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It was a warm, pleasant evening when I checked myself into the mad house. The irony of my situation wasn’t lost on me. As a psychology PhD, I fully expected to see the inside of such an institution in a professional capacity. But I now sat on the other side of the clinical transaction: a patient, tremulous and anxious, in the small admissions room of a large, gloomy psychiatric hospital.
The hospital was the archetypal big house on the hill, the sort of looming grey institution that comes to colour people’s idea of an entire town. I grew up at a school just 20 miles away, and I remember how we’d use the town’s name in our playground taunts. Simply accusing someone of coming from the town was an effective takedown. Say the word by itself, at just the right moment, making sure to draw out the syllables in a nasal exaggeration of the regional accent, and you could make a class of silent ten-year-olds dissolve into a sniggering free-for-all. These were the associations I carried with me. Despite all those years of study, after all those dinner conversations where I railed against the stigma associated with mental illness, much of what I thought of in the weeks after my admission had its roots in those childhood impressions. I was in the mad house. Inside me, a ten-year-old boy felt very frightened and very ashamed.
My memories of the weeks leading up to my admission are cloudy and grey. I spent a long time unravelling in slow motion, which gave great concern to those who cared for me, but I couldn’t do much about it. I knew I was falling apart, but I felt like a spectator on the side-lines of my own crack up. The phrase “all over the shop” would loop in my mind like a little mantra. I’d whisper it to myself during desperate, booze-fogged moments behind the drawn curtains of the little flat I shared with a man I didn’t know. “All over the shop,” I’d whisper. “I’m all over the shop. All. Over. The. Shop. I’m all over the shop.” The mechanics of mental illness are looping.
The simplest tasks became feats of endurance. I would lie on my floor, avoiding my bed because I associated it with insomnia, and try to convince myself that a shower was worth the effort, a battle that could last hours. Curling in the fetal position became my trademark activity – narrowly ahead of walking around the kitchen in circles – and there were days I did more of this than anything else. I cried much of the time too. At first at stuff that was outright sad, but soon the things that made me cry became more oblique. I managed to find sadness everywhere, by projecting tragedy onto the most innocuous objects. An incomplete list of the things that made me cry during that murky period includes the following: an episode of Home and Away, a burnt dinner, a hole in a sock, a far-off car radio playing pop on a sunny Sunday, and my own face in the bathroom mirror, haggard and bleeding from a shaky shave.
I was drinking, and the booze was tangled up with my depression in a pattern familiar to any problem drinker. I was drinking to fend off depression while at the same time it was making me depressed. Thinking back now, what I most remember about the weeks immediately prior to my admission was the constant hot vapour of booze in my nostrils, a literal cloud I carried with me everywhere. I was slowly poisoning myself. After months of deterioration, my mental health finally unspooled entirely. At my wits’ end, rudderless and exhausted, I found myself late one night in a bright room, relating the grim details to a succession of clinicians while my mother listened in tears.
A few hours later I was drifting in and out of sleep on the hospital’s most secure ward, the section where, for our safety, windows opened only an inch before they hit bars. The bathrooms had no locks and the shower activated from a hole in the ceiling, rather than from a nozzle, which might support a noose. At that particular moment, with all the obvious means to harm myself removed, my situation seemed to me the better end point to a process that had only one other possible ending. In that regard I was safe. This was the consolation I clung to during moments when the shame of my situation rose up to claim me for its cold depths.
On my first morning on the ward, I was awoken from a broken sleep of noisy, hurtling dreams by a rhythmic slosh. The curtain rail around my bed enclosed the ward’s communal sink, and stood in front of it was a man who could only be described as sparkly. He was wearing a sequined pink tube top, wrap-around sunglasses and was in his fifties. He was manually washing a pair of ragged old Y fronts in some soapy water. “Ah, the new man. You don’t mind if I do this?” His voice was oddly metallic and ran a little too slow. I thought of a musical toy with knackered batteries. Not that I knew it then, but I’d soon come to recognise that voice in its many variations. It was the voice of anti-psychotic medication, drugs that seem to inhabit a person’s entire being, altering how they talk and how they move (the movement is sometimes referred to as the ‘Risperidol shuffle’). How disturbing it must be for those people’s loved ones to see them so altered, to see their essences flattened in order to manage that vast and still unknown illness we call schizophrenia.
