The Center Cannot Hold: My Journey Through Madness (21 page)

Nevertheless, my parents said they were going to come and see
me, at which point my own anxiety shot ceiling-ward. "No, no, there's
no need for that, it's not necessary, everything here is fine." But they
were insistent. So was I.

Oddly, however, I was becoming aware of a kind of yearning inside
me. I did need them, I did want them to come, I did want to see them.
I needed somebody to be here, someone on my side. But if they came,
then it meant there was an officially declared medical and
mental-health crisis—and so far, I'd avoided looking that reality in the
face.

Since the earliest days of my illness, I had kept most of the details
(of my behavior, of the various diagnoses, of all the doctors' opinions,
of my therapy sessions) away from my parents. The reasons were, and
remain, complicated. First, I was ashamed; surely someone of my
intelligence and discipline should be able to exert more power over
herself. Second, I didn't want to worry them; they had two other
children, a business to run, and their own lives to lead. After all, I was
an adult, and so far I'd managed not only to handle things on my own,

but also to accomplish two fairly rigorous academic degrees.

Third (and this is the most sensitive of my reasons), I did not want
them interfering in my life. I already had many more people than I
could handle weighing in on the state of my brain and all the possible
treatments and outcomes, and there hadn't even been a clear
diagnosis yet. Why increase that burdensome cast of characters if I
could possibly help it? Why do that to myself? And besides, what could
they do to help?

So—up until now, by my own choice, my parents had been on a
need-to-know basis about my illness, which both shielded them and
protected my privacy and autonomy. Now that was over.

Later that day, as I was getting ready to leave the Intensive Care
Program room, I asked one of the attendants if I could get a pack of
cigarettes from my purse; it had been more than twenty-four hours
since I'd had one, and I was craving both the nicotine and the physical
feeling and ritual of lighting up. The nurse said that was fine.

Maybe it was the nicotine craving; maybe it was the aftereffects of
the phone call with my parents. Whatever the reason, I was suddenly
overcome with fear again, and when I opened my purse to get my
cigarettes, I spotted a small piece of metal, in the shape of a ring,
about the size of a Life Savers candy, something I'd retrieved in my
rooftop ramblings with my telephone-wire belt. Not sharp at all, not
weaponlike in the least. More a talisman, if anything. Quickly, I
slipped the metal ring from my purse into my pants pocket, and, after
smoking one cigarette, I slipped another—together with my
lighter—into my pants pocket as well. All of these, of course, were
contraband given my status at the hospital.

A short while later, I was told it was time to prepare for bed, and
instructed to change my street clothes for a hospital gown. As I was
getting undressed, the piece of metal and my lighter dropped out of
my pocket to the floor, catching a nurse's attention. Panicked, I
stooped down and grabbed them, then ran to the back of the small
room where I'd slept the night before.

"Give me the metal and the lighter, Elyn," the nurse asked.

Oh, God. "No," I said. "I need to keep them, for protection."

"You won't need them," she said. "We'll protect you. Hand them
over."

"No!" I insisted. "You're not going to get them unless I want to give
them to you, and I don't want to. Actions will be taken if you try to take

them away."

I don't know where this came from. I don't know why I felt about
the metal ring and lighter as I did, or why I threatened the nurse. I
had no intention of hurting her, or anyone else; in fact, I felt small and
helpless, unlikely (and unable) to hurt anyone. Nevertheless, out of my
mouth came the words, unbidden and scary, and I'd pulled myself up
to my full height while I spit them out.

The nurse turned and left the room. When she returned several
minutes later, she had a number of staff with her. A posse of four or
five in fact.

"Elyn, we want you to put yourself into restraints," the nurse said
firmly. "And if you don't do it willingly, we'll put you in them."

I couldn't believe it. "I'm sorry, I'm sorry," I begged. "Please don't
tie me down again. I'll be good. Anyway, I was just kidding.
Please!"

But I'd already lost the battle, and I knew it. So I passively lay back
on the bed while the staff did their handiwork. This second round was
almost worse than the first, because now I knew what the next hours
would bring.

Despite being given dose after dose of Trilafon, I was attacked by
my delusions, which swarmed thick and fast. The creatures in the sky
wanted to kill me; the creatures here on the ground were on the
attack. No one protected me. No one helped me. And as the night wore
on, my psychosis deepened. I sang, I shouted, I cried out in terror. I
was being
attacked.
And I struggled against the restraints until my
back ached and my skin was raw. All the while, the door to my room
was left open; anyone who walked by could look in, and a lot of people
did.

