13 years ago…my last admission at South Street

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Photo credit: http://www.lhsc.on.ca

For me, PTSD is extremely linked to anniversaries of dates.  January into February is a difficult time, with the memories of my last extended hospital stay in 2005 and my family law trial in 2016.  I often have flashbacks, memories and symptoms, and then notice the date and realize what is triggering them.

My last admission to South Street was in early January 2005.  I was there for about 5 weeks, my longest admission at that facility.  I was transferred in early February to the Regional Mental Health Care facility, the former London Psychiatric Hospital, where I stayed until sometime in March.  Since then, I’ve largely been free from in-patient admissions.

In my mind, I can walk through the buildings at South Street, especially the main building.  The large stone steps which led to the main entrance.  The single stall washroom off the lobby where I cut myself on a number of occasions, with sharps I brought back inside from walks.   The smell of institutional brown paper towel, and the cheap, strong soap found in hospitals everywhere still brings me back to South Street.  The smell of adhesive first aid tape and band aids, bring back the rusty smell of blood harden on towels during long emergency room waits.

Past the lobby was a small gift shop on the right side of the hall.  I would go down there to browse sometimes or to buy a magazine.   Just past the shop was a cafeteria.  It was more of a snack bar, I suppose they had meals there, but at that time I rarely ate more than a muffin or rice krispie square.  Being in the hospital was an excuse for Ana to get away with restricting more, when nobody was watching me eat or expecting me to do so.  I remember walking through the line style cafeteria.  I’m not sure what I bought, maybe cookies.   A little further, past the first set of elevators was a Tim Hortons kiosk.  It was small and didn’t carry a full selection of items.  It was open longer hours than the cafeteria, which shut at the end of the office hour work day.  I remember it being more dimly lit in the evenings.  There was a second set of elevators, the only ones which went all the way to the 7th and 8th floor: psychiatry.   If you kept walking to the rear of the building, there was a door to the “patio” which was where people went to smoke.   It was also the place where psych patients who had off unit privileges but not full privileges to leave the property, went to get fresh air.   The hallway split into a Y shape at this point.  To the left was the admitting department.  You could walk down a long hallway and exit there as well.

That last time I was admitted, I was a patient on the 7th floor.   There was an orderly who sat at a desk at the entrance to the inpatient unit, which was to the left side of the Y.  The stem of the Y had offices and the right hand side of the Y had other departments, like occupational therapy, and a patient dining room.   The hall was carpeted.   The carpet was dirty, even though it was vacuumed daily.   Patients and visitors had to sign in at the desk.   As a patient, passes off the unit were awarded in increments.  Maybe a 15 minute pass, lead to 30 minutes, led to 4 hours and then to an overnight pass.  Smokers were given 15 minute breaks at intervals throughout the day.  Visiting hours ended at 8pm and at that time the orderly went home and the door to the unit was locked.  Patients returning after 8pm had to ring a bell which alerted the nurses to let us in.  I remember coming back after an evening home, or out with my ex-husband.  The hospital was quiet, the main floor abandoned with the exception of security at the main entrance.  The elevator ride was quiet, the halls semi darkened.  It was easy to believe the building was haunted.  I would be buzzed back onto the unit, check in with the nurses to get my evening medication and then get ready for bed.

The rooms all had reinforced glass windows, many of them had metal grills covering them.  Some of them opened a tiny crack and others did not.   The hallway seemed impossibly long, with the nursing station 3/4 of the way towards the far end.  For all intents and purposes, it wasn’t all that safe.  The nurses were quite far away from most of the patient rooms.   They didn’t search us when we came back from passes.  It was quite easy to smuggle in anything.   On a different admission, I had a roommate who used cocaine and cut herself in our shared washroom. Another time, a patient who was supposed to be recovering from an eating disorder continually smuggled in laxatives which she took by the handful.   A third patient, being tube fed and struggling with bulimia would order large amounts of food and then purge.

It wasn’t exactly a safe place.

I spent a lot of time sleeping, resting and talking to other patients.  I filed out my menus and looked forward to the muffins and cereal at breakfast.   I ordered peanut butter and jam sandwiches for lunch.  The vegetarian and vegan options for dinner were largely inedible.  Sometimes I went home for dinner, sometimes I just didn’t eat.  The meals arrived at 8am, 12pm and 5pm on trays, covered with burgundy or dark blue coloured domes to keep the food hot.   There was a fridge with cheap Colt Ginger ale cans (regular and diet).   Sometimes I brought cereal from home.  I often went for a walk to the Tim Horton’s down the road where I would order caramel coffee cake and black coffee.   They don’t make that cake anymore, but you could order extra caramel sauce drizzled over it.

I coloured and read books.  I waited, sometimes what seemed like endlessly, for the doctor to arrive.  Sometimes the doctors checked in with you ever week day.   Sometimes they didn’t appear for days.  They appeared at unpredictable intervals.  Much of the time they spoke to us in our rooms, even in ward rooms with 4 beds, affording us little privacy.   If we were lucky we might get 15 minutes to talk to the Dr.    That last admission I had a very kind doctor.  He spoke to me in a private room.  It wasn’t his office, just a room for meeting with patients.  He believed me.  He talked about referring me to the mood disorders program at the RMHC.  He didn’t think I was borderline.   Sometimes there would be medical students or nursing students.  I liked them because they were allowed longer to talk to us.  It was lonely and there was little actual treatment in the hospital, aside from medication and medication adjustments.  The medical students gave each patient a physical exam within 24 hours of being admitted.  Even when I was in and out of South Street, I got the check up every time.  In reality, these 1st year medical students were just using us to practice doing physical exams.  But I didn’t mind.  I liked the attention and the chance to speak to someone.  The days were often long, and even the nurses were busy, assigned to multiple patients each shift.

Sometimes, if I was having a rough night, my nurse would bring me into a small room attached to the nursing station.  We would talk about how I was doing.  Mainly I talked about the urges I had to self harm.  Even in the hospital I generally harmed myself on an almost daily basis.   Looking back it’s hard to see exactly how I was helped by these admissions.  Once I even ended up needing stitches, while I was admitted.  I cut myself in the ground floor washroom, then went up to the 7th floor to confess.  A different medical student, maybe a psychiatry resident stitched it for me in my room.

In the sad, lonely state of mind I was in, there was something about the ritual of having my cuts sutured, that comforted me deeply.  I think it was a moment of literal relief to have something FIXED.  The inner trauma I was struggling with was coming back to the surface with frightening intensity.  I was in a new relationship that had rapidly become all consuming, emotionally and then sexually abusive.  I felt trapped.  I felt numb, depressed and hypomanic, agitated and anxious all at once.  I was in a frantic state which was triggered by SSRIs and other antidepressants.  I wasn’t thinking clearly for over 4 years.  I was afraid all the time, and yet I felt invincible in a way.  I knew only peripherally that my impulsive self harm and suicide attempts were extremely dangerous.  I both wanted to die, and felt like I was not at risk from the self harm.  I felt torn, tangled and pulled down, like I was drowning in trauma and suicidal thoughts.  I felt like a mechanical robot, and a wind up toy spinning out of control.

When I look back at myself during those 4 years, I barely recognize any aspects of my true self.  I was changed, and not in a positive way.

