Hello everyone! This is Amy here to introduce the next chapter of Kate’s memoir (as she finds these kinds of summaries impossible to write)…
Where we last left off Kate was on the brink of losing her freedom forever to a locked psychiatric ward. Her last hope was the appointment she just scheduled with the only doctor in the area, Dr. Cortado (a pseudonym) who agreed to treat her as an outpatient. At the time she lived alone, battling OCD, contamination fears, hallucinations, stress-induced fecal incontinence and a Bipolar Disorder diagnosis. Her final chance appointment was scheduled for 3:00 p.m. the next day.
💜 If you’d rather explore this week’s new Healing Lab post from Kate,
a “Lab Notes” entry on the science behind Feelings, check it out here.
Now, here’s Kate…
Chapter 6: The Unmentionables
As soon as I hung up with the receptionist, I started to prepare. This was the appointment of a lifetime. The appointment that would determine if I spent my life free and independent or in a locked residential ward.
So I needed it to go perfectly. I needed to prepare. But preparing and acting on that preparation were two very different things for my OCD-brain. So first, all I could do was pace around and around my 300-square-foot apartment in loopty loops, obsessing over how to “optimize my plans and preparation.”
The reality of my life back then was consumed by this kind of overthinking. Every action, every step, every single thing I did or even thought had to be planned, prepared, and evaluated in full. I also “had” to map out every worst-case scenario, brainstorming every possible way to prevent disaster.
This was exhausting and all-encompassing.
But back then, I didn’t know that these thought patterns were OCD. I also couldn’t realize these thought patterns were not a choice — this was a trauma response that swallowed me whole and shrunk my world completely. (To make matters worse, I was also under the heavy sedation of an antipsychotic at its maximum dose at the time, further obscuring my OCD). I was living a life of trauma reactions, on autopilot with one mission and one mission alone – survival.
I began preparations with step 1: I replayed my past. The ritual was old hat now: figure out what the hell happened to me. Learn from it. Make sure it didn’t happen again. Everything was a threat back then — a battle for freedom and my mind could not fathom it any other way.
Walking in circles, the events of the past few months began to wash over me in waves.
There I was at my new job – lonely and unwell and missing Maura while she was on a 90-day hold in Concord. There I was in the psych ward learning of Atlas’ diagnosis of terminal colon cancer, accompanied by the attending’s solemn words that I, “needed a new therapist within the next few months, or I’d have to go to residential treatment.” Next, there I was on the floor of my old apartment with the sun streaming in as I called every single therapist within 50 miles before that one therapist called me back and said she was willing to see me.
That was when the light bulb finally flickered on in a faraway room of my mind. That was when I found the clue I was so desperately looking for.
OMG. The failed appointment with that doctor. The one who first agreed to treat me, then said she couldn’t work with me after all. It’s the key. Now, what went wrong? Kate, what went wrong!?
Writing this now, it seems so obvious to me. I mean, of course, the last time I tried to do this, I was utterly and completely rejected. I was told I’d spend my life locked up. How could that not have been my first thought?!
But again, self awareness was very hard to come by back then, so this simple connection felt like a revelation of epic proportions.
Knowing I needed more details — details I couldn’t yet place — I began to frantically search my journals. The pages of these notebooks always held more clarity than my mind, with its lost time.
After a few false starts (dating pages and labeling have never been my jam) I found the pages that described the failed appointment. it was clear that it had gone incredibly well, or at least, incredibly well for me. The doctor had been deeply kind, and I had walked in and stayed true to that appointment’s OCD-created plan — that the appointment was my “new beginning” and I would therefore again begin appointments like I had when I was younger and had not yet been harmed or silenced by the healthcare system.
Hi my name is Kate. I am a human and radical transparency is my jam. I also believe there is no wrong way to be human. So today, I will share my whole human self here. Thank you, deeply, in advance, for listening.
The journal entry went on to talk about how I’d been “all me” and shown up in full unabashed Kate optimism and candor. I had shared everything:
The lost time — coming to in the woods, in my car, in random states, and my need to use pain to stay earthside when I was driving
The extensive nature of my hallucinations — the visual ones, the auditory ones, the command ones, and even the violent ones where I killed myself and others
My belief that I didn’t have bipolar disorder — that this current state I was living was actually the side effect of a side effect and that the diagnosis was wrong and all my symptoms were just te result of a bad drug trip
And lastly, that I was barely a human any longer – just a being who didn’t want to hurt her parents, but in all honesty, only consisted of that hope and a simultaneous deep desire for death because the suffering and chaos of it all was just too damn much
My words on the page brought tears to my eyes. I had been so proud when I left that appointment. I had been so hopeful.
This is my new beginning, and for the first time in a long time, I told the whole honest truth so for the first time in a long time, my whole self gets to begin again too. Maybe it really can get better.
Tears began to fall. That entry was then. But this was now.
And so many things had happened since. First, came the voicemail where that doctor had said clearly that after reflecting on all that I had shared, she realized I was too sick to live outside a residential psych ward. Then, came the multi-day fugue state that the voicemail had triggered and its aftermath that resulted in my weeping in Atlas’ office. And then, came Atlas being triggered by my weeping, and in his triggered state, telling me that I was failing him and my parents.
And then, well, then, I killed myself. Or. I tried to. I couldnt even do that right.
That was when it hit me — the truth I kept relearning time amd time again:
The whole truth isn’t allowed if you want to survive the mental health care system.
