If you’re familiar with my story, my journey into true mental health advocacy began in the Two West Psychiatric Wing of Dartmouth-Hitchcock Medical Center in January of this year. This, it seems, is a bit taboo to talk about. No one can seem to understand why one would willingly share that a hospitalization occurred. No one seems comfortable talking about it. In conversations with friends and family, more often than not, if it comes up at all, it’s referred to as, “You know… when you were struggling” or “Well… in January…” or simply an awkward and hasty “When you were in hospital…” with an unspoken plea for an immediate change of subject.
No one asks what it is like to be on a psych unit, but you can see the curiosity beyond the silence, the unasked questions in the awkward pauses, and the speculation in the avoidance. With the year rapidly coming to an end, and eleven months of reflection under my belt, I’ve decided to answer the question people don’t ask. Not because they don’t want to, mind you, but because it’s awkward. Psychiatric Hospitalization is mythical in out culture. From horror movies to historical documentaries, what people believe happens beyond those locked doors is infamous and ingrained. Rather than challenge those beliefs, people tend to avoid asking any real questions and then engage in an impressive dance of cognitive dissonance and denial. (Really, there’s an interesting response by those not in crisis.)
But, what’s it actually like to be in a “psych ward”?
For me, at least, it was nothing like I expected. I went in completely unaware of what I was walking into, but I definitely held some of those same preconceived notions. As such, I was understandably terrified.
I don’t think anyone expects that a psychiatric unit would be “fun”, but I also think that there is a lot of misinformation out there. A collective idea that a psychiatric ward is the worst possible place you could end up.
My feelings on my own experiences are mixed, as are the feelings of many others who have had the unique experience of an inpatient mental health hospitalization.
Still, my experience was nothing like the depictions you see on television or read about in books. I’d like to share with you 5 of the things I learned about psychiatric hospitalization during my seven day stay at Dartmouth.
There is a “special section” of the ER for potential psych admits.
My best friend took me to the hospital. After speaking to the secretary and an intake nurse, and after my name was called, we were lead through the “standard” portion of the emergency room to a back wing. It was sectioned off and had two or three exam rooms, I think. Only they weren’t exam rooms. The room I found myself in was set up like a therapist’s waiting room. Two arm chairs. No bed. An open door with a security officer sitting in the hallway. I wish I’d taken a picture of the “quiet room,” as it was called. Had I known that this blog was in my future, I would have. As it is, I only took one picture while waiting to be admitted:
Because… what better time for a selfie? Am I right?
In the background of that picture, though, you can sort of see the “soothing” grass-land trim that traced the entire room. On the side opposite us was a mural of a lake. The colors were all blues and greens and beige. Except for the black security camera in the corner, of course. I waited, along with my best friend, for over 7 hours in this room. I was interviewed, I had my blood tested for any potential physical causes for my symptoms, and, ultimately, I was told that I would be admitted if I agreed. And agree I did. Through all of the terror, uncertainty, and honestly muddled and confused thoughts, one thing was clear in that moment: the professionals knew I needed it, my best friend knew I needed it, and, on some level, I knew I needed it. Despite some of the other points in this blog post, it was the right choice and it saved my life.
Inpatient Units in Hospitals are Based in Psychiatry, not Psychology.
This one really took me by surprise, even though “psychiatry” is pretty clearly implied in the term “psychiatric unit”. I was expecting a few days of intensive therapy. I was expecting that I would be required to talk with a therapist frequently. In this particular unit, however, there was absolutely no individual therapy. The focus was strictly on medication and skills to cope. There was no “processing” the events that lead to my hospitalization (except when one nurse attempted, but the effect was adverse, not positive*). Unless you wanted to talk with a Chaplain (I did not), one on one conversations with professionals were non-existent. The experience of being in a psych unit is not about laying yourself bare and sharing your feelings, it is about crisis stabilization and, in theory, securing follow-up services for all that emotionally messy stuff. (I say “in theory” because I unfortunately saw first hand that that is a luxury not everyone can access).
Group Therapy Actually Helps.
While individual therapy was not available, there was Group Therapy. A lot of it. CBT groups, DBT groups, Art Therapy groups, Mindfulness groups… in fact, I was essentially in one group or another from 9 AM to 4 PM every day. Again, these were not “share your feelings” groups, they were skills based. They were recovery based. They taught truths applicable to every single person in the room, regardless of what landed them in the hospital to start with. I found these groups incredibly helpful, as they allowed me to detach from my specific situation enough to absorb the knowledge being taught. It was in these groups that I learned the majority of the “bumper sticker wisdom” that actually helped me begin what has proven to be a turbulent but persistent journey toward wellness and recovery.