I was so young.  I was 20-24 years old.   I felt like a child, colouring, whining for help, begging for someone to SEE me.  I didn’t feel truly SEEN by anyone at that time.  I think I’d felt invisible and misunderstood for so long, that I actually was disappearing, even to myself.  I felt like I’d aged decades in a few short months.  I felt like a child trapped in the body of an older person.   My health was poor, due to medication side effects, self harm, self starvation and lack of structure and routine.  I became more and more socially isolated.  I lost connection with the “normal” world and I became a full time psych patient.  I filled out and inhabited the role of a sick person.  So much so that I no longer realized I was playing a role.  It became all I knew of ME.  I lost myself.   I lost myself in more ways that I can express in words.  I wanted to be rescued.  With all my heart I wanted to be rescued, but I learned to carefully shut people out.  I was also being isolated by my abusive partner.

That last winter in South Street, I was so suicidal I couldn’t leave the hospital alone.  I was perpetually compelled by thoughts of throwing myself in front of traffic on the busy road near the hospital.  I didn’t trust myself to walk anymore.  I knew all the train tracks that criss crossed the  neighbourhood, and all the shops which sold sharps I could use to harm myself.  I was a dead person walking.  I was more than half dead, I had more than one foot out the door of life.  I had 95% given up.

But somehow that last doctor who admitted me, he didn’t see my case as hopeless.  He didn’t see me as someone who was just “trying to get attention” or “manipulate the system”   I think he realized that it was possible the medication was making me worse.  I think he realized, and actually believed me that my next suicide attempt would be a completion.  He quietly talked to me, and quietly sent the referral to the specialist.  I didn’t have much hope, but I sensed that things were different.  Instead of lying to get myself discharged, I stayed there until the bed became available on the mood disorder unit.

5 weeks later, I was off all anti-depressants and on a new mood stabilizer.  The mood disorder specialist retrieved my life from the purgatory and hell of anti-depressant side effects, including medication induced hypomania.

Less than a year later, I was pregnant with my first child.

I never had another extended hospital admission.

South Street has been demolished for years now.  I visited the site last summer to see for myself that it was gone.

But South Street haunts my memories.  The images are so vivid, but in the faded colours of a worn down, dirty building.  Those years were brightly intense simultaneously to being muted and grey.

I expect they will be with me always.  But 13 years ago, I never imagined I would even get out alive.

Another abandoned hospital.

I visited another hospital where I spent time as a patient.  This is the now abandoned Regional Mental Health Care Centre, otherwise known as the LPH, or prior to that the Asylum for the Insane.  There has been a psychiatric hospital on this site since 1870.

I walked around the large property.   Back in the late 1870s, asylums were located on large properties where patients lived and worked.  This property included a farm and a separate chapel.  For a time, there was a type of treatment known as “moral therapy” which included involving the patients in activities such as farming asylum land.  This site also witnessed many tragic and scary “cures”, like surgeries and electroshock treatments.

When I was a patient at the Regional Mental Health Centre, the facility was already operating at a much reduced patient capacity.  It has now been closed altogether and patients relocated to a modern, newly built site.

This site was creepy then and it is even more creepy now that it is abandoned.  I felt the energy around the property to be cool and sinister, despite the beautiful sunny day.

When I was a patient, we used to go for walks around the property.  There are long tree lined roads, which provide shade.   There was also the abandoned insane asylum.  The new building stands in it’s shadow.

This is what the building looks like today.  10+ years ago, it was even more run down.  The ceiling was falling in.  The glass in the windows was shattered in many places.  At night it was frightening.  I imagined ghosts and spirits of dead patients haunting the property.   On this visit I noticed that the city has added a new roof and boarded up all the windows.  Today, the building looks more like a museum.   The chapel and barns have also been boarded over and trees and grass are beginning to reclaim the entire site.

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It’s strange to think that the hospitals where I was treated are now torn down and abandoned.  I wonder what will happen to the brand new build in another 50-75 years time?

The time I spent at this hospital was a turning point in my recovery.  The mood disorder specialist who treated me recognized that I was being made sicker by the psychiatric drug cocktail I was on.  He changed all my medication, and within 5 weeks I was released from the hospital a significantly more stable person.  This marked the end of the 4 years I spent in and out of hospital.  It marked the beginning of the next chapter in my life.  It allowed me to become a parent.  My mood disorder specialist followed me closely during both my pregnancies and postpartum periods.  Without him, I would probably be dead and I certainly would not be a mother of two healthy children.

I have mixed feelings walking around the site.  I’ve always been fascinated by the history of medicine in general, but more specifically the history of psychiatry.  I feel captivated by the old building, while at the same time frightened and ill at ease.  I feel thankful that I was able to get the care I needed to begin my recovery.  But I feel unsettled that I had to spend time in a place like this.

Trusting my younger self.

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I’ve been reading through my journal from the first year of the relationship with my abusive ex-husband.  I’ve been reflecting on how I was gaslighted and how, in a way, I gaslighted myself.  I used the same coping techniques I did when I was abused at age 15. I found myself in another abusive relationship and I immediately began self harming, restricting food, and thinking about suicide.  As a distraction it worked, just as it had when I was a child.  I did what I needed to do to survive. I turned to creative (if self destructive) coping techniques that got me through very difficult situations.  But my inner self, my younger self did know something was wrong.  There was a part of me, healthy me, which was separate from “the voice” or “Ana.”  That part of me knew that my new relationship was deeply and integrally connected to my relapse and worsening psychiatric symptoms.  My wise younger inner self knew that I was in trouble, but she asked for help in ways that distracted and confused other people, even her own healthy self.

This is a concept that is often very difficult for those who have not survived abuse to understand.  It can be challenging to understand that the survivor will do whatever it takes to survive, even if those coping techniques may look like self destructive behaviours from the outside.  The survivor may feel she has limited or no options.  For various reasons she has been conditioned not to scream, tell, ask for help, run away, fight back etc…or maybe she tried those things and they didn’t work. So instead she turned to disassociation, self harm and eating disorders as a way to modulate and live with the abuse and all the symptoms of PTSD.

I was conditioned, maybe almost from birth, not to make a fuss.  I was conditioned, maybe almost from birth, to be a “good girl.”  I internalized this in a way that led me to blame myself for the abusive behaviours of others.  If I was being hurt it was because I wasn’t a “good girl” and if I wasn’t a “good girl,” then I must be a bad girl, maybe a very bad, shameful, dirty and disgusting girl.  Thus, Ana/”the voice” was born.  There was a part of me that split off and became self abusive and self critical.  A younger self, a part that never ages or matures.  A 15 year old frozen in time.

This is how I described “the voice” when I was 20 years old (ironically the description came right after mentioning intimacy with my ex):

February 21, 2001

My body feels too big and uncomfortable right now.  I know it’s because I’ve been eating more normally and feeling hungry.  The sensation of hunger is not an easy one for me.  It is frightening. Like I feel afraid of losing control of myself. And yet I know that the E.D is out of control. It is a part of me that often deceives and betrays me. I know that in the end, though it feels comfortable, it cannot be trusted.  The voice which tells me not to eat, tells me to cut my skin, to smash my head against a wall, to step out in front of traffic all sorts of dangerous hurtful things.  It speaks to me in persuasive ways.  It is a part of me and yet foreign.  My ally and my enemy, my strength and my destruction. But after so many years it is the way I know.  A method of ridding myself of unwanted feelings”

When I was 20 I was able to recognize some of the signs of abusive behaviour in my ex. I was able to identify that I felt afraid.  But I didn’t draw the right conclusions from there. I blamed myself, I thought I needed to work on my depression, my recovery, get better at coping with anger etc.  My younger self tried to problem solve by changing herself, just as she had at age 15.  Just as she had for her entire life.

