Partial hospitalization: There is no shame in seeking help

The fact that I can write about this with the awareness that there is even a 0.0001% chance someone I know will read it is telling. Ten years ago, maybe even ten weeks ago, there is no way I would ever go public with what I am about to write about. The fact I can write about it is a positive step in my understanding that it is okay to accept that my mental issues are an illness and that there is no shame in seeking help.

Butler Hospital is located in Providence, Rhode Island. It is about fifteen minutes from my home in a pretty ritzy part of town. There are million dollar homes along Blackstone Boulevard that leads to this hospital campus. There are two wide streets that make up the boulevard. They go one way in each direction. There are bicycle lanes which are constantly being used. Dividing the two roads along the whole way is a decent stretch of grass, lined with trees, and with a paved walkway running down the middle. It is a popular spot for joggers and for people walking their dogs. 

Also located on this boulevard is Swan Point Cemetery. It is a beautiful cemetery with rolling hills. The graves are spaced out nicely as if to give the deceased room to stretch out. The horror author H.P. Lovecraft is buried somewhere on the grounds. I’ve attempted to find it a couple of times but have been unsuccessful. To be fair, I haven’t tried that hard.

No offense to Mr. Lovecraft, but more significant to me is that Charlie’s remains are here. Charlie was my best friend and a mentor during my young adult years. He died in a car crash in Dallas, Texas, at the age of 42. His ashes are in an urn in a glass display in a columbarium near the entrance to the cemetery. 

Also buried in this cemetery are two brothers, Jorge and Carlos. They were my cousins. Charlie was married to their sister. All three would die within the same year. They were all about the same age.

I used to visit them often, but haven’t in over a year. I have to drive past the cemetery and its beautiful archway entrance on my way to Butler. A cloud of sadness and guilt envelopes me. This isn't off to good start.

I drive past the cemetery and with my thoughts still thinking about Charlie, Carlos, and Jorge, it is soon time to turn left to cross the median, to cross the opposite lane of traffic, and enter Butler’s campus. I let some joggers cross in front of me.

As I enter the Butler campus (“you will drive over five speed bumps and you will see a big parking lot on your right where you will park”), I am reminded of a time, a few years ago, when I brought my mother here to one of these old buildings in hopes of finding a psychiatrist that could help her (us) with her dementia. For a brief moment, my mother was sitting next to me as I remembered circling around a particular building looking for a parking spot. 

As quickly as she was there, she was gone. She has been gone for two years now.

This time I was not coming here for my mother. I was coming here for me. I was the patient.

About three or four months ago, my therapist had mentioned to me something about partial hospitalization. All I heard were the words “Butler Hospital” and I didn’t hear anything else. You see, I grew up thinking (knowing) that Butler Hospital was where all the crazies went. I pictured the movie with Jack Nicholson,  “One Flew Over the Cuckoo’s Nest.” Nope, that was not for me.

But then the holidays came, as did my mother’s birthday on January 9. I also had my hearing coming for my Social Security Disability case in late January. I was a mess. 

To make matters worse, on Christmas Eve I received a mysterious text. “Merry Christmas to my favorite general manager, Sadie.” It was from my previous employer! It even had a smiling face emoji after it. My previous owner has to be in his mid to late 60’s. What the hell was this??? 

Sadie was now the general manager at the McDonald’s I had run for five years. She was the third general manager in ten months that they had tried to replace me with. I had hired Sadie around 2019. She had some previous experience and I got her promoted rather quickly. I never thought of her as general manager material. My supervisor sat in on her initial interview and didn't want to hire her, but said it was up to me. I frequently reminded him of that.

She was young and immature. She smoked pot daily and would come into work reeking of it often. She would also sit in her car on her breaks or leave the parking lot, entirely. It would be obvious she was high when she returned. Her commitment to the job seemed lacking. She had little in the way of leadership skills and she liked to goof around. She was also very flirtatious and was rumored to be involved with a couple of employees. When I heard she had been promoted to my old job, I was shocked, to say the least.

