IT'S NOT A RIGHT, IT'S A PRIVILEGE: Four Days in a Psychiatric Ward


Karen Bell

Suffering-curious as it may sound to you-is the means by which we exist, because it is the only means by which we become conscious of existing; and the remembrance of suffering in the past is necessary to us as the warrant, the evidence, of our continued identity.
--- Oscar Wilde

Part I

Two paramedics accompanied me out of Holyoke Hospital, located in Springfield, Massachusetts. The head paramedic , a stocky Italian-looking fellow, made inane jokes to his partner, a young kid about my age. He had long blonde hair, tied back into a ponytail. If he hadn't been so innately goofy, with that hollowed-chest look and if he hadn't stooped when he walked, he might have even looked cool. Once in the ambulance, he did put on a good radio station, and I was disappointed that he never turned it up. The Italian sat in the back with me and my bags. Between asking me questions, he would yell to the blonde in front and give directions.

"Make a left up here, I said," while glancing back in my direction with a look of exasperation as if to say 'see what an idiot I have as a partner?' I looked back at him dully as if to answer 'does it look like I care?' Heedlessly, this man continued to talk and ask questions. Only half of me even listened. I did remember him asking me if I had a gun. Odd question, I thought. I answered truthfully: not here.

"You don't have one in your bag right?"

"Oh no," I answered, of course not. He sighed with relief, scanned my attire, and mumbled something about the fact that I didn't look like I would carry a gun. Message received loud and clear: I'm white and look middle-class. Therefore, there's no need to worry.

After parting from my escorts and ushered onto the ward, The Fowler Wing of Noble Hospital in Westfield, I was brought into the nurses' station. I was told to leave my bags there. I hesitated. To walk out of sight of my leather briefcase, wallet and imported leather jacket seemed unwise, yet I reluctantly agreed and followed a man into a back room. Several people kept interrupting my interviewer, who seemed hurried and distracted anyway, and offered to 'finish up' for him; he finally agreed. I learned that the "populations" on this unit weren't segregated. I learned that there were designated smoking times, five per day: 9:30 am, 12:30 pm, 3:30 pm, 5:30 pm and 9:30 pm, each 15 minutes long. My matches and lighters were confiscated; only staff light cigarettes. I learned that, unbelievably, I was in a locked unit. The windows were escape-proof and the mirrors some aluminum alloy in which you viewed a distorted image of yourself.

I could have band-aids but no antibiotic ointment without a doctor's order. I could take a shower, but staff would have to unlock the door for me. I could lock up valuables but if I wanted any of my stuff in the locker, they would have to open it for me all the while standing over me and asking what it is I'm getting. All of my medication, including my vitamins, were confiscated, and I could only take them if their doctor okayed it, and that took hours to do. I was allowed no day time passes until my treatment team decided I was normal enough again to join the community for a few hours. Caffeinated drinks were simply forbidden altogether.

The first night I came to the psychiatric wing of Noble Hospital I was relieved. I had begun the hospitalization process early that morning and due to problems with one hospital and my insurance company, the entire ordeal had lasted eight hours. After being shown my room, I immediately took a shower. I hated the liquid soap they gave you as a substitute for shampoo. It smelled like what I imagined lye soap smelled like during the Civil War. Nevertheless, I thanked the staff for it and settled in for the night.

My roommate's name was Jo, a nickname that didn't fit her at all. She was a timid, petite frail woman in her 50s who acquiesced to everyone around her. She was not one to upset the standard order. She was amiable and polite, and I was grateful she just wasn't psychotic, and to my relief, she left me alone. The night before I had gone to sleep instantly, but at 5:30 am I was awakened by noise in the room. Since Jo was obviously a person who lived on minimal sleep, I too, would have to adapt myself to her insomnia. I lay in bed until 7 am, when I was informed that I needed to get up for bloodwork. I sleepily got dressed and sat out in the hallway waiting for the nurses.

The Fowler Wing looked like a co-ed college dormitory. It had one long hallway, the ends of which were locked. Along each side were bedrooms, with two twin beds in each, as well as different meeting rooms in between the bedrooms. There was a sink opposite the beds and a bathroom adjacent to the bed near the door. There were windows with curtains, and you could look out and see a green lawn spotted with a few trees. Beyond the lawn was a residential street and some small homes opposite the hospital. I would look out occasionally but the screens which were keeping us secluded were so thick and made with such small mesh, the view seemed more like a grid map of an imaginary neighborhood. I opened the curtains for the light during the day, but I avoided gazing out of the window since I had no outside 'privileges' and didn't know if and when I ever would.

