Voluntary Madness: My Year Lost and Found in the Loony Bin (11 page)

Where are the boundaries? What can help really mean? And isn’t that why we leave it to the professionals, who, in turn, leave it to a lost cause, or to the pharmaceutical path of least resistance? Nobody wants to do the personal work. It’s disgusting. What’s more, it challenges—no, rakes up and scarecrows—every humanitarian illusion you have about yourself. It makes you know that at heart you are a little bit of a fascist like everybody else, thinking in the way, way back of your mind that wouldn’t it really just be cheaper and better and utilitarian—now there’s a word we can work with—to be rid of these people?

Yes, this is all very ugly—but so true. I don’t want to know what’s in your soul. Not really. And you don’t want to know what’s in mine. Keep back, we tell each other. Those are your problems, which is really just a polite way of saying, “Go starve somewhere else. You’re ruining the view.”

I couldn’t do well by these people. Not that it was my job to do so, but it felt like my obligation somehow. And maybe, for some of the same reasons, nobody else could do very well by them either. It was just too much. Too hard. Too late. The question is there all the time. What to do? I can denigrate the system, impugn it with all the progressive zeal that makes my brain twitter with self-satisfaction, and I might actually be right. The psychiatric emperor has no clothes. But I would be lying, or pruning the full picture, if I said I didn’t see why that system fails the chronics and admit that I abandoned them myself.

You got tired of their ceaseless intrusions after a while, and in order to draw boundaries that they would respect, you had to be a little mean.

I was on the pay phone with my shrink one day, the one I had on the outside, when Clean started orbiting me like some kind of demented circus balloon. Per Dr. Balkan’s instructions, I was trying to make an appointment to see someone when I got out. I was trying to explain how I’d landed in Meriwether without even so much as a by-your-leave, or a drowning wave, or some indication that I was in distress. I didn’t want to put him in a sticky position by telling him that I was A-OK fine and doing research, so the conversation was odd and halting, with me trying to avoid direct answers until I got out and could explain the whole thing. I didn’t need Clean leaning in every two minutes to bug me about when my visitor was coming and whether or not he’d have cigarettes.

“Norma?”

I put my finger to my lips and pointed to the phone.

“Oh, okay. I’m sorry, Norma.”

He walked away.

Two minutes tops and he was back.

“Norma?”

Again the finger routine, more emphatic this time. Another apology, another departure, then another approach.

And finally from me,

“Fuck, Clean. I’m busy here. Can’t you see?”

It made you feel bad, like you’d slapped a puppy. But it had to be done. Callousness was one of the things that happened to you along with the other effects of being institutionalized. Callousness and, what? Xenophobia, I guess.

To wit: it is significant that while I was making that phone call to my doc, I was holding the receiver with a paper towel.

I know. You’d be justified in thinking that maybe I was getting classically obsessive-compulsive along with the rest of them, always thinking about germs. You would think so, that is, until you remember that each year alarming numbers of people contract fatal staph infections while in the hospital.

But that is not the whole truth, or maybe not even the half of it. Not the real point.

The point is, I held the receiver with a paper towel because I did not want to touch the things that my fellow patients had touched. That is the beginning of spiritual disgust. It starts in the body, in the nose, and moves to the skin, proverbially crawling, sliding first paper, then walls between itself and the unclean, then verminous other.

And once that had happened, and you could admit it to yourself, that’s when you started to understand why the nurses were as grouchy as they were, and as distant and demeaning. They’d learned, as I had, first, that setting limits was paramount, but second and more shamefully, that good intentions were the casualties of contact—the same theoretically exalted human contact that I had started out so in favor of, and had seen soiled somewhere along the way.

Life at Meriwether was lived in patterns. Patterns of marked time and lost time, and doobie-do this, and doobie-do that.

The Yenta turned to me in the dayroom one afternoon and said:

“What month is it?”

“December.”

He looked surprised.

“God, time is passing me by. The drugs make me so out of it I can’t think straight. It’s like waking up from a dream.”

“So you don’t know how long you’ve been here?”

“December what?”

“Fifth.”

He counted on his fingers.

