Mental Health and Partial Hospitalization

It’s through a haze of essential oils I realize I’m more or so stuck. A diffuser hisses in the corner. I remember I’m supposed to do something asked of me a second ago, but my mind is foggy. I stare down at the laminated “Check-In” sheet that I’m clutching.

“Hi. My name is Kristin H. My mood for today is anxious…at about a six out of ten,” clarifies my disembodied voice, reading the prompts. “Today my goal for therapy is to learn what I can about Dialectical Behavioral Therapy. I can accomplish this by listening and using mindfulness?”  

Ella, the clinician leading group smiles. Nods encouragingly. “And can you read one of the group rules on the back?” She indicates at the sheet.

“Refrain from taking illicit drugs while in program.” Some nods. Mostly at the floor. A girl in the corner lets her head loll over her lap, hair covering whatever it is she’s drawing in her notebook. I strongly suspect she’s been tracing a circle figure for the last fifteen minutes.

“Thank you, Kristin. Next?” Ella indicates that I should pass the laminated sheet along to my right.

I pass along the sheet and let my thoughts flow in and out of the room as all fourteen of us “check in” to group therapy, stating our names, answering the questions, reading the rules.

I’m an investigative journalist here, I rehash in my head. I’m not one of these crazy people. I’m fine. I don’t know why the hell I thought this was a good idea. I should be in work. Maybe I can write an expose on this once I drop out tomorrow…

I glance up as the sheet makes its way around the room. We’re all a bit unkempt, disheveled, though some of us look like we’re trying. The chairs that line the room are uncomfortable, so many of us fidget as the chairs reject our desire to sit still. Group rules are read one or two at a time by each patient, some rules more obvious than others.

Refrain from personal relationships. Do not talk about personal details related to suicide, addiction, and trauma. Use “I” statements.

I try my best to be a model patient, as if persuading the clinicians that my presence here is a silly mistake. Hands resting on my lap, back straight as an arrow, I realize I’m one of only a few women who aren’t scribbling in mandalas with colored pencils. Is this allowed? I continue to listen intently.

“Alyssa T. I’m tired. At about a seven…”

We’re required to start every session with our firstnamelastinitial, so names begin to bleed into one another, forming meaningless labels. Sarah E. becomes Sarahee, Whitney N. becomes Whitneyenn. Chris R. has a strong Boston accent, so she becomes Chrisahh. The faint smell of booze and tobacco linger around the room. A door slams somewhere down the hall of our classroom. Yelling. A fresh wave of paranoia hits me.

I’m in the looney bin. For all I know, someone got ahold of a gun and intends to shoot up the place.

My thoughts have been along a similar line for a few months now, ebbing and flowing in my mind, not discriminating based on my location, time, or place. But this fear has been increasingly asphyxiating me as each day slips by, and the medications I’d begun taking (and defiantly stopped taking for a few days last week) hadn’t appeared to quell these thoughts yet. I was convinced every forty-year old man on the commuter rail was plotting to kill me and bomb the train. Anyone who looked at me on the streets would follow me home and torture me. I was in an almost-constant state of fear. There had been one too many panic attacks as of late.

“…Jessica, J-E-S-S-I-C-A. Pizlowski. P-I-Z-L-O-W-S-K-I,” a nasally voice interrupts my thoughts. A girl across the room with amplified cat-eye transition lenses states her full name and mood matter-of-factly (“I’m OK”) much to the clinician’s dismay. I think she believes she is showing how little of a f*ck she gives that she’s here.

I stare longingly at the door. Only three forty-five minute morning sessions, a forty-five minute lunch, and two forty-five minute afternoon sessions until I can escape.

***

I definitely don’t want to ruin the suspense for you, but I did not end up dropping out of the Women’s Partial Hospitalization Program I had enrolled in that day. I spent my half-birthday plotting my liberation and ended up staying the full amount of days my insurance covered. On weekdays last month, I drove myself to a hospital and participated in group-based and individual therapy from 10am to 3:15pm. It proved to be emotionally exhausting and not every day felt positive. Some days felt downright heavy and frustrating. But others reminded me of how strong my group of women were, how strong I could be, and how there can always be hope for treatment.

This came at a minor cost.

