Voluntary Madness Part 3

And sometimes, fairly often, I envied her for it. She was socially hermetic.

My envy, of course, led me to wonder whether the lucidity and the sanity we were so eager to impose on her were really so preferable to her world. Would they make her feel better? Or was consciousness-brutal, imposing consciousness-precisely the thing from which her mind was fleeing with all its creative energies awhirl?

Is this a romantic view of madness? Probably. Or maybe just a realistic view of reality.

Can we really say that our lives are in every way preferable to the madman's? We spend our lives running from consciousness, too. Every chance we get. Our lives are full of guzzled substances and vapid entertainments, the generically familiar, h.o.m.ogenized, franchised world, all a distraction from the emptiness at the heart of ourselves and our heavy, heavy awareness of same.

Yes, awareness.

We as a society wanted to make Sweet Girl aware. We wanted her to know that she was a lost soul, or an outcast, or unloved. We wanted her to dwell on all the unbearable truths that her florid mindscape had kept her from really knowing. We wanted her to face the weather like the rest of us, even if it meant waking up to a nightmare. Or at the very least, the lackl.u.s.ter present tense.

But maybe, just maybe, awareness is overrated, and Sweet Girl knew that as well as we did.

Now it's arguable, on the other hand, that she was, as the medical model would have it, a prisoner of too much unconsciousness. Her strange mentality may well have been exactly what kept her isolated from the world, and therefore intolerably lonely and dysfunctional. G.o.d knew, in her present state, she was not functional in the world's terms. She could not hold a job, or most jobs. She could not sustain relationships or pay rent. And, as the smell of her would often attest, she couldn't even manage to bathe or change her clothes.

Sanity, of whatever sort she could achieve on medication, would presumably allow her to do those things. But if that was true, it was also true that the "sanity cure" was a cure only in the sense that it would d.a.m.n her to living with and like the rest of us. That is, holding a less than blissful job at best, and paying bills, and perhaps marrying with a 50 percent chance of getting divorced. It would allow her to fit, or pa.s.s as fit, as so many of us do, and maybe that was better than falling out the bottom of society because no one knew what to do with you.

Certainly, I had seen in other fellow patients the stress and pain that mental illness had caused in their lives, the loneliness and isolation that only made them take sterner refuge in delusions.

Mother Teresa was a cla.s.sic example of this process at work. She was a forty-two-year-old Puerto Rican woman who, a year or so prior to landing in Meriwether, had left her three teenage children with relatives back home on the island and come to the mainland United States.

At the time of her admission, she had been living in a homeless shelter and working on and off at a fast-food restaurant. One of the other patients, a recovering alcoholic and depressive named Jose, had given her the nickname Mother Teresa because she was, to say the least, extremely religious, a pathological proselytizer and self-styled saintly minister to the G.o.dless and suffering.

A few weeks before I met her, she'd been arrested for disturbing the peace in the lobby of an office building in one of the outer regions of the city. By her own admission, she'd gotten a little excited and started running up and down the main floor of the building, laughing and singing and declaring herself the bride of Christ. She'd gone out to this part of the city, she told me, because she had seen Jesus flying that way, calling her to follow.

When I met her, Mother T's delusions were many and various, though all biblical in origin and extremely pressing. She couldn't stop herself from describing her visions of Jesus and the second coming and trying to convert or preach to pretty much everyone she saw.

This, more than anything, was responsible for the crippling loneliness she felt, and spoke of tearfully, on the few occasions when she wasn't talking about Christ. She wanted very much to find a husband. She had been married very young and had had her three children, but her husband had left her not long after the children were born, and he was no longer in her life. She missed her extended family terribly. Before she left Puerto Rico, she had been living with her mother, father, and siblings. She spoke often of wanting more than anything to be reunited with them. But it seemed they were unable to deal with the wild vicissitudes of her illness and had sent her packing.

