Nortriptyline didn’t work. One week passed, then two, then three. I developed acid reflux. Then, one night, about a month in, I experienced a kind of shift—my chest relaxed, and I felt that I could breathe more easily. I had a moment of clarity and calm. I was in the common room. The night’s visitors had gone. People were watching TV. Was I getting well? I’d been so dizzy, but now I had my balance. I went to find a nurse. I wanted to tell someone what was happening. I walked with steady steps from the common room to the nurses’ station, where I said that I was feeling better, that I felt a little lighter. But by the time I got back to the common room, the effect had disappeared. It was a blow. I sat on the sofa. That night passed, and then another, and then another.
Our contemporary clinical terms—affective disorder, mood disorder, unipolar depression, bipolar depression, and so forth—are taxonomic, overlapping, and minimally descriptive outside the professions that use them, though some patients feel a clinical diagnosis to be helpful. The professional psychiatric diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders, currently in its fifth edition, lists disorder after disorder, including suicidal behavior disorder, which is applied to people engaged in some form of self-harm, or who are experiencing suicidal ideation, or so on. A psychiatry of disorders indicates categories of the brain gone wrong; we think of medical intakes, personal histories, hospital wards, health insurance, and trial and error with medicines. Our more colloquial terms—madness, lunacy, insanity, and other everyday labels—point to what is seen, heard, felt, and imagined in society, to appearances and the disposition (caring, contemptuous, or both) of observers through history. We use these terms casually and interchangeably, without much knowing their historical origins or literal meanings. The word “lunatic,” for instance, derives from luna, Latin for moon. People who cycle through mood changes were once thought to be under the influence of the moon. Grief, sadness, and despair are common enough experiences for most of us; they are universal states of being, painful yet transformative. But suicide, an illness with strong common symptomologies from patient to patient around the world, cannot adequately be explained in terms of grief, sadness, or despair. And Hell and the abyss? Those places don’t exist outside myth and religion.
Eight weeks is a long time to sit getting worse in a hospital. Three times each week, I had psychotherapy with Dr. A. I begged for his promises that I would ride my bike again, or write a story, or survive my loss of my mother. At the end of every session, he asked me to draw a house. My houses were plain; and I can’t draw anyway. So what if the walls were crooked and the windows oblong? No one was ever in those houses, no stick-figure family, no mom, no dad. My feeling that I would die, or that I would at least never leave institutions, grew stronger, and I became convinced that I was in the wrong hospital. I remember conspiring on the phone with Regan. I told her where it hurt, and insisted that I was sick in my body, not my head.
“I feel sick all over,” I told her.
Sometimes I wept in the quiet room; on other days, I wept to friends on the pay phone, or talked to nurses, or looked at the computer. I wrote short notes to my friends—terrors and updates. I stretched out on a sofa and waited for the meds to calm me enough to watch the news or read a few pages of a book from the patient library, a room right outside the locked doors of the ward. The library featured works on psychiatry, and there were paperback novels, memoirs, and biographies left by previous patients.
I couldn’t read much, not at a time. Moving my eyes, even to gaze around the ward, was fatiguing and painful. I took Seroquel, an antipsychotic, when the anxiety was excruciating, and the doctors kept up the Ativan. The anxiety by now had become less a matter of shaking and trembling, and more a kind of buzzing in my chest. Seroquel made me sleepy, but didn’t put me to sleep. I lay still, but I wasn’t still, I was vibrating. I was clumsy. I might reach for a cup, and then knock it with my hand. I might walk down the middle of the hall, and then my shoulder would brush against the wall. Sometimes I lay like a corpse, my arms folded over my chest, just as I had in the months before admitting to the hospital, when I was lying on the tarp, preparing in earnest for death. At the Institute, I sometimes jumped up and darted around the ward. Other times, I sat still, rigid, afraid to move or try. I asked the nurses if I would be all right. Would I make it? I made the effort to move my jaw, my mouth and tongue. Did the others on the ward feel as scared as I did? Were they afraid that they’d never be well?
