Fridge was MI. Some undifferentiated mood disorder that made him p.r.o.ne to attacks of rage. He was the one who had been "very upset" while I was waiting downstairs. He got upset fairly frequently, and when he did, he often kicked open the magnetic doors that were supposed to keep us all locked in. There were three sets of them. He never got past the second. Not that he would ever have made a run for it. I doubt if he could have run: his size alone hobbled him. But he also had an understandable tendency to trip over his own feet.

Fridge had been in St. Luke's about ten times before, ostensibly to have his meds adjusted. He seemed to have some problem taking them when at home, or at least doing so consistently. He lived with his grandmother and was subsisting on welfare or disability or both. He said he was the victim of fetal alcohol syndrome, and that at least a good portion of his emotional difficulties were attributable to that.

When he wasn't in a rage Fridge was a lapdog, friendly and sweet, always amenable to teasing. He did remarkably well for a large man confined in a small s.p.a.ce.

As I sat there in the kitchen munching my bright green b.u.t.tered broccoli, he was standing with a sandwich in one hand, head in the fridge looking for more. He said a chewing h.e.l.lo. I nodded and smiled.

Soon there was a parade of others coming into the kitchen, like Fridge, for a snack and a gander at me, the new meat.

There was Clay, a fifty-one-year-old father of four. He wandered in sighing, wearing scrubs and socks. St. Luke's distributed scrubs to patients instead of pajamas, if they wanted them, though this was mostly just for the ICU, where people were more likely to have shown up without a change of clothes.

After a long look at me, Clay said quizzically, "What are you doing here? You look great."

"Appearances can be deceiving," I said.

"I don't know," he countered. "You look like you work here."

He wandered over to a chair and fell into it, grunting painfully.

He was paying what for him was attention, but he was not altogether there. His eyes were at half-mast, and he was swaying ever so slightly on his feet, as if he were standing on a boat. He was one of the addicts. Chemical dependency. CD. He was detoxing hard from a spree.

He had lost his job a few months back, just before Christmas. Then on Christmas day he'd had a terrible fight with his wife and stormed out of the house. He'd spent the next three months in what he called "the rubber room," which meant that he'd holed up in a cheap motel on the edge of town, a place infamous for being a drug den, and had gone on a protracted 24/7 bender, drinking beer and shooting c.o.ke all day and night, bouncing off the walls until they had to sc.r.a.pe him off the floor, near dead, with a needle stuck in his arm.

You can have a mighty good evening on a couple of grams of c.o.ke. When they found him, Clay had done an ounce. An ounce is 28 grams.

They took him to the emergency room. Then, once stabilized, they transferred him to St. Luke's. Now they were giving him 10 milligrams of Klonopin a day (1 milligram will make a novice woozy), plus trazodone (an antidepressant that everyone at St. Luke's said made them feel like a wet noodle), Ativan (another benzodiazepine, or "benzo," like Klonopin), and the famous sleep aid, Ambien. All this just so that he could cope, and pa.s.s out for a while at night.

Coming to see me in the kitchen was a feat at that hour, around seven. He'd had his evening meds, which is why he had the sea legs. Usually at that time, he was sitting on the couch in the octagon, his knees bouncing like they had a jolt in them, his face flushed, his eyes darting, his whole nervous system in overdrive.

I would see him in this condition fairly often over the next few days, but just as often he would be on the opposite pole. He tended to alternate between these two states. The one when he was on the edge of a panic attack, the c.o.ke making its hair-trigger way through his system, or the silly semistuporous one he got into about half an hour after he'd had his meds. Then, like now, he just smiled a lot, stated the obvious, and cheated very poorly at cards.

Clay, like Bunny, was still wearing a wristband. Seeing it, and having the same squeamish reaction to it that I had had with Bunny in the lobby, I was thankful that St. Luke's didn't use wristbands. To patients they are indicative of anonymity and neglect, and the doctors who owned St. Luke's seemed keyed into that, or so I imagined, understanding on some level that being tagged is a gross insult to your dignity. It makes you feel like property, or a corpse, a body not a person, the implication of the tag-maybe the need for it-being that if you pa.s.sed out in the hall, they'd know who the h.e.l.l you were.

