First Contact As A Patient in Psychiatry: Story, Pilot Project Proposal
October 27, 2018 (published)
I share snippets of personal experiences from my first involuntary hospitalization with psychosis, labeled as Bipolar Disorder: a backdrop for my specific recommendations and a Pilot Project.
I am writing this on October 25, 2018, the 6 year Anniversary of my receiving a Psychiatric Label.
October 25, 2012
I am brought in to the Emergency Department by my brother (my only sibling) and my friend.
Over the proceeding days, I had elevated mood, extra playful, not concerned with societal norms.
I made a bizarre choice to bring my two dogs off-leash to a Government Building while meeting a friend the day prior. For a couple of weeks, I had difficulty managing my light schedule.
The day of admission, I was feeling more and more physically unwell. I felt an overwhelming amount of energy coursing through my body. I was physically exhausted, unable to drive. I asked someone to pick up my daughter from the fitness center and she walked in the room. Apparently I had driven her home but could not recall it. So weird. Did someone do it on my behalf? Using my body? Bizarre.
Later that evening, I went into full trance channelling mode. At the time, I did not know to call it that. Years later, I came to understand what had happened. It was a young woman from India speaking spiritually pleasant truths through me. In the moment, I was happy that my family could witness these beautiful messages. My daughter (15 years old at the time), former marriage partner and brother were very alarmed. They could clearly see that it was not me. And it wasn’t. I was freaked out too by their reaction and the newness of the experience.
It was decided, I would be taken to a local hospital for psychiatric assessment. It was my parenting partner, trained alongside me as a Physician, that made the decision. A reasonable one. I recall on the drive knowing full well that I would be committed to stay in the hospital. Commitment is a legal act to ensure that a patient with a Psychiatric diagnosis remains in hospital. A surreal realization.
When I arrived at the Emergency Room – familiar to me from my medical training- I went a little deeper into my unshared reality state. I got such clear messages that the entire medical system was backwards. 180 degrees. Which felt very funny to me. I thought I was being videotaped and might appear on a Juste Pour Rire show.
The nurse asked for the patient’s Alberta Healthcare Number. I was tickled to suggest to my brother that he show his. He was the one with concern. He was the patient. I was feeling lighthearted and playful despite my concern about being committed. I notice that my usually jovial brother had his serious Engineer face on. Hmmm…
Every step of the way, I was receiving messages about the unwellness of the healthcare system that was serving me. The messages resonated as true. Matching my own observation from when I worked as a training Physician and Family Physician. Yet there was much more certainty and some new twists added. I felt I was being upgraded and was elated in what I felt was a new and improved state of being.
After some waiting, 2 Psychiatrists assessed me in the company of my friend and brother. The 2 Physicians appeared undead, like zombies. They had x’es appearing over their eyes as seen in cartoons. My friend and brother appeared normally. I was asked many closed questions that made me feel boxed into a corner. Knowing what they were doing, I was reluctant to answer their questions. Feeling a sense of a conspiracy. Wow! Their questions were perfect. Like they knew that people cannot lie while in this state. They can be led to incriminate themselves. I was thinking, what a great way to stall human evolution. This Psychiatry System. My fascination over the years prior was with self-actualization, like Jesus Christ. Notice, I did not think I was Jesus Christ. That is so last millennium. I was inspired by the story of Jesus Christ as an example of what every human being is capable of. I wanted to experience my most optimal self. I actively pursued this vision.
Never discussed or asked about by the medical team, my episode was triggered by 3 separate past life regression sessions the week prior to admission. Against the better judgment of the practitioner. I was motivated to optimize myself as quickly as I could. A big lesson I learned from this was to ask for it to come … with ease and grace. I feel that I got exactly what I asked for. Partly because I had no idea how my request would play out. We are all sovereign beings much more in control of our experience than we have been taught to believe. Yet I see these episodes as self-healing somehow. As chaotic as they seem in the moment, they served my journey to wholeness. Kind of a rotor rooter for the psyche.
