I was an adult before I learned what happens to a caterpillar when it’s in a chrysalis, mostly because between the age of about seven until adulthood, the metamorphosis of a butterfly just wasn’t at the top of my priority list of “things to know about.” I knew that butterflies had four steps to their lives: egg, caterpillar, chrysalis, butterfly. I knew that I got really excited whenever I saw a butterfly. But I never really cared to find out what the process of changing from a caterpillar into a butterfly looks like.
(the process of changing from an egg to a caterpillar is basically the same as egg to chick or egg to leopard gecko or egg to spider baby: you get out and you are the thing)
I suppose, even into adulthood, that I’d always assumed it involved the caterpillar just sleeping for a couple of weeks and growing wings while asleep, despite that butterfly bodies and caterpillar bodies look so very different. Maybe when I was smaller, I’d thought that it involved more thought on the caterpillar’s part, like they spent two weeks in front of a closet full of wings trying to decide what color to wear. Had I been a child with access to Sailor Moon (which I was not), I’d probably have imagined a teeny tiny magical girl transformation within the chrysalis. As far as I knew, those things were magic.
Well, as it turns out, the magic of turning from a caterpillar to a chrysalis to a butterfly is kind of messy. Essentially, the caterpillar’s body digests itself from the inside out. Everything it used to use in order to process the leaves it ate instead turns and just… eats its body. All but a few tissues of the old caterpillar are broken down and destroyed as the biological processes that create a butterfly take place.
(moths do essentially the same thing, except they have cocoons, which are silky, instead of chrysalises, which are hard)
Imagine if that’s how puberty worked. Your kid suddenly starts eating like a bottomless pit then finds a place to hang upside down by their ankles and wrap themselves in a random suit of armor. If you open the suit of armor anywhere within about two weeks, you’ll find nothing but goo because your kid’s stomach acid just devoured them, and then when they come out two weeks later, their legs and mouth are the same, but the rest of them is completely different.
Bugs are weird.
So anyway, week one of partial hospitalization!
Every day starts at 9:00. About fifteen of us assemble on a Zoom call, which functions pretty similarly to most non-work Zoom calls. Some people are in their living room, some people are in their bedroom, some are in their office, some are on their phone and we get to see the entirety of their house over the course of the day. One of our team of five therapists (we also have two psychiatric RNs) comes on, and we do our check-in.
Check-in is a little bit like checking in for a doctor’s appointment except that nobody sees your weight or tells you to take off your clothes afterwards. We’re asked a series of specific questions about the last 24 hours (or weekend, if it’s a Monday): what did you do last night, did you have any challenges, what sorts of coping skills did you use, things like that. The two big questions end up being “how are you” and “what do you want to accomplish during today’s session?” The first question seems pretty straightforward, but when you’re in a partial hospitalization group for mental illness, it’s anything but. We’re also not allowed to use any noncommittal answers: no “good” or “okay” or “bad.” Every day, we receive a list of potential mood descriptors that we can use. Instead of “good,” maybe you’re “content” or “reassured.” Instead of “okay” you’re “nonchalant” or “preoccupied.” Instead of “bad” or “sad” you’re “pessimistic” or “lonely” or “restless.” The idea there is to get us to really narrow down our feelings so that we can identify where they’re coming from and what, if anything, will help us cope with them.
The other question is pretty straightforward, sort of, but we have to give a concrete answer. Something like, for example, “I want to listen” or “I don’t know,” doesn’t work. Things like “I want to gain one new coping skill” or “I want to participate in the discussion once for each group” are much better. It gives us a metric to reach or not reach so that, at the end of the day, we can talk about whether or not we managed it and, if not, what we can do to change that in the future.
We have a ten minute break. I usually run out and use the bathroom and give the kids each a hug and a kiss (and Kyle, if I can reach him above all the kids).
The next two groups are also divided by a ten-minute break, but they’re more teaching groups, helping us to learn skills that will ease the burden of our mood disorders or addictions or whatever else we have going on when we’re not in group. These are a lot harder to break down into a simple paragraph of description because they run the gamut, everything from watching an Instagram model talk about stream of consciousness writing and putting it into practice to finding five sensory objects that we can focus on when our minds begin to spiral out of control to practical advice on when and how to talk about our mental illnesses with other people, including employers.
