The mental hospital is a mysterious place for many, and no one ever wants to be inside one. It has derogatory names like the “nut house” and the “looney bin,” but it saved my life. Here is my attempt at destigmatizing mental hospitals.
The following is an excerpt from my memoir Seeking Happiness: A Bipolar Story:
I parked at the hospital ER, even though I didn’t want to believe I needed emergency services. I walked past the ER entrance to the front desk on the other side of the building and told the elderly woman working there that I needed to be admitted into the hospital. She asked why, and I could not hold back my tears as I told her I could not stop contemplating killing myself. She had an officer escort me back to the ER, and with great shame I told the admitting nurse I could not stop thinking about suicide. She admitted me, and we walked past an armed guard as we entered the psychiatric ward. The doctor came in and asked what was wrong. In my hospital records, my ER doctor recorded that I told him my brother Arthur, who lived with me, was going to be gone the following weekend, and while he was away, I was going to go through with buying a handgun and shoot myself. He asked me if I wanted to be admitted to the Marian Center, the hospital’s adjacent mental health facility. I told him I did, and I walked into my first mental hospital just like three of my other siblings had as well.
The inside of a mental hospital is remarkably bland. The walls are a single color and unadorned. The rooms typically have two beds, a bathroom, and a barricaded window. The only activities permitted are to mingle in the common room or go to group therapy. The common room had card games, old movies, and tables to sit at. The nurses switched the coffee to decaf at noon. The hospital also had an atrium filled with greenery if we wanted to take in some sun and be outside for a moment.
I was part of the non-critical ward: no one wore straitjackets or had medication injected into them without consent. Everyone wore scrubs, slip-resistant socks, and had their own unique story to tell. I met a middle-aged man who earned his admission by saying the wrong thing after having a heart attack. I met a young man who said his attempted suicide was just a ploy because his parents were throwing him onto the streets. I met a gay gentleman who was a repeat visitor. He told me he could leave anytime he wanted to. And then I met a young man with a severe back injury who brought me to a new understanding of my disorder.
Since my original diagnosis of depression, I always believed that I could be normal again. In many respects, I thought my medication could fix me and make me whole. When that young man told the group that his uncle – his middle-aged uncle – hanged himself, for the first time I believed I would never outgrow my disorder. I would always struggle with depression and suicidal ideation, and I could never overcome it. I realized then that suicide would always hang over my head until I was old and passed away.
The morning after my admission to the mental hospital, I saw my psychiatrist for the first time. Dr. Cade was surprisingly small, but she might as well have ridden into the room covered in armor and on a horse. She had just finished her training to be a psychiatrist and was hitting the ground running despite the hospital’s ridiculously overbooked schedule.
She started asking me a variety of questions to evaluate my mood and symptoms. She asked how I slept, and I said I slept very inconsistently – from six to eight hours some nights and from ten to twelve others. She then asked me about my energy levels and concentration, and I told her they were very low and poor. This was, however, incongruous with my energy lifting weights and reading religious texts extensively. I told her I still felt pleasure in the things I did, so we marked off anhedonia off my depression checklist. Changes in appetite and excessive or inappropriate guilt followed suit and were marked off too.
Then she asked me if I had ever been diagnosed with a disorder before. I told her I had been diagnosed as bipolar at Vanderbilt, and she asked me to describe my manic/hypomanic episodes. I found myself unable to do so, and I told her I didn’t know. She asked me to describe my antidepressant-induced mania, and I did to the best of my ability.
During my evaluation, certain symptoms came across without me describing them. My psychiatrist noted my goal-oriented focus, psychomotor agitation, and she even flagged me for grandiosity. The hospital monitored how much I slept, and I was experiencing a minor reduced need for sleep. Certain symptoms failed to come across because I didn’t know they were symptoms at all. Most notably of them was the lavish spending spree I had been on for the past month or my intense preoccupation with religion to the grandiose point I thought I was going to radically reshape an entire denomination. Because I didn’t understand myself, I could not accurately describe my symptoms to my psychiatrist, and she could not give me a precise diagnosis. She recognized that I was bipolar, but she could not categorize me as bipolar-I (with manic episodes) or bipolar-II (without manic episodes), so she put me into the catchall category bipolar-NOS (not otherwise specified).
Dr. Cade discontinued all of my medications. In place of them, she prescribed the minimum maintenance dose of the mood stabilizer lithium, my first antimanic drug. Lithium is an interesting drug. If overdosed on, the outcome can be lethal, but at the same time, lithium is the only mood stabilizer shown to reduce the risk of suicide and suicidal behavior.[i] I discovered that the benefits far outweighed the risks.
Dr. Cade released me several days later after she felt the lithium was in my system. I still thought about suicide. Twice after my discharge I asked for a dosage increase. I saw her again, in an outpatient setting this time, and said I was still struggling. She prescribed the drug risperidone (trade name Risperdal), but it was $150.00 for a single prescription. I didn’t have health insurance, and because of my spending spree, I couldn’t afford it. It was a shame because risperidone is effective at treating mixed mania.
I started thinking about how I would give away my possessions if I killed myself. Notably, I decided I would send my most prized possession – my Vanderbilt class ring – to Hannah. I had a second episode of intense suicidal ideation during which I thought about going to the hospital again. I rode around my job on an adult size tricycle crying my eyes out. I hardly felt able to bear what I was feeling, but at the same time, I could not afford a second ten thousand dollar hospital bill, so I gritted my teeth and bore it.
[i]. Miklowitz, Bipolar Disorder Survival Guide, 127.