Stay with it. Stay with the hard stuff. Stay with you. Accompany you. Help you. Rely on you. It was everything all in one. Occupying the empty center. Giving myself—could I say it now?—compassion. Assistance. Walking through the mask of rage, the false front, to the sanctuary behind it and living there.
“I choose to be here,” I said, and threw my handful of colored sand into the water.
The morning I left, Diggs drove me to the airport. I said my farewells to Carol and Sam and Josie with long hearty hugs and just as hearty thanks. Carol gave me her number and told me to call if I wanted to set up phone therapy sessions in the future. Dr. Franklin shook my hand and told me to come back any time.
“We’re always here for you,” he said, and meant it in more than a commercial sense.
And I thanked him just as sincerely, thinking, in stark contrast to the way I felt when I left the other places I’d been, that I wouldn’t be at all averse to coming back to Mobius for a tune-up if I needed one. They were good people doing good work, even if their clientele wasn’t always as receptive as one would have hoped. Their success rate was probably still higher than at most other places. That is, if you measure success in more than neurotransmitters.
They were doing everything right as far as I could see: integrating mind, body and spirit; granting freedom, and yet providing sanctuary; using medication, but not overusing it; offering the healing routine of a structured day and intensive personal therapy, but not hemming you in with rote bureaucratic restraints and petty forms of control.
Most of all, they seemed to have fostered and implemented the belief that therapy and biochemistry are not either-or propositions, that the body and the mind are not separate. They did not inundate clients with pills, thinking that medicine was the only way to affect the brain. But rather they used meditation and talk and compassion to reach the brain through language and thought. They understood that words and ideas have physical life, that the things you say to someone in therapy and the things they say to you, or the things you think about in meditation, can and do have a physiological effect on the brain, an effect every bit as powerful as the endorphins and adrenaline you release in physical exercise or the serotonin and dopamine you manipulate when you take drugs.
When Carol told me that there was nothing wrong with me, those words entered my brain and brought about a chemical response that took the form of relief and tears. And who’s to say that the emotion and the physiological response were separate things, one becoming the other, the relief, translating into tears. Who’s to say that they weren’t in fact the same thing. Simultaneous. Emotion as physical response, a physical response brought about by another human being’s sympathetic thoughts spoken aloud. Brain chemistry affected, even improved, by good therapy.
This, I saw as the doorway to a new life: eventually free of, or at least less ruled by, drugs; a life where routine tasks, being present, and giving my full attention to detail could calm me; where talk, laughter, and compassion could counter both the habitual force of my negative experience and whatever might be chemically awry in my brain. Whether it was congenital or acquired, it didn’t matter. I could fight it with new skills, new practices that treated me as a whole person, porous to the world but not submissive to it, alive and reactive to slings and arrows, sticks and stones, and even the cruel names that could actually hurt me, but never, never again just passively diagnosed in a waiting room or cowering paralyzed in the bathtub.
CONTINUUM
I began this project with the intention of exposing institutions. That was my prejudice. I had been to the bin my first time in genuine distress, had languished there, and had left with the intention of lobbying for change. I wanted to show, by doing, that locked psych wards are not conducive to recovery or good health. In fact, to my mind, quite the opposite was true. You could take a perfectly sane, well-adjusted person, lock him in the hospital for a few weeks, or even days, and his mental as well as his physical health would be virtually guaranteed to deteriorate.
Now, at the far end of a long haul, having spent my time at Meriwether and St. Luke’s, and finally at Mobius, I still believe this to be true. Institutionalize someone and he will become institutionalized. Lock him in and down, and he will do the same. Institutions don’t heal—they hold. At best, as I found at St. Luke’s—which incidentally, I would not quite characterize as an institution, since it was not a hospital—mental wards neutralize the person and the world in such a way that some small comfort in terror may be found, if you are willing to find it.
But then, holding or neutralizing is all that most psychiatric facilities were ever really intended to do, and, having completed my journey through the system, I can see now that I was supremely naïve to believe otherwise. Not naïve about the system, but about people.
On one level, the system is the system, ruled largely by the laws of economics: competition, overhead, profit and loss, etc. Everyone knows that, whatever the treatment you are in for, private hospitals tend to be better than public ones, and specialty clinics or spalike facilities are better than private hospitals. Privatizing or specializing anything, from schools to public works, tends to improve facilities and quality of service across the board. This, too, is no secret, though it may be a matter of heated political debate.
But there is something else at work in the system, and this is the part I hadn’t counted on. My first night in Meriwether, as I looked around me at the semisqualor and the degraded clientele of the public hospital, I wondered about cause. I wondered whether the system is the way it is because people are the way they are, or the other way around. Now I know that the answer is both. As I have just said, the system is the way it is mostly for economic reasons, and it brings down the people in its care. But the system is also the way it is because people—patients—are the way they are, often lazy, stubbornly self-indulgent, passive, and irresponsible, and they bring down the level of care accordingly.
