Voluntary Madness

by Norah Vincent

  “Just so you know,” I told the Yenta.

  He got his discharge a few days later, and that, presumably, was that. He would go on taking the same pills to live as he’d taken to try to die. Poison in therapeutic doses, didn’t someone say? Medicating, no longer self-medicating, or something like that. Getting drugs to get you over the hump, or through the objectionable days, or to help you cope, or coast, or, as in Casey’s case, to do double duty, to keep you going and to help you sleep.

  Casey, like me, had been prescribed the antipsychotic Zyprexa on the outside, and for the same ass-backward reason. Antidepressants had made her hypomanic, so her doc had decided on a mood stabilizer.

  But not just any old mood stabilizer—the pet mood stabilizer of the day. An antipsychotic that had been approved by the FDA to treat bipolar disorder. Zyprexa: the same trendy pill that, interestingly enough, was well advertised in the Meriwether ward. “Informational” (read: promotional) displays were posted, complete with detailed, four-color leaflets, on the bulletin board outside the dayroom. Some of the nurses even carried their papers around on Zyprexa clipboards stenciled with the same promotional information that was in the leaflets. Others carried clipboards or wrote with pens that advertised competing drugs like Abilify.

  Like Mother T and others, Casey had gained a lot of weight on Zyprexa. This, along with a propensity to cause diabetes, is a common side effect of the drug, and one that its manufacturer, Eli Lilly, knew about all along but failed to disclose to the public. The truth came to light in early 2007, when the New York Times reported in a series of articles that Eli Lilly had agreed to pay hundreds of millions of dollars to settle thousands of law-suits brought by people who had taken the drug.

  Wisely, Casey had gone off Zyprexa on her own. But at Meriwether they were tossing her Seroquel instead.

  Thankfully, Casey was only in for three days before her therapist either came to her senses or responded to pressure from Casey’s family and friends. She showed up at Meriwether and corrected her mistake.

  Casey left Meriwether as bitter, angry, and frightened as I had been my first time around in the bin, and she had learned the same lesson. No matter how bad you feel, never go to the bin. In fact, never confess enough to your therapist to give her even the slightest inclination to commit you to the bin, unless you know her well enough and trust her enough to know she’d never do such a thing.

  Don’t assume she’ll be able to tell the difference between contained, nonspecific suicidal thoughts and real, imminent danger to self or others, because the truth is, more often than not, she’ll probably commit you either way, just to cover her ass in case you do end up trying something.

  Discernment can be hard to come by in psychiatrists. This has been my experience, anyway, and, obviously, it was Casey’s as well. The human touch is not very often their strong suit. Nor is true empathy. Attend the annual American Psychiatric Association conference, as I did, and you’ll see that the emphasis is far and away on the science, not the emotional intelligence.

  As noted psychoanalyst Adam Phillips wrote in the New York Times (“A Mind Is a Terrible Thing to Measure,” February 26, 2006), “Psychotherapists of various orientations find themselves under pressure to prove to themselves and to society that they are doing a hard-core science. . . . Given the prestige and trust the modern world gives to scientific standards, psychotherapists, who always have to measure themselves against the medical profession, are going to want to demonstrate that they, too, deal in the predictable; that they, too, can provide evidence for the value of what they do.”

  These people are thinking in categories, not only because that is how they are trained but because anything else is too vague, too absurdly metaphysical, to advance the cause of their credibility in medicine.

  And yet, given what it is capable of doing, the brain is like no other organ, and does not submit, at least in the lived experience of the patient, to anatomy and chemistry alone. How can we treat it the way we treat, for example, a kidney? There is the brain, whose business is thought and feeling and judgment and even mystical experience. And then there is the kidney, whose business is piss.

  I can heal your kidney, or your heart, or your bowel without empathy, though bedside manner never hurts. But can I heal your mind without empathy?

  So much of psychiatry is perception, not just bodily function. And so, to be effective, mustn’t a psychiatrist feel? Mustn’t he, too, have experience? And by experience, I don’t mean how many patients he has diagnosed, or how long he has been diagnosing them. I mean personal experience. How much he actually knows, or at least can vividly imagine, about what it’s like to be mentally ill, or what it’s like, day-to-day, to take drugs that alter your consciousness, or, finally, what it’s like to be locked in a ward.

  It might do wonders for the profession if all psych residents were required to spend ten days incognito as a patient in a locked ward. Or to be given antipsychotic medications to sleep. Or to have their intelligence insulted by someone who doesn’t know what neurotransmitter that drug happens to work on. Then, at least, they would know a bit more whereof they committed, prescribed, and consulted, and they’d think twice before suggesting hospitalization as a means of putting the Caseys of the world to rights.

  If you ask me, Casey and I fell into the same category: the overdiagnosed. Certainly we were or had been depressed. Behaviorally, anyway. That was clear.

  The question is, were we what you might call naturally depressed by life and our prospects? Were we too hypersensitive? Were our expectations too high? Were we clobbered by life’s disappointments, as everyone at some point is? Or were we clinically depressed, suffering, as they say, from a chemical imbalance? Was depression in our DNA? Were we mentally ill, or were we struggling through a bad patch?

