Where do you get dreams like this?

It is the day after Easter Sunday and I’m thinking about redemption.

I’m not a religious person by nature. Something about this holiday struck a chord with me.

I believe in redemption. That may seem like a strange thing to say, like redemption is a matter of faith. But for me, it is.

I am reading a series of novels right now by Stephen R Donaldson called The Chronicles of Thomas Covenant, which is a story of redemption. It features a man who has been plagued – but not overcome – with leprosy. He is a man who was once a beautiful human, turned wretched – physically, emotionally, and spiritually – by illness. He lost everything to leprosy, first in the physical realm – his wife, his child, any social ties – and then he pushed himself to become almost mechanical, nearly sub-human, in order to survive.

Early in the first book of this series, Lord Foul’s Bane, Thomas Covenant commits an act so atrocious that I – as a reader – was not sure I could forgive him. I’m still not sure I have. And yet, somehow, the characters in the book maintain faith that there is good within him. They hold not only to their precept of peace, but the majority of them somehow forgive him.

I have not finished the series, but I believe Covenant will be redeemed.

I’m afraid I am on a similar journey to Covenant. Although there is no singular event to pinpoint as the height of my instability and grotesque illness, I have definitely been near where Covenant was. For Covenant, he was not dead, but on the brink of dying, and fighting to stay on life’s edge of death. For myself, I was not dead, but on the brink of living, and unsure what side of death I wanted to be on. We both made ourselves sub-human, for a time. And in becoming sub-human, we immersed ourselves in self-loathing.

My story of redemption has sat squarely in the realm of allowing myself to be vulnerable, uncomfortable, and honest. A big part of this, I realize, is accepting that, while I have a unique set of life experiences, this does not mean others cannot engage with me as a whole person. I do not have to pare down myself into bite-size chunks and only dole out the ones that I think people want, hoarding the rest to go rotten.

I struggle to write on the topic of the redemption of others, as I have much more fear that it may not be universal, redemption. I fear that redemption is not available to all. It is a fear that sits deep in my chest. But in the end, I choose to have faith. I have faith in redemption. I guess, in the end, I have faith in myself. In humanity. In the world.

Mara Passio

Ah, what then?

The last hospital I spent time inpatient at treated all of their patients with significantly more dignity, allowing us to shower in our own bathrooms, for example. The biggest difference for me is that the other hospitals used eating with the group as a privilege, and if you didn’t attend therapy or misbehaved you’d have to eat in your room. The last hospital did not use food or social interaction as a reward or punishment in any way. The therapists also just spent time with the patients, instead of interacting with the patients solely in therapy settings. When we’d be between therapies, we would all be in the group area, and there would be two or three therapists in there interacting with us and treating us like human beings. That never happened at the other hospitals. These are all important factors in making patients feel that they are valued, and that they have agency in their recovery.

In a treatment style that, quite honestly, has very little to do with what the patient wants, as psychiatry often does – especially for patients who are ill enough to need to be inpatient – the most important factor in making sure that patients recover is to teach them how to have agency in their recovery. Psychiatry often takes away a patient’s agency, but that is the opposite of helpful. Yes, sometimes people go kicking and screaming inpatient, but once they’re there, they should have a say in how they’re treated. They should not be manipulated or forced into treatments they do not understand or want unless there is absolute necessity, and what goes behind that judgment call that is far too poorly developed.

Patients are often called on to make medical decisions for themselves while they are heavily medicated and unable to understand what they are being told; it’s happened to me. I’ve been given PRNs when I wasn’t asked for consent until the medication had already been drawn into the needle and they were prepping my arm – and when I said no, I was treated as if I had done something wrong. I’ve consented to an injection of Haldol that resulted in horrific side effects for five days afterwards – because I was explicitly told it would not cause side effects.

In my various other treatments, I’ve generally been presented with at least two different treatment options, given the pros and cons of each, given general advice, and then I was called upon to make the final decision. I have never experienced such a phenomenon in psychiatry. With psychiatry, I am evaluated, given a prescription for a medication that is often not explained to me at all, and sent on my way. The only discussion is of symptoms, not of solutions. I am deemed incapable of making such a determination myself, but why is that? It is because I have been intentionally under-educated on the topic of medication management, in a way that is simply not standard in any other field. Whenever I have wanted to even find out about the intended effects of a medication I am on, I have generally been forced to seek out answers on the internet, not from my doctors.

