treatment is the insurance companies. As a psychotherapist, this is a heinous problem. Therapy takes time and it is not fair to push patients out the door because their insurance has run out. Do you realize the decline in the number of days for inpatient hospitalization? About ten years ago you might stay for ninety days, today because of the decisions made by the managed care people, you may only stay for ten days. Soon you will have a drive through window! I am not saying the goal should be to keep a child in the hospital for three months, in fact that is not the philosophy today. But for the seriously ill patient, to shorten their stay because of insurance seems ludicrous to me. Discharging them prematurely could have disastrous results.


Janet Cooper, R.N. Staff nurse at Mother Hospital


We definitely strive for a caring environment. We are very small, we have only ten beds. This is our ninth year here and we have all the original people who started this program. We created the program and have evolved and improved it over the years. We have a nurturing environment and we really care about the kids and we treat them with respect. The stability of staff is key. We have four full time masters degree level and one part time bachelors degree level. So our staff is professional. We have very specific programs, we are very much into family therapy. We have sessions every day, one on ones, group, art class. The kids have goal sheets and they are given specific plans. We give out a lot of printed materials to kids and their families to educate them.

Managed care has definitely affected the length of stay for patients, sometimes they only stay for nine days at a time, depending on the problem. It is very challenging. We have to intensify efforts to help our patients.


Kathleen Switzer- parent of an inpatient teenager.


Making a hospital like home is a very important goal. My daughter has been through what we parents jokingly call the Long Island Leap Frog. Our kids have gone from hospital to hospital, because of doctors preference, insurance or money issues or not enough room. I could write a book about all the experiences Ive been through with the hospital system. It is so hard to deal with having a sick child. You end up feeling guilty and blaming yourself for her illness. But there were some terrible factors that led to my daughters hospitalization. I can honestly say my husband and I have been there every step of the way for my daughter though this whole nightmare.

To make a home place, the people are crucial. Some of the staff are so professional and welcoming to families. They have excellent programs and give you a lot of information so you dont feel in the dark. It can be so confusing with the diagnosis and the drugs they prescribe. You have to be in constant communication with them. Some are very accessible, some are not. Some hospitals are terrible. The staff is evasive, or they dont have much time for you or your child. Some of them are downright abusive. My daughter was so traumatized by one place that I wanted to take her home. I will never forget what the Doctor said to me, it chills me every time I think of it. He said, Your daughter will be dead in a year. Probably if she had stayed in that hospital she would be.

The most important thing I can say is you have to speak out and fight for your kid and make sure they are getting everything they are entitled to and not falling through the cracks. Are they getting their therapy? Are they getting help? I found the hospitals that had a variety of therapies really helped my daughter. And family therapy helped all of us, because a childs illness affects everyone in the family.

The paperwork is absolutely endless, the insurance forms, the hospital forms, it never ends. And there are constant battles with the insurance companies. They dont want to cover this or that. The best thing is to put your kid in a private hospital. But they are so expensive. For example, therapy that cost $1300 in a state hospital cost $7000 in the private hospital! That is outrageous, but what do you do, sacrifice your kid? The insurance companies dont cover it all for private hospitals. This whole managed care thing forces the kid to be discharged before shes ready. We are already going through hell with having a sick child, we dont need this bull shit from an insurance company.


Dr. Goddard, Ms. Cooper and Ms. Switzer recognize staff quality as an integral part of the


nurturing environment. In dealing with adolescent psychiatric programs, qualities of caring,


personal contact, commitment and how well the staff relates to adolescents seems to be


associated with program success. (Brooks-Gunn & Foster, 2000) Staff has to be fully involved,


not neutral, but biased, in a truly loving, and safe relationship. (Kennedy & McCarthy, 1998) I


agree with a philosophy of professional credentials plus a vocational calling to work with



Our familieswere utterly absent from our hospital lives. This quote from Susanna Kaysen


in her book Girl, Interrupted, could have been written by my case study, Beth, whose


hospitals philosophy is to distance family from the treatment process. Ms. Switzer talks of the


importance of communication between staff and family. An adolescents psychopathology


greatly affects the family. Parents are already bewildered and cant make sense of extremely


disturbing behaviors in their daughter. They dont know how to respond. (Karp &


Tanarugsachock, 2000) Ms. Cooper prescribes family therapy . The treatment team should want


to foster good relationships with the patients family. Obviously this makes the work of healing


the patient have a better chance if everyone is working toward the same goal. (Korpell, 1984)


The American Nurses Association advocates that families should be included in the treatment


process. (Mohr, 2000)


Dr. Tonla raises important issues with regard to finance. Is my search for home in the hospital


all for naught if there arent sufficient resources? Dr.Goddard talks of the problems of


insufficient staffing and nurses who are overwhelmed and overburdened. Budget constraints


to limit staff or cut programs will definitely affect quality. Ms. Cooper and her co-workers are


able to provide a nurturing environment in a small unit of a private hospital where more


resources are available. Ms. Switzer prefers putting her child in a private hospital but points out


the exorbitant costs; the downside of getting quality healthcare. She doesnt want to


traumatize her daughter by putting her in terrible hospitals, but how can she afford it?


Which brings me to the most frustrating factor for doctor, nurse and parent: managed


health care. Professional agree that the interference of healthcare systems to interrupt psychiatric


care will negatively affect the healing process and outcome. (Masters, 1997) Patients discharge


planning often coincides with the date the insurance benefits run out, regardless of patient,


doctor or family wishes. (Sharkey, 1994) Dr. Tonla humorously points out the trend of


shortening the inpatient stay with his drive through window prediction. I found entire web


sites devoted to managed care humor, like the following cartoon:


North County Psychiatric Associates.




Managed care is an argument for home in the hospital, by forcing an intensive, therapeutic,


effective hospital stay. Or it is an argument against by prescribing a no frills, stabilize and


release philosophy. Pro or con, it is the source of controversy and frustration for all.






Adolescence is the rickety bridge between childhood and adulthood. It is the time of rapid,


profound change. Puberty, in Websters dictionary, deals with biological readiness for


sexual reproduction. This simple definition leaves out the emotional, social and physical angst


that adolescents experience. As though at a carnival, they ride the hormonal roller coaster, get


horrified by distorted fun house self images and get trapped on giant pendulum ships, moving


from childhood to adulthood and back again. It is a time of excitement and frightment.


Teenage girls are at particular risk during this time. They are overwhelmed by an oppressive,


media-worship culture; pressured to be sexy, beautiful and sophisticated while feeling the


awkwardness of their evolving bodies. They go inward, become more secretive, internalize hurts


and confusions. (Pipher, 1994). It is no wonder that the rate of psychopathologies increase


during adolescence. (Steiner & Yalom, eds., 1996)


I felt it important to examine the predominant disorders affecting my four case study


teenagers. It would be impossible to explore all adolescent psychopathologies in this research


paper, since the main focus is on looking at home elements in the hospital. I wanted to


consider what special needs the girls might have because of their illnesses. All the girls were


found to have multiple disorders, but these four dominated their diagnosis: major depression,


drug addiction, anorexia, and obsessive-compulsive disorder. The reflective nature of this next


section, in no way attempts the depth of complexity that these disorders deserve. This is meant


merely to offer another perspective on the issues of security, comfort and sense of belonging.


Categorizing psychopathologies is not an exact science. I found conflicting information, but


selected an excellent comprehensive text by Steiner & Yalom eds., which bases the categories on


the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). I created the table below


to highlight the four disorders and show what category they fall under. This is an abbreviated list


and does not include every single psychopathology.








Major Depression





General Anxiety



Conduct Disorder


Anorexia Nervosa

Bulimia Nervosa


Drug Abuse


Psychotic Disorders

Psychiatric Trauma

Fig. 2


Major Depression:


Major depression is the most extreme of all the affective disorders and manifests as a feeling


of profound sadness. Teenagers with major depression may exhibit sleeping problems, loss or


increase of appetite, weight fluctuations, trouble concentrating or a focus on suicidal ideology.


They can no longer do all the things that they used to do, like schoolwork, part time jobs, sports


or social activities. They can lose interest in appearance and personal hygiene or engage in


promiscuous sexual activity. An overall feeling of not caring pervades. At its worst it can lead


to suicide, alcohol and drug abuse, total failure at school or increase in risky behavior.


Teenagers at high risk for major depression include those with a family history of depression or


substance abuse, those who suffered trauma or abuse and those whose families are going through


divorce, marital conflicts or problems with children. Girls have a higher rate of depression at


puberty than boys. Poor body image may be one reason girls feel more unhappy, anxious and


unattractive than boys. (Steiner & Yalom, eds., 1996)


Hospital staffs have specific strategies for dealing with suicide risk patients. They may


assign a nurse to a patient for a one on one watch to get the teenager through the dangerous


period. (Shoen Johnson, 1995) As mentioned earlier, anything that can be used for a potential


suicide is confiscated. This includes use for self harm as well as suicide. Girls are increasingly


engaging in self mutilation as an outer physical expression of their inner anguish (depression).


(Piper, 1994) Two of my case study girls, Petra and Kirsten, showed me their scars as a result


of this destructive practice. A chilling reminder of how deeply the girls were wounded on the


inside. Another factor with suicide patients is the idea that suicides can occur in clusters.


(Gould, Wallenstein & Kleinman, 1990)


My home element of safety is at stake here. A girl with major depression and suicidal


tendencies needs a vigilant, sensitive staff to recognize symptoms for intervention and to keep


the environment safe. Awareness of the influence teens have over each other is key. I think this


implies getting to know the girls and who their inpatient friends are. Like a good parent, the staff


needs to be on constant watch for signs of trouble. Teenagers can be very creative in their drive


to obtain implements of harm. Case study Danielle assisted Petra with a smuggled shoelace


noose. I want to suggest that all staff members be vigilant in this matter, not just doctors, nurses


and social workers, but the cleaning woman, the cook, the aides etc. This may be a philosophy


in certain hospitals but I was unable to obtain that information about the six hospitals in this



Ophelia by J.E. Millais depicts a scene from Shakespeares Hamlet.