As I waited for my bloodwork that first morning, I mused on how out of place I already felt among the schizophrenics, drug addicts, and other patients. I had come to the hospital of my own accord, hoping to break an unusually long depressive episode that was on a collision course to suicide. Having learned to live with depression (at 25, I already had 15 years under my belt) I am capable of knowing when intervention is necessary, when I can't do it on my own. This particular episode, well into its second month, commanded drastic measures, and hospitalization seemed the only panacea.

The nurse finally called me into the examination room, and the phlebotomist stuck a needle in my vein, (I like using my right arm when giving blood not only because the vein is easier to find but so every phlebotomist can notice my tribal arm band tattoo that I'm so proud of). I asked her what tests were being taken. She obviously felt it would be a waste of my time and hours to explain and simply said it was "admission bloodwork," and that she didn't know the names of the tests. Before I could get irked by her incompetence, another nurse listed off the test: bilbirubin, glucose, thyroid etc. I wanted to be sure I wasn't having bloodwork done that I'd already had done recently elsewhere. If I had told them not to perform one of the tests, I imagine the entire nursing staff would have been personally insulted by my non-compliance of standard procedure, or they may have just thought the request part of my symptomology.

Breakfast was served bright and early at 7:30 am. After finding the meal very unappetizing, I decided to forgo the dish all together and got myself a box of cereal instead. I'd hardly eaten the day before, and I was still hungry after eating the Bran Flakes but was also too anxious by my new surroundings to explore and find something else to eat. I went to my room to wait what seemed like a very long time for our 9:30 am cigarette break. And I got to meet with my psychiatrist.

The most significant person in all of our lives was, of course, our psychiatrist. There were several working with all of us, and I regret to only have one story to tell about one man. Dr. Allen was a short well-built Jewish man in his 40s and going bald. He was quite attractive and intelligent. He had amazing control over his facial expression so much so the wrinkles around his eyes appeared only rarely and then only when he deigned to smile. During my first visit, in the very pathetic, vulnerable state I was in, I was convinced that he was the first Jewish Nazi I'd met. He had sequestered me in a nuthouse, trapped in a surreal bubble of madness, and he denied me my freedom in the form of immediate discharge. I was "too high risk." Although it had initially been my idea to be hospitalized, I suffered miserably for my mistake. 'I didn't belong with these people!' I thought indignantly. Outside of intermittent contacts with staff, I was forced to be in the company of degenerate, sick and insane people whose lives up to that point had been utter failures. I became hysterical at being secluded and locked up. I demanded my release; I begged for my release (I remember saying pathetically, crying at the same time, "Don't do this to me"). This behavior only encouraged Allen to escort me out the door of his office saying pedantically "You need to sit and think about why you're depressed." Not only was that a futile task, having tried and failed to answer that question for the last fifteen years of my life, but I had, in the meantime, failed to get what I wanted: my car, my home, my work, my life.

By morning's end, I had already finished being hysterical over the injustice of my situation (and hating Dr. Allen all the while) and was playing mental games to distract myself. I had each cigarette break time memorized, and I was amusing myself by calculating how many cigarettes I could smoke in a day. Deciding that two cigarettes were the most I could smoke at once, I figured I would be able to smoke half a pack at the maximum. Later, a fellow in-patient told me some very significant information: patients could smoke whenever they wanted during the night. You just had to ask the nurse to light your cigarette. Now I began again ratiocinating. Of the two comparable necessities, smoking and sleep, which was more important? Fortunately, my roommate's insomnia helped me decide. That night I smoked as much as possible when I couldn't sleep.

The smoking room, also called the lounge, was a large conference room with soiled couches and chairs, many with cigarette burns in them. It was also the only room with a TV. The administration felt it prudent to limit how much the patients watched, and the TV sat mute for most of the day. The ingeniousness of the Fowler Wing administration was remarkable. There was no on/off button anywhere on the set. After fiddling with a few buttons in vain, I realized they must have a remote. When to turn the TV on or off was one less decision I got to make in my new life.

I also noticed that the lounge was the 'Fowler Wing Library.' It was replete with Reader's Digest Condensed Version books and some very old magazines. I discovered a few New Yorkers, and I immediately hoarded them in my room. The total number of books in the library came to around 50. None looked interesting and most were mainstream pulp fiction. I was glad to have brought my Norton Anthology of Short Fiction as well as my still unfinished copy of War and Peace. However, I avoided War and Peace as I was stuck in the part of the book where Napoleon resurfaces, and considering my situation and state of mind, I just couldn't concentrate on battles and bivouacs right then.

