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On Not Dying but Not Living: Insights from the Psych Ward

The hospital is not where you go to figure out how to live. It's where you go to not die.
Jaqueline Miller via Stocksy

Should you ever find yourself unexpectedly on the way to one of New York City's Comprehensive Psychiatric Emergency Rooms make sure you put on underwear. Underwear is the only thing they let you keep. If you don't have underwear on, the compulsory strip-down that preludes any meeting with a doctor gives the whole experience an extra layer of shame. I didn't have underwear on underneath my leggings, the same pair I'd worn the night before when I shuffled into Rite Aid looking for enough Zippo lighter refills to equal a lethal dose of inhaled butane. The hospital's security guard supervising the inventory of my possessions (a purse full of cosmetics, weeks-old fast food wrappers, yes; underwear, no) at the ER was getting squeamish about how hard I was crying, which made me feel guilty, which made me cry harder.


I had, over the past 18 months, become so depressed I could not bathe myself or eat anything besides Lucky Charms out of paper bowls. I reused the same paper bowls until the milk caused them to disintegrate in my hands. I had lost three jobs in six months because even after sleeping for 48 hours, walking to the bathroom to pee and trying to put on shoes was so physically exhausting I had to get back in bed.

What's actually wrong with me depends on who you ask. The chart at my current psychiatrist's office reads:


My old therapist would take bristle at this diagnosis as she was against using the term "mental illness" and preferred to look at all of humanity as a spectrum of skill or lack thereof in regulating one's emotions. Another doctor quibbled with the borderline diagnosis. A third doctor waxed philosophical about "characterological depression" which he doubted would ever respond well to drug therapy and may have to just be accepted as part of my nature.

If asked to describe myself, I'd say I have a hard time acting like a grown up and am mostly sad all the time. Sometimes, I hate myself.

Before I dragged myself into the Rite Aid that night, my temp agency called and informed me I had been fired from a job I didn't have the strength to show up for. The phone call didn't trigger the death wish, it was simply the catalyst for a reaction months in the making. Now, finally, felt like the right time in my life to die.


I ambled down the drug store aisles in my leggings and two sweatshirts (but no underwear) looking for a means to end my life. No stranger to the logistics of self-induced euthanasia, I knew enough to avoid the pharmacy completely and stick to household chemicals. I settled on butane, since I'd read it was easy enough to die abusing it even if you didn't mean to, and started doing the math to determine how many containers I needed and whether I could afford to buy them or if I would have to shoplift to get the job done.

Then I thought about my apartment and the garbage that covered the floor wall-to-wall. I thought about my mom having to fly across the country to clean up my shit. I thought about what a selfish bitch I was and how if I were going to kill myself I'd better at least get my act together a little bit first (and at the very least, tidy up my apartment). When I walked out of the drugstore I rang my doctor, hoping maybe that conversation would motivate me to get things in order. I told her I was feeling a little worse than usual; she made an emergency appointment for the next morning. I held on through the night on a friend's couch who bought me a pizza and watched me cry. By the time I sat across from my shrink, I'd convinced myself that it all wasn't that serious so I described the previous evening honestly, the sobbing in my apartment, the soothing decision to take action, the math calculations. She asked how I was feeling now and I said I was fine, though I had continued to look up fatal doses of butane on my phone in her waiting room. She said I needed to go to the emergency room. This surprised me, but I was very tired so I said okay.


I've never been so dumb to believe the right pill or therapist or yoga class would be my perfect cure, but pulling up to the hospital that day I did allow for a small sliver of hope. I briefly and naively let myself believe this was where something might finally change, where something might click into place and smooth out the hill I'd been climbing for the last five months since losing my first job, the last 12 years since coming to New York, the last 30 years since I was born. I was wrong.

The hospital is not where you go to figure out how to live. It's just where you go not to die.

Most days in the hospital I felt like a fraud. Even when faced with the reality of my circumstances—I stopped caring for my basic needs and took meaningful steps to end my life—it was difficult to understand why everyone took me so seriously, even though part of me was genuinely glad they did. But if I allowed myself to contemplate the situation too long I became paranoid that any moment a nurse would come find me, laugh at how long I'd kept them fooled, and tell me to gather my things and get out. It was difficult to hold this belief alongside the thought that if I left the hospital I did not have the power to change any of my circumstances and I certainly wouldn't have the guts to tell someone the next time I ended up in a drugstore after midnight. This paradox made me constantly vigilant, poised to strike at anyone who seemed to suggest I was too sick or perhaps not sick enough. Around me, no one could win.


Before the butane, the disintegrating paper bowls, and days lost to sleeping, my first coping mechanism was Wonderbread, consumed by the fistful when no one was looking. The pleasure of the shoving sugary, forbidden starch in my body was a ritual so heady and private it bordered on erotic. I was raised in strict religious household, the youngest of four painfully perfectionist siblings. My father was unpredictably cruel and my mother was just trying to keep everyone happy. In my 2nd grade diary entries I chastised myself as a "disgusting child" for my secret binges. I started cutting myself at summer camp at age 13 and throwing up my food in late high school, and while I've mostly put down the simple starches, the other two behaviors may always be with me.

Cutting and purging function for me like some law of thermodynamics: energy through a system tends to organize that system. Though I'm well aware of the myriad of strategies I could use to replace these behaviors, when everyone in the room is staring pinholes into my skin and the volume of the world has been turned up so high my eyes are watering and it's certain every bad thing that every happened to me is because I'm a filthy whore who doesn't pay her cell phone bill on time, squeezing an ice cube or taking a walk around the block doesn't quite do the trick.

