(b)reaching liminality

“The Sun Also Sets” by Beth Horton

1. In agricultural research, growth carts or growth rooms are used. These give seedlings the optimal conditions to grow, depending on ideal germination temperature, humidity, light level, and air circulation. This does not depict any of the variance in conditions that normal growers are likely to face, from power outages to compost to rainfall. These are used not to stimulate what growing plants is actually like for most of the population, but instead to provide a theoretical summation of potential. This is what plants could be like, if all needs were met and variables eliminated.

People in crisis often wish to escape their lives, to disappear or become someone else entirely. When pain gets overwhelming, it can be hard to see anything else. Doing a breathing exercise or holding an ice can seem like a ludicrous way to manage emotions, especially when circumstances are largely external. As an anonymous stranger on the internet, I can validate someone, but that alone may not change their feelings of alienation. I can’t rescue someone from intimate partner violence or give someone a home, as much as I wish I could. All I can do is be a witness to their experience, listening and offering resources as needed.

There are two Dixie cups by my window right now, their interiors dark with soil and a potting mix. The earth comes from the organic garden on campus, Crocus Valley. The garden has been nurtured for years, with manure, organic compost, and careful planning of crops each year. The seeds within these cups are heirloom organics, shared by indigenous seed-savers. One is a red poppy, the other a purple spinach. Since all of the instruction given was “sprinkle a handful into the soil,” and my window faces north, I wasn’t expecting much. Several days later, I saw a magenta stem rise and unfurl its leaves, with others waiting to do so. In the other cup, tiny seedlings sprouted, that bright green of new life. These plants have been started from seed and nourished for centuries, even despite environmental obstacles. While I’ve been gardening for years, seeing life take root, again and again, is remarkably affirming.

There is no way to calculate whether my plants would be growing right now if the sun didn’t shine as much, if there was insufficient water, if the soil microbes were less active due to years of monoculture and pesticides. So many plants do not have optimal growth conditions, from routine soil disturbances to a lack of diverse cover crops. Studies have suggested that conventional crops are less nutrient-dense than their sustainable peers; simply getting the bare nutrients, combined with intensive spraying of chemicals, is not enough to ensure success. In an environment where the soil is not healthy, how can the plant be expected to flourish? Research shows that good soil health includes several key elements: a variety of cover crops, crop rotation, living roots in the soil as much as possible, minimizing tillage, and integration of livestock. This is not simply a checklist of regular pesticide application and harvesting crops once they’ve finished growing, but a complex ecosystem. It is far easier to apply more pesticides than to reconceptualize what a healthy or successful farm looks like.

In and of itself, my work as a crisis counselor does not necessarily drastically change lives. I can’t implement a cover crop for a plot, let alone transition a field from conventional to sustainable agriculture, which takes years. Conventional agriculture impacts everything from bills passed to water access to which products are subsidized; there’s no way I can change that on my own, let alone in 45 minutes. 

Sometimes, I remember my own piecemeal history, an education as much group therapy as it was group assignments, monitored meals instead of college dining-hall meal plans. The end of my adolescence and most of my early adulthood was shaped by my treatment team’s decrees, the blank walls of mental health treatment centers and arguing in appointments with clinicians and carefully-portioned meals on trays. It is strange to learn to become a person in a setting where malnutrition has labeled you unreliable, where your behaviors are scrutinized and second-guessing yourself feels more like home than any building. Instead of spending my 21st birthday at a bar or restaurant, I was an inpatient in eating disorder treatment. At the weekly diabetes group that evening, we got take-out for dinner (a trying challenge!) and had gelato with sprinkles to celebrate. I was so numb to any sense of normalcy that I was hardly bothered by the monotony of daily weights at 5:30 am and sessions with a therapist who barely seemed to care. The fact that many of my peers had eclipsed me in terms of developmental milestones stung, but only to the extent that it buried me deeper in my own shame.

In March of 2019, I wrote:

As one of my roommates jokes about overdosing, I give a friend a recommendation for the best general psych ward in the area. My search history is populated both by Googling the weather and eating disorder treatment reviews. For years, I have straddled the boundaries of health. My grades and CV show evidence of dedication and accomplishments, a calculated mirage of success. Between the lines: a series of bone-white hospital bracelets; anxiety spikes over plates of French fries; unusual vital signs and laboratory values which point to the body’s decline, chronic and acute.

[I can hear how much pain you’re going through.

Some people experiencing an eating disorder have

thoughts of ending their lives; are you having

any of those thoughts right now?]

The therapist remarks, “Safety check! Plan, intent, means?”

I glance away. “No.” She notes that on the yellow legal pad all therapists seem to have. With that, we end our session. During my intake appointment, she had asked about coping skills, and I listed them off instantly: drawing, reading, going for walks, baking, talking to friends, journaling. I’d mentioned that I was a crisis counselor and she’d replied, “So you know all the right answers.” (Of course, she wasn’t wrong.)

