The most I could expect from a psych ward, even a good one like St. Luke’s, was to walk out with revised definitions of my terms, more resigned to the grays, and with my veil of necessary illusion firmly replaced.
I was better when I left—not well, but better. And I would remain better until I wasn’t, which was bound to happen. And happen again. And go on happening as long as I lived.
As long as I live.
That is why psychiatry is as bankable and recession-proof as prostitution. There’s always a demand for it. I, and other people like me, will never be fine—that is, impervious. We will just be more or less balanced over, cripplingly aware of, or functionally oblivious to the abyss.
And how was this miracle, this overhauling of perspective, achieved for me at St. Luke’s? Not by meds, that’s certain, though meds would come back into the picture in small doses after I left. That, too, was certain.
But right then in St. Luke’s, recovery happened because I began finally to use, to make progress on, some of those ideas that I had spent way too much time futilely indulging while in despair. Ideas and words.
Like hope.
And so, for me, hope came stubbornly back, with its helping hand on my back. But with all its false promises and mean little pinches, too, saying, “Go forward. But I’ll get ya. But go forward anyway.”
I began to unwind the loops my ideas came in and got stuck in, and I began to internalize them in new ways. I took them with me like talismans or touchstones in my pockets.
Courage. There’s another word. Another idea too big for its casing. It, too, means something new to me now. It means blind. And deaf. And dumb as a god who doesn’t answer. It means put on your helmet and jump, or cross yourself and charge. Stop thinking so much and just do, because there is nothing else for it but a crazy, all-out, arms-flailing gumption and gusto that defies all logic and sense.
Normal life is nuts. It’s a downhill deterioration to death no matter how you spice it along the way, and there’s nothing you can do about it. Now, a sane person, when faced with that, would just plunk his ass down at the starting line, or wherever along the way this realization finally came to him, and say, “Are you kidding? I quit. I’ll slide the rest the way or sit here and smoke.”
It takes a true lunatic, or someone functioning with the critical apparatus of a worker bee, to keep scrabbling up that hill when he knows his destiny is dust.
But that is what is required. Go on.
It’s not that my view of the world changed at St. Luke’s. I just learned to stop obsessing about it so bleakly. Or, I should say, I learned this again. It wasn’t new knowledge. Not entirely anyway. I had learned it, or implemented it in the past, through the wondrous circuit-breaking, cloud-busting effects of medication. That, in my view, is the great virtue of medication. It blocks thought, or filters it to a manageable glow.
But you can get some of the same results with your mind, too, if you work at it.
At St. Luke’s I got it through the silence and calm and privacy of retreat in a room with a night-light, and I got it with the help of the kind of group therapy that you get in card games in a dayroom with drug addicts and other high-functioning kooks like me. I got it through announcing my troubles aloud to a good listener and by meeting a doctor I could believe in. I had my faith in the system restored a little at St. Luke’s, and this can do wonders for your outlook on the world. Realizing that some people are good at what they do, that they care, that they want to make a difference, and do—all of this gives you back a little spark of belief.
And then we are back to words.
Yet another puffed-up word. Belief. That was really the big one for me. And, boy, was it redefined. Because when I say “belief” I really mean “make-belief,” and by make-belief I mean pretend.
I learned to pretend. To pretend that I didn’t know all the heavy things that I thought I knew. I learned to purposely forget.
Because—and here is Sister Pete having her say again—as Eve and then Adam found out, there is a whole hell of a lot of knowledge about the goddamned human condition that we are not ready for.
So when you happen on it—it being some kind of insight, which may or may not take the form of a really delicious apple—and it convinces you of a bunch of true, inescapable stuff that you really can’t live with, the best advice I can give you is this: just hand the apple back. Just unknow. Because you can. That’s one of the beauties of having fallen from grace. You can lie, especially to yourself. What’s more you can lie to yourself about lying to yourself, and best of all, really believe it. That’s denial. The real sinning graduate’s prize. Lying in layers, glazing your eyes until the view is like a Monet. One pastel blur.
