My Experience at Partial Hospitalization Programs

Last week I attended my third partial hospitalization program in the last 3 years. Where have these been all my life? I wanted to share my experience there to encourage others to check these out.

Who should enroll in partial hospitalization?

Don’t let the name scare you; you’re not actually admitted to a hospital. It’s generally a 9-3 type program, consisting of several group sessions or classes, individual therapy, and meetings with a prescribing doctor. They may also do bloodwork to diagnose any underlying medical issues.

Partial hospitalization programs are for someone who is not crippled enough by his mental illness to be an inpatient, but who needs something more than regular therapy. I have been inpatient as well, and they don’t focus so much on coping skills; they mostly focus on regulating your meds, keeping you safe, and getting you past the crisis point. Many people go to a partial program after they are discharged from being inpatient, to gain the skills to re-enter daily life.

What is group therapy like?

Not as awful as it sounds. You can keep quiet if you like, but I’ve found that the more I share, the more I get out of it. First of all, it helps to hear that you’re not alone. Second of all, hearing people who struggled with problems similar to mine often jogs my memory; I will remember coping techniques that have worked for me in the past, and in teaching them to others, I remember to apply them to my own life.

There are group classes, and then there is open-ended group therapy. A good group leader will gently guide the conversation, giving prompts and making sure that people don’t get too off-topic and that the quieter people get a chance to speak. I’ve also experienced very hands-off group leaders, who will let people talk about anything. In this case a single person will often monopolize the conversation. Sometimes you have to be pushy to make sure that your questions and issues get addressed, too.

What kind of skills will I learn?

You will learn the basics of whatever therapy your program is based on, like CBT (Cognitive Behavioral Therapy) or DBT (Dialectical Behavioral Therapy). You will learn relaxation techniques and mindfulness techniques; you will learn general practices to get in the habit of, as well as specific practices to help you get through an emotional crisis.

Depending on the program, classes can address specific issues like sleep, infant care, and time management. At Butler’s CBT program, I took classes in anxiety management, challenging negative thinking, mindfulness, gratitude, anger management, distress tolerance, illness management, self-compassion, functional analysis, and values clarification, as well as basic Acceptance and Commitment Therapy (ACT). You will probably also encounter art-based therapy.

I already know all this stuff.

So do I. But it’s really helpful to be immersed in a setting where you have nothing to do but remind yourself of the skills you know, brainstorm about your particular triggers and needs, and create a plan to keep yourself from spiraling down again. I understand CBT theoretically; but it’s quite another thing to sit down and complete a functional analysis chart, identifying my particular triggers, negative thoughts, emotions, and problem behaviors, and brainstorming alternative thoughts and behaviors with a licensed therapist.

A partial program gives you the chance to focus on your mental health in a way you will not be able to during your daily life. Think of it like the mental health equivalence of a spiritual retreat. You will emerge with more “tools in your toolbox,” more education and inspiration, and the beginning of new healthy habits. Even if you’re not able to escape work and daily chores the rest of the day, that 6-hour block will be yours to focus on yourself.

Feel free to comment with any questions, or to share your experiences! I hope anyone who struggles with depression or anxiety has a chance to attend a program like this.

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If you’re in the Rhode Island area, I especially recommend the Women and Infants Perinatal Day Hospital and the Butler Partial Hospitalization Programs, both in Providence. Women and Infants is mainly CBT-based. Butler has several programs. I have done the Integrated Therapy Program, which I didn’t like as much–it focused on existential therapy–and the Cognitive Behavioral Therapy Program, which was fantastic–very concrete and practical. Butler also offers a Dialectical Behavior Therapy group for women which I have heard fantastic things about.

Both Butler and Women and Infants also offer aftercare groups where you can meet with other people who have been through the groups and check in, with a therapist leading the group. Women and Infants offers the added benefits of a nursery for children up to one, free lunch, and a social worker who can help with things like finding childcare, applying for disability, getting doctor’s notes for your job, etc.

“Observing without Judgement”

Here is a mindfulness exercise I am constantly forgetting about and re-discovering: the five senses exercise. Observe, one at a time, what input is coming in through each of your five senses. Focus on what you see, taste, feel, hear, and smell without allowing your mind to wander to anything else. When your mind wanders, don’t feel guilty; just gently guide it back to focus.

Here is the tricky part: you need to “observe without judgement.” This means you need to focus on the sense perception as a matter of fact and not take the next step your mind wants to take: wondering why it is the way it is, what you should do about it, what memories it brings up, etc. Just observe that it is.