The underwear washer, who had introduced himself as Ger, made himself comfortable by sitting at the foot of my bed, making uncomfortable contact between his backside and my big toe (I quickly discovered that boundaries of personal space simply do not apply in psychiatric hospital). And then he cracked the first terrible joke of my stay. “You only need to know one thing about this place”, he said, leaning in even closer. “The patients are the least mad people here.” This turned out to be the tip of a groaning iceberg of ward humour.
Ger’s teenage girl dress-sense aside, the most striking impression of my first few days on the ward was of the smell of tobacco smoke. I was one of eight men there, and the only one who didn’t smoke. Traumatised as a child by the sight of a cigarette butt floating in a cold cup of tea, I still have a pathetic revulsion to the smell. I found myself battling disgust a lot during those first few days, not least when Ger leaned in, as he was wont to do, all close-up yellow whiskers and orange fingers. I quickly found out that the solitary outdoor place to which I had access, a fairly grim caged area near the television room, was used as a smoking area by the other patients. Patients would crowd into it around the clock, because smoking is a serious and sustained business in psychiatric hospitals.
There is a theory that schizophrenics use nicotine to self-medicate. The drug apparently alleviates the disorder’s associated psychoses and improves short term memory. Schizophrenics tend to smoke in a certain way too, in violent rapid sucks that can incinerate a half a cigarette in one go. Their faces are shaped by smoking – pinched, hollow, and capable of crumpling around a cigarette in the most remarkable contortions. I remember, when I was a teenager, getting the bus home from a shopping centre one evening, when a lanky man with rolling eyes marched up the aisle, sat beside me, and immediately lit a cigarette. By the time the bus driver had stopped the bus to reprimand the smoker, the cigarette was as good as gone. Inhaled. I can still see a length of ash as long as the cigarette itself falling from the orange tip as the man whispered nonsense around it in a papery voice.
Each night, about ten minutes after the lights on the ward were dimmed, the smell of smoke would drift faintly up the floor. I wondered why the nurses seemed to ignore it. But then I thought of the humanity of it, and I understood. It was around this time of the night, too, that I engaged in my own little attempt at self-therapy. I’d sneak my contraband mobile phone out, and slyly log on to Twitter beneath the sheets.
Before my admission to the hospital, I had worked hard, even throughout the most chaotic phase of my breakdown, to maintain an outward appearance of normalcy. I carried this delusion with me well into the early part of my stay on the ward. Somehow, I had reached the conclusion that maintaining an ordinary-looking Twitter feed would be a key survival strategy while in hospital. It was only after I had updated my status with a wise crack about the nightly news that I could fall asleep, consoled by the knowledge that my acquaintances probably pictured me on a couch at home, sprawled in front of the news with a laptop, instead of curled beneath starchy sheets in a psychiatric institution.
I spent my first full day in hospital pacing the ward, slick and jittery from alcohol withdrawal, in search of any sort of material that could stimulate me or distract me from my anxieties. The auguries weren’t good. There were no newspapers. There was a television room, but I found it to be the saddest place on the ward, as patients with catatonia tended to spend their time there (i.e. were ‘placed’ there), rigid and vacant, providing an ironic commentary on the daytime rubbish that streamed from the TV screen. There was also a ‘games room’, which I explored with a rising sense of dismay. There was a white board on the wall to keep scores for the games that were surely there, but which I struggled to find. Someone had scribbled a quote from Jonathan Swift, who had donated towards the building of Ireland’s first psychiatric hospital, on the board: “He gave what little wealth he had/ to build a house for fools and mad/ and proved by one satiric touch/ no nation needed it so much.” Below this, there was an A4 page tacked over a cupboard. “Bored?” it proclaimed in comic sans font, “Then why not try something from the games cupboard?” I opened the cupboard. It contained a monopoly board missing half of its pieces and all of its paper money, a solitary table tennis bat with a peeling rubber front, a crumpled table tennis ball, and a giant clot of cobwebs.
Then I discovered the hospital’s small library. From then on, when I wasn’t quixotically maintaining an illusion about my life via Twitter, I occupied myself with reading.
I read voraciously, reclaiming a rush of escapism that I had lost somewhere along the way in my reading life. I would read in bed for hours after the nurses put the lights out, making use of a small rectangle of light that came through the ward’s upper window and fell serendipitously across my bed alone. I was astounded by how much you can read in a day if you put a bit of effort into it. At my peak, I was getting through about 400 pages a day, managing Philip Norman’s biography of John Lennon (the sort of book a child might stand on to reach high up objects) in two days flat. Once I had spent a few days like this, alone and reading, the chaos of my life began to recede like a slow tide. I raced through a series of books in a fantasy saga called The Sword of Truth. I became so hooked on these utterly formulaic novels, that I legged it to Waterstones the day I left hospital so I could buy the next one.
