When we last left my poor depressed self, I was enroute from my local hospital to the psych ward. But what I didn’t mention was the most important thing, what got me admitted: I had a plan. I honestly think, no matter how much pain I was in, how miserable I was, I would not have been admitted if I hadn’t admitted to having a plan. I won’t say what that particular plan was (it probably wouldn’t have worked anyway), but I had an out available if I got too tired of fighting myself.
That said, let’s return to November of 2012. I was taken by ambulance to a hospital 45 minutes from home to be admitted to their “Behavioral Health” ward. Read “psych ward.” Now, throw out any images you may have gotten from movies or TV about psych wards. There was no padded room, no drooling patients, no Angelina Jolie leading patient revolts.
This hospital, located in an affluent suburban area, had multiple areas within the “normal” hospital for their psych patients. Patients were separated by age (child, adolescent, adult, geriatric), medical condition (did you require constant monitoring? Were you detoxing from something? Did you have any physical problems that needed watching like open wounds or broken bones?), and how functional you were (were you in a psychotic state or not). Obviously, I was taken to the adult ward with no major medical problems and was functional.
To picture the ward, imagine a square separated into four quarters with a circle in the center. The circle in the center is the nurses’ station. One quarter was for administrative stuff (where they kept the meds, charts, and the staff break room), one for the geriatric patients, one for adults with medical problems, and one for adults without problems. Each section was kept locked so a patient couldn’t wander into a section they didn’t belong to. Everyone on my floor was functional. Those who weren’t or were younger were kept on another floor altogether.
By the time I arrived at the ward it was one in the morning. The EMTs had me strapped into a gurney and they wouldn’t let me get out until we were actually in the ward, behind locked doors. A psych tech met us in the ER and lead us to the ward, unlocking the doors on the way. I was to later find out that the locks were because we weren’t supposed to leave without permission.
After I was allowed off the gurney, I was strip searched. Yep, strip searched. I later found out that they had to do that to be sure that we had no hidden wounds or contraband (sharp things, drugs, etc) hidden under our clothes. The tech was very respectful, she didn’t touch me, but it was still embarrassing. They even had to check between my rolls of fat. Humiliating. After allowing me to dress, they took an inventory of what I brought with me. My wallet was locked up and any personal items, including my cell phone, were tucked away in a locked storage room. I was allowed access to them twice a day. Then I was taken into an office and asked a bunch of questions about my medical and psychiatric history. Everything from “have you ever been abused” to “how often do you feel suicidal.” I had to sign a bunch of paperwork, including one that said I agreed to be admitted for at least 3 days. I was told that I didn’t have to sign that form, but that if I didn’t my case would be brought before a judge and the judge would commit me against my will anyway. I had to sign another form that informed me that I would not be allowed to legally own a gun for the next 3 years.
Then I was given the rules. They were simple: no violence, be respectful, no personal items on the floor that could possibly be used to hurt ourselves (with the exception of pens. I guess they had to allow us to write), if we wanted to use our own toiletries we could (but they were kept locked up and only allowed out while we were using them), family could bring us books and candy but it all had to be searched before we were allowed to have it, and we had to attend as many activities as possible.
Finally, I was lead to a room. It mostly looked like your basic hospital room. Two beds, a couple of nightstands, a bathroom. The big differences were that all the electrical outlets were covered and the beds weren’t your typical hospital beds. They were wooden platform beds attached to the floor. They gave me a couple hospital gowns (since I didn’t bring a change of clothes with me) and some toiletries. I didn’t have a roommate (I got one the second day), and they allowed me to close my door to sleep (although they did do “bed checks” to be sure I was where I’m supposed to be throughout the night).
