Trauma Therapy III: Leaving the Hole

This is part III of a III part blog. If you haven’t read part I, read it first by clicking here. If you haven’t ready part II, read it by clicking here.

Once I reached the bottom of the hole, it was difficult to pick myself back up and find my way out. Everything was painful, but the pain had become comfortable. I was used to being raw. I didn’t know how to fold up the mess and prepare to get back to my life. My everyday life had become so encased in reviewing my trauma that I wasn’t sure how to go about my daily life anymore. I had done the work, but now I had to actually recover.

When I was hospitalized, I could tell the day I started feeling better because I started straightening up the common room. For nearly a week, I floated around, not particularly caring about myself or my surroundings. But two days before I was released, I threw out old papers that had piled up, organized the crayons and coloring books, and put all of the remotes in a little basket. That was the moment I knew that I was getting back to normal. While sometimes my obsessive organizing can be a negative sign, here it pointed to the fact that I was getting back to normal. The same was true in PHP/IOP but in a different way: I started mentoring other women.

New women arrived in the program each day, and I watched them go through the same phases I had experienced. When I saw them fighting the process, I called them out. When I saw them willing to be vulnerable, I celebrated. My recovery was no longer just about me but about the women around me as well. My therapist relied on me and other “old-timers” in the group to help guide new women who needed to let go and trust the process. I began to see that I knew everything the program had to offer, and that, if I stayed too much longer, I would start to go backwards.

This happens pretty often in recovery programs like the women’s trauma program at Ridgeview. We reach the bottom of the dark hole, we claw back out, and then we’re not sure what to do. For me, I was too afraid to enter back into real life, so I started crawling back into the hole again. The hole was painful, but at least I knew my way around in there. It seemed like a kind of strange Stockholm syndrome where my trauma was holding me captive. I started to feel comfortable in the misery and resisted returning to my old rhythms. I was different now and didn’t know how to negotiate daily life with my new tools. I knew how to negotiate trauma therapy, though, so I held tight to it as long as I could.

On my last day of the program, I cried constantly. I have always been a sentimental person, so I knew I would be upset about leaving all the women who had been on this journey with me. But it wasn’t just that. I was terrified. I didn’t know if I could do it. I knew I had tools and I had done recovery work to prepare me for being on my own, but I was afraid I was going to fail. I was scared that without the daily support of Ridgeview, I would end right back up where I started. What I didn’t realize was that, even when I messed up, it was impossible for me to go back to the place I had been in before.

Recovery isn’t linear but it isn’t circular either. Even when you mess up, you’re moving forward. Each time I relapse into self harm or have suicidal thoughts, I’m still learning about how to overcome those urges. Each time I have a panic attack, I make it through and I’m reminded that it will end. There are plenty of bad days, but each one makes me stronger. Everything that has happened in the past brings me to where I am now, so even though I’ve had difficult moments since Ridgeview, I can’t go back to where I was in May. I’m not the same.

The hole is still there, and there will always be more to work through, more to sit in. In fact, I am sitting in it right now. But the goal is to not avoid the hole for so long that it overflows again. I now have the tools to clean out the dark hole as I go. I will still be angry along the way. I will still sit and sob at night. But I’ve also witnessed my own strength and know that I can make it to morning.

Trauma Therapy I: Anger and Release

When I was first released from my week in an inpatient hospitalization program, I felt better. I thought I had figured out the reasons I fell so far off the edge and believed I had the all the tools I needed to start again. My problem, I thought, was that I had failed to properly use my support system. I had plenty of people who loved me and cared for me, but my perfectionism had been preventing me from letting them in to help. While this was true, this was far from the root of the problem.

Upon my release, I agreed to attend a Partial Hospitalization Program (PHP). Literally the day after being discharged from the hospital, I had to show up at the same hospital again and keep talking about my feelings. I didn’t think I needed to be there. My first day, I thought, “I’m way more well adjusted than everyone else. I’m fine. I’ll be out of here in a snap.” (Spoiler alert: nope.) That’s the thing about trauma, though, is that it tricks us into believing we’re fine. Rather, our maladaptive coping strategies trick us into believing we’re fine because it’s the only way we know how to survive. I entered into the Women’s Trauma PHP assuming I didn’t have any work left to do. But I was about to do the hardest work of my life.

