Cold childhood, involuntary commitment and healing

So she has really made the call. I can’t believe she has really made it. My psychotherapist has in fact called 911, called an ambulance and told the medics to take me to a psych ward because I would be in danger of ending my life. When she told me, she had no choice and was forced to overrule me, the fucking walls of my existence came tumbling in. Cracks opened in the borders of my perception and the term self-determination ceased to have any meaning for me. I just sat there, speechless and mentally incapacitated.  

I believe I said something like “Please wait, let’s talk about this” or “How can you do this to me”. And my therapist might have said that she was so very sorry to do this, but she cared about me and would not want me to do anything I’d regret. It is all shrouded by a foggy blur. Now, I am sitting in a room in a psych ward, a desk in front of me, with a computer on it and the usual stuff you’d expect in a hospital office. A nurse just brought me a plastic cup of lukewarm water and asked me if I was okay. I guess, I have said “yes”. My mind was occupied with something much more important than a cup of water. My mind was mobilizing all its strength, firing up every single synapse in my brain, to restore what was holy to me. To claim back, what should never have been taken from me. To recapture the very basis of my existence – my freedom. 

A person wearing a white coat entered the room at sat down at the desk facing me. The doctor who will conduct the admission interview. She was here to examine me and pass judgment whether or not I should be confined against my will. A female nurse wearing blue scrubs came in as well and stood a little aside, folding her arms and resting her scrutinizing gaze on me. I did my best to adopt a posture that radiated confidence and self-assurance. 

The doctor briefly looked at some print out she has brought with her. Then she typed something in her computer. Finally, she looked at me. 

“I understand your therapist is worried about your well-being.” she said, “Would you tell me what prompted her to call an ambulance?” 

I waited a moment, and another one. Show no weaknesses, no flinching, no backing off.  

“I need to make very plain that I am here against my will. The only reason I let the medics bring me here was that I wanted to save me the trouble of having the police bring me here in handcuffs.” I said. I guess, my voice was sufficiently carried by a decent level of confidence. 

“I see.” the doctor said, remaining completely calm, “I am sorry about what happened.  It is my duty to verify if you can take care of your own safety. And when a therapist, your therapist, calls 911 because she thinks you are an imminent danger to yourself, we need to take this very seriously.” 

Time to up the ante. 

“Correct me if I’m wrong. But I believe the burden of proof lies with you. You have to proof to me that I’m in a mentally deranged state. I, certainly, do not have to proof to you that I’m sane and normal. Having said that, has someone even checked whether the person who has called 911 is in fact a psychotherapist? And if so, whether I am a patient of this person or related to that person in a very different manner?” I said, trying to sound cold and aggressive and believing I have gained some ground. 

“You are correct, the burden of proof in fact lies with the hospital, which currently is represented by me.” the doctor said, still unperturbed, “But I believe we agree that someone has in fact called 911 on your behalf to make sure you are okay.” 

“I have already made clear that I am here against my will. I will not spend a single second in this facility voluntarily. Therefore, the only – the only – decision you have to make is whether or not you want to commit me against my will. And, therefore, the only aspects I will talk about are the legal requirements for involuntary hospitalization. I am very willing to point them out to you.” I said, and I believe I even managed a slight smirk. 

“You seem to know about your rights.” the doctor said. 

“Yes, I should. I am a lawyer.” I said, conveying pride and resolution. 

“I understand. Have you represented clients in similar situations or have you had any bad personal experience with psych wards in the past?” 

The calm composure of the doctor began to irritate me. 

“No, I am specialized in M&A and capital markets law. I do not occupy myself with matters like this”. I felt I didn’t hit home with this bragging, “And I believe I have a very realistic conception of psych wards and how patients are treated. It's not like in Twelve Monkeys, far from it. But still, you’d take away my freedom – which you already have –, my personal belongings, my privacy and eventually my dignity.” 

“I can perfectly understand that you believe psych wards are not spa hotels and that being confined here for a certain period of time may likely feel awful. It is not our intention to keep anyone here longer than necessary. We are here to make sure that patients are stable enough to take care of themselves. As you have said, this shall be the only aspect we will be talking about and which I shall assess. It is absolutely fine that you would not want to stay here voluntarily. I just want you to know that whatever has prompted that person to call 911, I am sure that person cares a lot about you. And we care about you, too. No one here wants you to harm yourself.” 

That hit hard. The doctor appeared to be genuinely concerned. I did not want to, but I had to clench my teeth to gather myself. Which made my cheekbones stand out and which the doctor could not fail to notice. I was being pushed into a corner.  

“There are legal requirements for involuntary confinement. You cannot keep me here unless you have sufficient reason to believe that I would seriously and significantly endanger myself because of a mental illness. As I see it, you have not established a single one of these requirements yet. Again, I will not stay here voluntarily for a mere second.” I said, feeling my confidence fade. 

“I can feel that you are very tense. I am sorry that you had to come here and are now sitting here at my desk and must talk to me. From the moment, that person, be it your therapist or not, has called 911, things got out of your control. And no one, believe me, no one, likes to let things get out of control.” the doctor said. 

My mind was racing to formulate a retort. Something to get the upper hand. Something to shut up that stupid doctor, who was so unimpressed by what I have said. Before I could come up with anything clever, the doctor continued. 

“Being in control. We are not here to take control away from you. We are here to give you back control over yourself. If you have experienced, maybe very early on in your life, that you had to take care of yourself, because no one else did, because this was the safest route to take, then this was a burden which should never had been put on your shoulders. If that has happened, I am very sorry.”  

I had no nothing to say. I let the words sink into my mind, unable to say anything. 

