Janalynne Rogers shares her experience with electroconvulsive therapy (ECT), often called “shock treatment”—but it’s far less crude and risky than you might think:
Note: The kind editors at The Atlantic gave me the option of posting this anonymously. I’ve decided to use my full name because there is absolutely nothing to be ashamed of when it comes to having a mental illness and seeking whatever treatment works for you.
With the tragic death of Carrie Fisher propelling mental illness back into the mainstream media spotlight, I’ve been fielding more questions than ever about living with bipolar disorder. As someone with bipolar I [characterized by at least one manic episode, compared to the lesser bipolar II], I experience manic episodes wherein I feel invincible. I also have episodes of crippling depression. The most dangerous episodes are mixed, presenting with unbearable sadness combined with intense anger, self-loathing, and frenetic energy. Not only do I desperately want to die, I have the motivation to make that happen.
It’s terrifying.
One of the things people are most curious about is ECT (electroconvulsive therapy). Carrie Fisher was candid about her experiences with it, yet for many people ECT remains a mysterious, frightening concept. But ECT saved my life.
In 2012, an overwhelming mixed episode had me fighting for my mind and my life, and I begged my psychiatrist for help. He admitted me to the psych ward. After I settled in, we discussed changing my medication. We’d been conducting this chemistry experiment for 15 years, but it wasn’t enough. I had run out of options. He recommended ECT. It was my best shot at taking back control of my bipolar brain.
Also terrifying.
Before I agreed, I did some research. I learned that ECT was still the recommended second line of treatment in the standard medical guide to mental illness (the first being the drugs that had failed me). I considered the list of side effects, including memory loss, impaired thinking, and headaches. When the other option was waiting until I finally snapped and took my own life, these seemed like minor inconveniences.
So, I signed up for voluntary brain electrocution. For those unfamiliar with ECT, it goes something like this:
You are given general anesthesia and taken into the treatment room. You are given a drug that paralyzes your body. The doctor then sends electricity into your brain to disrupt its signals. In simple terms, you experience a seizure-like interruption of the electrical current inside your head and, over the course of treatment, the mind over which you’d lost control is supposed to return to its old self. The procedure itself is thankfully quite brief, and you wake up in recovery with no memory of what happened.
Despite the memory loss that followed my first treatment, that day stands out with startling clarity. The hospital had already been scheduled for demolition, and the interior was aged and neglected. As I rode the rickety elevator to the fourth floor, I struggled to squelch my growing terror. My mind is my primary marketable feature—the sudden reality of what I was about to do turned my stomach when I realized that my choice of treatment might leave me with permanent impairment. And might not work at all.
There were eight of us scheduled for ECT that morning. The nurses lined up our stretchers in the pink tile-lined hallway and systematically administered our sedatives. It was an assembly line of last resort. The fluorescent lights came in and out of focus as I slipped into the drug-induced slumber. My next memory is of being thrust back to awareness by the force with which I vomited on the recovery-room nurse.
I had felt nothing during the procedure and was shipped back to the main hospital while I was still numb. The memories from before, during, and after the treatments are either completely blurred or simply missing. Trying to recall specifics from the rest of my hospital stay is like searching in vain for a simple word that rests on the tip of your tongue but refuses to be said. I don’t remember that Christmas with my family or spending time with my parents in Florida. The photos I took while I was there look foreign and staged.
I did three sessions a week for six weeks. On treatment days, I was ferried to the regional mental health centre in a taxi before sunrise. Nothing quite cements the idea that you’re crazy like daydreaming of Nurse Ratched.
I still whole-heartedly recommend ECT. Obviously, I’m still alive. Electroconvulsive therapy was more effective than any combination of drugs I’d ever taken, and in less time. It did, however, take over a year before I felt I had complete control of my mind. Those around me saw the difference long before I did.
Since bipolar disorder is a life-long battle, the odds are good that my medications will once again fail. If my doctor recommends another round of ECT, I’ll most likely volunteer. When staring into a suicidal abyss, grasping for lightning doesn’t seem so bad.
What also doesn’t seem so bad is this video of ECT from 2013, especially when compared to the Hollywood version embedded above, which was filmed in 1975 and based on the 1962 novel One Flew Over the Cuckoo’s Nest—both of which negatively shaped the popular conception of ECT more than anything else. The main difference between that movie scene and the real-life version is the use of anesthetic in the latter, leaving the patient unconscious and not in need of physical restraints. The patient still convulses for about 30 seconds (starting at the 3:30 mark), which is a bit unsettling to watch. But as the narrator explains, there’s very little to worry about:
Serious physical complications from ECT are rare. Mortality rates of ECT are low—1 in 50,000. This is comparable to risks of general anesthetic for minor surgery.
In contrast to Cuckoo’s Nest, the two people most responsible for normalizing ECT in the public consciousness are Kitty and Michael Dukakis. This recent NYT profile of the married couple calls them “the nation’s most prominent evangelists for electroconvulsive therapy.” Following Michael’s defeat in the 1988 presidential election, Kitty spiraled into a deep depression and several years of rehab for alcoholism. But then she tried ECT—and it was a godsend:
Mrs. Dukakis, 80, still receives maintenance treatment every seven or eight weeks. She said that she had minor memory lapses but that the treatment had banished her demons and that she no longer drank, smoked or took antidepressants. She went public with her use of electroshock in 2006 in her book, “Shock: The Healing Power of Electroconvulsive Therapy,” which she wrote with the journalist Larry Tye.
