I was in a psychiatric hospital in New Jersey for five weeks in 1970, at the age of 15. I was depressed, rebellious, and flunking out of school. I had taken an overdose of Quaaludes, a drug I used habitually back then. After the overdose, my parents shopped me around to psychiatrists, one of whom told them I was schizophrenic and would have to be institutionalized for life.
My family was a mess. My brother told me years later that my mother had initiated proceedings to get me removed permanently from our home; he wasn’t sure how, being just slightly older than me, but she had told him about the plan. That tension, and others, certainly were things I sensed at the time.
My first psychiatrist before hospitalization gave me Tofranil, a tricyclic antidepressant and a reasonable thing to prescribe at the time. He also prescribed, very improbably, Dexedrine, an amphetamine and popular street drug. Of course, like the drug user the doctor knew I was, I popped these amphetamines at far more than the prescribed dose. Twenty pounds came off my already thin frame. My moods shifted drastically up and down. Thus the hospitalization.
I am an “organic bipolar,” which I say bearing in mind that the disorder has become wildly over-diagnosed these days and is rare. I believe bipolar disorder is an existential state as well as something that, in my case, might exist in some form in the body—as the roots of many of our ways of experiencing the world do. It is not an illness. I don’t argue with the term bipolar; I want to redeem it. As I argued in my book A Mind Apart, just as the world needs biodiversity to survive, so too does it need neurodiversity.
I have diaries I began keeping at the age of nine, and they clearly describe my mood swings—my “A moods” and “B moods”—and show evidence of what would fall under the heading of psychotic thinking. I wrote at one point that my family was trying to poison me; though this was a delusion, I do believe who we are is deeply knit into psychosis. Given what was probably already happening with my mother, that belief gave shape to a reality I intuited and was actually living. Perhaps on this website it goes without saying, but never did any medical interventions look into my life.
So instead, starting at 15, I received multiple rounds of electric-shock treatment, some as an outpatient and some in the hospital where I began this story. These treatments wiped out chunks of my autobiographical memory—my life— and left me with cognitive deficits in spatiality and math that I have to this day. When I had shock treatment (though of course I had no idea of this) the procedure was in a state of public relations crisis stemming from justified reporting and patient testimony about abuses. As David Rothman, a medical historian, reported at a National Institutes of Health conference, it is one of the only psychiatric treatments often used not for cure, but for the benefit of hospital staff.
The knowledge of shock’s use as a threat, and as a way of creating a hazy docility that makes ward life easier, damped down enthusiasm for it. Two years after I last received shock treatment—1974—California outlawed it. ECT was revived in the 1990s, and the talking point I hear from doctors, and see again and again in both popular articles and medical papers on the topic, is this: The abusive stuff was bad, yes, but it all happened in the 1950s.
This judgment wasn’t true to my experience. Shock treatment was often mentioned in connection with bad behavior at my hospital, and as it was a private one (my father had health insurance), we also heard that if staff chose to transfer us to a state hospital, there would be more and worse treatment, and more shock.
Patients called the shock machine the “buzz box” and it spawned a number of rhymes we sang to the tune of “The Hearse Song.“ They all began with the line “If you should see the buzz box go by…” followed by things like, “…remember that if you get high.” A majority of my fellow patients were also young girls and some stole pills from nurse’s carts to get stoned. Not all of these girls were patients who had been drug users on the outside. In a hospital like this, you have slender chance to assert that you are a human being with your own will.
I have clear, if fragmented, mental pictures of the worst moments at that hospital. I recall the chilly conducting gel being pasted on my temples before ECT. And I remember a particularly awful group-therapy session with the chief psychiatrist, a graying man as chilly as that conducting gel. During this session, he announced that a patient, a girl whose name I don’t recall and who was pretty with large breasts, would like to sleep with him, and that he would like to sleep with her but had decided to let us have a say in whether he in fact did.
He was middle-aged and she was a teenager like me, and his face held the same expressionlessness posing this question that it always had. My 15-year-old response is hard to explain now. I mostly registered that I was not pretty or busty enough to be the object of this discussion. Otherwise, it felt like a question arising out of life circumstances far beyond my understanding, and the right answer seemed to be yes. I think most of us said yes, with uncertainty, as we all felt some critical test hovered at the back of his words. I assume they then had sex. I don’t know.
I have had kind psychiatrists and uncaring ones over the years, more of the latter than the former. I will brush over the years I spent on large doses of Haldol to get to this point, for psychiatry is a discipline in which treatment and gaslighting exist in a complex braid. One side might show more than the other at times, but they’re closely woven together and hard to pick apart. Doctors are trained to believe patients lack self-awareness and are likely to be treatment-resistant due to their conditions, particularly if they have been labeled with psychotic disorders. The hardwired belief in treatment resistance means patients must be talked or coerced into treatment, a situation that exists very uneasily with informed consent.
