Black Girl Inside Outpatient

Photo of a white paper and a black pen lying on top of it

The seven of you are planets which happen to occupy the same galaxy. They don’t do introductions. They barely do eye contact. The guy on your right bounces his knees so rapidly it makes his chair squeal, the pitch yoyoing up and down like a teeter-totter. He keeps his hood up, shrouding his face even though it’s 8:00 a.m. and the middle of August and you’re indoors. Across from you, a grey-haired woman in a lavish fur coat lets her head loll back like she’s going to sleep. The blond girl on your left furls her long limbs awkwardly inward toward her chest. She wraps her pointer finger and her thumb around her bony wrist like a bracelet; there’s plenty of space to spare.

Out of the group room window, you watch the patrons loitering by the entrance to the 7/11 on the other side of the street. Two men—one white, one Black—both with greying unruly beards, share a pack of cigarettes. You wonder if they’re friends.

The group therapist enters with a swift and empty, “good morning.” He offers you a silver pen with the treatment center logo on it, a welcome gift of the saddest sort. You click it once. Then three more times. And then four more times after that, which is when your blood finally stops fizzing beneath your skin like a dropped soda can.

“Lena, let’s start with you today. How are you doing?”

The girl beside you sighs before gathering her curtain of hair loosely at the temples and pushing it all straight back. You’d guess she’s around nineteen, with life already swirling around her like flushed toilet water.

In a tone flatter than Kansas, Lena replies, “I’m doing amazing, Gregg.”


No phones out—in orientation they informed you that electronics were to be kept in your locker during program hours.

Your “independent work space” is the size of a single person restroom. The beige walls are adorned with inspirational posters about how “the journey is more important than the destination,” and whatnot. On the desk, you’ve got a stopwatch and a stress ball at your disposal. You count the number of ceiling tiles while you wait. Twenty-seven. Odd: already a bad sign.

There’s a knock on your door and a Black woman enters. She introduces herself as Dr. Hinsdale but says you should feel free to call her Margaux, “if you’d like.” As she pushes one of her twists behind her ear, your first thought is that now you’re going to agonize over how to refer to her. Your second thought is that she’s too pretty for a place so drab; her skin is too clear, like she’s going to film a Proactiv commercial after this. Your third thought is the epiphany that you’ve never, in all of your twenty-six years of life, had a doctor who looks like you. As a matter of fact, she’s the only person of color you’ve seen since you got here.

Dr. Hinsdale/Margaux flips over a fresh page in her legal pad, clicking her own silver “welcome” pen as she settles into the swivel chair across from you. The engagement ring on her left hand catches the overhead light, and you imagine the fiancé she goes home to every night. He’s white, maybe, with a goatee and those round glasses with the clear frames, the kind of guy who wears cardigans and reads for fun. You picture the two of them drinking Chianti on opposite sides of a luxurious couch at the end of a hard day, laughing about the crackpots she encounters at her job.

Dr. Hinsdale/Margaux asks you to tell her a little about yourself, about what brought you to their program. You repeat what you told the charming bald man who did your intake interview: “I was referred here by a coworker. They thought it would be good for me to take some time off.”

Dr. Hinsdale/Margaux nods and must call bullshit in her head because she follows up with, “and that’s all?”

You know she knows that by “your coworker,” you really mean Annie, the head of HR, who assured you during the last meeting, the one where it was strongly recommended that you take some time off, that “there’s no shame in the occasional breakdown.”

But you also know that it’s important to test people’s limits early on, to know how much runway you’ve got before imminent takeoff.

“Pretty much,” you answer.

Dr. Hinsdale/Margaux smiles: warmly, easily, genuinely—and you hate her for it.

“Let’s get started, then.”


The program day ends with art therapy, where you’re reunited with the rest of the group. You’re greeted by a counselor named Jenny with an auburn pixie cut who says “like” a lot, either as a nervous tick or an attempt to be relatable. She sets out bins of crayons and markers and colored pencils, and tells you all to each draw your mental illness as a monster. You end up with a lopsided gremlin with glowing red eyes and thick, blue fur. You look over at Lena’s paper where she’s created a painfully accurate portrait of Jenny, from the abundance of freckles down to the ugly pink and purple sweater. When Jenny comes around to check on all of the work, her face contorts to a strained smile.

