My Short Stay in a Mental Health Hospital

This is one of my favorite places in the world: Acadia National Park in Maine. I took this picture along one of the park's many trails and I have named it "Walking Out of the Woods. — Lori Kaminski

Part 1: Crisis

 It took the entire weekend, but they finally found me a bed. For the past seventy-two hours I had been a guest of Mercy Hospital’s emergency room and both the hospital and I had settled in for the wait. I had my own room, a real hospital bed instead of an ER examination cot, and a menu card for the next day’s meals. I occupied a special secure room, a safe place. Everything was locked down tight: cabinets, drawers, everything. There was a security guard or hospital aide sitting right outside my door day and night. I was allowed to keep my cell phone and tablet, although getting a wireless signal in this emergency room basement was difficult. My husband brought me extra changes of clothes, company and news of the outside world. He brought things I needed and things I didn't, like a brush for my short, brown hair when I only needed a comb.

It was comfortable, but boring—just the thing I needed after the last few days. This situation had been building for a while until it finally exploded on Saturday. It was past 2:00 in the afternoon and I was still in bed, dozing or listening to news podcasts. My husband, a full-time high school math teacher, as well as an amateur but accomplished musician, had just come back from a practice session and found me sitting up in bed. I told him I didn’t feel right. It was our code phrase for a familiar condition.

“What do you want to do?” he asked in reply.

I thought for a moment, trying to make a difficult decision. At 63 years old and working for a living, I'd had to force myself through episodes like this before. This time felt different, though, more severe. “I think…” I started. “I think I need to go to a hospital.”

My husband hesitated. “Why don’t you start by getting dressed?” he suggested, as he sat down next to me on the bed. We’d get some breakfast and then go for a walk. It was nice out and I’d been cooped up all day, he continued. Maybe we’d start with just getting out of the house.

I wasn’t sure this was going to work, but I had no interest in arguing. I had no interest in anything. I pushed myself out of bed and pulled on a pair of white trousers in some need of laundering, then found the energy to put on a fresh, blue T-shirt, socks and sneakers. We ended up at a pancake restaurant in Watertown, not far from the Charles River and a 20-minute drive from our home in Arlington, Massachusetts. I ordered a waffle and then stared dumbly at its four sections. I focused on breakfast and started to feel myself come to life again, then fade away into lethargy. I chewed on a maple syrup-coated section of waffle, then switched to another section with blueberry syrup. I’d always wanted to try blueberry syrup, but this stuff just tasted like fake fruit. I don’t remember much about my 3:00 p.m. breakfast, but I don’t think I finished it.

It was a nice day, sunny and warm. I remember our walk along the Charles River, since it scared the hell out of me. I stared at the water as we walked and it seemed to say, “Come into me.” It would feel so good to end my existence, to pretend that I never was. I challenged the feeling and walked onto a wooden observation platform that extended out over the water. That heightened my temptation to jump in and I retreated to the path.

The river continued to extend its invitation, but another part of my brain rang every mental alarm and panic button I owned. Get the hell out of here! Get away now! it screamed at me.

I told my husband I needed to get away from the water. I recounted what I had been thinking when we were by the river and repeated that I thought I needed to go to a hospital.

Again, my husband demurred. “Call your doctor first,” he said. He was a methodical man and wanted me to cover all my bases before resorting to an emergency room visit.

“It’s Saturday,” I countered. “No one will be in the office.” I knew the drill from my therapist’s answering machine message: If this is an emergency, dial 911 or go to your local hospital’s emergency room. I was prepared to follow that advice to the letter.

Clearly my husband wasn’t. “Just call,” he insisted. “Someone will be there.”

So, I called my psychiatrist’s office and got an answering machine from an evidently-open urgent care clinic. I described my feelings and also mentioned I was debating what the next step should be.

Ten minutes later I received a phone call back. “Go to the emergency room!” the nurse told me. “You’re in crisis.” She said she’d call the hospital to let them know I was coming. Good, I thought, someone with greater knowledge and authority was in charge of the decision. It wasn't up to my exhausted and stressed brain anymore.

 They were waiting for me at the emergency room. I went in, talked to the receptionist and felt relief for the first time in a week. I was fitted with a hospital bracelet with my name and a bar code on it. My husband presented our insurance information—I was not up to the task. He relayed the information precisely, as he always did with tasks involving numbers. The receptionist took me to a room with a desk where I described my day to one doctor after another, then waited a bit longer for the ER shrink to do a more thorough examination. Once he arrived, I got the standard set of questions.

What were my symptoms?

A gradual build-up of strange, alien feelings, I told him. Low stress threshold. Intrusive thoughts of death or non-existence. Anxiety so strong it tightened my chest to a choking point and made me feel like cutting myself to bleed the anxious feelings out of my system. No appetite, exhaustion, lack of motivation. Derealization, or a drift away from the here and now to a place further away. 

Was I taking any medications? he asked me.

Yes, one for depression and one for anxiety.

Did anyone else in my family experience mental health issues?

Yes. One sibling with bipolar disorder and a parent with psychotic depression, neither one chronic. Both had been hospitalized over the years. My other sibling was fine and so was my other parent.

         While I answered, I was also looking at the shrink’s desk and fantasizing falling against its sharp corners to kill myself. Just fantasizing, but yes, part of me loved that idea. Part of me didn’t and that part confessed the feelings to the psychiatrist.

         I was definitely going to a psychiatric hospital, particularly since this was a weekend and my regular outpatient care team wasn’t available. Better safe than sorry. The shrink warned that it might take some time to find a bed, but that they would keep trying. In the meantime, they had a secure room in the hospital that became my home for the weekend. Then, on Monday, a bed became available at a place called Thompson Behavioral Care in Hingham.

I’d been admitted to the Mercy Hospital emergency room on Saturday afternoon.  It was boring but safe and I tried to make as little fuss as possible. I didn't want to attract attention to myself and assumed that a hospital emergency room had bigger problems than a depressed but cooperative patient.

The ambulance taking me to Thompson arrived on Monday night, complete with two courteous drivers and an enormous stretcher. One of the men smiled apologetically when I said I could walk.

“It’s policy,” he said. “We have to strap you in. Sorry.”

I laid down on the thing, feeling engulfed by it, as the two attendants attached a series of straps across my chest and over my arms and legs. It was embarrassing, but I could understand it. I wasn’t going to flee or fight against them, but they had no way of knowing that. I could have made any madcap move and they would have been responsible, although I wondered if they really expected this small, sixty-something woman to try anything wild. 

I was wheeled out of the emergency room, through the public areas. My husband wasn’t allowed to go along for this trip. I felt foolish and tried to focus on the ceiling lights rather than look at anyone sitting in the waiting room.  I was rolled into the ambulance headfirst. I gripped a paper bag full of extra clothing across my chest and watched the hospital recede behind me as we drove away. I saw everything in reverse: a column of streetlights and trees backing away, the center line of the street following suit. Buildings moved backwards before eventually fading into the distance.

After being wheeled out of the ambulance I was met near a bank of elevators by a hospital staffer. I was released from my temporary bondage and I remember riding up an elevator, then walking down a long hall, still carrying my paper bag of clothing. There was an office-sized metal desk behind and to the right of a pair of double doors. I got greetings from facility personnel and was asked a number of questions. Then I signed a form that confirmed my commitment to this institution for a period to be determined by a medical professional. The prospect of a long incarceration didn't scare me. I was so numb that it didn't even register.

 The staffers followed their questions with a thorough inventory of my clothing and other possessions, starting with the paper bag. Were there any pajamas or yoga pants with strings? I had a pair of pajamas with pull strings. They gave me the option of pulling the string out or cutting it. I didn’t care, so they cut the strings. I had to surrender my cell phone and iPad. I handed them over without complaint. As far as I was concerned, the circumstances of my life were in the full control of the facility. Next came my shoes. I had to take the laces out and either walk around without them, or just wear socks. I chose the latter option.

This was overkill for a patient like me, but I understood their actions. To the staff, these were necessary precautions and I didn’t begrudge them that responsibility. Beyond that door were people who might hang themselves with strings from a pair of shoes or yoga pants. They could hide behind their cell phones and never interact with a live human being or maybe throw the phones at someone.  I felt a slight weariness at the prospect of going around with no shoes and no cell phone, but nothing else. I had been hit by too many things, in too short a time. My emotions were tucked away, hiding.

 Once we were finished with the intake, I entered the room beyond the double door. It was large and shabby. The carpet was old and a drab, an institutional gray color. The furniture looked worn and well used, as did the linoleum. Everything was hospital-clean, though. In lieu of our cell phones, two telephone booths were located near the front of the room. Bedrooms with two beds and a single window ringed this common room. A few people were watching television or talking. There was a nurse’s station at the front near the telephone booths. Most people in the room were engaged with others, with the exception of one older woman who stood apart, her back against the wall with her arms crossed over her chest. It seemed that on one level, she was not really in the room with the rest of us. She might not have been anywhere at all. I took it all in—the television, the people, the blank-faced woman against the wall, the beds and thought, “What the fuck am I doing here again?”

Part 2: Orientation

I’d been in a psychiatric hospital before, almost a year ago to the day. I’d had the same passive suicidal thoughts, ramped-up anxiety and cutting fantasies. Back then I was admitted as an outpatient to a hospital in downtown Boston called Craigie. Thompson, where I was now, reminded me of Craigie: the same sad furniture and vacant looks on the faces of some of the patients. There was one significant difference though. Craigie’s outpatient treatment facility, called a Partial Hospitalization Program (PHP), was structured for those who were not actively suicidal or psychotic. Participants in a PHP were well enough to function without constant supervision. My admission to Thompson Behavioral was a different story. I was a full-time patient and considered a potential danger to myself. I could not leave the facility. I required on-site monitoring, drug review and individual and group therapy.

I was shown to my room and dropped my paper bag of extra clothing onto the bed farthest from the door. I stared out of the large window at a tree-lined parking lot. Then I walked back to the common room. A large flat screen television took up the farthest wall and a smattering of patients sat before it, watching a comedy show or light movie. There was a small worktable in the center of the room against a column with pictures for coloring, mostly adult-level mandalas and nature scenes. Next to it was a small assortment of books. A group of dull crayons was scattered next to them. There was nothing hard or sharp. I looked at the crayons and wondered if I’d be able to keep my pen, the one I used for writing in my journal, which I had brought along with my clothing in the paper bag. I've been a strong and purposeful writer all my life and had kept journals since junior high school. They were my place for descriptions of times and places and a repository for my feelings. My journal was my first therapist, where I recorded frustration, anxiety and depression. That and long walks were my only counter-balances to those dangerous feelings.

I returned to my room, since I was not up to socializing. My intake on the other side of the double doors had taken over an hour. I had no shoes, no iPad and no phone. My pajama strings, the ones that kept my pants around my waist, were in a trash can. That, plus the emergency room limbo and backwards-facing ambulance ride, had me in a confused fog, one that blurred faces and left snippets of impressions rather than the whole scene itself.

One of those blurs approached me from the nurse’s station. I’ll call her Cheryl.

“Well, hello there, Lori,” she said cheerfully and introduced herself as we shook hands. “It’s a little quiet now,” she continued. “But a lot is going to be happening tomorrow. You’ll be meeting your care team and starting treatment. In the meantime, let me show you around.”

“Thank you,” I said, still dazed.

Cheryl waved an arm around the room. “This is our common room. You can always come here between therapy sessions. It’s open all the time. You can watch television, color, read or write. We usually have movies playing after dinner.”

We left the common room and started down another long corridor. Cheryl pointed to a Dutch door just to the left of the nurse’s station. Both the top and bottom sections were locked up for the evening.

“You’ll be getting your morning meds, starting at 8 a.m.,” she explained. “Just line up in front of this door. Breakfast will be at 8:30. We’ll also take your vital signs before breakfast, right over there.” She pointed to the column near the table in the middle of the room. The faraway woman with the crossed arms remained standing at the wall, opposite the table. I don't think she'd moved since I’d first seen her.

Cheryl and I continued down the corridor. I could hear the squeak of her sneakers as she walked across the tired linoleum. She stopped to show me the laundry room with a washer and dryer. I could sign up to wash my clothing—a good thing since I assumed that I would be here for a while.  Then she escorted me to some smaller rooms and switched on the lights. “These are for our group therapy sessions,” she explained. “There’s a white board in the common room that lists all the activities we have. You’re welcome to participate if you feel up to it.”

