As soon as I sat down, Magic Doc delivered some bad news. Or what would have been bad news to a normal patient, but which turned out to be of interest in my case.

"I have to apologize to you," he said. "It seems your insurance company is not going to cover any more of your stay here."

"Really?" I said. It wasn't clear to me why this was, or why it was his fault. "I don't understand."

"Well, they gave two reasons. One is that you're not taking medication. The other is that you've been going on two-hour pa.s.ses every day."

"They think I don't need to be here?"

"Right."

"Because I'm getting fresh air and exercise?"

"Well, their reasoning is that if you're well enough to leave the hospital for two hours a day, then you're well enough to be at home. I don't agree at all, but that's the way a lot of insurance companies see it. I didn't realize that you had out-of-state insurance. If I had, I wouldn't have given you the pa.s.s and risked this cancellation. Around here, most local insurance providers won't stop coverage because somebody is going on a pa.s.s, so it's usually fine. But a lot of carriers in other states will. Obviously, yours is one."

"It's amazing. I do something that will actually speed my recovery, and they penalize me for it," I said, shaking my head. Then I added, "You know, that reminds me, not that I haven't been immensely grateful for the pa.s.ses, for all kinds of reasons, because I have been, but I've been meaning to ask you this anyway. Why don't you have a gym right here in the hospital, or an outdoor track or something? That way people could work out and not have to leave for two hours to get it all in."

"I agree," he said. "I've tried. I lobbied for a lap pool and all kinds of things, but the liability insurance costs are just too high to have exercise facilities here. It's just easier to give you a pa.s.s so that you can go across the street to the Y."

"Ridiculous."

"I know. I know."

"And the meds are the same story?"

"It was probably both things, the pa.s.s and the lack of meds, but again, att.i.tudes on meds are different in this state. That's, in fact, why I came here. I'm not from here, and, as you can imagine, I wouldn't have chosen this town for lifestyle reasons, but it happens to be one of the few places in the country where the insurance companies don't make it impossible to practice real psychiatry."

"You mean psychiatry without meds?"

"Yes, or at least the option not to use them."

"What happened with that back in your home state?"

"I was practicing child psychiatry, but I didn't want to prescribe Ritalin to kids. First thing I did when I got a new patient was take them off the drugs. I wanted to see who the person was."

"So you think the drugs really got in the way of therapy?" I asked.

"Oh yeah. And the kids end up taking much more than they should. What often happens is that the mothers give the kids the pill in the morning and it works great. But then when it wears off, the kids are worse than before, so they give them another pill in the afternoon, even though they're not supposed to."

I thought of Bard, and asked, "And do you think that this ends up predisposing them to taking street drugs like meth as they get older?"

"Sure. They're craving that high."

I thought of myself going off the Prozac and feeling worse than I'd ever felt before taking it. I wondered if I was hooked in much the same way, needing the drug just to feel normal. I told Magic Doc that I thought a lot of psychiatrists were prescribing too much medication to a lot of people and either not understanding or not disclosing the dangers of dependency.

He agreed.

"A lot of psychiatrists these days are not really practicing anymore. They're not listening. They're just prescribing meds. I don't know why most MDs even go into psychiatry."

"No s.h.i.t. Most of them have got the emotional intelligence of sandstone. And I won't even get into the way too cozy relationship between doctors and pharmaceutical companies."

"Yeah, I had that out with the drug reps at one point. They wanted to sell me on Lexapro when it first came out. Lexapro is just half a Celexa molecule. The patent was running out on Celexa, so they needed a new drug that essentially did the same thing. They realized that they could get the same effect with half the molecule, so they created a 'new drug' by cutting an old drug in half. I told them that I'd prescribe Lexapro if they admitted that they'd released it when they did and in the way that they did because the patent was running out on Celexa. But of course I got no answer."

This jibed with critiques I had read in which it was a.s.serted that when drugs go off patent and the pharmaceutical companies market their patented replacements, only then does the public learn about the original drugs' downsides or unknowns. It is either that or, as happened with Zyprexa, lawyers and the media got hold of suppressed information and blew the whistle.

I brought up Zyprexa, and mentioned how heavily I'd seen it being advertized in places like Meriwether. I told him about the pens and the clipboards that the nurses carried around.

