Voluntary Madness: My Year Lost and Found in the Loony Bin (24 page)

In the end, I don’t think that the real difference between the quality of care my fellow patients and I received at St. Luke’s had as much to do with money (private versus public) or even location (rural versus urban) as it had with a sense of mission. And I don’t use this term in the religious sense, even though St. Luke’s was a Catholic hospital. I use it to mean that the people who ran St. Luke’s (unlike the people who ran and worked at Meriwether, or the people who operated the private hospital I stayed at my first time in the bin in 2004) believed in what they did and knew that the personal touch, however trite that may sound, went a lot further than drugs and diagnoses.

Many pundits and social theorists, from Robert Putnam (
Bowling Alone
) and Francis Fukuyama (
Trust
) to Marvin Olasky (
Renewing American Compassion
) and Christopher Jencks (
The Homeless
), have explored the importance of human bonds in the overall health and well-being of both the individual and the society. My experience at St. Luke’s led me to similar conclusions.

We need each other. We do better with the support of other people who know and care about us than we do at the hands of indifferent professionals who squeeze our untidy empirical woes into theoretical abstractions and boil our lived experience down to chemistry. We do better when people listen to us, even if we are not making much sense. And, most of all, we do better when we are given respect.

I’m not offering this as a cure, but I think it is a better way through our challenges.

 

As for my own journey at St. Luke’s, that was a slow-motion course of obstacles that took place largely in my head. My depression had its own logic, twisting every positive into another source of pain, every avenue of escape into a weak spot where the enemy could get in. I hunkered down in misery and brooded. I turned ideas on their heads and shackled myself with contradiction.

Take hope, for example. Even that became a devil in my brain.

To me, hope was an open wound. A form of vulnerability. Hope was waiting with the door ajar. Hope was looking for rescue. It was weak, because it was dependent. Dependent on the arrival of someone or something else. A savior, a miracle, a change.

But despair. Despair was strength. Despair was the scab and then the scar. The walled city in a time of plague. A closed fortification. A sure thing, because it was always safer, less painful to stop trying than it was to repeatedly try and fail. Failure—disappointment—was a poison in my blood. Despair was the antidote.

And so, in that sense, depression was not my disease, but rather a sign of health, my immune system’s response to an assault. The assault of hope. Of contingency. Of chance.

In my little head downturned, my lidded eyes looked inward. I curled in a ball, my back to the world, knees up. Everything inside was known, accounted for. There were no variables there. To rid my world of disappointment, I had to rid it of luck and surprise. And so I chose despondency, because in it there was no relevant question. The answer was always no. The sweet consistency of negation in a word. A perfect answer, a loud, comforting, final, punctuating word. No. A muscular sound, like the bark of a guard dog. Keep out.

My thinking seemed clear on the matter. There could be no more loss in what was lost already, in what was thrown away. No more falling at the bottom of the well. Just the rock of isolation, the dark, the silence of no evil seen, heard, or spoken, and no good either. No contrast of shadows to make me long for the light. No gray to make me loathe ambivalence.

What was not admitted, not let in, was unknown, unmourned.

People say that darkness is a negation. An absence. The privation of light. But for me this was not true. Darkness was full. Robust. Complete. Privation was a substance, the way that black is a color. It sustained. It hid. It comforted. It excluded.

This was why my depression happened, why it worked. But it was also why it had to come to an end, at some point, or kill me. Because, of course, life cannot be lived permanently alone in the dark, any more than it can be lived in a coma, however restorative or protective that state may sometimes be. We are pack animals and heliotropes all, bending toward the light, the open, the air, dependent on it, even as we bemoan the constant flux and injury to which free will and society subject us.

It’s a battering life. But it is the only life.

So at the end of my time at St. Luke’s I began to emerge from the despair. I began to know, to risk hope again in all its variety. And use it. And allow myself to be used by it, understanding newly that it was an elixir with a kick, a bitter kick.

The most I could expect from a psych ward, even a good one like St. Luke’s, was to walk out with revised definitions of my terms, more resigned to the grays, and with my veil of necessary illusion firmly replaced.