But what to make of this text? In five years working for this guy, I had never received a holiday text. We had texted each other somewhat on a regular basis when I was having issues with my supervisor. Maybe he still had me listed in his phone under the generic name, “East Providence.” But there was no way Sadie could have been his favorite G.M. My partner, Erin, still worked there part time and would tell me about all the problems the store was having. Sadie had only been G.M. for less than a year. This guy owned eighteen restaurants. He had a lengthy history with many of those managers. There was no way she was his favorite general manager. No way.

So what other explanation was there? Did he intentionally send this to me? I haven’t heard a peep from anyone from the company since I left two years ago. Was this what kids today mean by “gaslighting”? Was he, inexplicably, trying to goad me after all this time?

Well, it worked. Even now, a month later, I am still very worked up by this extraordinary text. I don’t know if you can tell. It seems so surreal. I don’t know – maybe the near 70-year-old owner is having an affair with the 20-something, Sadie. That could be a third explanation. It wouldn't be the first time I saw something like that happen in my McDonald's career.

So with all this shit going on, my therapist brought up partial hospitalization at Butler again. She told me she still thought it would be a good idea. She even told me she had called to inquire about it and was told if I wanted to do it, I would have to call myself to register. She couldn’t do it for me.

This time I didn’t dismiss the idea. I told her I would think about it and would get back to her at our following week’s session. I went back and forth about it the next few days and figured, “What did I have to lose?” At the very least, it would be an experience. Maybe I'd learn something.

So here I was, on January 12, pulling into Butler Hospital’s visitor parking lot, exactly five speed bumps down the long entrance road. I walked up to the entrance of the main building – the Sawyer Building. I immediately noticed a yellow sign on the door with the silhouette of a dog on it. The sign said something to the effect of, “K-9 on site. If any contraband is detected, it will be confiscated and you will be escorted out.” Nice first impression.

I checked in at the security desk inside, got my visitor sticker (which barely stuck at all), and went to the registration office. So far so good. I didn’t notice anyone walking down the hallways drooling or wearing straightjackets. I met with a few different people during the registration process.

One woman brought me into a room just to ask me about my medications. Another guy gave me a tour of the facilities. And then a third person, Josh, introduced himself as my therapist for my stay.

He explained to me how this partial hospitalization works. I was going to be there for six consecutive days, excluding Saturday and Sunday. I was told five on the phone, but okay. I was to be there by 9am each day and report to room 158. That would be my group’s room. Before going to the room, I needed to check in at an office down the hall. I would be given a paper to fill out asking me questions about such things as my mood, sleeping, appetite, etc. the previous 24 hours.

A group leader would arrive at the room at 9am. The day would end at 3pm. In between, there would be four hour-long “group sessions” with 45-minute breaks in between. The group sessions would cover all the typical topics such as coping strategies, dealing with negative thoughts, accepting things the way they are, communication, etc. 

I came to despise the third group session. It was right after our lunch break and was from about 12:30 to 1:30. This was just an open forum where the group could talk about anything they wished. The group leader would just give us some opening guidelines such as be respectful, be careful of any trigger words, and don’t swear. That was it. Then he or she would open the floor to us and he or she wouldn’t hardly say a word the rest of the hour. Inevitably, these sessions always started with an awkward five or ten minutes of silence as no one would say the first word. I would, usually, be the first one to speak just because I couldn’t take the silence anymore.

Josh explained that at some point every day, he would pull me out of the group and have a one-on-one session with me for about thirty minutes. The time was never set. It could be at any time.

So that was the framework. When he was done talking, he took me to room 158 where I met my group and my group leader, Joe. The room was cozy enough with a fireplace that I am sure at one point was operational. There was a conference table in the middle and some chairs along the sides of the room. For some reason, there was an old worn out basketball in the corner. That immediately caught my eye. There was a whiteboard at the front. On the center of the table were buckets with crayons and coloring pencils. There were also clipboards with coloring sheets and word searches. The therapist had warned me ahead of time to expect to see people coloring or doing these word searches, or other things to keep them busy.

He was right. There were about three other “patients” already sitting at the table. Each one was coloring. It was odd. The group leader, Joe, introduced himself to me. He was nice enough of a guy (don’t you have to be to do this job, though?). He was a portly, middle-aged with receding brown hair and a brown mustache. He had one of the softest voices I ever heard which, I would soon find out, was perfectly suited for guided meditations.