“Then, nineteen days.”

“How did you get here?”

“From rehab.”

“How does that work?”

“I was in rehab in this really dark and dingy place, and I just felt like hell. Really depressed. I was talking with my counselor in this glass-enclosed room and I made the mistake of telling her that I wanted to bash my head right through the glass. So they sent me over here to emergency with a bottle of antidepressants. While I was waiting to be checked in, I went into the bathroom and took the whole bottle at once. They kept me in the ICU for a couple of days, having convulsions and spasms and weird shit.”

“What are you on now?”

“Another antidepressant.”

“Which one?”

“Effexor.”

“Oh jeez,” I said, and gave him a speech about the horrendous withdrawal that people who stop taking that drug can undergo. I told him what the docs probably weren’t telling him. After I told him, he confirmed that, yes, I was right. The docs hadn’t warned him.

I’d been on Effexor at one point, and had gone off it abruptly under a doctor’s care. The doctor—actually, more than one doctor—hadn’t warned me that withdrawal from Effexor can, and in my case did, cause, among other joys, vivid, prolonged nightmares, fever, sweats, chills, dizziness, crying jags, and what I can only describe as brain zaps, a kind of electric shock sensation inside your skull. When I started experiencing these symptoms, I went on the Web and found out that a lot of other people had endured the same torture.

“Just so you know,” I told the Yenta.

He got his discharge a few days later, and that, presumably, was that. He would go on taking the same pills to live as he’d taken to try to die. Poison in therapeutic doses, didn’t someone say? Medicating, no longer self-medicating, or something like that. Getting drugs to get you over the hump, or through the objectionable days, or to help you cope, or coast, or, as in Casey’s case, to do double duty, to keep you going and to help you sleep.

Casey, like me, had been prescribed the antipsychotic Zyprexa on the outside, and for the same ass-backward reason. Antidepressants had made her hypomanic, so her doc had decided on a mood stabilizer.

But not just any old mood stabilizer—the pet mood stabilizer of the day. An antipsychotic that had been approved by the FDA to treat bipolar disorder. Zyprexa: the same trendy pill that, interestingly enough, was well advertised in the Meriwether ward. “Informational” (read: promotional) displays were posted, complete with detailed, four-color leaflets, on the bulletin board outside the dayroom. Some of the nurses even carried their papers around on Zyprexa clipboards stenciled with the same promotional information that was in the leaflets. Others carried clipboards or wrote with pens that advertised competing drugs like Abilify.

Like Mother T and others, Casey had gained a lot of weight on Zyprexa. This, along with a propensity to cause diabetes, is a common side effect of the drug, and one that its manufacturer, Eli Lilly, knew about all along but failed to disclose to the public. The truth came to light in early 2007, when the
New York Times
reported in a series of articles that Eli Lilly had agreed to pay hundreds of millions of dollars to settle thousands of law-suits brought by people who had taken the drug.

Wisely, Casey had gone off Zyprexa on her own. But at Meriwether they were tossing her Seroquel instead.

Thankfully, Casey was only in for three days before her therapist either came to her senses or responded to pressure from Casey’s family and friends. She showed up at Meriwether and corrected her mistake.

Casey left Meriwether as bitter, angry, and frightened as I had been my first time around in the bin, and she had learned the same lesson. No matter how bad you feel, never go to the bin. In fact, never confess enough to your therapist to give her even the slightest inclination to commit you to the bin, unless you know her well enough and trust her enough to know she’d never do such a thing.

Don’t assume she’ll be able to tell the difference between contained, nonspecific suicidal thoughts and real, imminent danger to self or others, because the truth is, more often than not, she’ll probably commit you either way, just to cover her ass in case you do end up trying something.

Discernment can be hard to come by in psychiatrists. This has been my experience, anyway, and, obviously, it was Casey’s as well. The human touch is not very often their strong suit. Nor is true empathy. Attend the annual American Psychiatric Association conference, as I did, and you’ll see that the emphasis is far and away on the science, not the emotional intelligence.