There was a pay phone on the ward accessible to any patient, but long-distance calls required a calling card, and most of the patients, including Mother T, didn't have the money for one. I did have one, though, so one afternoon I suggested that perhaps she might feel better if she gave her family a call. Maybe they could patch things up. She was very excited by the prospect, dialing the number eagerly as I walked away.

But only a few minutes later she appeared in the doorway of my room, crying.

"They told me to shut up. That I'm crazy and I can't come home. They don't see Jesus as I do. They don't understand."

After an episode like this, Mother T would spiral vigorously back into her delusions. As I watched her deal with the pain of her family's rejection, and later with other rejections and crushing disappointments, I saw her grab hold of her visions and her perceived special connection to Christ like a buoy in a raging sea. They kept her afloat. They were a refuge from the cruel knowledge that no one wanted her.

"It's okay," she would say, her sobs abating, "I have the Lord and he knows me, and his plan for me is the most important thing. I must be here to do his work."

"Yes," I would say, stroking her back. "Yes. That's right."

"Ah, and you know, Norita, he is so beautiful. His eyes are like fire. Clear fire. And when his spirit descended, and my crown came down on my head, oh, it was . . ."

"Heavy?" I said.

"Very."

"I bet."

I put my arms around her.

"It will all be okay," I said.

And then came a reprimanding voice shouting from the nurse's station: "NO TOUCHING. Down the hall, there. You two. No touching."

"What?" I said, looking at Mother T as she pulled away. "Is that a rule?"

"Oh yes," she said. "It is a rule."

A necessary rule in some ways, as I came to learn, in a world where people had few or often no natural boundaries, and where tempers were likely to flare into violent altercations over almost anything. Keeping the patients from getting s.e.xually or amorously involved with one another was a wise policy, and giving vitriolic patients as few pretexts as possible for overreaction was a prerequisite for keeping order.

But depriving lost and desperate human beings of the healing comfort of something as innocuous as a hand on the shoulder or, in extremis, a kindly hug was, at moments like that one with Mother T, just another form of gratuitous deprivation, just another reason why this place made you feel less than human.

I realize that this may sound hopelessly naive, and I also realize that there was a lot about my fellow patients' histories and conditions that I didn't and couldn't know, but it seemed to me that a lot of the therapy they needed was of this simple tactile and sympathetic kind. Not because they were crazy, mind you, or because such therapy could cure them, but because they were human and everybody benefits from sympathy. Yet, as far as I could see, it wasn't even being tried. Basic human contact, most of which need not always come in the form of touch but rather in the form of engaged (not clinical) listening and the occasional sympathetic response, was not much in the repertoire.

I spent a good deal of my time in Meriwether trying to offer this to my ward mates, not spontaneously, but in response to the artless promptings of people like Mother T and Mr. Clean and even Sweet Girl (when she emerged), all of whom sought me out, not just for cigarettes and candy, but because, as Mother T said once, "Your eyes are so calm."

I am not calm by nature, but, as you might expect, psychosis and its attendant restlessness are as distinct from run-of-the-mill high-strung as depression is from the blues. In a place like Meriwether, Zelda Fitzgerald would seem serene, and so did I. My ward mates seemed to have a nose for the less afflicted. They picked me out right away as being not not one of them, and they took what they could get from me. one of them, and they took what they could get from me.

One of the women in the room next door to me, Cherise, a Meriwether veteran, and the person who taught me how to flip on my light with a comb or a pen, nailed it the first time she spoke to me: "You keep nodding, and your head's going to fall off."

She was dead-on. I did a lot of nodding. Maybe out of politeness. Or maybe because it seemed useless and hurtful to disdain someone's delusions, as I remember seeing one of the surliest nurses do.

"I am not your Jesus, okay?" he shouted to Mother T one night as she interrupted his bleary TV watching on shift. "So leave it."

I thought it was cruel and unnecessary, like correcting a grown person's grammar. What for? To humiliate her? Establish your own superiority? Your power? Your remove? Were these even in question?