Seven months ago, the PA had asked me to contract for safety while I was on the unit. I replied, “How do you contract for suicidal thoughts?” In my mind, this was nothing short of Big Brother, but I sensed that arguing this point wouldn’t exactly help. I agreed to talk to staff if my thoughts increased in intensity.

[It takes courage to reach out about

the thoughts you’ve been having.

Do you have a plan for how

you would die by suicide?]

Sometimes, the messages make me gasp. Not necessarily the razor or the bottle of pills or the rooftop, though those are each concerning. Mostly, it is the gun in the cabinet, its potent immediacy. Once, it was insulin. Though as crisis counselors, we are encouraged not to share our own experiences, I yearned to let the person texting in know that I understood, all too well.

[I appreciate your openness;

it sounds like you’ve thought about this a bit.

Do you have what you would use to die?]

When we were in high school, my twin went inpatient for suicidal ideation. They had urges to hurt themself, their means attached to their body by means of an infusion set. As a result, they spent hours in a safe room; I found out via text. It is possible to put away sharps, to step away from the bridge railing, but to detach a Type 1 diabetic’s insulin pump could in itself be lethal. It is easy to manipulate dosage, either to under- or overcorrect and do lasting damage. Growing up diabetic, weathering the constant lows and highs is its own complicated calculus. Who would not tire of having to micromanage their life, day in and day out, simply to survive?

[I can hear how much pain

you’re going through.

Do you have a time-frame in mind

for when you would die?]

I spent weeks planning, figuring out the logistics of when it would be most feasible. I scouted out discrete locales where I thought I wouldn’t be noticed, finalized a schedule for when those close to me would be unavailable. This question marks a volta; it is at this point that mental health professionals can suggest or require hospitalization. At Crisis Text Line, the rules we are bound to are more specific. The time-frame must be within 24 hours and the texter must be unable to agree to stay safe for us to contact emergency services.

[I care about you and your safety.

Are you willing to come up with a plan

so that you can stay safe tonight?]

October 29, 2018. I hesitated when agreeing to safety plan; after my therapist had me call my dad to take me to the hospital, my desperation escalated - I needed to escape the pain that had held me captive for months. I was “safe,” and then I wasn’t. I sat in the outpatient bathroom of the treatment center, injecting myself over and over as my dad waited outside. The receptionist, Kathy, asked if I was okay as I walked out of the restroom. I faked normalcy on the drive to the hospital where I’d been inpatient only weeks before, knowing that my blood sugar was plummeting with each passing minute.

*** 

INT. PSYCHIATRIC CRISIS EMERGENCY ROOM - AFTERNOON

[FADE IN]

KATIA (20) sits on the stiff hospital bed, wearing rust-colored scrubs. The walls are white and the door is gray. NURSE enters the room and asks about suicidal thoughts. KATIA discloses attempt.

NURSE

And how much have you taken?

KATIA

(shifting gaze)

80 units of short-acting insulin.

NURSE

And whose insulin was this?

KATIA

Um, mine?

 (beat)

 Whose else would it be?

NURSE

I won’t tolerate being spoken to in that way.

KATIA

(sniffling)

I’m sorry, I didn’t mean to.

NURSE scribbles on her clipboard and leaves the room. NURSE re-enters, carrying a glass of orange juice.

NURSE

(shortly)

Drink this.

KATIA does not touch the styrofoam glass of juice. KATIA runs her fingers through her hair and jiggles her leg.

[FADE OUT]

 ***

Aftermath: a dextrose IV, when the juice is refused, as reality TV shows play in the background. A rotation of quiet 1:1 sitters and blood sugar checks every four hours overnight on a medical floor. Mother and aunt visiting, one after the other, bringing books to read and small everyday conversations. A picked-at dinner and the tangle of monitors, shuffling to and from the bathroom.

You insist you will stay safe, there is no way you plan on hurting yourself while in the hospital, but they do not have to believe you. Your actions have rendered you unreliable.

When transferred to the psych unit: the staff’s glances of recognition, the same community groups each afternoon, the amorphous shame ember-hot. The daily menus carefully circled in pencil, half-finished coloring pages, pacing the floor in socks. The 15-minute rounds and DBT worksheets and twice-daily vitals by mental health technicians.

You abstain from short-acting insulin and barely eat at meals; some of the nurses plead with you to eat a little more, while others grow frustrated when you refuse the insulin prescribed. You exercise in your room in between checks, pour glasses of juice given to treat lows down the bathroom sink, give away your snacks whenever possible. You stack the small containers of mixed nuts and packets of saltines on the shelf in your room. You eat just enough in order to avoid being seen as noncompliant; why bother eating when you don’t want to stay alive?

