psychiatric hospitalization

Breve

Coffee beans ground finely, roasted into a toasty but stringent espresso.  Over the darkness two poles are poured, milk and cream, the pauper and the prince.  The elements combine to form the color of life, discernible and livable, clouds and shadows swirling on the gentle landscape.

I had called the psychiatric emergency crisis line two nights in a row.  The therapist on the other end could feel the tickling tentacles of my demons reaching through the airwaves and requested I come into the emergency department to be evaluated.  The air in the ED was thick, heavy, and populous, yet there was not enough to sustain a single breath.  The tentacles were misbehaving, spreading to great reaches and tapping shoulders of others.  I had not eaten in close to twelve hours, my receptacle empty and my reserves slim.

The evaluating therapist tamed the tentacles long enough for me to get my story out.  The illustrations were old comic book style, bold colors and patterns, but little shading.  Little bits and pieces of our conversation stick on the post-it note covered wall of my brain.  Central nervous system suppression.  Trauma.  Maladaptive coping mechanisms and behaviors.  Apparently my story was publishable, earning a coveted spot with the exclusive board of directors at the hospital, the individuals who were the news and who told the news.

Being on the board of directors was quite interesting.  My tenure was short-lived, only six days.  Sometimes the overseers allowed respite from rigidity of the duties of formulating and planning, and the board members could dance in unadulterated bliss to the beats of Uptown Funk and shake booty to popular rap songs.

The tentacles were retreating and retracting, and the smog in my brain lifting.  Puppet strings pulled the corners of my mouth upward, an action foreign to the nerves firing to my facial muscles.  I left the board of directors well respected and soared with a proper farewell.

The darkness of the depths of the brain, where depression and the evils reside, becomes mitigated by the paupers and princes of life, the poor and rich experiences that serve to draw color to the darkness.  Through acceptance of the dialectic existence of the poor and the rich, darkness lightens.  Last week I experienced my thirteenth hospitalization.  Acceptance has the capacity to color my espresso differently and to alter the fabric of existence upon which I reside.  

Fractures

Colors.  Our sun bleached blond and red hair messily restrained in lycra swim caps, goggles tight across our faces.  We take turns as the leader calling out red, orange, yellow, green blue, white, pink… as the other two of us swim as stealthily as we can muster across the deep end of the pool.  Red, orange, yellow… I splash as I attempt to make it to the other wall untouched, but I feel a tug on my leg and know I have failed.  We all laugh and begin again, playing for hours on end, burning to a crisp in the hot Southern Californian sun.  The concerns of life were simpler, punctuated by swims and games of Sailor Moon in the small orchard alongside the house.  What would we not give to return.

Wildfires were burning up Southern California.  Ash was raining and smoke hovering.  As my world burned, I retreated within, further falling into a zombie-like trance.  I went through the motions with little knowledge of my doing so.  It was another nondescript day at high school, and I wandered from class to class.  Once again I had slept too much and not completed my assignments; I was starting to see no way out of this.  My lack of functioning plummeted me further into the depression, igniting a vicious, self-perpetuating cycle.  The world was ashen black, and the narrative music had ceased.  My Bach and Beethoven transformed into sinister voices speaking about death, urging, encouraging.

It was lunchtime, and I sat in zombie trance as I heard over the loud speaker a secretary beckoning me to the front office.  I was too tired to question or ponder this occurrence and trudged in a slow shuffle to the office.  My mother was there, waiting to pick me up, and again, unquestioning, I obliged to her offer.  Once in the car, she explained that she and Dr. Azad conversed, and I was going to spend some time in the hospital.  In my state of emotional indifference, all I could offer was an “okay,”  I imagined a hospital room with machines and a bed – a bed I could sleep and sleep and sleep in, endlessly.  Little did I know that it could not be further from the case.  I was to imminently enter a little prison that would sequester me for the next five weeks.

We arrived at the University of California, Los Angeles Neuropsychiatric Institute Adolescent Psychiatry Ward, or 2-South, as I would come to know it.  A psychologist completed an intake and mental status assessment.  I was quiet and confused, but compliant.  My naivete was a sedative drug, overriding all brain function and nervous system response, for had I known the domain I was to enter, storm clouds would have rained torrentially.  The naivete was a protective factor, stemming from my interminable internment in a vortex of a tornado untruthful and unforgiving.  So yes, I complied, with what composure could be mustered.