“Thanks,” I said, knowing I would.

We walked on to a room with a cluster of round banquet tables. Like the rest of the facility, it looked functional but worn, with the same nondescript linoleum to accompany its dingy white walls. There was another Dutch door, closed like the other one, at one end of the room.

“This is the cafeteria,” Cheryl said. It’s open between 8:15 am and 7:00 pm. Unfortunately, it’s too late now to show it to you in action, but it’s a pretty typical place. Are you hungry?”

I shook my head. “I’m okay, thanks,” I replied. I hadn't been hungry all day.

“No problem,” Cheryl said. “Let me know if you change your mind. I’d be glad to get you something.”

We continued the tour, stopping at a row of showers, which, like the rest of the place, were dingy but clean. We walked back to the common room. “Please ask if you need anything,” Cheryl said. “I’ll be happy to help.”

“Thanks,” I said, both for the tour as well as the information. Cheryl smiled, then returned to her work at the nurse’s station. I liked this place, despite the décor. It was friendly and informative, not like Craigie at all.

Not sure what to do next, I turned my attention to the white board in the common room to check out the next day’s activities: group therapy, art, cognitive behavioral therapy, coping skills, meditation, meals and free periods, all blocked in by the hour. The white board reminded me of the daily schedules posted at Craigie, where I had been before. Like Thompson, they filled the day with activities that provided structure and predictability, the two things I needed as much as medication and psychotherapy.

I returned to my room, dropped down on the bed and stared at the ceiling. Then I got up and picked through my paper bag for my journal and began to write. “So, what the hell am I doing here?” I wrote. I thought back to the last few days and didn’t have far to go to answer that question. I re-read the entries for the past week. Anxiety attacks at the supermarket and while driving; night-time despair so deep it took physical shape.

Pretty terrible anxiety attack at the supermarket yesterday. I think it was just too much stimulation: a crowded parking lot and store, negotiating a large unwieldy shopping cart between other shoppers and employees stocking shelves. The wait at the deli counter nearly blew my head to shreds. One employee was new and the other clerk kept stopping to help him. Waiting for my order to be completed became intolerable.

I stopped reading, remembering when the anxiety attack began:

I suddenly lost my ability to think clearly. I couldn’t make decisions about what I wanted to buy. I kept leaving and then coming back to items, all the time fighting carts, kids and shoppers going about their business. I began to have trouble breathing, as though I couldn’t get a full breath in, my chest was that tight. Then I got a headache, followed by an upset stomach bordering on indigestion. By that point I could barely comprehend the list of things my husband had written down on the shopping list. Getting stuff on my own initiative was a nightmare.

That night had been just as bad: a misery from the time I went to bed to the time I got up.

I felt despair like liquid sloshing in my gut and kept thinking back to my analogy of a rubber band. The band was stretched and stretched and stretched until it broke. You could tape the two ends together, but the rubber band would never assume its original shape and strength. I felt like that rubber band, stretched out of shape and finally broken. I lay in bed, feeling like I wanted to cry, I was in that much emotional pain. So, I let myself do that, not even sure what I was crying about. I just wanted to feel that release. I let myself go a few times and then felt alone and miserable.

I wanted my husband, who had fallen asleep on the couch in our living room. I got up and quietly walked downstairs and laid down next to him. He woke up and we ended up talking for hours. He held me, said he wanted to be there for me and that he loved me. He admitted that he didn’t say that enough, but that it was true. I curled up into his arms and talked as he hugged me and cradled my hands and fingers. After that we both went upstairs to the bedroom where I eventually fell into an unquiet sleep.

 My husband’s ministrations helped, but not enough. The next night was downright dangerous, a culmination of my anxiety attacks and nighttime agonies. My thoughts that night were part of what put me in this hospital:

Last night I started to think about death and cutting. I considered the appeal of both scenarios. Death. I wanted to die but not kill myself. I just wanted to be dead. Cutting? The idea was appealing and I could almost see myself doing it. Somehow, it felt like the gesture would relieve my anxiety.

 I finally put the journal down. I hoped I could channel those feelings into healthier forms of release, like meditation, walking or writing. “So, what the hell am I doing back here?” I re-read to myself. Then I finished writing:

Getting better and, finally, sorting things out.

I decided that would be my start.

Part 3: Among the Walking Wounded

 My impromptu tour-guide of the night before had been right: the next day was extremely busy. It began at 7:30 am, when I was awakened by the low murmurs of patients talking and milling around the common room.

I had not slept well.  Groggy, I slowly rose from my bed, rubbed my eyes and blinked a few times. I pulled down my clothes from the shelves provided in the bedroom for clothing and other necessities, dressed and went into the common room. The nurses’ station was ahead of me to my left. A line had formed behind the top partition of the Dutch door, now open. The nurses seemed to be distributing medications.

I had no idea what to do first, so I headed over to the nurses’ station and approached a tall, lightly-bearded staff member. His name badge said Tom Wallace, NP.

“Excuse me,” I said.

Tom Wallace looked up and smiled. “Good morning!” he said.

His warmth cheered me. “And a good morning to you,” I replied. “I just got here last night. I’m not quite sure where to start.”

Tom asked for my name. “Kaminski…,” I answered and automatically added: “K-A-M-I-N-S-K-I…, first name Lorraine.”

“All right, Kaminski, Lorraine. Let’s make sure we’ve got all your records.” He found my file and flipped it open. “Okay...” He rubbed his beard. “Looks like your meds got transferred over,” he confirmed. “Did you get a tour last night?” he asked.

 I nodded.

“In that case, why don’t you line up behind the others at the door to get your meds? You can go get breakfast after that...you know where the cafeteria is?” I nodded again. “Or you could get your vitals taken. It’s just stuff like blood pressure and pulse, nothing fancy. If you get breakfast first, don’t forget to get the vitals done afterwards, okay?”

“Sure thing,” I said. “And thanks.”

“We aim to please,” Tom replied. “Please let any of us know if you need anything. “Oh, and just one more thing,” he added. “After breakfast you’ll be going to a group therapy session in that room down the hall, the big one.” He pointed at the large room at the end of the hallway. “You have an appointment to meet your psychiatrist, Dr. Smythe, at 11:30. That means you’ll miss the first part of your next group therapy session but you can always join it late. Happens all the time. You’ll be seeing some other folks later on today, but for now just get your meds and vitals and get yourself something to eat. Is there anything else I can help you with?”

“Nope,” I replied, appreciating the kindness. It felt good having someone else—a whole institution—make decisions for me. “Thanks.”

I joined the queue at the medication line and looked over at the other patients. Some stood patiently, seeming bored. Others fidgeted, especially one woman whose entire body seemed to shake, from a pulsing foot to fidgety hands. Manic? I wondered. The silent, staring woman was in the line, still quiet, although her arms were no longer crossed. I guessed at her diagnosis as well. Schizophrenia? Schizo-affective disorder? Who knew? I figured the depressives like me were the quiet, patient ones, standing in line and not making a fuss.

By now my confusion had started to clear. I looked at the line ahead of me and wondered how I’d explain all this to my clients. I was self-employed and wondered if this hiatus would have an effect on my income and reputation. Who wanted a social media and marketing consultant who’d spent time in a mental hospital? My last hospitalization had put me out of action for months, first with the hospitalization itself, then during the much longer period of stabilization and a return to normal functioning. It had taken its toll on my business, as this one would, I was sure.

I also had a trip scheduled to visit my family in upstate New York that week. Airfare being what it was, I’d chosen to take a bus and had already purchased my ticket. While at Mercy Hospital, I had talked to my sister and we'd decided to keep news of my hospitalization from our father, our one remaining parent, who was quite elderly at that time. We made up a cover story about extra work and promised to reschedule the trip. I had to leave other rescheduling logistics to my husband, both while at Mercy and now here at Thompson. Could he call a client and tell him I had been hospitalized, but would be back soon and not to worry? Could he contact Greyhound and find out if he could get my ticket price refunded?

Returning to the here and now, I eventually reached the Dutch door and was handed multiple medications in a small plastic cup no larger than a shot glass. I swigged the familiar pills down with some water. Then I got my vitals taken.

“You’re all set!” the nurse taking my vitals declared. “Everything looks great.”

Yeah, “great” below the neck, I thought.

I joined another line of people just outside the cafeteria and waited for my turn. The room was pretty basic, as the nurse last night had told me. Serving women wearing hairnets and food service outfits stood at the head of the room handing out meals on plastic plates. They didn’t skimp on portions. I took a tray, then got eggs, toast and bacon. But no coffee since they didn’t have any decaf other than Sanka.

I looked around at the quickly filling space. There was another area, separated by glass walls, within the cafeteria. It had couches and a low table. No one was there and I wondered what its purpose was.

I felt shy in the large room of twenty or so strangers, but asked if I could take a seat at one of the tables. I stared at my eggs and bacon with the same look I’d given my waffle at breakfast with my husband on Saturday. I still had no appetite and ate each bite of egg or toast slowly, enough so that I wondered if the breakfast period would be over before I finished eating. No one talked much. Perhaps they were new to each other as well.

I introduced myself to a few people who looked up to acknowledge me with greetings as shy as mine. It was obvious that some people knew each other and that others didn’t. I wondered if I would fit in. I caught a few names and noticed a fairly even distribution of men to women, old to young. I worked at my eggs and bacon and tried to get comfortable. It wasn’t too bad. I missed real decaf coffee, but other than that I was satisfied. When breakfast was over, I stood up to return to the common room and the first of the day’s activities. I dumped my trash in a garbage bin on the way out and left my tray with a pile of others on a table nearby.

“This isn’t too difficult,” I thought. Routines, even new ones, made everything easier.

Was I already getting better? As I walked to the first therapy session, the events leading up to my hospitalization seemed increasingly surreal. Had I really wanted to sink into the Charles River and drown? Had I left the real world to the extent that it existed beyond me somehow, as if I were separated from it by a gauze curtain?

This group meeting was the first event of the day. I made my way to the large, dull gray room that eventually filled up completely with about 30 or so patients, including some I had seen at breakfast. It reminded me of my stay at Craigie and the group therapy sessions there. I felt comfortably anonymous and curious to see what this session would bring.

A staff member was sitting in the room wearing a name tag that identified her as Kathy Lopato, LMHC. She welcomed patients as they entered the room and seated themselves in a ragged semi-circle of blue stacking chairs.

“Good morning, everybody,” Kathy said after we had settled down. “My name is Kathy and I’m a licensed mental health counselor. I’ll be facilitating our session. We have a lot of new people here today so I thought we’d spend some time going around the room and introducing ourselves. Don’t worry if you don’t feel comfortable talking,” she added. “You’re welcome just to sit with us and listen. I only have one request.” She paused a moment before going on, to make sure everyone was paying attention. “All I ask is that you keep our conversations here confidential, to respect other peoples’ privacy. And yours, of course. Does that sound okay with you guys?” 

Most people nodded. No one left.

Kathy smiled and looked satisfied. “Great! I’ll go first, how’s that for ego?” There was some tittering around the room. “I’ve been at Thompson for over six years as a therapist,” Kathy started. “I’ll be working with a lot of you on a one-to-one basis. I also head up a number of different groups here, like art therapy, for example. I’m here during the week, from seven in the morning to three in the afternoon. You’ll get a chance to meet our other counselors later today and during the week.” She sat back. “So, would somebody else like to introduce themselves?” she asked.

People shifted in their chairs and started in, in no particular order. No small number surrendered their stories with a frankness that startled me. Others merely stated their first name and mental health condition. Most cited depression and anxiety, my particular ailments, although there were plenty of other mood disorders in that room: bipolar, obsessive-compulsive, borderline personality disorder and more. Many were here with post-traumatic stress disorder, or PTSD, so common following participation in armed conflict and in some cases, the result of physical or sexual abuse. These too were veterans, but of a different sort of war. A roomful of traumatizing stories helped put my own problems into perspective. I had fantasized killing myself or otherwise ceasing to exist, but quite a few in this room had actually tried it. The suicide stories, and the people who had attempted it, were the ones I remembered the best.

