My Night in the Psych Unit Part 2

***Trigger Warnings*** This post discusses self-injury, cutting, suicidal ideation, and time spent in a psychiatric unit, reader beware

Disclaimer from yesterday's post:

[As mention in previous blog (link here), I had an experience with my OCD and OCD meds in 2014 that led to my spending one night in the psych unit at Yale-New Haven Hospital in New Haven, CT. Before I begin this story, I want to acknowledge that my experience is personal and I do not intend to generalize the experiences of individuals who may also have spent time in a locked unit due to mental illness. I also want to recognize that this post may be triggering to those who have personal experiences, direct or indirect with mental illness, psychiatriac hospitals, and involuntary commitments. I want to make clear that I sought treatment myself and made a conscious decision to spend the night in the psych unit because I felt I was a threat to myself. Working in the mental health field for several years, I know that my experience was more independent and person-driven than others' experiences and I want to acknowledge how unique my experience was. That being said, let's start at the beginning.]

 

 

I wrote down my uncle's phone number since I knew my phone would be confiscated and told him I would call when I was discharged. He hugged me and I held back tears, trying to put on a brave face. I headed to the locked psych unit, a place I had referred so many clients and families before and even called EMS for actively suicidal clients in session. Two officers escorted me to the locked unit and asked if I had ever been through this before. I answered, sheepishly, "No, but I'm a therapist, so I think I somewhat know the drill." They confiscated my phone, hoodie (because of the drawstrings), and my shoes. I was given hospital slipper socks with grips on the bottom and a stack of magazines. The psych unit was so crowded that evening, I was sequestered to a stretcher in the hallway. My leg cuts at this point had dried over the cut up sock I used as a makeshift bandage before I left my grandmother's house. I asked several times for someone to give me supplies to clean my cuts, but it took hours before someone came to cut the blood-dried sock-bandage off my legs and clean me up. I knew I didn't need stitches. 

 

 

 

My cutting was rarely deep, but always sporadic and spastic. I cut fast and non-discriminately, although somewhat discriminate since I only cut places that would be easy to cover up. For me, cutting was more about the pain after. The cutting itself was a means to an end. Cutting was a punishment. Days and sometimes weeks later, my cuts would still ache. I cut myself the most when I was a daycare teacher, because I was in a very abusive and controlling relationship, living hours from my family without a vehicle. When I cut my thighs, days later I would squat down to tend to one of my toddlers and I would feel the sharp, burning sting of the cut stretching over my thigh. It was a painful reminder that I deserved to feel hurt and punished.

 

 

 

While I waited, the hours ticked by. I estimated I arrived at the hospital around 6pm and by 11pm, I still hadn't been evaluated by a doctor. There was a young man, maybe around 19 or 20 years old, in a bay with a closed curtain. He was talking and laughing and screaming, carrying on whole conversations for which I was only hearing one side-the side being in his mind. A nurse checked on him often and the young man asked to leave. The nurse informed him his family was concerned about him and he was on a mandatory 72 hour hold (in North Carolina we call that an IVC-involuntary commitment). The nurse informed him he had threatened to harm his grandmother and then himself. The nurse spoke with familiarity and I imagined she knew this patient well. Overhearing this encounter made me feel selfish and privileged to have chosen to come to the hospital. Was this a pathetic excuse to escape my responsibilities? Was I really a threat to myself? Why was I here? The thought You're not crazy if you're afraid you're crazy kept repeating. 

 

 

 

I hadn't emoted in any way, shape or form for hours. I absentmindedly leafed through magazines. After midnight, a doctor finally spoke to me and asked me why I was there. I told him about the self-injury and the fear of hurting myself again. In a monotonous tone I stated "I'm afraid the children I counsel are going to die and if they do, I'll kill myself." The doctor stated he wanted me to move to the crisis unit for the night and be reevaluated in the morning. Even though there was nothing physically wrong with me, I was transported by wheelchair down several hallways and rode on a number of elevators. I remember laying in the room I shared with another individual in a psych crisis and wondering How did I get here...how did it come to this? My dog, Chrissy, had died the previous year and from time to time I would swear I could feel her physical presence on the bed with me, typically at times I was distraught. I hadn't felt her presence in a while, although looking back it's possible her spirit tried, but I was too numbed with alcohol and food to feel it. That night, I promise you, I felt Chrissy's spirit on the hospital bed with me. I felt her body snuggled against my back in the same way she did when she was alive. I felt her warmth and I felt comforted. 

