Documenting my journey through the mental health system

I’m already at my two month mark for IOP. I can’t believe it.

Today started the module I’ve been simultaneously dreading and looking forward to the most – distress tolerance. As Dr Black and the therapist in IOP explain it – emotion regulation is for day to day life and utilizing coping skills. Distress tolerance is for crisis management and prevention.

The therapist asked us to think about times we behaved in unsafe or maladaptive ways, and that there was no judgment in the room if we did engage in unhealthy behaviors in the past. “What matters is you’re here now.” For me, it’s excessive drinking, quitting my meds, giving up on work, giving up on treatment, hearing command hallucinations, suicide planning and date setting, giving away my things, giving away my cat, inability to engage other coping skills, and other impulsive behaviors.

This is going to be an emotionally charged module. She also asked us what we thought distress tolerance looked like. I had one word in response: “prevention.” And that I was shaken in my faith – my last crisis and subsequent detention came eight months after a hospitalization in the VA psych ward in which I spent a lot of time on safety planning and distress tolerance. I thought I had done what I needed to do. And maybe I did, but it all seemed for naught when July came around and the police were dragging me out of my apartment to strap me down on a waiting gurney. “So I’ve lost some of my belief that it works, that I can make it work,” I tried to explain to the therapist.

She’s very understanding. Her voice is soft and lilting, and she’s very patient with the…patients. At first my jaded exterior bristled at the soft voice and overly nice words. I’ve grown to be less blunted in my own affect, and less judgmental of the other patients. I found both when I was in the hospital and here in IOP, my thoughts towards the other patients are sometimes harsh and critical. In the hospital I said I had nothing in common with these people. In IOP I silently judged the girl who wouldn’t leave an abusive boyfriend. I cast judgments left and right – this guy’s a narcissist, that one is dumb, this one talks too much. Her voice is grating and awful, that deep south accent is not cute and makes a person sound backwards and uneducated. I am trying to soften these harsh judgments because that was last week’s psycho-education hour lesson – holding a nonjudgmental stance.

All those judgments we hold about how the world should be or how things should go – those are the judgments that can hold us back and increase our distress.

During the process hour I said I’d had 6 hours of sleep in the last two days. I felt like I didn’t need that much sleep. There was still an “oof” reaction from the group when I said that.

“I’ve been out of my mood stabilizer for going on a week. It’s my own dumb fault – I go through that med twice as fast as the others because I take it twice a day and just didn’t put the refill request in soon enough. It’s on the way, but I have to wait, grinding my teeth and clenching my jaw in the meantime.”

A few group members could tell I was trending a bit manic, compared to what they knew of me so far. I spoke with rapid pressured speech and talked about my coping skills used for the past few days – I went to karaoke on Thursday and out to dinner with Ceila on Friday so I was using mood momentum and trying to keep the good mood going, or at least keep it neutral. I used to read and watch movies voraciously, and I’m distressed that I can’t seem to do that, my concentration is so poor I can’t read a book or watch anything for more than a minute. So I was focused really hard on mindfulness and staying present. I have practiced this one hard, daily, in a desperate attempt to stay sane because a madman was just re-elected to the white house and that is absolutely fucking terrifying but there isn’t a damn thing I can do about it. I cannot live in the past or the future. It is easy to say, the reality is mindfulness takes work and practice and is frustrating at first because I keep feeling like I’m doing it wrong. The reality is I have a lot of regret and flashbacks and sometimes I’m dragged back into the past.

I said all this to the group in a rush, not wanting to take too much attention or time. But sometimes once I start talking I can’t shut the fuck up, especially when I’m elevated. The therapist guided the discussion from distress tolerance to protective factors – what are they? What were ours?

In short, a protective factor is that which keeps you going, gets you up in the morning, gives you purpose, meaning, a reason to live. In my detainment paperwork the DCR (designated crisis responder) as well as the police mention me giving away my cat to my coworker, a known protective factor, or something that kept me alive. I’ve been taking stock of my other protective factors besides my cat – my brothers, my VA healthcare, my job (though not sure if that counts) a few good friends, my books (when I can read them) and my writing. Sometimes protective factors are the lack of something, like avoiding drugs and alcohol or removing all guns from the home, something that was done for me whether I wanted it or not.

IOP today was HEAVY. I’m still processing, and this post shows my thoughts are a little all over the place. I am a bit overwhelmed, wondering in my ability to safety plan again, all over again, and again. Wondering if I can truly change. My desire is genuine. I’ve been up and down this road so many times. I really scare myself and the extent to which my bipolar can absolutely wreck my life. It is like I said at the beginning of IOP – I’ve gotta do something because this shit has almost killed me more than a few times now.