Another Kind of Madness

by Stephen Hinshaw

  As so often happens with even the best-intentioned reforms, these retreats became ever larger and more medicalized. As the nineteenth century progressed, with the full onset of the Industrial Revolution, state legislatures aimed for cost savings and protection of the general public by re-creating huge institutions, usually far from urban centers, under the supposed edict of moral treatment. In the aftermath of the Civil War, such massive public facilities came to dominate treatment for severe mental illness. Dad experienced the full horror of the “care” they offered. Although he’d been raised in a middle-class, Prohibition home and attained the status of professor, involuntary mental hospitalization knew no class distinctions. Brutality was widespread.

  By the 1970s, deinstitutionalization had finally led to the closing of nearly all public mental facilities, to promote community care and humanization. Who could argue with such a trend? Yet these community-based alternatives were never funded adequately. Indeed, many contend that deinstitutionalization was actually reinstitutionalization, as huge numbers of people with mental illness began to flounder in jails and prisons or in poorly staffed, isolated, urban “community” centers. In addition, too many of today’s homeless population have chronic forms of mental disorder, fueling fears of contagion—as though a serious mental disorder can be transmitted by close personal contact—and promoting the view that everyone with mental illness is incompetent and potentially exploitable.

  What about deeper currents regarding attitudes toward mental illness? One view is that when people encounter individuals who struggle to maintain psychological balance, their own stability is threatened. When reminded of the fragility of life, or of their own imperfect self-control, many observers try to keep the source at arm’s length. Even more, illnesses enshrouded in mystery, like cancer several generations ago or leprosy before its bacterial origins were uncovered, become highly feared and stigmatized. Today, breast cancer is a “cause,” the subject of huge fundraising campaigns. Leper colonies are a thing of the past, as people with Hansen’s disease receive state-of-the-art antibiotics. Yet mental illnesses—still viewed as the result of irrationality, weak personal will, unpredictability, or maladaptive parenting—receive contempt and outrage rather than compassion. As noted by Princeton social neuroscientist Susan Fiske, those with mental disorders are typically viewed as the “lowest of the low,” perceived to be deficient in both warmth and competence.

  Little wonder that teaching factual information about mental illness may actually increase social distance. “Facts” promote stereotypes, while the information that needs to be conveyed is the great potential for coping and recovery if treatment is made available. Emphasizing the fundamental humanity of those affected must be the main objective of any outreach. With greater openness and discussion, mental illness can take its rightful place on the national agenda. With access to effective treatment, people within the entire range of mental disorders can thrive. Still, the road ahead is long and steep.

  *

  By the end of the fifties, Mom had reached a crossroads. When Dad would return from an episode, she’d know nothing of the details. What if he didn’t come back next time? Where would the family go, whatever was left of it? Once she and I began speaking in earnest, Mom told me that Dad had divulged very little about his past during their courtship, saying only that he’d had “some trouble” back in high school and at Princeton. This phrase was the sum total of what she knew. “Steve, no one ever talked about mental illness back then,” she said. The stigma was supreme.

  After they were married, the truth became clear, especially when Mom became pregnant with me and then with Sally. Each time, before her eyes, he escalated into full-blown mania. It’s well known that women with histories of mood disorder show high risk for postpartum depression. In fact, this diagnosis is now recognized as a key public health problem. Far less understood, however, is that men with genetic risk for bipolar disorder often become symptomatic when their partners become pregnant. Obviously, a direct hormonal link does not exist here, the way it does for postpartum depression in women. Is the lack of sleep a trigger—or perhaps an existential fear related to bringing a child into the world after experiencing years of cyclic madness?

  By my after-the-fact count, Mom experienced at least six of Dad’s episodes during the first ten years of their marriage. Each time, her fear grew. At the end of the decade she took stock of the situation and scheduled a meeting with a lawyer. Although keeping it private, she wished to explore the possibility of divorce, in case Dad never returned or became too debilitated. She was also making plans to return to graduate school and find a job, in case her income would become the sole support for the family.

