A week ago I was being held prisoner. No, I didn’t get arrested, although I guess you could say someone arrested my negative thoughts. See, I was having a bad day at work the previous day. Objectively, it wasn’t that bad of a day. I spent nearly 8 hours doing one task, because I first did it using the wrong login and had to start over and do it all again. Then in the course of doing this, a coworker made some comments that offended me (saying that anyone who wouldn’t do one of my other tasks a certain way is retarded, although she knew nothing about that task and was completely wrong about how it should be done). Neither of these events sound that bad, right? Well, as will be further addressed later on, I have very few skills in the area of distress tolerance.
In response to this situation, I wrote “kill me now” on my arm. Then it looked so lonely there that I started writing related words. Words like “noose” and “pills” and “razor”. Eventually my entire forearm was covered in suicide-related terms. Did I actually feel suicidal? No, not at all. It just seemed like a thing to do to channel my frustration.
I had been planning to write a letter to my therapist and give it to her in my appointment 2 days later. Some things have not been working for me, and I knew I’d freeze up if I tried to explain it out loud, so a letter seemed like the best way to bring up the topic. Suddenly I felt as though I couldn’t possibly wait 2 more days. I was even willing to try saying it out loud, if that was what it took to get it over with. So the next time my boss checked in on me, I asked if I could leave after I finished up the task I had almost completed (for the second time). He said yes.
I was out of work in the early afternoon and showed up at the mental health center to ask the receptionist if my therapist had any openings. She did not. I was halfway out the door when she asked if I needed to see the on-call therapist. I declined and kept walking. As soon as I stepped out in the bright sunshine I started crying. I sat in my car and cried until I couldn’t tolerate the heat anymore, then got out and went to sit on a bench by the building where there was shade and a nice breeze. I kept trying to talk myself into going back and saying I’d changed my mind. I sat there for nearly an hour before going in.
What convinced me? A random man walked up to use the ashtray by the bench. He introduced himself. I introduced myself. He said, “Want to see a neat tattoo?” and pulled off his shirt. As he turned around to show me a silhouette surrounded by flowers, he said, “My son committed suicide. He took my rifle and shot himself.” I managed to say the socially appropriate things: that it was a nice tattoo, that I was sorry about his son. After he left, I burst out laughing at the absurdity of the situation. There I was with suicide-related words written all over my arm and someone coincidentally came up and mentioned suicide.
Once I contained my laughter, I went back inside and said I’d changed my mind. I was sent over to a different facility where the on-call therapist was currently located. I had to fill out pages and pages of redundant paperwork, and was almost done when she came out to tell me I didn’t need to finish that because she had all that information on file. Now, I was planning to just get some things off my chest. Maybe talk a little about my plan to discuss some potential changes in approach with my therapist. Maybe share the frustrations of my work day and get some advice on how to better handle those situations in the future.
This is not what happened. Yes, I shared those things. Then she started talking about wanting to admit me to inpatient. I said that wasn’t necessary, that I wasn’t really going to kill myself and I would have mom hide my medication again just to be safe. She was not buying that. She tried to convince me that I’d feel better in a safe environment, and that maybe I needed some medication adjustments that can be more easily done in inpatient. I am weak and just went along with what she was saying. I guess maybe part of me wanted that little vacation from reality.
She sent me out to the waiting room while she consulted with the psychiatrist, then came back to tell me he agreed with her. I had another brief moment in her office, then was sent to the waiting room again. She wouldn’t let me leave to take my car home and have mom drive me back, and as it turns out mom wasn’t even home at the time so I guess that worked out for the best. However, I sat in that waiting room obsessing over the idea of running out the door and driving off and being anywhere but home when she sent the cops to find me.
It felt like an eternity, but I guess it was only about 15 minutes that I sat there before I was called back again, this time to actually walk into the inpatient unit and start the admission process. It was a weird feeling this time, knowing exactly what to do and say, what questions I would be asked. It was also weird feeling so strongly that I did not want to be there. From almost the moment I walked in, I was desperately plotting how to get out as fast as possible. I had realized that I was going to miss a major event at work. I had realized that I would probably miss some dinner dates with friends that weren’t firmly scheduled yet, but I had been planning to try scheduling them for a few days later.
I was sure I’d be there for 4 nights again this time, but on the first morning after I arrived, I spoke with the psych APRN and immediately started asking when I could leave. At that point she said she’d speak with the psychiatrist but if I left that day it would probably be AMA. In the afternoon, after many hours of going stir-crazy, I called and left a message for my therapist that I was being held prisoner and wanted to know if she could come see me there in the event that I wasn’t released in time for my appointment the next day. Mere minutes later, the woman who had insisted on admitting me came up and asked if I really felt like I was being held prisoner. Yes, I did.
The evening was filled with drama pertaining to mom’s wishful thinking that my request for a prison break meant I was coming home that evening. I ended up storming off to my room during visiting hours, pulling myself together, and coming back to talk to her more. However, I did have her leave half an hour early as my medication was sending me into the land of grouchy and exhausted. I went to bed without attending evening group or having my final snack of the day.
The next morning, the psych APRN came to talk to me about being discharged. I continued telling her that I felt fine, just like I did when I was admitted. She told them to release me, and I got out of there a little before 11 am. What I didn’t say to her is that I didn’t actually feel fine. I felt impatient and agitated. I was fighting to not find ways to injure myself with the “safe” objects that we were allowed to have. Most importantly, I was strongly thinking of overdosing the moment I arrived home. I felt terrible about lying, but at that point I valued freedom over honesty.
I did not overdose. I held out until the next day, and then handed my pills over to mom and admitted that I lied to get out of there. In the time since my release, I have been depressed and clingy, and mom has asked if it was a mistake that I came home. I think it was, but I’m scared to say it in front of anyone who can send me back there.
Inpatient this time was a very different experience from when I originally went there in March. The only thing that was different was me. The first time around I was in such misery and so convinced that I was going to kill myself, but I had hope that being there would help solve the problem. Plus I was curious about what the experience would involve. This time I didn’t feel nearly as bad going in, so I fought against being there with everything I had. Maybe it could have helped me if I’d been more honest. Maybe they could have adjusted my medications then instead of having me wait 3 more weeks to see my outpatient psych APRN. Maybe talking with the other clients could have changed my perspective. I didn’t give it a chance to work.
What did come from this experience? The day I was released I went to my therapy appointment. I handed over the letter I had written while being stuck in inpatient. My therapist said we could try to make some changes to our approach. However, the inpatient staff had strongly recommended making an addition to my diagnosis. Previously we had a deferral on Axis II, with a note to rule out Borderline Personality Disorder (BPD). Now it has been ruled in. I’m still struggling to come to terms with this addition, despite the fact that I know it fits very well. It explains the missing pieces to the puzzle that weren’t covered by my existing Bipolar I diagnosis.
So our new approach is going to involve half the session spent on a more freeform approach where I can ramble on about whatever pops into my head (my preferred method) and half spent on the highly structured Dialectical Behavior Therapy (DBT). I was asked which set of skills I wanted to work on first, and there was no hesitation when I said “distress tolerance”. Like I mentioned before, I have no skills in that area. I do not cope with things going wrong, no matter how minor the wrong is. I get frustrated by what people say or don’t say, by dropping things, by breaking things, by just not feeling perfect. Let me tell you, I never feel perfect so it spirals into me always feeling miserable.
Tomorrow will be our first time with this new approach, and I am anxious but hopeful. As much as I love the freeform talking and feel it’s necessary in order for me to feel like I’m being heard, I can admit that the structured approach is probably good for me. I need to feel like there are tangible things I can do to make progress.