Giving patients agency and treating their decisions with respect is a basic human right. Beyond that, it is good treatment policy. It will help patients recover. Patients that take an active part in their recovery are more likely to stay recovered. Patients who feel that they have a responsibility to care for their own well-being, that what happens to them is a direct result of how they behave, will make more healthy choices.

I do not trust the psychiatric community as a whole because I do not believe that the general psychiatric community has the understanding or the desire (or both) to effectively treat patients who are viewed as having severe mental health problems. I believe that these patients are viewed as hopeless cases and are often viewed as incapable of caring for themselves. But the truth is that they have been taught not to care or themselves by the very culture of the psychiatric community that is supposed to be helping them. They have been taught that they are not responsible for their behaviors. They have been taught that they have no control over themselves. They have been taught that they are powerless. Because the system makes them powerless, over and over again, and tells them it’s what’s best.

Mara Passio

Somewhere beasts of prey prowl

There is a link going around about a soldier who left his position and was then held captive by the Taliban, who has since been diagnosed with schizotypal personality disorder. I have seen calls for this man’s execution, and claims that STPD is not a mental illness, but rather a personality disorder, which is supposed to be different. I understand that the military is a very polarizing topic, but I’d like to give my two cents.

First of all, there are multiple categories of personality disorder. STPD is categorized under Category A, which is described as odd, eccentric, bizarre. The personality disorders people usually think of when they hear the term Personality Disorder is Category B, described as dramatic or erratic, and includes Narcissistic Personality Disorder, Antisocial Personality Disorder, and Borderline Personality Disorder. These are the three that carry the stigma of the term Personality Disorder, and I have further opinions on whether all of them deserve that stigma, but that is irrelevant here.

So, what we have established is that the traits normally associated with the term personality disorder does not necessarily apply here, so let’s go over what personality disorder does mean. Here is the definition of personality disorder from the Mayo Clinic

A personality disorder is a type of mental disorder in which you have a rigid and unhealthy pattern of thinking, functioning and behaving. A person with a personality disorder has trouble perceiving and relating to situations and to people. This causes significant problems and limitations in relationships, social encounters, work and school.

Now, my understanding, from this definition and from further research, is that a personality disorder is, effectively, a mental illness that is much more pervasive than what is traditionally expected of a mental illness, especially in terms of interpersonal relationships. So now, here is the definition of STPD specifically, also from the Mayo Clinic:

Peculiar dress, thinking, beliefs, speech or behavior
Odd perceptual experiences, such as hearing a voice whisper your name
Flat emotions or inappropriate emotional responses
Social anxiety and a lack of or discomfort with close relationships
Indifferent, inappropriate or suspicious response to others
“Magical thinking” — believing you can influence people and events with your thoughts
Belief that certain casual incidents or events have hidden messages meant specifically for you

So, given the context of a man in the military who feels his superior has made a dangerous decision, and this man has STPD, it is entirely foreseeable that he may believe that attempting to bring his misgivings to an even further superior officer in a traditional manner would either result in nothing, or worse, in persecution. It would also be entirely foreseeable that a man in this position with STPD would feel that it was most appropriate to cause a scene in order to gain the attention he felt was suitable for the seriousness of the issue. By not only getting the attention of a superior officer, but the attention of multiple bases, he would, in his mind, force the hand of the superior officer to take notice.

Calling for this man’s execution, saying that STPD is irrelevant to this issue, and many other responses I’ve seen on social media to this issue have appalled – although not surprised – me. It shows me just how little understanding there is of mental illness, still. It also shows me how we pick and choose when mental illness is and is not an excuse for behavior.

This man did what he did because he viewed it as his best option in order to protect his comrades, and we call for his death. When a random white man kills several women for no reason other than that they are women and he wants revenge, we say he was mentally ill (without any proof of such) and call it a tragedy for all involved. Not only does this show me that we value the military more than we value the lives of women, it also shows me that what we value most about the military is not necessarily our soldiers or their well-being.

Mental illness is not something that can be cherry picked as an excuse when it suits one’s worldview. Murder is immoral regardless of whether a person had mental illness, and mental illness should not be an excuse, unless, perhaps, there is a break from reality, such as psychosis. What this man did should not be excused either simply because of mental illness, either; however, he did not murder, and what he did do is much more ethically ambiguous. Why is it then that he is the one who deserves execution by the standards of the masses?