Here’s another story of ECT, this time from a reader:
I sort of had my heart in my throat when I read you were soliciting stories about time spent in the psych ward, since I was hospitalized three times in the past year or so after experiencing the most harrowing episode of post-partum anxiety and depression. Even though I didn’t really want to re-live it, I knew I had to write you.
So here goes.
The first stay in the psych ward was for a month. I remember thinking at a certain point that they were never going to let me out, because I was never going to get better, and that I was going to have to either 1) make a break for it, or 2) kill myself on the unit. I remember actually planning it.
Every day they would ask me if I have any intent of harming myself on the unit, and I would lie—even though I told them in the emergency room it was my intent to kill myself, so that at least my partner would feel he did everything he could. I remember feeling awful about that, as the nurses were (in hindsight) generally kind and well-intentioned people. But I remember feeling like they were my captors, and not really feeling like my well-being was their concern so much as my safety in the most basic physical sense.
One of the early nights I was there, another patient howled through most of the night. I mean, really scream. My roommate had PTSD, so she would sort of start howling too. Another woman I met told me she really believed that she was being watched by the government. She knew how it sounded. Another had actually tried to kill herself; she’d jumped in front of a train. They’d had to amputate a leg and arm, and she was in a wheelchair. She is the hardest person to think about.
They threw the book at me in terms of medications: Klonopin, Effexor, Remeron, Zoloft, Lithium, Seroquel, and Zyprexa—serious drugs with awful side effects. After one dose of Seroquel, my tongue started making weird circles in my mouth and I start smacking my lips—it’s called tardive dyskinesia, or TD—and one of the doctors told me it was possibly permanent. I remember that I didn’t even care. At that point I had so thoroughly lost my mind—myself—that if this drug could bring that back, it would be a small price to pay.
***
Eventually, the psychiatrist recommended ECT. ECT! It was something that would have struck terror in my heart in my former life: the general anesthesia, the possibility of memory loss, the tinkering with your brain. And all I remember thinking was “Well, maybe I’ll just die on the table.”
Believe it or not, I am actually well now. The ECT helped, eventually. (20 rounds! I kid you not.) I can no longer really access that person I was; her thoughts, her feelings, are hermetically sealed, and mercifully alien to me. It’s almost as if it happened to someone else. I guess that form of magical thinking is part of mental health.
But the psych ward kept me safe so I could outlive my worst thoughts, and for that I am grateful. Like anyone who survives suicidal depression, I hope that maybe someone else out there somewhere will read this and think “Hey, if she could get through that, maybe I can get through this, too.” Because the adage really is true: This, too, shall pass.
***
Update from a reader:
Hello, and thank you for publishing the poignant stories regarding stays in psychiatric wards. There is one thing I believe needs to be addressed—this line in the first reader story: “As someone with bipolar I [characterized by at least one manic episode, compared to the lesser bipolar II], I experience manic episodes wherein I feel invincible.”
It’s important, particularly because so many contributors (and readers, I’m sure) of this series struggle with bipolar disorder, to clarify that bipolar II is not the lesser of the two bipolar disorders. The differences are far more nuanced and complex.
True, the mania associated with bipolar II is less destabilizing than the mania experienced in bipolar I. However, bipolar II patients are often dogged by longer periods of deep depression.
Additionally, the absence of psychosis in manic episodes present challenges in both diagnosing bipolar II and convincing individuals to accept that diagnosis. It took my very astute clinician four years to get me to accept my bipolar II diagnosis. It’s also important to note that bipolar II hypomanic episodes can become more acute with the passage of time.
I often hear bipolar II referred to as the “mild” bipolar, and each time it gets me in the gut. Every day is struggle. For me, it’s prolonged, paralyzing depression.
Anyway, given how often bipolar is in the news these days, especially with the passing of Carrie Fisher, I think an exploration of both bipolar I and II is in order. (Catherine Zeta-Jones suffers from bipolar II.) Best wishes, and thanks again for providing a platform for stigma-free mental health awareness.
A long-time reader experienced the harmful consequences of low funding for mental-health facilities:
I have had major depressive disorder my whole life >60 years. I’ve been hospitalized 25-30 times—once for three months. And yes, you can get psychiatrists who say “You do what I tell you or I will put you in involuntary admission to the state hospital for a MINIMUM of six months … and there is NOTHING you can do.” What a power trip!
I have watched psych care change from three separate units in the hospitals to one general ward where the psychotic drug abusers, the schizophrenics, and depressives are all put in one large room. Health insurance pays BIG for major trauma—surgeries, ICUs, ER physicians, physical therapy, more surgeries. But for psych? Tiny by comparison.