Eventually, exhaustion and the drug dropped me into sleep—a
black pit of dreams and nightmares and a lonely, aching body.

By the time daylight staggered in, I'd been in restraints for the
better part of thirty hours. "Please let me out," I wailed, but the
answer was a flat no. If they had a timetable as to when I might be set
free, they weren't sharing it with me. The day passed, and at eight
o'clock that night, I was still bound hand and foot.

Finally, the nurse I'd threatened the night before came in, again
with a stern-looking posse. Or maybe, in this instance, a jury.
Summoning whatever will I had left, I picked my way through an
apology—because I was learning that an apology for bad behavior,
made specifically to the person one had threatened (or insulted or
offended), was the down payment on a ticket out. And indeed, they
released the restraints. I struggled to sit up, and the room swam
around me.

"But you cannot leave the room," I was told. "We're waiting for a
bed to open up on the evaluation unit at Yale-New Haven Hospital.
When it does, we're sending you back there."

Was this all a dream? Was I doing this to myself, for some reason
that up until now had been so deeply buried that no one could
pinpoint it? Or was I, finally, just another crazy person? Would my life
be spent going in and out of mental hospitals, tied to a series of beds,
trying to fend off attacks from both without and within, and inevitably
losing on both fronts?

Fifteen hours later, I arrived once again at Yale-New Haven
Hospital, this time at the Psychiatric Evaluation Unit. Memorial Unit
10, aka MU10. One more stop on a journey that had become, on every
level, completely beyond my ability to comprehend.

chapter twelve

F
OR A PLACE
that existed ostensibly to promote the mental health
of the vulnerable people in its care, YPI had been a brutal experience
for me. I'd spent the better part of two days locked up, tied down, and
forced to swallow a medication that (while not without its benefits)
quickly made its side effects apparent: my face felt wooden and looked
like a mask; my gait had slowed until it resembled a stroke victim's
shuffle more than my own long-legged stride. And I couldn't track
even the simplest conversation. "How are you feeling today?" might as
well have been coming from ancient Sanskrit.

I desperately hoped that MU10 would be an improvement. The
hospital itself, New Haven's largest teaching hospital, was new and
modern, and the unit (on the tenth floor) was small, usually holding

fewer than a dozen patients. I was placed in a room directly opposite
the nurse's station (where anyone in it could be easily observed), and
there I waited to meet my doctor. For hours.

Finally, I was directed down the hall to the office of Dr. Kerrigan.
"Our plan is to work up a full evaluation and come to an actual
diagnosis," he said. "I know this has been a very difficult and
confusing time for you, Elyn, and we want to answer some of these
questions. And then get you referred as quickly as possible to a facility
that can help you." He gave every sign of someone warm and
encouraging, but appropriately authoritative. I wanted to trust him—I
wanted to trust someone—but I was learning to bide my time until
people showed their cards. So I listened as best I could (not easy to do
inside the fog of medication). But he seemed to be saying my future
meant only more hospitalization.

"No, you don't understand," I said. Inside my head, my voice
sounded like an old LP record on a very slow speed. "I need to get back
to law school. I'm losing valuable time. I agree about evaluation and
figuring out a treatment plan, but I can't stay in a hospital." I could
have both treatment
and
school, right? After all, that's the way it had
worked with Mrs. Jones. And we weren't talking junior college or adult
extension courses, either—I'd managed
Oxford. Graduate
school. And
I'd done well.

Dr. Kerrigan responded with what I quickly learned was his
favorite verbal tic, the highly annoying "I hear you"—in spite of the
fact that either he did in fact not hear me, or he did and didn't much
give a damn. "I hear you," he said, nodding solemnly. "And I
understand your concerns. But going back to school, I don't think
that's going to happen, Elyn, at least in the foreseeable future. You're
very sick."

"I'm feeling much better now."

"We can talk about it." The tone of his voice and the expression on
his face made clear that the subject was closed.