What possible good could it do to trample on someone's defenses? It wouldn't work anyway, either because, as the docs maintained, the visions and beliefs were spontaneous and chemical, or, as seemed at least partly true in Mother T's case, precisely because they were defenses. They were elaborately crafted and strongly fortified walls against the world. Attempts to dismantle them were perceived and responded to as threats, a.s.saults as grievous and harrowing to the psychotic as a mugging would be to us.

Making them see it your way would fail. It wasn't the way in. On the contrary, I often found that validating the delusions, learning and mapping their contours, nodding, not in toleration, knowing better but in earnest, won you a person's trust, and once you had that, increasing lucidity often followed.

That, I suppose, was part of what led me to believe that the delusions were a defense in the first place. All the people on the ward whom I got to know and befriend spoke to me exclusively in riffs and riddles when I first met them. They didn't know me. They didn't trust me. But without exception, they spoke to me coherently, and often without digression, by the time I left.

Undoubtedly, you can attribute some of this to the medication. I was in Meriwether for ten days, and many of them had already been in the hospital for some time before I got there. Ideally, the plethora of drugs they were all on might have had a chance to kick in by then. But I noticed they kicked in temperamentally; as Sarah, the med student, acknowledged to me in one frank conversation, they worked only up to a point. They tended to tone down the voices and visions but not to banish them.

Depending on the day's stresses and the encounter at hand, whether it was a quiet exchange between two friends or a confrontation with a nurse or another patient, the lucidity factor would go up or down. If Mother T was feeling relatively secure and supported, she could deviate from the G.o.d talk. But if her parents had just hung up on her or someone had roughly rebuffed her preacherly advances, she would pace the halls agitatedly and insist that I read aloud portions of the epistle of Jude.

Another patient, Deborah, was the same way. When I walked into the ward for the first time, this very short, unabashedly potbellied, pewter-maned, and mustachioed woman stood directly in front of me there in the bright pacing hall. She looked me lewdly up and down, wolf whistled, and walked away. It scared the living s.h.i.t out of me, and it was meant to.

During my first few days there she cursed under her breath whenever she was near me and rambled on about how the staff was trying to infect her with HIV. She thought she had sailed the Nile as a queen and was convinced that there was a bomb in the pay phone at the end of the hall. She was like a lot of the other patients in that way. She had her pet obsessions and irritations, and she'd stop you in the hall or the dayroom and rant about them in bursts. Usually the rants weren't long, and I'd just say "Okay," or "Makes sense," or "I hear ya," and then she or whoever it was would seem satisfied and walk away.

That was the getting-to-know-you phase. The test.

Deborah's first test was the whistle. Then there were her frequent iterations of the word "s.h.i.tpot," a term of execration that she applied mostly to blacks and Hispanics whom she deemed, in her temper tantrums, to be inferior.

"Your people were servants on the Nile," she'd say, forgetting, of course, that Cleopatra herself was not exactly white-or from suburban Connecticut, as Deborah apparently was.

Deborah would get into "s.h.i.tpot" tiffs with her Hispanic roommate, Carla, a tattooed toughie who had a habit of getting uncouthly down and dirty with her boyfriend in the visitor's room, and who looked to be the type for whom the ballpoint pen rules were made. Deborah didn't like Carla, not because she was Hispanic but because she was rude, and p.r.o.ne to her own fits of temper. When the two of them b.u.t.ted heads over nothing, Deborah walked away muttering, or sometimes shouting, "Puerto Rican s.h.i.tpot."

For a while afterward, that's all you could get her to say.

"Calm down, Deborah," the nurses would say. "Calm down."

Carla, too, would storm around agitatedly, usually crying and whining.

If this went on for too long or was too disruptive, the person in question was "medicated." Usually, there was a warning period. The nurses would say, "Do you need to be medicated?" or "You're going to get medicated if you keep that up."