Two people in particular made an impression on me. One was young, tall and slender with a pencil mustache and curls of jet-black hair. I’ll call him Paul. I don’t remember much of Paul’s story, although I do recall some mention of family troubles and a child who had died. “After that, I attempted to take my own life,” he confessed.

In another part of the room a shorter man, with brown hair and wearing well-kept clothes, introduced himself. “My name is George,” he said. George had been in a relationship of some kind that had ended badly. He had attempted suicide and now was here, like the rest of us, coming back to life. How had he come to be rescued, I wondered? Had someone found him in time? Pumped his stomach, assuming he’d taken pills? And Paul: Had someone talked him down from his dark place, back to sunlight and survival? Would I ever do such a thing? I thought not, although the three of us subsequently ended up hanging out together and creating a clique throughout our hospital stay. Did this mean my urge towards suicide wasn't as passive as I'd originally thought? As far as I knew, thinking about death—passive suicidal ideation—was a different condition from active suicide attempts. Serious, but separate. I felt as though I was solidly on the ideation side and always had been, both here as well as my earlier stay at Craigie. The thought comforted me.

Not everyone had a coherent story to tell. One tall young woman with a pinched face tried to tell us what was wrong, but what came out of her mouth was a frenzy of barely connected words. Sentences raced by so fast I couldn’t reproduce them if I tried. Her words related to one another tangentially, like a stone skipping across a body of water and touching down on one part, only to leap across to another.

It was my turn next. “I’m Lori,” I said. “I have depression, with anxiety. I’ve had worsening fantasies of harming or killing myself and I haven’t been able to get rid of them. I took a walk along the Charles River a few days ago and kept imagining myself willingly sliding in and drowning.” It was not the most horrible story of the day among the group attendees, but the experience was frightening enough to me.

Talking made a difference, no matter how long or short or how garbled. It emptied chests of the heavy weights they bore. It helped us laugh. We had all suffered and we were all here to get better. I left the session feeling stronger and more connected. I wasn’t quite there yet, but I was—slowly—coming back to myself.

The session ended on a positive note and as I left, I saw the woman with the crossed arms in the common room, this time in fuller detail now that I could concentrate. She was middle-aged, slender and of medium height. I walked over to her.

“Hello!” I said. “My name is Lori. How are you doing today?”

The woman smiled and extended her hand in greeting. “I’m Catherine,” she said. “And I’m doing well.”

Part 4: The Doctor

 I saw multiple clinicians after group therapy that day. The best remembered was my assigned psychiatrist, Dr. Smythe. He was an older man, bald except for a fringe of graying hair surrounding the top of his head. He had compensated by growing a well-trimmed beard. Funny, I thought, how many men ended up with hair on their chins as soon as it disappeared from their heads. Clean-shaven bald men were a rare sight, like flightless birds walking down a city street.

Smythe was a snappy dresser, with a soft-looking blue shirt and tie that picked up the accents in the shirt as well as his pressed brown pants. We met just outside of the group therapy room and shook hands in greeting. He escorted me to an office across from the cafeteria, took a seat and invited me to do the same. He checked some records in my file, then looked up at me with a pleasant expression. “So,” he started. “What happened? Can you tell me a little bit about it?”

“I’ve been experiencing really high levels of anxiety,” I said. “I addressed it with my regular therapist, but nothing we tried was working.”

         “What would happen?” Smythe asked, jotting brief notes onto a pad of lined paper.

         “I started freaking out in heavy traffic,” I continued. “I also couldn’t handle crowded places, like supermarkets. They gave me anxiety attacks.”

         “Describe your anxiety attacks,” Smythe urged, pulling information out of me in a slow and steady way.

“I can’t breathe,” I started. “My chest gets tight, and it feels like I can’t get in enough air. I get light-headed and dizzy and can’t focus my attention or make decisions. Once I was in a crowded supermarket and was picking up only what was written on my shopping list. Usually, I like to wander around and see what else I might need. I couldn’t, that time.”

I remembered that day. I could barely focus on the list in my hand. The words stopped making sense and I had to focus hard on their meaning. Bread: brown, wrapped in plastic in the first aisle from the end. Margarine: brown tub in the dairy aisle near the flowers. Yogurt: that white tub with the blue writing in the dairy section. I had to force myself to walk to each aisle, select the item and put it in the basket. It seemed to take forever.

“The crowds in the store made things even worse. I kept trying to navigate around huge shopping carts coming at me from every direction. I had to do the same to get around someone stacking groceries from a pallet. The wait to cash out was torture. There were long lines everywhere with overflowing shopping carts. I couldn’t get myself to relax and stand still. I continued to panic in heavy traffic on the way home. It was a nightmare from beginning to end.”

“So, you panicked at the supermarket. What else? When did you start thinking about drowning yourself and cutting?”

         “That came later, just this past weekend,” I answered. “I couldn’t get out of bed on Saturday. My husband had to get me up in the middle of the afternoon.” I explained the walk along the Charles River and the overwhelming feeling that if I cut myself deep enough to start bleeding, my anxiety would drain out with the blood.

“And how are you feeling now?” Smythe asked. “Still the same?”

         “No,” I said. “I feel better now,” I said, relieved that this was the case.

“Good!” Smythe continued to scribble on the pad of paper. So how are other things standing now?” he asked. “How’s work?”

         “A challenge,” I admitted. How had I managed to run networking sessions and help individual business owners with their social media accounts at the same time I was fending off anxiety and depression, both of which were galloping out of control? Freelance work was difficult enough, even though I enjoyed being my own boss. Adding a looming mental breakdown had me coming and going at the same time. Work did help, though. It was something stable to hang onto.

         “A challenge?” Smythe prompted. “Tell me more about that.”

         “I’m self-employed,” I started.

         “Always?” he interjected.

         “No,” I said. “I worked at a university for about ten years. I got laid off in 2000 from a new job I’d gotten just that school year. Before then I had a position for about nine years but the work was boring so I left and got another job at that school, the one I was laid off from. I tried to get back into that place for a whole year. I applied for at least 50 jobs there, both at my administrative level and below it. Part time, full time. This was happening during a recession so other employment options were limited. I finally gave up and tried my hand at freelancing.”

I remembered the intense stress of sending out resume after resume and not even getting the courtesy of a response. Almost no interviews, despite the pile of applications. I eventually realized that I would have to apply for unemployment compensation, something I'd never done before. I’d always had a job, no matter how lowly. I rarely cry, but that realization had brought me to tears. Again, my husband served as my shoulder. I told him that unemployment payments felt like going on “welfare,” something I had been brought up to avoid at all costs. He assured me that wasn’t the case.

         Smythe pulled me back to the present. “So, you got stuck with freelancing,” he said. “And during an economic downturn, too. That must have hurt.”

“Actually,” I countered, “the exact opposite happened. I was in a state unemployment office and saw a flier for starting your own business. I took the course they offered and loved it. It fit me in ways traditional employment didn’t. I loved being my own boss and I still do.”

“Does it pay the bills?”

“No,” I admitted. “The work is really unpredictable. You never know when you’ll get your next client.”

         “So, money’s tight?” Smythe continued. “How does that work for your husband? Any tensions?”

         “Plenty. He’s a teacher so he often doesn’t earn money during the summer.”

         “So, he’s not supportive?”

         “We have our spats, but overall,” I said, “he’s very supportive. He covers most of our household expenses and goes to couples counseling with me. It’s stressful now, though. Everything seems hard. My house is a mess. We're getting a remodel and don’t have a functioning kitchen right now.” I had to laugh at the absurdity of it: Our refrigerator was in the dining room and we washed our dishes in the basement sink. I could see through the floorboards in the denuded kitchen to the washer and drier below.

“How does your husband feel about you being here?” Smythe asked.

         “He’s fine with it. In fact, he’s doing a bunch of stuff to keep things going at home and for my work. He’s calling clients, rescheduling appointments, talking to my family. I was going to take the bus to visit them this week. Right now, he’s on the phone with the bus company trying to get my money back. And he’s coming tonight to visit and to bring me some more clothes.”

         “I’m very relieved to hear that,” Smythe said. “Families are important.”

Before long I would come to appreciate how important a sensitive and responsive family was to an individual with a mental illness. For now, I was just grateful that my husband was doing all that he was.

Dr. Smythe flipped a few sheets in the file on his desk and looked up at me. “So, you get migraines,” he said, changing the subject. “How are those going?”

         I recalled the rush to the medicine cabinet to swallow migraine and nausea relief pills before my aura—a type of visual distortion that often precedes the actual headache—wore off. My auras took the shape of a sideways V, getting larger as it made its way across my field of vision. My eyesight became wavy and warped inside the V. When the V disappeared, the pain began. If I took the migraine pills at the beginning of the aura, I had enough time, 20 minutes or so, for them to take effect and blunt the force of the headache. After that I usually lay in a darkened room, avoided food and tried to keep sounds to a minimum. A migraine could take up residence for a few hours or a few days. Mine usually ended after a day.

         “They’re fine for now,” I was glad to be able to report.

         “Do you know what brings them on?”

“Lots of different things, but mostly poor sleep,” I answered. From the beginning, sleep and I never got along. To this day, we remain mortal enemies.

         “How long have you had sleep problems?” Smythe continued, scribbling away.

         “All my life,” I said. “Naptime was torture in kindergarten.” I thought back to the other little children sleeping peacefully while I stared at the ceiling, waiting for the period to end. I loved kindergarten—the games, show and tell, cookies with chocolate milk and a great teacher. The only downside was naptime. I hated to see those cots come out.

         Dr. Smythe smiled. “So, a lifetime of poor sleep,” he said. He checked my file again. “Do your medications help you sleep, make you drowsy?”

         “Yes, they do,” I replied. “But even with them, I have problems.”

         “What keeps you up?” he asked.

         “My brain doesn’t turn off at night,” I explained. “I keep thinking about things.”

         “What kinds of things?”

“Anything,” I replied. “What happened that day or what I was going to do the next day. I fretted a lot about my university job and how it had treated me. Name any subject and I’ve thought about it when I should have been sleeping.”

         Dr. Smythe sat back in his chair. Then he described me in detail, every major aspect of my personality, as if he’d known me all my life.

“Here's what I think might be going on,” he said. “You’re a Type A, very independent. You like working on your own, being in control, but the problem is that you’re not in control. You haven’t had steady employment in years, your house is in disarray. Kitchens can be central to a person’s comfort level. They’re places to cook, to sit and to socialize and you don’t have that right now. And your husband is supportive but he’s also unemployed for the summer. You’re not working—you’re here. Your mind can’t take it. Someone who’s in control, who’s organized and who likes to get things done is thrust into a situation where you can’t do any of that. No wonder you’re having problems.”

         “Uh, yeah…” I muttered, surprised at his analysis of my situation. “So, what do I do?” I asked. “I can’t just stay in a depression all my life and this is my second hospital stay. Not everybody who has these problems goes into a suicidal state.” I posed my question, the answer to which would either doom me or give me needed hope and relief. “What can you do about me?”

         Dr. Smythe looked thoughtful. “We’re going to start with sleep,” he said finally.

“Sleep?” I repeated. I certainly wasn’t expecting that.

         “It’s a risk factor for depression,” he explained. “For you it goes back to the beginning. Yes, depression runs in your family and that’s an issue, too. Tell me, though, does anyone else in your family have sleep problems?”

         “No,” I said. “They all sleep pretty well.”

         “I want to try some medication changes. I know there are other factors affecting your depression, but I want to start with the earliest symptom to emerge and one that still gives you trouble,” the doctor concluded.

         “Well,” I said. “Okay, then.” I found myself respecting this shrink’s suggestions, despite their unexpected nature.

         Dr. Smythe glanced at the clock. “That’s all for now,” he said. “We’ll be meeting a few more times this week. For now, why don’t you join another group therapy session? I’m glad to see that you’re feeling better now that you’re here. I hope we can help you even more.”

         We shook hands and I thanked him. Sleep? Sleep. I left the office confused but optimistic. Maybe this would be the first step towards ending an old and persistent war.

