Category: The Biomedical Alternative

Life on the Psych Ward

Several friends have wondered aloud what it’s like on the psych ward. In particular, they’ve wondered what my fellow patients are like. Is it, e.g., like the movies in combining the constantly wailing with the mental zombies? Well, no. I thought I’d describe some of my co-patients in rough outline to address the curious.

There’s an elderly gentleman who suffered black outs after a few strokes and was latterly charged by police with assault. He can’t recall the incident at all. He can have a short temper, to be sure, but other than that he seems “normal”. Good company, in fact.

There’s a grandmother who, for the first time in her sixties, found herself with dark suicidal thoughts. What a thing, to confront mental illness for the first time at her age! She was released today. I hope she keeps in touch.

There’s a young man on the autism spectrum who is mostly non-verbal but for occasional angry outbursts. I think everyone is at least slightly frightened by him because a) he’s massive, at roughly 300 lbs and b) he seems utterly unpredictable. An instance: he walked by one lunch time and just grabbed my plate. He quickly ate all the macaroni and cheese thereon and then jauntily returned the plate to me as if nothing untoward had occurred. Another day, he started yelling at me in the lounge, repeating (as best I could tell) “No sister! No sister!” He then threw his drink on the ground when the nurses came in to see what the ruckus was about. I just retreated to my room. Him I won’t miss.

There are several people with dementia who walk the halls and forget which is their room. They all seem gentle enough, thankfully. One of them is only about my age, decked out in a Tragically Hip T-shirt and London Knights cap. So far as I can tell, these patients don’t receive any treatment while here.

There’s a young man who is paranoid and thinks that I was sent here to watch him. He laughs knowingly whenever I say “Hello”. He’ll tell me: “I know who sent you”. Also paranoid is a die-hard Leafs fan, 50 years old (as he’ll tell anyone who listens), who seems to be developmentally delayed. Tragically, he has tangled with a couple of the dementia patients, thinking they are after him when they stick their heads in his room. He very loudly threatens to call the police on them.

There’s a retired schoolteacher, a quiet soul, who doesn’t seem to have anything much wrong with her, though the staff are trying to convince her to have electroconvulsive therapy. Maybe she’s quietly suicidal? We’ve had nice conversations about the whys and wherefores of ECT.

There is a thirty something mom who needs to dry out before going to rehab. Her young kids have visited, frightened by we strange folks wandering the hall. I like her very much and hope she conquers the cravings for alcohol.

There’s an Eastern European woman who for whatever reason calls everyone ‘Mi amor’ in Spanish and sings “Guantanamera” in the hallway for hours on end. She contends that her daughter-in-law had her committed solely to seize her assets and has repeatedly asked me to serve as her legal representative. Explaining that I’m a professor not a lawyer carried little weight.

There’s a very talented trans man who plays the piano and sings lively Christian songs. I think he is kicking a drug habit. He’s a Facebook friend now.

In short, my co-patients run the gamut from the barely independent to the (seeming) entirely neurotypical.  Young and old. Black, white and indigenous. Queer and straight. I wonder how they would characterize me if they were blogging?

Arriving at Homewood

I was admitted two days ago to Homewood psychiatric hospital in Guelph, Ontario. It’s a private mental hospital with about 300 patients, especially renowned for helping with addictions and eating disorders. (See here for more: https://homewoodhealthcentre.com/.) My admission is initially for a couple of weeks, to the Assessment and Stabilization Unit. Potentially after that, I’ll be moved to a unit that specializes in anxiety and depression and in the use of Cognitive Behavioral Therapy (CBT) techniques.

Here are some reflections on my first two days.

I arrived Thursday morning and mostly slept. I felt very scared about being dropped off by Anita; very afraid of being away from her for weeks at a time in an unfamiliar place. When I awoke around 2 pm, I was welcomed by several peers on the wing. They gave me a tour of the facility. I attended our daily check in, where every patient describes a positive event of the day and one of the skills that they used. (My positive event was meeting the new people and my skill was Opposite Action, specifically, attending the session rather than staying in bed, which is what I felt so strongly inclined to do.)