Then, a group of five or six large men would appear on the ward wearing dark purple rubber gloves. They would usher the party or parties in question, one at a time, into the seclusion room, or sometimes into their own rooms, hold them down if necessary, and give them the hypodermic. A few minutes later the team would disappear as quickly as they had materialized, and the patient would either remain supine where they had left her, falling quickly into a torpor, or emerge peevishly, rubbing her a.s.s.

I have no idea what they gave them, but it worked so well that the person would usually pa.s.s out facedown on her bed, with one foot still on the floor, shoes half kicked off, pants fumblingly unb.u.t.toned and abandoned about the hips.

Deborah always wore her one pair of jeans or her Meriwether issue pajama bottoms unfastened at the waist, because her belly was too big to fit into them. She often wore a large polo or T-shirt draped over the top, and on her feet she wore Meriwether issue shoes, black Chuck Taylor-style low-top sneakers with Velcro straps. Whether she was really from Connecticut, there was no way of knowing, but she spoke like someone who had been raised in a fairly wealthy family in the northeast.

She often whistled songs from West Side Story West Side Story and and Top Hat Top Hat as she walked back and forth down the hallway, smiling at me mischievously as she pa.s.sed, and winking. as she walked back and forth down the hallway, smiling at me mischievously as she pa.s.sed, and winking.

Her hair was shoulder length and pin straight, and she was only a little over five feet tall. Like Clean, she was diabetic and her belly was similarly localized and protruding, perfectly round and proud like a baby just about due. Also like Clean, she enjoyed her sweets, especially fruity beverages like the blueberry juice shakes that my visitors sometimes brought me and packets of peanut M&M's, which I learned to request on her behalf.

Looking back, it's hard to believe that I was ever afraid of Deborah. She was like some errant WASP homunculus who had tripped sideways out of her good breeding via Great Aunt Eugenia's bad genes and landed on the street. As it turned out, she had a big soft spot for me, and when the antics fell away, she was perfectly harmless.

"I just want to follow you around and look at you," she'd say. "You're the freshest face I've seen."

She said she had a room somewhere in the city, but she spent most of her time on the street, in the parks, or sitting on benches feeding the pigeons. Like Mother T, she'd been hauled in by the cops, probably for loitering or disturbing the peace. Like many of the other people on the ward, she'd been to Meriwether several times before, her last visit having been only two months prior to this one. Probably like most of the rest of them, she was on a cycle. She came in here, got meds, meals, and shelter, broke the choke hold of the delusions, left with some prescriptions, hit the street, stopped the meds, lost control, got arrested, landed back here, and did it all over again.

She usually stopped taking the meds when she was out, for the same reason that everyone else did. The side effects were too bad. The fog, the sluggishness, the tardive dyskinesia-abnormal involuntary, spasmodic movements, especially of the face, lips, and tongue-and the overall shaking parkinsonism that so many of the dopamine-blocking antipsychotic medications induce. Deborah, like Clean and many of the others, was on Haldol, among other drugs, a moldy old neuroleptic first used in the 1950s and developed on the basis of an entirely unproven theory that psychosis is the result of abnormally high levels of dopamine in the brain. There is great debate within the scientific community about the safety and effectiveness of these drugs in reducing hallucinations and controlling delusions. If they work at all, they work because heavily sedating and inducing Parkinson's in a person is a little like hitting them over the head with a frying pan, medicine practiced Three Stooges' style. The blow will probably stop the agitation and devivify the psychotic experience, but, as with the antidepressants, not because it's redressing a chemical imbalance, but because it's creating one, one that some have argued amounts to brain damage, and is in no way precise, but tends instead to shut down the system wholesale. It's the theory of person as pinball machine: unplug them and they'll stop binging.

It works. But then, lobotomy worked, too.

And most of the people I met, Deborah included, did stop binging, or at least they stopped binging as loudly and insistently as they had when I first met them, but at the cost of one h.e.l.l of a hangover. And that's from only one drug.

