Talking to Yourself

Talking to Yourself

It is so very easy to be hard on ourselves. When we come up short, that is an obvious testament to our lack of worth and ability. Yet, when a friend fails, we are there to remind them that failure is impermanent, and that they can do better next time.

Read More

Tuesdays in the Toolkit

Tuesdays in the Toolkit

Mirror Therapy is a potent, introspective tool. I like to have a mirror directly in front of me, and one off to the side. This allows me to speak to myself, and also catch side glances of my reactions along my periphery. The first time I tried this, I spoke to myself from two drastically different perspectives - the depressed me, and the “normal” me.

Read More

Life in a Psychiatric Hospital - Part 5 of 5

It took my fourth hospitalization before I realized the folly of lying to expedite my release.

Psychiatric-Health-Facility-15.jpg

During my first three hospitalizations, I learned the rules and then acted accordingly. Doctors, nurses, and other caretakers are, in my experience, personally invested in a person getting well. I had many wonderful interactions with compassionate and empathetic professionals at each hospital where I spent time. That said, the medical business is a business.

Insurance companies are not keen on paying for beds for patients who are stable. A hospital cannot be financially sound if patients are kept on the ward until their caretakers are absolutely sure a patient is capable of taking care of themselves, or at the very least, not in any danger of self-harm.

It is a system that constantly cycles people in and out. Because it is a system, though, it can be gamed.

I am exceptionally good at putting on a facade to the world. In my first hospitalizations, I lied.

hiding_illness.jpeg

Told the nurses I felt great. I smiled. I held doors open for other patients. I politely requested shaving privileges, and did my very best to be of no concern to those running the ward. This strategy worked brilliantly to get me released because there was no behavior the doctors or nurses could point to where I demonstrated the desire for self-harm.

I appeared psychologically “stable,” and that meant I should be released, and my bed given to someone at more acute risk of overdose, self-harm, etc.

I knew the system. I had read about emergency psychiatric hospitals and insane asylums. The best patient is typically one that causes no problems. So I lied and became the best patient I could at the expense of my health.

At this point someone might rightly condemn me: “How could you lie to your doctor? Didn’t you want to get better?” Spare me.

If everyone told their doctor the truth, there would be no medical drama category on Netflix.

I wanted out of the hospital, and I was willing to sacrifice my long-term health for short-term freedom.

There are no quick fixes for mental illness, and lying can only be maintained for so long. Eventually, I did not have the energy to keep the facade going. My mask of normality crumbled away.

My last hospitalization was a result being committed following my outburst in the seclusion room. I stayed in my bed for days. A nurse kept coming into my room to encourage me to venture out and interact, but I stubbornly stayed under my sheet. After a while, though, it was pretty boring by myself, and I shuffled outside.

Six years after my first hospitalization I had finally had it with putting on a show of normality. It was exhausting and counter-productive. Once I stopped playacting and started working on my recovery, life got better.

It is realistic to expect that I will be back in a psychiatric hospital someday in the future. I learned that fact from a delightful older woman who checked herself into the hospital every year or so for a couple of weeks. She knew that when she did not feel safe, she should be in the safest place possible.

That was a great lesson to learn. I can use the hospital just like any other treatment. That understanding makes it much more bearable to willingly be locked into a ward, watch Law & Order SVU reruns, eat poor food, and talk with doctors.

Using the system, as opposed to gaming the system, was the lesson I wish I knew years and years ago.

Life in a Psychiatric Hospital - Part 4

Group is a regular part of every day in a psych ward. The type of groups may differ between facilities, but they are invaluable to the patients and to the caretakers.

Facilities have different rules on expected behavior. Ridgeview required me to attend all groups in order to get the privilege of dining in the mess hall. Those that avoided group, got their food delivered to the ward in a styrofoam box. At St. Joseph, food was delivered to the unit so there was no real penalty if you did not attend group, but, since group is a primary method for determining a person’s readiness to leave, attendance is a good idea if you want to get past the locked door at the front of the building.

Most of us went to group begrudgingly. If nothing else, it passed the time. Also, the staff turned off the television during group time.

Looking back, I would say that Ridgeview’s groups were focused on everyday life skills, and St. Joseph’s groups were focused on communication and interpersonal skills.

Behold! My awesome hot plate!

Behold! My awesome hot plate!

I definitely enjoyed group more at St. Josephs, because they were more fun.

Reminiscent of a kindergarten class. Feel like coloring? Go color! Want to play with blocks? We have all the blocks! I even learned to grout and made my own hot plate over a three day period.

