Voluntary Madness Part 6

If you ask me, Casey and I fell into the same category: the overdiagnosed. Certainly we were or had been depressed. Behaviorally, anyway. That was clear.

The question is, were we what you might call naturally depressed by life and our prospects? Were we too hypersensitive? Were our expectations too high? Were we clobbered by life's disappointments, as everyone at some point is? Or were we clinically depressed, suffering, as they say, from a chemical imbalance? Was depression in our DNA? Were we mentally ill, or were we struggling through a bad patch?

Moreover, was medication, and lots of it, the answer? Was it the only, or even the best treatment?

n.o.body has answers to these questions yet. But in the absence of such answers does it make sense to pound everyone with the same rubber mallet? Does it make sense to give powerful antipsychotics both to someone who thinks he is talking to G.o.d and to someone who is just having trouble falling alseep? Does it make sense to put someone like Casey away, and keep her away despite her a.s.sertion of the plain fact that being in the bin was making her feel worse, not better? Wasn't that kind of treatment just going to make her, and me, and a h.e.l.l of a lot of other people, shy away from consulting psychiatrists at all, for fear of being dangerously overmedicated and incarcerated?

These were all the questions in my head as I watched Casey leave the ward, and as I sat waiting out my time, succ.u.mbing more and more to fear and depression, despite knowing that I was only likely to be there for a short time, and that I was actually just doing a job. It was hard to keep any kind of perspective. Almost impossible. The intimidation and lethargy of the inst.i.tution hung on me and ripened like a stink, and I sat in that stink with worsening amnesia, as if I neither had nor knew of any other life outside the confines of Meriwether Hospital.

I realize that this sounds overblown. And sitting here now, back in my privileged life, mentally so far away from Meriwether and that time, it sounds that way to me, too. But then I remember that my roommate Ellen had been stuck in there for six months, and who knew what was going to happen to her.

I wasn't Ellen, of course. Far from it. I had access, if necessary, to a whole host of resources, legal and otherwise, that Ellen and most of the rest of my fellow patients didn't. That, after all, had been most of the reason why Casey had managed to get out so quickly. She had resources. Family, some money, and enough education, savvy, and middle-cla.s.s wherewithal to apply pressure in the right places. Yet she, like me, had seen on her first trip to the bin that although she had committed no crime, her accustomed freedoms could be taken away more quickly than they had ever been before, or than she had imagined they ever could be, even if only temporarily.

This is something that we in the free world, especially Americans, are not used to. It has never happened to most of us. On the contrary, we're spoiled. We're used to saying what we like, and suffering few or no consequences as a result. We're used to knowing, as surely as we know our own names, that we have rights. And it's not that patients in places like Meriwether don't have rights. They do. It's just that-and I can't overemphasize this-it feels as if you don't have rights when something as simple as coming and going, or smoking a cigarette, or seeing the people you love is taken out of your control because your mind, whether it actually is or not, is thought to be diseased.

Being put away does a number on you very quickly, and very thoroughly, no matter who you are in the outside world.

Finally, after watching other people leave, after losing a sense of time, and after losing more and more perspective on the system and my own position within it, my day did come. I was going to get out.

I had been through the treatment, such as it was. I had been given eight Lamictals and ten vitamins. I had swallowed one each day but not the other. I had had roughly ten to fifteen minutes of therapy a day, either with Dr. Balkan or with Sarah. I had sat in on the absurd fifteen-minute morning community meetings, where those who were awake or could speak intelligibly had said their piece, been heard, and usually been told that what they wanted either couldn't be had or would be taken into "consideration."

We all knew what that meant.

I had been aiming for the ten-day mark as a release date. So when Sarah or Dr. Balkan asked me how I was doing each day, I steered my answers progressively toward the lighter side of disaster, going from "I'm not as bad as I was," to "Getting better, I think," to the unequivocal, "I'm ready to go now, please."

Dr. Balkan and I decided together about midweek that day 10, a Friday, would probably be the day. Of course I knew enough not to take this dangled freedom for granted until I was on the other side of the door, but I did allow myself just a whiff of elation.

I told Deborah as soon as I knew.

"It will be heartbreak for me when you leave," she said, looking up into my face with eyes that bore no trace of their former mischief.

