rich girl rehab, part I

zoomed in: the memoir portion

When I was 20, I got sent to rich girl rehab.

I was in a psychiatric hospital following the kind of scenario that gets you sent to a psychiatric hospital. This was not nearly my first time in a psych hospital, this was my second hospitalization in three months, and this time, the cops had driven me to the hospital where I was, like always, involuntarily committed¹. I had been getting sent to the psych hospital intermittently since I was 13. So a week before my release date from the hospital, I was given an ultimatum by my parents: either we ship you across the country so you can get permanently fixed, or we’re going no contact. 

At this point I was on my second medical leave from music school at a fancy liberal arts college and was crashing with my parents. I had nailed down a part time job washing dishes at a diner a few weeks before getting hospitalized; I lost the job when I got hospitalized. Things were pretty dark. I was feeling trapped and isolated; even before hospitalization, I had just been sleeping all the time. I knew that getting kicked out of my parents’ house would mean couch surfing at first and then, when I wore out the welcome of the few people who were likely to take me in, eventually winding up on the street. That sounded like a better option than going to rich kid jail. I initially told my parents and my doctors that I chose the street. A kindly and level-headed hospital psychiatrist dissuaded me over the course of several days. Though she didn’t use exactly these words, she could see clearly what I couldn’t see at that time: if you have a psychiatric history like mine, once you’re on the street, it’s nearly impossible to get off. You choose the street, you die in a gutter or under a bridge. Residential psychiatric treatment would at least give me a chance to escape that fate. 

So I was discharged from the hospital on a perfect May evening and I got on a plane to Texas with my mother the next morning. I was in the stupor that new heavy duty drugs and the trauma of the psych ward puts you in. I weighed 108 pounds. My mom bought me some shorts because I didn’t have any and she treated me to a haircut. Then we rolled up to the rich girl rehab.

getting my hair cut the day before rich girl rehab

I’m sorry if the next sections are stilted and weird. I’m trying to talk clearly about my experiences, but it’s difficult to do so while maintaining the privacy of others and not doxxing myself too hard. It’s hard to know what qualifies as identifying information².

I learned that the program I was going to was designed for girls with borderline personality disorder and similar. At the time I was admitted, I had the black mark of a BPD diagnosis on my chart. This “diagnosis” was not the result of any kind of evaluation, it was the result of getting hospitalized over and over again, and if that happens and you don’t have psychosis, the hospital just hits you with the borderline label, so they can bill the insurance company, basically. Borderline personality disorder, if you’re not familiar, is one of the most highly stigmatized DSM diagnoses, up there with its cousins, antisocial personality disorder (psychopathy) and narcissistic personality disorder, and its more distant relatives, bipolar disorder and schizophrenia. According to the DSM-V, 75% of BPD cases are women. It’s characterized by rapid mood swings including explosive anger, unstable concept of self, relational instability, self-destructive behaviors like cutting and chaotic substance use, and suicidal gestures. Basically, it’s crazy woman disease, modern day hysteria. It’s thought of as extremely difficult to treat—basically, if you’ve got it, you’ve got it for good. Of course, I don’t meet the diagnostic criteria for borderline personality disorder, at least not on an ongoing basis. In the moments where I was involuntarily hospitalized, my mood was unstable, I was a husk of a person, no one was with me, and, yeah, I was being pretty self destructive. Obviously. In this way, a hospital psychiatrist “diagnosing” a traumatized young woman with BPD (after not reviewing her case at all) is completely tautological: the crazy girl, who wound up at our hospital for acting crazy, has crazy woman disease. I have come to find out in the intervening years that this kind of slapdash “diagnosis” of BPD is very common, at least anecdotally. There were plenty of other young women in rich girl rehab with me who were in the same boat; more in-depth evaluations within the program evinced diagnoses like DID, autism, and, perhaps it goes without saying, PTSD. But I’m getting ahead of myself. 

So yeah, we rolled up to the rich girl rehab. The facility was nice—ostentatiously homey, shabby-chic à la Texas. I didn’t see “But I’m A Cheerleader” until years after my time in Texas, but the welcome sequences are weirdly reminiscent of my welcome to rich girl rehab. We were welcomed by a smiling lady who gave us a tour of the grounds. We ran into a few other girls; some of them looked normal, some of them didn’t. We were then ushered into a cutesy office. The smiling lady explained a bit about the structure of the program. She explained that most girls completed it in about a year. My mom wrote the rich girl rehab a fat check, and then she left.

