 This will likely be one of the hardest series of posts to write because it was one of the hardest experiences of my life. However, people have been curious about two things: 1) how I ended up being admitted into the hospital and 2) what’s it like to be in an acute psychiatric ward. So let’s start with the first. While I was in a major depressive episode, which is not uncommon given I have Bipolar Mood Disorder, I got into an argument with my partner. The discussion did not go well, and I ended up even more depressed. I allowed myself to fall into the darkness and let suicidal ideation have free rein on my brain. You would probably not have noticed I was in bad shape if you talked to me. I went to my son’s music recital, went to my music group practice, cooked dinner and did everything that was expected of me. But I did it all with the thoughts that “maybe this will be the last time I play this song” and “how should I leave my five-year-old son a note?” After about three days of being unable to control these thoughts, I called my therapist with the hope that he would recommend I reschedule my appointment or offer some quick fix that could stop the ideation. Instead, after I told him about my weekend, he told me to go to ER for an emergency evaluation. I was not happy and I was not surprised either as even I had realized I was a danger to myself. Granted, I did not have any firm plans to kill myself, in large part because I could not figure out logistics. I wanted a quick, painless death that caused very little gore and distress to someone finding me. That’s a super high bar to set and pretty much rules out every method. The rational me knew this, and the irrational me kept digging for an answer. However, both the irrational and rational me agreed that I was in severe pain and did not want to be in pain anymore. After speaking with my therapist, my spouse drove me to the ER, where I was met by my therapist and quickly triaged. It appears that those coming with thoughts of self-harm get preferential treatment – they do not want to keep you waiting because the longer you have to wait, the more likely you will simply get up and leave. They rolled me around in a wheelchair, which I tried to refuse, but it was so that I wouldn’t get up and run away. It became clear real fast that shit just got real. After some blood work to “check your electrolytes” (which included checking me for all drugs and alcohol as well), I was stripped down and given a hospital gown. I had to hand over all my personal belongings, except for my cell phone, to my partner, and I was wheeled over to a secured area to wait for an emergency evaluation.
The emergency evaluation was one of the most intense exams I’ve sat for, and this is coming from someone who sat for the bar. By this point, my partner had left to pick up our son from school, my therapist returned to his office, and I was on my own in a room sitting across from two doctors, a resident, and two medical students while wearing nothing but some undergarments and a flimsy hospital gown. This arrangement essentially made the situation go from really bad to a fucking nightmare. I started to regret making that phone call to my therapist. I was put more and more on the defensive about my thoughts and emotions. The barrage of questions ran the gamut from boilerplate like “how often do you think about killing yourself?” and “did you actually hold the pill bottle in your hand?” to accusatory such as “why do your doctors think you have bipolar?” and “are you actually taking your medication everyday?” The longer the evaluation continued, the more it was apparent I needed help. After “failing” my evaluation, I was given a false choice. I could either voluntarily admit myself to the acute psychiatric ward on the hospital's 13th floor or be forcibly committed, by court order, to their acute psychiatric ward on the 13th floor. At least with a voluntary admit, I could immediately demand to be discharged within five business days. So I checked myself in. After signing myself up to be admitted, I waited for a very long time in the secured waiting area. The staff let me charge my phone, which I used to frantically text people and to call my partner who, unsurprisingly, was not happy about this turn of events. He was on the phone to the doctors and hospital staff trying to figure out why I was being admitted and when I would come home. He was doing this while being a single parent to a confused child. Our son wanted to know, why didn’t Mommy pick him up from school today? I tried to choke down some hospital chicken with congealed gravy during my wait – I had not eaten in almost 24 hours. It was awful even as hungry as I was, and I actually wished I had just continued my hunger strike. I wished I continued a lot of things during that long wait, including just suffering in silence and in pain. Finally, I was taken upstairs and checked into the psych unit, or “the unit,” as the staff and patients called it. I turned over my phone to protect other patients’ privacy and got my clothes back. I was led to my very stark, but somewhat spacious room. They also gave me a bag with some toiletries and showed me around the unit, including where towels and bedding were kept and where I would eat my meals. The hospital I was admitted to is one of the best in the city, and their psychiatric unit was no exception. I had a private room, and they had a lot of amenities, including free phone calls, computers with internet access and round the clock nursing services. Even though I was in an excellent facility, it still felt like a prison. I couldn’t leave. Even if I wanted to, I could not leave. Short of a court order or my untimely demise, I was not walking out of that building. For the first time in a long time, I finally cried. Continued in Part 2
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Generally, I lack the patience to sit through internet videos, but I came across this TED talk by Andrew Solomon, author of The Noonday Demon: An Atlas of Depression. His discussion on depression is a much watch for both those suffering from depression and those who are caregivers, loved ones or friends trying to understand what this disease really is.
