The Center Cannot Hold: My Journey Through Madness (27 page)

Eventually, our client was moved to a new ward. There, he spoke to
no one, most especially staff, because he didn't trust the doctors or
anyone else. On the other hand, he would call us almost daily, or we
called him, to discuss his case; in fact, there were some days we could
barely get him
off the
phone, he was so engaged with the legal details.

After several weeks of back-and-forth calls, the hospital scheduled
a hearing to appoint a guardian for our client. As preparation, Steve
and I went to the hospital to meet with him and explain how the
procedure would go. We were met by one of his nurses.

"He's psychotic," she said with absolute certainty. "If you don't
believe me, take a look at the record."

So we did. A typed evaluation, and entry upon entry, stating the
following: "Patient is very bizarre. He is totally mute. However, we
know that he's able to speak, because many times he's been overheard
talking on the telephone about his legal rights with his imaginary
lawyers."

Steve began to sing under his breath the Temptations song "Just
My Imagination."

No one had bothered to notice that in addition to making phone
calls, sometimes our client
received
them; no one had bothered to
inquire whether he actually may have had a lawyer or lawyers. He was
crazy—ergo, his lawyers were imaginary. Imagine the staff 's
consternation when the imaginary lawyers began introducing
themselves to their client's doctors and nurses.

One of my favorite cases, involving someone I would end up
working with on and off for six years, was Jefferson, a young man
barely out of his teens. When we first met him, Jefferson had been on
a back ward in a state mental hospital for many years, after spending
even more years before that at a state hospital for adolescents. In
addition to having been diagnosed as mentally ill, Jefferson was
moderately mentally retarded. And therein lay the problem:
Retardation is not equivalent to mental illness, and there seemed to be
no current evidence that he was still mentally ill. And if he wasn't, a
state mental hospital was absolutely the last place he should have been
living.

After our first visit, it took Jefferson another three or four to
recognize us and remember who we were; soon, he actually seemed to
enjoy our visits, and seemed to have decided to trust us. Whatever his
limitations, he had, we believed, "dignity interests" that required us to
try to find out what
he
wanted.

"Do you like it here?" we asked.

A stony face. "No. Don't like it here. It's a bad place."

"Why?"

"John, he punched me once, but I whupped him."

"Do you want to stay here?"

"No," he said. "There's nothing to do here."

"Do you have any friends here?"

"No, don't like anyone here. The other people, they're not like me."

"Have you met with any teachers? To do some schoolwork?"

"What schoolwork?" he asked. "We don't get no schoolwork."

It was clear as day that Jefferson needed to be with people who
knew how to help him; he needed a group home. But his long history
of being in mental hospitals, together with his size (well over six feet
tall and weighing more than three hundred pounds), made us cautious
and concerned—was there anyplace that would actually take him on
now?

We started looking for someplace for Jefferson, and the search
went on for weeks—this one was too small, that one too large, others
had no openings (with long, long waiting lists) or housed residents
who appeared neglected. The whole time we were looking, we kept
going back to the mental hospital to check in with our client, just so
he'd know we hadn't forgotten him. "Can I please leave yet?" he asked
each time. Inside that large body was a lonely child who knew he was
in the wrong place.

Finally, we heard of a vacancy in a very pleasant group home in
west New Haven, where most of the other residents were both autistic
and retarded. The right size, with competent staff and a good track
record. Could this be Jefferson's new home?

After several overnight and weekend visits in which he did very
well (and was obviously very happy), Jefferson was finally released
from the mental hospital, a warehouse where he hadn't belonged in
many years—if, in fact, he had ever belonged there. I wondered: How
was that first diagnosis made, so many years ago? Who made it? And

how many more Jeffersons were locked up inside places just like
that—lost, or misdiagnosed, spending whole lifetimes waiting for
someone to really see them and recognize them for who they were?

chapter sixteen

As
THE END of law school drew near, I knew only one thing for
certain: I was never going to be able to stand up in court and orate like
Perry Mason. And I probably wasn't ever going to deliver an
impassioned closing argument to a jury on behalf of a good guy or in
prosecution of a bad guy. Nor was I going to orchestrate the legal
machinations of a Fortune 500 corporation as its counsel, or be one of
many names on some prestigious law firm's fancy letterhead. But I
was
going to have to find a job. Finish school, navigate the bar exam,
and then a job. Some job. Someplace.

This was...daunting. Aside from selling Cokes and popcorn at a
movie concession stand, my brief stint as staff trainee at the Center,
and summers working at LSO, I'd only ever been a student. And I'd

had to battle some terrible demons even to be consistent at that.

I was excruciatingly uncomfortable speaking up in class, so I
rarely, if ever, did. After one final exam, the professor called me on the
telephone and said that he had no idea of who I was—but that I'd
written the best exam in class. Each time it happened, in spite of the
grades I'd earned in the past, this kind of comment came as a surprise.
I had to replay it repeatedly in my head, before I could effectively shut
off the tape that ran almost all the time:
There's been an unfortunate
mistake, they've confused me with some other student, in fact my
true performance was less than stellar, and it's only a matter of time
before everyone finds out the truth.

Commenting in class was not the only thing almost impossible for
me. I was also terrified of research papers, which scared me right up
until the time I became an actual academic. One paper that still
resonates for me today was for a class on Freud taught by George
Mahl. I was so afraid of having to write a paper that I almost didn't
take the class, and did so only after Steve managed to persuade me
that it would be a wonderful course despite the paper I'd have to
write—and it was, one of the best I've ever taken. The subject of the
paper was Daniel Paul Schreber, who at one point in his life had been
the chief justice of the supreme court of the German state of Saxony.
Schreber had a schizophrenic breakdown, which he wrote about in
A
Memoir of My Nervous Illness.
Freud wrote a case study of Schreber,
and I constructed a somewhat different interpretation of his
delusional system, his principal delusion being that he was being
transformed into a woman to be fertilized by the Rays of God in order
to bring forth a new race of man and woman. (When describing this in
a job interview with Notre Dame Law School, I was met with a
hilarious comment by one of the nuns: "What's wrong with that?")

