A personal essay by Paula Harris: “I was admitted, under the Mental Health (Compulsory Assessment and Treatment) Act 1992, to the secure unit of the psychiatric ward just after noon on Friday…”
Content warning: This essay contains references to suicidal ideation which may be confronting for some readers.
It was Friday the 13th. That isn’t a joke; it isn’t some literary device to further this piece. It actually was Friday the 13th. I had a meeting at 9:30am with my new hospital psychiatrist. People said to me beforehand that Friday the 13th is awesome, that this was a good sign and that this meeting – my fourth psychiatrist in six months — would go well. It’s Friday the 13th! It’ll be great!
Spoiler alert: It wasn’t great.
*
I’d had a really rough week. My hospital psychologist was away for the school holidays, so I hadn’t seen him for a fortnight. I was sad and hope-lost and so very sick of myself, because that’s what severe depression is like. I had been due to meet with my Community Mental Health Services key worker, Jimmy, on the Wednesday. (A key worker is your primary contact at CMHS, there to help you navigate essential services.) This was a stop-gap measure to talk with someone while my psychologist was away, but, at the last minute, Jimmy had to cancel when another of his patients had a crisis.
I was anxious about having to meet with the new psychiatrist, because the last one had made me really uncomfortable; I’d walked out within 90 seconds of him commanding me to sit down. Because the new psychiatrist was going to be the 13th mental health professional I’d seen, which meant I’d have to explain all my background stuff for the 13th time, and I’m so exhausted by having to talk new people through all of this. Because at some point he’d ask me if I think about suicide and I’d say yes, and he’d ask me if I had a plan and I’d say yes, and he’d ask me to tell him my plan and I’d say no, and he’d frown and push me for details, because that’s the interaction I’d had so many times before. Because I was anxious about sleeping through my alarm, because my depression is exhausting and I struggle to wake up.
I’d never thought of myself as someone who had anxiety. I tend to be shy and introverted, so I can feel stressed when having to deal with strangers, especially in large groups, but at the same time I’m used to teaching groups of people — in my life I’ve taught Pilates and massage and Italian cooking and Argentine tango — and being loud and funny and outgoing, and that being a part of who I am.
As my current episode of depression has progressed — as I write this, we’re nearly three years into this episode — I have retreated more and more from the world, so that when I do have to go out and interact with people, I get stressed and, yes, I become anxious. My psychologist, the Lovely Harry (his name is Harry and he’s quite lovely), told me that this is called social anxiety. My social anxiety really only became real, as opposed to me feeling stressed around people, as a result of one of the antidepressants I was taking. I can’t even remember which one it was now — there have been so many antidepressants — but I remember how it gave me chest-crushing palpitations. And somewhere along the line, while my ribs felt strapped down by the medication and my heart was trying to escape, somewhere in the middle of that, social anxiety found a spot to plant itself. In the fertile manure of my depression, it grew well.
On Friday the 13th I was five minutes late to my psychiatrist appointment. I had overslept a little — why do hospitals make psychiatric appointments for the morning, when a sizeable number of psych patients struggle in the morning? — and had rushed to have a shower and eat breakfast and get dressed and walk the seven minutes from my house to the hospital. Community Mental Health Services is the home for psych outpatient treatment. It’s housed in an old two-storey brick building that would be stunning if someone showed it some care.
Jimmy came to get me from the waiting room, because your key worker sits in on your psychiatrist appointments. The mental health system has fucked me around since I was referred into it by my GP, and I tend to push back when I feel that people are messing me around, so Jimmy is my third key worker. I like Jimmy. My patient file at CMHS notes my trust issues with people, including (possibly especially) with CMHS staff. The Lovely Harry had told me, before he left for his holiday, that I need to take chances; I need to give people the opportunity to not disappoint or hurt me.
I won’t refer to my psychiatrist by his real name. The simple fact is that hearing or saying his name triggers an anxiety attack. And I don’t need that shit. I call him Voldemort instead.
Voldemort didn’t give me bad vibes straight away, not like my third psychiatrist had. But, whereas numbers one and two had been open and engaging in their energy, he was aloof and closed off. My inclination was not to answer his questions, but I kept thinking about Harry telling me to take chances and trust someone. I kept thinking about how I needed to be upfront with people so that they could help me get better. I was depressed and worn out, and then Voldemort asked, “Do you think about suicide?”
