Then, postinjection, she began keening in scales like a wounded bloodhound.

Mother T and I had been walking the length of the hall talking about her merciful G.o.d. As we pa.s.sed the seclusion room she pointed at the door.

"This woman in here," she said. "It's not right to be in such a small room when you're losing your mind."

Ellen protested mostly to herself, spitting soliloquies under her breath or, occasionally, when I asked her about herself, spitting them only slightly more audibly at me.

"I'm sixty-five years old," she'd say, with trenchant economy. "And I've been here for five months. I sit in this chair and I pray."

She, like Tracy Chapman, thought she'd been shot in the head. I wondered if this was a common explanation among psychotics for the confusion and broken thoughts. She told me about what I can only presume was an imaginary, truant, or deceased son who, she said, brought her breakfast every morning, but was stopped at the hospital doors and turned back.

"They won't let him visit me," she said. "So he has to dump that breakfast in the garbage every day and go home."

When I heard things like this I marveled at what great mercies the mind seemed capable of. If you were spending your golden years languishing in a public hospital while your son, probably alive and well and not giving a s.h.i.t, had left you there for months on end, the breakfast pilgrimage was a beautiful lie to tell yourself, a sustaining image of thwarted devotion, and a glimpse in one lonely, clinging mind of the origin of human myth.

Myth was her form of revolt. That, and once, late at night, from beneath her swaddling shroud, there came the soft, proud sobs that I could hear her choking out and swallowing.

And Deborah, of course. She had lots to say on the matter, not just of confinement or things taken away, but of technique. Survival in the mind.

I asked her about Sweet, trying for a way in.

"What's she doing? What is all that talk?"

"She's doing the same thing you do. Just more extreme."

"Why?"

"Because when they take away everything that you care about, that's what you have."

"Is it how she copes?"

"She's hiding," she said finally. "We all are."

She rolled up her sleeves and showed me the scars from where she'd tried to open her wrists.

"I did this when I knew the police were coming for me."

That shut me up. I didn't have anything else inquisitive to say to that. She looked at me for a minute, full in the eyes.

"You have your pen. You have your notebook. You have soft skin and you have your mind. That's all you need. Keep it. Don't let anyone take it away from you, because they will. s.h.i.t, I want your mind, too."

Like Deborah and Ellen, Clean also had his take on the matter. He thought a lot about power. Like so many of them-Deborah, with her ethnic s.h.i.tpots, or Mother T with her not so extreme or uncommon apocalyptica-he reflected the prejudices and obsessions of his culture. He thought that all white people were German. Germany meant power. Again, the authoritarian tinge to the "crazy" person's view, history cherry-picked for meaning, out of date, but symbolically in the ballpark.

"Norma," he asked me, "was Rome civilized?"

"Yes," I said, betraying my own distortions. "Once."

"And who's Rome now?"

"We are," I said.

Still, let's not get too high-handed about all this. The insane are not sages of ill repute, or martyrs of an empire in decline, standing n.o.bly outside or above its vices, crying into the wind. They are deeply and indicatively of their culture, our culture. They are not enn.o.bled by their suffering. They are like the rest of us. And so was I. I responded to them just as the system and everyone else did, even if for a moment I convinced myself otherwise.

They were not, for example, immune to coveting possessions simply because they had none. If I gave, they wanted more. Always more. (How American.) And very quickly they ceased even to be grateful, becoming as ent.i.tled as the rest of us to our accustomed bounty. And when I gave, I became The Giver, the smarmy Samaritan who gets off on giving, the goody-good whom everyone admires, the blessed, kind answer to their prayers. And I began to loathe myself in this position, smiling beneficently, handing out my balms and prizes, graciously accepting thanks, and thinking all the while that G.o.d was working up one h.e.l.l of a performance report for me that quarter. Cha-ching.

But for a while, before the saintly stand-up gal routine started to make me sick of myself, and before it made me want to bury my greedy, grasping fellow patients alive under a pile of McDonald's french fries-There! Choke on it!-I played the role. I made myself the wish granter of Ward 20.

As I lay there, listening to Ellen cry that night under her shroud, I felt so G.o.dd.a.m.ned overwhelmed by guilty thankfulness for the unjust accidents of birth that I resolved the next morning to make her happy, or at least backhandedly, gustatorily happy, the way a jailer grants the death row inmate a last meal and manages to feel magnanimous about it.

"If you could have anything to eat tonight for dinner," I said, "what would it be?"

