The Center Cannot Hold: My Journey Through Madness (26 page)

Yale's Legal Services Organization—LSO—always had students
work in teams, so Steve and I worked on our mental health law cases
together, and from the beginning we represented psychiatric patients
and children. One of our first cases involved the two young sons of a
man then in prison for multiple rapes. The boys' mother didn't want
them anywhere near the dad, an obvious psychopath with a certain
quality of persuasive charm. While there's a significant body of
evidence that argues that keeping ties to an incarcerated parent is
good for a child, there's an equally strong argument on behalf of
deferring to a custodial parent—and in this case, the custodial parent
was a very good one. The boys were healthy, happy, and well taken
care of, in a stable home, by someone whose judgment could be
trusted. In Connecticut, children are entitled to their own lawyers in
custody and visitation issues, and as attorneys for the boys, we
explored what would be best for them, drawing as well on the
expertise of the Yale Child Study Center.

Increasingly, Steve and I and our small band of friends hung out at
Yorkside Pizza in New Haven—red vinyl banquettes, Yale memorabilia
and team pictures on the walls, a jukebox upstairs, a Pac-Man
machine downstairs. Over meatballs and sauce, or calzones, or
endless slices of cheese-and-pepperoni pizza, we strategized our cases
and talked about our classes. It was about as normal as I'd been, and
felt, since college.

At the end of spring semester, the academic work grew more
intense, and exams loomed. Possible grade range at Yale: honors,
pass, low pass, and fail. For the in-class exams (which were open
book), I always earned honors, except for my first. For the take-home
exam in Joe Goldstein's criminal law class, we were given a choice of
topics to write on, and I chose to discuss whether there should be a
special law for mentally ill mothers who kill their children. I spent
hours consulting with Steve (which we were allowed to do) and hours
more putting it all together. When our exams came back, Steve's rated
honors—mine got a pass. Like most of the students around me, I cared
intensely about my work. Unlike them, however, that work was all
that I had. I didn't play sports, I didn't play a musical instrument, I
didn't have any hobbies, and whatever social life I'd managed to
construct was small and fragile. So the grades I earned were the only
objective signal I ever received about how I was doing in the world.
The task of setting and achieving academic goals operated as a sort of
adhesive; I needed it to hold myself together. Failing (or, at least in
this case, failing my own expectations) tore that adhesive off and
further splintered my fragile sense of self.

After I retrieved my exam in the department secretary's office and
noted the grade, I went directly back to my dorm room, closed the
door behind me, and crawled into bed. There, I curled up in the fetal
position and spent the rest of the day moaning and babbling, totally
convinced that faceless, nameless beings were controlling
("interdicting" was the word I had begun to use in my psychotic
ravings) my thoughts. I was in danger of daggers; they were aimed at
my flesh, and would slice me in pieces if I dared go to sleep. Afraid to
leave the room, afraid to stay in it, I dragged myself to my afternoon
appointment with White, who took one look and knew immediately

that something was very wrong.

"I only got a pass," I said. "They passed me up. From Jo-Jo.
Interdictions are flying everywhere and the other children ate the
porridge. No news is good news, bad news brings a flap. Like flipper."
The evil presences were in the room. "They're killing me! Tell them to
get away!"

White tried to get me to explain what had happened, but it was
beyond me, and I grew angrier by the second. "Murders are necessary
and evil or necessary evils! The orders will come from elsewhere!" I
was pacing frantically around the room, clenching my fists.

"We need to take this seriously," said White. "Do you think you
need to be in the hospital?"

"No," I shot back. As if any other answer were possible. As bad as
my devils were, the specter of the hospital was worse.
Mrs. Jones, oh,
Mrs. Jones, I need you need you need you need you.

Dimly, I was aware that White was wrestling with his decision and
my obstinacy. He could have insisted on hospitalization; in all
likelihood, he probably could have had me locked up immediately. But
he didn't do that. "All right, no hospital," he replied in a measured and
thoughtful tone. "But I want you back on Navane, double your usual
dose. And I'd like to meet twice a day until this levels off."

