"Are you feeling anxious?"

"Very."

"What about?"

"Myself."

A pause.

"I don't feel safe."

This was gold. Safety is to be found in the hospital. Theoretically, anyway. It was a mission in this place. A point of pride, you could tell. She would check off "inpatient" after that for sure.

"Do you think you need to be admitted?"

"Yes."

"I do, too."

She left the room to telephone the on-call psychiatrist and tell him that I needed in.

I am pathetic. I have insurance. They won't refuse me.

After the Meriwether experience, I decided it would just be easier, and would certainly make me much less conspicuous, if I owned up to having insurance and presented my card right away. I had to do everything possible to make sure I got into St. Luke's without a hitch. I didn't want them shuttling me off to another public hospital. Besides, I still had to chase down my insurance company about reimbursing them for Meriwether, so I figured I could pay up for St. Luke's at the same time.

One of the menopausal mommies made a copy of my insurance card and called it in. Mary Jane came back into the room.

I was admitted to the hospital.

I had not been told what to expect, or what voluntarily committing myself would mean when I wanted to get out, though I signed the papers that told me these things if I had cared to read the fine print. I had not, however, seen an MD. But somehow it didn't seem to matter. It was like going into someone's home. You feel bad? Poor dear. Come in.

I had been formally admitted, but I was still waiting in the lobby some time later. They were ready to take me in, Mary Jane informed me, but someone upstairs was apparently "very upset," so I was waiting out the tantrum downstairs.

A voice on the loudspeaker, which was very tame and dulcet as loudspeakers go, said calmly, "CIT second floor. CIT second floor."

I heard this designation again once or twice during my stay. Crisis Intervention Team. But it was for other floors, so I didn't see who came. I imagined they wore dark red or dark green blazers and ties, like offertory ushers in church.

Sitting there waiting, I began again, as I often did when the depression got to this point, to get stuck in a spiral of thought. There was nothing else to do, so I was asking myself all the kinds of confused philosophical questions I always asked myself when I felt done for.

How does a person get here? To the point of commission, I mean. Is it a failure of will? Of discipline? Or worse, a metaphysical lack?

I could not escape this prejudice, if it really was one. I still can't. In the culture of depression as chemical imbalance they a.s.sure you that it is is a prejudice. Words like "will" and "failure" are not only unfair-signs of an unenlightened view of major depressive disorder or bipolar disorder, or whatever as yet theoretic ailment I am purported to have; they are also false terms. They do not apply. Or so we are given to understand. a prejudice. Words like "will" and "failure" are not only unfair-signs of an unenlightened view of major depressive disorder or bipolar disorder, or whatever as yet theoretic ailment I am purported to have; they are also false terms. They do not apply. Or so we are given to understand.

This is my fault. My deficiency. My mistake.

Thinking back on it now, I remember one of the videos they screened in the dayroom at St. Luke's, a video produced and paid for (surprise surprise) by one of the major pharmaceutical companies that markets antidepressants.

"Depression is not your fault," it said.

The white words appeared on a black background, the letters jumping off the screen, moving toward the viewer, highlighted in a box, the narrator intoning, too, for emphasis.

"Depression is not your fault."

That is what the drug companies and the doctors and a whole lot of patients wanted you to know. If you contradict this idea or question it, it's merely the depression talking, or ignorance. But is it? Entirely?

"I'm diagnosed," said Teary Molly, one of the depressed patients I would meet in the ward upstairs. She was a cherubic plump twenty-two-year-old mother of two. Her face was always pink and smeared with fresh tears.

"I want my father to know that I am diagnosed," she told me. "He doesn't believe in depression."

"Neither do I," I had wanted to say, but I didn't quite mean it the way her father did. I believed in depression as a phenomenon all right. I believed in it then sitting there in the lobby. I believe in it now. The fact of it, surely, is incontrovertible for me. I had been in the tub. I had been reduced to a quivering ma.s.s.