I told him, “Yes.”
“Do you have a plan?”
I slipped deeper into my chair. “Yes.”
“Can you tell me your plan?”
“No.”
Everything in the room changed. It was as if someone had mixed cornflour into the air to make it thicker. Voldemort’s body tensed, as if every cell inside him had shrunk.
Because you’ll ask, I don’t tell anyone my plan. Because it’s the security blanket I curl into when I’m having a really bad day, knowing that there is a way out. Because I don’t want to risk anyone taking that from me.
The long story involves two hours of papers being shuffled and people talking about me in hallways and Voldemort and another psychiatrist — who met me for all of five minutes — signing paperwork. The long story involves my realisation that as soon as I said yes, no one would listen to anything I said after that. The long story feels surreal. The long story is about how it felt like all of this was a joke, a misunderstanding, and any second now it would all be cleared up.
The short story is that I was admitted, under the Mental Health (Compulsory Assessment and Treatment) Act 1992, to the secure unit of the psychiatric ward just after noon on Friday the 13th.
*
Being sectioned has various time frames. Your sectioning can be cancelled early, if an appropriately authorised person signs a form to say that you are no longer mentally unsound, but otherwise the first time frame is five days. At the end of the five days, if you are not released, there is a further 14 days. After the 14 days, the time frame moves forward in periods of six months.
“We’ve just finished making up your room,” I was told, as if I was staying in a nice hotel.
My cell consisted of an upholstered plinth and a mattress, along with a pillow and sheets, which I was repeatedly reminded that I should be grateful to have been allowed. I sat down on my mattress. I was shock and confused and alone. I had no real idea as to how things had reached this point. I realised that whatever I had done wrong that got me declared mentally unsound on day one wasn’t going to go away by day five. And then I’d be here for another 14 days. And I didn’t know what I could say on day 19 that would change things, so then I’d be here for six months.
That is when I truly developed anxiety.
The ward staff rang my emergency contact, and I was shown to the phone booth to talk with her. Her only concern was how she could get me sufficient supplies of clean underwear. How could she get into my house? Was there a spare key somewhere? She could go to Farmers and buy me some, if that would work? Did someone else have a spare key to my house?
All I wanted to do was cry. I couldn’t see how I was ever going to get out.
I was tired and scared and alone and hungry. The ward staff had promised to bring me some lunch when they finished admitting me, but they forgot until sometime after four o’clock. They gave me a plate of ham sandwiches, even though I’d said that I don’t eat pork products. They sighed. I pulled the bread away from the ham and ate that, and then found one egg sandwich at the bottom of the stack.
I pushed back at the psych ward system. I wanted to see a psychiatrist. Surely, if I saw someone other than Voldemort, they’d realise that this was all some crazy mix-up and would let me out. Or, at least, they would start me on a new antidepressant, since that had been my main aim for my appointment with Voldemort. The nurses kept telling me I wouldn’t be released ‘until you get better’, and, to me, starting medication seemed like the best way for me to start getting better. The ward psychiatrist — whom I’d initially been told I’d see on Friday afternoon — had finished for the week, but I found out that there was an on-call psych registrar. I asked for them to be paged. I was told they could only be paged if there was a reason. I stared down the nurse and said, “It’s my right as a patient to see a doctor.” She frowned at me, and left.
The psych registrar showed up around ten at night. He made it very clear from the start that he had no interest in taking any active steps. He wouldn’t prescribe me any medication. He wouldn’t tell me what I needed to do “to get better”. I’d have to wait until the ward psychiatrist arrived on Monday before anyone would discuss medications or treatment with me. I would spend three days of my initial five-day time frame without any form of treatment, but I’d only get out on day five if I was better. It seemed impossible.
I was tired and scared and alone and I tried to go to sleep. In the secure cells the light switches are flat metal buttons. I closed the blind, which was secure between two panes of glass, and pressed the buttons so that I could have darkness. But only one light went out. I pressed the buttons again. Still, light. I tried the button on the other side of the room. Still, light. I pressed the button to page a nurse.
When the nurse arrived she told me, “You have to have the light on. You’re at risk.”
