Within my most powerful episodes of depression, I would awake each morning, shower, apply makeup, and attempt to create a fabulous outfit. My worst appearance offense during these periods would be to go out in public in a pair of bright pink sweatpants with a hooded sweatshirt — but the makeup and hair were always done.
I would do what was required of me — attend work, my internship, and classes. At school, I focused on the blackboard through tears, isolating myself from my classmates by default. None of them, I would learn later on, wanted to talk with me because my facade was intimidating. They said I looked like I didn’t want to be bothered.
When I did not have to fulfill obligations within these episodes, I would literally spend all of my time sleeping, or lying on the couch. I described my life as that of looking out of a snow globe — my world had ceased movement and I watched everyone around me carry on at normal pace. My chest constantly felt as though I was wearing a weight upon it — yet the contents of my chest were that of nothing — hollow and empty inside. I would lay on the sofa, extremely thirsty for extended periods of time, too depressed to walk into the kitchen and pour myself a drink.
I am 27 years old. In May, I received my master’s degree in clinical and counseling psychology. I completed the semester with a 3.94 GPA and obtained admission as a second year student into the doctoral program at Chestnut Hill College where I will pursue my Psy.D. I have accepted a job as a psychotherapist at an outpatient mental health clinic. I am married and my husband and I own a house in South Philadelphia. We have three parrots, of which I am their caretaker. I write and publish poetry, and enjoy going to poetry workshops, giving readings, and creating abstract art.
In addition to the above, I also have diagnoses of bipolar disorder NOS, borderline personality disorder, and generalized anxiety disorder. I am a chronic self-injurer and I cut myself on a daily basis. I have intense mood swings, bouts of severe depression, various impulsive and self-destructive behaviors, mixed episodes, relentless agitation and anxiety, and recurrent suicidal ideation.
On April 29th, 2008, at the strong urging of my psychiatrist and therapist, I packed my belongings and my husband drove me to Friends Hospital in Philadelphia. The main reason for seeking an inpatient stay was my self-injury, which had become completely out of control. I have been self-injuring for nine years, but this was by far the worst it had ever gotten. Despite the work I had been doing with my therapist, it seemed as though the only way for me to break the cycle of self-injury would be to place myself in a controlled environment, in which the means to self-injure would be absent.
In addition to the cutting, I was also engaging in various self-destructive behaviors, which served as ways to almost cross the line of my suicidal ideation. These behaviors included putting a large number of tranquilizers into my mouth and then spitting them out, cutting my wrists, but not enough to do any serious damage, and engaging in reckless driving. There are nights in which I cut, but I have no recollection of the action. I wake up the following morning and the bandages are there — I struggle to recall the behavior, but it is as though it never happened. There are also times in which my mood reaches a manic irritability, in which the razor swipes down and hits like a hammer. I feel nothing. These are the times in which I have lost the most control and end up cutting deeper than I had intended.
When I arrived at the hospital for my intake, I was dressed well, but casually. My hair was styled and I was wearing makeup, as I always do. When I interviewed with the psychiatrist, I told him my diagnoses. He asked what I did for a living and when I told him about my career and level of education, he looked surprised, as though I was the first doctoral student to ever set foot in a psychiatric hospital. I used terms like “depersonalization” and “psychodynamic”— not to be obnoxious, but because that is the language I know and the best way, I feel, to deliver information to a psychiatrist. I gave insight into my cutting behavior, splitting it into three groups — the need to relieve agitation, the addiction, and the piece of my identity that I am too fearful to give up. I spoke to him about the difference between my hypomanic episodes fueling creativity in my poetry versus the natural creativity itself. I told him how I felt I could benefit from the structured environment of the hospital in addition to the intensive groups. I explained that in therapy, I explore the underlying meanings of my behaviors, but at this time it was too out of control and I needed a different type of intervention.
I also told him about the mouthful of tranquilizers, the erratic driving, suicidal ideation, and the agitated manias. I showed him my scars and told him that the last time I cut was about 10 minutes before I left to go to the hospital. I expressed my fear of cutting deeper than I meant to, or in a place where I shouldn’t have cut at all.
It was then that the doctor told me that he didn’t believe that I would benefit from inpatient hospitalization. He stated that the criteria they use in the Crisis Response Center is to think about whether if they sent an individual home after the evaluation, would he or she die? He didn’t think I would die. He said that I wasn’t in any immediate danger and that obviously, my daily living skills were excellent. He mentioned that the other individuals on the unit were “sick.” He then offered to me and my husband to stay around for a few more minutes while he consulted with another psychiatrist on staff.