While waiting for our first smoke break, we had what was known as 'community group.' All of the daily meetings were called such and such 'group,' in an effort, I believe, to sound chummy- although it was hardly what I considered fun. At community group, a staffperson would tell us the news of the day, mostly to explain procedures to the new patients who had been admitted the night before. Staff explained that some of us would be in either A or B discussion support group. Our names were listed on an eraser board in the hall with either an A or B next to it, and we were to go look to find out which group to join. As my primary counselor, Jan, explained to me later that evening, I was in the "high-functioning" (A) group: "Since you're obviously high-functioning and can keep a conversation going, you'll be in the A group," she had said with significance, as if I should feel privileged to learn this information.

The A group started at 9:45 am, after our deserved cigarette break, and was forty-five minutes long. There was one staff whose role was to observe and make germane comments when appropriate. After waking at 5 am every morning because of Jo, I was usually somnolent throughout and rarely spoke. I would look at my watch as the time slowly crept to 10:30. Two more hours until a cigarette. I had begun organizing my day, what little of it was in my control, by those cigarette breaks.

The people in A group, my fellow high-functioners, were solidly supportive of one another and made laudatory comments concerning the staff and the ward. It appeared to me as if I alone would be the voice of dissent. On that first day though, I remained silent, but these were my thoughts.

The staff of the Fowler Wing were, well, some were very unprofessional. They simply did not see you. It was the first time in my life that I understood that invisibleness that Ralph Ellison wrote about in Invisible Man. Unexpectedly, they all seemed to know our names. That is, they often responded to your query by a "Yes, Karen..." with a resigned sigh. I learned to ask as few questions as possible. It quickly became frustrating to wait and wait at the nurses' station only to be told that whatever you needed was not available. For example, I wanted one of the medications that I had brought in with me and which was a prn (as needed) medication. I could take it whenever I wanted, only they had all my medications. No, my meds were not there but in the pharmacy where they were being kept and besides, one needs a doctor's order for that sort of thing. Come back later, I was told. I heard one female staff, who I held no particular love for anyway, tell a patient who said he was hearing voices, "oh well, at least they'll keep you company."

The male staff with whom we had to interact were especially difficult. Your presence at the nurses' station, where both staff and nurses worked, was definitely an inconvenience to male staff, although many of the female staff had the same attitude. Their jobs involved paperwork- couldn't I see that they were busy? One, an older, thinly shaped man, would get you what you asked for or would open the locked shower door (what, were we going to do water torture on ourselves?) without so much as a glance or word while obviously thinking about a topic far removed from the task at hand. Sometimes I would amuse myself by saying "thank-you" to them and also respond "you’re welcome" for them since they were not able to complete the exchange themselves.

The paradigm under which the employees of Fowler Wing worked consisted of a definitive status difference between themselves and the patients. They were normal; we were not. This rigid dichotomy was lapidary and intractable. It was part of the system, and not one of us or them would dare to question it.

At a little before 11:00 am that day, I lay in bed brooding about my situation, feeling completely immobilized. By the time 11:00 am came, I had turned in a 3-day discharge notice, one of the few rights I still had under my voluntary admission status. I would be leaving at 11:00 am in three days, on Saturday.

The rest of the day I was introduced to the other types of groups I would be attending. They were usually geared for the more purblind patients, i.e. "low-functioning," and I stiffly sat through them watching silently while patients answered questions, mostly incorrectly, about side effects of their medication. There was an arts and crafts class which I pointedly refused to attend, to staffs' disapproval. I didn't like arts and crafts at age 8 so why would I like it now? The art teacher reminded me of a caricature of the smiling and enthusiastic kindergarten teacher who puts her kids' childish drawings all over her refrigerator and house and schoolroom. She was well-meaning and nice, but I just didn't dig the scene. There was a group for almost every hour, and by the end of the first day, I vowed never to use the word group with a positive connotation again. To eternal damnation I send you, foul word! The word group has always, since then, immediately brought forth in my mind a mental image of the Fowler Wing psychiatric ward of Noble Hospital, one I shall never forget.