The five of us sat in the Suburban, father driving and mother in the front seat, sisters and I in the back with the dogs.  The windows were all down, the air rushing and blowing in, twisting and turning loose strands of hair, coaxing the laughter from our throats and carrying away with it the happiness gently oozing from our depleting stores.  We drove through the streets of Westlake Village, and as we did so, we honked at strangers on the street, waving enthusiastically in the ruse that we were acquaintances or knew each other well.  Some strangers waved back in confused embarrassment from an apparent amnesia, while others stared blankly in confusion.  To us, it was hilarious, a wonderful warm afternoon pastime.  

Every evening, twice daily on weekends, my mother made the drive to UCLA to visit me for five weeks, and continued to do so for the following five hospitalizations.  As we played cards in the dining room on a plasticized wooden table, two sisters sat at home in the care of my father, who himself was distant, existing in a world that was slowly deviating from our collective.  In fact, we were all shifting into and out of different collectives.  Fractures forming.  We played gin rummy every night, the only rope that could draw me out of catatonia.  Two sisters, hours without their mother in the prime of their childhood.  My father was no longer allowed to visit.  I could not tolerate his presence.  Fractures.  My illness tore through the burlap of our family fabric with the ease and adeptness of a razor shaving hair.  First the tibias and fibulas broke.  Then, as time progressed, the femurs, the metacarpals, the bones necessary for the cohesiveness and function of the family.  A mother’s sacrifice twofold.  An ailing child in the hospital and shrinking children at home in the loss of a childhood, a forced maturity.  Loss, on all accounts.

Every Sunday, my sister would don her Cleveland Browns jersey and watch the Browns football game with my father.  Two peas in a pod, one large, another growing, nesting in their pod as they cheered each touch down, groaned at every fumble.  She was still young, bleach blond hair not yet turned brown, swimming in her jersey, swimming in the camaraderie and happiness, the naivete still nursed to her from the bosom of childhood innocence.  She was deserving, and when the milk ran dry, roads diverged, carrying her youthful body far from the familiar into terrain rough and rugged.  Thirsty, she was, perpetually thirsty.

Not long after I was discharged from my fifth hospitalization, my aunt committed suicide.  My mother and I went back to Ohio to attempt to piece together the remnants of my aunt’s abandoned life – clean her house, organize for donations, and plan a funeral.  The fractures of my mother’s family thrusted to the forefront as many came to converge upon the death of my aunt.  Fracture upon fracture does not hold in firmness and promise a structure capable of supporting a family ailing in many avenues. Following our days in Ohio we returned to California in time for another seismic shift and fracture in the walls of a house precariously resting upon the San Andreas Fault.  My father was leaving the marriage, dissecting the family lines.  A cut through the flesh with a sharp blade.  The casualties?  Two sisters shadowed by an illness and a broken marriage.  Our feet bled as we walked upon the shattered china littering the kitchen floor.

Their sister was thrusted to the forefront, ill and hospitalized, discharged only to return a day later, a week later.  The two sisters metamorphosed in the aftermath of an illness, the melting and drying wax of their dwindling candles slowly molding and melding to the life and care of their older sister.  Years pass, school absences abound.  Depression ensues, anger bubbles from fresh wounds.  Fractures ever more apparent.  One sister spends nearly three quarters of her year driving her sister to electroconvulsive therapy treatments, a sucking, a sequestration of nine months of her life.  No, not her life.  She struggles to exist in the wake of the aftermath of the seismic shifts, her life an entity separate from that of her sister, of the illness.  Enmeshment and inseparability are words served cold with dinner each night.  

A mother plays doctor, suturing lacerations and bandaging wounds, attempting to tie again what has been untied, to meld together what has been fractured.  Such pressure, this role.  Unfair.  Caught between the worlds, the collectives divided by illness and seismic shifts.  Of pinnacle importance?  The knowledge that the body seeks self preservation and perpetuation.  Fractures heal.  Fractures once apparent connect and dissolve.  There exists a remaining faint scar, a reminder that life is messy and that our ills and struggles will crack what we hold to be impervious.

Memory and Blank Spaces

This term I am taking a wonderful women’s studies class entitled Women, Writing, and Memoir.  The first two classes of the term involved the completion of free writes on the prompts “I remember…” and “I don’t remember…” My responses were highly reflective and raised my intrigue for these exercises.  I have decided, for this blog post, to combine the exercises and complete a free write just to see, out of pure curiosity, where it goes.

