Doctor: "A pound of cotton and a pound of iron, which weighs?" ”
Ahang: "A pound of cotton weighs." ”
Doctor: "Why?" ”
Ah Hang: "A pound of cotton is very big!" Of course it's heavy. ”
This is a conversation between a psychiatrist and a newly admitted severely mentally ill patient, and the story takes place in the fifth ward of Guangzhou Baiyun Psychological Hospital, where doctors judge the patient's condition through dialogue.
The fifth ward is the intensive care ward of Guangzhou Baiyun Psychological Hospital, which has treated more than 150 male patients with severe mental disorders.
Vice President Li Jianping introduced that serious mental disorders are mainly divided into schizophrenia, bipolar disorder, paranoid psychosis, mental retardation, delusional disorder and mental disorders caused by epilepsy.
In life, severely mentally ill patients may be dominated by hallucinations and delusions, and some aggressive and hurtful behaviors may occur, and the targets of attacks are often the patient's family. How to effectively supervise and prevent mentally ill patients has always been the focus of social attention.
According to data released by the Disease Prevention and Control Bureau of the National Health Commission in 2018, by the end of 2017, the number of patients with various mental illnesses in the mainland had exceeded 200 million, and the total prevalence rate was as high as 17.5%. And the number of people with severe mental disorders, more than 16 million.
What happened in the fifth ward of Guangzhou Baiyun Psychological Hospital is a microcosm of all the psychiatric hospitals in the country.
Baiyun Psychological Hospital is located in the northern suburbs of Guangzhou, bordering Baiyun Mountain in the south. Baiyun Mountain is a branch of the Jiulian Mountains extending southwestward, with a wide hilly mountain range that separates the hustle and bustle of the city center.
At six o'clock in the morning, the sun crawls into the corridor of the fifth ward, and the patient who wakes up early hangs out or washes back and forth in the corridor.
Eight o'clock is the arrival time of the early shift. Zeng Youjian is a male nurse here, and he usually arrives at the nurse's station in advance to make a handover with his colleagues who work the night shift.
It's the busiest time of the day.
He wants to learn from his night colleagues the latest situation of the patients: whether there are any abnormal movements that need special attention, and which patients need to be scheduled for examination. Some patients love to sleep late, and he has to wake up one by one and urge them to get up and wash up.
After breakfast, the nurses dispensed medicines to the patients one by one. Usually, Zeng Youjian would take the patients to the garden every day for morning exercises, doing eight dan jin and fitness exercises. During the epidemic, in order to avoid gathering, I changed to going to the garden once a day in the afternoon to do aerobics.
In 2017, Zeng Youjian, a university graduate, worked in a general hospital. A year later, he transferred to Guangzhou Baiyun Psychological Hospital and became a nurse in the fifth ward. Although he graduated in nursing, on the first day of work, he deeply felt that this was different from the ward of the general hospital. When he talks to the patient, the other person can't listen at all.
The fifth ward is the severe ward of the mental hospital, which is a male patient with more serious mental illness. Such patients often cannot take care of themselves, express themselves clearly, and even have uncertain aggression.
When inspecting the room, Zeng Youjian would try to keep his back against the wall to prevent the patient from suddenly attacking him from behind. Between the patient and the patient, maintain a safe distance of one meter, and leave room for evasion at any time.
In the psychiatric area of the mental hospital, the proportion of male nurses is much higher than in the general general hospital. Of the 16 nurses in The Fifth Ward, half were men. In China, male nurses are particularly in short supply. There were more than 1,000 graduates in a grade of Shaoguan College Medical College, but there were very few male students majoring in nursing, a total of only 40. Like him, fewer men go to psychiatric hospitals to work as male nurses.
People with mental illness often do not know themselves and do not have self-control when they are onset. In the day and night with patients, Zeng Youjian found a way to get along with these patients - he tried to communicate with the patients' ideas first, and then guide them to live, take medicine, exercise...
Every day, patients with smoking addiction have three opportunities to smoke, and nurses keep the lighter and uniformly light cigarettes for patients who smoke. When inspecting the house, there was a building to open each chest of drawers and carefully check for dangerous goods. Here, lighters, knives, ceramics, and even shoelaces are dangerous goods.
The work of nurses is trivial and complicated, requiring great care and patience. In addition to routine nursing and inspection work, daily life tasks such as haircuts, shaving beards, and nail cutting are also handled by nurses. To patients, these people are actually more like "parents".
At 10 p.m., the ward will turn off the lights on time and urge the patients to go back to their rooms to sleep. Often patients can't sleep, get up and wander the corridors. Nurses have to go from room to room to check whether anyone has not yet fallen asleep; bathrooms and toilets must also be carefully inspected to prevent patients from sneaking inside and not coming out.
For patients, the day ends like this, but for nurses, the most alarming moment has just begun.
To ensure that no surprises occur, nurses must patrol every 15 minutes, even at night.
After working in the fifth ward for a long time, patients like to talk to Zeng Youjian, and he also regards patients as friends and listens patiently. Because of the impact of the disease, some patients are even hostile to their loved ones, but they trust the nurses who accompany them. Zeng Youjian understands the past of these patients and understands their delicate tempers.