Part 5: Night Terrors 

My first night at Thompson was the worst. The new antidepressant Dr. Smythe had prescribed to help me sleep would require some time to take effect, if it worked at all. In the meantime, I underwent 12 dark hours of emotional pain worse than any physical ailment I’d ever endured. All the trauma that was brought up and dissipated in therapy during the day returned to sit on my chest like a harpy, clawing at me to get in.  At times I suffered psychic pain like the blues to the thousandth degree. At other times there was nothing but a vacant, empty feeling like a house that should be there, but wasn't. My loneliness was cold and barren, a windswept plateau of nothing. Despair ran hot beneath it, bringing up frost heaves of emotion when it got close enough to the surface. My husband says he can always tell when a depression is coming on by the expression—or lack of one—on my face. I go blank, on the inside and on the outside.

There was a physical element to my depression. It centered on the area at the top of my stomach. Dark moods felt as though they were being injected directly into my abdomen. I stifled overwhelming urges to crawl into a ball on my bed and cry. In addition to all this, a song by a British folk singer named Martin Carthy kept playing in my head.

The Famous Flower of Serving Men

My mother did me deadly spite

For she sent thieves in the dark of the night

Put my servants all to flight

They robbed my bower, they slew my knight

They couldn’t do to me no harm

So they slew my baby in my arms

Left me naught to wrap him in

But the bloody sheet that he lay in

They left me naught to dig his grave

But the bloody sword that slew my babe

All alone the grave I made

And all alone the tears I shed

The rest of the song was as bleak as the beginning. The bereaved widow assumed the identity of a serving man and went on to play this role before the king and his court. Now that I write about it, several years later, I think I understand why the song had the effect on me that it did. The woman in the ballad lost everything—her husband, her child, her place in society, and even her own identity as a woman. Despite that fact, she decided to go on with her life. I think I identified with her since I, too, had decided to live, no matter how traumatic living was right now.

That first night at Thompson felt like it would never end. I stared at the ceiling and the walls until the early dawn, fending off attacks from myself. I’d have gladly taken any physical illness over this: diabetes, appendicitis, a heart attack, maybe even cancer. I retreated to an old, familiar phrase of mine, that I’d rather have double-dog pneumonia than depression. On top of all that, my bedroom was physically cold. It was midsummer outside and in the middle of a heat wave. Inside it was fall, on the verge of winter. I wrapped myself up in additional layers of clothing, and then grabbed the blanket from the empty bed to my left. That felt better and I began to settle in a bit, but not for long.

Shortly after I’d commandeered the room’s second blanket a woman walked in, her figure silhouetted against the light from the common room. She carried a paper bag, presumably one with an assortment of clothing and other items accumulated over an emergency room stay. I wasn’t annoyed by her arrival. It was a welcome distraction from my own deadly thoughts. I rose from the bed.

“Hello?” I said tentatively. “Let me get you a blanket for the bed. I took yours. Sorry.”

The woman looked surprised. “I didn’t know anyone was in here,” she said. By then staff members were in the room, gently escorting her out and apologizing to me for the intrusion. Then I recognized her and still remember her features to this day, they were that striking. She looked to be in her mid-30s. She was slender, well dressed and clean, unlike so many other patients who arrived disheveled and unshowered. A conservative blouse was tucked into a pair of casual slacks. Her hair was tied into a neat bun. She had a tight, drawn expression that nonetheless leaked anger. Earlier that evening she had harangued staff members who were standing behind the nurse’s station. She demanded her cell phone and purse and at one point followed the night nurse into the station herself. She was not a large woman, but her anger made her seem big and threatening.

After my late-night visitor left my room, I managed to sleep for a few hours, but was up again at 5:45 am. The woman was at it again with the staff, every bit as belligerent as before. I saw a staff person raise his hands and say, “Okay…” to which the woman snapped, “Okay, what?”

This seemed to be a continuation of a conversation from the night before. I thought I’d heard a night-shift nurse say that they’d “deal” with something in the morning. Now it was morning and the woman was demanding her belongings. Her loud and angry tones were disconcerting, especially that early in the morning. Despite the disturbance, I was more fascinated than annoyed by this woman. Where had she come from? What would she do next? She pressed hard, however the early morning nursing staff remained polite but adamant. She would get her belongings back only when the morning crew allowed it. I began to worry that she might get violent if her demands were not met. To my relief, she did nothing more than argue and harangue.

It was nearly 6:00 am. Not that many people were up at that hour, just two patients: Catherine, the quiet woman with the crossed arms, who was already dressed for the day. A tall, white-haired man stood some feet behind her. Both Catherine and the white-haired man watched the spectacle and kept their distance. I kept an eye on the proceedings from the safety of my bedroom. The woman eventually calmed down and left, by which time the medication station opened and I gratefully got in line for my morning meds. 

Part 6: Anita

 My nighttime visitor made an appearance two days later, at breakfast. She sat by herself with a plate of food that she ate slowly and deliberately. Her face looked blank and the rest of her was controlled and tidy with pulled back hair, pristine trousers and a matching blouse that somehow looked as if it had just been ironed.

People were avoiding her and she looked isolated and lonely. My first instinct was to join her at the empty table, but I was as afraid of her as everyone else so I kept my distance. Instead, I attended to the relationships I was beginning to create with other patients, especially George, the young man who had attempted suicide. George and I often sat together for meals and were usually joined by Paul, the curly-haired, mustachioed other suicide survivor. My night-time agonies were retreating and I could feel a tendency towards recovery. I sensed the same progress in George and Paul. Our companionship helped heal us. Interaction was potent medicine, one that was slowly replacing trauma with laughter. People who could, talked and paired off into little groups based on their personalities. I felt myself recovering in slow, small steps. My sense of humor began to come back, along with an ability to engage others and offer them comfort and support. I could eat a bit more. George assumed the role of a self-appointed outreach coordinator who helped others during their moments of anxiety or fear. He took vulnerable people under his wing, like an obese young woman in a rumpled track suit. She worried about her boyfriend who had gone missing for the last few days. George, Paul and I offered our encouragement and support. The boyfriend would show up soon—we were sure of it. (The woman did finally find her boyfriend, at another psychiatric hospital.)

My midnight visitor had no such company. She hadn’t shown up for group therapy that morning, and that afternoon she engaged in a bizarre ritual. Apparently, the staff—or her therapist—had given her a job to do. She had been equipped with a few Recycle stickers, the kind that adhered to waste paper bins. She carefully selected baskets and applied the stickers to some of them. I put down the mandala I was coloring and watched her continue. She also had a few paper bags which she carefully folded to fit in the trash bins. This is where it got strange: the woman would line one basket with a paper bag, then another. Then she’d go back to the first one, take out the paper liner and put it into a different basket. OCD? I wondered. She did the same for all the paper bags, whether or not they were put into the newly-designated recycle bins. She did this during a break between therapy sessions, when people were mostly free to observe her odd behavior. It made her no friends.

I found the woman’s focused routine fascinating. I watched her a bit longer, then I moved on to participate in an art therapy session. I had been trying to learn how to draw. I was a natural when it came to writing and music, but the visual arts weren't as comfortable a fit. I saw the drawing session as a challenge, something to get my brain on a different path. I followed others as our unshod feet swished down the main corridor to a smaller meeting room, one as nondescript as the rest of the place. Its one window provided weak, outside light. Drab, institutional chairs and rectangular banquet tables formed a square around the room. One side of the square held art supplies: paper, chalk, regular and colored pencils, glue and, in its own small box, an assortment of colorful feathers and buttons. I picked up a pink feather, even though I had no idea what I would do with it. I squirted some Elmer’s Glue onto my paper and affixed the feather to it. Then an image formed itself in my head: my younger sister’s street as seen from her front window. An orange fenced-in running track was located directly across from her house. There was a gate, but it was rarely locked and I had occasionally walked the track for exercise when I visited my sister. 

I decided to start with the chain link fence enclosing the track area. A chain link fence is not difficult to draw. I’d start there and include a half-open door. A series of crisscross lines within a frame created a realistic fence. I added the slightly open gate and drew in a few clumsy houses on the other side of the field. I looked over the picture and liked what I saw. The pink feather added nothing to the theme, but I left it there anyway. For some reason the open gate kept attracting my attention. Then I realized what I was looking at: family and freedom. A way out, with support. An open door that had formerly been closed. The revelation nearly made me cry.

The therapy session included a period towards the end where each of us had the opportunity to describe our work. I picked up my drawing and showed it around. “I’m originally from upstate New York,” I explained. “My sister still lives there. There’s a fenced-in athletic track across the street from her house. I decided to draw that as if I was standing at her front window.” I pointed to my drawing of the open door. “I drew this door open,” I continued, “and it occurred to me that it represented my freedom, not from here but just generally.”

“You’re feeling free?” the art therapist asked. When I nodded yes, she asked, “What do you think that means? What are you free from, or what are you free to do?”

 “I think it means…” I hesitated. “I think it means I’m getting better, maybe that I’m becoming free from depression.” I certainly hoped that was the case.

There were no activities scheduled after dinner. People congregated in the common room and watched a movie, read or colored. I retrieved my mandala picture from the activities table and continued coloring. It was a mindless, repetitive activity and for that reason it was calming and engaging. As I added accent colors to the drawing, I noticed my night visitor gradually come up behind me and take a seat. I put down my crayon and looked behind me to say hello.

 The woman hesitated, then said tersely, “I guess I’m just a neat freak.” Her brown eyes never looked directly at me.

“Oh, that’s okay,” I replied, feeling an urge to talk to her despite an initial nervousness.

“Actually, it kind of reminds me of my mother. She was very meticulous. It took her all night to do the laundry.” I laughed. She didn't.  I decided to extend my hand in greeting. “My name is Lori, by the way.”

 The woman took my hand, barely touching it as we shook. “I’m Anita,” she said.

  “Would you like to do some drawing?” I asked, feeling a bit more comfortable around her. “It’s very relaxing.”

   “Oh, thank you, no,” she replied.

   “Okay,” I said. “Well, I’m going to get back to it, then. It was nice to meet you.”

     “Yes,” she said. I turned back to my drawing. Anita sat for a moment longer, then eventually got up and drifted away.

Part 7: The Inmate 

The next phase of my recovery may have started with the shower. I had one in my bedroom—a rare luxury for patients—and I decided to indulge a few days after my arrival. The shower was a disappointment. It was lukewarm, even with the cold tap turned all the way off. I stood in the frigid water, glaring at the stall's small blue and white tiles. I had been at Thompson for five days. How much longer would they keep me here? The hospital was still a safe place, but it was beginning to wear at the edges. I continued to enjoy the therapy sessions and felt in good hands with my care team. Some of the patients, though, were starting to get on my nerves. Two people in particular stood out in this way. One was a tall, slender, fair-skinned woman with short, dark blond hair who had spent two days in bed after her arrival. She joined us all on the third day. I noticed her filling in a large, old book with artwork, collage-style. She also played with the book itself, adding fancy paragraph headers and inserting curlicue borders between paragraphs.

“I'm more of a writer than an artist,” she explained. “Art doesn't come naturally. I like to challenge myself.”

Just like me, I thought.

As time went by, she grew loud and aggressive. One day she told us she'd lost her temper and had overturned beds and furniture in the common room area the night before. I did notice workmen coming in that day to reinforce or replace beds. I was hesitant to believe her, since my sleep would surely have been disturbed and I hadn't heard a thing. I noticed her fretting and hugging her arms every morning as we stood in line to collect medications. Was she manic and in need of drugs to calm down? My inner shrink said “Maybe.” In any event, I eventually found myself wanting to put as much distance as I could between myself and her. I had enough to deal with.

There was a second person on the ward who, over time, had a similar effect on me. She was a middle-aged black woman with a wrinkled face and an out-loud personality accompanied by a boisterous sense of humor. I'll call her Wanda. She wore a baggy yellow dress on some days and a baggy green dress on others. Like most of us, she wore slippers. Wanda said she had two children, neither of whom visited. She constantly criticized them in a way that was funny rather than offensive. Although I'd never had children, I was sure a little venting by parents was common. She joked constantly, in tones loud enough to reach to the other end of the room. She never stopped. At first it was amusing and made me laugh; after a while it was grating. I was starting to feel better and I didn't want this woman to upset my new-found equilibrium. Being at Thompson was challenging my patience as it was. I was tired of the air conditioning, the chilly showers, the laundry room and the old mattress on my bed. I wanted my phone and my iPad. I hated the long lines to use the telephones on the ward floor. I wanted out, even though I knew I was still sick. I tested myself regularly, asking the same question every day: Do you still want to slip into a river and drown? The answer that now came back was: maybe. No, I wasn't ready for the world quite yet, even though I would have happily walked out of the hospital if I could.

