My Monkey, My Circus: My Second Stint in Partial Hospitalization and Why it Stuck This Time
Trigger Warnings: Suicidal Ideation, Alcholism
Going outpatient is sometimes a necessity for T/MIs. When you don’t think you can sustain the façade that you are okay, and you need to take some time to step away from wearing the mask (the one you’ve created to ensure no one asks how you’re doing, because if they did, you’ll fall completely apart), hospitalization may be your only way forward.
It's a hard thing to accept. It was for me, anyway. Both times.
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I was waiting in the car, parked outside the outpatient center for substance abuse, where I took my then-boyfriend-now-husband for three-hour periods while he recovered from alcoholism. It was a long road, and a difficult one, and I finally felt like he was in a good place. But I certainly wasn’t. I had given every ounce of energy I had to ensure that he was doing better in his sobriety, that I had failed to recognize that I needed help, too. In that car, I started having suicidal ideations. Not just thoughts, but actually planning my demise.
My therapist at the time had me map out a plan for if I was having these kinds of thoughts (who I would call, or places I could go, or things I could do). I picked up my phone and called my sister. She heard the desperation in my voice, heard the hurt and the pain, and she said, “You need to call the behavioral health center for an assessment. I’ll call for you if you want.”
Long story short, I got the assessment and they told me that I needed to go inpatient, per my psychiatrist’s recommendation. I flat-out refused. I was so co-dependent with my then-boyfriend at the time that I couldn’t imagine being separated from him. The admissions lady was adamant, and I was adamant right back. So, tersely (after attempting to guilt-trip me by asking me what I had against their facility), she gave me instructions to go outpatient and said that if I didn’t show up at the address at 8am the next morning, she would call the police to do a wellness check.
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I had been having severe tooth pain, to the point that eventually I had to have my two back molars pulled because the pain was so great. But that hadn’t happened yet, and I had no relief from the pain. I was on a liquid diet, losing weight at an alarming rate. I was having panic attacks regularly, and my parents, who I was very attached to at the time, just told me that they were moving to another state. I was also in the midst of planning my own wedding completely on my own, and the stress was overwhelming.
Any of these things, individually, would not have caused me to start having suicidal thoughts, but all of them combined? I had no chance. I made the decision in an emergency therapist session to go for an assessment.
When I went in, the admissions counselor gave me the usual 20 questions, but she questioned the validity of my suicidal ideations. She asked, “Are you actually planning or are you just having thoughts? It sounds like you’re just having thoughts. I don’t think you’d really go through with it.” I wanted to say, “I need help. You want to squabble about the way I’d like to kill myself today?”
Despite that experience, I was determined to get the help that I needed.
Both of these experiences were hard to swallow for different reasons, but regardless of the way it happened, I went into partial hospitalization both times. The first time, I went unwillingly. The second time, though… I made the conscious decision to go outpatient. And that, I think, made all the difference.
THE ONLY STEP IS FORWARD WHEN BACKED INTO A CORNER
I realized that I could either decide not to care (which is where I was at during my first stint in outpatient), waste my money, time, and energy, and subsequently not get anything out of the experience, or I could contribute, not only to my health but to everyone else’s mental wellbeing around me.
First stint was hard. I never felt like I was being heard, and when I did open my mouth, I felt like I was being misunderstood and belittled (yes, by the counselors who were supposed to be helping me). Other than art therapy, the one thing I remember very clearly from that stint was one of the counselors being absolutely flummoxed at one of my core beliefs and repeating it in a voice that clearly had “Are you kidding me?” undertones. I didn’t talk again for the rest of the session.
Second stint was my choice. It was difficult in its own way, but it was a challenge that I had accepted for myself. And I had realized that if I was going to change, to become a better version of me, I needed to put in the fucking work. Despite the circumstances that led me to this place, only I could take the first step to mental wellness.
FINDING YOUR VOICE & A SEAT AT THE CIRCLE
I knew I needed to speak up, but damn, group therapy can be HARD. Especially when social anxiety is one of your major diagnoses. Typically, outpatient provides a group setting for the majority of the time, with a few individual sessions with the resident psychiatrist and your own assigned therapist per week. So the need to speak up was ever-present… and ever-anxiety-inducing.
When the conversation is flowing and you don’t have the courage to raise your hand to be heard in the right amount of time, someone else will take the opportunity, and by the time you get a chance again, the conversation has already shifted to another topic. You think, “Damn, I missed my chance,” and you try again. And again. But your courage is a little less each time, and you start to waver, thinking your opinion doesn’t need to be shared.
