Anhedonia

Gesundheit.

Don't know what anhedonia is?  You probably are not alone.  But it is one of the big symptoms of depression.  Before you scamper off to google it, I will just go ahead and tell you.  Anhedonia is the inability to take pleasure in things that are typically pleasurable.  So basically, you do not enjoy anything.  The things you used to love doing?  They are just another thing.

I certainly had/have anhedonia.  Things I used to love doing became passe.  They were boring, they provided no joy, they no longer made me happy.  So can you imagine that?  When something you love to do is suddenly a pointless venture.  Ok, so maybe not suddenly, but it still sneaks up on you pretty quickly.

I am getting past it though.  I can find things fun again.  For over a year I really didn't find much that was fun or at times even enjoyable.  But now, I finally find myself smiling, laughing, enjoying simple things. 

So remember when I told you about weird vivid dreams?  So, I was in my old apartment, the one I grew up in in North Kansas City.  In the bathroom to be exact.  There was a window that looked out towards the park.  I looked out of it and I see this thing flying towards me.  Its brown.  It get's bigger.  It's a duck-billed platypus.   A flying duck-billed platypus.  It smacks into the window and just stands there looking at me.  I do what any normal person would, I pull out my phone and take a picture of it.  It cocks it's head to the side staring at me.  That is the last I remember of that dream.  I am pretty sure no one in the world has ever dreamed of a flying duck-billed platypus in Missouri hitting their window.  

So I decided to go onto the interwebs and see just what the significance of a platypus is in dreams.  I am actually a little taken a back by what I found.

"To see a platypus in your dream refers to your tendency to wallow and dwell on your emotions.  It may also suggest that your repressed thoughts and subconscious materials are slowly coming to the surface and making its presence known. Alternatively, a platypus is indicative of shyness and reservation, especially in social situations." 

Interesting to say the least.  Ok now to see what it means to be in a bathroom.

"To dream that you are in the bathroom relates to your instinctual urges. You may be experiencing some burdens/feelings and need to "relieve yourself". Alternatively, a bathroom symbolizes purification and self-renewal. You need to cleanse yourself, both emotionally and psychologically."

 Now this is getting a little odd.  Let's look at window.

"To see a window in your dream signifies bright hopes, vast  possibilities and insight. If the window of a house is dark, then it indicates a loss to your perception or vitality. 

To dream that you are looking out the window signifies your outlook on life, your consciousness and your point of view. It also refers to your intuition and awareness. You may be reflecting on a decision. Or you need to go out into the larger world and experience life. If  you are looking in the window, then it indicates that you are doing some soul searching and looking within yourself. It is time for some introspection. To see another face in the window in your dream suggests that you are feeling emotionally distant and physically detached.  Also consider the emotion depicted on the face."
 I am not one to believe in dream interpretation, but this is just odd.  Who would have thought that dreaming of a platypus while in a bathroom looking out through the window would be interpreted as things so close to what is going on in my life.  But, I guess that you could just about apply those definitions to just about anyone in any situation.  I am still pretty sure no one has had a dream like that though.

Mostly cloudy with a 70% chance of meh.

I'm not ok. I tell myself that I am but, in reality, I am a work in progress. It is true that I am better than I was 6 months ago, better than I was a year ago, better than I was 3 years ago, but I am still not good. It is hard sometimes to explain why I feel the way I do. Like I am hard wired to dislike myself. Like nothing I do is ever good enough. Seeing the bad in situations instead of the good. My mind is a dark cloudy place where sunlight is slowly peeking in. Just like a never ending springtime storm when all you want to do is go to the park. I know how this sounds. It sounds like I am terrible. It sounds like I have broken again. But, I'm not. I am better than I was. Before, it was all clouds with no peeking sun. All downpour, with no relief from the beating wind driven rain that pelted my minds eye.

I have never really put much thought into why I am the way I am. There is no answer that doesn't sound like a cop out. People have had rougher lives than mine and been just fine. Deeper struggles and less support. Does that make me weak for allowing myself to fall so deep into depression? I can't help but think that it does. That is just the way it is.

Now people will tell me, "you aren't weak," but how am I to believe them? Who are they to tell me what I am and what I am not. Someone like me should be able to handle emotion, not run and hide from it. Someone like me should be able to get better more quickly than I am. Someone like me should be a man and quit his bitching.