Then we went for dinner together in the shared cafeteria. We played cards – they taught me a variation on gin rummy. My meds were distributed by a kindly, friendly nurse; but from behind a screen, just like in a movie. I went to bed around 9 pm, which is normal for me these days, and slept really well: the nurses stop into our bedrooms every two hours, apparently, to make sure we patients are safe; but I didn’t hear them or see their famous flashlights, I was so thoroughly out.

Friday morning at 9 am was music therapy. We learned to do some circle drumming, we improvised a song together under the guidance of the very gifted therapist, and we ended by harmonizing Beatles songs. It was lovely and soothing and started the day off well. The afternoon included two Dialectical Behavioral Therapy group sessions, one on Distress Tolerance and one on Behavior Chain Analysis, topped off by that afternoon’s daily check in.

Dinner in the group again; cards again; pills handed through a screen again; sleep at 9 again.

My first impressions is that there is too much free time and that the DBT that I’m encountering is both once-over-easy stuff and, furthermore, material I’ve seen before, whether with Dr. D or during Group Sessions at Toronto Western Hospital via Zoom. But I’m trying not to judge too soon, trying to remain optimistic that this famous place can help with my anxiety and depression.

ECT Update at the Half-way Point

Being about halfway through the treatment protocol – I just had the 12th “zap” today – I thought I’d provide an update on how the electroconvulsive therapy was going.

The outlook is mostly positive. I think the treatments are really helping.

Some progress I’d highlight. 1) I still get passive suicidal ideations, thoughts of the form “I can’t manage this, I’d be better off dead, I wish I just wouldn’t wake up”. But I’m getting fewer suicidal ideations, and I never have concrete plans for self-harm these days. 2) There’s some improvement with respect to anhedonia. My appetite has improved and I have some limited interest in TV shows and novels. (I read a few chapters last week.) I’m doing lots of physical exercise, including getting out on my bike on my own and with friends. I’m getting to be social again, making chit chat with strangers. There has even been an occasional quirky joke. Also on the “F-you anhedonia”-front, I am making travel plans for the Summer and feeling excited about them. (I am going on two fishing trips: to northern Ontario with my dear “hermano” Gustavo on June 7th for 10 days, and then to the Yukon with my dear “jefe” Jay on June 25th.) 3) My sleep, buttressed by Trazadone, has been much, much better. And most markedly, 4) my episodes of grief and sadness are mostly neurotypical now: i.e., appropriate to the situation and even largely in an appropriate degree. Yesterday, for example, I was able to recount the story of my first wife’s cancer in a matter-of-fact way without breaking down. I did get very sad describing how little I am supporting Anita these days, but that’s a sad situation (and one I hope will be remedied soon).

On the other hand, I’d flag three remaining and interrelated obstacles:
1) I need to continue working on anhedonia. I’m very far from back to normal. 2) I need to overcome the fear, fear, fear! That’s the most important thing. People always ask what I’m afraid of. Fair question. Well, I’m afraid of the unknown, especially related to what life will be like as I and others age physically and mentally. But truly and mostly, I’m not afraid of anything — I’m just fearful. What I feel is hypervigilance for something unknown that is going to go badly wrong. I liken it to walking down a dark, silent, abandoned alley, expecting someone or something to jump out at you. I try not to give in. In particular, I force myself to get out of bed and to do what have somehow become unfamiliar and daunting activities (ride my bike, BBQ). My fierce determination notwithstanding, the terror is keeping me from many previously normal activities. I suffered a panic attack during a play at our local theatre and had to go home after half an hour. I suffered another during a guided bird walk – despite birdwatching not being an obviously fearful activity (!), there were “unknowns” that popped into my head half-way through, and I never recovered my calm, despite using all my DBT techniques. Sometimes (yesterday, for instance) an entire day is spent frightened. 3) As a result, I can’t concentrate, don’t have enough motivation/energy, and lack all confidence in my abilities. I thus can’t engage with academic texts and projects and wouldn’t be able to teach yet either. (My July-August class has been cancelled because I may not improve enough on these fronts by then.)