“Good job, Lena. Very creative.”

Lena beams.

You’re all dismissed for the day. No goodbyes are uttered; no sentiments exchanged.

You drive home, all the while thinking to yourself that these people may be crazy, but for you, this is eight weeks tops and then it’s back to the lab again. Back to Nate. Back to days of brainstorming social media strategy, rather than spending four hours a day in that humiliating pseudo-school for despondent basket-cases who never learned how to be a person.


After two weeks you start to work out diagnoses: Lena’s a ’rexie. Brendan’s got a cocktail of major depression and PTSD. Olive’s another OCD, but keeps it classic: contamination. She’s got a big thing with doorknobs, so you sometimes find her in the hallway outside the lobby, waiting for someone to let her in. You think the older woman might have social anxiety, but she never says anything so it’s hard to say. You get snippets of origin stories in group: Brendan hasn’t seen his kids since Christmas, and Olive can’t hold down a job because her ninety-minute showers are always making her late. The rhythm of the program becomes internalized: art therapy Mondays, ACT Tuesdays, CBT Wednesdays, ERP Thursdays, and reflection on Fridays.

During individual time, Dr. Hinsdale/Margaux doesn’t ask you about your childhood or your first heartbreak or your past traumas. Instead, she asks about your fears. And when you say that if you don’t check the lock sixteen times before bed, your roommates will meet a gruesome end via a violent home invader, she says “okay.” When you explain to her that upon closing your eyes, you frequently imagine accidentally defenestrating yourself, falling seven stories—bones shattering, organs popping like pus-filled pimples, blood pooling on the sidewalk outside your building, crisp and smooth as a rainy-day puddle—Dr. Hinsdale/Margaux says simply, “I understand.”


You don’t tell your friends; you sure as hell don’t tell your family. When they call, you lie so easily it feels like a first language. You assure your father that work is going so well, and promise your mother that you and Nate are still looking forward to visiting come December.

The way you see it, there’s no need to jumpstart the inevitable lecture about how you’re embarrassing yourself. About how these hippies are ripping off you and your insurance. About how you are a Strong Black Woman descended from Strong Black Women. About how this country was built on the bodies of your ancestors, the soil on which you stand watered with their sweat and tears. About how your grandfather spent so many hours bent over a conveyor belt that, when they buried him, his spine curved like a scythe in the casket. About how your grandmother heard so many slurs from the white women whose homes she cleaned and children she weaned, that she would recite them in her sleep when the nightmares got bad. About how you wear the strength of your ancestors like chainmail, and carry their aspirations alongside the oxygen in the veins of your forearms. About how things are better now than they have ever been, but the fight rages on and you have to be ready: eyes open, head cocked, fists clenched, guard up. About how, compared to kidnapping and cotton picking and sharecropping and lynching, you have nothing worth crying about.

During check-in on Friday, Gregg calls on Olive. She talks for a whole two minutes, her personal record, before Gregg finally realizes she’s just reciting lyrics from “She Will Be Loved.” He clenches his teeth before saying, “that’s enough.”

Here, there’s no rest for the weary and no punishment for the clinically imbalanced.


As an exposure exercise, Dr. Hinsdale/Margaux suggests you leave your house without checking the lock all the way (“Maybe only fifteen times today?”). On the first try, you become so convinced you’ve done something cataclysmically horrible that you sprint home. Your shoe catches on a crack in the sidewalk and you scrape your calf so bad that the surrounding skin flakes off in strips like a ripe onion. You end up keeled over your dining room table, paralyzed by heaving sobs that leave you equal parts parched and lightheaded. Your poor roommate, a barista you found on Craigslist, just wants some microwave popcorn when she finds you. You promise her you’re fine, you’re fine, really, this just happens sometimes, okay?