“Voluntary admit” is a loose term.
When one “voluntarily” checks oneself into a psych unit, one may be under the impression that walking out the door at any minute is an option. One would be incorrect. If you verbalize a desire to harm yourself or another, the option is completely off the table. But even if you are not suicidal or homicidal, the process of leaving is, well, a process. Yes, with much fighting and a complete lack of suicidal ideation, you can check yourself out Against Medical Advice, but you can only do that once you’ve met with a doctor. That doctor has to tell you that you are doing so against his advice, and you have to sign a paper stating that you met with him and that you understand that. There was a girl on the unit while I was there who decided to check herself out. It took a day and a half after she stated that she wanted to leave for her to actually leave. The typical stay on a psychiatric unit for stabilization is only 2-3 days. I went in with the plan to discharge in 3. Then it became 5. Then 7. Had I asked to leave at any point before the treatment team agreed, I would have been denied that request as I was struggling with suicidal thoughts. So, while I voluntarily admitted myself, and I did voluntarily stay, knowing that leaving was not an option sort of took the “voluntary” out of “voluntary admit”.
No one there was “crazy”
On this point, many will disagree – even in the mental health community. I know many advocates who are the first to say “I’m completely nuts!” But I am not that kind of advocate. I am a human who lives with chronic medical conditions which happen to be of the mental health variety. I don’t deny my illness, but I also don’t consider the term “crazy” to be very helpful in the dialogue against stigma. And, while I certainly felt crazy, I quickly learned that no one on that unit, myself included, was. Not the young man with Schizo-Affective Disorder who would pace and talk to himself, not the young woman who was so anxious she physically shook for four days straight and had a trembling voice the entire time, not the girl who had flashbacks just like me, not the old man who had been on the unit for months after a suicide attempt and was receiving Electro Convulsive Therapy, not the kid who was so depressed it took him three days to speak and five days to crack the slightest hint of a smile, none of them. And not me.
A funny thing happens on a psych ward. You’re terrified at first, but then you realize that the “gig is up”, so to speak. If you’re on a psych unit, there is no room to pretend you’re OK and all pretense goes away. No matter the struggles each person on that unit was facing, those who had been hospitalized before comforted and encouraged those of us who had not. We all found things to talk about, and even laugh about together. I’m still friends with some of the truly wonderful people I was lucky enough to meet in those seven days. That week changed my life for the better, even though there were undeniably triggering, frustrating, and upsetting moments. It was in the psych ward that I first began to realize that I was not “crazy”, I was simply struggling. (This has been an area in which I’ve needed frequent reminders, but, as I learned in group therapy, “relapse is part of recovery” and “recovery is a process, not an event.”)
BONUS FACT: The psych unit is not even close to a cure all. You will not leave feeling “healed”, but it is a fantastic first step toward true recovery if you are in crisis. Despite my mixed feelings, it was a necessary and helpful resource for me.
There you have it! Now, I want to acknowledge that I was at one hospital at one moment in time. This article reflects my subjective experiences and not the experiences of everyone. It is also important to note that I checked myself in of my own volition. I was not psychotic or brought in by police or EMS personnel. Many in our community have had these experiences, and they can be traumatic. I am not seeking to invalidate that trauma, simply sharing my own experiences. Even with my relatively positive stay, I had some distinct realizations around the lack of Trauma Informed Care (*read more about my adverse nurse experience here) as standard practice on the unit. Let me be clear, psychiatric hospitalization is the absolute last situation in which I want to find myself ever again, unless, of course, I need it. In that case, the hospital is the first place I want to be.
I hope you enjoyed this week’s post! Next week, Parallel Dichotomy is going to be a busy place! On Monday, I’m hosting a wonderful guest post by Kelsey, host of the blog The Brave. In this post, she shares her experiences with the immense stigma surrounding Borderline Personality Disorder. You don’t want to miss this honest and informative piece, believe me! Following that, we’ll have a triple header – three straight days of new posts, starting on Friday, covering the three sections of Interpersonal Effectiveness. I’m running this series in quick succession close to the holidays because… well, what better time to know how to effectively engage with people with whom you may not quite see eye to eye. It’s my blog-mas gift to all of you, my beautiful readers!
Thanks for reading! As always, I’d love to hear your thoughts, be it your experiences with hospitalization if you’ve had one (or more), or, your reaction to reading this as someone who’s never been hospitalized. Drop a comment below, or Tweet me @paradichotomy. Also, feel free to jump over to Facebook, give the page a like, and join the conversations happening over there! Finally, if you found this insightful and helpful, please feel free to share it!