Voluntary Madness Lost and Found in the Mental Healthcare

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ALSO BY NORAH VINCENT
Self-Made Man
 VIKING
Published by the Penguin Group
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First published in 2008 by Viking Penguin, a member of Penguin Group (USA) Inc.

Copyright © Norah Vincent, 2008

All rights reserved

Names and certain characteristics of individuals, hospitals, and other facilities have been changed to
protect people’s privacy.

LIBRARY OF CONGRESS CATALOGING IN PUBLICATION DATA

Vincent, Norah.
Voluntary madness : my year lost and found in the loony bin / by Norah Vincent.
p. cm.
eISBN : 978-1-440-64103-9
1. Vincent, Norah—Mental health. 2. Psychiatric hospital patients—United States—Biography.
3. Journalists—United States—Biography. I. Title.
RC464.V56A3 2008
362.2’1092—dc22 2008029034

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TO TEDDY
CURRICULUM
In November 2004, just as I was finishing the research for my book Self-
Made Man, I checked myself into a locked psychiatric ward in the hospital.
I never finished that research. Instead it was cut short by a depressive
breakdown that scared me enough to convince me that it would be better
both for me and for those around me if I didn’t go on walking the streets
looking for someone to hurt me.
It may sound unduly dramatic to suggest that writing a book would drive
a person into the bin (though I’m sure there are at least a few hundred
thousand Ph.D. candidates and other wee-hour scribblers out there who
would beg to differ on this score), but in my case, it was quite literally true.
I lost it, in medias research, so to speak, and for good reason.
The research for Self-Made Man had been unorthodox, to say the least,
since it had entailed disguising myself and then living, dating, working, and
recreating as a man. I became a man, at least as far as the people around me
knew, but I remained a woman, and that psycho-emotional contradiction in
terms pulled me apart at the seams slowly and insidiously for eighteen
months, leaving me limp and in tatters, sitting semicatatonic in my pajamas
outside a nurse’s station in the hospital, torporously signing away my
freedom and giving my consent to be forcibly restrained if necessary.
Real lives and lived experience are the laboratory of the immersion
journalist, and the journalist herself is the guinea pig. Consequently, a lot
can change between the proposal and the finished book, and always does.
That is the whole purpose, after all. If you knew what was going to
happen in the end, there would be no point in starting. Setting out to prove a
point only colors the experience and then skews the results more than your
inescapable subjectivity and prejudices already do. You have to leap. You
have to be a bit reckless. Maybe more than a bit. Maybe a lot.
This is at once the adventure and the peril of what I do, and, for better or
worse, it means I follow where the rabbit hole leads.
Last time around it landed me in the bin. But once I got there, I realized
that bins are pretty fertile ground for writers of my stripe, and not altogether
uninteresting places to be locked away for a few days with a notebook and a
crayon (or whatever other nubby stylus they’ll let you get your certifiable
fist around).
As I sat there in the ward that November, wondering how the hell I was
going to talk my way out of that zombie parlor, I said to myself, “Jesus,
what a freak show. All I have to do is sit here and take notes, and I’m
Balzac.”
And that was it. Bam. That was how the idea for this book came to me,
and I to it. Of course, “idea” is the operative word here, since the book I set
out to write and the book you are holding in your hands are two quite
different things. But then, as I’ve said, being an immersion journalist, I
expected that.
I started in that ward with the theatricality of it all, distanced from my
own condition, contemptuous, trapped, yet interested. But interested the
way a field entomologist is interested, stooping to see, a deigning species
apart, marveling at the hive or the colony and poking it with her pencil to
get a better view.
Somerset Maugham once wrote that quotation is a passable substitute for
wit, and so for me, prurience was a passable substitute for something better.
Imagination? Diligence? Insight? I don’t know. I thought I was in a foreign
country, and so, like every frisky tourist, whose intrusiveness is pure
entitlement, I was curious about the customs—and possessive, too. I wanted
these people to myself, to make them mine in word and sentence.
These were living dolls, characters ready-made for me, shuffling by in all
their goggle-eyed magnitude and efflorescent distress. I liked them that
way, and I watched.
I did not accept, then, that I was one of them, and that the foreign
country, the theater, the rabbit hole, was not out there but in my head.
I spent four lost, interminable days in lockup that first time in the bin,
getting worse, weeping at the sealed windows, yelping for rescue through
the pay phone in the soul-destroying dayroom, wrapping into my
roommate’s seamless paranoia, and, finally, out of sheer rage, altogether
losing what was left of my tenuous grip.
Then, scared Soviet of being stuck in there for months, I resolved to slip
the trap and ingratiate myself to the pen pushers and paper pilers of the
system. I put up a front of cool argument and reasoned my way out.