In my experience, going into the hospital for depression at a place like St. Luke’s was a little bit like having a sit-and-spin, or performing that whirligigging motion you did barefoot in the grass in your backyard as a kid. The spiraling dizzied you, and then when you stopped and got your balance, for a second, you looked at your surroundings with new eyes, as if you had never seen them before.
That’s the idea. To bring yourself back to ignorance, back to the empty center, because it’s the only way through, or at least it was in my case at that time.
Asylum did that for me. Reset me to blank and sent me back into my life with the energy to pretend. It’s the first game you master as a child— pretend—and, for my money, it’s one of the most helpful skills you can cultivate as an adult.
Magic Doc was right. The best doctor may very well be a dyslexic one, someone who sees the world a little backward and is kind enough to turn your head around, or, true to the slang of the profession, shrink it. Shrink your view, anyway. Resize the picture. Make the cosmic rinky-dink.
Bottom line? Definitely lose the forest for a tree, a branch, bark, a leaf, whatever your pathetic little mechanism can handle, because it certainly can’t handle the whole show.
Is this a skill? Yes, but not one you learn in medical school. It’s not learning at all. It’s unlearning, which is why someone who thinks he knows everything can never teach it to you. I guess it sounds like I’m talking in circles. And I am, sort of. Because reason, of all things, is the enemy. An excess of sense is senseless. That way madness lies. Take refuge instead in the cupcake, the sugary sop morsel that gets you through. The digestible piece and no more.
And whatever you do, stop asking so many questions. It’s true as advertised. Knock and the door will be opened to you.
So don’t fucking knock.
Or do, because you’re writing a goddamned book, and so you have to.
I had one more place to go.
I found this third facility, Mobius Group, on the Web. I was looking for a place that was offering a different approach from the locked-ward, often drug-riddled treatments I’d found in conventional hospitals like Meriwether and St. Luke’s.
There weren’t many. The first few I tracked down were outpatient facilities that were either defunct—not enough clients—or nearly defunct, struggling by with one or two stranglers and a mountain of crumbling goodwill.
These places presented themselves as being philosophically opposed to the use of psychiatric medications (deeming them addictive, dangerous, and purely cosmetic). They relied instead on intensive therapy, play, companionship, the human touch. I was sympathetic to the approach and eager to try it myself, but I didn’t fancy being the only patient in the facility bouncing from shrink to paid playmate to art therapist like some overgrown special-needs child. I wanted to be among other people trying the same thing.
This kind of therapy is a lot of work. It’s expensive and it takes time and effort. Most insurance won’t cover it, so the clients need to be wealthy. They have to have weeks, if not months, to devote to therapy, and they have to be willing to fight their demons day in, day out, head-on. Most people would rather take—or are only offered—a pill. It’s cheaper, faster, and easier.
But Mobius seemed to be up and running, prosp
ering even. I suspected there were two reasons for this. First, while they catered (as advertised) to the mentally distressed, their primary client base was addicts in recovery. As I learned when I got there, a fair number of the people there were court-mandated to be in rehab, and as private, nonhospital rehab joints go, Mobius was quite a bargain. The program was often partially covered by insurance, depending on your plan, and even if it wasn’t, it was only just over $6,000 for a two-week stay, less than half what it cost to stay at Meriwether or St. Luke’s for ten days. And as for quality of service and environment, Mobius was a far cry from Meriwether and St. Luke’s. It wasn’t as cushy by a long stretch as some of the fancier private rehab facilities that celebrities and the obscenely rich frequent—these can easily cost $50,000 a month and up—but it was by no means uncomfortable. It was within reach of the middle class, and even possibly the working class, and gave you far more freedom than locked wards.