By the time the introductions with Fridge and Clay were over, Bunny had made her way into the unit as well. I looked over and saw her slumped in a lounger in the octagon.

She was as wrecked as Clay, but alcohol was her drug. As she told me later, she was only recently out of prison, where she had done a six-month sentence on her third drunk-driving conviction. Depending on the state, the legal limit for blood alcohol content (BAC) is either 0.08 or 0.1 percent. When Bunny was admitted to the hospital, her BAC (or so she said) was 0.59, a poisonous, quite possibly fatal amount.

Though obviously an alcoholic, Bunny was, by her own admission, primarily depressed and self-medicating. Her mother had died a few months back, and that was most of what had precipitated her recent binge.

She was a bright woman and had spent her life in this d.i.n.ky prairie town going mostly nowhere. There was nowhere to go but out and away, very far away. But she never had, and so, like so many of the other addicts and depressives I met at St. Luke's, she sank, and then did drugs and drank to pa.s.s the time, or obliterate it.

That part of the world would depress anyone-anyone with imagination or ambition. It was easy to see how it would happen, how slowly, over the course of years and many dull days, the landscape would destroy you.

The people were a mirror of that landscape. Flat, simple, but existentially in pain. They spoke plainly but liltingly, their vowels all attached to an e e, as if transcribed from the Greek-ae, oe, ie. They were eager to help, and easy. Not southern sluggish, but in no particular hurry or busy snit either. They were eager to help, and easy. Not southern sluggish, but in no particular hurry or busy snit either.

They were real, and rudeness was rare, but they would not let you into their hearts. They would not even let themselves. They were kind on the surface, but, as on the farms so plentiful in the region, the soil underneath was black. Not the black of cruelty, but of despair. The thing that nearly everyone around me was in the hospital for.

And the prognosis was not good. Not good at all. Because even if these people landed in St. Luke's or places like it, there would be no lasting remedy for the disease-the disease of their lives. Even if you cleaned a person up and dusted him off and stanched the flow of immediate tears with a rub on the back and a pat on the head, there would still be the same world out there to confront when the treatment was over.

There were still the hours to fill and the lack of opportunities or hope. These people would still go home to an empty apartment or a family fight, all the same stressors still in place, and they would have no means of lessening them, because their will, if they had ama.s.sed any in their time away, was still weak and always a quick casualty. No match for the horror of lost chances.

That's why they all landed back in here. They came in zonked. Got sober. Went home, and the minute they put their keys down on the counter, took their first real breath, and the smell of all they were running from got way up in their nostrils, they reached for the same solution, and did it all over again.

That's why, when Clay was on the phone talking to his mother or his cousin, he said, "Yeah, that guy who kicks in the doors is here again. Remember him? And that lady with the red hair, too."

He was talking about April, another depressive alcoholic repeat who may have set some kind of record for rebounds. This time around she had been in St. Luke's half a dozen times in as many months. She was fifty-eight years old and divorced, living off the settlement and boozing her way through it, drinking 1.75-liter bottles of liquor in two days with no food. Now she was on a boatload of tranquilizers too. Five milligrams of Klonopin a day, trazodone, and Lunesta for sleep.

Living alone with no occupation was the killer for her, and the reason why she relapsed so fast, usually within hours of release. It usually took her a few weeks to work her way into such a state of acute malnutrition that she had to come back to the hospital, but she always did it. A terrible, common cycle.

Of course, not everybody was a repeat. Chloe was a first-timer. I met her, too, that first night.

She was a nineteen-year-old student at the local college who had come in for suicidal ideation. She was yet another one of those hapless people-there always seemed to be one, usually a woman-who, in an unguarded moment, confessed to feeling suicidal or inclined to self-harm and got shuttled off to the psych ward.