Visitors came at eight, mothers and fathers, brothers and sisters, couples and single friends. The nurse let people in, locked the door, and then called our names or came looking for us. All guests stopped at the nurses’ station, where a nurse looked inside bags and backpacks. Some families didn’t talk, but instead sat gathered around tables, playing board games. The hospital had a closetful of games. Other patients were alone during visiting hours.
My friends and I might hug when they arrived, but lightly, and only for an instant. We sat in the common room. I asked about the world, and my friends talked about their lives. I tried to describe my state to Dave and Geneve, to Kathy and Jon, to Paul, to Jane, to Jenny, to Nicky, to Janice, to Sasha and Vlada. But I didn’t have many words. And how were they to understand my feeling that I was dying, that I was leaving them? I felt as if my friends were far away. I think of that remove not as a distance but as a disconnect. The disconnect felt, for want of a better way of putting it, dimensional—a disturbance in the cosmos. I have heard this sensation described as the glass wall. My friends and I occupied, it seemed, different times and places. We were sitting together, but we weren’t together. They lived in historical time, not in eternal dying; they had yesterdays, and a today and a tomorrow. The world from which they’d come, and to which they would return, was lost to me.
When visiting hours were over, my friends picked up their purses and bags, and I walked them to the door. The nurse unlocked the door, and my friends went out. Sometimes I wept. I could see them through the little window. I wanted them to stay another moment, at least that. We might glance at each other through the window in the door, but then they turned, and I watched them walk down the hall.
I’d wept deeply before my time in the hospital, and have since, though never for as long during a day, or over as many days, as in the quiet room at the hospital. I went into the room, lay down on the mattress, and sobbed over my betrayal of my mother; over old loves; over my choice, when younger, to write; and over the houses that we’d lived in when I was growing up, and the friends that I made and then said goodbye to whenever we moved. I cried over our cats Zelda, F. Scott, Justine, Pippin, the litters of kittens on blankets in boxes—so many cats. I’d held them, and slept in bed with them, and cradled them in my lap.
The nurses urged me off the mattress. They suggested groups for game-playing sessions, and leisure activity workshops. How do we find peace and pleasure in our lives? Might I try keeping a journal? Writing would promote neuronal growth and emotional insight, but I refused. It was awful to see my misshaped letters and unreadable words. I’d worked most of my life at writing; I’d been a professional, and now I couldn’t bear it. Sometimes I wrote short notes on the computer. I recall an afternoon in the common room. Maybe I had been in the hospital for a month or so. The TV was on, and patients sat watching. I was lying on my back on the sofa. My head rested on the canvas bag, and my arms were crossed over my chest. It was late in the day, and, looking out the windows, I could see blue sky. I got up and walked across the room. I could sense the hair on my arms, as if blown on some faint breeze. It was a burning feeling.
Around that time, sometime in late June, I noticed that my feet and lower legs tingled and ached, and often looked blue. My nails hardened, thickened, developed ridges, and became opaque. I couldn’t bite through them. I wasn’t shaving, and my beard grew stiff and wiry. I complained to Regan. Was I suffering a vascular disease? Was I suffering a rheumatologic disease? Why was I being held on a psychiatric ward? I knew the doct
or’s position on these questions. They understood, or knew, or simply believed that I was not making sense. How would they have thought otherwise?
“I’m not delusional,” I said, over and over again to Dr. A. I told him that I knew that I was sick, but not in a way that he believed, and that I needed another kind of medicine. In order to calm me, he made an appointment with the internist on call, who crossed the skywalk from Columbia Presbyterian, read my lab reports, checked my neurological functioning, listened to my heart and my breathing, and told me that I was medically fit. I was relieved, though only for three or four minutes. I thanked the internist for his patience. I left the exam room. My chest tightened, and my arms and legs again felt leaden.
In early July, my memoir of my mother came out. I’d been on the ward for two months. There had been no time for the publishers to delay the publication. Had I been in better shape, I might have given readings, or traveled to promote the book. Maybe there would have been a publication party, and dinners. Someone brought a copy, but I didn’t want to hold it. The book jacket features a picture of my mother taken in the 1950s by the photographer Joseph Steinmetz. Steinmetz had a studio in Sarasota, and took pictures of iconic Florida scenes, like tourists grilling on the beach, as well as portraits of Ringling Brothers Circus performers, including the clown Emmett Kelly.