For the next two weeks, I shuffled back and forth to his office twice
a day, head down, shoulders hunched, eyes on my feet. I spent the
intervening hours sitting on the floor in my room or curled up in a ball
on the bed, alone and muttering to myself, accompanied only by my
demons, and the occasional knock on the door, which I didn't answer.
Few showers, very little food. Gradually, the increased dose of Navane
kicked in, the demons receded, and the fog lifted. I got up off the floor,
cleaned myself up, and one more time I went back out into the world
and started all over again.

Many of my classmates spent the summer after first year in New York
City, where impressive law firms paid them lots of money to be
summer associates, all the while wining and dining and courting them
for the future. That kind of summer was the last thing I could
imagine—the stress of a big law firm and the dislocation of a frantic
summer in the city seemed too much for me to handle. Besides, I
needed to stay near White.

Through one of his clients at the mental health law clinic, Steve
found out about a halfway house for the homeless mentally ill and
decided to volunteer there for the summer as a live-in counselor. So
we both stayed in New Haven and continued our work at LSO,
representing mental patients and poor children for a few dollars an
hour.

One of our clients that summer was a young anorexic woman, not
quite twenty, who had been a patient at a private psychiatric hospital
in Connecticut for almost two years. She wanted to get out—her
parents wanted her to stay. Their concern was understandable; both
physicians and the lay public were learning the truth about anorexia,
that it was neither a disease of choice nor a case of weak wall, but was
real, and potentially fatal. But even that didn't automatically mean the
young woman had surrendered her right to have a say in her own
treatment. One of her old friends from high school, now a Yale
undergraduate, called us about the case, and when we met the young
woman, I quickly identified with her, not only because of my battle
with my parents around my own weight loss, but also because of the
great frustration that comes when your fate is completely in someone
else's hands and you're helpless to exercise any control.

Psychiatric patients always have someone (or a whole chorus of
someones) telling them what they're supposed to do. In my own
experience, I had discovered that it was much more effective to be
asked what
I'd
like, e.g., "If you could arrange things your way, what
would that look like and how do you think we could help you get
there?" Indeed, the young woman accepted that she did need
treatment—she just wanted, and was entitled to have, a voice in the
decision-making about where and how that treatment would happen.
It was my job to help her get that. And as empathetic as I felt toward
her, I also began to understand, as the case progressed, that as her
legal representative, I was not advocating for
myself—
I was using my
skills to advocate for someone else. Ultimately, Steve and I were
successful in finding a place for her at a different hospital, where we
were hopeful that her disease would be well treated and her autonomy
better respected.

I stayed on the increased Navane dose for the rest of the summer, and
took an antidepressant as well. I had to concede that the medicine was
working—I could do my schoolwork, I was functioning reasonably well
in the world—but I was still looking forward to the day when I'd be
able to stop taking meds.

With September came the challenges of second year, and new
classes, and a lowered Navane dose—back to ten milligrams. The
meetings with White were back to four times a week. But in spite of
the meds and meetings, I was having some brief hallucinations,
mostly at night—once of a large spider crawling up my wall, but mostly
of people standing and staring at me.
They're not there. They're not
really there. And even if they are, they're not really looking at you.

Our work at LSO representing children and psychiatric patients
afforded Steve and me easy access to Yale's Medical School and the
Yale Child Study Center. We both did an "intensive semester" at the
Child Study Center, participating in almost all the classes that the
psychiatry fellows and psychology post-doc students were taking. For
law students interested in the psychoanalytic approach, there was no
more ideal setting. There were times, though, when reminders of my
own history as a hospitalized psych patient popped up
unexpectedly—like walking past Dr. Kerrigan in the halls. He was the
one who'd kept me hospitalized at MU10; he was the one who'd
ordered the restraints. Every time our eyes met, I wondered whose
bad idea it was that this man come to the Child Study Center. I'm sure
he wondered the same about me.