Ah Qiu was just over 20 years old, but he was an old patient in the fifth district of the psychiatric department, and he has been hospitalized since 2016. Like many patients, he was prone to mania and emotions when he was first admitted to the hospital, and he pestered Zeng Youjian every day, asking when he would be discharged, and beating people when he was angry. With the medication and the guidance of the nurses, Ah Qiu gradually learned to control his emotions. Later, he took the initiative to find Zeng Youjian, hoping to help with the work.
In the evening, it was bath time, and Ah Qiu helped distribute toiletries to the patients. There were patients eating and vomiting on the ground, and Ah Qiu took a broom to clean up. There are elderly patients, slow to bathe, and spend a long time in the bathroom, and Ah Qiu will also go in to inspect in case of accidents.
He has clear expectations and visions for his future, hoping that after being discharged from the hospital, he can do some work to support himself, such as a cashier in a supermarket.
The nurses' station has a public telephone. After dinner, Ah Bin was holding the public telephone and reciting the words, and in his consciousness, he was calling his friend outside the hospital. But Zeng Youjian knew that this phone could only be answered but could not be dialed.
26-year-old Ah Bin, who used to work as a security guard, has a low income but likes to splurge, often asking his family for money to spend money and wine. Once, he asked his father for money, but his father did not give it, and Ah Bin was furious and smashed the furniture, so he was taken to the hospital by his father.
Fang Min, 37, who likes to sing Cantonese songs in the corridors of his ward, was once the head chef of a canteen at a large company in Guangzhou and came here for treatment because of bipolar affective disorder.
From childhood to adulthood, Fang Min felt that his parents did not pay much attention to him and lacked love in his heart. He has always wanted to have a good family, but after marriage, the relationship between his wife and his mother is not good, his wife cannot communicate well with him, he is extremely depressed, and he has symptoms such as auditory hallucinations.
"He even cut his veins and gave birth," Zeng Youjian said. Fang Min is fatter and stronger, and every time another patient falls ill, he will help the nurse control the patient. In order to allow Fang Min to overcome the emotional barrier, Zeng Youjian encouraged him to communicate more with other patients.
"What do you want to do after you're discharged from the hospital?"
"The first thing I want to do is to see my children and hope to have a good marriage again," Fang said.
Before Chen Chao entered the hospital, he was the owner of a pig farm, with a master's degree and an annual income of more than one million. But because of the setback in his business, he fell from the peak of his life to the bottom and suffered from schizophrenia.
Zeng Youjian remembered that Chen Chao had just entered the fifth ward, and once someone spoke to him, he would beat himself with his fist and bite his fingers. The nurses had to forcibly restrain him with restraint belts. Through treatment and medication, he gradually learned to control his behavior.
In the fifth ward, time seems to lose its meaning, and each day is the beginning and end of repetition. They also gradually calibrate their habits in this cycle. Almost every patient can clearly remember their admission date. Some patients even painted names and dates on the walls of the wards.
Li Jianping said that psychiatry does not have the theory of cure, but clinical remission and clinical cure.
The criteria for clinical cure include: first, the patient's symptoms must disappear completely; secondly, the patient himself has a full understanding of his own disease, his abnormal behavior, and can realize that abnormal behavior is a state of disease, which is a problem of self-control recovery.
The third is the restoration of social functions. Examples include improved learning, work and social skills, and family responsibilities. If these conditions are met, the patient can be considered to have recovered clinically.
To do this, in addition to receiving long-term treatment, it is also necessary to give sufficient support after returning from the hospital to society.
Li Jianping said that patients with serious mental illness need to take medicine for a long time, and some even need to take medicine for life. The article "Psychiatry Today" once mentioned that more than 80% of psychopaths will relapse within 5 years, and 40% to 50% of the first psychopaths will relapse within 2 years. The cause of recurrence is mostly related to the unprovoked discontinuation of the drug.
Many patients have lived in psychiatric hospitals for more than 10 years, or even longer. They can't go home without the hospital, mainly because the existing social rehabilitation system cannot guarantee that patients are effectively managed outside the hospital. Originally, it met the criteria for discharge, but there was a high probability that many patients would relapse, so patients could not be discharged from the hospital, and family members did not agree to discharge the patient.
Ignorance of the disease makes the disease itself full of guilt and humiliation, and makes the mentally ill who suffer from the disease a special group that is demonized.
Many people think that "mentally ill people are very dangerous", in fact, this is mainly due to the fact that some patients have not been effectively identified and intervened, and some extreme cases have been reported by the media after they have occurred, forming a wide spread and impact.
In fact, in all violent crime cases, the probability of mentally ill people causing accidents is much lower than that of normal people.
Many psychopaths during an onset of illness show symptoms of fear of going out and avoiding all social activities rather than taking to the streets to harm others.
The prejudice of illness and others brings double harm to the mentally ill. Therefore, even if a small number of lucky patients leave the psychiatric hospital after clinical recovery, they begin to miss their lives in the psychiatric hospital.
That evening, Ah Bin, who stood at the nurse's station to "call", added Zeng Youjian WeChat before leaving the hospital, and one day, Ah Bin called him: "I want to go back to you, feel safe around you, the whole world is fine, like spring."
(The patients in this article are pseudonyms)
*The content of this article is a popularization of health knowledge and cannot be used as a specific diagnosis and treatment recommendation, nor is it a substitute for face-to-face consultation by a practicing physician, for reference only.
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