Recently, I was trying to describe my experience to somebody by comparing it to the way sheep and cattle are herded. Unfortunately, I didn’t have very specific words for the process, so I was just like, “You know, the livestock is walking down this chicken-wire corridor and there are gates, but the farmer can just close more and more gates and at some point, the number of options for where the animals can go dwindles down to exactly one. So there would have been various choices if the gates were open, but sometimes only one gate is open and the sheepdog is forcing them to walk, so the livestock get absolutely NO say in where they want to go.” I wasn’t able to describe it very well, but I did find some YouTube videos. (I would suggest clicking the gear to increase the playback speed if you don’t plan on actually becoming a rancher and you just want the general idea.)
Story Time
So. I have been working with Dr V the psychiatrist since 2020. For the most part he’s fine, although I do have a rather lengthy list of concerns that it’s extremely unlikely we will ever be able to discuss due to time limitations, since an appointment is strictly 30 minutes and we’re supposed to just talk about meds during that time. One of the concerns that I do have is that before Dr X did the 14-month intervention (April 2021 to June 2022), my life was chronically at risk and I was just supposed to accept this. I was absolutely forbidden to go to the emergency room no matter how suicidal I was, because I had gone too many times. He even endorsed my having a VNA, presumably due to liability concerns, although the service increased SI on my end and the message I was getting was that I was on hospice care. Everyone expected me to do myself in, and their main concern was not being liable when it happened. If I ever did go to the emergency room (which I did), I would have hell to pay afterwards because I was supposed to have given up on saving my life- everyone else certainly had.
So, this is chronically in the background with my interactions with Dr V. Meanwhile, the Department of Mental Health has me on their list, and they subcontract to a company that we’ll call “VF.” So, I get services from them. The team lead is a woman who I used to feel connected to. She really seemed to “get” trauma and she knew what to say. Then she went out on maternity leave. I honestly didn’t expect her to come back, but she did, and I was pleasantly surprised. However, she’s been very different since then. For example, VF has an on-call service, which is staffed by clinicians who are known to me. This used to be a tool to help me stay out of the hospital. In late July of last year, VF communicated to everybody receiving services that we were to just use the on-call in the event of an emergency. I emailed the team lead and asked if I had been using the service incorrectly, and the email she sent back simply said, “I asked the team to talk to folks about the purpose of on call, so yes it was a general announcement. The message isn’t to not call on call too much, but rather for everyone to know and be reminded that the on call is for urgent matters.”
I interpreted this as meaning that I hadn’t done anything incorrectly. I usually go to the ends of the earth trying to avoid having to call these sorts of numbers, so I didn’t try to call the on-call after that until November. At that time, the clinician didn’t return my calls for a couple of days, because she felt from my voicemails that it wasn’t a true emergency and she didn’t want to get in trouble. When she did call back, it was just to very quickly say that she wasn’t allowed to talk to me unless I needed transport to the emergency room. To me, this was devastating. I had been going through life feeling safe because I felt like there was an on-call that I could use if I needed it. I contacted the team lead on the next business day, and after a while playing phone tag, she insisted that the on-call had always been for just only if I needed transport to the hospital, and if it had ever been used for anything else, the clinicians had been using it incorrectly. My thing was that even if the clinicians had been using it incorrectly, I should have been informed of that. Because what ended up happening was that I had no idea that the on-call had abruptly switched from being a tool to keep me out of the hospital, to being a service where I could leave a courtesy voicemail that I was calling 911. I pointed out that I had even asked if I was using the on-call correctly, and she insisted that she hadn’t specifically said that I wasn’t using it wrong. To me, using vague language to dodge the question seems unfair, especially since it was a service designed for when I was in crisis, which is not a good time to be finding out about policy changes. She continued to insist that there had been no change, continuing to throw the clinicians on the team under the bus, and totally ignoring the fact that I wasn’t present in whatever meeting when she told the clinicians she was cracking down on what was apparently misuse of the on-call. This was followed by, basically:
- “I’m only human and I can’t be all things to all people”
- “Let me explain to you the correct use of the on-call”
- Dead silence
I tried to tell her that I was pretty sure I understood the new use of the on-call, and in fact I had deleted it from my phone because it was unlikely that there would be a scenario in which I was able to wait two days for a call back about how to arrange for transport to the emergency room; and besides, I’m intellectually capable of calling an Uber unassisted. And I didn’t need her to be perfect, I just needed her to understand that I felt abandoned in a time of crisis, and I wanted some assurance that she would try to communicate more directly in the future. Over the summer, there had been a similar incident when I had asked whether XYZ was true, and the reply had been super vague, and then it turned out that XYZ was not true and I was supposed to have figured that out due to the fact that she had not specifically said that XYZ was true. I explained that the therapeutic alliance had been damaged, in hopes of being able to repair the rupture. At that point, the team lead went totally silent for probably 30 seconds, after which she indignantly asked if there was anything else I wanted to say, and when I said there wasn’t, she ended the call. I was really emotionally affected because I felt like I couldn’t trust her anymore, when previously I did trust her very much.