When the group started, I immediately noticed that we all were not at the same stages of hospitalization. Joe would say things like, “As we discussed yesterday…” I realized some people had already been here one, two, three or more days. Joe announced today was the last day for one of the patients. I found this to be weird. I figured we’d all start on the same day.

Joe immediately started with a meditation exercise. He made sure to emphasize that if we didn’t want to do it, we didn’t have to. Interesting. After the meditation exercise, he went around the room and asked everyone to discuss a “rose” and a “thorn” that had happened to us the previous day. The rose being something good that happened and the thorn being something bad. Again, he said if you didn’t want to do it, you could pass.

After this, Joe gave a lesson on something or other. I forget. But I have a folder of papers to remind me. Joe loved making copies and handing out papers. The whole first hour I was struck by how it seemed no one was paying attention to Joe. Instead, the other people continued coloring. Some would stop, momentarily, to go through the buckets of coloring pencils and rummage through them until they found the color they wanted. 

Some people would just get up and leave the room without asking permission. One new person arrived about 45 minutes late and Joe greeted her like it was no big deal.

Then it was time for break. Despite it being a chilly, winter day, I walked out to the parking lot and sat in my car for the entire 45-minute break to collect my thoughts. The experience, so far, was nothing like I expected.

Again, I forget what the second group session was about. The point was that I found myself starting to talk. I was the only one, but I felt like Joe appreciated someone getting involved.

Then it was time for lunch. I had brought a sandwich and a Pop-Tart so, again, I sat out in my car during my lunch break. When I returned, it was time for that open session I mentioned earlier. I think a couple of people may have spoken, but it was mostly awkward silence. The guy running the thing would just sit at the head of the table and look at everyone, but he wouldn’t say anything to stimulate a conversation.

Then it was time for break again. Again, I sat in my car and listened to some sports talk on the radio. I may have played some Boggle on my phone. 

I returned for the final group session which started at 2 p.m. I was exhausted. I haven’t been used to this kind of a schedule in a long time. And the novelty of all this was mentally and physically exhausting for me. 

A few minutes into the session, I saw the door creak open a smidge, and my therapist peaked his head through the gap and signaled for me to come hither. Being a rookie, I gathered all my belongings, including my jacket, and followed him. After this one time, I would realize that room 158 would be my home base and I would frequently be coming and going, so I could just keep my stuff there.

My therapist, Josh, asked how my first day was going. I told him it was going fine and that I was enjoying it. I told him how he was right about people coloring, but that it still amazed me. I told him how I was surprised at how many breaks we got and how long they were. We talked about some other stuff and he said we would talk again at some point tomorrow.

So that was about it for the first day. I won’t go into as much detail about the following days. I already feel like this article is pretty long and I am only finishing up day one. But I felt it important to outline the structure of the day for the days that would follow.

The second day was the same group as the first one, minus the person whose last day was yesterday. I was one of only two males in the group. The other guy had muscular dystrophy. He was a tall, slim guy with glasses. His upper body was distorted and atrophied. He shuffled his feet when he walked. He was bitter, as I know I would be too if I were in his shoes. He swore a few times to emphasize points but seemed very intelligent and well-spoken. It sounded like this wasn’t his first stay. 

There was a tall, athletic looking, young blond girl who I believe was currently a teacher, but she mentioned working at Dunkin’ Donuts often. She was the one I was saying would waltz in late and leave sporadically. Her behavior continued the same during my whole stay. She really got into the meditation exercises, though, and always complimented Joe on his voice after each one.

There was another middle-aged lady who always wore a sweatshirt with the hood over her head. She was the only one not to sit at the conference table. She slouched on a couch in the corner and stared at the ceiling almost the entire time.

I got more involved on the second day. The group tended to follow my lead and become a bit more talkative. It was nice getting to know a little about each of them. It was hard for me to focus when I watched someone coloring, or staring at the ceiling, and I didn’t know what their story was. Curiosity was killing me. I couldn’t get the lady in the corner to talk, but I, eventually, got everyone else talking.

The lady with the hoodie in the corner did perk up, however, during the open forum session in the afternoon. Someone started talking about online bullying. The lady in the corner said something about a relative of hers being the victim of bullying and that this whole conversation was triggering to her so she got up and stomped out. I think the only other time I heard her speak prior to this she had said something about being in an abusive relationship so I never did find out what the main reason why she was there. I'm sure it was a combination of things.

