Voluntary Madness

by Norah Vincent

  What might happen if we as a culture took even the most minor responsibility for the lost among us, rather than consigning them, and quite possibly ourselves, to the ravages of the system? The indifferent system.

  Have we abandoned each other to “the professionals,” pushed ever on by our definitive work ethic to perform or sink, to behave as though we do not live in bodies, do not have emotional lives, have no ties to community? If we are healthy, we get the benefits of family and a place in the social order, a place that reinforces our mental health, makes possible our continued ability to hold that place in the social order.

  We are pack animals sustained by companionship, bonds, and our position in the web of human contact. But if we fall, if we fail, if we succumb to the breakneck pace and onerous demands of our lives—too much work, too much family, too many responsibilities and natural, normal fears—then we are cast out, shut away, ripped from the sustaining web, and expected, alone and abandoned, to recover.

  What about a community that makes a place and takes personal responsibility for the impaired, accepts them as part of the larger civic body and takes the burden on itself, spreads it among the healthy to lighten the load? What about a community that says, “We will care for our own”? Instead there is the alienated demi-apocalyptic world that detaches signified from signifier, piece from whole, and sends the wounded off to languish in the psychic poorhouse.

  It is the difference between public and private solutions, the cold grasp of the institution, and the warm fold of a refuge where people have names and not wristbands.

  This reminded me of Meriwether again, and Mother T.

  I remembered Mother T trying to say the word “psychosis.” She never stumbled over other English words, but this one she did. Psychosis. She said it like she was trying to get her mouth around it, like it was too big a bite taken from a burger. She’d learned it from her doctors. Her diagnosis. Psychosis.

  That’s how Sister Pete said the word “kerygma,” uncertainly, but with gusto nonetheless.

  “What is that again, Sister? Kerygma?” I inquired.

  “Yes, kerygma.”

  She was telling a joke about Jesus.

  “Is that what you get when charisma meets enigma? Jesus as charismatic enigma?”

  I liked my own bad joke. She did, too. She laughed.

  “No no. Kerygma.”

  I asked her to write it down. The whole joke with the word in context. She produced a piece of scrap paper from a memo book she was carrying. The memo book was full of scraps, none of which was much bigger than a gum wrapper. Some were blank. Some had old jokes or reminders written on them.

  She told the joke as she wrote.

  “Jesus asks the modern-day apostle: ‘Who do you say that I am?’

  “Answer: ‘You are the eschatological manifestation of the ground of our existential being, the kerygma, in which we find the ultimate meaning of our interpersonal relationships, the pristine quintessence of Him whose very essence is to be, the primordial sacrament exerting a transcendental holding on our becoming.’ ”

  She paused here before the punch line, her wimple rising.

  “And Jesus said: ‘Huh?’ ”

  Her eyes went especially wide when she said the “Huh?” and then she grinned and started in on a long lilting laugh.

  “That’s good, Sister,” I beamed, charmed as always by the pure joy Pete took in the smallest things. And I began to wonder whether true goodness wasn’t, in this fucked-up creation, a form of retardation. Not an avoidance of vice but an ignorance of it, a lack of acquaintance with it that cannot be willed after the fall, no matter how strong the intention.

  The temptations the rest of us are forever trying to elude are things that would never occur to Pete, wholly oblivious, in her tree house still, listening to the birds and blissed out on God. This led me to thinking something I had thought before, that perhaps mental illness is a form of brain damage or brain trauma. Maybe the upside of that is that it functioned, as it appeared to in Sister Pete’s case, like a protective coma that kept the thinker from thinking too much.

  And so in this vein, like a jackass, I said sophomorically:

  “Sister. Don’t you ever feel the burden of existence?”

  She cocked her head to one side, brought up short from her laugh in true puzzlement.

  “The burden of existence?” she asked.

  Touché, Sister. Touché.

  Now that I was upstairs, the program began in earnest. First thing each morning, as soon as I emerged from my room, perhaps of my own accord, perhaps coaxed by the gentle sarcasm of Nurse Maggie, who chirped, “Good morning, Sunshine,” or Nurse Candy, who wheeled in a blood pressure monitor and said, “May I?”

  However it happened, first thing, when I sat myself down in a chair in the octagon or the kitchen, someone, a nurse or a psych tech, handed me my self-inventory form.

  This form was used as the basis for the first group meeting of the day, which began at 10 a.m. and was variously called process group or goals group or social work group. In this group, all the patients on the unit met with a nurse or a social worker or a psych tech to take stock of our progress or lack thereof.

  Question 1: Target behaviors

  Depression

  CHECK ONE.

  Not at all_____Not much ____Somewhat ____A lot ____Extremely ____

  Anxiety

  CHECK ONE.

  Not at all___Not much ...

  Suicidal ideation

  CHECK ONE. . . .

  Question 2: How is your relationship with your family?

  Improving ___The same ___Getting worse ____

  Question 3: How did you sleep?

  Well ___Fair ____Poor ____Required Medication ___

  Question 4: My appetite is:

  Good ___Improving ___Poor___

  And so on down the line. My energy level is . . . my ability to concentrate is. . . . Have you had suicidal thoughts today? (If yes, please tell staff immediately.) What are your goals for today? Did you meet yesterday’s goals?

