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.

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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.

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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.

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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.

Life in a Psychiatric Hospital - Part 3

My seclusion room story requires a bit of set up.

I voluntarily committed myself to Ridgeview in 2011, and was given a brief tour to get comfortable with my new little world. Part of that world was a seclusion room.

It’s pretty bare, but safe.

It’s pretty bare, but safe.

It consisted of four walls with a solid, rubber mattress on the floor. Why solid rubber? So that someone could not strangle themselves with sewn fibers.

A brilliant white light radiated from the light fixture that was mounted flush with the ceiling. Why flush? So that someone could not hang themselves from it.

A substantial, but easily opened door with a large window separated this little psych ward from the big psych ward. Why the window? So the nurses could keep an eye on the patient. The door was strategically located directly across from the nurse’s station for even easier tracking.

There is no straight jacket, no one is getting chained to the wall, and no one is locked in without round-the-clock supervision. But, I distinctly remember thinking,

“I’ll never be in one of those.”

Life, as I have come to learn, loves irony.

In the fall of 2016, I had the “choice” between involuntary commitment or voluntary commitment at a facility in Maryland. More on that in a later post.

After my release, I entered an Intensive Outpatient Program, or IOP. Basically, you go to the hospital every morning, stay till three, and get to sleep in your own bed at night. This program gradually gets a person into a more regular routine, and they can more easily transition into the life they choose to live.

Bedlam from 'A Rake's Progress' 1733, By William Hogarth - “Bedlam” was the byname of Bethlem Royal Hospital due to the noise. Visitors were welcome! For a shilling or two, you could walk through the hospital and gawk at the crazy people.

Bedlam from 'A Rake's Progress' 1733, By William Hogarth - “Bedlam” was the byname of Bethlem Royal Hospital due to the noise. Visitors were welcome! For a shilling or two, you could walk through the hospital and gawk at the crazy people.


I was there for extreme panic attacks, that were a side effect of a new medication I was cycled onto by my psychiatrist. I have never experienced such terror, and I hope to never experience anything close to the sensations I had while on that medication. I write this because it explains why I needed the seclusion room on a crisp Friday afternoon in November.

“They’re looking at me.”

“They’re spying on me.”

“They’re judging me.”

Such are the thoughts of a paranoid mind in the early stages of a panic attack. Truth be told, the nursing students had no idea who I was, and they certainly had no evil intentions toward me. But, my mind was unaccustomed to seeing them. The unexpected and unwanted presence of several new faces in my safe hospital ward triggered a massive panic attack.

Almost entirely paralyzed by fear, I somehow got a nurse’s attention and communicated with him by grunting and shaking my head “yes” or “no” to his questions. He gave me a high strength, anti-anxiety medication, which was nice, but at that point, it was about as effective as putting a single sandbag in the path of a massive flood. Using our meager method of communication, we agreed that I wanted to go into the seclusion room to feel safe and ride out the worst of the panic attack, but I could not move.

Four nurses picked me up in my chair and placed me in the room. They lifted me out of the chair, removed my clothes and put a paper gown on me. Why paper? Think about it and you’ll realize why.

A nurse asked if she would be safe sitting in the room with me. I grunted, “yes,” but my mind was on fire, and after a few minutes I told her:

“I need you to get out of this room and lock the door.”

She did, and I lost it.

Dramatic recreation

You already know that seclusion rooms are designed to prevent someone from significantly hurting themselves. I knew this too. So I used the room to cause pain that I could control.

I punched the walls. I chained combinations together until my knuckles bled. I screamed. I paced. I raged. When I could no longer lift my hands, I slammed my head against the wall.

I did not feel agony. I WAS agony.

I unleashed all of my panicked energy while the nurses and doctors pleaded for me to stop. Protocol dictated that they stay outside the room. Sure, it would have been nice to have someone restrain me, but the safer course is to let a person burn themselves out until they are no longer a threat to themselves or their caretakers.

