Falling Into the Fire: A Psychiatrist's Encounters with the Mind in Crisis (15 page)

Mental illness, and the suffering it carries with it, can consume a person’s whole life. And when it does, there is no room for the most basic pleasures, let alone the loftiest of great creations. For my patients, madness is not a political statement. More important, it is something by which hardly any of my patients would choose to be burdened. For those of us who are fortunate enough to be comparatively sane, it is abhorrent to stand in celebration of Woolf’s madness. It did, after all, cost her her life. It is audacious and self-serving of us to celebrate mental illness as rebellious and brave, as productive and ingenious, as the mythical, maniacal muse of our artists and writers. At the end of so many of these stories, we are left with their masterpieces. But the lives behind the stories are riddled with suffering and hospitalization and suicide. The brilliant psychologist and author Kay Redfield Jamison has said that bipolar disorder—an illness from which she herself suffers—“benefits mankind at the expense of the individual.” Who are we, exactly, to say that it is worth it? Even if madness is at the root of some of the world’s great creations, it is hard to imagine that if someone asked each of us to live an entire life of suffering in the service of the arts, we would agree to do so. Even if we might choose such altruism, it’s unlikely we would allow anyone else to make that decision for us.

And as fiercely as we hold to this romantic argument of greatness arising from madness, are we sure we have it right? What if the opposite is true in the cases we cite of van Gogh and Schumann and all their sad, mad peers? What if the greatness of these artists existed not because of the madness but in spite of it? Might our mad creators—and the countless other artists who were so afflicted—have blossomed even more fully if not hindered by depression or haunted by psychosis? For Plath and Woolf and Sexton and others who prematurely ended their own lives, we must also consider what further genius might have arisen over the full course of their lost years.

There is no glamour in my patients’ lives. For the vast majority of them, their daily existence holds much misery, and no romance. And yet it is comforting to those of us gifted with sanity to believe that there might be some redeeming, glorious, even magical aspect to the deadening, punitive force of madness. There is surely veracity in Woolf’s description of her mental illness, but in celebration of the “lava” of madness and its fantastic by-products it is all too convenient to lose sight of the story’s end: a brilliant woman loading her overcoat pockets with stones and stepping into the river Ouse to die.

“I feel certain that I am going mad again,” Woolf wrote to her husband in her suicide note. “I feel we can’t go through another of those terrible times. And I shan’t recover this time. I begin to hear voices, and I can’t concentrate. So I am doing what seems the best thing to do. . . . I can’t fight any longer. . . . You see I can’t even write this properly. I can’t read. . . . Everything has gone from me but the certainty of your goodness.”

•   •   •

I
n the earliest moment of morning, a mockingbird perches on our neighbor’s redbud tree and lets fly trill after trill, fluted note after fluted note. Our bedroom windows have been cracked open all night just enough to let in the mossy chill of spring. In the daytime I find this bird’s song to be an enthralling spectacle of flawless copies: now a pewee, now the mewing squawk of a catbird, now the whistle of a wren. I could listen all day. Sometimes I do. But at 4:00
A.M.
, burrowed beneath an old quilt and half aware that my young children have managed, for nine hours, to sleep soundly without a single “Mama,” the mockingbird’s call grates at me, all painful awakening and incessant noise. If I could throw a pillow out the window and hit my mark, I’d have to say I would.

It’s a reminder. The thing stays the same. It’s our vantage point that changes. Humanity has a fickle vein in which something can be sometimes loved and sometimes hated. What is it that tilts the balance?

I used to sleep until midday if I could. When I was a teenager, a twenty-year-old even, visiting my grandparents on a school vacation, my grandfather would cackle to see me rise, all rose-cheeked and rumpled. “Eleven o’clock!” he’d crow. “Oh, to sleep like that.”

My grandmother, a great bird-watcher, would’ve been up hours and hours earlier to see what she could see. I wish I’d asked her, before she died, what it was about birds that she loved so much. She was, however, prejudicial in her admiration. She’d tell me a hundred times about tramping through the northern Michigan jack pine forests with her friend Kay to catch a lucky glimpse of a Kirtland’s warbler. Then, just as often, she’d disparage “those horrible starlings,” or curse the invasive merganser ducks that infiltrated our Michigan lake.

