This was the cross-purpose of it all, in my view. They saw me as a set of chemicals. They were dealing with my brain as an organ, palpating it with categories, forgetting of course that, unlike its illustrious sister discipline, neurology, psychiatry is not just the science of the brain as brain, but brain as organ of thought, seat of incandescent function, impalpable, the only organ in my body that can answer back.
So, talk to me.
But even their names and titles were too heavy for such intimacies. Doctor. Dr. It gets bigger with abbreviation. Degrees are magical that way. They make gods. The doctor who tells you what she knows, as if she knew it for certain. Yet, she is a deeply fallible, mostly chimerical being created by us to talk down to us when things are at their worst, because somehow that makes us feel better. In the absence of someone who actually knows what she’s talking about, we are just as comforted by someone who sounds like she knows what she’s talking about. That is enough. Just say it with conviction and it will make the boogie man go away.
Dr. Balkan suggested Lamictal, a mood stabilizer that I’d tried years before, but had quickly abandoned because of a swelling in my groin. A very small percentage of patients who try Lamictal develop a dangerous rash. According to the docs, it is the only side effect of the drug, but a very serious one. At the time, my groin swelling had made my doc nervous, so she’d advised me to stop the course. As it turned out, the groin swelling had been a side effect of another, nonpsychiatric medication that I had been taking.
“It’s worth trying Lamictal again, then?” Dr. Balkan said.
Having done my homework on meds, I was skeptical. I’d read a lot about the undisclosed or unknown dangers and unpleasant side effects of so many of the pills my docs had been prescribing for me over the years, and I’d been appalled to read, first in books, then in newspapers, of how thoroughly corrupt the drug development and approval processes are in this country.
Pharmaceutical companies have their fingers in the pie every step of the way. They fund clinical trials of the drugs for which they hope to obtain FDA approval. They ghostwrite the papers that report the results of those trials. They provide most of the advertising revenue for, and therefore exercise undue editorial influence over, the journals that publish those ghostwritten papers. They pay large sums of money to many of the doctors and “experts” who advise the FDA, and often vote directly on which drugs to approve.
Their sales representatives call directly on primary-care physicians and psychiatrists, providing free samples of their drugs, as well as reams of so-called informational literature, which is actually carefully crafted promotional literature about those drugs. Often this promotional literature is the only source of information that most docs consult about the drugs they are prescribing and, more alarmingly, the conditions for which they are prescribing them.
The drug companies often go so far as to hire individual doctors as “consultants,” paying them thousands of dollars and sending them on all-expenses-paid trips to exotic locations where they can attend conferences about the company’s star drugs. Finally, the drug companies go directly to the consumer, flooding the airwaves with advertisements not only for their products but for the diseases those products are purported to treat. This is one of the major reasons why most people think they know—not just believe, but know—that serotonin deficiencies cause depression, even though there is no real scientific evidence to support this claim. But we know. We know because the drug companies told us so.
So you can see why I wasn’t eager to take any more drugs, and why I was, in fact, attempting to wean myself safely off of the 20 milligrams of Prozac that I was already on when I came into Meriwether. (I had been on it for at least a year, sometimes at slightly higher doses, but usually right at 20 mg, where the side effects seemed least intrusive, but the benefits sufficient to keep me afloat.) You can also see why I didn’t exactly trust that Dr. Balkan knew—or if she knew, would tell me—what I needed to know about Lamictal.
“What neurotransmitter does that work on?” I asked.
“I’ll have to get back to you on that,” she said.
A few hours later she produced something she’d printed off the Web, a typically useless document that betrayed how little anybody knew about what the hell this drug was doing or how.
Apparently, Lamictal acts on the neurotransmitter glutamate, blocking its release in the brain. Glutamate is the same neurotransmitter that appears to be activiated by the street drugs ketamine and PCP, or so the paper said. Lamictal was first approved for use as an antiseizure medication for people with epilepsy, and it is still used in this way.
That’s all I could glean from the paper, and it wasn’t really of any use, except to confirm my worst fears that when it came to understanding these meds and their real effect on our brains, we were all shooting a blunderbuss at a field of daisies in the dark.
I told Dr. Balkan that I wasn’t comfortable with the drug routine and thought it might be best to go the therapy route for now.
She was insistent.
“Bipolar disorder is a chemical imbalance that is something like eighty percent inherited.”
The idea was that I was unlikely to get better without meds.
Of course, the theory that there is any such verifiable chemical thing as bipolar disorder is far from proven. Besides, the idea that I had bipolar disorder at all was built on a pretty flimsy foundation, having come about because I had become hypomanic while on antidepressants. Enough people have done this that antidepressant-associated hypomania, or bipolar III, though it is not, as yet, listed in the DSM, is now an unofficially recognized mental disorder.
The side effect of a medication had become an organic disorder, poof, just like that.
I spent almost the entirety of my first two ten-minute daily therapy sessions going back and forth with Dr. Balkan about the meds. Finally, I succumbed to the fear that they might keep me longer than I’d planned if I refused to take anything, and said I’d take the dose.