Most hospital protocols specify that restraints be used for the least amount of time necessary.

Most hospital protocols specify that restraints be used for the least amount of time necessary.

Eventually, everything slowed down. I collapsed onto the mattress and the door opened up. Several large men secured my limbs and put me on a gurney, to which my wrists and ankles were strapped.

Didn’t I write no restraints earlier? They are used as a final resort to protect a person who has clearly demonstrated the recent capacity to hurt themselves, and to protect those around them.

A nurse injected me with Haldol, an antipsychotic drug that “decreases excitement of the brain.” It’s the human equivalent of horse tranquilizer - you get real chill, real quick. Then she gave me another injection to counteract the side effects of Haldol.

I woke up two days later with a pounding headache and swollen knuckles, and all I could think of was how wrong I was so many years ago.

Life in a Psychiatric Hospital - Part 2

Routine.

Visit any psychiatric ward, anywhere in the country, and you will find a daily routine that the caretakers follow. Why is routine important? Why are vitals taken each morning? Why are meals served at the exact same times? Why are groups part of every day?

Because in the throes of withdrawal or with someone not long after a suicide attempt - the mind is shattered.

USS Constellation - I run by it most mornings.

USS Constellation - I run by it most mornings.

Imagine your mind as a ship. You are the captain of the ship, but you are also every officer, every deckhand, and even every piece of wood and rope that make up the ship. Then a storm comes, the ship/you runs aground, and splinters into pieces. You reach out and grab hold of a floating plank, where you desperately try to keep your head above water in the heaving seas.

You become the captain of a wood plank, floating alone in the chaotic abyss.

Routine is the starting process for rebuilding a ship. You don’t throw wood and nails into a dry dock and expect a ship to come together without a plan. Nor should you expect that to happen with your mind.

Most hospitals follow a routine:

Vitals are taken every day so the nursing staff and doctors can notice any significant changes in a person’s physical health.

Vitals are taken every day so the nursing staff and doctors can notice any significant changes in a person’s physical health.

  • Morning

    • Wake up, vitals, meds

    • Breakfast

    • Group session

  • Afternoon

    • Lunch

    • Group session

    • Break

  • Evening

    • Group session

    • Dinner

    • Meds

The routine is dull, uninteresting, and unexciting - by design!

Imagine you’re desperately gripping your wooden plank, and, by some miracle, a party cruise liner breaks over the horizon. You are rescued and immediately thrown into a world of bright lights, loud noises, curious food, and you haven’t a clue what the destination is. You’re grateful to be out of the water, certainly, but you have a whole new host of issues to navigate.

Now imagine you are saved by the Coast Guard. Everyone is wearing the same uniform, everyone fits into a particular role, everyone is calm in the face of danger. A medic checks you out, you’re given a blanket and a cup of coco, and told where you will be taken to next. You’re just as grateful to be out of the water as you were in the first scenario, but all of your issues are taken care of for you.

That is the magic of routine. It gives a mind in chaos something to hold onto. Something that makes sense. Something that can be counted on.

That is where recovery can begin.


A GIGANTIC thank you to the following people for breaking my $1,000 goal for the Baltimore Out of the Darkness Walk!

  • Collette Dixon

  • Roger and Margo Coleman

  • Lou and Mary Jo Corsetti

  • Caitlin Corsetti

  • James Hunt

  • Samantha Perrine

  • The Smith Family

  • Natalie Wills

  • Kate and Mark Bernal

  • Andi O’Connor

  • The Assaf Family

  • Kevin Greene

  • The Arney Family

  • Jim Fiora

  • Cara Morris

Life in a Psychiatric Hospital - Part 1

There is a common misconception that a psychiatric hospital will be eerily similar to “One Flew Over The Cuckoo’s Nest". Uncompromising doctors treating crazy patients with a strong helping of electroshock therapy and powerful antipsychotic medication. Such were my preconceptions of what was an underwhelming, boring, but ultimately helpful experience.

