Three weeks in a psychiatric clinic

Three weeks in a psychiatric clinic

I came across a picture that I took when I was in a Psychiatric Clinic this time last year. I remember that picture vividly: I was lying on a bench in the garden, looking up at the sky through the branches of this magnificent tree with the most intricate details on its bark, and I was reading my book – Dreams from my Father by Barack Obama. In that moment, I felt small and insignificant and I remember that I kept on telling myself that I will be okay, that I shouldn’t be so hard on myself because only I know my own journey. (I ended up posting this on Facebook and it showed up as one of those “On this day one year ago” things and for the first time I actually appreciated that function. I appreciated seeing how far I’ve come, how much things have changed, how much better they are now).

I got some bad news last week, news that shook me and made me question my friendships, made me wonder who I can trust, made me question myself and my attitude to relationships and friendships. This little reminder with its cliche’d caption (“Don’t be so hard on yourself for only you know your own journey.”) made me feel a bit better. This all started one year ago when I spent three weeks in said Psychiatric Clinic.

I ended up in the clinic because of a suicidal episode. I don’t remember how many of those I had prior to my admission, but that was not my first, it just happened to be the worst. I got admitted to this facility on a Friday evening, fully expecting to be discharged by the Monday morning so that I could study for my final exams. Hah! I ended up being in there for three weeks.

My first night was confusing. I got to the clinic and immediately saw a person smiling and waving at me. This is where internal biases creep in: I thought to myself “Oh shit, what have I gotten myself into? I’m just a little bit depressed, not insane!” I immediately despised myself for thinking that because that sort of thinking is exactly the reason why the stigma surrounding psychiatric institutions still exist. It did not help that I had to empty my bags, hand in anything that could potentially cause harm (including my anti-perspirant which was in a glass bottle – thanks, Nivea!) and then immediately walked into a room with someone sobbing uncontrollably about how (s)he did not want to be there. Honestly, I was pretty terrified. Don’t get me wrong, the nurses, doctors and staff were lovely and I met some amazing people in the clinic, but I was terrified. I was worried about what my family and friends would think if they knew where I was, so I told only a few people. I did not want visitors, so I asked the few people who knew where I was to tell little white lies, to tell anyone who asked about my whereabouts that I was just really busy preparing for exams.

I came around quickly enough. When we go through truly dark times, we need care. We need someone to look after us, to protect us from the world, to be there for us. I got a new psychiatrist, I tried out new drugs and I spent a lot of time in therapy. I had people waking me up, making sure that I ate and making sure that I took my medication on time. I spent my free hours building puzzles, reading books and accepting some visitors. I spent my time cultivating friendships with people who were as hurt and lonely as I was, people who knew exactly how I felt.

Mental illnesses are horrible in that they are isolating. It is difficult to understand just how broken someone can feel when nothing works. When friends try, but they don’t succeed, when sleeping numbs the feelings of emptiness and inadequacy, but only temporarily, when people seem to be living on three hours of sleep every night and succeeding, but somehow this cannot be done by yourself. For months, I barely slept. I was exhausted, I got at most three hours of restless sleep every night. In this clinic, I got enough sleep to feel human again. I could play 30 seconds (and dominate, if I do say so myself), I could read and retain information, I could do puzzles, have conversations, feel normal. It helps so much to be in a safe space.

One of the problems with mental illness is that there is no blanket solution. The medication that works for one person might not work for another. I could not sleep, some people sleep too much. I tried out some strong sleeping pills and new anti-depressants which really helped. That does not work for everyone. For many people it takes multiple tries before something works, only for it to stop working after a while and the whole process to be repeated. I was fortunate that I have only had to change my medication three times in about two years because for many people it is so much worse. Typically it takes about three weeks for psychiatric meds to start working, so that means that for at least three weeks, there is severe depression or insomnia or suicidal ideation or whatever symptom comes to mind, if the medication works. If not, this can go on for much longer. Being in a controlled environment, in a clinic, is so much safer. Nurses monitor the patients’ progress, there is regular interaction with a psychiatrist and with psychologists. This is a much less dangerous process than having to change medication alone.

