Voluntary Madness

by Norah Vincent

  In short, voluntary did not mean free. It meant I had not come there in cuffs, but I could not leave when I chose.

  “Do you understand?”

  “Yes.”

  “Sign here.”

  Voluntary means will. An act of will. Free will. I will this and it is so. Or so it is in the free world. But there, in Meriwether, it meant a resignation of will, the last free act until they discharged you. And this, to my mind, was the worst part about being there, the worst part about being mad, or deemed mad.

  Madness is a disease of the will, of judgment. That is what is impaired. And so, in there, along with so much else, your will was taken away, like a pen, because you could not be trusted with it. Yet your will is the thing that makes you feel human. Without it you cannot be well, which is why no one in there really got well, or, arguably, much better.

  This is the paradox of asylums, and their fatal flaw. Put a person in a cage and you cannot help him. But leave him to his devices and he cannot help himself, or will not. Freedom is a prerequisite for healing a broken mind. It cannot be fixed against its will. Yet a broken mind is a broken will, a freedom that does harm, even potentially serious physical harm to itself and possibly others, a freedom that can attack or maim. So, how else to heal but by force?

  I looked at my wristband. White, with my name, date of birth, my age, too (for the lazy), and a code I couldn’t decipher. MXE. Again, it seemed like the most natural thing in the world to play at breaking this code: methotrexate enema; maximal xenon eczema (a rash of computers; could be bad). But that’s what crazy people supposedly do, right? See cryptograms everywhere. And when you are looking, you will find them.

  It’s like learning a new word. Someone uses it—“Esperanto,” for example—and you say, “What the hell does that mean?”

  They tell you, and you are amazed. “It was a language made up by linguists in 1884. It was supposed to be something that the whole world could learn, so that we could all speak to each other.”

  “Really? I’ve never heard that before.”

  “Haven’t you?” they say. “How odd.”

  Then, as if by public consensus, it’s everywhere. Someone brings it up in conversation. A newspaper article tells you it’s in Finnegans Wake. And then, there in Meriwether of all places, where the TV was blaring above my head all day and evening, it was the daily double on Jeopardy! No joke.

  “What is Esperanto?”

  Fuck me. Don’t tell that to the nurses.

  I have my pet theories like everyone else. Madness as the extension of sanity, the same propensities, only more so. A mental game gone too serious and scary, a dream we cannot wake from, or better, a somnambulist’s midnight lack of sense running prime time and permanent in the day.

  Maybe you, the normal man, walk into the kitchen in the wee hours and eat jelly by the tablespoon right out of the jar, and have no memory of it in the morning, only the weird evidence in the sink. Or maybe when you wake, you turn to your wife and say, “I had the strangest dream last night. I was flying in a tiger suit over Wall Street and your mother was there wearing a turban.”

  And she will nod at you understandingly, knowing the oddity and cogency of dreams. You get up and go to work, sit in board meetings. You are sane.

  But a mad person will say the same thing in the middle of the day, all day long, and he will find it more convincing because unshakable after a shower and a cup of coffee. Is he wearing his subconscious on his sleeve, as he tells you (or usually himself, aloud) of tigers and turbans? Has his mind turned itself inside out, switched night and day, abstract expression and photo real?

  Maybe our art is his life. Maybe he lives every day in the stream of consciousness we so admire in Joyce, with little breaks of coherence in between, the precise opposite of our daily grind, the stone-dry workaday that we relinquish so happily for a bit of science fiction fantasy on TV. Maybe the madman is a model of rationality in his dreams, while you are all over the map.

  Breakfast came at eight. A small pack of raisin bran, a roll (processed “wheat” flour bleached to a fare-thee-well, with riboflavin, niacin, and God knows what else, preservative or homogenizing, chemically added back in), margarine, grape juice, and a four-ounce carton of milk. I was determined not to gain weight while I was in there, eating all that sugar and starch, and sitting all day. But I was equally determined to shit, daily if possible, so I downed the sugared cereal for fiber and passed on the rolls and juice. For good measure, I managed to get another milk and cereal off an unclaimed tray and made quick work of that as well.