"Yeah, I've seen that, too," he said. "I used to walk around the offices throwing away all that stuff-calendars, pens, clipboards. I used to say that if they want to pay us to advertise for them, fine. Otherwise the stuff was going in the garbage."

I was really impressed. What a find. This guy was a jewel, stuck out here in the boonies because it was one of the few places he could help people try to get better without drugs, and where he could give them access to a few healthy and genuinely recuperative options like fresh air and exercise. He was in the minority in his profession, it seemed. Maybe even fighting a losing battle in the system. I admired him even more for that and was grateful for having met him.

He saw to the greedy core of the pharmaceutical companies and refused to buy the line they were selling. Not that he never prescribed drugs. He obviously did. He was nondoctrinaire enough to realize that the meds on the market were, in some cases, probably better than nothing. But he was exercising his judgment, evaluating patients as people and not just opting for the prescription pad as a reflex.

As for the insurance problem, I told him that it was fine. I could cover whatever was left. I'd been in for a week already, so I figured I didn't have much longer to stay. We worked it out that he'd discharge me on day 10, and they'd bill me for whatever my insurance didn't cover.

As I left his office, laughing again and glowing with appreciation for his renegade style, I said, "Welcome to the lunatic fringe."

I spent my last two days at St. Luke's trying to avoid as much group therapy as I could, hiding on the addicts' side or in my bathroom until the session had already begun. I was bored and I had gotten the material I needed. I didn't see the point. The staff wasn't usually too strict about hunting you down or making you go to meetings if you really didn't feel like it, and, unlike at Meriwether, I didn't have any fear of jeopardizing my release if I didn't comply.

I tried to sneak my way into some of the addicts' meetings, just to get their stories, because I knew from people like Fenske that I was bound to hear some pretty entertaining stuff. But those meetings were very closed and carefully monitored, so I usually ended up going to one or another of the meetings I was supposed to be in, just because I felt it was part of my homework.

I went to occupational therapy and finished my tile trivet. I played Cranium and Worst-Case Scenario with Trevor and Delilah, Gerald and Molly, and the rest. I counted the minutes until three o'clock when I could pound it at the Y across the street and then pound a couple beers at the brewhouse thereafter.

I took long hot showers when I got back, and then washed my dirty workout clothes in the washing machine and dryer in the hallway between the octagons. I went on every smoke break, just to overhear things and breathe the air a little more. I started taking the offered Ambien at night to sleep, because it was just nice to turn off at ten or eleven when pretty much everybody else was dead to the world too, having taken their own Ambien, and usually a whole boatload of other downers to stave off the jitters or the withdrawal or whatever else was wrong with them. Pretty much everybody was on Ambien. It was kind of a joke. We'd all be sitting around the TV at nine thirty, and somebody would ask you: "Have you taken yours yet?"

A few hours after dinner, a line always started to form outside the medication window. Then people would recongregate in front of the TV and maybe have a bowl of raisin bran or a bag of microwave popcorn while they waited for the dose to kick in. Bit by bit, people would peel off, and you'd hear their doors closing softly behind them until there was n.o.body in the dayroom but me and some other holdout. That's when I usually made my way back to my night-light.

I loved that dependable sleep. No tossing. No going over the failures of your life as you lay there clenching your jaw. Your head hit the pillow, you closed your eyes, and you enjoyed those few aimless moments of knowing that you were coasting to the other side untouched. I knew the Ambien probably wasn't good for me, and I was as suspicious of it as I was of every other drug, but at times like that I just didn't care.

On my last night, Sister Pete came to see me in my room, as usual, where I was sitting with night-light. It was Palm Sunday, in fact, so she had made me an elaborately woven little token out of palm leaves. She gave it to me with a small card that had the Memorare printed on it. I remembered this prayer from childhood, the special prayer of the distressed calling to the Virgin for help. It had always moved me. Rereading it with Sister Pete, with her wide surprised eyes gazing into my still teary, still uncertain ones, I couldn't help but be moved by it again, and hope in some residually superst.i.tious way that it could help me.

Remember, O most gracious Virgin Mary, That never was it known That anyone who fled to your protection, Implored your help or sought your intercession,Was left unaided.

Inspired with this confidence, I fly to you, O Virgin of Virgins, my Mother; To you do I come, Before you I stand, sinful and sorrowful O Mother of the Word Incarnate, Despise not my pet.i.tions, But in your mercy hear and answer me.