Being scared of a relapse is tiring. Scared of a sequel to the act that took place just a few short months ago. Terrified of the legacy you will leave for the people around you. My thoughts used to be people would be better off without you, your kids would be better without you in their lives, you would not be missed for long, the world would forget about you and move on. Now, my thoughts stay away from ideas like that. They now invade me with thinking how can you be so weak? How can you be so reckless? How can you not be normal? Why couldn't you have just died?

Then POW. You snap out of it. You know this path all too well. You know where this leads. You know...better. Thoughts like this do no good. They only reinforce that part of you that needs to be fixed. That needs time to heal.

This is the point where my therapy comes into play. Cognitive Behavioral Therapy, or CBT, to be exact. The point of it is to change your thinking. To replace those thoughts with more healthy, more positive ones. Tell yourself everyday, multiple times per day, that you are a good man, you are a good father, you are on the right path, you are loved and worthy of that love. The thinking behind it is if you do this, you can retrain your brain to believe in these affirmations as truth. That you can talk or think yourself better. Does it work? Studies say it does. I guess time will tell. Like I said, I am better than I was 6 months ago.

I know this post seems very dark. Darker than my others. But this is me. This is depression. You have good days and bad. The key is to start having more and more good days. For a long time good days were few and far between. Now, they are coming more often. I still have trouble with my thinking, with my ability to enjoy things, and with irritability and anger. But it is getting better, and that alone is enough to keep me going on. To keep me fighting. To keep working towards being me again. To not give in to the thoughts when they come. To find something better to do than sit and think thoughts I know I shouldn't. To go out and do things, fun things, maybe even with people I have not seen in awhile.

So there I am. Scott Rivera at 32 going on 33 years old. Sure things could be better, but they certainly could be worse. I still sometimes worry about things, things that don't need to be worried about so much, but that is anxiety. I always thought anxiety was just nervousness squared. Panic about things. Anxiety wasn't me. But I have since learned that anxiety is the overreaction to minor things. Making a mountain out of a molehill if you will. Every little thing becomes a big deal, every minor failure is devastating, every minute character flaw is no longer just a quirky personality, it is much more, your flaws define you. You begin to believe these things as truth. They snowball by quickly out of control and you are stuck. You do not see a way out. You end up in a by bad place if you don't find your way.  When you compound that with something like depression, it can be so much worse.

Don't be me.  Don't wait until it gets out of control.  Do something early.  That is the best advice I can give to someone who may have mild depression and is just realizing it.  Get help, it is much better than the consequences of not getting help in time.  You owe it to yourself to not let yourself slide down the spiral of depression, because it is not just you sliding down, it is everyone you care about too.  They won't let go of you, you will drag them down, you will hurt them.  But you can avoid that.  You can get help before that happens.

I have decided to add two pages to this blog.  As you can see at the top, there is the blog page, the music page, and now there are two more.  One with a "Depression Quiz." and no it a quiz about my posts, it is a quiz to see if you have signs of depression.  I am also adding a page with links to some local and national resources.  I know there are some of you out there from far away, so I am sure the local links won't apply to you, but maybe they will help you find help in your area.

As always, if you have any questions, comments, or anything else, do not hesitate to contact me via the comments on this page.  I will do my best to respond to them as I can, even if I don't know you.  Do not hesitate to post anonymously if you wish to not be identified. 

Sleeeeeeeeeep

So for me, the medications I am on cause a few unwanted side effects.  The ones that are most annoying to me are weight gain, concentration issues, lack of motivation/energy, and vivid strange dreams.  The weight gain sucks for obvious reasons.  I really need to do something about it, but alas, that is where the lack of motivation and energy come into play.

The Remeron I am on causes severe cravings for food.  Most notably, it makes you crave sugar and carbs.  As my psychiatrist put it, "One of my patient's who was on Remeron sat down and ate a whole cake in one sitting because of the cravings.  He also said it made him want to sit down with a spoon and eat a bag of sugar."  Now I am not that bad.  I have not devoured whole cakes or snorted powdered sugar, but have partaken in more sweets than I probably should.

Concentration issues, well that one is easy enough to understand.  I am in school and it almost causes an ADD type feeling.  Professor will be lecturing and I find myself being distracted.  Thank god there are no windows in the classroom... SQUIRREL.