Being admitted to a psychiatric clinic literally saved my life. I am not saying that things were easy once I left. I had to face the real world again, I had to interact with people who did not understand, I felt isolated and inferior again, but being in that clinic was like a reboot. I now know the warning signs, I know when I am slipping, I know when I am having a panic attack and how to deal with it, I know when to seek serious professional help. I have had to do that twice since I left the clinic, most recently about a month and a half ago, but in a year, I have not been suicidal. Severely depressed, yes, but never to a point of wanting to take my own life. That, to me, is a win, especially considering how much of a roller coaster this year has been.

I keep on getting compliments on how happy I look. I don’t know how true that is. I am happy, but I also know that what most people see is the image of happiness, it is not the panic attacks, the self-doubt, the anger and frustration, the scared little girl. For the most part, however, I am better and getting better every day. I am recovering, I am reading, learning, standing up for myself and developing into a stronger woman.

I realise how fortunate I was to have had medical aid that would cover three weeks in a clinic. Most South Africans do not have that ‘luxury’. I was so frustrated when I realised that I had to pay for my medication and therapy sessions in cash because my new medical aid did not cover them. That’s R500 per month for the medication alone. I am so privileged and fortunate that I can afford that. I don’t know how much worse things would have been if I had to choose between food and medication.

This is why mental health issues are never treated correctly, why we have students failing and dropping out, why we have mothers who suffer from post-natal depression and loathe themselves for not feeling connected to their babies, why we have crime and unemployment. I am so fortunate and eternally grateful.

Please, with the festive season approaching, donate to a mental health facility, donate to a children’s home, donate to a women’s shelter, donate to a rape counselling service. Choose one and run with it, but try to help. Mental illness is isolating, even for the privileged like myself, so imagine how much worse it is for the less privileged.

Lastly: don’t be so hard on yourself for only you know your own journey.

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Emotions are complex

Today is bittersweet for me, just like this day last year. Not this date exactly, but the same events roughly a year ago with some of the same, but mostly different, people. It is bittersweet.

My timeline is filled with the joy of people who have passed their PGDA exams. Last year was slightly different – I heard the news first hand from my closest friends as I was not allowed to have my phone with me in the psychiatric clinic where I spent this exact same, but different, day last year. On the issue of the psychiatric clinic – I have been trying to write about it all year, but I just can’t get myself to do it properly. Maybe soon, maybe not. I am trying not to rush the process.

Just like last year, I am overjoyed and excited for the friends, acquaintances and strangers who passed their exams, who enter the world as Baby CAs, readying themselves to write their Toddler CA exam in January.

I am so happy for all of you, but sad for myself. Sad, angry, frustrated. Sad because for two consecutive years I have watched friends, acquaintances and strangers move on, pass, enter new chapters in their lives, while I have not. Last year because I did not pass, this year because I did not have the financial means and mental health and stability to repeat the program. Angry because I should have passed. It is so easy to blame others, to blame broken systems, to blame a disease and a three-week hospitalisation, but at the end of the day, that anger remains: I should have passed.

One of my favourite qualities about myself is that I am ambitious. It is also one of my least favourite qualities. This raw ambition means that I am driven and curious and have a good work ethic. It also means that I am jealous and competitive and unable to be happy for others without somehow feeling inadequate or jealous or a little bit bitter. (I am also now seeing, after reading this paragraph, that I clearly do not like to use commas when I list things.) I don’t know if this makes me a bad person or if it is normal. What is normal really anyway? Just to be clear, I am not referring to my aversion to commas here.

It does not change the fact that I am proud and happy for you all. It just means that even now, a year later, I still have not managed to deal with my own failure. Of course I know that things would have been so different if I had passed, for instance, I would not have been able to say that throughout my life, I have been signed with three different audit firms (Google audit firms, merger, medium-sized). As a colleague would say: “Winning, Girlfriend!”

Maybe next year will be my year. Hopefully next year this time I will post that I, too, have acquired the title of ‘Baby CA’.

For now, well, allow me to be happy and sad because after all, emotions are complex.

I failed my CTA – now what?

In order to become a chartered accountant (CA) in South Africa, one has to complete an accredited undergraduate degree, an accredited postgraduate degree or diploma (also referred to as CTA by Unisa) and complete three years of practical training, or articles. During these three years, aspiring CAs are to write and pass two national exams which are set by SAICA (the South African Institute of Chartered Accountants). Once all of this is done, and this takes about 7 or 8 years minimum, a new CA emerges.

