The Center Cannot Hold: My Journey Through Madness (11 page)

Dr. Hamilton, however, did not want to focus on my weight loss.
"It's a red herring," he said calmly. "It's not what's really going on with
you."

I was disconsolate. "But what's wrong with me, that I can't eat? Is
this anorexia? Am I going to die?"

He said anorexia was a grab bag term. "We're not going to focus on
symptoms and labels, Elyn. Let's focus instead on you getting your
work done. And for now, just eat more, OK?"

His simple-sounding approach to my weight loss didn't help much,
but it didn't dampen my feelings for him, either. He was so smart, so
sensitive, so kind.
He knows me like no other,
I thought,
and he
knows what's best.
I would leave his office temporarily
reassured—well, if this is what he thinks, it must be true—but once
outside, I'd slam into the wall of the truth: It was all going badly
wrong. I started muttering again
—I am a bad person, I deserve to
suffer. People are talking about me. Look at them; they're staring at
me. They're talking about me.
In all likelihood, that part, at least,
wasn't paranoia. Given my appearance, it seems quite likely that
people
were
talking about me.

In all this time, I'd never told my parents about my illness or
hospitalization. I didn't want them to worry; even more important, I
didn't want them to think less of me, that I was somehow a weak or
crazy failure. I wanted to fix myself, and not have my problems in any
way leak into their lives. But the time for keeping the secret was
coming to an end. They'd let me know that they were traveling to
Paris—quite naturally, they expected that I would come join them
there and we would spend some time together.

In spite of the fact that I was thin as a rail, jumped at my own
shadow, refused to speak to virtually anyone, and went around talking
to myself, I hoped they wouldn't notice. Indeed, it was a mark of my
impaired judgment that I believed I'd actually be able to pull it off. But
as soon as we met, the stunned looks on their faces told me I wasn't
going to get away with it.

Nevertheless, it was four or five days of phony joie de vivre before
my father finally knocked on the door of my room and said he needed
to speak with me about something.

"Your mother and I are extremely worried about you," he said. I
could hear the intensity in his voice and see the effort he was making
to keep his face relatively calm looking. "We've tried to give you a
number of chances to tell us what's happened, but you're not saying.
We're so worried, Elyn, we're not sleeping at all. Please tell me what's
going on."

I took a deep breath and then plunged in. "I'm sorry I didn't tell
you," I said. "I got depressed during the year."

Was that relief on his face? It made me wonder what he and my
mother had been imagining the past few days. Had they been
discussing me each night in their room? "You're so thin," he said. "We
were convinced you had cancer."

"No," I said. "Just depression."

"How did they treat you for it?" he asked. "Because you are being
treated, aren't you?"

Here it comes. "I was in a mental hospital."

He paused a moment. "Did they give you any medicine or
anything? Don't they have medication now for depression?"

"Yes, they do," I told him. "I didn't want to take it, but finally I did,
and it has helped."

Yes, there it was—definitely, it was relief I saw. "Let's go and tell
your mother."

We walked without speaking to their room.

My mother was sitting on the edge of a chair, clearly waiting for
some kind of dire news that would no doubt involve my impending
death. When I told her what was actually going on with me (albeit the
same shortened, tidier version of the truth that I'd given my dad), she
initially flinched at the news, but relaxed when she heard about the
medication. It was a problem, there was a solution, and now it was
fixed. End of discussion. Each person's privacy and dignity was still
reasonably intact. And so, where shall we go for dinner? "Elyn, you
simply must eat more."

What transpired among us didn't much comfort or reassure me,
but at least my worst fantasies had not come true. They didn't disown
me, or tell me I was a failure, or accuse of me being weak by having to
take medication. In fact, they were kind, concerned, supportive. But I
was such a horrible disappointment to myself. How could I not be a
disappointment to them as well?

For the remaining days of our Paris trip, my parents pressed me to
eat. Have a bite of this, try a taste of that. And, as pleasantly as I could,
I took a tiny taste, faked a little bite, but in truth I continued to resist.
I am bad. Only good people get food. I deserve to starve. I deserve to
be tortured. Starvation is a fitting torture for me.