Sleep and dreams are maybe the worst of the side effects though.  You know how sometimes you have a dream and you wake up for a minute then go back to sleep and it is just a continuation of the dream?  It is like that.  Every night.  The dreams are very life like and typically stem from real life.  Your mind plays tricks on you since they seem so real.  Was it a dream or did this actually happen?  Sometimes, it is harder than it should be to tell. These dreams are sometimes referred to a hallucination dreams because of how real they seem.  Take the one I had last night.  I don't recall much of it, but I remember stirring a powdered flavor to my water.  It was purple and didn't dissolve well.  I can feel the coldness of the glass, the condensation on my hand as I use a straw to poke and stir the powder into the water.  The feel of the ice on the tip of the straw as I move it around.  The cold rush of the first sip, the undissolved powder gritty on my teeth as I break it down with my front teeth.  You see, these dreams are so real, you believe them.  You are in them as you.  It is like an alternate reality, where reality is blurred.  The dreams often involve things you have thought about before, a movie you watched, a song you heard, a story someone told you.  You are in them, but not in a cheesy Hollywood way.  It is hard to explain just how it feels to be in these dreams, so deep, so involved, so... real.  But they aren't real.  They aren't reality, they are imaginary.  But at times you recall them so clearly and remember the taste of things, the smell, the breeze, the smallest little nuances that make you think it is a memory, not a dream.  When you can not tell reality from dream, you begin to wonder if you are ok, if you are becoming more than just depressed.  You start to wonder about your mental health a little more.  But it is all just a side effect of living with depression.  The drink, was grape-lemonade, like Kool-Aid's Purplesaurus Rex from long ago.  A drink I had as a kid.  So you tell me, was it a dream or a memory?

One of the reasons for all of this is extended REM sleep in people with depression.  The Rapid Eye Movement (REM) sleep cycle is one where you aren't in deep sleep, and dreams typically occur in the REM cycle.  The Non-REM cycle (NREM) is deep sleep.  This is where your brain is able to relax, rest, and recharge.  Studies have shown that people with major depression have nearly twice as much REM sleep as people without depression.  They also show that it takes someone with depression half as long to get to REM sleep, which means a large decrease in the initial deep sleep pattern, where the brain gets to rest and separate reality from dreams.  There are some studies that suggest REM sleep in people with depression could be 3 to 4 times that of people without clinical depression.

So what does all that really mean?  Well, during REM sleep your brain, and body are excited.  Your brain is stimulated and working hard.  Additionally your body is excited and working as well.  You may not be moving but your muscles are working along with your brain.  You don't get as much of a  release of human growth hormone when you don't get into that first deep NREM cycle.  This doesn't just affect growth, it also has an affect on the bodies ability to recover and heal.  Studies also show that this change in sleep cycles lowers your white blood cells by up to 20% affected your ability to fight off infections.  Maybe this finally explains all of my illnesses and inability to recover well from surgeries.  It is as good an explanation as any I guess.

So why does this happen?  Well we are back to our old friend serotonin.  Serotonin as you remember is one of the major neurotransmitters linked to depression.  Almost all antidepressants work to increase available serotonin.  In regards to sleep, serotonin inhibits REM sleep.  So basically you need to have serotonin to break out of REM sleep and to get into a deeper sleep cycle. 

So many things are tied to good sleep, and so much is lost when the sleep you get is not the proper type.  Someone, like me, with depression may sleep 7 or 8 hours at night, yet because of the disturbed sleep cycles, only feel like they have gotten one or two hours.  This compounds and increases anxiety, agitation, concentration deficits, and so many adverse affects.  For me, sleep and agitation were two of the worst symptoms I had.  Now, at least I sleep and feel much less irritable, but when I sleep I often wake up not refreshed, but tired.  Worn out from sleep.

Kid gloves and some science

I feel like people sometimes handle me with kid gloves.  I really do not want anyone to walk on eggshells or to treat me differently than they used to or would treat anyone else.  Would you treat someone with high blood pressure or migraines differently than someone who didn't have a dissese or illness?  It is pretty much the same thing with depression.  I'm not an outcast, I'm not broken, I'm not something you need to avoid.  You want catch what I have from me.  It is not contagious.  It's depression not the plague.  