Back to admission day: I noticed that I am fully incapable of telling an untruth. My friend, a like-minded person who worked as an alternative healer, became like a translator. She recounted that I did not seem to understand the doctors but could understand her. She felt she understood me very well and was shocked and traumatized by the way I was treated by the physicians. Her intuitive senses were not pleased.
No surprise that I would be kept in hospital. Officially against my will but I knew that I needed some support. So I waited in Emergency until a bed would become available. Once arrived at the ward, I was quite delighted. There were many like minds to interact with. Peaceful, loving, playful patients. Here for the same reason I was. It did not take long before I got into trouble. I had no impulse control. I was just let loose on the ward. First, I was caught hugging another patient. Against the rules. Then, I was caught smoking in the bathroom with a fellow patient who wished to demonstrate how to do it without getting caught. I was not a smoker then but enjoyed the connection with another human. Second rule broken. Lastly, I was found lying in a bed with a fellow patient. Fully clothed, both exhausted yet enjoying the close company of each other. Holding hands.
I interject here that while in this state, we were like 5 year old children. I know that is not always the case but for the two of us, it was. We were both in a similar altered state. I was attracted to him like a magnet. He, the same. It felt really comforting to spend time with him. I truly wanted to take a nap with him by my side. It was very innocent. It was not anything about adult sexual desires etc. I can say this definitively because I debriefed with this young man and he remains a friend to this day.
Suggestion: When a patient is in this state lacking impulse control and in a loving state of mind, supervision is required to ensure to avoid unsafe situations. Yet, there is an argument that in a supportive environment, none of these situations were unsafe. Yet supervision is prudent.
The solution for the system: send Angèle to a lockdown unit. At the time there were less than 30 beds like this in my city. I was deemed to require one.
The only 2 solutions available were no supervision or lockdown. Not optimal. There is a middle ground to be explored.
So now I am in a room with windows showing out to the ward. With that wire mesh within. Locked door, at times. And a personal bathroom.
I came to learn that the prior tenant had left it in quite a mess. Markers and feces all over the wall.
The lockdown ward was not all bad. There were other gentle souls to connect to. It was not too long before I earned the privilege to spend time in the common area outside the 10 rooms for meals and various activities. Played a fast-paced card game with a fellow manic patient. There was an amazing fellowship amongst the patients. Most of us exuding a defiance against the system as it stripped us of our basic freedoms. Yet we were supportive and gentle with each other.
There was an awesome high-tech bathtub which I made daily maximum use of. I was surprised there was not more competition but was thankful for my long grounding baths. I even entertained a visit from my longest-standing friend from Grade 7 onwards. She arrived while I was soaking. I did not want to miss her visit (or my bathtime) so I suggested to the nurse to give me a towel which I fashioned into the form of a bathing suit in order to visit while I soaked. We both fondly recall regularly this strange scene.
I share a more spirited and alternate focused version of my first admission in a story called Sharing My Crazy. I choose not to go back and edit. It serves as Raw Data in my journey to wholeness.
I am occasionally haunted by a couple of incidents. I want to document these here, share what I have learned … and then move on with my life.
At one point, during one of the first nights in lockdown, I felt like I was close to death. I felt extremely unwell. I was frightened for my life for about 10 minutes. I took all medications prescribed at their full dose. I had not taken the time to consider my full rights as a patient to refuse, even if partially. It felt like a severe hypoglycemic episode – unlike anything I had ever experienced before. I was feeling so blessed that my mom had left a care package that included some dried blueberries in the drawer of the nightstand. I dug into those, ate them all. As I was waiting for the effect, I tapped into my medical mind. I attempted to stand and call for help but instantly lowered myself to the floor, without harm thankfully. Hypotension, low blood pressure. I recall checking my pulses to estimate my blood pressure. At the wrist, nothing. Systolic less than about 80. At the neck, yes. Systolic greater than 60. At the elbow, nope. Likely less than 70 systolic blood pressure.