Works of Art have sometimes romanticized suicide. (Chiles, 1986)





Drug Abuse:


The staggering amount of information on teenage alcohol and drug abuse available is


astounding to me and implies the serious prevalence of this problem. Dr. Les Parrott III, author


of Helping the Struggling Adolescent, describes the following warning signs:


social withdrawal, deterioration in school performance, resistance to authority, behavior problems, high-risk behavior such as stealing, extreme mood swings (which include signs of depression), sexual promiscuity, physical complaints, changes in relationships, changes in eating habits, and the more observable signs such as alcohol on the breath, slurred speech, staggering, appearing spaced out, dilated pupils, the presence of drug paraphernalia ( pipes, pill boxes, straws, spoons), and clothing depicting drug themes. (p. 125)


My research turned up volumes of theories on the reasons why a teenager becomes


addicted. There are many physiological, genetic, social, peer pressure, media, familial and


psychological factors which dont need to be defined in this study. Rather my focus is on the


issues of inpatient treatments and how this will relate to our home elements. One big problem


identified, is the grouping of adolescents with adults for treatment, rather than recognizing their


different needs. If teenagers find themselves in group therapy, surrounded by adults, they may


feel very uncomfortable and never benefit from it. The traditional model looks at physiological


and genetic factors which excludes the psychological aspect prevalent in teen drug abusers. If


teens are lucky enough to be placed in an available adolescent unit, there is still the mixing of


drug and alcohol abusers who need different considerations. Different levels of abuse require


locked or unlocked units. A patient may not be placed in the hospital that can best suit her needs


(Steiner & Yalom, eds., 1996) I agree with this and identify it as the home element, sense of


belonging/fitting in, as in fitting in with the right hospital setting. Case study Danielle,


had a cocaine addiction and mild manic/depression. Fortunately she was treated in an adolescent


only unit that was psychiatrically and medically oriented to deal with both her issues.



The Scream by Edvard Munch.

For drug abusing teenagers, anxiety can reach

levels of intolerable intensity. (Chiles, 1986)



Anorexia Nervosa:


You cant be too rich or too thin. The frightening prevalence of the later part of this


mantra, has provoked a dangerous modern disease of young women that proves the opposite.


You most certainly can be too thin. Everywhere one looks, thinness is idealized. Every day there


is a new diet or a new exercise machine to be bought from an infomercial.


Anorexia Nervosa is one of the most difficult psychopathologies to treat and has the highest


fatality rate. (Piper, 1994.) Anorexics are hungry all the time but obsess themselves with


silencing their appetites. (Steiner &Yalom, eds., 1996). They eat low fat foods and no calorie drinks,


they eat slowly, hide food so people think they are eating, use laxatives and diet pills, engage in


excessive calorie burning activities, throw up food and develop little rituals. It is ironic that a


disease that begins as a idea of beauty turns into unhealthy ugliness. Concentration camp


thinness, dark hair growing all over the body for warmth and blackened teeth from incessant


vomiting; it is this image that the anorexic has twisted into beauty, and it is hard to convince


her otherwise. At seventy nine pounds, case study Kirsten still didnt feel thin enough! It is no


wonder therapists are frustrated when attempting to work with anorexia. The therapist must be


committed to a long, arduous process, working with a medical doctor and nutritionist.


(Steiner & Yalom, eds., 1996)

Several sources for my research mentions family therapy as being the most important in the


treatment of anorexia. The reason for this, is that it is believed that the relationships in the


family helped create the disease. Parents who are obsessed with the child/adolescents physical


and mental functioning to the point that their actions hinder individuation and separation from


the parent/child relationship. (Shoen Johnson, 1995) The child/adolescent in this situation


becomes the center of family conflicts, often playing one parent against the other. The parents


may then turn the blame on the child. Thus the anorexic gets used to putting her parents conflict


on herself. (Minuchin, Rosman, & Baker, 1978)

Families are highlighted again as an important home element. Besides creating the surrogate


family, hospitals need to consider the real family and actively engage them in the process of


healing with family therapy, especially for the anorexic.



Girl at the Mirror, by Norman Rockwell

A young woman strives to be beautiful, but in

the end anorexia takes on a life of its own.

(Piper, 1994)


Obsessive-compulsive Disorder:


A typical day for a person with OCD, is a continuous repetition of rituals that destroy


emotion, time and the joy of life. Its roots are in fear and anxiety. Uncontrolled thoughts turned


into uncontrolled actions. This last of the psychopathologies to be examined is perhaps the most


relatable. We all have all had haunting thoughts that trouble the mind over and over again. And


we have all had irrational impulses that we are compelled to act out. The difference for us is that


we are able to stop and continue on with the flow of life.

It has been suggested by Dr. Les Parrott III, the reasons why teenagers becomes OCD may


be rooted in their attempt to reduce fear, control self-doubt, alleviate guilt through perfectionism


and live up to unrealistic expectations of parents. The National Anxiety foundation suggests a


biological link with serotonin and therefore is treatable with several different medications.


Unfortunately finding the right combination may involve painful trial and error, as was the plight


of case study Beth, who underwent some terrible side effects until the right combination was


found. Dr. Parrott prescribes a three way therapeutic approach including behavioral techniques,


cognitive techniques and exposure to stimuli. So treatment might involve relaxation methods to


deal with anxiety, using daily records to note obsessive thoughts to begin the process of altering


thought patterns and slowing desensitizing the adolescents fear. I knew a young


man who had OCD. He would constantly stop his car because he feared he ran over someone.


His therapist actually went out driving with him to help him by exposing him directly to the fear.


One could imagine the stigma associated with the actions of the OCD teenager. Ridicule and


ostracizing would further induce anxieties. Beth told of painful incidents of cruel comments that


haunted her to the point of exacerbating her OCD. She felt others avoided her and she had


trouble making friends.


I consider two vital elements for the OCD patient: creating a sense of belonging and


providing frequent, appropriate activities. The staff can encourage a welcoming environment for


the OCD girl, where she does not feel perceived as weird but rather healing from an illness.


Exposing her to others with similar problems and quality group therapy prevents feelings of


isolation. Also, the question of quality and amount of activities becomes important too.


Hospitals can provide exercise or yoga classes, along with journal writing and other cognitive


therapies. Boredom and lack of activities dominated some of the girls experiences in certain


hospitals, with lack of physical and mental activities. Hours of TV watching is certainly not




The Anguish of OCD, artist unknown.

(National Anxiety Foundation, 2001)



My research of these four psychopathologies persuades me to ask some additional questions


about the hospitals in this study.


Do they have:


-         Close relationships with patients and vigilant watch over them?

-         Family therapy?

-         Segregation of adolescents from adults?

-         Special units or considerations for different psychopathologies?

-         Supportive environment to reduce anxieties?

-         Varied multidisciplinary activities?






The four case studies presented are white, middle class females, ranging in ages (at the


time of hospitalization) from 14-18. All were hospitalized for multiple psychopathologies,


multiple times. Collectively they stayed in six different hospitals on Long Island. I struggled


with the choice of presenting long excepts vs. pertinent quotes, but I believe the longer passages


strongly demonstrate, existence or lack of, home elements in the hospital. The girls stories are


fascinating and moving. Similar experiences overlapping the hospitals made it unnecessary to


transcribe all of the interview material, avoiding redundancy. I included the girls memory of a


hospital if more detailed or significant. I changed the names of teenagers and hospitals for


privacy and legality issues. I left out some details contributing to their illness and leading to


hospitalization, which were very serious, traumatic issues. This was at the girls request. I feel


very grateful to these four girls for their candor, bravery, poignancy and wit in revelations of an


anguishing adolescence.




Petra is twenty years old and has been in and out of hospitals from age 14-18. Of all the case


studies, her experience was the most extensive, with intermittent stays in five different


psychiatric hospitals/hospital units:


Petra had numerous suicide attempts and suffered from major depression, some bulimic


episodes and sleep disorders.


Petra at Mother Hospital:


I was fourteen years old, I was very depressed and plotting my suicide, planning it in my journal. My therapist, Patrice wanted me to have a psychiatric evaluation. She told me to pack a suitcase. I felt some relief, but not total relief because I knew my parents didnt know how bad I really was. Part of me wanted to say, Oh, Im fine, forget the whole thing, because I felt guilty about my parents, but I knew that I really wasnt fine.

I had to get evaluated by the director of the adolescent unit at Mother Hospital. I packed my Muttsy, my stuffed animal I had since I was seven, this old raggy little dog that I loved. But they go through your suitcase when you get admitted. I couldnt have shoelaces because I was a suicide risk. If youre a suicide risk you cant have shoelaces, or a belt. If you need to hold your pants up you get basically this thin piece of string, like yarn, if even that. No one was allowed anything sharp, for everyones safety and the staffs safety. And they wouldnt let me keep my stuffed animal because, people could smuggle stuff inside of things. They go through everything looking for contraband as they call it. No drugs, no alcohol, no pills, no razor blades, knives, tweezers, no glass, no mirrors. That was pretty hard as a teenager, not to have mirrors. They had mirrors in the bathrooms, but they were like this plexi-glass stuff, so you couldnt break off pieces and try to kill yourself. Everything there had grounded electricity, so theres no way you could electrocute yourself. You couldnt have your door closed.

Sometimes I would have a private room, but there were only two private rooms on the unit so mostly you had to share. You were allowed to wear you own clothes, but they had rules for that too. No shirts that exposed midriffs, or anything like that. One time when they put me on 4S, which is a suicide watch. They took everything out of my room, everything, even the bed sheets and comforter. I had to lie on the bed with just a hospital gown on. I was only allowed a blanket at night. I was on a one to one watch, so someone was with me 24 hours. Some of them would even come into the bathroom with you, others would be nice and just stand outside the door. The rule is they needed to legally be in arms length of you at all times. They had to be able to grab you just in case.

