# When Should You Be Hospitalized for Depression?



## David Baxter PhD (Jan 11, 2011)

*When Should You Be Hospitalized for Depression?*
by Therese J. Borchard, _Beyond Blue_
January 11, 2011

I wish psychiatrists sent depressives home with instructions on when to go to the hospital similar to the ones obstetricians give to pregnant women once they reach 37 weeks of gestation: when your contractions last for a minute each and are five minutes apart, start the ignition!

"How did you know it was time to go to the hospital?" a friend asked me the other day. 
"I didn't," I replied. "My friends did."

Each psych ward experience is different. And no doctor judges the decision to enter one in the same way. 

In hindsight, I wonder why my therapist didn't urge me to commit myself months before I did. I talked about wanting to die most of my hour with her. Because it was all I thought about. That idea, alone, gave me relief. But I guess since I had been depressed for so long and hadn't attempted suicide before, she felt I wasn't a threat to myself.

Eric didn't recognize my dangerous state, either. He was used to seeing me with a Kleenex in my hand, because I cried during 80 percent of my waking hours. (That's not an exaggeration.) I sobbed while I ate, cooked, peed, showered, ran, cleaned, and fornicated. And that went on for a few 24-hour periods, like at least 100 of them.

Sometimes an outsider has the sharpest vision, like an out-of-town sister telling you how much your kids have grown since she saw them last.

It was two girlfriends who hadn't seen me all summer who convinced me to pack my bags. When David's preschool started back in September a year and a half ago, I joined my friend Christine for dinner after David's (and her boys') karate class. When she arrived home she called another friend, Joani.

"I'm worried sick about Therese," she said. "She sat at the table like a zombie, not able to follow the conversation. She was crying at karate. The last person I saw that depressed is dead. We've got to do something."

The next day Joani knocked on the door. I was in my robe because I was trying out the advice of some stupid magazine article: if you surprise your partner with sexy lingerie you won't feel depressed. But instead of having amazing sex with Eric during his lunch hour (yeah right, I was crying the entire time), I listened to Joani tell me how concerned some of my friends were. I called my doctor to tell him I was going to the hospital.

It was absolutely the right thing to do. A person can't fight suicidal urges forever. Eventually willpower wilts. And that day was getting closer for me. I couldn't continue to expend 99.9 percent of my energy on NOT killing myself, on not pursuing one of five ways of ending my life, since everything in me gravitated toward the curtain of death.

My friends knew that Eric was planning on taking the kids to California to visit their newborn cousin Tia for four days. They knew I shouldn't be left alone with my stash of prescriptions that could stop my pulse. Did they know that three-quarters of me had planned my suicide for then? Or did they see from my spaced-out gaze that I was too doped up on sedatives and antipsychotics to think clearly? Maybe both. 

I've sat through enough psychiatric evaluations to know the right questions to pose to my friend Sarah. 

"Do you have suicidal thoughts?" I asked her.
"Yes."

"All the time, or here and there?"

"They are getting more frequent."

"Do you have a plan?"

"No. But I'm starting to think about some ideas."

"Okay. You really need to see someone right away. I'm not qualified to say much more than that, but I suspect you need to give your body the chance to rest and recover so that you can get your strength back to fight this thing," I told her.

That's how one of the evaluating physicians at Johns Hopkins phrased it to me.

"You're carrying this backpack full of heavy rocks. Lugging the thing around consumes all your energy, leaving you with only exhaust fumes with which to accomplish your other responsibilities, like taking care of your kids. A hospital stay will allow you to drop the backpack long enough to recover some of your strength. Because you are safe within our unit, you won't have to devote so much stamina into not pursuing suicide. Does that make sense?"

Did it ever.

I gave my friend my therapist's number. 

"If you decide it's time to go to the hospital, give me another call," I said. "Since I've been to a few in the area, I can tell you which has the better menu. Deal?"


----------

