My dad was in the hospital for the last ten days and just got out as I write this (February 24, his birthday). I spent as much time there at the hospital as I felt I could get away with, which turned out to be on the order of four or five hours most days; I’m grateful I have the flexibility in my life to do things like that when it seems important, and my job doesn’t get in the way. It feels a bit awful to be around for such a trying time without any ability to really help, but My dad certainly appreciated the company, and that’s good enough for me.

Part of why it felt so important to be there is that being in a hospital setting clearly disrupts a person’s mental health. It’s common for patients to exhibit confusion and paranoia, especially older patients, and particularly when confined to a clinical setting for long periods of time. The staff have various techniques to keep patients suffering from this mental state from presenting a safety risk to themselves or others, but these techniques are ultimately about restraint, and that additional restraint just exacerbates the feeling of entrapment and paranoia.

In other words, left unchecked, a patient’s mental instability induces a response from the staff which tends to cause more instability in the patient. The existence of this feedback loop makes it extraordinarily scary and dangerous. There were moments this last week in which I was very concerned that we’d start slipping over that edge into a self-reinforcing nightmare.

Imagine an elderly person who has been living independently for years, with little issue. Imagine that they have some chronic health concerns, but they’ve never had difficulty managing it. They shop for themselves, maintain neighborly relationships, and live a healthy independent life. Now imagine that this person has a single serious health issue and end up in a hospital for two or three weeks - during this time, they are often medicated, always in a disorienting enclosed space, constantly without any semblance of privacy, and rarely able to sleep or rest. It is not hard to imagine that this person has an episode of confusion, in which they think they are being imprisoned against their will (is that even confusion?) and are subsequently restrained, leading to more conviction they are being mistreated, leading to more intensive management, until finally the health episode is over, but the individual is released into a heavily managed nursing home. There, instead of the kind of environment that fostered their independence previously, they may encounter more alienating clinical treatment, less freedom, and have less mental and emotional stimulation.

Nothing of the sort happened last week to my family, but I did see a little bit how the self-reinforcing trap of dependence can get started. Without doing some research I have no idea how common the above nightmare scenario really is, but its plausibility really concerns me.