So they cut staff and room for psych. We used to have art therapy (drawing with crayons), ping pong, basketball—tough to do when they take your shoelaces. But no money! Registered Nurses no longer come onto the ward. They sit behind one-way glass watching us on monitors. Cameras are even in our bathrooms and bedrooms! The nurses sit and watch computers.
Last time, there were 30 of us crammed into one room—just enough room to crowd in 30 stuffed chairs. Many of us are put on major tranquilizers and just want to sleep, but we are gotten out of bed at 0630, marched to the ward room, then stand in lines to get our meds—determined by a doctor who puts you on what THEY want, even if I’ve been on the same meds for decades. The change in meds can result in auditory and visual hallucinations, or the feelings of ants or spiders under your skin. Patients are screaming, crying.
We had HUGE techs—mostly former football players who stand around and yell at us. And if we do something wrong (most of the time we have NO idea what we did!) we can’t go to the cafeteria to eat! I went from 140 pounds to 125 in two weeks. And you cannot go back to your room and sleep! Not until 8:30 pm.
Why is the place is run by huge techs? Because psych patients CAN injure each other and the staff, so the ALL-important thing anymore is staff safety. But when you USED to have many aides, nurses, space, group therapy, patients were caught BEFORE getting violent.
Because of state rules you aren’t allowed to put leather restraints on wrists and ankles and chained to a gurney. Now they just put you in a padded room—mustard yellow-green, like baby shit. Only a bare mattress on the floor—no blankets, just a paper patient gown, and it’s ALWAYS cold.
Getting medications? You know how when you buy a ticket at a movie theater, you talk into a microphone and they slide the ticket under the clear plexiglass glass—in the slot? That’s how you get meds. You have a bar code on your wrist band and the LPN scans the bracelet, then her computer opens the drawer and you get your meds. You say, “That’s the wrong meds.” They reply, “Take it up with the doctor.” Sure, a different doctor gives you two minutes a day. Your internist is NEVER called; these are isolated units.
The last time I was in, I also had breast cancer. The surgeries made my chronic pain syndrome worse and the radiation caused all the ribs on my right side—where the cancer is—and four spinal vertebrae to break. I was placed on opiates. The doctor REFUSED to give me pain meds other than Motrin 800 mg 3x/day! So not only was I dealing with terrible depression—4th anniversary of my husband committing suicide in front of me with a gun, losing our home, being in horrible debt—but NOW I’m going to go into withdrawal. It’s TEN times worse than anything on TV.
As long as those of us with psych problems are seen as “crazy people” or nut cases and told to “cheer up,” PEOPLE WON’T CARE. It would be like telling a person with a brain tumor to “Go running, take up yoga, volunteer to get your mind off yourself—it works for me!” We respectfully treat patients with cancer, heart disease, diabetes. But psych patients? We are a throw-away society, so nobody cares!
Two readers emphasize the brighter sides of their time in psychiatric care:
My experience after checking myself in at a mental hospital was almost entirely positive. I had been diagnosed as bipolar at 25. At the time, I was fresh out of a top-10 law school, but I had managed to endanger my career through a series of poor decisions.
After a brief round of treatment with lithium, Prozac, and Tegretol, I decided that sanity was overrated. I quit all my meds and slipped into a five-year period of uncontrolled mania. It was, in all honesty, the happiest time of my life.
I was completely manic (and happy) for five years of marriages, near marriages, and one-night stands. I slept one to two hours a day and salsa danced until five in the morning.
But after five years of partying, drinking, and dancing, my professional life was in ruins. Then one day, I woke up tired. The mania was over, and my thought space became a maze of reflections upon poor decisions, broken commitments, and manifest incompetence in both professional and family life. Bedridden, I slept and cried for months. Finally, I begged my mother and an ex-wife to drive me to a mental hospital.
As soon as I was admitted, I was given the hospital rules, a mountain of blankets, and a schedule. After years of making bad decisions, it was liberating to be told what to do.
I met other patients who, like me, had made messes of their lives. We reassured each other. We told each other we we would fight our mental illnesses together. And we proved to each other that we were not alone, that there were other people like us, and worse off than we were.
There were arts and crafts and shared TV. But above all else, there was joy—because we had plucked ourselves away from our lives and could rest and look at our existences from afar, and make decisions about our lives as if we were deciding for someone else.
I remember thinking, at the time, that checking myself into the hospital was the only good decision I had ever made. I even promised myself that I would do it again every year during vacation time. I never did, but that does not change my conviction that being at that mental hospital saved my life, and that hospitalization is the best option for many people at the end of a very short rope.
This next reader details his “quite positive” experience in a psych ward, noting several moments of kindness and support from strangers:
I’ve found the whole thread on psychiatric hospitalization to be worthwhile; I’m grateful to Eva for starting it. The story told by the woman who took her boyfriend to be committed was of course especially harrowing. I was sorry to read that she would intend to complete suicide rather than go back to a mental hospital. I really, really hope she never faces that situation. If (God forbid) she ever does, I really, really hope that she has or finds some motivation to endure it.
I’m not sure if there’s much I could say to her to talk her out of her intentions; she formed them in response to her own experiences. But, having read her story, I would like to share my own story of being hospitalized.