I completed my undergrad degree at UCT and attempted my CTA there as well. Unfortunately I failed the CTA.

Although not unexpected, it was and is still very difficult to deal with. My CTA year was a bit of a mess. I went through a deeply depressive time during my June exams, which I have documented in detail in another blog post (Mental Health Issues in the Student-Sphere), and it showed in my results. Coming back from a situation where your highest mark is 37% is not impossible, but it is a tough ask. Still, I tried. I worked hard and I really tried, but I definitely did not believe that it was possible for me to pass. This of course stressed me out. I did not have the money to repeat my CTA full-time and I needed the CTA to take up the job I had lined up. So, of course, as MY November exams approached and the stress mounted, I once again went through a deeply depressive episode, this time landing me in a psychiatric clinic for 21 days.

I will write about my experience in this psychiatric clinic in more detail another time, but what I will say right now is that that hospitalisation was the best thing that could have happened to me at that point in my life. I think that was the first time in my life that I could focus on myself, just myself. My mom and boyfriend were the most amazing people during this time for me. I cannot imagine how horrible the whole experience must have been for them and how scared they must have been, but not once did they blame me and not once did they project their own fears and their own guilt onto me. They respected my boundaries and allowed me to heal and recover. If you ever have a friend who is hospitalized for a mental illness, feel free to ask them for advice on what you should do in order to provide said friend with the best possible support.

So back to CTA: because I was hospitalized for 3 weeks, I had to defer my exams to the January examination period. I then proceeded to fail two of these four exams.

This was really tough for me. Although I appreciated the opportunity to recover in a private psychiatric clinic, which itself is a privilege that very, very few people with mental illnesses are afforded, I still struggled to deal with the failure.

For as long as I can remember, I was neither artistic nor athletic, but I was intelligent. My mom managed to teach me to read in 2 weeks (she is an amazing teacher!) and then nurtured my love of books by driving me to the library every week and sometimes twice a week because I went through them very quickly.

Unsurprisingly, then, I ended up defining myself by my academics. In short, my academics became me and you don’t need a degree in psychology to know that that is an unhealthy and very narrow definition to have of oneself. Failing at anything academic-related became a major struggle, and I failed quite a bit during undergrad. The issue was that I would fail tests and pull miracles out of my ass (horrible image, I apologise) in the exam, which allowed me to pass the course overall. I had gotten through undergrad without failing a single course. Clearly that did not work for my CTA year. Some miracles are impossible, even for me.

So when I realised that that there was a very real chance of me actually failing, I spiraled completely. I became more depressed and anxious than usual and ended up being hospitalised for a suicidal episode.

In the end, it seems that the idea of failing CTA was so much worse than actually failing CTA. Failing was tough and I sometimes find myself feeling sad about it; it is something that is always there when I hear my friends talk about their upcoming graduation and when they talk about their board exam results which will be released soon. I still feel it, but I also know that if it hadn’t been for those 3 weeks in the clinic, I would not have been able to handle this failure like I am handling it now. I am immensely proud of myself for not spiraling into suicide mode immediately, but for instead understanding that my journey is just a little bit different from my friends’, and that we’ll reach the same destination in the end.

The most amazing thing about failing at something so important is that one suddenly realises how many alternative options are available. So, here is my advice to the class of 2017:

  1. Apply to Unisa’s CTA program as a backup:

Even if you are confident that you will pass, apply anyway. The program is called the Postgraduate Diploma in Applied Accounting Sciences (CTA level 2). Get this right, because you don’t want to end up applying for a bridging course by accident. Unisa is confusing like that. The closing date for applications is usually around 25 November of each year, but keep an eye on the website in case it changes.

  1. Many small and medium-sized firms allow you to pursue your CTA while you do your articles:

Apply to these firms. You can write your CTA in your first year and write both ITC and APC in your second year, which means that you will still qualify in line with your initial timeline.

  1. Sometimes something goes wrong with an application:

Maybe you missed the application deadline or you applied for the wrong program or you just do not have the health and stamina to pursue your CTA in your first year. It happens. Some firms allow you to do your CTA in your second year for a valid reason. You can then do your CTA in your second year and write ITC and APC in your third year. Discuss this with your employer or prospective employer and try to figure something out.

