Self-care in the psych ward

Beauty routines can be important when you are struggling with a mental health crisis.

Self-care in the psych ward

Beauty routines can be important when you are struggling with a mental health crisis.

“Don’t worry,” the psych-ward tech told me after snapping a photo for my file. “We won’t post it on Facebook.”

I was so far gone at that point that I actually forced a trembling smile at his tasteless joke. But the face in that photo — a copy of which was taped to my bedroom door for the duration of my five-day stay at Oceans Behavioral Hospital in Broussard, Louisiana — and the one staring back at me in the bathroom mirror was horrifying. It was mine, I knew that, but I barely recognized it. The eyes behind the Selima Optique glasses were frantic, the hair dull and coarse, the lips drained of color.

Prior to my slide into debilitating depression, I took pleasure in getting ready each day. The satisfaction I derived from it wasn’t just the result of lipstick giving focus to my face and giving it color; or from how smooth my hair was after I passed the flat-iron through it. The routines had the weight of ritual for me: uncapping a tube of lipstick and swiveling up the stick of pigmented wax; separating my hair into sections and then drawing the hot flat iron slowly through each one, curling up or under at the ends depending on which direction I wanted them to go.

These were small things, of course, no matter how much power I invested them with, and hardly enough to save me. But they did provide some connection to normalcy, to the self I had been before I bottomed out, the one to whom I desperately hoped to return. After all, it helps to know what that person looks like.

Take a shower. Wash your hair. Brush your teeth. Trim your nails. Almost every individual living with mental illness has heard this litany of commands, whether from loved ones, therapists, psychiatrists, apps made specifically to remind you, or the parts of ourselves that still cling to sanity. Basic hygiene is often abandoned when a mental-health condition begins to manifest itself or grow more extreme. When my depression was at its worst, the effort to accomplish the most ordinary task was herculean, exhausting — even drawing breath was excruciating. What was the point of grooming myself when everything was pointless?

As unlikely a marker of mental health as putting on makeup might seem, when a regular routine happens less and less frequently and is then discontinued altogether, it can be an indication that there is something wrong. Similarly, reintegrating those routines can be a way of uncovering the markers and, however slowly, finding your way back to yourself.

“Self-care” has become a buzzword hollowed out by corporate marketing departments and Instagram influencers, but it can still be a vitally important concept for those of us who become incapable of properly caring for ourselves from time to time. Beyond good hygiene, things like getting enough sleep, eating healthfully, and exercising have been joined by journaling, paying attention to emotions, and learning how to respond rather than react; all of these were emphasized or at least touched upon at the facilities where I was an inpatient and an outpatient. But while self-care is touted in therapeutic settings, the institutions meant to assist patients can present additional obstacles to wellness.

For the five days I was an inpatient, I had no access to cotton swabs, dental floss, my name-brand toothpaste, facial cleanser, and moisturizer, or the tube of lipstick that I always carried with me. I was unable to clean my ears, shave my legs or armpits, or pluck out the offending hairs that sprouted between my eyebrows and on my chin.

The restrictions, and there are many, on what items mental health patients are allowed access to at most hospitals are designed to keep patients from inflicting harm to themselves or to others and to protect the facilities from lawsuits. “Sharps” — e.g., razors, tweezers, nail clippers — or devices with electrical cords — hair dryers, curling irons, flat irons — could be (and have been) used as weapons. Dental floss is prohibited because the small metal lip used to segment off a piece of floss could also be used to slice through flesh and veins.

As an inpatient at the National Institute of Mental Health (NIMH), in Bethesda, Maryland, where I participated in a clinical research study on major depression, I had considerably more freedom than I did as an inpatient at the for-profit facility in Louisiana, where I had, well, no freedom. But restrictions still existed, and they still chafed.

I was allowed to keep cosmetics and personal care products (shampoo, toothpaste, facial cleanser, body lotion, cosmetics) in my room, but my flat iron, razor, tweezers, and nail clippers were kept at the nurses’ station. I was able to sign them out and use them in the privacy of the small bathroom off my room, but I always felt hurried; the routines became procedures to be accomplished as quickly as possible, before a nurse knocked on the bathroom door to make sure I hadn’t harmed myself.

While self-care is touted in therapeutic settings, the institutions meant to assist patients can present additional obstacles to wellness.