 

 

 

I drifted off to sleep and when I woke up, I ate breakfast that was delivered to my room. I hadn't had my medication yet, because, as the nurse reported, "I think the doctor is going to make some changes." Mid-morning I wandered down the hallway to what appeared to be a vacant conference room and found some coloring pages and broken crayons. I busied myself with that for a while until the doctor was ready to speak with me. The mere question, "So, what's going on?" was all I needed to completely break down for the first time not only since I had been in the hospital, but in months. I began sobbing as I explained the unreasonable demands of my job, my anxiety over something happening to my students, my decision to kill myself should something irreparable happen to them. I cried so hard I hyperventilated as if I was remembering how to cry. The doctor was very kind and compassionate, although stated the obvious "You can't keep on like this, you'e too hard on yourself, you're putting too much pressure on yourself" all the things I have heard my entire life. But, for some reason, it resonated with me that morning. I was expecting and hoping for the doctor to write me a letter saying I couldn't return to work-ever. I was looking for someone else to take on the responsibility of making that decision for me. 

 

 

 

After I let out everything I had held in for months, I immediately became aware and knew what I needed to do. Being a problem-solver has always come easy to me and in an instant I knew what I had to do. The doctor cleared me to go home and increased my Prozac to 80 mg daily. I called my uncle and he stated he would be able to pick me up after 3pm. I ate lunch in the hospital bed and napped some more until it was time to leave. With a clear head, I asked my uncle if I could spend the next couple nights at his house, understanding part of my depression and anxiety was the living environment I was in. I also called my boss (my mother had called him earlier that morning and told him I was in the hospital with stomach pain at my request) and asked if we could meet on Monday so I could discuss with him what's going on with me. He was supportive and obliging. I took two weeks off and shared with my boss (in so many words) that I was having serious mental health reactions to the work load and I needed to take all the PTO I had saved, effective immediately. I also advocated and stated before I returned to work, I needed to return with help. That the job I was doing was unmanageable for one person. Interestingly enough, it took less than 2 weeks to find additional help, even though I had been asking for 4 months.

 

 

My Night in the Psych Unit Part 1

***Trigger Warnings*** This post discusses self-injury, cutting, suicidal ideation, and time spent in a psychiatric unit, reader beware

As mention in previous blog, I had an experience with my OCD and OCD meds in 2014 that led to my spending one night in the psych unit at Yale-New Haven Hospital in New Haven, CT. Before I begin this story, I want to acknowledge that my experience is personal and I do not intend to generalize the experiences of individuals who may also have spent time in a locked unit due to mental illness. I also want to recognize that this post may be triggering to those who have personal experiences, direct or indirect with mental illness, psychiatriac hospitals, and involuntary commitments. I want to make clear that I sought treatment myself and made a conscious decision to spend the night in the psych unit because I felt I was a threat to myself. Working in the mental health field for several years, I know that my experience was more independent and person-driven than others' experiences and I want to acknowledge how unique my experience was. That being said, let's start at the beginning. 

 

 

I mentioned in my previous post, that I was officially diagnosed with OCD in 2012 and was treated with Prozac. By Fall 2013, I was on 60 mg of Prozac a day, but also going through a break up, moving back in with my grandmother (with whom I had/have a contentious relationship), and transitioning to working full time as a school counselor in Bridgeport, CT for two Catholic schools. By November 2013, I already felt I was drowning and attempted to be proactive and inform my clinical supervisor. Because I worked in a depressed area with little funds, I was informed there wasn't enough money in the budget to hire the extra counselors I needed to help offset the weekly influx of new students I was assessing for high risk situations, including domestic violence, child abuse/neglect, suicidal ideation, and self-injury. Each week, I was flooded with dozens more students to meet with and assess, all of whom would qualify as high risk and all of whom I was supposed to be coordinating with the Catholic Charities clinic for follow up therapy. Herein lies the problem, the majority of my students were Latinx and Carribbean, two cultures that historically do not feel comfortable seeking counseling, especially not for their children for fear of Department of Children & Families (DCF) involvement, as well as Immigration. In addition, most of the families did not have the means or ability to drive their kids to and from counseling several days a week. It was more convenient and most trusted for the children to see me in their school. So, that's what I did. To my own demise.

 

 

By Christmas break, I was more than burnt out. I was drinking a bottle of wine and binge eating daily all in an effort to fall alseep and escape reality. I would sleep until 2pm on the weekends, eat "breakfast" and go back to sleep. I dreaded work, but worse than that, I dreaded not being at work as I began to feel overly responsible for everyone's well-being and safety. The Friday before Christmas break, I had barely walked in my front door when the prinicipal of the school called to say I should check my work voicemail. An irate parent had left a threatening message in regards to my reporting her actions THAT SHE REPORTED TO ME to DCF. In this voicemail, she threatened to kill me so I felt compelled to save the voice message. Somehow, I still felt "okay" and "in control" of the mounting pressure and debilitating stress. When I returned from Christmas break, I was met with the same unreasonable demands, high risks check ins, and no aid from the mental health clinic I was contracted through. My cancelling weekly supervision with my clinical director due to the overwhelm of high risk families and children should have been an indicator I was drowning. That and the fact that I was actually drowning!

