What to know about proper care during a mental health crisis

My days were punctuated by benzodiazepine dosages, one in the morning and one at night,…

What to know about proper care during a mental health crisis

My days were punctuated by benzodiazepine dosages, one in the morning and one at night, that imparted stability for maybe a half-hour or so until I got frantic again. My psychiatrist was doing her best, prescribing everything from Trazodone to gabapentin for sleep, but she could only do so much, short of jumping inside my brain to rewire it.

Meanwhile, I was having trouble finding a therapist, like just about everyone these days. The kind, grandfatherly man at Harvard was about to retire; the wacky woman I’d found in Psychology Today thought I could try crystals. I’d finally connected with someone compatible but costly, but we’d only met maybe once or twice. Meanwhile, I was trying to keep it all hidden from my two young kids (not easy) while working (because, you know, psychiatrist and therapy appointments are expensive and not usually covered by insurance).

Anyhow, the woman on the other end of the hotline was perfectly nice, but the conversation felt lonesomely scripted. We concluded that I should proceed to the nearest ER. I absolutely know that these hotlines have their place. They save lives. But this particular exchange only made me feel worse: She could triage me, hang up, and go about her day. What I wanted more than anything was to take someone inside my own head and pull me through. But that’s not how this works.

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So after Andy and Peter left for school — just a normal day, dudes! — my husband, Brian, and I headed to the emergency room. Showing up at an ER with a mental health complaint sets in motion a series of tests and brushes with authority that, while necessary, are incredibly unnerving to someone who feels guilt over old parking tickets. I was drug-tested and placed in a room to wait. My third-grader was probably at recess; my preschooler was likely munching apple slices. I, meanwhile, was staring at a dry erase board, trying to close a paper gown over my mottled rash, wondering who would help me. I started crying: shuddering, primal, guttural sobs, as if I could dislodge the pain through shrieking. I couldn’t.

Finally, a social worker — who looked incredibly tentative and so, so young — entered with a clipboard. Part of me wanted to do the instinctual thing: Make friends, chat as if I were complaining about a yeast infection. Any fun plans this weekend? The other part of me wanted to convey that this was truly serious and if I didn’t get some kind of help, right here and right now, I was going to crawl out of my skin. Did this person have the power to transform my personality?

I had two options: There was a bed for me on the psychiatric floor of another hospital, where I’d be on a locked unit. There was also room for me at an adult day therapy center, which involved a regular, weeks-long commitment. The thought of checking myself into a hospital, away from my kids (and my weighted blanket! and my laptop!) seemed terrifying. The adult therapy option was more reasonable, except for practical considerations such as the fact that I worked and was also on so many tranquilizers that I couldn’t drive.

I felt so choiceless. I had a successful career, healthy kids, a husband who was doing his best trying to hold it all together when lesser people probably would’ve walked. I was lucky — and bleakly, horrifically trapped.

My therapist explained it to me later: When a mental health patient presents at an ER, the key goal is to detox or to stabilize. This orientation of treatment wasn’t what I needed, and often not what the 30 percent of adults who will cope with an anxiety disorder at some point in their lives need. I wasn’t so sick that I was going to hurt myself, but I also couldn’t continue living this way. It wasn’t the ER’s fault. They were following protocol; I was stuck in a gray area of despair, but not despair that rose to a level of urgency.

I called my new therapist, and thank God, he answered. He told me to go home. Together, we made the decision that I would continue taking 10 milligrams of Lexapro, an SSRI used to combat anxiety … and bide some time. Mental illness is formless, amorphous. There are no blood tests. There are no milestones for treatment: shrink the tumor by 20 percent; elevate the platelets. Instead, it’s a highly subjective waiting game. Will this be the day I feel better? Or will this be the month my medication slowly, subtly at first, stops working? These questions weren’t going to be answered on a gurney.

And so I walked out of the ER and squinted at the sun like someone leaving a movie theater, home in time to get my kids from school, with three hours to go until I could take another benzo. There wasn’t a cinematic happy ending; there wasn’t a definitive moment when I felt cured. Instead, I slogged through October and November. I showered (usually). I got dressed. I did my work. I sent perky e-mails and posted cute photos of my kids to Instagram because sometimes you have to fake it. I took my medicine. I went to my therapist — being driven at first, and then, as I weaned off tranquilizers, driving myself.

And then one day, around December or so, the clouds began to part. I didn’t feel bad anymore, and I haven’t felt bad since. The only thing that saved me, really, was time. I just hung on until the good days began to outnumber the awful ones.

This might not be a wholly satisfying ending. Illness is often framed as linear, a process of valiant struggle and triumph, with a clear arc and concrete solutions. We often are told to call a hotline, go to the hospital, talk to a friend. But for people like me who exist in this murky, non-acute but life-sucking middle ground, this might not work. Sometimes, confiding in a friend only makes you feel more alone because they aren’t living it; sometimes, a doctor won’t be able to help you right away. Giving over your sense of safety to someone else might actually make you feel even more helpless and lonely. During Mental Health Awareness Month, I want people not to feel disappointed or even worse if these solutions aren’t a cure-all.

Don’t give up. Here’s what really helped me and still does: the realization that, even though mental illness isn’t a tumor that can be extracted through a standard protocol, it’s also not woven into our every fiber. It is not all-encompassing and personality-defining. People with mental illness are separate from our disease, just like any other sick person, which is a hard concept to grasp when this particular enemy affects your behavior, your perceptions, your feelings, your outlook. I am someone who is highly functioning, happy, stable. I am also someone who has a chronic illness that needs to be managed and beaten back. It is its own demon, one who decided to take residency for a while and, with therapy, medication, and time, could be evicted.

And, while I waited, I told myself: I will not always feel this way. This illness doesn’t define me, and it is temporary. Nothing is as strong as me; nothing can beat me.

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Kara Baskin can be reached at [email protected]. Follow her on Twitter @kcbaskin.