I was almost kicked out of the program in the first week. My suicidality was so acute that the rich girl rehab couldn’t accommodate it. I was given a stern talking-to by the therapist who had been assigned by my case. Suicidality is your only coping mechanism and it’s not good enough. Either you get your ass in gear, or you’re on the street. I didn’t get my ass in gear, but I was too tired to fight. (Except for later that same week when I got in a fistfight, but that’s a story to be told in person.)

I eventually emerged from my nigh-catatonia and got to know some of the other girls in the program. Like me, they were all rich girls whose rich parents were mad at them. And they had all absolutely been through the wringer. For many of them, this rich girl rehab (I just decided I’m gonna call it RGR from now on, for brevity) was one of many they’d been to. All of us in the program were between the ages of 18 and 24; some of the girls had been bouncing from residential treatment to residential treatment since they were in middle school (many of them had been to the same RGR that Demi Lovato went to, which I just think is a fun fact). Some of them had been hospitalized even more times than I had, with even more significant medical vestiges of those times. Some of them were on upwards of 5 psych meds. Some of them were addicts, some of them had done sex work. Many had eating disorders. We all had the personality quirks that can arise when you’ve been though some serious shit. And a few of them became dear and lifelong friends of mine.

It was in RGR that I was introduced to the concept of attachment styles. (This was before instagram heard about it; it was 2017.) The idea is that the way you were treated as a baby and a young child sets the template for how you are able to relate to others going forward in your life. If things didn’t go well back then, things probably won’t be going well for you now. We all have an implicit understanding of this; it’s readily apparent in animals. Cats who were separated from their mothers as young kittens, for example, might be either especially mistrustful or especially clingy; they might do atypical things like lick or chew on on your fingers; they might be overly aggressive and unpredictable. Attachment theory is the idea that the same principle applies to humans. According to the formulation that’s in vogue today, there are four clusters of behavior that indicate four attachment styles: secure, anxious-preoccupied, dismissive-avoidant, and fearful-avoidant (also called “disorganized”). People who have a secure attachment style have an easy time relating to others. They know what their needs and responsibilities are within relationships and have a relatively easy time expressing those. Other people aren’t generally seen as threatening. This pattern arises from having your needs met consistently as a baby. People with the anxious attachment style had some of their needs met as a baby, but the care was inconsistent. This can lead them to become very clingy in their adult relationships. They might need a lot of external validation and reassurance that the relationship isn’t going to disappear. People with an avoidant attachment style are people whose needs were met very inconsistently as a baby, they might have been lightly neglected. In adulthood, this can lead to being very remote and withdrawn in relationships; it might lead a person to not seek relationships at all; it can lead to a sort of “why try?” attitude toward other people. People with a disorganized attachment style are people whose caregivers were frightening, abusive, intrusive, or severely neglectful. This can lead to a lifelong feeling that relationships are inherently threatening: care equals pain. It’s often said that the disorganized attachment style comprises the more extreme relational strategies of the anxious and the avoidant styles. Practically, this can look like deep mistrust with a simultaneous deep need for closeness. It can look like ratcheted-up push-pull dynamics in relationships (“I hate you, don’t leave me”). People with the disorganized attachment style can be very hard to be in relationship with. And perhaps it goes without saying that all of us in RGR had the disorganized attachment style. 

Attachment style is not a life sentence, it’s just a patterning that’s deep seated. In the years since RGR, most of my relationships have followed the pattern of a person with a secure attachment style. However, in some of my closest relationships, the feelings associated with disorganized attachment definitely arise, especially some of the more avoidant feelings. I can get overwhelmed by emotional closeness, especially by someone needing something from me. I wish it weren’t that way, but it is. It’s way less bad than it was. I don’t usually act out about it, I can just let the feelings move through me and then pass. Usually.