This was about exactly eight years ago. I was in my senior year of college. I had gotten to the point of tentatively testing whether my belt would hold my weight when I decided to go to University Health Services. They suggested I should go to the hospital.
I had to wait a little while for an ambulance. (I had offered to take public transportation, an idea which the clinician rejected.) I contacted my girlfriend to let her know; she got the idea in her head that she might be able to come and stay at the hospital with me, and packed overnight clothes for herself in my backpack, which she brought to me with a few of my things. She rode with me in the ambulance to the hospital and then had to go back. I wore her pajama pants for most of my stay. (I am male. The pants were purple.)
Most of what I remember from my time in that unit is, in fact, quite positive. The main negativity I remember is the realization that the staff (about whom I have no complaints in general) were monitoring me and evaluating my behavior. Of course this was odd, and it colored my interactions with them and the way I carried myself, but I understood why they were doing it. I’m sure the food wasn’t great.
Mostly I remember friendship and solidarity with the other patients. There’s the guy I roomed with my first night. We barely spoke to each other, and he was released after a day or two. But as he was leaving, he wordlessly passed me a piece of paper with “for any reason” and his phone number written on it.
There was another guy who I think was a few years younger than I am, but who seemed much more world-wise, who laughed at/with me (in a friendly “look at this nerd who thinks he’s getting high” kind of way) and gave me a high-five as I reacted with bemused surprise to the effect that a med seemed to be having on my vision.
Another patient’s family sent her edamame and she shared it with me and some other patients. It was a few days into my stay, and it was the first time I had had edamame. I in turn invited a newcomer who was passing through the dining room to come sit and eat edamame with us. Now, whenever I eat edamame, I remember the first time I had it, and it is a pleasant memory—a comforting and reaffirming moment from a dark time of my life. I usually have an impulse to share that memory with my dinner companions, but I suppress the impulse.
I have since studied to be a Christian pastor and hope to be ordained before too long. During my candidacy process I did disclose my hospitalization and my history of depression. Generally, one doesn’t want to talk too much about oneself when offering pastoral care. But I’ve wondered sometimes if there will come a time when the right thing to do will be to share with an individual or a congregation that I have been admitted to a mental hospital. Inpatient psychiatric care is not the end of the world, and I think it’s important for people to know that.
In an airport I came across your writing prompt for stories and started crying. I haven’t been a patient at a psychiatric facility, but just a few weeks ago I spent one of the worst days in my life at one.
I had been dating a guy for barely a month, but it had been a quick ramp-up. Part of why our relationship had developed an intensity so soon was an early realization that we shared some mental wiring—or mental-wiring defects, to be more accurate. What I didn’t realize until it was too late was that although we both struggled with depression, he was on the cusp of a major breakdown.
Not that he had been dishonest, or that we hadn’t talked about it; I just didn’t realize how bad it was until suddenly I was driving him to a psychiatric facility so he could voluntarily commit himself. Sitting with him in the stark, cold bleakness of an ER psych room, trying to distract him and calm him and cheer him for nine hours, was one of the hardest things I have ever done. He was on a gurney, and I was in a chair, and there was nothing else in the room: bare walls, a picture window facing a hallway where the ER psych staff sat. It was frigid, and they knew that because they brought blankets in right away, but they didn’t offer to adjust the heat.
Other than the initial checking in and psych evaluation, all completed within two hours of us arriving, we were just waiting. They never told us why it took so long, and they hardly even checked in as the morning and afternoon wore on. I babbled on about anything that came into my mind, and I tried to help him think through practical matters: Who do you want me to call? Is there anything I can bring you from your apartment?
When the doctor came in for him to sign the paperwork, I learned that the law in our state is that if you commit yourself and change your mind, the hospital is allowed to keep you for five days to evaluate you. And even then, it can go to a judge who might still rule against you. Five full days.
He signed those papers. Watching him, everything in me screamed DON’T DO IT!, but I kept my face still and nodded encouragement. And then a few hours later I had to leave, had to walk away from him and leave him behind a locked door.
I hated visiting him there. I hated my anxious interactions with the staff, who unevenly enforced rules and always hovered nearby. I hated knowing how much power they had over him and over me while I was in those walls. I hated the overpriced parking garage. I hated having to sign in and wear a name tag. I hated locking my purse and coat and cell phone in the waiting area. I hated planning my entire schedule around the limited visiting hours.
A few years ago I went to the ER for an extreme panic attack. I took an Ativan, called my psychiatrist to adjust my meds, went home—and it took a year to pay off the massive hospital bill. This episode with my boyfriend brought that all back, and whatever strength or progress I’d gained crumbled in a matter of days.
And then he broke up with me—a searing rejection that seemed to confirm my worst fears about being unlovable.
Later, after he was out, I told him the day he committed himself was one of the worst days of my life—and he told me it was one of the best days of his. And so you can imagine our mental healths as two lines on a graph, his slowly creeping upward just as mine comes crashing down, and that day is where we intersect. Before I had been so healthy, so great. But now I know I am not so far from needing to be in that place.