When you reveal these results to Dr. Hinsdale/Margaux, she tells you that you are bigger than your thoughts and smarter than your insecurities and kinder than the cruel images that bombard your sleep-addled brain late at night would have you think.

Of course, you don’t believe any of that. But you begin to imagine how nice it would be if you did.


It takes two days for you to notice that Olive has been discharged. According to Lena they don’t make a big deal about it in program.

“So many people end up readmitting, anyways,” she explains during check-in. “It’d be like throwing a Christmas wreath on the doorway to Hell. Festive, but useless.”

Still, you think to yourself, good on Olive for getting the fuck out of here. You hope she never comes back.

During CBT group, you’re given MCAT vocab words like “dissociation” and “depersonalizing” to describe the lovely ability you’ve mastered over the years in which one simply detaches their soul from their body like a child letting go of a helium balloon.

Of course, there’s still Newton’s third law to contend with. But that’s always been a “later” problem.


Dr. Hinsdale/Margaux asks you to make a list of everything you like about yourself. You come up with your height and the fact that you can whistle whole songs without getting out of breath. She asks you to dig deeper, and you shrug. “Maybe I’m just that shallow.” She asks if you’d be open to a family session, and you scoff before answering, “I’d prefer a lobotomy.” For once, she’s the one who shrugs.

“We don’t really condone those anymore.”


“These disorders are chronic and incurable, but they are also very treatable.”

Four weeks down. Monday. During art therapy, Jenny gives you all knock-off pipe-cleaners called “Bendy-Boos,” which are thicker and better coated so they aren’t sharp. You bet they were intended for toddlers, not mental hospitals, but so be it. You’ll make a bird today.

Jenny sets a pile of Bendy-Boos in front of everyone except you. She catches your gaze, dead-on, and hands you exactly thirteen of them. Your diaphragm drops out from your abdomen sending your lungs in a free-fall toward your stomach. The clock melts away; you’re trapped in a Dalí painting. Lena creates another likeness of Jenny. Today must be a Good Day for Brendan, because he’s got his hood down and appears to have made a fuzzy little spider.

The world has slipped off its axis and started spinning backwards, and no one’s noticed but you.

Jenny comes up behind you, precise and deliberate as a sniper with a mark. She asks, “Everything okay?”

In response, a missile detonates in your chest—obliterating your internal organs. You’ve dematerialized; you’re the dust on the rafters and the squeak of too-small sneakers on glossy tile.

Jenny suggests, “Let’s go outside.”

She thinks you’re delicate.

Your words evaporate before you can tell her that you’re just fine, that you’re Strong. You stumble after her, and the hallway is as welcoming as a grave. You grasp at the wall like it’s a life preserver in the middle of a tsunami. Your airways grow salty and dry in the midst of the gut punch that accompanies each tidal wave.

You’re so tired of treading water.

And then there is no water, only porous concrete. Stray crumbs and dirt roll beneath your heels. Every time you feel yourself slipping, a harsh breath rips you from your reverie. You follow her lead: in and out.

Too abruptly you are real again, dizzy and swaying like a drunk ballerina. The art therapy door is wide open. Other patients are watching. Gaping.

“I’m sorry. I’m sorry. I’m sor—”

Jenny cuts you off, “Count back from five.”

It’s an order. You obey.


Later when you apologize—arms crossed, eyes on the floor, embarrassment making your skin glow all over—Dr. Hinsdale/Margaux cautions against judgments.

“They’re a slippery slope to self-loathing.”

But, fuck, if you don’t love skiing.

Dr. Hinsdale/Margaux continues, “Panic attacks are very common.”

You flip your welcome pen over in your hands. You inadvertently click it once. Then you have to make it twice. Then you go twice more just to be safe.

“I know. I’ve read all the brochures.”

Your snark is undermined by the fact that you have to keep blinking your eyes dry. You can’t recall the last time you cried in front of your own mother, so you certainly won’t give Dr. Hinsdale/Margaux the satisfaction.