For example: I observe red flowers on my desk in a blue vase. I don’t allow myself to think “oh boy, I really need to change the water;” or “why doesn’t my husband buy me flowers more often” or “I wonder how much these cost” or “I wonder if that bud will bloom” or “I’m no good at keeping flowers alive.” I just think, “Those flowers are red. That vase is blue. It’s a bright spot in the room. It’s red like those red pens. It’s on the right side of the room. There’s a computer over there on the left side.”

Another example: I observe pressure on my ankle, warmth in my belly, coolness on my arms. I don’t think “I need to get a sweater. I wonder where my blue sweater is. Why is it always cold in this office? I’m such an idiot, I keep forgetting to bring sweaters.” I just think “this is cool and that is warm. Huh.”

The point is to take you away from the racing, analyzing, scrutinizing part of your mind and place you in the here and now. Even farther than that! You don’t want to be thinking very much at all, just observing. This really works to still your mind when it’s racing with anxiety. You can do it while you’re waiting at a red light, while you’re in the bathroom, in between calls at work, whenever you have a few minutes.

Would You Do It All Over Again?

There’s a beautiful scene at the end of the movie Eternal Sunshine of the Spotless Mind. After recovering the lost memories of their rocky relationship, the characters Joel and Clementine remember why they first fell in love–and why they broke up. They face a choice: should they go their separate ways, or should they make a new start–knowing that they will have the same struggles all over again? It’s like a version of the old test–“if you had to do it all over again, would you still marry me?”

I won’t spoil the ending, but I’ve often pondered this question. If I knew what our life would involve–poverty, miscarriage, mental illness, unemployment, unplanned pregnancy, and so on–would I still have married my husband? The answer, of course, is yes–but not necessarily because I’m brave or noble. We were in love, and when you’re in love things like that don’t phase you. No suffering seems too great, as long as the two of you are together. So, even if I knew all the roadblocks we were going to hit, I’d still say yes again; because the force of love disregards such obstacles.

I thought of this the other day as I prayed the Sorrowful Mysteries. If Mary knew what was going to happen–if she knew that she would have to watch her son be tortured to death–would she still have said “yes” to the angel’s invitation? And at once I realized, of course she would–not just because she was brave and noble, but because she was in love with God. A woman in love with her husband considers the potential sufferings of pregnancy, childbirth, and motherhood insignificant compare to the joy of bearing her beloved’s child.

On this feast of the Annunciation, Mother Mary, pray for us to fall in love with God so that, like St. Paul, we can “consider that the sufferings of this present time are not worth comparing with the glory that is to be revealed to us.”

Gauguin’s Annunciation–Mary pondering as the angel leaves

A Feeling Just Is

Today, for some reason, I’m awfully tired, and my back aches. It’s a pregnancy-like exhaustion, making me limp around and stop for breath. (No, I’m not pregnant.) But the familiar feeling of this exhaustion made me think of pregnancy, and suddenly I thought “well, maybe I will get pregnant, and then I’ll have a good excuse for feeling this way.”

A good excuse! As if I just woke up today and made the choice to feel tired. Unfortunately, I think this way a lot. When I feel tired, angry, sad, restless, or hopeless, I often beat myself up for having unwanted or irrelevant emotions. I have no reason to feel sad at the moment; I don’t deserve to feel sad; so why do I? Only when I step back and examine this thought process objectively do I realize how irrational it is. You can’t blame yourself for feelings; feelings happen to you. Obviously, it’s then your choice to act on the feeling or to push it aside; to entertain it in your mind lovingly, or to do your best to overcome it. But a feeling itself is neutral.

This can go the other direction, too. You can beat yourself up for not feeling a certain way–again, as if you had a choice! You can be angry at yourself for not feeling affectionate, or not feeling sad, or not feeling joyful. And once again, this blame won’t help at all, because you can’t just decide to feel a certain way.

One aspect of mindfulness is that it teaches you to tune into these unconscious thought patterns. Because I “listened” to myself having that inner conversation about my exhaustion, I was able to identify some unhealthy self-blame. Even just being aware of your emotions, without judgement–“I feel sad right now”–can help drive home the lesson that feelings come and go, and we are not to blame for them. A lesson I have to learn over and over again.