Mara Passio

We live in deeds, not years; in thoughts, not breaths

There’s a version of me that only exists in past tense. I think that’s true for everyone, but I realized recently that the difference is much more stark within me than it is within many. My past tense is a stranger towards whom I reach, simultaneously trying to pull inwards and push away. The realization that I cannot become who I once was is viciously painful. Sometimes I wish to forget that I have a past tense, as I realize more and more that the virtues I hold dear were stronger in me past tense.

There’s a version of me that only exists in the present tense. I came to the realization that I do not like who I am, present tense. And I have not liked who I am in the present tense for a while. This is not a new realization; it’s one I come to every few weeks, and I make changes and hope for the best and those changes stick or they don’t and I still don’t like myself present tense.

There’s a version of me that only exists in future tense. I’m not sure this is true for everyone, but it’s true for me, and it seems that my future tense is so wildly separate from my present tense that it could be a whole different person. My future tense has all of my emotional and physical limitations, but none of the character flaws. When building my future tense I didn’t plan to continue being unhappy with who I am.

I don’t believe I can reach my future tense until I become happy with who I am present tense, but I do not believe that has to or should involve giving up my values in order to find peace with my faults that I find intolerable and unethical. I also have come to the painful but necessary realization that the flaws I dislike about myself, others dislike about me as well.

I have become my illnesses. I have become narcolepsy. I have become bipolar disorder. I have become arthritis. I have become chronic pain. I have become post-traumatic stress disorder. I have become sickness. My personality is Unwell. And I am not proud. I am utterly ashamed.

I try to have empathy with myself, to realize that my life for the past few years has been a barrage of injury and illness. And on a level, I do understand that there is a reason I became the way I am. What that does not mean, however, is that I am excused to continue dwelling in despondent self-loathing. I am no longer excused from trying. And I don’t just mean trying on my own behalf. Trying means working to understand others. Trying means cooperation. Trying means being willing to be uncomfortable. And on a larger scale, trying means trying to work to improve the world as I see myself capable.

To be clear, I do not seek to divorce myself from my body, or from my illnesses. What I do seek is to divorce myself from the idea that my illnesses culminate into the total of my self. I have chronic illness, and I cannot and will not act otherwise. However, I am also a human being outside and alongside my illness, and these aspects of my self require time and space to thrive.

My future tense is a very long way away, and to be honest, I will always have some of my character flaws, although they may be smaller, more manageable shadows of the hulking barriers I currently have. Eventually though, my future tense may become my present tense. And in my future tense, I like myself uncompromising. If none of the rest of my future tense becomes my present tense, I dearly hope that I can one day like myself, present tense.

Don’t make me suffer, I’ve got dreams

Growing up, I was taught that going inpatient at a psychiatric facility was a form of punishment for people who couldn’t hold it together, that it was shameful, to say the least. No one ever told me these things, but they were taught to me in the way that my dad insisted that if I let myself get too sick, I’d have to go to the hospital, or worse, that he knew I was strong enough to hold myself together and keep myself out of the hospital.

By the time I was twelve I had a pretty strong case of EDNOS (Eating Disorder – Not Otherwise Specified) where I would fluctuate between extreme restricting and binging. I would lose incredible amounts of weight and then gain it back with excruciating rapidity. I was also self-harming. This is when I first went to see a therapist. My tactic at the time was to deny everything, which, to a certain extent, got me what I wanted, which was to be left alone.

I didn’t return to therapy until I was fourteen, and at that point I was put on Zoloft, and my parents were assured that this was a teenage thing, and it would likely clear up in nine months. Two years later, I was successfully weaned off of Zoloft, and a year later stopped going to therapy. We all assumed they were, for the most part, correct, and that my mental health issues were just adjustment issues.

In the midst of my second semester of my freshman year of college, a few months before my ninteenth birthday, I started to deteriorate again. The symptoms were different, but similar enough that I thought they were the same problem as before, and assumed a couple pills and some tune-up therapy would do the trick.

I only got worse though. And this is where my story truly begins – this is where my distrust of the psychiatric community really grows its roots deep.

It started with my sliding scale therapist, who, to be honest, was sub-adequate at best. She listened to me talk and then I left feeling like I had, well, talked. That’s not enough to induce distrust though, there are mediocre professionals in all fields. What happened, is that I told her I wanted to kill myself, and asked her for her advice, and she told me to wait two more weeks until I could see one of the psychiatrists in her practice.

