The Nuthouse

Gather 'round, boys and girls, and listen to the story of Rachel's trip to the nuthouse. The loony bin. The insane asylum. Whatever derogatory name you prefer for "psychiatric inpatient." 

It was 2001: not a space odyssey. The previous year, I'd been diagnosed with Reflex Sympathetic Dystrophy (RSD, also known as Complex Regional Pain Syndrome Type I), first in one leg but rapidly spreading to both. It's a shitty disease. Really shitty. The pain - burning, crushing agony - never stops. The nerves get crossed, so normal sensations like a light touch can feel like a red-hot belt sander. I was still in Stage I of the disease, though rapidly on my way to Stage II, so fortunately it wasn't that bad. It was just miserable. The best parts are that the doctors gave me about a 5-10% chance of total remission (you're never "cured" of CRPS), it spreads in more than 90% of cases, and more than a third of patients eventually have symptoms throughout their whole body. So it was utterly hopeless.

I was depressed, naturally. In pain, can't do anything, dreams shattered, no hope, miserable side effects from the medications. But I went through the motions. I let myself be carried along by the currents because I didn't know what else to do. Some parts of the ride were even pleasant - the weekly spinal anesthetic injections I got in the OR felt sooo good. It was also, strangely, a respite from my bouts of intense emotional hurt and rage shortly before. In hindsight I was (hypo)manic for much of high school, and even younger (I first experienced psychosis in elementary school), but at the time I was just "impossible." (That description has a lot of meaning rolled into it that I don't feel like unpacking. I'll just say that if someone calls me "impossible," they will generally trigger either a flashback or an intense fight-or-flight - usually flight - response.) And now that I was depressed, that had settled down.

But my depression needed treatment, the doctors decided. To their credit, they first tried an antidepressant with proven efficacy for alleviating nerve pain. But that made me completely dissociated, so no go on that one. They tried a couple others with minimal effect. Then they tried Paxil.

Now, normally if a story involves putting a 18 year old on Paxil, it's not going to end well. When it's a 18 year old with undiagnosed bipolar disorder and miscoded 5-HT-2A receptors, it ends like this.

My energy started to come back. I was more alert. I also got even more grumpy than usual, but that didn't register until it was too late - I had reason to be grumpy after all. I was snippy and implacable. And I started to realize some things. I started to really grasp how hopeless and miserable things were. I started to realize there really was something I could do about it. I could force them to make me better. They didn't want me to die, but that was my ultimate way out. So I could force them to make me better or watch me die, and I'd win either way.

Now, this wasn't arrived at by any kind of rational thought process, or even coherent chain of thinking. It was more a subconscious emotional realization that came into the conscious when the time was right.

I wanted more Norco (hydrocodone). I'd taken the max dose, but I was in pain and I wanted more. I got very, very angry that mom wouldn't give me more. I don't remember things all too well, but at some point while screaming at her, I picked up a nearby pair of scissors and slashed at my arm with them. I think I was wrestled to the ground, but trying to cut my arm open with the scissors is the last thing I remember.

I don't know how I was transported to Stanford University Hospital, but I was taken there under a 5150 order: "danger to self." Basically, I was involuntarily committed by the State of California.

My memory picks up again inside the psych ward doors. I was assigned a room near the entrance on the lockdown side of the ward. At least one of my parents walked me in, I don't remember who, of if it was maybe both. All I could do was cry and scream. The more I did, the more they disregarded me. I gathered enough control to stop and be silent. They left me alone. This was what I needed.

They clearly weren't going to help me, they just wanted to keep me from escaping my misery. Well, if they weren't going to make things better, I still had a way out.

I pulled the pillowcase off my bed. Making sure they didn't see, I tied it to the doorknob. I tied a slipknot in it and slid my head through. Then I squatted, kicked my legs out, and dangled with my butt off the ground. Things were going dim, but they caught me. I know they got me down and restrained me. Next thing I know they're shoving a pill down my throat. Zyprexa, a powerful antipsychotic.

I passed out and awoke in a dissociated fugue, unable to move. The rage was gone, but all the hurt, both physical and mental, was still there. I couldn't cry. I could barely whisper. Lifting a hand was difficult. They administered my morning medications, plus more Zyprexa.

They dragged me down the hall (not literally - I was stumbling as they held me up) to bathe me. I don't really remember it. I had a visitor whom I won't name. They wanted to give me a massage to make me feel better. The orderlies helped lay me face down on a... something, I don't remember if it was a bed or a gurney or what... in a room with privacy.