Psychiatrists, by the terms of their profession, need to exist in a mental sphere far above those they deal with, and as a last resort, can point to the “illness” itself as their argument. Many psychiatric papers I’ve read on shock—and I’ve read hundreds—describe cognitive and memory losses as being caused by the “patient’s” depression or other neurodivergence itself. The author of one paper I read on the screaming gender biases in shock administration, with at least two-thirds of patients being female at the time I was treated, said he believed the reason was that women patients might elicit more “caring” from their doctors.
I say all this as one of those people who does use medication, in spite of the fact that I’ve found the dispensing of it rife with problems. My reports on the side effects I experience from what I’m taking, even listed side effects, are generally met with some reassurance that “that can’t be happening,” or at least happening at the levels I report. My responses to the drugs also count for nothing in favor of the all-important “clinical dose,” which means you must take a certain amount even if it is less is helpful. As if taking a few milligrams less of something renders it pointless, like swallowing air.
Our doctors also may not like us, not just individually, but as a tribe. I believe this antipathy is much more prevalent than anyone in the profession would admit. In 2011, the Albany Times-Union newspaper ran a blog post by a doctor-in-training titled “Psychiatry: The One Specialty Where It’s Okay to Hate Your Patients.” This woman had had an encounter with a patient who, she wrote, “really pissed her off.” Her own fury led her to understand that this patient had Borderline Personality Disorder. This soon-to-be doctor learned in her medical training that providers’ emotional reactions to psychiatric patients are part of diagnosing them. She wrote chirpily that “In fact, I hear the psychiatrists discussing their (often negative) feelings about patients every single day.”
Imagine reading “oncologists” and “cancer patients” into this sentence: “I hear oncologists discussing their (often negative) feelings about cancer patients every single day.” It horrifies me that such a thing was ever published. It never would have been if it referred to any other pool of medical patients.
The other psychiatric assumption I encounter over and over again is that things now are “different.” Abuses happened decades ago. Shock treatment, now unilateral and done with pulsing currents, doesn’t do any of those terrible cognitive things. I’m agnostic about whether this “new” form of shock is better: I haven’t had it, and maybe it is. But I question the “now,” a time presented in psychiatric literature as new and enlightened and better, with the bad stuff left in the dust. That bad stuff includes the astonishing eugenics of the 20th century, the attitude toward the value of neurodiverse people that allowed for the mass sterilization of men and women held in asylums, as well as lobotomies, and the use of shock for punishment and silencing. The last U.S. lobotomy happened in 1967, just three years before I entered the psychiatric system. The patient, a woman named Helen Mortenson, had a brain hemorrhage and died. If this death had not occurred, lobotomy would probably have been on the list of my possible cures.
The last U.S. forced sterilization took place in 1983. All these events are recent enough that doctors trained during that era are still out there practicing, possibly training others. Many are no doubt good people who would knowingly do nothing harmful. But historically, a few decades are an unlikely amount of time for attitudes to have actually changed so much.
Here is a story from today’s “new” psychiatry: Several years ago, I took a bipolar family member (I’ll call her Sarah), to the emergency room. She was having a manic episode, taking extreme risks with her own safety, and I believe she needed to be stabilized, or held until she again became stable. Nurses sedated her—she knew she needed that— and informed me they had no open psychiatric beds.—This is sadly normal at the main hospital of my small city. The ER nurse called places around the state and finally found one with open beds, a privately owned facility near Seattle.
We moved Sarah there by ambulance and I visited her the next day. She was so medicated she drooled and passed out as I spoke. It was clear we needed to move her somewhere, anywhere, else. At my questions about releasing her, a nurse mumbled something I couldn’t catch, then clammed up. My husband and I called hospital administrators, we called lawyers. We finally learned a commitment hearing had been scheduled behind our back, intended to keep her committed for two more weeks. We learned this only through endless persistence and found out just a day and a half before the hearing. We grabbed Sarah and moved her out.
I shared this story with almost no one. It sounded so Cuckoo’s Nest, like something an activist like me would invent. Or a patient like me. Later, though, a friend forwarded me a link to a Seattle Times expose of this hospital, titled “Free to Check-in But Not to Leave.” It detailed similar commitment abuses. Right now, a class-action lawsuit alleges this hospital did extensive, video-recorded strip searches of incoming patients. On Sarah? Maybe. She was too drugged to remember.
I want to end by saying that I have not only encountered psychiatrists who were good, caring people, but also that I believe more are out there. I recently wrote an article for The New York Times about my psychotic episodes, specifically about my rejection of the medical model. Whatever I might choose to do about such an episode, I wrote, there is no sick-me and well-me. There is just me. I cannot condemn a part of myself as sick, and I need control over what to do about my own cognitive and intellectual life.
After this article came out, I heard from people with psychiatric diagnoses and from family members of such folks, which I expected. I also heard from a surprising number of psychiatrists. I was invited to speak to grand rounds of psychiatric practitioners at hospitals and asked to just give them some sense of what their treatments should look like. I felt a hunger in at least some in the profession to provide care that respects that actual human before them, we who now mostly drown in the diagnostic numbers of the DSM-5. In this I am following in the footsteps of Dorothea Buck, psychiatric activist and Nazi sterilization survivor, who died at 2019 at the age of 101, still asking one thing of psychiatry: listening.