When I told my therapist how much I hated being in the psychiatric ward, she agreed with me that they are not built to be therapeutic; they’re built to be emergency safety measures. I understand that. But I also know I will never voluntarily submit to such a place. I’ll die first. That’s the plain truth, dramatic as it sounds. I’ll swallow pills and cut my wrists and make damn sure there will be no hospitalization. It will not be an attempt.
If you or someone you know ever gets to that point, the National Suicide Prevention Lifeline is 1-800-273-8255. And if you, like our reader, have an experience to share about a loved one or yourself in a mental hospital, please send us a note—especially if you think it might help in some small way. It seems to have helped Eva, the reader who started this whole series. In response to me mentioning that her story sparked a wave of reader emails, she replied:
Thank you so so so much. That’s the biggest, most beautiful compliment I know. For someone to find brief comfort or compassion or someone who gets it—that really is the best gift I know. Better than health.
Depression really feels like you are in this alone. I’m never really sure why that’s so, but it feels comforting that people understand. And if someone buys that book Stay for another person, that also means something to me. It’s the only one of its kind I know as a librarian, the only one to combine anything and everything secular that there is to reject suicide with. I give the book whenever I can.
Update from a dissenting reader who makes a nuanced distinction between our reader’s story and the general impulse to commit suicide:
You quote a woman who, reflecting on her time in the psych ward, says, “I will never voluntarily submit to such a place. I’ll die first.” She’s not actively suicidal; she’s trying to convey how extreme her desire to avoid the psych ward is. You immediately follow her words with a suggestion that readers at “that point” should contact the National Suicide Prevention Lifeline. According to the policies on their website, “a crisis center staff member’s decision to initiate active rescue for unwilling callers at imminent risk should be made without concerning oneself of the potential effects of involuntary hospitalizations.” I know referring your readers to a respected institution seems like the responsible, caring thing to do, but this series itself should be a reminder that those well-intentioned actions can have dangerous, devastating consequences.
My name is Emily, and I’m writing in regarding your series on experiences under psychiatric care. On October 25, I was admitted to an inpatient hospital after having suicidal thoughts. Although I did not attempt suicide, there was definite ideation. For 15 years I’ve been dealing with anxiety, depression, and an eating disorder (which goes back and forth between bulimia, restricting and purging, and just restricting).
I spent 11 days inpatient, and I just “graduated” from an intensive outpatient program yesterday. I could go into lots of detail about what I went through, but here are the major bullet points I’ll remember for the rest of my life:
Bawling myself to sleep the first night, but then experiencing a calm in being isolated and separated from my daily life and the outside world. (There was joy in not having access to my cell phone or a computer; the break from social media was freeing beyond all belief.) While most people around me were talking about when they would be discharged, I felt an emotional and physical release, which ultimately turned into very deep revelations about myself and my core beliefs. Among them: I am unworthy of love. Arriving at that understanding as an inpatient allowed me to work through what it truly meant and to figure out a strategic plan for combating that line of thought once I was discharged to “the real world.”
There were actually some fun times in the hospital. One patient told me a story about how he was pulled over by a cop who asked if he could walk in a straight line. The patient’s response? “No, but I can snort one!” It was one of those “too soon or not soon enough” jokes on a psychiatric ward that made me chortle. Later on in my stay, I became friends with some women my age, and we sit together drawing in adult coloring books, sucking on the straws you use to stir coffee for the oral fixation, sipping on actual coffee, and pulling out of our coloring trances to discuss whether we were feeling anxious, angry, upset, depressed, etc. I also remember trying to do the worm in the common area, and every patient in the ward was laughing to the point of tears, myself included. I was told I looked like a fish flopping around on the land. I hadn't laughed like that in ages, and it felt so good to just naturally laugh like that while making a slight fool of myself.
Having my meds changed multiple times in a short time span and feeling like a guinea pig.
Seeing people detox off drugs and alcohol was terrifying and saddening, and it also made me reflect on my own drinking habits. I’ve now been sober for 46 days.
Making Girl Interrupted jokes to my best friends when I would call them on the patient landline—our only source of communication.
From a 67-year-old reader:
When I was 40, I had simple shoulder surgery that somehow went wrong—improper oxygen intake, most likely. By the end of that year, my IQ dropped from 132 to 78. I had cognitive problems, long- and short-term memory glitches, and some physical symptoms as well. For the next six years, I was in and out of the locked psych ward in my local hospital for major depression that was eventually deemed resistant to treatment. I was under suicide watch, so my room was filmed to ensure my safety.
I got to know a few patients very well over the years. Our paths would cross in a group or in outpatient therapy, and I found each patient’s story fascinating. We really wrestled with ways we could reshape each other’s thinking strategies.
One trick was to try to figure out what someone was in for, before they told us. Some were easy: the grandma who lifted her skirt up when someone came in the room, or the man hearing voices who just wanted quiet (so no TV or radio in common room). My only mistake was a friend I knew from different intakes who always had a journal and a pen. When her pen broke one day, I told her I had a pencil and tried to give it to her. I hadn’t been there long enough to realize she had a pencil problem—and it ends with the pencil in and through her hand. Not knowing that, I gave her the pencil, I hear running, and—yup, she’s done it, and now I feel terrible.