At this point, some readers may be wondering, “Really? Coloring books? This is supposed to make you better?” No. Group does not make a person better. It facilitates recovery because human beings are social creatures.

Isolation can destroy a person. Ask any prisoner who has spent time in solitary. Or, just watch this video about Harry Harlow’s Pit of Despair experiments with rhesus monkeys:

Now, I am an introvert’s introvert. I find nothing more enjoyable than reading a book on a lazy Sunday afternoon, and never saying a word to anyone for the entire day. That said, I am human, and I do not do well with extended periods of isolation. No one does.

group_ridgeview.jpg

Group, in the context of psychiatric care, establishes a place where someone with a frayed mind can get their bearings under controlled circumstances. The depressed person who cannot speak can, at least, listen.

The person coming down from a manic episode can ease out of it with people who won’t judge. The addict who just got through the worsts of withdrawal can talk about their experiences.

The hospital is not real life, and group allows for an approximation of life. As such, it gives insight into a person’s state of mind around other people that is objectively measurable by those providing care.

For instance, for the two days that I avoided group entirely and stayed in my bed, I was not ready to leave the hospital. Because I likely would have gone home, got into bed, and avoided my life. But, oh how a nurse’s face lights up when you walk out of your room and sit down in group! Even if you do not say anything, your presence shows a willingness to engage with others.

Group is a means to an end. It gives patients the opportunity to experience time with people in a controlled setting. Combined with daily therapy, consistent medication, a good diet, and sleep, the whole treatment becomes greater than the sum of it’s parts. It is a staggeringly simple idea, but that is why it works. Put a human being in varied, yet safe, social situations and give them time to learn how to exist with others.

Neurostimulation

ECT was first used in 1938 when an Italian psychiatrist, Ugo Cerletti, observed pigs in a Rome slaughterhouse being anesthetized with electroshock before being butchered.  His first human patient begged Cerletti, “Non una seconda! Mortifierel” (“Not another one! It will kill me!”).

- Kenneth Castleman, PhD

When people think about electroconvulsive therapy, an image of someone strapped to a table with electrodes on their temples comes to mind. Just like the image on the left of Jack Nicholson’s character, Randle Patrick McMurphy, from One Flew Over the Cuckoo’s Nest. But really, the image on the right more accurately shows what neurostimulation is today.

Nicholson

Nicholson

Corsetti

Corsetti

Wait, what’s the difference between neurostimulation, electroconvulsive therapy, and electroshock therapy? Mainly, the words used.

Electroconvulsive therapy (ECT), formerly known as electroshock therapy, and often referred to as shock treatment, is a psychiatric treatment in which seizures are electrically induced in patients to provide relief from mental disorders.[1] The ECT procedure was first conducted in 1938[2] and is the only currently used form of shock therapy in psychiatry. ECT is often used with informed consent[3] as a last line of intervention for major depressive disordermania, and catatonia.[4]

https://en.wikipedia.org/wiki/Electroconvulsive_therapy

I kind of like the term electroshock therapy. Makes me feel like more of a badass strapping my electrodes on in the morning. But, it sounds scary so electroconvulsive therapy became the term du jour.

Now we’re onto neurostimulation, which, to be fair, covers more than running an electric current through a patient’s brain.

tms.jpg

Neurostimulation is the purposeful modulation of the nervous system's activity using invasive (e.g. microelectrodes) or non-invasive means (e.g. transcranial magnetic stimulation or transcranial electric stimulation, tES, such as tDCS or transcranial alternating current stimulation, tACS). Neurostimulation usually refers to the electromagnetic approaches to neuromodulation.

https://en.wikipedia.org/wiki/Neurostimulation

Make no mistake, I am shocking my brain with electricity. Not with 180-460 volts, but with 0.5-2.0 milliamps. That’s 0.00000434782% the maximal voltage for ECT. Prevention, as it turns out, is often less severe than the cure.

And ECT isn’t necessarily a cure! We still don’t know exactly why creating a strong electric field inside a person’s skull helps with certain mental illnesses. We know it sometimes works for some people where medications and other therapies have fallen short. Why exactly, we’re still trying to figure out.

I’m always looking for new tools to add to my toolkit. Personal neurostimulation is great for me when I’m traveling, new environments are scary, or when I feel my meds aren’t quite cutting it for my anxiety symptoms.

Like any tool, it’s not a panacea, but when used in conjunction with my other tools, the whole is greater than the sum of its parts.