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On July 5th, 2011 I voluntarily checked myself into the Ridgeview Institute after my hanging attempt. At intake I answered a myriad of medical and personal history questions in triplicate, was interviewed about my most recent mental health problems, given an ID wristband, and led behind the first of many locked doors in the complex. 

An orderly brought me into Cottage C, which specialized in addiction recovery and mental health issues consisting of depression, bipolar disorder, and schizophrenia. From intake I was sat down, got my blood pressure and temperature taken, then told to wait for a staff member to search me and inventory my belongings.

After thirty minutes of people watching, which is very amusing on a psychiatric ward, a nurse ushered me into a very utilitarian office where all of my belongings were searched. Even the clothes I wore were searched for contraband or possible weapons or tools I could use to harm myself. 

After the search I was fed a rather delicious meal of fried fish and vegetables, and then a nurse showed me to my bedroom where I met my roommate. A very polite older gentleman there for treatment of his severe alcoholism. Once I saw the bed, I laid down and tried to rest because I had not slept well since my suicide attempt three nights earlier.

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I was on a fifteen minute bed check, which meant that every quarter of an hour a nurse came into my room with her smartphone as a flashlight to check that I was still breathing.

You may think that is a little much, but it is essential for someone not far removed from a suicide attempt. The bed checks also establish a regular pattern for a shattered mind to recognize and accept.

My mind was in utter chaos, and knowing a nurse would check in on me every fifteen minutes was oddly comforting.

The Noonday Demon

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“Grief is depression in proportion to circumstance; depression is grief out of proportion to circumstance.” 

― Andrew Solomon, The Noonday Demon: An Atlas of Depression

Andrew Solomon is one of the best writers I have ever encountered.

He also took the time to reply to the message I wrote him after reading, “The Noonday Demon". I thanked him for the care that he took in writing about depression, and for his honesty in disclosing his personal fight to the public. So he gets major brownie points for that.

Mr. Solomon’s honesty inspired me to open up about my history of depression and suicide attempts. If I never read his book, I do not believe that I would have had the courage to talk so openly about my life with mental illness.

His openness helped me understand my illness better, and I hope my writing and videos are doing the same for someone else.

If you do not understand depression and how callous a taskmaster it is, I highly recommend picking up a copy of “The Noonday Demon". You will finish the book a far more compassionate person that when you started. Even if you do not live with a mental illness, you will better understand what a loved one is going through, and how to be there for that person.

"The opposite of depression is not happiness, but vitality, and it was vitality that seemed to seep away from me in that moment." In a talk equal parts eloquent and devastating, writer Andrew Solomon takes you to the darkest corners of his mind during the years he battled depression.

The Mental Dictator

Consider the following by Thanatologist, Dr. Sneidman

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Every single instance of suicide is an action by the dictator or emperor in your mind. But in every case of suicide, the person is getting bad advice from a part of that mind, the inner chamber of councilors, who are temporarily in a panicked state and in no position to serve in the person’s best long-range interests.

Then it is time to reach outside your own imperial head and seek more qualified and measured advice from other voices, who out of their loyalty to your larger social self, will throw in on the side of life, and - to use a Japanese image - will urge the chrysanthemum, not the sword.

- Edwin Shneidman

I cannot stress enough how important it is for me to externalize my depression. It is incredibly difficult to fight yourself AND depression. Imagine sparring yourself while depression wraps around your body and taunts you like Venom.

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The whole time you can’t hit yourself because you know yourself too well, and the depression just laughs and laughs.

It’s exhausting, infuriating, and, despite the massive amount of energy you put into fighting, ultimately ineffective.

As Shneidman alludes to, I consider my depression a unique entity within my mind. Something that may be a part of me, but is definitely separate from what I consider to be ME.

This mindset lets me attack thoughts and feelings that arise from my mental dictator. What depressives have in common is our relative inability to recognize when our dictator is taking greater control over territory within our mind.