And yet still there was an argument going on in my head.

I am here. Depression exists. As for cause? Disease? That is something else altogether. I am open to it. I suspect it. But there is no truth to this as yet. And there may well be will or partial fault involved nonetheless.

There must be.

The argument goes on now, in much the same way as it did then: What is the role of will?

After all, even established, testable diseases and conditions, like heart disease or the famous depressive corollary, diabetes, can be and usually are exacerbated by human choices, lifestyle choices, hamburgers, sweets, cholesterol, laziness. Should depression be excepted from this list because it comes from the brain? And does it come from the brain, or is that just another effect? An effect of some as yet undiscovered virus, say, or simply the old culprit, stress?

Unknown.

I hated-sometimes I still hate-Teary Molly the way I hated and sometimes still hate myself, and probably the way her father hated her, too. I hated what I saw as her mewling, self-sorry ent.i.tlement to the mantle of illness as ident.i.ty, her overeager taking of refuge in "diagnosis," in the imprimatur of the medical establishment that absolves her of all responsibility.

I come back to this theme again and again. There are no diagnoses in psychiatry. Only umbrella terms for observed patterns of complaint, groupings of symptoms given names, and oversimplified, and a.s.signed what are probably erroneous causes because those erroneous causes can be medicated. And then both the drug and the supposed disease are made legitimate, and thus the profession as well as the patient legitimized, too, by those magical words going hand in hand to the insurance company: "Diagnosis" and "It is not your fault."

But what if it is my fault? Or partly my fault. Or what if it is, at least, a deficiency of my own neglect?

Maybe this was just the depression talking. More self-hatred, self-blame. But that didn't mean I was altogether wrong either.

Suddenly I was aware again of the television, of the ladies typing behind the desk, of myself sitting in that armchair. I wondered if I was making too much noise.

I must stop this. Stop the train of thought, too long, too arduous, too loud.

Let it stop.

I begged myself, because there was no commanding at this stage.

Let the relentless ideas stop. Let the judges stop p.r.o.nouncing their sentences on me. In every free moment, in the shower, walking to an appointment, in the appointment, harping in the background, harpies overhead, shrieking and circling, in bed, in my dreams, in my teeth grinding themselves blunt in the night, I am pulverizing myself raw. appointment, in the appointment, harping in the background, harpies overhead, shrieking and circling, in bed, in my dreams, in my teeth grinding themselves blunt in the night, I am pulverizing myself raw.

You. You. You. You. The finger points at you. Who is right? Who is wrong? Am I making an argument? Are we having an argument? Can't we have this out another time?

FUUUUUCCCCCKKKK. Stop.

But it did not stop. It went on.

People say that depression is tears and la.s.situde and fear and self-loathing. But they do not say that it is a brain made of tacks, that it is a relentless pa.s.sing of sentence.

Guilty. I am guilty.

And an equally relentless rumination and breaking down in response to it. Perhaps like autism, depression is a protective reaction to too much information. Too many thoughts.

In this context it's interesting to ask: Why can't a depressive get out of bed? Because if the minute you woke up, you thought of all the ways you could die or be injured or fail or cause death or failure or harm to others in any given day, you wouldn't get out of bed either. If you thought too long and hard about all the people who die in crosswalks, you would never cross the street. If you thought of all the people who die in car accidents, you would never get in a car. And those are only the simplest considerations.

Life is lived on ignorance, on not thinking about all the possibilities, about ignoring the most basic fact, that you are mortal and that it is unreasonable to expect a sentient, self-conscious creature to live with the idea that she is going to die.

Life is lived on denial. Denial of the obvious and awful. Healthy happiness is the careful adjustment of the veil of obliviousness, the very same gossamer veil that acts of G.o.d and terrorist attacks punch a hole in. But only for a moment. And time stops. Life stops while the hole gapes. Because it must stop. Life cannot be lived full face. And that is what grief is. The stopping of life and time in the face of knowing, seeing too much.