 

 

The following 2 months after returning from Christmas break, things went from bad to worse. I was often at the school from 6:30am to 5pm facilitating calls to DCF and STILL making mandated reporter calls on my hour-long commute home. While this didn't happen everyday, it happened often enough that I was beginning to unravel mentally. In the past, I had struggled with self-harm and I was beginning to have thoughts of self-harm again, for the first time in years. I was on 60 mg a day of Prozac, but often felt emotionally muted and commented that I was unable to emote appropriately to the stress that was happening to me. I was numbing myself with medication, food, and alcohol. 

By February 2014, my only escape was sleeping. I slept all weekend and my grandmother didn't understand or approve of my sleeping the weekend away. Even though I was 32 years old, working full time (and then some), paying rent, and attending to all my other adult responsibilities, my grandmother would come into my room (her reason for "barging in" was "it's my house, so this is my room") and demand I get up. Her reason? "I don't like it. I don't like that you sleep all day." My response was: "I'm depressed." But, after some time, sleep wasn't an escape any longer and the tiny "office" I shared with the school nurse, that wasn't heated (in February...in Connecticut) seemed to be getting smaller and smaller. My world was closing in around me. Everyday, my kids (students) were having crises and I was only one person and I couldn't fix everything. I was constantly afraid of my 8th grade girls killing themselves or my 6th grade boys assaulting another student and somehow it would be: ALL MY FAULT. 

 

 

"All my fault" is classic OCD symptomology. Feeling the full weight of real or perceived responsibility is a crushing obsession to hold onto everyday. Even more crushing is asking for help and being told "there is none." Thinking about something traumatic or tragic happening to one of my students "under my watch" made me so anxious and depressed, I began to concede to this thought: "If one of my student's kills themselves, I'll kill myself. I won't be able to live with myself. So I'll go too." Once that thought became an option, it was somewhat easier to push on. 

On Wednesday February 26, 2014 I started the day like "normal", binging on Dunkin Donuts and coffee while listening to NPR on my way into work. I was still exhausted from the previous day and already exhausted from my upcoming day. Around 7:30am, one of my 8th grade girls came in with a crisis. She had been harming herself. More specifically cutting herself. Instantly I was triggered. I remember thinking "I'm going to cut myself when I get home today. I want to die." I barely held it together the remainder of the work day. I wrote my hours and hours of notes (by hand). I got in my car. I drove home, silent tears streaking my face, numb and powerless. I walked into the house and cut my legs up. I don't want to go too into detail about the self-injury itself because it can still be triggering for me, but I knew I wanted to do more and I knew I wouldn't be able to stop myself. And I scared myself bad. I called my uncle and calmly stated "I cut myself and I need to go to the hospital." He instinctively knew the cut was self-inflicted because when I climbed into his huge pick up truck, he said "Yale Psych?" and I replied "Yeah."

I approached the check in counter and stated "I cut myself. On purpose. And I feel like I'm going to do it again." 

Old, Cranky Douche (OCD)

A central theme to my writing has been discussion of my anxiety disorder, specifically my diagnosis with Obsessive-Compulsive Disorder (OCD). As I explore my anxiety disorder more and see just how far it reaches all aspects of my life, I am reminded that my OCD traits have actually impacted my personality. There is a mental health diagnosis called Obsessive-Compulsive Personality Disorder and while I do not meet the criteria for that, I can see where my OCD traits impact my sense of self, my relationships, and my daily life.

I cannot recall a time in my life when I didn't feel anxious, obsessive, compulsive, or generally worried at all times. That being said, my childhood was fairly typical. A child of the 80's and 90's, I enjoyed technology-free play including Barbies, bike riding and swimming in our above ground pool. I enjoyed reading and journaling and I remember from very early on that self-soothing and "creature comforts" have always been key in decreasing my anxiety. As a child, things were comforting. I had to have "my things" in order to feel safe, secure, and comfortable. At 37-years-old, I rely on these things the same way and often get teased about how much stuff I pack when on vacation.

