Hospitalization gets a bad rap, but sometimes it’s the place you need to be during a severe mood episode of mania or bipolar depression.
The phrase “for your own good” is usually attached to something you know you’re not going to like — such as ending up in the hospital because of an episode of bipolar depression or mania.
But the fact is, there may be times when your current safety and future well-being require some … well, tough medicine. Even if the hospital is not where you want to be, or what you think you need.
“It can get scary,” admits Megan C., a musician from Massachusetts who has bipolar I. “You’re not thinking clearly and you can feel like you’re losing a lot of your freedoms — and in some ways you are. Big decisions are being made about you. But having people around who you can trust and advocate for you is important.”
Not every facility is going to offer state-of-the-art care. Some interventions can be traumatizing, such as physical restraints or a medication regimen that you haven’t agreed to. Nonetheless, a hospital stay can give you the space you need to begin to get well—a break from everyday stresses, an opportunity to get concentrated attention from professionals dedicated to pulling you back from the brink.
Unlike a hospitalization for something like pneumonia, however, getting inpatient care for a mood episode may stir up difficult emotions—shame, self-blame, embarrassment. Yet mood disorders, including bipolar disorder, are the third most common cause of hospitalization in the US for people ages 18 to 44, according to the Department of Health and Human Services.
It often takes a shift in perspective to view going to the hospital in a positive light, rather than as some sort of disgrace or personal failing.
“Being proud doesn’t make you stronger, it just makes you avoid getting help and means you suffer longer,” notes Andrew B. Klafter, MD, a psychiatrist in Cincinnati.
Participating as much as possible in your care tends to improve the outcome no matter how you are admitted (involuntarily or with your consent), where you are admitted (whether a locked ward in the community hospital or a plush private facility), and how long you stay (from 24-hour crisis care to inpatient treatment spanning several months).
Perhaps because of exaggerated portrayals in movies and on TV, some people look at psychiatric hospitalization as an extreme measure—almost a punishment. The opposite is more often true: It’s a form of protection.
“For me, it was necessary to seek additional help because I felt unsafe on my own and couldn’t guarantee my safety,” reports J.K. of Illinois, who was hospitalized once for suicidal ideation and a second time while experiencing hallucinations. “Anyone who is in a similar situation should not feel ashamed in asking for help outside of your regular care team, family and friends.”
When a psychiatrist recommends hospitalization, it’s usually intended as a short-term intervention to resolve an acute situation. Longer-term stays may be necessary depending on the situation, notes Sue DiGiovanni, MD, associate chair for clinical services in the psychiatry department at the University of Rochester Medical Center (URMC) in upstate New York.
“We try to keep the hospitalization as brief as possible,” she says, “yet long enough so that [people’s] symptoms stabilize and we have time to work with them, their families or significant others, and others involved in their treatment on an outpatient basis to come up with the best possible discharge plan.”
At a teaching hospital like URMC, a treatment team might include a psychiatrist, social worker, nurses, nurse practitioners, psychiatry residents, and, at times, a nutritionist and chaplain. The team coordinates on fine-tuning medications in order to rein in the mood episode and on developing the all-important discharge plan that will follow you home.
Daily visits with the psychiatrist can be short, from 10 minutes to a half hour. DiGiovanni says people may mistakenly expect to receive intensive individual psychotherapy, but the hospital is not the setting for that.
Rather, the goal is to calm the crisis and have individuals exit the hospital with a blueprint for getting “connected to the resources they need,” she says.
During Megan’s last hospitalization, it took more than six months to reach a point where she was well enough to leave. At her discharge, she was worried about being assigned a different support system than the team of professionals she’d been working with for four years.
However, the current arrangement has proved extremely beneficial, she says. She was connected to a program of the Massachusetts Department of Mental Health that helps adults with mental health conditions set and work toward meaningful life goals.
Megan meets once a week with a clinician to talk about anything from managing her symptoms and relationships to applying for benefits to whether she should go back to school. She also meets weekly with a peer specialist.
The appointments regularly fill her with optimism and hope.
“I’ve gone almost a year without being hospitalized,” she says. “For me, that’s a good run.”
