Voluntary Madness

by Norah Vincent

  Who do I imagine I am? This was a pressing question suddenly. But unanswerable, of course.

  I stood abruptly. Rushed to the mirror. I held my face close and stared, reminded of a friend who, after a traumatic brain injury, emerged from a coma, looked in the mirror, and did not know who she was looking at. Really did not know who that person was. Had never seen her before. Could not fathom identity.

  That was happening to me, only it was happening in the way that simple everyday words like “because” and “hello” lose their meaning when you stare at them too long on a page, or are suddenly unsure how to spell them. It was a fundamental falling away of the most basic assumptions. The known suddenly somehow foreign.

  Who the fuck are you? And what the hell are you doing in the bathroom?

  This was a real question. I meant it. I really meant it.

  I was in a bad way, and it was my own fault.

  I wanted to go off the meds and so I did, tapering slowly, wisely, this time, or so I thought. I had coping mechanisms in place, exercise, meditation, work, experience. And for weeks I was fine flying solo, though fatigued and susceptible to cold, even gaining weight, such that I wondered whether my thyroid had been thrown out of whack by the serotonin, another of those effects no one seems to know about and can only guess at from the symptoms.

  After a few more shaky weeks, I began waking in the morning with the dread. And then the bathtub and the mirror. And then the extension of the morning dread into the day, and a darkness being thrown over the world, and a solid belief in the untenability of my life. The infantilization. The curling up. The sense of being ill-equipped for everything, the conviction gathering speed that death was the only real option.

  I cannot work. I am useless. I am taking up space. Consuming resources. I have no function. I am stupid. I will fail.

  I had gotten out of Meriwether untrampled and I thought I was on my game. And then there I was thinking about where I could buy a gun.

  A gun seems best. I am a maimed animal. Perhaps I can hire a hit man. I will tip him very well to take a clean shot.

  Cowardice. You see?

  I had been commissioned to write a book about loony bins. I had been to one already. I thought it was going to be a success story. Look at how I got off the meds and learned to make it on my own. But that is not how it worked out. I was going in again, this time with a wound in my side.

  For research?

  If you say so.

  Pah. For real.

  There was no need to pretend this time around. I cried in earnest in the admission interview. And why? Because that is another thing that happens when I stop the meds. I cry a lot. Big jags of tears over things like Oprah, which was what I was watching on a 52-inch plasma TV, waiting in the lobby of yet another hospital.

  The intrepid reporter undercover.

  I want someone to take me in. I want to pretend that I am doing my job, but I belong here. I am a pitch-perfect silent screamer, a forlorn lump.

  Oprah. And I was crying in this tiny Catholic hospital—facility, really—more like a clinic, a specialty clinic for addicts and lunatics plunked down there in the middle of the plains where the freight trains passed through town outside the rain-bespeckled windows, moaning like whales under the broad gray sky.

  I listened as I sat. Sometimes I walked to the window and looked, saw the red signal lights flashing on the gantries, the line of waiting cars with their echoing rows of red taillights blurring in the downpour.

  In the corner of the room, next to the window, there was a life-size gilded statue of the clinic’s presiding saint, Luke, standing over the four rough upholstered armchairs, one of which I was occupying.

  There was a Fisher-Price play station at my feet, with ramps and tracks and obedient balls, a knee-high table and chairs, a box of toys half scattered in the corner. They treated children here, too.

  What a place, I thought. What a place. So kind. So homey. Carpeted and warm. Quiet. There was only the TV, the volume low, and then only the sound of fingers softly typing, phones mutedly ringing, genteelly being answered.

  It was late Friday afternoon. I had come for an appointment I had made by phone earlier in the week. I had called in supposed distress. Said I was on the road, about a hundred miles out of town. But I really made the call on my cell phone safe at home in New York.

  Right. Safe.

  As soon as I got the appointment, the so-called needs assessment appointment, I booked a flight.