The other day at the pharmacy getting my prescriptions refilled the tech or whoever was checking me out looked at each bottle then up at me.  For all three.  She had this look on her face like "Are you a psycho or something?"  It was really awkward, but that is the price you pay when you get three antidepressants at the same time. 

So, as I said above I am on three medications right now.  Zoloft, Remeron, and Wellbutrin XL is my cocktail at the present time.  All three are antidepressants.  None are anti-psychotics.  So why treat me like I am psychotic?  Maybe it stems from a lack of knowledge.  Maybe people just need more information to understand.  That's why I am here.

So I am sure there are some of you out there that are familiar with antidepressant medications and some of you that are not.  Here is a brief rundown of the different medications used in treating depression and anxiety.

The most common class of medications used in the treatment of depression are known as SSRIs or Selective Serotonin Reuptake Inhibitors.  Basically you have neurons that put out serotonin, a monoamine neurotransmitter attributed to feelings of well-being and happiness, into the gap between that neuron and another neuron, known as the synaptic gap or cleft.  SSRIs come in and block the serotonin from going back into the neuron that released them, known as the presynaptic terminal or axon terminal.  The reabsorbing of neurotransmitters by the axon terminal is also known as reuptake.  When reuptake is blocked, it allows for the serotonin to stay in the synaptic gap longer, thus allowing more to be transmitted to the receptors on the second neuron or dendrite.

Here is a picture of a neuron.  Neurons are the building blocks of the nervous system.  Note the dendrites on one end and the axon terminal on the other. 

When lined up in a row these neurons create a pathways for signals to travel within the brain and spinal column as well as transmit from the rest of the body to the brain.  Even though it sounds like it may be a long process, the neurons communicate very quickly.  Think about how when you get a paper cut or a pin prick and how quickly you feel pain.  Sensory neurons carried that pain signal from the site to your brain in a fraction of a second.

They do that in much the same way as described above with serotonin, just with a different neurotransmitter.  Here is a picture of the area between an axon terminal of one neuron and the dendrite of another.

So SSRIs block the reuptake allowing more time for serotonin to sit in the synaptic gap so more can be taken in by the receptor cell.  Common SSRIs include: Zoloft, Paxil, Prozac, Lexapro, and Celexa.  Some of the side effects you see with these most commonly are dry mouth, extremely vivid or strange dreams, weight loss/gain, sexual side effects, and suicidal thoughts, especially in patients in their teens and early 20's.  SSRIs are very popular as it is difficult to overdose on most of them.  However, large amounts can cause serotonin syndrome which can be fatal or leave the person with permanent damage.  Serotonin syndrome is rare, but is known to happen when large amounts are taken or SSRIs are combined with other Serotonin acting medicines.  Funny story, when I was first put on an SSRI (Celexa) I had what was thought to be a mild serotonin syndrome reaction: fast heart rate, tremors, sweating, and color hallucinations.  Fun right?  Well severe serotonin syndrome is no fun.  High temperature (106 F), severe increase in heart rate and blood pressure, uncontrolled muscle movements and spasms (can be permanent), seizures, and mental status changes.  A common over-the-counter herbal medication called St. John's Wort if taken with an SSRI can lead to serotonin syndrome.  So make sure, if you are on medications or thinking about going on them, to let your doctor know all things you take.  This includes vitamin/mineral supplements, homeopathic/holistic medications, pain relievers, or antacids to name a few.  Also, some foods can trigger bad reactions as well, the main one being grapefruit and grapefruit juice.  You wouldn't believe all the medications affected by grapefruit juice.  If you get bored and want some knowledge you can google it sometime.

Another class of medications are SNRIs or Serotonin-Norepinephrine Reuptake Inhibitors.  They work in similar ways as the SSRIs, but they also block the reabsorbtion of norepinephrine, also known as noradrenaline.  One of the main functions in the body is acting as part of the fight or flight syndrome, but it is also increases energy and elevates mood.  SNRIs that are commonly prescribed are: Effexor, Pristiq, and Cymbalta.  Cymbalta also works to reduce neurologic pain such as fibromyalgia.  Many of the side effects of SNRIs are the same as SSRIs.

