Voluntary Madness: My Year Lost and Found in the Loony Bin (34 page)

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 assertion 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 class. 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 passive submission to the dictatorial effects of medication. Circumvent the will with a pill, as so many institutions and practitioners 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 institution, 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 institution, 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
. 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 assigned 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 bumper sticker, pasted there for the benefit of whichever bored fellow pilgrim happened to be stuck behind her in line, in class, in church, or, in this case, in a short bus full of life-skill spastics paying for the privilege of getting their shit 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
or not
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 participate. 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 God. But it gives me the vital sense of getting somewhere under my own power, of refusing to accept passively 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 participation 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 repetition 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 crap, 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 hell 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 succumbed 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.