On the second day of my institutionalization, I had become assimilated and I found the entire situation amusing. I even began playing pool with the schizophrenics. The patients themselves were what provided most of the entertainment. There was Sid Vicious, a young schizophrenic who looked and dressed like the bassist of the Sex Pistols. If the real Sid Vicious had lived I can only imagine him in the form of this guy, whose name was Gabe. Sid Vicious was alive in this kid, just as if he'd popped right out of a page of Option or Spin. He wore an old T-shirt, on top of which was an old flannel shirt, tight jeans, old yellow work boots and had straight short black hair that was always sticking out everywhere. His hands shook noticeably when he held a cigarette. Only this Sid was too far down the highway of madness to ever be capable of playing in a band although one could reasonably argue that the same was true of the real Sid Vicious. I came to like Gabe, although he really never said much. When he did say something, he did it with such seriousness and sincerity it was really humorous. I remember once we were all in the lounge smoking and someone said something of no consequence to Gabe, and he brusquely replied, "Get off my back!" It became a big joke with us although we weren't sure he even understood why it was so funny. Another time, I was walking past the nurse's station, and I saw Gabe standing there, telling them quite calmly, "I'm having a seizure." I laughed to myself and continued walking. When I think of him now, I still smile. He was so young; it doesn't seem fair that he should be so fucked up.

Jim was admitted that day. I'd heard staff allude to his previous stay at Fowler, and I took a closer look at him although he was strikingly noticeable anyway. He looked like a cross between an ex-con and a Grateful Dead follower. He most definitely was an ex-con, but as to the verisimilitude of his musical interests, I could only guess. (Later I found out he was of the 70s heavy metal generation.) He was so huge and intimidating that at first I avoided him although I would often stare at him from afar.

He was a tall, broad man in his 40s although he looked younger. He wore combat boots with the laces untied, above which tight-fitting jeans accentuated his huge muscular legs. The most impressive thing about him, however, was his face and voice. His complexion was reddish in hue with long thick cheekbones and a high forehead. He had a large red mole, the same shade as his face, next to his nostril on the right side. His eyes were small and blue, and his long wavy hair, cut short on the top and sides, was brown with a touch of dyed blonde on the top near his forehead. He talked with a deep baritone raspy voice, so deep and slurred, it was difficult for anyone to understand him. He had several prison tattoos on his forearms, those black ink tattoos that become indistinct quickly and are in that category of ex-girlfriend's names and war slogans. However, I never got close enough to him to see the designs. Later, I asked him if he'd gotten his tattoos in prison, and he said some of them. He told me he had 30 tattoos on his body and that he wished he hadn't gotten the ones on his arms because he "was sick of looking at them."

He'd called 911 and told them that he needed to be hospitalized because he would either kill himself or kill someone else. He told us the story of his "old lady" who seemed paranoidly jealous of him, his girlfriend's senile mother who lived with them and drove everyone nuts, how he'd been on Valium since age 11, and how he'd met his girlfriend in detox. Called a detox romance, they had fallen in love and had been together for seven years, including the times either he or his girlfriend were hospitalized or in respite. He'd taken 30 valium and had had a quart of whiskey the night he'd called 911. This was not apparently an overdose attempt since he knew it wouldn't kill him, having taken 100 before with the only consequence that he'd slept 72 hours. He had been to Fowler two years prior, and we were eager to hear about how it used to be run, similar to how Solzhenitsyn describes the old prisoners' tales of imprisonment under the Czar or under Stalin in the Gulag Archipelago.

Jim was one of the nicest men I've met. He would help the elderly people on the ward; he would readily give away his food; he would talk and eat with anyone. He had this way of telling his stories that you couldn't help but laugh. If I'd had been able to I would have readily hugged him when I left, but his "old lady" was there visiting, and I was afraid I'd make her jealous. I miss him and our late night smoking group.

There was Don, a man whose amiability endeared him to a number of friends of both sexes. He was a chronic alcoholic and claimed to have been in and out of VA hospitals over 90 times. He reminded me of many of the melancholic men I'd heard speak at AA meetings. He had a good manner about him, was cross to no one, friendly to everyone, but nevertheless was a complete failure in life. His persistent hope in a better future amazed me; he was already in his 40s and the only thing he'd managed to do was to fuck up his family and himself with drugs and alcohol.

Then there was Ian, a big burly fellow with long frizzy black hair in a braid down his back and a beard and mustache to accentuate it. He was the lascivious one of the group, often approaching women and saying inappropriate things. He was the first person, other than staff, to talk to me. "Come on..." he'd drawled, "where's your smile, yes, yes, I can see it!" chaffing me in that irritatingly flirtatious way some men have. I watched him with other women and noticed that I was not the only target of his indiscriminate affection. I maintained a high level of awareness, an antennae of sorts, when around him. I was just waiting for him to get out of line, as I intended to come to the defense of whoever he was harassing. I was disappointed that by the time I'd left, he hadn't provoked anyone, and I never got the chance to act heroic.

Part II