  “This was a high-priced attorney,” she told me. Yet when she got to the well-appointed office near downtown Columbus, she froze. She’d planned out just what to say, but once her hour began she could hardly speak. She knew that the talk was confidential because of attorney-client privilege but still couldn’t describe the actual problem: her husband’s periodic plunges into serious mental illness. Instead she spoke in vague, general terms about the potential for separation.

  “The attorney must have wondered what was wrong with me, fumbling around as I did,” she said. “I’d wasted the appointment.” She summed up by telling me that back then, mental illness was off limits. Her bitterness permeated each word. It’s hard to think of a clearer example of stigma.

  Over the ensuing months, as the fifties wound down, Dad stabilized once again. Mom and he contracted with an architect to design a new house, and Mom gradually let go of her silent idea of the need to separate. The new home was a vote, made from blind faith, for the family’s continuation.

  When I was in second grade we sometimes drove to the building site. Nearby, like a giant spaceship, its spindly legs holding a vast mother ship to earth, a huge cylindrical water tower loomed over the farmland. Pretending to be explorers, Sally and I walked on top of the house’s foundation, crossing through the wood-framed doorways and skeletal walls.

  Heading back to Wyandotte Road in the car, we saw strings of colored lights next to the vast parking area for the new shopping center near the water tower. “Can we see, Daddy?” we cried out in unison. As he turned the car around, we made out silhouettes of carnival rides and begged to go. The makeshift fair smelled of dust, metal, sweat, and the gasoline that powered the rides. Like pink and purple glue, cotton candy stuck to our hands as the rides twirled and spun.

  In mid-summer, the enormous van arrived, men packing up everything. Our new house on Kirkley Road was a split level, fresh white paint against the jet-black driveway. Inside was Dad’s new study, which he’d asked the architect to design, with golden-hued shelves built right into the walls. Our new high school was to be constructed on the large city block right behind our own.

  But just before school started, I noticed that Dad was missing once more. I calculated that he’d be back in a couple of months, like last time. But I had no real idea, only hope. Third grade began at my new school, and I came home each day vaguely wondering about him. Yet no phone call ever arrived, no letter. Dad had entered a void.

  Ever so slowly, my world began to cave in. It was a fight to keep up my morale.

  Maybe I’d done something to make Dad disappear yet again, but what? As the weeks wore on, I needed some answers. I had to figure out how to ask Mom.

  Looking for the right moment, I braced myself.

  4

  The View from Right Field

  After Mom said good night, I tried to lie still on the top bunk in my new bedroom. Shutting my eyes as tight as I could, I hoped in vain that sleep would overtake me. Dad stayed missing that entire school year, and all my thinking made it impossible to relax.

  Somewhere in the hazy territory between wakefulness and drowsiness, I saw something in the distance, as if projected on the bedroom’s far wall. I couldn’t make it out at first but it soon came into focus: a large silver machine hovering in the air, whirring so
ftly. From an opening at its front, white ribbon slowly spilled out. Folding over on itself, the ribbon floated through the air. As it wafted downward, its folds and loops revealed shadows underneath. Always at the same steady pace, the ribbon continued to emerge, filling in the space in front of me. It was the ribbon of time, eternal time.

  It never stopped.

  Dad had told me about infinity, which is more, he said, than googol, more than googolplex. “It’s not even a number,” he told me; “it’s a concept beyond numbers.” Was the universe infinite? Or infinitely finite? My mind reeled as he raised the questions.

  But eternity was far more frightening. I thought about time constantly: How little there was to get everything done, how slowly it passed when I thought of my questions that never got answered. Yet if time never stopped, what did anything mean? Fractions no longer made any sense. What did it mean to travel a third of the way somewhere, a tenth, even a hundredth? If time is eternal, you can never get closer to the end. However far you might go, exactly that much more ribbon keeps pouring out, so you’re just where you started. With eternity, there’s no progress, only another day’s futile attempt to get somewhere. Nothing had any meaning against the eternity of time.

