A Note to the Reader: Thorough searches of my memory reserves have failed to provide me with a complete and detailed account of my first inpatient stay on a locked unit in Westchester County, New York in the late summer of 2004. The memories I do have are more like vivid snapshots or brief clips, and as a result, this chapter will be written in the same manner, with snapshots written in the present tense and clips in the past.
My room was the first on the right side of the long hallway I found myself in upon entering ‘The Haven’, furthest from the nurses’ station and closest to the locked door that connected me to the ‘real world’. I was pleased to discover that I had a single room with my very own bed, standing closet, armoire, television, bathroom, and barred window. I felt privileged and lucky to be in such luxury and immediately thought about how different things would have been had I gone to a state hospital. In fact, it felt a bit like I was settling into a hotel, although the lack of appliances and the un-lockable door to the bedroom and bathroom reminded me that I was not on a vacation but in a hospital, on a locked unit, my rights to be in the presence of wires and glass stripped away. I dropped my bag to the floor and sat for a minute on my bed, my mind producing the cognitive equivalent of white noise, the crunch of the thin plastic mattress underneath a starchy sheet and scratchy cotton blanket feeling very different from my bed at home.
All I could sense—for it wasn’t a feeling and it wasn’t a thought, just a vague and slightly detached awareness —was that I was in an entirely alien situation that I never, in my wildest dreams as a child, could have imagined I would ever be in. This was not a place that normal people came to. This was not what a person would aspire to become in life. In fact, it slowly dawned on me that instead of moving forward linearly, my life had done exactly the opposite, its trajectory nothing more than a loop bringing me right back to the very beginning. I was once again a child, incapable of taking care of myself, needing to be watched and told what to do.
As this realization sunk in, the numbing silence growing around me and pushing me further into my thoughts was broken by a knock on my open door as the same cheerful nurse who’d ushered me in and told me they were ready for me appeared in my doorway and asked to come in. ‘We’re just going to do one more bag check, and a quick body scan. It’s standard procedure.’ ‘Body check?’ I asked. ‘Yes, to document any scars, cuts, or burns. Just to keep track. Do you have anything on your body?’ I pointed her to a few old scars. ‘Anything active to show me?’ She asked, waiting, pencil in hand. ‘No, just these,’ I replied, my voice trailing off as I watched her make notes on a body diagram in my folder, the unusual thought that I’d somehow disappointed her entering my mind for the first time. What was she writing down? What if she didn’t think I was depressed enough to be here? What if I didn’t appear sick enough to her?
It is in this moment that I unknowingly and fully embrace a new inner dialogue, a self-assessment of sorts, which would play in the background of my mind continuously for the next six years, and still, today, will emerge at certain moments in time. ‘Am I behaving like a good patient should?’
After I was scanned and my bag rechecked, I found myself once again sitting alone in my room. I considered closing my door, but worried it would appear suspicious. I decided to leave it open, and wondered about whom, if anyone, I would be seeing next in my doorway. This subtle notion—that I wouldn’t know when I’d be looked in upon next—brought me back to Jeremy Bentham’s 18th century idea of the Panopticon, a design concept I’d studied in a college course on the history of madness. The belief was that by structuring a space—for prisons and asylums, mostly—in which the prisoner or patient could never tell if he was being watched, that individual would come to view himself, his relationship to his superiors, and therefore his behaviors in a new and much more self-regulatory light. And here I was, lucky enough to be sitting in a ‘private’ room, but completely unsure of who might be watching me and when that might happen. Rather than condemn the situation, as I might have done back when I first learned about this concept and saw it as nothing if not Orwellian, I tried to reassure myself that this was vital for me, to feel safe and protected by the knowledge that I was being observed, because left to my own devices, who knew what might happen? I quashed any notion of Big Brother right then and there, and latched on to this growing sensation of protection—from myself—that had begun to sweep over me. I now understood why this unit had been named ‘The Haven’, and appreciated its aptness.
