The Center Cannot Hold: My Journey Through Madness (10 page)

When I trudged back to the Warneford and reported to the staff
what my weekend stroll had consisted of, they upped the ante. "You
need to come into the inpatient unit now, Elyn. You need to come in,
and stay in. You're in serious danger if you don't." I didn't need much
convincing. Terrified of what I might do if left to my own devices, I
went back to my dormitory room, packed up my belongings, and
boarded the bus that would deliver me to a mental hospital.

I boarded the wrong bus. Confused about where I was, where I
needed to go, and how exactly to get there, I finally arrived at the
Warneford several hours late.

I had all the makings of an excellent mental patient.

When I'd first gone to the day hospital, I at least went back to my
Oxford dorm at night, and so could continue to tell myself I was a
student. Throughout each day, I often felt caught somewhere in
between. Was I a mental patient or a student? Where did I really
belong, at Oxford or at the Warneford? Should I spend my days in the
library or in group therapy? The choice always seemed to be mine.

But the minute I checked into the inpatient unit, the pretense of
being a student no longer held: I was a psychiatric patient, in a
hospital for the mentally ill. The in-sane. Unlike inpatient units in the
States, however, this one had no locked doors.
I can leave anytime I
want
, I told myself, trying for reassurance. After all, if I stayed, it was
because I decided to.

As part of my admission to the inpatient unit, it was necessary for
Dr. Smythe to give me a complete physical exam. At first, it was
comforting to feel her gentle touch, hear her voice soothing me, telling
me everything would be okay. Her entire manner was pure kindness;
when was the last time I'd even experienced kindness? When was the
last time another human being had even touched me, let alone gently
and with the kind of care that might be seen as a kind of affection?

But then my mind abruptly corkscrewed:
I'm vulnerable, I'm open
to attack, I'm exposed in front of her and she's going to hurt me.
Once
the exam was over, I sat up quickly and covered myself, staring
straight ahead as she completed her intake notes.
Only the craziest of
the crazies come to a mental hospital. I am lazy. I have not fought
hard enough. If I had really tried, I wouldn't need to be here.

Most patients, including me, slept in a large dormitory, with ten or
so beds in a single large room, although there were a few single rooms
in each ward. The people I met, and ate with, and was in group with,
were not all that different from those I'd met at the day hospital. One
of them, a pleasant young woman named Lynn, was a nurse who
believed that people were sending her coded messages by the way they
parked their cars. She was typically British in appearance—fair skin,
fair hair, medium height, a bit plump. She had an approachable
manner, and I was so lonely. We became friends.

Lynn and I often took long walks around the Warneford grounds,
sometimes talking for hours. One of her favorite topics of conversation
was the many meds she was taking. "They're giving me placebos for
medication," she said, laughing, "not the real thing!" She then shared
with me her amazement and delight that they actually worked!
Months later, long after we'd both gone back into the world, I saw her
walking around Oxford in a daze, grown obese from the drugs.

Another patient, an older woman back at the Warneford for the
second time, relayed the information about her repeat status in a
matter-of-fact manner, as if it were not uncommon and might even be
a good thing. Simply, she had been "in" last year, left for a while, and
now here she was, back again. It gradually dawned me that many
other patients were here not for the first time, but for the second, or
the third.
No,
I thought.
Not me. This is my first. My last. My only.

Dr. Smythe, along with the other staff, kept arguing on behalf of
antidepressants. I resisted; they kept the pressure on. "What you have
is not a fault of will, Elyn," the doctor explained. "It's biochemical.
Untreated depressions can last a year or more—do you truly wish to
wait that long? The meds will have you feeling better in a few weeks.
These are not street drugs, they're a way to get better."

I refused. "People ought to get better because they work at it, not
because they take some pill," I said. "Taking pills is cheating." The
words of the counselors at Operation Re-Entry rang in my head like a
big brass bell:
Take responsibility for yourself
The idea of putting a
pill in my mouth disgusted me. Just as disgusting was the idea that I'd
somehow become so weak of character that I needed a drug to get
better. "I'm not sick," I protested. "I'm bad."