  Finally I began to drift off. At school, I’d once thrilled whenever my teacher returned another test or assignment. But now, as each day wore on, it felt as though a gauze bandage was wrapping itself around me, insulating me from the world.

  Some nights, my head filled with thoughts I couldn’t stop, especially swear words like God damn and hell. A little song repeated itself: darn damn God, darn damn God. No matter how hard I tried, the words kept coming. What would happen if God heard these awful words?

  Lying there, trying to calm myself down, I started to wonder whether I’d peed enough. If I tried one more time, squeezing out those last drops, maybe I could finally relax and fall asleep. I hauled myself up from my bunk bed, climbed down the ladder, and walked across the hallway to our bathroom, with its double sinks and aquamarine tile floor. Straining, I made a trickle into the toilet and marched back to bed. But within a few minutes I started wondering whether there might still be a little left, starting the whole process once more. What I didn’t know is that giving in to ruminative thoughts by performing compulsions—peeing to stop the fear that I’d not cleared my system—provides only fleeting relief. In an endless cycle, the obsessive thoughts roar back, ever stronger.

  I couldn’t tell Mom how upset I was because she’d get that look on her face letting me know that she couldn’t bear to see me unhappy. I’d never been lonelier in my life. I sometimes felt like smashing things. Didn’t anyone know how hard I was trying? All the pretending was getting harder every day. I finally made up my mind that I just had to find out something about Dad.

  During the fall, Mom sat at the kitchen table on a bright afternoon. The sliding glass door overlooked the back yard, revealing our skeletal new trees and the squares of sod that were gradually turning yellow-brown. The house was deathly still. Hesitating, I forced myself to walk toward her.

  “Yes, Stevie,” she said, looking at me, “what is it?”

  It was now or never. I took a large swallow of air. “Mom, I have a question. Where’s Dad?”

  Her smile quickly faded. She didn’t seem angry but her look was plenty serious all the same. Moments ticked by. In her clearest voice she finally spoke up. “Your father is resting in California. We don’t know when he’ll be back.” She held my gaze. “It’s best,” she concluded, “if you ask no more questions.”

  I replayed her words in my mind and managed a choked reply. “He’s resting?”

  She nodded. That was it. Head down, I walked slowly back upstairs.

  I pictured Dad taking lots of naps, keeping his mind fresh for all the books he read and all the ideas he had. I tried to be happy that he was resting, but where in California was he, exactly? Why didn’t we ever hear from him? That evening in bed, the ribbon of time once more unfurled from the machine, softly folding on itself, its flow never ending.

  Our third-grade teacher, Miss Searler, told us at the beginning of the school year that this was her first year of teaching. Young, with wide eyes, she had a round face and an eager look that made me want to answer all her questions. After the final bell one afternoon, the kids whooping as they departed, Miss Searler asked me to stay. The empty desks formed straight rows, workbooks lining the shelves. High up was the American flag and beneath it those forest-green vinyl strips featuring print and cursive letters of the alphabet written neatly on them. Handwriting was my worst subject. I bore down hard, really hard, almost snapping the pencil lead as I wrote or drew. Even now, I can still see the ultra-dark letters and words I formed on the lined paper, graphite thick on the page. I can still feel it today, the stab of pain inside my right shoulder blade from all that bearing down, the muscles and tendons permanently knotted.

  The afternoon sun shone obliquely through the high window as Miss Searler looked toward me, all the hope in the world on her face. “Steve, I have a question for you.”

  “OK,” I replied, hoping this wouldn’t take long so I could get outside.

  “Where’s your dad? We haven’t seen him around.”

  For a few seconds I stopped breathing. Did she know something? Or was she just curious? Those big eyes of hers: She really wanted an answer. I suddenly remembered that back-to-school night had been the week before, so maybe she was just wondering why he hadn’t been there. Nearly all my classmates had two parents attending.

  I swallowed. “Miss Searler, my dad’s in California,” I said, trying to sound assured. “He’s resting there.”

