One study showed that people who develop delirium during a hospital stay are 13x as likely to die in the hospital as equally sick people who don’t develop delirium. (Wes Ely, see 20 Jun Overview for attribution.)
So what’s going on here? What’s the root cause? In my opinion, the largely unrecognized epidemic of hospital-acquired delirium has a simple psychological error on the part of health care professionals at its root: patients are viewed as mechanical and chemical objects to whom mechanical and chemical treatments can be applied with little thought to the effects of those treatments on their minds.
When a mechanic changes the oil in a car, he doesn’t worry about the impact of that oil change on the car’s mind. The health care system tends to treat patients the same way. I suspect that when people are physically and chemically restrained — via ventilators, IV lines, in some cases wrist and ankle restraints, drugs like fentanyl (which, besides being used in ICUs, doubles as a drug “to incapacitate people in hostage situations” according to Princeton University’s WordNet) and midazolam — their minds make a break for it in an attempt to escape the confinement.
In the process, they often suffer terrible, violent hallucinations in which captivity, torture, and profoundly brutal, bloodthirsty opponents loom large. My take on it is that those hallucinations represent their minds’ interpretation of the hostage-like situation in which they find themselves, a situation in which they are physically and mentally almost paralyzed.
People in intensive care may be “receiving doses of sedatives, narcotics and anesthetics high enough to make even healthy people stop breathing on their own.” (Gina Kolata, see 22 Jun for attribution.) One doctor wondered whether the sedatives keeping patients comfortable might actually be making them worse. He “tried an experiment, waking patients briefly every day by turning off their infusion of sedatives. Not everyone approved. ‘People were concerned about waking patients every day, that that might put patients in a state of fear and dread and anxiety,’ he said. But, he added, ‘we found, to the contrary, that patients actually did better’ and even had a significantly lower rate of post-traumatic stress disorder.” (Kolata, as above.)
Note the assumption on the part of most care providers that people can simply be drugged into oblivion. It doesn’t work. Their minds don’t turn off. They struggle valiantly to escape the captivity — and they break.