The memoir came out around the same time that I developed eczema on my forehead. The eczema presented as a patch of reddish skin above the bridge of my nose, an itchy patch between my eyes, exactly where the mystical “third eye” appears in religious iconography and artistic imagery, and directly over the area of the brain known as the medial prefrontal cortex, which is associated with empathy, anxiety, temporal and spatial awareness, autonomous nervous system functioning, memory retention and sequencing, stability of mood, and executive functioning. The medial prefrontal cortex helps provide for what we call our humanity and our condition, our cognizance of ourselves, our competency at navigating society and the physical world, and our health and well-being under stress or under threat—the medial prefrontal cortex is crucial to proprioception, bonding with others, and our safety in the world.
Touching on the ward was not permitted. The hospital is meant to halt and reverse the effects of trauma and its aftermaths, but is governed by protocols that enforce patients’ separateness from one another—a new isolation. For many who have survived alone, alone in an apartment or house, the hospital might be our first time, maybe in a long while, spent with a group, in this case a community in pain but nonetheless with memories or fantasies of wellness. In the hospital, we live among people trained to ease our crises, doctors and nurses, nutritionists, medical technicians, and social workers—the hospital can be seen as a therapeutic city, and psychiatric patients as problematic through-traffic; in sickness, we take the ward as a gulag. Some of us had been sexually or otherwise violently abused—hit, bullied, intimidated. Some of us had been left by loved ones. Some didn’t know what had happened; the disease had seemed simply to appear, maybe during childhood, maybe in college, maybe, as with me and many men, in middle age. It is terrible for the old. Physical contact between patients was potentially traumatizing. Touch came from nurses drawing blood, or light hugs with visitors, who, when saying goodbye, seemed eager to go. I wanted to leave with my friends, if only to have dinner with them, something over on Broadway, a few blocks east.
I could not have made it to Broadway. Had I stumbled, beltless, in my socks or unlaced shoes down the hall, I surely would have run back and banged on the door. Had my friends helped me escape, make a break for it, I nonetheless wouldn’t have gone far. I could not have held a menu and calmly chosen what to eat, or picked up a glass without spilling, or held a knife and fork without trembling. I could not easily swallow; my jaw hurt, and my mouth was dry from medications. I could not have joined the conversation, only made people nervous. Dining out, driving a car, making coffee—these things were not possible. They were unsafe. Everything outside the ward was unsafe. My apartment was unsafe. The subway was unsafe. The street was unsafe. Back in the spring, in April, I’d left the Brooklyn hospital and passed in an instant from shelter to exposure. On one side of the steel door, I’d felt competent, ready to resume my life. On the other side of the door, I was frightened and lost.
Once we called hospitals asylums. An asylum is a refuge, a place away from harm. That word is no longer used to describe the hospital, unless in a derogatory fashion; we might call the hospital a psych ward, and yet imagine it as a crumbling home for degenerates, or a maze of hallways where halfway naked people sit. The word “asylum” describes the institution, the hospital; but in another, perhaps fuller sense, asylum is a provision. Asylum can be legislated and granted. Refugees, political prisoners, those persecuted over race or their way of life might find asylum in a church, a new country, an international airport, or any hidden place. Children bullied at school may find asylum at home, but for children abused in the home, there is no asylum. Society allows victims of violence in marriages and partnerships little protection. Soldiers in battle have no safety from war, only weaponry, their training, and their trust in each other; and the survivors, the returning, the lucky ones, often struggle to recover from war’s effects, and many die of suicide. Who shelters the victims of rape? Grave psychotic illness has one refuge. “Why won’t they take me to the right hospital? There’s nothing wrong with my brain. I need to be in a regular hospital! They’re going to kill me!” I cried to Regan, and begged her to tell the doctors that they were making a mistake.
“They won’t listen to me! They think I’m crazy!” I shouted into the phone, over and over again.
“You’re not crazy,” Regan might say; and eventually she did phone my doctor. She talked to him more than once.
But we were also fighting.
