The Center Cannot Hold: My Journey Through Madness (23 page)

Not only did they take my shoes away, they wouldn't allow me to
wear socks at night, no matter how cold it was on the ward. I couldn't
imagine how I could hurt myself with socks, but evidently staff had
seen otherwise with other patients. So no socks, even when it meant I
shivered through the night.

I was on a high dose of antipsychotic medication, attending a few
therapy groups, and in individual session three times a week—total
saturation. But there were no miracle cures; instead, there was only
the dreary sameness of day-to-day life on a psychiatric ward, and this
one was particularly grim. Old, run-down, with shabby, narrow halls,
yellowed paint, and grate-covered windows which never drew in any
sun (and a pathetically weak sun it was, too). I was followed day and
night by my minder, and never allowed to go outside to fill my lungs
with some fresh, cool air, or for a change of scenery. I'd made no
friends on the ward; other patients never tried to socialize with me at
all, no one broke through my isolation, and even Eric, the
father-killing Ivy grad, shunned me-who was he, I wondered, to shun
anybody? I hadn't been this bone lonely since my early days at Oxford.
Every day was the same, and would be for a long time. The years
yawned out ahead of me; my hair would turn gray here, I knew it,
while every dream I'd ever had would be absorbed into the ugly
yellowed walls.

And then something threw a switch in my head, and I got it. I
got
it. The only barrier between me and the door out was me. I simply had
to
stop
it. Stop voicing the hallucinations and delusions, even when
they were there. Stop babbling incoherently, even if those were the
only words that came to my lips; no, no, it was better to be quiet. Stop
resisting; just behave.
Being in a psychiatric hospital is nonsense,
I
thought.
I'm a law student, not a mental patient. I want my life back,
damn it! And if I have to bite my tongue until it bleeds, I am going to
get it back.

What was happening, of course, was that after weeks of steady
medication, the psychosis was beginning to lift. Maybe I couldn't keep
the thoughts from coming into my head, but I could organize them,
and keep them from getting out.
OK, here I go.

It took staff a week or so to notice—much too long, it seemed to
me—and when they finally did, it took another week before I was off
the Intensive Care Program and allowed more privileges. I could sleep
with socks. I could use the bathroom in peace. I could shower without
company.

Yes, yes, I absolutely agreed with them that I needed treatment.
"But not here and not this kind. I want to go back to England," I said.
"Mrs. Jones knows what I need to get well again. I can go back into
treatment there with her."

The request was met with stony faces and heads shaking "no." YPI
didn't like that idea; YPI wasn't going to relinquish control of my
treatment to some woman in England who in their estimation likely
didn't know what she was doing.

As sudden (and effective) as I thought my change in attitude had
been, what happened to me next was just as sudden, only in the
reverse direction. In fact, it's a case study—partly—in the ups and
downs of heavy drug loads and the complicated biochemistry that
results: Soaked in antipsychotic medication, with the psychosis
actually clearing, I became profoundly depressed, and felt the brief
flash of energy and focus leak right out of me. Suddenly, I couldn't
follow the simplest sitcom on the unit TV, or decipher the lines in a
book I'd been reading just days before. I was given an IQ test and
scored "dull normal" in the verbal portion and "borderline mentally
retarded" in the quantitative section. It's not that I wasn't trying—I
just couldn't function. I had no way of knowing that depression
following a psychotic period is not unusual; I only knew I was sliding
backward. I called my parents and pleaded with them to get me out.
"It's all going wrong again!" I cried.

They promised to help, and once again we began the search for
another hospital, where a stay might be shorter. My parents even
contacted Karen, the therapist whom I'd seen the summer after my
first year in college, and she suggested a hospital in Philadelphia,
where she was now living. I remembered what she'd said to me so
many years before: "You do need help. And I just want you to know
that when you decide you're ready to get it, you can and should come
back to see me."

The staff at YPI did everything they could to dissuade me from
leaving, from either going to Philadelphia or back to England. They'd
move me to an open ward, they said, with more privileges. I could
even have my shoes back. I politely declined.

