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November 6, 2020

What my Time in a Psych Ward Taught me about the Power of Routine.

In October 2019, I spent two weeks in a psychiatric ward.

Looking back now, there was a grim inevitability about my admission. I’d been skating on thin ice for a long time, and had been flirting with full-on mental disintegration for decades; at the end of last year, I simply, at long last, consummated the relationship.

There was nothing histrionic or exciting about any of it.

There was no flamboyant head-shaving in the full glare of the world’s media à la Britney. Outwardly, it was all distinctly low-key. You could almost say it was a very British break-down.

One night, I sat on my sofa and realized I had nothing left to give. I was empty. Spent. A shell of a man. An echo of who I used to be (though, to be honest, I’d been that shell, that echo, for years).

That night, I thought about suicide.

Twenty-four hours later, I was admitted to the ward.

Although it was a strange and scary place, it ultimately saved me.  It didn’t just give me a chance to step out of the “eye of the storm” for a bit, it also taught me several lessons I’ve carried with me as I’ve tried to rebuild my shattered life.

The importance of routine:

In the immediate aftermath following my admission, my mind was a maelstrom of thoughts and emotions—most of which conflicted with each other.

Although it might sound nonsensical—the kind of thing that the Mad Hatter might utter—following a breakdown, one is able to be both ecstatically happy and heartbreakingly sad at the same time; it’s not impossible to be both up and down at any given moment.

You are trapped—for a short time at least—in a world of dichotomy, of dissonance.

In those strange days following my arrival on the ward, I could easily be relieved yet anxious; physically exhausted but with energy to burn; utterly clear on what I needed to do in order to be discharged from the hospital, yet simultaneously completely bewildered by what lay ahead of me.

But, as crazy as that may all sound, there’s also no better way to describe the bizarre wonderland in which you find yourself after your mind has reached and gone beyond breaking point.

Up isn’t just down; it can be left or right as well.

However, among all the paradoxes and contradictions and conflicting ideas, there was, for me, one idea that did not double back on itself. For the first few days on the ward, there was one thing that remained clear and clean and crisp. And it was a question:

Why were the mealtimes so fixed?

Initially, it seemed incredibly harsh to me that, if you weren’t up and about by 10 a.m., you didn’t get breakfast. That if you lost track of time between midday and half past, you’d go without lunch. And, if you were otherwise occupied from 5 p.m. to 6 p.m., you’d miss dinner.

The reasons that had brought us all together on that ward were varied, but all of us were in turmoil, in some shape or form. Our minds were scrambled; most of us struggled to construct coherent sentences or to remember to brush our teeth. Couldn’t the staff cut us some slack and allow us to eat when we felt like it?

It seemed draconian beyond measure to be so rigid about mealtimes when my mind was shot. I couldn’t remember loved ones’ birthdays, but I had to remember what time food was served every day? Where was the compassion, the humanity?

Yes, yes, yes…my indignation seems absurd now, especially considering I had so many other and profoundly more important things to think about (but, in my defense, my mind wasn’t exactly firing on all cylinders; it was barely operating on one).

However, there was, of course, a reason why the mealtimes were set in stone; it was a routine.

Remember that maelstrom of dissonance and dichotomy I talked about? The mealtimes were a bulwark against that. One of the many small but powerful anchors the ward gave you to hang onto. Just as so many other things were: ward reviews began at 11 a.m.; afternoon activities began at 2 p.m.; evening medication was dispensed at 9 p.m.

All of these helped bring certainty into my world—a world that had fallen into disorganized chaos. Which, let’s be honest, is the only thing that mental illness excels at.

When you are struggling with your mental health, you have the added difficulty of managing an array of accompanying problems. It might be financial difficulties or job loss, or combating the inevitable stigma that—even in 2020—still trails after you everywhere, or a breakdown in personal relations with family or friends that so often go hand-in-hand with a prolonged bout of poor mental well-being.

So much chaos.

Regardless of what mental illness you might have, regardless of its severity or duration, disruption and upheaval are inevitable.

In addition to devastating your bank account, your career, your love life, and testing every other relationship in your life, mental illness will leave your mind reeling, unsure which way is up, and which way is down (you’re down the rabbit hole, remember?).

Medication, talk therapy, exercise—there are many things you can do to help soothe your troubled mind, but establishing routines is—as I found—absolutely vital.

Routines offer certainty when all you can feel is uncertainty.

As I said before, they’re an anchor—something to cling to when the seas around you are violently churning. Routines, in themselves, won’t solve all your problems, but if used well, they can be a foothold, a base camp as you start ascending the Everest that is recovery.

And recovery does seem as daunting as Everest when you take those first, halting steps.