March 12, 2001  [written after being asked to swing dance with and dancing with a friend, a man I’d briefly dated]

So the evening was going well until one crucial moment…asked me to dance.  I figured one dance wouldn’t hurt and I didn’t think [he] would mind…but [he] did get upset and left the room.  I followed after the song was over. [He] got angry at me saying that I couldn’t stand up for myself and say NO.  He totally misunderstood and overreacted.  I got terribly upset and started crying totally uncontrollably…I was so disappointed that my night was ruined.  I felt so much like hurting I became filled with intense suicidal thoughts. I hate feeling my independence threatened by a relationship. I want the freedom to choose who is in my life.  When [he] gets angry it just terrifies me and makes me want to hurt, with him is when I feel the strongest feelings

My younger self clearly articulated that she felt uncomfortable with being controlled and with the jealous behaviour.  She clearly made a link between the angry jealous behaviour of her boyfriend and the suicidal and self harm impulses.  My younger self was wise on a deeper level, and yet she stayed with that man for 13 years.  It’s difficult to make sense of.  My adult self wants to travel back in time to that night, to go back to the dance with my friends, to tell him in no uncertain terms to F*#K OFF and leave me alone.  My adult self wants to protect that younger me, give her the strength to listen to her instincts and fight back rather than turning to a downward spiral of self destruction that would lead to 4 years in and out of psychiatric hospitals.

The next day, March 12, 2001 I was admitted to the hospital.  I wrote in my journal again, but made no link between the previous evening and my suicidal obsessive thoughts.  The self destruction worked as a distraction from his controlling behaviour.  The hospital was a place to get away from him.  The routine and the process of hospitalization was an escape.  I would feel safer in the hospital for a few hours or a few days, then I’d realize that the hospital wasn’t a solution and I’d want to be home.

I think what I really wanted was to be safe.  What I needed to be safe was to exit the abusive relationship in those early stages, when I still had the chance.

Because within a few short weeks I was already beginning to convince myself it was my depression and PTSD causing the issues in our relationship:

March 26, 2001

“The things that I thought were stable and unchanging have become uncomfortable. I can’t tell if it’s my depression pushing [him] away or actually me. It’s so hard to face that possibility. I want things between us to be simple again. I miss how easy we used to be together.  Now I feel distant from our relationship”

April 4, 2001

“I don’t feel as easy around [him] lately. Mind you I haven’t felt easy around anyone lately. I feel withdrawn, like I have built up the walls around me for protection from the storm.  But this is so ineffective because my storm is coming mainly from within. I don’t know how to protect myself from myself. I really am my own worst enemy”

Maybe I was never my own worst enemy.

Maybe the storm was never “mainly” from within.  Maybe I was confused and living with emotional abuse and gaslighting.  Maybe I bought into blaming myself as a coping technique, as a way to survive, and as a way to feel more in control of a scary situation.  I blamed myself and my mental illness rather than facing the reality that I was in an abusive relationship.  It was “easier” to seek help through psychiatry than it was to leave the relationship.

Looking back it all seems clear.  But my 20 year old self had less wisdom, less experience, less resources and less knowledge.  My 20 year old self did the best she could.  She did try to express herself, she just didn’t have the skills to listen to herself or to ask for the type of help she truly needed.  And those around her weren’t able to interpret her self destructive behaviours as, not a cry for attention or a manipulation, but a message.  A red flag waving, signalling that all was not well.  Help was needed, but psychiatry wasn’t the correct tool for the task.

Unfortunately, my younger self wouldn’t cross the threshold of a rape crisis centre for another 12 years.

The roots of an abusive relationship.

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Through some parts of my youth I kept diaries.  Never entirely consistently, but consistently for periods of time, especially when I was in treatment or in hospital.  I’ve been thinking back to this time of year in 2001.  My first year with my abusive ex husband.  My first year in psychiatric care.  My first year engaging in severe self harm.  My first psychiatric admissions (aside from eating disorder treatment).  My first suicide attempts. It’s interesting how all these “firsts” coincided so neatly in time with my new relationship.  At the time I thought it was because memories of the abuse I survived as a teenager were triggered and surfaced when I became sexually active.   That was part of it.  But there was more to it than that.  There was subtle abuse in my relationship with my ex husband that started very early on.  The seeds of gaslighting and emotional abuse were being planted.

It started with showering me with affection and attention.  It started with making me feel special and loved, almost to the point of making me uncomfortable.  It started with planning for the life we’d have together, the kids we’d have, the marriage…within months of meeting me (I was 19!).  It started with gifts, cards, flowers, spending all our time together.  It started with gradually isolating me from my other friends and social outlets.

Then some lies started.  And the lies were repeated so often I believed them to be true.

These lies were focused around my mental health problems and their link to my feelings about his abusive  behaviours.   He would tell me that it was because of my PTSD that I was uncomfortable with something.  He would tell me that a “normal woman” would be okay with it.  He would make me feel guilty, tell me that he felt like there were three people in the relationship: me, him and X.  He made me feel like I was CHOOSING to have flashbacks, like I was CHOOSING to think about X rather than him.  Almost like X was someone I never quite got over, a lost lover, rather than an abuser who had traumatized me to the point I often had flashbacks during any type of intimacy.  Over time, the lies were repeated to the point that I felt crazy.  I felt like I was to blame for the problems with intimacy in our relationship.  We even sought out support from a sex therapist to talk about this.  I had blood tests and was checked to ensure my hormone levels were normal.  I was completely manipulated into believing that the issues in the relationship were entirely my fault.

Today, in 2017, I realize I like some types of sex just fine.  I just prefer consent to be a factor in that sex!  In other words, I like sex, but I don’t like sexual abuse!  It turns out, I’m not physically broken.  I have PTSD.  I have flashbacks, but with a safe, trusted and patient partner I can be okay.  But because of the lasting impacts of gaslighting, I struggle with saying no. I struggle with blaming myself for anything that might go wrong. I struggle with identifying and communicating what I want or enjoy.  And I still fall back into patterns of believing that I’m crazy.

When I left my ex husband, I mainly remembered and talked about the sexual abuse that happened in the last 5-6 years of our marriage.  These were the incidents I felt most comfortable labeling “sexual assault” and “rape.”  When asked, I couldn’t really describe when the sexual abuse started.  I couldn’t really remember the first time.  I couldn’t really say when things started to go wrong.

But reading back in my diary from 2001, the first year we were together, there are so many red flags.  I can hear my 20 year old self trying to convince herself that things were okay.  I can hear my 20 year old self trying to believe that she loved this man she barely knew. I can hear my 20 year old self trying to rationalize that things would be better with him when SHE was better, when SHE stopped cutting, when SHE stopping being so depressed.  I can hear her trying to convince herself it was the right choice, and I feel deeply sad for her.

June 8, 2001

“The evening went well until the car ride home.  Before getting in the car I was feeling panic starting. [He] tried to kiss me but I pulled away.  He got offended.  I tried to explain but he got angry and said he felt stifled like he couldn’t be spontaneous.  He said I only make love to him out of duty.  I got really upset and started crying and I couldn’t breathe. It was like a panic attack and I couldn’t stop hyperventilating. I just was so very scared.  I’m terrified of being with [him], but I do love him too.  It’s such a dilemma all the time. I feel like it would be easier for me to get better without the strong feelings of a relationship.  But on the other hand [he] is my support.  I don’t know.  It’s so tough right now.  I’m so scared of my life and everything in it”

Looking back on the things I wrote, I realize that I was barely more than a child myself. Just turned 20 years old.  I had just disclosed the abuse from my childhood, just started counseling.   I was talking about abuse I’d kept inside for 5 years.  I was in full PTSD crisis mode, complete with flashbacks, hyper vigilance, anxiety and nightmares.  I was on psychiatric medication cocktails for the first time.  I was self harming almost daily and had recently attempted suicide.

