Voluntary Madness Part 19

As it happened, the next day was my last full day at Mobius, so the sand-tossing ceremony made a fitting end to my stay. Instead of doing den chi bon in the exercise room as usual that morning, Sam and Carol took us to the site of an Indian mound in a nearby park. The mound overlooked the beach and was shaded by tall whispering palms. At the very top there was a flat clearing covered with loose soil. Sam set up his iPod speaker on a bench to the side of the clearing. He gave us each a receptacle-a bucket, a coffee can, what have you-and told us to walk down to the beach to gather sand.

When we came back, he told us to outline a large circle on the ground with a trail of sand. The circle had to be large enough for us all to stand along its circ.u.mference and still have plenty of arm and leg room to do den chi bon. Once we had finished outlining the circle, and had chosen our positions along it, Sam told us to make another trail of sand leading from each of our positions to the center of the circle, thereby forming spokes in a large wheel. Once we had done this, we took up our positions again along the circ.u.mference, and Sam took up his at the center.

Sam was wielding a long wooden staff that he had obviously fashioned for similar ceremonies. Gary had done this at least once with Sam. He claimed at one point to have had visions of spirits appearing on the mound in the form of wolves. n.o.body else saw them, naturally, and n.o.body believed that they were there. But Carol had taken some photographs during the ceremony, and when she developed them, sure enough, you could see wolves in the circle. That was the story, anyway. I never saw the photos myself, and would have remained an unbeliever even if I had, but I did believe in the ceremony's power to unleash suppressed emotion, and that's all I was hoping for.

Being outdoors in that setting, standing atop a mound of crypted culture, made it easier somehow to let loose and connect with your own buried past. The open sky made you feel as though you could curse a blue streak without it bouncing back, and all that borrowed native juju seeping up through the soil was hard to beat when you were getting down and dirty with your inner child.

After we'd performed the usual den chi bon exercises, Sam took up his staff, aligning himself in turn with each spoke in the wheel, facing each of us one by one, and dancing up along the length of the spoke until he was close enough to kiss whoever was standing at the end of it. Then he invited each of us into the center of the circle for a little private mano a mano with him and the staff.

Actually, he didn't quite invite each of us. He didn't bother with Katie. When he made his way up her spoke, she looked at him like she'd beat the living s.h.i.t out of him if he came any closer, so, no doubt knowing her history, he thought better of the gesture and backed off.

But the rest of us had a turn inside, an invitation to grab hold of the staff and try to wrestle it away from Sam while we put one lowered shoulder to his chest and leaned in hard against his resistance. Or as hard as any of us would. Almost everyone, even Petunia, whom I'd expected to mate more willingly with his demons, just moaned gamely and went through the motions, too embarra.s.sed to really sumo in front of the group, or maybe just too emotionally impacted to purge the load.

By this point, I was a little more lubricated. I went at it with everything I had. When it was my turn, and Sam made his way to me, twirling and thrusting his staff, and grunting from the bottom of his throat, I said jokingly, "You're a brave man, Sam," and stepped into the circle.

Writhing against him, digging my toes into the dirt and pushing with all the strength in my legs, I barked, growled, and bellowed so hard and so loud that I sc.r.a.ped my throat raw. All the rage that I'd felt in Carol's office and during rebirthing came charging out. So much so, that I very nearly took a bite out of Sam's shoulder.

We went at it this way for at least five minutes, which feels like a h.e.l.l of a long time when you're wrestling someone with superior spiritual skills. Sam encouraged me to drain myself, saying, "Come on. Let it out." And I did, until I couldn't make another sound or push against him any harder. And then, as the emotion slowed, so did we. Our grips on the staff loosened, and we swayed slowly to a stop, breathing heavily, leaning against each other gently, and then not at all, until we were standing again fully upright, our breath coming back, our hands only lightly on the staff. Sam led me back to my place in the circle, returned to his place at the center, put aside the staff, and tapered out the ceremony as usual, calling us in closer so that we could hold hands and close our eyes and breathe together as the music ended.

Then in silence, we took the sweepings from the sand mandala and walked to the water's edge. Each of us grasped a handful of the sand, ready to throw it out into the water, expressing our guiding thought for the day as we did so. Since it was my last day, mine was a guiding thought for the coming weeks and months, and maybe even years. In keeping with the symbolism of the chair that I had traced on the sand mandala, and the theme of inhabiting myself that I had been developing throughout my stay at Mobius, I came back in my mind to one of those four-letter words that I had written in caps in my notebook and underlined for emphasis: STAY.

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?-compa.s.sion. a.s.sistance. 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 compa.s.sion 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 compa.s.sion 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 pa.s.sively diagnosed in a waiting room or cowering paralyzed in the bathtub.

CONTINUUM.

I began this project with the intention of exposing inst.i.tutions. 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. Inst.i.tutionalize someone and he will become inst.i.tutionalized. Lock him in and down, and he will do the same. Inst.i.tutions don't heal-they hold. At best, as I found at St. Luke's-which incidentally, I would not quite characterize as an inst.i.tution, 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 naive to believe otherwise. Not naive about the system, but about people.

On one level, the system is the system, ruled largely by the laws of economics: compet.i.tion, 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, pa.s.sive, 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 inst.i.tutions have learned through experience that patients cannot be healed by inst.i.tutions, 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 inst.i.tutional 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 partic.i.p.ate 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 partic.i.p.ate 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, compa.s.sion 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 partic.i.p.ate, and neither could any other place, however sw.a.n.k or progressive.