Mother Hospital was really the best. Each room had a private bathroom. And it seems every single hospital Ive been in always had the psychiatric unit in something north. 2 North, 5 North, 10 North. The room was pretty nice, it was plain, but the furniture was homey looking. When you were not on suicide watch, they let you have pictures, but not in frames, and you could tape up art or whatever you wanted. As long as it wasnt things like Marijuana is great or a suicide note or my life sucks or something like that. There also was a rec room, but they called it the day area, with a foosball table, a T.V., and separate couches so you could sit privately. And they had Nintendo, but you had to have certain level privileges to play it. They had a CD player/radio, but there was a lot of rules with it, you could only have it for ten minutes at a time. You werent allowed to have your own walkman, this is something I really wished they allowed because music is so important to teenagers. Kids got into fights all the time about the radio. And they didnt want us listening to certain music. I liked the group Hole, but the cover of the CD showed a girl with her wrists slit, so they banned stuff like that. No suicidal ideology, or curses or drug stuff. They made a rule later on that if you brought in CDs you had to have a booklet of the lyrics so they could read them first.

The day area was nice, thats where you could visit with your family and they were allowed to come every day in the afternoon and evening. Your family could bring food, but you had to be at a certain level to have a snack stored for you in the kitchen. When you first arrive at the hospital, you are at level 1 which means you dont really have privileges to go on off the unit activities. If youre on level 1 you go to bed at 9:00 in Mother hospital, level 2 you stay up till 10:00 weekdays and 11:00 on a Friday night. Level 2 with a note from your Doctor, you could go to the other units for arts and crafts, play games. They had a pool table. At this point the staff and doctors had observed you and you werent considered dangerous to yourself or the other kids.

The staff really was great at Mother hospital. One time we were all upset because one of the girls who had gone home, ended up killing herself. She was one of my friends. I really took it hard. The nurses were really nice and let those of us on level 2 and 3, go off the ward entirely to go to a candy vending machine. I dont know what possessed me, but it was the dead of winter, at night and I just bolted from the hospital, out of the emergency room doors, I just ran, it was an impulse. I ended up somehow in the backyard of some Happytime Nursing home with no jacket and shoes with no shoelaces. I realized, Its cold, what am I doing?, so I went back on my own. They had police and guards out looking for me. I remember walking back through the emergency room doors and some police officer asked me, Are you by any chance from 2 North? I said, Yeah and he said, A lot of people are really worried about you. But he was really nice about it and took me back to the unit and said to the two nice staff people, Now go easy on her, she came back on her own. But those two nurses were really mad at me and wouldnt talk to me for a week. They really acted like family, they were hurt that they trusted me and I betrayed the trust.

We had community meetings every morning after breakfast where you could bring up all the petty stuff. Then we had school for a few hours, the tutors would come in they were pretty nice. You would get homework from your school district and the tutors would help you. If you didnt have anything they would always give you something, they had good teachers there. We had cooking class, we played games, or you would make something, art or poetry. We had relaxation class every night, they would play music, we would lay down, and that was supposed to get you calmed down before bed. We had some free time during the day, a couple of hours.

You were on a point system, you would get points for doing good things, like making your bed, going to breakfast, taking your shower. Rather than the opposite where would get points taken away if you didnt do them, which was the case in other hospitals. This was a more positive system. You would get points taken away, like if you cursed. You also started out with points. If you got higher points you would get more privileges. If you made a certain level, the hospital unit got points, and once a week you would go on a trip with a recreational therapist and one of the staff, to the movies, bowling, or go to sports plus. There was a rule too that you couldnt have any physical contact. It was coed, so no hugging or kissing. You werent supposed to hug the staff either. But I got plenty of hugs from the staff. That was one rule they didnt enforce, they were very loving.

We got our meds in the morning and at night. Some people used to cheek their pills, so they could store them up. They would make you open your mouth and check to make sure you swallowed. They knew almost every trick in the book. Once before going back to Mother, I knew I wanted to have my tweezers. I took a stick deodorant, which they let you have, and I rolled out the deodorant stick. I took my tweezers and I wrapped it in paper towel and stuck it in the bottom of the empty container and then put the stick back on top and rolled it down. So I was able to keep my tweezers. I didnt want to hurt myself, I wanted to pluck my eyebrows. You werent allowed to shave, you had to be hairy the whole time.

I made friends, you bond with people. Danielle and Kirsten came to my sweet sixteen party. We lucked out they we were all out of the hospital at that time, because we were always in and out. Mother was a really good nurturing place, the staff spoke to you nicely and kindly, there was always someone there to listen to you. The doctors were great, it was the most like home of all the hospitals. I was there six different times over four years. Thats why I remember so much. My problems went very deep and it took so long to be where I am today. I can honestly say if it wasnt for Mother and all the great therapists Ive had, plus my family, I wouldnt be here today.


Petra at Dangerfield State Psychiatric Center:


Dangerfield was the worst of all the hospitals I stayed in. Right from the start the staff was mean and just turned me off. The place was filled with dangerous kids, one claimed she sold weapons. The staff was horrible. The more I wouldnt cooperate with them the harsher they became. I wanted to leave and they started threatening me and making up lies. I ended up confined to my room for days. Print this from my diary:


Dear Diary,

It is horrible awful. I just stopped crying. Today Lina told me if I left it would be AMA and she called my parents and told them that. That made my mom nervous. It means they could commit me against my will. Then they had a team meeting. They said I had consequences either I could transition or stay in my room, no radio, no books for 10 hours every day. Lina was calling my mother to tell her not to take me home. Lina laughed at me THAT BITCH. I told her she has no heart etc. Then she said they were keeping me for an extended period of time. I said, Weeks, months? She didnt know. So I became hysterical. Elaine, the bitch came in and talked to me and was mean and said I wasnt going home. So tough luck. And then out of nowhere, with no merit whatsoever, told me I havent been eating and I still want to hurt myself. I screamed, WHAT? I threw out my nasty tuna, so fucking what?? I eat like a pig and I dont want to hurt myself. So I signed a legal 72 hour letter to get discharged and Im praying I get out. The problem is my parents. I know Lina must have talked them out of taking me home. So what to do? I also got yelled at and sent out of activity into my room for comforting someone and refusing to drop asking what was wrong under the staff director. Fuck this shit. 10 hours a day in room, no CD player, no TV. This is a violation of right # 3. No reading materials, meals in the room. They are lying now, making up stories to keep me here. Mocking me, laughing. I am so terrified of these people. I have been in my room almost all day. Ive already signed myself out, they cant keep me here. My mom called and I told her what they are doing to me, she started crying and saying she didnt understand how they could do this to me and they told my father they were just enforcing strict consequences. They have also been telling my insurance person that I am extremely dangerous. My mom and I know I am not! They are just trying to dick me over. So my mom was so angry and said that on Friday, her and my father are signing me out. They are saying Im coming home with them. My mom told me to just keep my calm and Ill be out in 72 hours. My dad too. Im so grateful my parents are supporting me. God, I pray to you I am safe and I need to go home!!!


After I left Dangerfield, I wrote a letter to the state complaint board. They violated many of my patient


rights and they got investigated because of my letter!


Petra at Rocky Stream University Hospital:


I was attending a special private high school for girls with psychiatric and other problems when I wasnt in the hospital. This evil district representative showed up at my parents house and said I had to be evaluated at the Rocky Stream psych E.R. It was so scary. It is a total locked unit, everyone there is totally crazy! This girl with died black hair, you know the gothic look, came running at me yelling, You bitch, Im going to kill you. She was on a bad acid trip. I ended up having to have ECT, which that hospital supposedly has the best set up for. I dont remember a lot about that hospital stay because the ECT kills some of your memory. But I remember it was a circular unit and it was big and you could get lost. You were free to walk all over the place. And people ran rampant, some really psychotic adults. It was not a safe place for teenagers. I was 16 and I was the youngest person there getting ECT. I dont really know if it made a difference because its hard to differentiate what happened. My mom seems to think it helped me a lot. My psychiatrist didnt want me to do it. I was fine with getting it, they had to have my permission to do it. You have to have no food or drink for twenty four hours, cause you could die. It was scary, but they show you a video of the process. You had to get into a hospital gown in the morning and they take you in to do it, and I loved getting anesthesia, I loved the doctor counting backwards and you would feel the waves come over you and then you are out. I loved the feeling of going down, a total rest, no dreams, no nightmares. After the procedure, I hated waking up, I was hysterically crying and screaming and disoriented. I dont really know what they did. But its very safe, not like the olden days, its very routine now. And its weird the next treatment I had, I woke up hysterically laughing. And supposedly this doctor who was renowned for his expertise in ECT was treating me. Thats why I ended up staying in Rocky Stream. He was this famous guy and I thought he was an asshole. So before they even put me under the anesthesia, I dont know where I got the balls to say this to him but I said, You know you think youre such a big shot, youre such an asshole! And all the nurses were gasping because here I am about to go under anesthesia and get shock treatments from this guy. They thought it was the funniest thing, because he was on this big ego trip like Im Dr. Bigshot.

Petra at Dragmont Childrens Psychiatric Center:


At one point I was sent to Dragmont, I think we couldnt afford Mother at the time, you know the they were very expensive and the insurance didnt cover everything. There were people who were out of control, violent. There were these girls in Dragmont - thank God I wasnt there when they did this - but I was on pass and I came back from Christmas, and I found out these girls had plotted this whole thing to escape, and they set a fire in the kitchen and they jumped the staff. They attacked them, like some of them got bit. Thats a dangerous job. I knew this nurse Marianne and she was kind of gruff but she was okay. This girl bragged about attacking her. I got really mad at her and told her that was wrong. Marianne got really hurt, like with permanent damage. I didnt like Dragmont at all. They did not have enough therapy. I had been through the process so many times I knew how to demand more. The step up program was very punishing. It wasnt like Mother at all. I didnt feel safe there. The only good thing I can say was that my therapist, once I got her, was great and she did help me somewhat. The whole place was very institutional and they had to deal with real behavior problem kids and the staff was mostly terrible.




