A friend of mine is in the hospital, and has been for a few days1. I gave her a ride to the ER twice in 24 hours, and on the second time (her third total), she was finally admitted.
What for? Insomnia. Depression. Bipolar. Anxiety. Self-harm urges. Racing thoughts so unbearable that suicide, although not at all desired, was altogether too tempting if it would make them stop.
Sound familiar? It certainly does to me. I absolutely supported her in her choice to seek in-patient therapy — both her right to self-determination, and the specific action — but it’s not one I’ve ever chosen. Even though I’ve been right there. Even though I’ve been worse.
This question has been swirling in my head since the repeated hospitalization of another friend, and grew this week into toddler-proportion persistence: why do some people seek in-patient therapy and others not? Why do some of us have the threshold set so high (so low?) for “bad enough” to pursue that course, and others less? Why do some of us think of hospitalization as only for those so ill they do not go voluntarily, and others as the logical treatment for any crisis severe enough to earn the term?
Why have I never been in the hospital?
I’ve long said, when describing my illness, “I’ve never been hospitalized — but I probably should have been, a time or two.” Before that, I would say that but for the stabilizing, protective presence of The Man, I would have been. And that was when the only person I’d known who went through it was my older brother, hospitalized for psychotic mania when I was sixteen. With that example, no wonder I minimized my pain for so long, such that I was misdiagnosed as “merely cyclothymic”2 when I first sought psychiatric help. Perhaps too no wonder I never explored in-patient options for myself, for all that I have been in crisis more times than I care to contemplate.
But also there is this: mood disorders, craziness of any kind, are grossly stigmatized in my society. Given the way “nut houses” are portrayed in media, is it so surprising I didn’t think I, with delusions warping “only” my sense of my own worth, qualified? On the other side, given the too-often-horrifying treatment of patients at the mediocre hospitals, and the dehumanizing procedures at even the best institutions, is it so surprising I never thought it worth it? Given how hard I knew some people had to fight to gain access to those services — such as my friend and her three ER visits — is it so surprising I never tried?
There is so much broken in mental health services, I hardly know where to begin unraveling it. Should I have sought this sort of care? Certainly in a less-ableist society, it would have occurred to me far sooner. But what sort of “care” would I have received, even with relative protections of being a male-partnered middle-class white woman? What sorts of traumas might I have risked acquiring through the experience? Would I even have been admitted, or dismissed as not-crazy-enough, and what would the pain of failed help-seeking have done to me?
Do I really wish I’d spent time in a place with 24-hour every-fifteen-minute bed checks? With three-inch flexible pens my only writing implement? With rules about food, and clothes, and everything else? Do I wish I’d sought access to a system that calls its psych ward “Adult Behavioral Health”? (What the hell does that even mean? Do we call oncology “Cell Behavioral Clinic”? Urology “Hooha Behavioral Center”? Why does only mental illness warrant such shaming euphemisms?)
Whether it would have been a good idea for me back then or no (or, most likely, a highly mixed bag), I can’t go back to where I was and try again. But now, having stood by two beautiful, strong, amazing women who have been through the process, I know it’s more of an option for me for the future, even as I am more determined to do what it takes for it to not ever be necessary.
These are the only two certainties I have amidst all these questions: we need to make it easier for people to access the mental health services they need, including by reducing the social barriers. And we need to improve the services offered.
What can you do to help?
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- Which, if you were wondering, is part of why I haven’t posted in a while. ↩
- Cyclothymia is a “mild form of bipolar disorder”, characterized by mood fluctuations from mild depression to mild hypomania. Bipolar 2, which I have, includes major depressive episode(s) and hypomania(s). Bipolar 1, or “classic” bipolar, includes full or psychotic mania and any level of depression. And that’s without getting into things like mixed states, rapid cycling, or comorbid conditions such as PTSD or addictions, each of which might complicate the diagnosis. ↩
Good post. I agree. IFF one has good enough health insurance AND a support system capable of getting you there, outpatient clinics used to be available. But my state kicked folk out of inpatient wards cause outpatient care was ‘better’ then cut the outpatient clinics.
It is part of the problem of unsympathy rampant in our society. I deserve the best, so (maybe) to you my friend or family, but the stranger deserves only what they can pay for. “Just don’t make me pay for their problems!”