Fortunately, all great generals have advisors. AND that is where I missed the mark for so many years.

When I was younger I did not consider that others might notice the hostile takeover of my mental dictator before I did. So I modified the advice of Sun Tzu:

Be extremely subtle, even to the point of formlessness. Be extremely mysterious, even to the point of soundlessness. Thereby you can be the director of the opponent's fate.

My enemy is within me. It knows what I know. It feels what I feel. It has one hell of an advantage over me, but it only has that advantage over me. Because of this, it is incredibly weak to my family, friends, therapists, and coworkers.

I cannot recognize that I am about to be depressed due to my depression. It’s a weird blind spot. I only realize it when I am much deeper in the hole than I care to be. So I outsourced identifying the problem to the people that care about me.

Here’s what I do when the dictator begins a new attack:

  1. I say less and less (very subtle, often displays as never answering my phone).

  2. I stop shaving.

  3. I start showing up to things later and later.

  4. When asked, “how are you?” I reply: “I’m okay”, or “I’m alright”.

  5. I decline plans at the last minute.

There are other behaviors, sure. But these are the ones that are more easily identified by other people.

So, if you see me exhibit one or more of these behaviors - do me a favor, and ask me if I’m really doing okay.

Mind Hack: More Vitamin D

I am naturally Vitamin D deficient. Which means I have to find ways to increase the amount of Vitamin D my body can produce. Some of that is with supplements, waking up to a UVB blue light, and driving without my sunglasses. Watch the video to learn more.

Vitamin D Deficiency in Adults: When to Test and How to Treat

Vitamin D: The “sunshine” vitamin

Vitamin D and Depression: Where is all the Sunshine?

Treatment of vitamin D deficiency with UV light in patients with malabsorption syndromes: a case series

Philips goLITE BLU Therapy Device - At $275, it’s pricey, but it makes waking up so much easier for me. Just to note, I’m not a paid spokesman for Philips. I’ve used several light devices and this one has worked the best for me.

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.

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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.

The Origin and Meaning of "Suicide"

The word, suicide, is one of the most taboo words in the English language.

It is rarely discussed, and often referred to obliquely: “There was an accident,” or outright denied: “She didn’t jump, she fell.”

Suicide, as a word, feel heavy. Those that have practice lifting it, professionals and anyone with lived experience, are the ones who can most readily talk about suicide.

The actual word is a noun, and is described well in the Online Etymology Dictionary:

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Suicide (n.)

"Deliberate killing of oneself," 1650s, from Modern Latin suicidium "suicide," from Latin sui "of oneself" (genitive of se "self"), from PIE *s(u)w-o- "one's own," from root *s(w)e- (see idiom) + -cidium "a killing," from caedere "to slay" (from PIE root *kae-id- "to strike").

The meaning "person who kills himself deliberately" is from 1728. In Anglo-Latin, the term for "one who commits suicide" was felo-de-se, literally "one guilty concerning himself."

Even in 1749, in the full blaze of the philosophic movement, we find a suicide named Portier dragged through the streets of Paris with his face to the ground, hung from a gallows by his feet, and then thrown into the sewers; and the laws were not abrogated till the Revolution, which, having founded so many other forms of freedom, accorded the liberty of death. [W.E.H. Lecky, "History of European Morals," 1869]

In England, suicides were legally criminal if of age and sane, but not if judged to have been mentally deranged. The criminal ones were mutilated by stake and given degrading burial in highways until 1823.

Less than 275 years ago, the body of someone who died by suicide was defiled, mutilated, and discarded. Which is incredible considering the terrific amount of respect we human beings give to our dead. Respect given except when a human being willingly dies by their own hand. I will explore why I think that is in future posts.

It is only until very recently that organizations (both national and grass-roots) have begun celebrating the lives of those that died in the hopes that those struggling with suicidal thoughts don’t feel more isolated than they already feel they are. I’m proud to work with these organizations.