Kirsten is 21 years old. She has been in and out of hospital from age 13-19. She was an inpatient at the following hospitals:

Kirsten was diagnosed with anorexia nervosa and mild depression. Her eating disorder was severe and pervasive.

Kirsten in Mother Hospital:


I absolutely hated Mother hospital the first time I went there. I hated it because my mom put me there. My parents couldnt deal with my dieting, which is what I called it at the time. I had to travel down a long road before I was able to admit I was an anorexic. My parents were always fighting with me. My mother was a beast, she was the original mommy dearest. We had the perfect house, the perfect looking children, our rooms had to be perfect, we couldnt get less than As. I wanted to be a model. In modeling you are encouraged to be thin, and they encouraged drug use to stay thin. I am six feet tall and I weigh 135 pounds. I like myself now at this weight. But once I was 79 pounds and I thought I wasnt thin enough. With anorexia you literally starve yourself to death. Im Catholic and I even used to throw up the host from communion. I still struggle today but I am so much better. I dont live at home anymore and I still go to therapy every week.

Anyway, as I said I hated Mother hospital at first. All those rules and regulations. I found it very invasive to my rituals. They would never let me just be alone. They made me go sit at a desk for an hour after eating, doing nothing while someone watched me, so I wouldnt purge. They monitored everything I ate and kept careful watch on me all the time. They were trying to help me.

They had this rubber room for you to go scream in when you wanted to act out. Sometimes they would announce this code over the hospital loud speaker Mr. Powers, Mr. Powers! Please come to 2 North. Which was a message for all the manpower to come to the ward because someone was freaking out and going crazy. And they would come and put the person in the rubber room. You could flip out. It was all kind of surrealistic. Seeing people flip out and act weird. It was like being Dorothy in the Wizard of Oz. All of a sudden you are completely uprooted and in a weird place. Some of its friendly and supportive. People want to help you find the way. And some of it was as scary as the witches castle. It was after I went to Rocky Stream that I really appreciated Mother and I began to let them help me. They really were so nice to me even though I was so hostile to them the first time I was there. They didnt give up on me and they were strict, but not in a bad way.

I met Danielle and Petra there. Danielle was a very out of control girl and I know she thought I was uppity. She just wasnt my type. But Petra was my anchor, she was a really good friend. They had lots of family therapy which was great, it helped me free myself from my mother. She had a tough time with this, but it helped her too. Our relationship will never be perfect, but its improved a lot. And with me being out of the house now, things are much, much better.


Kirsten at Dragmont Childrens Psychiatric Center:


I ended up at Dragmont, I dont even remember why, I think it was the insurance or maybe Mother had no beds. Anyway, I hated that place. There were a lot of poor kids, kids from crack homes and really abusive homes. They were scary and violent, always acting out. I hated the point system there, they had more rules than a prison. You werent treated as an individual, if one kid did something wrong the whole unit got punished. Then kids would get violent towards each other. One girl almost beat up another one because we lost phone privileges. So instead of learning to take responsibility for yourself you just hope that all the other girls dont do something stupid. Everyone else has to do what they are supposed to so you can get a lip gloss. So that wasnt a fair place. The food was disgusting! Here I am with an eating disorder and they want you to eat. It was made with really unhealthy ingredients and most of it came from giant cans. Gross. It could make you want to starve.

Then this horrible thing happened. The staff was mean, but this one guy, a staff aide, was really nice and would listen to me and he was really cute. And then he hit on me! And his wife worked there on another unit. He wanted me to meet him somewhere when I got out on a pass, and I thought he was cute. But I realized it was dysfunctional and wouldnt be a good idea. I knew it wasnt professional and normal. Can you imagine how screwed up I would be if I had an affair with this guy? I told my therapist but I didnt tell her his name, but she guessed it because an accusation was made against him that this girl met him at a hotel and they had sex. She was 15. He was a scumbag and it was passed over because they said she was crazy. I had to go through this whole investigation. He got suspended while the investigation was going on. And his wife worked on the other unit and she was this big terrifying lady and here I am this skinny anorexic. She would give me dirty looks and she was friends with the people on my unit. They already didnt like me so this was another reason for them to hate me. The whole thing wasnt conducive for me to get better. Some of the staff and my therapist all wanted to get me discharged because they knew this wasnt healthy for me. It wasnt a safe environment. I have had as much trauma in the hospitals as I have had in my life!

Kirsten at Rocky Stream University Hospital:


They didnt have enough beds in Mother one time so I got sent to Rocky Stream Hospital. That was an insane place. I was with adults. I never saw so many sick, demented people. There was this man who thought he was Jesus and argued with another man who thought he was Satan. Some lady went up to my mother and started talking to her. My mother had no idea she was a patient. And they were talking all friendly small talk and she says to my mother, Yes, I lost my son. And my mother said , Oh, Im so sorry. And she says to my mother, Yes, hes lost in the universe and they ate his penis. I just loved that. The look on my mothers face was so funny.

The unit was so huge, like a big circle. It was like a prison, all locked up at night, but I really had the most freedom here, but not in a good way. You could go around and around all day doing nothing. There were house phones on the walls everywhere. You would get paged on the phone if they were looking for you. One time I got paged and while I was on the phone, I saw this man standing outside my room running his finger over the number plate. I had to go to the nurses station and when I came back to my room, he was standing completely naked in front of the mirror by the sink. He was holding my face powder compact open and he was scooping it out with his fingers and eating it! I was only 15 at the time and this traumatized me. I wanted to get out of there, I was hysterical. I called my Dad and he called the head of the unit who said to him, Oh weve advised Mr. So & So to not go in her room again. Like that was supposed to make me feel safe! So I didnt feel safe there at all.

Then one night my mother called to see how I was doing, she called the nurses unit and they told her not to panic but they couldnt find me. What had happened was the night before it was really hot in my room. The lady who had the lost son with the eaten penis had the room next to mine. She was getting ECT, so I slept in her bed because it was too hot in my room. Her bed had all this padding next to guard rails so she wouldnt fall out. So they couldnt see me asleep behind the padding. They thought I was lost. Thats what kind of close observation they kept on me. In Mother they check on you every 15 minutes.




Danielle is nineteen years old. She has been in and out of hospitals from age 15-18. She was an


inpatient at the following hospitals:



Danielle had a serious cocaine addiction and was also diagnosed with a mild bipolar disorder.


Her behavior was often reckless and she described herself as a wild teenager.


Danielle in Mother Hospital:


I was fifteen and so into drugs and I was this totally manic girl. Lets face it, I was wild. I was three years in and out of Mother. Thats where I met Petra and we became friends. I knew Kirsten too but she was such a fucking princess. Oh sorry, are you gonna bleep out my curses? Anyway, I felt Petra had a right to kill herself, so once when she was on suicide watch, I smuggled her a tic tac box that I stepped on and made sharp pieces. I passed it to her in a book. I was a crazy kid. She used it on herself under the blanket and the one-to-one nurse almost died when she found out. Petra only hurt herself a little, it wasnt sharp enough to kill her. I smuggled a shoelace and I helped her rig up this shoelace noose with a chair, but it hurt her neck and didnt work. Later on we got found out and we lost all our privileges .

We were a coed unit at Mother, that was pretty cool. Most of the girls were depressed, suicidal or into self mutilation. I was a drug addict and I just wanted my junk. My boyfriend would visit me and pass me some coke. They caught on to him pretty quickly so he was banned from visiting, which really sucked at the time. Hes not my boyfriend now, he really is a loser, he lives with a woman thirty years older, shes hes coke mamma and has eight dogs, its really weird what drugs will make you do.

But about Mother, lets just say I rebelled at first and really acted out. It took me a while to agree to be healed. They would not let you stay in your bedroom at all, you had to be busy with activities and school all day. There was this boy who was really depressed and he wouldnt get out of bed, so they pulled the mattress out into the hall with him on it, because you absolutely could not stay in your room. They didnt want you in a funk, they wanted to get you up and keep an eye on you if you were depressed. They were really committed to making you better. I rebelled, but in the long run, this was the best way they could have been. What can I say, they won me over, it really was like a family. It was work to get free of my coke addiction, but even harder was dealing with all the issues after I was clean. I had a bipolar problem, but its very much under control now.

My therapists were all great. They had great group therapy, with a social worker. But she cant do that anymore because she spends all her time fighting the insurance company. The biggest problem for me was getting kicked out because the stupid insurance ran out. My Mom was fighting with the insurance company all the time. I would be let out too soon, then pressures would build up and viola, Im baaaaack! Thank God mostly my Mom got me back to Mother.


Danielle at Birmington Hospital:


One time when I overdosed I was taken to Birmington. I was there for a month and a half, and it sucked. It was very different from Mother. Because it was an adult unit and maybe there was only one or two other teenagers there. It was very unstructured, you hardly had any therapy. You had to be smart and know who to seek out to get therapy. If you didnt fight for your time, you wouldnt get therapy, or have anyone to talk to. The head guy really pissed me off, he just didnt know how to deal with me. Some staff were nice but they just didnt have time. Staff really does make a difference, one guy, an aide, was really nice, he was so funny, he called me Danielle from hell, because of my devil tattoo. He made me laugh all the time. Sometimes one person who cares can make a difference. But mostly that place was for adults so they could care less about us.