Oh, and Brene Brown. SO MUCH Brene Brown.
I like those groups a lot, especially the ones that offer practical advice and coping skills. It’s one thing to gain those theories of “vulnerability is courage and leads to fulfillment” and “shame is neutralized by the words ‘me too,’” and not that internalizing those messages (which it’s hard not to do when you’re being bombarded by them) isn’t helpful and useful, but having practical advice gives me something I can incorporate into my days and either cope MUCH better with the issues I have or else prevent them from getting as bad in the first place.
For example, one that we talk about SO MUCH is called the 5-4-3-2-1 technique, which I’d heard about before, but it comes up basically every other session at least twice. It’s a grounding technique you can use when you’re having a panic attack or dissociating or feel yourself spiraling out of control. You find and identify (by saying out loud) five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste. This gets you out of the panicky mindspace and helps to calm your body down by focusing your mind on concrete things rather than abstracts. I’ve learned to start keeping focusing objects around my desk for those inevitable times when I’ll start panicking or getting too in my head (Kyle is, for his part, not complaining that he’s smelling my perfume more often).
Another ten minute break (and time for me to take some of my meds), and then it’s our last group, check-out. The questions at check-out follow a similar pattern to those at check-in: did you accomplish what you set out to do today, what is one thing you learned today, what are your plans for tonight, etc. And each check-out ends with the question: are you safe at home? If you seem like you aren’t doing so great, the therapists offer to have someone call and check in with you at some point, and they make sure that everyone who wanted to speak with the psychiatric RNs or with their case manager has done so.
It doesn’t sound like it would be terribly helpful, but it is. It’s all so simple, but it’s what I–and, I think, all the people in the program–need. It breaks things down for us, gives us very simple and practical ways of looking at our mental health and caring for ourselves so that we don’t feel overwhelmed by the task.
That doesn’t mean we all do really well all of the time. I haven’t walked since Wednesday (in my defense, Thursday and today were rainy, but I have no excuse for Friday), and I had a really bad night last night (more on that in a minute). Mental health is more of a squiggly up and down line than a straight incline–your rough days and good days are going to be all over the place. But hopefully, soonish, the trend for me will be more up days than down ones.
Like I said earlier, part of the program is having a psychiatric RN available to help you adjust your medications as needed, and that’s where my bad night yesterday began.
It was so dumb, really. Yesterday was SUCH a nice day, and I was feeling really good going into the weekend. We didn’t have any concrete plans beyond D&D tonight (I’m skipping because I am just worn thin), but I thought it would be fun to try and get the kids out to a park somewhere tomorrow because it’s going to be really nice. Before doing that, though, I talked with my psychiatric RN about how increasing the dosage of my antidepressant was difficult because the first few days following that increase are always marked by me being really sleepy (or, as they call it in the medical world, “somnolence”).
“Why don’t you try taking your meds at night instead?” my RN suggested, and I was like
Obviously! If the meds make you sleepy, take them before you’re about to go and sleep! Problem solved! You’ll start getting really sleepy just in time to go to bed, and everything will be happy funtimes!
So here’s the thing about my antidepressant: it has a REALLY short half life, about 3-7 hours depending on your dosage and body and whatever. Miss your dose by too long and you’re in for a rough time because my antidepressant, an SNRI, has really bad discontinuation symptoms. We’re talking everything from the jitters to nausea to panic attacks to psychosis.
I’d experienced a lot of it before, once. I was on half the dosage I’m on now, and I’d forgotten to take my pill with breakfast (this was well before I started using a days of the week pillbox, an accessory that makes me feel like I need to subscribe to AARP magazine but also basically saves my life because depression destroys your memory). I didn’t realize that I’d forgotten for most of the day, and as the day came to a close, I developed a terrible headache, jitters, general agitation, and a very bad mood. I went to bed early, figuring that I could just sleep off whatever this was.
But no, that’s when things got WAY worse. Effexor, my antidepressant, already causes vivid dreams, which has been a lot of fun over the last ~6 years I’ve been on it (I can still tell you most of the details in the yellow house dream or the numerous “we’re going to Disney World but something is going terribly awry” dreams). When the drug isn’t in your body anymore, though, you start having really vivid night terrors.