I call my mother, now that I cannot ask my grandmother for her own answers. “Didn’t Grandma have some reason not to like mockingbirds?” I ask my mother. No, she says. Not that she can remember. “Are you sure? I thought they laid eggs in other birds’ nests and then their babies grew bigger than the others and took all the food, and . . .” I’m thinking of cowbirds, my mother tells me, which, yes, Grandma loathed. But mockingbirds? Nothing rings a bell.

My grandmother could be ruthless, in the way that nature also can. A cardinal built a nest outside her first-floor window, and I mentioned it to her, delighted. “If that bird is dumb enough to build its nest that low,” she scoffed, “it deserves to have its eggs eaten by a snake.” They had a garden and a little orchard at their rural Indiana home, and one Saturday of my childhood I ran to the blueberry bushes only to find a sparrow who had died after it got twisted in the netting around the bushes. “He shouldn’t have tried to eat my berries,” she said. Still, I noticed how tenderly she untangled him from the nylon threads. She held the body in her palm and had me look closely at what we rarely had the chance to see: beak, and wing, and claw.

My brother and I took a garden spade and dug a grave for that sparrow beneath the peach tree, solemnly marking it with . . . what? The pink-white flower from a pea tendril? A fat zucchini blossom? Clover? I can’t recall. But for nights after, lying in my twin bed, I’d think not of the dying but of the struggle. How flight turned into entrapment. How little the poor bird must have understood. How the more it moved, the more tangled its feathers would have become.

People who have schizophrenia are more prone to kill themselves in the early stages of the disease than at any other time. The theory is this: A person in his first psychotic break is in a kind of netherworld. He has had years—maybe eighteen, maybe twenty—of sanity. Then the voices come, or the visions, or the paranoia, and he begins to occupy a space in which the symptoms are present but so is his awareness of the stable life that is slipping from his grasp. It is a horrible kind of bridge—the interspace between sanity and brokenness.
Schizo-,
“to split.”
-Phrenia,
“mind.” Later—it’s awful to say—he likely won’t be as aware of what he’s lost. Yet in that first grip of madness’s net, in that first struggle and the sanity that comes after, he can understand the implications. The full impossibility of escape.
I’m not sure about this existence,
Colin had said to me.
Are you?

As we prepared him for discharge, Colin said he couldn’t promise us that he would continue the medication once at home. And the day he left, I felt unease in the pit of my stomach. I told Colin that I wished him well and reached out to shake his hand. He grasped my hand in both of his and held on, longer than he ought to have. He looked deeply into my eyes, as if he saw something there.

“I wish the best for you, too, Dr. Montross,” he said earnestly, with a meditative smile. “I really do.”

I worried for Colin after his discharge. I worry about many of my patients after they have left the hospital. “There are two kinds of psychiatrists,” wrote Robert I. Simon, himself a forensic psychiatrist. “Those who have had patients commit suicide and those who will.”

•   •   •

M
y most memorable patient encounters come from interactions with my schizophrenic patients. They tell me all kinds of things about myself.

“Montross? Like ‘mantra,’” said one, smiling in adoration.

“You will die in your sleep tonight by my hand,” said another. It can be unnerving.

Once, from his jail cell, a man said to me, “I know you!” I thought perhaps he did. A past psychiatric admission, maybe. Something else. “We smoked crack together!” he announced triumphantly, as if I had simply forgotten.

Riddled by voices, overcome by delusions, or persecuted by fear, these patients are pressed to take action in the world. And though the results of their actions can be ridiculous, or terrible, there is sometimes an unmistakable urge toward goodness behind their errant behavior. One of my patients bought hundreds of dollars’ worth of lighters in an attempt to stop gangs from setting fire to abandoned buildings. Another was brought in by police when, having caught a pigeon whose foot was injured, she held the bird in her lap with a fork and a pair of pliers to try to operate on it.

Because the content of delusions is so frequently religious, my patients have all kinds of ideas, too, about God. They are God, or are sent by God, or are persecuted by him. He has told them to fast, or to take drugs, or to beware of me. When I’m with them in the midst of their torment, I wonder about God more than at any other time in my life. After the writer Annie Dillard read a book about human birth defects, she imagined herself “hollering at God the compassionate, the all-merciful, WHAT’S with the bird-headed dwarfs?” It’s a fair question.