  The flight had been due to arrive more than an hour before the appointment. This, I thought, would give me plenty of time to take a taxi, even if the flight was late. It wasn’t, and the airport was a joke. Two gates and two baggage carousels, like something on a Caribbean island. It had never seen a crowd. I had to call for a taxi, and the one cop on duty at the curb knew all the drivers by name. It took ten minutes to get from the airport to “downtown.” It cost $13 including tip.

  So there I was, early, flipping through magazines. Waiting alone in the lobby. A business reply mail card fell out of Bon Appétit. On it someone had repeatedly scrawled the word “Bored” in big letters. Other cards that fell out of other magazines, Redbook, AARP, Popular Science, had more messages embedded. Always the same. “Bored,” “I’m bored,” or “Boring.”

  A good joke, and for me, an unexpected smile I was thankful for. Solidarity left behind.

  Been there, my friend. I have so been there.

  The admitting staff was not pressed. Behind the long bulwark desk, with its glassed-in hutches and computer nooks, impeccably dusted, veneered, and generic as a floor display, two menopausal moms floated at their workstations, their fat fingers fluttering papers.

  They multitasked smoothly, smiled patiently like women who had spent years darning mittens and cutting the crusts off sandwiches. They watched snatches of Oprah, admitted the odd visitor, touched up a database, caught the phone on the second ring.

  This was restful. It calmed the fear—the extra added fear, even though I was convulsed by fear already—of having flown into a far-flung place to check myself into the bin. Yes, this was all of my own doing, of course, so whatever happened would be my own fault, perhaps even deserved. And yet. And yet.

  It was not all bad. Not at all. I felt strangely young, sitting there, and new to the big world, guided by these ladies, as if this were Take Your Daughter to Work Day, instead of take yourself to the psych ward.

  The harbingers of good care in the clinic above were in the furniture and the carpeting downstairs. The carpet was so impressive, so calming. Sage green. A luxury bespeaking control in the clientele. It meant they didn’t expect anyone to vomit or shit himself or otherwise besmirch the premises.

  Effort had been made, even in the three yellow gerbera daisies in a pot on the side table in the small consulting room where they asked me to wait for the needs assessment counselor. There were color photographs on the walls. The trunks of tall oaks growing clustered in luxurious stretches of green grass with shafts of mystical sunlight beaming through them. There was a box of tissues on the coffee table, thoughtfully placed, close to hand, an accoutrement of admission. Admission of instability, depression, suicidal urge, and admission to the hospital for same.

  Like a ticket in my pocket. Admit one.

  I waited in the room and looked at the pictures and the tissues, and allowed myself to be soothed by them a little, until the counselor came in.

  The counselor, the girl—she was a girl to me, no older than twenty-five. Or at least she had the sprightly affect of that age, and the uncreased eyes, and the babyfatted mode of inquiry, and the eiderdown belief in what she did. The girl was very kind.

  She had not yet felt the bludgeon of experience. She sat with her legs crossed at the knee, a clipboard in her lap. And on her feet—one bouncy foot dangling over the other—a pair of what I would call Mary Janes if you could hike in Mary Janes. Sassy schoolgirl upper. Bumper toe. Gripper sole. I liked her for those. They made me trust her.


  And so a tear rolled out of my eye.

  I was seized unaccountably by rue. I was ashamed, awed by the unspoiled attention of a girl assessing my needs, a girl who wrote down my answers so carefully in slow, looping script.

  She seemed somehow outsized in her kindness, almost allegorical, the figure of Help in the pilgrim’s regress. And I was in retrograde motion for sure, slipping out of the light, the line of waning day making its way across my face and leaving me in shadow, like a planet turning from the sun. She saw this and understood. It was not beyond her, though she herself had never known that kind of orbit.

  She asked what I was doing in that town, because it is not a destination, barely a stopover, and even to the locals it was the middle of nowhere. I told her I had been hitchhiking across the country from New York, fleeing an unmanageable life.