Yes, if you live with serious mental illness and you want to survive, you don’t get to have both your truth and your freedom. You can only choose one.
So once more, I dove back into my journals to guide me. And there, I found the entry from the first time I had learned this lesson.
The Unmentionables – Kate’s Rules to Survive By
In new appointments with independent practitioners, absolutely no mention of suicidality in the present moment. Discussion of past suicidality is acceptable, but do not think for a second it’s okay to tell them that you are done with fighting, Kate. Doctors pretend it’s okay to disclose this, but hear me loud and colorful — they always punish you for it. They always punish you for it so unless you are so psychotic and losing so much time that you are actively afraid you will kill yourself and die (and thus need a direct admit), only discuss suicidality in the past tense.
In new appointments with independent practitioners, absolutely no mention of losing time, and ending up in weird places. Be especially careful not to disclose how you actively self-harm and still use a razor blade in your arm to be able to stay earthside while you drive to work. Stories like these result in more antipsychotics ALWAYS and the meds never help. They confuse you more. They make you lose more time, and sometimes, they even make the command hallucinations even worse. So please, don’t go there. Your mind is already hating you always. Don’t go there Kate.
Last and most importantly, absolutely positively no mention of your belief that you do not have bipolar disorder and that your psychosis is one big disastrous drug trip. I know you know this truth. I know this is the truth. I also know what you live is exactly like what all your friends in the ward experience when they have a bad drug trip. This is true but do not fucking talk about it Kate. Disclosure of this is the fastest way to a 90-day hold and a lifetime of psychiatric incarceration. Remember. Doctors have egos. Doctors need to be (or at least feel) in power and control. And above all, doctors hate being wrong. They especially hate it when you question them and accuse their positive intention and care of harming you. Adding in the idea of medication non-adherence and that their diagnostics are incorrect will not help. So again Kate. Do not mention (your belief) that you are actively drug tripping on prescribed medications and do not have this psychiatric condition. Just do not.
There was an iciness to my being after I read the list, a chilling calm that lingered in the stale air of my tiny apartment. I knew what had to be done. It was simple and surgical — precise in all the ways just how the healthcare system liked it.
I had to erase myself. I had to erase my darkness once and for all.
So, without even a moment’s hesitation, I grabbed a fresh journal from the little bookshelf in the corner and on a fresh first page, vowed to never mention the unmentionables again – not on a page, not in a conversation, not ever.
And with that, I set out to rewrite my life story without them and practice it in the mirror over and over again, sewing confusion into my self and future for years to come.
In case you forget in the morning, Kate — your life has been one great big knowing of the truth that whole truth honesty, radical transparency as you like to call it, is the only thing that sets a human free. The hard part is that your mind is shattered by lost time. Every shatter was caused by very real harm you suffered for telling the whole truth. The result is that the shattering forced you to doubt your truth and the safety of honesty. Furthermore, in every single shard, you’ve had to reckon with the harm the whole truth brought to your life — how it separated you from the rest of your life— and then still bravely choose to re-learn this truth and live it once more.
(And Kate please —- even though I know telling you from one shard of yourself — please never stop telling the truth. It’s the only way we can all ever go home to you.)
This list is what I needed, to remind myself that the conversations doctors liked to say that were “safe” where I was “absolutely okay to disclose,” in fact, harmed me.
After reading my three rules, three times (in perfect OCD fashion), I launched into practicing a version of my story that followed those rules in the mirror.
Just like when I relearned how to walk and talk while watching “V for Vendetta,” and “Supertroopers” on repeat, I practiced telling a sanitized version of my story to myself over and over — finding a way to stay honest but to also not break any of my rules.
I practiced this sanitized story in the mirror until two or three in the morning.
Only when I had finally mastered how to tell it without the unmentionables was it time to pick the perfect outfit.. So, at three in the morning, I tried my entire closet on in sets of three while my mind and its many self loathing voices tithed me with hatred again and again.
My perfectionism exhausted me. Everything about my life did. But it didn’t matter. I had to keep going. I had to get this right.I could keep explaining how brutal it was — but the truth is, it’s too exhausting for both of us to make you weather every single minute with me. So all I’ll say is that my rituals lasted all night.
The self-hatred did too, and as the sun rose, I settled on two nearly identical blue dresses with black leggings and the truth that my truth didn’t matter any longer. All that mattered was that I didn’t harm my family any more, all that mattered was that I made it through with my freedom intact.
This is where my memory begins to fragment. I don’t yet have a fully realized “download” of that first appointment and the many accidents I had on my way to it. All I know is I soiled every piece of clothing I brought — all six pairs of backup leggings in my go bag — and before falling asleep, I scrawled this on a piece of scrap paper:
Doctor Cortado is terrifying.
TERRIFYING.
And
He said that, first, I tell my story — and then, we decide if we work together.
So, Kate, before you lose time again and forget it all, remember this. KATE REMEMBER THIS:
don’t you dare share The Unmentionables because you are not safe from a life spent in that locked ward, just yet.
Thank you, so very much, for being here and being such kind witnesses to these stories.
As promised last week, I am still writing guides to healing here, and this week we have prepared a Lab Notes edition on Feelings as our monthlong exploration of feelings vs. emotions continues. This one is a deep dive, with all the nerdery you could ask for, and probably some you didn’t, LOL.
And If you’re new to the Healing Lab, and want to read this series from the beginning you can start with our (1) Nervous System collection, and then move to (2) Finding Safety.