I dragged my body over the floor, out the door. Finally a nurse saw me. My blood pressure was not initially detectable via their equipment. Concurs with my shortcut assessment with the pulses. When I reported that I thought I was having a severe hypoglycemic episode, a nurse declared that it was impossible because she checked my chart and I did not have diabetes noted.
I was seriously shaking my head with that line of thinking. Kind of scary to see such ignorance in a healthcare provider. I never did look into which of the 3 medications had that impact.
My lesson: Do not accept the full dose of the medication given. Aligned with my intuitive sense that I was not being treated optimally.
I am shy to add the other data point that led me to not accept full doses:
I became severely fecally impacted. Constipation that felt uncurable. I was so stubborn and fiercely independent, I never told anyone about it. Even in all these years. I felt so much animosity towards and from the staff. I felt the better option was to digitally disimpact myself. With great pain and difficulty. My assessment: this was more than any enema or laxative could handle. Certainly anyone could question my judgment on this. It gave me some insight on why a patient might choose to smear feces all over the walls as the prior resident did. Not my choice. I kept it tidy. And washed my hands probably 20 times. I was pretty offended by having such a disgusting condition. On the outside, I might be called fastidious.
Insult was added to injury.
Suggestion: In the current era, drug dosages should be re-evaluated. I hypothesize that dosages as low as 1/6 current standards may be just as effective for at least some patients with much reduced side effects. Combined with my complete suggestions, taking a slow and cautious approach with medication would be ideal. As in the Peer Assisted Open Dialogue system that I will share more about later. I do hypothesize not requiring any antipsychotic class medications may one day be the norm. High dose Vitamin B3 (nonflushing niacin) 3-6 grams per day may be effective at grounding the manic episode. With a much safer side effect profile.
There is a perspective in the alternative Psychiatric movement that never taking antipsychotics, ever, is the optimal. Being naive to this class of medication may prevent the current cycling we tend to see. The condition recurs due to withdrawal of the medication. So … the Doctors put the patient back on the medication. Then it is a perpetual loop. See the importance of attempting to clarify this issue?
First episode psychosis. An important event. An hypothesis that already has reasonable support in the alternative community: first-episode psychosis patients that never receive antipsychotic medication do better in the long-term than those who do. Maintain the naiveté. Use alternatives that will not enter into the cycle of withdrawal triggering another acute episode. Food for thought.
Suggestion: I do agree that it is helpful to ground a patient into a shared reality state. My current favorite to test out: high dose niacin 3-6 grams per day and Ativan prn. Dosage will be dependent on whether the patient is naive to benzodiazepines or not. I was naive and found 1mg, a miniscule dose, to be quite calming. Ativan was the only pharmaceutical used in my last (4th) acute episode. Less than 10 mg over the course of 6 days.
Hypothesis: Connecting with an integrated peer with lived experience of psychosis could have an extremely grounding and nourishing effect. Experiencing the energetic field around the body of another human being who has integrated an unshared reality experience may be the therapeutic modality. Lots to discuss here. A safe demonstration would not be so difficult. Risks: minimal.
Aside from the fact that there is not an abundant supply of integrated peers … yet. Perhaps it is not about the peer aspect but a highly evolved integrated human being. For me, my therapist played that role. She was not a peer but her presence felt to have a very physical impact on me.
The peer would also be communicating to a patient in crisis in a supportive, humane fashion. Talking about hope and wanting to help the patient sort out this experience. Attempting to understand a patient and being willing to listen to their point of view: felt to be an essential component by most psychiatric survivors I have communicated with.
There is a Facebook Group over 5000 members where this theme is echoed consistently.
Practicing Psychiatrist, Dr. Peter Breggin’s video Helping Deeply Disturbed People (click title to view).