In the morning, they woke me up at 7am. I was told that I could hang out in my room or in the group area (a living room type area) until breakfast. The group area had a coffee maker/hot water dispenser (for tea or hot chocolate) that we were allowed access to most of the day. Our days were scheduled from 7am to 10pm. The first few hours of the day were for getting our meds, having our vitals checked (blood pressure, temperature, etc) and getting access (monitored access) to our personal items. After breakfast, we alternated between group counseling and free time until lunch. After lunch there was an hour of visiting time then more group counseling. At 3 there was a “shift change”. Basically, we had to stay in our rooms while the first shift staff updated the second shift staff about our individual statuses. Then there was more group counseling until dinner. After dinner, we were again allowed access to our personal items, there was another visiting time then, yep you guessed it, more group counseling. After a final bit of free time, we had “snack time” (granola bars, chips, pudding, etc), a final group then more free time. We had to be in our rooms by 10, although they didn’t make us go to bed if we didn’t want to. Bed checks occurred throughout the night and we weren’t allowed out of our rooms until 7am. On weekends and holidays, the schedule was slightly different, more free time, an additional visiting time, and less group counseling.
Group counseling in the psych ward isn’t like it is out in the real world. Yes we sat in a circle and yes there was some sharing, but each session was focused on something different. In the morning, we each had to set goals for the day (something concrete and attainable for the day. “Feel better” was too vague, “sharing more in group” was better). Our final group was a check to see if we accomplished our goals. Some groups consisted of being taught the symptoms of our various diagnosis’ while others were about specific things we could do to manage our diseases. Not all sessions allowed for sharing, but most did. And there was at least one art therapy session and one “spirituality” (non-specific spirituality so as not to offend anyone) session a week.
You didn’t have to attend all the group counseling sessions, but it was highly recommended. The psych techs wrote down everything we did. How much time we spent in our rooms, how much we ate, if we showered, how many groups we attended, if we participated, and so on. The more cooperative you were, the more you shared, the more groups you went to, the faster you were discharged. The first day we got a physical from a medical doctor and, if we had any concerns, specialists were called in. In my case, the doctor called in a nutritionist since my diabetes wasn’t well regulated. We saw a psychiatrist the first day as well. Everyone was immediately placed on meds. You then saw the psychiatrist every day or so until you were discharged. You were also assigned a social worker who was supposed to help you with your family issues and discharge planning.
My section of the ward held mostly people with Depression and Bipolar disorder. There were also a couple of people who had substance abuse issues. If they were still detoxing, they slept in the medical section of the ward and allowed onto our area for counseling when they were coherent enough to participate. The ward was co-ed, but each room was, of course, single sex. We had access to two phones in the hallway that we were only allowed to use during free time. We were told that our calls would be monitored if it was necessary (like if we had problems with an abusive partner or were an abusive partner. During my time there this wasn’t an issue).
I spent the first part of my first day wide-eyed, hyper-vigilant, with my shoulders up around my ears and my arms wrapped around me. I think some part of me expected the other patients to grab at me or something. I must have looked pretty freaked out because the staff kept asking me if I was okay. After lunch, I started to get sick with a headache. That’s when the proverbial shit really hit the fan. My room was right next to the phones and one of the patients was constantly on it. Unfortunately, this particular patient had one of those high, screechy, loud voices which set my teeth on edge. The anxiety of being in a strange place, being strip searched, her voice, and my headache made me completely lose it. I threw up, argued with the staff, and refused to go to a group counseling session. These are all things I never do. Especially since I hate to throw up (control issues) and feel disrespectful if I argue with those in authority. After a nap, my head felt better. Unfortunately, that was when the anger set in.
Suddenly, I felt that I didn’t need to be there. After all, I knew I wasn’t going to kill myself, even if I did have a plan. I’d lived my entire adult life suicidal and never had to be hospitalized before. I was self aware and in control of myself (or so I thought). I was a g**d*** psychology major! And every group counseling session just made me angrier. It was all Psych 101 stuff (because most of the patients didn’t know much about psychology, therapy, or their diagnosis). I didn’t need this, I thought, I already know this, I’m better than this. I was a confused, arrogant, messed up soul.
