Voluntary Madness

by Norah Vincent

As expected, I learned a lot about madness at Meriwether. By madness I mean, of course, madness as we currently recognize and label it, or, more specifically, as I was able to observe it in Ward 20 at Meriwether Hospital. I can make no meaningful generalizations about madness per se. I don’t think any of us really can. Even if madness as some definable entity can really be said to exist, which I don’t think it can as yet, nonetheless, mad individuals are as singular as other individuals, even if they tend to have certain propensities in common (delusions, paranoia, despondency, mania, and so on).

  Yet generalizations are unavoidable, and we all make them, usually in less than charitable ways. Like most people, I harbored strong prejudices, especially about psychotic people. But living in close quarters with Deborah, Sweet, Clean, Mother T, and the rest of them disabused me of many of those prejudices, even as it reinforced and engendered others.

  For example, it may surprise you to know that I never felt unsafe in the ward.

  Portrayals of “psycho killers” and stalkers in movies have conditioned most of us to believe that psychotic people are always violent, menacing, and dangerous. When a mentally ill person makes the news, it’s usually because he has brained a pedestrian with a cement block or pushed someone in front of a subway train. Sick-flicks and tabloid cover stories have given us our picture of psychosis and made it a staple of our worst fears and nightmares.

  Sometimes psychotic people will play into this warped preconception, simply as a means of ridiculing our ignorance or deflecting the sting of our gawking eyes. Deborah did this when she cruised me so blatantly that first time in the hallway. And I allowed myself to be frightened by it. Looking back on it now, my reaction was as absurd as flinching when a clown says, “Boo.”

  Otherwise my fears in Meriwether did not stem from my fellow patients, but rather from the hulking, glowering institution itself, and the power it had over me.

  The psychotic people I knew and lived with were more confused and disoriented than anything else. This may have been due in large part to the effects of the medication, but whatever the case, even at their most paranoid and fluent, they were more scared than scary. When they were exercised, it was more out of annoyance that nobody seemed to be listening to them or taking their wishes into account. I never worried about being in rooms alone with them. I never lost sleep thinking they were going to creep into my room and get me, and this wasn’t, I can assure you, because I thought the nurses would get there in time.

  They were as human as everyone else, of course. As selfish and petty and generous and witty, and most often, just as run of the mill. They were just as much a reflection of their class and culture as the average person on the street. They liked MacDonald’s, iPods, M&M’s, and TV. They were fat and fond of the same poisons that we all buy on every corner or in bulk at Costco. They didn’t like being told what was good for them, and they didn’t like being told what to do. But when they fell, they wanted to be picked up. They wanted to be saved and provided for, but made the minimum effort on their own behalf. I’d say that made them pretty normal.

  None of this is to say that I came away from Meriwether with a sense that the psychotic people I knew were, in every way, just like everybody else. They were psychotic. There’s no getting away from it. And I had to adjust my approach to them accordingly. When I spoke to them, I wasn’t speaking to someone who processed information in socially common or easily navigable ways. It was different, and often it was harder, more off-putting, and even unpleasant.

  Still, something very strange happened in my mind as a result of these everyday interactions on the ward. This partial normalizing of crazy people in the bin had the opposite effect, too. It made normal people in the outside world seem crazier.

  Instead of going back into the public sphere and luxuriating in all the confidence and like-mindedness that I could have and find in normal people, I actually approached strangers with a new reserve. I realized how stunningly naïve I had been to assume that most people I met were sane. Most of us do this. We presume people are sane until they prove otherwise. But, after Meriwether, it suddenly seemed a lot wiser to approach strangers as if they were nuts until they proved otherwise.

  I was so struck by this reversal—by how sensible it seemed, and still does. I mean, really, what an astonishing trust we place in other drivers on the highway, in teachers and priests and parents and government officials, in the power of social norms. And how astonishingly often is that trust misplaced?

  This will sound crazy, no doubt, but, after leaving Meriwether, it seemed patently clear to me that the vast majority of the crimes in the world are committed by normal people. Either that or insanity is a lot more prevalent and on the loose than we like to think.

  Obviously, whether for good or ill, Meriwether bent my mind. Or the world. Or both. But it also taught me some interesting and rather more mundane things as well, things about the health-care system, and about health insurance in particular.

  When I presented myself at Meriwether, I told them that I had no health insurance. I was there to conduct my research, after all, and not because I really needed to be hospitalized. I didn’t want the cost of my stay to be billed to my insurance company. But as it happened, because I had listed myself as having no insurance, the billing people at Meriwether took the logical next step. They put in for Medicaid. That’s when the computer did a search and kicked back the information that I did indeed have insurance coverage. When she relayed this information to me, I told the billing administrator that I didn’t want a bill sent to my insurance company.

  “Just bill me,” I said.

  Naturally, they didn’t. Nobody who shows up in a public hospital is capable of paying the bill out of pocket. They sent the bill to my insurance company, and another copy to me.