In the video, at 9:20, Dr. Breggin asks, “What is the beginning of recovery …? It’s not very complicated. It’s the building of a trusting relationship with someone. He goes on to describe (in the next 2.5 minutes) how even the craziest individuals will settle within minutes to an hour when given an authentically caring presence and a safe container to share feelings. He reassures the patient that he does not lock people up against their will or medicate someone in extreme emotional states. I can truly imagine how comforting that approach would have been in my First Contact with the Psychiatric System. I watched this video only once before, years ago, after being labeled in my extreme state. It inspired me. I feel that I want to be a part of this style of care. I dream that this viable option will be widely available – sooner than later.
One of the major roadblocks is a lack of willingness from Psychiatrists in practice.
How can we, as a society, overcome this roadblock?
Remains to be seen.
An Open Letter To The Spiritual Community About Psychiatry is quite a comprehensive article written by Dr. Kelly Brogan, another practicing Psychiatrist who is also modelling this viable alternative care. (Click title to view).
I want to emphasize: When in that altered state, linear, logical communication was not online. Yet another form of communication was. It baffled me quite a bit at the time. My exploration of mediumship at the Arthur Findlay College in 2015 filled in some blanks from this first involuntary admission. When I was first brought up to the ward, I was confused. I was well aware that my sense of reality did not match the caregivers. I continued to see the doctors looking like zombies (x’s over their eyes like in a cartoon) even the following day. The nurses seemed like they were moving on tracks, just like in the table top hockey game where you use a knob to twist/turn/move the hockey players in their slotted track.
Symbolic communication. Very similar to how mediums receive data from high-vibrational nonembodied energies on the other side of the veil.
It is a form of information that psychic mediums learn about to deliver messages between dimensions. Yes, this may sound kind of science fiction but there are many who use this vocabulary. I am one of them. I do prefer to translate into terms of physics whenever possible. It is not always possible.
This symbolic communication is more of a right brained, non-linear communication.
When I attended Arthur Findlay College, I had the same experience of channeling a spirit as prior to my 1st admission. Yet in 2015 at the College, it was the most mundane thing. Like dialing a new channel on a radio. I dialed in, dialed out, then went for coffee.
The first time (prior to admission and labeling), I had no idea what was going on along with the severe physical overwhelm. The impact was much more chaotic. To have the same experience while in an ordinary state and within my conscious control added to my understanding.
A difficult topic of discussion with medically trained professionals.
Not that I have ever tried.
Of course, there was zero therapeutic alliance with any of the caregivers so I was non-transparent with them. Their focus of communication was similar to a multi-level marketing campaign. They wanted to ensure that I believed about my condition everything that they believed. You may be shocked to learn that there was no attempt to talk about my experiences. Diagnosis is made upon admission and then treatment is to talk you into the new future they have laid out for you. I would never get better. I would need medication for the rest of my life. If I ever were to stop the medication “the fire would restart in my brain and may never be extinguishable again”. For me, this was shock beyond belief. I now call it a soul shock. It felt like an invalidation as a human being. I have experienced layers of grief related to all this. Both as a Physician and a labeled patient.
I stopped all antipsychotic medication within 6 weeks of the first hospitalization discharge. Living as an automaton was not a result I could support. I maintained only a low dose of Lithium Carbonate. During my 2nd involuntary hospitalization, I took the antipsychotics while an inpatient. I discontinued them upon discharge. I feigned compliance on my 3rd stay. Not taking a single dose of the antipsychotic class of medications. Unbeknownst to the attending staff. I left the 8 day hospitalization taking the very same medication I took prior and during. Hinting at the self-limited nature of these altered states I had experienced. Being captive in a hospital is pretty grounding for me. Heavier, less healthy food. Etc.
I will add that I have not taken psychiatric pharmaceuticals since November 2016. I experienced my 4th out of the ordinary episode (medicine calls psychosis) in January 2018. I initiated a Nutrient regime using Hardy’s Essential Nutrients. I was treated outside the system by Peers, people with lived experience of psychosis. The Pilot Project detailed below was tested on myself first.
