Documenting my journey through the mental health system

I finished my first week of intensive outpatient, or IOP, through the mental hospital’s outpatient program. Tomorrow I start my second week. I am still processing it and how I feel about it. I am still just not sure.

Everyone is very friendly, very supportive. Almost too much. On the first day the therapist running it introduced herself and I was struck by her soft, lilting voice. It is almost like she is about to sing everything she says. You know that song, Comfortably Numb, by Pink Floyd? There’s a lyric near the middle of the song – “I do believe it’s working…good…” And that is how she says the word good, in response to the things other patients say. At first I didn’t make the association, I just knew the way she said that was maddeningly familiar.

I have issues with vulnerability. Issues with showing weakness, or being open. It is hard just to be open with a single therapist, let alone a whole room of people. If I am given compliments, or someone is open and vulnerable with me, I feel awkward. I feel strange if people are sappy and effusive with feelings. And this is definitely a very sappy group. The first half is spent processing – sort of like an informal counseling session with a whole group instead of just one person and a counselor. People talk about their problems – mainly with family, work, people – specifically in the past week. When it’s my turn, I’ve only been able to report what’s on my diary card – a sort of short questionnaire asking about sleep, appetite, med compliance, thoughts of self harm, and current feelings of depression/anxiety and such. They are like the morning and evening group sheets when in a psychiatric facility. On my first day I didn’t want to share at all but on the second day I thought, well I’m in this group, might as well talk – so I just reported my diary card and nothing else. Depression was low, appetite shit, sleep is shit…but my energy level is good because I have some hypomanic symptoms. I don’t need much sleep or food right now. I take handfuls of psych meds every day and I have been compliant. While others go on about their week and their problems, I just call it good with the diary check-in card and let the next person go. I feel shy.

I am on the hook for the next three months. They said at the beginning it can take time to recover from a mental health crisis, or at least, find an even keel. I had a hell of a crisis and was detained for nearly two weeks so it feels like I need this, I need something to grasp onto, to establish some kind of normalcy and stability even though I’m not normal and even though I am functioning a lot better. I am hoping this IOP will help me maintain things for longer. I’m hoping I’ll develop better insight into bipolar and borderline and learn when things are going south. This last time hit me like a ton of bricks in the face and after years of dealing with this shit, I still get blindsided.

After the first half of process hour, we take a break and come back for psycho-education. They follow the DBT model of therapy, or dialectical behavioral therapy. My first and second day was the DEAR MAN style of communication, or pursuing what you want and need from people. DEAR MAN is an acronym – Describe – state the facts. Express – how does it make you feel? Assert – state what you want/need. Reward/reinforce – do they get anything in return? Did you get what you need? Sometimes “thank you” is the reward. Mindfulness – be mindful of self, thoughts. Appear confident – even if you don’t feel like it, practice body language that makes you feel confident and look assertive. Negotiate – be willing to compromise, meet halfway, and adjust needs/wants. Sounds simple enough, right? But a lot of people have trouble with this and communication breaks down so easily. A lot of people also have trouble with boundaries – that’s the next subject we’re tackling this week, especially today. I think I have less trouble with boundaries than others – mine might be a little too good. I can drop a person and burn the bridge without a second thought. I left my own house when my mother became unbearable to live with, saddling me with all her emotional labor needs and attempting to micromanage me in my own house besides. I have no problem saying no. I have no interest in pleasing people. Half or more of the people in the group admitted to being people pleasers. I think I will do well on this part of the psycho-education for this week.

I am just having a lot of trouble opening up. The amount of support and positive affirmations in the group almost makes me sick. Haha. Not that they make me sick, just the amount of positivity with which to contend is a lot for me. I’m trying to be engaged and listen but I haven’t been able to talk at all yet, with the exception of the check-in on the diary card.

Mondays are busy. I see the psychologist, Dr Black, after work. She also uses a lot of DBT in her therapy. Then right after that I head over to IOP for three hours before finally getting a few hours of sleep and getting ready for work again. I have IOP every Monday, Wednesday, and Thursday and it goes for 3 hours each time.