Things American: Treatment vs. Healing

Pills header for Jenna Kahn essay

1.

The nurse woke me at four-thirty in the morning to take my blood. Someone else had taken it less than six hours before, in the emergency room, but pointing that out seemed disrespectful because he was a nurse with years of schooling behind him, and I was just another suicidal senior in high school. After he left with five vials of my blood, and I was sufficiently drowsy, I rested fitfully until it was time for the morning devotional at six.

Wrapped in a beltless robe and wearing slip-resistant socks, I trudged to the room at the end of the hall to meet with the chaplain. As a former Mormon and current agnostic, I was skeptical of this process. But I was at a Catholic hospital, and I hoped that showing up for every meeting and group therapy session would score me brownie points with the attending psychiatrist, and I would be able to go home sooner. Even though I had fought to get admitted just the night before, I was already disenchanted with the experience. Mere hours into that stay, I was beginning to realize that the treatment I would receive would not lead to the healing that I desired.

I was eighteen, it was one week before Christmas, and my only objective was to be discharged.

 

2.

When you skin your knee and treat it with some Neosporin and a Band-Aid, your course of treatment and healing are the same. When you suffer from a psychiatric illness, these two things can be profoundly different. Treatment sometimes looks like hospitalization in an overcrowded psych ward and medication that can dissolve personality.

 

3.

That morning’s devotional was on forgiveness, and, per usual, the frequent fliers at the hospital dominated the conversation. I sat quietly, holding my robe around me, not sure where I fit into the group yet.

You could tell who was new in the room because they still stank of booze, which overpowered the smell of hospital antiseptic.

I was not prepared when the chaplain, a small woman with graying hair, asked me to stay after. Feeling I had nothing to lose, I told her my story and shared with her my loss of faith. She did not try to reconvert me, or soften my heart, or change my mind. Instead, she simply listened to me and then sent me off to my breakfast tray of leaking scrambled eggs.

 

4.

I suffer from bipolar disorder, and in our globalized economy, treatment options are plentiful: I’ve tried various forms of therapy, such as Dialectical Behavioral Therapy and Cognitive Behavioral Therapy; a slew of medications and yoga; and less-conventional approaches, such as skipping doses of my medication so that I might access my artistic side while boiling my hand in a pot of water.

When I wasn’t seriously injured from the boiling incident, I wondered if God had selected me to be some kind of saint. After merely thinking of the snowy outdoors and then finding myself outside of my dorm in the middle of the night, sans shoes and socks and any kind of jacket, I decided to reject sainthood and go back on my meds.

My moods range from the ups where I cannot sleep for days and incessantly babble or sing to myself, to the crippling lows where I cannot function and fantasize about dying. I’ve gone a week without showering. Additionally, I occasionally experience psychosis, when I hear bells, whistles, and mumbling voices telling me to hurt myself.

 

5.

I started seeing my current therapist about a year ago, and one of my favorite things about her is that she recognizes me as an artist as well as patient with bipolar disorder. She was the first person with whom I shared my short story containing a fictionalized version of my illness.

When I am in the worst throes of an episode, she encourages me to record and to write. She was the person who initially suggested that I look into how other authors write about mental illness.

 

6.

As a child, I felt a very strong connection to Alice in Wonderland because, like Alice, I’d long sensed that “it’s no use going back to yesterday, because I was a different person then.” I knew that my moods changed faster than my friends’, and my eccentric behavior sometimes got me in trouble. The idea of abandoning my yesterdays, giving in to the mood swings and pushing towards tomorrow, was appealing.

This summer, I started with a simple Google search for “mental illness short stories,” and I was quickly directed to perhaps the most famous recent example, David Foster Wallace’s “The Depressed Person.” Combing through lists of stories about mental illness, I was reminded of Amy Bloom’s “Silver Water,” which I had read in my Advanced Writing Fiction course at Towson. The story reduced me to tears, and I had hastily found a PDF version online, emailed it to my mom, and called her up, begging to know if I, like Rose, the protagonist’s sister who suffers from schizophrenia, tormented my family.