When he says that “The opposite of depression is not happiness, but vitality” I actually cried. Not only because it resonated so deeply but also because it finally put eloquent language to something I could only explain as “I’m fucked up.”
In therapy, we have been discussing what not being depressed looks like. What does my identity become if I am no longer “depressed”? The reason I have this conversation with my therapist a lot is that I am wondering how all this intervention will change what I view as my fundamental self. Deep down I fear that all these meds, talk therapy, and coping skills are akin to plastic surgery, where it changes something perhaps for the better, perhaps for the worse, but at the end of the day will make me into something artificial. With that being said, his answer to my question of what not being depressed would look like is instead of being barely functioning (or just going through the motions of daily living) I would have more robust functionality - operating above and beyond what I currently think I am capable of doing. Perhaps I will always have negative self-worth and a need for external validation, but I will be living and functioning at my utmost potential. In other words, I will have vitality. Another major theme in Solomon’s talk is about all the ways depression is misunderstood. This misunderstand shows through with how we treat depression and how we view depression in ourselves and in others. I agree that treatment is shoddy - I have had different psychiatrists diagnose me with various conditions (major depressive, bipolar disorder, and dysthymia), prescribe different medications with little therapeutic or even harmful effects, and provide no guidance about what the best course of action should be to treat whatever is wrong with me. If I had a physical health condition, I could have filed for malpractice by now. Armed with the experience and understanding that most people consider psychiatry a “pseudoscience,” over the years I have become more proactive in my own care. I will research any recommended medication before taking it, ask as many open and honest questions as I can about all my options (using assertive communication), and recently I have included my partner in my coordination of care. To quote from Solomon’s remarks, “I hope that 50 years hence, people will hear about my treatments and be appalled that anyone endured such primitive science.” I was unsurprised that Solomon saw such stigma around discussing depression, even with those we are supposedly most intimate with (the husband and wife story greatly amused me). The stigma surrounding mental health is lethal and prevents people from seeking out the help they need to get help for their illness. I still question if I made the right decision getting “voluntarily” admitted to the acute psychiatric unit - it took weeks for me to reveal to my friends and family why I was incommunicado for three full days. I got a lot out of watching this talk. It was informative, and I have made it a must-watch among those close to me. I hope you can spare a few minutes for it as well.  I am currently in an Intensive Outpatient Therapy Program (IOP), and there are lots of different acronyms thrown at me on a daily basis. This includes the acronyms that correspond to the different therapy styles used in the program. For the uninitiated, this post is a summary of three different therapy styles that are in some ways very similar and in other ways very different in their approach to mental health treatment.