“You do not have to walk alone. You do not have to bear that burden all by yourself. There are people who care and who a very willing to help you. I am absolutely sure that the person who has called 911 did not make that call thoughtlessly. On the contrary. I believe that person has waited as long as possible and has done everything in his or her power to prevent it. It was a last resort. It was the ultimate step to ensure your safety. Even if that meant to deprive you of your freedom temporarily.” the doctor said with a soft voice. Even the nurse let a warm expression wash over her face. 

I still could not utter a single word, so the doctor went on. 

“And I believe that person was your therapist. You were taking care of yourself by undergoing psychotherapy, trying to resolve whatever was bothering you. You were reaching out seeking assistance. And compassion. And now, and there is absolutely no shame in this, now you ran out of strength. Maybe you are at your wits end and lost all hope. And right there, at your lowest point, your therapist has thrown you a lifeline. She couldn’t let you leave. She feared you would harm yourself. Would you really let anyone of your closest friends walk away if you feared you might never see them again? Your therapist cares about you, a lot. I care about you, too. Let us help you carry that enormous burden on your shoulders. Grab that lifeline and let us walk side by side, just as long as it takes you to be able to walk alone again.” 

A tear fought its way out of my eye. It slowly ran down my cheek. I hated myself for this weakness. 

“Being in control. I believe that is what’s bothering you. Staying in control no matter what. We don’t want to control you. All we want is to make sure that you stay safe. Stay safe for however long it takes you to overcome this situation.” the doctor said and walked around the desk, squatted down next to me and laid her hand on my shoulder. 

No more words. No more needed. My jaws tightened. Tears were running out of my eyes, even though I shut them as strongly as I could. I bent forward, buried my face in my hands and sobbed uncontrollably. And suddenly, through all the pain and distress, the doctor’s hand on my shoulder no longer felt as an intrusion, but warm and soothing.  

______________ 

This never happened. But it could have happened. I was close enough for my mind to create a myriad of fantasies in which I rebelled against doctors and nurses, medics and even my own psychotherapist, not to be committed against my will. I imagined countless situations and corresponding strategies to wriggle myself out of the risk of being hospitalized. With the overarching and ultimate goal to retain my freedom.  

Freedom. 

Control. 

For me, these two aspects were inextricably linked. I just had to remain free, at all costs. 

It took me a while to realize what I had been doing to myself. If the concept of the inner child means anything to you, you know what it means to connect to your innermost fears and desires. And, brutally so, I had to learn something about myself.  

I grew up in an emotionally cold environment. Emotions were “not allowed”, only humor (mostly in sarcastic form) and slight happiness were okay. I have no memory of ever having physical contact with my parents (never, no cuddling, kisses or even a hand on my shoulder; nothing). If I wouldn’t know it better, I’d believe that I even had to change my own diapers as a baby. There is a term for this: CEN – Childhood Emotional Neglect. 

If you grow up in an ice-cold world like this, you are bound to take care of yourself. You must, because it is essential for your survival. You learn from early on that you can rely on no one except yourself. There is not a single person to turn to, if you are afraid, are insecure, feel ashamed or are hurt. You can ask no one for backup, guidance or help. You are on your own. You are utterly alone in an Antarctic world. That is what CEN feels like.  

Except it doesn’t. At least not for me. I guess in order to make it bearable, in order to survive, your mind keeps reality at bay. Your mind doesn’t let you feel the coldness. It creates a personal Truman Show for you where you seem to live in a world which is more or less okay. But underneath, in the background, your system is constantly running at full alert to keep clear of threats. To keep away from anyone and anything which might overwhelm you. And when you were forced to take care of yourself from early on, when there is absolutely no emotional support whatsoever, you would be easily overwhelmed. Very easily. 

Hence control. 

Control as much as possible to retain as much freedom as possible. 

That was my credo. 

And, unbeknownst to me, by fantasizing about preventing being admitted to a psych ward at all costs, I was doing to myself what my parents were doing to me since I was born. My parents were not taking care of me. And I was not taking care of myself either. I thought I was, because an involuntary commitment, in my imagination, was the worst thing that could ever happen to me. I’d rather take the risk of committing suicide than being admitted to a psych ward. And by thinking and feeling along these lines, I let myself down. I let my inner child down, big time. Because my inner, little Mara still thought that she had to remain in control all the time at all costs. Because she needed to do that to survive. But now I am here, the adult Mara. I no longer need my parents, for anything. I can take care of myself. But as soon as the risk of involuntary commitment arose, I, the grown-up Mara, let the inner child take over. And by doing so, I let my little Mara down. 

What I should do instead is to console my little Mara and tell her, that she no longer has to strive for control. For I am here. I am taking care of myself, of ourselves. I should have let the doctor commit me or, even better, should have committed myself voluntarily. In the story above, the doctor found the right words and behaved perfectly. That is what I should have done, what I should have said to my little Mara. 

Thank you, little Mara, for doing your best. You did exceptionally well. Please believe me. I am proud of you, and you can be proud of yourself, too. Without you, I wouldn’t be here. I would have perished a long time ago. 

I am deeply sorry that you had to carry that burden for so long. No child should have to endure that. You were so very strong and brave.  

I am deeply sorry that it took me so long to see you. To feel you. And, finally, to relieve you of this intolerable burden.  

I can only hope that you can forgive me one day. I would be honored if you talked to me, or give me a sign that you are better now.  

You are my little Mara and I love you. Deeply and truly and forever, unconditionally. I vow that I will do my best to never let you down again. 

You are Mara. I am Mara. We are unity. Together, we form our past and future.  

We walk on, proud and stronger than ever.