Imagine this: you get up on Monday and reluctantly go to work. As the day goes on you go from bad to worse and by 7 p.m. you're on a gurney in a hospital emergency room waiting to be admitted to a locked psychiatry ward where you'll stay for the next week. You'll lose most of your freedom along with your dental floss, which they lock up so you can't cut yourself with it.
Twenty years ago I had a bout of major depression. It dragged on endlessly for months while a psychiatrist prescribed a series of medications from the limited arsenal available then. One finally took hold, an anti-depressant called Nardil. After a few weeks on it, the hopelessness and despair went away, literallly overnight. A second depression hit a few years later but then relative calm settled in for many years. I was not free from depression, but it wasn't severe. Until last year (2005).
I went to my current psychiatrist after suffering a high blood pressure episode brought on by eating aged cheese, a dangerous combination with my anti-depressant. I wanted to change my medication and although he recommended against it, he agreed to help me. After tapering down and then stopping the Nardil, depression hit within two days. By day five it was so bad that there seemed no choice but to go back on it, which I did and was better within a few days. I assumed everything would be like it had been before, but was wrong. The next month, in the space of only a few hours, I became close to catatonic. I could barely speak or walk, but I could understand and interestingly, I wasn't terribly depressed. I didn't even have the energy for that. This event lasted for a day and a half then disappeared almost as quickly as it had arrived, which it continued to do every few weeks over the following months.
The sudden onset and rapid cessation of these episodes, along with some other symptoms led my psychiatrist to diagnosis me with Bipolar II disorder. Unlike Bipolar I (what most people think of as "manic depression") which is notable for its extreme mania, Bipolar II has what is called hypomania, often characterized by elation or hyperactivity. Anger is another way hypomania is expressed and unfortunately this is usually what happens to me. I go into a rage, screaming and throwing things. Once I broke a kitchen cabinet.
That fateful Monday followed a horrible weekend where I was consumed by depression and fixated on suicide. For the first time I not only wished for death but planned how to do it. When I told my psychiatrist, he asked me whether I really meant it. I couldn't say no. He asked if I would agree to go to the hospital. I didn't know what to say but somehow I finally said yes. I know now that I had no choice and that my psychiatrist let me decide on my own before he made the decision for me. I'm grateful for that. He called Phillip who came with clothes, toiletries and a look that combined fear, worry and caring. As we drove out of the parking lot my psychiatrist walked outside to his car, and all I could think was that he was going home and I was going to a psychiatric ward.
Aside from a half-hour with a crisis counselor and a couple of chaperoned trips to the bathroom, I spent six hours on that gurney in the hallway of the emergency room (except for the single psych ward, this was a medical hospital). Phillip and I talked during this time, and he gently and carefully explained how bereft he would be if I were to take my own life. His feelings reached and I started to believe that I had to stay, for him, and for the other people I loved. I sent him home at midnight, after they told us it wouldn't be too much longer. A woman in hospital scrubs took his place and sat with me for the next two hours while I continued to wait. She never said a word except to scold me when I threw my pillow down the hall.
They took me upstairs at 2am. The quiet after the emergency room hallway was a relief. The nurses asked me some questions, they weighed and measured me, and they calmed and reassured me. When we were done, they took me to my room and gave me a sleeping pill and a mild tranquilizer. I got into my dormitory-style bed, missing my husband, missing my dogs, wondering who the woman in the other bed was. I was depressed, anxious, but mostly stunned. I slept most of the entire next day.
One very unusual thing about the psych ward is that they lock up your dental floss and hair dryer but allow you to keep sneakers in your room. Certainly sneaker laces could inflict just as much harm as dental floss or a hair dryer cord? Not only do they lock up your possessions, but they go through the drawers in your room each day. They examine the contents of your visitors' bags but not always that well because one day Phillip managed to sneak in my laptop. The utensils are plastic and the pictures are caulked onto the wall to prevent, I guess, suicide by art.
I woke up most days in a panic about being there. My depression eased over the week, but the confinement had caused a whole new agony. Almost every day I played a game in my head, imagining that I could convince them to let me go home early, but knowing that it wouldn't happen. When the game was over, I went to my room in frustration where I would close the door and cry. My roommate asked what was wrong to which I could only say, over and over, "I want to go home."
We had two group sessions each day. They were optional but strongly encouraged. Most revolved around the stress in our lives and how we could reduce it. I don't remember much of what we discussed, but it wasn't very helpful for me. I wanted and needed to talk about how horrible it had been to plan my own death. Instead I got the Bob Newhart show. We had an hour of recreation in the afternoon where we could use one of three exercise bikes or glue shells to pieces of wood (I chose the former.)