And that is what depression is as well. A stoppage, or, as n.o.bel laureate John Nash called it when speaking of his own schizophrenia, "a mind on strike."

And so I was pleading again with myself from underneath the pile of disputes: MAKE IT STOP. Please make it stop.

And what would make it stop? What would expediently make it stop? Drugs. Wonderful, dreamy, ameliorating drugs. Legal drugs. Drugs that I could have because I, too, had been diagnosed, and because when it got that bad I didn't care about anything but silence.

The kiss of the unconscious.

I had secreted a Klonopin in the change pocket of my jeans. I slipped it into my mouth and sucked the pill like a mint. Then I chewed, hoping it would work faster that way.

And immediately it did. It worked. Not the pill, of course, but knowing I had taken it. Just the knowing that help was coming helped.

Help.

Just then a greasy-haired, puffy-faced blonde appeared in the armchair across from me.

Meet Bunny Wags.

Bunny Wags would teach me to play rummy in the ICU to pa.s.s the time in the evenings. She would tell me many stories about the system, because, though she was only twenty-nine, she had been through it like a lab rat who just wouldn't learn. Or maybe just wouldn't stop pressing the lever for the drug. She looked like a hundred and fifty pounds of chewed suet, sitting there pasty, slumped, defeated, with her white hospital band still on her wrist. She had come from the emergency room of another hospital, one that had those kinds of facilities.

St. Luke's didn't. They didn't get their hands dirty at St. Luke's. They didn't have an emergency room, or at least not the kind you'd find in a real hospital. They had an ICU unit, which was just another ward on the second floor, a ward just like the wards on the third and fourth floors, except that it wasn't permanent for most people. As at Meriwether, it was where everyone went first thing, in order to be processed and evaluated by an MD. You only stayed there if you were especially disruptive and needed to be watched or managed more carefully. Otherwise, in a day or two, you went up to the main ward on the fourth floor, which was shared by the addicts, on one side, and the mentals, on the other. If you were a kid, you went to the children's ward on the third floor and avoided all the rest.

St. Luke's wasn't like Meriwether. They didn't take people right off the street. They weren't on the front lines. They were a rehab clinic and small-time loony bin. All of it was coolly controlled. There was no triage in progress at St. Luke's. When I had called to make my needs a.s.sessment appointment and asked explicitly about their admissions policy, they told me that insurance was not a prerequisite for treatment, but I got the strong impression that if you didn't have insurance, they shipped you off pretty quickly.

That impression got a lot stronger later on when, while fantasizing aloud with a couple of other patients about how to escape or otherwise shorten our stays, a veteran of St. Luke's said: "You wanna get out? I'll tell you how to get out in a h.e.l.l of a hurry. Cancel your insurance."

St. Luke's was where they deposited you on the far end of a binge to dry out in clean quiet once they'd pumped your stomach or IVed your desiccated carca.s.s back from borderline malnutrition-once the life threat was over and you were breathing on your own.

Bunny looked like that, like a body brought back from the brink by tubes and technology and cursed by the genes of generations to be a drunk for the rest of her life.

I didn't say a word and neither did she. She was still a bit quivery from the treatment, and I was a pile of dirty laundry with legs, having a circular argument with myself about "the will," so what the h.e.l.l did I have to say to anybody?

Finally, Mary Jane came for me. Crisis over upstairs.

"They're ready for you now."

Did that sound deeply creepy to anybody else? I wondered. Like the thing the too-pleasant lady says in the slow-moving 1970s horror flick. The viewer's first inkling that the hero is really in h.e.l.l and all the staff are really demons.

But they were not demons there. At first, this worried me, as much as it surprised me. Everyone was just way too nice. Scary nice. The guy at the metal detector who searched my bag and wanded my body was that way too. Polite and accommodating.

It took him less than a minute to go through my things, which he handled with care and respect. He was just checking for anything blatantly dangerous-a knife-or illegal-drugs. The staff upstairs would do a more thorough job, taking inventory to make sure nothing was lost. He zipped my bag, handed it back to me and smiled, as if I had done him a favor.