Next you have tricyclic antidepressants or TCAs.  They work on similar levels blocking the reuptake of neurotransmitters.  However, with the rise of SSRIs and SNRIs, which have fewer and less severe side effects, TCAs are not prescribed as much anymore.  The most popular one still prescribed is Elavil.  TCAs interact with many other medications and can cause fatal implications if paired with medications like Calcium Channel Blockers and antipsychotic medications.  It was also possible to overdose on TCAs, which isn't always the greatest thing to give a depressed person something they can overdose on.

Tetracyclic antidepressants or TeCAs are very similar to TCAs, but are not as prone to overdose.  TeCAs such as Remeron and Asendin compare to SSRIs in that toxicity is improbable with overdose.  Side effects are much the same as the rest, but also cause drowsiness due to histamine effect, and weight gain. 

The next category has fallen primarily towards the wayside because of their side effects and drug interactions.  Monoamine oxidase inhibitors or MAOIs are typically the last line of medications tried to treat depression.  Next time you see a commercial for a medication and towards the end typically you will hear something like "Tell your doctor if you are on MAOIs."  MAOIs take a different approach than the reuptake inhibitors.  Monoamine oxidase is responsible for the removal of neurotransmitters from the synapse.  So in effect, MAOIs keep PacMan from chomping up all the serotonin, melatonin, epinephrine, norepinephrine, and dopamine dots.  People taking MAOIs need to watch their medications, supplements, and diet very carefully.  Some cheeses, chocolate, and alcohol can cause a spike in blood pressure which can lead to stroke or heart attack.

The final category are atypical antidepressants.  These don't really fit into the other groups, but are still antidepressants.  Wellbutrin and trazodone are popular atypicals.  Wellbutrin is a dopamine and norepinephrine reuptake inhibitor.  It also has a mild stimulant effect and is used in smoking cessation.  The major side effect different from the other antidepressants is a risk for seizures.  If you have had seizures in the past you should not take Wellbutrin.  Doses over 600mg cause a tenfold increase in seizures.

There is your science lesson for the day.  I figured I would have an educational post and subject you all to the basic pharmacology of antidepressants.

Ok, so back to me.  I had my faculty meeting with the instructors this morning and it went well.  Most of them were surprised by the news, but were very supportive.  I knew they would be, how couldn't a group of nurses be empathetic right?  There is a certain comfort that comes with having people know.  Like before, it was almost like living a lie.  I had to keep straight who knew what and which story they knew.  No more though.  Everyone gets the same story and it is nice to know how much people care.

I am pretty sure I was always meant to help people.  I guess that is why I was drawn to nursing.  That, and the science of it all.  So if you are reading this, and you appreciate what I have to say, and think someone could benefit from it I urge you to share this blog.  Even though you may not know of anyone who is depressed, they are out there.  The silent ones.  The ones like me a few months ago.  I am happy and more than willing to talk to anyone who needs someone to talk to.  So please, help your friends who do not know how to get help, or feel like they are not worth getting help.  Friday and Saturday nights can be some of the roughest days for someone with depression.  For most people it means the weekend and time to party, hang out with friends, go do something.  For someone who is clinically depressed weekends are lonely.  Weekends are scary.  Weekends mean, to put it bluntly, more people end up in psychiatric facilities.  It is no secret why I was released on a Thursday.  Friday and Saturday were the busiest intake days at the hospital I was at, and I assume it is like that elsewhere.  So please, take the time to share this site with your friends on Facebook, your followers on Twitter, anyone you can, so maybe, just maybe they won't feel so alone. Thank you.

Now begins the long road to sanity

You come out of the hospital feeling pretty good. You know you aren't alone in your struggles and you have learned some healthy coping skills to use when you are feeling depressed. You truly hope to be treated the same as always, but that isn't reality. Everyone who knows treats you a little differently whether they know it or not.

The first few weeks to months the people closest to you walk on eggshells around you out of fear of sending you back off the cliff. You know why they do it, you just wish they would see you aren't the same person you were just two weeks ago. You are empowered and feel as though you are so much better, but once again, that isn't truly reality. You aren't better, you are doing better, but you are not cured. You still need help, a lot of help. You are pushed in a good way to pursue the avenues for help you vowed to do. Relying not just on medication, but also going to therapy. Getting help with all aspects of your life.