The psychiatrist you are assigned this stay has a linebacker build and graying hair, wearing sportcoats and kindly smile lines. He listens more than is required for simply noting items on a checklist. Unlike the one from last time, he reads between the lines. In the meeting with your parents to determine a suitable discharge plan, he notes your intelligence and stoic nature. In some ways, his compassion is a balm for your family’s fear.

You become close to the other patients, despite the high-turnover nature of acute stay units. There is the middle-aged “frequent flyer” who sits up coloring late at night and plays guitar between meals. For her birthday, her husband brings in cake and party games; for a while, you forget that you are locked in, and life feels almost normal–you check out scissors from the nurse’s station so you can make her a card. The motley crew: an effervescent girl about your age, her stay court-ordered after a lapse with addiction, whose raging calls to her boyfriend and peals of laughter fill the halls; a quietly charming wheelchair-user known for his banter with staff and vending-machine expertise; a fantasy reader who works at a gas station and helped raise his siblings; a sixty-something inquisitive widow who peppers her speech with phrases like “big time, girl.”

The social worker, who looks like Edna from The Incredibles, notes your positive participation in groups, but that your recent history enhances the chance that they may not let you into the hospital’s day program. You have been trying to get into it for weeks, but now may not be allowed because of the liability–there are consequences to dying unsuccessfully. You are careful to make finite daily goals.  You plan to take a shower, to read a chapter of your book, to attend daily groups and finish your weekly coursework.

Years after my attempt, I have survived much more than expected: a university degree, turning 24, several romantic relationships, and working full-time. Slowly, the discordant pain has faded to a background hum; I no longer ache alone.

*** 

2. It is now July, 2020. The world is burning, has been burning for months. Several weeks ago, allegations came out about the founder of Crisis Text Line, Nancy Lublin, who was infamous within the company for her racist remarks, her callous tone with texters, the way she pushed and pulled young, inexperienced staff, bullying those who dared to stand out. This had been happening for years. When I had been a Crisis Counselor for a year, they sent me a sweatshirt, heather-gray, with the CTL logo in red.

Recently, the remaining Crisis Text Line staff hosted a town hall for Crisis Counselors and staff, many of whom were aggrieved, and justly so. The questions posed included queries about whether any of the data, which showed glowing satisfaction rates, had been manipulated; how secure texter and crisis counselor data was; how race-related data was used by the organization.

In Crisis Text Line training, a counselor is taught to contact their supervisor when the texter reports suicidal or homicidal thoughts, a plan, access to means, and a time-frame within 24 hours. Ostensibly, crisis counselors can create safety plans with the texter, anything from going to sleep to calling a friend. If they are at imminent risk, meaning they are planning on seriously harming themselves or someone else and are unwilling to agree to a safety plan, the supervisor will use the ping location from their phone to try to locate them, and send that to emergency medical services. Over the hundreds of hours I spent on the platform, I had at least a dozen active rescues. There is rarely any sort of follow-up once that call is made; you are left to sit with the uncertainty, stark and brutish. I still remember some of the details, and yet, what is there to do?

I’d taken a break from Crisis Text Line for several weeks before the story came out; I’d been more active in on-the-ground organizing, and felt that my responses on the platform were sometimes more mechanical than was ideal. Watching the outpouring of support on social media, both those speaking out against a toxic work environment and Lublin’s supporters, felt disconnected. I decided not to return. I had spent over 200 hours engaged with people in crisis, through over 1,500 conversations. It felt like there was a diminishing return of the time I spent being pressured to talk to four or five texters at a time, the lack of insight that the highly privileged upper-level staff displayed, the lack of reparations for black and brown staff and texters injured by theoretically color-blind policies. What does it mean to abandon an organization whose work is filled with virtue-signaling, the glory of intentions over impact?

Earlier this spring, I started to grow basil and beets from seed. I kept the trays of seedlings inside for too long, and watered them sporadically, causing them to wither. Recently, I set them outside; the characteristic mid-summer downpour, and resulting high humidity, ensconced the plants. Today, I saw a red-green stem curling its way out of the beets, two tiny sets of leaves in the basil. There is no undoing, but maybe there can be repair.

*** 

3. It is May of 2021, a year and some months into the pandemic. I work as a mental health technician at a local long-term residential facility for individuals with severe and persistent mental illness. Much of my position involves administering medications, from topicals to pills taken by mouth, and trying to contain emotional fires. My coworkers all say not to take it personally when residents get upset, but a few weeks ago I cried for over an hour after a resident verbally escalated a situation. Some of my friends tell me they’re not strong enough to do my job; most of the time I feel the same way.