It is bad for any disease but worse for mental health issues which are “only in the mind”.
and BTW hope your friend is OK and gets good care.
This is one of the issues I grappled with, both working in a mental health clinic for low-income families in an urban environment, and in observing my own father’s struggles (which included not-infrequent hospitalizations). The inability to access care disgusts me. I was grateful that I lived in a state where sliding scale community mental health centers existed, because it made it possible for people to access therapy. Many states do not offer these. However, although they existed, I’m not sure how people ever found them. It takes a certain level of education or connection to know that you can find a therapist who will treat you at a reduced rate. It’s not like there were television commercials or billboard ads.
And beyond that, the social barriers are still enormous. The comments I got just about my father’s illness alone made my teenage years very difficult. There is still the idea that mental illness isn’t real. I see how euphemisms contribute to that, but also the flip side, where because of the stigma of mental illness, euphemisms help people agree to treatment. For those who have not come to terms with their illness, perhaps terms like “adult behavioral health” are more “ok” than “psychiatric unit” or “mental health unit?” I wonder if better insurance coverage for mental health would help address the stigma…you know, offering the same coverage for therapists that is offered for other doctors to show all illness is equal. But, I also acknowledge that that would only benefit a portion of our population, as millions don’t have access to insurance. It is a barrier to access for the middle class now though….those who make too much to use the community clinics but whose insurance doesn’t cover enough to make therapy/medication affordable, and so many have to rely on the ER.
Services need to be improved as well, but I don’t even know where to start on that. I’ve met some amazing therapists in my time, but also a fair number who really looked down on their clients. Inpatient unit quality varied greatly depending on the hospital. If we all, those with a mental illness and those without, continue to speak up and speak out though, I think we can make changes.
As an aside, are you familiar with Bazelon? It seems they do a lot of advocacy work.
Thank you for this post.
I was hospitalized twice when I was a senior in high school…when I had the luxury of being able to do such a thing. Now, I am a poor, single mother. Not only do I have no idea how I would pay for inpatient hospitalization, but I have no idea how it would logistically work out. I have no family in the area and very few friends. Who would take care of my son? Because of the fact that I am a poor, single mother, the state would probably not look too kindly on me going inpatient. I run a very high risk of having my son taken away from me. Even in the therapy that I go to to try and process some of the trauma, I have to be very careful about what I say. I can never admit that I am suicidal, that I am having thoughts about self-injuring, because “mental health professionals” are mandated reporters. It’s so tiring. I want to get better. I want to not have to live in a constant state of depression and fear and flashbacks and nightmares. But the system just seems to be set up against people like me. And there are times when I just want to throw a big ol’ temper tantrum and scream at the top of my lungs, “IT’S NOT FAIR!” I did not ask to be traumatized. I didn’t do anything to make a brain that doesn’t produce the correct amount of serotonin. So why am I being punished for it?
what gets me is the lack of ANY sort of successful long term treatment for adults with Eating Disorders. Successful treatment for anorexia is 2-3 months inpatient MINIMUM. Not to mention the expensive outpatient therapy 2-3 times a week, often for years. (Specialist rates dont ya know) And treatment only has about a 20% success rate (if that) If you are bulimic and fat you get told things like “just puke for a month or two to lose the weight.” I have had a hard time gettng DOCTORS to belive i have a huge issue with food and bulimia, they think i am lyling about its severity. (there have been times i threw up everything i ate for YEARS and still was 250 lbs on my six foot tall, german peasant frame.) Imagine how hard it will be to get insurance or any sort of “free” help out there. It makes climbing out the the hellhole known as ED danm nar impossible. I am left floundering, struggling to learn things like FA, HAES and such just to come to terms with my body so i can stop destroying myself…not even knowing it will help.
The issues are legion. Broader, wider, taller than any issues facing the “regular” health care system. And those are plenty bad enough.
I’ve been hospitalized for psychiatric reasons many times (my husband and I refer to psych hospitals as “nut huts”, not because of the patients but because of the way they are run and the people who run them). A dozen, I think, most of them just 3-4 days, but a couple of times I stayed several weeks. Those experiences are the reason that we’ve decided that our son (who has bipolar with psychotic features) will not be hospitalized unless we can’t keep him safe at home. It is so important to us to keep him out of the hospital if at all possible that we’ve created a “safe room” here in our home.
