In Defense of our Psychiatric Wards

Venezuela es un manicomio. But, as I found out doing my rotation at Merida’s mental hospital, some of the manicomios are almost ok.


Ambulatorio Venezuela is a small building built in 1950, initially to treat tuberculosis patients. In 1973, it was retooled to house Merida’s Acute Psychiatric Unit (UPA, after its Spanish acronym), a place to treat patients in need of long-term psychiatric care under 24-hour watch.

I was apprehensive when I was told the next stop in my medical school rotation would be at UPA. Around town, people see it as some sort of creepy madhouse. Considering our current health crisis, I was dreading a Nick Caseyesque nightmarescape, with forgotten patients on the edge of starvation tied to their beds, crying and screaming.

My first impression was not positive. Like so much else in Venezuela, UPA has definitely seen better days. The paint, layer after layer, is peeling and cracking off the walls. As I entered, a nurse guided me through a  long, dark hallway barely lit by the last working fluorescent lamp on the ceiling. It reminded me of a found-footage horror movie.

It’s as creepy as everyone says, I thought to myself as I entered the library where doctors were meeting, checking the limited stock of drugs they still had on hand. They welcomed me and assigned me a woman to examine.

“You’ll find your patient on the last room on the left,” one of them said, as I headed back to the creepy hallway.

A nurse guided me through a  long, dark hallway barely lit by the last working fluorescent lamp on the ceiling.

I found my patient in a surprisingly bright room, illuminated by a single large window facing the gardens. Not creepy at all, except maybe for the rusted tube coming out of the bathroom wall that served as a shower.

There were five clean beds, each one occupied by a woman. The women were very quiet and relaxed: one was combing her hair, two were reading religious books and the rest were simply sleeping; none seemed to be hostile or angry.

My patient was the one combing her hair. A lady in her 70’s, she was admitted after her niece told the doctors that she was turning increasingly violent at home. She apparently experienced hallucinations concerning the Virgin Mary and her memory was  faltering. The twenty minutes I talked to her passed very quickly. She was cooperative and answered my questions clearly, if a bit slowly. She couldn’t understand why she was there, but didn’t really seem to care either. I made a quick, initial diagnosis: it looked like some sort of dementia. We’d need more tests to figure out which kind.

She had a rough road ahead of her, but she was receiving adequate care. The young man who saw Chávez every afternoon is getting help, too, as is the woman who tried to hang herself using a hammock after having to go two weeks without treatment because her pills are nowhere to be found in local pharmacies.

Nobody would call this place luxurious. As current coordinator, Dr. Ignacio Sandia explained to me, the crisis has hit UPA as hard as any other health institution in the country: obsolete equipment for which replacements never arrive and, more recently, lack of medicines, are the harsh reality.

The young man who saw Chávez every afternoon is getting help, too.

A year ago we treated patients here with the same drugs used in NYU or any other first world center,” he says. But today we’re forced to use 20th century medicine. The Health Ministry sends medicine regularly, but it’s not enough. Patients’ families also give us a hand when needed. If they have to go to Cúcuta to find the prescriptions, they do it,he says.

The food isn’t  what it used to be, either. Today’s breakfast was a María cookie and a glass of juice,” he tells me. “It wasn’t like that before.

And yet, you couldn’t say UPA has “collapsed” either. In broad terms, it works. There’s no sense that the patients here have been abandoned, much less forgotten. UPA does what it’s supposed to do: it takes in patients in enormous distress and gives them a refuge, and reasonable, scientifically-grounded treatment, free of charge.

People are the key, Juan,Dr. Sandia tells me.

The people here feel this place is theirs. As an institution, there’s an amazing work spirit here. UPA has always been different, and it always will be. A lot of people have tried to destroy our work here, but we haven’t let them do it, and we never will,” he says.

There’s no sense that the patients here have been abandoned, much less forgotten.

It’s easy to see the pride he takes in the work, and the sense of standing alone: a refuge for the mentally ill in a country that’s gone collectively insane.

“I think the worst aspect of our current crisis is not the economic, but the moral dimension. Everyone seems to have given up. This place proves that if you want something, you can do it, no matter how hard it might look.

As I walk back to the library to get my notes together, I notice that the patients are being taken to the gardens to get a little sunbath, so I join them for a while.

There aren’t many of them, maybe fifteen in all. A clear contrast with the perpetually overcrowded University Hospital. It was a beautiful day, the deep blue sky set off against the green mountains of the Sierra Nevada, the sun shining high, and that nice recent chill in the air.

On my way out, I could just imagine how beautiful the building must have looked 40 years ago. Even after years of underinvestment, there was something captivating about the way the light hit the walls and windows of the Ambulatorio designed by Carlos Raúl Villanueva over 60 years ago.