The first three days of PHP, I played my perfected role of “good student.” I didn’t disrupt, I listened, I responded when asked but only when asked, I took notes, I was friendly to the other participants. I knew all the answers. However, I had no intention of digging in, asking hard questions, or being vulnerable. I thought if I said all the right things and filled out my daily behavior log consisting of no urges to harm myself or others, I could get out of there and get back to my life. I stressed constantly about when I would be able to go back to work. The more “good” I was, the sooner I could leave. Trauma therapists, though, see right through that shit. So, around day 4, my therapist starting pushing my buttons. Our therapists often discussed how the trauma program would trigger us so we could learn how to deal with our triggers in a healthy environment, but they also emphasized that this triggering was not intentional. It just happened as a part of being vulnerable and interacting with others. However, my shell was so tightly encased, that I have a feeling my therapist had no choice but to grab a stick and poke the bear.

I’m funny when I get angry. Most people yell, become aggressive, or get physically aggitated. I sulk. I think a lot of my issues with anger come from both the fact that I’ve experienced the pain that misdirected anger can cause and also from my relentless Good Girl Syndrome. Because I’ve experienced emotional abuse, I don’t want my anger to ever feel that way to anyone else. In addition, angry outbursts seem like a form of losing control, and if I keep my anger dialed down, I’ll still be able to be perfect. It turns out, though, I’m SUPER angry. If you know anything about the Enneagram, this really shouldn’t be surprising. I’m a 1, and we’re notoriously the most angry number. But we keep our anger boxed up inside to seem measured and controlled.

This is what I did in PHP. For several days, I sat in the corner of each lecture and therapy session refusing to make eye contact and refusing to participate. The program was making me angry. The people were making me angry. My therapist was making me angry. And I was in such a delicate state that it was getting harder and harder to keep all my anger controlled. My second Friday in PHP, I told my friend in the program, “I’m never coming back here.” Later we laughed about it, but at the time I was serious. Anger is the gateway to so many other emotions, like grief and shame, so it’s where many of us start our trauma work. The minute we started to feel angry, the minute our therapist knew she was finally getting somewhere.

I finally moved past my anger the day I shared in group therapy. I had shared in group before, but never anything actually vulnerable. The longer I sat in the program, though, the more I realized that, in order to begin my true healing process, I would have to share some things that I hadn’t shared with anyone. I was terrified. Every day as I sat in group, it pressed harder and harder on me that I wasn’t going to get through this program if I didn’t start being vulnerable. I would rehearse what I wanted to say and how I wanted to say it when I was falling asleep at night. I didn’t even know how to make the words because I had spent so long trying to pretend that this particular thing hadn’t happened to me that I had started to forget about it. The fact that I had kept it shoved down for so long, though, was a huge source of my trauma.

One morning, I finally decided to share. I think, probably, I was so exhausted from being angry that I figured I had no choice but to let go and actually work the program. As I shared, I stared at the table in front of me, tears dripping off of my face, my breathing shallow, my hands clamped together in my lap. I felt no better, in fact I probably felt worse, but I had done it. Next came the worst part. The sitting in it. Our program therapist was very fond of telling us to “sit in it.” Because of my maladaptive coping strategies that I used to survive years of trauma, I had forgotten how to feel negative feelings and just feel them. Most trauma survivors, upon feeling negative feelings, use behaviors like substance abuse, self harm, avoidance, partying, or over working when we start to feel this way. We spend most of our time just trying to stay alive. In PHP, our therapist challenged us to feel without relying on these behaviors. She told us we were in a safe place to feel all of these emotions: we had mental health professionals around us all the time and we had a built in support system if we were unable to handle the feelings. The only way out was through.

(to be continued in a part II – there’s a lot to cover here, y’all. stay tuned.)

Psych Ward

*tw: mental illness, hospitalization, suicide, self harm, sexual assault*

At the end of May, I spent a week in an inpatient psychiatric hospital. While I don’t feel comfortable sharing the specifics of what led me to be admitted, I was admitted involuntarily, meaning I did not walk in off the street and decide I needed care. Instead, I had reached my saturation point for handling life’s variables and healthcare providers determined I would be safest in a hospital setting. I never thought I would need to be hospitalized, but in retrospect, I’m suprised it took me this long. I can now see warning signs in myself all over the place, but I wasn’t listening to them.