In the end, I was instructed to call the “mobile crisis” unit if there was any sort of crisis, and not to worry because eventually I would become familiar with the people on the crisis team. I don’t think VF realized how pessimistic that sounded. The team lead had closed a gate; the on-call was no longer available in any capacity that could be useful to me. They weren’t forcing me to call the crisis team; they were just taking away an alternative. Pretty much, my remaining options were the mobile crisis unit, the emergency room, or just toughing it out by myself.
Back to the Present
So, the holidays are tough and starting a new job is also tough, and doing both at the same time sent me over the edge. I was getting the command voices to unalive myself, which are definitely not present at baseline and are outrageously difficult to withstand emotionally. I don’t understand what’s going on… are the commands my internalization of my dad (who definitely was very abusive and did sometimes tell me to “drop dead” when I was a small child)? Are they just me trying to convince myself that I wouldn’t have these thoughts, and looking for somewhere to offload them? All I can say, is I used to get them all the time before Dr X’s intervention, and I tried everything. I’ve tried standing up to them, telling them off. I’ve tried being the “good cop” and thanking them for trying, in their own way, to help me. I’ve tried ignoring them. I’m pretty sure it was Marsha Linehan (but do NOT quote me, I do not need Marsha on my case) who suggested somewhere to just replay the same thing the voices were saying, except in a silly cartoon-y voice. A therapist once asked, “But is it really so hurtful if Daffy Duck says it?” Which, unfortunately, yes, it is every bit as hurtful if Daffy Ducks says it. I tell you all this here to explain that I 100% have explored every option I could find, and after years of experience, the one and only thing that seems to help this particular problem is antipsychotic medication.
Anyway, I was going through it. That was the series of events in my rear-view mirror when I signed on to my telehealth session with my new therapist, AY. I was all stressed out and had no idea if the situation was a clinical emergency, but the issue had been going on for several days and wasn’t letting up. I asked AY her thoughts on what I should do. This was where there was a lapse in communication, because one moment I was wondering if I should call my med doctor and ask for an adjustment, and in the next moment it registered in my brain that AY was in the process of double-checking my address and calling 911. I did not want that to happen because the psych section of the regional hospital near where I live sucks, and I wanted to take the train to the big city and go to the better hospital there. AY was not open to this but I managed to quickly smooth-talk my way into getting her to let me take an Uber. She needed to stay on the call until the Uber arrived, then I sent her a selfie of me in the Uber, then she needed to know when I was checked in in the emergency room… etc.
So, that was what happened. In the end, the hospital decided I was fine because:
- The voices were bothersome, and I didn’t have intent to follow through with their commands
- “It sounds like you just had a new therapist who doesn’t know you well yet.”
