Three hots and a cot. A casual phrase, but one that provokes an immediate, visceral reaction for me. The first time I ever heard anyone use the phrase was when I taught freshman composition at a local community college. I had assigned my students  an article to read about prison reform or unjust sentencing, and the class was discussing the author’s ideas. One young man defended the existing state of prisons and concluded by saying something along these lines, “Look, they get three hots and a cot, TV, and a workout room. In lots of ways, life in prison is better than where those people come from.”

Those people. The very anonymity of the description renders imprisoned people faceless shells of who they actually are. And for the past three years, I’ve volunteered in a local prison and gotten to know a lot of “those people.” Getting to know several of the men and women who are incarcerated in our state prisons has erased any stereotypes I previously held of who they might be. And the food and living conditions in our prisons are far from being better than where anyone came from, at least in my experience.

So when I heard a new friend use the phrase “three hots and a cot” in relation to patients in a psychiatric hospital, I was shocked into silence. To be fair, this woman, a physician’s assistant, was talking about the need for in-patient psych facilities run by the state as opposed to our current situation that leaves many people wandering the streets or being imprisoned. But again, the phrase was casually tossed into the conversation where she advocated for “three hots and a cot, a safe place to regroup, counseling, and meds for two to three weeks to help people get back on their feet.”

My reaction was instinctive, but I was mute. I listened and pondered what I could say. “Better than putting those people in prison, which is what we do now,” one woman said. And while I agree that we have a need for more care for people who suffer from trauma-induced emotional distress (I refuse use the term depression because of what it connotes), I know that the solution is not as simple as providing in-patient facilities for emergency care. And I wondered if any of the women in my circle had ever been psychiatric patients themselves. Like I had been. Like my mother had been. But I was silent.

I didn’t want to get emotional–passionate, really–with my response. This is what I wanted to say:

No, we can’t just medicate people, hospitalize them for a week or so (if you are very, very lucky) and then discharge them without addressing the environment that they will be returning to.  Have any of you ever read about what psych drugs can do to people over the long-term? Do you know about the dangers and difficulties  of discontinuing psych drugs once you start? Do you know there is no scientific proof that a lack of serotonin or an excess of dopamine causes depression, schizophrenia, or bipolar disorder? Do you know that sometimes taking  antidepressants can actually cause bipolar disorder?

And how about this admission (excerpted from “More on the Chemical Imbalance Theory” on the Mad in America website) from Dr. Ronald Pies, a highly-regarded psychiatrist?

The “little white lie” is, of course, a reference to the 2014 article by the very eminent and influential psychiatrist Ronald Pies, MD.  In that article, Dr. Pies characterizes the chemical imbalance theory as “…this little white lie…”

Dr. Pies has also insisted – arguably delusionally – that psychiatry never promoted the chemical imbalance theory of mental illness.  In a 2011 article he  wrote:

“In truth, the ‘chemical imbalance’ notion was always a kind of urban legend – never a theory seriously propounded by well-informed psychiatrists.”

But Dr. Pies’ words haven’t filtered down into mainstream knowledge. Part of the reason I didn’t speak up is because I meet so much resistance when I present the information about lack of evidence for the chemical imbalance theory  and the harm that can come from psychiatric drugs. But I am convinced, based all the books and articles that I’ve read over the past five or more years. And I’m convinced by my own life-experiences and the experiences of other people that I know.

Because I know that there is a desperate need for compassionate, community-based care,  I’ll be posting a blog on what would I advocate for in the next few weeks. In the meantime, here is a poem of mine, recently published on the Mad in America website, about my experience visiting a friend in a local psychiatric hospital and recalling my own experience.

A Therapeutic Environment

I bring a small basket of flowers
for my friend in the psych unit,
the nurse buzzes me in.
She silently yanks
the plastic card-holder,
then chides me,
It has a pointy end.
My friend tells me later,
“No one gets flowers here.”

My friend wears
blue paper pajamas—the only thing that will fit over her cast—
until I bring new sweatpants
“No drawstrings,” she tells me. “The nurses will take them out.”
Other patients wander
as if in an endless maze
blankets over their heads,
eyes trained on the ground.

The nurses stare into computer screens
behind thick walls of safety glass
—barricaded against what danger?
Perhaps mindful that one day they too
might be lost
like the wandering “others”
in the blue paper pajamas.

My friend is hospitalized
because she tried
to hang herself. She had stopped eating.
Has your appetite returned? I ask.
“We had fish sticks for lunch.
They were so hard I couldn’t chew them.”

She recites the meds in her psych-cocktail—
Lexapro, Topomax, Prozac, and Zanax.
She shrugs and whispers
“I don’t feel any better,
and the weekend doctor
wants me to add Ritalin.”

We move into the dayroom
and I step across a stream of time
to the same place I left in 1997.
The same tattered furniture,
the same dull green walls,
punctuated by a lone picture hanging
crooked and uncentered.

Board games thrown on the shelves—
lids with no bottoms,
scattered pieces from the “Game of Life.”
“No one bothers
to start a puzzle—
we can’t find all the pieces,”
my friend tells me.
A bin of crayons
sits on the shelf,
but there’s no paper.

When I see the flip chart,
I flash back 18 years and remember
the goals’ group twice a day,
but still no art classes.
No dance, no movement
except the aimless wandering
of the blanket people.
No way to shape the confusion
churning inside.
No play dough.
No glue.

Two nursing assistants
fill chairs on the perimeter of the room.
They poke their heads up quickly,
like prairie dogs scanning for predators,
then return to the games
on their mobile phones.

References for further reading:

See The Hidden Epidemicby Robert Whitakerfor more information on the history of developing psychiatric drugs, long-and-short-term effects, trends in rates of mental illness and disability, and alternative treatments.

See Psychiatry Under the Influenceby Robert Whitaker & Lisa Cosgrove for an exploration of the mutually-beneficial relationship between the pharmaceutical industry and the psychiatric community, including medical schools and professional development.

See Prozac Backlashby Joseph Glenmullenfor research on the clinical trials related to antidepressants and the numerous side-effects that patients experience. The book also includes a section on alternative treatments for emotional distress (depression).