Second, and probably more important, Mobius allowed you to bring your own prescribed medications, which you then surrendered to the program nurse for proper dosing. They also had a psychiatrist on staff who could prescribe medications as needed. This meant that you could get the benefit of their intensive therapy without having to commit yourself to a potentially brutal withdrawal from your meds, or worse, and far longer lasting, a discontinuation rebound effect that could mean—and in my experience had meant—a worsening of your original symptoms, be they depressive, manic, or psychotic. Getting intensive therapy and discontinuing your meds are two separate things, both difficult. Doing them at the same time can be brutal and, as one doc at the near-defunct antimedication facility told me, really means setting aside three to six months of your life.
While locked away in Meriwether and St. Luke’s, I often fantasized about the perfect therapeutic facility. I called it Therapy House and imagined building it from the ground up on spec with unlimited funds. I saw it as a kind of chalet, with a cathedral ceiling in the common room, big windows and lots of light, a working fireplace, sectional couches and reading chairs, and minimalist but cozy mountain retreat décor. Adjacent to the main room, I imagined a library with floor-to-ceiling bookshelves and a well-stocked assortment of periodicals, DVDs, CDs, and computers. Each client—say, the house could accommodate twelve—would have his or her own bedroom and en suite bathroom. There would be a large kitchen staffed by a full-time chef who would provide balanced, healthy, organic meals and snacks, which all the patients would eat together at one large table in the dining room. There would be an Olympic-size swimming pool, a fully equipped gym, a yoga and meditation studio and instructor, a spa with massage and body treatments, a large property with gardens and walking paths, bicycles, hammocks, climbing trees, and even tree houses. There would be a full-time staff of nurses, psychiatrists, psychologists, and social workers, and the patients would receive an hour of individual therapy every day, as well as several hours of various group therapies.
Sometimes I passed idle hours in Meriwether and St. Luke’s dreaming this stuff up, furnishing the fantasy, even imagining which foundations I would apply to for the money. Best of all, I imagined making it accessible to people of all income levels so that anyone from Mother T to pill-popping upper-middle-class housewives could qualify for treatment.
Having imagined all this, I was astounded to find that the people at Mobius were offering something quite similar, albeit on a less extravagant scale and not all housed in one self-contained facility, though they were working on just such a plan.
Still, here was a place founded by a clinical psychologist, Dr. Franklin, and his wife, a place that had been up and running for six years, that was committed to the practice of healing the whole person—mind, body, spirit—and doing so without the use of restraints or locked wards.
Their Web site was very detailed, and by perusing it, I learned everything I needed to know about Mobius’s facilities and program. Patients were housed in four three-bedroom apartments. Twelve was maximum capacity, a manageable group both logistically and therapeutically. Each client had a private bedroom, and shared two full baths, a living room with cable TV and wireless Internet access, and a fully equipped kitchen with small dining area. The apartments were all in a large apartment complex complete with a pool, a Jacuzzi, and a gym.
From 9 a.m. until 3:30 p.m. clients attended various group and individual therapy sessions at the Mobius offices. In the evenings, after class, clients did various things. Once a week they attended a yoga class; once a week they went to the bookstore for a few hours; once a week they did their grocery shopping (clients cooked all their own meals in the apartments); once a week they went to the movies; and three times a week they went to a spa, where they could book massages, pedicures, manicures, and facials (these were not included in the price of the stay, of course). They could work out in the gym, swim in the pool, or lounge in the hammocks out back on the shores of the bay. Not bad for three grand a week, and jubilantly close to my fantasy bin trip.
After St. Luke’s, the idea of flying into a place I’d never been before and committing myself to a recovery facility sight unseen didn’t seem quite so, well, crazy anymore. Besides, this was the last leg of the tour, I told myself. Get it over with.
So I did. I filled out the online application form and read all the material on the various criteria for admission. As far as I could tell, my admission to the program would not be denied or delayed for any of the reasons listed on the Web site. I wasn’t suffering from acute drug withdrawal or undergoing drug detoxification. I didn’t have a severe psychiatric disorder that required hospitalization. I did not have a severe sexual disorder (or at least I didn’t think so, but it was unclear what this meant). I did not have any infectious, communicable, or contagious diseases, and I did not engage in disruptive or aggressive behaviors that would be incompatible with a small group living environment.