Knowing that I was now safe from myself I felt swept up by a newfound calm, which was a sensation so much better than I’d been experiencing only an hour before that it felt outright enjoyable, and I rather contentedly pulled out my sweatpants, a couple of t-shirts, shorts, and pajamas, and put them in one of the drawers. I gently rested my baby blankets, which I was wrapped in when I was born and which I still brought with me everywhere I traveled, on the plastic pillow at the head of my bed. I put my toothbrush, toothpaste, and hairbrush by the sink. A stack of books that my mom had picked out for me went on the nightstand, along with a blank composition book and a couple of pens. Organizing these belongings made me feel like I was organizing my life— I am finally taking care of myself! Getting my act together! Turning over a new leaf!— and leaving the mess behind, starting afresh with an organized drawer of folded clothes, a made bed, and a clean toothbrush. This sudden wave of diligence and organization amazed me. It was a small start, but it was a start. What was it they said? ‘Today is the first day of the rest of your life.’
I am sitting in the dining room, about to eat my first dinner on the unit, and I look up at the one window in the room, very tall, thick and almost completely opaque—I am able to see light on the other side, but beyond that it is left to my imagination. As I’m wondering how reinforced it is (maybe bulletproof?) and as I’m realizing that there is a faint hint of green on the other side, most likely one of the fields I saw as I drove in earlier today, my eyes wander to the side. Pasted on the walls around the window frame are crayon drawings of flowers, rainbows, trees, sunshine, bright colors and cheerful scenes. I wonder which children drew these, until I realize that these were drawn by fellow patients who have come before me. I wonder if I’ll draw something that will be taped up on the wall for those who follow me to see.
As I was eating my dinner that first night on the unit, I looked over at the round table to my right to see another patient, M., eating dinner with his parents. His mother’s home-cooked pasta and chicken sat steaming on the placemat before him, and he sat, hands in laps, shoulders hunched, staring at it, as though he wasn’t sure what to do. I wondered what this young man’s story was, how long he’d been on the unit, whether or not he was getting better. I turned back to my meal, and ate in silence.
Later that evening, my paths crossed with M. again. It was after visiting hours, so his parents had left, and we began a conversation. He was of average height, with tanned skin, buzzed dark brown hair and facial scruff. I learned that he was trying to open his own tanning salon, and had never, in his entire life, experienced any struggles with mental illness. About two months earlier, he had discovered that his girlfriend had cheated on him, and he flew into a blind rage. Unable to handle what he’d learned, he got intoxicated and scaled to the top of a large suspension bridge. Once on the top, he sat pondering his life, as police and fire trucks and eventually a helicopter made their way to the scene. He eventually decided that he wanted a cigarette, but had left his pack at the bottom, so he climbed back down and was immediately apprehended. He was brought here soon thereafter, diagnosed with bipolar disorder, and medicated. When the medications failed to work in the first part of his stay, his doctors decided to give him electroshock therapy, ECT, to help him with his depressed mood. He had been receiving treatment three times a week since that time. I asked him how long he’d been on the unit for, and how long the average stay was. He told me it seemed to him like most patients stayed about a week or so. He had been on the unit for almost two months.
I sat, baffled, as he told me his story. I briefly entertained the idea that maybe M. did not actually have a mental illness like I had, but rather some serious issues with anger and pride. I assumed, however, that his doctors knew better, and that the medication regimen he had been on since getting admitted must be helping him. He looked and spoke like he was fighting sleep, his eyes droopy and his speech slightly slurred, and when I asked him what meds they had him on, he recited a list that included an antipsychotic, a mood stabilizer and an antidepressant, among others. I assumed, again, that his doctors knew best, and that if he was experiencing these side effects as a result of his medications, it was well worth the price. After all, he was getting well, wasn’t he?
It is the dead of night. I am awakened from a heavy, Seroquel-induced sleep by the sense that I’m being watched, and open my eyes to the sight of a man standing two feet away from my bed, bent at the waist, back straight, neck craned, glasses on the end of his nose, lips pursed with deep focus, hands on hips, peering over and staring intently at my chest. His silhouette is lit by the hallway light, which is seeping in behind him. “Just checking to make sure you’re breathing,” he whispers, as he backs silently out of the room, pulls my door back until it’s barely ajar, and I am flooded once again by darkness.