One day Wanda declared that she was leaving Thompson. I have no idea why she was being released since her behavior had not changed. I pegged her as bi-polar, in a manic phase.

The true extent of Wanda's illness didn't become apparent until the day of her release. There were jets flying over the hospital, she told us in loud tones. The pilots could read her thoughts. She insisted it was true.

One thing about depression, I thought—it was deadly but a lot quieter.

I had a new roommate who served as an antidote to the disorder that frequently surrounded me. Her name was Sue and she had come in during regular hours. She was a congenial, heavy-set woman with short brown hair and a hearty, cigarette-roughened laugh. Her somewhat swarthy complexion made me think she was either Italian or Greek. She occupied the bed closest to the door in our room and had already tossed her belongings onto a shelf nearby. Like most of us, Sue had come to Thompson via a hospital emergency room—in her case with psychotic symptoms. She and I created an easy friendship, although we tended not to interact with each other outside of our shared room.

Her psychotic break had been sudden and she was baffled by it. “It just happened,” she declared. She seemed more confused than anything else.

Sue was a great roommate. We shared stories back and forth and gossiped humorously about other patients, especially Anita, who had crash-landed into my life a few nights before. Sue became my sounding board and she loved hearing my stories about Anita as much as I enjoyed telling them. I was deliberately trying to remain open and friendly with Anita, who was as skittish as a mouse around a sleeping cat. A good story was still a good story, though, and Anita gave us plenty of material.

My husband was a regular visitor and one of the few people who knew I was here. I had told my sister and brother while I was still at Mercy Hospital, but cell phones were not allowed in this ward and I had no way of contacting them with more information or just to talk. My husband was my link to the world outside. When he visited, he and I spent time talking about how our days were going. I got updates on his parents’ activities. They didn’t know I was here, despite my closeness to my in-laws. I felt uncomfortable letting them know about my condition. There's a stigma around mental illness and—even though I believed they'd understand—I still felt uncomfortable sharing this information.

At several points I saw George’s parents at the hospital. George was also getting better, as were others whose families came to call. It seemed to me that a strong and supportive family could be a bulwark against mental illness. I also wondered if the opposite could also be true. From what I could see, the sickest patients seemed to be the loneliest. One heavy-set, young-looking woman, whose wrists were bandaged and whose forearms were latticed with cut marks, called for a family that never showed up.

“I want my mother, where’s my mother?” she cried, over and over. “Let me go home.”

 A staff counsellor eventually pulled up a chair in the common room to talk with her. Everyone else retreated to their bedrooms or found a therapy group to join.

“You’re here because you cut yourself,” the counsellor said gently. I recognized her as Kathy Lopato, the counsellor who had led my first group therapy session. That was only a few days ago, but it felt like weeks. Kathy and the woman sat against the wall opposite my bedroom, not far from the daily activities board.

“You can’t go right now. You need to get better first,” Kathy said. She was soft spoken but firm. Eventually the woman calmed down. From my room I could see her wiping her eyes with a bandaged wrist and nodding in agreement.

The woman's obvious distress saddened me. I remembered my own cutting fantasies, although I no longer felt those urges. My work at the hospital had driven them away. The crying woman's bandaged wrists were a reminder of how close I'd come to self-harm.

Sue had seen the entire incident. We talked about it and I shared my own experience. She listened with interest, then said she couldn't comprehend a fantasy like that.

Sue and I had the same psychiatrist, Dr. Smythe, and we agreed that he was competent as well as nice. He mostly worked with medication, to prescribe it and to gauge its effectiveness.

I also had a dedicated psychotherapist, an energetic woman named Christine, who engaged me in the difficult work of talk therapy. It was not an easy or relaxing experience. There was a reason I wanted to die, and our job was to find out what that reason was and to come to terms with those feelings. I grew up with certain expectations of life. Life was supposed to be fair and predictable, to follow a certain path through relationships, employment and everything else. You went to college, met a nice guy and found a job you loved. You settled down in a cozy house and had a family. Reality came up against these conceptions as early as college in the 1970s. My first experience of depression emerged around that time. It was never treated in those early days. People didn't acknowledge or talk about things like that.

Self-employment was both a boon as well as a major stressor. I loved being my own boss and was a natural leader. Unfortunately, the unpredictability of that lifestyle threw me out of the lifeboat of certainty. I loved the perks but could not handle the financial insecurity. It was a tightrope life and I never knew if I'd make it across to the other side or if I'd fall first. Neither my bank balance nor my emotions could handle the stress. I addressed the conflict in therapy and worked with Catherine to find coping strategies.

Thompson may have had threadbare couches, but its approach to treatment was robust. In addition to a psychiatrist and psychotherapist, I was also assigned a social worker. Frank was quiet and earnest. He worked with my husband and me to prepare us both for life outside of the hospital. He made sure I connected with my own therapist and our couples counselor. Depression affects couples, not just individuals, Frank said. His job was to make sure my husband and I supported each other in a healthy way.

Life at Thompson went on as before, with my incremental but continuous improvement. I spent the evenings socializing on the faded blue couch in front of the big screen television. I watched a movie, then looked on as a group of patients—led by George—started a game of charades. The game looked like fun and George invited me to join in. I declined, feeling bashful at the prospect of play-acting in front of a group of people. It was enough for me to watch.

I got ready for bed after the charades game. Sue was already asleep, but insomnia kept me awake. I was tired and the medication I’d taken before bed was starting to make me drowsy. I’d get to sleep at some point soon, I imagined. Unfortunately, Sue began to snore loudly after about an hour. I gave up on my efforts to sleep, grabbed a blanket and made my way to the cafeteria with the odd little glass room within it. The room was freezing, but there was a couch in it. I laid on top of the cold leather, wrapped myself in my blanket and eventually got to sleep.

Part 8: The Savior

I woke up the next morning and saw a line snaking through the cafeteria en route to breakfast. Feeling embarrassed, I wrapped myself up in my blanket and headed to my room. I quickly dressed and lined up for meds, then joined the queue for breakfast. I ran into George and Paul sitting together at one of the round banquet tables, along with the large woman in the tracksuit. Her stringy hair was tied up in a ponytail and she hadn’t changed her outfit over the last few days. This didn’t surprise me—depression (if that’s what she had) sucks energy out of a person, including the energy to shower regularly or even get out of bed. In fact, I had the same problems, although both symptoms were lessening with time and treatment. I had just taken a shower the day before and was having an easier time sleeping, assuming no loud noises interfered with the process.

In addition to new sleep medicines, Dr. Smythe had also prescribed a new anti-anxiety medication and I felt myself calmer and more in control during the days. I was socializing more and noticing that I had greater confidence. I felt more energetic overall and took my growing resentment of confinement as a good sign. I wanted to move freely, to be independent and in charge of my life again.

These improvements manifested themselves that day at lunch. The unwashed, obese woman, who I named Pam, had located her boyfriend the day before and looked relaxed for all that she was unkempt. To her right, Paul wore his typical dark t-shirt and jeans and waved me down as I approached the table. George pushed a chair back for me, which I accepted with a smile and an all-around hello. I ate a hearty lunch of Salisbury steak, mashed potatoes and green beans.

Some people never came to meals. Catherine, the woman with the crossed arms was a no-show, as was Anita, with the exception of that one morning. Healthier people like me were the cafeteria regulars, people who felt relatively comfortable with themselves and with others. I checked my watch as I chewed the last bite of meat, then got up to join others for the afternoon's group therapy session. I had to get there early to make sure I got a seat.

“Hey, Lori!” George called out. “You going to the meditation workshop later today?”

“Absolutely,” I said. I'd practiced mindfulness meditation for years; it was a regular part of my self-care routine. It helped me focus and clear my head of intrusive thoughts. I focused on my breath—in and out, in and out—and returned my wandering mind to it. Afterwards I felt calmer and emotionally refreshed. I was glad they offered a meditation workshop here at Thompson.

I turned back to George. “Are you going?” I asked.

George said, “Yes,” then added, “Maybe you can tell me more about meditation at some point. I really liked it the first time I tried it.”

I gave him the thumbs up and took my tray to the large trash bin at the entrance to the room. Then I walked through the common room to the big room where group therapy meetings were held. I settled in and waited for the session to start. Like our meals, group therapy was typically attended by healthier people, or at least people who seemed to believe they could get better. Group therapy provided an opportunity for us to describe our feelings and our struggles. It was also a way to meet new people on the ward. Group therapy provided the chance for new arrivals to introduce themselves and for those leaving to say a last goodbye. 

I looked around the room and noticed Sue, who was coming towards me. She sat down in the chair next to mine and said, “I apologize for keeping you up last night. I can snore pretty loud. I’m sorry you had to leave the room.”

I waved my hand and said, “Don’t worry about it. It’s me. I’m a very light sleeper. I can’t even sleep with my husband sometimes.” Then I added, “Are they making any progress on your symptoms?”

She shook her head. “I’m seeing Dr. Smythe this afternoon. They’re going over my medications.”

“Sounds like a good idea,” I said.

Group therapy started shortly after that. As it progressed, I found myself verbally consoling others, taking care of them in the only way I could. I took it as another sign of my progress. Kathy Lopato kept conversations moving and civil and made sure that everybody who wanted to speak could. She gently encouraged the shy and kept a friendly lid on over-excited people whose first inclination was to talk without stopping.

As I listened and talked, Anita came into the room. She sat down next to me. Her body was stiff and strained, as if she struggled to stay in the room after finding the courage to walk in. I kept a protective eye on her at the same time I participated in the conversations going on around the room. Then, suddenly, Anita lost it. Her face twisted, then she lowered her head and quietly began to cry. My hand reached out to comfort her before I knew what I was doing.

“It’s okay,” I whispered. I stroked her hair. “It’s okay,” I said again. “Stay here,” I urged. I thought she might benefit from the welcoming warmth and energy going around the room.

Anita didn’t make it through the session. She raised her head and left the room as quietly as she had entered it. I sat back, somewhat in shock. Anita had come to me. She had tried to participate but wasn’t ready yet, or so I assumed. Something about me encouraged her trust and I began to wonder what that was. In my profession I helped people, took a leading role. I had been doing the same thing here for the last day or two. Unlike before, it gave me an uncomfortable feeling. Was I being Lori the Savior and was that a healthy thing? Was I taking on too much responsibility? The group therapy session ended and I left the room with that question on my mind. Was that tendency a good or bad thing? It was an issue I’d be addressing with my own therapist once I left the hospital. For now, I had some free time. I wandered back to my room to get my journal.

Sue was in the room and looked up at me, smiling. “I’m okay!” she declared the minute I walked in. I could see the relaxation in her face and shoulders. “I’m going home! It was a new drug I’d gotten from my doctor. I took it the morning I freaked out,” she explained. “It was just the drug.” She almost laughed.

“Oh my God, that's great!” I exclaimed. Sue was fine and it was a relief to both of us. No one wants to be crazy and even less to be confined to a psychiatric hospital full of sick people.

Sue turned to me and asked, “Do you think something like that could have happened to you?”

I felt my energy drain out through my feet. There was no drug interaction when it came to me. “No,” I said, feeling sad. “It’s depression. It runs in my family. I’ve had it for years. It would be a miracle if it was only caused by medication.”

Sue looked at me with sympathy. “Will you keep in touch?” she asked. “I don’t have an email address but I’d be happy to give you my phone number. Maybe we can go out for coffee once you come home.”

That sounded good, so we exchanged contact information. I was glad to hear that Sue was the victim of a drug reaction and nothing more. As much as I felt happy for her, I felt some dejection for myself. When would I be leaving and what would be waiting for me outside of the hospital walls?

Part 9: Freedom Calling

“How are you feeling this afternoon?”

“Better.” We were in Dr. Smythe’s office the next afternoon, five days after I'd arrived. He sat in a chair behind his desk and I took the chair opposite. He wore a soft-looking maroon shirt with a dark tie and looked as if he’d just had a haircut. He was smiling as he browsed through my records.