"Fried chicken," she said. "And a Pepsi."

Ah, she was going to make this easy. How nice for me. I called my visitor for the evening and put in the order. I put in an order for Clean, too, who wanted cigarettes and McDonald's, and Mother T, who needed a Bible, though she was too resigned to ask for anything, and Deborah who wanted McDonald's too (they all did), as well as a National Geographic. National Geographic. By the end of my stay I was the delivery wh.o.r.e, pa.s.sing out dollar burgers that I got by the half dozen, and fries, and sodas, and Hershey bars, and sticky buns and any other cheap sop I could think of or got a request for. By the end of my stay I was the delivery wh.o.r.e, pa.s.sing out dollar burgers that I got by the half dozen, and fries, and sodas, and Hershey bars, and sticky buns and any other cheap sop I could think of or got a request for.

But before long, the predictable happened. It was like filling a bottomless cup. I gave Ellen her chicken and her Pepsi, and though she thanked me profusely, fifteen minutes later she flagged me down and said: "You got anything else?"

This happened with everyone, to the point where I couldn't even eat my own snacks without rousing the scavengers. I'd have given away twenty candy bars minutes before, but the smallest rustle of a wrapper and they'd be on me.

"Have some?"

I hated myself for begrudging them, and felt like some kind of despicable closet pigger when I took to going into the bathroom to eat, coughing loudly to cover any suspicious sounds.

Finally, when I was taking my orders one day, and Kid asked for an iPod, I got the reality check I deserved. I decided this whole fellow man thing wasn't for me. There was just too much childish need for gratification and endless expectation of same. This was no solution. I was giving junk food to diabetics, recovering addicts, and sedentary near-vagrants whose meds were already well on the way to making them obese. And all purely for the hit of pleasure it would give them and, more important, me.

The worst of it is that they came for me in other ways too. As soon as I extended my rubber-gloved helping hand to them, they grabbed hold. They latched on. They wanted to keep in touch on the outside. They wanted to be my friend. But I just wanted to help them from a safe distance and be rid of them. I didn't want their company. I was posing, or pa.s.sing, but I didn't really want to know them. They were my subjects, and if I cared about them at all it was out of authorial self-interest and pity and moral vanity. Moral vanity being that great middle-cla.s.s indulgence that makes us write checks to charities and do the right thing for the less fortunate, because doing so reinforces our fiercely guarded belief that we are good people. But when the less fortunate come banging on your door and your heart in real time, up close, blowing their not so fresh breath in your face, wanting to be a person instead of a project or a write-off, then your cherished little antibacterial ideals turn all squeamish and stuttery, saying "Well, but, . . ." "Yeah, but, . . ." and finally show themselves outright to be as vaporous and self-serving as they always were.

Where are the boundaries? What can help really mean? And isn't that why we leave it to the professionals, who, in turn, leave it to a lost cause, or to the pharmaceutical path of least resistance? n.o.body wants to do the personal work. It's disgusting. What's more, it challenges-no, rakes up and scarecrows-every humanitarian illusion you have about yourself. It makes you know that at heart you are a little bit of a fascist like everybody else, thinking in the way, way back of your mind that wouldn't it really just be cheaper and better and utilitarian-now there's a word we can work with-to be rid of these people?

Yes, this is all very ugly-but so true. I don't want to know what's in your soul. Not really. And you don't want to know what's in mine. Keep back, we tell each other. Those are your problems, which is really just a polite way of saying, "Go starve somewhere else. You're ruining the view."

I couldn't do well by these people. Not that it was my job to do so, but it felt like my obligation somehow. And maybe, for some of the same reasons, n.o.body else could do very well by them either. It was just too much. Too hard. Too late. The question is there all the time. What to do? I can denigrate the system, impugn it with all the progressive zeal that makes my brain twitter with self-satisfaction, and I might actually be right. The psychiatric emperor has no clothes. But I would be lying, or pruning the full picture, if I said I didn't see why that system fails the chronics and admit that I abandoned them myself.

You got tired of their ceaseless intrusions after a while, and in order to draw boundaries that they would respect, you had to be a little mean.