It’s worth noting too that the progress is visible on treatment days and then levels off as the weekend progresses. So, as I say, yesterday was a very fearful day; this morning and afternoon, following my treatment, I am feeling quite positive. The outlook is positive there too, however, in that the “positive” period between treatments is lasting longer.

I am getting Electroconvulsive Therapy (ECT)

I am being scheduled for ECT at the end of March or thereabouts. I am terrified but a little hopeful.

It might help friends, family and other readers to understand my choice to undertake ECT if I share my PROs and CONs list.

The CONs are very serious.

I’ll need to take six or seven weeks of sick leave from work. That’s because there will be about 20 treatments in total, three times a week; and then I’ll need about two weeks to recover from the whole series. There will also be a major disruption to our family life and to Anita’s work. The procedure has minor side effects like nausea and headaches. It has the major side effect of short-term memory loss during the entire length of the treatment regime. I likely won’t remember in the afternoon conversations that I had in the morning, that kind of thing. I might forget whole days. And ECT carries more serious risks such heart attack from the electric shock, broken bones or teeth if the anti-seizure drugs don’t entirely work and I go into major convulsions, and possibly death from the anesthetic. Also, occasionally patients have long term memory loss – if that happened, it would end my career. Speaking of anesthetic, I will be given an intravenous general every time. This for a person who has a phobia about needles: I’m genuinely as afraid of that as I am of the electric shocks.

Adding to the CONs, the specialist estimated only a 40-50% chance of a “clinically significant reduction in my symptoms”. This is a far cry from the 80% probability of remission that I had been led to expect from informal research. And the improvement, if it occurs, may be temporary.

The PROs are almost all “mights”. A significant improvement in my symptoms might get me back to working fully; able to travel; and interested again in things like food, novels, movies, etc. It might allow me to get off some of my medications, which in turn might take away various nasty side effects. As an example, my left hand sometimes shakes badly, to the point that I can only type with my right hand. I think the tremors are due to one of my meds. It might at the very least halt the continuing decline in my mental health. (Many times I’ve thought: “This can’t possibly get worse. What would worse be like?” Then it got worse, e.g., when agoraphobia struck.)

Maybe the most daunting CON of all is the potential for a total loss of hope going forward: ECT is basically my last resort, so that if it fails, I’m out of options. I have pretty much exhausted the possibilities for medications. I’ve been on 20 or so over the years. I’ve done lots of therapy, including Dialectical Behavioral Therapy, which has been the main topic of this blog. Yet my Bipolar continues to worsen. Being out of additional treatment options would be horrendous. I don’t see how I can continue in my career if I don’t improve. Nor go on fishing trips, nor function as a husband and father, nor…

Maybe the biggest PRO is that, if I do the procedure, I won’t wonder “What if?”

In short, the choice is between uncertainty and fear on the one hand and hope for the return of my most valued activities on the other. Scared as I am – and I have been literally shaking with fright today – I am choosing hope.

A shortage of multidisciplinary practitioners

Here in London, and in Ontario more generally, there is a severe shortage of clinicians who are willing and able to both track patients’ medications and provide psychotherapy.

This is not an accident. It’s part of our biopsychological machine: it’s built right into Ontario’s funding formula and the emphasis on meds.

The easily predictable shortage matters to us all. But it’s especially pressing for people like me, because my mental health troubles were over-determined.

My Bipolar Disorder is grounded in a genetic predisposition. There are good reasons to believe that there was something atypical about my brain from the get-go. There’s family history. And there were early signs such as an attempted suicide as a pre-teen, along with what I now recognize to have been hypomanic periods in my final years at high school

I also lost my beloved first wife Hamila to cancer in my late 20s after a five-year illness – three surgeries, repeated chemo and radiation therapy, and the slow breakdown of her extraordinary mind and beautiful body. In addition, I suffered pretty severe childhood trauma. (I don’t blog much about that, out of respect for the privacy of others. But one episode illustrates the interplay of the twin factors. When I made an inept attempt to hang myself as a boy, my father found me – and beat me for not appreciating how economically fortunate I was.)