“Still feel like drowning?”

“No.” The thought brought up images of me, cold, wet and miserable after a dive into the Charles River. “No way.”

Dr. Smythe nodded. “Meds kicking in? How’s your sleep?”

“Some of the meds are starting to have an effect,” I answered. Actually, all of them were making me sleepy. “Sleep’s better,” I added. “I'm calmer, too.” Sleep medications had historically failed me, but I was willing to give this regimen a try. To my pleasant surprise, my new drugs were helping. The physical and mental night horrors were slipping away, although it continued to take longer than I wanted to fall asleep. Still, I felt deeply grateful. Sleep did eventually come, and sooner than before. In my mind, I gratefully ticked the “win” column on this one, at least for now.

“I’m glad to know you’re improving in that area. I talked to your social worker,” Dr. Smythe continued, “and things seem to be going in the right direction. Do you agree?”

“Yes,” I answered, mulling over the question. There were bound to be stressors, but I now believed they could be addressed. In any event, I was feeling better about them. I had some coping skills and felt prepared for the work that was to come after my release. As I wrote in my journal after my appointment with Dr. Smythe:

I have to learn to let go, even though I’m not sure exactly what that means yet. Try meditating without the guide. Give my brain a rest. There are no easy answers, but I’ll blow my brain apart if I don’t give it some peace of mind.  

I decided I’d start with some work on my sleep habits, with the goal of improving them over time. Yes, this could work. I was out of the red zone.

Dr. Smythe put down my folder. “I’d like to release you tomorrow,” he declared.

Despite my progress, I wasn’t expecting this. My first reaction was one of fear. The hospital felt safe. I wasn’t so sure about the outside world. Then my second reaction settled in: relief. I was going home.

Dr. Smythe picked up my folder again and flipped through it. “Your regular therapist is...Claire Hannigan?”

“Yes. We’ve been working together for a few years. She knows I’m here.”

Dr. Smythe replied, “Your social worker contacted her and set up a post-release appointment with her next week. We also contacted your couples’ counselor and made an appointment with her the week after. Sound good?”

 “Yes,” I replied, impressed. “I’ll have to check with my husband to make sure he can make the couples appointment, but it all sounds do-able.”

“You can always change dates and times,” Smythe continued. “Just make sure you keep both appointments, and not too far out into the future.” He snapped the folder shut. Done. “How are you getting home tomorrow?” he asked.

“My husband will pick me up,” I replied. “I’ll give him a call as soon as we’re done here to find out when he can come.”

“Excellent,” the doctor said, looking satisfied. “I’d like you to take a walk outside today. You’ve been cooped up here since you arrived. Get some air.” Walks outside were a hard-earned privilege, open only to those who showed sufficient progress. It would be nice to get out, despite the day’s heat.

Dr. Smythe stood and extended his hand. I shook it and left the office. I walked back to the common room to check the activities board. There was one music therapy session remaining in the day and I decided to skip it. I turned my head and saw George enter the room. I waved him over.

“Hey!” I said. “I’m going home tomorrow.”

George’s smile brightened his entire face. “That’s great!” he exclaimed. “And guess what? I’m going home tomorrow, too.”

“Congratulations,” I said, realizing that I would miss him. “I’d love to keep in touch,” I said. “Can we exchange contact information?”

“Absolutely,” he replied. We walked over to the nurses’ station to get a piece of paper. I still have his phone number and email address to this day, although I only contacted him once. I figured he wouldn't want to be reminded of his stay here so I've let our connection drop.

After exchanging information, I returned to my bedroom. I was the only occupant now that Sue had gone home. I walked to one of the ward phones to call and let my husband know I was being released tomorrow. We settled on a time for him to pick me up. I returned to my room, pulled out my journal and wrote for twenty minutes or so, before the walk outside began. Now that I think about it, I wonder why they let me keep my pen. It was a sharp object, something I could have used to hurt myself or others. They took my shoes, my cell phone and iPad, but let me keep the journal and the pen. Maybe the ability to express myself and my feelings through writing was sufficient incentive for the staff to take that risk.

I went back to the nurses’ station and asked about the outdoor walk. The nurse, a stocky older woman with short graying hair and a rumpled blouse checked the list. “Oh, yes,” she said. “Here you are. Have you been outside before now?”

“No,” I said. “I’m going home tomorrow and Dr. Smythe encouraged me to join the walk.”

“Great,” the nurse said. By now there was a queue waiting near the exit for the walk to start. I thought about my pending release. Part of me still felt nervous, but a bigger part celebrated the accomplishment. I realized this was the first time I was walking out of the ward. No more locked doors! No more lukewarm showers. No more signing up to use the washer and dryer. No more manic patients disrupting an evening’s calm. The prospect of sleeping in my own bed and bedroom beckoned.

I followed the group as it walked toward the bank of elevators. Our wing was on the fourth floor. I realized how tired I was of this locked-room existence, more like an inmate in a prison than a patient in a hospital. I was ready for more. I took my current feeling against captivity as a sign of returning mental health and I found myself looking forward to the world.

The heat hit me like a brick the minute we got outside. I had no shoes, only my blue fuzzy slippers and I could feel the hot sidewalk beneath them as I walked. We traversed a roadway on the hospital grounds, then came to a large parking lot almost empty of cars. I breathed freedom in the scorching air as we walked. Now that we were outside, the thought of going home excited me even more. 

We eventually arrived at a picnic area with benches and trees that provided a bit of shade. I propped myself up on a table and chatted amicably with the other patients, most of whom said they would miss me. I realized I felt the same way towards them. Many of us had healed each other as much as had our therapies. We sat and talked for about a half hour. Eventually the heat tempered our congeniality and we did not protest when it became time to go back inside.

I spent the rest of the day packing, saying my goodbyes and finishing a book I had started reading. I’d found it on a bookshelf towards the back of the activities table in the common room. I no longer had a roommate and spent my final night enjoying my privacy. I had not seen Anita in days and wondered if she’d been transferred or released. When I finally saw her, I said goodbye. Her reply was vague but felt sincere.

My husband arrived the next afternoon. I was packed and ready to go. I signed some papers and got my possessions back. With one look behind me, followed by a wave goodbye, I made my way with my husband towards the elevators and home.

Lori Kaminski (not her real name) lives with her husband in the Boston, Massachusetts area. She is now retired but worked as a self-employed social media consultant and freelance writer. Lori was hospitalized four times for clinical depression with anxiety, but has been in remission for the last few years. She loves to write, cook, walk and spend time with her friends and family.

Be a part of my new book project!

Hello dear beautiful voyagers,

I’m embarking on my most ambitious writing project to date and I need your help! I’m looking for a wide range of perspectives from smart, skeptical people who have learned to let down their guards in order to experience mental/physical health breakthroughs. I want to help future overthinkers understand how their brains might be holding them back from healing. If you have any interest in sharing your insights, please answer the 4 questions below. Thank you for all you do to light the path for other voyagers, Meredith

Please answer these 4 questions about your breakdown experience

Letter From a Bipolar Mom to Her Children

My darling,

As I sit here and try to come up with a way to explain this to you, the first and most important thing I want you to know is that I am sorry. I am sorry that I failed you during this. I am sorry that for a short time, I wasn’t the mother that you needed me to be. I’m sorry that you’ve had to pay some of the price for my mistakes.
I am going to be very brutally honest in this letter I write to you. And the reason for that is because I want you to learn from my mistakes, and not make the same ones when you’re older. I believe you deserve the real truth, without any sugar-coating. I believe you deserve answers.

You see, mental illness is a dark and scary thing. It is not something easily explained. It is a manifestation of every bad thing that has ever happened to a person and every bad thing that ever could.

What I have is called Bipolar Disorder, which, by definition, is a mental condition marked by alternating periods of elation and depression. It is the excruciating pits of despair leaving you curled up in a ball on your bathroom floor, begging for someone or something to just come and save you from your own mind. It is the uncontrollable impulses that lead to bad decisions and reckless behavior. It is a constant battle within your mind. Two entities fighting for first place, with heartache as the only real winner.

There’s not a whole lot of things I’ve prided myself on in my life. But from the minute you were born at 1:14 am, being a mother was one of them. I liked to believe I was always kind and compassionate towards you. I was patient. I was empathetic. I was caring. I protected you at all costs. You showed me what true, unconditional love meant, and I will forever be grateful for that.

I’ve struggled with mental illness ever since I was a little girl, not much older than you are now. It has come and gone throughout the years. It wouldn’t be until you were about 5 years old that I would come to discover the real hardships that come along with being a mother and having mental illnesses.

It started out as depression here and there. I’d get sad, overwhelmed, lonely and then the dark thoughts would come over me like a giant wave that comes out of nowhere, takes you by surprise, and crashes over the top of your head while you’re playing in the ocean. I never knew or learned healthy coping mechanisms. I would always just shove the thoughts down as deep as they would go until I could feel “normal” again. The normalcy would only last for a short period of time though.

In May of 2017, I experienced my first true manic episode followed by a brutal, soul-sucking depression. The worst I’ve ever had. It started out as some minor careless behavior, that my friends and family noticed. Such as me spending money that I didn’t have, drinking more, using drugs recreationally, not sleeping, etc. Then I became a completely different person. I started sending you to your dad’s more often, partying all the time, doing reckless things that did not match up to my personality. People got worried, but I was on such a “high” that I didn’t want to hear it from anyone. Nothing could bring me down. I started spiraling out of control. I couldn’t control my impulses anymore, I was doing dangerous things, and digging myself into a deep hole, that I would soon come to find out would change our lives forever.

The worst night of my life.

It started off just like all the other nights I had been having recently. I had the same group of people come over to party, the only difference was that you and your sister were there this time sleeping in the next room. In the early hours of the morning, everybody else had either left or gone to sleep. I started to come down off the drugs and alcohol, and the “high” I had been on for the last several weeks started to wear off. I was alone with only my thoughts now.

The thoughts came over me harder than ever before. They were deep and they were dark, they wanted me to feel the misery I had been trying to hide for so long. I looked at you and your sister sleeping, and everything started to surface at once. I suddenly realized the devastating effects of what I had been doing, and of the decisions I had been making. I felt an immense amount of guilt wash over me. “Who had I turned into? Who was this person staring back at me in the mirror?” I didn’t recognize her at all.

In that moment of desperation and confusion, my impaired thoughts and distorted thinking had me truly believing that you and your sister would be better off without me. So, I went into the bathroom and coped the only way I knew how to. I started to self-harm. I want you to know that no matter what anyone has said or thought, my intention was never to die. Honestly, part of me did want to die, but I knew I could never take myself away from you and your sister. My intentions were purely to hurt myself, because I thought I deserved it.

The following moments were a blur. Nana came over and called your dad to come pick you up. It was then, that I realized I needed some true, serious professional help, so I decided to check myself into the local psychiatric hospital. I spent four days there, detoxing, adjusting my medications, getting therapy, and learning new coping mechanisms.

The days following the time I got out were a huge mess. Your dad was livid with me for harming myself while you were there. He wouldn’t let me see you or talk to you. He got a lawyer and ended up gaining full custody of you. I can’t even put into words the devastation I felt when I got that news. I knew that while I got better, you being with your dad was what was best for the time being, but to completely lose custody of you broke me entirely.

It’s been a little over a year now that all this has happened, and I want you to know I have done everything in my power to get better for you and your sister. Since I got out of the hospital, I had also checked myself into an outpatient therapy program that I went to every single day for eight weeks straight. That was one of the best decisions I ever made. There, I got to gain an enormous about of knowledge about having bipolar disorder, what it really meant, and how to manage it. I got to work through past traumas, learn new therapy skills and coping techniques, and really work through underlying issues that I had had for so long.

I have also continued to see a psychiatrist once a month for medication management, and I still go to therapy once a week to continue to work on myself and grow.

But it’s not all rainbows and butterflies now either. I still have my bad days. There are still some days that I can’t even manage to get out of bed because the depression is so bad. And there are days when I feel like I am invincible and don’t always make the best decisions. I’m still human, and I still make mistakes. But one thing I know for sure is that I will never give up on myself ever again. You need me. Your sister needs me. And that is enough to keep me going.