I got home a wreck, and swore that, no matter how bad I felt, I would
never willingly go into such a place again. Never.
And yet, there was the lure, the powerful lure of the spectacle, and the
human drama, and what I saw as the outright wrongs of the insanitarium,
wrongs that I so longed to expose and ridicule, and hold up to public
scrutiny. I felt centripetally attracted to the subject matter, to what I couldn’t
help seeing as the thematic cornucopia of the bin.
I wanted to immerse myself in that. Be the patient once more. It wasn’t a
stretch, obviously, but it was daunting nonetheless. I knew that in order to
write a book about madhouses, I’d have to spend much more time locked
away, and in several different types of institutions.
Wouldn’t that drive me mad again, madder than being a man had ever
done? Or would it only reveal a madness already there, entwined. Was I the
reason to do it? Mad me turning to face me in the mirror of other warped
faces?
After all, there was far more to my backstory, more to my personal
investment in the topic, than that first trip to the bin.
It began more than ten years ago when I first went to a psychiatrist
complaining of persistently gloomy and vaguely suicidal thoughts. I was in
my late twenties, still working as a glorified secretary in a job that I was
overqualified for and understimulated by. I had gotten to that age when all
well-loved children of the upper middle class begin to discover that the
world is not made for them, that all meaningful questions are rhetorical, and
that the term “soul mate” is, at best, a figure of speech.
I had had too many ill-conceived relationships defiantly not rise
phoenixlike from the flames. I couldn’t see spending the rest of my working
life wearing pantsuits, but I didn’t know how to convert my expensive
education into the bohemian Kulturkampf I was dreaming about. I did not
relish what I saw as my prospects for love or money. I was sorely
disappointed by my oyster, and so I despaired, flagrantly, aromatically, in
purple poetry and reefer.
What can I tell you? It was the 1990s. The épatant was the bourgeois,
and Kurt Cobain was dead. Despair was an icon, and I was in my Saturn
return. I was stuck at an age when a lot of people are stuck. I was morose at
an age when a lot of people are morose. I was spoiled. I thought life was
supposed to make you happy, and I wasn’t going to drudge for a living.
Did I need medication? Or did I need someone to talk to? Someone, that
is, who would do more than charge the going rate for nodding and whip out
a prescription pad before the first fifty minutes were up. Was I
physiologically depressed? At an innate biochemical disadvantage? Or was
reaching for the pad just the way things were done because the doc had
been well patronized by the drug reps and had plenty of samples in her file
cabinet?
I don’t know, and I never will know. I took my first Prozac and took
flight.
I went out like a turbocharged dorm geek after the last exam, a recluse set
loose on the world with the sudden hubris of ten presidents and all the pent-
up primal urges I’d been sublimating since the onset of puberty. I was a
stalled career flounderer set going again by a little green-and-cream-colored
Pulvule that made me feel so good I called it vitamin P.
In fact, my brain was never quite the same after I zapped it with that first
course of SSRIs. Those initial months on Prozac when I was thin-thin and
wildly productive and fascinated by everything and feeling every minute
like I’d just been fucked—they didn’t last and they never came again.
Pretty soon my brain adjusted, and pretty soon I got puffy and lethargic,
taking four-hour death naps in the afternoon, gaining weight, and guzzling
coffee just to keep my head up, and maybe, if I drank enough, get some
fleeting glimpse of the former glory.
My doc upped my dose to the max, and then we added other
antidepressants to amplify the effect, until I was a bug-eyed, constipated,
jangle-nerved sloth writing rants in the closet at 4:00 a.m. because I’d slept
all afternoon and a soft cell was the only place I felt safe. I got kinda
twitchy and geriatric when I ate, my fork shaking wildly all the way from
the plate to my mouth.
My doc and I tried a lot of other medications along the way, and I had all
the classic side effects. I went hypomanic on the Prozac, so we added mood
stabilizers to even me out. I lost interest in sex, so we tried another
antidepressant, Wellbutrin, to bring me back. We switched, jiggered, and
recombined, looking for that perfect pickle. But if one thing didn’t give me
a rash or panic attacks, then it made me gobble salty junk food in the
middle of the night. I tried most of the majors, and burned through their
effects. I got scrawny, then fat, petrified, then out of control, sexless, then
sex-obsessed.
Finally, beset by attacks of crippling anxiety, I got a scrip for Klonopin.
The velvet hammer. A relative of Valium and Xanax, and the best drug I
know for what ails you, if you’ve given up on all the rest. Just pop it and
bonk—you’re out. Sweet dreamless sleep.
But even this didn’t last.
Eventually the dope just doesn’t work the way it used to. Even Klonny
needs a boost to keep hammering you. And that’s when they start referring
to you in whispered tones as “medication-resistant.”
So I ended up in the bin that first time, to do some serious recalibration. I