It becomes more and more apparent just how much you have neglected the relationships in your life. I found myself taking an inventory of my relationships and saw for the first time the devastation I had on them. I begin to realize that I have no true friends, I have no one to confide in, the relationship with my wife is strained because of the things I have done and the things I haven't said. The thoughts begin to scratch through again. But this time you know what to do, you talk to your therapist, you use some the coping skills you learned in the hospital, and you tell yourself you are a good man, you just have some things to work through.

You successfully get rid of the thoughts. You won a battle. The war is far from over, but you are gaining ground. For the first time in a long time you feel like there is hope, there is a light at the end of the tunnel that isn't just the headlight jog a freight train coming at you.

The day after I got out of the hospital I had a faculty meeting at school that I had to go to. I knew they were going to ask where I was and what happened. I couldn't call my clinical instructor while I was in the hospital, so my wife had to do it. I missed lectures, I missed a day of clinically, and I missed an important presentation. They wanted an explanation. These instructors are all nurses, all very smart, well educated medical professionals. How am I supposed to lie to them about what happened? I am not ready to tell people the truth about what really happened.

The best I can come up with is telling everyone it was a medication reaction. I had a bad reaction to a medication. It is kind of the truth right? I mean isn't overdosing just having a reaction to the medication? Ok so it isn't the whole truth, but there is a shade of truth in it, sort of. I tell them it was a benzo for anxiety and they wee afraid I would withdrawal from stopping it, thus the weeklong absence from school. They bought it. I feel bad for lying, but at the same time good for not having to open up about my mental illness.

This week at the faculty meeting I will be apologizing for the lie, explaining what really happened, and asking forgiveness. Friday morning I will address the nursing faculty and open up to them about what has been going on and is still going on. If I keep telling myself this maybe, just maybe I won't freak out about it. Maybe I will actually tell them and be articulate in telling them. Maybe I will not stumble or stammer through my little speech. Maybe they will accept me for me.

I have come a long way in the past few months. But, I still have a long ways to go. I hope you all stick with me on this journey. I am sure there will be exciting times, as well as boring times. Some times the boring times will be a welcome relief. Boring is normal. Boring means you are ok in your own thoughts and in your own company. I never thought boring would be a great thing. Before when I was bored I got stuck in my own head. Now, boredom is a welcomed emotion. It has been so long since emotions were allowed.

Well here I am

So now I have made it through admission at the psychiatric hospital and am on unit.  I gave you the description of orientation, which certainly did not orient me to anything.  Not much goes on that first night.  All I know is that once the others got back from dinner, they were back for about two minutes while they passed out cigarettes for smoke break.  I learned very quickly that people here smoke, a lot.  Although they only get 3 smoke breaks a day, if it comes one minute late there is hell to pay.


After smoking they all file back in and head to various areas of the unit.  Some go to their rooms, some color on the lovely copied coloring book sheets spread out on the tables, some file in to the conference/group therapy/individual therapy/TV room.  I was in the TV room, I knew no where else to be.

The unit I was on was for non-psychotic patients.  So depression, anxiety, bipolar, anger, and any other mood issue were represented here.  We shared a wing with the chemical dependence unit.  My first impression of the people?  We have quite a mix.  I would say the oldest is about 60, the youngest was 20.  One guy said he was 19, but we doubted it.  He looked about 30, and acted 12.  Loud, gangster wanna-be from Arkansas.   Most of the people were very laid back.  Calm and quiet.  Either medications were working or they were plotting.  I could think no differently.  These people were in here for some serious things right?  I mean they weren't all just here for reasons like me, were they?

That night I got my first taste of "Group."  Some knucklehead with a clipboard starts yelling "Group!" over and over as he heads to the catch all room we were in.  This was evening goals group.  Basically you say how you are feeling and if you met the goal you set in the first goals group of the day.  I have no goal to share as I have just arrived.  My mood?  Freaking the fuck out inside.  "I'm ok, little anxious, but other than that ok I guess."  'Why are you anxious?'  "Well... this is my first time in a place like this."  'Ahh so just nervous about being here?'  "I guess so."  And we move on.  Most people lie in group I come to find out.  Responses of great, fantastic, outstanding, spectacular, and even stupendous flow out of people's mouths.  There are two common goals.  These apply to I would say 80% of the folks in there.  The first is to attend groups.  The second is to get out of here.  They both sound like fine goals to me.  I will probably use the first one tomorrow morning.