When I returned to Oxford from Paris, it got worse. I felt compelled to
go back to my first tutor, because he was the top person in ancient
philosophy at Oxford, and I wanted to study with the best. But it was a
complete disaster. His manner was distant, even dismissive; in my
view, he had a very low opinion of me. I felt doomed. I could not
concentrate. I did not write. I did not sleep, I did not eat. I did not
bathe.

I spent more and more time gibbering to myself, restlessly pacing
through the streets of Oxford, imagining what people were saying
about me. I narrated events to myself as I walked:
Now she's walking
down the street. She's ugly. People are looking at her. People are not
to be trusted. Be careful. Be vigilant. They will hurt you That man's
face just turned into a monster face. Be inconspicuous. Don't let them
see you.

There were fantasies as well.

Dr. Hamilton finds me in my bed, emaciated and confused. I have
not been able to get out of bed for weeks. He is gentle and reassures
me that he can help. I want to believe he can help me. He helps me
get out of bed, but even with his help I can barely walk. I am too
weak. I am weak.

Thoughts of suicide came rushing back in, along with intense
fantasies of exactly how I'd do it. Throw myself into the river. Set
myself on fire. I was particularly drawn to the latter. I was, after all, a
witch; being burned at the stake seemed especially fitting. It was only
what I deserved.

Meanwhile, I was telling Dr. Hamilton some, but not nearly all, of
what was going on inside my head. He'd made it clear he didn't want
to delve into my darker self—and since I was still desperately trying to
please him, how could I tell him something so ugly?
Please like me;
please want to help me. Please don't be disgusted with me.
He
constantly urged me to eat more—and then suggested (or maybe went
along with my request, I can't remember now which it was) that
perhaps the medication needed review. Maybe it was the medicine
that was failing me, rather than me failing myself.

I'd barely had time to digest this possibility when he announced
that I shouldn't become too dependent upon him, since it was time
that we change the schedule of our meetings—to once every
other
week.

I was horrified. I needed more therapy, not less—even in the midst
of my worsening state, I knew this was true. I was also baffled; in
effect, he'd cut our time together in half. Was this rejection? Was I
such a disappointment to him? Finally, Dr. Hamilton explained that
he was being rotated. As of the next month, he would be transferring
to another unit in the hospital. So the news was even worse than I'd
thought: He would no longer be able to treat me at all.

I tried to cling to the logic of his explanation, but it only felt like
loss. It was Dr. Hamilton who'd led me out of the dark woods the last
time—how would I ever get out of the woods now? By the time I
arrived for my next appointment, I had deteriorated badly; I could
barely speak, I could not meet his eyes.

Years later, after I received my records from the Warneford, I read
the note Dr. Hamilton wrote upon seeing me that day: "Looks
ghastly."

He asked if I was thinking of killing myself.

"Yes." Hunched over again, eyes to the floor.
Don't look at me,
don't look at me.

"You have to come back into the hospital, Elyn. Right now."

And so, eight months after my first hospitalization—where I had
had the vain hope for a quick fix and had begun to experience the "am
I a student/am I a crazy person?" two-trains-running conundrum—I
wearily checked back into the Warneford for my second
hospitalization, officially one of those patients who had "come back."
The admission note summed things up pretty well: "Thin, tall,
chain-smoking, sad, inappropriate laughter at times, seems physically
and mentally retarded."

I hated myself.

chapter six

A
LL THROUGHOUT THOSE
first long hours of my second stay at
the Warneford, I stood alone in the dayroom and rocked back and
forth, my own arms wrapped around me like a straitjacket, rocking
myself much as a mother will quiet a distraught baby. The even
regularity of the movement comforted me. Skeletal, dirty, and
gibbering disjointed syllables under my breath—and unceasingly
rocking—I slid deeper and deeper into my head with each passing
moment. Doctors, hospital staff, and other patients moved in and out
of the room and along the corridor outside it: I could barely see or
hear any of them, and I cared even less.