UPA’s courtyard was also oddly cozy: a tall, 50’s-era post on which a once glamorous lamp stands, is planted in the middle of a tiny concrete platform, completely surrounded by gardens of perfectly mowed grass with roses, mandarine and orange trees as well as some crops, all planted and cared for by the patients as part of their therapy. Scattered around the gardens are several benches and the ruins of a basketball court. The place feels like a school more than a hospital.

Most of the patients are just sitting on the concrete benches, letting the sun shine on them for a while. Some of them are playing a game I can’t understand on the derelict court: they lay down on the floor, roll over for a few seconds and then jump up to their feet again, repeating the cycle for several minutes. They’re having fun, or at least it looks like it.

These patients don’t know anything about inflation, about out-of-control violence, about the recently resupplied stock of the government’s political prisoners.

A twenty year-old girl who had to give up art school to battle schizophrenia draws the mountains in her notebook. She slowly shows me the flowers and birds she’d drawn earlier that day. She stays silent the whole time, her eyes lost in the horizon, trapped in her own mind. After she finishes, one of the doctors gently asks her to give her pencil back: they’re not allowed to keep them when not supervised.

These patients seem to be doing as well as could be expected given their situation.  They aren’t what you’d call “happy,” but today at least they seem pleased and relaxed. They’re living in their own heads, unaware of the harsh reality the country is facing. They don’t know anything about inflation, about out-of-control violence, about the recently resupplied stock of the government’s political prisoners. Some of them don’t even know how hard it is for us or their families to find the prescriptions they depend on on a daily basis. Their world is this courtyard and the gardens around it.

And it’s a nice one.

And then it strikes me: those psychiatric patients had more peace of mind than me and most Venezuelans I know right now.

Just when you think you understand the Venezuelan crisis, it surprises you. You read horror stories like Casey’s from the mental hospital in Barquisimeto, and assume they stand for the whole.

They don’t. Not yet.

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  1. Excellent piece. Uplifting, and hopeful. Very well written, too! Unfortunately, many Venezuelans – it seems – are focused on phantasms, not believing these can be easily dispelled, and in that belief, one perpetuates the phantasms. Btw, the patients’ game you mentioned could just be a way to get some exercise, or just a game for the fun of a game. The place does look nice, and your description is very good. Keep up the good work! Just a guess on my part, but the artist may be the victim of an immensely evil person (intensely evil people are rare, bu they DO exist, and are terrifically destructive). Hopefully, it isn’t a family member. Ask her, or find out by asking about her early life, her grammar school, etc., when she was last doing well, happy with herself, carefree, productive. If she gets that, and brightens up, leave it there for a while. Then try to find out what happened after that, when something started to mess things up. You may find that she was summarily invalidated for being “a useless artist” and her artistic ability or method questioned. Just get her to talk to you, and listen patiently. She’ll solve her own problems to some extent, if you just listen. If something bad happened, don’t let her return to that same environment.

  2. Juan Carlos, thank you for this, but, it’s only a small island in a flotsam of misery: 15 patients (?); building built by MPJ (that hated dictator who did so much for Venezuela compared to his successors); previously used for patients with tuberculosis, which was stamped out in Venezuela by virtually all Govts. from MPJ through the IV, but is now coming back under Chavismo; and, some medicines still available, since mainly oral, whereas in virtually all public hospitals patients are dying for lack of essentials such as antibiotics/anesthetics/plasma/etc…..

    • To go with the author’s metaphor, there are pockets of sanity in Venezuela, but that sanity is heavily subsidized and supported by private savings, for a lucky few.

      I would not dispute that this facility in Merida is a well run place with highly dedicated staff, who probably themselves make huge sacrifices to keep standards up. They deserve high praise for their work and the lives they help and the lives they no doubt save.

      However the fact that people have to rely on friends and family to find and pay for meds, even in this well run facility, is illustrative. The sanity we are talking about here is sanity for the better off, the better connected, and the just plain lucky. I would doubt this is typical.

  3. Very well written Juanky, as usual. The UPA does not seem to have changed since my rotation 8 years ago. At least the building’s conditions you describe seems similar to what I experienced. I also remember there was a patient who insisted he had a meeting with Chávez. Kudos to Dr. Sandia…

  4. “Today’s breakfast was a María cookie and a glass of juice,” he tells me. “It wasn’t like that before.”

    I can’t think of a worse way to start the day: sugar and more sugar. That alone should ring bells. Those of fragile minds need nourishment that won’t spike the value of their glycemic index.

  5. Dear Juan Carlos Gabaldón

    I just read your article and found it very interesting. Maybe you can help me with some questions. I am working on an art exhibition about stigmatisation of schizophrenia. For one artwork I am looking for cultural differences of stigmatisation between countries. Therefore, I wanted to ask you, if you maybe know about the characteristics of stigmatisation in Venezuela? Are there any special features compared to other countries? What is done against it? What do you personally think would be the best thing to do against stigmatisation? Or maybe you know other people who could help me?

    I am very much looking forward to your answer.
    Best regards
    Laura Luessi


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