When I Went Crazy: Day Care at the Psych Ward
By Dan Hoffman
Just as when I went to the ER, I felt a sense of relief when I decided to once and for all end it with my girlfriend, as painful as that was. Perhaps now I would move on, I thought. But it was not really a matter of moving on, I realized then and even more so now. It was an escape. I could no longer face the situation and I couldn’t decide what I wanted to do or where I wanted to be. But as they say, not making a decision is a decision, and in not making a decision I ended up living at home. It was only months later that I returned to all of this turmoil and confronted, head-on, everything that had happened.
At home I was forced to ask myself, now what? I started breaking down and panicking every two hours or so. I began to realize that another trip to the hospital was probably in order.
But my parents work in mental health (this is not surprising, really), and they knew that it probably wouldn’t do any good to take me to the ER because I wasn’t technically suicidal by industry standards – that is, I didn’t have specific plans and I wasn’t a hazard to myself or others, even if I thought about suicide constantly. Yes, the ER would take me – they have to take everyone – but I would be discharged in short order.
I learned about a program called “Alternatives,” where you spend six hours a day in the psych ward, Monday through Friday, sort of like public school. The idea is that it’s an “alternative” to in-patient treatment, but that is really a misnomer, because patients don’t really have a choice: if they’re suicidal or homicidal, they will be placed in in-patient. Otherwise, it’s “alternatives.” And even if you “opt” to go to Alternatives, they will send you “upstairs” where there are beds if you display certain behaviors. The time there they allot you is based on what the social workers tell your insurance. If they can prove you’re really crazy, you can get up to two weeks. This model of in-patient/out-patient care is very common, so I’ve found.
Again I felt a huge sense of relief when I finally got there, because I thought, finally I’ll have something to do that is constructive. I also put an inordinate amount of faith in the medication I had recently started, and I assumed that over the course of my time at Alternatives, I would surely feel a significant improvement from the meds building up in my system. I came there expecting to spend a lot of time in a group therapy setting discussing my feelings and reaching insights about the nature of depression and what had happened to me. I was confused about what had lead me to where I was, and I thought that reaching an understanding about it might alleviate some of my suffering. I had been in group therapy before at school and it was a positive experience.
I was quickly disillusioned. We were all given charts where we noted such things as how many hours of sleep we got, how many meals we ate, and what we did the evening before that related to our “treatment goals.” In addition, we ranked each of our “symptoms” – depression, anxiety, insomnia, anger, etc, on a scale of 1 to 10. Anything above six or seven, if I remember correctly, was “dysfunctional,” meaning that the symptom was so severe that it actually interfered with our day-to-day lives. Certainly, most of us were necessarily in this range, otherwise we wouldn’t have been there.
In a large conference room each morning with a dry-erase board we sat filling these out and sipping coffee or eating crackers. Everyday, somebody was supposed to sign up for lunch duty and clean-up duty, although I was able to avoid both over the course of my time there. After what seemed like an overly long period of time – all of us felt like we had too much down time there to sit and think about how depressed we were, especially seeing as they always told us that we had to keep ourselves busy if we didn’t want our mental illness to get the best of us – we would be split up in smaller groups to report on what we had written.
This was always good fun. Everybody always seemed so out of it, including myself – probably because we all suffered from insomnia. People reported two, three, four hours of sleep. Two meals. It sort of felt like not only were we falling apart mentally, but also physically. And this was true – we learned about the physiological consequences of drastic behavioral changes. No one was particularly concerned with reflecting on their journal or expounding on what they had written. Most people reported anxiety, depression, and sleep troubles. Sometimes people would get more specific and say things like, “racing thoughts.” A six was rare. It was usually between seven and ten.
There was one rather large, Hispanic woman named Lisa who always seemed very happy and reported 2s for her symptoms, suggesting that things were just going swimmingly. She was not only verbose, but seemed to always have something to say, a personal anecdote or a bit of wisdom, in response to statements made by other patients or the social worker in charge of us. I don’t think anyone knew what the hell she was talking about. I do think everyone knew that her journal reports were suspect. But I found her endearing, all the same. Her optimism, regardless of whether it was merely a reflection of a state of mania or mild psychosis, was somewhat encouraging, and when she bummed me a cigarette once and said, “you’ll be OK,” I felt like something meaningful had just transpired.
These discussions were, essentially, meaningless. We rarely talked about anything in the way I was accustomed to from individual therapy and group therapy. No one, including me, made many attempts to reflect or introspect about what had happened to us. Not only were the people not very close with each other, and so speaking openly and honestly about ourselves felt strange, but also, it was not the approach of the social workers to encourage that kind of the thing. I wanted to talk about what had happened to me at great length, but I never had the feeling that anyone on the staff had more than a passing interest in that. This all might seem counterintuitive, but the staff there practiced a method of therapy known as “Cognitive Behavioral Therapy,” or CBT, and this method is founded on ideas in cognitive psychology which refute psychoanalysis-based modes of therapy where patients analyze and think about what happened to them.
In theory, the CBT model is a proven approach to treating mental health problems. But what it amounted to in this particular setting, a public hospital’s psych ward, was a “forget it and move on” kind of approach. When simplified, the CBT model basically attempts to get patients to change the way they think and their behaviors so they can forget about the depressing shit in their lives. This process entails filling out journals, like we did, and reading lots of pamphlets that talk about coping skills.
In effect, I never had the sense that anyone cared much about what had happened to me, because I was just supposed to stop dwelling on the past. There was one workshop ran by Tina, a social worker, called “Understanding You,” which was an attempt at getting us to reflect on what had lead us there. The whole thing was laughable; Tina spoke in truisms and said things like “now it’s time for you to look at yourselves” in a self-consciously serious kind of way. We all had a “WTF are we supposed to say?” kind of expression on our faces throughout the duration of her workshops.
I did connect with a few of the other patients, and in some ways they were more helpful to talk to than the staff. In a rare instance where I shared something very specific about myself, I mentioned to the group I was in that I was faced with a decision over whether to see my ex-girlfriend one last time when I went back to New England to retrieve my things from my apartment. The following day two women from the group inquired as to what had happened when I called her. One of them was a baby boomer and former hippie who suffered from Multiple Chemical Sensitivity – I told her about Todd Hayne’s film Safe — who always said, “you know sometimes you just have to do what feels right even if it doesn’t make sense.” The other woman, Nina, also asked after me. She explained to me personally how she ended up in the hospital. She worked as a nurse, and after discovering a dead patient she had moments before seen alive, she began to lose it. I still feel moved by her story today. Other patients were not positive influences, the ones who always wanted to talk about suicide, for example, or the ones who were living in shelters and screamed at other patients sometimes.
My time there only ended up being helpful in so much as it imposed structure on to my day. It was as if I needed daycare, and the psych ward was there for that. After I was discharged, I realized that it had done nothing for me, and that I had a whole road ahead of me that I had not even begun to traverse.
There is an idea that the social workers tried to drive home to us everyday. They would draw a line on the board and mark the left end “past,” the center “present/now,” and the right end “future.” We are only ever at that center point, and we had to accept that we can’t be anywhere else. I tried to take that to heart. But it seems like bullshit. Our past and the people we’ve known and loved stay with us. Maybe we don’t want it to be this way, but we can’t help it. It took me a very long time, all the while feeling as if I was on the brink of total despair, to realize that to move forward with my life I actually had to try and go back; I had to go back to the source of all my angst and see if it could be any other way. It was only after that that I began to approach that center point on the line again.