To add insult to injury, when I went to see said psychiatrist, he prescribed me ten milligrams of Prozac. Now, let me give some insight. I was, at the time, a 300lb, 5’11” woman who has shown suicidal ideation, and ten milligrams of Prozac is the smallest dose one can be given, and usually doctors start at twenty milligrams for adult patients. He told me to come back in a month and tell him how I was feeling. If you’re following at this point, this man essentially gave a pill with the functionality of a placebo to a suicidal teenager.

Two weeks later I was in the emergency room, where my next, and biggest, assault from the psychiatric community came. I had come to the emergency room due to paranoia and hallucinations (that was discovered much, much later to be caused by narcolepsy, not psychosis), and it was discovered that I had been cutting myself. It was 11:00PM on a Friday, the emergency room was packed, and I was escorted to a cell with padded orange walls and flooring, with a table, chair, and medical bed bolted to the floor. My best friend accompanied me, although she was asked to leave during my interviews with the psychiatrist on call.

The interview with the psychiatrist was hellish and, to be quite honest, extremely traumatizing. He manipulated my words, asked me questions repeatedly if he didn’t get the answer he wanted, asking them different ways so that maybe I would answer “yes” to a question I had previously answered “no” to. I would like to note that, by this time, I had not been suicidal for several days. But he kept asking me, did I want to kill myself? did I want to die? did I wish I didn’t exist? And the answer was always no, no, no. Finally he asked after over an hour of interrogation, at 2:00AM, “You sometimes think though that it would be better off for everyone else if you weren’t around though, right?” to which I said, exhausted, yes.

He wrapped up our interview pretty quickly after that and declared that I needed to be hospitalized. Then came the next portion of the manipulation, the guilt tripping. It turned out he didn’t actually have the authority to forcibly admit me, and he would need to get the authorization from the head psychiatrist to do so. He presented this information to me as the following paraphrase:

The head psychiatrist is the only one who can involuntarily admit you into a psychiatric hospital, and he’s off right now with his family, definitely sleeping – it is really late, you know – and I’d have to give him a call and wake him up and go over everything you and I just talked about so he can authorize my decision to involuntarily hospitalize you. Do you really want to have me do that? If not, you can just voluntarily agree to be hospitalized by signing this form right here.

I was very easily manipulated at eighteen. I signed the form, feeling guilty about wasting everyone’s time. It took another eight hours before I was transferred to the psychiatric facility I was to stay at, during which time I was completely ignored in that tiny room, denied food until my best friend nearly assaulted the locked door to get their attention, and denied the bathroom until she assaulted the door again, and then I was humiliated for asking for a maxipad by the security guard, who first berated me for not saying I needed one before I left the locked room, and then shouted across the room to a male security guard to retrieve one for me, all while I sat in an open-doored bathroom, because I was a “risk to myself.”

My first psychiatric hospital stay was mostly uneventful. I was quickly moved to the “low security” section of the hospital, where it was primarily drug addicts and people with low level mental illnesses who were not a danger to themselves. My psychiatrist at the hospital at least could tell that I wasn’t suicidal and wasn’t in the mood to manipulate me into saying I was.

The day before I was to be discharged, I had an anxiety attack and scratched my outer wrist open with my fingernail, probably a circle the size of a penny, and just barely deep enough to bleed. It was a fiasco, and I was sent back up to the “high security” section and my discharge date was postponed. Soon after I was sent back to the “low security” section again, and discharged. I was there a total of two weeks.

I followed up my inpatient stay with an extended participation in Intensive Outpatient Therapy, during which time I maintained close contact with my psychiatrist from inpatient. Now, I mentioned that my psychiatrist wasn’t in the mood to manipulate me. I could more accurately state that he wasn’t in the mood to interact with patients at all. He had, as the therapists described, a “poor bedside manner” and is one of the most impatient people I have ever met. I was terrified of him, but he was highly respected in the psychiatric community as being somewhat of a miracle worker for difficult cases like mine.

Perhaps six months later, after I had been long discharged from Intensive Outpatient and only saw my psychiatrist once a month for medication management (I was still seeing my inpatient psychiatrist), I went in for one of my monthly appointments, and I mentioned that I wanted to die, but had no desire, intention, or plan to kill myself. He had me escorted to the inpatient facility and I spent two weeks there. After I was discharged with a new set of medications and a new referral for Intensive Outpatient, I became actively suicidal, and returned to inpatient a week later. This time, I only spent a week there, as they were worried I was becoming “dependent on the hospital.”

