On Thin Ice

The weeks following my daughter’s release from her first mental health hold were a tenuous mix of hope and dread. I was hopeful the change of medication would help stabilize her, and at the same time I was terrified that the change of medication would not help stabilize her. Worse yet, I was afraid the change of medication would aggravate her already fragile demeanor.

It felt as if we were walking on thin ice, fearing a web of cracks with each step.

Walking_On_Thin_Ice_by_X_ample

(Photo Source)

My daughter returned to school, and it’s hard to say whose nerves were more frayed. Returning to classes and trying to explain to her peer group all that had happened could not have been easy for her.

I still had daily worries about her younger sister and the volatility within which we were all living. It was clear that, although the five days in the psych ward had helped to temporarily steady the crisis we were facing, our predicament was by no means resolved.

Soon enough the unpredictable and explosive episodes returned. The fragile and subdued girl who left the behavioral center after a psych eval was gone. In her place once again was a struggling teen unable to manage the emotional eruptions that plagued her.

There were necessary boundaries I was continuing to implement for her safety and my sanity, but I tried to allow my daughter time for friends. Though the dynamics of those friendships were not what I would have chosen (for any of them), I wanted to honor her need for her own identity and self-discovery. It seemed to be an integral part of the solution for her, but only if done in a healthy way.

I offered to drive them to the local ice skating rink or make our home available for their gatherings. All offers were declined, sometimes with a dismissive or angry attitude, sometimes with what seemed like abject hopelessness.

I tried to arrange my work schedule so that I could pick her up at school not too long after classes ended for the day. Getting in enough work hours could be difficult, and there were days she would call me filled with rage, demanding I pick her up right away.

on the phone

(Photo Source)

I wasn’t often able to leave early, though if I felt she was not emotionally safe, I would try to head out as soon as possible for the half hour drive. Memories and thoughts of her self inflicted wounds were never far from my mind.

It could be tough to know the right thing to do: Was she trying to manipulate me with her anger, expecting me to respond to her every whim? Or was she truly incapable of regulating her emotions, succumbing to the darkness that enveloped her like a cloud?

The answer to both questions was a resounding yes.

I was often confused by the seesaw of emotions I witnessed. She would insist that she wanted to stay after school to be with her friends, dramatically declaring that they were the only reason she went to school or kept herself alive. But her insistence about the importance of being with her peers was equally matched by her absolute loathing of them at times.

Life remained utterly unpredictable.

One thing that was relatively unsurprising was my daughter’s therapy sessions. As per the discharge paperwork from her hospitalization, she started seeing a new counselor. Unlike the previous therapist, this one was not located near our home. In all fairness, it wasn’t too terribly far; it just felt that way. The drives there and back were filled with heavy silence or forced, uncomfortable conversation.

What was not a surprise was the refusal from my daughter to fully engage in the help that was available to her. While she would talk on a superficial level with her counselor, she had in truth done nothing but reinforce the brick wall that surrounded her, the wall that she mistakenly felt would protect her from pain and struggle. At times she would even agree with insights her therapist offered, but by her own admission, she simply didn’t care.

Sometimes near the end of her sessions, I was brought into the office and the conversation. It was not unusual for me to watch my daughter sit in stony silence, her arms crossed tightly, her breathing heavy with anger. Her eyes would be filled with rage while she stared at a distant point, as if to will her bodily out of this universe and into one of her own making, one that would soothe her despair and anguish.

Sadly, she was unable to see that she was surrounded by people who truly wanted to help her reach a place of calm and peace. Her depression had convinced her that this was not a possibility for her.

Our lives continued to be lived in the shadow of her illness.

© Monica Simpson and Help To Hope, 2013
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Work

My daughter’s stay in the psych ward (her first stay, at least) was five days. Yet it seemed interminable and exhausting to me. I can only imagine how it must have felt to her.

While my daughter was hospitalized, I worked. I worked to find the new therapist she needed. I worked to prepare my younger daughter for her sister’s return. I worked to prepare myself for her return as well. I worked at calming my nerves in anticipation of the unknown that lay ahead for us.

