It is my great honor to introduce to you one of the most courageous women I know, Cassandra Tillinghast. This is her story.
This is a story about the importance of giving ourselves gifts - you see, I just celebrated my 42nd birthday, and so gifts are front of mind. These days, though, I’m finding that the kinds of gifts I value most are taking on a different sort of patina. For example, last year around this time, I gave myself the gift of attending a week-long silent meditation retreat in West Virginia. My 30-year old self definitely would not have considered that such a great gift (she would have preferred a pair of Jimmy Choos) - but she would at least have acknowledged it as a loving act of self-care. But sometimes the gifts we give ourselves don’t feel that way. And it’s one of those types of gifts that I want to write about today - it’s a gift that I gave myself not all that long ago, one that didn’t feel like a gift at the time, one that I almost never talk about and about which only a very few close friends and family members know. It’s a gift that I’m terrified, and yet feel compelled, to share with the world now. That gift was the night several years ago when I checked myself into the emergency room, and then the psychiatric unit, at Inova Fairfax hospital. At the time, it felt less like a gift, and more like an act of desperation – and in a sense, it was. At the time, it felt like the most conclusive evidence I had to-date (and believe me, I had LOTS of evidence) that I was a complete failure. A fraud. A nobody. A disgusting human being. Not even a human being. At the time, living felt too big, too hard, and basic acts of self-care (such as eating and sleeping) were beyond what I was willing or able to do because of the extreme hate I had for myself, and for the world. I later learned how to peel the layers off that hate, to seek the truth behind it. At first what I found was a deep well of sadness, profound grief, intense fear, and the darkest shame. I later returned to love. And admitting myself to the the psych ward was the gift I needed to begin making the journey back.
You may be asking what was it that happened to me that brought me to that point? The stories that answer that question are complex and go back as far as 35 years. Some of those stories I've shared, and many others remain my secrets to keep (for now - maybe forever). But this story - the story of finding the courage to get help - I’m sharing today, even though the telling is terrifying, as another gift to myself, and also as a gift to others, in the hopes it helps to destigmatize mental health diagnoses and treatment, and maybe even give someone the courage to seek out the help they’ve been putting off getting. So many people are suffering – I know I’m not alone in my story. I don't want to to turn this into a litany of statistics, but the data on mental health is astounding. Some 20% of American adults experience a mental illness each year - including 18% living with anxiety and 7% living with major depression. The impact that mental health issues have on our societal well-being is staggering. If dollar figures impress you, consider that some estimates suggest mental illness costs the U.S. $193 billion annually in lost earnings. Or how about lost lives, rather than lost earnings, as an indicator - 90% of those who die by suicide have an underlying mental illness, and before you file that under the category of the blindingly obvious, did you know that suicide is the 10th leading cause of death in the U.S.? And the ways that our mental health (or lack of it) play into other societal challenges we face - domestic abuse, rape and sexual assault, drug and alcohol abuse, gun violence (and the list goes on) - cannot be overstated. By the way, only 41% of adults in the U.S. with a mental health condition received mental health services in the past year - and preventative mental health care isn't even something that we're talking about in a cohesive way. Yet.
So it's actually pretty remarkable that I sought - and received - treatment when I was in crisis. In terms of the immediate triggers that got me there - frankly, the days and weeks leading up to the night I checked myself in are a blur. I remember that I was overseas, traveling on business, when the cracks started to show. I remember, on the morning of a big presentation to a client, receiving an upsetting text from my father (as it turned out, I later learned, he was having a stroke). I remember my already high levels of anxiety, which pretty much was a normal state of being for me at that point, amping up to complete panic. I remember my primary thought being how I was going to get through what I was sure would be a disaster of a presentation, in no small part due to my own ineptitude at trying to transform myself into something other than the myopically focused work-a-holic M&A lawyer I had fashioned myself into over the prior 10 years. And in that moment, I remember judging myself for worrying about the silly presentation when lord knows what was ailing my dad, but feeling trapped into thinking my job assignment first because I was the primary provider for my husband and children. I remember feeling like I was failing all over the place - as a professional, as a daughter, as a wife, as a mother, as a woman.
Memory is a funny thing - I have no memories of the presentation (it must not have been too much of a disaster) or the flight home. The next thing I do remember is being back stateside, gripping my steering wheel, white-knuckled, as I sped down the George Washington Parkway on an early morning commute like an endless series of so many others, still dark out, with NPR like white noise on the radio with the latest unbiased report on…something. As I neared the Key Bridge, suddenly, I wasn’t feeling the vibration of the road beneath me, but instead the breeze in my hair as I stood on the side of the bridge, watching my car accelerate off and over the guardrail and plunge down into the Potomac River below. And then I was back in the car, water all around me – in my hair, in my eyes, in my mouth and lungs. The rush of water turned into the rush of wheels on the road, and the vibration returned as a reminder of the here and now. I don’t recall how I got through that particular day at the office, but I remember that night. I remember being angry at myself for not having retained my life insurance policy after I left my BigLaw job with its BigLaw salary in an effort to reduce monthly expenses now that I was earning significantly less, because I had Googled whether life insurance would pay out in case of suicidal death (the answer was not if it occurs in the first two years of the policy). And so I was crunching the numbers on how long my husband and two children would be able to cover expenses on our current savings after I was gone (I’m the one in the family that is responsible for our financial well-being), and it wasn’t long enough.
