Grateful for this powerful reflection by Faith Perry.

I wasn’t going to write about this—the scariest part of mental illness. But here it is: an ode to loss of control and how “the system” can contribute to a person’s newfound overwhelming helplessness.

I am a nurse in an emergency room. Nighttime falls, and on cue, the mental health patients begin to roll in. And I understand. I’ve been there. When darkness comes, the inner darkness comes for everyone struggling with mental health issues. I am privileged to be one of the first people in contact with patients when they experience their own personal loss of control. And that is why they are here. Someone has pried the gun out of their hand and brought them in. Someone settled their mania enough to get them into the car and brought them in. Someone brought them in after their first break from reality, after their sudden desire to kill their neighbor, after they overdosed, after they haven’t been out of bed in three weeks. Whatever the reason and however they have lost control, they are joining me in the emergency room this evening.

In clinical terms, a loss of control can be thought of as a “lack of the ability to provide conscious limitation of impulses and behavior as a result of overwhelming emotion. States of agitation such as fighting, screaming, and uncontrollable weeping are most often thought of as behavior illustrative of loss of control.” The definition proceeds to mention that involuntary immobility and trembling may also appear in loss of control. I would venture to include psychotic breaks into this definition, too.

Some people know that they have “lost it,” and they know they aren’t thinking rationally. Maybe these people even brought themselves in. Other people have no idea. They will need a little time and some help before they realize they have gone off the tracks. While both groups will be detained in the hospital, it’s hardest for the people who know. Internal and external dialogues go something like this:

“I don’t know what to do. I can’t go on like this. I can’t do anything. I can’t get out of bed. I can’t think straight. What if depression really does lead to Parkinson’s disease? What if I’m here forever? What if this happens again? What if nothing ever gets better? Why am I even here? Help me. I can’t fix this. I can’t do this. I can’t live like this.”

Which is true. They cannot live healthy, productive lives in a state of no control. If a patient has voluntarily come to an emergency department in Virginia, they likely have no problem taking the next step and going to a mental health facility. At this point in time, while they still have a long ways to go, patients can begin to regain some control of their mental health.

But what if they aren’t there voluntarily? That looks something like this.

A person has pills in their hand. Another begins rambling and making no sense. Someone else is having a panic attack and makes a suicidal comment. A person begins believing they are under attack. Somebody runs out in front of a car. A friend, family member, or random passerby sees or hears what is happening and calls 911 with the belief that this person is a serious threat to themself or others. The police come, and they serve what is commonly known as an ECO—an emergency custody order. They place the person who is currently experiencing loss of control into handcuffs and bring them to the emergency room. This seems like a great idea: find the person who feels out of control, and immediately take away all of that person’s rights and abilities—handcuff them, too. That will likely help the situation a lot. Once I settle this person into their new prison cell in the emergency department, which has security at the door, mental health counselors come to talk to them.

These people gently break the news to them. You are going to be admitted to a facility. You can go voluntarily, or we will detain you, and you’ll go anyway. At this time, the weeping, fighting, screaming individual typically gives in. They give away the last bit of control they have. They turn over all their rights— where they sleep at night, what food they eat, what they do every day. And they do it “voluntarily.” An officer I know once put it like this: “That isn’t really voluntary. That’s like me saying, ‘Let me search your house, or I’m going to get a search warrant and search it anyway.’”

And what do you do to comfort someone who really has lost all control? The mind went first, and then, temporarily, their freedom. I’m still learning, but the most important thing I can do in this situation is to be kind. For the other person, this is a hard, weird, scary, and overwhelming place to be. If I step back and look at these individuals as people who are experiencing temporary loss of control, not just “being crazy,” I can develop empathy for them. I am not in their situation. I am not experiencing the pain that brought them to this place. I am not experiencing it now, and I haven’t been dealing with it in the days, weeks, or months leading up to their admission in my ER. I don’t get to judge how much pain they are feeling or how much they feel they are at a loss. I don’t dictate their responses to me or to their situation.

But I can give them choices, even just the choice of what they eat for breakfast while they’re with me. And I can listen to their stories. These are seemingly small gestures, but to a person who is experiencing this kind of traumatic life event, helping them regain control over little things can mean everything. And yes, I’ll still call for an ECO if they try to leave me, because my priority is keeping them safe. But in the meantime, a little kindness goes a long way. It is important to not write these individuals off as crazy but continue to see and treat them as people.