As they are no doubt required to do, the nurses at Meriwether watched you take your meds. They wheeled around a cart full of pills and liquids, stopping in front of every room to dispense them. By the time they started giving me the Lamictal, on my third day up there, I’d figured out that they weren’t terribly vigilant about making sure you weren’t hiding anything under your tongue, or holding it in your mouth or palm. Besides, I’d requested a multivitamin, which they gave me at the same time as they gave me the Lamictal, so I was able to make it look like I was popping both pills into my mouth, when in fact, I was holding the Lamictal back, lodged between two fingers.
When the nurses left I went into the bathroom and flushed it.
After the triage hole, the ward seemed like a penthouse. It had big wide windows, albeit elaborately gated and locked. But you could still see through them enough to get a sweeping view of the city below. We were on the twentieth floor, and the width of the sky at that level was intoxicating to my trapped mind. Diffuse light pervaded the large rooms for most of the day, though no fresh air made it in, or very little. My bed, one of four in my room, was pushed up lengthwise against one of these windows, and I spent a lot of time, especially late at night when I couldn’t sleep, sitting up in bed watching the lights glowing in the windows of skyscrapers. The seal on my window had a sliver gap in it somewhere near the bottom, and as I sat there, desperate for a lungful of unprocessed oxygen, I’d lean my face against the grating and listen to the slow whistle of the winter wind, feeling the momentary caress of the cold on my cheek.
In that place, where there was so much that you weren’t allowed to do, leaning that way felt like stealing, like I’d get busted for breathing wrong when the head nurse, Mrs. Weston, strode into my room, as she periodically did, and searched the slim freestanding closet by my bed. It was more a power play than anything. She usually missed half of the contraband that was in there, that being a few pens I’d asked visitors to bring me, a couple of oranges taken from a box in th
e dayroom, a plastic bag for dirty clothes (possible suffocation risk), and a pair of pajama bottoms with a string tie (strangulation risk; the Ping-Pong table in the dayroom had no net for the same reason).
We got oranges around eight o’clock, as a snack after dinner, usually along with peanut butter and jelly sandwiches on Wonder bread. You had to eat all this in the dayroom, though, because we weren’t supposed to bring food back to our rooms, lest it attract bugs and mice, or worse—that was the official rationale anyway—though that seems appalling in a hospital.
But, like everybody else, I used food as a form of succor, hoarding it for late-night snacks. It was about the only thing you could do in there that felt good, aside from masturbate, that is, and I don’t know what they did with you if they caught you doing that.
The oranges served double duty, as they were especially useful for making what I dubbed prison potpourri. This was the kind of thing you learned to do when you had extremely limited resources and you were faced with the foul odor of the unlockable en suite bathroom that you shared with your three roomies, all of whom were less hygienic than one might have hoped. The odor was mostly of piss, strong concentrated piss of the kind you get on the floor and walls when you’re overmedicated and underhydrated, have bad aim, and are not particularly concerned about flushing the toilet after use.
A janitor gave the bathroom a cursory going-over most days, often very cursory. That didn’t always include mopping the floor, or if it did, it didn’t help for long. The stench was overpowering, yeasty, and thick as no piss I’ve ever smelled, such that you had to keep the bathroom door closed at all times. Otherwise the whole room would smell like hell’s own pissoir.
To make prison potpourri I’d take my oranges into the bathroom to peel them, standing over the toilet as I did so, thus allowing the pungent oil in the peels to spray the room with what amounted to a home remedy cleanser. For extra effect I’d stand in front of the steel plate mirror (no glass), hold each piece of peel up to the fluorescent light, and squeeze it as many different ways as I could make it bend, watching the fine spray spurt into the air. Finally, I’d throw the peels in the garbage and let them suffuse the room for as long as they could.
Standing there squirting my orange peels under the light, sometimes holding them right up to my face to get a really good look at the spray, and doing so with the kind of keen attention that other people devote to their taxes, I realized I was doing something that, if you came upon me doing it, big as you please, in my blue issues with their dodgy snap fly open, and my Acti-Tred socks half pulled off like clown shoes, you’d be inclined to think that I was mistaken in believing I needed to be anywhere but exactly where I was.
But all these elaborate bathroom cleansing plans were foiled for the day if Mrs. Weston stalked in. Usually, I was sitting on my bed, leaning into my grated window sipping the air, or writing in my notebook with a pen, propping it against my upbent knees to keep the writing instrument mostly out of sight. When I wasn’t using one of my pens, I kept my stash of them safe in the front pouch of my hooded sweatshirt. But even in my bed, taking precautions, it was hard not to get caught using one, so my marsupial supply dwindled quickly.
Mrs. Weston had a keen eye for ballpoint pens. She could see them from the hallway, and before she got halfway across the room, she’d put out her hand imperiously to demand the precious item. She’d take it, then proceed with a vigorous search, flipping open my closet, pulling out the oranges she could see, and saying in her loud ward voice, “No food in the rooms, people. No food in the rooms.”