When I say “night terrors,” I don’t mean dreams that were logically frightening–those, at least, I could have accepted as waking me up all night long. No, these dreams weren’t even that scary. They were otherwise completely normal dreams that just left me absolutely terrified and certain I was going to die in dreamland. It was around the third bad dream that I woke up in a cold sweat, put two and two together and realized, “Oh, shit. I forgot my meds yesterday.” The next night terror took this information into account and focused on me trying to get to the hospital to get my medication but constantly missing the subway stop, which, in this bizarre dreamworld, was the scariest thing imaginable.
When my RN told me to start taking my meds at night, I knew I’d be in for something of a rough time beforehand, but I figured that it wouldn’t be nearly as bad as the time before because I wouldn’t have to deal with it while sleeping. No night terrors, maybe a headache or some jitters, but I wasn’t missing a dose. I was just taking it later.
I mean, about eight hours later than I’d taken it the day before, but it would be fine, right?
Around the time Kyle and I put the kids to bed, it started. I felt so irritable. Furious scoldings of my children were in the back of my throat, but the withdrawal hadn’t completely kicked in, so I held them in with some deep breathing and visualization. I came downstairs, and the jitters began. I wasn’t shaking outside of my own control, but my arms and legs felt like they needed me to shake and flap them (“why, brain?” I wailed internally. “You gotta,” my brain, the asshole, replied). I tried to ignore it while eating ice cream, but as I took the last bite, a sense of absolute dread descended on me.
If you’ve ever had a panic attack, you know what this is like, but I think everyone has had that kind of fear at some point in their lives, even just as a kid. It’s beyond the usual fear of “haha that was a really scary movie, good thing zombies aren’t real, but I’m going to sleep with this baseball bat under my bed just in case.” It’s that sense that if something doesn’t change IMMEDIATELY, you are going to die, with all of your primal instincts to preserve your life kicking in. And that’s super cool and helpful if you’re a caveman and there’s a sabretooth tiger stalking you, but when you’re a 21st century mom who just wants to get to the kitchen to put away her ice cream bowl, it’s a little inconvenient.
I put the bowl back. I grabbed a bottle of water. I sat down. It was half an hour early, but I took my antidepressant anyway because I couldn’t stand it anymore. And I wish I could say that the relief was immediate, but medication that goes through your bloodstream has to actually get there first, so I had about an hour, maybe more, to wait until the medication kicked in.
By now, I was shaking like a leaf and couldn’t stop. I took my phone and my iPad out to the living room and flipped on the Weather Channel, not to pay attention (it was something about trucks and snow, I think?) but to have consistent noise. I tried to focus on every exercise I’ve learned to get through a panic attack, and they’d work for a couple of minutes before the panic set back in, because it was physiological not psychological. My brain wasn’t panicking because it was afraid; it was panicking because the medication that makes sure it gets enough serotonin and norepinephrine had vanished from my system, and the only fix for that was to get that medication back.
(psychiatric medications are a trip, let me tell you; this is why you have to taper off them instead of quitting cold turkey, and I 100% understand why it’s so hard to stop using illicit drugs)
Kyle eventually came out to the living room and sat with me and let me talk and talk until I could stop panicking, which was about an hour and a half after I took the meds. Even that was scary at first, because I couldn’t keep my train of thought, and half the time, I wasn’t 100% sure that I was saying words in a way that could be understood either. But the meds did kick in, slowly, and I came down from my panic, slowly. It still wasn’t a great night afterwards, and I felt exhausted this morning, but at least my lizard brain isn’t currently telling me that DOOM IS COMING anymore.
The exhaustion that carried over to today translated into me taking a nap this afternoon, since today was just. Gross. Super humid outside, rain all day (but not the pleasant kind, the kind that gives me a migraine), everything feeling like it was dragging through sludge. And then I was supposed to do D&D tonight, but five minutes in, I started panicking and cut out as quick as I could because I didn’t want to have another attack.
It’s like. Days where I have the PHP, I’m tired but okay. Days where I don’t, everything goes upside down and sideways. But on the plus side, I’ve been coloring a bunch of downloadable pages and that’s been fun. And it’s still just the end of week one, so who knows. Maybe at the end of next week, I’ll be. Saner? We’ll see.