I also came across Kevin Barry’s “Monument” while flipping through a back issue of Tin House. This was another story I over-identified with — Martha, the protagonist’s lover, who may or may not have bipolar disorder, has extreme, episodic mood swings and ultimately dies at the age of thirty-nine.

For Wallace’s depressed person, for Bloom’s schizophrenic Rose, and for Barry’s erratic Martha, things don’t end well.

 

7.

Long after that Christmastime committal, during my junior year of college, I begged an emergency room psychiatrist and psych nurse to admit me.

“When was the last time you hurt yourself?”

“Two years ago.”

“That’s excellent. Do you have an active plan to kill yourself?”

“No, but I’m afraid that if I go home, I will hurt myself,” I said. “Please don’t send me home.”

I had always been taught that if I was feeling suicidal or if I was afraid my self-injury was going to relapse, I should call 911 or go to the hospital. So there I was in the ER, sitting on a paper-covered chair, trying to plead my case to the professionals. I was not offering an acceptable narrative or, in any case, not one that would allow me to find shelter for the night.

“There’s no code for that in the computer,” a tired-looking nurse told me as she looked at her computer monitor. “There’s no way we could explain this to your insurance.”

“So you’re saying that if I go home and came up with an active plan to kill myself, I could be admitted?” This logic was like waiting for the flames to fully consume the house before calling the fire department.

“If it gets that bad, come back. We will try to find a bed for you.”

“Is there anywhere I could go?”

“I wouldn’t recommend sending you to a hospital in the city,” she said, speaking quietly. “Off the record, it could actually be more dangerous for you, as a woman.”

I packed up the plastic bag containing my belongings and left the hospital.

 

8.

One of my major frustrations with Bloom, Barry, and Wallace’s stories is how bleak they are. Their outlooks are grim, and they reflect a trope commonly seen in literature about mental illness: for a family or friend group to find closure with their family member or friend’s illness, the person with mental illness has to die. Otherwise, the person remains leech-like, siphoning time and energy away from the hosts.

I don’t know how I feel about this.

It’s certainly distressing to imagine that the only true cure for mental illness is death (though such a bold, stark, and romantic notion of psychiatric distress ironically appeals to suicidal inclinations and self-injurious behaviors).

Some might rightly point out that Wallace, Bloom, and Barry are writing fiction and, as such, it’s unfair to treat their stories as roadmaps for healing. That’s fair enough, but anyone who has ever felt the warm companionship of literature knows just how transformative (and, yes, healing) the act of reading can be.

While literature is not expected to have clinical applications, it should be fair enough not to condemn one in four (the number of Americans who will experience mental illness at some point in his or her lifetime) to death—even in fiction.

 

9.

Therapy is a place where I have had the most success in finding healing, but as it is for so many people, the path there was full of potholes and littered with failed techniques.

In Wallace’s “The Depressed Person,” the therapist serves as a catalyst for self-pity and emotional deterioration. The patient is taught to exaggerate trauma in the toxic environment where the emphasis is on helpless circles of narcissism and excruciating self-awareness (a hallmark of much of Wallace’s work, fiction and nonfiction alike).

 

10.

The protagonist in “The Depressed Person” reminds me of a Woody Allen-lookalike I met in group therapy. He sat to the side of the circle, bored, until the therapist leading the group asked him how much therapy he had had, and he muttered something like “thirty years,” followed by a list of acronyms. She promptly diagnosed him as having too much therapy, complete with an overextended, psychology-based vocabulary. The Woody Allen-lookalike was miffed with this new diagnosis, and he proceeded to attempt to pit various members of the group against each other for the duration of the session.

 

11.

In Bloom’s “Silver Water,” the therapist who is finally able to reach Rose and help her make progress dies of an aneurism while eating a chili dog. Arbitrary insurance restrictions make Rose’s quest for further treatment entirely futile. She must be symptom-free for forty-five days before she can be covered by long-term psychiatric insurance. Of course, it’s during this waiting period that Rose dies.

