Psyched Ward

Posted by fxckfeelings on July 21, 2014

Despite what the Ramones (R.I.P.) once declared, most people do not want to be sedated, especially if it’s for reasons involving “going loco.” Some people can’t think about psychiatric hospital admission as other than a form of kidnapping, and others as a failure that should never have happened if they took proper care of themselves. In reality, it’s good to think about psychiatric admission as something that can happen again regardless of how well you take care of yourself, and will rarely happen for reasons that you won’t ultimately agree with. The more you accept the possibility of hospital commitment and consider your own views about what makes hospitalization necessary, the more skilled you’ll be at managing the situation if it occurs again, even if it’s something you’re never going to wanna do.
–Dr. Lastname

I’ve got depression that is usually controlled well by medication, but I had one bad episode three years ago when I got really down, couldn’t leave the house for a month, and was on track to starve myself to death. My parents were right to pull me out and take me to the hospital, but it was a horrible experience; there were some scary, sick people there, and staying there was traumatizing. Now my shrink wants me to put together a crisis plan that will tell my parents how to decide when they should take me to the hospital, if it ever becomes necessary again—a sort of “advance directive”—and I’m trying to figure out how to make sure that I don’t have to go back unless it’s really, really necessary. The last thing I want is to visit an emergency room where they like to lock people up, so I end up trapped in the nightmare ward again. My goal is to figure out how to minimize the possibility that I will get admitted again.

As traumatic as it felt to be admitted to a psychiatric hospital, you are familiar with the bigger trauma that you would have experienced if you weren’t admitted. The scary people you say in the psych ward were probably fairies and pussycats compared to the hellscape that your own home had become.

You know how painful your depression was, how it interrupted everything important in your life, including work, relationships and your ability to care for yourself, and how it endangered your health and your life. That’s the trauma it’s now your job to manage, and avoiding the job because you’d like to avoid the hospital is a foolish move.

You don’t have to worry about being kidnapped by over-zealous clinicians eager to save you from yourself while keeping their inpatient colleagues busy; the idea that men in white coats can lock up innocents in straight-jackets is as an antiquated, unrealistic notion perpetuated by Scientologists and old Ozzy Osborne videos.

In actuality, most of the world’s straight-jackets now belong to magicians, shrinks tend to dress business casual, and your medical insurance won’t pay for you to go into a hospital unless it’s absolutely unavoidable, because they don’t want to pay for such expensive treatment. Institutionalization isn’t just outdated, it’s also out of everyone’s price range.

So don’t make it your job to protect yourself from the pain of commitment and inpatient treatment, because that’s out of your hands. Instead, think of the more important risk: of dealing with the potential trauma of severe symptoms and maximizing your influence over that management.

Draw on your experience to list the situations that would, in your opinion, make hospital treatment unavoidable. They would probably include: a serious risk of suicide; an inability to care for your physical or medical needs; and an inability to engage in a treatment trial or continue treatment that might help you recover.

Avoid getting lost in your admission fears alone by pretending you’re taking care of a friend whom you would never put in a hospital unless you could see no alternative. Then draw up criteria that would leave you no choice but to put your friend in the hospital, and ask your family and friends to follow those instructions if it ever becomes necessary again.

Yes, thinking hard about painful symptoms can make you feel scared and helpless, but creating a management plan is what puts you in charge and keeps the nightmares about straight-jackets at bay.

It assures you that, though you can’t necessarily prevent relapse, you can be sure that people treat you according to your wishes and values, and that you get the treatment you may fear, but also desperately need.

STATEMENT:
“I hate thinking about my crazy time in the hospital, but I know I’m perfectly sane now and the best way to prevent a relapse or at least stop one from being as frightening as the first episode is to take charge, let people know what I want them to do, and assure myself that I can be a good manager of a dangerous situation, even when I feel I’ve lost control.”

I had one really intense anxiety attack last year that landed me in the hospital—I’d never had one before, or even felt I had to see a shrink up to that point—and it felt like I was having a heart attack and drowning at the same time. I don’t know how I survived it, but I’ve done everything possible since to not go through anything like that ever again. I take my medication regularly, get to bed at the same time every night, and avoid any and all stress, from over-working to even being over-stimulated with happiness. I’m proud to be able to say that I haven’t had a relapse, and I intend to keep things that way, but I’m not sure if there’s anything else I can do to insure I can stay sane and safe. My goal is to make sure I never get that sick again.

After a health-scare of any kind, medical or mental, most people feel the need to “control their health” by gathering knowledge about their condition and taking preventive action in terms of lifestyle changes, vitamins, and exercise. They often assume that the whole scare probably wouldn’t have happened if they took proper care of themselves in the first place.

Unfortunately, the only thing that could have prevented your anxiety attack was for your parents to refrain from having sex and passing on their genes. Now that they’ve screwed up and you already exist, there’s no hope. At least you know, though, who’s to blame, but unfortunately, it’s not vitamins.

You’re doing goods things to prevent another attack, but don’t hold yourself totally responsible for controlling a process that is basically uncontrollable; if and when you do have a relapse, you’ll then feel that your efforts have been in vain and you’ve failed yourself. Meanwhile, your life has become controlled by anxiety-avoidance, instead of by the interests and values you brought to it in the first place.

Don’t let anxiety-control become the purpose of your life. Make good use of all you’ve learned and keep up with your excellent regimen, but accept the notion that painful attacks can occur again and that they’re just a form of pain. You have other goals that carry a risk of stress and are nevertheless worth doing; don’t let your anxiety about anxiety take those opportunities away from you.

Prepare to face anxiety attacks when they come, and you’ll find they come less often, and have less control over your life decisions than if you vowed to never let them happen again. Remember that life is short and you have more important things to do than prevent anxiety; the attack may have felt deadly, but you survived it, and life goes on.

STATEMENT:
“I never, ever want to have another anxiety attack, but I do not intend to lead a stress-free life of no risks and no accomplishment. I will manage and minimize anxiety without expecting to prevent it completely.”