One of the few treatments available to us was called peer group. Peer group took place every Tuesday and Thursday afternoon in a small room that smelled of art materials and chlorine. The purpose of peer group was to share anxieties or talk about your treatment progress with your peers. I could see how this worked conceptually, but my abiding memory of it is of one of the most painful communication breakdowns I ever hope to witness.
A tearful man was telling his story about a marriage breakdown, alienation from friends and family, and a suicide attempt. Meanwhile a woman sitting opposite would regularly interrupt to proclaim that Barack Obama was to blame, not just for this man’s problems, but for all the ills of the world. (She could be heard around the hospital, throughout my stay, returning again and again to this core guiding principle, often to the accompaniment of Bob Dylan’s ‘Maggie’s Farm’ as sung by another patient, every hour on the hour.)
In spite of my attempts to mediate between the poor man and the Obamaphobe, the three of us appeared locked in the sort of hopelessly doomed personality clash you’ll find in Samuel Beckett’s bleakest plays. And all the while, the staff member in charge appeared to want to take the Barack Obama thread as seriously as the man’s nervous breakdown. Perhaps there were times when peer group wasn’t a frustrating tangle of people with clearly incompatible treatment needs, but I never got to experience them.
I got to sit down with the psychiatrist carrying my caseload on three occasions, adding to a grand accumulated total of 45 minutes over the course of a month. He was a beleaguered yet friendly-looking man with huge sacks under his eyes which reminded me of the composer Philip Glass, and he was as helpful as he could possibly be within the short periods he had to advise me. He recommended cognitive behaviour therapy as the most suitable treatment intervention for my depression. “Oh good. I could do that”, I said. “when or where do I go to receive it?” “Well that’s the thing. It is not available here. We have one clinical psychologist providing therapy for all the hospitals in the northeast region, and there is a six to eight week waiting list”. This psychologist was a mythical creature, as far as I could see, a shadowy promise of treatments that people clearly required but would not receive.
The psychologist’s cap stayed on my head throughout my time on the ward, and I’d wonder such things as whether the environment – a small ward, barred up windows, very little stimulatory activities, zero fresh air – was appropriate for good mental health. I’d often consider the more obviously ill men in my ward and wonder too if some of their problems weren’t brought about by over-prescribed medication.
Days ebbed and flowed around the dispensation of medicine. There was a brief window of time every evening when certain patients’ eyes sharpened and their tongues seemed to deflate. This window was quickly shut by a trip to the medicine dispensary. A tell-tale amphibious film went up over their eyes again shortly before bedtime. Of course, many of these people needed drugs for their respective illnesses, but one or two incidents made me wonder, such as the night an elderly man got caught short on his way to the ward toilet. He ended up sitting on the floor in his own excrement, sobbing in a tiny voice with a look of vulnerability so unusual to his typically taciturn countenance that I could only look at him for a brief moment. The first nurse to tend to him offered him something to calm him down. I couldn’t help but wonder if kindly and carefully deployed words alone might have been just as effective. I found out the next day that it wasn’t the first time this happened to him; it was a unfortunate side-effect of his medicine, treated by more medicine.
My own treatment consisted primarily of running through anti-depressants in the hope of finding a combination that worked, which in practice meant experiencing a chain of physical side effects that included bloating, nausea and due to the vagaries of serotonin uptake, a confounding inability to pee. My secondary treatment related to alcohol. I met a lady, a nurse with addiction counselling qualifications, who ran me through counselling options and the groups I could access once I left. Her main advice was “don’t pick up that first drink”, and you know, it’s hard to fault that advice. An entire culture of sobriety treatment is built upon that foundation. More to the point, she was a wonderfully sympathetic woman to chat to, and my half hour of face-to-face time with her – an eternity in that place – was perhaps the best therapy I received on the ward.
I am not exactly sure what it is, even now, but I got something from my stay in the big house on the hill, something that I would probably not have gotten elsewhere. I remember sitting up in my bed with a book one night, reading in my precious rectangle of light, moving my toes against the crisp sheets, and feeling so secure in my surrender to the help of others, and so very far away from the trembling mess who admitted himself only a couple of weeks earlier, that I whispered as much to myself. “Thanks,” I said.
DARRAGH MACAUSLAND holds a PhD in psychology from University College Dublin. He writes on music and culture for Totally Dublin, AU Magazine and his blog Asleep on the Compost Heap. @darraghmc.