You mainly watched TV all day. I got to see a ton of videos. Nobody cared what you watched, you sat around, played solitaire, you shuffled around, if you got visitors, fine. You could go in your room, sleep all day, but you mostly just wandered around. They didnt really know what was going on with us. The food was your typical hospital crap, but at least you had a choice. They did do searches for contraband and stuff, but if Petra and I had been in Birmington togetheroh God, it scares me to think I would have successfully helped her commit suicide, because with all that unsupervised time we would have found a way. That would have been horrible. What an asshole I was then. Drugs make you into an asshole.

So you could be depressed, and unless you got therapy you could stay down for days, and no one would notice. They had group therapy, but because they didnt have any separate program for teenagers, you could be mixed with anybody, even people who werent psych patients but were depressed, like old people. Or they had Alzheimers. There was this old lady who was dying, it was so depressing. And this other lady was in her late 80s. They put her in the group and she thought we were her relatives and she was visiting us for dinner. She was psychotic but it was from dementia or something. She would say Im off to the hair dressers, dear, it was nice chatting with you. Or she thought she was the nurse and shed say, Now off to bed honey, I have to do my rounds. Or she would just start singing, Daisy, Daisy It was weird and hilarious at the same time. You could be with people who had really horrible things happen. It was traumatic, but it was better than doing nothing. I went back on drugs soon after I left there.




Beth is fifteen years old and is the only one of the case studies still in the hospital. She spent


her first month in:



She is currently at:



Beth suffers from obsessive-compulsive disorder. Her mother wanted the unique


manifestation of Beths obsessive-compulsive behavior to be left out, keeping her anonymity.


She takes several medications to keep this under control, but has trouble staying focused or


staying still. Difficulties in interviewing effectuated her mothers filling in pertinent details. I


combined their comments and put them in Beths voice. TV


Beth at North Maple Psychiatric Hospital:


North Maple has beautiful grounds. But thats about it. It was stark and sterile inside. Its a total locked ward. I thought I was raped at North Maple by a man, one of the staff. It turned out to be a psychotic episode. But I had to go through the whole rape kit and talk to the police. They had to examine me. It was all so horrible. I was so scared when I first got here. I felt traumatized and nervous so it triggered this psychotic thing. I was hearing voices of the kids from school, I thought they were talking about me all the time and I could hear them. I dont hear voices anymore. Im cured of that now.

They had a separate place for teenagers. They had separate units, like they had a separate eating disorder unit. I was there for acute care to be stabilized and moved to Dragmont. They didnt have a lot of resources. They had a lot of poor kids who were in and out of foster care who had emotional problems. Once I was calmed down, it was better. Mom liked the doctors and the nurses and staff and thought they were pretty good for a state hospital. But the social worker sucked. I felt sick a lot from the medications. I was like an experiment. They were always giving me tests and different drugs. I dont rememberI slept a lot, watched TV a lot. My Dad and Mom brought me lots of videos. The food was terrible. Before I knew it, a month went by and I was sent to Dragmont.


Beth at Dragmont Childrens Psychiatric Center:


I hate it. It isnt helping me. I dont understand why I have to stay there. I want to go home. This is like the army, they have million rules and some of the kids are scary, they are tough and get violent. But I am more scared of some of the staff. They are trashy, lower class, not very professional. One African American aide made a racial remark against me. Girl you better stay out of my koolaide, cause you dont know the flavor. Okay wonderbread? Thats not right from a staff person, whos supposed to be there to help you. But the white aide is mean too. Some are low class and very mean. This one very mean aide, Audrey, has been abusing me since the day I got there. She says I look too fat in my clothes. She says Im lazy, Im not lazy, I have a problem with my motor skills. She calls me a wet dog when my hair is wet. If kids have hygiene problems she humiliates them in meetings. She thinks Im sloppy. Its not therapy when they look down on you. Most of them are bad, except Sue is nice; she gives me my meds all the time. Shes kind and has a sense of humor. She helps me in my room. Janet has a nice personality. She runs the creative club I go to every Wednesday. We write down our feelings in a book, we are doing an assignment, Who Am I? The teachers of the classes and therapists are nice its the other staff people who are mean and terrible.

The first day I was here, I was scared. I was in the infirmary; they asked me all kinds of questions. They searched my shoes; they searched my pockets for knives. A lot of kids bring in weapons. They look for contraband. Nobody told me how long I would be here. They told me I would be here for socialization, schooling and to help me with my OCD. Its very restrictive; I felt I wasnt going to make it. There is no freedom. After a while you just get used to it. Do I feel safe? No, I feel I should be home.

They give me three different medications. I hate the side effects, I gained a lot of weight and my face broke out really bad. They told me about the side effects first, so I was so scared to take the medicine.

I go to school 9:30-3:30. The teachers and classes are pretty good. I get group therapy on Mondays from 4:00-5:00. Its good, but thats it, its all the therapy I get. Its not enough. I feel I should have therapy every day. Creative club and group, thats all I do. Group therapy is a bunch of girls talking about their feelings. They talk about being sexually abused, some talk about drugs or their parents physically abusing them. The girls in my group are age 12-18. I like group.

I dont like the way the building looks; the whole place needs to be remodeled. And the place is very dreary with hard plain furniture and bare walls. It has big brick walls, like prison walls. They painted them pink for girls and blue for the boys. There is artwork, some Picasso paintings. They need more colorful art on the walls. I have a closet and drawers for my stuff. But they need more nice furniture. They let you bring your own blanket and stuffed toys from home, but I get searched every time I go home on a pass. Plus they do room searches. Only one to a bathroom at a time. Ten of us share a bathroom. No boys. There is three or six in a room. I have two roommates: Estelle was raped by her father and Marissa slit her wrists. All the girls here are a lot sicker than me; I dont understand why I am here. I dont act out, or get violent; I dont take drugs or have sex. I dont self-harm or harm others. I didnt do anything bad.

The food is terrible; its all fattening canned stuff that tastes so bad. Its thrown together and barely edible. The staff will have a really nice steak dinner and they dont share it with the kids. My medication makes me gain weight, and then I have to eat this fattening, canned, institutional food.

There are a lot of bad kids here. When they get violent, they get a needle and they go in the seclusion room. Bad is acting out, screaming at the staff, using contraband or if they find drugs. If I had talked back to Audrey, they would have put me on ITL. They take away privileges like TV. You cant go to activities. So you have to take it when the staff are mean, cause they have all the power. The point system isnt fair. They make it hard and very uncomfortable to ask for things you need or complain about anything.

We do tons of chores. We do all the cleaning. Mop the bathroom floor, clean the linen closet, clean the kitchen. If you are on the highest level, they will pay you something for it. They dont have big cleaning staff so the kids do the cleaning. This is not like home; its like a prison. You are under constant supervision. You can only wear makeup on full privilege. You start out at the lowest level and you are there for a while. You have to do your own laundry. You have to work. If a kid is depressed and cant get out of bed, they rip the covers off and say, GET UP! Two hundred negatives! If you get negative points up to 1000 you go on ITL. I was put on ITL for losing my card three times. Its a paper we write on.

They do have a lot of activities. They have baseball, volleyball, swimming, table games, full privilege table games, sewing, reading, art, creative therapy, rollerblading. They make all the boys put on roller blades and skate around and around the gym to get their aggression out. You can use the computer, they have TV, you are allowed your own CD players and music if you are on level two. To get a lot of the stuff you have to be level 2 or higher, but its really hard to get to level 2. We hardly get to go out. Everything is inside.

The worst thing that made me cry was not being able to go home one weekend because I was on ITL. I hardly get to see my family as it is. I miss my family so much. Family can only visit once a week. They dont want any visitors during the week and dont let anyone else visit. The first ten days no one is allowed to visit you at all. Those were the worst ten days. I am only allowed to call home on Tuesday and Thursday night. Some of the kids come from really bad homes, so its actually better for them, but not for me.

I also hate it when I have to see kids go in the seclusion room when they flip out. A kid threw a chair through a glass window. Bad things happen. This girl was saying that another girl forced herself sexually on her. They called my mom to ask if it was okay for me to be a witness. Mom said no, because she didnt want anything upsetting me, besides I didnt see anything. A lot of that stuff happens here.





Analysis of the Interviews:


To make sense of the interview data, I created a rating chart to organize and clarify the girls


perceptions of the six hospitals. I chose criteria from: the home survey, my study of the


psychopathologies and the professional and case study interview material.

JAlways/Excellent KSometimes/Fair LNever/Poor N/A not applicable






Rocky Stream

North Maple

Was the staff friendly, caring, kind, supportive, respectful?







Did you feel you had enough therapy?







Did you have individual therapy?







Did you have group therapy?







Did you have family therapy?







Did you have a variety of mental and physical activities to do?







Was there a point system?







Did you think the point system was fair?







Was the hospital equipped to handle your particular illness?







How did you feel overall about the other kids?







Were you allowed frequent visits from your family?







Did you feel you had someone you could confide in?







Were you allowed frequent visits from your girlfriends?







Did you feel safe and secure in this hospital?







Did you feel you had privacy from other patients?







Were you allowed visits from your boyfriend?







Did you have good tasting, quality food?







Did you have a nice place to take a shower/bath?







Could you have a walkman or listen to your own CD's?







Were you allowed to use the telephone regularly?







Did you feel like you belonged, fit in?







Fig. 3




I expected tales of sterile decor and plain walls. I expected complaints about restrictions and


lack of freedom and privacy. What I didnt expect was that the girls dont feel safe, dont always


have a quality staff, may suffer abuse from staff or feel threatened by other patients, dont get


enough therapy, dont have enough activities, have no one to confide in and feel they dont fit it.


Adults are mixed with adolescents and families are sometimes left out. And yes, the food is


terrible. My home elements of safety/security, comfort and sense of belonging are blatantly


lacking in most of the hospitals except for Mother hospital!


The egregious lack of safety tops the list. All four of the girls had episodes of feeling unsafe.