  After breakfast I sat some more, and thought, and watched, and listened. I was already in despair of that place, which was itself collectively despairing. Even the people who worked there had given up. Perhaps they most of all. It was written all over them. The way they fell asleep in front of the TV during their shifts, the way they moved and operated, slowly and sighing, as if only with great effort. The way they talked to us, with the tone people reserve for the retarded and the elderly of whom no improvement is ever expected.

  We were held together there, the attended and the attending, the lazy and the infirm, and choice did not really come into it anymore. The staff were there of their own accord, just as I was, though what does that really mean? That they had many other, more desirable employment prospects? I doubt it. That they went home at the end of the day? But to what? A furlough at best, and an all too brief one. To doughnuts and coffee and movies of the week, to the sustenance of empty lolling. What lives was that place really sustaining? What was done on the outside? More of the sleeping and eating and lassitude that we were all practicing in there?

  We were a reflection of them and they of us. Hardly different in kind, though surely in quality? You go crazy the way your culture goes sane. We were getting fat, eating junk food and rotting our brains in front of the TV, popping pills to make us palatable, and our lives palatable to us, inanity everywhere and we a party to it, dumbly coasting.

  Contempt. They felt contempt. That was it.

  “You want what? A cup? A toothbrush?”

  Sigh. Lumber, lumber.

  “Just a minute.”

  I had gotten through my first night, and the morning and partial day thereafter. I had succeeded all too well in penning myself in. It was done. I was committed. Not just to Meriwether, but to the first leg of my long year’s journey to three psych wards.

  I was scared and—oh, how the magic had worked in one night—I was depressed. More than depressed. Caged. A trapped, too cognizant animal, tiptoeing my way to the clogged toilet, over the foul floor of the women’s bathroom on flagstones of piled paper towel. It was just about as bad as I had imagined, maybe worse because I was there, not imagining, but stuck firm in the hours that dragged on so harsh and idle.

  I looked for comfort in the gurney that I got, finally, only an hour or two before they came to take me upstairs. I lay on it, and then couldn’t, because I didn’t want to be another one of those lumps lining the hallways.

  It wasn’t just that I didn’t want to resemble the rest of them, lying, as they were, face to the wall. It was that I didn’t want to become them, because I feared that lying with your face to the wall in that place could make you into a person who lies with his face to the wall in that place.

  Or was it the other way around?

  Did the people make the place, or did the place make the people? Did the fact that these people were mostly poor, or at least of modest means, and sometimes even homeless, turn the place into a zoo, or did the zoo turn the people into animals? I knew, even in just one night, that the latter was true. You become your environment, and you become what you are expected to be. The lower the standard, the lower the result. The ruder the treatment, the cruder, the more animal, the man.

  But did causality move in the other direction, too? This seemed true as well, even in the outside world. Public places become disgusting because no one cares about them. They belong to no one, even though ostensibly they b
elong to all. And so they decline. People litter. People piss. They deface whatever they can reach, leaving all those grimy little marks of insignificance that add up to a slum. What is not yours is not your problem, and then it is everyone’s problem, or eyesore.

  Or bedsore.

  Yes, I thought. It goes both ways. Viciously. We shit where we eat, and then we become shit where we are eaten. We write on the walls, and then the writing is on the wall.

  I wore the flimsy johnnies and the Acti-Tred socks, and they wore me. Down and out.

  I lost my pen to the nurse and learned to write legibly with a marker, in fat, loopy, childlike cursive just like Nil’s.

  I went in well and turned ill overnight.

  I was, and I was becoming, a patient at Meriwether Hospital.

  I made it up to the ward that afternoon. Day two.

  They took me up in the wheelchair, the same wooden one with the seat belt that I’d ridden to radiology the night before. No walking yourself between wards, apparently.