Late on the Monday night before Memorial Day, I sobbed in the car as my roommate drove me to the emergency room. I texted my boss and my therapist and called my partner, but I remember very little after that. I spent the night in Emory University’s ER, attempting to watch Sex in the City and drifting in and out of conciousness as we waited for the rotating psychiatrist to come and evaluate me. Around 5:30am, my partner left to go home and rest. Around 6:30am, the psychiatrist finally arrived. I talked with him for a few minutes, answering questions about what brought me to the ER, my medical and psychiatric history, and how I was feeling. Not long after, the attending nurse told me I was being taken to a psychiatric hospital. They assured me they would find one that would accept my insurance. I was loaded onto a stretcher and into an ambulance with no specific idea about where I was headed. I was terrified and exhausted, and I slept the whole ride.

When we arrived, I was unloaded along with my backpack I had somehow managed to bring along. Still in blue papery hospital scrubs, I sat scrunched up in an armchair alone in an intake room for what felt like hours, waiting to be processed into the hospital. Eventually, I was able to put my own clothes back on and use my phone to text a few people to tell them where I was. I wrote down important phone numbers so I would still have them after they could confiscate my phone. They took my bookbag as well, and it would be two days before I could get the rest of my things out of it. I was taken to a section of the hospital that I now know is primarily for people who are psychotic, delusional, aggressive, or paranoid. I didn’t fit any of these categories, but the women’s trauma unit I was eventually bound for was full, so I was stuck in holding until there was an open bed.

I walked around for three days in a complete fog. I’m sure the sleeping medications didn’t help, but as the reality of what was happening set in, I began to feel less and less in control of my body. I had panic attacks and cried constantly. I had no idea what was going on. I felt entirely alone. I wanted so badly to process what had happened but felt I had no one to talk to. I watched people get shots of sedatives to calm them after having raging outbursts. I watched one man try to escape twice in one day. I watched another walk around wearing only one shoe, in a psychotic daze for 48 hours until they corrected his medication and he became a completely stable person. I was scared and I had no clue how to move forward.

On day 3, I finally had visitation hours. Seeing my partner and my best friend was both jarring and comforting. They said they were surprised at how good I looked and seemed. Looking back, this is especially strange because of how out of control I felt. All of my defense mechanisms to keep my life together had finally failed. My perfectionism, my obsessive cleaning and organizing, my intellectualization of my problems, and my avoidance of conflict and difficult emotions had all worked for a long time. But the thing about defense mechanisms is that they work until they don’t. I avoided digging deeply into myself for so many decades that I started to believe I could forget that certain things had happened to me by simply not acknowledging them. (Spoiler: This does not work.) I was dishonest with myself and the people who love me about how I was really doing because I was ashamed of the pain I was actually feeling, and, at times, completely unaware of the pain I was actually feeling.

I started to unwrap all of this once I was moved from the chaotic holding unit to the women’s trauma unit. I was surrounded by women who shared my diagnoses and my life experiences. We never discussed specifics, but we just knew. It was such a relief to get hugs from other women after not having any physical contact for days in the other unit. I started to smile and laugh again. “This isn’t the psych ward!” we would yell across the table at each other, as we color pictures of mandalas and animals with dulling colored pencils. We laughed because there was no other way we could make it through. Because we were in the psych ward. And our reality pressed in from all sides as we walked around in our pants without drawstrings and shoes without laces. Our backs ached from mattresses without springs and our eyes were tired from the wellness checks every 15 minutes during the night to make sure we were breathing. It was an overwhelming week. It was a week I never thought I’d have. But it was real, and now it’s a part of my story.

Since being released, I’ve been participating in a partial hospitalization program for women’s trauma. It’s possibly the most difficult work I’ve ever done. I’m not quite ready to share my reflections on the work I’ve been doing in trauma therapy yet because it’s still so close and because I’m still doing it. But I wanted to at least share the beginning of this journey. I want to share this experience because I want to help normalize psychiatric care. Inpatient hospitalization programs are for everyone. If you feel out of control of your emotions, a situation, substance abuse, or your behaviors, admitting yourself to a program like the one I was in could be a helpful step. Inpatient programs help stabilize you in moments of crisis. Getting help before you’re in a full blown crisis is also a valid reason to seek hospitalization.

I’m getting better, but I can’t say I’m getting better every day because that would be a lie. Healing is not linear. I’m learning new ways to cope and some days I use those new coping skills effectively, but other days I don’t. I’m back at work part time, but I’m teaching my self to take it easy. I’m scared to integrate back into “real life”, but I know that I’ll be ready when it’s time. I’m still not sure what all I’m supposed to have learned from the psych ward, but I trust that I’m learning it.