After completing a viciously competitive university conservatory program in the performing arts, I enjoyed cautious early success in my field, and when I did well, I felt well, for the most part. Any negative feelings were treated with a combination of talk therapy, Zoloft, cocaine and binge drinking which worked great until it alienated every business relationship I had and left me night after night passed out into a mason jar of Four Loko next to somebody's boyfriend I'd fished off Craigslist.


Sobriety brought vital relief but also left many nerve endings raw and exposed. Without the speedy, channel-flipping distraction of alcohol and drugs I was left with just myself.

This re-discovered bummer, combined with a not unusual drop in effectiveness of a medication I had taken for many years plus growing discomfort with my lack of meaningful contribution to society was the blueprint for a sinkhole into which I would nearly disappear.

Last summer, I started having panic attacks at work, then began missing work to avoid panicking. Though I'd been with that company for years, they couldn't employ someone who never showed up (for health reasons or otherwise) and eventually let me go. Convinced that particular office had been the problem, I threw myself into landing a newer, improved job, sure that more money and better bosses were the necessary cure. Meanwhile, my psychiatrist tweaked my medications and I decided to stop eating anything except cold cereal from disposable bowls since I could no longer bring myself to do the dishes and had left most of mine dirty for so long they had to be thrown away.

Laundry became too difficult even to drop off at a wash-and-fold, so I obscured stains with jewelry and scarves and stopped wearing underwear. I mastered updos I was certain masked the fact I hadn't washed my hair in weeks. Though no one ever said anything, I'm sure I smelled. A new job came and still there were days when no amount of inspiration, cajoling or temptation could drag me out of bed and onto the subway. I didn't want anyone looking at me or I couldn't face the thought of so many hours upright. Often, I just felt too tired. I'd spend the entire weekend asleep trying to ensure my ability to wake up for work Monday morning, and still wake up so exhausted there seemed no choice but to call in sick. Friends checked in but I waved them away. I made and cancelled plans hoping to lure myself out of bed but always thinking better of it in the end. The job was quickly lost and you know what happened to the third. In hindsight, I'm surprised I avoided the Rite Aid as long as I did.


During my stay on the ward, boredom became my constant enemy. Boredom led to wandering thoughts, wandering thoughts led to wandering hands, and before I knew it there might be a bloody patch of skin that I couldn't conceal and an uncomfortable conversation with a staff member about whether or not I needed to be kept under constant supervision. My hospital did it's best to keep days full but often, especially on weekends, I jawed prescription nicotine gum and stared at the single clock in the hall, willing an hour to go by so I could go to the medication window and get a fresh piece. That exercise might take up a whole three to five minutes, but then 55 more had to tick by somehow. I entertained myself by napping, eavesdropping on other people's conversations, watching television if all three TVs weren't inexplicably tuned to Spanish language channels. I read five Harry Potter books, ate contraband snack foods hidden inside my shoes, started showering regularly for the first time in months, and started using some newfound assertiveness skills to actively participate in my own life.

I begrudgingly agreed to go for walks in the courtyard as long as they were led by the cute psych tech, and looked forward to Saturday afternoon manicures where a nurse painted my chewed up nails since my hands shook too hard to do it myself. I slowly caved in to the small pleasures afforded to patients, like early morning coffee, and ice cream with every meal. I still napped twice a day. I did my best not to entertain the obsession with why I was in the hospital, or whether I belonged there, or who believed me, since most of the time it didn't actually matter -- I was just there. When they told me to, I would leave. Probably, I would come back someday. Surrender has been described to me as the point in a battle when you put down your weapons and ask the enemy, "What do I do now?" Surrendering to my hospitalization turned out to be the best option available.

Before I was ready, my doctors started pressing me to think about post-hospitalization plans. This was difficult, as the whole idea had been not having any post-Rite Aid plans at all. At this point there was no job to return to, and because there was no job there would soon be no apartment. At age 30, over a secured phone line in a hospital conference room I asked my mom if I could come home and she said yes. It was, I continue to say and believe, the best of all the bad options. I spent a few more days stabilizing my medications and reassuring my doctors that when the time came I would in fact take the train straight home. I would spend a week disposing of most of my stuff and then I would get on a plane. No funny business. That's what I did and now here I am.

Being in the hospital did nothing to change how I felt, and it wasn't supposed to. In the beginning, I honestly told them that my desire to end my life had not changed and that the only thing keeping me from following through on that desire was the practical burden my current apartment/lifestyle situation would impose on my family.

As time went by, I was given space and time and helped to put plans in place to hopefully change that situation and perhaps make a way out. Whether those plans will work, I don't know. Today, I sleep in my mom's guest room on the same twin mattress I used as a child and have the backache to prove it. I do my best not to cry during shifts at my part time job at the local hardware store, a job I got to earn pocket money and structure my day but which serves as a constant reminder that I haven't yet paid off my degree from a top 10 school. I enjoy the luxury of having a dishwasher and a washer/dryer for the first time in 12 years. My nieces and nephews finally recognize their auntie on sight. Four days a week involve some kind of mental health treatment and because I'm able to keep my income so low, the state pays for most of it. I take walks on the suburban sidewalks of this new town and marvel at the uncomfortably safe feeling, longing for the constant low level adrenaline of my old Brooklyn block. In my phone is a list of local psych units that accept Medicaid patients in crisis. In my bathroom drawer is a single can of butane, just in case.