Amen.

I was better than I had been ten days before, but I wasn't firm. I was still weakened and half down. I was susceptible to the power of prayer, as I always was in the bleakest times, not necessarily because I believed in its ability to make things happen but because I believed in its ability to comfort.

I thought it so perfect, so quintessentially Sister Pete, that at the bottom of the Memorare card there was a hotline number and a Web site address.

I said good-bye to Sister Pete, grateful for all the things she had made me think about, even if a lot of them were things she had probably never wasted time thinking about herself. I hugged her long and hard in the doorway of my room. We wished each other well. She turned to go, and as I stepped back to close my door, she turned around to face me one last time.

"Trust till ya bust, Norah Baby. Trust till ya bust."

And then she laughed her lilting laugh.

"I'll try, Sister," I said, smiling, and closed my door.

As for other partings, Fenske caught the flu a couple of days before I left, so he spent most of the time in bed in his room, or occasionally wrapped in a blanket on the couch in the dayroom. The last I saw of him was a handwritten sign on his door that said: "Wake me ONLY for (a) smoke break, (b) a phone call, (c) food, (d) if Keith Richards is here to see me."

Josephine got out a few days before I did, still wearing the puss face. Delilah got her wish and left too, still impish and unchanged. The others were still there when I left: Gerald in his chair looking at the floor, Trevor sitting with his hands crossed formally in front of him, and Molly, coloring and crying.

I didn't say good-bye to most of them. I hadn't established enough of a connection. I hadn't wanted to-maybe because I saw in them too much of a reflection of myself, or maybe because I just didn't have the energy to make friends. It had taken all my resources just to pull myself out of my own funk, and in that process, the only company I was capable of entertaining was the touch-and-go, snack-and-mumble variety that I found with some of the addicts, most of whose names I can't even remember.

I saw Magic Doc one last time, just to say good-bye and get the formal approval on my discharge. Short and sweet. Five minutes tops. He was very busy and I wasn't technically his charge anymore, so there really wasn't much for me to say or do except shake hands and say thank you. He was gracious, as always, and thorough. He wanted to make sure that I had a safe way of getting home and someone to greet me when I got there. He urged me to follow up with my psychiatrist in New York, and I told him that I would. (Per discharge procedure, I had made an appointment for two days after I got home.) He wished me well and I wished him the same, and that was it.

The nurses expedited my paperwork because they knew I had a plane to catch. I had no prescriptions to delay matters, so I was walking out of the ward by just before noon. Nurse Maggie escorted me down to the lobby, chatting cheerfully the whole way, as though we were just two happy housewives at a Tupperware party who happened to have spent the past ten days behind locked doors together.

I waved to the security guard at the metal detector, and to the menopausal mommies, too, as I strolled through the sage green carpeted lobby, past the golden statue of St. Luke, the upholstered armchairs, and the 52-inch plasma TV.

Maggie had given me two taxi vouchers, one to get to town, where I planned to eat lunch, and one to get from town to the airport. I waited for the first taxi in front of the clinic, sitting on the curb of the small circular driveway. I texted a friend on my cell phone, which had been returned to me fully charged, and I checked my messages. The sun was out in earnest at last, and I turned my face up to it. I closed my eyes and breathed deeply, feeling the first warmth of spring on my eyelids and smelling the first hint of that rich black prairie soil coming to life again underneath me.

PENDULUM.

If you had to go to a locked psych ward, you could do a lot worse than St. Luke's. It wasn't paradise, but it was a far cry from Meriwether, that's for sure. And, interestingly enough, for the same length of stay (ten days), the bill came to almost exactly the same amount: just under $14,700. When you consider how much more I got for that money at St. Luke's-as many snacks as I could eat, fifty minutes of therapy three times a week, a room to myself-it's pretty astounding. Granted, this difference can be accounted for, at least in part, by the fact that St. Luke's wasn't paying urban rents. But it may also be the case, and this is the fiscal conservative in me showing, that bureaucratic waste is often prevalent (some would say endemic) in the public sector, whereas privately run inst.i.tutions, subject as they are to the corrective influences of compet.i.tion and profit, are forced to bang more for the buck. Think of the difference between the U.S. Postal Service and Federal Express, and you will have a pretty good indication of the difference between Meriwether and St. Luke's.

