On Thursday morning, my bags are packed, and I’m ready to go to the psychiatric hospital.
I haven’t slept much. I’ve looked though the timetable of mandatory activities for inpatients, and they mostly look okay, but I’m terrified they’re going to make us do some kind of interpretive dance workshop where we pretend to be trees. (My anxieties are apparently very specific.) When it occurs to me that I’ll probably have to share a bathroom, I almost change my mind completely.
I’m desperate, but I also feel centered. I’m out of control to the point where I can’t see any option other than being in a hospital, being supervised, kept safe, forced into a routine that will pry me out of bed…and there’s a strange kind of peace in that. I have total conviction that no matter how frightened and averse I feel to doing this, doing this is the only choice and so I have to get through it. The anxiety is muted beneath a full-body sense of deadly calm. Dissociation, probably.
Things on Thursday don’t go smoothly. Based on my experience, the admissions department is run by six Beagle puppies and a dead tarantula, and their process is something like this:
The first hurdle: the day before, the psychiatrist from the emergency room decided I was “resistant” to being admitted because I said that I hadn’t made a final decision yet, and so he elected not to send my discharge papers over; I can’t be admitted without them. (I find this out from my boss, who’s rearranged meetings to drive me to the hospital and is angry with me for screwing up the process. I tell him I don’t want his help if he’s going to be like that, and hang up (angry, sad, sobbing: I didn’t do anything wrong, I don’t understand why the ER psychiatrists always treat me like I’m so difficult, I’m not, it’s not fair)).
The second hurdle: once I’ve dealt with the paperwork nonsense, the hospital changes their mind, and decides I have to be assessed by Psychiatrist #11 before they’ll take me. (I’ve seen him twice before, to get a referral for DBT.) I’m so phone phobic and overwhelmed I have to burn myself to gather the courage to make the call, and he won’t discuss it over the phone, so I have to make a ($400) appointment to see him the next day.
The needy, clingy part of me wins over the guilt and shame: I want Nikki to know where things are, what the plan is. I want to feel that she’s keeping track of me, keeping me tethered, contained, watching and ready to step in. I don’t want to do this on my own.
So I text her, and tell her her I have an appointment, and ask if she’ll be in her office (only a couple of minutes walk from the psychiatrist) afterwards. I can be; no, don’t come in specially, just thinking about a safety plan if things go badly; okay, but call me from his office as soon as you’re done.
She ends her last message with ‘Night‘, and I’m stung; I know how to judge when a conversation’s over. I wouldn’t have replied anyway; you don’t have to push me away.
It isn’t until afterwards that I think: What? I’m making a safety plan?
At the third hurdle, I fall.
I fuck up. I sleep in, and wake up one minute before my appointment. I can’t go without showering, I can’t leave the house if I’m not clean, so our appointment is cut down from 45 minutes to 15.
There are ligature marks around my neck; I choked myself the night before, too many worries, too much despair and anger to sleep. I tell him about the overdose, the cutting, the burning, that I feel out of control.
In a voice that tells me it’s a decision and not a discussion, he says that he thinks being admitted will make me worse, and everything goes numb. I’m somewhere very far outside of my body.
Okay; why do you think it will make me worse?
Because I’ve worked with a lot of people with your kind of issues, and based on my experience, I think it will make you worse.
I don’t cry yet. I feel like I’ve just been told that someone I love is dead, and I know that I’m devastated, but it still feels unreal. I nod blankly when he tells me to come back on Monday, and to call tomorrow morning to make an appointment once I’ve decided whether or not I’ll be going to work that day (no, he won’t give me a morning or evening appointment unless I’m sure I really need one, those are sought after and if I’m not going to go to work anyway then I should come during the day, call once you’ve decided – because, evidently, on Saturday by 12pm I will know whether or not I’ll be able to get out of bed on Monday).
I hate him, and I hate myself more.
As promised, I call Nikki. I tell her that he won’t admit me, and she’s frustrated (Oh, you’re kidding!), and immediately responsive.
(Do you want me to come?
I don’t know.
I’ll jump in the car now. I can be there in 10. Okay?
A long pause. I feel completely devastated. I don’t think I can talk. I don’t really have the money for another session. I didn’t bring a cigarette lighter, so I can’t hurt myself enough to make me coherent. But what’s the alternative? I can’t just go home.
Less than 10 minutes in to my explanation of what happened, I’m crying. Raw.
I don’t know what I’m supposed to do.
I don’t think I can keep myself alive if I go home. The private hospital won’t take me; the psychiatrist dismissed me, cavalierly (I’ve lived this long without being admitted, and I’m not somebody who can be helped, anyway; probably just looking for attention, best not to indulge that sort of thing). The emergency department thinks I’m difficult, one of those patients.
How? I don’t understand what’s so wrong with me that they can look at me bleeding and bruised and poisoned and choking, drowning, asking for help, and turn me away. Make me feel bad for asking.
I was going to do the yoga class and focus on mindfulness and talk in group about practicing coping skills. Carol and Megan were going to visit and Chiara was going to look after my cats. I don’t understand. How could that make me worse? How can I be any worse?
Nikki suggests we make a list of options of what to do. Yes. Okay. That makes sense. Option one is to try again to find another hospital that will take me; option two is to do nothing in response to the immediate risk, to continue seeing her once or twice a week (once? why once? why are you saying once?), keep doing DBT and keep seeing Psychiatrist #11.