The first few days on the ward are a bit of a jumble. Apart from my confused indignation at the fixed eating times, I wasn’t aware of much else. I was still very much in Wonderland with all those contradictory emotions pinballing around inside of me. At least, that was what I felt internally. Externally, I knew I was something else entirely—certainly to everyone else.

Although my insides were on fire, burning, and churning with a kaleidoscopic range of emotions, outwardly, I was a depressed, middle-aged man who staff had to check in on every 15 minutes.

It frightens me to think about this now; if you ever needed confirmation that your mental health (and, indeed, life) has spiraled out of control, requiring 15-minute check-ins to simply see if you had a pulse is the clearest one imaginable. 

But, even in those early days, I kept to a schedule—well, with the staff’s help, that is. With prompting, I ate. I took my nighttime medication, and I was ready and waiting in the visiting area to see my mother and brother for their twice-daily visits.

As my mind slowly eased itself away from crisis point, I gradually started to add my own additions to the skeleton framework that was breakfast, lunch, visiting hours, tea, visiting hours (again), medication, bed.

I began to shower between breakfast and lunch. I would read in the interval between lunch and the afternoon card games with my two family members. After tea (before my family arrived again), I had some “alone” time in my room. I didn’t do much; I simply sat on my bed and missed my daughters.

Once my mother and brother left, I would force myself to sit in the communal living area. Although I wasn’t up for talking, it was a healthier option than isolating myself in my room for the second time in the day.

I’d love to say that I arrived at that conclusion, but that’d be a lie; my designated mental health nurse suggested it. Just as he did so much else that helped to slowly pull me back from the precipice I’d found myself on.

Then suddenly, things change.

In the second week, my family returned to their homes; my mum drove back to the South of England, whilst my brother had the slightly longer journey back to his own family in Australia. In addition to missing them, those huge swathes of extra time I would now have when my visitors would’ve normally sat with me were suddenly a bit terrifying. What would I do?

A little trace of anxiety stirred in my belly when I first considered my new-found free time. However, again on the promptings of my nurse, I kept to the same schedule: it was working for me—why change it?

So, even if I had no guests that day, I’d still go and sit in the visiting area during visiting hours; I’d just read instead of playing cards or discussing arcane cricketing trivia (something my brother excels at). I also, at that time, began writing again.

I’ve always written. I’ve never finished anything, mind. But it’s always been a hobby. And it made sense to incorporate something “familiar” into my (new) routine. Especially given that I was in such unfamiliar surroundings; although I’d got used to the rhythms of the ward, it wasn’t home. I could never truly be at ease there, despite the wonderful people around me.

Writing was a little recognizable piece of “me” that I could transport there, and take the edge of the strangeness.

At that point, I certainly wasn’t considering writing about the whole experience. I simply did so because I always have written.

I didn’t write anything of consequence—it started as a diary, but mutated into a series of random vignettes about the ward, about the people there, about me, about my daughters. At least, that’s what I think it mutated into. I don’t really know. I haven’t had the courage to read it back yet. The black notebook I used is sitting on my bookcase, waiting. One day, perhaps soon, I’ll take it down and look at it—delve into my very own “Diary of a Madman.”

But not yet.

I’m not ready.

I’m too afraid of what I’ll see written there.

I have no problems facing my demons—most of them, anyway. But I need a bit more time before I’m ready to face those particular ones lurking in that notebook.

As my discharge approached, my routine was fixed. And working. So, when I arrived back at my flat after a fortnight I’d never forget, I simply kept to them.

And, although it might sound melodramatic, the little array of routines I’d learnt on the ward did as much to aid my recovery in those early days as my medication or my therapist did. Not least, as they had become ‘familiar.’

Strangely, despite only having a relatively short stay, and despite never fully adjusting to being there, the ward had felt more comfortable to me than my home did upon my return. My flat felt alien and, given that it had always been possible for me to find someone to talk to in the hospital, lonely.

Also, the last time I’d been here, I’d spent the night sitting on my sofa, debating whether to hang myself. Despite not being in that “place” anymore, that memory infected everything.

It still does. Some nights, it’s harder than others to push that memory to the back of my mind. That happens less now. But it’s still there.

However, it was very much there when I first returned home. As was the loneliness and all-around weirdness of being “out.” So, just as I’d brought a little piece of “me” into the ward when I’d started writing again, I transferred a little—well, a big—piece of the hospital into my home.

To all intents and purposes, I kept to the same timetable: I ate meals at the same times as I had done in hospital; I took my medication at the same times; I went to bed at the same time every night.

Slowly (so, so slowly), tiny slivers of order returned to my life: having felt powerless and out of control for so long, I gradually began to wrestle power back. Gradually, my life began to feel like my own again. I was starting to be in control; not my mental illness.