That is where you—and I, in this instance—would be wrong. I learned this the morning I finally raised my hand on the third day. And it wasn’t a meek little hand raise that said, “Please don’t pick me,” but I had my hand all the way in the air. And our group therapist, seeing me raise my hand for the first time, smiled warmly and said, “Amy, way to go! You’re ready to share your thoughts?”
Empowerment was the word I’d use when I heard him say that. I didn’t just hear what he said, but the intention behind the words: “You had the courage to speak up. Now we can’t wait to listen to what you have to say.” That was such a foreign concept for me, and instead of getting shy and sneaking away to a corner of the room, I spoke up. I contributed to the conversation and helped it flow, and I raised my hand three more times during that session. It was like I was on a high from the courage of my first step. And damn, did it feel good to be heard.
By mid-way through my treatment, I was raising my hand 3-4 times per group, and empathizing and giving suggestions and forming relationships and being authentically myself. By the time I was discharged, they were calling me the “Mom” of the group, not just because I’d been there the longest, but because they said my advice was “wise beyond my years.” The sincerity and vulnerability of that group as we worked through the most difficult aspects of our lives together made me feel comfortable enough to be the most authentic version of myself, and subsequently helped me realize things that I had never considered before. I got more out of being in those group sessions than if I’d had 50 individual sessions with my therapist.
SEEING YOUR FAULTS IN OTHERS
But perfection is a myth, and you can’t have too much of a good thing, right? Well, one day, a newcomer joined the group. Let’s call her Stacey. From the very first introduction, she took over the group sessions. Every time she raised her hand, the conversation shifted to her own concerns and neglected the point of the group. She was using us as a means to vent her frustrations and hurts without giving others the opportunity to voice their own concerns.
It was the second day she was with us, and the group therapist had asked her repeatedly to stay on topic and allow others to speak, which she pointedly ignored, and you could feel the tension in the entire group. No one liked her, and everyone was on edge from her emotional outbursts.
The umpteenth time that she opened her mouth (without raising her hand), I realized that I had been playing with the hairband on my wrist, flicking it against my skin to the point where I was hurting myself. I had to step out of the room for a minute before I started to hyperventilate and my face was so hot. I did some calm breathing in the bathroom, and when I came back out, the session had ended. I didn’t know why at the time I was having such a reaction to her, but my own therapist was the next group leader, so I went up to her and told her what had happened. She told me something that I will never forget:
“Not your monkey; not your circus.”
It was such a… baffling thing to hear. But my therapist had explained that I was feeling the intense emotional experience that Stacey was relaying, and her pain was causing me, an empath, to feel those things, too. What I also realized was that no matter what any of us said in that group in response to Stacey, she would not hear us—she refused to comprehend the advice she was given. She just kept rehashing the same stuff over and over again.
I hadn’t understood at the time, but I now know that I saw a little too much of myself in Stacey. Before this stint, I was the same way. I refused to hear what other people had been telling me, the sage advice I was given, because I was too wrapped up in my own emotional mess. And now, hearing it coming from someone else, after I had had the courage to move past that stage, made me angry. Made me worried that I would fall back into that same ugly pattern.
My therapist told me to release the negative energy that wasn’t related to me. At the time, that helped. But what helped even more was figuring out that the real reason that Stacey got under my skin was that I didn’t want to go back to being just like her. It actually was my monkey, my circus. Luckily for me, that propelled me forward instead of holding me back.
ALL IN OR NOTHING—A SELF-PROPOSED ULTIMATUM
So despite those few setbacks, I made it a point to get the most out of this stint in partial hospitalization. I threw myself into group therapy, I made the adjustments to my medications that were recommended, I did my therapist’s homework, and I even ended up giving myself extra homework when group topics weren’t completed by the end of a session.
I read every packet, completed every worksheet, and I gave myself the time and space to relax and settle back into my “new normal”—a healthier, happier version of myself that I didn’t recognize but was really starting to like.
If I hadn’t dared to raise my hand that third day, I would never have thrown myself into treatment and achieved anywhere near the same results. When I got out of this stint, my mental health was possibly better than it had ever been before.
I created the conditions for myself to succeed. I wanted to succeed and, because of that resolve, I made it happen. That confidence was not just necessary, but it compounded. It helped me develop a new version of myself.
MY TASK, MINE, MY OWN
What I really learned about these experiences was that no one can force you to get help. You have to want it. Like an alcoholic who hits rock bottom, it’s your task to recognize that you need help and that you can’t do this on your own.
And hospitalization doesn’t need to be scary. It resets your brain and gives you a chance to breathe away from the struggles of everyday life. It also gives you a chance to make changes to your meds in a safe, controlled environment with people who understand that you may have side effects.
You have the capacity for mental wellness. You might just need a little help getting there.
