Table 2.

Distrust group: dehumanization and punishment rather than care

Theme	Example quotations
Analogies to prison or jail	”it was like a prison. You wake up at this time, they come in to wake you up, if you want to shower they have to be [there] monitoring. We would ask, “When are we going to do this? When are we going to do that?”. It wasn’t like [we were] talking to them, it was like they were just standing guard and just very cold. ”
Dehumanization	“After lunch, maybe, they’d take us outside [to] this little enclosure that was all fenced in. Felt like little animals on display there. After that, a few hours until dinner. All the time, you were just nothing. You’d sit there and watch the television like if you weren’t insane before, you would go insane at this place.”
Moral judgement	“…they didn’t see us as people. It was just another patient coming in and out. The staff would kind of make jokes to one another, think they were above us because we were in the facility and they were in the staff”
	“[At the hospital] I just really noticed a lot of power trips… It’s really easy to slip into a mindset of judgment when you’re interacting with mentally ill people, because it’s … it felt like they wanted that career not to help people, but to feel better than people”
Learning to lie	“The mindset you get into there, at least what I got into was like, ‘Okay, I need to pretend I’m okay so that they’ll let me out.’ Because you aren’t going to get better in that situation. You’re just gonna pretend to be better, so they’ll let you out, so you can go back to an easier life.”
	“[One of the other patients said] ‘Hey, you need to stop crying,’ and I was like, ‘Why? I don’t care. Why?’ And one of them is like, ‘Well, they won’t let you out unless you show emotional stability,’ and I was like, ‘Oh my God. Okay.’
‘Learning to Lie’ carrying over to post-discharge behavior	“…the first thing I learned as soon as I was put into the hospital was that I couldn’t actually talk about what was wrong. Because then I would be taken against my will somewhere, and my parents would have to pay for it… So as soon as I was told I couldn’t leave, then I shut out even more. And I’d already been reluctant to hand out information, but at that point it was, ‘I’m just going to say whatever I need to get out.’ To anyone, to my parents, to therapists, whatever I need to do to make them think nothing is wrong.”
	“Well…you learn really easily. You learn really easily. Unless you have some [condition] where you actually don’t understand what it is that the person could be looking for from you, of course you know. Do you want to kill yourself today? ‘No, I would never want to kill myself. I would never do that.’ Are you depressed? ‘No, I’m not depressed. Everything’s great. Of course, I’m not going to …’ [If] you show your honesty, you get sent away. So from that point on, you’re done [being honest].”