Staying Out of the Hospital: Five Tips


    In July, I celebrate 16 years hospital-free.  How is it that I managed to stay on the outside for so long?  In a moment, I'll talk about what you can do to increase your chances, too.


    Before I do, I have some exciting news: SchizophreniaConnection will post next week a two-part interview I conducted with Dr. Xavier Amador, the author of I Am Not Sick, I Don't Need Help!  I've recommended this book to family members whose loved ones lack insight that they have schizophrenia.  The author, an esteemed psychologist, has helped over ten thousand people convince their loved ones to accept treatment since his book was first published in 1997.  It was updated in 2007.

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    Now I'll move on to some ideas I have for staying out of the hospital long-term.


    First, if you haven't, read my blog entry, Seven Steps to Recovery.  That's a good companion to the following suggestions:


    1.  Consider one-on-one sessions with an objective yet empathetic therapist.

    When I was released from the hospital in 1987, my mother paid for me to see someone privately.  Once a week I'd drive to Dongan Hills and talk about what was going on.   For nearly a year, I was quiet, barely saying anything and staring off at the wall beyond his face.  I had chosen to enter therapy with Angelo because he was the supervisor on the inpatient unit and had visited me there, inquiring about my favorite rock-n-roll bands and taking an interest in me and my life as a disc jockey.  At the time, I felt he wanted to drum up business, and this impressed me.  Three days after I was released, I phoned his office to make an appointment.


    One-on-one sessions are vital in unlocking your recovery because often there are things you don't want to tell anyone—not your parents, and not your friends, either.  In Angelo's room, I felt for the first time like someone listened to me, accepted me without judgment, and let me be who I wanted to be.  Having a therapist who "gets it" and is there for you, even if you sit in the chair without speaking for moments at a time, is the best kind of solid, steady encouragement.  We need such "gateway relationships" in the early years. 


    As you progress in your recovery, and fall out of therapy, you may reach a point years or even a decade later when you need a booster.  Three years ago I was at a point in my life where I sought individual help again, and it has worked out well.  Attending therapy isn't a sign of weakness; indeed, years ago I read somewhere that people in therapy often go on to double their incomes.  Additionally, with the right counselor, it will increase your self-confidence, enabling you to take new risks and plan for the future.


    2.  See a psychiatrist once a month instead of every three months.

    This way, she can observe your symptoms and recommend dose changes, and give you information about the drugs you're taking and what they're supposed to do.  (Review my blog entry, Ten Questions to Ask Your Doctor.)  I don't recommend seeing your pdoc less often, even if you're fairly stable and feel you could stretch it every three months.  Often, things build up slowly and then they become crises.  It's better to monitor your mental health on an ongoing basis so that the psychiatrist can make changes before things get out of hand.  I've had three doctors in 21 years: the first I saw for 11 years (he was more of a happy-go-lucky friend), the second (a dismal failure) for five years, and the current guy (a true professional) for five years now.  He's a keeper.  If you and your pdoc feel you could meet every two months, consider that; however, I wouldn't go longer without a visit.


    Another reason to see a psychiatrist monthly: he may detect things that need adjusting that you don't see in yourself.  An unintended yet welcome side effect of my switch to an atypical from the older drug was that I fell asleep earlier, slept more soundly, and woke up earlier in the morning.  For the 17 years I'd been in the workforce, I had trouble sleeping, and the meds caused me to be so fatigued that I woke up late and was late to nearly every job I had.  Imagine this: I spent 17 years in a fog, held hostage to a side effect that took me against my will.  So that was the good thing about last year's mini-meltdown: I found a drug that stopped cold my insomnia.

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    Speak up, speak out if you're having side effects or symptoms.  Schedule more frequent visits if you're going through a rough patch.


    3.  Establish good sleep hygiene.

    Insomnia is often the precursor to an episode.  Wake up and go to sleep at the same time each day, aiming for seven to eight hours' sleep at night.  Shut the lights at or before eleven o'clock.  Resist the temptation to watch late-night news, which can be triggering.  Avoid eating or drinking for at least three hours before you go to bed.  If you wake up in the middle of the night, stay calm and refrain from looking at the hour on the alarm clock.


    Even with the new drug, though, I too have to remember the advantages of shutting off the lights early, and if I'm not tired, resting patiently in bed until sleep comes.  Another healthful technique: shut the computer off by nine o'clock in the evening.  As hard as it could be, force yourself to turn in bed early by reminding yourself of all the benefits of a good night's sleep.  You'll be more alert and rested during the day.


    4.  Get out of unhealthy environments.

    The myth of the schizophrenogenic mother has been proven wrong.  However, I have no doubt that environment plays a part in triggering an episode.  All those years ago, I lived in a house where my mother and father argued and fought all the time.  Thus my Mom couldn't be there for me in the way I needed her to be, because she had her own problems.  She was hyper-critical and in subtle ways I got the idea she wasn't happy with me and I fell short of her expectations.  I couldn't live up to her impossible demands that I be the good little daughter and a reflection of everything she wanted me to be.  I didn't like to clean the house; I would rather be doing my writing projects or listening to music in my bedroom.


    Compounded on that, I was beat up by the neighborhood girls, and at school.  In those days (the 1970s), the staff at the school refused to get their hands dirty in policing student bullies, so things got out of hand.  Had Mom realized just how difficult it was for me, would she have changed her tune?  When I got sick, that was the wake-up call, and she knew things couldn't go on the way they were.  That's why I had to get out and live in the halfway house and then in a supported living apartment.  This isn't intended to place blame on someone else for what happens to us.  However, we're only human and having schizophrenia, we are sensitive to how we're treated and what goes on around us.  External stimuli gone awry could destroy our mental health.  Also, this isn't a screed denouncing us for not being able to withstand abuse.  Verbal, physical or mental, abuse is abuse, no matter the kind or the severity.  If a study was carried out, I'm convinced we'd find that living in a shaky environment could set off the schizophrenia in people with a genetic predisposition for it.


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    5.  Celebrate the anniversaries instead of expecting a setback.

    In my early days at the halfway house, I always worried that something might happen and I'd land back in the hospital.  "What if I can't handle the things that come my way?" was the top question I asked myself, when I had one foot in the future and the other planted in the present.  "Would I get sick again if I ____?" was the running commentary in my head.  This fear could've stopped me from exploring life.  How do I propose you counter this worry?  Understand that it's a natural response to what happened to you.  Yet staying in one place is not an option if we want to have optimal mental health.  We need to move forward, or it's like we're in retrograde, sliding back. Take baby steps each day to get comfortable with the demands of life.  Do one new thing each day until you get the experiences that validate your ability to take care of yourself in the world.


    This is in keeping with my "conscious living" philosophy.  It's also why weekly therapist sessions, in the beginning, could aid you greatly: as you start to take risks, your therapist provides the "eyes and ears": he can detect your progress, compliment you, and offer feedback if he feels you're in danger.


    I hope the five ideas for staying out of the hospital that I've outlined here sparked you to be inspired that yes, indeed, you can live on the outside for a long time.  I'd like to start a "Happy Anniversary Club" and have people post comments in which they testify to their successes living on their own.


    When a trip to the hospital is unavoidable, take heart.  In a coming blog entry, I'll give techniques for making the most of your time on the ward.


Published On: May 08, 2008