  You’re sick. You sit.

  I have no idea what happened to Nil. I never saw him again. I didn’t even say good-bye. He was and remains a ghost of that night. I’d almost believe I thought him up, except that I have that torn page from his “notebook,” which, looking at it again now, I see was taken from a 2001 edition of a literary review called Glimmer Train, a publication that you’d be far, far more likely to find in a university library than just lying around in the asshole of Meriwether Hospital.

  What poor tasteful soul had taken refuge in that artifact, I thought? Or had come in clutching it to his breast years ago? And had he left it behind purposely, a grim reminder of a time he was determined to forget? Or had it fallen from his grasp inadvertently while he gave himself up to a gurney and turned his face to the wall?

  I took that page with me up to the ward, taking my own brand of refuge in it, as had Nil. I took it, and my notebook, and Nil’s Crayola, which he had kindly given to me for keeps.

  I went into a consult room and met my treatment team first thing.

  The word “team” sounds good here—thorough—but wasn’t really. They were more of the “How many mental health professionals does it take to screw in a lightbulb?” variety. Their effect was not increased by their number.

  There was the unit chief, who made brief appearances twice during my stay (at the first interview and the last). There was Sarah, a medical student; Kim, a chirpy social worker, whom I never met again after the first interview; and Dr. Balkan, the staff psychiatrist, who would be attending to me most directly.

  We gathered at a long conference table in what I remember as a poorly lit room, but this may just be my memory shading the scene to fit how I felt. I felt exposed yet shadowed, intruded on but not seen. There was too much attention and not enough.

  This gloominess was, I think, the effect of the way these people did their jobs, like civil servants, dryly, colorlessly, in unison. They had procedures and they followed them. They asked me more of the usual questions about my history, my family, and what had brought me there. They wrote it all down on their notepads, and then they looked at me to see what they could see.

  I don’t know what they saw. A classic depressive? A charlatan? I worried that they might see through me. But a night in emergency had lowered me to the right level, or thereabouts. So what were they really going to see? Fear? Desperation? Distrust? Those were real enough.

  I know that I did not see them any more clearly than I thought they were seeing me. I was jaundiced as hell. I went in there predisposed not to like them.

  My first time in the bin in 2004 had soured me pretty soundly on ward shrinks. I’d been at the mercy of a prick on a power trip, the kind of buttoned-up banty rooster who gets off on control and then, when you resist him, tells you that you’ve got issues with control. It had taken me two days of forced calm and tactical parlay to convince him to let me out of that place, when all I wanted to do was leap across the table and bash his bald pate in. Again, who wouldn’t look crazy doing that? And yet, who wouldn’t want to do it when squaring off against a pug jailer with an advanced degree.

  Aside from Baldy, I’d met my fair share of shrinks over the course of the previous fifteen years. One of the last ones in the string had been the genius who’d convinced me to go into the bin that first time, even though it was the worst possible advice she could have given me. She’d also been the one, back in my twenties when I’d first consulted her, to prescribe way too many medications way too soon, without telling me about their side effects or the dependency and withdrawal they could induce.

  Coming into Meriwether, I had, let’s say, a sore spot for doctors.

  That’s undoubtedly why, among the team, I liked Sarah, the medical student, best. She wasn’t a doctor yet, and so she still had sense enough to doubt herself. She hadn’t yet cultivated the persona that she would get with her degree, the nonstick coating that so many psychiatrists spray on an inch thick somewhere between memorizing the material at school and coming into contact with actual human beings. All too often, by the time you found yourself sitting across from them in the hospital giving them your sorry spiel, it was like talking to a diving bell.

  But Sarah still had cracks. Now and again actual thoughts were getting through, thoughts that had not been placed there by others or rooted out by the training. Her face was frequently strained by the effort of appearing remote, professionally cool.

  She wasn’t.

  Early on, when we were alone for a moment, I asked her something about her manner, about what she was learning to do, and how you could really hope to relate to another person as a person if you were practicing the art of galvanizing your own soul.