As we’re all aware, there is a plethora of stigmata behind mental illnesses. I try to be candid about the mental illnesses that affect me in hopes to destigmatize and change the narrative surrounding them, but admitting my health had deteriorated to the point of partial hospitalization seemed like a fairly different ballgame. Should I be embarrassed? Was this something I should avoid telling relatives and friends? Had I literally entered the realm of bat-sh*t crazy? Do I need explain this to my employer?

We’re all aware that psychiatric hospitals conjure up images of Electric Shock Therapy, One Flew Over the Cuckoo’s Nest, gurneys, restraints, and hospital gowns. Before my experience, they did for me too. While this is certainly a realistic (and sad) view of how psychiatric hospitals operated in the 18th century up to more recently, my experience was quite different (though I can not speak to inpatient care).

In practice, partial hospitalization is a program designed for those who need treatment for a psychiatric disorder and are not seeing improvement when meeting extensively with their outpatient therapist, but do not need twenty-four care. Partial is set up to give one “tools” to become more stabilized and able to cope with life. This is certainly not something to be embarrassed by.

I realized I may need this increase in care about a month ago. Both inpatient care of partial had previously been suggested to me during my sophomore year of college, but I could never imagine halting my life for full or part-time care. Now I had a full-time job. I couldn’t just take three weeks off, the thought was ludicrous.

I’ve normally been pretty adept at using coping skills I’d learned through Cognitive Behavioral Therapy (CBT) over the years, but recently found myself drowning in an ever-increasing amplitudes of emotion. I’d been off medications for two years and hated the thought of taking pills again, especially given I have been diagnosed with Bipolar II Disorder (which historically, is hard to stabilize). I needed a space to safely and effectively learn how to regulate my mood while adjusting to the medications I was started. Partial seemed like the right choice for me. And it was. It felt like one of my last viable options.

***

I call it the “brain itch”. When I feel it, I know I’m not well.

Most of the time, it begins with fleeting thoughts that spin around in my mind. When I’m healthy, I’m able to ignore them or address them with a healthy coping skill. However, when I’m already feeling particularly vulnerable, it can quickly escalate into what I perceive to be utter madness.

I’m sitting at Barnes & Noble. I have a book in my hands, but I can’t seem to read more than one sentence without constantly repeating it over and over in my head. Why can’t I read? Am I anxious? Try harder. Eyes glazed over, I turn the page without really finishing the sentence I left off on. “Artemis glanced at me…” A cold knot forms in my stomach. What’s going on? It’s probably nothing. Or what if that napkin I touched earlier had some sort of contagion on it that I now have? Is that why I can’t focus? It can’t be. I know I’m not well. Just ignore it. I stare harder at the book’s stark white pages. That napkin had some sort of blood on it, I knew it. I glance around. A kid sits lazily to my right, reading a comic book. People line up on the escalator. Who is that man and why did he glance this way? He might have explosives. I need to get out of here. I put my book down. It’s not real. You’re so stupid. He doesn’t have a bomb. I need to get out. I get up abruptly and place the book back on the shelf I found it. Exit the store. The clerk looked at me on the way out- did he think I stole something? No. Get in the car. I start the engine. Drive home. Tap your right foot for every striped line you drive past. I tap my foot. I miss a few. Bad things are going to happen. I get home. Avoided danger. I lay on my bed and the stress slowly seeps out of my body onto the covers below. Breathe. I don’t think I’m sick. Threat neutralized. I laugh. I’m so stupid to think someone was going to bomb a Barnes & Noble. But now I’m bored. I don’t want to do anything, yet I have to do something. I’m so bored, what can I do? I sit up. I don’t want to paint. I don’t want to read, I can’t. Study, you need to study for the LSAT. I pick up my study guide and look at it blankly. Try a question. Wrong answer. You’re beyond stupid, you’re worthless. Why even try? Stop it. Try again. I’m trying to fight off the tears that are inevitably coming. I can’t even focus, maybe I did catch something from that napkin. Text your sister. You do not have a disease, but confirm this with her. She’s going to roll her eyes. This is so dumb. I can’t seem to bring the energy to look at another question. I glance at the clock. 7:37pm. Those numbers add up to seventeen. It’s a safe number. I throw my LSAT book on the floor. Open my drawer. Lay out half a pill from one container, two pills from another. One from another. Two from the last. I take every last one of them, just as they have been prescribed. What if they all mix and kill you in your sleep? I get into bed and pull the covers up to my chest. Hands at my side like a wooden soldier. Did you check the doors? No. You should. Check the doors or someone will abduct you as you sleep. I think I did. Did you though? I get up. Check the door. It’s locked. You’re so pathetic. No plans for tomorrow? No one could stand you anyway. No reason to get up. No wonder you were dumped by the last guy you saw. Get back into bed. Covers up. A tight feeling in my chest. Am I dying? Please make this end I can’t be in my own head like this. I can’t do this. Make it stop. Make the noise stop. It’s been two hours and I succumb to the drowsiness that takes me down…down. Down. Sleep five hours. I’m not tired at all. But hungry. Did I eat dinner yesterday? Blank space. I do not remember.