The unprofessional, low class or punitively oriented staff contributed to this. The verbal abuses


towards Beth, sexual harassment of Kirsten or overly punitive reactions to Petra in Dangerfield


shouldnt be tolerated, period. Mixing of adolescents with adults and mixing of violent/behavior


patients with other psychopathologies sets the scene for safety issues. The argument for


segregation based on age and psychopathology surfaces again. Some of the more frightening


experiences, like Kirstens encounter with the naked makeup eating man, occurred because


teenagers dont always have separate wards. The university hospital has a psychiatric childrens


ward up to age thirteen and an adult ward. The adolescent is overlooked even by renowned


hospitals. Placing anxiety riddled teens like Beth in with teens who commit violent acts


predisposes her to more anxiety as a captive witness. Understanding the various different


conditions and severity of patients illness needs exploration to improve treatment. (Leon, 2000.)


Also, lack of supervised activities leaves teenagers open to all kinds of trouble, especially for the


suicide patient, drug abuser or anorexic. I think about Petra, Kirsten and Danielle wandering


around for hours like stray cats, unsupervised and ignored.


Would anyone ever think of psychiatric hospitals as not providing enough therapy? This


surprised me more than anything since inpatient hospitalization fundamentally should focus


efforts on healing the patient through therapy. Are therapies lacking because of poor resources?


I would think other amenities would suffer before therapy would.


Families are the number one priority of our teens and yet not all the hospitals allowed for


visits or offered family therapy. Dragmont actually barred parents from the first ten days of


treatment. Is this because the majority of the patient population came from abusive families?


The girls rated most of the hospitals as not giving them a sense of belonging. If families are not


included and a surrogate family is not created, our patients are sure to feel isolated and lonely.


Feelings not conducive to healing.


In 1992, Louise Armstrong wrote And They Call It Help, an expose of psychiatric hospital


treatment for children and adolescents. She found similar issues with unqualified staff, therapies


not provided and punitive restrictions. Why almost ten years later do we still have the same


problem? Why are the hospitals so lacking?




My attempt to keep this study well rounded has its restrictions. I was routinely and


irrevocably denied access to psychiatric wards, a policy strictly enforced to protect patient


privacy from uninvited guests. I took this graciously but I didnt appreciate the flat refusals for


interviews via telephone or ignored phone calls. No pretense worked; hospitals did not want to


comment. I wanted to give administrators equal time, but such is the plight of a researcher:


denial of some pieces of the puzzle. The only exception: Mother Hospitals Nurse Janet Cooper


generously granted me a telephone interview and offered me printed materials normally given to




Undaunted, I hunted down some statistics on the hospitals to look for connections to


the lack of home elements:




Type of Facility

Number of Beds

Predominant Psychopathology*

Neighborhood Location*

Mother Hospital

Private Hospital-Separate Psychiatric Units for Adults and Adolescents.


Affective Disorders

Eating Disorders

Psychiatric Trauma

Upper Income


Dangerfield Psychiatric

State Run Facility

For Children under 18

(wards of the state reside here).




Psychotic Disorders

Lower Income


Birmington Hospital

Private Hospital- Separate Psychiatric Unit

No Children under 13

Adolescents treated w/Adults


Affective Disorders

Anxiety Disorders

Upper Income


Dragmont Children's Psychiatric Hospital

State Run Facility

For Children Under 18



Middle Income


Rocky Stream University Hospital

University Hospital

Separate Psychiatric Units for Children 5-13

Adolescents treated w/Adults


Variable/Many patients referred for Intensive ECT

Upper Income


North Maple Psychiatric Hospital

State Run Facility

Separate small units for Children/Adolescents

Most beds for Adults.



Psychiatric Trauma


Psychotic Disorders

Middle Income


Fig. 4 *Data is based on case study, staff or parent observation. All other statistics are courtesy of Newsday online.



Obvious influencing variables are private vs. state hospitals, separate adolescent units vs.


adolescent/adult units and few vs. many beds. Private hospitals like Birmington have more


resources, but if spending doesnt include specialized units and treatment plans, what good does


it do our teenager? North Maple rated excellent for their staff even though they lacked resources


for programming. This challenges the argument that you need resources to produce quality


staffing. North Maples success, in this one area, may lie more in good management and their


philosophy of staff to patient relationship; too bad they couldnt provide much else. Rocky


Streams lack of an adolescent unit surprised me. I thought a university teaching hospital would


offer a wide scope of treatment programs.


Economic demographics shows no influence on hospital ratings in this study. Hospitals


received poor ratings regardless of upper, middle or lower income locations. The demographics


however, may affect the type of psychopathology treated. Middle and lower incomes hospitals


above, have a predominance of behavior/violence issues. I empathize with staff in dealing with


this difficult and dangerous patient population. I refer back to Petras recount of Marianne, the


staff member attacked and bitten while the kitchen was set on fire in Dragmont. Even


the most loving and conscientious of workers would sour after continual exposure to this.


State hospitals and large facilities tend to focus on controlling behavior. (Almond, 1974)


Dragmont and Dangerfield are both state run, under age 18 facilities, dealing with issues of


violent behavior. This explains the reason for the punitive point system and restrictions used to


maintain order. These teens are not criminals, they have a psychopathological cause for their


behavior, but should patients like Beth, Petra and Kirsten be treated in the same kind of


environment? Researchers and psychiatric professionals alike show interest in matching patients


to separate treatment environments to improve the outcome of their therapy. (Walsh, Craik &


Price, 2000) Only trial studies measuring treatment outcomes will prove the point.


My lack of information from hospital administrators and staff of the five deficient hospitals,


hinders my ability to answer for them.


Mother Hospital a model for home in the hospital


It was the most like home, the staff was nurturing, nice, kind. They really listened to you.



They didnt give up on me.



They were committed to making you better. It really was like family.



The best argument for the value of home in the hospital is Mother hospital, a model for


creating the therapeutic environment for teenage girls.


The secrets of their success lies in:

-private hospital/available resources

-professional staff who truly cares for the patient, will listen and be a confidante

-small number of beds puts an ideal staff to patient ratio

-full spectrum of frequent therapy provided: individual, group and family

-individualized treatment plans

-full involvement and visiting rights for family, keeping them educated and well informed

-full program of activities and quality schooling

-safety, comfort and privacy in a pleasant environment


Mother received an almost perfect score. A little more effort in food preparation and lighter


restriction on CD players are all thats needed to make this a utopia of hospitals for Petra, Kirsten


and Danielle. The most poignant quote comes from Petra:


If it werent for Mother HospitalI wouldnt be here today.


Beautiful outdoor garden and atrium area of Mother Hospital.

Buildings can convey subliminal messages as to how the patient

is perceived by the hospital. (Lennard & Gralnick, 1986)





Over the last thirty years, the number of patients hospitalized in three of Long Island state run


psychiatric hospitals, declined from 33,000 to 2,300. State hospitals are receiving limited funds


as community based support systems increase. (Newsday, 1999) Inpatient care ranks as the


highest expense of mental health treatment. (Mechanic, McAlpine & Olfson, 1998) Economics plays a role in the


decision of placing an adolescent in the hospital. Insurance company pressure might not make it


the treatment of choice. (Blanz & Schmidt, 2000) Dr. Tonla brought out the issues of managed care to


shorten hospital stays and reminds us hospitals are in the business of making money first.


Looking at all these factors plus the inadequacies I discovered in this sampling of hospitals


might lead me to abandon my search and hope for home in the hospital. Why should anyone


bother improving programs with nurturing elements of home, if limited by resources and time?


The shift toward more outpatient vs. inpatient therapy places our teenager in the hospital for


short intensive stays followed up by outpatient services. This is less expensive and restrictive,


but there is no proof yet that this is an effective solution. (Blanz & Schmidt, 2000) As with the girls in this


study, many inpatient adolescents have multiple psychopathologies increasing the seriousness of


their illness. Outpatient services arent adequate to help the more severe cases. Most inpatients


have already tried outpatient therapy without success. (Blanz & Schmidt, 2000) Hospitalization is still very


necessary, so I champion the cause of home in the hospital.


Hospital budget administrators need to look towards the forgotten adolescent and offer


resources for improving programs. I suggest sensitivity training and education for all levels of


personnel to improve staff quality, especially with safety issues. This can be done in house to


cut costs. Families absolutely have to be part of the process, open communication costs nothing


but time. If therapy is not a priority, why bother at all? Hospitals must support this.


I realize my research is limited to a small corner of the psychiatric hospital world, examining


a tiny demographic by a researcher without a psychiatric background. I challenge others to pick


up the cause to look for abuses, deficits and solutions to the problem. Identify model hospitals


and examine them for patient outcomes which may serve to change the mind of managed


care to spend less on wasted outpatient services for the seriously ill teenager and more on quality


inpatient care.


Indulge a humble researcher in creating a fantasy hospital. If I were in the drivers seat and


money were no option I would create a world of healing:


A small hospital complex on beautiful grounds, near a mountain or lake, with gardens and waterfalls. The complex includes a main building surrounded by individual little cottages. These would serve as small group homes, keeping adolescents with similar illnesses together The house would be fully staffed with nurses, aides and a professional cook. The main hospital offers all traditional medical, individual, group and family therapies plus alternative healing therapies i.e. mind/body techniques, massage therapy, light and aroma therapy. Activities would be abundant and varied, with emphasis on outdoor physical exercise and sports, cognitive problem solving with puzzles and games, art and music classes, yoga, pet therapy and gardening. All emphasis would be on building self esteem and healing the body, mind and soul.


I am not in the drivers seat. Managed care is driving the car, and the hospital budget


administrator is in the passenger seat. A teenage girl, named Beth, is in the back seat. They drive


her to an unknown destination. I pray for a safe journey home.


Is valuing home in the hospital worthwhile? For my answer, I have only to look in the eyes


of three beautiful, young, healthy girls: Petra, Kirsten and Danielle.








