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Welcome to Notes from the Edge, where we have the conversations we should have been having all along. We talk about the things that we're not talking about. I'm your host, Lisa Lacey, writer, trauma educator, executive advisor, and author of the upcoming memoir, Notes from a Certified Mad Woman. Welcome to the Edge.
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Welcome back to another episode of Notes from the Edge. This episode draws directly from the central argument of my memoir, Notes From a Certified Mad Woman, due to be on pre sale in October and launch November 1st. While the veil is still thin now, the book is not anti therapy or medication or psychiatry. It is an insistence that accountability and treatment must not come at the cost of context, dignity and humanity. So right now I am sitting here with a blood clot in my leg. Now, it's been diagnosed previously at the beginning of the year when I had a cluster of embolisms in my left lung and a new diagnosis of lupus pancreatitis on the right side, and they were just hoping it wouldn't cause symptoms. However, it is killing me right now. Maybe literally, who knows? Well, I walk through. Well, it's time to play hospital roulette. So I walked through the doors and am I going to be treated as a medically complex woman with a hereditary clotting disorder who has survived 10 pulmonary embolism events, events more than one? Or will somebody open my chart, see my psychiatric history and decide they already know what kind of patient I am? Crazy, not sick. Emotional, not symptomatic. Anxious. I get that a lot. That is hospital roulette. And the stakes are considerably higher than the complimentary grippy socks. Welcome to Notes from the Edge. I'm Lisa Lacey and this is where we have the conversations we should have been having all along. And today we need to talk about what happens when a psychiatric diagnosis enters the room before the patient does. We need to talk about institutionalization, medical dismissal, medical health facilities, jail, hospital trauma, and the dangerous moment when a living, breathing human becomes paperwork. This conversation is also deeply connected to my forthcoming memoir, Notes from a Certified Mad Woman, which again, you can pick up in October. I did not write the book because I woke up one morning and thought, you know what sounds relaxing? Revisiting every psychological collapse, hospitalization, addiction diagnosis, trauma response, and public unraveling I've ever experienced. That would be a strange hobby. I wrote it because I almost died again and I felt like it was necessary. Before I go. When you become paperwork, you are institutionalized in a mental health facility. You are often treated like a dog with a bad owner, much like when you're in jail because I've been in both. So I'm not speaking from theory. I am not speaking from a textbook or a continuing education seminar or carefully controlled professional distance guys. I am speaking from lived experiential wisdom. The minute you enter, your dignity is checked at the door. Your shoelaces are taken, your belt is taken, Your purse disappears, your phone disappears, your jewelry disappears. Your choice disappears. And depending on how you arrived, your freedom disappears, too. Then the paperwork begins. Name, date of birth, insurance, medication, substance use, previous diagnosis, suicidal thoughts, homicidal thoughts. Are you hearing voices? Do you know where you are? What day is it? And yes, those questions can be necessary. Assessment matters, safety matters. Medication can save lives. Psychiatric intervention can save lives. But something else can happen during that process. Within an hour, one hour, you go from being a human being in distress to a diagnosis. I've had people diagnose me. Within an hour, you're a liability. A room number, an insurance claim, and a medication schedule. Congratulations. You are now a chart with grippy socks. In the memoir, I write about being 40 years old when I learned how quickly a person can become paperwork. Not a mother, not a business owner, not a woman. Women in pain. A jar, a case file, an intake assessment, a list of symptoms attached to a wristband. And once those psychiatric words enter the room, they change the way everyone looks at you. Even you. Especially you. There are major similarities between jail and psychiatric institutionalization that make people uncomfortable when I say them aloud. Both environments remove your belongings. They restrict your movement. They run on a rigid schedule. You are controlled by people who possess far more power than you do. In that moment, both can reduce your life to procedures performed under fluorescent lighting. Stand here. Empty your pockets. Remove this. Sign this. Wait. Sit down. Take this medication. Go back to your room. Ask permission for everything. And in both places, people can begin talking to you. Well, actually, they don't talk to you. They talk about you around you. That does not mean a psychiatric patient is a criminal. It means that losing