Voluntary Madness Part 2

But Sarah still had cracks. Now and again actual thoughts were getting through, thoughts that had not been placed there by others or rooted out by the training. Her face was frequently strained by the effort of appearing remote, professionally cool.

She wasn't.

Early on, when we were alone for a moment, I asked her something about her manner, about what she was learning to do, and how you could really hope to relate to another person as a person if you were practicing the art of galvanizing your own soul.

A blush spread over her cheeks. Would she learn to repress that later, I wondered, if it came so readily now? What a loss if she did. Sad, because it was such a pleasure to watch her thoughts bloom on her cheeks like hot little pools of appet.i.te. Intellectual appet.i.te. A noticeable idea coming through her ears in waves of sound, landing on her brain as chemical information, a wave becoming a particle, then the information somehow-G.o.d, how?-pouring itself into an emotion, giving rise to a physiological response, and then a color in her face. For me, it was the best part, the miracle of the brain that it could take my question not just as language but as implication and turn it to a rush of blood.

But if Sarah was going to make it in this line, she'd have to learn to check that evidence. Dry up. Cover. Get stupid.

The unit chief was stupid in that way, I thought. Not genuinely stupid. She seemed bright enough. Doctorly stupid, I mean. Stupid because cut off and rendered arrogant by her profession and her position. She was in charge, and she sat in her sovereignty with unnerving ent.i.tlement. But to me, she knew and controlled a lot less than she thought she did. She was catered to, but mistaken, like a fat newborn, thinking her little sphere was all the world and her will the axis it was spinning on.

She wasn't like other doctors I'd known in this respect. It wasn't Baldy's kind of ent.i.tlement, overweening and repugnant. And yet it was of the same strain, because doctors are trained by doctors to be doctors, and part of being a doctor is acting like one. She came off as if her sphincter had been tied shut like a reticule. Baldy was more the type you suspected might have buried people under his house, people like his high school valedictorian, or maybe, from his ubermensch period, a landlady or two.

Who knows. Maybe she was a really nice cuddly lady at home, as tame as they come. But I didn't see her at home. I saw her on the job, and that is how I judged her, by how I saw her doing her job. It wasn't really what she said so much as how little she said. It was clear that she knew exactly just how little she needed to say to exert her influence. She sat heavily, like lead in a boat, pulling all the ballast toward her. The others deferred palpably, unthinkingly, as if by force of gravity or instinct.

Dr. Balkan was a type, too, and does not yield an inspired description, I'm afraid. She wasn't particularly bad or good. Not singular. Just a yeoman, you might say, doing service day in, day out. Showing up. Trying, but knowing the limitations of talk in a place where most people were too delusional to have what the rest of us would think of as a conversation. She was doing her job conscientiously. She was efficient but not officious. Removed but not too proud. She listened, though maybe a tad hurriedly, during our ten-minute consults each day. She cared, you could see that, and she really did want to accommodate my desire for more therapy and fewer drugs, but there was only so much time in the day. And even if there had been a spare hour, she wasn't practiced at the long, slow muse, or probably much inclined toward it.

Anyhow, Sarah was different. She interested me. I almost wanted to save her, cut her free and say, "Go and be a person. Get out before it's too late." But then I was hardly a recommendation for that approach, at least in my present condition, or what she perceived to be my present condition.

But what did she or any of them perceive? This was part of the problem. My private conversation with Sarah had begun with me asking her about herself, about the way she handled situations where a patient asked you something about yourself or tried to establish an exchange. She had said that she hadn't quite worked out yet what to do on those occasions. She wasn't sure when and or if she should ever let the patient see her. I admired her for admitting even that much.

The dance with patients could be tricky, I knew. I mean, you wouldn't want someone like me blundering around inside your head. And I suppose there were always people like me who were wanting to do that, either for entertainment or because it was just too hard to have any kind of therapeutic relations.h.i.+p with a cipher.

I had both motivations, as it happened. I wanted to see what she'd do, what any of them would do if you challenged their remove, if you said in effect, "Be a person with me, will you? I'm not a petri dish." I wanted to relate to them, to connect as a human being. But I also wanted to get a reaction that wasn't preprogrammed. I wanted to poke an actual working apparatus. Stimulus, response. Action, reaction. Slap and gasp. Spit and grimace. Whatever worked.

