The reasons why I suffered a nervous breakdown are none of your business. What is the business of anyone who cares about mental health is that the most harrowing days of my life were when I recently tried to get help for a mental illness.
I am a white, middle-aged professional man with many years experience navigating laws and bureaucracies. By training and temperament I am better equipped than many to advocate for myself.
After two weeks of straining to hold it together because of the things that are none of your business, and deteriorated from weight loss and sleeplessness, I could see and feel my emotions and my behavior gradually sliding out of my grasp and beyond my control.
I thought I could handle it.
What finally broke me was something as simple as furious, I-hate-myself-regret for hurting someone I love.
A breakdown is like this: I spent almost an entire Saturday night crying. Not boo-hooing but sobbing convulsively. This kind of crying is like an epileptic seizure. Who you are becomes a servant to your crying.
I telephoned my sister in the morning. She gave me the toll free number of a suicide prevention hotline for Southern California and told me she would jump in her car to meet me. The plan was for me voluntarily to admit myself for treatment at the closest hospital with a psychiatric ER -- Harbor UCLA.
I called the hotline. A twenty-something female voice answered. She asked if I would mind taking a brief survey. "It is important to maintain our funding," she explained. I stammered an OK. She asked me my age, my ethnicity. I think she asked my highest level of education; I'm unsure because I hung up. She called back. I hung up again.
My sister arrived at about 10:30 am and drove me to Harbor. With her arm around me, we walked the dingy halls together, following the green line on the floor to the psych ER.
My father suffered mental illness. I had lived my whole life determined not to be like him. When I saw the sign that announced the Psychiatric Ward, I dropped to me knees, chest heaving with sobs. On top of everything else, my whole life now felt a failure. I was at the one place I vowed I would never be.
The ward is about the size of an average McDonald's dining room. It is rectangular and brightly lit. In the center is the windowed nurse's and doctor's station, also rectangular. There are plastic chairs abutting the walls of the station. A few patients wandered around but most slept on mattresses strewn either on the floor or in the small rooms that rimmed the ward.
My sister was not allowed in with me. Sleepless, exhausted, drowning in emotion, I was on my own.
I sat, head between my knees, still sobbing uncontrollably. A nurse in orange scrubs sat next to me and firmly but not aggressively urged me to "get myself together." At some point I was given a pill.
A young doctor in blue scrubs sat on the seat next to me. I tried to get my story out. He said my sister was worried I might hurt myself. A small alarm went off in my head and I gathered just a bit of focus. I recall him asking me that if I were to kill myself how would I do it? Since I heard this as a hypothetical, and I was there for treatment, I told him my favored option. He did not ask me how likely I was to do it.
Later, he returned with a form. On it was checked "involuntary commitment" and written on it was that I had told him I intended to kill myself. I stared at it, dimly recognized the error, but I was too spent to protest.
At that moment I became a "5150," named after the California statute number, meaning someone who was being involuntarily detained for my own safety.
I was for the first time in my life entirely at the mercy of "a system."
Later that night I was taken by ambulance to what I now know is a prominent psychiatric hospital fairly nearby. The part of the facility I was in was one long hallway. Patient rooms were on both sides of one end. Each room slept up to five. A glass walled room with tables and chairs was at the other end of the hallway. A glass enclosed nurse's station faced a glass enclosed common room, with a TV (always on), two leather couches and an assortment of plastic chairs.
I was guided to sit at a small table. Someone -- I don't recall who, she was a woman -- sat to my right. My belongings were inventoried and my shoelaces removed. I was given a pill and some badly printed brochures about my rights. Nobody explained the routine or schedule. I was taken to a room where three men were already sleeping, two snoring like bears. I fell asleep.
In the morning I was awakened for breakfast (predictably awful) and told to see my psychiatrist. In a tiny office I briefly told him my story but received no counseling and was promised none. He told me that I was there for a seventy-two hour hold but that if in his sole opinion he felt that I was still a danger to myself he could hold me for fourteen - fourteen! - days. My business would collapse. Nobody told me this way back at the ER. My choice to seek aid now posed a risk to my very livelihood. My visit with the psychiatrist lasted for perhaps five minutes.
And, after that visit, all my attention turned toward getting out of there in seventy-two hours.
Of the twenty or so patients, most were experienced in the system; just a handful of us were first-timers like me. I noticed that social workers in scrubs wandered about with clipboards, silently scribbling observations about the patients, Jane Goodall-style. "Group" -- consisting of a therapist asking how we are doing and offering advice about avoiding bad thoughts -- was held twice a day in the TV room. Once a day they let us outside into a small courtyard for "adjunctive" therapy: a Nerf football and soccer ball and a radio. The line for our meds started about 8:45 pm. Lights out by 11pm.
I obediently took the anti-depressant they provided but never named. Most other patients sought additional drugs but I dared not. I didn't want to appear too disturbed so I didn't ask for anything other than a sleeping aid to help me blot out my snoring roommates.
There was nothing to do. The TV was always on. I wanted to retreat to my room to read the magazines my sister had brought but I did not want to appear anti-social. In any case, my roommates were always there, snoring.
Watched, bored, scared, the place itself quickly promoted anxiety and depression. There was no therapy. Almost nobody had a kind word of encouragement. Petty rules were sometimes enforced petulantly. Nobody outside of "group" asked how I was. With a couple of welcome exceptions, the staff ranged from politely tolerant to why-are-you- bothering-me? impatient. At some point I learned I had been assigned a social worker but she never introduced herself to me.
Nobody acted unprofessionally. But, neither did anyone act in a way that was memorably tender or kind. One woman who arrived after I did walked the halls with tears welled in her eyes. Nobody consoled her.
I got out in three days, in part with some logistical help from my social worker. I signed a form that says I cannot buy a gun for five years. I am on meds and in counseling. And, to the extent that I was truly at- risk, at least I am here.
I feel somewhat ashamed for not signing my name to this. Of course, to protect me and my family, I cannot. This is a sad referendum on how we stigmatize mental as opposed to physical illness.
Indeed, one thing I learned first-hand is that dividing physical from mental illness is wrong. The rational part of me did not entirely vanish that dreadful Saturday night. I could still hear, still feel, that voice, my better mind. I therefore do not escape responsibility for what I have described. But, the rational part of me was reduced; its jumping up and down, arms waiving cries for reason rendered tiny and feckless in comparison to an overwhelming, orchestral, emotion-impelled mania caused by a part of my body -- my brain and thus my mind -- misfiring.
Whether I acted in ways previously unimaginable to me because of bad genes awakened in middle age; a soul and happiness-shattering heartsickness stemming from the foremost and most confusing of the somethings that are none of your business; the stomach-clenching, self- hating regret I mentioned before; lack of sleep and food; or all of these things in unlucky combination, I do not know. What I do know is that my mind got injured by some or all of these things as surely as a car accident can break a leg. On a broken leg, you limp. On a broken mind, you behave badly. Hopefully, this is the kind of injury that resolves as opposed to the kind that is managed.
I think about the patients I left behind and I am afraid for them. They are now as I was tangled in an uncaring, impersonal, and arbitrarily subjective system that might preserve life, but, at best, tragically misses the chance to heal, and, at worst, degrades and frightens those who, at their most vulnerable, deserve better.
It was helpful to me to write this all down. I hope your awareness of what happens to sick people still in this system somehow ends up helping them.
Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.