Then one day something happened that changed my way of
thinking—that changed everything.

I looked into a mirror.

It was the first time I'd actually seen myself in weeks. And it felt as
if someone had punched me in the stomach.
Holy shit
, I thought.
Who
is that?
I was emaciated, and hunched over like someone three or
even four times my age. My face was gaunt. My eyes were vacant and
full of terror. My hair was wild and filthy, my clothes wrinkled and
stained. It was the visage of a crazy person on the long-forgotten back
ward of a hospital for lunatics.

I was scared of dying, but even more scared of what I saw in the
mirror. The woman looking back at me was in some kind of terrible,
terrible trouble. I vowed that I'd do whatever I needed to do to get her
out of this place in any way I possibly could.

The choice seemed clear: drugs or death. I went off immediately to
find Dr. Smythe. "OK, yes, I'll take your drugs," I said to her, the
words all running together in a panicky, clumsy mess that fortunately
she understood. She smiled at me in return.

"Oh, Elyn, I am so glad," she said. "This is best for you, you'll see."

Then she told me that she was going to be out of the country for
some time, and that Dr. Edwin Hamilton would be my new doctor.
The following day, I met with Dr. Hamilton for the first time. And for
the first time I finally took a prescribed psychiatric medication—
amitriptyline, an antidepressant. Three times a day, the hospital gong
would ring; three times a day, I queued up with the rest of the patients
for my pills.

Amitriptyline's most prominent side effect is sedation—
immediately, my speech slowed down, my agitation decreased, and
the world seemed to be operating in slow motion. And my mouth was
always dry and I was constantly dizzy. As uncomfortable as I was (and
as annoyed with how slowly my mind seemed to be working), I was
determined to finish what I'd started. The good news was that I
immediately began sleeping through the night, and I couldn't even
remember the last time that had been the case—the summer before?

In our first therapy session after the drug started to kick in, Dr.
Hamilton asked me how I felt. I mentioned the side effects, then
thought about it for another moment. "Strangely, I feel less angry," I
told him.

"That's very interesting," he said. "Indeed."

Not until that moment had I realized how much rage I felt,
directed mostly at myself. It was as though I had been carrying a large
sandbag on my back, and now some of the sand—just a little, but
some—had been let out. And with my load just a bit lighter, maybe
another kind of hard work could begin.

I trusted Dr. Hamilton immediately, and he was so easy to like, not to
mention easy on the eyes as well. His mother was foreign, so he didn't
look or act in a way I'd come to think of as classically British; he
seemed more open and approachable than anyone I'd met in Oxford.
He effortlessly made jokes; he spoke to me as though we were friends;
he seemed to care about me. I looked forward to our appointments, no
matter how difficult the conversations were. It was human contact,
and I craved that.

While he listened to my negative thoughts and feelings, Dr.
Hamilton showed little interest in knowing what they were about;
instead, he focused solely on how I might make them go away. Rather
than delving into my past or my unconscious, he focused entirely on
my present—what we could do to make things better "right now" and
how I might begin digging out of my depression. He offered some
simple, concrete suggestions, like making written lists and a schedule,
to keep me on track and not overwhelmed by what I had to do (and
things I kept forgetting to do, like washing my clothes).

His approach meshed well with the daily activity groups I was
attending, where I was encouraged to accomplish small things; for
instance, coming up with a good word in Scrabble or helping set the
table for a meal—simple achievements that I'd always taken for
granted before, but which now allowed me to feel some sense of
mastery and even pride.

I adored Dr. Hamilton, and I would have done anything to get
better
for
him. Freud had picked up on this phenomenon in the early
1900s; he labeled it the "transference cure." Like a schoolgirl with an
apple, I was eager to polish up my mental health and give it to my
wonderful doctor.

After just a week, I told Dr. Hamilton I wanted to get out of the
hospital, soon. And a week after that, I firmly announced that I was
officially ready to leave.