It was perfectly normal that I didn’t always want to be intimate with someone.

Perfectly normal.

Today, I choose to forgive my 20 year old self for not knowing this.  I choose to forgive her for not knowing that she was having normal coping reactions to trauma and that she was not crazy.  I choose to forgive her for being tricked into a situation where, instead of healing and support, she found gaslighting, confusion, entrapment and more sexual abuse.

I know I’ll wake up tomorrow, or the next day and feel confused again.  I’ll wonder if the abuse was my fault.  I’ll think that I’m exaggerating or that I’m making things up.  I’ll start to feel the thoughts creep in that I’m not normal.  I’ll start to wish that I had died all those years ago when I attempted suicide.  I’ll start to believe his lies again, because a long term emotionally abusive relationship includes an element of near brainwashing which can take years of healing, therapy, patience, self love and self forgiveness to recover from.

But just for today, I want 20 year old me to know that her reactions were normal.  That she was allowed to say no to that kiss for any reason.  She was especially allowed to say no to that kiss when she was triggered.  She had the right to say no without consequence, without anger, without bullying and blaming.  She had the right to have needs and preferences and anxieties.

It wasn’t her fault that he didn’t understand consent.

South Street.

Photo credits to the London Health Sciences Centre website documenting the decommissioning and destruction of South Street Hospital.

I’ve been thinking about South Street.   It’s been completely demolished now, destroyed and decommissioned but it’s still alive in my memory.

I haven’t written many posts about being in the hospital since I started this blog almost a year ago now.  Those were first posts, the first thoughts on my mind which I wanted to share.

I think people who have never spent time on a psych ward often have a dark curiosity about what they might be like.  I find myself filled with the same morbid curiosity as I search through pictures of the abandoned South Street hospital online.  How can a place where I survived so much just be demolished?  On one hand I’m glad it is gone.  It was a horrible place!  On the other hand, I feel like it should have stood there forever as a monument to the suffering and the intensity I felt there.

What were days like as a patient at South Street?

The days varied slightly depending on which unit I was on.  There was something comforting about the meals being delivered on neatly organized trays.  In the morning you could select your choices for the following day, marking them off on a paper slip.  The selection for vegetarians was rather poor.  The food in general was awful, but they would bring me a peanut butter and jam sandwich for lunch.  I wrote in my request beside the offered choices.   In the morning there were little boxes of cereal and tiny muffins.  Breakfast was always my favourite meal.   For your first day or two, your meals are delivered directly to your room.  After that you were encouraged to eat with the other patients in a small dining room which was unlocked at meal times for this purpose. I never ate there.  I carried my tray carefully back to my room where I ate alone.  The meals arrived like clockwork at 8AM, 12PM and 5PM.  You could order ginger ale as a snack or a treat, it arrived in a paper bag with your name.   I used to order Colt diet ginger ale, but I’d use the edge of the can to hurt myself, I never drank the pop.   Dinner was the worst meal.  There were a selection of about 4 different vegan dinners that came in plastic trays, preheated.   I would peel the plastic wrap off and sample them, sometimes eating very little.   The arrival of the trays marked the passage of time through the day and the long hours after dinner stretched out, especially if you didn’t have a visitor.

Medication times were another way to tell the time.  At first my nurse would come to my room to give me the selection of pills (at one time I was taking more than 11 pills a day).  After settling in, patients reported to the nursing station at set times to receive their pills.  Each pill came in a tiny sealed plastic bag, labelled with my name and patient number (I still have it memorized!).  The nurse would check my wristband carefully against the name on the plastic bags.  Then the nurse would rip them open carefully and tip the pills out into a small paper cup or into my hand.  I would get another small cup with water and the nurse would watch me swallow the pills.  Night time medication was always greatly anticipated as it marked the end of the day and the time at which it was acceptable to go to sleep for the night.  Realistically, on high doses of anti-anxiety and anti-psychotic medication I often slept during the day as well.   Floating in between high levels of anxiety and thoughts of self harm and suicide, and drugged, sluggish, words slurred together medication induced slumber.

There were no cell phones at that time, difficult to imagine!  There was a Bell payphone at the end of the hall in the TV lounge area.  There was a black leather chair you could sit in while you were on a call.  There was another payphone halfway down the hall, at the edge between the Y and Middlesex portions of the 7th floor (older and comparatively newer parts of the wing).  Talking on the phone to friends and family members was one way to pass the time.  Some patients also sat in the TV room watching whatever was on. I rarely sat there, preferring to stay in my room or in the room of a co-patient I had befriended.

If you were upset, you could ask to speak one on one with your nurse.  There was a small room attached to the nursing station where we could sit.   Sometimes the nurses would speak to me in my room.   The psychiatrist would visit once every few days.  These visits were highly anticipated.  Sometimes I would wait around the floor for hours, figuring that my Dr might check in on me.   Visits from the psychiatrist meant changes in medication, changes in privilege levels, and often discharge from the hospital.  The doctor generally just spoke to me in my room, even when the room was shared with 1-3 other people.  The level of privacy on the psych ward was very low, unless you were lucky enough to be moved to a private room.

Private rooms were highly coveted.  On the psych ward private rooms had nothing to do with the insurance coverage you had and everything to do with privileges.   When I arrived on the 7th floor I was generally in a ward room, 4 beds separated with curtains.  I didn’t mind this as long as I had one of the two beds by the window rather than one of the two beds by the door.   Patients who just arrived on the unit were placed in the ward rooms closer to the nursing station.  Aggressive or self destructive patients were placed in these rooms.  If I stayed longer, I would often be allowed to move further down the hall, further from the nursing station and closer to the exit (both literally and symbolically).   I loved the single rooms which had their own washrooms.  All the rooms had these chain link grills over the windows, but some of them did open a crack.   There were also double rooms, some of which did not have washrooms.  There was a shared shower room.  It had space for 3 people to shower or bathe at the same time, but the showers were separated by curtains.   Rumors circulated that people had completed suicide in these shower rooms and all the patients believed them.  There was also a laundry room where longer staying patients could wash their clothes.

The best part of staying at South Street was that I was generally allowed to come and go for brief periods on my own.  Sometimes I was allowed only on hospital ground, in which case I would go down to the patio at the back of the building.  This was a place where smokers could smoke and psych patients who were not allowed to leave could get some fresh air.  I would go down there with fellow patients sometimes and it was almost like an outing.  Smokers looked forward to the scheduled times we were allowed to leave the unit.

Other times I was allowed to go for short walks around the neighbourhood.   I used to walk down to the river by the hospital.  I’d walk around the streets in the area.  Sometimes I’d walk to Tim Horton’s and buy a piece of caramel coffee cake.  There was a walking path along the river to a small waterfall.  I know we sometimes though of jumping into it.  There were ducks which could be fed if you ordered extra bread with your meal.  Sometimes I walked alone, sometimes with visitors and sometimes with other patients.   I made some friends at South Street.  A few of them I still stay in touch with today.

Ironically enough, many of the patients were allowed to basically come and go as they pleased.  At night the door was locked and you needed permission from your psychiatrist to have a pass home for the evening or overnight.  Sometimes I had accompanied passes which meant my boyfriend had to sign me in and out.  Other times he would just drop me at the front entrance.   Ironically, though I was often admitted to the hospital for self harm and suicidal thoughts or attempts, I was still allowed freedom to leave the floor unaccompanied.   In reality I could have harmed myself pretty much anytime I wanted, even when in the hospital.  Sometimes I did, but other times I didn’t.