As noted psychoanalyst Adam Phillips wrote in the
New York Times
(“A Mind Is a Terrible Thing to Measure,” February 26, 2006), “Psychotherapists of various orientations find themselves under pressure to prove to themselves and to society that they are doing a hard-core science. . . . Given the prestige and trust the modern world gives to scientific standards, psychotherapists, who always have to measure themselves against the medical profession, are going to want to demonstrate that they, too, deal in the predictable; that they, too, can provide evidence for the value of what they do.”

These people are thinking in categories, not only because that is how they are trained but because anything else is too vague, too absurdly metaphysical, to advance the cause of their credibility in medicine.

And yet, given what it is capable of doing, the brain is like no other organ, and does not submit, at least in the lived experience of the patient, to anatomy and chemistry alone. How can we treat it the way we treat, for example, a kidney? There is the brain, whose business is thought and feeling and judgment and even mystical experience. And then there is the kidney, whose business is piss.

I can heal your kidney, or your heart, or your bowel without empathy, though bedside manner never hurts. But can I heal your mind without empathy?

So much of psychiatry is perception, not just bodily function. And so, to be effective, mustn’t a psychiatrist feel? Mustn’t he, too, have experience? And by experience, I don’t mean how many patients he has diagnosed, or how long he has been diagnosing them. I mean personal experience. How much he actually knows, or at least can vividly imagine, about what it’s like to be mentally ill, or what it’s like, day-to-day, to take drugs that alter your consciousness, or, finally, what it’s like to be locked in a ward.

It might do wonders for the profession if all psych residents were required to spend ten days incognito as a patient in a locked ward. Or to be given antipsychotic medications to sleep. Or to have their intelligence insulted by someone who doesn’t know what neurotransmitter that drug happens to work on. Then, at least, they would know a bit more whereof they committed, prescribed, and consulted, and they’d think twice before suggesting hospitalization as a means of putting the Caseys of the world to rights.

If you ask me, Casey and I fell into the same category: the overdiagnosed. Certainly we were or had been depressed. Behaviorally, anyway. That was clear.

The question is, were we what you might call naturally depressed by life and our prospects? Were we too hypersensitive? Were our expectations too high? Were we clobbered by life’s disappointments, as everyone at some point is? Or were we clinically depressed, suffering, as they say, from a chemical imbalance? Was depression in our DNA? Were we mentally ill, or were we struggling through a bad patch?

Moreover, was medication, and lots of it, the answer? Was it the only, or even the best treatment?

Nobody has answers to these questions yet. But in the absence of such answers does it make sense to pound everyone with the same rubber mallet? Does it make sense to give powerful antipsychotics both to someone who thinks he is talking to God and to someone who is just having trouble falling alseep? Does it make sense to put someone like Casey away, and keep her away despite her assertion of the plain fact that being in the bin was making her feel worse, not better? Wasn’t that kind of treatment just going to make her, and me, and a hell of a lot of other people, shy away from consulting psychiatrists at all, for fear of being dangerously overmedicated and incarcerated?

These were all the questions in my head as I watched Casey leave the ward, and as I sat waiting out my time, succumbing more and more to fear and depression, despite knowing that I was only likely to be there for a short time, and that I was actually just doing a job. It was hard to keep any kind of perspective. Almost impossible. The intimidation and lethargy of the institution hung on me and ripened like a stink, and I sat in that stink with worsening amnesia, as if I neither had nor knew of any other life outside the confines of Meriwether Hospital.

I realize that this sounds overblown. And sitting here now, back in my privileged life, mentally so far away from Meriwether and that time, it sounds that way to me, too. But then I remember that my roommate Ellen had been stuck in there for six months, and who knew what was going to happen to her.

I wasn’t Ellen, of course. Far from it. I had access, if necessary, to a whole host of resources, legal and otherwise, that Ellen and most of the rest of my fellow patients didn’t. That, after all, had been most of the reason why Casey had managed to get out so quickly. She had resources. Family, some money, and enough education, savvy, and middle-class wherewithal to apply pressure in the right places. Yet she, like me, had seen on her first trip to the bin that although she had committed no crime, her accustomed freedoms could be taken away more quickly than they had ever been before, or than she had imagined they ever could be, even if only temporarily.