Bri Whitbread first landed in the hospital at age 14. She hadn’t eaten in days. Her blood pressure and heart rate levels were plummeting, putting her at risk for heart failure.
It was the first episode in a struggle that would ricochet Bri from one inpatient psych unit to another for more than four years.
Her volatile combination of eating disorders and self-harm was, for many facilities, untreatable. Facilities for eating disorders couldn’t cope with her self-harm, and facilities that could weren’t set up for eating disorders. Meanwhile, insurance balked at the cost of long-term inpatient care. A cascade of inpatient stints created a pattern of stabilization and discharge that, far from breaking Bri’s self-destructive pattern, reinforced it.
A cycle of institutions
“She felt rejected,” says Gautam Rajendran, MD, child and adolescent psychiatrist at Children’s Hospital Colorado. “She spent so much time at all these different facilities that she couldn’t establish trust with any long-term provider.”
By the time Bri ended up at Children’s Colorado, she was nearly 18 years old. She’d spent most of her teens in institutions. The longest period she’d spent at home was two and a half weeks.
“I assumed they were going to give up on me,” Bri recalls. “I assumed they’d just try to get me out of there ASAP. I didn’t want to open up, because I thought if I opened up, they’d let me go like the other places had.”
As a result, she rejected treatment. Near-constant institutionalization had left Bri wary of well-meaning but empty attempts to help. She refused to eat, drink or take meds. As a way of numbing her emotional pain, she physically hurt herself with any object or sharp edge she could get, and ripped out the feeding tubes staff placed to get her food and fluids.
To protect her, staff monitored her every movement — in her room, in the hallways, even in the bathroom. Staff checked every item she picked up and sat next to her in groups. Bri avoided what she didn’t want to deal with by shutting down and refusing to talk, but her therapists refused to give up.
Chipping away at the resistance
“We just kept coming back, consistently, every day,” says Amy, Bri’s primary therapist. “It was a couple of months before she was like, ‘Okay, these two are not going away.’”
It wasn’t an easy process. Over months, Amy and Dr. Rajendran chipped away at the resistance. Because Bri flatly rejected encouragement or praise, staff would go into her room during the night and write encouraging phrases with dry-erase markers on her window, so she’d wake up to them. Amy insisted she hear it from her family, too.
“We weren’t ever allowed to say anything nice,” says Carrie Whitbread, Bri’s mom. “Amy wouldn’t let her get away with that. She’d go, ‘Well alright, we can all just sit here until you’re ready.’”
As Bri was able to take more responsibility for her own health and safety, Dr. Rajendran and Amy worked with Bri to give her more freedom to make her own decisions: what she wanted to eat, where she wanted to go, what groups she wanted to attend. Bri sometimes struggled. The process was often two steps forward, one step back.
But slowly, surely, Bri took more control over her life within the hospital. And as she did, Dr. Rajendran and Amy helped her look forward to the day she’d leave. For the first time in her life, Bri started thinking about the future, maybe even college.
Six days after her 18th birthday, Bri left the unit for good.
“Bri saved her own life”
Bri credits Amy and Dr. Rajendran for saving her life. “I told them things,” she says, “I couldn’t imagine ever telling anyone.”
“To me,” says Amy, “Bri saved her own life. I just supported her along the way. She did the work.”
Seven months later, Bri is still doing the work. When she feels depressed, anxious or like she wants to hurt herself, she tells someone. She talks about it and gets the support she needs. She started a body-image blog, which has picked up followers as far off as Germany. She got her GED and is going to school to become a psychiatric nurse. She wants to pay it forward.
And she keeps in touch. She brought a gift basket to the unit over Christmas. Dr. Rajendran got a mug.
“I had it made for him,” Bri explains. “It says, ‘How many psychiatrists does it take to change a light bulb? Only one, but it really has to want to change.’”
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