I remember the way I existed in a constant zombie, absent state as I progressed from class to class in that fiery October when I was mysteriously, unprecedentedly called to the high school administrative office for my mother to pick me up.  To the hospital, she said we were going, and all I can remember is the relief that I can finally sleep, sleep, sleep.  Sleep away the demons rooting residence within the fabric of my brain, quickly signing their renewal leases, tenants disruptive and unforgiving, destined to never leave.  I remember the discovery that no, I was to be imprisoned in a psychiatric ward where sleep was a commodity, a rarity, a luxury to be bartered for.  It was Halloween, the mountains of Southern California were ablaze, and they painted my face, me a child, the color strokes not indicative of the fourteen years of age I carried. Visitors presented, yet I was absent, my ties to the world severed, floating in catatonia.  I bowed my head, unaware of the forces struggling to break the barrier and draw me from the depths of hell in which I resided.  I remember smuggling broken tiles from occupational therapy, feeling deftly for the sharpest edges and drawing the points across my forearm until they drew blood.  There was a girl there.  I did not know her well, nor did I express the choice or will to, but I remember the ways she tried to touch me and the protests of discomfort and intense dislike I offered.  I remember the day I was allowed to leave, realizing the broken way in which these two worlds attempted to collide.

I don’t remember the white hot flashes that surged through my mind and danced their bruises across my mother’s arms, her hiding them at work to avoid the questions she knew would be asked.  I don’t remember the rages that possessed me and elicited horrific acts, only that they occurred and that I collapsed in confusion and unknowing.  While I remember the breaking of the glass, I cannot recall how it felt to pull the shard across flesh, nor the specific hue of red that emerged and trickled like a slow-flowing creek carrying away garbage cast afloat by a desperate teenager seeking cleansing and catharsis.  I do not remember the first time I prostrated to pray, but only how I ardently seek to replicate the feeling of connection I felt to God in that moment – the worlds beyond being opened to me and offering solace and forgiveness to and an understanding of the monster residing within me. I don’t remember the first time I contemplated suicide, only that the urge has never left.  I have little recognition of childhood, of a semblance of normalcy, a state in which my mind was quiet and not disruptive, sadistic, or cruel.  Most of all I do not remember familial happiness, a time in which the devils did not dance, the connecting ropes strained by illness and marriage, a time when sisters partnered rather than eschewed.  I do not remember every tear shed from red eyes, but I remember in vividness the ones which I caused.

Hanging in Limbo

What is wellness?  Stability?  These are questions that I have oft asked myself over the last month or so. How will I know when I have achieved the coveted status, the pinnacle place of mental health wellness? I ponder the importance of this contemplation.  Does it matter or hold significance in whether I perseverate over whether I am “well” and “fit,” or rather is it more important to just “be,” to live in the moment with mindfulness and awareness?

Since the beginning, I have been highly treatment-resistent.  I have had twelve hospitalizations, been on over twenty different drugs, and have endured thirty-eight electroconvulsive therapy treatments. In the last few months, I have explored alternative routes of treatment as a supplement to my psychiatric care.  A naturopath has honed and fine-tuned a special concoction of supplements and extracts that have positively affected my mental wellness, resulting in some symptom reduction.  In fact, a significant reduction.  Natural approaches coupled with the psychiatric approach have proven highly effective.  I am still weighed down with depression, anxiety, obsessions, and agitation, but utilizing my arsenal of coping skills and treatments has created a life and existence for me that has been elusive for many years.  So am I well?

My psychiatrist recently placed me in partial remission, which was the impetus for my perseveration surrounding what it means to be well.  Initially, this instilled in me a belief that I am now healed and should act and conduct myself as such.  Symptoms I may feel should be diminished, and I should embrace a life in which I no longer have sickness.  This led solely to frustration, as I knew that my true predicament was incongruent with these notions.  Then I started to think.  Is this black and white, or is there a spectrum? Room for the vague and the unsure?  For relativity? I see this as a complex phenomenon. In a linear direction, there is the spectrum of mental instability to mental wellness.  A person may land anywhere on that spectrum at any given time, but this categorization is superficial and not the only factor in involved.  In comes the concept of relativity.  Someone may fall closer on the spectrum to the societal understanding of instability, but yet have exceptional coping skills and support, thus creating a situation in which they could cope and exist more adeptly than someone in the same position – thus possibly more well than first perceived.  Contrarily, a person may fall closer to mental wellness on the spectrum, yet be unable to effectively cope.