The door had locked behind her before she had gotten her bearings enough to know that she couldn't just walk out, and she was stuck here at the mercy of a total stranger's judgment about her own internal life.

I found this bitterly amusing, and so indicative of the state of psychiatry today. They admit a person to the hospital based solely on what she tells them about how she's feeling. They diagnose her on that basis, too. Yet once she's in the hospital her word is no longer good enough. She has been magically diagnosed, and that diagnosis supersedes her testimony. Suddenly the doctor knows better, even though he knows only what you have told him.

Does the word match the disease? Does the disease exist at all? The doc is dealing in shadows. Yet we all speak with such conviction, as if diseases were made entirely of ideas, floating in judgment between doctor and patient, and then somehow locked down, the person locked in and trapped by the doors and the diagnosis.

When I first saw her that night, Chloe was talking on the pay phone, crying. The trap had done its work. She was frightened and feeling worse, looking around at all the rest of us downhearts and drowsers and thinking, "What the h.e.l.l have I done?"

She was a tall, broad-shouldered, athletic girl with medium-length dirty blond hair, which she often wore in a ponytail. She was wearing jeans and a jean jacket over a T-shirt, the jeans and the jacket both fitted and faded to the same ice blue.

She moved and held herself upright and square-shouldered, with the command of someone whose body is an instrument, efficient and well trained. Her face was covered with shiny pink pimples, which she picked unself-consciously, often until they bled. This, combined with an air of insouciance that somehow coexisted with her depression and self-loathing, had the effect of making her seem even younger than she was, and more exuberant, as if her youth could not help bursting through all the worldly woes that had gotten her here.

She was filled with determination and energy. Nothing like the other depressives I met at St. Luke's. But then this was part of her problem. It was what drove her to self-harm and a suicide attempt.

She told me that when she was a child her father used to give her a sheet of paper every morning and tell her to use it to make out a schedule, dividing the day into fifteen-minute increments. She was then required to write down exactly what she had done during each of those fifteen-minute periods, everything from brushing her teeth to saying her prayers. At the end of the day her father would read over her schedule and tell her whether or not she had had a good day.

Her life was a drive. One long drive to be good enough, to achieve, to use time, not to fail. She was a good athlete, she said, basketball and soccer, and a good student, though not a natural one. She had been on antidepressants for two years, and had been cutting herself for longer than that, just trying to find some relief from the expectation.

"I don't feel that I will be loved if I'm not the best at everything," she said.

Nonetheless, she had her head screwed on pretty straight. She had enough perspective to say that her father meant well, as no doubt he did, even as he hammered her into shape. He wanted her to succeed, wanted to teach her to order her world, a skill that she knew had served her well in many respects, even as it had drummed home the message that love was to be earned, not freely given. She knew that medication was not a hale holy panacea, and that she would have to build her emotional well-being out of effort and vigilance as much as the almighty chemical fillip.

She waited in the ward thinking what I had thought in the same circ.u.mstances, that this was not a place much designed to help people like us, the semitalented, sometime wayward overachievers who got a little carried away with the X-ACTO knife when we got a bad grade, or otherwise tripped on the ladder to betterment.

Having a doctor tell you how it was when you b.l.o.o.d.y well knew how it was, and had told him; having to be paternalistically shut in for your own good despite your protestations that no good was to be had in the shutting; this was not the stuff of recoveries. She shared this sentiment, especially since it was the weekend-her G.o.dd.a.m.n weekend-earmarked for some well-earned play.

Incongruously laughing now after her phone call, scribbling furiously in a coloring book at the adjacent table, she said, "I'm a kid. It's my job to play."

And so we played. All of us. Me and Clay and Bunny and Fridge. Per her invitation and instructions, we played Indian poker.

"What the h.e.l.l is Indian poker?" I asked.

She held a card up to her forehead, face out.

"Like this."

It stuck to the grease on her face like a cartoon feather, and she smiled, lowering her hand. She dealt us each a single card.

"Don't look at your card. Just put it up," she said.

We did.

