My first Thanksgiving after the hospital

This is a composite story, drawn from common experiences shared in the schizophrenia community. It does not depict a real individual.

I am a 29-year-old woman living in Boston. I was hospitalized in early November of last year for a psychotic episode — my third — and discharged ten days before Thanksgiving. The discharge planner asked me what my plans for the holiday were. I said I did not know. She said, "You should think about that before Friday." She was right.

I want to write about that first Thanksgiving after the hospital, because the holidays after a psychiatric hospitalization are their own beast and I had not been able to find anyone writing about them honestly. The advice I had read was either "skip the holidays" or "act normal so your family does not worry." Neither was useful. What helped was a plan, and what helped me make a plan was the discharge planner, my therapist, and one cousin.

Where I was, mentally

I was ten days out. My medication had been changed in the hospital and I was still adjusting. I was tired in a deep, post-episode way. My voices were quiet but my anxiety was loud. I was embarrassed about the hospitalization. I was not yet ready to be in a room with twelve people I had not seen since before the episode.

My family is large, loud, well-meaning, and not particularly informed about mental illness. Thanksgiving is held at my aunt and uncle's house, an hour outside Boston, with about fifteen people. It is a long meal. There are toasts. There is wine. There are jokes that are sometimes funny and sometimes not. In a previous year, I had loved it. This year I was afraid of it.

The plan

My therapist and I built a plan over two appointments in the week after my discharge. I want to share what was actually on it because the structure was what got me through.

Pre-game

• I called my mother and told her honestly that I would be coming, but that I needed to leave by 4 p.m. so I could get home and rest. She was protective of that boundary the entire day.
• I called one cousin — the one I trust most — and told her about the hospitalization in advance. I asked if she would be my person. If I needed to step out, I could text her and she would meet me on the porch.
• I did not call the rest of the family. They knew, vaguely, that I had been "in the hospital." I decided to let the explanations come at my own pace, not at the dinner table.

The morning of

• I took my medication on time.
• I ate a normal breakfast. (Not eating before a long meal sets up a hypoglycemic crash that mimics anxiety.)
• I packed a small bag with my afternoon medication, a phone charger, headphones, and a change of clothes in case I sweat through what I was wearing.
• I drove with my mother instead of alone, which I would not have done a year earlier but which I needed.

At the house

• I greeted everyone, briefly, on the way in. I did not have long conversations in the doorway.
• I sat next to my cousin at the table. She had saved me a seat next to her on the end, where it was easier to step away.
• I poured myself sparkling water in a wine glass so I would not have to explain why I was not drinking. (Antipsychotics and alcohol are a bad combination, especially in the post-hospital period — see alcohol and schizophrenia.)
• I had a script ready for the question "How have you been?" The script was: "Recovering from a rough patch. Doing better." Repeated as needed.
• When the noise level in the room got too high, I took a fifteen-minute walk around the block with my cousin. We did this three times.

The exit

• I left at 4:15. My mother drove me home. I did not stay for dessert.
• I texted my therapist to let her know I had made it through. She had told me she would check her phone that day.
• I went to bed at 8 p.m.

What was harder than I expected

• The well-meaning hugs. Two relatives held me for a long time when I came in. One whispered, "We are so glad you are okay." I had not been ready for the public-ness of being known to be unwell.
• An uncle's joke. About midway through the meal an uncle made a joke about "going crazy" that was not aimed at me but landed near me. I felt my face go hot. I did not say anything. I texted my cousin. She and I went outside for ten minutes. I came back. I survived.
• The smell of food. One of my new medications had nausea as a side effect. I could not eat much. I pushed food around my plate. I worried someone would notice. Someone did. My aunt asked, kindly, if I wanted a smaller plate. She did not push it. I ate what I could.
• The expectation of normalcy. Several people made small comments — well-meaning — like "It is so good to have things back to normal." I was not normal. Things were not back. I let those comments go.

What was easier than I expected

• Most people were kinder than I had been afraid they would be.
• The plan worked. Having decided in advance when I would leave, where I would sit, what I would say, and who my person was, I had to make almost no decisions in the moment.
• My cousin's presence was the difference between staying and not staying.
• The drive home was quiet and my mother did not ask me to debrief, which was exactly what I needed.

What I would tell someone in my position

• You do not have to go. If skipping the holiday is what you need, your treatment team will support that, and the family who matters will understand. There is no medal for showing up sick.
• If you are going, plan it. Choose your arrival time, your departure time, your seat, your scripts, and your person. Do not improvise.
• Pick one ally and tell them in advance. Not the whole family. One person.
• Skip the alcohol. The combination of new medication, sleep loss, family stress, and a drink is the recipe most likely to destabilize you that week.
• Keep the medication on schedule. Holiday timing changes — eating later, traveling — make it easy to forget. Set a phone alarm.
• Tell your therapist or psychiatrist that you are going. Schedule a follow-up for the next week. The decompression matters.

Thanksgiving was hard. I did it. I went home. I did not relapse. I have been to two more family holidays since, with progressively shorter plans, and the most recent one I went to alone. The plan, I have learned, is a kind of scaffolding. You can take it down a piece at a time.

For more, see Thanksgiving with schizophrenia, holiday stress and schizophrenia, and surviving the first week out of the hospital.

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.