Somehow, in that moment, some rational part of me realized that this was insanity, that I was in crisis, and that I needed to seek help. And so I started trying to figure out how to do that. I just want to say that process was not easy and required multiple attempts. If I were not who I am - an educated, empowered, resilient and feisty bitch - with the resources I have available to me - including supportive friends and family, money, a good job, and great insurance - I'm not so sure how things would have ended up. After some internet research and several phones calls to a friend, a therapist, a crisis hotline, and a private wellness center, I learned that my options were to: (1) do some deep breathing exercises (thanks for the tip, but not sufficient), (2) wait for space availability and check myself into a private wellness facility (which would not accept insurance and would cost in the tens of thousands of dollars for a 2-4 week stay), (3) wait for space availability and seek outpatient care from a hospital-run mental health treatment center (that might accept insurance) or (4) admit myself to the nearest emergency room for immediate evaluation and treatment. I chose option 4, and my husband drove me there. The rest of that night, a resident and a nurse took turns holding my hand as I cried what seemed like an ocean of tears I had waited a lifetime to release. They waited with me for hours to find out whether a psychiatric unit had a bed that I could take that night, or whether there was space available in an outpatient facility that would accept my insurance and could take me the next day. As it turned out, the only immediately available option was the psychiatric unit at Inova. I remember a social worker asking me several times if that was what I wanted to do, because maybe we could figure out something "nicer" for me. But I didn’t feel like I could wait – and I wasn’t really worried about making sure it was "nice,” because at that point the alternative was death, so beggars can't really be choosers was my philosophy. So, once my bed was confirmed, the nurse put me in a wheelchair and an orderly took me on what felt like a very long trek from the ER to the 4th floor psychiatric unit.
I have struggled mightily to find a good way to describe my first night on the psych ward. In that, yes, it is an experience that is decidedly not good, and it’s also just incredibly difficult to convey to the uninitiated. It was dark on the ward – it was the middle of the night – but hardly quiet. Patients, inmates, I didn’t know which, shuffled aimlessly around, some vocal, some mute. There was a muffled sort of painful sound as I entered my room and found my roommate asleep, but not peacefully. As she moaned and cursed, I fumbled in the darkness toward the bathroom with no door and flipped the light to find a sink and a toilet, but no mirror (a safety measure, I was later informed). I rinsed my mouth out with water, flipped off the light, and crept into bed. I felt such complete and total exhaustion. But also a sense of sheer relief at having temporarily escaped the torture of being me; at finally being able to rest; at getting a vacation from myself. And I was terrified. I closed my eyes, my mouth felt sour, and pulled the covers over my ears as I tried to drown out the sound of my roommate’s nightmares, and to hide from my own.
I was “on the inside” for a week, and there’s probably a chapter (maybe even a whole book) on what that week looked like for me. I’m not sure what you imagine a psych ward to look like, but if scenes from One Flew Over the Cuckoo’s nest come to mind, at least in the case of the place I was, you would not be too far off from reality. The walls on the ward were a dingy green, the smell of disinfectant and urine and worse – nothing at all like the pretty pictures I had seen on the internet of the private wellness facility that I probably could have afforded, but that I would not have availed myself of anyway because I didn’t value myself enough to think I was worth it. I remember the morning after I checked in going to the showers and looking down at the water that covered the floor, ankle deep and covered in places with frothy grey scum. I had summoned everything in myself to go bathe, to let the hot water strip away the dirt that permeated from my skin down into my very soul. There were towels on the ward, but no soap or shampoo, and I hadn’t been in a frame of mind to pack a bag when I left for the ER the night before. So I undressed down to my socks and carefully tiptoed over to the showerhead under which there was the least amount of sudsy grey. Lukewarm water poured over me, but I couldn't feel clean. I never had. I scratched myself dry with the threadbare towel, redressed, and wrung out my socks. When I returned to my room, my roommate took one look at my bare feet and handed me a pair of pink fluffy socks from her bag. “Take these,” she said, “until your husband can come and bring you another pair.” I still have those socks in my drawer today and wear them from time to time as a reminder of how far I’ve come and of the beauty of small acts of kindness of others. I smile every time I put them on.
