You Just Got Out of the Hospital. Now What?

The paperwork is on the counter. Somebody has folded it.

You are home. The kitchen looks the way it looked. Your coat is on the same hook. And you are standing in a house you have lived in for years feeling like a guest in it.

Nobody prepared you for this part. There is a great deal written about getting into treatment and almost nothing about the Tuesday after you come out.

Three feelings, all at once, all correct

A man I treated arrived a few months after a three week stay on a psychiatric ward and a month in a day program. He described himself as afraid, angry, and disoriented.

Not one after the other. All three, continuously.

Afraid, because the thing that happened to you can evidently happen. You used to have a floor. You now know that the floor is a thing that can go.

Angry, and this one surprises people. Angry at the hospital, at whoever signed the papers, at the person who insisted, at the diagnosis, at how everyone speaks to you now. The anger tends to arrive with shame stapled to it, because it seems ungrateful and you cannot see who you are permitted to be angry at.

Disoriented, because you have been handed a word for yourself that you did not have last month, and nobody has explained what you are supposed to do with it.

All three are appropriate responses to what actually happened. They are not symptoms of a relapse. Frightened people in your position often assume that any strong feeling is the illness coming back, which makes them frightened of their own feelings, which is an exhausting way to spend the spring.

A hospital admission does not only interrupt a life. It installs a permanent question in the people who love you, which is whether this is a bad evening or the beginning of one. Somebody has to treat that question too.

The diagnosis is information, not a name for you

You have been given a word. It belongs on a chart. It tells your doctors what has worked for people whose illness behaves the way yours does, which is genuinely useful and is the entire reason the word exists.

What it does not do is tell you who you are.

I have watched people take a diagnosis and quietly reorganize their whole life around it, until every ordinary bad mood is evidence and every plan is checked against it first. That goes well past caution. The word was never built to carry that much.

You had a life before the admission. Most of it is still there.

The ladder

The man I mentioned later described what we built together as a mental ladder. It is his phrase, not mine, and I have kept it because it is better than anything I had.

A ladder is not a leap. It is one rung, then the next, and each one has to bear weight before you trust it with the one above.

In practice the first rungs are unglamorous to the point of insult. Get up at the same time. Eat something before eleven. Walk to the end of the road and back. Return one message. People fresh out of hospital nearly always want to know when they can go back to work, and the honest answer is that it runs through that walk, several dozen times, first.

Let me put that accurately, because I am not describing this as easy. Small is not the same as easy. Some of the hardest work I have watched anyone do was getting dressed at nine in the morning for eleven consecutive days.

To whoever drove them home

You were in the room for all of it and nobody has asked how you are.

The wife of the man I have been describing sat in on our work, and she needed it as much as he did, for different reasons. His family relationships were suffering and his ability to get back to ordinary life was badly hampered, and both of those were happening to her as well.

Three things worth knowing.

The watching is the hardest part and it does not end at discharge. You will find yourself listening to how they come up the stairs. That vigilance is not paranoia, it is what the last few months trained into you, and it will exhaust you if nobody names it.

Your own resentment is allowed as well. At the situation, and some days at them. It does not make you disloyal, and swallowing it does not make you kind.

And you should have somebody of your own to talk to. Not the same person they are seeing, and not only your friends. This is the single most common gap I find in families who are otherwise doing everything right.

What the first appointment looks like

I will want your discharge summary and the actual list of medications, including anything that was tried and stopped.

I will ask your husband or your mother to come in, at least once, if they were part of it. Not to talk about you in front of you. Because they were there and they saw things you were in no condition to see.

And a good deal of the first hour is spent on the ordinary shape of your day, which surprises people who arrived expecting to discuss the illness. The illness is on the chart. The day is where the recovery actually happens.

An Invitation

The first ninety days are their own distinct problem, separate from the illness that put you in the hospital, and they respond to being treated as their own problem.

If you are in them now, you are doing it correctly. It is simply harder than anyone told you, and it does not stay this way.