So, the next day, I was back in my house and still miserable. I had an appointment with Dr V, and one of the reasons I had kind of downplayed my issues in the emergency room was to keep him from freaking out on me. Usually Dr V doesn’t usually exude warm and fuzzies, but honestly I was really hoping the appointment would go well. I was hoping he would give me credit for seeking treatment as an outpatient, and hopefully empathize with how much the situation sucked and apply a little bit of validation followed by a pharmaceutical remedy.
Well, the telehealth appointment was scheduled to start at 3:30, and V hopped on at about 3:35. Usually this would not matter at all, but in this case it did. Because when the call started, he very quickly implemented a med adjustment that would have been extremely reasonable and tbh probably would have solved the problem. However, far from being empathetic or validating, he was severely disappointed that I had gone to the ER. Now, I have a huge list of personal reasons why I didn’t want to go to the ER, which I plan to devote a separate entry to. My impression was that Dr V did not acknowledge this at all, and absolutely did not comprehend on any level that AY was mere seconds away from dialing 911 when I told her about the command voices. He felt that I had just wimped out basically and the therapist didn’t section me (which I guess technically is true?) and I just went to the ER of my own volition with flagrant disregard for the fact that I wasn’t supposed to.
The situation at that point potentially could have been salvaged. However, Dr V had apparently arranged (without consulting me) for another party to join the zoom call at 3:45. (So, for those keeping score, we got 10 minutes rather than 30 when I was at above-average need for psychiatric help.) Well, guess who he decided to bring on board but literally the exact same lady who was the team lead who had taken away the on-call which probably would have prevented the crisis in the first place, because her objective was to force me to have to call the crisis unit and go to their “alternative” facility which exists in order to divert people from inpatient settings. Apparently you sleep there and it’s like the hospital but not. She had offered to bring me in for a tour, but the thing that nobody seems to understand except me is that I’m trying to be mentally stable and thus not overly familiarized with every resource that exists for chronic basket cases.
I kid you not, Dr V and the VF team lead spent the remaining 15 minutes having a conversation, the objective of which the explicitly laid out as “how to avoid a repeat of yesterday.” Now, probably I would have been allowed to reject having the team lead on the call, but they clearly had arranged their schedules and I didn’t want to be a bitch. They were definitely interested in professional dialogue with each other, though. There is a certain type of professional “communication,” often seen in job interviews, where people say things that sound overwhelmingly professional, but if you break it down, the person isn’t actually saying anything. Given that I do not have a degree in healthcare, it felt like the conversation was needlessly inaccessible to me. For example, at some point they figured out that their organizations had different “EMR” systems. Now, it’s not like either of them was going to tell me what EMR meant. Fortunately I’m smart so I eventually figured out that it was “Electronic Medical Record,” but by then the conversation had gone on without me. Instead of just meeting with my doctor and talking about what was going on with me, I was witnessing a conversation and being excluded from participating. Which, if they’d been open to me jumping in, it might have cleared a few things up. For example, apparently when they realized that they didn’t have the same EMR, they both concluded that they must not have the same version of my “safety plan.” This was entirely fake news because every time I’ve ever updated the “safety plan,” I send it to everybody. So I would have sent it to my psychiatrist/med-prescriber over his organization’s file-share service, and I would have emailed the exact same document to everyone at VF. However, they were just boucing catastrophizations off of each other with absolutely no regard for the issues that I thought were an emergency.