There are so many options out there. I think that it is nice to have options. I did not think of these things, so I had a crazy amount of pressure on me to pass first time around, to the point that I became suicidal. I know how ridiculous this sounds, but when I think about where I was in November 2016 and where I am now, I am immensely grateful to be alive. I did not plan on making it past 11 November 2016, but it is now 14 March 2017 and I am still here. I have a new job, I celebrated my 7th anniversary with my boyfriend just last week and I recently got to see my ‘baby’ brother head off to university to study Astrophysics.

I got to experience all of that because of alternatives. We don’t all have to have the same journey, as long as we get to where we want to be.

I don’t think that I can ever thank my support system enough. My mother, my two brothers, my boyfriend and my three closest friends who really helped (and still help) me through rock bottom, panic attacks, depressive episodes and everything else.

I am alive because of you. I have a job because of you. I am a functioning adult with adult responsibilities and a new outlook on life because of you. Thank you.

Mental Health Issues in the Student-Sphere

Mental Health Issues in the Student-Sphere

I have been wanting to write about mental health for a long time, but it always seemed like the type of issue which could easily result in workplace discrimination and unnecessary stigma, so I remained silent. As much as I know that someone with a mental illness is just as able and often more able than someone who does not have a mental illness, I chose to keep quiet about mine for fear of being judged and thought of as less than capable, a liability to an employer, or weak.

I remember how difficult it was for me to tell my closest friend about my diagnosis and when I finally did tell him, I felt small and weak and so incredibly alone. This was not because he was not supportive or because he was ignorant; it was because I just felt that way. It is difficult to change how one feels about a mental health diagnosis, regardless of how incredibly supportive one’s support structure is. Whenever I have to tell someone (other than a medical doctor or therapist) about my mental health, I shrink a little bit with fear because what if that person thinks that I am weak, different or just stops talking to me? What if he or she judges me and discounts all of my ideas because of this one aspect of my life? What if I make a mistake and now this person thinks that because of that, every other person with anxiety and clinical depression is inadequate and prone to making mistakes by extension? If this is how I, a liberal twenty-three-year old university graduate feels about my mental health, I can only imagine how difficult it must be for an eighteen-year-old who just started to study at a university, or a sixty-year-old man who grew up thinking that depression was a made up ‘white’ illness for bored housewives.

The worst part after my diagnosis was that I knew when I had a ‘down’ day, but it was difficult to explain to others why I was cancelling plans or feeling down, because mental health issues are not visible and generally aren’t taken seriously until one has an episode and ends up in hospital. It is also an ongoing illness which isn’t automatically cured by medication after a week or two like the flu – it is often incurable.

My initial medication lost its effectiveness during a particularly stressful academic period, our June test period. When I finally realised that my medication wasn’t working anymore and that it wasn’t just me being stressed (because the medication doesn’t take away healthy human emotions and feelings) the tests were upon me and I had to survive. It was an extremely difficult moment in my life because I knew how important those tests were, but there were days when I would get out of bed only to use the bathroom because I was that depressed. There was one particular week that went by and I still do not know where it went because I spent most of it in bed. I don’t even remember eating during that week.

The worst part about depression (for me) is the extreme loneliness. I was surrounded by people, but I was still so incredibly alone. I hit rock bottom when I walked to a train station and stood on the platform, more than ready to jump. I’m not entirely sure why I didn’t jump that day, there were many different reasons: I have two younger brothers who need my financial help as they pursue their tertiary studies, I have a mother who would be devastated if I were to jump, but none of that mattered to me in that moment. The thing about depression is that it causes you to hate yourself and therefore by extension you believe that no one else could possibly love you, that no one could possibly miss you if you were gone, that no one would really even notice if you ceased to exist. In that moment on that platform, though, the one thing that kept on going around and around in my head was that I had forgotten to write a note. I don’t know why it bothered me so much, but it did, so went back home and decided to write one.

I had a therapy session later in the morning and I thought “hey, what the hell, let me go to this session one last time”. If anyone ever tells you that therapy is a waste of time or that you are weak for going to therapy, do me a favour and show that person your middle finger and go to your therapy session anyway. After being in therapy for years and feeling no different, on that day, at my lowest, going to that session was the best thing I could have done. The concern on my therapist’s face the moment she saw me (I didn’t even have to say something) said much more to me than anyone ever had.