  A blush spread over her cheeks. Would she learn to repress that later, I wondered, if it came so readily now? What a loss if she did. Sad, because it was such a pleasure to watch her thoughts bloom on her cheeks like hot little pools of appetite. Intellectual appetite. A noticeable idea coming through her ears in waves of sound, landing on her brain as chemical information, a wave becoming a particle, then the information somehow—God, how?—pouring itself into an emotion, giving rise to a physiological response, and then a color in her face. For me, it was the best part, the miracle of the brain that it could take my question not just as language but as implication and turn it to a rush of blood.

  But if Sarah was going to make it in this line, she’d have to learn to check that evidence. Dry up. Cover. Get stupid.

  The unit chief was stupid in that way, I thought. Not genuinely stupid. She seemed bright enough. Doctorly stupid, I mean. Stupid because cut off and rendered arrogant by her profession and her position. She was in charge, and she sat in her sovereignty with unnerving entitlement. But to me, she knew and controlled a lot less than she thought she did. She was catered to, but mistaken, like a fat newborn, thinking her little sphere was all the world and her will the axis it was spinning on.

  She wasn’t like other doctors I’d known in this respect. It wasn’t Baldy’s kind of entitlement, overweening and repugnant. And yet it was of the same strain, because doctors are trained by doctors to be doctors, and part of being a doctor is acting like one. She came off as if her sphincter had been tied shut like a reticule. Baldy was more the type you suspected might have buried people under his house, people like his high school valedictorian, or maybe, from his übermensch period, a landlady or two.

  Who knows. Maybe she was a really nice cuddly lady at home, as tame as they come. But I didn’t see her at home. I saw her on the job, and that is how I judged her, by how I saw her doing her job. It wasn’t really what she said so much as how little she said. It was clear that she knew exactly just how little she needed to say to exert her influence. She sat heavily, like lead in a boat, pulling all the ballast toward her. The others deferred palpably, unthinkingly, as if by force of gravity or instinct.

  Dr. Balkan was a type, too, and does not yield an inspired description, I’m afraid. She wasn’t particularly
bad or good. Not singular. Just a yeoman, you might say, doing service day in, day out. Showing up. Trying, but knowing the limitations of talk in a place where most people were too delusional to have what the rest of us would think of as a conversation. She was doing her job conscientiously. She was efficient but not officious. Removed but not too proud. She listened, though maybe a tad hurriedly, during our ten-minute consults each day. She cared, you could see that, and she really did want to accommodate my desire for more therapy and fewer drugs, but there was only so much time in the day. And even if there had been a spare hour, she wasn’t practiced at the long, slow muse, or probably much inclined toward it.

  Anyhow, Sarah was different. She interested me. I almost wanted to save her, cut her free and say, “Go and be a person. Get out before it’s too late.” But then I was hardly a recommendation for that approach, at least in my present condition, or what she perceived to be my present condition.

  But what did she or any of them perceive? This was part of the problem. My private conversation with Sarah had begun with me asking her about herself, about the way she handled situations where a patient asked you something about yourself or tried to establish an exchange. She had said that she hadn’t quite worked out yet what to do on those occasions. She wasn’t sure when and or if she should ever let the patient see her. I admired her for admitting even that much.

  The dance with patients could be tricky, I knew. I mean, you wouldn’t want someone like me blundering around inside your head. And I suppose there were always people like me who were wanting to do that, either for entertainment or because it was just too hard to have any kind of therapeutic relationship with a cipher.

  I had both motivations, as it happened. I wanted to see what she’d do, what any of them would do if you challenged their remove, if you said in effect, “Be a person with me, will you? I’m not a petri dish.” I wanted to relate to them, to connect as a human being. But I also wanted to get a reaction that wasn’t preprogrammed. I wanted to poke an actual working apparatus. Stimulus, response. Action, reaction. Slap and gasp. Spit and grimace. Whatever worked.