I recall the days prior to going to the hospital when I was supposed to be packing and getting emotionally prepared for this. My husband calls me on his way home from work.
“What are you doing?” he asked me.
“Oh, I have a 4:45 appointment to get my eyebrows waxed. I’ll be home a little bit after 5:00.”
(Who the hell worries about what their eyebrows look like two days before they go into a psychiatric hospital?)
“But that’s part of what makes you, you,” my husband tells me. He’s so right.
Now I will make a shift to one night before the hospitalization. My husband calls me from the train. He’s on his way home from New York.
“What are you doing?”
“Oh, just a little pre-mental hospitalization shopping. You’re never going to believe what I got! I found these socks with a sparkly, insane looking cat on them, holding a chainsaw — then they say on them — don’t make the crazy girl mad! How perfect is that?”
And so my husband and I sat in the waiting room of the Crisis Response Center — me with my perfectly shaped eyebrows, bag packed with my new socks that I was way too excited to wear, all of my beauty products, and my books: Yalom, Redfield-Jamison, Shakespeare, and Kafka.
The psychiatrist eventually returned and invited me and my husband into a small office, where we met another doctor. This doctor expressed his agreement with the evaluating psychiatrist — that I was not appropriate for inpatient hospitalization.
“Do you ever fear that the cutting will become dangerous?” he asked me.
“Doctor,” I answered him. “I believe it already has. But if you are speaking about a matter of life and death, all I can tell you is that sometimes I don’t know how deep I’m cutting, or where the cut is going to land. Sometimes I cut my wrist, but not deep enough to do any serious damage. What if, in one of my impulsive, out-of-my-mind times, it lands there really deep?”
“Yes,” he answered. “I would be concerned about that, too.”
The doctor then offered me the recommendation of partial hospitalization. I asked him, already knowing the answer, if he could please explain to me, the type of individuals that would show up in the partial-hospital program.
“Typically low-functioning clients,” he responded.
“Individuals who require assistance with their daily living skills?”
Both psychiatrists confirmed this. One stated that he only suggested it because he didn’t want to prejudice me against any treatment. He added that he hoped I had a good relationship with my therapist, and would be able to increase my sessions each week. I told him it was great — a great non-insurance relationship. He said, “Oh. Well, at least it’s a great relationship.” I left the hospital that night angry and defeated — and with no more intensive treatment than I had gone in with.
Once I left the hospital, I left a message for my therapist in a torrent of animated, angry words. I stated to him, “I got past a doctoral school interview, a therapist job interview, but I can’t get past a psychiatric hospital interview?”
That irony has a powerful truth to it. Those first two interviews had required me to dress well and speak intellectually and openly. Apparently I had done the same thing with the psychiatrist at the hospital, only the content was different — I was telling him of my pain, self-destructive behaviors, and suicidal ideation. I was also engaging the doctor in some light debate, based on a question he had asked me in regards to hypomanic mood and creativity.
I couldn’t get past a psychiatric hospital interview because I was acting too much like myself.
I came to this conclusion a couple of days later as I sat with the women in my borderline personality disorder support group. I recounted the story of my failed hospitalization and a couple of the women stated that perhaps I had been too intellectual and not enough emotional. As we talked about the possibility of trying admission into another hospital, the women suggested that I “leave the adult at home” next time I go for an evaluation.
I didn’t understand why I would have to leave an entire compartment of my personality at home, or put it to sleep. This was my true self. I felt it unfair that if I showed up as my true self, with all of the pain and need for help underneath, that I wouldn’t be perceived as “sick” enough to be in the hospital.
Obviously a stigma exists in within all aspects of mental illness. However, I have always been aware of a separate stigma for those who are mentally ill, but functioning at a high level. When I say functioning at a high level, I am referring to a variety of factors in any combination: these individuals may have graduate degrees or are actively involved in attending school, hold professional jobs, are of a middle to high economic status, and have optimal daily living skills (in regards to hygiene, dressing, grooming). They may present well, speak well, and not appear “sick” to even the most seasoned therapist or psychiatrist.
My saddened affect has been perceived by my coworkers and school peers as though I am stuck-up, unapproachable, or isolative. At home, I was writing research papers through tears and cutting myself, sometimes up to 20 times each night. However, it was winter so I was able to easily cover my cuts and I was just viewed as being just a bit unfriendly — certainly not ill.