I often wonder exactly what made the hospital safer than being at home.   I think it was the thought, or the hope, or the desperate idea that it was safer which kept bringing me back there.  I was almost hypomanic and highly impulsive about self harm while I was taking anti-depressants.  I felt unsafe, I thought I’d be safer in the hospital, admitted myself then realized I felt trapped.  I was generally a voluntary patient, so I soon discharged myself and the cycle began again.  I never really felt safe anywhere.

Sometimes the hospital was a comfort.  The routines, the quiet, the break from real life.

Sometimes the hospital was terrifying, like when one of my roommates was cutting and snorting cocaine in our shared washroom.  Leaving blood and white powder traces for me to find.   Like when a patient who dressed in black and openly worshiped Satan was restrained by multiple security guards and wheeled down the hall on a gurney screaming.   Like when an old man came up behind me in the hall and placed his hands around my neck, whispering that he would kill me.  Like the blood stains on the 7th floor carpet, from where a man had been seriously injured trying to escape.

There was  tenuous grasp on order there, and we all knew it.   Sometimes people think of the psych ward as being filled with crazy people.   But in reality, I was neither more nor less crazy than the other people there.  I wasn’t psychotic, like some of them were, but I was destructive and depressed.  Everyone was there because they weren’t safe.  Our reasons were different, but the result was the same.  We all lined up for our pills.  We all ate our meals off plastic trays.  Some of us were allowed real cutlery and others only plastic.   The lines were drawn in terms of privileges, delineating various levels of “crazy.”  But in the end we were all there together.  We were all psych patients.  I see myself as being no different from the others.

Even today, over a decade later, there is a part of me that still holds that identity.  The identity of being on a psych ward, of being hospitalized against my will.  It did change me and it did shape me.  But it no longer defines me.

 

 

September 10 -World Suicide Prevention Day

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On this day I remember the friends I have lost to suicide.  I think of the friends I know who are suicide survivors.  I think about the service users I work with who struggle with suicidal thoughts.  I think about what it means to be a suicide survivor.

I am a suicide survivor.

I can’t speak to the experiences of other people who have survived suicide attempts, but I would like to share my own thoughts.  I think there are a lot of myths out there related to surviving suicide, how to help people who are suicidal and why people attempt or complete suicide.   It’s a taboo subject, one that people skirt around.  Sometimes the mere mention of suicide can silence a room, create uncomfortable looks and make those around you ill at ease.  I think this is mainly due fear.  It’s almost like people think that suicide is contagious.

I rarely talk about my experiences as a suicide survivor.  There seems to be a tacit agreement that it is not a suitable conversation topic.  Even in therapy there is the worry that talking about suicide will lead to unwanted consequences, trips to the hospital, worrying others, making others think that you are “crazy” or “unstable.”

Here are some of the myths surrounding suicide that I’d like to dispel.  These are my own thoughts and I don’t claim to speak for everyone who has these experiences.

  1. Suicidal thoughts and suicide attempts are impulsive reactions and pass quickly.
  2. Talking about suicide means that someone is not serious and is not really at risk
  3. Suicide attempts are always a “cry for help” and the person doesn’t want to die
  4. People who survive suicide attempts are grateful to be alive and recover quickly
  5. Talking about suicide will just “give someone ideas” and it will increase their risk
  6. The best way to help someone who is suicidal is to call 911 or take them to hospital
  7. If someone is habitualy suicidal, the experience is normal for them and they don’t feel afraid or need support.

Realities

  1. I’ve struggled with suicidal thoughts on an ongoing basis since I was 17 years old.  That’s almost 20 years.  My suicidal thoughts can sometimes be impulsive, but in my experience they are usually long lasting, persistent and even obsessive in nature.  I wouldn’t even like to hazard a guess as to the number of hours I’ve spent planning ways to die and thinking about ending my life.  In my experience, the impulsive thoughts are the most dangerous and the scariest, but the chronic obsessing about suicide is more exhausting and creates  a sense of hopelessness.   Many people struggle with suicidal thoughts over a long period of time, just because they don’t act on it or don’t talk about it, does not mean they are not at risk.
  2. I hear this a lot.  “If she is willing to talk about her suicide plan it means she isn’t serious and she really wants help.”  This is a dangerous assumption.  Every person is different, every situation is different.  Some of the times I tried to kill myself I didn’t tell anyone, I didn’t talk about it before hand, there wasn’t an opportunity to intervene.  Other times I spoke about it to many people, I asked for help, I went to the hospital without harming myself, and I often found that I was not believed or taken seriously.   It was incredibly frustrating because when I went to the hospital AFTER harming myself the doctors were angry that I didn’t “ask for help.”  When I went without harming myself, they assumed I was safe and rational and did not need help.  It was a vicious unhealthy cycle.  In my opinion, if someone is talking about suicide you should listen and you should take it seriously.  Many people who complete suicide have talked about their thoughts prior to taking the final step.  On the other hand, if someone never talks about suicide we can’t assume they are not at risk.
  3. Suicide attempts are not always a cry for help.  Sometimes the suicide survivor really did want to die and their attempt failed.  Suicide attempts are not a way to seek attention.  They are not a way to control or manipulate people.
  4. When I attempted suicide and survived, I was not grateful.  I felt like a failure.  I felt worthless and ashamed.  I felt like I couldn’t do anything right.  I felt ill and I had physical effects from harming myself.  I felt alone and I felt stigma. Even today, years later I regularly wish I had died years ago when I attempted.   Not all suicide survivors are happy to be alive.  We don’t all wake up the next day, thankful for a second chance.  It’s also common to be happy to be alive sometimes and wish you had died at other times.  The recovery process can take a long time and will last far longer than the short time someone might spend in the hospital or away from work/school.
  5. Talking to someone who you think may be suicidal will not increase their risk.  It’s far more risky to stay silent, not ask the questions, not check in with someone.  If you are concerned about someone you care about, I recommend asking them directly if they have thoughts of harming themselves, ending their lives, or wishing they were not alive.  Ask them if they feel like a burden, ask them about what connections they have in their lives, ask them if they feel hopeless.  It’s better to know the answers, then to assume someone is not suicidal.  Sometimes a suicidal person feels like nobody cares about them, and staying silent could reinforce that belief.  I can’t even remember the number of times that I was stopped from harming myself by receiving a phone call from a friend, or a connection with someone around me.  Connection is the opposite of depression.  Asking someone about suicidal thoughts is not easy, but losing them to suicide will be harder.
  6. Calling 911 or taking someone to the hospital is not always the best way to help a suicidal person.  Sometimes involving the police, ambulance or hospital can escalate a situation.  Sometimes it can destroy the trust you have with that person.  In many situations it can be helpful to give the suicidal person choices and options.  Thank them for opening up to you.  Ask them what they feel would be most helpful.  In my experience, suicidal feelings are often linked to feeling out of control and overwhelmed.  Taking away choices from someone or punishing them for suicidal thoughts can add to feelings of powerlessness.  Offering choices can be an antidote.  Maybe the person wants company, maybe they don’t.  Maybe they just want a chance to talk about their suicidal feelings without being judged.  Maybe they do need medical intervention, maybe you can take them to the hospital and stay with them.  If someone is suicidal and impaired by drugs and alcohol, or has access to lethal methods such as a gun, you may have fewer options.   But calling 911 without somoene’s permission should be a last resort.  Hospitals don’t even always admit someone who is suicidal.   I’ve been in the ER, highly suicidal and at huge risk, and just sent home.  I’ve been told “she isn’t psychotic so  she can go home, she isn’t at risk.”  I’ve often felt WORSE after unpleasant and unhelpful interactions in the ER.  It’s a myth that hospitals always help suicidal people.  Consider all your options and include the suicidal person in decision making as much as possible.  Also make sure you take care of yourself.  You are not responsible for saving anyone.
  7.  People like me, who struggle with suicidal thoughts on a chronic basis, still get scared.  Feeling suicidal is a scary thing.  It doesn’t matter that I’ve felt this way hundreds of times before.  I’m afraid.  I always worry that I will become impulsive and make bad choices.  I always feel afraid of telling someone, afraid of their reaction, afraid of the stigma.  Afraid people will think I shouldn’t be working, parenting, left alone etc.  If you know someone who chronically talks about suicide or habitually harms themselves, don’t give up on them.  Don’t assume they don’t want to get better.   Suicidal thoughts and self harm behaviours can be a coping mechanism for many survivors of violence.  Sometimes thinking about harming myself feels like the only way I can have control in an out of control and scary world.  Suicidal people need and deserve compassion.  Never underestimate how much good you can do by just non-judgmentally acknowledging someone’s struggle:  “Those thoughts sound very scary, you must feel pretty overwhelmed right now, I’m sorry you are struggling, what can I do to help?”