“Are you talking to her? Why is she coming to see you? Why do you let her?” Regan shouted through the phone. She meant my ex-girlfriend Fran, with whom I’d cheated during the lead-up to hospitalization, and who both visited and called. “She’s worried about me,” I said. “She is afraid for me.” I told Regan that Fran and I were not in resurgence.
“How is this supposed to make me feel?” Regan cried. I didn’t know how to answer. I wanted to hear from anyone, anyone at all, who could visit or call. Now I realize how scared Regan must have been, and how much she must have felt my psychosis, maybe felt it as hers; and I wonder whether she was not rebuking me so much as trying to save herself.
Regan, and my friends who visited the ward and then returned to the outside, and my colleagues, my publisher and editor, the people I depended on and who depended on me, would no longer want or need me; I was certain of this; it seemed inevitable. I would never write again—that was over. “I ruin everything,” I told everyone, my friends in New York, and the ones who came from out of town. Some came often, and others were scared to visit, but came anyway. They sat across from me. They were furtive, exasperated, wanting to go, wanting to flee, not knowing what to do with their hands, smiling too much, forcing calm expressions, making sympathetic faces, posing. My nails were yellow and thick. My hands shook. My skin was itchy, and my hair was growing out. I was unshaved. My beard grew down my neck.
“You haven’t ruined anything! Don’t say that!”
“I’ve ruined myself.”
“Donald.”
“I have.”
“Donald.”
“Look at me! Can’t you see what I am?”
Every night at nine, after visitors were gone, safe outside, the nurses unlocked the dormitory. This was when I took my night meds. The med nurse was older, and kind. He had good words for us. “Here you go,” he said. For sleep, I took Trazodone, Ativan, Seroquel, nortriptyline, and chloral hydrate, which came into use as a sedative in the nineteenth century. I drank it as syrup. It came in a shallow plastic cup topped with a tear-away foil lid. After swallowing meds, I might sit in the common room and talk to Kathy about her own medication, or about what it
was like to live on disability. I asked Thomas when he might go home. Was his Prozac working? How long had he been taking it? What else might the doctors give him? How long had he felt suicidal? When had that begun? When would his family come to visit?
Nighttime was when I felt best. In bed, I waited. These were my only moments, the twenty or thirty minutes before sleep, as the medications began to work, my only times of anything like peace. At the beginning of my stay, I had a roommate. He was young, in his early thirties. His face was scarred, as if slashed with a knife. We had our beds and dressers, and a bathroom with a shower. My face in the bathroom mirror looked gray. I could see the circles around my eyes. Beside the bedroom door, and running the length of the door, an outside curtain covered a strip of unbreakable glass. Every twenty minutes, throughout the night, a nurse pulled the curtain aside to peek in at us. Were we breathing? Had we found a way to die? Doorknobs were narrow and thin, rather than bulbous; there was no way to hang a knotted sheet. No nails showed in the furniture. My roommate was nervous, aggressive; he moved in bursts. I was uncomfortable around him, though I never felt in danger. Maybe he needed a friend. We didn’t talk, and I never learned his history, though it seemed to me that he’d suffered some great and lasting violence. That was what I felt—I felt his past, you could say, and my own. Later in my stay, I was moved to a single room at the end of the hall.
I slept two, three hours, and then woke. Sometimes I got up and stumbled down the hall to the nurses’ station, where I asked for more Seroquel. Then back to bed for a few more hours before waking again, startled, early in the morning, when the medical residents and daytime staff arrived. I could hear their footsteps and their voices. Patients lined up for blood pressure and weight checks. Sometimes a nurse or a resident took me into the medical examination office and drew blood. I clenched my fist. The nurse searched for a vein—tap, tap, tap on my arm. When the nurse couldn’t find a vein, I felt relieved and scared. It usually took a minute. The nurse cleaned the skin with a cotton pad. I could smell the rubbing alcohol—the smell of going to the doctor. “Just a little pinch.” It usually took one poke, and then another and another, before the vial started filling. I watched blood seep into the vial, and then looked away. The nurse popped one vial cartridge out of the hypodermic chamber and inserted the next. I felt the needle moving beneath my skin. When would it end? I needed the procedure to be over. I was sweaty and breathing quickly. The nurse taped a cotton swab over my skin.
One Friday in April Page 4