  Moreover, was medication, and lots of it, the answer? Was it the only, or even the best treatment?

  Nobody has answers to these questions yet. But in the absence of such answers does it make sense to pound everyone with the same rubber mallet? Does it make sense to give powerful antipsychotics both to someone who thinks he is talking to God and to someone who is just having trouble falling alseep? Does it make sense to put someone like Casey away, and keep her away despite her assertion of the plain fact that being in the bin was making her feel worse, not better? Wasn’t that kind of treatment just going to make her, and me, and a hell of a lot of other people, shy away from consulting psychiatrists at all, for fear of being dangerously overmedicated and incarcerated?

  These were all the questions in my head as I watched Casey leave the ward, and as I sat waiting out my time, succumbing more and more to fear and depression, despite knowing that I was only likely to be there for a short time, and that I was actually just doing a job. It was hard to keep any kind of perspective. Almost impossible. The intimidation and lethargy of the institution hung on me and ripened like a stink, and I sat in that stink with worsening amnesia, as if I neither had nor knew of any other life outside the confines of Meriwether Hospital.

  I realize that this sounds overblown. And sitting here now, back in my privileged life, mentally so far away from Meriwether and that time, it sounds that way to me, too. But then I remember that my roommate Ellen had been stuck in there for six months, and who knew what was going to happen to her.

  I wasn’t Ellen, of course. Far from it. I had access, if necessary, to a whole host of resources, legal and otherwise, that Ellen and most of the rest of my fellow patients didn’t. That, after all, had been most of the reason why Casey had managed to get out so quickly. She had resources. Family, some money, and enough education, savvy, and middle-class wherewithal to apply pressure in the right places. Yet she, like me, had seen on her first trip to the bin that although she had committed no crime, her accustomed freedoms could be taken away more quickly than they had ever been before, or than she had imagined they ever could be, even if only temporarily.

  This is something that we in the free world, especially Amer
icans, are not used to. It has never happened to most of us. On the contrary, we’re spoiled. We’re used to saying what we like, and suffering few or no consequences as a result. We’re used to knowing, as surely as we know our own names, that we have rights. And it’s not that patients in places like Meriwether don’t have rights. They do. It’s just that—and I can’t overemphasize this—it feels as if you don’t have rights when something as simple as coming and going, or smoking a cigarette, or seeing the people you love is taken out of your control because your mind, whether it actually is or not, is thought to be diseased.

  Being put away does a number on you very quickly, and very thoroughly, no matter who you are in the outside world.

  Finally, after watching other people leave, after losing a sense of time, and after losing more and more perspective on the system and my own position within it, my day did come. I was going to get out.

  I had been through the treatment, such as it was. I had been given eight Lamictals and ten vitamins. I had swallowed one each day but not the other. I had had roughly ten to fifteen minutes of therapy a day, either with Dr. Balkan or with Sarah. I had sat in on the absurd fifteen-minute morning community meetings, where those who were awake or could speak intelligibly had said their piece, been heard, and usually been told that what they wanted either couldn’t be had or would be taken into “consideration.”

  We all knew what that meant.

  I had been aiming for the ten-day mark as a release date. So when Sarah or Dr. Balkan asked me how I was doing each day, I steered my answers progressively toward the lighter side of disaster, going from “I’m not as bad as I was,” to “Getting better, I think,” to the unequivocal, “I’m ready to go now, please.”

  Dr. Balkan and I decided together about midweek that day 10, a Friday, would probably be the day. Of course I knew enough not to take this dangled freedom for granted until I was on the other side of the door, but I did allow myself just a whiff of elation.

  I told Deborah as soon as I knew.

  “It will be heartbreak for me when you leave,” she said, looking up into my face with eyes that bore no trace of their former mischief.

  Sweet must have overheard this, though I don’t remember her being nearby at the time. But then, she had a way of floating in and out of rooms unnoticed. I walked by her in the hall later that day, and she showed me once and for all that it was a mistake to assume she wasn’t paying attention, just because she was talking to herself most of the time.

  I heard the swish of her trench coat, and then, clear as a bell, she said:

  “I’m going to miss you.”

  The others reached out, too, as expected. Clean wanted to give me his number at a halfway house, and did. Mother T told me which shelter she was likely to be staying at when she got out. Even Kid gave me a number.

  My last night, I lay in bed awake for hours filled with what was by then an irrepressible excitement. Like the Yenta, I thought with relish and in detail about the first things I was going to do when I got out.

  I pictured and tasted each course, each bite of the meal I was going to have at my favorite restaurant. The juicy steak, medium rare, marbled with fat, oozing in my mouth, the buttery whipped potatoes, the firm julienned vegetables, the lemon custard, the red wine swirling in the bulbous glass.

  I thought about the taste and smell of the fresh winter air, and the feel of it cooling my lungs and my lips and my ears. I thought about what it would be like to talk to people who didn’t have power over you or weren’t hearing voices. Normal society seemed desirable for once. The beautiful, beautiful mundane. What a thing.