Not just because he’s so young, either. I can’t properly describe the experience of being a psychiatric inpatient. I’ve been in 5 different hospitals and in 4 of them, I felt about as important as a rodent who sneaked in under the door. Not conducive to healing from anything, much less depression so profound that suicide seemed like the least I could do for the world.
Interestingly, that hospital where I had the better experience was the first one I was ever admitted, and that was before HMOs took over healthcare. Anecdotal, of course, but from the reading I’ve done, there seems to be a connection. Not that psych hospitals were great before the HMO ascendancy; they definitely were not, and I was in a hospital that took private insurance and not medicaid, but the financial pressures were not as acute then.
Sigh. I better stop or I’ll write all night. Have you read Pete Earley’s book? I highly recommend it.
I hope (really, really hope) that your friend gets what she needs. No doubt she’s feeling (or will, when she’s able) very grateful to have a friend who loves her enough to do all you’ve done for her.
Have you looked at National Alliance for the Mentally Ill (NAMI)? Both my brother and I have experience with mental illness, and they have a Family to Family class that has HUGELY benefitted my mom and step-mom… both actually took the class, then got the training to teach it themselves. NAMI also has many resources for people with brain diseases, support groups, classes, etc.
http://www.nami.org/MSTemplate.cfm?Site=NAMI_Oregon
I was in an inpatient situation many years ago. While there I met someone who was in for the third time in something like 10 years. I asked one of the therapists why she kept coming back, and the woman said it was because some people need to come to a safe place to get back on their feet. Maybe your man is your safe place. Yes, I know that sounds simplistic and dorky. : )
I have had a couple of major depressive episodes since the big one that resulted in inpatient care. Each time I called my psychiatrist, and got in to see her asap. I stayed in bed otherwise. I know that I am showing my privilege here big time. I’m so glad I have access to good care and I have a supportive social circle now.
I agree with an earlier poster that they probably call it adult behavioral health to stay away from the bad connotations associated with words/phrases like psych ward, or mental health.
My situation is very similar to Always Scared’s. I worry I’ll need hospitalization in the future but I cannot afford it and I’ll have no one to keep my child while I’m there. I, too, have kept thoughts of suicide and self-harm from therapists due to the fear of my son being taken away in the event such thoughts are reported. Even therapy doesn’t do me much good, because I can’t be honest I’m not getting all the help I need. I went to a psychiatrist but was only prescribed a mild anti-depressant because I couldn’t tell him just how bad it is (and when going through my county’s health dept I won’t see the psychiatrist for more than 20 minutes, if that, and I’ll only be able see him when I MUST). I’m kinda terrified at the moment, trying to figure out how to make this work without breaking-the-fuck-down. I don’t really want to die, I just *really* want out of this situation. It’s not fucking fair at all.
This is an awesome post. I was hospitalized two years ago for my first psychotic/manic episode, and I still can’t articulate how messed up our system is.
I hate to admit how bad my OCD is. But i had to. Because I needed meds. And let me tell you, explaining my obsessions and compulsions made me feel like a lunatic. Not because my shrink looked at me funny (he’s so wonderful, I adore him) but because I knew thses OCD things were SO irrational, and yet the ruled my life.
Mental illness frustrates me. I hate my OCD.
I wasn’t afraid of hospitals until I was in one. Among other things, the mental health people I saw tended to ignore my views on things. It’s like the rationale was that because I was there (or seeing them) I must be crazy and if I’m crazy and they are professionals, then obviously they are right and I am wrong about… whatever. Even that their treatment wasn’t working for me. I was actually told that I was doing better even though I had been hospitalized much more often than ever before. I had to get better outside the whole system (so far as I can tell) because of their false assumptions. And I know that if I were to tell any of those people this, they’d likely be sure I had some sort of persecution complex. People with mental illness can’t possibly be persecuted, right? Sigh.
