Earlier today, a depressed friend and I were trying to make each other say nice things about ourselves. The conversation quickly took on the tone of a Mexican standoff: 

This made me think: why does self-compassion feel so fingernails-on-a-chalkboard awful? I have no idea. It does remind me, however, of my experience of going to the emergency room earlier this summer. It went something like this: 

I arrived with a friend. We'd gone to dinner together that night, and after a few drinks and crying and talking about how much I hated myself, I admitted, "I think maybe I should go to the hospital." So my friend took me to the hospital, which was good, because my follow-through with most plans was, at this point, poor.

At the hospital, my friend and I went to the front desk, where they asked me what brought me in. I struggled for a few moments to find a polite way to explain; fortunately, my friend intervened and did the explaining for me. A nurse immediately swooped in and whisked me away to a back room, where they gave me a hospital gown, locked away all my clothes and possessions, and brought me to the Safe Room. 

The Safe Room was a room with three armed security guards and about a dozen hospital beds arranged in a circle. In each of the beds in the Safe Room was a patient struggling to sleep through the seven to eight hours that it would take to see a doctor for a psychiatric evaluation. This was fine with me: my plan was to sleep for eight hours and then wake up entirely cured, at which point I would calmly explain to the attending physician that I was perfectly normal. Then she would say “Of course you are!” and I’d be discharged. I felt confident my plan would go without a hitch. 

Unfortunately for me, and for everyone else trying to sleep in the Safe Room that night, three of our immediate neighbors had other plans. These were the Devil man, the Praying man, and the Man with Incurable Constipation. 

The Devil man was convinced that the Devil was going to possess him at exactly 4 AM that night. Every fifteen minutes, he would get up from his bed and go to the front nursing station (which was not allowed; you were supposed to remain in your bed unless given explicit permission to do otherwise by a guard). There, he would explain with terror in his voice the oncoming arrival of the Devil, and beg to be allowed to see the hospital chaplain, while the nurses and the security guards shouted him down until he returned to his bed. With a touching gentleness, he would apologize to them profusely and lie back down, chastened. He would remain there for exactly fifteen minutes, at which point he would do the whole routine over again.

The Praying man was more sedentary, but was also much louder, as he was continuously reciting the Islamic morning prayer at the top of his lungs. But he had a very lovely voice. 

But the strangest case in the whole Safe Room had to be the Man with Incurable Constipation. This was a man who had been admitted to the Safe Room against his will. He did not believe he needed a psych evaluation. He simply had, as he explained insistently over and over again, a blockage that had prevented him from emptying his bowels for weeks. The nurse explained to him that he had had an exam a few hours ago, and that there had been nothing there. Nevertheless, he refused to leave the hospital. In response, he was sent to the Safe Room until he could be evaluated. 

When a doctor finally came to speak to the Man with Incurable Constipation, it was 5:30 in the morning. The Devil Man and the Praying Man had been seen, referred to other institutions. I myself had been seen at this point by a very kind young resident. When I had explained to him that I was perfectly fine now and could be safely sent home, the resident tactfully told me that he would prefer to voluntarily admit me to the hospital, as he was not confident that I would not feel bad again very soon. I had not thought of this, I admitted. He handed me the admission paperwork. I later read this doctor's notes in my chart: 

"Patient's judgment poor, but help-seeking behavior. Malodorous." 

Malodorous?! I had only been stress-sweating in a hospital bed for eight hours, three feet away from a man ranting ceaselessly about his intestinal blockage.

The Man With Incurable Constipation was seen immediately after me, by the same resident. "Why am I seeing this man?" the resident asked the entire room, a note of despair in his voice. But the resident gently calmed the Man down, listened to him, and persuaded him to go home for now. The Man finally agreed to go.

Back to self-compassion. 

It was only as I was leaving the Safe Room to be taken upstairs that I fully understood my situation. I was fine, I had thought. I didn't really need to be there, with the Devil Man and the Praying Man. It wasn't as if I was a danger to anyone. Why did I need to be in a room with security guards? 

It was only as I was pushed upstairs in a wheelchair, attended by another security guard, and brought to the psych unit, that I understood: I had confessed to planning a murder. A murder of myself — but that counted.

When you've stopped thinking of yourself as a full person, you're able to speak to yourself in the worst, most demeaning ways, and to consider doing the most terrible things to yourself. I think this is why self-compassion is both so difficult and so necessary. It can feel so painful to admit, yes: I am also just a human — not a devil or a god. And just like I would at least try to treat any other human with kindness, I have to do that with myself, too.