'YOU ARE LOSING your grip on reality."
I sat back in shock, letting the verbal slap sink in. I had just been informed me that I was officially crazy.
This was not an offhand comment from a run-of-the-mill shrink, but the word of Dr. Otto Kernberg, a leading authority on the "borderline syndrome" and head of New York Hospital's Cornell Medical Center at Westchester. Not only that; by emphasizing the deteriorating quality of my mental condition over the years, Dr. Kernberg implied that my illness might be as serious as schizophrenia.
My own opinion of my rather bizarre experiences -- which had included anorexia nervosa, psychotic-like rages, suicide attempts, paralyzing depression, panic attacks and agoraphobia -- was that they were mere eccentricities that my former friends had not properly understood.
As I considered Dr. Kernberg's tentative opinion later, I became aware of how a cancer patient must feel upon being informed of the gravity of his or her disease. Even though he or she may have suspected the nature of the illness at times, its all-inclusive scope prevents the full impact of a diagnosis from taking effect -- until a doctor whom you must believe, a specialist, tells you so.
So now what?
Having spent a number of years in therapy (including six hospitalizations) and having been unable to use therapeutic techniques effectively, I was beginning to feel a little more than just discouraged. I had turned to therapy initially because it was clear that I was unable to cope with life's stresses effectively by copying my mother's principles to live by; nor had I formed any of my own coping mechanisms. Now therapy, I felt, was letting me down, too.
So what would help at this point? According to Dr. Kernberg, only another hospitalization -- for a full diagnostic evaluation. My heart sank. After the previous hospitalizations, I wasn't sure what good this one would do. But no doubt was left in my mind as to choice: There was none. Both Dr. Kernberg and my husband -- as well as the doctor whom I had been seeing "on the outside" and who had sent me to Dr. Kernberg in the first place for a "senior" consultation -- agreed that if I didn't go voluntarily, I would be committed. I was not ready to give total authority over my life to anyone else, so I signed the papers that would lock the doors behind me again.
My previous hospitalizations had done little good. At this new hospital, which I was informed ranks among the top four or five psychiatric hospitals in the country, I expected nothing new. I had been around mental hospitals long enough to have developed a preconceived and probably cynical notion of how they all must be, of necessity. I could not be expected to be eager to experience again these inconveniences, no matter how good the hospital's reputation.
First of all, the patient goes in there because he's feeling hopeless and helpless and unable to cope. So the first thing they do with their hospital routines is contrive to reinforce how helpless the patient really is.
The staff is usually nice enough. They're always friendly and smiling, and everyone's on a first-name basis so no one feels discriminated against. (They can afford to be smiling; at the end of the day, they get to get out of the menagerie and go to a decent home).
The first three days they take away your radio and they watch you like a hawk -- when you want to be, and are convinced you need to be, left alone -- to see if you're going to be "good" (cooperative) or "bad" (and therefore requiring a lot of attention and more time out of their busy day.) After that, if you're a good one and cause them no trouble, they leave you alone -- just when you've begun to feel like talking.
The staff then begins holding endless meetings, after which they still seem more confused than many of the patients and still refer most questions to the doctor, who, of course, is never around to answer them. There's always one "intellectual" aide (or "psych tech" or "psychiatric assistant" -- whatever name they call themselves to give themselves status) and one brawny one -- to cover all the bases.
At a teaching hospital, there also are usually a couple of female psychology students, very young, attractive and sympathetic -- and I wasn't exactly in the mood to be reminded about what an intelligent, college- educated, 35-year-old like myself could have been if I had not had my years of mental problems.
As for the doctor, I wouldn't mind talking to him -- if I could find him. Just locating this man with all the power in the unit is a major accomplishment, a safari out into the jungle. Everywhere you go, this ephemeral twit has just been. Someone said he'd be around the nurses' station around 7 p.m., but it's after 9 p.m. now. I ask again. Oh, he left at 5 p.m. Of course. How stupid of me.
By the time I do nail him down, everybody else is surrounding him, like a bunch of little kids, with the same complaints I've had all along. Of course, he's busy and can only take care of a few selected requests and then he's off. Where's he headed? Probably to his patients "outside." Well, I sure wish I was on the outside again, then, so I could get some of this attention they said I was going to receive so much of here on the inside.
Meanwhile, the staff tries to distract patients from the red tape with little amusements called group meetings and busy work -- your elementary basket-weaving classes. These activities are coordinated by some social worker -- who is either a fresh-faced college girl or a fortyish woman who sent her own kids off to college and went back to work so she could acquire a new family to care for at the hospital. In either case, they treat patients like 6-year-olds; they must alllhave been cheerleaders, with their overwhelming enthusiasm.
Then there are the physical discomforts -- lousy, greasy food (which constipates anyone, if that's not due to the medication that dopes you up so bad you can hardly stay awake due to the lack of activity), uncomfortable chairs in the so-called lounge, and the general mess and noice level caused by the disorganization of the general populace, which is, after all, a rather crazy cross-section of humanity.
Of course, 80 per cent of the general populace is usually as depressed as I am, which is somehow not helpful. Everyone gripes about how awful the hosptial is, but since they are so down, it's hard to imagine them feeling any differently about any place they might be. They can't sit through one television show or even concentrate on leafing through a magazine. What would they be doing at home?
Occasionally, there are one or two manic- depressives or obsessive-compulsives who are interesting and intelligent. And then, of course, there are the one or two real "freaks" (the hard-core schizos) who may either posture or hallucinate -- fascinating in their own horrifying way.