While this waiting period is purely fictional, it is true that bizarre and seemingly arbitrary policies do, in fact, preclude proper treatment. In some instances, parents cannot assist their children or even be a part of the treatment plan because of HIPAA, the Health Insurance Portability and Accountability Act. Essentially the only person with the permission to make decisions is the person who is potentially the most unwell.

While I understand that everyone, including people with mental illness, has a right to privacy, I also know that we are not always our best advocates. You might not have heard of the Angells, but you might have heard of the Deeds family. Mothers and fathers across the United States are left to grieve their adult children with mental illness because of legislation that excludes them from the healing process in the name of treatment.

 

12.

Despite being a staunch advocate of psychiatric medication, I concede that the side-effects of these powerful drugs are horrible, and that it’s difficult to force myself to take my pills each day. I have experienced weight-gain, a seemingly endless fog in my head, and fatigue. I practically slept through the spring semester of my sophomore year.

One medication made me so nauseated that I couldn’t keep it down without taking a copious amount of ginger. My lithium irreparably damaged my thyroid, so I take fifty micrograms of Synthroid (which does precisely what it sounds like it should do, synthetically replicating thyroid function) each morning.

When there are medications for the medications and treatments for the treatments, it’s hard to call the process healing. All of which is to say that while I resent the ultimate doom assigned to Wallace, Bloom, and Barry’s mentally ill characters, I fully understand Rose’s “Thorazined fat,” and I empathize with her desire to negotiate her pills away. I know how Martha’s “medication had put the trace of a slouch in her walk,” and I agree with her lover that sometimes the medicine itself seems like “the great wicked thing.” The paranoia of Wallace’s protagonist is familiar, too—I also worry about exhausting my friends and loved ones with my desire to be heard and comforted through each episode.

 

13.

As an individual with mental illness, I am not the only person who pays the price for the failure of treatment to mimic or support healing. My family and friends, much like Wallace’s Depressed Person’s Support System, experience alienation, fear, and frustration, among other distressing emotions. When you’re connected to a person who is experiencing daily emotional and mental anguish, it’s difficult to separate yourself from their pain.

Home from school this summer, I almost brought my mother to tears when I reintroduced her into my hellish routine. She was sitting in a leather recliner in the living room trying to read a book but was distracted by my pacing. I felt like there were ants in my joints as I walked from the living room to my bedroom, perhaps moving a tube of chapstick or rearranging a book on my shelf, singing “Jingle Bells” to myself softly in Croatian.

She finally closed her book and gave up.“I was hoping each day wouldn’t be this difficult,” she said.

 

14.

After being captured by another’s mental distress, after the illness’ elliptical orbit loosens its hold, these people must re-emerge. As Barry puts it in “Monument”: “we walk back into the world.” When I come home from school, I pull my family closer to me, and they feel the heat from my episodes. When I leave, they have time to recover.

Three years ago, during that Christmas committal, I attempted to find my own recovery within the walls of the hospital, pasting fake jewels onto a pre-made birdhouse and creating a colorful mosaic for a trivet for which there weren’t enough tiles of any one color to create any regular pattern.

If you hadn’t felt off when entering the hospital, try going to the crafts area (more out of boredom than any real creative impulse) only to find that the thing you can make, that trivet, isn’t going to come out as expected—that your trivet, to put it bluntly, is going to look like the work of a crazy person. (It was later sold for 50¢ at a yard sale; the pre-fab birdhouse was trashed).

I confessed my history of self-injury in group therapy, opening up to a room of people suffering with addictions to all manner of substances and behaviors. Like them, I sought healing in the treatment: I took notes during all of the sessions the nurses offered, and I participated in every activity, from filling out worksheets identifying my triggers (reality TV, repetitive noises, taking on too much responsibility at school) to making “self-care acrostics” using the letters of my name:

Journaling

Enjoying time with friends and family

Nourishing my body

Napping

Accepting my situation

 

15.