Sweet must have overheard this, though I don't remember her being nearby at the time. But then, she had a way of floating in and out of rooms unnoticed. I walked by her in the hall later that day, and she showed me once and for all that it was a mistake to a.s.sume she wasn't paying attention, just because she was talking to herself most of the time.

I heard the swish of her trench coat, and then, clear as a bell, she said: "I'm going to miss you."

The others reached out, too, as expected. Clean wanted to give me his number at a halfway house, and did. Mother T told me which shelter she was likely to be staying at when she got out. Even Kid gave me a number.

My last night, I lay in bed awake for hours filled with what was by then an irrepressible excitement. Like the Yenta, I thought with relish and in detail about the first things I was going to do when I got out.

I pictured and tasted each course, each bite of the meal I was going to have at my favorite restaurant. The juicy steak, medium rare, marbled with fat, oozing in my mouth, the b.u.t.tery whipped potatoes, the firm julienned vegetables, the lemon custard, the red wine swirling in the bulbous gla.s.s.

I thought about the taste and smell of the fresh winter air, and the feel of it cooling my lungs and my lips and my ears. I thought about what it would be like to talk to people who didn't have power over you or weren't hearing voices. Normal society seemed desirable for once. The beautiful, beautiful mundane. What a thing.

As I lay there with my eyes open, and with my eyes newly opened, I listened to the nurses talking and laughing down the hall. I thought about how strange it was that so many of them considered themselves to be superior to the patients they oversaw, when the patients knew enough to leave as soon as they could, and even the worst among them were eventually discharged. But the staff was there all the time. By choice. Actual choice. Not, in my sense of the word, by voluntary commission, and then no choice at all. No. They had decided completely and repeatedly, of their own accord, to be in that place.

It's bad enough to be committed to a mental hospital, and to spend your time unwillingly in the company of disturbed people. Even disturbed people know that. So why would anyone choose to work in such a place, choose to spend at least forty hours a week there, and never have enough sense to get out? If you ask me, that's a far more deranged, senseless person than any so-called lunatic.

Of course I know now that this is too harsh a judgment, coming, as it did, out of extreme resentment and trapped exhaustion. I feel certain, even in my still jaundiced mind, that some public hospital somewhere employs one person, h.e.l.l, maybe a few, who actually give a s.h.i.+t, and try to do some good.

The point is, fair or not, informed or not, this is how I felt at the time. Meriwether skewed-maybe even took away-my judgment on these matters for a while. I cannot deny that, nor should I. That is what inst.i.tutions do.

I slept restlessly for a few hours, and then in the morning I woke again to the sound of Mrs. Weston clacking into the room. This, too, vaguely amused me for the first time, because I could just about relish how good it was going to feel to write about her.

The docs signed my discharge papers at 9:25 a.m., but I didn't make it out of the hospital until 3:15 p.m.

Those were the worst six hours of my stay.

I sat all day in antic.i.p.ation, watching the hours drag by, tasting my freedom, but anxiety-ridden at the prospect of it being somehow revoked, or worse, eroded by my paperwork's slow, careless pa.s.sage through the clogged procedural channels of the hospital bureaucracy.

Time had come to mean everything. A visitor who arrived ten minutes late, for example, could never know how painful those ten minutes were to someone watching every tick of the clock, living for a friendly face.

Discharge was that much worse, because you sat there, after having been boxed in for too long at the mercy of a flyby doctor's will, finally knowing that you were technically free at last, but having to wait nonetheless for the heel-dragging staff to make it happen.

The staff's blatant indifference was offensive enough in the daily rounds, but it made you boil when one more day of your life was coming rapidly to a close and your release papers were languis.h.i.+ng on the table while the nurses studiedly procrastinated.

After making numerous inquiries at the nurse's station, I learned that we were waiting on the pharmacy, which had yet to fill my prescription.

"Can't you just write me one that I can fill outside?" I asked Dr. Balkan.

This was not hospital policy, she said. And so I waited for several more hours.

At three o'clock, desperate, I cornered the unit chief on her hurried way through the ward and managed the miracle of bent rules. She wrote me a scrip, and I got the nod to go.

Finally, having spent the day convulsed by turns with rage and despair, I stepped over the wide white line in front of the nurse's station, the one that patients were forbidden to cross, and stood by the locked double doors of Ward 20 for the last time.