Now those services would be even worse for me. I have a neuro-degenerative disease. Some bits of my brain don’t work and some work sporadically. Before I had a handle on how to deal with this, I once ended up (because of an ignorant and biased neurologist) being sent from one hospital to another with the intent of commitment in a psychiatric hospital. At that point, my memory was very iffy. I had a spiral notebook in which I wrote everything down that I thought was important. To transfer me, they took it away. Without it, I couldn’t keep track of what was going on. I was wholly lost. I had to beg the people at the desk to give me back the notebook, to give me back my memory-substitute. Absolutely terrifying. There’s that… and just the fact that my brain works very differently from, well, almost everyone’s. I have serious doubts any psych, any counselor would try to work with me as I am rather than trying to fit me into any number of the boxes they’ve been taught. That’s something that needs to change, I don’t know how… None of the putting people into neat little boxes. This is not the world of spherical patients in a vacuum (or on a frictionless psychiatrists couch) — the simplifications aren’t real. I wish that were emphasized. But no, I don’t know how it make it so. It is, however, a barrier that would prevent me from trying to access mental health services.
I’m terrified I might end up in a mental hospital. I’m transgender. I’m terrified because friends I know who are like me have spent time in the hospital and have come out with stories of abuse. I’m afraid that if I ever have to go to the hospital I’ll be treated as if I were a man. I’m afraid the staff will try and take away who I am. I am depressed and I have major issues with my self-image; the last thing I need is someone who has that kind of authority over me telling me that who I am is sick.
(Late response woah, that’s what happens when I lose my tabs)
….Oh dear satin hospitals. Hatehatehate.
I hospitalized myself when I was in my senior year of high school because my hallucinations had gotten to the point where I was worried about the safety of the people around me. I knew I could handle my own safety (mostly, or maybe I was kidding myself and I should’ve gotten help sooner) but I didn’t know if I could for others simply because during my episodes, I couldn’t see them anymore – they became warped threats in my mind instead of the people I knew.
I told the doctors what was going on, what I thought was going on, that I was hallucinating and I was scared and I needed some time away from school and stress and a chance to take a break from the world…. they didn’t believe me. They diagnosed me with depression, fed me anti-depressants that didn’t work, forced me into group therapy with people I hated and people who stared at me as if I was the crazy one that belonged there and not them (ironically enough, they were the only ones that believed what I told them – the sick ones like me!), forced me into group socialization with movies and activities when all I wanted was to be left alone in my room…. and released me two weeks later because I had basically surrendered and stopped fighting them. Which they assumed meant I was doing better. Which I was, in the sense that the hallucinogenic episodes had stopped, but because I was right in that I needed a break from the school that tormented me.
To this day I am still terrified of hospitals. I hate them. I never want to be in them, and sometimes just walking in them will give me anxiety attacks. And every time I go back and deal with staff that act as if they know better because they’re the professionals and I clearly have no idea what’s going on with me because I’m the crazy one or the sick one and have no expertise, that anxiety comes back. And I’m scared to go back into a facility that otherwise could have been beneficial for me. One that should be, if people weren’t being such stuck-up, arrogant assholes.
While I was there, there was a girl with severe Bipolar (I don’t remember which type) that kept coming back and forth. She was the regular of us. Her room had no door because at one point, before I got there, she had torn it off – and they refused to fix it. They just made it her room permanently, almost as a punishment… “You’re not allowed a door anymore, look at what you did to that privilege”, when we’re not even allowed to close the doors fully anyway.
I still remember her. And I feel like part of the reason why she kept going back in there was because she never got adequate help, because of their attitudes in their. If they had their act together then maybe it wouldn’t have been so frequent. I don’t know. I can only imagine, and considering my experiences I don’t particularly want to.
Anti-Princess, do you have a pipeline to my brain? I had a friend who was hospitalized twice, for severe depression. Me? Also diagnosed with depression, never been near a hospital. I think the main difference was that she was also dealing with neuralgia, and a pair of parents who did everything in their power to discourage her from getting treatment. I remember visiting her and feeling like such a hypocrite when I told her that yes, anti-depressants might help. (I’d been off them for four years, and stopped taking any kind of medication after I graduated. I’d been bouncing between ADD drugs and anti-depressants from the time I was eight.) I’m still terrified when I don’t hear from her, and my friend and I are planning to buy her a cell phone, because we get spooked when she’s out of touch.
I think my main reason for not considering suicide was the trauma I’d cause my family and friends.