This was the cross-purpose of it all, in my view. They saw me as a set of chemicals. They were dealing with my brain as an organ, palpating it with categories, forgetting of course that, unlike its ill.u.s.trious sister discipline, neurology, psychiatry is not just the science of the brain as brain, but brain as organ of thought, seat of incandescent function, impalpable, the only organ in my body that can answer back.

So, talk to me.

But even their names and t.i.tles were too heavy for such intimacies. Doctor. Dr. It gets bigger with abbreviation. Degrees are magical that way. They make G.o.ds. The doctor who tells you what she knows, as if she knew it for certain. Yet, she is a deeply fallible, mostly chimerical being created by us to talk down to us when things are at their worst, because somehow that makes us feel better. In the absence of someone who actually knows what she's talking about, we are just as comforted by someone who sounds like she knows what she's talking about. That is enough. Just say it with conviction and it will make the boogie man go away.

Dr. Balkan suggested Lamictal, a mood stabilizer that I'd tried years before, but had quickly abandoned because of a swelling in my groin. A very small percentage of patients who try Lamictal develop a dangerous rash. According to the docs, it is the only side effect of the drug, but a very serious one. At the time, my groin swelling had made my doc nervous, so she'd advised me to stop the course. As it turned out, the groin swelling had been a side effect of another, nonpsychiatric medication that I had been taking.

"It's worth trying Lamictal again, then?" Dr. Balkan said.

Having done my homework on meds, I was skeptical. I'd read a lot about the undisclosed or unknown dangers and unpleasant side effects of so many of the pills my docs had been prescribing for me over the years, and I'd been appalled to read, first in books, then in newspapers, of how thoroughly corrupt the drug development and approval processes are in this country.

Pharmaceutical companies have their fingers in the pie every step of the way. They fund clinical trials of the drugs for which they hope to obtain FDA approval. They ghostwrite the papers that report the results of those trials. They provide most of the advertising revenue for, and therefore exercise undue editorial influence over, the journals that publish those ghostwritten papers. They pay large sums of money to many of the doctors and "experts" who advise the FDA, and often vote directly on which drugs to approve.

Their sales representatives call directly on primary-care physicians and psychiatrists, providing free samples of their drugs, as well as reams of so-called informational literature, which is actually carefully crafted promotional literature about those drugs. Often this promotional literature is the only source of information that most docs consult about the drugs they are prescribing and, more alarmingly, the conditions for which they are prescribing them.

The drug companies often go so far as to hire individual doctors as "consultants," paying them thousands of dollars and sending them on all-expenses-paid trips to exotic locations where they can attend conferences about the company's star drugs. Finally, the drug companies go directly to the consumer, flooding the airwaves with advertis.e.m.e.nts not only for their products but for the diseases those products are purported to treat. This is one of the major reasons why most people think they know-not just believe, but know-that serotonin deficiencies cause depression, even though there is no real scientific evidence to support this claim. But we know. We know because the drug companies told us so.

So you can see why I wasn't eager to take any more drugs, and why I was, in fact, attempting to wean myself safely off of the 20 milligrams of Prozac that I was already on when I came into Meriwether. (I had been on it for at least a year, sometimes at slightly higher doses, but usually right at 20 mg, where the side effects seemed least intrusive, but the benefits sufficient to keep me afloat.) You can also see why I didn't exactly trust that Dr. Balkan knew-or if she knew, would tell me-what I needed to know about Lamictal.

"What neurotransmitter does that work on?" I asked.

"I'll have to get back to you on that," she said.

A few hours later she produced something she'd printed off the Web, a typically useless doc.u.ment that betrayed how little anybody knew about what the h.e.l.l this drug was doing or how.

Apparently, Lamictal acts on the neurotransmitter glutamate, blocking its release in the brain. Glutamate is the same neurotransmitter that appears to be activiated by the street drugs ketamine and PCP, or so the paper said. Lamictal was first approved for use as an antiseizure medication for people with epilepsy, and it is still used in this way.

That's all I could glean from the paper, and it wasn't really of any use, except to confirm my worst fears that when it came to understanding these meds and their real effect on our brains, we were all shooting a blunderbuss at a field of daisies in the dark.

I told Dr. Balkan that I wasn't comfortable with the drug routine and thought it might be best to go the therapy route for now.