I will have to deal with this demon that is a mental illness for the rest of my life. But the difference is now I have the tools and knowledge and healthy coping mechanisms to push through.

So once again, my love, I am sorry for putting you through this. If I could go back in time and do things differently I would in a heartbeat, but the truth is that I cannot. I can only learn from my mistakes, and better myself for my two beautiful daughters. I can only hope and pray that you both will learn from my mistakes as well and never have to go through the things that I’ve had to go through.

I’m still trying to gain custody back, and I want you to know that. I want you to know that I am fighting for you and I will never stop fighting for you. Not for one second. You are my entire world and I love you more than anything in this universe. You give me purpose. You are the reason I keep going and pushing forward. You are my reason why.

I pray that you will never resent me for this and will always know that I never stopped loving you, I just lost myself for a moment. I also pray that you will never resent your father for keeping you from me, because he was only doing what he thought was best. I pray that you will never have to fight these silent battles yourself and that if you do, you know you can come and talk to me and I will fight them with you. You are never alone in this world. You will always have me. You are my daughter, and I am your mother. Nobody can take that away from us and nothing will ever change that. I love you to the moon and back, baby girl. Forever and always.

Editor’s note: This letter is resonating with people! It was originally published in March 2020 and updated Nov 6, 2023.

When Not to Meditate

Photo by Pawel Czerwinski

People don’t talk about this as much, but it’s important to consider when not to meditate — or how to approach meditation— if you have an anxiety disorder or depression.

Meditation can help you get through an episode of anxiety, depression or mania by betraying the thoughts that fuel such episodes as false, by giving you some calm space to survey your situation and predict your moods, and by revealing some ideas on how to intervene. But only if you have an established practice. If you have not meditated regularly, or at all, and you’re in a period of depressed ideation, impulsive mania or torturous anxiety, don’t start now. You’ll just sit there agitated and ruminate and your condition will likely get worse. Seek help elsewhere. Begin practice during a stable period.

When I first considered meditation, my mind was still troubled by an episode of mania that resulted in a hospitalization. Anxious rumination unsettled my thoughts, and to sit quietly observing such thoughts likely would have pushed me over the edge. I read the Psalms instead. Today, with a well-established practice, focused attention helps me navigate and overcome such difficult periods. But as a beginner, silent practice right then would have been dangerous.

This piece is an excerpt from George Hoffman’s upcoming book, coming out Feb 25, 2022.

It’s best to begin meditating during a period of relative stability. If one is depressed and contemplating suicide, a new meditation practice will not help at all. If a terribly depressed person sits with those thoughts, things are only likely to get worse. After establishing a strong practice, the same focus at the same time may help a person release such thoughts and be well. But not as a beginner.

Anxiety is a similar situation. The beauty in using meditation to manage anxiety is the revelation of self-defeating thoughts. As I stated before, we’ve all thought, I’m so anxious I could die! Meditating on this reveals that you don’t die. Thoughts fuel the anxiety, and if you can see the thoughts as erroneous and let them go the anxiety inflamed by them will pass, too. But not until you’ve practiced long enough to face and release thoughts with confidence. As a beginner, the rumination will only further convince you that, yes, the anxiety will kill you.

Most studies that prove the beneficial effects of meditation have their subjects meditate for 20 minutes a day for four to eight weeks before lasting positive results are established. (Of course, you have to keep practicing for the positive effects to remain.) It takes about that long to learn how to successfully sit and notice the changes in and around you. It takes about that long to learn how to release thoughts that don’t make sense. It takes a bit longer to predict episodes by noting signals in your body, emotions and mind. If you haven’t put in a few weeks of practice when you’re well, don’t meditate when things are too challenging to endure. Call a hotline or reach out to a loved one or doctor instead.

Today many teachers with little depth of understanding of the challenges meditators can face are leading students into practices that, while often very positive and relaxing, can lead a troubled mind into very dangerous places. Just as a poorly trained yoga teacher can push a student to physical injury, an insensitive meditation teacher can introduce practices that add dangerous rumination to the challenges one may face. This can be especially damaging to people with serious mental illness.

Even expert, world-famous teachers have students who have come apart, some requiring hospitalization. Recent research published in PLOS One indicates that 25% of people who have meditated for at least two months have reported a particularly unpleasant psychological experience, such as anxiety, fear, distorted emotions or thoughts, or an altered sense of self or the world while meditating. Meditators who have practiced for years, or long periods of time during each sitting, had an even higher occurrence of challenging experiences.

Those most at risk include those who suffer from high levels of repetitive negative thinking, as do many with serious mental illness. This is not to say that meditation cannot benefit those with serious mental illness. It saved my life from the ruin of bipolar disorder. It just needs to be entered into carefully, and with support.

About the Author

After a series of hospitalizations and a lot of bad behavior, George Hofmann managed to overcome the worst of bipolar disorder by adding practices in focused attention to the usual therapies of medicine and talk. He works to show others with anxiety, depression and bipolar disorder how to do the same. Before he began to write and teach, George studied with several well-known teachers in the Zen and secular mindfulness traditions. He is the author of Resilience: Handling Anxiety in a Time of Crisis, and maintains the site "Practicing Mental Illness," which promotes meditation, movement and meaningful work as keys to growth and healing. This post is an excerpt from George’s book Practicing Mental Illness, coming out in Feb 2022. George has conducted workshops on meditation for individuals, families, support groups, healthcare professionals and corporations. George also writes a weekly commentary on the Psalms from an inquisitive, ecumenical perspective at The Psalms Meditations Project. He lives in Philadelphia, Pennsylvania with his wife, their daughter and two poorly behaved dogs.

Teen Cutting

Photo by Matthew Waring

Signs, Symptoms, Prevention, and Treatment

When confronted with intense emotions, some teens may turn to self-harm, such as cutting, as a means of coping. While some claim that cutting serves as a temporary distraction from difficult feelings, this confuses others who wonder how physical pain can ease emotional pain.

Familiarize yourself with this self-harming behavior so you'll know what to do when your teenager engages in it.

What Is Teen Cutting?

Nonsuicidal self-injury (NSSI) is the intentional harming of the body without the intent to end one’s life. Cutting is one example of NSSI, but it can also be done through scratching, hitting, and burning, among other methods. Additionally, NSSI is more common in people who suffer from anxiety, depression, or have difficulty regulating their emotions. 

Why Do Teens Engage In Self-Harm Like Cutting?

While there are many causes and factors to self-harm, some teens do it because they are looking for a way to alleviate or distract themselves from their intense thoughts and emotions. 

A meta-analytic study from the American Academy of Child and Adolescent Psychiatry analyzed the prevalence and characteristics of self-harm in adolescents across 41 countries. Results showed that the average age of starting self-harm was 13 years old and the most common type of self-harm was cutting. The most common reason is to find relief from their thoughts and feelings. 

Additionally, a 2016 study looked into the reason why adolescents self-harm, with results showing that the most common reason is “to get relief from a terrible state of mind”. 

What Are The Signs That A Teenager May Be Engaging In Cutting? 

Some teens who engage in cutting might try to conceal it, so adults might not have an idea that it’s happening. The following signs will give you an idea if your teen is engaging in this dangerous behavior:

• Fresh cuts or scars on the skin (e.g. wrists, hands, legs, or other body parts)

• Using bandages and plasters more often

• Wearing clothes that are not suitable for the weather to cover cuts

• Covering certain body parts with clothes or jewelry

• Avoiding situations where they have to show their body (e.g. swimming)

• Self-isolation 

• Symptoms of depression (e.g. hopelessness, reduced appetite, sleep problems, irritability)

Is Cutting A Sign Of Suicidal Intent?

When teenagers engage in self-harm, it's often a way for them to deal with or find some relief from their emotional suffering. But even though people who engage in NSSI might not have suicidal intent, parents should still be concerned for their children. 

Researchers have investigated the relationship between NSSI and suicidal intent. In a 2013 study, the findings suggested that NSSI is a risk factor for suicide. Additionally, another study found that a history of NSSI predicted suicidal thoughts and behaviors. This suggests that it may serve as a “gateway” behavior for suicide. 

Can Cutting Become An Addiction Or Habit? 

When teens repeatedly rely on cutting as a way to cope, it can form into a habit. For instance, instead of learning how to regulate intense emotions, teens might feel the urge to self-harm to find relief from what they’re feeling. 

What Are The Treatment Options For Teenagers Who Engage In Cutting?

Teenagers who engage in self-harm have access to different treatment options. You can look into the following:

Cognitive Behavior Therapy

Cognitive behavior therapy (CBT) is a type of psychotherapy or talk therapy that uses strategies to change a patient’s unhelpful thinking patterns. It is based on the principle that a person’s thoughts, feelings, and actions are connected. 

For instance, if a teen’s distorted or irrational thoughts causes emotional distress, which can lead to self-harm behavior such as cutting, CBT can help them understand the reason why they self-harm and find healthier ways to cope. 

Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) is a psychotherapy that is based on CBT. It is helpful for teens who are struggling to regulate their emotions. It was originally designed for patients with borderline personality disorder (BPD) but can also be effective for those who struggle with major depressive disorder, suicidal behavior, and nonsuicidal self-injury. 

The main goal of this type of therapy is to teach patients two opposite ideas — acceptance and change. For example, you will be taught to accept yourself, your challenges, and your experiences. Additionally, you will also learn to make positive changes in your life. 

How Can I Create A Supportive Environment To Help My Teen Stop Cutting?

A supportive environment can help your teen who’s struggling to stop harming themselves. Here are some ways you can help them:

Communicate with your teen

If you’re still in doubt if they’re harming themselves, you can communicate your concerns with your teen in a safe and private environment. But be prepared for other reactions, as they may try to deny it or get upset. The best reaction is to stay calm and communicate again next time. 

When having this conversation with your teen, be as calm and nonjudgmental as possible. Express concern and communicate that you want to help them. Be patient because it can take a long time for your teen to make the necessary changes.

Be Available For Your Teen

Support your teen by listening to their problems, offering comfort, and thinking of solutions together. Help them practice healthy coping mechanisms to help minimize their stress, such as practicing yoga, spending time in nature, and taking deep breaths. Additionally, it is also important to check up on your teen often even if you think that they’re getting better.

Research and learn

Gain a deeper understanding of self-harm and explore strategies to help your teenager overcome this behavior. There are plenty of research studies and learning materials available online for your reading. This will help you understand what they are going through and also find out what treatment options are available.

Be a good influence

How you respond to difficulties, express your emotions, and behave will influence your teen. What you do, what you believe in, and what you say can have an impact on them. 

That’s why it’s a good idea to also learn how to regulate emotions, have self-compassion, and practice healthy problem-solving skills when faced with challenges. This way, you can be a positive influence on your teen.

Create a safe home environment

Remove or lock up hazardous objects in your home, such as knives, weapons, and other dangerous household items to keep your teen safe when they are having self-harming thoughts. Your teen’s therapist can help create a safety plan to teach teens to cope with their thoughts and emotions and also help you make the home environment safer. 

When To Seek Professional Help

If you're worried that your teenager may be participating in self-harming activities, it's recommended to reach out to a professional for assistance. A mental health professional can provide the treatment that your teen needs. 

If you feel overwhelmed, don’t hesitate to ask your trusted support network for help. You can also benefit from seeking professional help for yourself if you’re struggling as a parent. Remember that you can only take care of your teen if you also take care of yourself. 

The Bottom Line

When teens engage in self-harm, it's often a sign of intense emotional pain, and discovering that your teenager is struggling in this way can be incredibly shocking and unsettling. Aside from your teen’s determination to stop this unhealthy habit, strong support from their loved ones can go a long way to making a positive change. Be patient as they overcome their struggles and find healthier ways to cope.

Michael Vallejo is licensed as a Clinical Social Worker in Colorado and Oregon. He received a Master’s Degree in Social Work from Portland State University in 2010 and has extensive experience with children with behavioral and mental health difficulties. He’s worked in a residential treatment center for children and teens as well as in a shelter for at-risk youth and he co-owns Mental Health Center Kids.

Meet a Voyager: Rachel Hunter

Editor’s note: Rachel emailed to ask if she could share an essay about her mental health in honor of the launch of her new blog, Positively Anxious. She describes her goal as “to help others who might be experiencing the same issues feel seen and supported, and to put a splash of positivity into the planet, too!” Here’s her post!