  “When I got here,” I said, “I knew I was in trouble.”

  My voice caught in the lie. She noted this with her eyes, then noted it down with the pen. She was filling out a form, several forms, back and front, the first of many. They were positively German about this. Her forms, along with the others completed by the doc, the nurse, the social worker, and me, would end up in a three-ring binder with my name on it. And next to my name the initials MI.

  “What does MI stand for?” I would ask.

  “Mental illness.”

  “Ah. I see.”

  The other labels were CD, for chemical dependency, and DD for dual diagnosis, which meant that you were a loon and you did drugs. Technically that was me. DD. My file would say “history of cannabis dependence,” but not, thankfully, “unhealthy preoccupation with bowel movements” or “mean drunk.” It would also say, notably, “Patient is homosexual.”

  This was one of Mary Jane’s many questions in the interview, slipped in nonchalant.

  “Do you consider yourself to be heterosexual, bisexual, or homosexual?”

  They asked this of everyone, I learned, though I feel sure that “patient is heterosexual” never appeared in anyone’s chart.

  There were other odd questions. Ones I hadn’t heard before, designed, I presume, to see how cognitively impaired I was.

  “I’m going to hand you a piece of paper with something written on it,” she said. “I want you to read it aloud and then do what it says.”

  She handed me the paper. It said:

  “Close your eyes.”

  “Close your eyes,” I repeated, and did.

  “What is this?” she said.

  I opened my eyes. She was holding up her pen.

  “A pen.”

  She pointed to the door.

  “What is this?”

  “English as a foreign language?” I ventured.

  No smile.

  “Sorry. A door.”

  She handed me another piece of paper with two interlocking squares drawn on it.

  “Draw what’s on this paper, then write a sentence. Then fold the paper and hand it back to me.”

  I drew the boxes and wrote pompously, “When does it begin?” I folded the paper and handed it back.

  She unfolded it and glanced at what I had written.

  If I had to guess, I’d say she thought, “Geek.” But maybe it was “faker.”

  “Are those real?” I asked, pointing at the daisies.

  “No. Are you having thoughts of self-harm?”

  “Yes.”

  I didn’t believe that I really was. Not right then. But I had been a few minutes before, hadn’t I? Or was it hours? Or days? Still, I said it anyway, for the research, I told myself, because admission of danger to self, others, or property is pretty much guaranteed to put you in the bin, if not of your own will, then against it.

  “Are you feeling anxious?”

  “Very.”

  “What about?”

  “Myself.”

  A pause.

  “I don’t feel safe.”

  This was gold. Safety is to be found in the hospital. Theoretically, anyway. It was a mission in this place. A point of pride, you could tell. She would check off “inpatient” after that for sure.

  “Do you think you need to be admitted?”

  “Yes.”

  “I do, too.”

  She left the room to telephone the on-call psychiatrist and tell him that I needed in.

  I am pathetic. I have insurance. They won’t refuse me.

  After the Meriwether experience, I decided it would just be easier, and would certainly make me much less conspicuous, if I owned up to having insurance and presented my card right away. I had to do everything possible to make sure I got into St. Luke’s without a hitch. I didn’t want them shuttling me off to another public hospital. Besides, I still had to chase down my insurance company about reimbursing them for Meriwether, so I figured I could pay up for St. Luke’s at the same time.

  One of the menopausal mommies made a copy of my insurance card and called it in. Mary Jane came back into the room.

  I was admitted to the hospital.

  I had not been told what to expect, or what voluntarily committing myself would mean when I wanted to get out, though I signed the papers that told me these things if I had cared to read the fine print. I had not, however, seen an MD. But somehow it didn’t seem to matter. It was like going into someone’s home. You feel bad? Poor dear. Come in.

  I had been formally admitted, but I was still waiting in the lobby some time later. They were ready to take me in, Mary Jane informed me, but someone upstairs was apparently “very upset,” so I was waiting out the tantrum downstairs.