When my paper on Schreber came back to me, it contained a note
from Dr. Mahl, telling me that the paper was "publishable." (Later the
professor wrote that my final exam was the best he'd seen in
twenty-five years of teaching.) This meant a lot to me, particularly
because I found Dr. Mahl one of the finest lecturers I'd ever heard, or
have heard to this day. There were no class discussions in Mahl's
course, but his lectures were so amazing nobody missed having
discussions—and nobody skipped his classes, either.

Professor Mahl's feedback had an enormous effect on me—positive
at first, then almost immediately negative: I stopped taking my
medication again.
I'm publishable, I'm not mentally ill at all—which
means I don't need to take medication for the mentally ill. I'm done
with this.
The last time I'd tried to stop the meds—using White's
"weaning" method—I only became more anxious as the weeks went by
and the dosage went down.
That was the wrong way. This time, I'll do
it all at once. Just pull the bandage right off!

I felt fine for a day or two; ecstatic, even. By day five, I was
completely and floridly psychotic, convinced that evil beings were
about to destroy me. I gibbered; I cowered. I couldn't work, and the
end of the final term was coming up. Finally, White insisted: back to
the Navane, and increase it again. The effect was almost immediate,
but instead of being relieved, I was angry.
I'm sick of this.
It all came
down to supporting the patient's choice—didn't it? If I was competent
when I decided to stop taking the meds, then it was a competently
made decision. A decision made by a competent person. Wasn't it?

One tragic example of supporting a patient's choice was the case of
my close friend Dan, whose first client in the mental health law clinic
was an adolescent named Tony, who'd been institutionalized most of
his life. When Dan took his case, Tony was at the state hospital for
adolescents with mental illness, although oddly, his only clinical
diagnosis at that point was attention deficit disorder—ADD. Tony
wanted out of the hospital, and Dan got Tony released to his reluctant
parents, who only after much pleading had finally agreed to take Tony

Some months later—at a point at which Tony would perhaps have
been out of the hospital anyway—Dan got a phone call from Tony: He
was being held in prison on a murder charge. He had burned down the
family trailer with his mother, father, and seven-year-old brother still
inside; they'd all died. Dan was devastated; indeed, the entire mental
health law class was. For a bunch of idealistic law students, some
lessons were harder to learn than others, and this one—that "helping
people" isn't always a good thing (or, maybe, that "helping" translates
differently from case to case, and must be cautiously scrutinized)—was
tragic for all parties. The caveat, of course, is that there is no way of
knowing whether Dan's intervention made any significant difference
in how Tony's story turned out.

Generally, though, helping psychiatric patients felt pretty good to
me. There were so many factors in their various hospitalizations, and
so much potential for error and neglect in the way they were treated.
Some damage
could
be undone; some lives
could
be changed for the
better. I realized early on that going to the mental wards sometimes
set me off emotionally—it probably aroused my own dependency
needs, as well as my anger at how I had been treated when I was being
held in the hospital. But I was convinced I understood more than most
people did (medical professionals as well as man-on-the-street
people) about what it was like to be the helpless patient in that bed, or
the terrified patient in four-point restraints.

And yet, even as I adamantly denied my illness, I understood all
too well my limitations. If I couldn't even speak up in class, it wasn't
likely that I'd be capable of being an impassioned advocacy soldier
slugging away in the courtroom trenches, trying to get either a hospital
administrator or an intransigent legal system to pay attention to me. If
I were really going to make a change in lives of mental patients, I had
to find a different way to do it.

The
Yale Law Journal,
established in 1891, published (and
continues to publish) "original scholarly work in all fields of law and
legal study." Its articles and essays have always been contributed by
the leading professors and legal minds throughout the world, but the
Journal
also includes shorter pieces, called "Notes," written by
student-staff members. In order to be a member of the
Journal
, I had
to submit a topic statement on the subject I wished to write about in
my Note—the use of restraints in psychiatric hospitals. When my
statement was accepted, I asked Steve if he'd help me revise and
prepare the Note for publication, and of course he said yes. I wanted
my argument to be as cogent and powerful as possible; in fact, on
some level, I wanted the words on the page to do the impossible—go
back and change the outcome for that young woman tied to a bed at
the Yale Psychiatric Institute and Yale-New Haven Hospital's MU10. I
wanted my words to change the minds of all the doctors who had ever
treated me and gotten it wrong. It might have been too late for me. But
perhaps it wasn't too late for somebody else.

The research I did showed that restraints hadn't been used in
England for more than two centuries; certainly I'd never seen any sign
of them when I was there (and I'd been neither a docile nor a
particularly cooperative patient). Yet they were used liberally in the
United States. Was this truly the best we could do? What were the
rules, what were the parameters, what was reasonable (and
unreasonable) care when treating patients who were already terrified
at that moment when someone in authority forcibly tied them down?
In my Note, I proposed a Model Statute (a statute that could serve as a
model for legislation in individual states); in addition, I argued for a
greater degree of negligence before a doctor could be held liable for
not
restraining someone—in short, I wished to change the incentives
for doctors. My doctors, everyone's doctors.

While I was preparing my Note, I spoke to one mental health
professional then on the Yale faculty. "Wouldn't you agree that being
restrained is incredibly degrading?" I asked. "Not to mention painful.
And frightening."