Ohh Rachel, you worry too much. Oh Rachel, just relax! Hey Rachel, uh, I think you’ve sweated through your shirt…yep, all phrases I have heard uttered countless times in my worrisome little life. You see, I have an anxiety disorder called, Generalized Anxiety Disorder (maybe you’ve heard of it?), and like the other 6.8 million people it affects in the US, we know all too well that it can sometimes blow some hot stanky ass. In case you aren’t familiar with GAD, it is mental health condition that involves persistent anxiety that interferes with your daily life. For me, this also includes panic attacks and more recently, PMDD, but it can look differently on different people.

My earliest memory of having anxiety was when I was around 10 years old and was having some trouble falling asleep at night. Each night, my young brain would swirl with worry about mostly irrational and out of my control things, like natural disasters, diseases, and car accidents. My nightly prayers became a loooong list that took me several minutes to rattle off each night. It was exhausting, but I was too terrified to leave anything or anyone out. One time I saw an outbreak of meningitis on the news and couldn’t stop worrying about contracting it. The news anchor had mentioned if you could touch your chin to your chest, you didn’t have it, so every night and every morning, I would lower my neck to verify I could still touch my chin to my chest. Looking back, this makes me really sad. I didn’t know any other 10 year olds checking themselves for meningitis every day! I knew something was wrong, but as a kid, I didn’t fully understand what.

It would be years later in college when I would finally get diagnosed. I was in the student center and it was mental health week. I had never had any school or program ever hold a mental health week before. It was early days in the discussion of mental health and there was still a stigma around talking about mental issues. I feel awful saying this now, but back then, I was worried everyone would think I was crazy, so I never told any adult what I was going through. Aside from my best friend, I kept it to myself and handled it the best way I could. But suddenly, here it was, being talked about out in the open, so I wandered around and found the anxiety booth. I snuck a pamphlet and poured over it back at the dorm. And let me tell you what- it felt SO good! As I read it, I was like, yes! That’s me! Omg, I feel all these things! Yes, I do have panic attacks! Yes, I do have unwanted thoughts and nervous sweating! I felt so seen and for the first time, so relaxed. It had a name. There were other people like me. And the best part? My school offered free counseling. For real?!

In those counseling sessions, I found out which type I had (GAD) and learned some handy coping techniques. I also talked for the first time about what I was experiencing with an adult. It changed a lot for me. I am eternally grateful that my school offered this service free of charge for students. I hope every college always offers free counseling, and I hope every kid that needs it is brave enough to grab that pamphlet and make an appointment.

I also hope everyone has a roomate like I did, who when she noticed I was always gone around the same time every week and not for a class or for work, asked me what was going on. After dodging the question for weeks, I finally confessed I was going to therapy for my anxiety. She looked at me, smiling and said, “Oh, cool. I’m really happy for you.’”

I said, “Really? You don’t think it’s weird?”

“Nah, I always knew you were crazy,” she playfully joked, and then we both burst out laughing and went to get dinner. Just like that, it was no big deal. It was nice to be accepted just as I was.

So now, here I am, a million years later, wanting to talk about it. ALL OF IT. So no one feels left out or crazy or ashamed like I did. Because as great as the help I received in my youth was, this is something I deal with on a daily basis, and always will.

But it is also only one part of me. One super inconvenient and often overwhelming part of my bad-ass self. There is a lot more to my story. And to yours, too.

So while we may anxiously fear the big bad unknown, we can also try to embrace the good stuff for as long as we can. After all, the other side to this blog is POSITIVITY. And these days, that is my main focus. I want to help us all find ways to cope so we can give more of our energy to finding our purpose,  maintaining healthy relationships, and enjoying many years of good health. I’m not talking about that easy cheesy optimism, but rather a true joyful outlook. It requires acknowledging the hurt, pain, and devastating facts of our world and doing our best to process these things (and help others where we can!) while still striving for joy. It requires honesty, courage, and putting in the work. But trust me, no matter what you are feeling or where you are at in your journey, I promise you are worth the work.

So now that you know my past, let me catch you up a little on my present. I am a new mom (hello nothing but scary unknowns!), a kick-ass wife,  a rock climber, hiker, & dancer.

I am a feverish night owl. TV and movies are my jam.

I am overly particular about almost everything. I ruminate and question almost everything.

Eating real food and being in nature feels like a big hug to me. Music, a well timed fart, and abundant sunshine bring me glee.

I am someone with a mental health disorder.

I am positively anxious.

Rachel is a writer and new mom based in Colorado. She studied film at Kent State University and in a past life, ran a sketch comedy group, made a parody video about boobs, and wrote a short film about love. She loves to create, and can often be found hiking in all seasons with her husband and the brightest, sweetest little girl in the world.

Three Quigong Techniques to Try Right Now

Editor’s note: Betty Lee reached out to me to share some of her favorite Qigong exercises. I happened to be angsty when I got her email and immediately tried the breathing and movement exercises and they did help!

Breathing exercise

Did you know Qi means “Breath of Life?”  Here’s a basic Qigong breathing technique that’s good for relieving stress.

1. Breathe in through your nose for 8 counts deeply from your diaphragm

2. Blow out through your lips for 8 counts. 

3. Do this 8 times, and you will feel calmer.

Movement exercise

Chow Qigong exercises balance your energy to boost your immune system — even 15 minutes can help you feel energized and positive! Hip rotation exercises massage all your inner organs. Here’s an 18-minute video of the 8 Brocades Qigong practice. These exercises can be done sitting down, if you are in a weakened condition. 

Here’s another version of movement exercises featuring Dr. Chow, a world renowned Qigong Grandmaster. (She rehabilitated herself from wheelchair to climb stairs using these exercises, when she was in a weakened condition at 88.)

Brushing Technique

The Chow Qigong Brushing is a unique technique that helps you brush away excess energy that can cause pain. 

1. Start by choosing a painful point on your arms or legs, e.g. for when you have a charley horse. You are going to brush away excess energy from that point.

2. Now put your hand 3 inches from that painful point and and sweep down firmly towards the ground. Do this a few times until you obtain relief quickly.  

3. Make sure not to brushing that energy back onto yourself or anyone else. 

4. For a painful point like a hip it may be more effective for another person to do it, because you are standing and the distance from painful area sweeping  firmly to the ground is longer.

Betty Lee was born in Hong Kong and is bilingual in Chinese and English.  She was certified as a Chow Qigong practitioner by Dr. Effie Chow.  She has helped maintain people's health for nearly 5 years in San Francisco and Reno.

Meet a Voyager: Mike Mather

Mike Mather is the founder of the Dharmaholic newsletter and community, and this bird is their mascot.

Q: Can you tell me about your childhood?

I was born in 1963 in Brisbane with 2 larger sisters, and in 1965, a sickly brother was born. Just before my 6th birthday, David died. That year, my only male cousin choked and died, and my granddad passed after mowing the lawn. Dad and I were the only males the eye could see.

Photo taken right before Mike’s dad died and Mike got sober.

My father was a heavy drinker and hit the bottle hard then, and my mum, sisters, and I suffered from that as well as the loss. What he didn’t tell until later was that he fathered another daughter in 1965. He was trying to support that child too.

Eventually, he stayed sober for 3 years and got financially and physically fit. My sisters married young, and I was Mum’s only one left. Dad began to drink again, and Mum made me a surrogate spouse.

Q: How did that affect your life? What about your mental health?

I didn't know about mental health then. I felt that my family was the best in the world.
A sobering alcoholic is a very hard person to live with, and my dad didn't have AA, therapy, or spirituality to help him with this transformation. I remember he was very strict with my sisters and me, including 'Be seen and not heard', 'Go to church on Sunday and holy days, and 'Do what I say, not what I do'. So, my mental health? I was a crier and got teased about it by my brothers-in-law. I became a very studious and pious boy and never missed a day at school, went to Mass every Sunday with my sisters or alone, and I played all the sports I could manage. In hindsight, I was trained to not feel but to do. My sisters both married when I was around 9. I was also being nurtured by my grieving mother.

Q: What happened next in your life?

I got my girlfriend pregnant, and we married. Adam was born. I began to drink alcohol right from the start and was seeing a psychiatrist at 20. We divorced in our early 20s, and I tried several selling professions to make a career.

From left: Sebastion, Imagen, Mike and Adam

Sebastian and Imogen were born from a chaotic yet convenient relationship. I was pretty successful at Real Estate and owned my own agency for a while but went bankrupt in the late 20th Century.

Mike and Imogen

Imogen and Sebastian moved with their mother to Ireland, but Sebby didn’t like it, so I flew him home, and he lived with his drunken Dad for 15 years. Imogen and her mother came back to Australia. Imogen died of complications arising from her Down Syndrome in 2019. Seb now lives with his Mum and doesn’t answer my calls.

I now have a long-term partner, Heather. She is also a sober alcoholic. I received a small inheritance and restored a 1967 vintage caravan, in which I live. It is 2m × 4m. I pull it around Australia in a 20-year-old Subaru Forrester.

Q:  How do you describe the link between mental health and alcoholism? 

Alcoholism is a mental, physical, and spiritual disease. I have a mental obsession to drink to alleviate pain or suffering. The physical craving then steps in and I cannot stop when I want to. I do not know if I was bipolar as a child, but the highs for me are very high, and in our family, we drank to celebrate anything. My depression feels like it has always been there, and my father suffered badly too. He would take sick leave often and sit in front of the TV, shouting out for more cups of tea for hours. When he drank, he always got drunk. I not only saw this as role-modelling, but I was powerless to do otherwise. Alcohol relieved all my suffering until it began to cause suffering. I became a morning drinker in my thirties. 

Q:  What about when you got sober? What finally helped you get sober?
I have rarely worked in this century, but due to the Disability Support Pension the government gave me when I was 44 I have had an income. I was back living with my Mum and Dad in the coastal paradise apartment that I sold them. Dad’s lung cancer got worse, and he died. One year after that, I got sober.

I cared for my mother when I got sober in 2008 until she needed full-time High-care.

It took me 2.5 years of going to AA before I stayed sober for more than 50 days. I am now 15 years sober. The week that I finally got sober, I went to my first Buddhist Dharma class, and I combined Dharma and AA for my spiritual resurrection.

Being a solid part of both the Kadampa Buddhist community and AA has saved my life.

Q:  How did you find Buddhism? Can you describe what you felt when you discovered it? 

I became a reader of all matters Theological when I turned my back on religion the day after I got married (I was a grown-up now!) Eastern mysticism seemed attractive and the Beatles might have helped. When I was struggling with AA, and on the first anniversary of dad's death, I picked up a flyer for a Buddhist class that was on the next Thursday night. On Monday, I got valium for the DTs from the doctor, went to AA every day, and began to study Tibetan Buddhism in a newly formed group in my city of Gold Coast. I did a lot of service work for both organisations and felt a sense of purpose for something other than me and my family.

Q:  How do you support yourself now?

I write a weekly newsletter structured around a 12-month cycle of Dharma and AA work. My Dharmaholic business has just made a little income this week. I have plans to build a platform that combines the two guidelines provided by Buddhist philosophy and the framework of the 12-Step Workbook. There will be courses to complete and people to associate with that can bring relief from suffering and a genuine community.

Myself, I feel that approaching 60 without any money or security is scary. I have the opportunity to share the experiences that I have been blessed to have with others. The digital age has certainly provided that opportunity.

I feel some real responsibility to give back what was given me. The Kadampa Buddhist community is a worldwide organisation that helps spread Tibetan Buddhism in the West, and AA is a worldwide community that helps alcoholics achieve and maintain sanity without drinking.

Q:  If you could share one piece of wisdom about mental health and alcoholism to your younger self, what would you share? 
You're not that important. You are unique, valuable, and precious, but your life is not all about you. Our interdependence is what is real, and constantly trying to fix your own problems is a losing game. Help others and learn from the experience of giving compassion. The rewards in life come from giving of yourself, not from getting for yourself.

Q:  What do you wish people understood about you that they might not?
Being an introverted, bipolar man, I tend to enjoy the business of learning how to do “the business,” more than actually meeting and helping people. At least, that’s the story I tell myself.

I am a part of both houses—on my own terms, in my caravan.