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1.          SURVEY OF HOME

What is your first name (no last name)?



E-mail address?



How old are you?



What kind of house/apartment do you live in? Describe it and also draw a picture if you want to:





What do you like best about your home? Think about what makes you feel good.





What sights do you like?





What sounds do you like?





What smells do you like?





What tastes do you like?





What do you like to touch, what feels good to your hands?





Do you have any plants? Do you like having plants?





Do you have pets? Do you like having pets?





Do you have privacy in your home?





Do you feel comfortable in your home?





Do you feel safe and snug in your home?





Describe your room. What do keep in your room? How is it decorated? Write about it and include a picture if you want to.




What else would you add to your room if you could?





How many people are in your family? How do you feel about your family?





Have you ever been away from home? For what reason and how did it make you feel?





Have you ever been in the hospital over night? How did it make you feel?




Did you ever visit anyone in the hospital? What did you think of it?





Here is a list of 30 things from HOME. Heres what you do:



v    Put numbers next to each thing in order of importance.

v    The most important would be number 1, then 2 and so on.

v    If you dont think its important cross it off the list.

v    You may add things you think are important.


___Sleeping in a comfortable bed ___Playing on the computer


___Wearing favorite clothes ___Eating junk food


___Watching television/videos ___Having art/decorations


___Eating home cooked meals ___Feeling safe/secure


___Reading favorite books ___Having a cozy chair/couch

___Spending time with your family ___Having leisure time


___Having plants/flowers/garden ___Wearing cosmetics

___Personal stuff from your room ___Listening to your CDs

___Exercising/playing sports ___Having privacy


___Spending time with girlfriends ___Talking on the telephone


___Taking a warm bath or shower ___Playing video games


___Playing with your pets ___Having someone to confide in


___Celebrating birthdays/holidays ___Studying at your own desk


___Having enough drawer/closet space ___Having freedom to go out


___Spending time with a boyfriend ___Feeling like you belong/fit in



Pretend you are going into the hospital for a few months to a year!

WHICH THINGS FROM HOME WOULD YOU WANT WHILE IN THE HOSPITAL? Remember there are no wrong or silly answers, if you think

it's important it is!


v    Put numbers next to each thing in order of importance.

v    The most important would be number 1, then 2 and so on.

v    If you dont think its important cross it off the list.

v    You may add things you think are important.


___Sleeping in a comfortable bed ___Playing on the computer


___Wearing favorite clothes ___Eating junk food


___Watching television/videos ___Having art/decorations


___Eating home cooked meals ___Feeling safe/secure


___Reading favorite books ___Having a cozy chair/couch

___Spending time with your family ___Having leisure time


___Having plants/flowers/garden ___Wearing cosmetics

___Personal stuff from your room ___Listening to your CDs

___Having exercising/sports equipment ___Having privacy


___Spending time with girlfriends ___Talking on the telephone


___Taking a warm bath or shower ___Playing video games


___Playing with your pets ___Having someone to confide in


___Celebrating birthdays/holidays ___Studying at your own desk


___Having enough drawer/closet space ___Having freedom to go out


___Spending time with a boyfriend ___Feeling like you belong/fit in












E-mail: jasmina@excite.com


















Jane Schreck WWII 2/7/01


Objects of Affection (Infection)


Joseph is eighty-one years old. On the surface he is white, Irish, Catholic, Republican, father of eight, grandfather of eight, retired corporation employee, ivy school grad, war vet, suburban home owner and by outward appearances your regular cup of Joe. These labels can hint at influences and some stereotypical behaviors but so much of Josephs psyche is revealed when you take a metaphorical look at three ordinary yet highly significant belongings: a red sweater vest, wooden rosary beads and a black logbook.

The red sweater vest is old, pilled, faded, worn and still considered wearable by the owner, an arguable point to his relatives. He wears it almost every day, pausing only to launder it occasionally. We all have those clothes that are so comfortable by our own definition, items that soften and break in with age and mold themselves to our frames. We hang on to them, even in tatters, because we dont think they can be replaced or we wont find that level of comfort again. We invest much time wearing them down like ocean waves soften beach glass, that they become as familiar as a family member. But in the case of Josephs red sweater vest, comfort and familiarity are only superficial reasons for his wearing it, because he will admit he has many equally comfortable, new sweater vests on the shelf, gifts from well meaning family members, which he doesnt prefer to wear. Why? One could say the reason is a generational concept for his age group. Frugality, for those who experienced wartime, is a leftover notion created from ingrained habits of rationing, saving and using every scrap; the opposite ideology of our current throw away society. Yet even with this added layer of explanation, there is still a much deeper meaning for this sweater. For Joseph it represents the expected self denial of a rigid Catholic upbringing, the welcoming of this denial on a subconscious level, a desire to be like Jesus with few meager possessions and taking very little of the world for himself. The idea of sacrifice is a powerful spoken and unspoken message of Catholicism. Josephs religion permeates most of his thinking and actions even to the unconscious level. Although money is not a problem, he very rarely buys anything new; no lavish vacations, no expensive toys men are fond of, no fancy restaurants etc. Those who know him well attest to this. He sacrifices even when its beyond necessary to do so, without apparent self-awareness of it.

It is very interesting to note, that although a father and grandfather, Joseph at one time aspired to be a priest, something long forgotten by him and his family. Priests generally wear the same garments or robes; they strive to emulate the sacrifice of Jesus. Josephs sweater, worn on an almost daily basis can be seen as a symbol of sacrifice and emulation of Priest/Jesus. It is also ironic that the color of the sweater is red, like that of the Roman robe thrown on Jesus during his crucifixion or red like the blood of Christ. At any rate this garment goes beyond our surface explanation of comfort, familiarity, beyond the socio-political concepts of post war survivors into a deeper spiritual subconscious representation of Joseph.

The rosary beads are old, and made of wood, blessed by a holy man. Joseph uses them several times daily, saying rosaries, novenas and special saint related prayers, which are the more complex prayer dogma of Catholicism. He goes beyond what most Catholics do, by making up lists of people to pray for in different categories; sick, dead, poor, dying, divorcing, political figures, sport teams etc. If we look at the rosary beads and the obvious religious symbolism of such an item, we could be tempted to use the same explanation as the red sweater to define their significance, that of a deep spiritual, unconscious meaning. Subconsciously he desired to be a priest, rosary beads and frequent prayer are the domain of priest. These rosary beads are made of wood, symbolically the wood of the cross. But here, as with the sweater, the meaning goes much deeper.

To discover this we need to question why does Joseph pray? Is it to be a good Catholic or to emulate the priest he never was? Is it because when faith is strong, people pray because they believe their prayers will be answered? He does pray for these reasons, but this is only the superficial answer. Underlying this is a deep psychological reason. Joseph prays because he is afraid. He lives in constant fear and always has. Fear of death, illness, financial loss, robbery, murder, injury, fire, drowning, attacks, the worst of scenarios imagined, plague this man. A person who prays so fervently, so religiously should have the peace of mind one is said to get from prayer. Joseph would never be described as a man with peace of mind. He lives a life of extreme caution, a live of dont dos, a belief that the worst always happens, so better to not attempt something at all. He fills himself on the bad news of the day, repeating it, believing in it as much as he does the doctrines and scriptures. He spends a tremendous amount of time praying, hiding behind religion to avoid living. Life and living involve some risk, some danger, for Joseph it is better to be the one doing the praying instead. To pray for everyone seems so noble, and in his mind it is because he does sincerely want to get divine help for his friends and family. But he does not see why he is so driven to do it, and that it does not come from a peaceful place within. Still, its curious, people know of his prayer lists and will ask to be put on them. They see him as a pious, quiet individual with his wooden rosary beads, and to some degree he is, but truthfully the religion is a mask for the fear underneath. The red sweater can be seen as more of a true religious symbol for Joseph, as a subconscious emulation of Christ, then the rosary beads are.

The final item to be looked at is the black book, specifically used by Joseph to painstakingly log every medical detail of the last four terrible years of his wifes life. He recorded medications, symptoms, vital signs, glucose levels, and insulin dosages. His wifes diabetes ravaged her body causing near blindness, organ damage, skin damage, multiple heart and circulatory crises. Doctors were amazed at the level of detail recorded that even they wouldnt attempt. He spent hours doing this. Partially this was a way to have some semblance of control over a devastating disease of a loved one. But so much time devoted to some details that were irrelevant was overkill, and left little time to improve the emotional and mental health of his wife. He attended faithfully to her basic needs like food, medications, trips to countless doctors etc. But he never considered the emotional needs of his patient. Intimacy was avoided by spending countless hours behind the black book.

The black book had been used throughout the years for assorted important figures. It was used for bookkeeping for bills, household expenses, careful logs of who owed him money, sport statistics, historical facts, and countless numbers, columns and bottom lines. Joseph was a mathematical, statistical man by nature so it would seem natural for him to do so much record keeping. But to his loved ones he was emotionally inaccessible. When he wasnt praying he was immersed in logging detail. The black book was an impenetrable wall, a safe numerical barricade to keep busy behind. It is the strongest representation of the psychological structure, organization and control he tried to have over himself and his life. The effect the book had on him was like a black hole that swallows up all matter, so powerful was the draw. Yet it never lets light escape, the light that illuminates a soul and opens them up to intimacy with other souls.

It is an interesting onion peel exercise to examine the significance of the metaphor represented in the ordinary objects of a persons life. Each one like another jigsaw piece in a puzzle of a lifetime. We can start to know a person through each of these odd shapes, a clue to the inner being. We can learn a lot from a red sweater, wooden rosary beads and a black logbook.



Jane Schreck



House of Pain


House of pain, house of insane,

All described by a poet named Jane.

Wild eyes that dont see reality,

Eyes that want to put themselves shut,



House on haunted hill the hauntings of the mind.

Catatonic, histrionic, stereophonic; all so ironic.