Anyway, we were all disorganized in RGR. It seems clear to me that that’s why so many of us exhibited symptoms of borderline personality disorder from time to time. Remember, some of the hallmarks of BPD are mood swings, relational instability, unstable concept of self. Well, if you have a disorganized attachment style, your moods might be confusing of frightening to non-disorganized people. This might lead to unstable relationships. If you have trouble knowing who you are in relationships, you might have a hard time knowing who you are, period. In my case, feelings of isolation and alienation led to persistent acute suicidality. These are not new observations; plenty of people over the years have said that BPD is just the disorganization that follows developmental trauma; plenty have quibbled with what the borderline group even is, what counts as a borderline “symptom”. There’s plenty of discourse out there about how BPD in most cases could more accurately be called complex post traumatic stress disorder, c-PTSD (which still isn’t in the DSM for a host of political reasons but which most clinicians recognize anyway). It seems in my experience that even among clinicians, “borderline” just means developmental trauma but extra scary. It usually points to high levels of unpredictable anger, or sullenness, or basically any very difficult relational traits—like I said before, it’s crazy woman disease, modern day hysteria. Put another way, if your developmental trauma causes you to act out, it’s BPD. If it causes you to “act in”, i.e. mostly hurt yourself instead of others, it’s c-PTSD, unless you’re in the psych hospital, in which case, the insurance company wants it to be BPD.

Back to RGR. I won’t get too much into what the treatment actually looked like because I fear that that could be doxxing or at least google-able. Suffice it to say that real treatment actually happened there. There are RGRs out there, especially substance-specific ones, that are very coddling. This was not one of those. We were doing some kind of therapeutic intervention on a nine-to-five kind of basis. And there are RGRs out there that are very traumatizing and abusive, like in those netflix shows. This was not one of those, either. A lot of girls felt like their time at our RGR was transformative and they went on to live, full healthy lives afterward. Some girls didn’t; some girls wound up on the street after all. As for my treatment, it ran the gamut from asinine and ineffectual to very stunting to pretty useful. I finished the program in 9 months, which was unusually fast.

shortly before finishing RGR

My therapist at RGR had a pet theory that what was really wrong with me was not only not a personality disorder, it was not developmental trauma at all. She thought it was autism. I was formally assessed for autism by a professional diagnostician of autism and, if you can believe it, she found that I had autism. (Something about hammers and nails.) I believe that I really met the DSM-V’s expanded diagnostic criteria for autism spectrum disorder. I also believe that if I were assessed today by a different clinician, I might but very likely might not not be diagnosed as autistic. You know how what people really mean when they say “BPD” is “crazy woman disease”? I think that these days what we mean by “autism” is basically “weird person disease”. And I definitely had weird person disease back then, the same way I sometimes had crazy woman disease. I still have weird person tendencies and sometimes touch of crazy woman ideation. One thing I guess my RGR therapist didn’t appreciate was that some manifestations of developmental trauma are practically indistinguishable from the symptoms of high functioning autism under the expanded criteria.

I’m a lot healthier now overall. But my healing was no thanks to RGR. I’ll write more about what I attribute my healing to in part II of this essay. For now, I’ll say that the things that I think were most helpful about RGR were 1) I didn’t wind up on the street, 2) getting space from my family that had open contempt for me, and 3) the autism diagnosis made my family treat me a lot better. For most of my life my parents were eager to attribute my confusing and upsetting behavior to a desire to manipulate or punish them, instead of the natural expression of excruciating pain and overwhelm that it really was. The BPD diagnosis gave them license to blame me even more: if I tried to kill myself, it was just an attention cry and they should just ignore it unless it was very medically significant. If I was failing out of school, I was acting out, being oppositional, and I should be punished. If I was acting in a way that was interpersonally jarring, I was provoking a reaction. If I was angry, it was just scary borderline rage. The autism diagnosis helped my parents not blame me for my own distress. It helped them see me as disordered instead of monstrous. I didn’t have an evil heart, I just had a brain that was permanently sick with weird person disease. It’s much easier to treat a person with compassion if you see them as disabled and pitiable than if you see them as a chronically untrustworthy menace.

