Notes from Inside

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Probably the first thing you notice on a psych ward is that the category of "crazy" spans an entire continuum from severely-depressed-but-otherwise-rational-and-somewhat-functional to suffering-from-irreversible-dementia. It seems that this continuum presents as a bell curve, with a small number of basically "okay" individuals at the far left end, a few of those tragically lost and gone forever at the far right end, and the majority distributed in between. In general, the "okay" individuals tend to stick together for obvious reasons, but probably also to validate their own sanity to themselves. They talk, joke, laugh, play games, and try hard to conceal whatever emotional greyness led them here in the first place. They're no more or less damaged than anyone else, but can either mask their pain or have had a genuine reappraisal of their whole scene. They (or I should say "we," since I rightly or wrongly count myself as a member of this group) congregate for the most part in the common room, where meals are eaten, meetings are held, and staggering quantities of TV are consumed. (I watched eight episodes of House on Friday, for instance). This room serves a double purpose for these folks. Of course it provides the basic and still functioning need for socialization, and this group seems genuinely to be interested in the lives and woes of the others, their laughter never forced, their affection and camaraderie never feigned. On the other hand, however, I think that we use the common room as a sort of safety net. It's easy when you're a generally affable person to surround yourself with similar people in a common place where you can tune out your brain to the Kardashians or Monday Night Football. It's far more difficult to confront yourself nakedly in the harsh light of long-ignored truths.

The folks in the middle part of the curve tend to come and go as befits their mental and emotional state; at times they sleep through the entire day without encountering another person on the ward except their "team" (more on this in a bit). Or they just can't handle being around others. For some, this is due to physical difficulty -- complications with new medication or drug withdrawal. Others are too mired in their own hurt, and require a sort of tortured solitude in which to sort through their scattered emotions and understand their battered psyches. When they shuffle through the halls, faces tight and drawn, they radiate the depth of their ache. Their silence is chilling really, and no matter how badly you want to crack them open and show them some light tucked away in a forgotten place, there are just some people you know better than to approach. Others in the middle flutter around the margins, drawn like moths to what they perceive as light. They'll come into the common room and sit to the side, laughing nervously or venturing a comment on a joke or a discussion about whether or not you'd let Tom Brady have his way with you (this was an actual conversation). They're visible but withdrawn, "around," but not really there.

Often the individuals in the middle part of the curve are older -- seasoned veterans when it comes to institutions and psychotropic drugs. To a younger observer, their situations are both heartbreakingly tragic and troubling. What to make of the gentleman in his 60s who hasn't said a word the entire time you've been here? He's like a ghost, a bearded ghost who sort of haunts the hallway, and you can tell he's been through some shit in his time, but what happened to him at this point in his life to bring him back here? (You've learned this is hardly his first time). What kind of infinite sadness causes life to break down so many times at a point where identity has been negotiated, decisions made, major life experiences conquered and celebrated? But then there's the woman in her 40s who does nothing but laugh, whose ataxic staggerings and stumblings into your chair has already caused two coffee burns, and whose slurred queries re: AA meetings make you wonder if maybe she isn't here because of an acute emotional crisis, but rather a solid case of Wernicke-Korsakoff.

The third subset is without question the most tragic. These guys are the ones who aren't coming back. They're entirely enclosed within their illness or the ravaged remnants of a decades-long addiction. You generally try to steer clear of these folks, or at the very least, interact with them while exercising extreme caution with the awareness that there's a pretty good chance that the conversation will veer off into a succession of disturbing non sequiturs. For which reason, this crowd tends to function as entertainment-cum-antagonist-in-chief. The one exception I've come across here is a 19-year old kid whom we shall call R. R. is one of the most gentle and kind individuals I think I've ever met. R., however, suffers from advanced schizophrenia, and has been put in four-point restraints three times since I've been here. The meds he's taking to keep him from flying apart keep him heavy-lidded and sedated. He plods through the unit and speaks slowly when he speaks at all. He sleeps 16 hours a day. This is unspeakably sad.

The others that comprise this group consist pretty much of your garden variety schizophrenics, bipolar individuals, and addled former drug addicts. There is naturally some blurring of these boundaries. We'll pick it up there tomorrow.