As I waited for the nurse, with his jangle of keys, to unlock the door, I looked back at Deborah and Clean and Mother T, who had gathered to wave me off. I knew what they were feeling. I'd felt the same mixture of pleasure and envy when I'd seen Casey and the Yenta discharged during my stay. You couldn't help but share in the free person's joy and be happy for them, but watching them leave, you also couldn't help but feel that much worse about your inability to follow.

I left Meriwether hospital with my few belongings in a paper garbage bag that I got from one of the janitors. It was the same kind of bag that I'd been filling with desiccated orange peels and secreted candy wrappers for ten days. They had lost my backpack somewhere between triage and the ward, and I wasn't going to spend one extra minute in that place trying to find it.

It had only been ten days, and I was supposedly just a journalist at work, but I was a wreck, a pathetic, quaking, permission-seeking, cowering nonperson in petrified thrall to the keepers of mental hygiene.

As I made my long, slow way out of Ward 20, as I heard the locked double doors click behind me, with me at last on the right side of them, the outside, as I rode all the way down in the elevator and scurried all the way down the labyrinthine halls of the main floor, even as I stood in line waiting to sign for my valuables, I really thought that some disembodied arm was going to reach out and grab me by the shoulder and say: "Where the h.e.l.l do you think you're going?"

And when I finally walked into the same vaulted lobby that I had come through ten days before, pushed my way through those so much more symbolic revolving doors back out onto the street, and took my first lungful of liberated air, all I could say-and I said it out loud, yes, talking to myself-was "Thank G.o.d. Thank G.o.d. Let it be true. Let it be true."

And then I ran. I ran for blocks, clasping my crumpled paper bag to my chest, still thinking I might be chased and dragged back screaming in futile protest for the brief taste of gorgeous, real life that I had been given.

But-and I said, "Thank G.o.d" again out loud-no one came for me. As I slowed to a walk, it felt glorious to be out of breath, to have a wallet, and shoelaces, and a meandering gait, and my own sweet, whimsical will again.

INTERIM.

As expected, I learned a lot about madness at Meriwether. By madness I mean, of course, madness as we currently recognize and label it, or, more specifically, as I was able to observe it in Ward 20 at Meriwether Hospital. I can make no meaningful generalizations about madness per se. I don't think any of us really can. Even if madness as some definable ent.i.ty can really be said to exist, which I don't think it can as yet, nonetheless, mad individuals are as singular as other individuals, even if they tend to have certain propensities in common (delusions, paranoia, despondency, mania, and so on).

Yet generalizations are unavoidable, and we all make them, usually in less than charitable ways. Like most people, I harbored strong prejudices, especially about psychotic people. But living in close quarters with Deborah, Sweet, Clean, Mother T, and the rest of them disabused me of many of those prejudices, even as it reinforced and engendered others.

For example, it may surprise you to know that I never felt unsafe in the ward.

Portrayals of "psycho killers" and stalkers in movies have conditioned most of us to believe that psychotic people are always violent, menacing, and dangerous. When a mentally ill person makes the news, it's usually because he has brained a pedestrian with a cement block or pushed someone in front of a subway train. Sick-flicks and tabloid cover stories have given us our picture of psychosis and made it a staple of our worst fears and nightmares.

Sometimes psychotic people will play into this warped preconception, simply as a means of ridiculing our ignorance or deflecting the sting of our gawking eyes. Deborah did this when she cruised me so blatantly that first time in the hallway. And I allowed myself to be frightened by it. Looking back on it now, my reaction was as absurd as flinching when a clown says, "Boo."

Otherwise my fears in Meriwether did not stem from my fellow patients, but rather from the hulking, glowering inst.i.tution itself, and the power it had over me.

The psychotic people I knew and lived with were more confused and disoriented than anything else. This may have been due in large part to the effects of the medication, but whatever the case, even at their most paranoid and fluent, they were more scared than scary. When they were exercised, it was more out of annoyance that n.o.body seemed to be listening to them or taking their wishes into account. I never worried about being in rooms alone with them. I never lost sleep thinking they were going to creep into my room and get me, and this wasn't, I can a.s.sure you, because I thought the nurses would get there in time.

