7 Days In a Crisis House With 'High-Functioning' Complex PTSD
When people ask me who I am, I usually mention that I have my master’s degree in social work, that I am a mom of two brilliant teenagers, I like to travel, and I volunteer whenever I can. Sometimes I mention that I also have complex post-traumatic stress disorder (C-PTSD). I do not mention that I lived at a Crisis House for eight days, but I should and that is extremely important.
To understand what took me to that point, we should discuss how my life started to unravel. If you asked anyone who knows me, they would say I go above and beyond for everyone, I am always accessible, that I genuinely care and that I am constantly working towards a better future for all. What no one will mention is that I neglect myself while also being stuck in survival mode with C-PTSD.
Complex post-traumatic stress disorder causes acute and chronic changes in neurochemical systems in different brain regions, that result in long-term changes in brain circuits. The amygdala is hyperactive to trauma-related stimuli, which causes exaggerated startle responses and flashbacks that can cause a failure of higher brain regions (such as the hippocampus and the medial frontal cortex). This means that people with PTSD have difficulty recalling certain parts of their traumatic event(s) or might have vivid fear responses.
Some studies suggest that when there is constant stress, it will damage the hippocampus because of releasing a hormone called cortisone. This can lead to signaling the immune system, which releases inflammatory chemicals called cytokines, which activates cells called microglia. This is a huge problem because when there is so much activated, it switches from producing serotonin to producing a higher level of glutamate, and if producing in excessive amounts, it can lead to brain cell damage or death.
Two weeks ago, I went from my friendly, helpful “high-functioning” self and turned into a constantly spooked, dissociated and sleepless child who could not even remember whether I had showered or eaten for the week. After going to a clinic, I was proscribed medicine for being “psychotic,” instead of being prescribed medicine for anxiety or to help me sleep without nightmares. One thing led to another and I was in the emergency room blacked out, dizzy and throwing up.
I was constantly asked, “Are you suicidal? Do you feel you may hurt yourself or others?” This question, I had asked my own clients hundreds of times. It was always a struggle for me to answer. The answer was “No,” by technicality, but having a social worker background made me thoughtful in my response. “I feel unsafe driving when I am constantly getting flashbacks and unwanted vivid memories, which leads me to be an unsafe driver, putting myself and others at risk, especially when I can’t sleep without having numerous nightmares.” Every professional just wanted a yes or no answer, and all were unprepared for my answer. Was I suicidal? Not exactly. A danger to others? Unclear.
Time and time again, I passed, leading therapists and professionals to downplay my symptoms as “tiredness” or “lack of sleep.” No one in mental health takes “high-functioning” mentally ill individuals seriously. We are written off, expected to solve our own problems with the resources we clearly have from our degrees or our time in specific fields of work. I ended up running into an old friend of mine, who was working in the ER as a nurse. I struggled to find the words to ask her, “You know me, how I used to me… How do I get help for my PTSD? I can not even function right now!” She looked down toward the ground; we had never been close. She could tell I was desperate to hear her answer: “You won’t get the help you need unless you are 5150ed.”
A “5150” is a medical code that stands for when a mentally ill person is involuntarily detained for a 72-hour psychiatric hospitalization. I started crying to her, “I can’t remember the last time I slept. Can the ER at least refer me to a crisis house?” As a social worker, I had called 211 and made numerous referrals for clients to go to crisis houses. A “crisis house” offers intensive, short-term support to help someone manage a mental health crisis in a residential setting. She told me that I could not be referred unless I was in a 72-hour 5150. When my doctor came in, I suggested I be detained. He smiled slightly, “I can see you got some sleep. Unfortunately, 5150’s do not work like that and you are conscious enough to understand the meaning. You cannot volunteer yourself to an involuntary hold, especially when you are not technically suicidal.” His answer felt like a death sentence.
I heard, “You are too smart to be in the position,” even if he did not say it. I started crying, unable to contain myself. “Is there something you can do for me? I need help, obviously. Can you refer me to a crisis house?” He chuckled, “No, we don’t refer people in this department. Do you want some more time, a little more time to sleep?” I nodded. I spent my whole weekend asleep in the ER. That night, the psychologist came in and told me that I will be discharged, “because you cannot just sleep in the ER and we have no reason to keep you.” It was brushed under the rug and it was irrelevant that I could not think straight, had nonstop flashbacks, had been avoiding my environment for about ten days, wasn’t remembering my work shifts, could not drive safely, hadn’t showered or eaten all week, and was overcompensating by smoking weed and cigarettes nonstop. As I was about to discharge, the psychiatrist told me that even though he never refers people, it would be a good idea for me to try inpatient therapy, as a crisis house, and that, against his procedure, he had called to arrange I get checked in the next morning. “Are you safe tonight? Do you have somewhere to go? You aren’t suicidal, right?” I didn’t even have the energy to answer, “You are sure I am set up to go tomorrow?” He nodded.