The system does not aim to heal patients, partly out of cheapness and lack of effort, but also because the people who run these institutions have learned through experience that patients cannot be healed by institutions, or, for that matter, by any outside force. They know what I now know: nothing and no one can do for a person what he will not do for himself, even if he is crazy.
I was wrong initially to think that institutional staff and administrators do not understand the role of the will in healing. On the contrary, they understand it only too well. They know what it took my visit to Mobius to teach me, that no amount of money or luxury or therapy will do anyone any good if he is unwilling to participate in his own recovery. In that, Carol and the folks at Mobius were absolutely right. No one can heal you except you. But, and here is the heart of the matter, the vast majority of people don’t want to participate in their own recovery. They are unwilling to try, even when they are given every advantage, every freedom, and an abundance of what was lacking in Meriwether, namely, compassion and the human touch.
The people I knew at Mobius had everything that the people at Meriwether didn’t. And yet, with the exception of Gary, they refused to change. They went through the motions resentfully, and then got drunk or stoned again as soon as they had the chance, or went on in superficial, halfhearted sobriety, but without having changed underneath. And why? Because they hadn’t come to Mobius of their own free will. They were there either because their families had sent them, or because they’d been arrested and were facing prison time. Rehab was part of their sentence. But you cannot sentence people to recovery. You cannot cajole them into it either. Charity, or therapy, or enlightened treatment, is wasted on people who don’t want to or can’t change.
That is not to say that Mobius could not do a world of good, and had done so (if the testimonial letters I’d seen posted in the kitchen were any indication) for a number of people over the years. But these were willing clients. Mobius could do nothing for you if you didn’t participate, and neither could any other place, however swank or progressive.
In
my experience, whether you were dealing with a psychotic, indigent, inner-city population, a depressed and addicted middle-class rural population, or a depressed and addicted upper-middle-class suburban population, the number of people in any group who were willing to take responsibility for their own lives and behavior is always small. So even, for example, if you had taken someone like Mr. Clean and transported him to a place like Mobius, he probably wouldn’t have been any more likely than Katie or Bobby to get something out of it. Equally, you could have taken someone like Katie or Bobby and had them waste time and money at a place like Meriwether just as easily as they wasted it at Mobius.
And this, I think, must be where so much of the cynicism in the system comes from. Why waste therapy and resources on people who will actively resist, and so derive no benefit from them anyway? Why not just medicate the bejesus out of people, when medication is the one thing that requires no effort or willpower to have an effect? If people aren’t going to heal, because they don’t want to heal, then containment is the most any system can do for them and for us. And containment is necessary. Bobby and Katie couldn’t be left to keep driving under the influence, and Mr. Clean and Mother T couldn’t be left to wantonly disturb the peace.
Now how much willpower Mother T and Mr. Clean, as individuals, could have exerted over their conditions I have no way of knowing. I doubt the doctors could know that either, precisely because it was a matter of individuality. Psychosis, as a condition, isn’t necessarily beyond self-help. The psychotics that I met at St. Luke’s, people like Karen, had shown as much, as, arguably, had John Nash in his assertion that his own mental illness was in part the effect of a mind on strike. The will could play some role even in the schizophrenic mind, but how much, it seems, would depend on the person. Beyond that, clearly, medication could and did help tamp down the hallucinations and delusions of the psychotics I met, even if it did so largely by hobbling the brain.
But from what I saw in Meriwether, St. Luke’s, and Mobius and what I experienced in my own struggles to cope with mental distress, a person’s condition, whatever it was, whether depression, psychosis, or addiction, has less to do with his prospects for recovery than his personality, his willingness to change. The same was true of social class. Yes, it made a difference to be educated and supported by family and friends. Yes, it made a difference to have better food and exercise and therapy. But this alone was not enough.
Facilities matter. Everyone should have a clean bathroom and nutritious food and fresh air. Those are basic needs and rights. I still believe, as I did at the outset, that the system could do a lot better, and it could do so cheaply and easily with only minimal effort. Even if you don’t expect patients to improve, and even if you loathe them on some level for their learned helplessness and indulgent immaturity, or even for simply being sick, you need not treat them with contempt. Kindness is not expensive, even if it is often trying. Therapy should be made available to people who want it, as should recreational activities and hugs and human contact.
But in the end, this is not the solution as I see it. The system, flawed as it is, is not solely, or perhaps even primarily, responsible for (or capable of bringing about) the health and well-being of the individual. The individual himself is. The luxuries or advantages that any psych facility might offer are what philosophers would call necessary but not sufficient conditions for mental health and recovery. With an individual’s effort, they can make all the difference. Without it, they are virtually useless.
Now, I realize that all of this sounds terribly pessimistic. And it is, if you remain focused on the system. If, as I did at the outset, you think that the system is broken, and, more to the point, you think, as I also did at the outset, that throwing more and more money and human resources at the problem will bring about miraculous recoveries, you will be sorely disappointed. The patients themselves will thwart you. In this, Mobius was the ultimate case in point. Even if every Meriwether were made into a Mobius, a lot of people still wouldn’t improve, except possibly through passive submission to the dictatorial effects of medication. Circumvent the will with a pill, as so many institutions and practitioners do, and that’s the most you can hope for.
