Impulse Control

“As for impulsiveness, a volume could be written about the disastrous consequences of this symptom. It has ruined many a business, many a marriage, and many a life.”

- Karl Menninger

Before I turned twenty-five I had:

• Committed early to college to play lacrosse

• Blew all of my money skydiving

• Changed my major multiple times

• Enlisted in the Marine Corps

• Moved into an apartment without steady income

• Attempted suicide three times

I was impulsive, and I was young. My prefrontal cortex was still developing.

In fact, some research indicates that, “the frontal lobes, home to key components of the neural circuitry underlying ‘executive functions’ such as planning, working memory, and impulse control, are among the last areas of the brain to mature; they may not be fully developed until halfway through the third decade of life” (Johnson, Blum, & Giedd).

Kids, I get to call them that now that I’m thirty, do not have the mental hardware to deeply consider anything beyond their immediate future.

Many adults look at the behavior of adolescents with bemused concern. Surprised at what we consider silly behavior, we ask: “don’t they think about the consequences?” They do! Just not like adults with fully developed frontal lobes.

Kids, for the most part, have a dial-up connection to their impulse control center. Adults have a 4G connection. It is no wonder that young people will think through a decision, experience slow loading times, and decide to do what they want.

The lack of impulse control may be why we see that, “suicide is the 2nd leading cause of death in the world for those aged 15-24 years.”

15-24. Ages where a young person goes through at least three different learning environments, experiences vast changes to their bodies, simultaneously juggles youth and adult personas, and, as if to add more to their plate, every adult asks what they plan to do with the rest of their life.

Add in the potential for bullying, social isolation, poverty, physical and sexual abuse, mediocre parenting, poor parenting, or no parenting, and you can see that kids, despite our adult objections to the contrary, do not have it easy. To say otherwise demeans them, and calls into question the validity of our own growing pains.

Are you worried about your child, but do not know where to start? The American Foundation for Suicide Prevention has an excellent list of resources that will help: https://afsp.org/campaigns/talk-about-mental-health-awareness-month/teens-and-suicide-what-parents-should-know/

https://afsp.org/about-suicide/suicide-statistics/

Keep Walking

I bartended the summer before my sophomore year of college. Legal to do in Georgia, as long as you were over eighteen. It turned out to be the perfect job for me, even though I considered myself socially awkward and anxious in most social settings.

Why would bartending appeal to me? Well, I had three feet of granite separating me from everyone else, and the more drinks I served, the funnier and more charming I became to my patrons.

I operated in a safe environment that alleviated my anxiety, and I could practice interacting with people. At the end of the summer, I decided to get a new tattoo. This time of Johnnie Walker’s Striding Man with the company’s tagline: “Keep Walking” below the logo.

As you will see in the gallery below, the advertising campaign was of the Striding Man walking in a straight line, far beyond a variety of earlier obstacles.

The word “stride” means to, “walk with long, decisive steps in a specified direction,” or to, “cross an obstacle with one long step.”

I always took this to mean that action, movement, and incremental forward progress will always create a measure of distance from previous struggles. This is supremely practical advice because everyone can relate to the feeling of being stuck in a situation.

“Caught in a rut” is another familiar phrase that encapsulates how frustrating it is to feel as if you are trapped. I think this harkens back to our evolutionary past. When our ancestors risked exploring new environments because wherever they were living, was no longer sufficient to their long-term survival.

Whether we evolved to move, or we moved and then evolved is beside the point. We feel better when we act, and we feel confident when we act with purpose. My purpose is to live a disciplined life, and share the methods I use to move from living with an affliction, to living well with mental illness.

Eight things NOT to Say

Sticks and stones may break my bones, but words will never hurt me.

What a lie. What a terrible, terrible lie we tell kids.

“I think the saddest people always try their hardest to make people happy because they know what it’s like to feel absolutely worthless and they don’t want anyone else to feel like that.”

Words cut deeper than any sword, leave invisible bruises, and take far, far longer to heal than a physical injury. We quote things like:

No matter what people tell you, words and ideas can change the world. - Robin Williams

And then we tell kids, “don’t listen to what she said; words cannot hurt you.”