I worked at contacting personnel in my daughter’s high school to let them know why she’d missed school and was failing her core classes. I worked to advocate to her teachers on her behalf as depression, anxiety, and panic had interrupted class tests, make-up tests, and all manner of school work and homework in the preceding weeks.

I worked to make it clear to her teachers that I was not trying to excuse any behavior; I simply wanted my daughter to know she could walk into a classroom, take a test, and not let anxiety continue to drag her into a dark abyss leading to self harm and despair.

I worked to prepare the way to help my daughter find even a tiny but necessary victory.

I worked to release the frustration of not hearing back from several of her teachers. I worked to let go of the fear that they would judge me as “that mom”, the one who let her kid get away with anything, then made excuses.

mean-teacher

Source

 

I worked to remember that my goal was not to get my adolescent daughter to pass English, sing in choir, or even pass her freshman year. I worked to stay focused on helping her reach a place of mental wellness, health, and personal safety.

I worked, literally, to keep my daughter alive, to help her want to stay alive.

I worked to respond to the teachers who had kindly and compassionately replied after I contacted them to inform them of my daughter’s deep struggles. I worked to contain my tears, to thank these good people for seeing the inherent value in my 15-year-old, even though she could not see it in herself.

I worked to remind myself that they were bearing witness to the good in my daughter, and helping me hold onto hope, whether they realized it or not.

I worked at letting go of the frustration that I was the one having to do everything, with no help from my children’s father. I worked to not allow wasteful bitterness about that overtake me.

I worked to arrange my schedule so I could be where I had to be when I had to be there, whether taking my youngest to cheer practice, or visiting my older daughter in the psych ward.

I worked at pushing aside the grief I felt as a widow, the utter sorrow I felt at not having my husband to talk with at the end of an exhausting day. I worked at trying to think of the encouraging words I knew he would say to me.

I worked to recall the feel of his arms around me, the safest place I’d ever known. I worked to remember that, no matter how distant it now seemed, I hadn’t imagined him in the first place.

I worked at staying awake and focused despite little sleep. I worked at the dailies of life: carpool, laundry, dishes. And, of course, I worked at work.

I was tired.

 

(One of my favorite bands/songs/videos. Best when played at a loud volume.)

 

Saturday finally arrived. Though two days earlier my daughter had angrily demanded I pick her up “Saturday morning at 6!” I kept my word and arrived around 9:30 a.m. The requisite paperwork took a little while. And there were new friends she’d made to whom she wanted to say goodbye.

We left with a prescription and a plan, and I was hopeful they would work at the same time I was terrified they would fail.

One of the perks of a psych ward stay (who knew there was such a thing?) was that my daughter was able to continue as the patient of the psychiatrist who saw her during her days there.

While that may not seem like such a big deal, the truth is that finding a qualified psychiatrist can take more time than one might imagine. And after finally tracking someone down, it’s not unusual to have to wait up to two months (yes, TWO MONTHS – or more) for an available appointment.

This one not-so-small detail had now been taken care of. It’s not like the appointments would be close to home, but just to HAVE appointments for someone who could manage medication was a major hurdle crossed. I was very grateful.

sunny day

 (Source: Google Images) 

 

My daughter and I stepped out into a bright, sunny February morning in Colorado. She hadn’t had the freedom to be outside for several days. She seemed small and fragile, a combination of embarrassment, nervousness, and relief. I felt much the same as she.

I didn’t know the rules for what a parent is supposed to do when they pick their kid up from the psych ward. So we went to Jamba Juice. It seemed like a good idea. And it was.

© Monica Simpson and Help To Hope, 2013
https://www.facebook.com/HelpToHope
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Curiouser and Curiouser

I tried hard to be a voice of reason to my daughter. But how does one reason where there is no willingness to receive it? It didn’t work for Alice after she fell down the rabbit’s hole, and it wasn’t working for me. Still, it seemed all I could do.

alice in wonderland confusing

(Source)

Tuesday night had seen a change to my daughter’s medication. The two SSRI anti-depressants she’d tried in the previous weeks had served only to take her deeper into rage, depression, and thoughts of suicide.