They were as human as everyone else, of course. As selfish and petty and generous and witty, and most often, just as run of the mill. They were just as much a reflection of their cla.s.s and culture as the average person on the street. They liked MacDonald's, iPods, M&M's, and TV. They were fat and fond of the same poisons that we all buy on every corner or in bulk at Costco. They didn't like being told what was good for them, and they didn't like being told what to do. But when they fell, they wanted to be picked up. They wanted to be saved and provided for, but made the minimum effort on their own behalf. I'd say that made them pretty normal.

None of this is to say that I came away from Meriwether with a sense that the psychotic people I knew were, in every way, just like everybody else. They were psychotic. There's no getting away from it. And I had to adjust my approach to them accordingly. When I spoke to them, I wasn't speaking to someone who processed information in socially common or easily navigable ways. It was different, and often it was harder, more off-putting, and even unpleasant.

Still, something very strange happened in my mind as a result of these everyday interactions on the ward. This partial normalizing of crazy people in the bin had the opposite effect, too. It made normal people in the outside world seem crazier.

Instead of going back into the public sphere and luxuriating in all the confidence and like-mindedness that I could have and find in normal people, I actually approached strangers with a new reserve. I realized how stunningly naive I had been to a.s.sume that most people I met were sane. Most of us do this. We presume people are sane until they prove otherwise. But, after Meriwether, it suddenly seemed a lot wiser to approach strangers as if they were nuts until they proved otherwise.

I was so struck by this reversal-by how sensible it seemed, and still does. I mean, really, what an astonis.h.i.+ng trust we place in other drivers on the highway, in teachers and priests and parents and government officials, in the power of social norms. And how astonis.h.i.+ngly often is that trust misplaced?

This will sound crazy, no doubt, but, after leaving Meriwether, it seemed patently clear to me that the vast majority of the crimes in the world are committed by normal people. Either that or insanity is a lot more prevalent and on the loose than we like to think.

Obviously, whether for good or ill, Meriwether bent my mind. Or the world. Or both. But it also taught me some interesting and rather more mundane things as well, things about the health-care system, and about health insurance in particular.

When I presented myself at Meriwether, I told them that I had no health insurance. I was there to conduct my research, after all, and not because I really needed to be hospitalized. I didn't want the cost of my stay to be billed to my insurance company. But as it happened, because I had listed myself as having no insurance, the billing people at Meriwether took the logical next step. They put in for Medicaid. That's when the computer did a search and kicked back the information that I did indeed have insurance coverage. When she relayed this information to me, I told the billing administrator that I didn't want a bill sent to my insurance company.

"Just bill me," I said.

Naturally, they didn't. n.o.body who shows up in a public hospital is capable of paying the bill out of pocket. They sent the bill to my insurance company, and another copy to me.

For a ten-day stay at Meriwether, the grand total came to $14,276. That's $1,400 a day. You could get a king room at the Ritz-Carlton in New York City for that and still have plenty left over for exquisite food and a private nurse.

Soon after getting the bill I called my insurance company to explain the situation. I told them that I was writing a book about mental hospitals, that my recent billed visit const.i.tuted research, and that I wished to reimburse them for the full amount they had paid out.

I may actually be the first person in history to willingly attempt to reimburse an insurance company. You can imagine that the fine folks in the claims department didn't know what to do with me.

In fact, irony of ironies, they thought I was nuts. I'm not kidding. After making repeated calls to various departments, in an effort to make myself clear, I finally got a call back from a social worker. She explained, in the most delicate possible terms, that she had called expressly to determine if I was insane.

Apparently, it's not uncommon for genuinely compromised individuals to call their insurance companies and attempt to stop payment on claims. Such people don't offer to pay the claims themselves, but they attempt to dispute the claim, mostly because they adamantly deny that they needed to go to the hospital in the first place, but also because, having gone, they don't want their hospitalization to appear on their record. They don't think they're crazy, and they don't want other people thinking it either, or having evidence on paper to prove it.

Because I, too, had told the insurance company that I wasn't legitimately ill, I fell immediately into the "I didn't need to go to the hospital, even though they dragged me off ranting and raving" category.

It only made matters worse when I claimed to be a writer who was under contract to write a book. I offered to have the social worker call my publisher. I even said, "Just Google me, and you'll see." But this didn't seem to fly, and I can see why. You try not to sound like you're having delusions of grandeur when you tell people that you were on the New York Times New York Times best-seller list and appeared on best-seller list and appeared on The View. The View.