Can it be true that words have the power to change the world, and at the same time, have no power over an individual?

No.

This is why I remember three separate times I split my head open before I turned seven, but, twenty-three years later, I can only recall the facts; I can barely remember how I felt. But, I can still remember, with HD clarity, the comments a few kids used to put me down in middle school.

What many people without depression do not understand is the level of shame that accompanies the disease. I never wanted to feel confined to my bed, unable to summon the energy to wash my face, or the willpower to eat something. Then you hear, “well, you should just think more positive.” If I had the energy, I would positively throttle you.

View full lesson: http://ed.ted.com/lessons/lessons-from-auschwitz-the-power-of-our-words-benjamin-zander

Here is what I heard over the years:

1. Get over it

2. It could be worse

3. Life isn’t fair

4. Snap out of it

5. Don’t think about it

6. I know how you feel

7. Quit being so lazy

8. It will be okay

There are dozens of articles explaining the failure of these, and other phrases, with somewhat snide retorts: “You know how I feel? How could you possibly know how I feel?” I would like to demonstrate the limiting nature of these statements in a different way.

Depression, has been described as grief absent context. Let’s take that a bit further.

Imagine, if you will, how you felt the moment you learned that someone close to you had passed. If you do not have that experience, then please imagine how you think you would feel if you heard that news.

Then someone you know, or don’t know, comes by and says: “What’s wrong with you? Snap out of it.” How would you feel immediately after hearing that? I’ll wager not good. Probably worse than if you had not heard it at all.

“The fire is all in your head!”

Perhaps another scenario, taken to an absurd extreme: You are walking next to a good friend or family member, when they spontaneously combust! We all know what to say in a situation where someone is on fire. It’s been drummed into us since grade school: “Stop, drop, and roll!” How idiotic would it be for you to shout: “It could be worse!”

We would not even consider saying anything else, other than also shouting for help, when someone is on fire. We know what we are supposed to say. The problem with mental illness in our society is that we are growing out of our infancy about how we should help someone we care about.

Old habits and fossilized beliefs die hard. Just look at Dr. Semmelweis, who, in 1847, proposed that doctors should wash their hands before delivering babies. Was he celebrated as a wise forward thinker who saved the lives of newborns and their mothers? No! He was vilified by his contemporaries; who were aghast that he would accuse them of being the primary cause of death to new mothers. Taken aback by the forceful denunciation of his peers, Semmelweis had a nervous breakdown and later died in an insane asylum.

Today, in the case of mental health, we are caught between what we think works, and what we know works. Telling someone who is suffering that, “It’s all in their heads,” may be medically accurate, but it does more harm than good.

Simply being next to the person. Telling them that you are there for them, and asking “how can I help?” or “what do you need?” is far more effective.

The person you care about is caught in a mental typhoon. They do not need advice on how to get to shore, they need a life preserver.

Be the life preserver.

Why I Dress Nice

When my dad was a kid, his mother, my nana, would tell him to go to the deli, and get some “nice ham”. Not just any ham, “nice ham”. That became a running joke in my family. If we bought some cold cuts, invariably, one of us would ask, “did you get the nice ham?”

With my sister’s BF, Nick, in Fells!

My coworkers commented on my change of style to a nicer, even quite dapper, look at the office. Since I have always felt like I should have been born in the 1960s or earlier, I quite like the idea of rocking a debonair look.

A few days ago a friend said he liked my new look, and was curious why I was walking around in nice shoes, a buttoned down shirt with cufflinks, and a vest. Was it to “look good, and feel good”?

Almost, but not quite. I dress this way for two reasons.

First, changing my clothes after work is a custom-made mental doorway. Have you ever walked into a room of your home, and stopped with no idea why you are now in that room? There are some fascinating studies on the doorway, or “threshold”, effect on the human mind. The hypothesis is that crossing a barrier frees the mind from the constraints of the previous environment.

Establishing mental dominance over my sister’s BF.

This is why the first few days of a vacation feel awesome, and the last day is considerably less awesome. The mind has a sense of where you are, and when you are in an environment where you have work and personal stressors, there will be thoughts in your subconscious relevant to your regular surroundings.