autonomy feels like losing autonomy. Regardless of the building's sign, the first 24 hours inside a locked unit can feel like entering an alternate reality. Electric doors locked behind you. People move through hallways and paper in and paper scrubs tiny. Or those damn paper socks. Too tiny. Medication cups appear at scheduled intervals. A television plays in a common room. Nobody is ever watching. And it's always way too loud and on something stupid. The air smells antiseptic. Overwashed laundry, cafeteria food. And collective exhaustion. And after time passes, the strangest part is how quickly it begins to fill. Like Your new normal. My manuscript describes the normalization as more frightening than the screaming panic attack, psychosis and breakdowns. Watching intelligent, articulate people slowly adapt to institutional life in real time. You stop being the teacher, the nurse, the mother, the cop, the executive, the neighbor, the woman who used to make everybody laugh. You become the bipolar patient, the addict, the borderline, the difficult one, the non compliant one, the frequent flyer, the attention seeker, the psych patient. Human complexity becomes administratively inconvenient and categories are simply easier. The system can help, but we also need to look at the fact that it can still cause harm. This is not an attack on every therapist, nurse, psychiatric person, technician, social worker, counselor or mental health facility. I've encountered extraordinary people inside imperfect systems. People who did have compassion and listened and recognized the I was not. Merely a list of symptoms and treatment did save my life. Sobriety saved my life, Therapy saved my life, and recovery communities helped me. Sometimes some diagnoses gave language to the suffering I could not yet explain. Medication helps. Psychiatric stabilization certainly saves lives. All of this can be true at the same time that the system still needs an overhaul because it can still cause trauma. Both truths fit into the same psych room. My book was not written against these systems. It was written from inside them, as a participant and an observer. As someone who sat in psych wards, inpatient rehab, emergency rooms, therapy offices, support groups, recovery spaces and trauma education environments, asking one central question. What happens when a human nervous system adapts to prolong emotional danger? Because too often the symptom asks what is wrong with this person instead of what happened to this person? What did their body endure? What did their nervous system learn about safety? What behavior began as intelligent adaptation for destruct survival, but now has become destructive? What was happening around them when the diagnosis was made? Was she sleeping? Grieving? Detoxing? Hormonally destabilized? Being abused? Thank you. Thank you. Thank you. Physically ill? Terrified? Is she still inside the emergency everyone was using to define her? Context does not erase accountability, but context changes shame. And shame without context is where people stay trapped in a cage. I have witnessed deeply inhumane treatment inside mental health facilities. I've seen people at their most vulnerable, ignored, mocked, threatened, restrained, dismissed and stripped of the very humanity that the system claimed to be protecting. I've also seen extraordinary humanity among the patients themselves. Isn't that ironic? I watched psychotic patients comfort crying strangers. I've watched detoxing addicts share their food with people too depressed to eat. I've watched suicidal women talk to one another through panic attacks at 3 in the morning, while exhausted staff just moved from to room beneath the fluorescent lights, humanity survives even inside collapse sometimes, especially there. In the manuscript, I tell the story of a woman I met in treatment who gave me a pair of jeans because I complimented them. That was it. Two emotionally broken women inside a psychiatric facility exchanging kindness through denim. I still have those jeans. I can't fit into them because menopause hit it ensured. I do not currently have a diplomatic relationship with their waistband. But I still have them because they remind me that people inside those facilities were not diagnoses, insurance claims, cautionary tales. They were human beings with stories, families, memories, bodies, humor, pain, tenderness, and dreams. And dreams. They were people trying desperately to feel safe inside themselves. Psychiatric patients are not the other. They are nurses, teachers, mothers, executives, writers, pastors, daughters, neighbors, high achieving co workers answering emails while their nervous system claps quietly behind the conference table. Mental suffering is profoundly human, but a label will follow you because the problem does not always end when you leave the locked unit. It travels through electronic health records. It appears in your history, changes the atmosphere inside the examination rooms. And sometimes, the minute a doctor or provider sees psychiatric diagnoses, you stop being viewed as credible of the