"No, really."

To date, I have heard nothing more from the social worker or anyone else at my insurance company. I guess they didn't believe me.

Overall, Meriwether as an inst.i.tution made me think. I didn't come away with answers, but I came away with a lot of questions, which is at least a place to start.

Just as surely as I took on the mentality of the patient at Meriwether, I couldn't help taking on the mentality of the staff and the whole system as well. I saw why it was broken down and dysfunctional. I saw where the resignation and dislike began, and I saw where they ended.

I had gone, in an amazingly short period of time, from being one of the downtrodden to being the queen of social justice, and finally to being the laissez-faire absentee activist who says, "Not in my backyard." It was a predictable route, and one that left me unsure of how to effect or even propose lasting change, even though I knew that places like Meriwether needed to change.

To be sure, spending time in Meriwether had made me more sensitive to the plight of the indigent mentally ill. I knew what it was like to be treated like an inferior person whom no one cares about, a person who is never expected to get well, or even consistently better, and so doesn't.

I saw that taking people out of their lives, pumping them full of drugs, offering them no real psychotherapy, and then sending them out again to their old lives amounted to a revolving-door policy. They were bound, as so many of the patients I knew at Meriwether had been, to get arrested or committed again, and again.

But I also saw that working with people who behaved-I'm sorry to say this-like children could wear down your good intentions to a nub. What could you do with people who, when you tried to help them, often either tried to take advantage of you or allowed themselves to be infantilized by your efforts and made no effort to help themselves?

It wasn't Meriwether's fault, after all, if patients went off their meds or didn't go to follow-up appointments. I could understand why the meds were intolerable, and why these people's experiences with the mental health system hadn't left them wanting more, even on an outpatient basis. But I knew that these things were a recipe for relapse.

This is a cla.s.sic public policy debate. What will work and what won't. The liberal will raise taxes to pay for places like Meriwether, a.s.suage his conscience, and see the sorry results of inefficient bureaucracy and impersonal care. The conservative will ask the community, often the religious community, which is usually already in the business of dispensing charity, to take up the burden on its own, rather than fobbing off the unwanted on big government. But that is a burden that many do not want to take on: certainly not families and individuals. Charity may begin at home, or in the neighborhood, but that is where it can be hardest to sustain. As I had learned firsthand, developing relations.h.i.+ps with people who are not only disturbed but quite often uncooperative, manipulative, and willfully irresponsible is a job that even people with an overabundance of fellow feeling often find too unrewarding, infuriating, and exhausting to perform.

Staying at Meriwether only inflamed this debate in my mind. I couldn't come down on either side. In a way, I had come down on both. But then I still had a lot more of the landscape to see before I would be in a position to make any sense of it.

I wanted to know, for example, if a private hospital would have more of value to offer a person in distress. I'd been to a private hospital before, my first time around in 2004, but that, too, had been a big-city hospital, and I'd had what I was still open-minded enough to think of as the misfortune of getting stuck with a lousy doc. I still held out hope for better consults-and maybe nicer staff, and better food, and cleaner bathrooms, and who knew what other luxuries.

Besides, I was looking for a totally different clientele. At Meriwether, I'd had the public, urban, indigent, mostly black and Hispanic psychotic experience. I wanted to find a rural, middle-cla.s.s, whiter than white private clinic, where I suspected depression would be much more common than psychosis.

I was also curious about what I'd find in a state that had gotten bad marks for its treatment of the mentally ill. On its Web site, the National Alliance on Mental Illness (NAMI) posted the results of a report they conducted in 2006, in which they graded all the states in the union on their treatment of the mentally ill. Almost every state received a C or below. I wanted to go to an inst.i.tution in a state that had been given an F. There were eight to choose from, and, conveniently enough for my purposes, all eight were in very white parts of the country.

To make it official, I consulted census data and found a place with a population that was both small and 95 percent white. I did a little more research on the Web to find a private hospital in the area, and then I had my target. I packed a bag and booked a ticket, and that was that. I was on to Phase 2.

Or sort of. Something unexpected happened around that time; unexpected at least as far as this project was concerned. It wasn't unexpected when you consider prior experience.

I fell into a depression.