They were all on c.o.c.ktails of antipsychotics and mood stabilizers: Haldol, Zyprexa, Depakote, lithium, Klonopin, Seroquel, Thorazine, and Risperdal, to name only a few. Depending on the time of day-we were given medication three times a day, at eight, five, and nine-and whether a person had been forcibly medicated or not, the patients were more or less sluggish, r.e.t.a.r.ded, zombified, mush-mouthed, or dead to the world, drooling big lakes of syrup onto their bedsheets, as Sweet Girl did every single night I was there. She used to wake up in the morning-it was more like noon, really, when she could finally pry herself out of her coc.o.o.n-and when she lifted her head, there was a long, viscous rope hanging from her mouth to the mattress like a snot umbilical.

I suppose if you looked at and dealt with people doing this kind of repulsive c.r.a.p all day, you'd be hard-pressed to see them as fully human, too. That's how it must have seemed to the staff, and that on top of the exasperation of having to shove someone like Sweet Girl into the shower because she smelled bad enough to make your eyes water. It wasn't likely to engender respect. And even though I felt defensive of my fellow patients, sometimes I could really see the other point of view.

I'd look at Clean, for example, in all his foul, pestering regression, and catch myself thinking, "You should be put through a meat grinder and fed to cats and dogs." I'm not proud of that, but I thought it. I thought it vehemently and with relish and with the most visceral disgust and hatred I have ever felt for another human being. Because as much as Clean could inspire the profoundest pity in me, his childish, relentless, mindless life force made me loathe him. Watching him eat, listening to the slurping, slapping noises he made as he sucked the anemic meat and drippy fat of a deep-fried chicken wing off the bone, I wanted to make elaborate and creative use of my ballpoint pen in all the forbidden, murderous ways that the staff had ever seen or imagined.

I wasn't on Haldol or any of the other doozies my ward mates were ingesting three times a day, so I enjoyed a comparatively stunning range of motion and mental agility. I had not been reduced to repellency. Yet. Or was I deluded? When you spend your days with society's rejects, the indigent insane, who are by turns caught in the chloroform embrace of modern medicine, chemically infantilized, swathed in inst.i.tutionalized helplessness, then coughed out the bottom of the system stoned and spiritless to languish on the street until the next arrest, you begin to wonder about your perspective on what's acceptable. These people are not acceptable as is. They are made mildly more acceptable when tranquilized or debilitated, or they are made less of a nuisance anyway, which is most of the point. Like kids on Ritalin, we medicate them mostly to make life easier for us, not them, to make them easier to handle, and the sight of them less guilt- or revulsion-inducing.

Casey came on to the ward on my third day, reeling in disbelief. She might as well have been wearing a sign that said, "I don't belong here." She was in shock, trying to figure out how she had gone from breaking down in tears in her therapist's office to being committed to a public ward with a bunch of homeless psychotics. I remembered the feeling well. I'd felt the same way that first time I'd found myself in the bin.

Her story was very similar to mine. She'd gotten depressed, said something vague about suicide, and had unwittingly set the whole confinement system in motion. Only instead of committing herself under advis.e.m.e.nt, as I had done, her doctor frog-marched her down to Meriwether personally and checked in via emergency.

She'd spent her first night in the same hole as I'd spent mine. Same inflight foldout chair. Same loud staff at the picnic table all night. She even confirmed that one of the night orderlies had once again taken a three-hour nap in one of the empty beds.

The next day she'd been shuffled up to the twentieth floor with the rest of us and gotten dumped in a room with Deborah, who made her usual memorable first impression.

"How'd you like me to break your neck for you?" she said, and Casey put her face under her pillow and cried.

I couldn't help smiling at this. Not outwardly, of course, when Casey told me-as she told me all the rest of it, while standing in my room with her arms crossed-but inwardly, to myself, knowing that Deborah was just giving Casey a little comedown from her superiority complex. Casey had this air about her, not just of someone who didn't belong in Meriwether because she wasn't sufficiently crazy, but of someone who believed she didn't belong here because she had too much cla.s.s.