She was switched to a medication initially developed to treat seizures but used off-label to treat mood disorders. As those with mental health issues often find, medication is not an exact science. Not at all. But the aim at this point was to stabilize her, which (ironically) meant taking her off anti-depressants.

She soon found out that the term “72 hour hold” was a misnomer, more a guideline than a declaration. This was first a rumor she heard from other adolescents in the unit, and then she found out it was to be her reality.

I tried to explain the reasoning behind the need for her to stay in the psych ward longer. “They’ve switched your meds. The old ones obviously didn’t work well for you. They need to make sure you don’t have a bad reaction to this new medication. It’s a safety issue.”

Predictably, she was not receptive. For the record, I’m not so sure I would have been either if I’d been in her shoes. Also predictably, her anger flared. She was not allowed contact with any friends while she was hospitalized, and even if the support system she’d built for herself was terribly dysfunctional and harmful, all she knew was that it had been taken from her. And she was mad.

There were some curious things I realized about myself in those few days, difficult things that made me sad and confused.

 alice in wonderland sad

(Source)

I knew that I was afraid for my daughter to be released from the psych ward and sent home. I was fearful that she would quickly return to her previous behaviors and that I was just too worn down to be an effective parent anymore. I was scared that there would be no lasting changes resulting from this awful ordeal. And I was so out of ideas.

I knew that my goal was not to keep my daughter from getting angry nor was it to have her like me. My goal was to keep her safe, even if she came to hate me in the process.

I knew that I wanted to put up all kinds of roadblocks so that her choices were limited and she couldn’t make decisions that would be harmful. But I knew that would be a disservice to her, that it would mistakenly teach her that she could not be responsible for herself.

I knew that, in the bigger picture, I couldn’t and really didn’t want to control my daughter; I wanted her to learn to control herself.

I knew that  for that to happen there had to be boundaries and consequences in place, and that she had to choose her actions and thus her own outcomes. This was a source of great pain for me, because I knew some of the choices she would make and that their results would be very hard for all of us.

But I had to let that go. Even though I could see that she was not yet willing (or able?) to face some of her bigger issues, I had to let her choose for herself.

I will once more refer to an email I wrote to my small and trusted circle of support. This was yet another middle of the night message, a bit disjointed and bearing witness to my fears and frustrations. This was written on day three of my daughter’s stay at the behavioral center, the day she had mistakenly decided she was going to be released and sent home.

* * *

I had a meeting today with C and her dad and caseworker.  There was a chance for C to have her say and a chance for us to, then time for us parents to meet alone with the caseworker.  We were told early in the meeting that C would not be released until Saturday (day five of her “72 hour” hold). We really lost her at that point. She wants to come home NOW.

She was not forthcoming about some stuff she’s been lying about lately, nor about what might have been bothering her that led up her hospitalization. She’s been telling me for weeks about some things that are just driving her crazy, but she never even mentioned them in today’s meeting. I told her that I’d learned about some of her deceptions but she would not acknowledge anything, just said she had no idea what I was talking about.

I tried to prepare her for the fact that things will be very different when she gets back home, that boundaries will be tighter, and privileges will need to be earned back.  I don’t think she has any idea what that means or thinks it will really happen anyway.

I am feeling extremely overwhelmed at the thought of her return home.  The caseworker had all kinds of thoughts and ideas, and while some of them may be helpful, the work of it all feels like it will bury me.

When her dad and I walked out of our meeting with the caseworker, C came straight over and asked me why she couldn’t be released sooner.  She was very angry and confrontational and kept demanding answers that I couldn’t give her.  I gave her the only answer there was to give, but she wanted more and I told her that was all I had, I couldn’t make anything up to satisfy her.

She directed all her anger and frustration towards me. I don’t think she even made eye contact with her dad for that 5 to 10 minute conversation.  She made vague threats about not eating (that’s her choice if she wants to make it) and swore she was better and ready to come home.  It was really pretty awful.

She chose me to be the one to pick her up when she is released on Saturday. She told me she wants me there at 6 in the morning. I told her I’d be there between 9 and 10.

I know there are many strategies to deal with her in the days ahead; I just honestly feel like there is nothing left in me to do it – to learn what I need to learn as a parent, to find her a new psychologist (her request and the caseworker’s recommendation), to drive her across town how many times a week for those appointments, to find extra-curricular activities & get her enrolled & to the activities, to meet with her school counselor and teachers and try to help her not fail her freshman year.