 

 

The Yiddish Policemen’s Union

Have you always wanted to read a book about a Jewish detective, his Native American partner, and a reluctant Messiah? Maybe one with organized crime run by an orthodox rabbi, a chess-playing heroin addict, a regretted abortion, mystical prophecies and portents, and a dog that insists on being tied up to await the return of its long-dead owner? Oh, and it should definitely take place in a slightly alternate future in which the Jews settled temporarily in Alaska. And yes, all that should take place in the first hundred pages.

Do I have a book for you!

 

The Yiddish Policemen’s Union is a gorgeous and heartbreaking book. It’s a noir-type mystery, an apocalypse, and a story of redemption. It’s also outrageously daring: in 400 pages, Chabon covers Jewish salvation history, the life story of more characters than anyone has a right to expect, American politics, a caricature of fundamentalism, and the meaning of redemption, homeland, duty, and identity–all in the present tense. And he pulls it off.

Even the writing itself is daring. The present tense gives the whole thing the feel of oral storytelling, which is enforced by the colorful descriptions. A short man, only mentioned once, is a “fireplug, his bowed legs and simian arms affixed to his neck without apparent benefit of shoulders.” It’s not just snowing; “the snow falling is like pieces of broken daylight. The Sitka sky is dull silver plate and tarnishing fast.” The Rabbi’s mind is a “library in a bonepit.”

Chabon is always on the edge of taking things too far. Then he pushes it over the edge, and brings it back again. At the very beginning of the book, one character describes another as “a broken man…like one of those sticks you snap, it lights up…[f]or a few hours. And you can hear broken glass rattling inside of it.” Okay, so it’s nicely done, but it’s a tired metaphor. But then, four pages later, Chabon pulls it back again and this time it pierces your heart: in an imaginary meeting, the detective and the dead man sit, “shedding the last of their fading glow on each other and listening to the sweet chiming of broken glass inside.”

But please don’t think it’s all darkness and heartbreak. For one thing, it’s funny. Darkly, ironically funny, in a very Jewish way, but funny. For instance, Chabon has created an entire dialect of Yinglish for his imaginary world, where “sholem,” literally “peace,” is an idiom for a gun–a piece.

And don’t worry, it’s not hopeless. It carries you through triumphantly, breathlessly, to an ambiguous, but somehow peaceful ending. It’s such a rush that only afterwards do you realize that Chabon has created such a full world that he’s left a lot of loose ends. But because it is a novel about what life is like, that doesn’t seem inappropriate. Although it doesn’t lack for plot, it’s about more than that. It’s a novel about fathers and sons; about identity, homelands, and assimilation; about the tension between waiting for Messiah and living life as it is, now and here. It’s a novel about a man who lives in the past, confronted with zealots who live in the future, learning to live in the present.

How Bad is Exclusivity?

So my son’s elementary school, God bless them, wanted to throw a little Super Bowl-themed father-son event. But of course they didn’t want to leave out kids without fathers, so they changed it to be an event for you and “that special man in your life.” And of course, they wouldn’t want to leave out girls who enjoyed football too! So pretty soon the whole event was a kind of amorphous get together for any kid and any adult to come and do something vaguely football snack related.

I’m not trying to blame the school for being inclusive. In a world of blended and broken and re-blended families, they are trying to make everyone feel welcome. But in the process, a well-defined event turned into a mush. Imagine for a minute what would happen if you took the same attitude toward every school event. You couldn’t have mother-daughter event either, because what about all those girls who lived with their fathers or their grandparents? What about that girl with the transgender mother? What about that girl who identified as a boy? What about that girl who didn’t like “girly” things? What about that girl with a twin brother who would feel left out? It gets messy pretty fast.

In our rush to be inclusive, we’ve kind of forgotten what the point of these events was in the first place. Witness the mess that various exclusive holidays have turned into: Mother’s Day is touchy, because no one wants to offend those with dead mothers, or mothers who hurt them; and Valentine’s Day–well, I just got an ad on my phone encouraging me to listen to songs about “exes and revenge.” The message is that, if a particular event or day doesn’t apply to you, don’t just ignore it; make it into something that fits you in particular. And if we’re so worried about all the people who are left out, we forget about the one group of people who were supposed to be celebrated in the first place.

So if you can’t stop thinking about everyone who’s been left out by a father-son event, by all means go ahead and make a separate parent-child event, or a guardian-minor event, or an event where everyone’s welcome. But for those families who happen to have a plain old father and son, don’t ruin it for them; let them have their own day, too.

