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Journeys to the edge of madness

To expose the insanity of mental health institutions, Norah Vincent had herself committed. Twice

  • Norah Vincent
  • The Guardian, Saturday 3 January 2009

I couldn't sleep because I was terrified. And because I was bedding down in a fold-out chair. All the trolleys in the hallway were taken, and the hallways were all that we had: women on one side, men on the other and the nurse's station in the middle.

Voluntary Madness : My Year Lost And Found In The Loony Bin by Norah Vincent Chatto & Windus, £12.99

Emergency triage was where you were kennelled until they had a bed for you on the ward upstairs. It was noisy and freezing, and all we had to cover us were sheets and paper-thin pyjamas. Seven hours earlier, all of my possessions had been taken at the door and put in a metal locker.

I hadn't been sure how to commit myself to Meriwether. In the event it was easy. As in all psych wards, when you say you are suicidally depressed, they take you at your word. But the things you say can also become a menu for drugs. I wanted to keep these to a minimum, so I reported the virtual truth of my own history. Depression, possibly bipolar - I was on 20mg of Prozac, and hoping to get away with nothing more than that.

In November 2004 I had checked myself into a locked psychiatric ward as a patient. I was in that zombie parlour for four days, and returned home a wreck, swearing that I would never willingly go into such a place again. And yet there was the lure of the spectacle, and what I saw as the outright wrongs of the insanitarium, wrongs I longed to write about and hold up to public scrutiny. Which was how I now came to find myself back in a big city public hospital - this time as a journalist.

The bright lights were kept on all night, so it was like trying to sleep in an interrogation room. The staff, too, went on all night, gabbing and laughing as if there weren't stranded sick people lying all around them trying to rest. We were invisible, discounted. We could tell no stories, the assumption being that we were all too drugged or nuts to notice or to lodge a complaint.

I sat up making notes. I had managed to smuggle in a pen, but had forgotten that I should not be seen with it, and so it was promptly taken by a nurse, officious and smug. "You can't have that," she sighed, flicking her fingers to her palm impatiently. "Give it here."

It was not a small loss to me, though a petty one on her part, and she knew it, took pleasure in it. Or was that the beginning of paranoia?

A man had crapped himself, a brown seep hanging low in his pyjama bottoms. He was shouting into the nurse's station, which was a fort of Plexiglas. Patients tended to loiter there and stare, ignored. If you needed something, you had to knock. Or shout. Or crap your pants, I guess.

Time had passed slowly after that. Sitting. Staring. I was already in despair of that place, which was itself collectively despairing. Even the people who worked there had given up. It was written all over them. The way they fell asleep in front of the TV during their shifts, the way they moved, slowly and sighing. The way they talked to us, with the tone people reserve for the retarded and the elderly. Contempt. That was it.

I looked for comfort in the trolley that I got, finally, only an hour or two before they came to take me upstairs to the ward. I lay on it, and then couldn't. It wasn't just that I didn't want to resemble the rest of them, lying, as they were, face to the wall. It was that I didn't want to become them.

Did the fact that these people were mostly poor, sometimes even homeless, turn the place into a zoo, or did the zoo turn the people into animals? I knew, even in just one night, that the latter was true. You become your environment, and you become what you are expected to be.

I met my treatment team first thing. I worried that they might see through me. But a night in emergency had lowered me to the right level. Fear? Desperation? Distrust? Those were real enough.

Dr Balkan, the staff psychiatrist, suggested Lamictal, a mood stabiliser. I was sceptical. I'd read a lot about the dangers and unpleasant side-effects of so many pills, and of how thoroughly corrupt the drug development and approval processes are in America. So I wasn't eager to take any more drugs. I told Dr Balkan that I thought it might be best to go the therapy route for now. She was insistent. In the end I agreed, because I thought that if I didn't, they might keep me in for longer.

The nurses at Meriwether watched you take your meds, but they weren't terribly vigilant. Besides, I'd requested a multivitamin, which they gave me at the same time, so I was able to make it look as if I was popping both pills into my mouth when, in fact, I was holding the Lamictal back. As soon as the nurses left, I went to the bathroom and flushed it.

When I walked on to the ward for the first time, a short, mustachioed woman looked me lewdly up and down, wolf whistled and walked away. It scared the living shit out of me, and it was meant to. Deborah thought she had sailed the Nile as a queen and was convinced that there was a bomb in the payphone at the end of the hall. She was like a lot of the other patients in that way. She had her pet obsessions, and she'd stop you in the hall and rant about them.

That was the getting-to-know-you phase. All the people on the ward spoke to me in riddles when I first met them. They didn't trust me. But without exception they spoke to me coherently by the time I left.