She was insistent.

"Bipolar disorder is a chemical imbalance that is something like eighty percent inherited."

The idea was that I was unlikely to get better without meds.

Of course, the theory that there is any such verifiable chemical thing as bipolar disorder is far from proven. Besides, the idea that I had bipolar disorder at all was built on a pretty flimsy foundation, having come about because I had become hypomanic while on antidepressants. Enough people have done this that antidepressant-a.s.sociated hypomania, or bipolar III, though it is not, as yet, listed in the DSM, DSM, is now an unofficially recognized mental disorder. is now an unofficially recognized mental disorder.

The side effect of a medication had become an organic disorder, poof, just like that.

I spent almost the entirety of my first two ten-minute daily therapy sessions going back and forth with Dr. Balkan about the meds. Finally, I succ.u.mbed to the fear that they might keep me longer than I'd planned if I refused to take anything, and said I'd take the dose.

As they are no doubt required to do, the nurses at Meriwether watched you take your meds. They wheeled around a cart full of pills and liquids, stopping in front of every room to dispense them. By the time they started giving me the Lamictal, on my third day up there, I'd figured out that they weren't terribly vigilant about making sure you weren't hiding anything under your tongue, or holding it in your mouth or palm. Besides, I'd requested a multivitamin, which they gave me at the same time as they gave me the Lamictal, so I was able to make it look like I was popping both pills into my mouth, when in fact, I was holding the Lamictal back, lodged between two fingers.

When the nurses left I went into the bathroom and flushed it.

After the triage hole, the ward seemed like a penthouse. It had big wide windows, albeit elaborately gated and locked. But you could still see through them enough to get a sweeping view of the city below. We were on the twentieth floor, and the width of the sky at that level was intoxicating to my trapped mind. Diffuse light pervaded the large rooms for most of the day, though no fresh air made it in, or very little. My bed, one of four in my room, was pushed up lengthwise against one of these windows, and I spent a lot of time, especially late at night when I couldn't sleep, sitting up in bed watching the lights glowing in the windows of skysc.r.a.pers. The seal on my window had a sliver gap in it somewhere near the bottom, and as I sat there, desperate for a lungful of unprocessed oxygen, I'd lean my face against the grating and listen to the slow whistle of the winter wind, feeling the momentary caress of the cold on my cheek.

In that place, where there was so much that you weren't allowed to do, leaning that way felt like stealing, like I'd get busted for breathing wrong when the head nurse, Mrs. Weston, strode into my room, as she periodically did, and searched the slim freestanding closet by my bed. It was more a power play than anything. She usually missed half of the contraband that was in there, that being a few pens I'd asked visitors to bring me, a couple of oranges taken from a box in the dayroom, a plastic bag for dirty clothes (possible suffocation risk), and a pair of pajama bottoms with a string tie (strangulation risk; the Ping-Pong table in the dayroom had no net for the same reason).

We got oranges around eight o'clock, as a snack after dinner, usually along with peanut b.u.t.ter and jelly sandwiches on Wonder bread. You had to eat all this in the dayroom, though, because we weren't supposed to bring food back to our rooms, lest it attract bugs and mice, or worse-that was the official rationale anyway-though that seems appalling in a hospital.

But, like everybody else, I used food as a form of succor, h.o.a.rding it for late-night snacks. It was about the only thing you could do in there that felt good, aside from m.a.s.t.u.r.b.a.t.e, that is, and I don't know what they did with you if they caught you doing that.

The oranges served double duty, as they were especially useful for making what I dubbed prison potpourri. This was the kind of thing you learned to do when you had extremely limited resources and you were faced with the foul odor of the unlockable en suite bathroom that you shared with your three roomies, all of whom were less hygienic than one might have hoped. The odor was mostly of p.i.s.s, strong concentrated p.i.s.s of the kind you get on the floor and walls when you're overmedicated and underhydrated, have bad aim, and are not particularly concerned about flus.h.i.+ng the toilet after use.

A janitor gave the bathroom a cursory going-over most days, often very cursory. That didn't always include mopping the floor, or if it did, it didn't help for long. The stench was overpowering, yeasty, and thick as no p.i.s.s I've ever smelled, such that you had to keep the bathroom door closed at all times. Otherwise the whole room would smell like h.e.l.l's own p.i.s.soir.

