Impact of the seclusion room experience

The seclusion room is a repository of intense feeling and strongly held opinion for members of psychiatric inpatient units. Patients, nurses, and doctors often find themselves in intrapsychic and/or interpersonal conflict over its use and misuse. Perhaps because of general discomfort, relatively little is known about what a patient actually experiences while secluded. In this report, we utilized an unexpected source of information on the meaning of the seclusion room experience for our patients: their art productions. The observations are based upon our therapeutic and research experience with acutely schizophrenic patients hospitalized on an NIMH clinical research unit located in NIH's Clinical Center. On this unit, pharmacotherapy was not used during investigation periods and, in keeping with the unit's treatment philosophy, was used sparingly or not at all during noninvestigative periods. As a result, the seclusion room was used frequently for severe management problems. Systematic collection of art productions was a routine part of the research protocol. Patients attended three individual art therapy sessions: during drug-free periods 2 to 3 weeks after admission, 2 to 3 weeks before discharge, and at follow-up 1 year after admission. The patient was asked to use pastels to draw the following pictures: a free picture (patient's choice), a self-portrait, a picture of his/her psychiatric illness, a picture of any hallucination experienced, and a picture of any delusion experienced. After completing each picture, the patient was encouraged to discuss it. Sixty-two patients were evaluated with this methodology. Particulary noteworthy is the fact that in no instance was a patient requested to draw a picture about a seclusion room experience. Nevertheless, over one third of the patients did so, underscoring the prominence of the experience for them. Furthermore, these pictures did not emerge from a large array of patient art, but from only threee art sessions per patient. The nature of the pictures fell into the following patterns: a) pleasurable hallucinations occurring while in seclusion; b) frightening delusions connected with the experience of seclusion; c) strong nondelusional feelings about being in seclusion (often the picture of the psychiatric illness was a representation of the seclusion room experience); d) special focus on the staff member in attendance outside the seclusion room door. The implications of these graphic expressions are discussed, with particular emphasis on the impact of the seclusion room experience for the patient.