Because. As much as everything in my entire soul wanted to avoid the emergency room, as much as I feared an inpatient stay would impede my long-term goals… it was, like the on-call, a thing in my back pocket that I told myself I could pull out if I needed it. There is a particular hospital (“ML”) that has staff who I’ve known literally for years- something that isn’t even really true in my regular life. I isolate from friends when I’m in crisis because I feel like it’s just a lot for them, so most of my relationships are superficial. I’ve also spent, like, a lot of calendar days in psych hospitals, and the people at ML are people who I’ve worked extremely closely with for an extremely long time. In fact, ML staff seems to have an informal back-and-forth with the hospital where Dr X did the intervention, so ML is my one and only connection to a world that I lived in for over a year. Sure, if I imagine myself being in and out of crisis for the rest of my life, perhaps these kinds of therapeutic alliances could be made with the people at VF’s stupid crisis unit. Again, I don’t want to take the time here to explain the reasons I try to avoid inpatient stays, including ML, but you’re going to have to trust me that I am deeply intrinsically motivated to stay out of the hospital and I’m for sure doing everything in my power to develop strong bonds outside of clinical settings. However, if the hospital is going to be my last resort, I at least want my last resort to be a place where I feel held and safe, not a “crisis unit” defined by loss of control. Dr V and the team lead had tried to close another gate, and they probably did so with the best of intentions. I think they genuinely felt that if I went to the crisis facility (they’re apparently both a hotline and a physical facility), I would believe that it was my choice and that it was a good choice and I was glad I had made it. The team lead paid a ton of lip service to how this was totally my decision, and I simply hadn’t “chosen” to go to the crisis unit yet. Never mind that she had personally closed every door except:
- “Crisis unit”
- White-knuckle things at home
It just feels incredibly insulting that she thinks I haven’t noticed that I really am not being given much of a say in this, and she thinks she knows what’s best for me without actually listening to any of the reasons why I make the decisions that I do. It’s not like it just hasn’t occured to me to do anything else.
Anyway, anybody with an average-to-above grasp on psychology can probably guess what went down from there. I was terrified, I still didn’t want to be in the hospital, it was getting harder and harder to stand up to command voices without risk of doing what they were suggesting, and my outpatient providers had obviously failed abysmally. So, I went back to the emergency room where I wasn’t supposed to go, and paid the price in terms of effects on my life. The nurses and MHS’s were mostly the same people who I knew and appreciated, but the doctor they gave me was this lady who definitely took a domineering approach. I’d never had this woman as my doctor before, but VF and Dr V had apparently contacted her to let her know that I wasn’t supposed to go to the hospital with an actual trauma unit anymore, and I had to go to their inpatient-diversion facility for people who cost too much money for the healthcare system. So, the doctor just decided to strongarm me, gave me no say in when I left (I probably would have left at the same time anyway, but I still wished I’d had a say) and from my perspective, made the admission as unhelpful as possible in order to discourage me from ever coming back or disobediently refusing to go to to VF’s stupid “crisis unit.” Honest to god, all I need is to feel like people are listening, people believe me, people respect my judgment, and I’m able to make genuine decisions rather than being given an extremely limited number of choices that are palateable to the powers that be. And, even if I’m doing my darndest to make it out here, I just want to feel like there is a place where I could feel safe and held. I understand that 90% of people who read this are going to think that that means I’m fine with being a frequent flyer and I don’t put in due dilligence trying to never come back. Those are people who don’t listen and don’t matter.
So, I’m out of the hospital, and thankfully my boss gave me my job back even though I was out for a week during the probationary period. Feeling like I have nowhere I could turn if there were an emergency is a huge trigger for me, but I’m trying to make it work for the sake of my LifeWorthLiving™ goals. I managed to get through the admission without any of my social supports finding out I was in the mental hospital, with the exception of this one wonderful woman who brought me my CPAP and some supplies. Other than that, social supports don’t know I was away, work fortunately thinks I was out for “medical,” and the situation with most of my clinicians is the all-too-familiar rupture with no chance for repair. All I really have is a couple clinicians who I still trust, my turtle and cat, my new job, and hopes/dreams for the future. I will say, I recognize cognitively that whenever I discharge from the hospital and it feels like it was not helpful, is when I have the greatest risk of returning, which would just further damage my LifeWorthLiving™, which scares me. The thing that would be most helpful to me in avoiding that, would paradoxically be providers who would respect my judgment if I ever were to go back to the emergency room.
So, anyway, I just needed that off my chest. I have two more entries brewing for my lucky readers: one about reasons I didn’t want to go inpatient and fears now that I did go inpatient as to how that could affect me down the road; and another you-can-either-laugh-or-cry sort of thing where I find dark humor in events that most people would consider to be really awful. Wish me luck!
