It Breaks You Down, It Does Not Fix You

⚠️ A care note before anything else. This conversation moves through suicidal ideation, a near attempt, and the cost of being broken down before you can rebuild. If you do not have the capacity for it today, that is okay. It will be here when you do, and so will the recording.

Last week we walked through the door of the unit, and we spent most of that hour inside my own admission.

This week we gave the hour to Steve and to his road through the American system.

If you missed last week’s conversation, start here:

The Place Where the Mask Came Down

There is one thing Steve wanted said before anything else.

Going inside is where a recovery begins, and it is not where you get fixed. The intensity has a purpose, and the harder, longer work comes afterwards.

The rest of the hour was the story of what that beginning actually asked of him.

You find the door yourself

Steve’s road into care looked nothing like mine.

In Australia you need a psychiatrist’s referral to be admitted, and the system makes a great deal of the decisions for you.

In the US Steve had to find his own place. The facility he told us about today was already his second, and he had driven roughly twenty-eight hours across the country to reach it, certain that if the best place he could find did not work, nothing would.

It was a former resort in the Colorado mountains holding around four hundred people. About half were there for substance use, and the other half for mental health or both.

He had gone looking for a mental health placement, and he has since said that landing in a mixed facility was one of the best things that happened to him, for reasons we come back to.

What it costs to go inside

In the US cost is the part that decides who gets help and who does not.

Steve’s facility ran at between one and two thousand US dollars a night. He stayed two months, and after insurance paid its share, his own bill came to between thirty-five and forty thousand dollars in cash. He counts himself fortunate to have had the resources to go.

My own month in Australia cost around forty thousand Australian dollars, almost all of it covered by private health, and we were out of pocket by about two thousand.

The contrast sat heavily with both of us. I have someone joining Voices From Inside the Arc soon who came out of three months of residential treatment in the US that she paid for entirely herself, at a cost of a hundred and fifty thousand dollars.

Care at this level reaches only a small share of the people who need it, and for a population where autistic and ADHD adults already carry frighteningly high suicide rates, that is hard to sit with.

It breaks you down, it does not fix you

Steve arrived certain that his problem was anger, and after his first month he felt good, even ready to leave. He took a pre-planned hiking trip with friends and told himself he had it handled.

What he had not understood yet is that a place like this is not built to fix you. It is built to take your armour off.

For Steve the anger had been the armour, and once the facility helped him set it down, there was nothing left underneath it to hold the weight. An intense sadness and self-hatred rose up where the anger had been.

Alone in his hotel room at around four in the morning, he came very close to a suicide attempt. He told his therapist at the end of their next session, almost in passing, that it had happened only hours before. She did not let him leave the room.

The safety protocols moved fast, his limited freedoms were withdrawn, and one of his first thoughts was for his two dogs, alone in the hotel, and what would happen to them. That descent is what moved him from outpatient into full inpatient care for another month, and it is, in his words, where he finally got to feel.

I recognised almost all of this. I had said the same thing to my own psychologist, that I was fine now, only to watch the process take over completely once the truth was out. Losing control of it like that is terrifying, and I have come to believe it happens for a reason.

The purpose of these places is not to fix you. It is to take the armour off, and you can only survive that somewhere safe, because every defence you have goes at once.

Intensive, but not individual

One thing Steve named has stayed with me.

The care is intensive, and it is not individual. You move through a programme and an institution, and for the most part it is a commercial enterprise that runs you through its system. You see your own therapist once or twice a week, and the rest is the programme.

No one tells you what the experience will be like, when you might be ready, or what the work on the other side involves.

Both of us watched people return again and again, the ones we each called the frequent flyers, some of them back for some of them coming back year after year, none of them ever feeling ready to leave. The comfort of the place is part of why. It is calm and beautiful and nothing is asked of you, and the world outside is the very thing that put you there.

For me there was a sharper version of this. I had been diagnosed autistic before I went in, and across the whole admission not one person mentioned my autism, or autistic burnout, or masking, or the toll it takes on capacity. The actual cause of why I was there went unaddressed.

Looking back, almost everyone I met who kept returning was most likely neurodivergent, going home to the same conditions that had created the crisis, with nothing changed.

The world you go back to does not change

This is where the mixed facility turned out to matter for Steve. Sitting with the people there for substance use showed him something he might have missed on the mental health side, that the environment you return to is at least as powerful as anything happening inside you.

Mental health gets treated as an internal problem, a you problem, while substance use is more readily understood as something the surrounding world feeds. His friends were going back to places where the people around them were still using, and watching that helped him see his own life clearly.

His own environment had not changed either. His manager was still going to be there. The leave he had needed in the first place had been denied until he invoked a US law that grants up to twelve weeks, and even then he could communicate with his employer only through his union. He had asked every senior leader for change before he left, and they ignored him.

I felt the same recognition. I had been bullied and pushed out of my last legal role, made redundant because it was the only way to move me while I would not resign, and I know I could not have walked back into that environment and survived it.

Learning a second language

The thing Steve most wanted to pass on is about men.

He left with a few tools, and with one thing that surprised him and changed everything, which was the language of feelings.

For the first time he could say what was happening inside him to the people in his life, to friends and to colleagues, in a way he had always believed was unprofessional or unmanly.

He found that the fear of being a burden was mostly unfounded, that people want to help when you let them see you, even when they do not have the words, because the actions are enough.

He pointed out that the mental health side of his facility was mostly women and the substance use side mostly men, and that men relapse at high rates partly because they never learn this language at all.

Talking in terms of feeling rather than fixing was, for him, like learning a second language as an adult.

He wanted to get on a live and say so, because he does not see it talked about much, least of all by men.

I share his sense that the silence is dangerous, and that women are often given a little more room to ask for help without shame.

If you take one thing from this

If you take one thing from this conversation, let it be that an intensive does not return you fixed, and it was never meant to.

It gets you to the starting line. As Steve put it, the marathon begins once you leave.

The work that actually changes a life happens on the other side, in the ordinary world that did not pause while you were gone, and it is far more survivable when you walk into it with language, with a few tools, and with people who have seen the truth of you.

What happens next

Next week we talk about exactly that, being released, and what it takes to walk back into ordinary life when the mask has come down and will not easily go back up.

Part four is next Sunday at 7.30pm EDT, which is 12.30am Monday in the UK and Monday 9.30am AEST in Australia.

I have opened a new thread for this series, linked below. If you have a question you would like us to answer, or an experience you want to share, including as someone who loves a person who has been admitted, it is there for you. You never have to appear or say a word on a live to be part of this.

The recording of part three is available whenever you have the capacity for it. Thank you to everyone who came and held this hour with us. It mattered.

With love,

Marie-Christine and Steve

P.S. If you want to catch up on our first live in this series, start here:

Two Roads To The Same Door

Steve is rare in the way he shows up. He found me after my most mortifying live and has been in my corner ever since, and I am better for knowing him. He writes at Outside Feet, and if any part of his story met you where you are, I would love for you to follow him there and tell him so.

P.S. This space remains free. If this work helps you, there are a few ways to support it.

Subscribing means you receive my posts as they are published, without having to go looking for them. It is also a signal to our community that this work matters.

Sharing means someone who needs this language might find it.

Thank you for being here. 💛

Come and chat with us in the thread:

Thank you to everyone who tuned into my live video! Join me for my next live video in the app.