She didn't mean to insult anyone. She was a nice girl. But underneath, she thought she was better than the rest of us, and her bearing betrayed her. Or, I should say, them, not us, because she had sought me out as a refuge. She appeared in the doorway of my room and said, "Can I talk to you for a second?" She had quickly concluded not only that I wasn't loopy beyond recall, but that I was another college-educated, middle-cla.s.s person whom she thought was on her level. And that was the vaguely prissy vibe she gave off. Of course, I'm sure I gave off more than a whiff of that myself. I know I had done so under the jaundiced watch of Baldy my first time around the maypole.

You can't hide what you are, or what you think you are, and crazy people don't have a filter, so despite the fact that you're standing there semi-petrified, with your hands in your sweatshirt pocket, the sweatshirt that, to add insult to injury, has the name of your college emblazoned on it in purple, you'll come across as the snooty brat that you are, and are secretly proud of being, and the likes of Deborah will sense that a mile away and a mile deep, and will say outright the things that normal people are just thinking. Let me break that long, white cultivated neck for you, princess, and then we'll see whether you don't feel that you belong here in the pig pile with us grunts, after all.

So Casey showed up in my doorway, having ferreted out a fellow princess, and asked if we could talk. I invited her in, against the rules. I invited her in, as I had done with no one else, because I was secretly, sn.o.bbishly as sure of her as she was of me. I knew she was safe, and unlikely to spit up, or freak out, or ask me for more than I was willing to give. And we conversed without fear, with the comfy cordon sanitaire cordon sanitaire of our shared superiority drawn perfectly around us, while Ellen in her chair and Sweet Girl in her shroud talked and burped to themselves on either side of us, lost in their own shifting worlds. of our shared superiority drawn perfectly around us, while Ellen in her chair and Sweet Girl in her shroud talked and burped to themselves on either side of us, lost in their own shifting worlds.

Casey told me how she'd gotten there, and asked me how the h.e.l.l to get out.

"Here's the thing," I said. "You gotta stay calm or you'll only make it worse. Be polite. Be cooperative. Palm your medication. Keep to yourself. And call legal services. Call your parents, and tell them to call your therapist and put the fear of G.o.d into her. Whatever you do, don't lose your temper and don't be disrespectful. You're dealing with egos here, and you don't want your doctor knowing you think she's a quack or she'll pull the power trip on you and draw out this whole horror show a lot longer. Believe me, I know what you're going through. I've been there."

Ellen, as if on cue, and for contrast, stood up on the other side of the room. She was having a bit of trouble. The devil in her stomach was on the rise. She was standing in front of her chair and stroking her throat, saying: "I need to vomit, but it won't come up."

"Should I get the nurse?" I asked.

Ellen nodded.

One of them was pa.s.sing in the hall, so I called to her. "Listen, Ellen is having trouble, can you help?"

She poked her head in.

"I need to vomit," Ellen said again.

"Okay," said the nurse. "So go into the bathroom."

"It won't come up," said Ellen.

The nurse looked at her quizzically, said something unmemorable and noncommittal, something like, "Just give it a minute," and then walked away.

Ellen stood in the doorway helplessly, still stroking her throat, looking down the hall after the nurse. After a moment, she walked into the bathroom and closed the door.

Casey and I turned back to our conversation.

"G.o.d. This place," she said.

"So what do you do for a living?" I said.

She was a grade school teacher in the city in her second year at a tough school. Lots of behavioral problems. Lots of parental neglect. The usual.

"Well, there's your problem right there," I said. "That's depressing. You don't need medication. You need to change your job."

"I know. I know."

Deborah's head appeared in the background over Casey's shoulder. She'd stopped in the doorway to get my attention. She pointed at Casey's back and put her hands to her throat, miming strangulation. I shook my head, smirking, as if to say, "Yeah, yeah," and waved her on. Casey turned around. Deborah smiled innocently and moved off.

Ellen emerged from the bathroom.

"Anything?" I said.