It started with my back. I didn't like it. It felt like they were using soap, not lotion. They didn't go far down, though, only about halfway down my back. Then they started on my legs. That outright hurt. Remember the non-painful sensations feeling painful? This is someone who knew about that symptom and inflicted this on me anyway. It hurt. "No," I muttered as loud as I could manage, "stop." They didn't hear me, apparently. "Hurts," I tried again. More massaging my calves, tearing at my flesh. The massaging moved upward. Knees. Lower thighs. Upper thighs. It just hurt before, but this was starting to feel violating. Starting to brush up to my butt and around to the inside of my upper thigh. "No," I tried to scream, but only a mumble emerged. I reached up with all my might to stop them, but my arm barely moved. But they did stop - to shush me and push my arm back down before resuming. I tried to crane my head to make them hear me. "Please, no." More shushing. "It's okay." My neck lost strength and my head fell back down. I quietly whimpered as they massaged my butt and inner thigh.

I passed out from the emotional exhaustion. I woke up in my room and dragged myself to a corner where no one could be behind me. I curled into the fetal position and let my head droop back and forth, sometimes hitting the wall. It wasn't forceful - I couldn't have managed force even if I wanted to.

I was already on a drug called Neurontin for my nerve pain. It dulled the pain, sure. It also dulled my mind, made me lethargic, slowed my metabolism, ballooned my weight, made speaking difficult (I couldn't word good), and wreaked havoc on my ability to form new memories. I was on 1500 mg three times a day when I entered the psych ward. Since it allegedly worked as a mood stabilizer (funny story, it totally doesn't based on all the best research), they increased that, first to 1800 then to 2000 for a total of 6000 mg/day. My pharmacologist would later call this borderline malpractice - it loses efficacy at such high doses and basically all you're doing is adding to side effects. Which may have been the purpose. It helped the Zyprexa with incapacitating me.

There was actually a plausibly legitimate reason for this. They needed to keep me from hurting myself while the Paxil left my system and I stabilized, and incapacitating me was a good way to do that. But it was miserable and it made me easy prey, as you saw.

I didn't really eat those first few days. I had to pick at it a little while they watched - had to be a good little psycho. But I didn't want to. I may have been too out of it for much of the pain to register anymore, but I still wanted nothing more than to die.

The 72 hours on my 5150 order expired and it was renewed with a 5250 order, a 2 week extension.

What finally drew me out of the room was the need for human contact, any human contact. I shambled out there, still weighed down by the Neurontin and Zyprexa (though building some tolerance at least), and I think talked to one of the nurses. It kind of went from there. The nurses were all very nice and respectful, even to a psychotic 18 year old, and I thank them for that.

Social contact got me in a different mode. It distracted me from my misery and made me forget I wanted to kill myself. But only while I was talking. Back in my room, in my thoughts, I still wanted to die. Still, I could be good and behave. It was the only way to get transferred to the normal ward, where they promised me better painkillers and a lidocaine IV.

So I behaved. And so I was rewarded a few days later. They took me out of lockdown and gave me a new, much nicer room in the nicer, bigger non-lockdown side of the ward. They also almost immediately gave me the IV anesthetic, as promised.

The people on the locked ward were all recluses in really bad places, so I didn't really interact with any of them. The unlocked ward had a crazy cast of characters. Old, young, middle-aged; mental illness, dysmorphia, addiction. Addiction was a pretty common thing for people to be there for. 

There was one girl there who still haunts me. She was so anorexic - like horrifying anorexic, Auschwitz-anorexic - she was in a wheelchair with a feeding tube up her nose. She was too weak to speak above a whisper. I'm not sure why, but seeing her like that really got to me. She made me feel sad, and not the kind of sad I was already feeling.

There was a lounge on the ward and access to movies. I distinctly remember watching True Romance with some roadie in there for rehab.

There were the silly arts and crafts activities. I got nothing out of them, naturally. No, less than nothing. They just gave me anxiety about how awful it would be if I drew/whatever anything and vicarious embarrassment when people would explain what they made.

At some point I think they might have told my parents I was bipolar. I don't really remember. They seemed to figure the Neurontin was plenty and there was no need to pursue other treatment. Just keep me off SSRIs, that's all.

I slowly picked back up to "normal" and even a little happy - other people's happiness, and their obvious hopes for me, was infectious.

After another 5250 and close to 3 weeks total involuntarily committed, I was released from the ward into my (IIRC) mother's custody. I did kind of miss it at first - there was no lidocaine IV at home.

Postscript: Being in the psych ward was one of the worst experiences of my life. It's also something I'm glad happened, considering the alternative is that I'd be fucking dead. People can be shitty, doctors can be dumb, others take advantage, but at least I'm still here.