  A voice on the loudspeaker, which was very tame and dulcet as loudspeakers go, said calmly,

  “CIT second floor. CIT second floor.”

  I heard this designation again once or twice during my stay. Crisis Intervention Team. But it was for other floors, so I didn’t see who came. I imagined they wore dark red or dark green blazers and ties, like offertory ushers in church.

  Sitting there waiting, I began again, as I often did when the depression got to this point, to get stuck in a spiral of thought. There was nothing else to do, so I was asking myself all the kinds of confused philosophical questions I always asked myself when I felt done for.

  How does a person get here? To the point of commission, I mean. Is it a failure of will? Of discipline? Or worse, a metaphysical lack?

  I could not escape this prejudice, if it really was one. I still can’t. In the culture of depression as chemical imbalance they assure you that it is a prejudice. Words like “will” and “failure” are not only unfair—signs of an unenlightened view of major depressive disorder or bipolar disorder, or whatever as yet theoretic ailment I am purported to have; they are also false terms. They do not apply. Or so we are given to understand.

  This is my fault. My deficiency. My mistake.

  Thinking back on it now, I remember one of the videos they screened in the dayroom at St. Luke’s, a video produced and paid for (surprise surprise) by one of the major pharmaceutical companies that markets antidepressants.

  “Depression is not your fault,” it said.

  The white words appeared on a black background, the letters jumping off the screen, moving toward the viewer, highlighted in a box, the narrator intoning, too, for emphasis.

  “Depression is not your fault.”

  That is what the drug companies and the doctors and a whole lot of patients wanted you to know. If you contradict this idea or question it, it’s merely the depression talking, or ignorance. But is it? Entirely?

  “I’m diagnosed,” said Teary Molly, one of the depressed patients I would meet in the ward upstairs. She was a cherubic plump twenty-two-year-old mother of two. Her face was always pink and smeared with fresh tears.

  “I want my father to know that I am diagnosed,” she told me. “He doesn’t believe in depression.”

  “Neither do I,” I had wanted to say, but I didn’t quite mean it the way her father did. I believed in depression as a phenomenon all right. I believed in it the
n sitting there in the lobby. I believe in it now. The fact of it, surely, is incontrovertible for me. I had been in the tub. I had been reduced to a quivering mass.

  And yet still there was an argument going on in my head.

  I am here. Depression exists. As for cause? Disease? That is something else altogether. I am open to it. I suspect it. But there is no truth to this as yet. And there may well be will or partial fault involved nonetheless.

  There must be.

  The argument goes on now, in much the same way as it did then: What is the role of will?

  After all, even established, testable diseases and conditions, like heart disease or the famous depressive corollary, diabetes, can be and usually are exacerbated by human choices, lifestyle choices, hamburgers, sweets, cholesterol, laziness. Should depression be excepted from this list because it comes from the brain? And does it come from the brain, or is that just another effect? An effect of some as yet undiscovered virus, say, or simply the old culprit, stress?

  Unknown.

  I hated—sometimes I still hate—Teary Molly the way I hated and sometimes still hate myself, and probably the way her father hated her, too. I hated what I saw as her mewling, self-sorry entitlement to the mantle of illness as identity, her overeager taking of refuge in “diagnosis,” in the imprimatur of the medical establishment that absolves her of all responsibility.

  I come back to this theme again and again. There are no diagnoses in psychiatry. Only umbrella terms for observed patterns of complaint, groupings of symptoms given names, and oversimplified, and assigned what are probably erroneous causes because those erroneous causes can be medicated. And then both the drug and the supposed disease are made legitimate, and thus the profession as well as the patient legitimized, too, by those magical words going hand in hand to the insurance company: “Diagnosis” and “It is not your fault.”

  But what if it is my fault? Or partly my fault. Or what if it is, at least, a deficiency of my own neglect?