       "I think I want to get off my medication now," I told Dr. White. Things
were going well; I was feeling fine. I could manage without drugs. "I
don't need it."

"Well," he said, and then paused for a moment. I was suddenly
aware of trying to read his mind. "How about this: you slowly taper
down, and we'll see what happens. Let's say we reduce by two
milligrams a week."

Too slow—at that rate, it'd be five or six weeks before I was done
with them completely. But whatever I did, I knew it had to be with his
knowledge and support. "OK," I said. "I'll start with that."

It wasn't just my usual reluctance to be med-dependent; it was the
side effects. Until a new class of antipsychotic meds was developed in
the 1990s, the drugs to treat psychosis carried the serious risk of
tardive dyskenisia—TD—a neurological disorder that causes
involuntary movements, first in your face and around your mouth,
and sometimes through your entire body. People with TD twitch and
jerk—in short, they
look
like mental patients, and once they've got TD,
it generally doesn't go away. I'd spent enough time in and around
psychiatric hospitals to know I wanted no part of that.

The first week, I didn't feel any different. "This is working well,
don't you think?" I asked White.

"We'll see," he said.

By week two, I was a little shaky. Tightrope walking.
It's ordinary
stress, everybody has it. Stop thinking about it. Stop.

By week three, I was visibly fragmented and struggling to hide it,
even from White. I was going to melt. I was about to be attacked and
ripped apart.
Stop. It's not real. It will pass.
"I'm feeling a little stress,"
I told White, "but it's probably just my imagination. Pation. Which is
related to being both patient and a patient. Don't you think? Pink?"

He raised an eyebrow. "It sounds as if you're having a bit of a hard
time," he said. "Should we up the Navane?"

I shook my head. "No. Too early. I'm doing OK. A-OK. I just need
to try a little harder."

"I don't think it's a matter of trying, Elyn. I think it's a matter of
whether you need the meds. But if you want to give it a little more
time..." There seemed to be a question mark at the end of his sentence.
Was he asking me?

"Yes," I said with whatever firmness I could muster. "A little more
time."

I don't know why he was so accommodating. Maybe he thought I
could really do without medication eventually; maybe he wanted to
respect my wishes. Maybe he, too, didn't want to see me with the TD
shakes. Whatever his reasons, this wouldn't be the last time White
would agree to be my copilot while I tried to fly without the meds.

By week four, I'd arrived in the land of full-fledged psychosis.
The
people in the sky poison me. I in turn will poison the world.

"I think you're having thoughts that are scaring you because you
need to be on more medication now," said White.

"No!" I was practically shouting. "It has nothing to do with drugs.
It's a massive attempt at medical and physiological, not to say
psychological, derailment which was a result of deregulation of the
rail!"

"It's hard to admit you need medications," said White. "But you
do."

Defeat, defeat.
"There's no need. I'm not sick. I'm wicked. La di da.
I'm ever so well, thank you, ever so well."

But we both knew I'd hit the damn wall again. And as soon as he
increased the Navane, I started feeling better.
But this has nothing to
do with me or being sick. It's just about being able to study. I'm not
sick, I just need some help so that I can study.

More than once while working with Steve on our LSO cases, I was
struck with the absurdities of the mental health care system. Almost
every time, there'd come a moment where we'd ask each other, "Wait
a minute, just who are the crazy people here?" In one case, the
patient's chart said he was restrained
because he wouldn't get out of
bed—
which was hardly an instance of "imminent danger to himself or
others" as required by the laws of Connecticut.

In another case, we represented a young man who'd been in the
hospital for months, refusing to take his medication for religious
reasons. There was no question that our client was seriously ill
(although he himself did not agree with that assessment); for instance,
he'd severely mutilated himself because he thought the Bible required
as much of sinners. At the time, Connecticut permitted forcible
medication of involuntary patients, but we wrote strong and
well-researched letters to the hospital arguing that our client should
not be medicated if he chose not to be: Freedom of religion required as
much. The hospital agreed.