narrator of your own body. This is where mental health stigma becomes a real medical danger. Earlier this year, I nearly died from a cluster of pulmonary embolisms in my right lung, lupus pancreatitis on the left side, and I turned 50 shortly after being discharged. There is something clarifying about almost dying and then having a milestone birthday immediately afterwards. Nothing says midlife reinvention quite like your organ staging a coordinated labor dispute. I knew I had to write this book. Not because it was convenient, because it hurt to do it emotionally. It was necessary. Though I live with this hereditary clotting disorder, I've survived 10 events of pulmonary embolism, sometimes massive, in both lungs. Every one of those clots, each one had to travel through my heart before reaching my lungs. What a dark little anatomical field trip. And now as I sit here, there's a clot in my leg. It's not a new one. It was diagnosed then, but we were hoping it wouldn't create symptoms. But it exists inside the larger reality of living in a body I cannot completely trust and navigating a health care system that I cannot completely trust either. When I consider going to the hospital, I do not hesitate because I misunderstand the danger I'm in. I hesitate because I truly understand the system. I have been mistreated, minimized, dismissed, felt the room change after somebody saw the psychiatric resection of my record. Suddenly I'm no longer a medically complex, medically complex woman describing very serious physical symptoms. I just become the psych patient. Crazy, not sick. Emotional, not symptomatic. Anxious, anxious, anxious, anxious. And that bias can kill people. One of the most dangerous consequences of prolonged dismissal is that eventually you begin dismissing yourself. You feel pain, but then you wonder, well, am I being dramatic? Is this anxiety? Is the pressure in my chest anxiety? Is something wrong, but you just negotiate with your own perception. Maybe I'm exaggerating, overreacting to emotional, or it's all in my head. In my memoir, I write about experiencing chest and rib pain after violence and initially believing it could be stress, panic, detox or anxiety. The pain worsened. Breathing became harder. By then I had been gaslit and destabilized so thoroughly that I did not trust my own internal signals. Later I learned that I had been walking around with massive pulmonary embolisms, blood clots in both lungs. Women can be so conditioned to question themselves that sometimes we almost die asking permission to believe our own bodies. That is why dismissal is not merely rude. It alters self trust. It can train a patient to ignore the very signals that should bring them back for care. And when the patient already carries a psychiatric diagnosis, their hesitation may be interpreted as non compliance rather than trauma. The system asks, why'd you wait so long? Well, she waited because the last time she came in, no one believed her. She waited because she did not want to be humiliated again.
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Or.
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Or she waited because she learned that visible distress could be used as evidence against her. Or she knew the minute she cried, the physical symptoms might become anxiety. She waited because surviving the system had become part of surviving the diagnosis. When I go to the hospital now, I'm often told some version of well, you're already on blood thinners and that's the treatment. Would you like to stay for observation? Translation we can put you in a room, wake you up every two hours, serve you one deeply philosophical cup of gelatin, and charge you a gross domestic product of a small island. So my answer is usually no. But the larger issue is not one hospital, one doctor, one inpatient nurse, one overwhelmed emergency department, or one terrible encounter. The larger issue is the way psychiatric history can contaminate clinical perception. Once a patient has been labeled unstable, dramatic, ancient, anxious, anxious, borderline addicted or difficult. Every future symptom can be filtered through that story. Chest pain becomes panic. Neurological symptoms become stress. Abdominal pain becomes drug seeking, Anger becomes pathology, self advocacy becomes aggression. Tears are evidence, and sometimes the provider is no longer evaluating the person standing in front of them. They are evaluating the reputation that arrived first. That is why reform cannot be limited to mental health facilities. The entire healthcare arena needs to overhaul in how psychiatric histories are understood. Mental illness should not cancel physical illness. A psychiatric record should not erase a patient's credibility. Trauma should not be used as proof that every physical symptom is psychological. And you know what? An emotional expression should not disqualify somebody from receiving competent medical investigation and care. So my book is not asking for excuses. Notes from a certified mad woman is simply not excusing dangerous behavior. It is not arguing that every