I was better when I left—not well, but better. And I would remain better until I wasn’t, which was bound to happen. And happen again. And go on happening as long as I lived.

As long as I live.

That is why psychiatry is as bankable and recession-proof as prostitution. There’s always a demand for it. I, and other people like me, will never be fine—that is, impervious. We will just be more or less balanced over, cripplingly aware of, or functionally oblivious to the abyss.

And how was this miracle, this overhauling of perspective, achieved for me at St. Luke’s? Not by meds, that’s certain, though meds would come back into the picture in small doses after I left. That, too, was certain.

But right then in St. Luke’s, recovery happened because I began finally to use, to make progress on, some of those ideas that I had spent way too much time futilely indulging while in despair. Ideas and words.

Like hope.

And so, for me, hope came stubbornly back, with its helping hand on my back. But with all its false promises and mean little pinches, too, saying, “Go forward. But I’ll get ya. But go forward anyway.”

I began to unwind the loops my ideas came in and got stuck in, and I began to internalize them in new ways. I took them with me like talismans or touchstones in my pockets.

Courage. There’s another word. Another idea too big for its casing. It, too, means something new to me now. It means blind. And deaf. And dumb as a god who doesn’t answer. It means put on your helmet and jump, or cross yourself and charge. Stop thinking so much and just do, because there is nothing else for it but a crazy, all-out, arms-flailing gumption and gusto that defies all logic and sense.

Normal life is nuts. It’s a downhill deterioration to death no matter how you spice it along the way, and there’s nothing you can do about it. Now, a sane person, when faced with that, would just plunk his ass down at the starting line, or wherever along the way this realization finally came to him, and say, “Are you kidding? I quit. I’ll slide the rest the way or sit here and smoke.”

It takes a true lunatic, or someone functioning with the critical apparatus of a worker bee, to keep scrabbling up that hill when he knows his destiny is dust.

But that is what is required. Go on.

It’s not that my view of the world changed at St. Luke’s. I just learned to stop obsessing about it so bleakly. Or, I should say, I learned this again. It wasn’t new knowledge. Not entirely anyway. I had learned it, or implemented it in the past, through the wondrous circuit-breaking, cloud-busting effects of medication. That, in my view, is the great virtue of medication. It blocks thought, or filters it to a manageable glow.

But you can get some of the same results with your mind, too, if you work at it.

At St. Luke’s I got it through the silence and calm and privacy of retreat in a room with a night-light, and I got it with the help of the kind of group therapy that you get in card games in a dayroom with drug addicts and other high-functioning kooks like me. I got it through announcing my troubles aloud to a good listener and by meeting a doctor I could believe in. I had my faith in the system restored a little at St. Luke’s, and this can do wonders for your outlook on the world. Realizing that some people are good at what they do, that they care, that they want to make a difference, and do—all of this gives you back a little spark of belief.

And then we are back to words.

Yet another puffed-up word. Belief. That was really the big one for me. And, boy, was it redefined. Because when I say “belief” I really mean “make-belief,” and by make-belief I mean pretend.

I learned to pretend. To pretend that I didn’t know all the heavy things that I thought I knew. I learned to purposely forget.

Because—and here is Sister Pete having her say again—as Eve and then Adam found out, there is a whole hell of a lot of knowledge about the goddamned human condition that we are not ready for.

So when you happen on it—
it
being some kind of insight, which may or may not take the form of a really delicious apple—and
it
convinces you of a bunch of true, inescapable stuff that you really can’t live with, the best advice I can give you is this: just hand the apple back. Just unknow. Because you can. That’s one of the beauties of having fallen from grace. You can lie, especially to yourself. What’s more you can lie to yourself about lying to yourself, and best of all, really believe it. That’s denial. The real sinning graduate’s prize. Lying in layers, glazing your eyes until the view is like a Monet. One pastel blur.

In my experience, going into the hospital for depression at a place like St. Luke’s was a little bit like having a sit-and-spin, or performing that whirligigging motion you did barefoot in the grass in your backyard as a kid. The spiraling dizzied you, and then when you stopped and got your balance, for a second, you looked at your surroundings with new eyes, as if you had never seen them before.