It felt like Kerrigan had taken his thumb and forefinger and
extinguished my single remaining flicker of hope. I was a student, not
a mental patient—why couldn't he see that? As the interview
continued, his words only made me more frantic and disorganized,
and I began to talk over him. "I can go back to school anytime I want,"
I insisted. "Did you know I was God? But I'm not anymore. What I am
now, I can't tell you. Have you killed anyone? I've killed hundreds of
thousands of people with my thoughts. It's not my doing. Someone
acts through my brain. I give life and I take it away." I stood up and
started to pace. "I'm almost as big as you. You can't hurt me. See that
hanger with your jacket on it? I can make that into a weapon to
protect myself. Do you mind if I take your hanger, please?"

"Sit down," he said.

"I don't want to sit down," I said. "I would like that hanger,
though."

"I don't think so," he said. "Please sit down now."

"No, I'd like to go back to my room now."

"I think that's a good idea," he said. "Another good idea is for you
to spend some time in restraints. We believe they help patients feel
safe, more in control."

I couldn't believe what I was hearing. "Restraints don't make me
feel better." I was pleading, but I was angry, too. At the very least,
somebody could have
asked
me what made me feel better.

"There's no need for alarm," he said. "MU10's policy on restraints
is a little different from Yale Psychiatric's. You can get out of them in
as little as half an hour, if all goes well."

Who defines what "goes well" is? I wondered. Kerrigan's tone and
expression belied any hope of negotiation—once again, I had no
choice but to run, which I did, right into the arms of the unit's staff. I
struggled, but again was tied to the bed, with a sheet pulled tight over
my chest.

MU10 considered tying people up a form of therapy. In fact, in my
chart, Kerrigan had written, "Use restraints liberally." And for three
weeks, they did.

Since I was considered too disruptive to be in any therapy groups, I
had very little to do with other patients, and was mostly kept apart
from them. I'd often sit under the little desk in my room and rock and
moan, gibbering away under the grip of fearsome delusions.

Much later, when I had the opportunity to read my own chart, I
discovered that the staff had actually been frightened of me; in fact, I
was so scary that I was "staff specialed," which meant that a staff
member was with me all the time, watching my every move. Staff
stood outside when I was using the bathroom, and the door was left
unlocked. I could shower with a curtain, but my "minder" could come
in at any time and pull the curtain back to see that I was OK. Which
she did. Which horrified me.

When I was allowed to wander around a little, I met a young
college student named James. He'd evidently had a very bad drug
experience, which spun him into a manic episode; he said they'd kept
him in restraints for three days. When I told him this wasn't my first
hospitalization, he reacted almost as though, in our brief friendship,
I'd somehow betrayed him.

"Wasn't once enough?" he asked angrily.

"It was, at least for me. I'm not here by choice, you know. I hate
hospitals. I hope you have better luck than I did and never come back.
At least there's something concrete you can
do:
never take drugs
again."

"I just can't believe you let this happen to yourself," he said.

I shrugged. "The killings were just getting me down. The ones with
my thoughts. The brain explosions which the crimes caused. Have you
killed anyone lately?"

James visibly recoiled. "Please don't talk that way. It really upsets
me."

"OK," I said, and thereafter, I tried to stick to it.

I was allowed only plastic utensils to eat with, and at one meal, I
jokingly held up my plastic fork and told a staff member I could stab

her if I wanted. I was immediately restrained.

When I became agitated and paced the corridors, I was restrained.

I kept careful watch whenever someone came onto or left the unit;
an open door was always an opportunity to make a run for it. Each
time I did it, staff caught me. And each time I was restrained.

When I voiced my violent delusions (which in spite of my best
efforts included thoughts about hurting staff, among others), I was
restrained.

In fact, any expression of anything that I was feeling—fear,
anguish, restlessness, disorganized and delusional thoughts—led to
immediate restraints. Even humor wasn't a good idea. My tendency to
bluff or make a wisecrack in difficult circumstances was
misinterpreted time and time again, and landed me in restraints.

My friend James couldn't understand why I kept setting myself up.
"Just do what they say," he said. "What's so hard to understand about
that? Do you
want
to be put in restraints?"

"No," I said. "What I want is to get out of here. That's why I keep
running for the door. Last time I made it down a whole flight of stairs.
I won't stop until I succeed. Massive unemployment and

introjections."

He sighed. "
Please
don't talk like that."