And on those rare days when my demons decided to make a re-appearance, I had something to combat them: routine.

I’m not going to lie: those early weeks following my discharge were dull. I was living by a carefully structured routine; my day was half a timetable and half a “to do” list. And, to start with, most of the things I did weren’t exactly anyone’s idea of fun:

>> Wake up
>> Brush teeth
>> Breakfast
>> Meditation

>> Housework
>> Work
>> Lunch
>> Work
>> Exercise
>> Dinner
>> Medication
>> Sleep

But, as boring it might have been, every day I kept to my routine was a day in which I moved further away from the Ward (both literally and emotionally) and closer back toward me. I couldn’t control everything in my life, but what I could, I would. Hour-by-hour, day-by-day, I’d slowly tame the chaos of mental ill-health with the power of routine.

Did that make me happy? Yes. The feeling that I could actually blunt the sword of my depression simply by making sure I ate lunch at the time I said I would, or logged on to teach English at two in the afternoon, as planned, gave me a sense of satisfaction (albeit a small one), as well as the notion that I was in control.

And if there’s one thing mental illness hates, it’s the sense that it’s not one calling the shots. If it’s not in the driving seat, it tends to go and sulk for a bit.

But, here’s another thing: my mental illness is depression. And, if there’s one thing depression loves just as much as being in charge, it’s low self-esteem. Depression is a parasite; it thrives on your doubts and lack of self-worth. It loathes—just loathes—achievement.

Because you achieving something allows you to ignore that nagging voice that tells you, “You’re not good enough. You’re not enough. You’re not worthy. You can’t do anything.”

Although they might have only been small things, ticking off each thing I did, keeping to my routine, showed my depression I could do it, I could achieve. It didn’t matter that it was only brushing my teeth—given where my mind has ended up just a short time ago, that (normally) small act was an achievement. One to be proud of. Every time I did stick to my routine, every time I was able to tick something off, I felt my depression recede just a little bit.

And, in its place, a tiny piece of happiness bloomed. All thanks to the power of routine.

One year on, and my routine is—essentially—still the same. I just work a bit more now (I’m back up to full-time hours), and have tried to incorporate a bit more “fun” (yes; it turns out you can actually schedule enjoyment).

However, I did say, “essentially the same.” Some tweaks have now been made. But initially, those “tweaks” caused me a tiny bit of grief.

There’s a flip-side to routine.

A little while ago, boredom crept in, and I thought I’d change my routine—just to spice things up. I’d teach at slightly different hours, try writing in the evening, instead of the morning; go for a walk in the morning instead of the afternoon. Nothing life-shattering; just a few tweaks.

However, those tweaks showed me two things: One, I’d completely over-estimated where I was recovery-wise; two, my routine is a bit more than just a bulwark, or an anchor: It’s become a straight-jacket.

For instance, although I always knew there would be teething problems with trying to alter my routine, I wasn’t expecting anxiety to be one of them. And that’s not an understatement. I did genuinely start to get anxious if I didn’t teach every day at the same hours I always did.

One of the very things that brought order to my life is now a bit of a prison.

So, how am I trying to escape?

It’s basically a matter of semantics. It’s quite an uncomplicated idea (again though, just because the concept is easy, doesn’t mean the execution is), but in my head,  I’ve simply replaced “routine” with the word “guide.” Simple, perhaps; but words and their connotations have power.

Some of it is set in stone, just as it would be for anyone else. We all have to work, after all. But the rest is, well, if it doesn’t have to be done at a certain time on a certain day, then I’m just cutting myself some slack.

Although it’s always nice to get something done when you wanted to, I also remind myself that it’s not the end of the world if a not time-limited task gets put off until tomorrow.

That sounds all straight-forward. It’s not.

I’m still wrestling with it. But that’s okay—I’m on a journey, and this is just the next stage of it. It’ll take me time to master it.

However, I’m also okay because, as much as routine has now become a bit of pain, I’m forever grateful to him.

For, along with my mother, my brother, a very dear friend, the staff and patients on the ward, and some really (really) strong medication, it was routine that pulled me out of the Wonderland I’d got marooned in back in October 2019. Without him, I wouldn’t have taken those first, halting steps of my recovery. I owe him.

So he’s allowed to be a nuisance right now. He’s earned that right. I’m forever in his debt, and it will be a very, very long time before I’ve fully repaid him. If I even ever do, that is. For he was there for me when I really, really needed help.

And, just as I’m thankful to the pills and all those people who got me through my time on the ward, I’m also going to be grateful to routine for the rest of my life.

Routine didn’t just bring me order when my life was chaos, he’s also helped bring a bit of happiness back into my life.

And, once I’ve mastered his flip-side, I’m certain he’s going to bring me a lot more.

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