My “nice” look gives me something to shed when I get home from work. I step across the threshold of my front door and change into something more relaxed. I have noticed a much smoother transition out of “work-mode” and into “do whatever I want” mode.

The second reason is more personal. I know my anxious and depressive triggers. I know them very well, but sometimes I miss one. Before I can raise my defenses, I might be on slippery mental ground.

My dapper look means more time for me to notice pre-depressive and pre-anxious indicators. If I do not feel like ironing my shirt in the morning, which is a lovely moving meditation, I can ask myself why. If I do not feel like taking some care in how my tie matches the rest of my ensemble, I can analyze why. If I do not want to shine my shoes, I can examine why.

All of these are new personal measures to combat mental slippage into stress and depression, with the pleasurable side-effect of compliments on my appearance.

https://projectsemicolon.com/

Plus, I get to wear my semicolon tie clip!

PANIC Attacks!

Not to be confused with worry or concern. Panic, is concentrated fear.

The symptoms can include some, or all, of the following:

• Palpitations, pounding heart, or accelerated heart rate

• Sweating

• Trembling or shaking

• Sensations of shortness of breath or smothering

• Feelings of choking

• Chest pain or discomfort

• Nausea or abdominal distress

• Feeling dizzy, unsteady, light-headed, or faint

• Chills or heat sensations

• Paresthesia (numbness or tingling sensations)

• Derealization (feelings of unreality) or depersonalization (being detached from oneself)

• Fear of losing control or “going crazy”

• Fear of dying

Panic attacks are extremely unpleasant and can be very frightening. As a result, people who experience repeated panic attacks often become very worried about having another attack and may make changes to their lifestyle so as to avoid having panic attacks. 

https://adaa.org/understanding-anxiety/panic-disorder-agoraphobia/symptoms

All of this sounds bad, but the symptoms and description of “extremely unpleasant’ and “very frightening” does not quite encapsulate what a panic attack truly feels like.

If you have never experienced a panic attack, I wish that you never do. But, you can imagine what one feels like.

Pretend that you are relaxing in front of the television, watching your favorite show; when all of a sudden, a 700 pound Siberian Tiger bursts into your living room. It roars, and your brain quickly realizes that you just got knocked down to the bottom of the food chain. The tiger sits back on it’s haunches, coiling it’s powerful rear legs, and then leaps across the room directly at you.

“I’m going to f____ you up.”

It’s mouth is wide open, large teeth clearly visible, and right before you realize you are about to die, the tiger vanishes into a wisp of smoke.

Then, a 700 pound Siberian Tiger bursts into your living room. Roars, leaps, is about to tear you about apart, and then it disappears.

Roar. Leap. Death. Fade.

Roar. Death. Fade.

Death. Fade.

Death. Death. Death. Death. Death.

Panic attacks are the psychological equivalent of this imagined scenario. You constantly ride the edge between life and death, almost 100% certain that you will die. That your death will be both agonizing and slow.

What would you do if a massive tiger leap at you right now? Fighting it is useless. You have no chance of running away. All you can do, is be frozen in place while you get yourself right with your maker.

See how horrifying that is? It is no wonder that a panic attack can be debilitating in the moment, but the effects can linger.

Say the tiger vanishes and does not reappear. Your mind is ready for it to pop back into existence to end yours. But it does not. Tentatively, you stand up, arms in front of your torso to give your vulnerable belly some measure of protection.

Imagine your mind on fire.

Your senses are heightened, blood is pounding, and fear compels you to either sprint or freeze.

At that point, you don’t think that you have to pick up your kids from school later that day. You aren’t worried about that staff meeting at 2pm.

Your brain is on overdrive, trying to find the TIGER THAT WILL KILL YOU!

It takes some time to come down from that state.

In my experience, there is no immediate “snapping out” of a panic attack. You need to let it run its course. It will be awful, but, I promise you, it will end. You will be okay.

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.

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.

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!

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, 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 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.

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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.”

https://thehowtobe.com/panic-attacks/

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.

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.

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.

• 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.

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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.

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.

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.