Part of the problem was that I was behaving like a patient in
psychoanalysis. When Mrs. Jones and I were working together, I was
encouraged to say exactly what was on my mind, always, no matter
how crazy it sounded—that was how analysis worked. That was the
point.
Otherwise, how would she know what was going on inside me?
But the people at MU10 didn't want to know. If they couldn't tolerate
what was in my head, why were any of them in this business? When
my scrambled thinking revealed itself, they put me in the hospital
version of "time out." Where was the "treatment" in this? Were they
wanting to help me get better, or did they just want me to be socially
appropriate? Overall, the sole message they seemed to want me to get
was "behave yourself!"

This is a classic bind for psychiatric patients. They're struggling
with thoughts of wanting to hurt themselves or others, and at the
same time, they desperately need the help of those they're threatening
to harm. The conundrum: Say what's on your mind and there'll be
consequences; struggle to keep the delusions to yourself, and it's likely
you won't get the help you need.

Staff decided that my drug regimen wasn't sufficient, so Kerrigan,
not wanting to exceed the maximum recommended dose of Trilafon,
put me on Valium as well. I hated Valium—it made me feel dopey, and
dulled whatever thought processes I had left. I could almost see my
cogent mind waving at me from the shore.

One day, I simply refused to take the Valium. Staff held me down
and gave me a shot. I later read in my chart that Valium is not effective
when given by injection. It just doesn't work that way. Even without
knowing that, I wondered whose needs were really being met on this
unit.

Contacted by Dr. Kerrigan and the MU10 staff, my parents came to see
me. (I had been embarrassed one afternoon when I overheard a
couple of nurses talking about their absence: "Where are Saks's
parents?" Despite having told me of their plans to visit, it had taken
them a week to appear.) To my surprise, they brought my two brothers
with them. As comforted as I was by their arrival, I was also
completely horrified that they were there. None of them had ever seen
me like this. I felt worthless, a failure. But I couldn't tell them what I
was feeling and they of course couldn't ask. And as hard as they tried
to put a good face on our time together, they, too, seemed stunned
that my law school life had come to this, a scant two months after I'd
first arrived at Yale.

We were allowed to have our Thanksgiving dinner together, in a
small dining area that had been "reserved" just for our family. As we'd
done during our summers and vacations together, my parents and I
coped as best we could, keeping conversation light and limited to easy,
even humorous subjects, while the gravity of my situation ran beneath
us like a furnace that held the potential for blowing me apart. We
joked that the fixtures on the wall were bugged and we were probably
being listened to, and our laughter echoed down the hall. My brothers
were somewhat quieter, and I could see by the look in their eyes that
they were confused and frightened.

The family therapist would later write that my parents had made
light of my illness and didn't seem walling to accept its seriousness.
The fact is, until this time, they'd only known as much as I'd told
them, and whenever we were together, including this time, I always
did everything I could to
hide
its seriousness: I cracked jokes, and
laughed, and was gratified when they did the same. It was our way of
handling it; it was our habit—and every family has its habits. The
levity and irreverence made it possible for us to be together without
everyone falling completely apart.

I had other visitors as well. Two of my law school classmates,
who'd heard what had happened, came by one afternoon, and
although it was obvious to me that they were struggling for the right
things to say, I was both comforted and moved that they'd come at all.
And my dear friend Sam from Oxford, who was now living in New
York, came to see me, too. When I showed him the leather straps on
my bed that were used to tie me down, he winced and shook his head.
He got it. And that gave me courage. It was so easy to feel isolated and
alone here; each one of these people who cared enough about me to
come and visit gave me reason to hope that I was worth saving.

Of course, visitors were turned away when I was in restraints
(although for obvious reasons they were not informed that was the
case). So some people went away believing I didn't want to see them,
when nothing could have been further from the truth. That said,
having company was sometimes exhausting and even confusing. I'd
summon focus and energy to keep the demons away during a visit,
and then go to pieces after friends and family were gone.

Young James left after my first week on MU10, and I then met two
new patients, Susan and Mark, and we spent a little time together
almost every day (that is, when I wasn't in restraints or trying to run
away). Susan, about my age, was bulimic. This was a condition only
recently recognized by the medical community, but it was far from
being understood—mostly, treatment seemed to consist of variations
of "mind over matter."

"My doctor says I should just stop binging and purging," Susan
said. "There's a simple solution to my problem, she told me—just stop
doing it."

I remembered when my parents, and Dr. Hamilton, essentially
said the same thing about my anorexia. "You know, it's my opinion
that 'just don't do it' is usually said by somebody who just doesn't get
it."