I am just spent, which may be exactly where I need to be but it doesn’t make any sense to me and I can’t see how it’s all supposed to get done.

I did tell her dad that with these added commitments I cannot logistically do all that needs to be done for both girls during the week (always on ongoing battle for me), and he said he’d be available but the truth is that he works during the hours these things are going on. I will have to continue to change and arrange my work schedule to take care of things.

I don’t expect him to make any sizable contribution to handling those details because he hasn’t before. It would be helpful if he actually had some input or action of his own; I feel like it’s up to me to take the lead on these things because he simply will not and we are at a critical juncture where action must be taken.  He does not seem to accept the seriousness of the situation. (Caution: ex-wife frustrations are surfacing!)

Again, the ideas for help and change sound really good in theory but the reality of it feels nearly impossible to me. There just isn’t enough of me to go around.

The diagnosis the caseworker gave for C today was General Anxiety Disorder and Depressive Disorder.  I don’t know if a new therapist will reach a separate conclusion.  C says she hasn’t been suicidal for about a day and a half.  She says cutting is stupid and disgusting and she’ll never do it again (which she’s said before), and she swears that she has learned all she needs to know and will be fine.

She also says she wants to “help” her friends who cut to stop cutting, which basically translates to her taking responsibility for their actions – which scares me especially when she cannot take responsibility for her own.

After today, I cannot imagine a conversation with her that is not angry and confrontational and manipulative.

I do get that her choices are her own and that my job, after assuring her safety, is to allow her to deal with the consequences of her choices.  I know very well what some of those consequences could end up being, and I can honestly say I hate that.

Maybe that is where so much of my anxiety is coming from and I need to work towards what is acceptable and adequate, not what is perfect and guaranteed (those two options really don’t even exist).  But I selfishly look at those consequences, should they come – and I know some of them will – and I know that they will result in even more being put on my plate and I feel frustrated and angry about that.

Well so there it all is.  I am too tired to make this (or me) sound nice. I have no neat or tidy wrap up for this message; I’m just continuing to ask for and appreciate your prayers and hoping that my ranting and venting haven’t been too offensive.

In a few hours I start a very busy day, not only working on my taxes, etc., but also working out C’s discharge, contacting her school, trying to track down and interview therapists and stuff like that.  I appreciate your prayers and support.

© Monica Simpson and Help To Hope, 2013
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I Left Her There

The moment had come. They psych ward doors had opened, swallowing us into the unknown, shutting tightly and unnervingly behind us.

Once again, my daughter was given scrubs and non-skid socks to wear until I could return with “approved” clothes for her. I was grieved that she had no personal items to comfort her in this most frightening of places. (Shoestrings, drawstrings, belts, and other such items were strictly forbidden in the locked ward populated by adolescents who might use anything they could find to harm themselves or others.)

black hightops

(Photo Source: Google Images)

It was around midnight after a very long day.  I honestly don’t remember much except being in a small, dark room where the clothes of the adolescent residents were kept folded and stacked on shelves.

As I look back on that time, I’m surprised at the details I simply cannot recall. The emotion of the moment … that returns to me in a heartbeat, and even now I weep as my body responds to the memory of all that I felt in those difficult hours. I can feel it in an instant.

I left my daughter. I left her there. I left her in a psych ward on lockdown. I left her there because she was suicidal. I left her there because I could not keep her safe. I left her there because I loved her. I left her there with a trail of my tears and much of my heart.

Upon returning home, I sent an email out to my trusted group of friends, those I’d been sharing the journey with on many a late night when I was unable to sleep or bring any order to my world or mind.

I so missed the strong support of my husband. It had been less than two years since we’d watched him be removed from life support and take his last breath. How desperately I ached for his wisdom and comfort.