The group was so nice to me over the pencil incident—explaining all the good I had done and brought to the table—that I had to forgive myself (and now I know not to repeat it). Years later I ran into that woman at a seminar. She held up her pen to me and said, “I’ve accepted no #2s, so I bought a Mont Blanc that cost a ton, so I feel so good about it; it’s all I want. You gave me that suggestion.” It felt good.
Normally all the staff was great, but what I found the hardest was arts and crafts. The limited amount of things you could make were equivalent to camp projects for 8-10 year olds. But participation is a must, and for some, crafts were about all they could concentrate on. So, a tiled box, a pencil case, and a poem came home with me. I think I still have them.
***
My ideation of suicide remained for a few years, and I would put myself in the hospital when I didn’t feel I could trust myself. I felt very safe there and worked through the issue.
The hardest thing to see is those who come in being newly diagnosed. These individuals are doubters; they’re not sure they really have an illness or how long they’ll have it. That acceptance takes time to totally ingested, chewed on—and they either spit it out and leave or swallow and start accepting “this is your life.” It is truly tough.
This next reader bonded with one of her therapists:
Thanks for compiling these stories. It’s nice to know I’m not alone in my experiences. I’m not sure if my observations would be of value to anyone else, but I reflect on them occasionally and still marvel at how strange my experience was.
I agree with Eva that most people didn’t seem “crazy”—except for the cute guy I was chatting up at lunch who mentioned that he flies with the witches (moral of the story: don’t look for love in a mental hospital) or the older gentleman who would literally only converse about the weather. But yes, they were all memorable. And they taught me little nuances of patience and empathy that I don’t think I could have gotten anywhere else.
One thing I thought was weird about hospitalization was the occupational therapy. I had always pictured that as helping someone to relearn how to write after a hand injury, but I guess in this context it was about helping people find joy in life or some such. So we did little-kid crafts, which seemed bizarre, but it was better than getting yelled at by the nurses for lying in bed too much.
My hospital was in a college town, so we had an occupational-therapy student working with us. She and I were about the same age and liked the same music, so we struck up a sort of friendship. She would come get me early for craft time so I could help her set things up and we’d hang out and talk.
One time we went to a park and sat on the swings while she told me how she was cheating on her fiancé but it was cool because she was going to stop once she got married. I sort of laid out why I thought that was a bad idea and talked her through what she really wanted in her relationship. She thanked me for the advice afterwards. That conversation reminded me that we’re all screwed up in some way, and it also made me wonder what the hell my parents were paying this hospital for if I was the one providing therapy.
Another strange thing about hospitalization was the field trips. I assume along the same lines as the latch-hook rug making, the trips were meant to bring us some measure of fun. I thought of it as an opportunity to possibly run into one of my college classmates and have to explain to them why I’m bowling with a bunch of strangers and psychiatric nurses. Luckily I never saw anyone I knew.
Probably the worst field trip we took was to the movies. For whatever reason, the hospital staff had chosen Forrest Gump. I sat next to a guy who grew up near me and who I’d hung out with over the past couple of weeks. He had ended up in the hospital after some sort of a drug arrest and contended he was only there because of that issue, but having talked to him a lot, I sort of thought he was deluding himself. At any rate, somewhere early in the movie we both realized the absurdity of taking deeply disturbed people to see what I assumed was meant to be an uplifting movie. We talked about how life is not like a box of chocolates; it just fucking sucks sometimes and you can’t do anything about that.
So I guess I appreciated the solidarity I felt with him over our hatred of the movie. He committed suicide a few months later, which further solidified my distaste for that awful film.
If you or someone you know displays warning signs of suicide, the National Suicide Prevention Lifeline can help: 1-800-273-8255.
This next reader had a horrible time as an inpatient, and her feelings ranged from lonely boredom to the fear of sexual assault:
I can’t tell if the timing of Eva’s letter is great or awful for me, because I’ve been in an inpatient psych ward twice in my life—and due to various circumstances, I recently began to wonder if I’ll soon be forced into a third. Eva mentions that her experiences have been a mixed bag, and I guess I’d categorize my experiences similarly, overall. But the negative moments have been so horrendous that more than once I’ve caught myself thinking it’s not worth saving my life if I have to be trapped in one of those places again.
I’ve only been in psychiatric wards in the U.S., and they’re pretty uneventful. The most notable thing about them is the widespread boredom. Sure, there are group therapy sessions and arts and crafts and meals, but all of those occupy at most 30 percent of the time. The rest of the day I spent lying in bed, staring at the ceiling and crying, or sitting in the community room watching whatever soap opera was on TV that day. You were not allowed access to any electronics—not even a cheap MP3 player to help soothe yourself—for the entire stay, and there were no locks on any of the interior doors.
The other inpatients were rather benign. (The only issue I had in that regard was an older man who either seemed to want to be my drug dealer or my sugar daddy, I’m still not sure which. Maybe both.) What elevated dull hospital stays into “Never Again” is the widespread incompetence and cruelty of the doctors who “recommended” my hospitalization and controlled my fate once I was there.
