Organized Chaos - Volume 7
Inpatient Treatment - What's It Like For Teens?
by Throstur Bjorgvinsson and Kimm Fountain,
with Michelle and Maggie
Menninger Clinic, Houston, Texas
Not many have experienced the conversation leading a family to admit their adolescent son or daughter to an in-patient OCD clinic. One can only imagine the sense of pain and turmoil that threatens to overwhelm those involved. Often for the first time adolescents find themselves uprooted from family, friends and all that is familiar. They start a new journey in a "psychiatric hospital" bringing severe struggle and anxiety along with many potential misconceived preconceptions. First, they have to meet numerous staff, are examined and questioned thoroughly more than once, given a list of rules and regulations to follow, are orientated to the physical unit, have treatment schedules explained, meet their peers, and have their belongings searched by someone they just met. It would be a daunting experience for any human being.
However, by and large, most all of these teenagers whose obsessions, rituals and ruminations plague them day and night, go through this initiation like seasoned pros. Their immediate resiliency is extraordinary. In the days following admission, they are asked and required to face their worst fears for extended periods of time over and over again. Each day they experience a leap of faith regarding themselves, their fears, their treatment and staff support. This is no simple task for someone suffering with OCD.
During treatment the adolescents engage in intensive cognitive behavioral therapy, especially in an activity called exposure and response prevention (ERP) for two hours each day. First, they create an ERP hierarchy during which they endure their fears without performing the rituals that temporarily serve to neutralize their anxiety. As a result, they tend to habituate to each situation so that it is no longer anxiety provoking. Of course, for many in treatment ERP lasts 24/7. What follows are essays written by two teenagers who were treated as inpatients at the Menninger Clinic explaining how they underwent the experience and how it helped them.
Fighting The Hardest Battle
Michelle, a teen from Massachusetts, writes about her inpatient experience.
It was December about a year and one half ago that my OCD had gotten to a severity that every hour, every minute of the day, I was preoccupied by it. I was either thinking OCD thoughts (obsessions) or carrying out rituals (compulsions). I had been pulled out of school right before December vacation and had started home/hospital based tutoring. I was working really hard on CBT (cognitive behavioral therapy), yet my therapists, my family, and I all knew that I needed to be in a place for a while where I would be immersed in treatment. I had a strong desire to get better, and fast. I had seen how Obsessive Compulsive Disorder had not only grabbed ahold of me, but, had also devastated my endlessly supportive and loving family (my mother, father, and younger sister) because seeing me sick pained them, too. I was involving them, especially my mom, in my OCD by having them help me carry out my rituals and by constantly asking them reassurance questions just so that I could make it through each day. When we found out about the Menninger Clinic, a hospital in Houston, Texas, with an OCD unit, we started to consider whether my going there was an option. When I pictured myself being in the hospital, I was really nervous, but also excited at the same time. I was nervous to be away from home for possibly a month or two, because I had never been so far away from home by myself and for such a long time. The last time I was away from home was the summer before going into my freshman year of high school; and it was during that month, at overnight camp, that my OCD was triggered. On the other hand, I had never met anyone that was suffering from OCD in the same way that I was. I had only told my best friend and family that I was struggling from this disease. I felt really ashamed and completely isolated. When I thought about being with other teenagers with OCD, I was ecstatic. Although I was getting tremendous support from my family, doctors, and best friend, I knew that the teens plagued by the same disorder would be able to comprehend the situation on a whole other level, since they, too, were experiencing it first hand. Although I knew that going away would cause a big disruption to my life and that this would be extremely hard work, I was certain that I could not and did not want to go on living my life suffering. When my family and I had consulted with my doctors and made the final decision that I would be going to Menninger, it felt surreal. This surreal feeling continued even when I was packing and while I flew down there with my parents at the end of May.
When I got there, I panicked. My OCD was around perfectionism and contamination; and my room seemed bare and was not clean enough for my high standards. Worse, I was under the impression that my family would be able to visit me the next week and that I would be able to call them every night. I begged my parents not to leave me there when I heard that they would probably not be able to visit for three weeks and that I would only be able to call them twice a week because it was important for recovery. As heartbreaking as it was for my parents to leave me there crying hysterically, I am forever grateful that they did. My road to recovery was in no way a smooth one; it had many bumps along the way. Fighting my OCD was the hardest thing that I will probably ever have to do. It requires facing your fears head-on. When your brain tells you to do something, you need to ignore it and do the exact opposite, despite how uncomfortable and anxious it makes you feel. If it is telling you not to touch a trash can, you must, for example, give it a hug or bury your hands in it. My work at Menninger included ERP (exposure and response prevention), SDE (self-directed exposure), GOAL group, making behavior plans for myself along with my therapist, going on outings to experience exposures in a public setting, and attending various informational groups.
Teens went to a school on-site for three hours on weekday afternoons, and also had plenty of downtime. With the tremendous help and support from the expert doctors, nurses, social workers, and therapists, I was able to conquer one task, and then another, and another. I started small, taking baby steps, and then working my way towards larger steps. Each accomplishment I made gave me confidence and more strength. All of the teen patients in the OCD unit worked together and encouraged each other in positive and supportive ways. We were able to actually joke about OCD and push it back as it bullied us. You really have to want to fight and change your life; in the end, only YOU can make yourself do something.
After nine and one half weeks, I was doing really well and it was agreed that I was ready to be discharged. An entire year has gone by now since I returned home from Texas and I am still doing really well. I have not relapsed. However, I know that OCD is a life-long battle. It is very probable that I will take some steps backwards sometime in the future, and may have to return to Menninger. However, Menninger taught me invaluable life-long strategies about how to fight this cruel disease, which I must use everyday to keep fighting. I am continuing therapy on an outpatient basis, and am feeling much more open and comfortable about having OCD. Additionally, I am starting a support group for teens in my area so that others can benefit in the way I did by meeting other kids with OCD. I am not lying in any way when I say that the Menninger Clinic really did save my life, because it helped me fight the hardest battle, and win.
My Messy Mind
Maggie writes about her inpatient experience.
I live a life of a messy mind. I don't mean clutter and ideas; I mean obsessive compulsive disorder or OCD. I've probably had OCD since I was three years old but just now discovered the inside of it at age 13. I deal with the frustration of obsessive and intrusive thoughts along with depression and anxiety.
OCD is a chemical disorder in the brain and there are many forms of OCD. I have intrusive thoughts, contamination fears with hand washing, checking and much more. I entered treatment at a short-term hospital not knowing what was wrong except that I had been sick for several months. I later learned I had OCD and I was transferred to a hospital that specialized in OCD treatment. I now receive treatment through exposure response prevention (ERP) and am learning coping skills for those suffering from OCD. Life is hard in general, but living with OCD is tough. Don't get me wrong, I don't want sympathy; I'm just saying it is hard. Several weeks at a hospital, not seeing your friends and rarely seeing your family has been difficult but it works. I am showing improvement in my OCD and am getting better. I know I will overcome the challenge of the messy mind.