***

I started appreciating partial on the third day. Once I realized (through conversations with the clinician at the hospital and my own therapist) that it was ill-advised to stay for a few days and leave, I began to embrace group sessions.

At my particular program, two to three of the five sessions revolved around Dialectical Behavioral Therapy (DBT). Each session was led by a staff clinician who directed, steered, and offered prompts for the group to discuss. Some clinicians offered a more psychoeducational approach, while others allowed for more of a group-led discussion. The structure was the same, but the quality of the group largely depended on who was in or leading each group (in my case, there were two rooms you could choose between each session).

A majority of our time was spent learning about appropriate coping mechanisms to help us through times of high distress. DBT tends to focus on the synthesis of the “logic mind” with the “emotional mind” through four main components: mindfulness, interpersonal effectiveness, distress tolerance, and emotional regulation. The idea is that instead of thinking in extremes, we should find the middle-ground between what is logic and our emotions as the result of an inciting incident. The ultimate goal of DBT is to create a “life worth living” through acquiring new skills and healthy changes in behavior. You can read more about it here.

Most of the time in each session involved learning and practicing coping skills in a controlled environment. By practicing in a “safe” environment, it’s become easier for me to utilize my DBT skills when in times of distress (such as doing the “opposite action” of when I am feeling sad, i.e. dancing to music, a coping mechanism taught in DBT).

The remaining sessions would vary upon the day. Sometimes we’d work on Cognitive Behavioral Therapy or do an Open Process session. Other times, art therapy was incorporated through painting or drawing. One of my favorite sessions was called “Empowerment”. My group of women was challenged to come up with empowering words or phrases for ourselves and create something on a blank sheet of paper. At the end of the session, we went around the room and spoke about what we chose to write and why.

I picked the quote, “who is stronger than you?” from the book Wild. Other women had their own phrases, but we all spoke to the challenges of finding our strengths through our depression, trauma, and other disorders. I’d never been so hyper-aware of the difficulties facing women who feel crushed under the weight of their mental health. We were all struggling, yet we built one another up during the session and let ourselves be vulnerable with one another. I left that day feeling much lighter than when I had walked in. I was learning to truly love myself and see the beauty in others.

***

I’m in the forest again, just like when I was a kid. This time is different, though. The path leads my tennis shoes down a wood chipped path, swallowed by thick, lush, green leaves and branches. I’m sweating lightly, having just returned from a run. Normally, I’d be slightly paranoid about being alone in the woods, but as I breathe in the deep, musky scent of the earth, I’m present. I’m here.

I stand in a clearing dappled in the colors of a warm May sunset. My eyes close slowly and I feel the air around me from my feet, to my skin, to my very being. What do you smell? A verdant oasis, the earthy smell of mud, a slight breeze wrapped in gold spun from the light, sweet honeysuckle. What do you feel? Hair brushing my temples, feet grounded like the tree roots swelling from the earth around me, the sun’s faint, glowing embrace on my face. What do you hear? The longing twill of a robin, the soft rustling of leaves in the forest’s topmost branches.

Opening my eyes, I begin to wander, fingers eagerly outstretched to the beauty around me. What do you see? Colors, the high contrast of sound and light, sharp definition of jagged rocks, soft light filtering through the delicate flora above. My worries melt away and I’m here in this moment. Nothing else matters except my exact position in time and space.

It’s the practice of shinrin-yoku, or forest bathing. To me, I’ve always known it as mindfulness.

We sometimes forget the little things because we’re focused on the future, on worrying about our next few steps. But it’s the little things like a walk in the woods or enjoying the scent of a wildflower that add up to make a majority of our life experiences. I’ve learned the art of finding myself in these fleeting moments. Through this, I’ve found peace in the madness.