Control Issues & Treatment Decision-Making
There’s no denying that being on a locked hospital unit can feel like a terrifying loss of control. That can be compounded by lack of insight during hypomania or mania—meaning you don’t see why you need help in the first place—and psychotic features that make it difficult to stay grounded in reality.
Jesse L., who has bipolar I and anxiety disorders, recalls that he hadn’t slept for several days before he landed in a psych ward.
“I was pretty much out of my mind with confusion and minor delusions, so I was afraid,” the Nebraska man says. “But I wanted to go someplace where I could be safe until I got healthy again.”
At first, the loss of his own clothes and knowing that other people were in charge of him intensified his manic paranoia. To calm his fears, he would focus on a pedestrian bridge he could see from his window and remind himself he would be walking across that bridge once he was released.
Short visits with the doctor were the highlight of his stay because “he paid attention to what was happening to me,” Jesse says.
Having to be hospitalized can be doubly difficult if you have negative residue from a previous experience—perhaps from feeling that certain treatments were imposed on you or because of how the staff acted.
“If that’s you, don’t be ashamed of it,” says Rebecca Christofferson, a registered clinical counselor in private practice in British Columbia. “You are a survivor.”
A movement labeled “trauma-informed care” recognizes the effects of feeling powerless when receiving mental health treatment. Christofferson suggests alerting the facility about any issues like that.
Conflicts may arise with even the most sensitive care team, however, such as when people argue that they’re ready to go home but the doctor disagrees.
“When that happens, for the patients it feels like, ‘You’re not listening to me. You’re not wanting to help me,’” explains DiGiovanni. “But there are times I have go against what they’re saying they want because, in my professional opinion and in my good conscience, I can’t just let them go without having the kind of supports they need to be successful once they return to the community.”
Hospital Discharge & Lessons for Long-Term Stability
Stephen T., who lives in the Toronto area, appreciates hospitalization as a dedicated break to work out the kinks in a new bipolar medication regimen.
“That’s probably the best place in the world you can try it. You’re monitored. You’re not at your job or in the real world. You can speak directly to the staff about how you’re feeling, and judge for yourself whether it’s working,” says Stephen.
Medications can take from a couple of days to a few weeks to come fully online, so patience is critical.
Stephen notes that in addition to the formal treatment, connecting with peers who are in the same boat can provide both important support and a source of satisfaction.
“You begin to form relationships,” he says. “You’re as much helping them as they are helping you.”
Stephen’s advice is drawn from three hospitalizations over seven years. Ending up in the hospital again, especially after a decent stretch of stability, can trigger feelings of hopelessness and frustration. Stephen prefers to view his repeat visits as part of the learning curve in managing his bipolar I.
He’s gone nine years now without a relapse severe enough to warrant re-admittance.
“My close friends and family who know my personal history are proud of me, considering where I’ve been and where I am now—with a great career, a loving wife, and a young daughter,” he says.
Getting released from the hospital typically doesn’t mean you’re in tip-top shape. Basically, you’re well enough to work on getting yourself healthy again, like starting rehab after a heart attack.
It’s important to continue treatment—either with doctors and therapists in the community or through partial hospitalization, which is an intensive outpatient day program—to rely on your support network, and to apply yourself to self-care strategies.
It’s also important not to jump right back into your usual routine as soon as you’re out. Trying to re-adjust too quickly could undo the progress you made during your hospital stay.
If you have a job, asking for shorter hours or fewer responsibilities as you transition back will make success in the long run more likely. It may be tempting to prove you can operate at your previous level or even do more than usual, especially if work piled up while you were gone, but it’s unrealistic to expect that from yourself right away.
“Understand that you’re recovering, and you’re not going to be at 100 percent capacity the first week,” says Klafter, the Cincinnati psychiatrist. “Maybe you’re at 75 percent, but that’s better than zero percent, which is what you would’ve been the week before.”
It’s worth addressing any lingering negative feelings about your hospitalization in therapy or through peer support. Feeling reluctant to go back when you need to could put you in peril.
“If you get to the point where you feel like you’re at risk of harming yourself or somebody else, always go to the hospital,” insists Jennifer Gerlach, a mental health clinician in Illinois, adding: “Your life is more important than that.”
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