 

I miss my friends who completed suicide, but they are not cowards.  They are some of the bravest, most beautiful people I have ever known.  Suicide survivors are all around us.  We are regular people, living regular lives.  Suicide isn’t just something that happens to “crazy” people.  It can happen to anyone.  Breaking down the stigma helps everyone.  I think about suicide on a regular basis, but I still have an ordinary, productive life.  If you struggle with suicidal thoughts, or have lost someone to suicide, you are not alone and you should not be ashamed.  Be good to yourself, I’m happy you are alive.

Restraint

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In the summer of 2001, I overdosed multiple times.  Some of these stories are described in other blog posts.  After the last of that series of suicide attempts, my psychiatrist put me on a Form (sectioned me, 72 hour hold).  He refused to release me from the hospital unless my parents came to collect me.   I remember my father driving down to pick me up.  I don’t really remember being released, but I ended up back home at my parents house, many hours away in another city.   The past few months felt like a bad dream.

I remember my parents had hidden all the pills in a bag in their bedroom closet.  I remember that there wasn’t a lot of trust, and for good reason.  I tried to relax, but the thoughts of self harm were propelling me forward.  I was caught in a vicious cycle, medication induced self destruction.  I would feel unsafe, hurt myself, go to the hospital seeking safety…then after a few days panic, feel trapped and beg to be released.  It went on over and over.  I always wanted to be where I wasn’t, I was chasing the feeling of safety, of quiet in my mind, of escape.

I remember walking up to the plaza by my parents house.  I bought an exacto knife at the dollar store and sneaked it into the house.  I was always buying, hiding, and throwing away tools during those years.  I often hide them in various places for safe keeping.  Intellectually I knew that having them in the house was the opposite of safe, but somehow their presence simultaneously calmed and panicked me.   It’s rare, even today that I don’t have something hidden.  Even though I don’t use the tools, I sometimes feel compelled to buy and keep them.   Sometimes I’ve called friends and asked them to help me throw them out.  I’ve handed them over to therapists and doctors.  I’ve hidden them and felt ashamed.  Even writing this brings up a feeling of shame inside me.  This is the power of addiction, the constant push and pull between the promise of safety and the threat of disaster and destruction.  Back then, I thought I was in control.  I thought the cutting kept me in control, but in reality the urges controlled me completely.

I had the knife at my parents house, I cut myself with it.  Deeply, but not deep enough to require medical attention.  I told my parents and asked them to take me to the hospital.  I told them I felt suicidal and I wanted help to control the urges.  I remember sitting in the ER waiting room, in a different city.

I don’t remember everything that happened.  I remember talking to a Dr, I was sitting on a stretcher, it wasn’t a special psychiatric emergency, just a regular bed.   The doctor agreed to admit me.  Then nurses came and gave me a gown, they took my clothes and items and put them into a white bag with a plastic drawstring labelled “patient belongings.”  This was different, the anxiety began, “why are they taking my things?”  Apparently this was the protocol at this hospital.

I was taken up to the 4th floor, to the Mental Health Unit.  It was a different layout and different style that the hospital I’d been in only a few days before.  It seemed larger and was laid out more like a large rectangle, rather than a long straight line.   I was shown to my room.   Outside the room was a cupboard and the nurse locked my things in there.   I was allowed to keep my teddy bear, but not my clothes.  In this hospital there were 2 beds to a room and each room had it’s own bathroom with a toilet and shower.

I stayed in the hospital for a few days.  It was the last week of June.  A few friends came to visit me.  I was given my clothes back and allowed to leave the hospital on passes.   During one of the passes I went to visit the psychologist who had treated me as a teenager.   To be honest the appointment was not helpful.  I don’t think she had a good understanding of me.  She didn’t understand why I was sick (because I’d been abused) and she didn’t understand why I was cutting myself and suicidal (because of the abuse and the medication cocktail).  I felt that she shamed me and threatened me to stop my acting out.  I don’t really remember exactly what was said.  I only remember feeling desperate when I left.  I think my parents dropped me back at the hospital.  I was in the lobby of the hospital, where there was a pharmacy and I considered buying a giant bottle of the medicine I had been told would kill me if I overdosed again.  I felt hopeless.

Somehow I managed to go back upstairs to the ward without incident.  I remember a few days later I wanted to leave, as was my usual pattern.  It was the weekend, I believe it was July 1 and I wanted to go home to see the fireworks.   I did as I would have in the other hospital, starting convincing them I was okay.  But somehow it backfired.  They didn’t believe me and they said I couldn’t leave until my doctor returned the next day.  I started panicking and becoming angry.   They told me they were holding me involuntarily because they thought I would just leave.  I was crying and banging my head.  I went into the washroom in my room, took off my earring and scratched my skin with the sharp end.  It wasn’t even enough to draw blood, just to cause pain and leave angry looking scratches on my body.   I remember being at the nursing station.  I was given a cup with liquid medication inside.  I was told it was Nozinan, a medication I’d used for panic before.  I drank it and soon after I realized something was wrong.  I became extremely drugged and when I asked the nurse had given me 5 times my usual dose.  They took away my clothing again and gave me a hospital gown.

Before I fell asleep or settled into my bed I realized what had happened.

I’d been chemically restrained.

They didn’t want to deal with my acting out and so they drugged me.

I felt betrayed, I felt scared.  I felt like I couldn’t trust anyone and I felt like my life was out of control.

The next day my doctor returned and agreed to release me.  The only useful part of that hospital admission was the doctor switched my medication to one that I still take today.  One of the few I’ve found over almost 20 years that actually makes me more, rather than less, sane.   For that I was thankful.

I soon went back to my home.  The cycle continued.  Looking back I realize an important lesson.  It’s not possible to keep someone else safe.  If someone is determined to harm themselves they will find a way.  Short of restraining someone and drugging them, it’s impossible.  The person has to want to help themselves, and they have to find both a purpose for living and a direction to move toward.  A goal, a passion, a reason to fight.  This is unique and can’t be forced or given to someone.  Believing in myself happened over time.  The psychiatric system is a crisis management system and nothing more.  The true help I’ve received over the years has come from other places entirely.

 

Inpatient bonds.

20160727_214408[1]One of the bright sides of spending so much time in hospitals during my teens and early twenties is the people I met there.  Some of them became lasting friends and the bonds between us defied understanding by outsiders.

If you’ve never spent a significant amount of time as an inpatient in psychiatric wards and mental health treatment facilities you probably won’t understand.