Sad. Very sad. But realistic.
If, however, you consider the flip side of this sad reality, the scenery looks a lot brighter. If you come to the conclusion, as I have, that you are at the helm of your mental and physical health, that you have more control than anyone over your own well-being, then the power to heal is put into your own hands. And what could be more optimistic and empowering than that? You do not depend on the institution, even if, when you are ready to work at it, you can be helped by places like Mobius or, indeed, harmed by places like Meriwether. The lesson is much the same in both places. Fend for yourself. For, as elaborate as the therapy at Mobius seemed, the message was simple. We are not helping you. We are teaching you that only you can help you. The message was similar at Meriwether, even though it came in the form mostly of neglect and hard knocks: Don’t ask us to fix you, because we can’t.
And so, in conclusion, I can offer only the same advice and the same report. Do it yourself.
This book turned inward more and more as it went along, for the most part, relinquishing even the vaguest objectivity. And it did so, not only because I was overwhelmed by the private emotional struggles that led me to pursue this project in the first place, but also because, philosophically, I began to feel that the point of interest, the point of healing, and the target of rebuke was less the institution, or the world as it is, than the individual. As it has done before, my immersive journey has brought me back to myself, and most of what I can say at this point is personal. I cannot tell you that Mobius healed me, because it didn’t. I cannot tell you that I have healed myself, because I have not. I am not healed. But I am fighting. And I am fighting, not with the aid of better facilities, therapies, and therapists, but alone.
I have a motto for that fight: Tertium non datur. In Latin it means, “The third is not given.” Or alternatively, “There is no third possibility.” I first saw these words while at Mobius. Bobby had them embroidered on the back of her jacket. When we rode to and fro in the white van, I often sat behind her and read the phrase again and again. It became a mantra for me by the end of my stay.
One day I asked her what it meant, and she offered the literal translation. The third is not given. She said she had read it somewhere in an assigned text in school and had internalized its meaning as “Blaze your own path” or “Make your own way.” In other words, don’t do the expected thing, the prescribed thing. Do it yourself in whatever fashion suits you best.
It was a philosophy she lived by, though clearly, given where she’d put it, the phrase was not a reminder to self. Rather it was like some kind of bumper sticker, pasted there for the benefit of whichever bored fellow pilgrim happened to be stuck behind her in line, in class, in church, or, in this case, in a short bus full of life-skill spastics paying for the privilege of getting their shit together.
I looked up the phrase later and learned that it’s a principle of logic called the law of the excluded middle. It means that something is either X or not X, or, as it is more commonly heard in general conversation, you can’t be a little bit pregnant. You either are or you aren’t. There is no middle ground.
The law of the excluded middle doesn’t have anything to do with blazing your own path, at least not when it’s used in its traditional sense. But for my purposes at Mobius, Bobby’s interpretation was perfect.
The third is not given. There was all the rebel hope in the world in that phrase when you learned it from Bobby. It meant that the script was not yet written. It meant that there was a middle way between resignation and folly, between my nightmare au naturel and the tinker-bludgeon approach of modern alchemic psychiatry. It was a place in my mind where I could put all of my aspirations and keep them alive, stocking my vision of the future with the belief that I could exert some influence over it, and over my co
ndition.
This is most of what I took away with me from Mobius, and from this project as a whole. The gist of it, anyway. Action. I am not bound by my diagnosis. I can help myself, and I will.
I, always the patient, am not condemned if only I can participate. If fortune is a wheel of fire, then I will not be bound upon it, but instead I will grasp it firmly with both hands and drive.
The metaphor holds in all respects. The fact that I am driving the car doesn’t mean that the road will always be smooth or that I can control other drivers, the terrain, the weather, flats, malfunctions, darting animals, and other acts of God. But it gives me the vital sense of getting somewhere under my own power, of refusing to accept passively a wandering servitude to medical whim and the lonely defects of personality or birth.
But it is not a wholesale rejection of biology and its entailed determinism either. When it comes to medication, I am going to take what I can use, if it helps, but in the lowest possible doses, and I will do so knowing, through my own experience and investigation, about the pitfalls that the doctors should have told me about in the first place.
By this point I feel I have little choice, anyway. I don’t know whether my brain chemistry has changed as a result of taking medication. I can’t prove it, certainly. But I strongly suspect it. How could it not have, adapting itself to constant chemical alteration over the course of more than a decade? Is this permanent? I don’t know that either, and neither do any of my doctors.
I know that when I go off medication I feel far worse than I ever felt before I took it, and I have never been able to stand the downside for more than a few months, so I don’t know how long my brain might take to recalibrate, if it can.
But, be that as it may, I am still left with work to do. I am still left with the consideration of what my participation means, and what this so-called middle way really entails, aside from popping the evilly necessary, or occasionally desirable, pill now and again.
Voluntary Madness Page 26