 

The Bible made Flesh

I haven’t thought about the phrase “Word made Flesh” in a long time; but yesterday I heard a beautiful sermon that gave it more meaning for me. Father J. explained that in the reading from Nehemiah, when Ezra read the scriptures from dawn until midday, it was because they had just returned to Jerusalem from exile and were rediscovering their heritage. In the Gospel reading, a rediscovery of scripture also plays a central role, as Jesus reveals that he is the one the book of Isaiah predicted. The way Father J. told it, in each reading, the people of God rejoiced to discover the word of God in their midst: in the Old Testament, through the reading of the actual words of the Bible; in the New Testament, through the presence of the word made flesh.

I have a strong background in philosophy, and I always thought of the Word made Flesh referring to the word of God in a metaphysical sense; God’s utterance so “living and effective” that it was a person in itself. But somehow I never thought of it as referring to God’s word in scripture! In this sense, Jesus as the Word of Flesh means Jesus as scripture embodied in a Person.

Jesus, of course, is so much more than that, just as the Body of Christ in the Church is much more than what we can get from scripture alone. But if you think about it, Jesus said that the sum of the law and the prophets was love. And who is love but Jesus? In a more-than-symbolic way, Jesus is the word of God, the actual literal written word of the Bible, standing in our midst.

P.S. I’m so excited to be writing again! I missed you guys. Hoping to write soon on the idea of inclusiveness, as well as a few book reviews: Sabbath by Wayne Muller, and The Yiddish Policemen’s Union by Michael Chabon.

P.P.S. This must all be related to the Jewish mystical idea of the meaning of letters and numbers in gematria and kabbalah, but I don’t know enough about it to say more. 

The Happiness Project

I first discovered Gretchen Rubin through a magazine article she wrote that included her genius “one-minute rule:” if you can do something in one minute, do it now. Hang up your jacket instead of leaving it on a chair; throw out your junk mail instead of throwing it on the table; respond to that email instead of leaving it for later. Her book, The Happiness Project, is a lot more wide-ranging and interesting than this household tip, but that’s what first intrigued me.

Rubin decided to spend a year reading every book about happiness that she could get her hands on, and trying almost every tip she found. Her goal was not to go on some grand Eat Pray Love-type adventure, but to find ways to make her current life happier. The result is kind of a cross between a memoir and a self-help book; some of it is relevant only to her, and some of it is startlingly insightful and universal. She’s a great writer, too; the book flies by.

I loved her point about expanding your identity through searching for more ways to feel happy and fulfilled:

One reason that challenge brings happiness is that it allows you to expand your self-definition. You become larger. Suddenly you can do yoga or make homemade beer or speak a decent amount of Spanish. Research shows that the more elements make up your identity, the less threatening it is when any one element is threatened. Losing your job might be a blow to your self-esteem, but the fact that you lead your local alumni association gives you a comforting source of self-respect.

After I had my first child, I felt like I lost my identity in a lot of ways, and gained the new and unfamiliar identity of motherhood. It took me many years to reconcile the two. I think this book would have helped. Rubin does a wonderful job of navigating the guilt and assumptions that keep you from trying things that make you happy, or stopping things that make you unhappy. She realized that

just because something was fun for someone else didn’t mean it was fun for me–and vice versa….I tended to overrate the fun activities that I didn’t do and underrate my own inclinations. I felt like the things that other people enjoyed were more valuable, or more cultured…more, well, legitimate.

There’s such great freedom in allowing yourself to do something you like, just because you like it. (And it’s heartening to hear that even Gretchen Rubin, an accomplished lawyer and bestselling author, worries that her pursuits are not legitimate enough! Self-doubt strikes everyone.)

Because of this book, I started doing light reading again. I gave myself permission to read things just for fun, and not only things that were edifying or “important.” Rubin includes her a great quote from C.S. Lewis:

When I was ten, I read fairy tales in secret and would have been ashamed if I had been found doing so. Now that I am fifty, I read them openly. When I became a man I put away childish things, including of the fear of childishness and the desire to be very grown up.

Rubin is secular, but she was also fascinated by the life of St. Therese of Lisieux–not just by her “little way,” but by the way she always appeared happy and cheerful, even when she was going through interior suffering. Rubin distills this into one of her major rules: “act like you want to feel.” She noticed that St. Therese didn’t just make herself act happy; she made herself be happy. It’s not easy, and it’s not fun (not at the beginning, anyway), but it works.