Slowly, I am getting used to the feeling of anxiety ramping up as the clock races on during the 9 pm med pass, never getting things done quickly enough for the residents’ liking, nor thoroughly enough for the nurse on the floor. After I go home, I try to relax, but I can’t help but rehash the medication mishaps I made, often for a day or so after the event.

The other night, in the break room over dinner, we were talking about residents’ drug use, and the difficulties that poses to individuals’ sobriety. Many residents have comorbid substance dependence, and of those who don’t, it’s a perfect storm to start using. The administration calls the housing-first policy harm reduction, but as the charge nurse that night mentioned, harm reduction is an active approach to diminish negative effects from substance use, while our approach, if you can call it that, has been more indirect. When I think about addiction, I think about the rat park; how rats, when offered adequate engagement, often do not exhibit behaviors characteristic of substance dependence. But then, we live in a country that, despite being one of the richest in the world, doesn’t even provide universal housing, let alone healthcare. Often I wish for a different world.

Often, pushy residents get their way despite direct-care staff wanting to enforce boundaries, because it’s easier for administration. Though the culture within the work setting is collaborative and generally positive towards employees, there’s only so much we can do. In a building with 200 people living there, the squeaky wheel gets the grease.

I was talking to a coworker of mine about how the facility stokes stagnancy. As she noted, residents as a whole aren’t getting worse but they also aren’t getting markedly better; many live there for years, and transition into nursing homes. Is that really all we can hope for? Maybe we can hope for more, but there simply isn’t enough time. When you have to pass medication to 24 residents in the span of two hours, the focus becomes on signing each square in the MAR as quickly as possible and getting onto the next person. Sometimes I barely have a moment to ask how they’re doing.

I think about myself, and how in an alternate timeline I could be a resident there, shuffling from meals in the dining hall to groups on how to take public transit. I think about my twin, the scores of diagnoses they’ve amassed over the years. I think about my younger brother, how he’s almost 17 and in a sense, it feels like we’re running out of time. I am worried that he won’t find stability or a sense of purpose, anything grounding enough to keep him safe. I am moving into an apartment for the first time; my dad and his partner gave me a small rosemary plant as a housewarming gift. I buy a basil plant for $5 at the local farmers’ market, and the two keep me company throughout early summer mornings spent on the balcony.

*** 

4. It is January of 2022, a handful of days into the new year. We are entrenched in the pandemic, with new variants emerging, the latest being Omicron.

I have stopped working at the other residential facility and solely work at this one, a 13-bed house for women who experience serious mental illness. The work here is far more therapeutically-engaging, with three evidence-based groups and two check-ins with mental health practitioners per day. It is a step-down from crisis centers and inpatient, a step up from my previous job. When I show up to work here, I am deeply engaged; running to get towels, serving and cleaning up from dinner, doing check-ins with clients, performing documentation, and leading groups. I have seen dozens of clients in the past nine months, some staying for a few days and some staying for months. Certain ones stand out to me, from a mom who left staff beautifully-painted watercolor flowers upon discharge to the woman who had to be hospitalized due to electrolyte imbalance from binging and purging near-constantly for weeks on end. I feel connected to the clients through a thread of empathy, gratitude and compassion and positive regard. It is not easy to share one’s story, especially when it’s been woven by trauma. At times I worry that I am too emotionally attached, and yet, I can’t imagine distancing myself more. There are some of my coworkers who excel at leaving work at work, and yet, some of the clients feel like they are no more than a box to be checked and a signature to be used for paperwork. Is there a right answer in all this?

(If I pause for a moment, I can still hear the thunk of a client’s forehead hitting the wall, self-harming over and over so desperately. I called the clinical on-call, and the supervisor asked if there was blood. When I said that there wasn't, she said to continue to monitor.)

What does it mean to be an actor in the circumstances where I used to be a patient, the one with power to perpetuate harm and impact further treatment? I’ve been reading more and more about the carceral nature of psychiatry, how coercive our practices and the history of the discipline is. The other day, one of my coworkers said that she “doesn’t allow” a client to miss scheduled meetings with her, especially when important paperwork is due. The basil and rosemary are long gone now, their leaves faded and frozen from the cold. Still, I keep their pots outside, a memento, reminding me to return.

About the author

Katia Kozachok's currently works as a psychology research assistant in Pittsburgh, and hopes to go onto further graduate study. When not reading or writing, she loves hiking, baking, and wandering around the city.

about the artist

Beth Horton holds a degree in creative arts therapy and majored in health science at Niagara University, located in Lewiston, New York. Her love for art began as a small child, watching her father paint into the wee hours of the morning. In addition to abstract art, Beth enjoys sketching and mixed media composition. Her work has appeared in several publications, including: About Place Journal, Aji Magazine, and Olit.