  As I lay there with my eyes open, and with my eyes newly opened, I listened to the nurses talking and laughing down the hall. I thought about how strange it was that so many of them considered themselves to be superior to the patients they oversaw, when the patients knew enough to leave as soon as they could, and even the worst among them were eventually discharged. But the staff was there all the time. By choice. Actual choice. Not, in my sense of the word, by voluntary commission, and then no choice at all. No. They had decided completely and repeatedly, of their own accord, to be in that place.

  It’s bad enough to be committed to a mental hospital, and to spend your time unwillingly in the company of disturbed people. Even disturbed people know that. So why would anyone choose to work in such a place, choose to spend at least forty hours a week there, and never have enough sense to get out? If you ask me, that’s a far more deranged, senseless person than any so-called lunatic.

  Of course I know now that this is too harsh a judgment, coming, as it did, out of extreme resentment and trapped exhaustion. I feel certain, even in my still jaundiced mind, that some public hospital somewhere employs one person, hell, maybe a few, who actually give a shit, and try to do some good.

  The point is, fair or not, informed or not, this is how I felt at the time. Meriwether skewed—maybe even took away—my judgment on these matters for a while. I cannot deny that, nor should I. That is what institutions do.

  I slept restlessly for a few hours, and then in the morning I woke again to the sound of Mrs. Weston clacking into the room. This, too, vaguely amused me for the first time, because I could just about relish how good it was going to feel to write about her.

  The docs signed my discharge papers at 9:25 a.m., but I didn’t make it out of the hospital until 3:15 p.m.

  Those were the worst six hours of my stay.

  I sat all day in anticipation, watching the hours drag by, tasting my freedom, but anxiety-ridden at the prospect of it being somehow revoked, or worse, eroded by my paperwork’s slow, careless passage through the clogged procedural channels of the hospital bureaucracy.

  Time had come to mean everything. A visitor who arrived ten minutes late, for example, could never know how painful those ten minutes were to someone watching every tick of the clock, living for a friendly face.

  Discharge was that much worse, because you sat there, after having been boxed in for too long at the mercy of a flyby doctor’s will, finally knowing that you were technically free at last, but having to wait nonetheless for the heel-dragging staff to make it happen.

  The staff’s blatant indifference was offensive enough in the daily rounds, but it made you boil when one more day of your life was coming rapidly to a close and your release papers were languishing on the table while the nurses studiedly procrastinated.

  After making numerous inquiries at the nurse’s station, I learned that we were waiting on the pharmacy, which had yet to fill my prescription.

  “Can’t you just write me one that I can fill outside?” I asked Dr. Balkan.

  This was not hospital policy, she said. And so I waited for several more hours.

  At three o’clock, desperate, I cornered the unit chief on her hurried way through the ward and managed the miracle of bent rules. She wrote me a scrip, and I got the nod to go.

  Finally, having spent the day convulsed by turns with rage and despair, I stepped over the wide white line in front of the nurse’s station, the one that patients were forbidden to cross, and stood by the locked double doors of Ward 20 for the last time.

  As I waited for the nurse, with his jangle of keys, to unlock the door, I looked back at Deborah and Clean and Mother T, who had gathered to wave me off. I knew what they were feeling. I’d felt the same mixture of pleasure and envy when I’d seen Casey and the Yenta discharged during my stay. You couldn’t help but share in the free person’s joy and be happy for them, but watching them leave, you also couldn’t help but feel that much worse about your inability to follow.

  I left Meriwether hospital with my few belongings in a paper garbage bag that I got from one of the janitors. It was the same kind of bag that I’d been filling with desiccated orange peels and secreted candy wrappers for ten days. They had lost my backpack somewhere between triage and the ward, and I wasn’t going to spend one extra minute in that place trying to find it.

  It had only been ten day
s, and I was supposedly just a journalist at work, but I was a wreck, a pathetic, quaking, permission-seeking, cowering nonperson in petrified thrall to the keepers of mental hygiene.

  As I made my long, slow way out of Ward 20, as I heard the locked double doors click behind me, with me at last on the right side of them, the outside, as I rode all the way down in the elevator and scurried all the way down the labyrinthine halls of the main floor, even as I stood in line waiting to sign for my valuables, I really thought that some disembodied arm was going to reach out and grab me by the shoulder and say:

  “Where the hell do you think you’re going?”

  And when I finally walked into the same vaulted lobby that I had come through ten days before, pushed my way through those so much more symbolic revolving doors back out onto the street, and took my first lungful of liberated air, all I could say—and I said it out loud, yes, talking to myself—was “Thank God. Thank God. Let it be true. Let it be true.”

  And then I ran. I ran for blocks, clasping my crumpled paper bag to my chest, still thinking I might be chased and dragged back screaming in futile protest for the brief taste of gorgeous, real life that I had been given.

  But—and I said, “Thank God” again out loud—no one came for me. As I slowed to a walk, it felt glorious to be out of breath, to have a wallet, and shoelaces, and a meandering gait, and my own sweet, whimsical will again.

  INTERIM