That’s the idea. To bring yourself back to ignorance, back to the empty center, because it’s the only way through, or at least it was in my case at that time.

Asylum did that for me. Reset me to blank and sent me back into my life with the energy to pretend. It’s the first game you master as a child— pretend—and, for my money, it’s one of the most helpful skills you can cultivate as an adult.

Magic Doc was right. The best doctor may very well be a dyslexic one, someone who sees the world a little backward and is kind enough to turn your head around, or, true to the slang of the profession, shrink it. Shrink your view, anyway. Resize the picture. Make the cosmic rinky-dink.

Bottom line? Definitely lose the forest for a tree, a branch, bark, a leaf, whatever your pathetic little mechanism can handle, because it certainly can’t handle the whole show.

Is this a skill? Yes, but not one you learn in medical school. It’s not learning at all. It’s unlearning, which is why someone who thinks he knows everything can never teach it to you. I guess it sounds like I’m talking in circles. And I am, sort of. Because reason, of all things, is the enemy. An excess of sense is senseless. That way madness lies. Take refuge instead in the cupcake, the sugary sop morsel that gets you through. The digestible piece and no more.

And whatever you do, stop asking so many questions. It’s true as advertised. Knock and the door will be opened to you.

So don’t fucking knock.

 

Or do, because you’re writing a goddamned book, and so you have to.

I had one more place to go.

I found this third facility, Mobius Group, on the Web. I was looking for a place that was offering a different approach from the locked-ward, often drug-riddled treatments I’d found in conventional hospitals like Meriwether and St. Luke’s.

There weren’t many. The first few I tracked down were outpatient facilities that were either defunct—not enough clients—or nearly defunct, struggling by with one or two stranglers and a mountain of crumbling goodwill.

These places presented themselves as being philosophically opposed to the use of psychiatric medications (deeming them addictive, dangerous, and purely cosmetic). They relied instead on intensive therapy, play, companionship, the human touch. I was sympathetic to the approach and eager to try it myself, but I didn’t fancy being the only patient in the facility bouncing from shrink to paid playmate to art therapist like some overgrown special-needs child. I wanted to be among other people trying the same thing.

This kind of therapy is a lot of work. It’s expensive and it takes time and effort. Most insurance won’t cover it, so the clients need to be wealthy. They have to have weeks, if not months, to devote to therapy, and they have to be willing to fight their demons day in, day out, head-on. Most people would rather take—or are only offered—a pill. It’s cheaper, faster, and easier.

But Mobius seemed to be up and running, prospering even. I suspected there were two reasons for this. First, while they catered (as advertised) to the mentally distressed, their primary client base was addicts in recovery. As I learned when I got there, a fair number of the people there were court-mandated to be in rehab, and as private, nonhospital rehab joints go, Mobius was quite a bargain. The program was often partially covered by insurance, depending on your plan, and even if it wasn’t, it was only just over $6,000 for a two-week stay, less than half what it cost to stay at Meriwether or St. Luke’s for ten days. And as for quality of service and environment, Mobius was a far cry from Meriwether and St. Luke’s. It wasn’t as cushy by a long stretch as some of the fancier private rehab facilities that celebrities and the obscenely rich frequent—these can easily cost $50,000 a month and up—but it was by no means uncomfortable. It was within reach of the middle class, and even possibly the working class, and gave you far more freedom than locked wards.

Second, and probably more important, Mobius allowed you to bring your own prescribed medications, which you then surrendered to the program nurse for proper dosing. They also had a psychiatrist on staff who could prescribe medications as needed. This meant that you could get the benefit of their intensive therapy without having to commit yourself to a potentially brutal withdrawal from your meds, or worse, and far longer lasting, a discontinuation rebound effect that could mean—and in my experience
had
meant—a worsening of your original symptoms, be they depressive, manic, or psychotic. Getting intensive therapy and discontinuing your meds are two separate things, both difficult. Doing them at the same time can be brutal and, as one doc at the near-defunct antimedication facility told me, really means setting aside three to six months of your life.