I feel as though I am slowly navigating my way from the instability end of the spectrum to the place of mental wellness. I am beginning to understand the ambiguities and relativity in the process, and labels such as partial remission are not all-indicative of a certain state or place in someone’s existence.  In fact, it is just a label used solely for documentation in medical records.  When considering the spectrum and the concept of relativity, I can see that while I may not be entirely well, I am walking in the right direction, and my obsessions over the worth of words and labels are insignificant. What truly matters is to live mindfully and unconstrained by one’s own psyche.  To be controlled by the spectrum is to hang in limbo, not knowing where one truly falls and whether that knowledge is important at all.

I am sitting in my new apartment writing this piece.  I am scared.  I am afraid.  Obsessions and anxiety are creeping from the darkness and grasping their sticky tendrils around the threads of my mind, attempting to draw me from my place of progress.  While I could succumb to their power and view my place on the spectrum as the be-all and end-all, I can instead draw to mind the concept of relativity and recognize that while I may have some setbacks, I am fighting with well-honed coping skills and implementing my naturopathic and psychiatric interventions, compounding the linear nature of the spectrum and allowing a more dimensional look at my wellness and stability.

Drifting

She gently placed three electrodes on my chest.  Sinus rhythm, minimal tachy she assures me as I lay in anticipation of drugs that will float me in tingles to worlds I know not.

What is that symbol on your necklace, she asks?

“It is the symbol of the Baha’i Faith…”

 

This piece is in response to a WordPress prompt to tell a story spawning from a source of inspiration, found in any form and told in any fashion.

Weekly Writing Challenge: Fifty-Word Inspiration

More to the Picture

For much of my treatment career – yes, I am indeed calling the taming of the beast these years have evolved into a “career” – I have painted a two dimensional piece, whether it be a Monet, a Picasso, or an unintelligible charcoal-smeared creation.  The point is, these pictures are flat.  For the last eleven or twelve years, I have relied oh-so-heavily on the powers of psychiatric medication.  I was once again recently hospitalized for bipolar symptoms, and during a visit with my mother following a highly frustrating and disappointing meeting with my inpatient psychiatrist, we made a list of the treatment options I had tried thus far.  First came the list of medications – lithium, depakote, risperdal, lamictal, clozapine, haldol, trilafon, thorazine – the list is endless, and nearly so.  We calculated an approximate trial of 20 to 25 different medications I had endured over the past years.  Next we tracked treatments I had undergone, including naturopathy, acupuncture, electroconvulsive therapy, and twelve inpatient hospital stays.  Is it time to paint a Van Gogh?

The use of psychiatric medication has drastically altered my life.  In fact, I can confidently say it has saved my life.  But then, what is left over?  There is only so much a psychotropic drug can do in the recovery of a person with mental illness.  It propels the car down the interstate, but there must be another driving force to push pass the border.  There must be more to the picture.  Effective coping skills.  Do not undermine the power of the mind to alter a mood state, thought pattern, or to deescalate a crisis through the implementation of learned skills and behavior modifications.  My greatest experience with learning and engaging in coping skills has been through Dialectical Behavior Therapy practice.  I have had much interaction with DBT, mostly beginning with the three week completion of an intensive outpatient program.  For three weeks – three weeks! – I ate, breathed, and slept DBT.  Yet I did not implement the principles into my life – mindfulness, acknowledgment and acceptance of painful emotions, distress tolerance, emotion regulation.  The invaluable things I learned in this program could have served to begin to possibly alter my art into three-dimensional pieces, had I been doubly persistent.

I also received intensive DBT exposure and training in the four hospitalizations I have experienced in this past hospital.  Our days were centered upon groups led explicitly in the informative and practical application of DBT principles.  Yet, I come home and once again fail to implement them into my life.  A few days ago, I came upon my medical records of my hospital stays at UCLA and documentation with the Department of Mental Health in Los Angeles.  I was shocked, disturbed, and distressed reading through the records, realizing how long and arduous a road this has been.  Medication after medication, unsustained improvement.  I suddenly realized that these medications are getting me only so far.  I must begin to exercise my inherent powers to alter my life, use my mind, thought processes, and cognitive abilities to effect change.  It is the only way I will cross the border and enter the adjoining state without disregarding or disparaging the gas the psych medications have fed me.  There is a possibility to work to control my neuroses and obsessions, to combat my suicidal urges, and to attack and smack down the thoughts of self harm and punishment that often plague my mind.

I am slowly working through the practice of these skills.  It is a process – an extremely slow process – to effectively learn and implement them, but I believe they are as valuable as my psych medications.  Perhaps in the future I will be able to exclaim the power of my mind and thought processes in their imperative role in the dismantling of the current and historical blockade inhibiting my path to recovery and the rescuing of my life.  No more Renoir.  Shall I try a Michelangelo?