The plastic bag was a much bigger deal, but she never found that, buried as it was under my underwear and books and papers (these latter items were not considered to be a risk). As I said, she was more interested in the symbolism of the act. She was a tall, imposing black woman in low-heeled boots and a semicasual pantsuit. Her voice was powerful, and she enjoyed using it as if she were herding third graders at recess.
I suppose it made her feel efficient to conduct her searches. It was probably in her job description to at least walk into every room in the mornings, just to be sure no one had died or stuffed someone else into a closet during the night. Still, the searches were intrusive, and always conducted with the same entitled attitude and condescending air that made me want to rig my closet with a dummy, or a leaning cup of piss, just to make Madam Suzerain think twice about where she stuck her nose.
But then I suppose that was part of why she treated us like kids, because given the circumstances—the rules, the restrictions, the unreasonable deprivations—you resorted to childish deceits just to meet your needs or show a bit of spunk. Pranks are the refuge of the powerless and the puerile, I guess. The elements of surprise and ridicule sticking out their tongues.
I found it unreasonable, for example, that they didn’t let the patients smoke. It was illegal to do so in the hospital, and I was all for that, especially on our hermetic ward. But once patients had been in for a few days and earned the privilege, we would be taken in small groups to the roof once—or if the staff was especially organized, maybe twice—a day to get some fresh air. It would have been quite easy to allow smoking on those breaks. And you can be sure they didn’t forbid it for health reasons, because when you saw the food they were serving to mostly overweight diabetics, you knew that, despite it being a hospital, this was no refuge for the metabolically convalescent.
Smoking was something almost everyone on the ward was dying to do. It was one of those few pleasures in a destitute’s life that made the days pass. Forbidding it was a form of torture to most of these people, who were homeless psychotics and had been picked up by the cops for disturbing the peace. This meant that they were quitting of necessity cold turkey. Nicotine patches were available to them. But the addiction was clearly far more psychological than anything else, and being trapped in that place, miserishly squirreling away my oranges, it made perfect sense to me why that was so. And I was there of my own doing. They were not—which, of course, made the deprivations that much worse. The one thing they had, their freedom, had been taken away and supplanted by the worst possible substitute, the shuffling shoelessness of the institution.
There are few things more humiliating, more soul-destroying and depressing, than the process of being institutionalized. And the worst part is your own collusion in the process. It doesn’t just happen to you. You allow it to happen to you. You partake. You adopt the mind-set of the place. You become docile, subservient, frightened, dull, unthinking, susceptible to the mysterious self-fulfilling power of the rule. You loathe the tone of your own voice as you mewl and cower to the dingbat shoving you your meds or taking away your pen. You are demeaned by the routine as you regulate your life by mealtimes, loitering in the hall at eight, twelve, and six. You change as you acquiesce to rudeness, becoming less, becoming small, a picker, a stealer, a scratching stray licking the hand that defeats it.
You do strange things. I tried, for example, to make shoelaces out of toilet paper, so that I could walk like a normal person instead of limping like a gangster because the tongues of my tennis shoes were curling absurdly to my toes. The laces tore, of course, but it was a way to pass the time, rolling the long strands of tissue between my fingers as tight and stringlike as they would go, and feeling, even though I failed to make the lashings tie or hold, the momentary elation of knowing that I could still exercise some form of creativity.
I learned to flick on the light over my bed with the teeth of a comb or the tip of the forbidden ballpoint pen so that I could read late at night when I couldn’t sleep and the dayroom was closed. The light switches were in the hall and recessed so that only the staff could access them with a key or some other lean instrument, and thus enforce lights out at eleven and lights on at eight. Controlling light is no small matter, as they well knew. Just one of many daily benefits you take for granted in the outside world and never notice, but which take on an almost religious significance in the bin.
There are many oth
er such things, things like, as I have mentioned, fresh air. Most of us never think about how little time we spend outdoors. We work in offices all day and colonize the couch at night. We rarely exercise the privilege of stepping out, and that is of course precisely because we know we can do it whenever we like. But when the door is locked and you have to rely on a lazy nurse to take you to the roof, only in groups of four (first come, first served), and only at specific times, for specific periods of time, you begin to get obsessive. You begin to think about the word “inspire” and its literal meaning, “breathe into,” and then you think of God breathing life into clay to make man. And you begin to feel that God is on the roof, or some angel who saves you with cool respiration, so that you can face the long night of disinfected air and urine coming through the dusty vent in the bathroom. And that, my friend, is a crazy thought. It’s exactly the kind of thing that any one of my ward mates would have told you on any given day, leaning close to you as if someone might be listening, whispering this heady, sacred secret of the universe: that God was on the roof of Meriwether Hospital just waiting to give you the breath of life.
Pacing was the same; a ritual made sacred by the trap. There was a long wide hallway in the ward. It ran the length, from the men’s end to the women’s, past the dayroom and the nurse’s station, the dining area and the activity room. It dead-ended at the locked door that led to the doctor’s offices and another locked double door that led to the adjacent ward. Usually the small windows in the tops of those double doors were covered with construction paper, but now and again it was ripped, and you could see into the north side of the wing, where other people like us were wandering around in their pajamas.
Voluntary Madness Page 4