To make prison potpourri I'd take my oranges into the bathroom to peel them, standing over the toilet as I did so, thus allowing the pungent oil in the peels to spray the room with what amounted to a home remedy cleanser. For extra effect I'd stand in front of the steel plate mirror (no gla.s.s), hold each piece of peel up to the fluorescent light, and squeeze it as many different ways as I could make it bend, watching the fine spray spurt into the air. Finally, I'd throw the peels in the garbage and let them suffuse the room for as long as they could.

Standing there squirting my orange peels under the light, sometimes holding them right up to my face to get a really good look at the spray, and doing so with the kind of keen attention that other people devote to their taxes, I realized I was doing something that, if you came upon me doing it, big as you please, in my blue issues with their dodgy snap fly open, and my Acti-Tred socks half pulled off like clown shoes, you'd be inclined to think that I was mistaken in believing I needed to be anywhere but exactly where I was.

But all these elaborate bathroom cleansing plans were foiled for the day if Mrs. Weston stalked in. Usually, I was sitting on my bed, leaning into my grated window sipping the air, or writing in my notebook with a pen, propping it against my upbent knees to keep the writing instrument mostly out of sight. When I wasn't using one of my pens, I kept my stash of them safe in the front pouch of my hooded sweats.h.i.+rt. But even in my bed, taking precautions, it was hard not to get caught using one, so my marsupial supply dwindled quickly.

Mrs. Weston had a keen eye for ballpoint pens. She could see them from the hallway, and before she got halfway across the room, she'd put out her hand imperiously to demand the precious item. She'd take it, then proceed with a vigorous search, flipping open my closet, pulling out the oranges she could see, and saying in her loud ward voice, "No food in the rooms, people. No food in the rooms."

The plastic bag was a much bigger deal, but she never found that, buried as it was under my underwear and books and papers (these latter items were not considered to be a risk). As I said, she was more interested in the symbolism of the act. She was a tall, imposing black woman in low-heeled boots and a semicasual pantsuit. Her voice was powerful, and she enjoyed using it as if she were herding third graders at recess.

I suppose it made her feel efficient to conduct her searches. It was probably in her job description to at least walk into every room in the mornings, just to be sure no one had died or stuffed someone else into a closet during the night. Still, the searches were intrusive, and always conducted with the same ent.i.tled att.i.tude and condescending air that made me want to rig my closet with a dummy, or a leaning cup of p.i.s.s, just to make Madam Suzerain think twice about where she stuck her nose.

But then I suppose that was part of why she treated us like kids, because given the circ.u.mstances-the rules, the restrictions, the unreasonable deprivations-you resorted to childish deceits just to meet your needs or show a bit of s.p.u.n.k. Pranks are the refuge of the powerless and the puerile, I guess. The elements of surprise and ridicule sticking out their tongues.

I found it unreasonable, for example, that they didn't let the patients smoke. It was illegal to do so in the hospital, and I was all for that, especially on our hermetic ward. But once patients had been in for a few days and earned the privilege, we would be taken in small groups to the roof once-or if the staff was especially organized, maybe twice-a day to get some fresh air. It would have been quite easy to allow smoking on those breaks. And you can be sure they didn't forbid it for health reasons, because when you saw the food they were serving to mostly overweight diabetics, you knew that, despite it being a hospital, this was no refuge for the metabolically convalescent.

Smoking was something almost everyone on the ward was dying to do. It was one of those few pleasures in a dest.i.tute's life that made the days pa.s.s. Forbidding it was a form of torture to most of these people, who were homeless psychotics and had been picked up by the cops for disturbing the peace. This meant that they were quitting of necessity cold turkey. Nicotine patches were available to them. But the addiction was clearly far more psychological than anything else, and being trapped in that place, miserishly squirreling away my oranges, it made perfect sense to me why that was so. And I was there of my own doing. They were not-which, of course, made the deprivations that much worse. The one thing they had, their freedom, had been taken away and supplanted by the worst possible subst.i.tute, the shuffling shoelessness of the inst.i.tution.