"Elyn, are you sure?" he asked. I could hear the skepticism mixed
with genuine concern. "There's no shame in being in a hospital while
you're being treated for an illness, you know."

Yes, yes, I was sure. "I want to get back to my studies," I said. "But
once I leave here, wall you continue to see me on an outpatient basis?"

I was grateful when he finally said he'd not only respect my wash to
go, but would continue to see me as an outpatient. The rest of the
staff, however, was visibly and vocally alarmed. The nursing staff
quizzed me about my plans and cautioned me about my expectations
for life back in the world. "Don't feel bad if you have to come back,"
they said. "That sometimes happens." No, not to me it wouldn't.

Just two weeks after arriving, I left the hospital, back to the dorm
and my academic work. I told anyone who asked that I'd been on
vacation and was eagerly looking forward to the new term. My old
tutor had gone on a sabbatical; happily, my new tutor seemed
amenable to working more closely with me. In my handbag, I carried
Dr. Hamilton's card with the time of our appointment the following
week. Everything was going to be just fine.

By my second outpatient appointment with Dr. Hamilton—four weeks
after I'd begun taking amitriptyline—it was clear to both of us that the
drug was doing what I'd agreed to take it for. I was brighter, less sad.
In spite of not having the kind of physical energy I'd have preferred, I
did feel more mentally alert, more focused, and the suicidal thoughts
had all but faded completely. I started to take pleasure in daily
life—food tasted good to me, outside air and even England's rainy
weather felt good to me, and, what's more, I could concentrate. I was
thrilled one night to realize that I'd been reading a complicated
textbook for three hours and hadn't once had to stop and begin again,
to try and unscramble text and meaning and hold my head in my
hands and weep from frustration. No, I was
getting
it. Slowly, I began
to speak to people in the dormitory and on the campus as I walked
here and there. I went to a few college events, and even out to dinner.
It was all falling into place again; I got up, I went out, I learned, I
spoke with people, they spoke with me. I ate, I worked, I slept. Simple
pleasures and goals, all seemingly possible. Despite my "training" at
Operation Re-Entry, I was beginning to have second thoughts—could
it be that drugs might have something to offer me after all?

Surprisingly, that whole academic term went very well. I did catch
up with the required reading, and ultimately wrote seven papers,
which impressed my tutor—at the end of that term, he wrote a very
positive evaluation for my records. The outpatient sessions with Dr.
Hamilton were proceeding nicely as well. I had no trouble
accomplishing the simple "homework" assignments he gave me, such
as preparing a daily schedule each morning and sticking to it; in the
evenings I was reading Aristotle's
Metaphysics
in the original Greek. I
was both the mental patient and the student, and was competently
balancing both, pacing myself, managing things.

And then, as the term was about to come to an end, I suddenly
stumbled. Mysteriously, I had trouble completing the final paper of
the semester. I'd read all the assignments, but couldn't come up with
anything to say. I made one false start after another, then crumpled
the paper and tossed it to the floor. A third sentence, a second
paragraph, a fourth page—nothing. I could not connect the dots. A
setback that might have been only simple frustration for someone
else—a slight case of writer's block, a change of plan that might have
meant taking a day or two off, going to a movie, having a beer—made
me wild with fear. Am I going backward again? Didn't Dr. Hamilton
and I solve this, didn't the amitriptyline fix it? Had it all been some
kind of chemical trick? I wanted to hit my head with something hard.
The very thought of meeting with my tutor to discuss the paper
reduced me to uncontrollable sobs.
I don't have anything to say. I am
a failure. It is only a matter of time before people see I am stupid.
And crazy.

The Warneford staff had tried to caution me that I wasn't ready to
leave the hospital yet, but I hadn't listened to them—and now, it
seemed, all I could do was watch helplessly as once more, everything
began to slip out of my grasp. I started to lose weight again; in just a
few weeks, I was down to ninety-five pounds. I looked like a torture
victim.