That day, I made a pact with her and with a friend that if I ever felt particularly suicidal again, I would go straight to an emergency room. That level of accountability seems to help, because although I haven’t felt suicidal in a long time, just knowing that I am accountable to someone, that I made a pact, makes me rethink my situation before I act.

If you are feeling suicidal, please do that. Find a buddy and tell your buddy that you need help; ask that person to be there for you to talk to if you need someone while you try to get your medication sorted or while the medication is not yet effective (anti-depressants often take two weeks to start working properly). There are also suicide prevention helplines – please call one of those if you need help.

The South African Depression and Anxiety Group (SADAG) has some very useful resources which really helped me when I was beginning to suspect that my low mood wasn’t “just one of those days”. One of the best resources on SADAG’s website is a variety of quizzes, the results of which indicate a possibility of depression, Postnatal Depressionanxiety, bipolar disorder, PTSD (Post Traumatic Stress Disorder) and/or ADHD (Attention-deficit/hyperactivity disorder). If you are suspecting that you might be suffering from one of the above, take the appropriate quiz and follow your results up with your general practitioner or a psychiatrist, whichever is more accessible to you. SADAG also has a toll-free helpline which you can call if you have any queries or need help locating your closest emergency room, psychologist or psychiatrist. There are also suicide prevention helplines and support groups available.

On the issue of psychologist versus psychiatrist: a psychologist does not have a medical degree and therefore cannot prescribe medication, but is trained to provide therapy. A psychiatrist, on the other hand, is a medical doctor who is able to diagnose mental illnesses and is able to prescribe medication. A general practitioner is also able to prescribe medication, but it is always a good idea to go and see a psychiatrist to evaluate the prescription so as to see whether the dosage should be adjusted or not.

Medication for mental illnesses can be tricky in the sense that there is not one blanket medication that works for every human being. Sometimes it takes a few different trials and/or dosages to get the correct balance, sometimes the side-effects are not ideal and sometimes the medication loses its effectiveness over time, which means that new medications and dosages have to be experimented with. It is an extremely frustrating process, but please do not give up, because once the medication actually starts working it really does make a massive difference to the wellbeing and general level of functionality of someone who suffers from a mental illness.

The Student Wellness Service (SWS) at the University of Cape Town (UCT) is usually fully booked, but there is a waiting list for therapists. The therapists are brilliant and often refer students to the psychiatrist there, so it is a cheaper consultation (although the waiting list for the psychiatrist is usually also very long because there is only one) than with a private psychiatrist.

Please do not let financial constraints deter you from seeking help from SWS. The general cost of one therapy session is R150, but anything at SWS is free of charge for students who are on financial aid and prices are negotiable for any other student. The charges are added to your fee account, though, so be sure to clear those charges before results are released, otherwise you will not be able to access your results.

I urge you to seek help if needed and even if you do not believe that you need help yourself, go and check out the SADAG website and read up on mental health issues. This is an area of life which is often overlooked and minimized because of ignorance and this can be frustrating and hurtful to loved ones who might need your support. Try to educate yourself and do some research because a good support structure is vital to someone with a mental illness in those first few months after the diagnosis.

Also refrain from using harmful, ableist language such as:

  • I understand how you feel;
  • Just think positive thoughts;
  • Everyone gets sad – you’ll be fine;
  • Suicide is a sign of weakness;
  • Pray about it;
  • Get over it.

There are many more and as you read and learn more about mental health you will learn about these do’s and don’t’s, but please follow the links below for any additional information:

There are obviously more resources out there, so don’t stop here. UCT students can follow the UCT Mad Hatters Society Facebook page (it actually gives me life).

If you are struggling right now: please do not think that this will blow over or that you have to ‘tough it out’. If someone can go to a doctor because they have a common cold, you can seek medical help for a mental illness. Do not let anyone discourage you from taking your medication. No one would tell a diabetic not to take his/her insulin, so no one has the right to tell you not to take your medicine. Seek help, take your medication, get therapy and/or join a support group, it will make such a big difference to your life. You will actually feel like a human being again.

Most importantly: no one can change or minimize your lived experience. This is tough and you are a warrior for seeking help, you are a warrior for surviving.