I was on the pay phone with my shrink one day, the one I had on the outside, when Clean started orbiting me like some kind of demented circus balloon. Per Dr. Balkan's instructions, I was trying to make an appointment to see someone when I got out. I was trying to explain how I'd landed in Meriwether without even so much as a by-your-leave, or a drowning wave, or some indication that I was in distress. I didn't want to put him in a sticky position by telling him that I was A-OK fine and doing research, so the conversation was odd and halting, with me trying to avoid direct answers until I got out and could explain the whole thing. I didn't need Clean leaning in every two minutes to bug me about when my visitor was coming and whether or not he'd have cigarettes.

"Norma?"

I put my finger to my lips and pointed to the phone.

"Oh, okay. I'm sorry, Norma."

He walked away.

Two minutes tops and he was back.

"Norma?"

Again the finger routine, more emphatic this time. Another apology, another departure, then another approach.

And finally from me, "f.u.c.k, Clean. I'm busy here. Can't you see?"

It made you feel bad, like you'd slapped a puppy. But it had to be done. Callousness was one of the things that happened to you along with the other effects of being inst.i.tutionalized. Callousness and, what? Xenophobia, I guess.

To wit: it is significant that while I was making that phone call to my doc, I was holding the receiver with a paper towel.

I know. You'd be justified in thinking that maybe I was getting cla.s.sically obsessive-compulsive along with the rest of them, always thinking about germs. You would think so, that is, until you remember that each year alarming numbers of people contract fatal staph infections while in the hospital.

But that is not the whole truth, or maybe not even the half of it. Not the real point.

The point is, I held the receiver with a paper towel because I did not want to touch the things that my fellow patients had touched. That is the beginning of spiritual disgust. It starts in the body, in the nose, and moves to the skin, proverbially crawling, sliding first paper, then walls between itself and the unclean, then verminous other.

And once that had happened, and you could admit it to yourself, that's when you started to understand why the nurses were as grouchy as they were, and as distant and demeaning. They'd learned, as I had, first, that setting limits was paramount, but second and more shamefully, that good intentions were the casualties of contact-the same theoretically exalted human contact that I had started out so in favor of, and had seen soiled somewhere along the way.

Life at Meriwether was lived in patterns. Patterns of marked time and lost time, and doobie-do this, and doobie-do that.

The Yenta turned to me in the dayroom one afternoon and said: "What month is it?"

"December."

He looked surprised.

"G.o.d, time is pa.s.sing me by. The drugs make me so out of it I can't think straight. It's like waking up from a dream."

"So you don't know how long you've been here?"

"December what?"

"Fifth."

He counted on his fingers.

"Then, nineteen days."

"How did you get here?"

"From rehab."

"How does that work?"

"I was in rehab in this really dark and dingy place, and I just felt like h.e.l.l. Really depressed. I was talking with my counselor in this gla.s.s-enclosed room and I made the mistake of telling her that I wanted to bash my head right through the gla.s.s. So they sent me over here to emergency with a bottle of antidepressants. While I was waiting to be checked in, I went into the bathroom and took the whole bottle at once. They kept me in the ICU for a couple of days, having convulsions and spasms and weird s.h.i.t."

"What are you on now?"

"Another antidepressant."

"Which one?"

"Effexor."

"Oh jeez," I said, and gave him a speech about the horrendous withdrawal that people who stop taking that drug can undergo. I told him what the docs probably weren't telling him. After I told him, he confirmed that, yes, I was right. The docs hadn't warned him.

I'd been on Effexor at one point, and had gone off it abruptly under a doctor's care. The doctor-actually, more than one doctor-hadn't warned me that withdrawal from Effexor can, and in my case did, cause, among other joys, vivid, prolonged nightmares, fever, sweats, chills, dizziness, crying jags, and what I can only describe as brain zaps, a kind of electric shock sensation inside your skull. When I started experiencing these symptoms, I went on the Web and found out that a lot of other people had endured the same torture.

"Just so you know," I told the Yenta.

He got his discharge a few days later, and that, presumably, was that. He would go on taking the same pills to live as he'd taken to try to die. Poison in therapeutic doses, didn't someone say? Medicating, no longer self-medicating, or something like that. Getting drugs to get you over the hump, or through the objectionable days, or to help you cope, or coast, or, as in Casey's case, to do double duty, to keep you going and to help you sleep.

Casey, like me, had been prescribed the antipsychotic Zyprexa on the outside, and for the same a.s.s-backward reason. Antidepressants had made her hypomanic, so her doc had decided on a mood stabilizer.