***

The penultimate moment in partial for me was when I decided to let go of my denial that I was not “okay”. For many months preceding this May, I’d been lying to myself and others about my well-being. I lost motivation and tried my hardest to remain optimistic while ignoring most of my feelings. After spending time with my family, friends, and their significant others, I focused on how alone I felt instead of how happy I was to be surrounded by positive, loving relationships. I could hardly focus on studying for the LSAT, but when I could, I quickly grew frustrated with myself. Was I stupid? I continued to beat myself up as if it was a sport. I felt like a fraud. I knew and preached what a healthy person should be thinking during times like these, but I couldn’t mentally convince myself to get there.

Sadly, it would be months until I realized I had been pushed to my breaking point. One day after work, I started uncontrollably crying in my car and could not stop. I wanted my brain to stop bullying me. I wanted to turn my thoughts off. I couldn’t go a day without experiencing a myriad of uncontrollable high and low thoughts. I didn’t need to be happy, but I desperately wanted to put a pause on being me. If I couldn’t commit to partial hospitalization for myself, I’d do it for my loved ones. It’s all I feel I had left. So I talked to my therapist, called the hospital, and asked for a place in their women’s mental health program.

Initially, I was relieved. But after getting buzzed through a double set of security doors at the hospital, I panicked. Once again, I convinced myself I was fine. I was functioning, right? I didn’t need this, it was a mistake to have committed to this program. I wasn’t a lunatic. I’d work on getting my way out as soon as I met with my clinician.

In my denial, I had convinced myself I already had all the necessary tools to live a happy, healthy life. But this changed as the women around me shared their stories and allowed themselves to be vulnerable while in group therapy. Suddenly, it was okay to admit I was struggling. It was okay to not know all the answers, okay to feel a loss of control. We were in partial together to figure ourselves out. To find a sense of peace in the madness. To acquire coping mechanisms to help us fight through trauma, depression, and life. In this, we were strong together. The moment I let my facade go was truly the moment I was set free. I was free to begin healing again.

Another large part of my healing process began with addressing the fact that I shouldn’t try to hide every negative emotion from myself and loved ones. Hiding my feelings is not the true meaning of being “healthy”. It’s okay to feel sadness, anger, and frustration- even when I’m not feeling well. It’s more so how I choose to address the amplitude of the emotion that matters in the short and long term. This is something I’m still working on to this day.

Overall, partial was a humbling, eye-opening, overall positive experience. It’s taught me that I want to become a student, not a sufferer, of my mental illnesses. Through psychoeducation, I’ve built up the skills necessary to bouy me to the surface when I’m in times of distress. I learned how to do this in partial, which provided a safe environment for me to do so. This is hardly anything to be ashamed of. I asked for help when I needed it most, and this is not a sign of weakness, but a sign of strength.

So circling back to my initial questions: Should I be embarrassed? Was this something I should avoid telling relatives and friends? Had I literally entered the realm of bat-sh*t crazy? Do I need explain this to my employer?

The short answer to all these questions is a simple “no”.

Taking control of your mental health, if not for yourself, but for the loved ones who surround you, is never something to be ashamed or embarrassed of. If you are surrounded by a great support group, you will have little reason to avoid telling your loved ones you had the strength to take charge of your mental well being. Those who do not support you despite this may not have a place in your future. And in my opinion, your employer only needs to know you are taking time off for your health (to keep things professional).

Mental illnesses are rife with stigma. It won’t be easy to change the negative narrative surrounding them, but it shouldn’t mean we do not try. While I once was afraid to admit I needed partial to regain a sense of meaning in my life again, I no longer feel this way. I’m strong through my struggles. I’ve learned a lot about myself through the time I’ve spent participating in group therapy. The women around me proved to be overall positive influences on my life and I wouldn’t change this for the world. I’m strong knowing I am on the path to finding a life worth living and this is largely due to facing my fears, admitting I was struggling, challenging stigmata, and participating in a partial hospitalization program. And this is the path I want to be on.

***

If you have any questions after reading this post, please do not hesitate to reach out to me in the comments section below.

3 Comments

  1. You are one of the strongest women I know! And if we had a broken bone we’d seek help, so mental help should be no different!

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  2. Kristin, I’m sorry to hear of your struggles. I think you are one of the strongest women I know. To recognize that you needed help and find it. I know you will succeed in your journey along with love from family and friends.

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