Finally, a nurse carefully walked up to me and positioned herself
directly in front of my face. "You seem so agitated, Elyn," she said, in

that deliberately moderated tone of voice one might use to approach
an animal chewing its own foot. "I would like you to see the doctor on
call."

I shook my head, and the room spun around me. "No. That's not
necessary," I muttered. "I'm fine. Thanks anyway."

As she quickly left the room to search for a doctor (evidently, she
didn't think my self-diagnosis very credible), I just as quickly headed
in the other direction, to go outside and wander about in the hospital
courtyard. It was January—cold and damp and raw, with light patches
of hoarfrost on the ground. I was wearing only jeans, a T-shirt, and
sneakers, and I was cold to my bones; given the circumstances,
however, I might have been just as cold if I'd been wearing a down
jacket, wool hat, and heavy winter boots.

My legs gave way beneath me, and I slowly crumpled to the ground
in a heap. There I stayed, curled up in a ball, for at least an hour. What
was happening to me? Why had it happened? And who would help
me? But no one came.
No one will ever come
, I thought.
I am
worthless, I cannot even control my own mind. Why would anyone
want to save me?
Eventually, I pulled myself up and wearily went
back inside, stumbling around until someone directed me to the place

where I was to sleep. I never did see a doctor that night.

The following day, I met with a group of half a dozen doctors for
what they told me would be an intake evaluation. The meeting was
held in a very large and intimidating office. I was relieved to see Dr.
Smythe, who smiled and acknowledged me in a reassuring way. Then
the inquisition began.

"You're very thin, Elyn. Can you tell us why you've lost so much
weight?"

"I think it's wrong to eat," I told them. "So I do not eat."

"But why?" they asked.

"Food is evil," I said. "And anyway, I don't deserve to have any. I
am evil, too, and food would only nourish me. Does it make any sense
to you to nourish evil? No. It does not."

After a few more rounds of questions, the doctors carefully
explained their recommendations to me. In England, treatment
recommendations were always just that—recommendations. To leave
a hospital, to stay in it, to take medications, to participate in group
activities or not—they never forced any of it on me, and each time the
decision was mine. Even at my craziest, I interpreted this as a
demonstration of respect. When you're really crazy, respect is like a
lifeline someone's throwing you. Catch this and maybe you won't
drown.

First, they wanted me to go back on the amitriptyline; I agreed.
Second, they wanted me to stay in the hospital for a while—how long,
they weren't yet certain. This, too, was fine with me; as befuddled as I
was, I knew I couldn't be away from the hospital now. But when they
suggested that I drop out of Oxford altogether after my hospital
stay—and then questioned whether it might be best to call my parents
and let them know what was going on with me—they had crossed a
line.

I came back in full force.

"I
will
remain enrolled at Oxford University. I
will
receive my
degree in ancient philosophy. I will
not
return to the United States
before I have completed my academic work. And under no
circumstances shall you contact my parents." This was more linear
speech than I'd been capable of in weeks; I wasn't quite sure where it
came from, but it was exhausting. And, surprisingly, the doctors
acquiesced to my conditions.

Perhaps I should have wanted or even needed my parents to know
what kind of shape I was in. Maybe I should have been hurt that they
hadn't seemed to pay much attention to my health after our last visit
together in Paris, after I'd "confessed" my struggles. And yet it's not as
though I'd been entirely forthcoming with them, either. My brother
Warren, who was living in Paris at the time, came to visit me at
Oxford, but I made him swear he'd not tell my parents how badly I
was doing. Once a week or so, I walked to a phone booth a few minutes
down the road from the hospital, and from there called them in
Florida, collect. The conversations were always brief, even skimpy, but
evidently sufficient not to raise any alarm bells. The basic script from
my end: "I'm fine, my studies are going well here at Oxford, and how
are all of you?" Aside from that, my parents usually did most of the
talking and I just leaned on the booth for the duration, responding
where appropriate, mostly in single syllables. As I watched everything
I valued disintegrate, I nevertheless fought to somehow hang onto my
autonomy—my
self.
Whatever this was I was fighting, it was my
problem; I would have to find a way to solve it without either asking
for my parents' help or incurring their disapproval.

