Sunday, September 1, 2013

A good psychiatric hospital experience: part one

From the point of me grasping my diagnosis it would take another six weeks for me to be mentally stable enough to be ready for discharge from hospital.

Over this time period a lot of work had to be done to get me from a place of that first glimpse of clarity to having a reasonable level of day-to-day mental stability.

I had the privilege of being in an excellent private psychiatric hospital where achieving this end was facilitated in every way and I remain immensely grateful for this rare experience.

In clinical terms I was suffering from a double whammy of obsessive thoughts and severe (indeed psychotic) depression which would take a lot of undoing.

There were three basic aspects to my hospital treatment. The first was finding the right type and level of medication to counter the neurological/chemical problems that predisposed me to being in the state I was. The second was group and individual therapy sessions where I became educated about my mental illness and learnt the skills to bring it under control so I could function healthily and sustainably as an individual. The third aspect was just as important as the first two: the care and company of the hospital staff, visiting friends and family, and other inpatients as I began to find my feet again (I will discuss this third aspect in an upcoming post).

I was put on lithium carbonate to treat the bipolar and a tricyclic antidepressant known to counteract obsessive thoughts in addition to its mood-assisting qualities. Thankfully this combination was a perfect fit for me as the ensuing weeks would show as my condition improved via the obsessive thoughts reducing and my mood regaining some stability. Over this time my doctor adjusted the dosages with surgical precision and was very good at explaining what she was doing.

I was helped greatly by a short book about lithium from the hospital’s library that explained its intended role for people with bipolar disorder. I highly recommend anyone experiencing mental illness to educate themselves about the medications they have been prescribed. Many of the side effect troubles I experienced in my pre-diagnosis phase (during which time I was prescribed a series of powerful drugs) may have been avoided if I had known how important doing this was.

Group and individual therapy
Group therapy sessions were run by a psychologist or social worker and happened during the daytime. Over the course of the week would cover a range of topics including distress tolerance, art therapy, anger management and pain management.

Nurses would lead group sessions in yoga and relaxation plus a daily morning walk after breakfast and a weekly trip to somewhere off the hospital campus. While none of the sessions were compulsory I was encouraged to attend them and did so to my great benefit. (One of my biggest criticisms of the public hospitals I have visited in my work is the lack of structure to the day of inpatients and minimal opportunities for group therapy).

I saw my doctor twice a week to discuss how I was going, did the same with my assigned psychologist or social worker, and had conversations of varying lengths with the different nurses assigned to me on a daily basis.

Crucially important was the time and space I had on my own to think and work through the things that I was learning from the group and individual therapy.

Part and parcel of this time and space was the atmosphere of the hospital, such as its picturesque and quiet geographic location, the decor and size of my room and ensuite and the quality of the food. These things helped me greatly, and they come to mind when I recall another one of those key breakthrough moments that happened sometime during week two or three of my stay.

Gaining control of the mind
I had been reading some literature about Dialectical Behaviour Therapy and in particular the concept of mindfulness which had been explained to me in several of the group therapy sessions. In short, mindfulness is a practice by which one learns to be fully engaged in the present moment with an agile but relaxed mind.

I sat down to practice a basic mindfulness exercise which involved being seated, still and slowly observing a series of things in my field of vision, then a series of audible noises, then a series of feeling points within my body. I can still remember the remarkable circuit-breaking effect this had on my obsessive thoughts the first time I successfully became fully aware solely of my physical surroundings to the exclusion of the troubling thoughts from which I could only ever seem to escape momentarily.

Another newly discovered exercise I found important to breaking the obsessive thought cycle was assigning a specific half hour in my day to “worry time” where I would deliberately focus my attention on those thoughts that were harassing me throughout each day.

The biggest challenge with deploying this exercise was the fear that I was trivialising the seriousness of the thoughts which had had me preoccupied for so long. Essentially obsessive thoughts work by filling the affected individual with an unshakeable sense that those thoughts must take priority ahead of anything and everything else.

It felt like I was going against my conscience when I decided to try the “worry time” exercise for the first time, but I had been gaining confidence in knowing where my mental illness had been interfering with my good sense. The exercise turned out to be another excellent circuit breaker for my mind.

This clip is a scene from the sci-fi classic film The Matrix where Neo (played by Keanu Reeves) achieves a new level awareness that helps him in his quest. I liken it to how it felt to begin to master my obsessive thoughts in hospital.