By the second or third day into my stay, I had slipped into a daily routine that felt easy and familiar. After being awakened by a staff member in the morning, I’d stumble down the long hallway to the nurses’ station to take my morning meds, my wristband checked each time to confirm identification, my hand held out, palm up, as the nurse ripped each pill out of its individual wrapping, dropped them into a miniature clear plastic cup one at a time, and placed the cup in the palm of my hand, along with another clear plastic cup of water. I would toss the contents of the cup to the back of my throat, follow with a small sip of water, and swallow, making sure that the carefully watching nurse could tell I wasn’t tonguing the pills. “I want to make sure I’m a good patient.”
Next, I would meander to the dining room, pour myself a cup of decaffeinated coffee (we were allowed no caffeine), and make a cup of oatmeal, grab a hardboiled egg, and some fruit salad. The patients would eat together, each of us sitting around the big rectangular table, surrounded sometimes by silence, or maybe some small talk. We all knew we needed to be social, to show our treaters that we weren’t isolating, but in our minds all we could think about was getting through breakfast so that we could go back to our rooms, whether to climb back into bed to sleep or stare at magazines or the television screen, and drag ourselves through the hours until lunch. When a satisfactory amount of time had passed, I would walk back down the long hall to my room and collapse onto my bed, wondering how it was that by 9AM I had already reached a point of utter exhaustion both physically and psychologically. Thinking coherent thoughts felt like I was dragging my brain through sludge, and the stack of books sat unread as mornings passed. I discovered that SpongeBob SquarePants, a cartoon I’d never before seen since it had arrived after my time, was on my television more than not and gave me the ability to easily pass the hours between meals, my senses passively receiving bright colors, loud noises and a basic plotline that needed little to no explanation. This became my primary goal each day—to find ways to make the time pass as quickly and painlessly as possible, the dreaded hours of daylight obstacles to the promised sedation that came with nightfall, when it was no longer considered problematic—indeed, symptomatic of a depressive episode of my bipolar disorder— to be in my pajamas and under my bedcovers, desperately awaiting the onset of dreamless sleep, no longer needing to be faced with the reality of my situation.
Within a matter of days, the connection to my previous life on the outside subtly dissipated, receding into the background of my awareness, so that the desire for fresh air, for physical health, or for a conversation about anything other than my mental illness, waned, and in its place came an indifference and apathy towards my future, towards a motivation to regain a high level of function, and towards the idea that maybe, one day, I could recover from what I was experiencing. I settled—without questioning, without challenging– into the notion that my life was not something to fully embrace and live, but rather something to manage, to maintain, to tolerate. This was what the doctors had told me—that with a properly adjusted medication regimen and a strong commitment to psychotherapy, I could have a normal life. Someday I could even graduate, get a job, have a family.
It is in conversations like these with my treaters that I lose touch with a once deep-seated belief in my innate capacity to excel, to thrive, to function. Being told that, one day, I could become integrated, whole, and healthy—normal— implies that these are qualities I do not have, and, more importantly, do not know how to have. I come to believe that I can only develop this capacity through a reliance on my doctors, on my medications, on being an obedient patient, and that without these, I am a lost cause.
There is commotion on the hall. Staff members are running around the corner, down the back hallway that is out of my line of sight. I wonder what is happening, and it registers that M.’s room is on that hall. I feel panicked, abruptly ripped from the fantasy that I am merely taking a respite from the real world, keeping my clothes folded in a drawer and therefore getting my life on track, and dropped into the cold, hard reality of my situation- I am in an environment in which life and death—mine, but also the other patients’—are at stake. What has M. done?
A few days into my stay on the unit, my good behavior allowed me to shift from Level 1 to Level 2—I was now allowed to experience fresh air under the supervision of a staff member. Waiting by the door with the other Level 2s as the social worker pulled out her overstuffed keychain and diligently searched for the right key, I felt a flood of pride sweep over me. I had successfully proven to my treaters that I was responsible enough to be able to leave the locked confines of the unit, and although I still needed supervision, they trusted me enough to believe that I wouldn’t run away upon release. And if they trusted me, maybe that meant it would be OK for me to trust myself.