  For a ten-day stay at Meriwether, the grand total came to $14,276. That’s $1,400 a day. You could get a king room at the Ritz-Carlton in New York City for that and still have plenty left over for exquisite food and a private nurse.

  Soon after getting the bill I called my insurance company to explain the situation. I told them that I was writing a book about mental hospitals, that my recent billed visit constituted research, and that I wished to reimburse them for the full amount they had paid out.

  I may actually be the first person in history to willingly attempt to reimburse an insurance company. You can imagine that the fine folks in the claims department didn’t know what to do with me.

  In fact, irony of ironies, they thought I was nuts. I’m not kidding. After making repeated calls to various departments, in an effort to make myself clear, I finally got a call back from a social worker. She explained, in the most delicate possible terms, that she had called expressly to determine if I was insane.

  Apparently, it’s not uncommon for genuinely compromised individuals to call their insurance companies and attempt to stop payment on claims. Such people don’t offer to pay the claims themselves, but they attempt to dispute the claim, mostly because they adamantly deny that they needed to go to the hospital in the first place, but also because, having gone, they don’t want their hospitalization to appear on their record. They don’t think they’re crazy, and they don’t want other people thinking it either, or having evidence on paper to prove it.

  Because I, too, had told the insurance company that I wasn’t legitimately ill, I fell immediately into the “I didn’t need to go to the hospital, even though they dragged me off ranting and raving” category.

  It only made matters worse when I claimed to be a writer who was under contract to write a book. I offered to have the social worker call my publisher. I even said, “Just Google me, and you’ll see.” But this didn’t seem to fly, and I can see why. You try not to sound like you’re having delusions of grandeur when you tell people that you were on the New York Times best-seller list and appeared on The View.

  “No, really.”

  To date, I have heard nothing more from the social worker or anyone else at my insuran
ce company. I guess they didn’t believe me.

  Overall, Meriwether as an institution made me think. I didn’t come away with answers, but I came away with a lot of questions, which is at least a place to start.

  Just as surely as I took on the mentality of the patient at Meriwether, I couldn’t help taking on the mentality of the staff and the whole system as well. I saw why it was broken down and dysfunctional. I saw where the resignation and dislike began, and I saw where they ended.

  I had gone, in an amazingly short period of time, from being one of the downtrodden to being the queen of social justice, and finally to being the laissez-faire absentee activist who says, “Not in my backyard.” It was a predictable route, and one that left me unsure of how to effect or even propose lasting change, even though I knew that places like Meriwether needed to change.

  To be sure, spending time in Meriwether had made me more sensitive to the plight of the indigent mentally ill. I knew what it was like to be treated like an inferior person whom no one cares about, a person who is never expected to get well, or even consistently better, and so doesn’t.

  I saw that taking people out of their lives, pumping them full of drugs, offering them no real psychotherapy, and then sending them out again to their old lives amounted to a revolving-door policy. They were bound, as so many of the patients I knew at Meriwether had been, to get arrested or committed again, and again.

  But I also saw that working with people who behaved—I’m sorry to say this—like children could wear down your good intentions to a nub. What could you do with people who, when you tried to help them, often either tried to take advantage of you or allowed themselves to be infantilized by your efforts and made no effort to help themselves?

  It wasn’t Meriwether’s fault, after all, if patients went off their meds or didn’t go to follow-up appointments. I could understand why the meds were intolerable, and why these people’s experiences with the mental health system hadn’t left them wanting more, even on an outpatient basis. But I knew that these things were a recipe for relapse.

  This is a classic public policy debate. What will work and what won’t. The liberal will raise taxes to pay for places like Meriwether, assuage his conscience, and see the sorry results of inefficient bureaucracy and impersonal care. The conservative will ask the community, often the religious community, which is usually already in the business of dispensing charity, to take up the burden on its own, rather than fobbing off the unwanted on big government. But that is a burden that many do not want to take on: certainly not families and individuals. Charity may begin at home, or in the neighborhood, but that is where it can be hardest to sustain. As I had learned firsthand, developing relationships with people who are not only disturbed but quite often uncooperative, manipulative, and willfully irresponsible is a job that even people with an overabundance of fellow feeling often find too unrewarding, infuriating, and exhausting to perform.

  Staying at Meriwether only inflamed this debate in my mind. I couldn’t come down on either side. In a way, I had come down on both. But then I still had a lot more of the landscape to see before I would be in a position to make any sense of it.

  I wanted to know, for example, if a private hospital would have more of value to offer a person in distress. I’d been to a private hospital before, my first time around in 2004, but that, too, had been a big-city hospital, and I’d had what I was still open-minded enough to think of as the misfortune of getting stuck with a lousy doc. I still held out hope for better consults—and maybe nicer staff, and better food, and cleaner bathrooms, and who knew what other luxuries.

  Besides, I was looking for a totally different clientele. At Meriwether, I’d had the public, urban, indigent, mostly black and Hispanic psychotic experience. I wanted to find a rural, middle-class, whiter than white private clinic, where I suspected depression would be much more common than psychosis.

