As the end of the year is now in sight and several meaningful holidays are nearing, our thoughts may turn to presents, celebrations, and happy reunions with family and friends. In prior years, if we were working in offices, there might be that highly memorable company Christmas party that, too often, turned into something we wanted to forget.

But for me, I have one outstanding memory that I shall never forget. No, it’s not of a major loss or a historical event like the mythic Christmas truce during one of our too-many world wars. It’s a memory of sadness and staff who were too poorly trained to know what they were doing.

When I was a psychology intern, patients who had become long-term residents of state psychiatric hospitals could expect a few things at Christmas, if not family coming to visit. An employee on one of the wards was tasked with ordering gifts for them from a man who had managed to receive the contract.

In years gone by, probably before many of us were born, they would have been the guys selling from the trunk of their cars or small vans that wended through the hinterlands in the US to sell inexpensive gifts of clothing for scattered families living in a rural area. It was an era before malls or shopping centers and with “dry goods” stores many miles away. Now they sold to institutions, but the merchandise was still low quality, cheap and forgettable.
I was introduced to this practice as an intern at a huge psychiatric hospital, now shut forever, where my curiosity pushed me to ask what a supervisor was doing.

“I’m ordering Christmas gifts for the patients,” she responded.
“What kind of gifts,” I asked.

“The same things we have to choose from every year; sweaters, pajamas, hats, scarfs, or gloves,” was her annoyed reply.

The budget she was given for her 60 patients wasn’t anything but meager, but in her heart, she knew it was the one gift these patients would ever be getting from someone, too bad it was like the lackluster food trays they used every day.

OK, the patients were getting a gift at least and there would be some semblance of their participation in a holiday all of us looked forward to each year. And there would be ward decorations to further the attempt at holiday cheer. But there was one thing that stands out over the small gifts: the decorations on the unit.

Staff at the hospital did their jobs, but training in too many things was missing. I can’t, however, bring myself to think anyone needs training in poison control.

Ersatz fireplaces were in each day room on each unit’s ward. I don’t believe they were more than non-functional design elements meant to provide a homey atmosphere but what homes also provide reinforced doors on nursing offices?

During times of ward stress, the staff would lock themselves in the offices and watch as the ward was disrupted in fury. Furniture, however, was from a specific company and very difficult to move because of its weight. But anything that wasn’t bolted down was fair game to be used as a weapon.

On one ward, infamous for the publicity it received when a state senator, using the information of a known criminal sex offender, became a staff member, had a special way of decorating their unit. The fake boughs of pine with decorative candy canes draped over the mantels did add an air of Christmas. The staff knew that those candy canes were too enticing to patients who had no access to candy, and they came up with a solution, insect spray.

A staff member carefully sprayed all the canes and all the decorations with the insect spray in the belief that knowing it was inedible, the patients wouldn’t touch it. Wrong.

These patients were seriously mentally ill, and a candy cane was too enticing. One or two of them grabbed a cane and began to eat it. They were, of course, sent to the local hospital since this hospital had neither qualified medical staff nor a place to treat them. Yes, some staff members even had board certification as pediatricians, although this was a hospital for adults.

Recently, there had been a young, psychotic man, believing that he could cure himself, who had eaten the pine needles of an on-grounds tree; the needles were deadly. Neither the nursing staff nor the physicians knew what to do and they tried an inappropriate medication meant for wounds and inflammation. He died.

I guess none of them had ever heard of Socrates or how he died, hemlock poisoning. Why were hemlock trees planted at a hospital for the seriously mentally ill in the first place?

But those ward decorations and the spraying of them with insecticide will always stand out in my mind. I’m sure the patients won’t remember because everything was kept from them. All they knew was that the decorations had been removed before Christmas and some patients were sent to area hospitals.

I can think of no place lonelier than a psychiatric hospital at Christmastime and it will always be that way. I hope things have changed around the country where state psychiatric hospitals are still functioning. I am, however, not sanguine that they have changed.

Dr. Farrell’s books can be found on Amazon: https://tinyurl.com/yckv2w6h and http://www.drfarrell.net