There are few things more humiliating, more soul-destroying and depressing, than the process of being inst.i.tutionalized. And the worst part is your own collusion in the process. It doesn't just happen to you. You allow it to happen to you. You partake. You adopt the mind-set of the place. You become docile, subservient, frightened, dull, unthinking, susceptible to the mysterious self-fulfilling power of the rule. You loathe the tone of your own voice as you mewl and cower to the dingbat shoving you your meds or taking away your pen. You are demeaned by the routine as you regulate your life by mealtimes, loitering in the hall at eight, twelve, and six. You change as you acquiesce to rudeness, becoming less, becoming small, a picker, a stealer, a scratching stray licking the hand that defeats it.

You do strange things. I tried, for example, to make shoelaces out of toilet paper, so that I could walk like a normal person instead of limping like a gangster because the tongues of my tennis shoes were curling absurdly to my toes. The laces tore, of course, but it was a way to pa.s.s the time, rolling the long strands of tissue between my fingers as tight and stringlike as they would go, and feeling, even though I failed to make the las.h.i.+ngs tie or hold, the momentary elation of knowing that I could still exercise some form of creativity.

I learned to flick on the light over my bed with the teeth of a comb or the tip of the forbidden ballpoint pen so that I could read late at night when I couldn't sleep and the dayroom was closed. The light switches were in the hall and recessed so that only the staff could access them with a key or some other lean instrument, and thus enforce lights out at eleven and lights on at eight. Controlling light is no small matter, as they well knew. Just one of many daily benefits you take for granted in the outside world and never notice, but which take on an almost religious significance in the bin.

There are many other such things, things like, as I have mentioned, fresh air. Most of us never think about how little time we spend outdoors. We work in offices all day and colonize the couch at night. We rarely exercise the privilege of stepping out, and that is of course precisely because we know we can do it whenever we like. But when the door is locked and you have to rely on a lazy nurse to take you to the roof, only in groups of four (first come, first served), and only at specific times, for specific periods of time, you begin to get obsessive. You begin to think about the word "inspire" and its literal meaning, "breathe into," and then you think of G.o.d breathing life into clay to make man. And you begin to feel that G.o.d is on the roof, or some angel who saves you with cool respiration, so that you can face the long night of disinfected air and urine coming through the dusty vent in the bathroom. And that, my friend, is a crazy thought. It's exactly the kind of thing that any one of my ward mates would have told you on any given day, leaning close to you as if someone might be listening, whispering this heady, sacred secret of the universe: that G.o.d was on the roof of Meriwether Hospital just waiting to give you the breath of life.

Pacing was the same; a ritual made sacred by the trap. There was a long wide hallway in the ward. It ran the length, from the men's end to the women's, past the dayroom and the nurse's station, the dining area and the activity room. It dead-ended at the locked door that led to the doctor's offices and another locked double door that led to the adjacent ward. Usually the small windows in the tops of those double doors were covered with construction paper, but now and again it was ripped, and you could see into the north side of the wing, where other people like us were wandering around in their pajamas.

Most of us paced up and down that hall at various times of day. It was the only exercise you got, unless you did push-ups and yoga in your room, as I did, or a few jumping jacks and miniscule laps on the roof for the fifteen minutes you were up there. Roof laps were always punis.h.i.+ng, though, because you had to do them in your stocking feet. You couldn't run in shoes without laces. The next day, my knees and the bottoms of my feet always felt like they'd been filled with broken gla.s.s.

Pacing calmed the mind, too, and a.s.suaged some of the restlessness we all felt at being cooped up under the ever-watchful gaze of Mrs. Weston and her staff. And they were were watching you. Believe me. You might think me paranoid for saying this, except that I got busted for enough petty misbehavior to know I was being observed. Sometimes the nurses would even object to your pacing itself, maybe because it made them nervous, especially because we often did it in pairs. But mostly they objected because they thought we were planning something. Which was, in fact, sometimes the case. watching you. Believe me. You might think me paranoid for saying this, except that I got busted for enough petty misbehavior to know I was being observed. Sometimes the nurses would even object to your pacing itself, maybe because it made them nervous, especially because we often did it in pairs. But mostly they objected because they thought we were planning something. Which was, in fact, sometimes the case.

All the patients on the ward figured out pretty quickly that I was both compos mentis and a sap, meaning that I could be manipulated into getting my visitors to bring them just about anything they wanted, from candy, to phone cards, to cigarettes.