(Please note here that Rubin is not talking about people with depression; she’s only talking about people who want to live their best life. A lot of her tips are actually quite helpful for depression, but if you’re depressed you may find many of the suggestions in this book inadequate and irritating.)

 

 

This book is uneven. Her discoveries about gaining more energy, cultivating habits of gratefulness and cheerfulness, and discerning what really makes you happy are valuable. Her chapters on money and meditation are particularly vague and muddled. Overall, this wasn’t just an interesting read; it changed my life for the better. I’m excited to read her next book, Happier at Home. I’ll let you know when I’m done!

Turning Your Life into a Story

I’ve been making my way through Anna Karenina over the last few months, and my mind has been immersed in Tolstoy. The other day I was happily preparing for a little family road trip. The weather was beautiful, I was going to have a few days off work, get time with extended family, and get to go to a wedding too. Then my 7-year-old came out and confessed that he had sat on his brand-new glasses, and they had snapped. It put a little dent in my good mood, and I automatically thought, Tolstoy-style, “a cloud settled over her happiness.” And you know what? It helped! Thinking of my very small suffering as a story helped me to see it objectively, and let the emotion pass.

This reminds me of something Viktor Frankl said in Man’s Search for Meaning. One of the ways he coped with the suffering of the concentration camp was to imagine himself, many years after he had been released, lecturing about his experiences there. Viewing his experiences as a story helped him put a little distance between him and his suffering. My mother used to quote this to me when I was a kid, and I still use this technique once in a while. I like to remember that someday whatever’s going on will make a great story, and I’ll be able to laugh about.

This ability to see your suffering objectively has a lot in common with the idea of mindfulness. When you are mindful of what thoughts and emotions are passing through your head, you can put some distance between them and you. Simply being aware of a negative thought, as objectively as you can, takes away some of the negativity’s power.

More on this coming soon. In the meantime, try narrating your life and see if it helps!

Bucket Lists and Anna Karenina

The concept of making sure to have certain experiences before you die has been on my mind lately. When I was little, I used to panic at the decisions that faced me when I grew up–how would I have time to focus on all the things I wanted to do with my life? As I got older, I began to worry about all the books I would never read, and occasionally I worry about all the places I won’t ever get to. But then I remember: it doesn’t really matter, because when I get to heaven, everything good in those places and those books and those experiences will be there. I won’t have missed out. I do believe that everything good on earth will be there in heaven, only more so. But does this mean that I shouldn’t worry about living life to the fullest?

If you don’t believe in heaven, of course, there’s no question; this life is all you have, so better make the most of it. I don’t know how people who don’t believe in life after death go on living. It’s so bitterly unfair. Some people get to travel the world; some people stay in the same town their whole lives. Some people live a long and happy life; some people die in the womb. Some people enjoy life with all five senses; some people are blind. I don’t want to believe in a world where that’s all there is to it.

But I also don’t want to believe in a world where, just because there’s life after death, life before death doesn’t matter. After all, God made the world beautiful for a reason. Everything that’s beautiful about the mountains will be in heaven, I’m sure of it; but God made mountains on Earth too, just for us.

I’m halfway through Anna Karenina and my beloved Levin, after encountering his dying brother, has just been consumed with thoughts of his own inevitable death. Suddenly he realizes that all his grand plans, his brilliant ideas for revolutionizing agriculture and society, crumble into dust compared to the vastness of the universe. And because he’s an all-or-nothing kind of guy, every time he thinks about it he decides that he’s completely done with life, and there’s no point in striving for anything. At the same time, though, he’s on the brink of consummating his deep love for Kitty, and he gets very flustered when he tries to reconcile these two parts of himself. Nothing in life is worthwhile, because it all ends in death; but at the same time, everything is beautiful, everything is precious, simply because it exists in the same world as Kitty Shcherbatsky.

Because of our faith, we can reconcile Levin’s dilemma. We can see the good in the world, without denying the fact that the world is fading away. We can enjoy a trip to Rome, without weeping over the fact that we’ll probably never get to India and Mexico. But there’s still an elusive balance to be found here. How much effort should we put into enjoying life? We all know it’s risky to love creation more than the creator; but isn’t there also a risk to ignore the beauty that God created just for us? I don’t fully understand God’s reasons for putting us here with the time and the capacity to enjoy so much. But there must be a good reason that God created the Earth as well as heaven! Next time I’m feeling fatalistic I’ll try to remember that God wants me to enjoy this old Earth right now, instead of just waiting for the new one.