In my experience, whether you were dealing with a psychotic, indigent, inner-city population, a depressed and addicted middle-cla.s.s rural population, or a depressed and addicted upper-middle-cla.s.s 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 a.s.sertion 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 cla.s.s. 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 pa.s.sive submission to the dictatorial effects of medication. Circ.u.mvent the will with a pill, as so many inst.i.tutions and pract.i.tioners 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 inst.i.tution, 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 inst.i.tution, 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 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 a.s.signed 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 b.u.mper sticker, pasted there for the benefit of whichever bored fellow pilgrim happened to be stuck behind her in line, in cla.s.s, in church, or, in this case, in a short bus full of life-skill spastics paying for the privilege of getting their s.h.i.t 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 X or not or not X 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 condition.

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 partic.i.p.ate. 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 G.o.d. But it gives me the vital sense of getting somewhere under my own power, of refusing to accept pa.s.sively 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 partic.i.p.ation means, and what this so-called middle way really entails, aside from popping the evilly necessary, or occasionally desirable, pill now and again.

Primarily, it means effort. That's the simplest way to say it. Constant effort. We tend to think of happiness (and by happiness I also mean health or overall well-being) as a gift, and sometimes it is, a pure gratuity. But most of the time it comes about because you've done the work, prepared the ground to allow it in or tended it carefully once it has arrived. You have to practice happiness the way you practice the piano, commit to it the way you commit to going to the gym.

You don't do it most of the time because it feels good to do it. You do it because it feels good to have done it. Or, more precisely, you do it because repet.i.tion lays the groundwork. It is the prerequisite for feeling good. Happiness is not a reward. It's a consequence. You have to work at it every day.

Part of this, for me, means literally going to the gym. Being in good physical condition, getting my heart rate up for at least forty minutes, stretching, doing yoga and other strength exercises. This has a direct effect on my mood. When I'm terrified, when I'm really down and feeling like c.r.a.p, I take myself to the gym. It's the first thing I do. I don't even think about it. I don't debate or consider whether I'm up for it. I do it. Automatically. And every time, even if the workout feels like h.e.l.l while I'm doing it, I always feel better when I'm done. If I go in at an emotional 4, I come out at a 6 or 7. Sometimes just the act of having accomplished something that is hard, that takes willpower, makes me feel good about myself. It may be the only thing of substance that I accomplish in a day, but it's something and it clobbers the fear and the loathing and the futility.

If the question is, What's the point? The answer is, Just do it. Doing it is the point. Don't think. Do.

I have learned to apply that principle to almost every aspect of my life. So, for example, I don't work at my writing because I love it. I work at it because I know that work, focusing and exercising my brain in very much the same way as I exercise my body, brings about a certain fulfillment and contentment in me that is lacking when I go too long without intellectual stimulation. Giving my brain something to occupy it tends to keep it from obsessing so much about my failures, or about impending disasters. I believe this to be true of all of us. Our brains are hungry, in constant need of stimulation, and when we don't feed them enough, especially when we feed them the junk food of bad television and other mindless distractions, they turn on us and begin to cannibalize themselves for nourishment, much the way our bodies consume our own muscle and fat when we starve them.

My brain did this a lot while I was at St. Luke's. It spiraled in on itself and tangled me in knots because I succ.u.mbed to intellectual inertia. I didn't feed myself, and so I fed on myself. Once that had happened, it was doubly hard to pull myself out, and that is why so much of my effort in managing my depression is given over to maintenance, to keeping things going. In this, the emotional world mimics the physical one. It is far easier to keep going when you are already going than it is to start going when you have stopped or fallen into reverse.

I don't often feel like working or doing something that's good for my brain, but I try to push myself to do it nonetheless, because, as with physical exercise, I always feel better when I've done it.

Likewise, I often don't feel like socializing, and I often find myself on the verge of canceling engagements with friends. Sometimes I do cancel them. But almost invariably I regret it. I resent the effort it takes to maintain relationships or meet the tedious obligations that family and friendships can impose, and yet I know that isolation is very bad for me. I know that my happiness depends, in large part, on human contact and intimacy. And so, as with everything else, I do it and reap the reward, or I don't do it and suffer the consequences.

It's all of a piece. Together, the pieces bring about the whole, and the sense of wholeness that is essential to staving off depression. The pieces and the bringing about are mine. It is up to me to tend to my wholeness. I do it or I don't. That's it. Sometimes I do well and sometimes I do poorly, but the point is, I do. The success or the failure is my own.

As for last words on the subject, as for cure, that's a fantasy. You don't finish. You continue. And you don't do it-you are not forced to do it-because you are mentally ill. You do it because that's how living works. Maybe depressives like me have to work a little harder at happiness. Maybe psychotics like Karen have to work a lot harder. But everyone has to work at it. Everyone has to try, even people who have everything. Probably they most of all.

I'm not saying that eating right and exercising, nurturing your heart and challenging your brain, will save you. It won't. There is no saving, of course. You never "arrive." You move. You get on with it. That's the prescription.

In the end, and after a long, long trip, there's only one thing I can tell you about happiness, about well-being, as I understand it. You want to be happy? You want to be well? Then put your boots on.

ACKNOWLEDGMENTS.

I would like to thank my agent, Eric Simonoff, for being, as usual, so much more than an agent; my editors, Molly Stern and Wendy Wolf, for their unflagging support, guidance and editorial ac.u.men; Viking president, Clare Ferraro, who has been the kindest of fostering mothers; my publicists Jump Coleburn and Ann Day, who make it all turn out beautifully; and my friend and cohort Laura Tisdel, who also just happens to work at Viking. I owe my life, body, and soul to my beloved friend Claire Berlinski, who has done more for me over the years than anyone could or should ever have been expected to. I owe this and a whole h.e.l.l of a lot more than I can ever repay to Lisa McNulty. In addition I would like to thank Bruce Nichols, Adam Bellow, and by no means last or remotely least, my family: Alex, Ted, Mom, Dad, and Kristen.