How to survive a psychiatric evaluation without getting locked up


Suppose you’re in the hospital emergency room. Suppose they suspect you might need to be in the psychiatric unit. And suppose you really don’t need to be there.

What’s the best way to handle the intake process? How do you answer those questions so you still have a chance of getting home that evening?

Jean MacDonald, speaking at Ignite Portland at the Bagdad Theater yesterday, offered practical advice on getting through a psychiatric evaluation, including a list of questions you might be asked.

What’s your name?

“You might think, ‘Oh, that’s a stupid question. It’s right there in front of them on the form that I just filled out.’” But, MacDonald said, in a psychiatric screening, there are no stupid questions, only stupid answers.

Just say your name. And, she added, “Don’t be hostile. That’s a good way to get labeled paranoid.”

What is today’s date?

They allow you some leeway on this one, MacDonald said, so don’t worry if you get the day wrong. Just make sure to name the correct year.

Do you know where you are?

Just answer with the city and hospital name, MacDonald advised. Don’t get creative, or you’re likely to get labeled paranoid and delusional.

Next, you will be given a series of three words, such as “apple, cat, house.” You are told to try to remember the words and repeat them back one minute later. But be careful, MacDonald says – they will also ask you for the words five minutes later.

Then, according to MacDonald, they will ask you to spell a word backwards. MacDonald told the audience that she has been asked to spell “world” backwards more than once, and she encouraged everyone to memorize the reverse spelling, “D-L-R-O-W.”

You will also be asked to count backwards from 100 by sevens. Don’t be too good at it, MacDonald warned, because then “they might think you’re a little crazy.”

Finally, says MacDonald, there are two questions you cannot screw up.

Do you ever think of killing yourself?

This is no time to get into an existential debate, MacDonald told listeners, and do not quote Virginia Woolf. Don’t discuss the times you mused about the meaning of life. “There are no innocent remarks in psychiatric intake.”

Are you thinking of harming anyone else?

Say “no,” said MacDonald, and don’t mention that, gosh, you’d really like to kill your sister sometimes. “Psychiatric intake, like airport security, is no place for jokes,” she said.

She also recommended that you not talk about knowing famous people, even if you do. That’s a good way to get labeled grandiose.

In closing, MacDonald said you should memorize one number: a close friend who can support you during the process. You don’t want to go through something like this alone.