My readmission to the Warneford coincided with Dr. Hamilton's
rotation and departure to another ward. Although I'd known it was
coming, I could not control the anxiety and sadness during our last
meeting, when he introduced me to Dr. Barnes, the young woman who
would now be treating me. "I'll come back and say good-bye before I
leave, Elyn," Dr. Hamilton promised. "Just to check in with you and
see how you're doing."

Being passed along to his replacement made it real—he was
leaving me. And even though he'd be just a few rooms away, he might
as well have been going across the ocean, since his move precluded
our having any further relationship. To make things even worse, the
good-bye visit he'd promised me never happened. He never came
back. When I thought of him, I thought my heart would crack in my
chest.

Unlike during my first hospitalization, this time around I was
completely unable to participate in anything that was going on in the
ward; the group activities that had seemed at least mildly helpful
before, such as ensuring that the table was properly set, were useless
now. I was in such terrible pain, physical as well as emotional. My
head ached, my arms and legs ached, my back ached; there was
nothing in or on me that didn't hurt. My sleeping patterns were so
erratic again that I was exhausted all the time and couldn't
concentrate—what earthly difference could it have made to me if
spoons and forks went on the right or left side of the plate? Instead, I
gravitated to the music room, where I passed hours on end listening to
classical music. Sometimes I was joined there by a somewhat
overweight woman ten years or so my senior. Like me, she barely
spoke, other than an occasional word or two about her mother, who
had died many years before. When she did speak, the content was
slim—she had what psychiatrists call "poverty of speech." Still, we
shared a kind of companionship; listening to Mozart or Brahms
seemed to calm and comfort us both. At particularly stirring passages,
our eyes would meet, and we would nod in a kind of recognition.

The other patients seemed afraid of me—or maybe, seeing me
every day with my face buried in my hands, they just thought it best to
leave me be. The disheveled young man from Oxford whom I had first
seen at the day hospital was now on this ward as well, in much worse
shape than before; he believed he was a baby, and would vomit after
meals and babble nonsensical syllables.
That's going to be me,
I
thought.
That's where I'm going.

One day, a good looking, middle-aged man was admitted to the
ward, but then quickly disappeared. I later learned in an offhand
comment from staff that my appearance especially had unnerved him.
Thereafter, he refused to spend the night at the hospital, agreeing to
be a patient on the day unit only and refusing to be with patients as
sick as I. There was, it seemed, a hierarchy of fear at the Warneford:
sicker patients unsettled me; I, in turn, unsettled less sick patients.

For a time, I was friends with a woman named Lucinda. She was
my age and was battling anorexia. The hospital had put her on a
behavioral system whereby, if she hadn't gained a certain amount by
designated days, she had to spend that day in bed. I, too, was very
thin, but my doctors had decided that the weight loss was due to my
primary diagnosis (severe depression) and not simple anorexia.
Lucinda had been treated by Dr. Hamilton at one point and told me
she'd taken a great dislike to him. This amazed me. How could
someone
not
like Dr. Hamilton?

A month after I'd been admitted, the staff moved me from a
private room to a dormitory with more than a dozen other patients,
explaining with classic British understatement that I "kept myself to
myself' too much, and that perhaps being with other patients would
resocialize me. The move did not have the desired effect—I simply
retreated to the bathroom, where I spent hours sitting on the floor,
smoking, rocking back and forth, and moaning softly to myself. The
bathrooms were filthy, as bathrooms can be in psychiatric hospitals,
but I didn't care. All I wanted was to be alone. If I needed to sit on
floors and lean against walls spotted with human feces in order to do
that, so be it.