  Goals and groups were the backbone of the day, both a way for staff to keep meticulous records about each patient and an opportunity for the patients to vocalize their feelings as well as make requests and complaints. Keeping us occupied and checking in was useful, even if sometimes it was a great heaving bore for anyone functioning above a murmur. Naturally, a lot of it was going through the motions, the staff asking the same questions over and over again—How are you feeling today? What’s your goal for the day?—and the patients, depending on their moods, usually giving answers that were either long-winded and peevish or prudent and angled to expedite their release. Still, it was better than being babysat by TV, and it did force each of us to mark the days in some meaningful way, however small.

  After Meriwether’s malign neglect, I respected the attempt at care, even if I made fun of it sometimes. When they asked me, for example, if there was anything I needed or would like, I wrote, “A heart, a brain, courage.” Or on the sleep question, after the last option, “Required medication,” I penciled in my own worst case, “Required bludgeoning.”

  Every day was the same. Process/goals group ended at eleven, with me and the rest of the crew having stated our purpose for the day ahead and condition of the night before. Then there was an hour before lunch during which most of us watched talk shows on TV, or doodled with the array of colored pencils that were piled in an old tin on the table in the octagon, or worked on a jigsaw puzzle that was spread accommodatingly on this same table. At noon we were lining up for the chow cart. They scooped the daily grub onto our outstretched paper plates and handed out plastic utensils. (Other than at meals, plastic flatware could only be had by special request.)

  At one o’clock, sometimes there was social work group. There we met with a social worker and bellyached about our prospects, or fidgeted about what we were going to do when we got out.

  If it wasn’t social work group it was medication group, where we bellyach
ed to a nurse about how stoned we were or weren’t, what kind of nightmares the meds were giving us, how shaky or sweaty or constipated we were, and so on, and she made notes to give to our docs.

  Some days there was no group at one, in which case we all ensconced ourselves in front of the TV, or resumed work on the pastoral scene with skipping girl that we’d so assiduously been coloring. Or, as in Gerald’s case, we got back to counting the pile in the carpet.

  At two it was either occupational therapy or activity therapy: OT or AT. In OT we headed into the art room and got all crafty-creative with beads and glue guns. For an hour, we made pieces of jewelry or wind chimes, or, in my case, a mosaic tile trivet, while listening to soft rock on the radio—“WDSM, the station everyone in the bin can agree on.”

  In AT, we either played a game like Scattergories or Cranium, or we headed down to the activities room in the basement, where there was a foosball table, a Ping-Pong table, an array of Nerf balls, a plastic Fisher-Price basketball hoop, and semifoam, semiplastic bowling ball and pins. There was also an Exercycle and a treadmill, though not the kind you could break much of a sweat on, or a limb, which was the point. Everything in the room was sue-proof, or as near as they can make it.

  OT or AT finished at three, and the rest of the day was ours, not that there was much you could do with it, unless you had a pass. I used my hour pass at this time, from just after three to just after four.

  The days went slowly, and as much as I found solace in my room, and in the company of the addicts, I found that working so often in groups with emotionally destroyed people only worsened my depression. The addicts were following their own program, based on a twelve-step model, and we never mixed in group therapy, so I was left to founder with my own kind.

  Looking around the circle in therapy meetings, I often found myself going back to my ugly round of thoughts.

  These are the palest, most rumpled, useless, yet somehow proudly despondent sacks of meal I have ever had the misfortune to call myself one of. The entitlement in all of us is appalling. My, me, mine. I’m unhappy. Fix it. Happiness is my right as an American. Not its pursuit, but its persistence, like an arc over my life, cradle to grave, a sheltering bough, for spacious skies and fruited plains, the bounty of my country. America the beautiful. And happy. Except that the next verse of that song says, “Mend thine every flaw.” Meaning make a fucking effort, you sloth.

  Sloth. A deadly sin. I’ll have to talk to Sister Pete about that. But sin is so unfashionable now anyway. Who needs it when you have the great exoneration of disease? Hell, that’s better than nihilism. That is nihilism. Nihilism with a candy coat.

  What’s easier than, Everything is permitted? I’ll tell you what. Everything is a disease. That’s what.

  I was not really making sense or being fair. I was pissed off, rage being just another form of negativity to indulge at these crumpled people’s expense, and my own. Yet, how could they expect the group therapy model to work for depressives the way it appeared to work for the addicts? They shared their stories, as so many other addicts did in twelve-step groups, and seemed to gain insight and relief from their fellow patients’ articulated pain and reciprocated understanding. I knew this, in part, because of things I overheard in the dayroom, or things they told me directly when I asked them. But I also knew it because, despite the usual separations, I did manage to sit in on one of the addicts’ sessions, an open AA meeting that met once a week in the basement of the clinic.

  There, among the resident addicts, as well as another forty or so outpatient former clients, people joked and laughed. They spoke seriously, too, of course, about their more sordid escapades and histories, and about the destruction they had brought to their own as well as others’ lives. But even the hard ideas helped cement the bond of public confession and shared mistakes. There was a sense of forward motion and positivity even in the darkest stories. People were there to lance their boils and walk away relieved. They were not, as my fellow depressives and I seemed always to be, intent on stewing in their distemper.