Of course, after that first day, I figured out how to play the system. Cooperate, hide your anger, do whatever the staff asks, attend all the groups, and talk in groups. Be a good girl and eventually they’ll let you out. What I didn’t realize at the time was that I was shooting myself in the foot. There was good information being discussed in group counseling. The staff was more than willing to have individual talks in private to help us deal with our specific needs. If I had had a more open mind, I may have learned that I needed to review all that basic psych stuff. It might have kept me from having another incident. If I had opened up and let myself talk about my issues, I might have felt better faster. But I didn’t do any of those things. I just played the game, kept everyone at a distance, and waited to be discharged.
There was one exception to my game playing. I was reluctant to contact my family. They didn’t know I was there. For all they knew, I was happily studying and going to classes. One of the requirements for discharge was to have at least one “family session.” Basically this was a meeting, either by phone or face to face, with a patient’s family and/or friends, whoever would be their support system upon discharge. The primary purpose was to be sure that the patient would have someone to keep an eye on them and help prevent relapses. The secondary purpose was to deal with any issues the patient may be having with their primary relationships and/or to deal with any questions or problems the family/friends might have with the patient’s diagnosis. I didn’t want to “bother” my family. Or at least that’s what I thought. Looking back on it, I now know that I was embarrassed to be in the psych ward. I felt that I was weak because I’d “allowed” myself to get that bad. My pride was bruised.
It took them three days to convince me to call my family. What eventually convinced me was that I had to get a ride home and I’ve only got my brother and sister-in-law in the area. No way was I gonna tell anyone else I had been admitted. If I had been thinking clearly, I would’ve realized that telling my family wasn’t that big of a deal. It’s not like they weren’t aware that I was a “screw up.” They knew I made bad decisions because of my mental illness. But what they didn’t know, because I never told them, was exactly how bad it was. They didn’t know how close to death I got or how much I worked to simply get through a day. So I finally got on the phone and called them. And, of course, they were understanding and supportive. After another couple days, we had a family session via phone (it would’ve taken them an hour and a half, one way, to drive out there). The only things I remember from that session were my family saying that I needed to talk more (everyone tells me I need to talk more. I’m not a Chatty Cathy) and that they would keep an eye on me, try to intervene if any symptoms of my disease got worse or changed abruptly. Then my discharge date was set.
Another thing you had to do before you could be discharged was have follow up appointments set with a psychiatrist and a counselor. This was to make sure they weren’t just sending us out into the cold world to try to figure it out all on our own, and to be sure we wouldn’t be right back in the hospital the minute we got out.
I was discharged the day after Thanksgiving, a day or so later than the psychiatrist said I could go home, by my choice. I didn’t want to disrupt my brother’s Thanksgiving plans, he always invites a bunch of people from work and my nieces would be there. I didn’t want any of those people, especially my nieces, to know I was “crazy.” Again, my pride was in charge. Thanksgiving at the hospital wasn’t that bad. There were less group sessions and the hospital fed us turkey. The food was actually good at this hospital, so that wasn’t so bad.
The thing was, I did get better while I was there. I was given medication that, while it didn’t completely alleviate the symptoms, did make it possible for me to finish out my last semester of college. While I was there the interaction with the other patients and staff, and my anger at the situation, kept my mind busy and I was able to ignore my suicidal thoughts. I didn’t leave cured, but I left safer than when I arrived, so the primary purpose of hospitalization was fulfilled. At the time I was too angry and ashamed to appreciate how much this was a gift.
Yes, hospitalization was a gift. It was one I didn’t do much with, but it was offered in kindness and respect by the hospital staff members. That gift was a break from my normal life, a chance to focus exclusively on my disease and try to manage it. It was an acknowledgement that I was worth spending so much time on, regardless of my disease. Because the staff at the hospital didn’t treat me like my disease. They treated me like a complex individual with a complex problem who needed to stop and breathe and be nurtured. They treated me like Bonnie, not like “Major Depression with Suicidal Ideation.” And sometimes that’s exactly what we need.
Stay tuned, my next post will be about my second hospitalization. Because I didn’t get it right the first time.