Life after my involuntary hospitalization

I was held involuntarily for nine days when I was 26. I am writing this six years later, which is far enough away that I can describe it without my voice shaking, and close enough that I have not romanticised any of it. If you are reading this from inside a psychiatric unit right now and you did not choose to be there, I want you to know that what I am about to write is honest about how angry I was and is also honest about what came after.

How it happened

I had been unwell for several months. I was not sleeping. I was convinced that my upstairs neighbour was running a surveillance operation against me. I had stopped going to work. I had stopped eating most days because I was suspicious of the food. My sister, who had been calling me daily and not getting anywhere, came over on a Thursday afternoon and called the local mobile crisis team.

The crisis team came to my apartment. They tried to talk to me for about forty minutes. I was lucid enough to talk in full sentences, and I was unwell enough that the things I was saying made it clear I was not safe. They told me they were taking me to the hospital. I said no. They told me I did not have a choice. I was placed on a 72-hour psychiatric hold (the legal mechanism varies by state — in California it is called a 5150; other states have their own statutes).

The 72 hours became nine days because, at the end of the initial period, the treating psychiatrist felt I still met criteria for an extended hold, and a court hearing extended it. I had a public defender at the hearing. I told the judge I did not need to be there. The judge disagreed.

What I felt in there

I was furious. I was scared. I felt humiliated. I felt that everyone — my sister, the crisis team, the staff, the judge — had treated me like a problem to be managed rather than a person with views about my own life. The clinical view, that I was psychotic and unable to recognise my need for treatment, did not feel correct from the inside. From the inside it felt like I had been kidnapped.

I want to record this honestly because the literature uses words like "lack of insight" and "anosognosia" and they are technical terms that can sound dismissive. The experience of being involuntarily committed is one of the most profound losses of agency a modern adult can have. The anger that follows is not a symptom. It is a reasonable human response to a real loss. Recovery has to make room for it.

What helped while I was in there

One nurse on the night shift would talk to me in normal sentences. She did not perform empathy. She asked about my life. She told me about hers. She brought me a second pillow without being asked. She made the time bearable.

The treatment team eventually included me in a meeting where they walked through their reasoning, what they had observed, why they had recommended what they had, and what they thought a workable plan looked like. This was the first time I felt I was being treated like a participant rather than a patient. I disagreed with parts of the plan. They were willing to negotiate on some of it. I started, very tentatively, to trust them.

The medication, for what it is worth, was helping. I did not want to admit it. By day five I was sleeping. By day seven the surveillance certainty had loosened. By the time I was discharged I could see, retrospectively, that I had not been okay.

What hurt

• The intake search of my belongings.
• The shoes-without-laces, the no-belt rule, the paper gown.
• Being addressed by my first name by people I had not consented to be on first-name terms with.
• The phone privileges that were technically available but always seemed to fall when the line was full.
• The court hearing, where I felt that no one in the room was listening to what I was saying as much as they were listening for whether I sounded ill while saying it.
• Being given medication and not always being told what it was or what to expect.

If you are a clinician reading this, the small dignities matter. If you are a family member, the small dignities matter.

The first year out

I left the hospital with a discharge plan that included a follow-up psychiatric appointment in five days, a referral to therapy, and prescriptions. I kept the appointment. I went to therapy. I also spent the first six months extraordinarily wary of the mental health system. I had been forced into care; I was not going to be forced into anything else. I was going to be a model patient on the outside and a furious one on the inside.

The thing that started to thaw the anger was a therapist who spent the first three months listening to it. She did not defend the system. She did not justify the commitment. She did not tell me I should be grateful. She asked what had been done to me, in detail, and how it had felt, in detail, and what I had needed in those moments that I had not gotten. She helped me write a letter to the hospital, which I never sent, that said all of the things I had not been allowed to say while in their care.

That letter was, weirdly, the beginning of being able to use the system again on my own terms.

The psychiatric advance directive

The single most useful thing I have done since my hospitalisation is write a psychiatric advance directive. This is a legal document, recognised in most US states, in which I — when well — record what I want to happen if I become unwell enough that I cannot speak for myself. I named two trusted people who can be involved. I wrote down which medications have worked for me and which have not. I described the early warning signs of my own relapse. I named a hospital I would prefer to be taken to. I wrote down the things I want clinicians to know about how to talk to me when I am unwell.

It is not a guarantee. State laws vary on enforceability. But the act of writing it gave me a kind of authorship over my future care that I had completely lost during my commitment. If I am ever held again, the document is in my chart. The treatment team is supposed to consult it.

What I want other people to know

• The anger is valid. Process it with someone who will sit with it rather than rush you past it.
• Trust takes time to rebuild. Your relationship with the mental health system has been altered. It does not mean the system is unusable. It means you get to set new terms.
• Write a psychiatric advance directive. Do it while well. It is one of the few tools that returns agency to you for future episodes.
• Find clinicians who treat you as a participant. The right therapist or psychiatrist will include you in decisions and respect your input. If yours does not, find another.
• Connect with peer support. Speaking with other people who have been involuntarily committed is, for many of us, the only thing that fully captures the experience.

I am six years out. I have not been hospitalised since. I take my medication. I see my psychiatrist regularly. I am also still, at some level, a person who was held against her will, and the work of integrating that into the rest of my life is ongoing. It is okay if your work on it is ongoing too.

This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.