It all goes without saying that most people can't stand their roommates, and when they want to change to be with someone compatible, the staff turns them down.
Oh, well, my husband says I'll at least get a nice rest here -- but I never knew anyone who got a nice rest in a place swarming with a mass of miserable, heaving humanity. As they say in therapy, though, it all depends on me.
After five weeks, I'm out. My hostility level is down to a minimum, thanks to a lot of Mellaril, an antipsychotic drug, and Lithium, a mood-stabilizer. I am learning to "tolerate boredom," as one doctor said I should, attending a day hospital -- which means I can live at home and report to group meetings each day from 9 a.m. to 1 p.m., just like a job only I pay them -- and trying to understand what the hell has happened to me over the past few years.
One of the matters I'm trying to understand is why this hospitalization was different from all the others. Perhaps it is futile to attempt such an understanding, but I try.
One factor is definitely my own point in psychological development. Although I had been considered by others to be mentally ill before, never before was the gravity of my condition impressed upon me.
My doctor at this hospital said that I seemed to want to get well. There were two reasons for this. Previously, I -- and, I felt, my doctors -- had not considered me seriously ill. After all, most people are depressed at some time. So what's to get excited about over a patient who seems to be suffering from recurrent bouts of low-grade depression -- similar to someone who runs a chronic, low- grade temperature?
Secondly, I was pretty terrified at how far I deteriorated into psychosis. No wonder I wanted to get well. The world of a psychotic is definitely not a pretty one. I remember well the feverish, sleepless nights I spent getting carried away to some magical realm by my own thoughts. My thinking process seemed to me a miracle that could conquer anyone else's. Yet these same thinking processes could overwhelm me into crying oceans of tears over some nostalgic trivia; worse, I could be seized by episodic spasms of sheer unknowable terrors.
The first one to recognize the overwhelming seriousness of my illness was Dr. David Leibow, to whom I came after a long period without therapy. He realized that it was a more complicated case than my psychiatric history indicated, and he was able to get me the best possible evaluation (by Dr. Kernberg) and subsequent treatment -- even though I doubted the wisdom of the recommended course.
As to the hospital itself -- what was different about it? Nothing in the routines and the procedures. I think, though, that one aspect may have been the nature of the staff. At a teaching hospital, the doctors and nurses are newer to the profession (usually younger, though not always) and don't suffer from the "burnout" syndrome.
For me, this meant one of the most understanding, kindest, third-year medical students I have ever met. He spent countless hours with me, going over my history in detail. And listening, really listening. And understanding. And responding. He treated me as an equal, as did the young resident in charge of my case.
Before I went into the hospital, I envisioned myself being treated specially, like a supreme being among mental patients, because there was no other patient in the world who had a more incisive, clear-cut insight into psychosis than myself. (Indeed, I had done a great deal of reading in the field of psychiatry, and some doctors have commented that I may be one of those rare patients who has too much insight and is harmed by it.)
Of course, that fantasy (only half-fantasy) in my mind collapsed. But I was treated specially to some extent by Albert Wu, the medical student, and by the resident, Dr. Mark Epstein. Dr. Epstein told me that he was touched by how deeply affected I was by what had happened to me. It would have been inhuman of me not to respond to sensitivity so caringly expressed. And that's what was special about them.
Another factor was the existence of individual therapy sessions as well as group sessions. Patients didn't have to feel so much that they had to fight for the doctor's attention as happens when group therapy is the only course of treatment.
Of course, I must not overlook the new medication. For some reason, doctors in the past had not thought Lithium would work with me; and Mellaril was one of the drugs that had never been used on me before.
And though all the hospital inconveniences were there, this hospitalization pointed out to me that the hospital, with all its faults, is a microcosm of reality. The sad fact is that no matter how unappealing reality is at times, there just is no other choice. The alternatives -- psychotic fantasies or, worse, death -- are much more unattractive.
Another thing: No matter how angry one gets at reality (including other people in it, and not just its conditions), the appropriate channeling of that anger (even if it does not get you the expected results) is always the least self-destructive method of preserving one's dignity and selfhood.
And, wait, a third thing -- that I'd never learned or only half-learned from a dimly terrifying adolescence -- is that sometimes one has to accept (really accept, not just give lip service to) the things that one cannot change and deal with them as they are. Just a couple of minor personal examples: Since I am, clinically speaking, suffering from a variant of manic-depressive illness, I have to accept that I must, like a diabetic with insulin, take Lithium probably for the rest of my life. And that will probably result in a 10-pound weight gain (which, to a former anorectic like myself who thought I was just perfect when I carried 78 pounds on my 5-foot-8-inch frame, is rather horrific to me.).
None of these realizations is particularly earth-shaking -- nothing to shout a "eureka" in psychiatric circles about -- but I feel they are the three most valuable lessons I could have obtained from just one hospitalization (which I gleaned from none of the others). I am also glad to have the official clinical diagnosis, because I have always tended to accept matters that can be proved by scientific facts, and I always knew that my previous diagnoses were incomplete or wrong.
Of course, I constantly tend to forget these lessons now that I am out. I still get down, still feel frustrated, still get angry -- but with somewhat less intensity. I still try to work on reminding myself of their value and plug away at it -- knowing that I still have another 35 years left to work on pulling it together out of what are now the ashes of the first 35 years. Because I remember, very clearly and with painful detail, how awful it was to be psychotic.
And, as I keep reminding myself -- there is no other real choice.