My answer typically revolves around my need to feel comfortable. Knowing I have options and potential back up items for when I don't feel comfortable. These items may include certain articles of clothing, a stuffed animal, a book or journal, music or podcasts that I've listened to before. Repetitive and binging on things has always been a comfort to me. I binge watched TV before that was actually a phrase. I would rewatch TV shows and movies repeatedly because they were familiar and comforting. At a particularly low and lonely time in my life, the cast of the TV show How I Met Your Mother felt like my friends. I counted on them everyday to help me through the pain and obsessions I was enduring at that time.

I was officially diagnosed with OCD in September 2012. I had watched a disturbing horror movie, V/H/S, and had dealt with a 3 day long panic attack that resulted in me seeking medical attention from my primary care doctor, because I was certain there was something physically wrong with me. I had had anxiety and panic attacks before and had been medicated with Paxil, Wellbutrin, and Klonopin. But, this was different. My doctor promptly told me I was experiencing a panic attack and increased my dose of Wellbutrin as well as my Klonopin. However, after two weeks I began to develop strange mental obsessions and even stranger compulsions. I was so preoccupied with forgetting to lock the door before leaving the house that I would often turn around 3-4 times to check the door before heading out to work, only to still feel uneasy and "not right" about the door. My obsessive train of thought was as follows: "The lock isn't latched, the dogs and cat could get out, we live on a busy street, they will be killed, my girlfriend will never forgive AND IT WILL BE ALL MY FAULT." And it will be all my fault is the end conclusion for every obsessive/compulsive ritual, even to this day.

What eventually led to my diagnosis of OCD and being put on medication specifically for OCD was an obsession I developed about dying tragically in a car accident. My compulsion to, in theory, calm my obsession was to picture myself dying in a tragic car accident my entire 90 minute roundtrip commute to work. Every. Single. Day. My "OCD logic" being people who die tragically in a car accident never see it coming, so if I am thinking about it, it won't happen. Needless to say, the mental torture my OCD was forcing me to endure was terrible enough and after a few weeks of that I returned to my doctor who informed me the increased dose of Wellbutrin likely exacerbated my OCD symptoms and I was then treated with Prozac. Over the next 2 years, my dose of Prozac would increase to 80mg a day and left me feeling empty, unable to emote, and dead inside. (Stay tuned for an upcoming post about how horribly THAT went...)

Looking back, I realize I had OCD long before I was diagnosed at the age of 30. As a child, I had rituals that I performed that "made me feel better." I often said goodnight to every single stuffed animal and doll before I went to bed. Most kids do. For me, it was a compulsion aimed to quiet the obsession which was: If I don't say goodnight to every single one, they will come to life and kill me in my sleep. Pretty heavy for a small child, but that obsession is two-fold. 1) OCD can oftentimes be graphic, violent, and sexual for no apparent reason and 2) my tv viewing was generally unsupervised and I exposed myself to edited-for-tv horror movies at a young age. Other rituals included washing my body in the same order and pattern every time I showered (one I keep up with to this day), eating certain foods a certain way, and even playing in a certain way.

For example, every Saturday morning, I dragged my huge bag full of Barbies and clothes out to the living room and played while my brother and I watched Saturday morning cartoons. I did this every Saturday morning for years. Starting at age 11 (until I moved out at age 22), I spent just about every Friday night cleaning and rearranging the furniture in my room in an attempt to maximize the size of my room. My favorite thing was to stay up as late as possible on Friday night, cleaning, organizing, and arranging, so when I woke up the next morning I could "spend the entire weekend in my new, clean, fresh room."

My OCD symptoms and traits haven't always been negative. Because my OCD also manifests a compulsive need to please people, my organizational skills coupled with my need to be seen as useful and helpful makes me an amazing employee. I came to learn I would be an amazing employee to the detriment of every other relationship in my life because I was so mentally drained from "being on" all day at work, I had nothing to give to my significant other, family, or friends. This inspired research into self-care before self-care was the hashtag phenomenon it is now. The more my anxiety about being the "perfect employee" increased, the more time I felt compelled to spend caring for myself to avoid burn out. That left little time for anything else and I often felt stretched too thin.

I'm currently attempting to balance all the things I like about having OCD (the organization, I always know where everything is, I'm rarely late or miss an important day, I'm efficient and productive at work) with all the things I hate (the news scroll of looping thoughts, the random violent images that seem uncontrollable, the inner turmoil of feeling contaminated just by hearing the word "lice" [even typing it just now gave me pause], the mental exhaustion of not forgetting to do something important at work that could directly [or indirectly] impact a patient). It's not easy and it takes effort every single day. I don't ever get a break from my OCD, but sometimes I can filter out the loudest noise and manage what is left. Sometimes, I have no choice but to give in and allow it to consume me (within reason) because I don't have an energy left to fight.