Looking back, it's hard to believe I was ever afraid of Deborah; when the antics fell away, she was perfectly harmless. "I just want to follow you around and look at you," she'd say. "You're the freshest face I've seen."

Like many others, she was on a cycle. She came in, got meds, meals and shelter, broke the choke-hold of the delusions, left with some prescriptions, hit the street, stopped the meds, lost control, got arrested, landed back here, and did it all over again.

She stopped taking the meds for the same reason everyone else did - the side-effects were too bad. The fog, the sluggishness, the tardive dyskinesia - involuntary, spasmodic movements, especially of the face, lips and tongue - and the overall shaking Parkinsonism induced by so many of the dopamine-blocking antipsychotic medications.

There is great debate within the scientific community about the safety and effectiveness of these drugs in controlling delusions. If they work at all, they work because heavily sedating and inducing Parkinson's in a person is a little like hitting them over the head with a frying pan. The blow will probably stop the agitation and devivify the psychotic experience, not because it's redressing a chemical imbalance, but because it's shutting down the system wholesale.

Often, inmates would get into tiffs, shouting, storming around agitatedly, crying or whining. If this went on for too long, they were "medicated". A group of five or six large men would appear wearing rubber gloves. They would usher the parties in question into their rooms, hold them down and give them the hypodermic. I have no idea what they gave them, but it worked so well that the person would usually pass out face down on her bed, one foot still on the floor.

There was so much you weren't allowed to do. There was little exercise - we were taken up to the roof for 15 minutes a day - no smoking and a no-touching rule between patients. A necessary rule, in some ways, in a world where people had few boundaries, but to deprive desperate human beings of the healing comfort of a hand on the shoulder or a kindly hug was, at times, just another reason the place made you feel less than human.

Given the rules, the restrictions, the unreasonable deprivations, you resorted to childish deceits just to meet your needs or show a bit of spunk. Periodically, the head nurse, Mrs Weston, strode into my room and searched the closet by my bed. It was more a powerplay than anything. She usually missed half of the contraband that was in there - that being a few pens, a plastic bag for dirty clothes (possible suffocation risk), and a pair of pyjama bottoms with a string tie (strangulation risk).

I called one of my roomies Tracy Chapman because of her comely face and short dreads. She was the only one of the three who didn't talk to herself most of the day and night. Ellen, a 65-year-old black woman, was my second roommate. When she wasn't sleeping, she was staring at the walls, or at 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, even pleasant. It was actually a relief to stop making small talk: one of the privileges of being "disturbed".

At night, Ellen wrapped herself in a sheet and put it over her head, so that she looked like a dead body. My third roommate, Sweet Girl, did it, too, though she did it for much of the day as well. As I came to understand that privacy was one of the other major deprivations of that place, I realised they did it because it was the closest they would ever come to having a room of their own, to reclaiming their minds as separate places that belonged only to them. Of course people who are a danger to themselves or others can't be left unwatched, and yet watching is a form of torture.

They were all on cocktails of antipsychotics and mood stabilisers. Depending on the time of day - we were given medication at 8am, 5pm and 9pm - the patients were more or less sluggish, zombified or dead to the world, drooling big lakes of syrup on to their bedsheets.

I suppose if you dealt with people doing this kind of repulsive crap all day, you'd be hard-pressed to see them as fully human, too. That's how it must have seemed to the staff, and that on top of the exasperation of having to shove someone like Sweet Girl into the shower because she smelled bad enough to make your eyes water. It wasn't likely to engender respect. And even though I felt defensive of my fellow patients, sometimes I could really see the other point of view.

Mr Clean was a 6ft 3in black psychotic. Watching him eat, listening to the slurping noises he made as he sucked the fat off a deep-fried chicken wing, I wanted to make creative use of my ballpoint pen in all the murderous ways that the staff had ever seen or imagined.

Then there was Street Kid, a lanky 20-year-old who wore his baseball cap sideways and punctuated his conversation with goofy dance breaks, chicken-winging his arms, or moonwalking with little hops of pleasure in between. He "got medicated" often and heavily, prone as he was to tantrums, so looked and sounded as if he was moving underwater. Clearly the kid had problems. But what might be causing those problems? Brain malfunction, recreational drug abuse, unstable home life, or just plain time-of-life maladjustment? It was anybody's guess. And that, of course, is exactly what his diagnosis was - a guess. So we take a kid whose signs of "mental illness" were classic youthful irritability, impatience, restlessness, rebelliousness, selfishness, rudeness, agitation and ebullience, and we turn him into a chemical waste dump.

Were his moods and outbursts more extreme than those of other young people his age? Sure. Was he unreachable? Not in my experience. He wasn't delusional or paranoid. The medication was the biggest thing standing between him and making sense. Was anyone even trying?