I made several friends by the second day, joining a group of four other women at meals. Our moods varied from day to day, sometimes from meal to meal, but there were always a couple of us doing well and we'd support the others. Two had been there before after suffering post-partum depression. Both were back because they decided they no longer needed anti-depressants. Let that be a lesson. I also got to know a funny and thoughtful man who had also contemplated suicide but was now more concerned about how he would tell his 13-year old son why Dad had been in the hospital.
Visiting hours were from 6 to 8pm on weekdays and 2 to 8pm on the weekend. Phillip spent every minute with me. Without this precious time together, I don't know how I could have made it through the week. Nothing was scheduled for us on weekends so those six hours really meant a lot. On Sunday the husband of one of my friends there brought a cake for Phillip. It was his 50th birthday.
By far the strangest and most ironic thing about the psych ward is the fact that no one asks for help or reports anything wrong to the staff. The only goal is to get out, and to mention side effects or unhappiness is to risk being given extra days by the psychiatrists and nurses who control your fate. We imagined a point system where you needed a certain number of points to get out. Points were gained for going to group therapy, chatting with the nurses, laughing. You lost points for crying, being angry, sleeping too much, or being negative. Hence the goal was to tell and show them what they wanted to hear. One day I started to hear an echo that no one else did, and noticed during the group meeting that everyone's voices were out of synch with their mouths, like a soundtrack that's a few seconds behind the movie. I thought it was pretty weird but figured it was just a temporary side effect of the new drug I was taking. In any case, I had absolutely no intention of telling anyone about it.
Each day we saw a psychiatrist who was assigned to us. Mine had the reputation as a superb psychopharmacologist, and although he was a pleasant man, his bedside manner left a bit to be desired. He met with his patients on one of the couches in the hall, where anyone could (and did) listen to the conversation. As my only goal was to be released, I was a fountain of good news everytime we talked. I missed my own psychiatrist but their involvement is limited to speaking with the hospital psychiatrist.
Most of my fellow patients were ordinary people, with a few exceptions of course. They ranged in age from 19 to over 70. The youngest, a petite girl who changed her clothes several times a day, had a temper tantrum her first evening. We all watched nervously as they led her into the "quiet" room, then listened to her scream and throw herself against the padded wall. They called in the cavalry, three burly security guards who accompanied a nurse with a syringe to sedate her. Another woman on the ward told us that she didn't work and did nothing day at home but watch TV and play on the computer. Her arms were covered with scars and healing wounds which looked like cigarette burns. Ironically, despite my earlier plan to commit suicide, I couldn't imagine how anyone could hurt themselves like she had. Another woman who was ate with us was in the hospital for ECT. No medication had significantly helped her depression and this was her last shot at health. When they wheeled her back to the ward after her fourth treatment, she had a big smile on her face. It was a thrilling sight.
The phone was our link to the outside world. There were two pay phones, located right next to each other in the hall where a TV blared most of the day. Phillip brought me a phone card with 900 minutes on it. I used over 300 during that week, five hours hunched in the corner, a finger in one ear to block the TV noise, talking to Phillip, to my sister, and to my friend Rita, a nurse trained in psychiatry who understood what I was going through. And each night I called my 88-year old father on Phillip's cell phone (also illegal) , who lived in a nursing on the west coast. The fact of my hospitalization could have done him in, so I never told him where I was, and tried to sound happy as we talked each evening. "What did you do today?" he'd ask. "Not much," I'd reply, truthfully.
One week after that fateful Monday I met with my psychiatrist on the couch in the hallway. He had been away for four days and I felt a lot better. I didn't think he would let me leave that day, but I was determined to make my best effort. So I told him how well I felt, how free of side effects I had been (putting aside that little matter of the echo, which, by the way, was short-lived) and why I should go home that day. Amazingly he agreed. Freedom was mine. I gave a thumbs up to my friends, then felt a huge surge of guilt for abandoning them.
Did my week in the psych ward help me? It did relieve my depression and allowed me to get to a therapeutic level of lithium quickly instead of having to build up to it. My suicidal thoughts dissipated in the emergency room as I revealed them to my husband. Phillip and I became closer than ever. He was my rock and I couldn't have made it through without him. I met some wonderful people and learned that I was not alone in my illness. The comfort we gave each other by our mere presence was more effective than all the pills we swallowed. My family rallied around me and provided nothing but support. But I am still reeling from the experience. The isolation and removal from the "real world" certainly contributed to my recovery, but that and the loss of control were terribly difficult to bear. It was an experience I hope never to relive. Given the nature of this illness, however, I can't be sure of it.
email (remove spaces) p s y c h @ l a u r i e k r a m e r