I also created a Therapy Cheat Sheet for an even quicker overview. CBT - The first is Cognitive Behavioral Therapy (CBT) which is one of the most well established of the skills-based talk therapy treatments used by psychiatrists. The core premise is if one has negative thought processes, their thoughts can be corrected toward more positive thought processes. These more positive thoughts should lead to a better mood and higher levels of functioning. The whole methodology and skills taught in CBT are meant to consistently promote positive thought processes as those positive thoughts will lead to better-coping choices in the face of situations that would typically cause depression, anxiety or other negative mood states. CBT is actually used for a variety of different mental health conditions beyond just depression and anxiety. DBT - The next therapy method is Dialectical Behavior Therapy (DBT) which is useful for patients with self-harm and self-destructive symptoms. There are four modules in DBT all working together to give the patient a better mood and higher levels of functioning. The modules are mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. There are a crazy amount of acronyms for skills taught in DBT, but the acronyms are actually quite catchy. One of my favorites is DEAR MAN which is how to get what you want from another person (useful for those who are too passive or aggressive in their communication styles). ACT - The final method is Acceptance and Commitment Therapy (ACT). This method is based on some fascinating philosophies surrounding the study of language and how using language to identify emotions can be to our detriment. Within ACT there are six principles - thought defusion, acceptance, mindfulness, self as context, values and committed action. ACT also subscribes to the notion that I summarize as “fuck your feelings.” Your behaviors are supposed to align with your values. Whatever thoughts and emotions you have should not be an impediment to values based behavior. So with all three methods - They all have their pros:
As you can see all three of these are pretty much doing the same things. You are learning skill sets that you can use to alter, adjust, and amend your negative thoughts and emotions so that you choose healthier and more positive behaviors. I think that is why the group therapy center I attend draws from all three of these methodologies. For more information on all these check out the following: The Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation & Distress Tolerance (by Matthew McKay, Jeffrey C. Wood, and Jeffrey Brantley) The CBT Toolbox: A Workbook for Clients and Clinicians (by Jeff Riggenbach) ACT Made Simple: An Easy-To-Read Primer on Acceptance and Commitment Therapy (by Russ Harris) Are Facebook, LinkedIn, Instagram, etc. ruining our mental health? There is a lot of research to suggest that social media is affecting our mental health (although it has been acknowledged that said studies are flawed). The conclusion from an article in the American Journal of Epidemiology suggests that: “...Facebook use does not promote well-being and that individual social media users might do well to curtail their use of social media and focus instead on real-world relationships.” Someone recently used the phrase “compare and despair” during a group therapy session on managing unrealistic expectations we have of ourselves. That phrase really resonated with me because I often find myself comparing myself to others and having some feelings of shame, envy and general despair when I do. When I check social media and see everyone has a perfect job, takes fantastic vacations, and are perfect parents with perfect children who can even have perfect tantrums. All this does is stirs up envy and lead to resentment and, well, despair. My life seems like shit compared to others, and I just start to ruminate down the rabbit hole of reflection and regret. I could delete my Facebook, Twitter, LinkedIn and Instagram accounts (I’m too old for Snapchat), but I really have no good way to catch up and find out what is going on with those from my past and present. Granted we all know that what is posted has been curated. I rarely post photos of my son and only when I know I can maximize my “likes.” I’ll post a few photos from our spring break trip to show just how excellent our vacation to Cabo San Lucas is, with no indication that our spring break trip was actually pretty crappy. But even knowing that, I still scroll through and compare and despair when I learn, through LinkedIn, that someone I went to law school with is up for an appointed judgeship, or see pictures on Facebook, of a friend, with an ideal legal job, on her annual trip to some European country with her beautiful family. I also find myself comparing and despairing when I see the man begging and holding a “Hungry as Fuck” sign on the exit ramp. Or when I drive by the homeless shelter and see the large groups of families getting a meal and a place to sleep for the night. I drive by in my luxury SUV on the way back to my condo on a 33rd floor overlooking the lakefront after dropping my son off at a fantastic private school we were fortunate enough to get him into. Although I will not take most of the credit for our financial stability, I am in a position where we are not living paycheck to paycheck, unlike how I grew up. We have the luxury of being picky about how to earn a living and not have to rely on government assistance, also unlike how I grew up. So I can now drive around in my air-conditioned car on an 85-degree day passing by people with literally nothing and still can have active thoughts of wanting to kill myself. I can still wake up in the morning and have a fridge full of food and still have active ideas of wanting to jump off the balcony. How can I be depressed and have such self-hate when I have so much in comparison to people who undoubtedly may not be happy with the cards they were given, but will play them out anyway? The compare and contrast game is real, and to me, it can be dangerous. I could just decide to disengage from the digital world and the real world, which I sometimes do by either not checking my media accounts or leaving the house. I have started using radical acceptance as a coping skill against this desire to continually feel the need to compare and contrast my life with others. Radical acceptance allows me to acknowledge these automatic thoughts and emotions, but not feel the urge to engage said emotions. I can have the emotion of envy without allowing my behaviors and mood to be influenced by that very intense emotion. It’d also help if I took the advice of the researchers and started cultivating “real world” friendships that are not based on filters and “thumbs up.” |