"Now," she ordered expertly, "you bet based on what everyone else has, but not knowing what you have."

"What are we betting with?" asked Clay.

n.o.body had money. Valuables were locked in the nurse's station.

"Skittles," she said, producing a large bag and doling out piles to each. She popped a few loose ones into her mouth, "Okay. Aces are high. Left of me bets first."

That was me. I looked around the circle. New faces that I seemed to know already. Eased into a game together on this Friday night in lockup. How strange. How somehow easy and almost normal.

Clay had a king. Fridge had a jack. Chloe had a five and Bunny had a ten. It wasn't looking good.

"f.u.c.k me," I said, throwing down my card, "I fold."

I had an ace, which provoked a chorus of near miss "Ohhh"s from the others.

"d.a.m.n," I said, "my deal."

And so I dealt and we played well into the night. I was coasting by then on my own popped Klonopin, nearly forgetting where I was and what I was, until one of the more officious members of the staff, who saw that we were betting (albeit with candy, but betting nonetheless), stopped us.

"Gambling is not appropriate in an addiction recovery facility."

Lights out.

No one woke me rudely in the morning. It was Sat.u.r.day, so no one woke me at all. Another human luxury. Another piece of myself handed back, left to my discretion. As was breakfast, which I wandered into the kitchen around ten to prepare.

On each table, thermal pots of coffee had magically appeared. It was bilge, of course, but I doctored a cup with creamer and sugar and drank it anyway, out of pure grat.i.tude for the option.

Clay stumbled in looking stupefied by the night, as if sleep for him was a beating, or hard labor he needed respite from. Then there was Herbie, whom I hadn't met the night before.

Herbie was a ninety-two-year-old former night watchman who fought in the Second World War and was now living a strange, reclusive life with his ninety-four-year-old wife of thirty years. Like so many of the rest of us, Herbie was in for depression.

"I don't have anything to do anymore," he said by way of explanation for why he cut open one of his arms in what was either a botched suicide attempt or a stab at self-mutilation. But for an extremely old and ostensibly depressed person Herbie was oddly upbeat and on his game.

He used a walker to get around, though he could navigate short distances without it. He often did laps around the octagon, the walker's wheels squeaking intermittently and wobbling at the base like a busted grocery cart. He liked to play games of chicken with whichever one of the other patients happened to be making the loop in the opposite direction, or he'd make a mock show of running us down as we crossed his path.

Herbie was always full of sly humor. I asked him why he was in St. Luke's.

"I signed the wrong papers," he said.

People had taken to Herbie and took care of him, making sure he was eating enough, toasting him a bagel or whatever else he wanted for breakfast, and bringing it to him at the table.

"Do you want some kiwi, Herbie? I know how you like it."

They'd had kiwi the night before as dessert with dinner and Herbie had never had it before. He'd loved it, and everyone had noticed, saving the leftovers in the fridge for him to pick at over the next few days.

Herbie had hit it off especially well with one of the other patients, Karen, the most high-functioning psychotic I have ever met. She was another repeat. She came in every now and again-via ambulance from a hundred miles away-to have her meds adjusted and chill out from an episode.

She knew enough about the course of her condition to know when she was losing touch with reality, and she had a very helpful circle of psychotic friends with whom she had what she called regular "reality checks." This meant that, because their delusions were all different, she could call one of them and say, "I think the CIA is watching me," and they'd be able to set her straight, confirming that, in fact, no, no one was lurking in the bushes outside her house or listening to her phone calls. Similarly, when they called her to ask if aliens were landing in the park down the street, or check whether the computer chip in their molar was actually picking up signals from police radios, she could a.s.sure them that they were, in all likelihood, mistaken.

Karen also went to group meetings, which functioned as a similar corrective if she was slipping into delusions.

Karen had a delightful sense of humor about herself. She said of one such group meeting, "Yeah, I was sitting in one of those meetings and I said, 'Am I G.o.d?' and everyone shouted, 'Noooo.' Now there's a reality check for you."