Once, there'd been a time in my life when thoughts were
something to be welcomed, and pored over, like pages in a favorite
book. Just to idly
think
about things—the weather, the future, the
subject of a paper I needed to write for a class, the friend I was going
to meet for a cup of coffee—these things felt so simple, so
taken-for-granted. But now thoughts crashed into my mind like a
fusillade of rocks someone (or something) was hurtling at me—fierce,
angry, jagged around the edges, and uncontrollable. I could not bear
them, I did not know how to defend myself against them, and I could
not bear to be near anyone when I was experiencing them.
You are a
piece of shit. You don't deserve to be around people. You are nothing.
Other people will see this. They will hate you. They will hate you and
they will want to hurt you. They can hurt you. They are powerful.
You are weak. You are nothing.

Dr. Barnes seemed to be working very hard on my behalf. At our
meetings, her manner was earnest and dogged, as though we were
archaeologists together digging for truth. But we simply could not
connect. She was so formal in her personal manner, somewhat
distant, even unsympathetic, and apparently I made her anxious as
well—she was obviously uncomfortable when we were the only two in
a room together. I didn't trust her, and I certainly didn't believe she
had any idea of what to do with me.
Useless, useless.

Of course, it wouldn't have mattered how competent Dr. Barnes
truly was, given how harshly I compared her to Dr. Hamilton and
found her wanting. I was actively pining for him, and would stand in
the doorway of my ward for hours, mute and rocking, hoping to catch
a glimpse of him in the hall, walking to or from a meeting.

I was surprised to find that I had a partner in this obsession,
another patient, in her twenties or early thirties. Dr. Hamilton had
treated her for a long time, and like me, she had developed a strong
positive transference toward him—in fact, she'd clearly fallen in love
with him. A day patient on the ward from eight in the morning to eight
in the evening, she was considered one of the most disturbed patients
there. One night, at home, she abruptly shaved her head for no reason
anyone could ascertain. Although she did not speak (at least to me),
we had more than our Dr. Hamilton obsession in common; she, too,
spent most of her day rocking in place.

Sometime after Dr. Hamilton had left the ward for good, my
companion-in-thought seemed even more agitated than usual. All day
long, I watched her frantically pace the corridors. The next morning,
my friend from the music room offhandedly informed me that the
woman had hanged herself the night before. I was stunned, as much
by my friend's tone as by the news she'd so calmly passed along to me.
This patient had killed herself, I thought, over Dr. Hamilton. Why
hadn't staff noticed what was driving her and done something about
it? Why hadn't
I
done something? Didn't anyone realize that
she
could
have been
me?

In my fog of isolation and silence, I began to feel I was receiving
commands to do things—such as walk all by myself through the old
abandoned tunnels that lay underneath the hospital. The origin of the
commands was unclear. In my mind, they were issued by some sort of
beings. Not real people with names or faces, but shapeless, powerful
beings that controlled me with thoughts (
not
voices) that had been
placed in my head.
Walk through the tunnels and repent. Now lie
down and don't move. You must be still. You are evil.
The effect of
those commands on me during those nights and days was powerful. It
never occurred to me that disobedience was an option, although it was
never clear what might happen if I disobeyed.
I do not make the rules.
I just follow them.

It was quiet and dark down in the old tunnels, with just enough
ambient light that I could find my way around corners. The air was
musty and damp, and although I couldn't hear any of the sounds from
the busy hospital above my head, I was aware of the building; it often
seemed to groan above me. I wondered how many hundreds, maybe
thousands, of patients had been here. I wondered what had happened
to them.

Another command (or thought, or message) I continually received
was to hurt myself. To inflict pain on myself, because that was all I
was worthy of. So I burned myself—with cigarettes, lighters (easily
come by—everyone smoked then, as I did), electric heaters, boiling
water. I burned my flesh in places on my body that I thought people
would never see. I'd do it in the bathroom when no one was there, or
down in the tunnels, or out on the grounds. Once in the music room,
when I was trying my best to set my sock on fire, an attendant went by,
saw what I was doing, and tsk-tsked in a mild tone, "Elyn, really, you
mustn't do that, it's simply not on, you know."

In fact, many staff members knew what was happening; after all,
they dressed my wounds, putting salve on the burns, noting the when
and where in their charts. "Aren't you concerned," one said to me
during a repair session, "that in summer, when you wear a bathing
suit, these scars will show?"