One summer semester I was taking a psychopharmacology class. We were learning about the mood stabilizers and antipsychotics. My professor made a passing comment pertaining to how he was sure that “no one in the class had a serious diagnosis such as bipolar disorder or schizophrenia,” which, in effect, meant that nobody in the class could be taking such medications. Little did he know, one of the few individuals who got an A in that class carried three mental health diagnoses and had been on 15 different psychiatric medications by that time.
My husband recently told me he “fell victim” to not believe that I was, in fact, ill, and that I have been for the entire time he has known me and even before that. He stated that he thought that since I work hard, gave therapy to patients at my internship, maintained a near 4.0 GPA, was accepted into doctoral school, and care deeply about my appearance, that it couldn’t be “real.” He revealed to me that he is just now beginning to understand the pain and severity of what I go through. It is an unbelievable, yet powerful symbol of the misunderstanding of mental illness — that someone I have known for seven years and lived with for six, could not conceive of the reality of my suffering.
This also holds true for my parents who were shocked when I told them about my decision to attempt inpatient hospitalization: “But you were doing so well —I mean, you look great, you are doing — wait, how is it that you can be ill and yet know so much about psychology?”
I had to explain to them how there was no connection between having an illness and working in the field of psychology. I had to explain to them that just because I was able to meet occupational and educational demands, an illness can still exist.
If my husband could not see it, how could I expect a psychiatrist to recognize it during a ten minute intake? No, I did not show up to the intake falling apart. I wasn’t crying, screaming, hallucinating, or even with a particularly depressed affect. However, I did show up with a well-spoken appeal for help, in an effort to take control over my self-destructive nature. I presented as a pink shoe-wearing, therapist, doctoral student with insights and purse to match. Underneath, I am a frightened, exhausted, confused, destructive, impulsive, sometimes little girl, with forceful and dangerous mood swings.
I truly believe that if I had shown up that night with the exact same story, but different presentation, I would have gotten the help that I needed. It leaves me with this question: Where do I, and other individuals like me, exist on the treatment spectrum? Yes, we have our private psychiatrists and therapists — but what happens when we need a greater level of care? My personal experience exemplifies a struggle in simply trying to get someone to recognize that I am ill enough to need intensive treatment.
As I write this, I would like to say that I am fighting the urge to self-injure, but that would be a false claim. It is an impulse that is much bigger than my resolve and has not ceased or slowed down since my unsuccessful intake at the hospital. I was offered another try by my psychiatrist and therapist, to be admitted into the hospital with intense support from them in order to gain admission. I declined because of the unpleasant, yet realistic disconnection in being ill, but highly functioning. This means that I have an obligation and a vast drive to begin my new job as a therapist. This also means that at the same time, I will be dealing with all of the symptoms that I have previously described. For the most part, I have always managed to keep my illness from interfering with my professional and academic life. I suppose this is why it is difficult for some to realize that there is an illness at all. However, I never forget because every day is a struggle of mood swings, impulses, and chronic emptiness.
I would like to think that at this moment, I should have been in a safer place than I am now. Or perhaps by this time, I would have been discharged and would have had some time to break the destructive cycle I am in. Maybe I would have benefited from the short-term skill-based therapy that I am not presently used to. Conceivably, the psychiatrists at the hospital may have adjusted my medications a bit in order to better stabilize my mood in a safe environment.
Unfortunately, none of these things could materialize. Frankly, I will probably continue to self-injure until I either do something incredibly dangerous (which I am afraid of), or until I am just ready to stop. I will continue to see my psychiatrist and will deal with medication adjustments and side effects while working and going to school.
Nine years ago, when I lived in New York, I was voluntarily hospitalized for very similar reasons. It was somewhat of a traumatic experience. All of these years, I lived in fear of the hospital, thinking it was only a place that could devastate one further. At the age of 27, I finally conjured up enough courage to reach out for the help that I needed, despite my intense fear of the hospital. I was denied. I was denied from the hospital because I did not “appear” sick enough.
, p. (2008). Denied for Being Myself: An Attempt To Be Hospitalized. Psych Central. Retrieved on March 12, 2014, from http://psychcentral.com/lib/denied-for-being-myself-an-attempt-to-be-hospitalized/0001407
Last reviewed: By John M. Grohol, Psy.D. on 30 Jan 2013
Published on PsychCentral.com. All rights reserved.