If I ever talk about my time at RGR (which I rarely do these days), I usually tell people that the thing it mostly did was make it easier for other people to be around me. I don’t mean that it gave me better relational skills; it didn’t. I mean that it made me obsessed with acting normal. My RGR therapist made it an explicit treatment goal to accept that I would just always be weird and there was nothing I could do about it. This made me hypervigilant for any trace of weirdness in my behavior. Believe it or not, obsessively checking your behavior to make sure it’s normal does not make you seem very normal. I grew out of that in a few months after leaving RGR. But the obsession with my abnormality remained. Instead of always checking myself, I just felt crippling shame anytime I realized I had done something out of the ordinary, and I still felt the niggling paranoia that I was probably acting weird all the time and just couldn’t tell. My obsession with being normal reached its most extreme and destructive when I tried to date and sleep with men for a few years (I have been out as a lesbian since I was 12). Over 6 years later, I am still recovering from the shame that stuck to me after RGR. But hey, at least I know I’m fucking weird now. I went back to music school thinking I could do it because I was fixed, and then I realized I couldn’t and I dropped out. It’s true that I don’t any longer do the scary self-destructive behaviors that led to my getting shipped off to RGR. That doesn’t mean that the feelings went away or became easier to manage while in RGR; they subsided for a while commensurate with my parents treating me better, then they came back again in full force when my parents inevitably started treating me badly again. The feelings have subsided over the course of these past several years due to a host of other factors that I’ll get into in part II.

RGR didn’t fix me. I’m not sure how much it helped me in the long run. There are some significant ways that it harmed me. It did keep me off the street, though, I’ll give it that. If I had wound up on the street, I would likely be dead by now.³

So, if RGR didn’t help me, what would have? People love to ask this. People are also usually not prepared to hear my answer. I will lay that out in part II of this piece, along with what I think is uniquely traumatogenic about the world I come from. I’ll close part I with a little bit about what my life is like now. 

I’m doing well. I have several dear friends and loved ones that I couldn’t have dreamed of having back in the RGR days. I got off my psych drugs with the help of a doctor over 6 years ago and have never looked back. I dropped out of college, like I said, and as such, I’m cut off from working many of the kinds of jobs that pay high wages. I have done only manual and service work for my whole adult life—dishwashing, cooking, farming, nannying, barista-ing, the like. I live alone in a pretty comfortable if shabbily-maintained apartment in the town I grew up in; I’m going to get priced out soon. Depending on the kind of work I’m doing, between half and three quarters of my income goes to my rent (right now I’m trying to do as little wage labor as possible, so almost 100% of my income is going to my rent). My parents have helped me with rent in years past; right now they do not. I don’t have health insurance right now, but my parents are graciously paying my therapy bills. In other words, I’m living a working class life with a few extra perks. I’m much happier than I was when I was trying to do the upper class thing, and a lot of my material needs are met. And I think I’m a lot more fulfilled than I would be if I was working at some kind of fucking nonprofit or consulting firm like I was supposed to. But my body is a lot more worn out than it would have been in that case. My life is a far cry from what was laid out for me. It’s very different from that of my peers in my extended family and the people I grew up with. I’m happy that way. I have been forced to make meaning out of my life path in a way that I think most people from the same socioeconomic origins as me will never have to do. So for that, thanks, rich girl rehab.

part II is now up!

1. It’s trendy among some people who’ve been involuntarily committed to call involuntary hospitalization “psychiatric incarceration”. I, uh, don’t like to talk about my experiences that way. I’ve been in a lot of different psych hospitals, some of them fancy, some of them woefully underfunded and scary. They have all been traumatic and unhelpful in their own unique ways. Some really messed up stuff has happened to me in there. I also think the kind of humiliation, degradation, and violation I experienced in there is just not comparable to that experienced in jails or prisons. I think it’s possible to have solidarity with other people who have had their agency revoked in a profound way without conflating our experiences. They aren’t the same. Being locked up sucks and shouldn’t happen. I just don’t think pretending hospitals and jails are the same is useful. It’s possible I just didn’t go to fucked up enough hospitals, I guess.

2. The fact that this place was in Texas is not in and of itself doxxing; Utah and Texas have a very high density of the kind of program I was in. My understanding is that the reason for these concentration is something to do with taxes, but I also suspect it has something to do with concentrations of Mormons; the LDS has its hands in the treatment industry in a big way, for some reason. The program I was in was founded and largely operated by LDS members.

3. I also gained cultural competence with Mormons. (They don’t like to be called Mormons.) They are by and large very nice people. And they are all beautiful. Not drinking coffee really gives a person a glow.