There were four or five of us, plus three staff members. As we wound down the stairwell towards the exit, I heard the locked door click behind us, leaving behind the Level 1s and those who had no desire for fresh air, and I realized that I was now on the other side of that lock. Although it had only been a few days, it felt as though I was reentering an old chapter of my life, one that had dimmed and faded and was now being temporarily relit for the next hour or so. It was like I was putting on a pair of old shoes I’d just rediscovered in the back of my closet, pulling on an old and once-loved jacket– it seemed vaguely familiar but somewhat clunky, ill-fitted and foreign. I felt awkward in my stride, hyperaware of each step I took and feeling a seeping tiredness spreading up my legs, as we meandered along the sidewalks and across the fields. I wondered how I appeared to the staff members, who had strategically placed themselves at the front, back and side of our group. Were they worried about me? The impulsive thought entered my mind to run, to just break free and run and see how far I could get, but I quickly repressed this rebellious urge and wondered where it came from.
By this time, I had decided to take on the task of reading one of the books my mother had left for me when I checked in. I picked an historical fiction novel about Elizabethan England, one that was apparently quite colorful, and wondered if I’d be in a mental place in which I could concentrate on, absorb, and maybe even enjoy the words. Once we were led to our final resting place, a grassy area next to a basketball court about a quarter of a mile from the unit, I sat myself down, pulled out the book, and was amazed that I was actually able to read, although each paragraph required two or more perusals. I watched two of the other patients tossing a basketball around on the court, felt the sun on my face as I sat cross-legged in the grass, and felt a sense of inner quietness—not quite serenity, but a reprieve nonetheless.
Realizing that I do, in fact, have the capacity to experience this reprieve, I begin to associate it with idle time—with sitting or lying down, with zoning out, with disconnecting from others around me and retreating into my mind—and to seek this idleness out, telling myself that I can’t handle anything more, that my emotional state needs a lack of external stimuli in order to remain stable. I begin to crave aloneness, the void of being apart from conversation, eye contact, and connection, for it is here and only here that I can truly shut off.
I am sitting by the nurses’ station on one of the sofas in the hallway, legs tucked under knees, trying with all my might to remain engrossed in my historical fiction novel, when I see the locked door at the far end open, and M. emerge. He is sitting slumped in a wheelchair that is being pushed by a staff member, his shoulders hunched and his chin dropped almost to his chest. It seems an eternity before he reaches me, the squeak of the wheels over the rug loud and abrasive, and as he is wheeled past where I sit, my eyes are riveted to his sedated face, desperately looking for the real M. behind the zombie I see before me. He is returning from his thrice weekly ECT, which has undoubtedly been amped up since he slit his wrists yesterday—the commotion I’d seen and heard– after getting permission to use a razor unsupervised to shave his face. I want to cry, but feel disconnected from my body’s ability to shed tears.
After a little less than a week had passed, I was told that I was ready to be discharged to an intensive outpatient program a few buildings away from The Haven. A part of me was disappointed that more hadn’t changed; for the most part, those few days were spent lying in my bed, watching television or slowly digesting my book. I had played board games and charades with other patients after being coaxed out of my room by staff, done arts and crafts, and sat in countless hours of group therapy where I was given countless handouts on Cognitive Behavioral Therapy and Dialectical Behavioral Therapy. I had been put on a new medication regimen for my bipolar disorder after having been off of all meds for the months between Outward Bound and my day of arrival on the unit. I had a new psychiatrist who had asked to work with me after seeing my potential for growth in one of the groups he had run. I kept telling myself that I was ready to incorporate these new components into my life and that all of these alterations would mean deep, fundamental change. I convinced myself that because my treaters believed I was ready to be discharged, because they told me that these medications were going to help me but just took time, because this outpatient program was meant to be profoundly beneficial, and I had this respected new psychiatrist, my life would get better. I had placed all my stock, all my faith in a better future upon these externalities. I had yet to realize that the most important piece in the puzzle—me, and my agency in my own life— was missing, even discarded, and that I was far from being an active, engaged participant in my life. I was a passive recipient, unsure of what I needed to do to live each hour of each day, and relying on my treaters and from the medications that once again filled my pill bag to show me the way.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.