There was a dynamic going on within the inpatient facility that I did not acknowledge at the time, nor long after, that likely should have been acknowledged and addressed by the therapists. I had become obsessed with one of the therapists in the hospital. I had gained his permission to call the hospital on occasion to check in with him, and this quickly became an issue of me calling him several times a day if I did not get in contact with him the first time. When I was inpatient, I would become depressed if he was not working that day, and would become excited when he was, to the point of following him around and creating scenes so he would pay attention to me. This was a huge problem and a major inhibition to my recovery, and no one in the hospital even acknowledged it was happening.

I am by no means trying to claim I had no agency in this situation. I did. I could have chosen to seek treatment elsewhere or to cease contact with him. I honestly don’t know if I had the self perception at the time to understand that I was obsessed with him. Perhaps I did and I was in denial. He was beautiful, cocky, intelligent, patient, and I viewed him as the one who would save me. I believed myself in love with him. I even managed to find out his last name at some point, due to a horrible slip up by a receptionist on the phone.

It was due to this obsession mixed with my psychiatrist being trigger-happy on sending me inpatient that I spent six total stays inpatient at that particular hospital, each between one and two weeks long, over the course of two years.

My sixth and final stay, though, was triggered by something else entirely.

My therapist had been referred to me by the hospital, and I later learned she did evaluations for the hospital herself, and had close ties to the hospital. She was a cognitive behavioral therapist, and I believed her to be the best in the world. She did make a lot of mistakes with me, it turns out, but the biggest one she made was at the end of our therapy.

I had called her a few days earlier telling her that I had started drinking again, a habit I was trying desperately at the time to stop, as I was a heavy binge-drinker. She had seemed distant and said we would talk about it when I came in that week. When I arrived, however, she announced to me as I sat down that she was closing her practice, effective immediately, and that this would be our last session. Shell-shocked, I accepted the news without comment and barely said anything else the rest of the hour. Two weeks later I made my first suicide attempt. I had thought about it plenty before, but I had never followed through on my thoughts before. The one person who I thought was supposed to be the most stable person in my life had just pulled the rug out from under me and I didn’t trust that life was going to be worth it.

After that stay in the hospital I moved back home with my parents, where I found a new therapist, who I am still with now, and who I find to be wonderful, but who I severely distrusted for over a year. My first appointment with her consisted of me telling her that if she wanted to be my therapist she had to never do what my last therapist did to me, and she agreed, so I decided to stay.

After my twenty-first birthday, I started drinking heavily again, and had a brief stay in an inpatient detox at a different hospital, which I have nothing negative to say about, except that I heavily resented being forced to go to AA, as I disliked their mantras and their serious superiority complex.

A good time later, I had a traumatic experience with a teacher that I will not go into here, and I was looking for partial hospitalization program, and the first one I went into was, well, horrifically useless. The majority of the six-hour day was spent in “classrooms” listening to lectures about mental health in a room with forty plus people in it, and no individualized treatment. In each day there was an hour or less of any activity where individuals could even participate. It was disgusting and I viewed it as a complete rip off, and after two days I left the program, and sought out something different.

After hearing of my dissatisfaction with the program, my insurance allowed for me to go to a different program and I was pretty happy with it, but soon after they billed my insurance for services I did not receive, which my insurance didn’t cover, and then proceeded to send the bill to me, and I had to have a big fight with the hospital, literally days after I had just been discharged from their partial hospitalization program for mental health. I felt like a lot of the good the program did was undone by that stress and sense of betrayal.

My final stay in a psychiatric facility was when I was twenty-two. This was at another hospital separate from all the others, and my only complaint about this hospital was that the emergency room literally had no psychiatrist on staff overnight, so I had to sit in a hospital room overnight. But they had me in a hospital room, not a padded room. It was not locked. I was checked on regularly and they took my shoes, but that’s to be expected. The attitude of this hospital was “how can we make sure you don’t come back here” as opposed to the other hospitals I’d been to, where the attitude was “how can we fix your current problem” and that is a very important distinction. After staying at the second hospital I never had another inpatient, intensive outpatient, or partial hospitalization stay.

All of these experiences have led me to believe that psychiatry as a whole tends to undermine the agency of its patients. I have written further on this topic here.

Mara Passio