On our fourth day together, Joe announced it was this lady’s last day. It bothered me that I knew she wasn’t ready to be discharged. She was in no condition to leave. I was worried about her. At the same time, I wondered why she bothered checking herself into the program if she was not going to actively participate in her recovery. She always "passed" every time she was asked to do something. All she did was look at the ceiling. This was just wrong allowing her to leave. I hated thinking it, but I felt things weren’t going to end well for her.

On the second day, on one of my breaks, I was sitting in a wide hallway on my break. On one side of the hallway were about five or six rooms that I remembered from my orientation. One was where a guy takes your blood pressure and some other vitals. Another room was where I spoke to a lady to confirm some stuff. So, I correctly assumed that all these rooms were for administrators checking in patients. 

On the other side of the hallway were the most comfortable sitting areas I had noticed in my travels. There was almost never anyone sitting there. Perfect for me. I, probably, wasn't supposed to sit there, but nobody told me not to.

After a few minutes of playing games on my phone, I decided to get up and stretch my legs. I walked the length of the hallway, casually looking at the nameplates on the doors of the rooms. When I got to the last one, I had to do a double take.

The name said “Gail Medeiros.” A “Gail Medeiros” was an office manager for many, many years for my original owner/operator boss, Lou. I spoke to Gail over the phone every week. It was usually something having to do with payroll or some other administrative issue. I only met her in person a handful of times. Those office secretaries were always a mystery to me. There were three of them. They were like disembodied voices.

I, vaguely, remembered hearing that Gail had, or was battling with depression. I don't think I had ever heard she worked at Butler, but it didn't surprise me.

When I got home I told Erin about my discovery. Erin mentioned that, according to her Facebook page, Gail does work at Butler. Just great.

On my third day, when it was my time to speak to my therapist, Josh, I must have been complaining about how stressful working at McDonald’s can be. I mentioned to him that one of the office managers here could vouch for me. I told him about Gail.

Josh hesitated for a second, then told me Gail did know I was there. It was her job. She was one of the people who checked people in. She had seen my name on the list of newly arriving patients.

He told me not to worry. He said she wanted me to know that everything here is confidential. I didn't have to worry about her telling anyone.

I wasn’t really worried. Like I mentioned, I was getting more and more comfortable here. Heck, I am writing about my stay at Butler, publicly, where if you look hard enough you can find a link to it deep in the bowels of a Google search.

I had seen someone who looked like Gail (again, I had seen her only a handful of times in the years that I had known her) a couple of times earlier that day. I promised myself that if I saw her again, I would say hi. I never did get the opportunity, and I kind of regret it.

But, yeah, it was something I had never considered – running into someone I knew here. It could have been either as a patient, an administrator, a security guard. But, that was fine. I wasn't ashamed.

It really was amazing how at home I felt here. I felt like I belonged. The building was welcoming. It didn’t have the feel of a hospital. It, actually, had a nursing home type feel which I had, sadly, grown used to. The outside campus was well maintained with nice pathways leading to and from buildings.

For the most part, I got along well with all the patients. There were maybe one or two exceptions. One was the guy with multiple dystrophy. I wanted to like him, but he was just too angry all the time. 

On his last day there, which was mine as well, I could see he was having trouble getting out of his chair at the end of our first group session. I said, from across the table, that I didn’t want to offend him, but if he needed any help. I was surprised to hear he agreed. He was sitting on an office chair which you could adjust the height by pressing a lever under the seat. I guess the seat had dropped on him when he first sat down. He needed the seat elevated for him to get up. I asked him if he wanted me to put my arms gently under his armpits and hoist him up. He said no, very sternly. He just wanted me to help him lift the seat. He told me when he lifted his butt off the seat to press up on the lever under the seat and it should rise. Each time we tried, it was an immense struggle for him to lift himself even a few inches. Each time I would press the lever, the seat would rise a little, but when he fell back into the seat, the seat would drop. I felt bad, but I couldn't help.

About ten minutes later, a random therapist came into the room looking for one of the other patients. We got the therapist to find someone to help. I didn’t expect Joe to be the one to come back. He used a cane to just walk, so I didn't know how he was going to be able to help. Another woman employee from down the hall came into the room.