Broken Lamps and Escorts

As you know from previous posts, I have struggled with mental illness most of my life.  I have had periods of ups and downs and in-betweens.  Since December 2012, struggles have greatly arisen, coming to head and persisting, and the last year and a half of my life has been quite a fight.  As I sit here tonight, I cannot help but recall “what started it all.”  My mind is ruminating and perseverating, and perhaps sharing the story will quiet my thoughts.

Finals had just ended.  A couple of days before I had knocked my ceramic lamp from the end table, shattering it, jagged pieces splayed everywhere across the wood floor.  I was tired, too tired to make any attempt to clean, and haphazardly brushed the pieces to the side.  Over the course of the term, I had been deteriorating – and quickly.  I was forced to leave my volunteer position at the campus Women’s Resource Center due to my declining state, and I barely completed my classes.  With the completion of finals I felt a sense of relief, but also a sense of trepidation.  School had given me purpose, something to consistently strive for and look forward to.  Finals had removed all of what had been keeping me going.  A night or two after I broke the ceramic lamp – which I never cleaned up – the jagged pieces began to look enticing.  I had cut before, but it had been over a year and a half since I had done so.  I made several shallow cuts on my leg and then the next one was deeper, into the fat.  I was shocked and panicked.  There was blood, and I grabbed the first item – a shirt – to staunch the flow.  I ran into the hallway of the dorm to find my neighbor, and of luck, she was there, just returning from walking her dog.  She calmed my hysterics, patched me up, and she and I and two other residents sat in the hall for over an hour chatting and conversing, which worked to calm my raging moods.

Bandaged up, I spent the next day or two going through the motions, but still deteriorating quickly.  About two nights later, I cracked.  It was late, and I went to my neighbor’s room and pled for help, for something to relieve the pain.  We decided to call the Campus Police and let them know we had a psychiatric crisis.  They were going to call an ambulance, but I adamantly insisted that I be driven in the police car to the hospital.  The idea of riding in an ambulance was quite terrifying at the moment.  They conceded and agreed to come to the dorm and get me.  I returned to my apartment to grab my belongings and began to check the level of water in my cat’s bowl, whether the burners were off on the stove, etc. until my neighbor gently ushered me out, interrupting my obsessive behavior.

The Campus Police arrived, wearing purple latex gloves.  At the time I could not comprehend why they would don gloves, but later thinking enlightened me that that they really had no idea what sort of situation they were stepping into.  They searched my bag and led me to the police car.  Once in the car came the questions . . . height, hair color, etc.  The other officer took a statement from my neighbor.  “Wanna talk about it?” the officer asked, and all I could do was shake my head no.

I was driven to the OHSU Emergency Department and walked in – no, was escorted in – by the two officers as the entire waiting room watched.  I cowered in humiliation.  Luckily I was taken back immediately.  I was searched for sharp items or other potentially harmful items and led to a room furnished with a mat on the floor, stuffed chairs, and complete with a camera.  My clothes and belongings were confiscated, and I donned paper scrubs.  I spent the first several hours crying uncontrollably and speaking intermittently with psychiatrists, pharmacy techs, and lab assistants.  Once the decision was made for admission to the psychiatric ward, I finally collapsed into sleep.  I was awoken early in the morning, only several hours after finally succumbing to sleep, to be informed I was being transferred to another psychiatric hospital in the area called Cedar Hills.  They wrapped me in a blanket, protecting me from the chilly December weather, and escorted me to a police-type car and drove me to the facility.  Upon arrival I immediately began intake, which involved – in all humility – stripping down to nothing more than my skin to check for and document marks and scars.  So began my journey, my revolving door, of the psych hospitalizations I have been experiencing for the past year and a half.

I earnestly wish I could say I have improved from this point, but four more hospitalizations and 38 ECTs contradict this notion.  I want so badly to get better – to be well – but the struggle is unrelenting.  I am continuing to fight; I am committed to fight, and I vow, with difficulty, to not give up.  There are bright days interspersed with the dark ones, and I pray for the arrival and multiplication of these days. I believe that sharing stories is important because not only is it cathartic and empowering, it raises awareness of mental illness and the experiences of those afflicted.  Stories should not be hidden and shrouded, shameful tales, but rather used as mechanisms of education.  If there is anything I can hope to do in my life, it is to share my story, educate others, and raise awareness.  Hiding mental illness hurts the sufferer, yes, but it also hurts society, as it loses a vital component that provides betterment and a strong bolster to the infrastructure of our social fabric.