“You had a few at your job before your LOA.”

The highlights flash across the surface of your brain: a montage comprised of one freak out after another. “Sure.”

“Are you ashamed?”

Of course. Click. Click. Click. Click. “Not at all. They’re actually some of my proudest achievements.”

Dr. Hinsdale/Margaux grimaces. “Anyone ever tell you that you’re funny?”

Click. Click. “You’re the first.” Click. Click.

Dr. Hinsdale/Margaux nods before watching you maneuver the pen for a few seconds. Without meeting your eyes, she says, “My mom was disappointed when I got my doctorate. She said she wished I was becoming a real doctor like House, rather than a bullshit artist like Dr. Phil.”

“I don’t think you’re a bullshit artist.”

She shrugs. “Can’t say the same for you.”

Click. You want to tell her that you think she’s funny too. Click. Click. You don’t. Click.


At home, Nate finally texts you back to say he’s “glad you’re taking care of yourself” but that he needs “more time.”

You respond: “how much time?”

He texts: “goodnight,” and you marvel at the fact that he can manage to sound condescending even when you can’t hear him.

You stay up until two o’clock in the morning, purging your camera roll of blurry selfies, screenshotted SnapChats, and cute candids with playful scowls and shitty lighting. When you wake up, the first thing you do is move everything in your trash folder back over to the device. The AI mocks your lack of conviction: “Are you sure?”


At program, you know you’ve lost some street cred because Brandon, Lena, and even mousy Nancy from beneath her lace shawl dare to make eye contact with you during check-in.

Abruptly, Lena leans over and says, “Do you ever notice the guys out of the window? The ones at the 7/11?”

You crane your neck to see the same two men as always. The Black guy is keeled over laughing. You can’t tell if the cloud in front of his face is from smoke or his hot breath in the early fall cold snap.


Lena asks, “What do you think they talk about?”

You pause for a bit, like it’s your first time considering it.

“Politics? Religion? Gas prices? Why? What do you think they talk about?”

Lena smirks, her yellow overbite threatening to push in front of her purple-hued lips like a rotting jack-o’-lantern. “Probably the weirdos who are always staring at them from across the street.”

Gregg bursts through the door, frazzled but trying to seem upbeat. He pops a squat in the empty seat next to you before saying, “All set to start?”

You try to seem triumphant. “Gregg, honestly? I’m doing real bad.”


“Rough day already?” Dr. Hinsdale/Margaux asks when she enters your independent work space ten minutes later. You wonder what gave you away.

“They’re all rough. That’s the name of the game, isn’t it?”

“Mhmm,” she says. You anticipated more push-back.

You can’t recall when you got the pen out of your bag, but now it’s here, resting against your palm. Your thumbs hovers against the trigger: click, click, click—

Then Dr. Hinsdale/Margaux puts out her hand, palm facing skyward. Your own fingers curl around the cool metal, calling her bluff. Ink blots smear your index finger.

Her voice is low when she says, “I know. I know. Really. You’re told every day, in one form or another, that you have control. And therefore, you bear culpability for any lapses. And you start to think that if you are careful, if you stay strong, if you work twice as hard always and screw up never, then you can make it.” Her hand creeps closer, so that it hovers directly beneath your own. In response, you clench your fist. She continues, “Unlearning that shit is hard. Haven’t mastered it myself, but I think it begins with giving yourself room to put it down, to not have your war face on, your gas mask, your…Kevlar. Not all the time. Because armor gets heavy.”

Something dormant erupts as though it was waiting for permission. A molten river runs jagged through your abdomen. You realize all at once that despite your best efforts, you’ve grown to like group and respect Margaux and see the mess of weeds furled around your synapses, thriving on your peace of mind, as something real—maybe not blue and furry, but definitively monstrous. One day, you’d like to not have to look out the window in search of something lively. One day, you’d like to look inward and find a garden.

You surprise yourself when your grip loosens. Your chest opens. Your eyes water. The ancestors go quiet.

And you drop the pen.



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