diagnosis is wrong, or that every patient is safe, or that every harmful action is a trauma response. Nor does it argue that behavior deserves to be romanticized if it's not great. Pain can create tenderness, but it can also create cruelty, violence, manipulation and harm. Trauma explains behavior. It does not excuse harm. I had to take responsibility for my alcoholism. Reactions, anger, decisions, the people I hurt, the way I became unsafe. Accountability matters. But reducing psychologically suffering people to pathology alone is its own kind of violence. Because once somebody becomes only a diagnosis, empathy erodes quickly and people do not heal well. Environments where they feel fundamentally dehumanized. Dignity restores agency, agency restores hope. And a hopeful nervous system behaves very differently than a hopeless one. We need treatment and humanity. We do need the structure, but with context. We need boundaries with compassion, accountability with dignity. This should not be revolutionary, but here we are. I wrote notes from a certified mad woman for the woman I used to be. The woman who survived things she did not yet have language for the woman who kept functioning while quietly unraveling. The woman who carried the label shame, rage, grief and still kept going. I wrote it for high functioning women who answer emails during a nervous system collapse. The mother who packs lunches after crying in the bathroom. The executive that can lead a meeting 15 minutes after a panic attack. The woman everyone calls strong because nobody recognizes that her strength has become a self abandonment mask. I wrote it for people who have spent years asking what's wrong with me? We need more useful questions. What happened to you? How did you adapt? How did you survive? And where? Do you still not feel safe? What did you become in order to function inside the environments that kept hurting you? That is the deeper framework underneath my book. Survival does not only wound us, it shapes us. Shapes identity, attachment, perception, behavior, ambition, anger, caretaking, overachievement, emotional shutdown, hyper independence, hyper vigilance, people pleasing, and the personality we eventually mistake for who we have always been. Healing is not becoming someone new. It is actually becoming aware of what survival taught you to be and deciding if that still belongs to you. So reform begins with different language. Instead of what's wrong with you, ask what happened. Instead of she's manipulative, ask what does she need to feel safe? Instead of he's non compliant, ask what experience made treatment feel dangerous. Instead of she's attention seeking, ask what happens when distress is repeatedly ignored until it becomes louder to be noticed. Instead of anxiety, it's probably anxiety. Say you have a psychiatric history and we will still evaluate your physical symptoms appropriately. Imagine how different healthcare could feel if the patient did not have to prove their sanity before receiving medical care. Imagine psychiatric facilities where dignity was understood as part of stabilization rather than an optional courtesy. Imagine a system where people are seen as human beings rather than being reduced to labels. The final invitation in my manuscript is simple. What becomes possible when people are finally seen as human beings before they are reduced to diagnoses? Sometimes healing does not begin when something is fixed. Sometimes it begins when somebody finally feels accurately seen for who they are. Now look. I've been institutionalized, incarcerated, addicted, experience psychosis, diagnosed, dismissed. I've also recovered, rebuilt, loved, led companies, raised a daughter, created work that matters, and survived things my medical records cannot accurately explain. I am a medical anomaly, but I am not one page of my chart. Neither is anyone else. A psychiatric diagnosis may describe just a small paragraph in my story. It should never be allowed to erase the human being experiencing it. Mental illness should not cancel physical illness. Institutionalization should not require the surrender of dignity. And surviving the system should not be harder than surviving the diagnosis. Notes from a Certified Mad Woman will open for pre sale in October. This is not a traditional self help book. It is a memoir, a nervous system, conversation and a reclamation process. And hopefully at times, it might be a mirror for you. It is not a book about having everything figured out, that's for sure. It's a book about what happens when survival finally meets context and a woman stops asking what's wrong with her long enough to ask what happened to her. The book does not ask you to read it looking for perfection that asks you to read it and then turn around and be honest with yourself. Because healing does not begin with performance. It begins when somebody finally starts telling the truth. I have spent enough of my life whispering about what happens inside these systems. I am not whispering anymore. This is Notes from the Edge. I'm Lisa Lacey and I will see you at the Edge.