I would, however, have to consent to a criminal background check, as all clients did. Otherwise, the admission form was remarkably short and to the point. It asked me to list my mental disorders—clients could, apparently, be trusted to do this accurately—what medications I was taking, whether I used drugs or alcohol, and what search engine and key words I had used to find Mobius on the Web. Essentially, it was like any other commercial transaction: name, date of birth, address, and method of payment.
I booked a two-week stay for myself, booked a flight, and got on a plane.
SANCTUM
Mobius
Diggs, a well-dressed, whippet-thin boy of Indian descent, was sitting in the baggage claim area holding a paper sign with my name on it. The sign was perched on his crossed legs facing him, as if he’d half given up trying to find me. I had stopped in the main terminal for a Starbucks, assuming from past experience that it was going to be my last good cup of coffee for two weeks.
The line had been long, so by the time I got to the baggage claim area, it was largely deserted and my bag had been put in a pile to the side of the carousel. I passed Diggs once on my way to the pile and again on my way back. I saw the sign in his lap on the return.
“That’s me,” I said.
“I saw you before,” he said, as he took the handle of my wheelie, “but I thought, No way is she forty.”
A charmer. That’s all he’d known about me. My name and approximate age. And presumably my diagnosis.
I wondered if they’d trained him to be this genial. Compliment the depressives right off. Women on their age. Men on their gadgets.
We walked the short distance from the terminal to the parking lot and Diggs heaved my bag into the Ford Expedition.
He was wearing pleated slacks, black loafers, and a pressed button-down shirt. Far better turned out than your average twenty-two-year-old psych major who is just out of college and makes his living shuttling fuck-ups to and from the airport.
He did more than that, actually, as I would soon learn. In the mornings, he shuttled clients to the Mobius group offices, where we underwent our therapy an
d took our daily instruction on how to stop being a danger to society and ourselves. While we were in therapy all day, Diggs did paperwork in the office, or took patients to the clinic for their blood work (state law mandated a test for syphilis), or made more runs to the airport for new arrivals. Then in the afternoon he shuttled us back to the nearby apartment complex.
He was dependable. Mature. A comely face to meet you in baggage claim when you’d bottomed out on substances, or sunk eyeball deep in the mood bog, or otherwise come undone enough to commit yourself to a place you’d only read about on the Web, and which you couldn’t be at all sure wasn’t a cult.
When you saw Diggs, though, your fears were allayed somewhat. You thought, “If this is the Moonies, they’re good, because this guy seems totally normal.”
And he was. Suavely normal. He knew not to ask anything intrusive, but he made pleasant reciprocal conversation that didn’t sound like what a gofer says to a cripple, which is, by harsher accounts, what we were. However you sliced it, his job was to make a fairly shameful situation seem respectable, and he did it expertly. He smoothed. He handled damaged goods gingerly without appearing to do so, easing the last leg of a breakdown so that he could bring us in calm. He was the discreetest of valets.
As we rode along in the Expedition, I asked him about where he’d gone to school and where he was from, if he had any siblings, and so on. He tossed back softballs—“And where are you from originally?” He drove assertively but well within the speed limit, the way you do with your mother-in-law or other passengers who scare easily.
I never felt the burden of making conversation. It flowed through the predictable channels without effort, and the drive went by without incident. We drove directly to the Mobius offices for check-in.
Despite my good opinion of Diggs, I was still harboring a few thorny worries about the potential Moonie situation. I had read on the Web site, for example, about the program nurse, Jan, whom Diggs had said we were going to meet right away. I was expecting the worst, and for no other reason than that the term “program nurse” had given me the creeps. I’d been unable to stop myself from imagining some type A crypto-Nazi in starched white and squeaky shoes with a chinchilla hiding under her peaked paper hat.
Voluntary Madness Page 19