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.