“But the light’s right over me. I can’t sleep with the light in my face.”
“You can have the light turned off once you get better.”
I lay on my bed thinking about how I was never going to get out, because I can’t sleep if it isn’t dark and therefore I was never going to get better. At some point the nurse came back and showed me where the main light control was for my room so that I would stop crying.
Finally, I had darkness. I cried quieter. The nurse shone her torch through my window every ten minutes.
I didn’t like how quickly I got used to the rhythms of the secure unit. There are just six beds, six cells; a maximum of six patients.
One nurse for every two patients. My morning nurse came in to wake me up and was surprised by my irritability.
“I spent all night cold and tired and hungry,” I said. “Why the fuck would I be irritable?”
The afternoon nurse brought me a blanket and told me that they could, technically, order me snacks from the hospital kitchen.
The night nurse tut-tutted that I had been given a blanket, since I was at risk and therefore should have nothing.
By Saturday lunchtime I was the only female patient in the unit. I was 20 years older than any of the others. I kept to myself, staying in my cell unless I had visitors and was in the interview room. I swung between freaking out that I was in the psych ward and accepting that I would be there forever. How can you possibly get out when you don’t know how you got there?
*
At this point my medical notes start to comment that I was improving. But I was giving up.
On the Monday I was woken by a nurse, as the ward psychiatrist was waiting to see me. I didn’t know what to expect. I was tired and scared and alone. I didn’t want to say the wrong thing again. I didn’t know the right thing to say. My head was still bogged down inside the little sleep I’d managed in those last few hours of night. I went into my bathroom, where I could tuck myself behind the door to get dressed out of view. The nurse was irritated that I was taking too long and called from the door to see if I was going to meet with the psychiatrist.
“I’m just fucking getting dressed!” I yelled back at her.
I finished putting on my socks — you can tell the patients from the staff because patients shuffle around in socks, our shoes taken from us due to the laces — and scuttled across to the interview room. The ward psychiatrist had a thick American accent. Her energy wasn’t tightly wired like Voldemort’s had been; she was relaxed and alert on the couch. I slouched into the chair opposite my nurse and a registrar, who wrote notes throughout. I didn’t know what the right things to say were and was too tired to filter my words. She asked what had happened that had gotten me admitted to the ward; I told her that my psychiatrist was a dickhead. But then we talked. She was yet another mental health professional whom I had to explain my stuff to.
“Well,’ she said in that way only Americans can say well, “there are two types of suicidality — acute and chronic.”
She felt that I was in the category of chronic, and in those cases treatment is best out in the community rather than in the psych ward. She was comfortable with the idea of discharging me, if Harry agreed. I would be transferred to the open side of the psych ward, to start “transitioning” back to the outside world.
I remember snorting inside that I would need to “transition”.
She said I might be released! Bring on the outside world!
My nurse took me for a tour of the open side of the ward. After the smaller, darker space of the secure unit, suddenly there was so much stimulation. I was overwhelmed by the people, the light, the voices. I stuck close to the nurse and shuffled back to the secure unit behind her. It took a couple of hours before a room was ready for me in the open side, and I didn’t want to go. I knew the secure unit, I felt safe there — and I felt freaked out at feeling safe there. But they needed my cell for someone else. My new room had a window that could open, and shelves and light switches and two chairs and an actual hospital bed. I stayed in my room. A visitor arrived for me, and we went into one of the interview rooms, where we could lock ourselves in and not be disturbed by anyone. The furniture was awkward but I fell asleep on a beanbag, my visitor stroking my arm as I was released just before five o’clock. Harry had told the ward psychiatrist that he thought it was the worst place I could be. My visitor stuck around until all the paperwork was finished and I was given the letter officially declaring me to be mentally sound. There was a brief joy of walking out of the ward and to her car, so that she could drive me and my accumulated belongings — poetry books, pens, notebooks, underwear — back home.
But once I was home, I struggled to return to the outside world. The next day, Tuesday, I had a scheduled appointment with Harry. The seven-minute walk took closer to 15, as I had to stop for an anxiety attack along the way. When I arrived, Harry led me through to the room where we have our sessions, and I cried and hyperventilated.