And over the course of the time I was there, in various group therapy sessions that all of us (patients? inmates?) were required to participate in, I learned I was keeping company with, among many others, a middle-aged woman (my roommate) with a husband, two children, and schizophrenia; a 9-11 first-responder and career firefighter/EMT with PTSD; a 20-something drug dealer, addict and father-to-be whose pregnant girlfriend was in rehab at another facility; a teenage girl who spoke barely above a whisper to share she was in for the third time, and was now a candidate for shock therapy. There were some of us there who were suffering from severe mental illness to the point of being catatonic, but there were others of us that seemed functionally "normal." As I looked around the ward, I wondered what is it that causes a person to crack. How is it that some seem to be able to endure and endure, while others break under the pressure? And for us broken ones, do we share some common trait, quality, defect? Looking at the statistics again as I write this, I'm realizing that we're all sort of broken, that suffering is part of the human condition - and that "cracking" is simply one indicator of the fragility of our human existence. I guess it's a relief to have discovered that I'm not defective - I'm just human.
After a few days on the ward, I was able to meet with a psychiatrist and tell her what I then understood to be my story (which, by the way, is constantly evolving as I lean in to better understand my past and my present). She quickly determined that outpatient treatment was the appropriate place for me to be. AND she commended my choice to come to the psychiatric unit first, as she noted that sometimes insurance companies balk on coverage for outpatient mental health facility services in the absence of clear evidence pointing to a need for treatment. Time on the psych ward was, apparently, adequately clear evidence. She also told me that a parent’s suicide is psychologically more harmful to a child than physical abuse– a message that I needed to hear. So I spent the week there, before moving on to spend another three weeks in outpatient treatment. And that outpatient treatment led me to an incredible therapist. And that therapist led me to many other things, one of which was the meditation retreat I mentioned at the beginning of this post.
Believe me, there is no one more thankful than me for the treatment I was afforded – I’m not 100% sure I would be alive today if I hadn’t received it. But I think we need to be very very real about the state of our mental health system – what works, what doesn’t, what we think good should look like, and how it can be better. And telling stories like these feels like one way to start that conversation. I have been – and still am – terrified to share this story with the world. But I’m feeling the fear and doing it anyway because mental health is a topic we desperately need to advance on as a society, and I want to be a part of the conversation and our evolution. Of course, it’s also possible that sharing this will affect my ability to “succeed” (in traditionally understood terms) in my current – or future employment. People judge – it’s what we are wired to do. But I’ve decided that it’s more important to me to take that risk and speak freely on something that I feel passionate about as an advocate for change. After all, I’m trained in advocacy. It’s high time I use that training in a way that feels meaningful.
I don’t know what that advocacy looks like just yet. I think it starts with sharing this piece of me with you – many of whom know me and may have thoughts about me that aren’t consistent with what you think about someone who has seen the inside of a psychiatric unit (or maybe they are entirely consistent, only you know). I think it also starts with something simple – and which involves an ask from you. On my last day on the ward, as part of discharge procedures I was presented with a “customer satisfaction” survey of sorts. As I checked through the boxes, rating the unit on a scale from 1 (best) to 5 (worst) on dimensions like cleanliness of facilities and tastiness of food, I wondered who would read my responses, and what, if any, change would result. I wondered if funding was an issue, and thought about the access I had to people in the “1%.” I wondered what the employees on the ward thought were the biggest challenges and needs in providing service that would warrant all “1” ratings, rather than the all “5” ratings I had given. So when I turned in the survey, I asked the nurse – if you could have anything you wanted to improve the level of patient service you are able to provide on this ward, what would it be? She looked at me blank and confused – she obviously didn’t understand the question. So I asked it again, in a slightly different way – if you could wave a magic wand, what would you wish to have on this ward to make things better for the patients here. She still looked confused, but this time she gave me an answer. “DVDs,” she said, “the patients always enjoy good movies.” I remembering feeling really crushed by this answer – just so disappointed as it seemed so mundane and simple and not something that would move the needle at all. And so you know, I didn’t give them that. It’s over four years later and I still haven’t given what she asked for. I don’t know why – maybe because it just didn’t feel big enough. Maybe because once I left, it took until just recently for me to be able to look back at the experience and the ask in a different light. And so this month, in honor of Mental Health Awareness, I’m going through my DVDs. And I’m assembling a box. And I’m taking that box to the 4th floor at Inova Fairfax. And if any of you have any DVDs you would like to contribute to the cause, please contact me and I’ll come get them from you. Because damned if I’m not going to give them what they asked for. And then I’m going to find a way to give something more. And I would love for those of you reading this to in some way be a part of that – whether it’s through donating DVDs, or money or time – because it’s going to take one hell of a village to make our mental health care system better.
So, today on heels of the celebration of my birth, sharing this story is my gift to myself, to you, and to the world. Thank you for reading it. And of course it’s not over yet – this is just the beginning. And so life goes on. Thank God.