Mr. Clean was the worst in this regard. He was a six-foot, three-inch black psychotic diabetic, who was, to say the least, not exactly looking after his blood sugar. Not that the staff was helping much, but what could you do? The guy wanted candy and his cheap cigars, which they'd confiscated on admission. He loved McDonald's and pretty much anything else salty or sweet that he could shovel into his spa.r.s.ely toothed mouth. He was obsessed with his few pleasures, as we all were.

"It ain't right to starve a person," he often said.

The whites of his eyes were yellowed and bulged out of his head like gone boiled eggs. His hair was long and nappy, and it always had lint in it. His belly was so incongruously round and protuberant that it looked as if he'd strapped it on for a part in a film. The front of his T-s.h.i.+rt was always dribbled with jelly or gravy or G.o.d knew what else-handprints, smears, and stains of all descriptions, crusty, oily, or wet.

I was his connection. He wanted cigarettes. Badly. So he spent a lot of time and energy coaching me on how to make this happen for him, stage-whispering as we walked down the hall.

"See, I'll save it till night. Then I'll take it in the bathroom and blow it into the vent. n.o.body'll know. Just get me one, and some matches. Okay?"

His breath smelled like decaying meat.

Breathing through my mouth, I'd say, "I'll try, Clean. I'll try."

And then he'd lean in and go through the scenario again, adding detailed instructions about how to get something past the nurses.

"Just put it in the wrapper of the hamburger or in with the fries, then put it in the garbage in the visiting room, and I'll go and get it later. Then I'll just take it in the bathroom late and stand on the toilet under the vent and blow it up in. n.o.body'll smell it. Just get me one, okay? Don't get a pack. And some matches. Can't do nothin' without matches."

If the nurses didn't explicitly hear what he was saying, they surely inferred it. It wasn't hard.

"Okay, you two," one of them would say. "In the dayroom or in your rooms."

Throughout the day he'd stop outside my room and moan.

"Norma?"

No answer.

Louder.

"Norma?"

I'd pretend I couldn't hear him or was too absorbed in my notebook to respond. But he was insistent enough to call attention to himself every time.

"You got any candy, Norma?"

Invariably the staff would see him standing there and tell him to leave me alone. Then, of course, after visiting hours he'd step it up, he and several of the others who'd sniffed me out as the soft touch. They'd prowl around so obviously in antic.i.p.ation of a fix that it wasn't hard to figure out who was the source. Very quickly I got caught and taken to task. I had my roof privileges suspended for two days, but they let me off without suspending my visiting privileges as well.

One of my three roomies was a ciggie hound too, though more tactful than the others. I called her Tracy Chapman because of her comely face and short signature dreads. She was the only one of the three of them who didn't talk to herself most of the day and night, and with whom you could carry on a fairly normal conversation. She'd told me she'd been committed or "called in" to the authorities by her foster children, whom she claimed had done it to punish her for denying them extra funds to buy clothes and high-tech toys.

It sounded plausible enough. Calling in fake abuse wasn't unheard of, and at first blush she didn't seem nuts enough to need to be in the hospital.

Ellen was my second roommate. She was a short, sixty-five-year-old black woman who had been in the hospital for five months. She said she'd gained sixty-five pounds in that time, which seemed very likely, since she never left our room except for meals, which she ate with gusto. She hadn't even realized that it had gotten cold outside, having come in July and having sat in this regulated air for so long.

She could barely walk, her ankles were so swollen with edema. She wore a white rag tied around her head, a sweats.h.i.+rt, sweatpants, and a pair of Acti-Treds on her feet. She sat all day and night in a plastic chair by the bathroom door. She never used her bed because she had some problem with mucous, or reflux-I wasn't sure which. She just said that the devil was in her stomach, and when she lay down he came up and she couldn't breathe.

When she wasn't sleeping she was staring at the walls, or at me doing my yoga or writing in my notebook. She saw everything I did unless I did it in the bathroom. After a while she started to feel like my conscience. Every time I looked up I'd see her staring at me in that blank unflinching way that went right into me, and then through me and past me.

When I still thought pleasantries applied, I'd smile nervously and say, "Hey."

She didn't respond, which was awkward at first, but came to feel natural and easy, even pleasant over time. It was actually a relief to stop making small talk. That was one of the things I liked best about hanging around my ward mates. Social conventions didn't apply. It was one of the privileges of being "disturbed." It was probably one of the diagnostic criteria. But G.o.d, it was nice. I really liked being able to just end a conversation and walk away, or say nothing to fill the silence.