"Okay. You're all set."

Then Mary Jane and I were walking through empty, carpeted halls and going up in an empty elevator, coming out on an empty floor, going through two sets of locked doors, pa.s.sing along the way whole quiet well-appointed exam rooms with long-handled sinks and boxes of rubber gloves. We pa.s.sed activity rooms and meeting rooms, too, all with intact tables and chairs neatly arranged. All perfect, clean, empty, new.

And then finally there was the third set of locked doors. The ward. The ICU.

Mary Jane turned the key in the lock, gestured me in, and followed.

The door shut behind us.

Click.

The unit was small, only six rooms, some double occupancy, all opening onto an octagonal dayroom at the center. The nurse's station was on one side of the octagon, so every room and the dayroom was visible from within it. Off to the side there was a kitchen, and a dining area with three round tables, each of which could comfortably seat five.

There was a full-size fridge stocked with bagels, cream cheese, bread, b.u.t.ter, cold cuts, bags of raw vegetables, broccoli spears and baby carrots, and various single-serving juices (grape, apple, prune, orange, cranberry).

The cupboards were stocked with Styrofoam cups, disposable plates and bowls, small boxes of cereal, raisin bran, cornflakes, frosted flakes, Cheerios, bags of microwave popcorn, bags of trail mix, graham crackers, pretzels, animal crackers, instant oatmeal, instant hot chocolate, tea bags, sugar, mayo, mustard, barbecue sauce, and almost any other condiment you could think of. In the freezer there were individual cartons of vanilla ice cream and orange sherbet, and more bagels, bread, and cold cuts.

Jesus. This is camp.

"Have you had supper?" they asked, they being the two ward nurses on duty who had introduced themselves, shaken my hand, and smiled.

Supper? This kindness was too quaint. I felt corrupt in the presence of the word, so anachronistic, so innocent. This kindness was too quaint. I felt corrupt in the presence of the word, so anachronistic, so innocent.

Have you had supper?

"No."

"Well, let's show you around the kitchen and you can make yourself whatever you like."

And so I did. Amazed. I put some of the raw broccoli in a bowl with a half-inch of water, covered it with another bowl and steamed it in the microwave. I melted a pat of b.u.t.ter over the top of it and salted it. I toasted a bagel (whole wheat; 4 grams of fiber) and slathered it with cream cheese. I took a Granny Smith apple and a banana from one of the bowls of fresh fruit that had been placed at the center of each table. There were individual servings of peanut b.u.t.ter in the cupboards. I spread some of it on each bite of the banana.

This and raisin bran was most of what I ended up eating while at St. Luke's. Lunches and dinners were egregious, catered unwholesomely by the same company that served a local college. Often entrees were some form of semicongealed mash ca.s.serole consisting of hamburger, corn pone, peas, and potatoes. It was either that or macaroni and ham and viscous, ersatz cheese all served with an ice-cream scooper. Starch was the staple. At times even the vegetables were adulterated by it. One side dish of glazed carrots had soggy bits of bread mixed in.

But snacks! Snacks. G.o.d, how civilized. How good.

Of course there were always people for whom too much idle time in the octagon and too much access to the kitchen weren't a particularly healthy combination, people like the 350-plus-pound, six-foot, four-inch mulatto whom I unoriginally nicknamed Fridge, not just because of the famous football player of the same moniker, but because this guy spent way too much time gazing into, and dwarfing, that particular appliance.

He was twenty-one years old and seemingly still afflicted with the near demonic munchies of the growing boy. The siren song of the sandwich was so strong in him that the whole ward eventually took to joking about the fridge itself being haunted.

"It's calling to you, man."

And he was indeed a comical figure standing there huge as a door himself, gripping the handles of both fridge and freezer, swinging them rhythmically as he rocked back and forth on his size twenty feet.