And then the conversation derails; what do you want in terms of therapeutic stuff, as in ongoing therapy in the long term? Would you rather go forward seeing a psychiatrist for psychotherapy instead, maybe Psychiatrist #11?
(Okay, okay, she’s just asking, it’s the wrong question to be asking right now, the wrong thing to be discussing right now, but it doesn’t mean anything, she’s just asking, giving you options. Oh god, it hurts that she’s asking. I feel sick.)
No, I tell her. I like that he’s direct, and I can have intellectual conversations with him, but he’s not somebody that I would be able to share anything emotional with.
And then she starts pushing. Maybe that’s just about building trust, maybe I should see him once a week and her once a week, once you establish a connection she’s heard he’s really good, and really, can you share emotional stuff here either? She’s not just giving me options any more; she’s pushing me away.
And then she’s talking about her maternity leave, and how she’s going to have to separate, and she’s not going to be able to be the crisis person, and she’s not supposed to be the crisis person anyway, so there’s going to be have to be a line. She wants me to have someone else while she’s gone, she’s nervous about me taking a break from therapy.
I don’t understand why she’s talking about this when we only have an hour to figure out some kind of plan; if we don’t figure out what’s going to happen right now, today, then I won’t be alive while you’re on maternity leave, so it isn’t going to matter. There’s a rhythmic swooshing sound in my ears. I feel dizzy, fuzzy, far away; my head drops backwards sharply, suddenly too heavy to hold up, before I catch myself, pull myself back upright.
This is not the time for you to panic about boundaries, Nikki. You can panic later. Don’t do this to me right now. Please. Don’t do this today.
It’s not like she’s suddenly cold and distant. She spends two hours with me; when I completely shut down and we’re stuck in silence, she convinces me to come for a walk with her and buy some lunch. (She gets a salad, and I get the world’s grossest smoothie which turns out to have bee pollen in it. Bee pollen. Why?).
It’s still clear she cares about me, is still drawn to care for me.
(I feel like I should have come with you [to the psychiatrist] today.
I don’t want you to sit for any more hours in that shitty hospital. I don’t want you to feel any more pain. This is so ridiculous to say, isn’t it? But just know. Just know.
If I could do the maternal thing, and drive you there, and set it all up, and settle you in, tuck you up in a nice clinical bed with some lovely matronly staff, then I bloody would, but I can’t.)
But I’m a client and she’s my therapist, and All I can really say to you is come and see me on Tuesday.
It’s a death blow. A hammer to my chest. I’m not going to make it until Tuesday.
I don’t want you to be going away from here today feeling like you’re completely alone and unsupported and lost, she says, but it’s exactly how I feel. I am alone. I’m going home, alone, and the only person who’s going to save me is me. That’s right, that’s the way it’s supposed to be, but it’s hard to reconcile that she’s going to leave me to die because she needs to move her car, and because tomorrow isn’t a work day. Three days ago she was driving me to the hospital; two days ago she was bringing me food and clothes. If she hadn’t, then being sent away now wouldn’t feel so bad. It would be normal, expected (though really, she should be calling the police, or an ambulance; at this level of risk, no therapist should just let me leave).
But I’ve had a taste of feeling like I matter. And being a client, with the expectation that I’m on my own until our next session, is crushing me.
I’m partway home when the obvious solution comes to me; I’ll fly home and stay with my brother, C. I’m safe with him.
It’s incredible, the shift. In the space of a second, I’m no longer at risk. I still feel terrible, but I have a way forward.
Half an hour after I leave, Nikki texts me, tells me she’ll call me after she’s spoken to Psychiatrist #11, okay? I don’t reply. I’ve shifted states completely, from vulnerable and desperate to completely self-contained. Nikki feels like a stranger, not so much intrusive as just irrelevant. I’m not trying to make her worry, but I don’t feel any connection to her, and I don’t care if she is worried, don’t feel any impulse to make sure she’s reassured. (There is anger under there; I hear it now.) Any way I respond will have layers of meaning, then Nikki’s reply will impact me, and I want to stay an island.
Twenty minutes later, she texts again, says she’s really concerned, she’ll have to call the crisis team unless I contact her within an hour and commit to staying safe until our next session on Tuesday. I don’t reply.
When the hour is up, she calls, to check in, she says in her voice message. I don’t pick up.
Three hours after that, she texts a third time, lets me know she only spoke with the psychiatrist briefly, that she wants me to catch up with a friend tonight, and she wants to touch base on Monday to make sure I’m okay; take care. I read it and I think: Why is she assuming that I’m still alive?
Saturday morning she texts a final time to remind me to call the psychiatrist and make an appointment for Monday; she hopes my Saturday is going better than my Friday!!; talk on Monday. All I feel is aversion. No warmth knowing that she’s thinking of me. No urge to reply.
Tomorrow, she’s going to call, and I don’t know what I’m going to do.
I don’t want to ignore her, to sit with the discomfort of behaving against my values, and be stuck with knowing that we’ll have to mend a rift next time I see her.
I don’t want to talk to her. I want to protect myself from disruption; it’s too dangerous, I’m feeling more contained, and I can’t risk having feelings right now. I’m in a safe bubble, here with C, and I don’t want her touching it.
I don’t want to tell her I don’t want to talk to her, and have her respect that and back off. I think that might kill me.
Ideally, I want her to just stop existing for a week. Maybe two. She can exist again when I’m ready. But right now, I’m not.