(Photo – I wanted a selfie while admitting myself to the psych unit… because that made sense. My wonderful friend humored me. This picture is denial incarnate, I think.)
Today was my final day of Intensive Out Patient treatment. This is a massive transition for me, as my life for the past 2 months has consisted of some form of group therapy almost every weekday. In January, when I admitted myself to the psych unit at Dartmouth, I was not anticipating the length of the journey upon which I was embarking.
In Dialectal Behavioral Therapy (DBT), there is a concept called Radical Acceptance. The basic idea is that you have to accept reality for what it is. If you accept reality, while there may be pain, you will not suffer. If you refuse to accept reality for what it is, then you will suffer. Another way of putting it is “willingness verses willfulness”. Willingness is the ability to accept where you’re at and do what it takes to get better. Willfulness is rebelling against or refusing treatment.
I struggled with willfulness at the beginning of my treatment. Though I voluntarily admitted myself to Dartmouth, I spent the first two or three days I was there insisting that I could not learn anything from the group therapy because I had a strong professional understanding of the topics being taught.
** A slight aside on my professional identity: I have spent the past four and a half years of my life as a residential instructor in a group home. My job was teaching emotional regulation and life skills to dual diagnosed individuals (think Autistic/Schizophrenic; Bipolar/Fetal Alcohol Syndrome, etc.) . In that capacity, I was very familiar with the concept of DBT as it is a resource offered to many of the clients with whom I have worked.
Back to the Dartmouth Psych Unit, sitting in a DBT group as a patient felt pretty unnecessary to me. On my third day on the unit, I had a good conversation with my nurse for the day. She told me that I needed to shut off the professional part of my brain, the part that “knew” DBT skills intellectually, and I needed to have “beginner’s mind” when approaching the material and consider how those skills could be applied to my current situation. This perspective helped me overcome my willfulness on the unit; but I was still willfully in denial of the scope and impact of the struggles I was facing. I was convinced I would return to work and school in a matter of days and that this little detour to the hospital would have no long-lasting impact on my life.
This, as it turns out, was a completely irrational belief. You can’t qualify for admittance to a psych unit one week and be back to business as usual the next. There’s all this follow-up care shit you have to do. (It’s not really shit. But that’s my angry, willful Bostonian coming out.) For me, aftercare was a month of Partial Hospitalization and two and a half weeks of Intensive Out Patient (IOP). Finishing up IOP, though, is also not the end of my journey to wellness. Now, I’ll be working closely with my PCP, therapist, a psychiatrist, and Voc Rehab to try to really get things evened out and get my life back on track. And I’m very excited to continue to learn and grow. Right now, though, I’d like to take a few minutes to reflect a little, if you’ll indulge me.
In the past two months, I’ve learned a lot about myself. I’ve learned that I have Bipolar Affective Disorder. I’ve learned that my PTSD symptoms don’t have some magic cure, and that I’ll have them, to some extent, for the rest of my life. I’ve learned that I have an unhealthy tendency toward numbing my feelings with alcohol. I’ve learned that the way to manage many of my symptoms is to set and follow a schedule (something I despise). I’ve learned that medications are essential for the foreseeable future at the least, and possibly for the rest of my life. Prior to each moment of learning were several moments of willful denial.
“Fuck off, I’m not Bipolar!”
“The PTSD isn’t a big deal. It will pass.”
“I’m not taking any meds heavier than Tylenol.”
“Schedules are boring.”
“I’m a night person. I’m not going to start being in bed and working on sleep by midnight.”
“I don’t even need this program.”
“Drinking with friends isn’t a fucking issue. I can drink whenever I want. Who are you to take away my social life?”
The above are all actual things I’ve said out loud to my friends and/or treatment team over the past two months. Honestly, there have been moments that I’ve been truly insufferable, I’m sure. But, one by one, I’ve moved away from my denial and toward acceptance. And you know? Accepting things as they are instead of getting angry about how they “should be” has truly helped me stabilize and engage fully in treatment, and I have come a long way.
Treatment isn’t over yet, though. And there are some immediate hurtles for me to try to jump over. I’m hoping I’ve got enough momentum to clear them. My insurance lapsed mid-February, which is making follow-up care tricky to coordinate and getting prescriptions refilled impossible at the moment. (I’m working on that, though, with both my PCP and a local mental health organization, and should hopefully have that resolved in the next few days.) But, it’s definitely a stressful note on which to leave the intensive, wrap around support of the IOP program. (There will, in the future, be a separate blog post all about the ridiculous struggles of finding and maintaining affordable, quality mental health care.)
For right now, though, I just wanted to take a few minutes to share with you some bits of what I like to call “bumper sticker wisdom” that I’ve learned in the last two months that I’ll carry with me for the rest of my life:
“Sometimes good is good enough” (for your inner perfectionist)
“Yeah but your yeah buts” (For the moments your self talk is not helping you.)
“Check your lens” (Also for the moments your self talk sucks and your inner critic is dictating your perception of yourself and others.)
“Your shit; my shit.” (For the moments you may struggle with being able to differentiate between your responsibilities and other people’s problems)
“There is no bad mindfulness practice, there is only practice or no practice.” (Even if you’re REALLY distracted, and being mindful is hard, as long as you practice bringing it back to the present, you are succeeding in practicing mindfulness.)
“Act Opposite” (This one is from Cognitive Behavioral Therapy – you feel like staying in bed all day because you’re depressed? Do the opposite, even if you only make it to the kitchen and do 10 minutes worth of something before going back to bed.)
“Use the 10 Minute Rule” (This is maybe exactly what it sounds like, you do something you are avoiding for 10 minutes at a time. Got an inbox full of emails you’re avoiding replying to? Set a timer for 10 minutes and start reading and responding. Wherever you’re at at the end of that 10 minutes, you can choose to stop or continue based on how you’re feeling, but at least you made a small dent.)
“Action Precedes Motivation / If You Wait Until You Feel Like It, You’ll be Waiting a Long Time.” (Mood dependent behaviors are going to keep you stuck in your cycle of suck. You’ve got to do something to break the cycle. 10 Minute Rule is great here.)
“It’s Simple, but not easy.” (All of these things seem simple enough, maybe even like oversimplifications of the struggles you’re facing. But no one is saying it’s “easy.” Doing this work is fucking work. But it will help improve your situation over time.)
“Distress Tolerance: Getting Through a Bad Situation Without Making it Worse.” (I literally have a card of go-to healthy coping methods I can use when things really suck. I also have a list of favorite activities – I call it my “kit-bag”)
“G.L.A.D. / What’s Not Wrong? Journal” – One thing you are Grateful for today, one thing you Learned today, one thing you Accomplished today, one thing you took Delight in today, and two or three things that are NOT wrong in this moment. Write it out every day. Keep track. Over all, it will help challenge those deeply entrenched thoughts of “My life sucks”, “Nothing good ever happens to me”, “Why bother?”, “Fuck it”, etc.
And finally, remember that we are all working as hard as we can, and we have been working as hard as we can, but recovery is based on finding a way to work better, not harder.
So, I’m onto the next step. Wish my luck in this insurance fiasco. I’m told going off my meds due to not being able to refill them at this specific point may undo all the work I’ve done in the last two months, and I’m really not trying to have that happen. I have several meetings tomorrow, so I anticipate a more technical/ resource filled post at some point.
Movin’ onward and upward, as they say.