  Maybe it was just this particular crop of depressives—they were no one’s dream team, to be sure, and neither was I—but I wasn’t getting anything except more negativity and a heightened sense of alienation out of listening to Trevor talk about his devil dogs and watching Gerald become one with the wallpaper.

  It wasn’t that I couldn’t see, in theory, how talking to other depressives might help me get some perspective on my own death spiral. It certainly had in the past, when I had spoken to depressive friends. But that had only been true when the depressives I had been talking to hadn’t themselves been depressed.

  Those conversations had helped me only because the person in question had recovered. They weren’t in the hole anymore, which meant that (a) the hole hadn’t swallowed them up, and so, by extension, it wasn’t necessarily going to swallow me up either, and (b) they were standing aboveground and had some perspective on where they’d been and where I currently was. They could throw me a rope.

  But these people on the ward were just as firmly in the hole as I was, so what rescue could they offer? To make things worse, it wasn’t even the same hole. We were all in our own separate holes, so we couldn’t even play blind patty-cake. The best we could do was overhear and cross-talk each other’s pitiful wailing and griping. We were just blobs in sweatpants in dire need of dandruff shampoo. All those groups were just wasted time, as far as I was concerned. I got much more out of my individual therapy with my psychologist.

  Not that that was transformative either. It was fine. It probably helped in the way that traditional psychotherapy is supposed to help, or at least in the way it has helped me in the past: by getting me to organize my thoughts through verbalizing them. But in the end it was just your basic three times a week for fifty minutes.

  My stalwart therapist was very sympathetic, obviously thoughtful and caring. A practiced and expert listener. She always tilted her head to one side and slightly down, and tucked her long hair behind her ear. Her watery blue eyes looked up at me and blinked slowly at all the right times. She compressed her lips sorrowfully when I cried, or, as was more often the case, when I tried not to cry and failed, and licked the snot off my upper lip. When I choked on a word, she always waited for me to go on. She never spoke before I’d finished. She understood. She responded. She tried. She had all the right tools of the profession, except maybe that spark of the dark arts that therapists always have in the movies, and that I had always looked for in real-life therapists but never found. It was probably just as well that I hadn’t, since the most appealing movie shrinks usually turned out to be serial killers anyway.

  I don’t mean in any way to denigrate her. I am grateful to her. She did well by me, such as doing well can be with bread and butter. She was the companion piece to my room. Another clear benefit of St. Luke’s that I had not enjoyed elsewhere. A place to rest and confer with myself, a wall to bounce my riffs against, a small but true light to steer by. It wasn’t her fault that I needed Hannibal Lecter as my therapist. Or thought I did.

  But whatever the misfires of the treatment, the staff treated us with what I came to see as St. Luke’s trademark kindness and concern, and sometimes staff members even made surprising and creative extra efforts to reach us.

  On one occasion, for example, a psych tech named Mitch did something far more inventive and healing than I would have expected from anyone in a hospital setting. Just before wrap-up group one evening, he hid a remote-controlled fart machine under Teary Molly’s chair. When it was her turn to blubber and whinge about her day, he hit her with a loud one. She looked puzzled. Didn’t get it. The group, presuming she had lost control of her sphincter in her distress, decided to ignore it. But then very quickly he sent another. The machine was well designed, offering an inspired array of sounds from plappy to squeezed, and every permutation in between. This one was a percussive blurt, like a low note from a flügelhorn, followed by a long slow deflating wheeze. At this Sam coul
d no longer keep a straight face. He dissolved in silent laughter. I, being me, took the helm on this one.

  “Jesus, honey, do I need to move?”

  Mitch sent another. A classic whoopee-cushion bubbler.

  “Okay,” I said, “you have my respect. Peace.”

  Now the whole circle was roaring.

  Mitch had done the impossible. He had tickled the walking dead. Like the employment of Sister Pete, this struck me as an awe-inspiring act of kindness on Mitch’s part, and I was impressed anew with the quality of person St. Luke’s managed to employ. Not only had the nostrum of laughter as best medicine managed to survive the pharmaceutical age, but it came sliding into that circle of pathetics on the whim of a young man who had no degrees or pedigrees, just some old wives’ wisdom about what was good for a soul in pain.

  Sister Pete was holding a black Grave Digger Monster Truck, a stuffed toy that a kid on the children’s ward had given her to mend. She was planning to sew up one of the wheels whose seam was ripped and return it tomorrow. But for now, sitting with me in my night-lighted blue-walled room after supper, she was holding the thing like a baby, fascinated as usual.

  I, too, was interested in this artifact. Where else but on a children’s mental ward would you find a stuffed truck? No hard edges allowed, even in toys, which could be and no doubt were thrown. The children’s ward was above us, and I had already heard loud pounding coming through the ceiling in the octagon on the addicts’ side, where I had been spending most of my social time.

  “What the hell is that?” I had asked Fenske, who was watching the Lakers game with me on TV.