Psychiatric Drugs Are More Dangerous than You Ever Imagined Another video by Peter Breggin, (click title to view, 9 minutes)
Following my stay in lockdown, I was given a large, professionally printed handout on the topic of Falling Down. How to take great care to prevent falls while staying on the Psychiatric Ward. I chuckled to myself. If lower doses of antipsychotic medications were given, a less is more attitude amongst the prescribers, we would have no need for a large handout explaining how to prevent falls. These medications do have side effects that can affect quality of life in many ways. Many patients prefer alternatives yet the healthcare providers feel content with the status quo. They lack motivation to look at alternatives. Not willing to look. Hence, they do not find alternatives.
Patients are motivated to discover alternatives.
Patient-led healthcare. The trend of this millennium.
Many hands make light work.
The caregivers appear a little overwhelmed from where I sit.
Systematic disempowerment leaves many patients requiring significant assistance from family and healthcare workers.
To tease out the issues and allow for progress in the field of Psychiatry is a subject of my dreams.
Likely requiring study of Consciousness in a more serious way. This will require collaboration between many different types of people. With and without credentials.
The Natural History of Bipolar Disorder: what do we really know?
A train of thought was adopted nearly a century ago.
I question many of the assumptions that were made in history.
The way the system is functioning, we can never discover the natural history of the condition. I understand it is a challenge to tease out the optimal truth in a safe fashion. Yet, I still want to do so.
Pilot Project Suggestion:
Manic patients naturally defy treatment.
While they are exercising their right to choose their therapy, they can be offered a more natural alternative: Niacin 3-6 grams daily (broken into three doses over the day) and Ativan PRN. With or without the Hardy’s Essential Nutrients, 12 per day. With the inclusion of the micronutrient formulation, this protocol was very satisfactory to me with my latest episode, January 2018. In the following months, I was able to process much trauma, grief and negative emotions. Somehow, I was not able to complete this while on medications.
A functional therapeutic alliance with at least one healthcare worker is essential. I hypothesize that most patients will be grounded down within 3 days. Extra niacin 3 grams was added to my care after 3 days. I have heard of quicker results, within 1 day, with higher dose, 6 grams of Niacin daily. With a reduced level of acuity, the healthcare team can take some time to develop a therapeutic alliance with the patient.
Recommended: a patient Peer Advocacy Service be developed by integrated peers. Not peers indoctrinated into the medical system as it exists. Initially, supervision and observation in an optimal fashion. It is essential to foster hope and optimism. Peers appear to be in the best position to deliver this care in the current environment.
The beginning of a new collaborative approach.
Looking for solutions. They exist.
I am pleased with my experience with the Pilot Project protocol. I wonder if it might benefit other people in an altered state of consciousness (psychosis in medical terminology).
I am brought back to a one-liner, alluding to learning medical procedures, from my Medical Training:
See one. Do one. Teach one.
I long ago added:
Sometimes you have to skip a step or two.
I wrote an article about the Peer Assisted Open Dialogue now running in a large pilot project in many Health Trusts in England. (click title to view).
I see this new paradigm as a good fit here in Canada also. Multi-disciplinary, non-hierarchal.
It would create the fertile environment to safely develop non-pharmaceutical strategies of care.
My intention was to keep this article short. But also to share transparently to enable as much information to be harvested as possible. I recognized late that I skipped over the temporal association of the Ayahuasca Ceremony I did in August 2012 while in Ecuador. Two months prior to my Out of the Ordinary experience in October of the same year. I do not want to attempt to squeeze it into the body of the article. I recognize that this could create confusion if not given proper context.