Whatever the case, $14,700 is still a h.e.l.l of a lot of money to spend (or for an insurance company to spend) when what I got out of my stay at St. Luke's could have been achieved by going on vacation. Clearly, pulling myself out of the context of my life, suspending myself in a neutral place where I had, by turns, privacy and company whenever I wanted them, was essential to regaining a sense of perspective. Theoretically, I could have done this at a resort or on a group vacation. I could even have found a therapist in the area and seen him or her on an outpatient basis as often as I saw my therapist in the hospital-or even more often. What's more, I would have had the same (or, if I got a recommendation, better) chances of finding someone good. In any case, this would have meant starting from zero with a stranger, which is what you always do with an a.s.signed doctor in a ward.

But if you had no choice in the matter and you were forced to spend time in the hospital, a place like St. Luke's would do fairly well by you. If it didn't make you any better, at least it was unlikely to make you any worse.

And in some cases, at least, people I saw there did leave in better condition than when they arrived. Karen, for example, had gotten something similar to what I had gotten. She'd found a place where she could step off the merry-go-round and catch her breath for a minute. It wasn't a permanent solution to her psychosis-what was?-but it was the next best thing. It was a place to go and rest or reorient herself when things got too out of control. The good effects would wear off, and she'd be back in a few months or a year, but because of the time she spent at St. Luke's, she was able to keep going, to manage her disturbance and go on.

A lot of other people appeared to get a lot less out of the experience. If they were drunks or addicts, they dried out or cleaned up while they were there, which surely wasn't a bad thing, given that some of them, like Bunny and Clay, had been near death when they'd come in. But that was about the extent of it for them. Bunny, as I heard firsthand on the phone, got drunk the first night she got home. Given her recent track record, April was likely to do the same thing. Clay had unemployment, a dying marriage, and his cousin's crime spree to deal with when he got home, which didn't bode well for his abstinence.

Fenske had a better chance in my view, simply because he had his education, a good job in computer programming, a relationship, and a supportive family to fall back on. His father had come to see him at one point during his stay, and I had seen them together visiting in the dayroom. I had seen other patients and their visitors doing the same, Clay and his wife, for example, or Bard and his ragtag group of not quite immediate relatives. In those cases, the tension in the air was palpable, but with Fenske and his dad you could feel a genuine bond, a sense of caring and support that far outstripped obligation.

Fenske was a screwup, but he was smart and resourceful underneath. He'd had the benefit of being loved, and in my travels through the system I knew that having been loved, as well as still being loved, was one of the best predictors of success and life change after hospitalization. It would probably take him a few rounds to kick the poison, but I felt sure that he would do it.

I suppose that was one of the things that was becoming clearest to me about how people with mental health and substance abuse problems fared in the system. The quality of the inst.i.tution-cleanliness, therapy, and kinder, more committed staff-made a difference, no question. The people who worked at St. Luke's had chosen to be there, not purely out of necessity, but usually out of some sense of vocation. It showed in how they performed their jobs, and that in turn showed in how their performance affected the patients in their care.

But community resources, family, jobs, prospects, good relationships, and education seemed to me to be far more important determining factors in how the patient would come out long-term. The people whose bonds with family were broken, or who had lost their jobs and had little hope of finding other or better jobs, people who were desperately lonely and without a sense of purpose or place in the community, these were the ones who had repeatedly slipped back into abuse or depression or both. People like Fenske, who was born and raised with it, or Sister Pete, who had been lucky enough to find mental health professionals who understood the importance of social bonds in recovery-these people were on the road. The inst.i.tution gave them the kick-start or the break they needed, and they were on their way. Perhaps not quite always thriving in the best sense of the word, but making do and staying clean or clearheaded most of the time.

In the end, I don't think that the real difference between the quality of care my fellow patients and I received at St. Luke's had as much to do with money (private versus public) or even location (rural versus urban) as it had with a sense of mission. And I don't use this term in the religious sense, even though St. Luke's was a Catholic hospital. I use it to mean that the people who ran St. Luke's (unlike the people who ran and worked at Meriwether, or the people who operated the private hospital I stayed at my first time in the bin in 2004) believed in what they did and knew that the personal touch, however trite that may sound, went a lot further than drugs and diagnoses.