As I walked to my car, I called the crisis house. They sounded as surprised to hear that I was to check in the next day as I was surprised they answered on the second ring. They confirmed my biggest fear: “No, we don’t even have room for a female client right now. I’m sorry. Who told you that you were supposed to check in tomorrow?” I started crying again, “That was the only reason I was released. They promised me I could check in tomorrow.” I had lost my voice from crying, I felt my anxiety hit my chest as if I had watched a puppy be hit by a car. I hung up the phone, but the counselor called me back: “I’m not sure who told you that but that is malpractice and I can see you are determined to come and work on yourself. Can I call you back on this number? Let me see what I can do and if we can make space for you. If so, can you be here tomorrow at 10 a.m.?” I was thrilled.
It was nothing like I imagined. Every client was friendly and warm toward me, most going out of their way to make me comfortable or telling me it was their first time, too. I was on a strict food and showering schedule. All clients were expected to attend group counseling two to three times a day, with individual therapy once to twice a day. Against my better judgment, I mentioned I was not supposed to be there, “I have my master’s degree in social work. I usually refer my own clients, here.” Everyone was very understanding and could sense I had been pushed over the edge, somehow, even if I already knew the coping skills.
They immediately gave me a safety plan. I stared at my “People I Can Call” list, eventually filling in two names of friends in Cambodia. I was here because my closest friend and neighbor had died. I wanted to write his name down. I had missed his funeral. They chalked my delay up as me just needing more time to adjust on my first day. The first few days were a blur and my sleep schedule failed to adjust immediately. Counselors knocked and peeked in our individual rooms every half hour throughout the night. I would wake up, traumatized as flashbacks came of the time my roommate had entered my room at night and raped me. The counselors were so compassionate: “You will get used to it, hun. We just want to make sure you are safe.”
After three days, I was adjusting better to the new medication and my new psychiatrist had mentioned I had been misdiagnosed, which is most likely why I had ended up with bad side effects in the ER. He mentioned this, very nonchalant, and minimized my symptoms of C-PTSD. On day four, I filled out an extension to remain in the crisis house. I had finally started feeling good enough to pick out outfits, not just grab whatever I could see. I was brushing my teeth for the first time in weeks. I even closed my eyes for a mindfulness exercise in groups. I went from smoking a half a pack of cigarettes to smoking a few, while giving the rest away to other clients. Every single person had their issues; grief, murders, gangs, sexual abuse, etc. Every single person did not have a support system, except me.
My extension was approved for an additional four days. We all joked about being drugged up on medicine, but what we were really doing was normalizing being medicated. I started cooking dinner every night, mainly because I was the only female and after they begged me for four days, I finally gave in. I had revealed my eating disorder to the counselors, so they were making sure I was eating, as well, not just cooking for others. The first four days, I started on the residence but after that, I felt “OK” enough to walk to the liquor store. I went from working 12 to 18-hour work shifts six days a week to being overwhelmed by walking 400 feet, but to the staff, it looked like progress.
On day five, I finally started feeling hopeful again and I was made many promises, such as the staff looking into clearing a speeding ticket I had gotten, finding new housing so I would not be triggered in my environment, and even counseling that would help me work on my relationship with my family. I never talked about my kids, it was too hard and I felt like a failure. I could not even drive my kids to school without C-PTSD sucking the life out of me for hours. I passed by where the lilac fire burnt my house down multiple times a day. On day six, I realized I had not seen my kids in about 10 days. I was frantic and after calling their phones, they told me they would be going to Sea World without me. This sent me spiraling, that I was out of the loop with my own children. I frantically begged to get a day pass to see my kids. The staff told me they only approved day passes that were submitted 24 hours in advance.
I scribbled a day pass for the next day and manically called my mother, yelling at her for not telling me any of their plans. She tried to be supportive but had no idea what would or would not set me off, so she agreed to pick me up the following day if my day pass was approved. More hopeful than I felt, I asked to go to Sea World. After about 12 hours, I found out my pass was denied, since “it isn’t for outpatient treatment with your goals of service.” My breathing became short and fast, “But I want to see my kid. I am trying to build a relationship with my mom. I don’t understand how that would not qualify.” The female counselor rationalized with me and told me that I was to discharge on Monday, two days from then, but that if I felt up to going to SeaWorld with family, I might be able to discharge early. I felt all the air sucked from my lungs. I didn’t feel up to going, I was making a huge effort by even asking when I could barely eat three times a day. I asked for an extension but did not even have the energy to fill out the half-page paper.