The old pros at Meriwether were simply going through the motions. Essentially harmless people who had often committed crimes no more serious than disturbing the peace were confined against their will, forcibly medicated with drugs of dubious, or at best limited, efficacy and usually unfathomed toxicity, and left to rot until the hospital needed the bed space, in which case they were turned back out into the world 20 to 80 pounds fatter, practically deployed for a relapse.

All the patients on the ward quickly figured out that I could be manipulated into getting my visitors to bring them just about anything they wanted, from candy to phone cards to cigarettes. And, for a while, I made myself the wish granter of Ward 20. But it was like filling a bottomless cup. I'd have given away 20 candy bars minutes before, but the smallest rustle of a wrapper and they'd be on me.

"Have some?"

I hated myself for begrudging them, and felt like a despicable closet pigger when I took to going into the bathroom to eat, coughing loudly to cover any suspicious sounds.

As soon as I extended my hand, they grabbed hold. They wanted to be my friend. But I just wanted to help them from a safe distance and be rid of them. Isn't that why we leave it to the professionals, who, in turn, leave it to the pharmaceutical path of least resistance? Nobody wants to do the personal work. It's disgusting. What's more, it scarecrows every humanitarian illusion you have about yourself. It makes you know that, at heart, you are a little bit of a fascist like everybody else, thinking in the back of your mind that wouldn't it really just be cheaper and better and, well, more utilitarian to be rid of these people?

I can denigrate the system, and I might actually be right. But I would be lying if I said I didn't see why that system fails the chronics, or did not admit that I abandoned them myself.

As expected, I learned a lot about madness at Meriwether. Portrayals of "psycho killers" in movies have conditioned most of us to believe that psychotic people are always violent, menacing and dangerous. But I never felt unsafe. Deborah, Sweet, Clean and the rest of those I lived among were more confused and disoriented than anything. 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 liked McDonald's, iPods, M&Ms and TV. They didn't like being told what was good for them. 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.

After Meriwether, I made the mistake of trying to come off my meds, and fell into a depression. I'd wake with a feeling of dread. The first conscious thought: something is terribly wrong with my life, with life in general. I looked for reasons, but they were irrelevant. That was the point. The dread came from nowhere. I crawled into an empty bathtub thinking about where I could buy a gun. I decided that trying to go without meds wasn't the greatest idea. I went back on Prozac, and began to get better, to think about the next stage of the project.

At Meriwether, I'd had the public, urban, indigent, mostly black and Hispanic psychotic experience. Now I was looking for a totally different clientele. I found Mobius on the web. Founded by a clinical psychologist, Dr Franklin, and committed to the practice of healing the whole person - mind, body, spirit - without the use of restraints or locked wards, its primary client base was addicts in recovery. Patients were housed in apartments in a large complex with a pool, Jacuzzi and gym. As well as various therapy sessions, they did yoga, went to the bookstore, the movies and a spa. I booked a two-week stay.

Every morning the day's activities began with den chi bon, which I can best describe as a cross between tai chi, tai-bo and a seance. It was the kind of too-earnest, misty-eyed exercise that I had trouble taking seriously. Early on, I hovered at the back of the room, embarrassed. By the second or third day, I was hooked. We all were, from the moment the starting music began: a tolling bell and an Indian man with a caramel voice talking about the dharmal door being open, transcending the path of sorrow and death.

Tuesdays were rebirthing days. Rebirthing sounds hokier than it was, though I admit it did have its moments. As it turned out, it was really just meditation. It was designed to access your subconscious, to function like a back door to your brain so you could sneak in while the rest of you wasn't looking and grab a few fresh clues as to what was really going on in there. It was a way around your defences. That's all. Not, as I had worried, some half-baked yankified shamanism all decked out in fake blood and feathers.

Mobius was all about learning to see your life differently. They called this "process therapy". On my first day, I filed into an activity room with five other clients. Carol, a staff therapist, was already standing up at a whiteboard writing the phrase: "I do not see things as they are. I see them as I am." Bobby, an alcoholic Xanax-head, was already asleep. But Carol kept right on, drawing three columns, the left-hand labelled Behaviour, the middle one Thought and on the right Perception.

The idea behind process therapy, a technique akin to traditional cognitive behavioural therapy, was that most of us act before we think. The problem is the behaviour. That's what sends people into rehab or the bin. In the addict's case, it's pill-popping, drinking, snorting. In the depressive's case, it might be self-abuse, cutting, burning, binging.

It isn't just a question of stopping the behaviour - that is, quitting drinking, cold turkey - it's a question of finding out what motivated the behaviour and addressing that source of distress so that the behaviour will no longer seem necessary or even appealing. That, anyway, was the theory.