Similarly, a fellow inpatient at NIMH I’ll call Keith had to check out his shaving cream and electric razor every time he wanted to use them. He describes self-care, including grooming, as being “extremely important” to his mental health. “The electrical cord restriction didn’t make a lot of sense,” Keith told me, “since I was permitted to keep belts in my room.”

Most of the nurses at NIMH understood patients’ frustrations and sympathized with us, but there were no exceptions to be made, regardless of how high-functioning a patient might be. As a federally funded research institution, regular reviews of the clinical center and its wards were conducted by an internal oversight committee. In contrast, oversight of for-profit and state mental health facilities often varies greatly from state to state.

How stringently restrictions are enforced also varies across — and even within — facilities. Sometimes the decision about what’s safe and what’s a potential threat seems arbitrary, determined by the nurse on duty rather than institutional policy. For example, another NIMH patient, whom I’ll call Beth, asked a nurse on the evening shift if she could take several pieces of dental floss at one time so she wouldn’t have to keep requesting access to it night after night. The nurse told her no. But what threat to self would the pieces of floss have presented? Beth was more at risk of gum disease without the floss than of self-harm.

It can be difficult to explain to someone who has never experienced a mental health crisis why anyone struggling with their sanity would care about lipstick. Beauty routines have long been considered frivolous, or vain, and while those conceptions may be changing, they are still regarded as at best an unnecessary distraction from the hard work of getting better. But beauty routines are important to many people, and the need for them doesn’t disappear when an individual is struggling with mental health issues.

Responding to a question I posted on a Makeupalley message board about the role beauty routines had served for members who suffered from severe depression, a user named Inezdelafressange described how women at the hospital where she had been a patient “poured hot water over colored pencils to make eyeliner. I had a scented hand cream that we all used as perfume.” “I like the process of putting my makeup on,” another member, BigSwingingOvaries, wrote. “It’s soothing.”

For the writer and mental health advocate Rebecca Chamaa, who writes about living with chronic paranoid schizophrenia, makeup makes her “feel more presentable,” she told me. “[I]t is significant for someone with mental illness to be perceived as put-together, as attractive. I’m starting at a very low baseline with most people [who are] meeting me, so I need every ounce of confidence that I can [get].”

It’s not only those of us living with mental illness who recognize the power of primping. Mental health professionals have begun acknowledging the positive role beauty and grooming routines can have for some patients. For someone with depression, “if doing your skin care routine is one thing that makes you feel … like you’re being a little productive and you’re getting out of bed because of it … I think that’s excellent,” Matt Traube, a California-based psychotherapist who specializes in skin conditions, told me. But, Traube cautioned, such routines can be detrimental. “For people with skin issues,” he said, “[we don’t want] to validate that it’s totally fine to check your skin and do your whole beauty routine 20 times a day, because that’s what … prevents them from focusing on other meaningful things.”

Despite the stringent regulations and policies of what a patient can have access to at a psychiatric facility, almost any object, no matter how commonplace and innocuous-seeming, can ultimately be a potential weapon. While I was at NIMH, another inpatient used a plastic utensil to harm herself. After that incident, patients had to sign out a packet of utensils at every meal and then throw it away in the presence of a nurse. (Some friends sent me a bagful of wooden chopsticks, which I used to eat most of my meals with for the remaining three months I was an inpatient. Soup, oatmeal, and cereal proved particularly challenging.)

Does limiting access to the personal-care products and devices that provide a measure of comfort and stability during a grueling experience prevent self-harm from taking place? Perhaps. But we also must think about the harm being done by overcontrolled access to such tools. As with most issues involving mental health, there’s no perfect solution. But taking into consideration the value of self-care would be a start.

It took more than a year before I once again felt pleasure in applying lipstick and flat-ironing my hair. But no matter how pointless it felt, I doggedly — almost grimly — continued to do both. My appearance often felt like a barely adequate facade, but constructing it on a daily basis allowed for the possibility that I could eventually rebuild myself. And when enjoyment finally began to return, I wasn’t about to jettison the tools that had helped with the reconstruction. As Chamaa put it, “If you use makeup and it’s part of feeling your best, then not having it takes away from feeling your best.”

Heather L. Hughes is a freelance writer based in Tucson, Arizona. Her work has appeared on Ozy, The Establishment, and Salon, among others. For more, visit https://heatherlhughes.com.