My wife and I call it "the crazies".
It's when I crumple to the floor, sob without restraint, and slap myself with full force, all while screaming about how I'm no good, my life is ruined, my wife should never have married me, and there's no chance I'll have any semblance of peace unless I get "this one thing": namely, my compulsion de jours. In recent months, it has grown from a disquieting development to a recalcitrant habit. It is hell for my wife and parents: those who have watched my 20 year mental health sojourn turn from baffling, to frightening, to managed, to terrifying, to back under control, to inches away from rending life at the seams. It's self-torture, and it's torture inflicted on those I love most. And yet, I do it anyway. How does one explain it? How does one explain OCD?
This latest episode leaves me verbally lashing my mother. "I don't want to get better! There is no point. God has cursed me!" At everyone's behest, I reach out to my therapist of 3 years, who refers me to a nearby hospital with a well regarded psychiatric unit. Medication management is the stated objective, but anyone with a working imagination can predict that this trip won't end tidily.
It is a Thursday. My wife leaves work early to take me to the hospital. As we arrive, the receptionist politely informs us that there is no direct route to the psychiatric wing; we have to go to the ED, get triaged, and wait for the appropriate staff to become available. She gestures to a fuzzy blue wheelchair and offers to wheel me over. It hits me that, in the eyes of professionals, I'm someone who might need this. I start crying again. Reading me correctly, my wife declines the chair.
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I have just enough regard for myself and my family to stumble over to the ED, where "triage" awaits. As I am received, I am treated with more sensitivity and patience than I would expect in a setting where staff are obviously stretched thin. It's both comforting and guilt-inducing; I'm not the sort of person who should be using these services. I'm well-educated, I know my condition both first-personally and academically, and I have all the social supports I could want. I'm not one of those people. But of course, I am one of these people. I wouldn't be here if I wasn't.
Intake begins with a psychiatric assessment. Having worked in behavioral health tech, I anticipate the assessments and the branching question paths as they come. PHQ9. Columbia. Now they're assessing suicidal ideation. Now they're assessing intent. I feel like I'm out of my body, watching myself respond to the psychometric instruments whose results I've spent years analyzing.
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| Photo by Luwadlin Bosman on Unsplash |
They finish taking my psychological pulse, and they put me in a chair in the triage room. I'm not quite alone, but no one is with me. Watching the nurses scramble to manage patients and complain about their lack of resources briefly lifts me out of my own head. Then, they pair me with a nurse from the psych department while I wait for intake.
I'm firmly back in my own head. I return to sobbing, and I describe my obsessions in terms that are even less comprehensible than usual. I know she doesn't understand, but I'm thankful to have an accomplice to my exercise in self-pity all the same.
I'm reunited with my wife, and we are finally ushered to the antechamber of the psych ward. They are about to give me an intake assessment—but before they do, I need to change into the plastic-wrapped, threadbare gown they have provided. This entails removing all of my personal effects: identification, cell phone, money, watch. The experience of relinquishing all of my effects—of becoming unmoored from normal life—adds a new layer to my despair. Giving up my last remaining effect—my wedding ring—pushes me over the edge. It seems fitting. My joy, my sense of self, my marriage: what hasn't OCD taken from me?
I completed the intake assessment, and it's determined that I do not need an inpatient stay and there's room for me in a Partial Hospitalization Program. At long last, I experienced a positive emotion that day: relief. It's amazing how quickly you can compose yourself when faced with the full gravity of your situation. We depart the facility, PHP referral in hand, and grab a burger at Shake Shack. Until that day, I would never have described the experience of eating a burger as "surreal". There's a first time for everything.
My misadventure in the ED happened four months ago. Since then, I've seen gains, but with much room for improvement. L-methylfolate plus a combination of medications appear to have helped, and professional and personal support continues to be essential. But ultimately, pharmacology, therapy, and social support are simply preconditions for improvement. The rest is up to me: a hard truth that all OCD sufferers learn, then forget, then learn again when the consequences of forgetting announce themselves.
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