Five weeks after I had arrived at YPI, my parents came to bail me
out. They pulled up the driveway, loaded all my stuff in the trunk of
the car, and together we headed out of New Haven. I felt safe, relieved,
even a little optimistic; if I closed my eyes, I could almost imagine I
was a girl again, safe in the car, on a trip with my mom and dad. But
the trip wasn't to Disneyland; it was from one hospital to another
hospital, and I was leaving law school behind. Nevertheless, it was still
a good day.

The Institute of Pennsylvania Hospital—IPH—was a much more
physically attractive place than YPI, in spite of being the oldest mental
hospital in the country. Located smack in the middle of a
neighborhood in serious decline, the building literally shone, with
high, vaulted ceilings and marble floors that were polished daily. I was
taken to my private room, with its own private bath. If there was a
food chain of treatment centers, it appeared as though I'd moved up.
Although I was still trying to get out from under the depression, I was
nowhere near as psychotic as I had been (thanks to the hefty dose of
Trilafon). I was convinced that I'd only be at IPH a couple of weeks. In
the end, it would be three months.

The doctor I'd be working with, Dr. Miller, was a short, round
psychoanalyst who had a welcoming Midwestern openness and used
words like "swell." It was easy to like him—a good thing, since we met
six times a week. In addition, I'd meet with Karen, the former Miami
therapist, once a week for several hours. And that meeting would take
place off-site, which thrilled me; in fact, I was granted the highest
level of privileges, which meant I could even walk the grounds alone.

As is usual in psychiatric hospitals, IPH offered many group
activities for patients. On my second day, I went to my art therapy
assessment. Not being an artist, I drew what I knew how to draw—a
stick figure and a tree. "This is wonderful, primitive work!" exclaimed
the therapist. I went to very few groups after that.

Instead, I read my law books in preparation for getting back to
school the next year. I'd gotten the course requirements and assigned
readings before I left New Haven, and every day I pored through the
material so I could be ready when the time came. Because I was going
back. Diagnosis or not, I was going back.

Having two therapists would likely confuse many people, because
even with the best intentions and the most open communication,
they'll probably trip over each other's feet. But I liked the
arrangement, and I liked the two of them both as well. And I quickly
figured out that it was an arrangement that would work to my
advantage. Miller was the one to decide when I could leave the
hospital, so I tried to be as circumspect as possible in terms of what I
revealed of the inner workings of my mind: I wanted out, and he was
the judge and jury. Karen, however, had no such role or authority. As
a consequence, I felt freer to tell her what was going on—my bizarre
and frightening dreams, and my ongoing violent thoughts.

The first time I tried to get to Karen's office, however, was a
comedy of errors that was far from funny. The cabdriver couldn't find
the house, and I certainly couldn't help. We went round and round
Philadelphia, stopping for directions at several gas stations, and when
we finally arrived, I was more than an hour late and completely
discombobulated. Shaking, I knocked on Karen's door.

"Thank goodness you're here!" she said. "I just got off the phone
with your parents saying you must have eloped"—hospitalese for
escaped. "Now I have to call them right back before we start our

session, they're frantic!"

In the beginning, Dr. Miller and I spoke mostly about how I was
experiencing and managing daily life, but soon our sessions became
more psychoanalytic. I even started lying on the couch and working
with dreams again. And I talked a lot about Mrs. Jones, and how
much I missed her.

"Why don't you write her?" he suggested one afternoon. "Or
perhaps even talk to her on the phone? Would you like that?"

I couldn't believe it. For some reason, I'd thought that he would
put up a barrier to that, as they'd done at YPI. "Not at all," he said. "I
think it's a good idea."

With his support, I wrote a carefully crafted letter asking Mrs.
Jones if she'd consent to our scheduling a transatlantic telephone call.
To my great relief, the letter she sent back to me in reply said yes.

When I actually heard her voice on the phone, my heart leapt—and
then I immediately felt overwhelmingly sad. So much had happened
since I last saw her, most of it bad. I felt as though I'd failed her. I told
her how terribly much I'd missed her; she said she'd missed me, too.
"Mrs. Jones, do you think I might come over and see you? Maybe this
summer?"