And so, my small but trusted band of friends had ‘listened’ faithfully as I’d regularly poured my heart out to them via email, lamenting my daughter’s depression, self harm, truancy, constant talk of blood and death, and all the other dark details that had been filling our lives for a number of months.

sad emailer

(Photo Source: Google Images)

There had been a few quick calls and texts to them during the daylight hours as we’d moved through the mental health crisis that had landed us in the emergency room. The following is part of the update message I sent to My Group after admitting my daughter to the psych ward for the first time. It’s a bit disjointed, though I tried to edit it to make it easier to follow.

It was sent on February 19, 2008 at 1:31 a.m.

* * * * *

Hello, friends.

I am just home from a very long night during which C was hospitalized for her own safety.  C’s dad came over to talk with her. He was very reluctant to admit her, but I am quite convinced it was the only safe option.

I did call 911 because C made it very clear that she would fight us if we tried to take her to the hospital.  So between the two squad cars, paramedics and ambulance, she went rather peacefully if not tearfully.  My heart just aches for her.

I had asked C earlier in the afternoon to rate her likelihood of suicide on a scale of 10 and she nearly yelled “10!” at me; I asked if she thought she actually would act on it and she said of course if everyone would just leave her alone (she used much more colorful language).  That was when it became glaringly apparent that she really needed to be admitted.

She had threatened to run away over the weekend and she and I even had a tussle in the driveway as she fell into a heap yelling about how much she hated me, much to the confusion of the man watching us from across the street.

We went to Children’s Hospital emergency room by ambulance about 6 p.m. Monday, and they had no empty beds so she was transported to [a freestanding behavioral center].

The supervisor I spoke with tonight said there is a decent likelihood she will be there more than 72 hours as there will likely be med changes they will have to monitor, but they don’t generally keep someone longer than 5 days.  He did tell me that last week they had 3 adolescents and in the past 24 – 36 hours they have admitted 15.  Wow.

Poor C may just be getting to sleep now (if she is lucky) and their days start at 6:15 and go until 9 or 10 at night.  When I said goodbye to her tonight she actually let me give her a kiss on the cheek and a good, long hug (which felt so good; I’ve really missed that).

I cannot describe to you her state of mind earlier today and over the past 4 days.  It’s been as if another person is living in her body, and this week I have been the trigger that has really set her off.  She told me, among many disturbing things, that she’s sick of people saying they love her and care about her and it just makes her want to kill herself when she hears it.

But she told me she loved me tonight so I felt free to return the favor.  I did tell her as I was leaving that she was going to be okay there and she agreed and said, “I know”, but in her real voice, not the unknown person she has been.  I think maybe, at least tonight, she might have even felt safer there than she did at home.

I spent about a half hour talking with the supervisor before I left and I feel like they are on top of things with the kids in their care; he even addressed issues before I had a chance to voice my concern about them.

This will, of course, take C way out of her comfort zone; that’s not a bad thing but I sure would appreciate your prayers for her.  I just want to scoop her up and cradle her in my arms and bring her home ~ which would defeat the purpose of everything we went out on a limb for today, but it just really hurt to see her like that.

Perhaps now that she is there the fear and anxiety of the unknown, and the threat of hospitalization (vs. the reality) will melt away and she can actually get to a safe place.  I know this may not be the last time we have to do this; I hope so, but I won’t be surprised if it isn’t.  There are so very many things going on concerning her treatment and the more people involved the more “options” are offered or brought up.

I feel very helpless to protect her, but I felt even more helpless when she was at home.  Now I believe she is in a safe place where she cannot hurt herself, and she can get some ongoing help, even if only for a few days.  I know it’s a long road ahead.  But I think I can get a few good nights worth of sleep, and I look forward to that.

K (sister, age 14) and J (brother, age 18) are both very upset.  I communicated with J several times by phone tonight and he was in tears.  K was here when all the uniforms and official vehicles arrived and that was very scary for her.  She was able to go to the hospital and see C before they moved her to another facility. I think that was good for both of them.

(My stepdaughter) went in to see her also and of course C apologized for the colorful tirade she let fly against her this afternoon.  As usual probably more details than you wanted, but as always I appreciate your prayers and concern.

C has not been able to tolerate any concern from others lately, and I don’t know if/how long that will continue.  But thanks for loving her with your prayers, even if it is from afar.

Monica

 

© Monica Simpson and Help To Hope, 2013