***
The first time I was an inpatient I was 16. I had been depressed since I was 11, and my illness had recently progressed into self-harm with scissors. When my psychiatrist found out, he forbade me from cutting myself and threatened hospitalization. Of course, because I was 16, I agreed out loud but in my head told him to go screw himself. I kept cutting.
At my followup appointment a couple weeks later, he asked me if I was still doing it. I didn’t take his threat seriously, so I admitted, yes, I had. He gave this long, exaggerated sigh and said he had no choice: He had to admit me to a psych hospital.
In Michigan, where I live, involuntary psych hospitalizations, even for minors, can only be administered by a court if the patient is an immediate threat to themselves or others [more details here]. I was not suicidal at the time, but my psychiatrist found a loophole: He said I could refuse to admit myself to a hospital, but if I did, he would call social services and have me removed from my home. And oh, he says, looking at the clock on the wall, “You need to make a decision quickly, because I have another patient in 20 minutes.” His reaction to seeing a 16-year-old girl in so much pain that she felt compelled to hurt herself was to rip her from the only sense of safety she had left.
So my parents admitted me to the hospital, where I stayed a week. When I had my intake exam, the nurse tutted, “These scars are nothing”—but they kept me anyway. For the first two days, I slept fully clothed and didn’t shower, out of fear that one of the random men coming to check on me in the middle of the night would assault me.
While I was there, the doctor on-call adjusted my medication. “How are you feeling?” she asked me the next morning. When I said I was just as miserable, she actually seemed confused, but anti-depressants take weeks to work. If even the doctors didn’t know that, why the hell was I even here?
The one bright spot came when a nurse took pity on me and showed me her clipboard. She let me know that someone was always watching us, and that they kept track of whether we took part in group therapy, whether we talked to other patients, whether we ate and how much. She said that little checklist was how they determined who had to stay and who got to go. She didn’t say it in so many words, but the subtext was clear: Fake it. So that’s what I did.
During my final interview with the on-staff psychiatrist, he asked me if I thought I’d ever cut again. And like a seasoned pro, I said, “No, because I don’t want to end up here again.” He smiled and nodded his head. “Good,” he said. “That’s why the doctor put you here in the first place.” That one statement was so repulsive to me—wasn’t the point of psychiatric care to heal people, not just scare them into compliance?—that I promised I’d never go back. That I would be so selective of what I shared with everyone, but especially medical professionals, that they’d have no reason to suggest it.
***
Four years later, the mask slipped, but my therapist pointed out that because I was an adult and the stay would be voluntary, I could leave at any time. I fell for it, only to arrive at a hospital where they said if I decided to leave, they’d just send me to another hospital that had no illusion of choice at all, and that hospital could keep me as long as it wanted.
I am not against inpatient hospitalizations, either voluntary or involuntary, in theory. But in practice, I can say with complete certainty that they have done far more harm to me than good.
Update from our reader, responding to my thanks for sharing such a personal and powerful story:
You’re welcome. I always feel a bit uneasy about sharing my negative experiences because I don’t want to outright discourage someone seeking help, but informed consent is important. Not all intervention is good intervention.
Another slap in the face I forgot to mention: being coerced into the hospital, having it not work, and having my parents get a bill in the mail for over $2000. Fun times.
Out of the blue recently, a reader emailed hello@ with a simple note: “I would really love it if The Atlantic did an article or collected reader experiences of stays in psychiatric hospitals.” I asked Eva if she’s ever been to one herself, and she replied:
Yes, I am in a psychiatric hospital even now. Not crazy, but in a severe depression for a year and a half now, with bad anxiety. Bad stuff in life a couple of years ago triggered this, plus a certain amount of genetic predisposition, plus not the right meds. In a year and a half, it’s been three psychiatric stays in the States, one in Norway, and three in Germany. I’m joking sometimes now that I should write about international comparisons of mental facilities :)
I do have the feeling that I’m finally better—knock on wood. I do often think about the everyday routines in these type of hospitals: the many biographies and patients with various illnesses you encounter, the humiliating events that happen, the bleak hopeless days where you merely hang in there, the struggle to maintain a measure of dignity for yourself, or the small unexpected comforts one finds.
I can think of many things to write about. And I would just love to hear from other people who have these types of experience. It is more common than one thinks.
If you’ve had a memorable experience in a mental hospital, either as a patient or staff member, please send us a note: hello@theatlantic.com. In a followup note, Eva elaborates on her experiences in poignant detail:
Humiliating events
There are many small things about psychiatric hospital life that can cause tear and wear on your personality and dignity—the whole sum of it, really: the meal times; the bed times; medications you may not want to take; having to be back on the ward by certain times; having to ring bells and wait for doors to be unlocked; staff going through your underwear and personal things whenever; having to step out of the shower to show you really are present when presence is checked; having to strip down completely upon admission to get searched for scars, wounds, injection marks, drugs ... between your toes and fingers, underneath your breasts. Just all of it as a whole, and keeping a measure of dignity, adult self-determination, and personality—and I guess, sass.