I’ve had people close to me tell me that I “shouldn’t have so many friends with problems” or that I should “try to make healthier friends” or that I “shouldn’t talk to people who depress me.”

These comments miss the point for a number of reasons.

First of all, if my “friends with problems” aren’t worthy and I shouldn’t be friends with them, does that mean nobody should be friends with me either?  In case you hadn’t realized from reading this blog, the secret is out.  I identify as living with mental illness! I’m not exactly 100% well myself, otherwise I wouldn’t have been in the hospital in the first place!  Does this make me less of a good friend?  Does this make me a person who should be shunned and avoided?  I certainly hope not.  I would like to afford my other hospital friends the same courtesy.

Two, it’s hard for people who are mentally well, neurotypical, never struggled with severe mental illness to understand me.  Sure, I have well friends who empathize and who don’t judge me.  But the bonds and mutual understanding I’ve shared with other people who struggle with PTSD, eating disorders, depression and suicide are very strong.   It’s like I can breathe again, when I talk to a friend who I know “just gets it.”

Three, when you are living in a hospital ward, you naturally form friendships and alliances with the people you are living with.  Some of them become friends.  It happens and it helps us survive.

So please, don’t judge these special friendships.  Even when I’ve lost friends to suicide, even when I’ve been triggered by friends and had to set boundaries, even when it feels like listening to their struggles is too much to bear, I never regret them.

My dear friends who are gone.  I desperately miss that feeling of belonging I had when I talked to you, laughed with you.  MJ, there was never anything I shared about PTSD that you hadn’t breathed and experienced yourself.  I never had to explain myself, you just knew.  This blog entry’s photograph is a picture of all the cards you wrote to me during our friendship.

Who else could I share my strange experiences with?  When I told her one day, crying in the bathroom in my ex-husband’s house, that I was scared because I thought I was seeing X everywhere.  I literally thought I could see him all around the city.  Intellectually, I knew he wasn’t there, but it felt real and my heart skipped a beat each time.   She almost laughed and said, “It happens to me all the time.  I see everywhere too”  We breathed out together, suddenly this PTSD symptom was normal and okay.  We understood each other, we weren’t crazy.  I loved her for this and I know she loved me for it too.

When I was in treatment for anorexia when I was 17, I met another young woman named M.  She and I were stuck on the eating disorder for 5 weeks together, while other patients attended groups.  We were on “modified activity phase” until we gained a certain percentage of our goal weight and it took forever.  During this time we talked, bonded and sometimes sneaked around doing things we should not have.   She was painting rocks when I got there.  I asked her what I was doing and if I could help.  She told me she wanted to paint 1000 rocks so her wish would be granted.  Soon, we had an assembly line going.  We would fill our pockets with rocks on our 15 minute outside break, sometimes walking further than we should have away from the break area.   Once inside, I would paint the rocks a solid colour, then when they dried she would write “Expect a Miracle” in careful lettering on each one.  The final step was applying a clear glaze once all the paint was dry.   We painted so many rocks, I don’t remember how many we had finished when I discharged myself 3 months later.  I still have some of them in my bedroom almost 20 years later.  I’m still waiting for a miracle.   I often wonder what happened to M.  We lost contact and I still think of her often.  I wonder if her miracle came true and I wonder if she recovered.

I met my friend Lexi at a support group in my city.  It was the first place I really talked at any length about leaving my ex-husband and what was going on in the marriage.  Lexi loved to crochet and knit.  She loved her family.  I used to go to her apartment sometimes and we would chat about all sorts of things.  Sometimes we shared stories of our trauma and sometimes we joked and laughed about our future.  I was inspired to try online dating because of Lexi.   I lost her suddenly last summer, about  a year ago now.  I still miss her.

Darlene, whose story I recounted in another blog post, her anniversary was this week.  14 years ago I lost her.   I wish I’d had the chance to know her better, but I won’t ever forget her.

Some friends like my dear sister LJ, I have kept in contact with for over 12 years, through email, fb, text and phone.  She lives in a different country, but she calls me sister.  I miss her and I hope to see her again one day.  I have ever letter and card she has ever sent me. She has inspired me in many ways and her commitment to recovery and to survival is tremendous.

My friend John, he is also gone now.  But his music lives on and I have his CD which I listen to from time to time and remember his gentle courage.

I will never forget the stories of survival I heard and witnessed during my hospital stays.  I met so many survivors.  I met war veterans who were kind and brave enough to share small details of their own private hells with me.  I met residential school survivors who shared with me the abuse they endured.  I met childhood abuse survivors who overcame.  I met women who were admitted to the hospital in full psychosis, speaking in delusions and making little sense.  I saw those same women, mere days later, completely calm and rational again after taking their medication.  I met people who had lost family members in tragic circumstances.  I met people who had nearly died from multiple heart attacks due to anorexia and bulimia and some of those women have children and are well and healthy today.

These friends give me hope.  They remind me that I’m not alone.  They remind me that recovery is possible.  And the ones that have died, I will hold in a special place in my heart forever.

Inpatient bonds are something to be celebrated.

Electroconvulsive Therapy (ECT)

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“Electroconvulsive therapy (ECT), formerly known as electroshock therapy, and often referred to as shock treatment, is a psychiatric treatment in which seizures are electrically induced in patients to provide relief from psychiatric illnesses” -Wikipedia

Basically, ECT is a treatment by which patients consent to have seizures intentionally triggered by electric shocks which are applied to the brain.

When you put it that way, it sounds barbaric and unnecessary.  Why would someone consent to have electric currents put through their brain under general anesthetic and undergo seizures?

The desperation and intense suicidal ideation that can accompany treatment resistant depression can be unbearable and even fatal.  Given the choice between suicide and ECT, some people choose ECT.  I was one of those people.

In 2011, I was caught in the grips of one of the worst depressive episodes of my life.  I was fighting off constant thoughts of suicide and severe self harm.  I was having difficulty functioning in my day to day life.  I had tried every medication known to human kind.  I was truly desperate and ECT was a last resort, something I hadn’t tried and something I hoped would provide even brief respite from my suicidal depression.

Over the course of about 8 weeks I received 15 electroconvulsive treatments.  This means I was put under general anesthetic 15 times and I had 15 seizures.  Some were unilateral (one side of the brain) and some were bilateral (both sides shocked simultaneously). I received the treatment as an outpatient, twice a week, Monday and Friday mornings at a hospital near my home.

Each morning I would report to the inpatient psychiatry floor around 6:30AM.  I would change into a hospital gown, remove my jewelry and be taken on a stretcher, by an orderly, down to the surgical area of the hospital.  I would wait in the semi-darkness, dimmed light of the surgical recovery room.  While in this room, nurses would place an IV into my hand so the necessary medications could be injected.  I was hooked up to heart rate monitor and other monitors.  There were usually 4-6 of us lying there, side by side, waiting our turn in the treatment room.  As I would wait, I would see the previous person being wheeled out of the treatment room, unconscious.  It was unsettling, as I knew my turn was coming soon.

The ECT room was a small procedure room attached to the surgical recovery room.  It was just large enough for a stretcher, the medical professionals and the necessary equipment.  It was bright and clinical.

Nurses and doctors began to work on me quickly.  I had the impression of an assembly line, a schedule being kept, patient in, treatment given, next patient in and so on.  My temples were wiped with alcohol swabs and electrodes attached.  The anesthesiologist talked to me about the medications he was going to administer.  A nurse would often hold my hand, there to keep me calm as everything was arranged.  The medications were injected one by one through the IV.  I could feel the cold fluid entering into the veins in my left hand.  I would keep my eyes fixed on the clock, trying to remember the time as I went unconscious, to later compare to the time on the clock when I awoke.  Sometimes I would lose no more than 15 minutes of time, the procedure was very quick.