After group was over it was pushing 10 o'clock.  Seems like a good time to go lay down.  Luckily I had no roommate yet.  They said I would likely get one though.  Doors have to remain open, and the light in the hall is very bright.  A lot of thoughts got through your mind that first night.  Mostly "What am I doing here?  I need to be here.  Does this mean I am crazy?  God, what will tomorrow be like?"  I begin to think about my kids and my wife.  What they just had to witness and go through.  The tears begin again.  Remorse, shame, and regret are now my roommates.

When I got here and throughout the evening I never payed much attention to the staff floating around.  They were here, they were there.  At night though, you are acutely aware of the staff.  The reason?  Q15 status.  Every 10 to 15 minutes the staff has to note where you are, what you are doing, and mood if you are showing one.  This is 24 hours a day.  The night guy, he does his rounds with a floodlight.  You know those big flashlights with the brick of a battery?  One of those.  Every 12 minutes like clockwork he is there shining that beam on your face.  If you have the blanket pulled over your head in an attempt to be shielded from the spotlight inquisition you are asked to pull it down so he can see you.  Because, I could have wadded up things to make it look like someone was there when really I was tunneling out using a rock hammer I fashioned out of crayons and markers.  With sleep interruptions like these you never know what time it is.  You have windows, the blinds are between the panes of glass and are closed.  There is an orange streetlight right outside, so the window is perpetually glowing that color regardless of the time.  The only clock is all the way down the hall at the nurses station.  So if you really want to know, you can stroll down there and check.  Let's just leave it at, you never need an alarm clock in the psychiatric hospital.

That night I am up at 2:00am.  The reason?  Someone comes into my room, takes a crap in my bathroom, flushes and comes around the corner, realizes it isn't their room and heads out.  I figured it was a good time to get upi and venture out to the lobby.  No TV after a certain time and the room gets locked anyway.  I discover that the refrigerator on the unit is stocked with chocolate milk.  Salvation.  Chocolate milk in hand I sit down on the plastic couch and begin looking through a magazine.  "Who will be our next president?"  Ok, we are a little over a month from the election.  I begin to read the story.  Quickly it becomes painfully obvious.  It begins talking about if Bush would be back, or if John Kerry, Hilary Clinton, or some other characters would take his place after one term.  Flip to the cover.  The date February 2004 .  Well then.  It is 2:30am and I can either read this time warp of a magazine that I already know the endings to, or stare at the wall.  Hello wall.

Time goes very slow when you have no where to go and no one to talk to.  Being committed, if you want to call it that, gives you a lot of time in your own head.  Good, bad, or ugly, it is just you and your thoughts.  And for most of us in there, that is a dangerous place.

My first full day in the looney bin.  The loud Arkansas native was sent packing.  They pretty much discharged him and sent him out on the street.  He couldn't find anyone willing to pick him up, so off he went.  We all figured he would be back, but alas he must have found his way somewhere.  I began to meet the other patients.  Most of whom were very good, nice people.  They just had problems, like me.  A fairly good percentage were either former military or current military.  Some there for help, some there to get medically discharged.

I begin to get fairly close to two of the other guys.  One just a couple years older than me, the other is only 20.  They both have similar stories as mine.  Both in there because they did something they shouldn't have.  The 20-year-old had already been there for 11 days.  That was after the military had to send someone to Florida to get him, as he had done his stupid act while on leave.  He hadn't been home for the entire month.  We shall refer to him as "A" from here on out.  He may have only been 20, but his eyes revealed someone much older.  I'm not sure if it was the meds or just him.

Medications are a whole other story in there.  The doctors... they like to tinker.  Let's change this, let's add that.  I wouldn't allow them to add anything.  I made them stop giving me benzodiazipines.  They put me in a fog, and had made things worse to that point, so I wanted to go without.  My inpatient psychiatrist doesn't think it is a good idea, but I don't care.

Later that day I meet with the medical doctor.  Things are going great until he looks at me and says "It's time to stop lying.  We know you use drugs."  Ummm I do?  News to me skippy.  "You tested positive for high amounts of opiates.  So we know you abuse drugs, and since you didn't tell us upfront about it we can't believe anything you say."  I am dumbfounded.  The last "opiate" I took was a Lortab when I had a kidney stone over a month ago.  He will hear none of it.  I tell him to contact the hospital I was just at and see if I tested positive there, or to check the one I did for school 2 weeks ago.  He just scoffs and looks through my chart.  Whaddaya know, negative yesterday.  So ummm, where during nearly constant observation between then and now would I have scored myself large amounts of opiates?  I later find out from one of the nurses that they get false positives from their tests all the time.