  As she pondered what I’d just said, she still smiled but the look in her eyes shifted. Squinting, she tilted her head slightly to the right, her bottom lip starting to push up against her top lip. “Really?” she asked, trying to keep her voice bright, but it was hard with her mouth at this new angle.

  “Yeah, that’s what my mom says.”

  “All right,” she replied. “But does anyone know when he’ll be back?”

  I thought but no answer appeared. “I don’t know,” I said softly.

  After an awkward silence, Miss Searler asked about something else, maybe an assignment. I answered woodenly, said good-bye, and walked down the stairs to the playground. For a long while afterward I thought of her expression. That shift in her eyes, the slight tilting of her mouth when her face went from hopeful to doubtful.

  I finally told Mom about needing to go to the bathroom each night, as she’d been wondering why I was going back and forth across the hall so much. With a worried look she called our pediatrician and made an appointment with a specialist.

  A week later we drove to the offices near downtown. The nurse asked me to put on a pale-green gown. Inside the changing room I took off most of my clothes and put my arms through the thin straps. “No, little boy,” she said when I came out. “It goes the other way. What seems like the back is actually the front. I can help you tie it when you’re ready.” Trying not to feel stupid, I finally got it right but felt really skinny in the gown.

  I swallowed some chalky liquid from a paper cup and lay down on a table, with a huge, pale-green x-ray machine looming above. I got moved around after every few pictures, for shots from different angles. I held my breath to make sure the pictures didn’t blur. Finally finished, I got dressed again.

  From the car’s back seat during the drive home, I couldn’t think of anything to say to Mom. I looked out at North High Street and the low-slung brick buildings under the slate-gray sky before we turned left, driving past the OSU football stadium toward our house. Next to me I could almost feel those poison balloons hovering, the lethal gas inside pressing for release.

  A few days later Mom said that the new doctor had called to say that the x-rays hadn’t shown anything. She looked puzzled, but I wasn’t surprised at all. I’d known that the problem was more in my mind than anywhere else in my body.

  Every few
weeks Sally and I spent the night at Grandmother’s house. It had long been our haven during those times when, far beyond our knowledge, things were unmanageable at home. Grandmother took us to movies—the Elvis movies she loved or, when she wanted to show us religion, The Ten Commandments, which I thought would never end. Religion was on Grandmother’s mind. In the small anteroom near her bedroom, she lectured to us after Bible readings. One afternoon she delivered her sternest lesson.

  “The Bible tells us that there are many things you can do and be forgiven,” she said. “But certain words are the worst. If you take the Lord’s name in vain, you will be eternally damned.” Suddenly frightened, Sally and I asked what that meant. “You will go to hell forever,” she replied with force. “The flames are hotter than anything on earth; the burning would hurt more than you can ever imagine. You can do many things and be forgiven, but you can never take the Lord’s name in vain.”

  Stunned, I couldn’t believe it. With those chants and songs I said to myself in bed each night, each one damning God, I was going to end up in hell for eternity. Although I tried not to let my horror show, I was in supreme agony.

  The next time Sally and I went to Grandmother’s house, I put my plan into action. Making sure they were busy in the kitchen, I tiptoed upstairs to the anteroom, which looked out over the back yard and the alley beyond. I might lie up there near the radiator if I’d had too much to eat for Thanksgiving or Christmas Eve dinners, but there was no time to rest today. Getting up my courage, I walked straight into Grandmother’s bedroom, finding her Bible with its pebbled, soft-black cover and onionskin pages, lying on the stand near her bed. Sitting at her desk, which smelled of hairbrush and perfume, I looked for the part in the Old Testament about taking the Lord’s name in vain. To my amazement I found the passage within a few minutes. My world reeled. Right there, the Bible stated exactly what Grandmother had said, that taking the Lord’s name was unforgivable. I stared blankly. My only hope was to try even harder in school and at home, which might count for something in the final reckoning. But what good would that do? My fate was sealed.