Perhaps it played a role in this episode. I don’t know. However, I want to clearly state that I made a decision to partake in Ayahuasca without fully understanding what was possible. Looking back, I may have blocked the potential to have prevented my episode. I heard a little bit about what was involved and proclaimed to myself that I would not vomit or have diarrhea. My fastidious nature did not want any messy stuff. The result: No diarrhea or vomiting. Yet, had I approached the ceremony without this limiting proclamation, I hypothesize that I may never have had the psychosis episode in the first place. Likely, I would have experienced more purging and taken a completely different path on my journey to wholeness. The experience I had with my first Ayahuasca Ceremony was very galactic. Because I said no to the embodied experience. Perhaps all part of my soul’s plan: to experience the Acute Care Psychiatry System. I believe this. I regret that this detail could easily be interpreted in suboptimal ways by those who may benefit greatly from a ceremony themselves.
I took part in a 2nd Ayahuasca Ceremony in March 2017 in Costa Rica. This time, I did not wish to control the results. I simply proclaimed that if I were to purge, it would be in the proper receptacle. The vomit bowl and the bathroom received all purgings. It was not pleasant. But I was not in need of laundry services. The experience was deeply emotional as much subconscious personal pain was purged. I would call it a complex, multidimensional episode. Loosened things up to make room for my wholeness.
Fun fact: The Social Worker in my first hospital admission asked, with a cynical sneer, if I used DMT while in Ecuador. I said no. Intuitively, I imagined a yes would result in a punishing lecture. It was clear there was no respect offered to anyone who might have chosen to take DMT. A more respectful tone would have been greatly appreciated. The atmosphere of judgment is the environment of the acute care I received. I would prefer a more humane, caring attitude in my caregivers.
I looked up DMT after discharge and realized that I had unknowingly lied. DMT is a psychoactive chemical found in Ayahuasca. Just another pointer that collaboration is very much needed.
I feel translation services, at the very least, are a potential beneficial service of Peer Advocates.
There is so much to discuss between the lived experience community and the traditional Psychiatric Professionals. Willingness from the professionals is a significant missing ingredient.
Everyone values their personal freedom. However, the legal backing given to the Profession of Psychiatry is very concerning to me. What system do we have in place to ensure that healthcare providers given these legal powers are healthy and balanced themselves? Who is in a position to make this assessment?
Prediction: The new paradigm for the Field of Psychiatry will not require legally backed authority tools.
Addendum #2: November 17, 2018
I return to this article to add that my 4th episode January 2018 was triggered by smoking cannibis.
I did not emphasize that fact to my family, yet it may have served very well.
At that time, I was still in the distrusting, fiercely independent mode.
Cannabis has not been a part of my life. I tried it a few times as a teenager. I took the occasional toke when in the presence of someone smoking – maybe a handful of times- in my adulthood.
I have taken an interest in cannabis as the legalization was approaching. I have several friends with great knowledge and passion about cannabis as a medicine. So I received some as a Christmas Gift. Haha. I smoked a little two days in a row. I have chosen to stick only to edibles moving forward. However not a part of my care. Tried it a few times. Had some great sleep following.
I feel it is quite relevant to ensure this addition to my story. Now 2 years without Psychiatric Pharmaceuticals.
Summary of my Treatment Modalities this past year:
I take Hardy’s Essential Nutrients 12/day, Extra Non-flushing Niacin 1g twice a day. Started January 2018.
I have used many bottles of Bach’s Flower Essences, as my intuition has guided. Probably about 20 bottles over the last year.
I have received 3 sessions of either QHHT (Quantum Healing Hypnosis Technique) or BQH (Beyond Quantum Healing). I feel this is one of the most efficient, effective, cost-effective treatment modalities out there.
November 9, 2018- I had the pleasure of receiving a “Quantum” (for lack of a better word) Massage.
The 2 practitioners aforementioned are dear personal friends. I have some talented friends!
I am very pleased with my level of functioning and wellness with my self-directed care, 11 months following my latest episode.
Hypothesis: I will not experience another episode. Remains to be seen.
Yet if I do, I will simply learn a little more.
It is nothing to fear. I think of it as a potentially efficient treatment modality in its own right.
Especially if it is optimally supported in a caring container with humane practitioners who are masters at forming a therapeutic alliance.
The wave of the future.