Joe made the mistake – just like I did – and asked if the man wanted to be lifted, manually. The man was even more upset when he again said, “No! My whole upper body is broken!” After thinking for a minute, Joe asked him if they could get a strap to put around his waist and lift him like that. The man said, “We can try.” It did work.

Joe checked the chair and determined it was indeed broken. I was glad it wasn’t just me. He had the chair removed and wheeled over the only other adjustable chair in the room. The guy sat in the chair and the chair must have begun to slowly sink down also. He got up and said, “You know what? I’m just going to leave.” He had only been there for a little over an hour.

Again, I felt bad. I just never felt like anyone left better off than when they got there.

So I was now the only male in the group. It was something I had noticed and I made mention to Josh, my therapist. The patients I had come across were, predominantly, white non-Hispanic women aged 20-45. Even though, as a society, I think mental illness is slowly losing its stigma, it still exists, especially in certain cultures and among men.

I am Portuguese and I know my father doesn’t understand my situation. For almost fifty years, I didn’t understand it, either. Men were measured by how strong their work ethic was. If you didn’t work, you were lazy. If you are sad, cheer up. I remember my mother telling me that when I would tell her I was feeling depressed. “Just smile and laugh,” she would say. For some reason, though, when she said it and demonstrated it for me, I would cheer up. But, again, she is no longer here to do that for me.

In certain cultures, it is a sign of weakness to admit they need mental health help, or help of any kind. Never let them see you cry, right?  Have you ever seen a movie where a gang member or Mafioso is shown crying?

In many ways, I think women have more reasons to suffer from mental illness. Men don’t have to deliver babies. Women, I think, spend more time alone than men. Women, many times, have to work harder to distinguish themselves from their male counterparts. Some would argue they don’t get paid the same and they get passed over for promotions more often. Many women have careers and are still expected to do household chores and bring their kids to soccer practice. They have to juggle much more than men.

It has always been acceptable for a woman to cry. But it was still a surprise to me that there was not more diversity among the patients and, now that I think about it, the staff.

I would guess about thirty patients rotated through my room. There was one day that the groups were so small, for whatever reason, that they combined two rooms. In all, I’d say I was one of five men. I met two other Portuguese people. I honestly don’t remember meeting any Hispanic patients. On the last day, a middle-aged African-American joined my group. I didn’t see an African-American male on the entire campus the whole time I was there.

On my last visit with Josh, he asked me what I thought of my stay. I told him I enjoyed it, especially the first few days when the group was smaller. I liked the routine of having something to do every day. I suggested (because that is what I do) that I would have liked a little more structure and discipline. I didn’t like the way patients came and went as they pleased. They could choose not to participate in activities such as meditations or games. I can understand why, but I kept thinking about that hooded lady and the guy with muscular dystrophy who weren't ready to be discharged.

Josh told me to not be afraid to come back if I ever needed to. I responded by saying that I not only would come back if I had to, but I would consider doing it, periodically, just for maintenance purposes. I was no longer afraid of Butler Hospital. I also thought that this could be my calling in terms of, maybe, a career as a therapist. I enjoyed being here.

At the very end of my last day with my group, Joe asked if I wanted to say any parting words. I made a joke that I didn’t have anything prepared as I pulled a random paper out of my folder and pretended to read it. My final group had grown to about twelve people. I liked it much better when the group was smaller. I will wrap up this article by paraphrasing my brief speech to the group:

“First and foremost, I want to thank all of you. I have been inspired by each and every one of you. Seriously. It takes courage to do what we are doing – not only admitting we need help, but seeking it. I would say to you, though, that while you are here – participate. Every day we are here, we’ve done the hard part just getting here. We got ourselves out of bed. Hopefully, we showered. We got all bundled up, stepped out into the freezing cold, and drove down here. That is the hard part. We didn’t have to do this. So, while you are here, make the most of it. You'll find that you are not alone and that your story may help someone else."

If you or someone you know is experiencing suicidal thoughts: 

• Text HOME to 741-741 for a free, confidential conversation with a trained counselor any time of day.
• Text or call 988 or use the chat function at 988lifeline.org.
• If this is a medical emergency or there is immediate danger of harm, call 911 and explain that you need support for a mental health crisi