That day, I asked for a few pages of printer paper and folded the papers in fourths, cutting my bending the paper continuously. I hand-wrote every client’s name and feeling like a rebel, made an invitation for a “Karaoke Party.” I had actually gotten the staff’s approval, and they all agreed it was a great idea. On the invite, it said, “From 9-11 p.m., be there or be heavily medicated with earplugs on.” Every single client had a huge smile that day and we all joked about it being a black-tie event when most of us had loaner clothes and/or sweatpants. Since I had such a good response, it gave me a rush to follow it with an event the following night as well — a poetry slam.
That night, everyone was talking about the party at dinner and we all did not have the patience to wait until 9 p.m. so we started at 8:30. We all sang our hearts out, with songs ranging from old school hip hop, to country, to Christian praise music. We all pretended we were “normal,” not mentally ill clients living in an inpatient crisis house. That night, even the nurse had tears in her eyes from hearing our performance downstairs. I felt we had accomplished something, although unsure of what. The night, a new client checked in around 11 p.m. and she was my new roommate. I was up all night, unsure of this new person. The next morning, she reentered our room crying, as she had been informed CWS would be investigating her parenting skills. I put on my social worker hat and had an immediate rebuttal for every cognitive distortion she stated. I gave her a pep talk for about 10 minutes and told her this is an opportunity for her to change her life around. I went into the office and asked for staff to unlock my “sharp box,” which was filled with essential oils, body spray, nail polishes and nail polish remover. I ran into my room with the essential oils and rubbed some all over my new roommate’s wrists. “This helps me; hopefully, it will help you,” I whispered to her, as she cried to her mom on a video call.
On day seven, I was given my death sentence. I was not approved to stay any longer. I begged to pay out of pocket or to appeal the decision. I was too shocked to cry. I was stuck for hours in the position I had been in when I heard the news. I was too weak to smoke a cigarette and too depressed to share the news with the other clients, who at this point felt like brothers and sisters. I slept all afternoon and played a sad song, as opposed to my usual gangster rap music. Everyone knew something had happened. I did not cook, even though it was my scheduled chore. I had been so helpful in the house that two clients immediately offered to cook, instead. I told the other clients I would be leaving in the morning, while we took a smoke break. We agreed that the show must go on, that we would still have the scheduled poetry slam, especially when it was now my last night. My poem won, titled appropriately, “Golden Opportunity.”
I didn’t shower that day and when a counselor knocked on my door, I became obsessively worried about shaving my legs. “I cannot give you a razor right now, but if you want to take a hot shower right now, to get to sleep, you can.” I looked at the clock on my phone — it was 2:02 a.m. as I walked to take a shower. I didn’t sleep the whole night. My favorite counselor peeked in, noticing I didn’t sleep.
“I leave tomorrow.”
My statement stuck in the air.
“Yeah, I know. You will be OK, though. Let me know if you want to talk about it,” he said, as he let the door slowly close behind him. I sat in the kitchen shortly after, binge eating again, for the first time since entering the program. I could not stop myself from eating. I went through two full bags of chips, feeling sick to my stomach.
I did not brush my teeth or change into real clothes on my last morning. I was hoping my cheetah print pajamas and no bra would be a red flag, as I imagined them frantically trying to reverse my discharge date. No one noticed. The thought of entering the “real world” again was terrifying and all-consuming. I had forgotten how to make decisions, such as when I should start working again, when I should take my meds, or when to go to sleep. Every single client broke the rules when it came to hugging me goodbye, many of us also exchanging numbers. As a social worker, I knew that giving clients my number was a horrible idea, but as a female, struggling with C-PTSD, I just wanted to stay connected to people, who genuinely understood and knew my exact struggles.
My week at the crisis house changed my life, but also made me realize how easily “high-functioning” mentally ill people become invisible. I was even told by friends I should “mask my emotions” so that I would actually get treated how I felt — sick enough to need longer care. Overall, I am so thankful I was admitted to the crisis house, and I relearned simple self-care and activities of daily living. After checking out, the first thing that was said to me was, “are you hungry?” I shook my head, no. My friend turned to face me and said, “When it is lunchtime, even if we are not hungry, we still eat. That is what we do.” She ordered me a sandwich. I know with any type of “high-functioning” mental illness, I need to constantly advocate for myself and keep creating a support system that will advocate for me, even when I am not feeling up to it.
Getty Images photo via wongmbatuloyo