Like Herbie, Karen was extremely well liked around the ward. People appreciated how easygoing she was, especially since they knew that she managed to be that way even while she was hearing voices and seeing shadowy figures skulking in the corners of the room. People would say, "How's it going Karen?" and she'd point to her head and say, "Getting louder in here."

Karen was a good example of what a support system could do for you when you were seriously mentally ill, and how much of a difference a social network could make in how functional you were. The people at Meriwether were largely without resources, and most of them lived on the street. As a result, they didn't get regular reality checks. They had no friends to speak of, certainly no psychotic friends who were functional enough to help anyone. And no "normal" person was going to serve as a touchstone in their world. Normal people gave them a wide berth and looked away as they walked past.

It's not hard to imagine that a sane person living on the street for a few weeks, frightened, isolated, and scorned, would start to lose touch with reality. It happens to any of us when we spend too much time alone in our homes. But then factor in the chaos of the street, the dangers, the drugs and alcohol that make beggardom bearable, the dejection and extreme loneliness of being an outcast, and you have a very bad situation for anyone's mental health. Throw voices and delusions into that mix, and you're guaranteed to get someone who is barely reachable.

Karen was getting the benefit of both friends and nurturing asylum because she was middle-cla.s.s. She had insurance. She had resources, both social and financial, and she got the benefit of effortful care in a hospital that was not overcrowded, overburdened, poorly managed, and resentfully staffed. In stark contrast to the patients at Meriwether, when Karen came into the hospital during an episode, not only was she greeted by nurses who treated her respectfully, but, most important, she found herself among other people like herself, people who were not the products of the ghetto or life on the street. This meant that they could almost all, in some measure, take care of each other, offer an ear, advice, laughter, and companionship in distress, even if only in a game of cards.

These are the luxuries of the relatively healthy and at least marginally grounded. Being such a person, I am learning, has a lot to do with your present economic station in life, as well as the one in which you were raised.

Karen was not the sole example of this type. I met four diagnosed schizophrenics during my time at St. Luke's, and all of them were like Karen, highly functional, capable of discussing their illnesses and taking part in group sessions where they could both give and receive at least some counseling. At Meriwether, you were lucky if you could keep order in a ten-minute meeting. Perspective and co-counseling were unheard of. Impossible. People were too drugged or too incoherent from their life on the streets to do much but slump or babble.

Of all the psychotics at St. Luke's, I got to know Karen best-or got her to say the most intimate things about herself-when we were on smoke breaks.

Among the many ways in which St. Luke's far outstripped Meriwether-allowing the patients to smoke and get some fresh air was one of the best.

Seven times a day-twice in the morning, twice in the afternoon, and three times in the evening-one of the nurses took us outside (there was no limit to the number who could go) to a small fenced-in garden area just off the ground floor. It wasn't much, and since I didn't smoke, I spent a lot more time inhaling the other residents' furious puffs than I did breathing actual air. But still, it was outdoors, and if the weather was fine and I found which way the wind was blowing, I could steer clear of the smog, and even get a little sun on my face. It was glorious, even when it was cloudy or raining. It got me through, knowing that I always had a break to look forward to.

People stood around in groups, having procured from the nurses their two allotted cigarettes, chain-smoking and catching up with people they knew from the main ward upstairs.

The main warders took their smoke breaks at the same time as we did, and this was usually when repeat offenders like Clay and Bunny reunited with other addicts whom they had met during previous stays at St. Luke's.

Slapping each other's shoulders and laughing, they'd say, "Still a cla.s.s A f.u.c.kup, I see."

"Oh yeah. Always."

"How'd they get you this time?"

"Oh, ya know. Dog ran out of the house. Got hit by a car. Caused an accident, and the cops came. I came running out after him so c.o.ked out of my gourd that I forgot I was carrying an armful of the stuff. Busted right there."

"Wow. Sucks. Dog okay?"

"Oh yeah. He's fine. Ducked right under the cha.s.sis. No scratch."

"Lucky f.u.c.ker."

"Yeah. I could kill him."