I remember feeling afraid.  The nurse asked me to count backwards.  An oxygen mask was applied to my face and nose, ready to breath for me while I was unconscious.  The medications worked quickly and then nothing.  There was only one time of the 15 when I was aware of part of the process.  The medications they injected to relax my muscles began to act before I was unconscious, I felt like I was suffocating.  I couldn’t breathe and I started panicking.  I literally couldn’t breathe, but I was awake.  I could hear them talking and feel the next medication being injected and then nothing.

I would wake up 15 minutes later.  Back in a different curtained bay of the recovery room.  I could hear the nurses helping the other patients on either side of me, also recovering from ECT.   This was the part of the treatments that I hated most.  I had to stay in the recovery room for 30 minutes following the treatment, as they monitored my blood pressure and other vital signs.  I felt trapped.  I was hooked up to machines.  I often had a sense of panic and wanting to flee, to leave, to be outside.  Sometimes I would cry and I don’t think the nurses understood why.  Eventually the Doctor would come, talk to me briefly and I would be released.   The first time I could barely walk and the nurses wheeled me to the entrance to meet my family member.  I was usually home by 9 am.  The whole process taking 2-3 hours.

Usually I would stumble, drowsy and disoriented to the car.  I would be driven home and I would go straight to bed.  Usually I would sleep and rest for most of the day.  I lost a lot of weight over those few weeks because I ate so little due to missing breakfast and then being nauseous from the medications.  I also had severe headaches due to the shocks, and many side effects from the medications.  I felt like a zombie.  My short term memory was foggy as to the events during those 8 weeks.  During that time, my grandmother passed away and the experience was surreal through the state of mind I was in.  I have no memory of my own birthday that year, and few of my daughter’s.

In terms of long term side effects from the treatments, I found that the area of my brain which recalled the order of the months of the year and the seasons of the year were impacted.   If someone asked me “What season comes before Fall?”  I would feel confused and have to think very hard to answer “Summer”   Similarly with the months of the year and the order of the holidays in the calendar.

Overall I don’t think I suffered any major memory loss.   At the time I thought that the treatments helped my depression a little.

Sadly, I only realized about 9 months later that a large portion of my depression was situational, related to my abusive marriage.  In the end, the treatment for my depression was to move away from him.

If I’d realized this sooner, I probably would not have endured ECT.

Looking back on the whole series of treatments, it feels unreal.  It feels traumatic.  It feels strange and difficult to process.

In what world does it make sense to further traumatize a traumatized brain?  But desperation will make a person take desperate measures.  I survived and that is what matters.

PES (Psychiatric Emergency Services)

INEWS101A-MentalHealthHolds

I’d been in the psychiatric emergency rooms at South Street hospital more times than I could count.  But that was an old hospital. The rooms were basically just regular rooms, except the chairs were bolted to the ground.  One of them had an ugly green tiled floor.  One of them had a stretcher in it.  There were chairs just outside for the security guards to sit.

In July 2011, I was in a different hospital emergency room.  This hospital was newer and had an updated PES (Psychiatric Emergency Services) department.  The door to the department was locked at all times.  There were 4 small rooms, similar to the one in the picture above except the chairs were bolted down, and one washroom.  In the washroom the toilet was metal and had no seat.  The sink was metal and attached to the wall.  In the central area between the 4 rooms there was a water fountain and two telephones attached to the wall.  In the central area there was also a stretcher with restraints on it. Separated by another locked door was the nursing station.  Each of the rooms had cameras in them (except the washroom).  The nursing station had a window which looked into the department.  The washroom reminded me of what I imagine a jail looks like.  In fact the whole experience was like being in jail.

My family was out of town visiting my ex-husband’s extended family.  I was in my last weeks of the practical placement that would complete my Masters degree.  Ironically my placement was in a psychiatric hospital.  The depression that had crept back into my life in the Fall of 2009 had worsened.  There were many reasons for this.  I felt desperate and I had tried all the medications that were available.  I began to seriously consider ECT (electroconvulsive therapy aka shock treatments).  This had been suggested to me in the past around 2004, fairly early on in my psychiatric survivorship story.  At that time I felt it was too soon, I hadn’t tried a whole class of medications.

In 2011 I felt like my options were suicide or ECT and I preferred the ECT.

I wasn’t coerced, I wasn’t pressured into it.  I sought out the treatment myself with the support of my outpatient psychiatrist.  Since he has no privileges at the local hospitals my best bet was to go to the ER and ask for a consult.

My plan was to do this as an outpatient.  But things went awry.   When I told the psychiatric resident how much I was struggling and how suicidal I was she wouldn’t let me leave.  The doctor on call told me I had to be admitted to the hospital and that if I didn’t agree to stay she would admit me on a Form, involuntarily.  At this point, locked in PES, I decided my best option was to cooperate.   I hadn’t brought anything with me, and there were no beds open on the Mental Health Unit, so I was forced to spend 24 hours locked in PES.

I can’t remember exactly when I cracked, but I phoned a friend.  I told him where I was and that I wasn’t allowed to leave.  I cried to him on the phone. He was a friend from school and I was so embarrassed to be calling him from the hospital.  I felt like it was my one call to the outside world after being arrested.   I didn’t want to tell my parents, but the next day I finally did, so they could bring me some clothes and items.

Staying overnight in PES was not a pleasant experience.  The lights were always partially dimmed in the center hallway.  There were no windows to the outside world.  This place was literally a prison.

The white sheet on the bed left lint and little pills all over my lululemon yoga jacket.  They are still there to this day!  Also to this day the smell of the soaps and sheets in hospitals triggers me.  Hospitals have this very specific smell, a mix of bleach and antibacterial soap (the cheapest kind).

Meals arrived on a tray, but there was nothing I wanted to eat.  Somehow in the morning, after almost no sleep and nothing to eat, I convinced the nurse to let me go to the cafeteria to buy a snack.  I argued that since I was a voluntary patient I should be allowed and for whatever reason they reluctantly agreed.  I ate a muffin and drank some hot coffee.

The doctors came back the next day, and eventually I was moved up to the 4th floor.  I stayed for one night on the unit.  I told the doctors what I wanted: outpatient ECT.  We called my ex-husband and discussed this with him.   Everything was agreed upon and I was given an appointment to meet the doctor the next week.  I convinced them that I would be safe at home and they discharged me.  They wanted me to stay but I wanted to leave.

The hospital always seems like a good idea from the desperation of home.  But once you are there you realize that it isn’t a very safe place either.  A good part of this is because you are at the mercy of others and have very little control over your own life.  That and the doctors have the power to hold you against your will at any time.

I wonder…why do they make PES look like a prison?

Why are psychiatric patients treated like criminals?

Surely someone could design a safe and secure section of the hospital that actually looked and felt healing.  I’m willing to bet the person that designed PES had previous experience designing prisons.

I’m not a criminal.  I would heal and relax more quickly if I was in a hospital environment that felt welcoming and relaxing.  The very environment of PES conveys a lack of respect and a perspective on the status of the patients/prisoners.  PES brings up a deep sense of shame in me.  I begin to feel crazy because I am trapped and forced to comply with the orders of the staff.  In PES, you feel you have hit rock bottom.

“You are crazy.  You can’t be trusted.  We think you are going to hurt us.  You need to be locked up for our safety and for your own.  Behave or you will be locked up here indefinitely. We couldn’t be bothered to make this place welcoming or comfortable.  Because you are crazy your comfort is not our priority.  Get used to it”

This is what mental health stigma looks like.