Many pundits and social theorists, from Robert Putnam (Bowling Alone) and Francis f.u.kuyama (Trust) to Marvin Olasky (Renewing American Compa.s.sion) and Christopher Jencks (The Homeless), have explored the importance of human bonds in the overall health and well-being of both the individual and the society. My experience at St. Luke's led me to similar conclusions.

We need each other. We do better with the support of other people who know and care about us than we do at the hands of indifferent professionals who squeeze our untidy empirical woes into theoretical abstractions and boil our lived experience down to chemistry. We do better when people listen to us, even if we are not making much sense. And, most of all, we do better when we are given respect.

I'm not offering this as a cure, but I think it is a better way through our challenges.

As for my own journey at St. Luke's, that was a slow-motion course of obstacles that took place largely in my head. My depression had its own logic, twisting every positive into another source of pain, every avenue of escape into a weak spot where the enemy could get in. I hunkered down in misery and brooded. I turned ideas on their heads and shackled myself with contradiction.

Take hope, for example. Even that became a devil in my brain.

To me, hope was an open wound. A form of vulnerability. Hope was waiting with the door ajar. Hope was looking for rescue. It was weak, because it was dependent. Dependent on the arrival of someone or something else. A savior, a miracle, a change.

But despair. Despair was strength. Despair was the scab and then the scar. The walled city in a time of plague. A closed fortification. A sure thing, because it was always safer, less painful to stop trying than it was to repeatedly try and fail. Failure-disappointment-was a poison in my blood. Despair was the antidote.

And so, in that sense, depression was not my disease, but rather a sign of health, my immune system's response to an a.s.sault. The a.s.sault of hope. Of contingency. Of chance.

In my little head downturned, my lidded eyes looked inward. I curled in a ball, my back to the world, knees up. Everything inside was known, accounted for. There were no variables there. To rid my world of disappointment, I had to rid it of luck and surprise. And so I chose despondency, because in it there was no relevant question. The answer was always no. The sweet consistency of negation in a word. A perfect answer, a loud, comforting, final, punctuating word. No. A muscular sound, like the bark of a guard dog. Keep out.

My thinking seemed clear on the matter. There could be no more loss in what was lost already, in what was thrown away. No more falling at the bottom of the well. Just the rock of isolation, the dark, the silence of no evil seen, heard, or spoken, and no good either. No contrast of shadows to make me long for the light. No gray to make me loathe ambivalence.

What was not admitted, not let in, was unknown, unmourned.

People say that darkness is a negation. An absence. The privation of light. But for me this was not true. Darkness was full. Robust. Complete. Privation was a substance, the way that black is a color. It sustained. It hid. It comforted. It excluded.

This was why my depression happened, why it worked. But it was also why it had to come to an end, at some point, or kill me. Because, of course, life cannot be lived permanently alone in the dark, any more than it can be lived in a coma, however restorative or protective that state may sometimes be. We are pack animals and heliotropes all, bending toward the light, the open, the air, dependent on it, even as we bemoan the constant flux and injury to which free will and society subject us.

It's a battering life. But it is the only life.

So at the end of my time at St. Luke's I began to emerge from the despair. I began to know, to risk hope again in all its variety. And use it. And allow myself to be used by it, understanding newly that it was an elixir with a kick, a bitter kick.

The most I could expect from a psych ward, even a good one like St. Luke's, was to walk out with revised definitions of my terms, more resigned to the grays, and with my veil of necessary illusion firmly replaced.

I was better when I left-not well, but better. And I would remain better until I wasn't, which was bound to happen. And happen again. And go on happening as long as I lived.

As long as I live.

That is why psychiatry is as bankable and recession-proof as prost.i.tution. There's always a demand for it. I, and other people like me, will never be fine-that is, impervious. We will just be more or less balanced over, cripplingly aware of, or functionally oblivious to the abyss.

And how was this miracle, this overhauling of perspective, achieved for me at St. Luke's? Not by meds, that's certain, though meds would come back into the picture in small doses after I left. That, too, was certain.

But right then in St. Luke's, recovery happened because I began finally to use, to make progress on, some of those ideas that I had spent way too much time futilely indulging while in despair. Ideas and words.

Like hope.

And so, for me, hope came stubbornly back, with its helping hand on my back. But with all its false promises and mean little pinches, too, saying, "Go forward. But I'll get ya. But go forward anyway."