Either factor likely would have required remediation. In the event, their intersection led to my first serious breakdown at 28, about six months after Hamila died. I was unable to care for myself, or even to speak. I just spent hours rocking on the floor in my Boston apartment, in a near catatonic state. (My (mis)adventures with medications began about then.)

Here’s the impact specifically on me of the shortage, looking forward. As this blog attests, talk therapy in the form of DBT has really helped, and it can help still more. However, my condition is almost certain to be chronic and permanent. I’ll likely never be fully functional without powerful medications or brain stimulation. I’ll die taking them. So, I – and folks like me – desperately require multidisciplinary practitioners.

That’s just what our system discourages.

[Correction: I fear that what I wrote suggests both that all practitioners should be multidisciplinary and that all should devote hour-long sessions to their patients. That suggestion would be wrong and unfair. Specialists are very important. And many mental health professional make the hard choice, based on ethical deliberations, that it’s better for them to take on more patients, given the severe shortage of psychiatrists.]

Postscript: My latest homework from Dr. D – to whom I’m very grateful, by the way, for choosing to treat patients at great cost to herself – is to try to disentangle the effects of my early/adult life traumas vs. the effects of my peculiar brain chemistry and circuitry. The aim, in part, is to help tease out the bits of mental illness (tracing from either or both) which I need to “radically accept”. As you can imagine based on the above, it’s going to be a tough nut because of how tightly they interweave. Tips welcome.

life before dbt: the psychiatric machine

As background to why DBT has been such a positive change, I thought I’d share my truly awful experiences with the “psychiatric machine” here in London, Ontario.

I’ve been taken to hospital twice. Both visits were soul crushing. I’ll describe the second episode in a later post. Here’s the chronology of the first.

It was September of 2018, and I was alone at home. I suffered an extremely severe depressive episode. After calls with Anita and visits from caring and concerned friends, ultimately, I was taken to Victoria hospital in a police cruiser. The time was about 4 p.m.

After two hours in the emergency waiting room, the kindly officer still standing by, I was finally seen by a triage physician. There being no cubicles available, I had to explain my diagnoses, my suicidal thoughts, the historical causes of my depression – childhood trauma, the death of my first wife, and other intimate details – in sobs, in the hospital hallway. Dozens of strangers stared and eavesdropped. He decided the case was serious enough to have me examined by someone more senior. The police officer was dismissed, and I was told to wait.

Two hours later, his superior came to interview me. He had no notes from the prior doctor. So, once again, sitting on a gurney in full view, breaking down, I retold the whole thing. It was an agony of shame and grief. Redux. This doctor concluded I was a danger to myself, “committed me” in effect, and put in a call for a psychiatrist. By now it was about 8:30 in the evening.

Eventually, a bed was found. I can’t recall how, but I had a bottle of zopiclone with me. I took the half dozen or so remaining pills, indifferent to overdose. I finally feel asleep.

At 4 a.m. I was awakened by the resident psychiatrist. You can imagine what happened: he had been given no notes on my case. So, for a third time, I described the reasons behind my breakdown. Sobbing again. Shame again. Agonizing memories again.

Here was his response. He explained that there was no way to admit me, there being no beds on the ward. I could, he said, remain in Emerg for three days, under the order signed by the prior doctor. However, he told me frankly that the nurses wanted me out. His own suggestion was that I go home, have a warm bath, and be sure to take vitamin D regularly. However, the decision was mine. What did I want to do?

At 4:30 a.m. he signed a discharge. He promised that I would receive a follow up call the next day from a mental health crisis nurse. I walked out of Emergency entirely alone. I called an Uber on my own cell and went home to an empty house.

I’m lucky. My niece came that same day to look after me. Anita and Saima flew home. Friends checked in. Many other patients get sent home with no support at all. All too frequently, they take their own lives.

Such is “biomedical” psychiatry in London.

[P.S. The nurse didn’t call.]