Over the next two months I spent so much time rubbing the tight spot on my sternum, just trying to breathe, that I was amazed I didn’t bruise. Harry encouraged me to take long exhales. I felt as though an alien would burst out of my chest.
My fear of being put back in the psych ward is a travelling storm that hovers above me. Harry reassures me that it won’t happen, that I won’t go back, that the ward psychiatrist would most likely refuse Voldemort if he tried to admit me again, but the rational argument doesn’t convince the reflex fear to go away. And every week I have to walk with that anxiety to CMHS. To walk into the building that Voldemort is in. To know that people can choose not to hear me and force me into hospital against my will, a power no other medical speciality has. To fear saying something wrong and being readmitted.
Anxiety is the gift that my fourth psychiatrist, and the psych ward, gave me.
*
I don’t leave the house much anymore. The anxiety became so overwhelming that, whenever I tried to work, I would spend the first five minutes of every Pilates session crying and struggling to breathe in the corner. Getting there had exhausted me and now there were all these people — my warm, loving clients — who I had to think about. I hated that I was doing this to my clients, so I closed my business of 20 years.
I have strategies to help me get to my weekly session with Harry. I never have an appointment earlier than eleven o’clock, so that I won’t get too anxious about oversleeping. When I wake up, and again before I leave the house, I use an essential oil blend to help calm me, putting a small amount at the base of my skull and on my sternum, where the alien wants to break through. I use a homeopathic spray to help calm me down as I sit in the waiting room.
For the first couple of months after being sectioned, I wore clothes that I felt I could run away in. Now I try to wear things that make me feel good. I put on my headphones and listen to music while I walk to my appointment. Aretha Franklin’s ‘Think’ is particularly effective while crossing the hospital carpark. It don’t take too much high IQs / To see what you’re doing to me…
If it’s a really rough day, I’ll keep my headphones on while I sit in the waiting room. If I can stay inside the music, then the anxiety has less space to grab hold of.
Harry helps by trying to book us into the same meeting room each week, so that I’ll be in a familiar environment. Every week he tells me to do whatever I need to in order make the room more comfortable, to open or close the windows, to shift the chairs around. What I really want is for the room to not be in the same building as Voldemort. To not be in the same building as Community Mental Health Services.
Voldemort’s decision made me stop trusting myself. He took away my power when I was incredibly vulnerable.
I want to not feel anxiety sprinting through my body anytime my heart rate goes up a little. I want to not feel that air is repelled by my body. I want to not have nightmares every single night. I want to talk openly with Harry and not hold back because I’m terrified that this might be the thing that changes his mind and makes him call out for a psychiatrist. I want to walk up my street without feeling anxious because I’m walking vaguely in the direction of the hospital. I want to not cry when I get mail from CMHS. I want to not jump whenever the phone rings, because I think they — the hospital, the police — are on their way to take me back in.
I want to go back to the old me, the person who just got hung up about having to meet new people. The me who was still here on Thursday the 12th.
Support services
Need to talk? Free call or text 1737 any time for support from a trained counsellor.
Lifeline – 0800 543 354 or 09 5222 999 within Auckland.
Samaritans – 0800 726 666.
Suicide Crisis Helpline – 0508 828 865 (0508 TAUTOKO). Open 24/7
Depression Helpline – 0800 111 757 or free text 4202. This service is staffed 24/7 by trained counsellors
Samaritans – 0800 726 666
Healthline – 0800 611 116
Counselling for children and young people
Youthline – 0800 376 633, free text 234 or email talk@youthline.co.nz or online chat. Open 24/7.
thelowdown.co.nz – or email team@thelowdown.co.nz or free text 5626
What’s Up – 0800 942 8787 (for 5–18 year olds). Phone counselling is available Monday to Friday, midday–11pm and weekends, 3pm–11pm. Online chat is available 7pm–10pm daily.
Kidsline – 0800 54 37 54 (0800 kidsline) for young people up to 18 years of age. Open 24/7.
For more information about support and services available to you, contact the Mental Health Foundation’s free Resource and Information Service on 09 623 4812 during office hours or email info@mentalhealth.org.nz
Paula’s essay is an excerpt from Headlands: New stories of anxiety edited by Naomi Arnold (Victoria University Press, $30), available at Unity Books.