That first day you have a lot of meetings.  Medical doctor, psychiatrist, psychologist, social worker, nurse, another social worker, and an expressive therapist.  They all pretty much ask you the same things.  I assume to see if you change your story, or become irate.  I do neither.

All the days are pretty much the same.  Schedule is pretty well set, although on the weekend, things don't always take place.  Some group sessions are absent.  The groups over the weekend were primarily art therapy and music therapy.  Plastic scissors, glue sticks, crayons.  Kindergarten all over again.  Except the art you are making is something you would have expected to come from Marilyn Manson or a young Ozzy Osbourne.  And music therapy?  A woman with a keyboard sings you songs that are supposed to be uplifting and inspirational.  The only uplifting that occurred were the lifting of people's asses out of chairs and out the door.

There are a handful of things very popular in the psych ward.  I already mentioned smoking.  The others include various card games, football, Criminal Minds, and chocolate milk.  I swear to you we went through probably 3-4 gallons of chocolate milk a day.  Trash cans filled with those little 8 ounce cartons.

I would be remiss if I didn't mention one of the employees there.  He is the epitome of what you don't want to have as an employee, especially with the clientele.  He is the guy who works at a place like this solely so he could exert his "power" over the patients.  On Sunday coming back from lunch, he was bragging about carrying a gun in his pants.  I ask to see it, he tells me it is there, and if he shows it to me it would be to shoot and kill me.  I press again, "Where are you hiding it?  You have no bulge on the small of your back, hips, or front of your pants, pockets have noting in them, and it isn't by your ankle because you just lifted your pant leg to scratch your leg.  So where is this gun in your pants?"  If you can't tell I have had it with him at this point.   He had been talking down to me and others all day.  He responds with, "It's a small gun."  Regrettably I could not keep myself from responding "Man, your girlfriend must hate that small gun in your pants."  This guy during my stay will make 4 other patient's cry, after I hurt my knee (I will explain in a bit) he told me he was going to kick my white ass up and down the hall, told me to stand up so he could kick me in my knee and watch me fall, and asked when I was being discharged so he could wait for me in the parking lot so he could show me his gun.  Not the most therapeutic person. 

So the knee story.  While at "gym time" we were playing volleyball.  Mind you the court is carpet over concrete.  At one point I jump, land, and pop with pain.  Sharp behind my knee right at the top of my calf.  I think maybe it is just a bad cramp or pulled muscle.  The rest of gym time I spend hobbling around.  It hurts so bad by dinner I decide to stay on unit and not go to the cafeteria to eat.  It took over 24 hours to be seen by anyone for my knee, the medical doctor who finally sees me tells me after the exam it appears I tore my ACL.  So if being here could get worse, it just did.

The other guy I become close with, we shall call him "D", is having some troubles.  They tell him he is to be discharged in the morning.  He confides in me that he doesn't think he is ready and that if he is released he will kill himself.  The fact that they are willing to release someone in that mindset is a testament to just how messed up our system is.  They send people out who are not ready, don't have the tools to deal.  I go to my social worker and my psychiatrist and tell them what he told me.  I had to right?  Even though he told me in confidence, I couldn't live with myself if he was discharged and followed through.  He later thanks me for telling them.  He ends up staying.

A lot of talk is made of keeping in contact with people.  I think when you are in there, and you go through some of the experiences with these people and you come out feeling very close to them.  Then out in the real world you just don't want to relive the time in the hospital by seeing them.  I should call them though, if for nothing more than to know they are still fighting.

Being released is an odd feeling.  You don't quite know how to react.  You are happy to be out, but scared to death at the same time.  You are treated differently than before.  At least it seems that way.  A long shower and a shave are a welcome perk of being free.  Inside you don't really get to shave.  Someone has to watch you while you do it and you have to use a single blade bic using just soap, but the biggest hurdle is getting a male staff member to watch you. 

I'm out.  Now begins the journey of truly seeking help.