While I was treating Colin in the hospital, I learned a little bit about Amma the Hugging Saint. At first I hadn’t even been sure she was real; then, standing in line for coffee at a Providence bakery, I saw a bookmark-size flyer tacked to a community bulletin board. “Amma: Summer Tour,” it read, “Marlborough, MA. All programs held at the Best Western Royal Plaza Hotel.” An Indian woman beamed in a photograph on the flyer. Her hands were clasped in front of her face, as if she had just seen something that absolutely delighted her. “Programs include inspirational music, meditation, spiritual discourse, and personal blessings,” the flyer read. Beneath the photograph of Amma was a quote attributed to her: “God is deep within us. He dwells there in pure and innocent love.”

There is plenty of footage of Amma on the Internet, and it turns out that she’s been covered by major newspapers. A 2006 movie was made about her, called
Darshan: The Embrace.
In 2010 she received an honorary degree from SUNY Buffalo in recognition of her humanitarian efforts.

Amma was born in southern India. Her father was a poor fisherman. The
New York Times
reports that Amma “was said to have been born with a bluish hue to her skin and became an outcast. Her father withdrew her from school in the fourth grade and made her serve as a family slave.” As an explanation of her mission, Amma explains that her childhood meant that she “had direct experience with the suffering of others. . . . I always wanted to know the cause of misery and thought if sorrow is a truth then there must be a cause and a way out. I realized my purpose is to console, to personally wipe away tears through selfless love, compassion and service.” As a teenager she began hugging strangers on the streets of her village. In the opening minutes of the movie
Darshan,
a teenage Amma is shown with a man whose skin is covered in boils. The voice-over tells us that many of the boils were covered in pus. Young Amma delicately licks one after another after another, then looks into the face of the man with great compassion.

These days her physical contact is limited to hugs, but devotees report that her hugs are life-changing, transformative. Even relative skeptics, such as Jenny Kleeman, a journalist who wrote for the
Guardian
about the experience of hugging Amma, described the encounter as “the most enjoyable hug I’ve had from a stranger.”

In Hinduism the concept of
darshan
describes the reciprocal interaction between a deity or guru and his or her followers. The revered person is beheld, and the person who beholds her subsequently receives a blessing. Amma travels the world performing her
darshan
—the hugs—for up to fifty thousand people in a twenty-hour session. According to her followers, Amma has hugged more than 27 million people worldwide. “She never seems to tire,” reports the
Times.
“Speaking in Malayalam, the language of her native state, Kerala, and translated by her chief disciple, Swami Amritaswarup, she said, ‘People’s happiness is my rest.’” A 2006 article in
USA Today
about one of her sessions of
darshan
notes that Amma “never flinches from the tide of pain and confusion.”

I had initially imagined Colin following Amma through the mountains of the American West on foot, a hiking disciple who followed a guru through rugged terrain by day and pitched a tent with her devotees at night. My image had been one of campfires and drum circles, not of banquet rooms in a string of suburban Best Westerns. Nonetheless, my questions about Colin’s experience—and the etiology of his symptoms—remained the same. Does a young man seek Amma the Hugging Saint because he is fragile, susceptible to unconditional acceptance and a persuasive atmosphere? Or is he delusional already and his sense of deep meaning and connection with her is derived wholly from an imbalance of neurotransmitters? Or what if—despite his fragility or illness—he is right after all and she
is
a deity or a saint? There is fervent faith and there is psychiatric hyperreligiosity. Both can be characterized by agonizing self-debasement. Both can bring about ecstatic joy. At what point does a transformation in one’s thoughts become something to be treated by medication? When does it become so severe as to impinge upon one’s liberty?

•   •   •

I
n the
British Journal of Psychiatry,
Yair Bar-El and his colleagues describe Jerusalem syndrome, an acute “psychotic decompensation” that afflicted 1,200 tourists to the Holy Land from 1980 to 1993. “On average,” the authors write, “100 such tourists are seen annually, 40 of them requiring admission to hospital.” The paper divides the patients into three categories. The first is made up of people who have already been diagnosed with a psychotic illness before traveling to Jerusalem. “Their motivation in coming to Israel,” the authors write, “is directly related to their mental condition,” frequently involving delusions. A subset of these patients “strongly identify with characters” from the Bible “or are convinced that they themselves are one of these characters.”