  I was also curious about what I’d find in a state that had gotten bad marks for its treatment of the mentally ill. On its Web site, the National Alliance on Mental Illness (NAMI) posted the results of a report they conducted in 2006, in which they graded all the states in the union on their treatment of the mentally ill. Almost every state received a C or below. I wanted to go to an institution in a state that had been given an F. There were eight to choose from, and, conveniently enough for my purposes, all eight were in very white parts of the country.

  To make it official, I consulted census data and found a place with a population that was both small and 95 percent white. I did a little more research on the Web to find a private hospital in the area, and then I had my target. I packed a bag and booked a ticket, and that was that. I was on to Phase 2.

  Or sort of. Something unexpected happened around that time; unexpected at least as far as this project was concerned. It wasn’t unexpected when you consider prior experience.

  I fell into a depression.

  And why? Because I went off my meds.

  Over the course of several weeks, I adjusted the 20 milligrams a day of Prozac that I’d been taking when I went into Meriwether and brought the dose down to 15 milligrams. Then 10. Then zero. It took a few more months before I hit the really rough stuff: to be exact, the three months between when I got out of Meriwether and when I made my trip to the bin in the hinterlands. The timing was almost perfect. I started scraping bottom, and then I got on a plane to present myself at a hospital once more. This time I didn’t really have to convince anyone that I was depressed. It was pretty clear, even to me.

  There are really two reasons why I went off my meds. One good and one not so good.

  The good reason was that, while doing some of the background research to write this book, I’d been doing a lot of reading about psychiatric drugs: how they were and are discovered or synthesized; how they’re tested, marketed, and prescribed; and how little anybody really knows about what they’re doing to our brains. The more I read, the angrier and more apprehensive I became about using them. Hence my reluctance to take anything at Meriwether.

  I just didn’t want to be dependent for the rest of my life on a drug whose effects neither I nor the professionals could understand or predict, and whose glowing reputation had been based almost entirely on the meticulous propaganda of the companies that were profiting hugely from its sale.

  I wanted to find a way to do without drugs, and not to succumb without a fight to what I considered to be the drug company’s and my doctor’s less than disinterested suggestions that I needed them.

  I thought that that was a pretty good reason to try to go off my meds. I still do.

  The not so good reason was that I did it for the book. I did it because, as I have said before, my brand of journalism is immersive. You have to have the whole experience, or as much of it as you can. You can’t just stand outside as an observer, the way I had in certain respects at Meriwether. The whole point is that you are not objective.

  Besides, I had started this book because I went to the bin that first time for real. I had experience with mental illness, or distress, or whatever you want to call it. I was a subject, too. My own subject. I couldn’t brush that aside or keep it discretely apart while I watched everyone else crawl through the tar pit.

  But, without actually becoming depressed again, I couldn’t really pull myself into the experience in retrospect. That’s the thing about depression, I have found, and this is a great mercy under normal circumstances. When you’re over it, when you’re not depressed, it’s really hard to remember exactly what it felt like when you were depressed. You can remember it as an idea. You can describe it analytically. You know you felt terrible, and you know you don’t want to feel that way again. But you don’t really remember the details, the quality of the suffering. But I wanted to be able to reexperience that, and then render that in real time, as it was happening, not after it had passed.

  I know, I know. Stupid. But there it is.

  And, for what it’s worth, here it is.

  So turn th
e page.

  ASYLUM

  St. Luke’s

  It began with dread in the morning. I woke with a feeling of dread. The first conscious thought. Something is terribly wrong with my life, with life in general, how it works, how it goes. It’s too much. I can’t face it. I am frightened. I am too small and impotent to handle this.

  This was only an inkling at first, like the vestige of a bad dream. I could not even remember what I was dreaming about, but I woke with this feeling that lingered well into the morning, well into my coffee making and shower.

  I stood in front of the toaster and thought: It is absurd to be this afraid of nothing. But I am. I am afraid of nothing.

  I looked for reasons, causes to assign, but they were irrelevant. That was the point. The fear. The dread came from nowhere. It did not correspond to the present or the prospects of the day in front of me. I was on firm ground. I had an enviable life. But it felt as though I was perched above the void. Blankness below. And my world crumbling around me.

  My doctors might have explained it as an incommensurate stress reaction, a flight response on overload but with no discernable provocation, my brain thinking I was rappelling on a cliff face, dangling in danger. Adrenaline pouring in, but nothing so extreme had happened. I was just standing in my kitchen. The cliff, the void, was in my brain, in my dreams—and then it carried over into the morning when I woke.

  This was disconcerting enough when it began. More so as it grew and extended itself throughout the day, through more and more days. Then I was genuinely concerned. Taking a moment to step outside the immediate storm, which had become so consuming, I thought: This is not normal. I have never been normal, but this is diseased even for me. There is something really wrong.

  I thought this especially when somewhere around midday I crawled into the bathtub without running a bath. The fetal position, taking comfort in the cool, white porcelain pressing against my cheek, a substance both strong and smooth bending around my bent body, binding me, solid, firm, the bounds of a disintegrating self, the bucket that collects me, dissolving into a pool.