There was no hesitation in her answer. "Why, yes, Elyn," she said.
"I think that would be perfectly acceptable and fine."

The elation returned—now I had something to look forward to,
and someone I knew and trusted who would help me formulate my
plan. I began to understand the deep ache I felt in my heart each time
I thought of her; I'd been so sad when I left her, so unhinged that day,
that we hadn't really shared a proper good-bye. I had not been ready
to let go, and wasn't able to find the right words. Perhaps this time, I
would be able to do it in a way that I could live with, something that
would help me stop looking back and start me moving forward again.

In spite of the side effects, I had to admit that the Trilafon was
helping. Nevertheless, I was, as always, anxious to get off meds. Karen
was rabidly anti-medication as well, and my parents were, too, so
Miller agreed that we could give it a try, but very slowly.

As cautious as he was in reducing my intake, I felt the effects
almost immediately. My blank, masklike face relaxed into its familiar
appearance, and I stopped doing the invalid shuffle down the hall. I
felt less fuzzy, more aware of what was going on around me. "You
seem angrier to me, though," said Miller. I'd walked out of a couple of
sessions before we'd officially ended, which concerned him.

"I can handle it," I said, impatient. "Let's keep going."

In two months, I was med-free, except for something to help me
sleep. At three months, I was one of the old-timers on the ward. In
fact, the staff sometimes consulted me in ward meetings about newer
patients—which one was doing OK, which one needed watching, and
who might deserve more privileges. I wasn't comfortable with this
role: Was I a colleague to them? Was I still a patient and, if so, why
did they trust me? And which of them could I trust? I'd have preferred
being left out of it entirely. But I knew that every move I made was
still being closely watched; if I was nonresponsive when asked my
opinion, I knew I'd pay some kind of price. Once, walking down the
hall, I jumped up to touch the ceiling, just to see if I could—and then
caught myself, panicky about what would happen if I'd been seen. I'd
be written up. My fear of being scrutinized wasn't paranoia. Others
really were watching me, and the risk was real.

By early April, I was more than ready to leave IPH, and once again
I asked my parents for help in getting out of a hospital. "Don't you

think you should stay until Dr. Miller thinks it's time?" my dad asked.

"No," I said. "Besides, he just told me he's going away on vacation
for two whole weeks. I want out of here now."

Miller suggested that I might think about going home during the
time he was gone—kind of like an R & R, I suppose—and then return
to IPH for another month or two in the open ward. There was a nurse
on the ward I trusted, and I asked her about this. "Why should I come
back if I'm well enough to leave?"

She pondered this for a moment. "In my experience, doctors know
much more than patients about what's best for them," she said finally.
"So I think I'd come back, if I were you."

My parents, on the other hand, agreed with me—if Miller truly
thought I was well enough to be on my own at home for two weeks,
then I was well enough to leave the hospital for good. No one else on
staff was very enthusiastic about this. Nevertheless, it became the
plan: I'd leave the day Miller did. My discharge papers read
"AMA"—Against Medical Advice.

As I walked down the hall on my last day, suitcase in hand, one of
the custodians who came to the ward daily, a good-looking, wiry man,
saw me. Although we'd never had a single exchange during my entire
stay, this time he smiled warmly and nodded at the suitcase. "Good for
you, getting out."

My own smile stretched as wide as his did. "Thank you," I said,
and walked out into the late spring sunshine.

In the taxi on the way to the Philadelphia airport, however, the
sense of having made my escape and leaving the hospital behind was
more than I could handle. I was alone, and unguarded, and as the
emotions piled on top of one another, I was quickly overwhelmed by
them. As though they'd slipped by a guard at the gate, the delusions
marched in—paranoid thoughts and a strong message from someone,
something, insistent upon being heard. I was the center of a massive
and intricate plot involving the creatures in the sky. It would somehow
involve the plane I was about to take. But the idea of returning to the
hospital never crossed my mind. Gritting my teeth, and trying with all
my might to focus on what I knew to be real, I grimly boarded the
plane for Miami.
Hold it together. Hold it together.
It was, as usual,
an uneventful flight.