was all used up. In the space of a few years, I went from being just another
twenty-something having a good old-fashioned life crisis to being a
psychotropic junky.
And that, crowded and distraught, is the short version of my history with
what we might broadly call mental illness. I qualify the term “mental
illness” here not so much because I am in denial anymore about my
challenges, but more because I don’t accept the terms by which mental
illness is currently defined.
That is part of the point. I am asking the question of myself, and perhaps
of you, as well as the culture at large. Am I mentally ill? Or have I been
diagnosed as such because it means that the insurance companies will pony
up for my meds and my stays in the hospital only if I am placed in a
category in the Diagnostic and Statistical Manual of Mental Disorders
(DSM), whether I truly belong there or not?
And what is “mentally ill,” anyway? What can it mean to say that
someone is mentally ill when the DSM, the psycho-bible, is, in my and
many other far more qualified people’s estimation, not a scientific
document, but rather an entirely subjective and seemingly infinitely
amendable and expandable laundry list of catchall terms for collections of
symptoms.
There is, at least in the quantifiable sense, no such thing as schizophrenia,
bipolar disorder, major depressive disorder, social anxiety disorder, and a
whole host of other accepted diseases listed in the DSM. There is no real
test for any of them (only questionnaires and symptomatic observation).
They are unduly subject to political and professional fashion, and even
lobbying by special-interest groups. Hence the successive redefining of
homosexuality in 1973 and 1980, and, finally, its excision from the DSM in
1987.
We are nowhere near understanding the causes and mechanisms of
mental illness well enough to develop reliable diagnostic criteria for any of
them. We infer backward from the symptoms to the disease, which is why,
when it came to doing the research for this book, it was so easy for me to
gain admission to various hospitals on the pretext of undergoing a major
depressive episode, even though in at least one case I was feeling quite
well.
People have often asked me how I was able to do this so easily, and I
always shock them when I say, “Anyone could do it.”
Getting yourself committed is very easy. Easier than it should be.
This has been true for a long time. In 1972, psychologist David Rosenhan
and a group of his colleagues and graduate students conducted an
experiment in which eight participants, or “pseudopatients,” none of whom
had histories of mental illness or institutionalization, set out to see how
difficult it would be to get themselves committed.
They presented themselves at various hospitals across the United States,
saying that they were hearing voices. They said that the voices were
repeating the words “empty,” “hollow,” and “thud.” They claimed to be
suffering from no other symptoms and otherwise behaved normally. All
eight were admitted, seven with diagnoses of schizophrenia, and one with a
diagnosis of bipolar disorder. None of the staff was able to identify the
pseudopatients as imposters during their stays, though a number of patients
were reported to have done so.
 The pseudopatients were all discharged after an average stay of nineteen
days, at which time their schizophrenia was diagnosed as being “in
remission.”
The results of the experiment were published in the journal Science, and
the authors concluded ominously, “It is clear that we cannot distinguish the
sane from the insane in psychiatric hospitals.”
I am sure that another Rosenhan experiment, if conducted today, would
yield equally worrying results.
But this book is not another Rosenhan experiment. Though it does cast an
unabashedly critical eye on the system, the practice of psychiatry, and the
prevailing view of mental illness, it does so solely through the lens of my
experience.
If you are looking for evidence, you will not find it here, except in the
notoriously unreliable form of eyewitness testimony. My own.
The formal case against the leviathan has been made already, and is still
being made in the courts and the newspapers. A number of people, several
of them professionals in the field, have written extremely well-documented
exposés of psychiatry, psychiatric medications, the pharmaceutical
companies, and the DSM. These books are far too seldom read, in my
opinion.
I admire and support what these writers, dissenting doctors, and
journalists have accomplished. Initially, I sought to follow their lead. I saw
probing the phenomenon of mental illness today as an effective and
provocative way to take the measure of my culture. But as I plunged myself
deeper in the project, I, and it, took a sharp turn inward, becoming
somewhat less about what I saw around me and more about my private
struggle to find a way out of chronic mental distress, a distress that the
system not only seemed unable to heal but, more often than not, had only
made worse.
As you read, you will see that what begins as the mostly detached report
of the proverbial journalist at large, first in a big-city public hospital, then in
a private rural hospital, and finally, in an alternative treatment program,
soon dovetails and then merges indistinguishably with the very personal
account of a bona fide patient’s search for rescue and, if possible, a touch of