Halls echo with Vincent Price laughter or moans or voices or worse,



Busy, busy, busy staff, busy putting you in order.

Square walls, square halls, communal stalls.

Pills against your will, or willingly thrill.

Your new home, home for a gnome, home alone.


They are all so much sicker than me-

Why am I here? Why bother? Whattteverrr


Ugly colors, institutional, destitutional colors.

Look at all these kings horses, and women and men.

Can they put Humpty together again?

Leave me alone, or throw me a bone,

But dont make me look at my childhood home.


Wait - Wait - Wait


Dig - Dig - Dig


Cry - Cry - Cry


Hope to Die -Die - Die.


Or die to hope, hope on rope, cleaner than soap.

Cleaning the soul, making you whole,


If youre lucky.





Jane Schreck

Writing Workshop II



Beauty and the Beastie Boys


What is beauty to an American teenager?

First, what is beauty? Beauty can be interpreted as that which pleases the senses. What we find satisfying to mind, body and emotion. Its a circular process; we perceive beauty through visual, auditory and tactile medium that creates an emotional response we could describe as a beautiful feeling. We achieve the intangible through the tangible. The more intensely we perceive beauty the more intense the feeling; pleasure momentarily swells up in us like rising ocean waves. People have been brought to tears of joy over what they consider beautiful. Think of the exuberance of sports fan over a beautiful pass or slam dunk, or the opera enthusiast moved over a beautiful aria, or the art lovers rapture over a masterpiece or the joy of mother holding her beautiful newborn. We are subjective creatures and so what we consider beautiful is purely personal. We are divided on what essence we perceive as beautiful, our subjective choices, but we are united as human beings in the use of our mind and senses for the perception of beauty. We are influenced by common themes relative to our particular culture, gender or age group. What an Australian Aborigine perceives as beauty is far different from a Japanese businessman or an American teenager.

Beauty for an American teenager in the twenty first century has many influences. For many teenagers the concept of beauty has been force fed by a mass media. Their chameleon choices are the result of peer pressure, popular culture or parental influence. Like their bodies, their tastes and sensibilities are constantly changing, underdeveloped and undiscovered. If beauty is defined as what is pleasing and satisfying and teenagers succumb to the popular notions of what is beautiful, what is really being manipulated is their concept of what is pleasing and satisfying. This leads to a conflict between perceived beauty/pleasure versus true human sensations. Take for example, getting multiple ear or body piercings and tattoos. Strip away all the popular cultural and social satisfaction a teenager has with these and they may find getting pierced and tattooed an unsatisfying, painful experience. The process of achieving the unrealistic emulation of the supermodel or Britney Spear-like icons is an unpleasant one if it leads to depression, anorexia or bulimia. These are examples in the visual/physical realm. The other senses are involved too. If we took popular teen music and peeled off the influential layers and teenagers listened purely from the human senses, they might find it unpleasantly loud or harsh. Even their taste buds are influenced by widely marketed fast food chains, candy and junk food companies. It is no wonder teenagers are conflicted when their perception of beauty, thus pleasure and satisfaction, are thwarted by popular dominant themes that cause new subliminal mantras like pain is good, physical beauty at all costs, loud, harsh, angry is okay, or junk food tastes best.

But even with all these influences, teenagers are subjective, individual creatures like the rest of humankind. Perceptions of beauty along with all human perceptions are based on our own individual experiences with historical, cultural and social references. Many try for uniqueness and originality, the teenager included.

So what exactly do teenagers find beautiful? Is it different for girls and boys? I decided to go right to the source by conducting some informal interviews of four teenagers via telephone. I asked them what beauty is and to think about all the senses. Here is what they had to say:


Nicole, age15:


Hmm. Thats a hard question. Its how you see yourself. You decide whats beautiful, what parts of yourself are beautiful. I dont listen to what other people say, I try to be myself. I like pictures of my friends and family because they remind me of the stuff we did, the good times. I like candles and soft colors. My room was white, then pink, then purple. Now I want blues. I create my own space, my vision. Oh yeah, and I like Moms Lladro statues, theyre beautiful. And paintings too. Its what makes you feel good. Animals are beautiful. I love my pets. I love flowers, plants. Smells, like perfume, flowers, cooking, like, cooking apples. I love my Plumeria cologne from Bath & Body works. Sounds are important too. I love music. Techno music. Tastes arent really beautiful, but fruit can look beautiful.


Chris, age 14:


Its physical, its how you look. But its also whats inside the person. Its artwork. I like blues and greens for a room. I like a modern house. I like to look at posters, like rock, girls, sports. I like paintings, especially if you make the paintings. Smells? Smells are beautiful, like cologne and perfume, fresh air and cooking food. Taste isnt beautiful. I like family pictures, pets. Music is important. Beauty is feelings, internal.


Kate Lynn, age 15:


Beauty is what you think about yourself. You have an opinion, feelings. Its girls in magazines, people on T.V. But its inner and outer beauty. I like to look at girls on TV, makeup, clothes, dresses. Certain kinds of music are beautiful. And smells like Cool Water or Tommy Hilfiger cologne. Tastes are beautiful, yes, really, like, spaghetti or chicken. Tastes can be really good. In my room I like color, textures. I like light blue. I like posters of M & N, popular music stars, candles, incense, pictures of animals. Pets are beautiful. Nature is beautiful. All animals are beautiful, water, birds, bees. I love nature. My family is my beauty.


Timothy, age 16


I dont know, no one has ever asked me this before. What is beauty? It is the one thing that will always leave you breathless. It can be anywhere, in a person, artwork. You have to see the whole. Never look at one part. A garden can look beautiful and smell beautiful. Smells are beautiful like sweet smells or Italian cooking. Tastes too, like your favorite food or desert or candy. I just love the candy Swedish fish or lasagna. Anything Italian. Music and voice are beautiful. If you havent heard from someone you love in a long time, their voice would be beautiful. With music and voice beauty is not just in the person whos performing but the listener too. I love the song by Bon Jovi, Its My Life. I love the words and how it makes me feel. As far as touch, textures, boys dont think about that as much as girls do. I like colors. Teenagers wear colors to reflect their personalities. Thats why you see so many teenagers wearing black, and I dont mean just the Goths. The Preppies wear bright blues and orange. I like dark blues or black. Everybody wants to look different with their clothes and the colors they choose. Beauty can be physical, but its much deeper.


Its a revealing exercise to compare some of their answers. All four teenagers related beauty with feelings and were able to use the different senses to detect beauty. Some details were different but they touched on a common theme of beauty being internal. They all mentioned blue in their color choice, could this be because teenagers feel the blues? Is wearing black or other specific color significant on a deeper subconscious level? All four found the smell of cooking food significant. Besides the basic hunger response, a deep feeling is triggered in our home-connection psyche by the smell of cooking food. Flowers, gardens and perfumes were mentioned, pure pleasure to most humans who arent allergic. Not surprising, the girls mentioned name brands of perfumes; they are cosmetic company marketing targets, as all American women are. Walking through any cosmetic department is like walking through a war zone; we dodge screaming visual torpedoes and cosmetic infantry ready to spray you with their perfume guns. The teens differed on their opinion of taste. Curious that Nicole and Chris didnt consider taste as beautiful. Teenagers are still growing physically; perhaps taste buds are the last to develop. Think of foods you considered detestable as a child or teen only to have acquired a taste for them later. I know very few children or teens, which consider olives, anchovies, liver or creamed spinach edible foods. Most of them mentioned pets and animals as being beautiful. Teenagers connect to their pets in a deeply emotional way. The girls reflected more on visual and sensual as it related to their space, their room. A room is particularly important to a teenage girl; they have a more developed sense of expression through decoration.


I asked the group to describe ugly the same way as they did beauty. I asked them What is ugly? Their comments surprised me:




Nothing. No, really. But plain, bare can be ugly.




It can be physical, but its more about an ugly personality. Like when someone is a bitch or mean.

Kate Lynn:


Nothing is ugly. Its all perception, opinion.




Ugly is something that makes you shiver. Going with the crowd is ugly. People can have an ugly personality. Its not really physical, butone time I saw this really overweight 13 year old girl in a tube top and tight pants, with way too much makeup. She was nasty. Excess is ugly.


I was astonished that the girls denied the existence of ugly, and that the boys gave much less detail than beauty. Do they really feel this way? Or were they trying to give altruistic answers? If beauty feels satisfying, then ugly does not, and they would not want to dwell on the details. Do feelings of ugliness get buried deep inside, pushed away and later expressed through drugs, alcohol, overeating etc.? Timothy mentioned excess as being ugly. Many teens go through mood swings and periods of depression. Is this just hormonal or are buried ugly feelings more the culprit? At any rate a true scientific study would have to be done to answer these questions. The boys talked of ugly personalities. Boys and men ridicule each other frequently under the guise of humor. Male bonding toughens, female bonding nurtures. All four gave their definition of ugly immediately in comparison to the pause and consideration they gave beauty.

Beauty for the American teenager is the feeling evoked through the evolving senses. The choices, the details are subjective and individual, grown from experience and influenced by cultural, social and historical themes. If it gives pleasure, takes your breath away it is beautiful. Beauty makes all of us feel good, even the teenager.




Jane Schreck


(More bad poetry. Inspired by teenage self mutilations.)




Dont Try This At Home


I cut myself,

Because I loathe myself, Im ugly and dirty.

I cut myself,

Because I hate you for not seeing the monster.

I cut myself,

Because I hate and love the monster/angel/monster.

I cut myself,

Because I hate myself for upsetting all the apple carts.

I cut myself,

Because I hate the clueless who think they can help.

I cut myself,

Because I hate this place and I want to go home.

I cut myself,

Because I like to see how the pain on the inside looks on the outside.

I cut myself,

Because I cant feel anything.

I cut myself,

Because I like it,

and you cant stop me.