Personally I found it very humiliating to return to the same hospital a second and then a third time—both after an overdose of pills—and for prolonged stays. I felt like shrinking into the ground, like not meeting anyone’s eyes for the first few days. Here’s Eva AGAIN, still depressed, still not cured, with yet another overdose.
Although there is wonderful staff, there really are quite a few Nurse Ratcheds everywhere, and the encounters with them can wither your pride and not let you keep your chin up and head held high.
My absolute lowest low, and greatest sense of humiliation ever, was just after my most serious suicide attempt and closest call. I did this—and I am truly ashamed of this—on the ward itself.
I woke up in intensive care. Apart from that close-to-death feeling getting under your skin, and the actual overdose itself making you feel awfully sick for days, it is the behavior of those around you that alienates and humiliates. I really do know what I did was wrong, and that suicidal people need a strict environment—but strict does not equal bone-chillingly-cold people who avoid you, are mad at you, or think you have deserved this misery.
For days after the suicide attempt, I received not a single smile, not a single kind word—no encouragement at all. Lots scolded me harshly, and each seemed to think they were the first and only people to do that. I started to not feel like a human being. I felt I was not worthy of having survived. My mom didn’t speak to me for one week and that was terrifying.
I first recall a woman whom I had initially seen as not that smart (shameful for me), judging by her spelling errors and reading skills. It turned out she had been kept home throughout her childhood and teenage years—she was the oldest of many children—and she had to run the household and look after the younger children while the parents randomly took off. She had never been allowed to go to school and no authorities had kept an eye on that. So she did not learn to read and write into her thirties. The abuse at home took a toll on her, but she was so warm-hearted and determined.
***
Really, it’s very hard to pick among patients. To me, about two-thirds seem very remarkable. I have simply never encountered such a high concentration of extraordinary life stories as in a psychiatric hospitals. Very few seem “crazy” by the conventional ideas that many have of the mentally ill. Patients are from both genders, all ages and professions. They’re just beaten up by life events, and some by genetic predispositions.
The addicts often really impressed me, the people who tried for the gazillionth time to get off alcohol and/or drugs. It takes so much trying to stop substance abuse. Also, it is pretty obvious to me that staffers treats addicts worse than other patients.
Anyone who keeps suffering from truly severe depression and keeps trying is perhaps the most impressive to me. That is only being one small step away from the dead, and to tolerate that state for months or years and not know if one can ever expect true improvement … there is simply nothing harder I can imagine. I was in that state for a year and a half. It is my biggest fear to ever ever be in such a state ever again.
However, I gave up on myself three times during that length of time and tried to commit suicide. There are people so much stronger than myself who managed to hang in there without resorting to that. I think the ability to hang in, out of sheer endurance, is so much more important than trying to achieve immediate dramatic changes.
***
The years 2015 and 2016 in German psychiatric hospitals also meant getting to know many refugees, who are now a noticeable presence not just in everyday life, but as patients in hospitals. Many of them were Syrian, probably 80 percent of them, but also Kurds from various regions (right now there is an African lady on my ward, as well as a Christian man from Iran). The refugees here have really enriched my life over the past year. They’ve had hardships and traumas I can barely imagine.
Losses, to me, were one of the hardest things to tolerate. I thought I had lost pretty much everything—my job, my marriage, my apartment, life as I knew it in the States. But many of the refugees have lost more. I still have my parents, my citizenship to a country willing to look after me medically for free, a good education, and an environment whose language I speak. Here are some individuals completely on their own, without German or English skills, who have recently not only lost homes and possessions, but loved ones. Many have experienced rape, war, cold, hunger. You really can start over from nothing, with just the clothes on your back.
I know now that I may have lost most things that most people consider the essentials of an adult life—but I have everything really important inside myself; the rest was mostly just stuff or things that time can heal. If I get and remain well, I can deal with the rest. Even if I didn’t get really well, my life is worth something.
Small comforts
Showers and soap—they make you clean and a little new and shiny when nothing else does. Locks on bathrooms—once you are well enough to have a regular room.
The movies and songs from the 1930s and ’40s. Fred Astaire. Putting a shine on your shoes and a crease in your pants. Art therapy—not because it was cathartic or anything, no such cliché, but just rediscovering I was actually good at painting and accomplishing paintings I am still fond of.
Jennifer Michael Hecht’s book Stay: A History of Suicide and the Philosophies Against It. Books books books in general. Perhaps predictably. But despite a severe depression, I was always still able to read. I basically read a book a day. I would not exist without books. How would the time have passed, especially in intensive rooms, when you are hardly allowed anything? What worlds could I have escaped to? Many people are not able to read while severely depressed. Thank God I was.
Speaking of Jennifer Michael Hecht, a few years ago I did a reader-based “Ask Anything” video series with her. A Dish reader called the following video “the most useful encouragement I’ve heard to keep your life.” In it, Hecht describes the suicide contagion effect that spreads to the family, friends, and even strangers of people who kill themselves, making it much more likely that others will follow suit. As she puts it, “If you don’t kill yourself, you’re saving someone else’s life”:
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