But not just any old mood stabilizer-the pet mood stabilizer of the day. An antipsychotic that had been approved by the FDA to treat bipolar disorder. Zyprexa: the same trendy pill that, interestingly enough, was well advertised in the Meriwether ward. "Informational" (read: promotional) displays were posted, complete with detailed, four-color leaflets, on the bulletin board outside the dayroom. Some of the nurses even carried their papers around on Zyprexa clipboards stenciled with the same promotional information that was in the leaflets. Others carried clipboards or wrote with pens that advertised competing drugs like Abilify.

Like Mother T and others, Casey had gained a lot of weight on Zyprexa. This, along with a propensity to cause diabetes, is a common side effect of the drug, and one that its manufacturer, Eli Lilly, knew about all along but failed to disclose to the public. The truth came to light in early 2007, when the New York Times New York Times reported in a series of articles that Eli Lilly had agreed to pay hundreds of millions of dollars to settle thousands of law-suits brought by people who had taken the drug. reported in a series of articles that Eli Lilly had agreed to pay hundreds of millions of dollars to settle thousands of law-suits brought by people who had taken the drug.

Wisely, Casey had gone off Zyprexa on her own. But at Meriwether they were tossing her Seroquel instead.

Thankfully, Casey was only in for three days before her therapist either came to her senses or responded to pressure from Casey's family and friends. She showed up at Meriwether and corrected her mistake.

Casey left Meriwether as bitter, angry, and frightened as I had been my first time around in the bin, and she had learned the same lesson. No matter how bad you feel, never go to the bin. In fact, never confess enough to your therapist to give her even the slightest inclination to commit you to the bin, unless you know her well enough and trust her enough to know she'd never do such a thing.

Don't a.s.sume she'll be able to tell the difference between contained, nonspecific suicidal thoughts and real, imminent danger to self or others, because the truth is, more often than not, she'll probably commit you either way, just to cover her a.s.s in case you do end up trying something.

Discernment can be hard to come by in psychiatrists. This has been my experience, anyway, and, obviously, it was Casey's as well. The human touch is not very often their strong suit. Nor is true empathy. Attend the annual American Psychiatric a.s.sociation conference, as I did, and you'll see that the emphasis is far and away on the science, not the emotional intelligence.

As noted psychoa.n.a.lyst Adam Phillips wrote in the New York Times New York Times ("A Mind Is a Terrible Thing to Measure," February 26, 2006), "Psychotherapists of various orientations find themselves under pressure to prove to themselves and to society that they are doing a hard-core science. . . . Given the prestige and trust the modern world gives to scientific standards, psychotherapists, who always have to measure themselves against the medical profession, are going to want to demonstrate that they, too, deal in the predictable; that they, too, can provide evidence for the value of what they do." ("A Mind Is a Terrible Thing to Measure," February 26, 2006), "Psychotherapists of various orientations find themselves under pressure to prove to themselves and to society that they are doing a hard-core science. . . . Given the prestige and trust the modern world gives to scientific standards, psychotherapists, who always have to measure themselves against the medical profession, are going to want to demonstrate that they, too, deal in the predictable; that they, too, can provide evidence for the value of what they do."

These people are thinking in categories, not only because that is how they are trained but because anything else is too vague, too absurdly metaphysical, to advance the cause of their credibility in medicine.

And yet, given what it is capable of doing, the brain is like no other organ, and does not submit, at least in the lived experience of the patient, to anatomy and chemistry alone. How can we treat it the way we treat, for example, a kidney? There is the brain, whose business is thought and feeling and judgment and even mystical experience. And then there is the kidney, whose business is p.i.s.s.

I can heal your kidney, or your heart, or your bowel without empathy, though bedside manner never hurts. But can I heal your mind without empathy?

So much of psychiatry is perception, not just bodily function. And so, to be effective, mustn't a psychiatrist feel? Mustn't he, too, have experience? And by experience, I don't mean how many patients he has diagnosed, or how long he has been diagnosing them. I mean personal experience. How much he actually knows, or at least can vividly imagine, about what it's like to be mentally ill, or what it's like, day-to-day, to take drugs that alter your consciousness, or, finally, what it's like to be locked in a ward.

It might do wonders for the profession if all psych residents were required to spend ten days incognito as a patient in a locked ward. Or to be given antipsychotic medications to sleep. Or to have their intelligence insulted by someone who doesn't know what neurotransmitter that drug happens to work on. Then, at least, they would know a bit more whereof they committed, prescribed, and consulted, and they'd think twice before suggesting hospitalization as a means of putting the Caseys of the world to rights.