The Secondary Gains (and Losses) of Psychiatric Hospitalization

Seven years ago today, probably at roughly this time, I was being admitted to my first psychiatric hospitalization. I was in my second real appointment with my first therapist (third if you count the intake assessment), and told her that I was planning to drive several hours away the next day to purchase a gun at a gun show. Looking back on this, I don’t believe I’d have ever reached the gun show, as my driving anxiety is so bad it would probably override the most intense desire to die.

Am I sorry that I was hospitalized to prevent me from doing something that I probably would not have done anyway? That’s a very difficult question. A month prior I’d been taken to the ER by a sheriff’s deputy who was sent for a wellness check, and when I spoke with him a week later he was appalled that I was still waiting for an intake assessment. He thought I’d be on medication by then. In fact, the process required an intake assessment and at least three regular therapy appointments before a referral to a psychiatrist could even be made. Hospitalization definitely fast-tracked that process.

On the other hand, that hospitalization set a precedent. Last week my therapist and I were discussing the Dialectical Behavior Therapy (DBT) concept of secondary gains. It’s the idea that when a person behaves in a way that causes harm, there is some (possibly non-obvious) way in which that behavior benefits them. That could be someone using illegal drugs because they alleviate symptoms of untreated mental illness. That could be someone self-harming because the endorphins released by physical injury create feelings of pleasure. That could be someone acting out in class because it results in being removed from that situation, where perhaps they are being bullied or experiencing some sort of embarrassment.

While I was discharged from my final hospitalization one year, three months, and 11 days ago, the 15 or so hospitalizations in the preceding almost six years were as much an escape as anything else. Very little of the treatment that took place was beneficial. The assumption when someone is hospitalized for mental illness is that medication changes are obviously necessary, so they piled on more drugs, raised dosages, switched out meds that hadn’t even had a chance to take effect. The answer is rarely “this medication is causing problems so we’ll remove it”. Instead the answer is “we’ll give you another medication to counteract the problems this one is causing”.

I try very hard to view life experiences, pleasant or unpleasant, as a source of knowledge that I can then share with others. I try to find the humorous stories to make others laugh. However, I’d be lying if I said that I didn’t wish that first hospitalization never happened. Coming out of a hospitalization is difficult, even if it’s only for a day or two, and the more times I was hospitalized the harder I found it to not be hospitalized. Looking back, I can see many instances where I was making progress in therapy and regressed, with the secondary gain of going to a place where I could escape the demands of the outside world.

There’s no way of knowing how my treatment would have progressed if avoiding hospitalization had been the ultimate goal at that time. With my current therapist it is a significant goal, and I very much appreciate her for that. I know my life would be very different had I not followed the winding path that started with my first hospitalization. I’m not sorry about what my life is now. I do sincerely wish I’d been given a chance to reach a similar place without the experiences I had. I will admit to being selfish internally. Although I do help people whenever I can, I also wish I didn’t have those experiences to share in order to help them.

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