She nodded. "Now they're going to put me on the ward with older
people, the one-month-maximum unit. Do you think that might help

me?"

"The people here suck!" I said. "So it's got to be better on the other
ward. I hope you'll get what you need over there, I really do."

Mark was barely eighteen, and clearly had some kind of organic
impairment, although I didn't know the cause. He had no short-term
memory (I had to reintroduce myself each time we ran into each
other), was in a state of perpetual confusion, and had difficulty both in
speaking and comprehending what was said to him. He was so
endearingly (and vulnerably) young, it was hard not to feel maternal
toward him.
This is a child
, I thought, feeling angrier and more
protective each time I spent time with him.
Isn't there anywhere else
he could be—someplace gentler, with professionals who might take
better care of him?

One day, Mark told me he was scheduled for an overnight EEG,
which would give the doctors a more detailed picture of his
brain-wave patterns. He barely understood this, and for days he'd
fought having the procedure. (Where were
his
parents? I wondered.)
There was no way he understood the doctors' rationale. All he knew
was, they were going to stick electrodes all over his head, do
something scary to his brain inside, and not stop until the next
morning.

"Don't worry," I said, comforting him as best I could. "The things
on your head aren't needles—they won't hurt at all, you won't feel
anything. It's like they're little cameras, and they're taking pictures
that the doctors wall look at, to help you feel better."

"But why are they doing this to me?" he asked in a tremulous
voice. "What if they make a mistake and do it wrong?"

"That won't happen," I said. "They know what they're doing; this
wall help them fix whatever's wrong." I felt a little hypocritical—I was
pretty sure that they
didn't
know what they were doing. "Hey, let's go
play cards, OK? We can play any game you like."

Meanwhile, the Physician's Emergency Certificate that had been
signed when I was admitted to YPI was about to expire. The certificate
allowed the hospital to keep me against my wall for fifteen days; once
that time was up, one of three things had to happen. The hospital
could let me go, which is what I wanted, but that wasn't going to
happen. I could agree to stay in the hospital, by signing a piece of
paper called a "voluntary," which would be the equivalent of me
saying, "Yes, I agree to stay here and get treatment." But that wasn't
going to happen either.

The third option was for the hospital to request a formal
proceeding called a "civil commitment hearing." When a patient
insists upon leaving the hospital, and the hospital insists that the
patient needs to stay, a civil commitment hearing is held before a
judge, and it's the judge who makes the ultimate decision. The choice
seemed very clear to me: I would demand a civil commitment hearing,
ask to be released, and the judge, seeing the absurdity of the whole
situation, would of course send me on my way back to school.

My parents talked me out of that one, because they understood
more clearly than I did that the hospital would prevail. "No, go with
the Voluntary,' Elyn," advised my dad. "You can't be on your own
quite yet, but you certainly don't want anything in the record where a
judge
orders
you to stay."

Unbeknownst to me then, the consequences of being civilly
committed to a psychiatric hospital are severe and can be long-lasting.
For instance, many application forms (such as an application to sit for
the bar exam) ask whether one has ever been civilly committed. I
didn't know it then, but there would a come a day when I would be
very happy that I wasn't compelled to check the "yes" box. So,
following my dad's advice, I signed the voluntary.

Then I discovered some stunning news—MU10,
without
my
permission or knowledge, had called the dean of students at the law
school, to confirm that I couldn't return that year, or possibly ever. In
effect, MU10 withdrew me from law school.

When the staff told me this, I was overcome with such a sweeping
feeling of betrayal that I could barely catch my breath. What had
happened to the assurance of confidentiality? What had happened to
their sense of my own autonomy? All right, I was certainly somewhat
compromised, but I wasn't
comatose—
surely someone could have
spoken to me first. Who had done this? Who had taken it upon
themselves to release information that was mine alone, and that now,
no doubt, had settled into my academic file, probably in big bold black
type.

Completely overwrought, I begged my parents to call the dean, to
plead my case that I be allowed to return to and resume my classes.
And they did. They may not have believed that I was completely ready
to return—they weren't unrealistic people, after all—but in this gesture
they demonstrated that they absolutely believed in me, which was a
powerful message for me to get at that point. Their support
notwithstanding, of course the dean had no choice but to reject their
pleas. Nothing was permanent; I could always try again the following