What good did hospitalization do me? What it did for me was give me rest. It wasn’t supposed to. I was supposed to get up and get dressed; go to breakfast; participate in groups; meet with my psychiatrist; stay out of my room; go to the dayroom and interact with others, and—above all else—I was supposed to take drugs. And I did. I did all those “therapy” things that were supposed to make me feel better. After while I did start to feel better, so the therapy must have been successful, right? Not necessarily.
I was hospitalized about fifty times in the thirty-two years between 1971 and 2003. In the beginning, the hospitalizations would last about three days. Then five days. Then a couple weeks. By 2000, I was on inpatient psychiatry for six months. And it wasn’t until the mid-1900’s that I began to suspect what was really going on.
On inpatient, I was restricted; I stopped running around. I did not cook or clean. I did not go grocery shopping. I did not drive anywhere. I did not go to work or school or church. Behind the locked doors of inpatient psychiatry my movements were so restricted that I wasn’t burning up energy. And I recovered from my episodes of depression. Might there have been a connection?
At home, I started testing my hypothesis that being over-tired was what was causing my depression and that resting would alleviate it. I had known for decades that there was a clear link between being depressed and being tired. As a teenager, I used to sit up nights probing the depths of my soul, trying to understand my depression. After many years, I recognized that being tired was the depression! When other people had a long hard day, they got tired; I got depressed. It was not the content in my day that was depressing me; it was the quantity of activities.
I think it was my grandma who finally got through to me: she kept saying, “Go to sleep—things will look better in the morning.” And they did because I was no longer depressed. Shakespeare knew what he was talking about when he wrote “Sleep that knits up the ravell’d sleeve of care. . .” For some of us, fatigue causes depression. It isn’t supposed to. According to current thinking, exercise is good for depressed people. The current thinking is that depression is caused by a chemical imbalance in the brain. You need to have your serotonin and norepinephrine neurotransmitters manipulated by the pharmaceutical companies. Or, maybe, you should just take a nap.
Exercise is supposed to produce endorphins in your brain, which is supposed to relieve your depression and make you feel better. According to my therapist, the reason people with dogs are happier is not because of some empathetic connection with the animal; it’s because the dog owner has to go out and walk the dog twice a day. Exercise stimulates endorphin production; high endorphin levels are consistent with happy people. But what about those of us for whom exercise causes dangerously painful depression?
I used to exercise. I used to jog and do calisthenics but I would stop when I got too depressed. I switched to gentler exercises like yoga, but I still got so depressed that I stopped exercising. Later, in the mid-1990’s when I began to speculate on what good inpatient psychiatry was doing, I began to rest. Plain and simple, I took naps. Everyday. And it eased my depression.
I would lay down every day after lunch—just like we all did when we were little kids—and I would watch my depression clear. I would lay down with my mind filled with irritation, frustration and despair. The longer I lay there, the more the bad feelings would clear. Sometimes I would go to sleep but it didn’t seem to matter whether I actually slept or just rested. By the end of an hour, waking or sleeping, I’d be cheerful again. I’d be happy. Smiling. All because I laid still and did nothing.
In 1999 I was in the Intensive Care Unit for a month following a suicide attempt. (Clearly, the absence of rest isn’t the only causative factor in depression!) Being in the Intensive Care Unit causes profound weakness. The rule of thumb is that for every day you spend in the ICU it will take you three days to recover your strength. I was in the ICU for a month then, after a week on a medical unit, I was transferred back to inpatient psychiatry where my psychiatrist ordered physical therapy to help get me going again.
I told him that physical exercise caused depression in me. He didn’t believe me but, being a really good scientist, he put it to the test. When making his hospital rounds, he would see me before I went for physical therapy and then he would come back and see me again after physical therapy. What he saw was a happy patient going off to physical therapy and a depressed patient coming back. For some of us, exercise causes depression. You can check if you are one of them very simply: go take a nap. Take lots of naps. See if your depression starts to lift. One caution: if you are taking antidepressants or other drugs, your body’s natural response may have been knocked out. Your positive response to rest may not be as good as it would be if you weren’t taking drugs.
The only therapeutic effect of hospitalization that I can see is that it enforced inactivity. Couldn’t we have done that in a kinder, gentler way?