At night, Ellen wrapped herself in a sheet and put it over her head, so that sitting there in the dark with the lights of the city coming through the window and picking out the whiteness of her form, she looked like a dead body, as if propped up by the staff for some sick joke. At first, I didn't understand why she did it. My third roommate, Sweet Girl, did it too, though she did it for much of the day as well. As time went on, and I came to understand that privacy was one of the other major deprivations of that place, and one of those other things that most of us take for granted in the outside world, I realized that they did it because it was the closest they would ever come to having a room of their own, to reclaiming the structural integrity of their minds as separate places that belonged only to them.

Of course, in public hospitals, private rooms are an uncommon luxury. And, of course, people who are a danger to themselves or others can't be left unwatched. All of this I understand. I am not comparing Meriwether to the gulag. And yet, as any Solzhenitsyn will tell you, watching is a form of torture. Being watched is a soft violation that grows into a harder one with every pa.s.sing day. Like dripping water on a stone, the eyes of other people wear you down, slowly, invasively. They leave a hole.

Lying there at night, unable to sleep, I'd look at Ellen and Sweet Girl wrapped in their shrouds and think that I was in the morgue. In part it spooked me, but most of the time it just made me terribly sad, because the shrouds were not only for privacy. They were, I think, also a way of saying no to what was happening. This was the pose of the abandoned, the dress work of a despairing mind that was tired of being poked at and observed, degraded by the treatment, and talked down to.

Yes, the "treatment." That deserves to be in quotes, and probably italics, too, because I mean it in both senses. I mean it disrespectfully, as in pseudo, as in your treatment is a joke and an insult and an arrogant, dehumanizing, lazy nonsolution. And I mean it, too, euphemistically, in the same way that cartoon hit men mean it when they say, "Give him the treatment." As in work him over, make him easy, like pulp. Treatment as in, dealt with, put in place, made malleable, and put down.

Sweet Girl was in her early twenties as far as I could tell. I never found out for sure, but she talked often of having been a student at a local college, and she had the face and bearing of someone very young. She was beautiful-high-cheekboned, mahogany-skinned. She hardly ever spoke to anyone but herself, spending most of her time deep in scanning speech colloquy with an imaginary friend she called Patsy. Usually she was curled up in the fetal position on her bed under the sheet, though sometimes she'd sit bolt upright as if surprised by or aghast at something Patsy had said. Then she'd stare into the middle distance and argue the point until she was satisfied, or maybe make a trip to the dayroom, where she'd continue the argument in front of the TV.

When I first heard her talking to herself, I thought it was a foreign or made-up language. But then, as I got used to it, I realized that it was English, just very fast English full of all kinds of shorthand and slang that presumably only she and Patsy understood. Sometimes she would coo and giggle and say discernable things like "I love you, too." Other times she'd blurt something about "your smelly c.u.n.t" or reprimand Patsy for saying something worse.

"You're disgusting. Shut up."

I tried to listen in, but with little success. Besides, it seemed to me that eavesdropping was just another breach of privacy that I had no right to inflict.

Still, from the parts that I couldn't help overhearing or taking note of, because they were shouted, or repeated, or chanted almost like a prayer, it seemed to me that somewhere along the line Sweet Girl, or perhaps her renegade brain, had done what any of the rest of us might have done in her position. I had no way of knowing what her reality was like in the outside world: where she lived, with whom, under what circ.u.mstances. The information was not forthcoming from her.

But she had clearly created a world of her own inside her head, an alternative to what I can imagine must have been a brutal, or at the very least unpleasant and alienating, world on the outside. Maybe she hadn't been abused. Maybe she had only been strange, unpopular among her peers, alone for too long with an unshared and unshareable view of the world, socially inept, and cripplingly shy. (This seemed undeniable from what I saw in our encounters.) Or maybe the docs were right, that it all stemmed from an innate chemical imbalance, as faultless as autism or r.e.t.a.r.dation. Whatever the reason, whatever the cause, she had produced for herself what seemed to me to be an eminently adaptive response to unbearable isolation. Unlike me-who spends way too much time thinking about all the things I wish I had done or had yet to do-Sweet Girl was not a prisoner of too much consciousness.

She was in her own world, peopling it with friends.