How can we expect healing to take place in a space where patients are underserved and fearful? When the focus of treatment is to create the greatest visible change in the least amount of time, why are we surprised when the results are short-lived? When truths are warped by the Byzantine rules of insurance and diagnoses are encoded as numbers, is there space left for a patient to heal?

Wallace, Bloom, and Barry answer this question with a definitive no, but I refuse to be satisfied. These stories aren’t holding a mirror up to the world I know. Life with mental illness can be frustrating, and we lose eleven hundred college students to suicide each year in the United States, but all I see presented to me in texts is cyclic struggle. In literature, I see little evidence of health and wellness, little evidence that healing is, in fact, possible. Instead, I see misery that can be relieved only by death.

 

16.

One of the greatest problems with the hospital environment is that it is entirely impossible to replicate outside of the hospital. How will I express myself outside when I cannot be trusted with a pen because I might stab myself? I once played hangman on a whiteboard with a few other patients. A disgusted nurse confiscated our dry-erase marker.

When I experience success in the hospital, I am rewarded with discharge papers. Once at home, there are pens everywhere, and I am not supposed to take a forty-minute nap in the middle of the morning. The real world is full of academic assignments and extracurriculars, repetitive noises like my neighbor mowing his lawn, and the siren-like call of reality television. I try to remember what I learned in the twenty-minute lessons taught by nurses in the unit on goal-setting and healthy-habit formation. Put simply, sometimes treatment in a hospital environment really proves only one thing: that I am not equipped for the real world.

 

17.

During that Christmas stay in the hospital, I gained a lot, including latent tuberculosis. I emerged from the environment with greater perspective and more empathy.

I also had an acute awareness of what I wished my experience to be. I want self-care to replace self-medication. I want to go to a place that is neither overcrowded nor over-scheduled. Some might sarcastically quip that I should “go to a spa,” but I do not think that I am asking too much.

When a doctor is making sure that one of my psychiatric medications is not causing my suicidality, I want to be sure that it is my chart in front of him, and I would like to talk to him for more than three-and-a-half minutes about my symptoms. I want to be discharged because I’m better, not because my insurance has run out, and there are five others waiting in the emergency room, vying for my bed. I want more structured time, time when I would be challenged to improve myself and not left to rot in front of a book of half-finished sudoku.

Most of all, after I am admitted, I want to be sure that I made the right decision and not to be filled with dread. I shouldn’t be trying to figure out how to trick the system and score points to win my escape. I should be accepting this time as a time to regain my strength and to renew myself.

 

18.

Sitting in the occupational therapy room, surrounded by magazines with all of the good pictures ripped out, games with the essential pieces missing, and books of crossword puzzles that have all been attempted in thick, green Sharpie and then abandoned, I wondered how I was supposed to mend.

An older man with few teeth leered at me from across the table, and a meaty woman my mother’s age scowled back at him, protecting me. If I was still here at lunchtime, I’d give her all of the salt packets from my tray to thank her. There was a camaraderie in our brokenness.

The hospital had done its job: no sharp objects had entered my body. I was alive. I was safe. But I was not whole, and I was not healed. That would take much longer than my insurance would allow.

On Christmas day, I was discharged. “Your mother is here and your paperwork is ready,” said a nurse who was holding my confiscated outerworld belongings. Despite the other fears surrounding my homecoming, I couldn’t wait to wear shoes again and to tie the laces tightly.

“I hope we never see you again,” the nurse said with a smile.

 

19.

This summer, I’ve amassed two shelves worth of books and photocopied short stories dedicated to mental health. I have not read all of the volumes, but as my collection grows, so does my hope. “The Depressed Person,” “Silver Water,” and “Monument” belong on this shelf, as long as they are not the only stories that populate the space.

 

20.

There are mental health professionals who are trying to create comprehensive healing plans for their patients, just as there are writers who are putting forth realistic portrayals of mental illness. I look to the voices of Esmé Weijun Wang and Marya Hornbacher. Wang, with her realistic yet hopeful essays on the challenges of purusing her art while living with schizoaffective disorder, and Hornbacher, with her unflinching memoirs of anorexia and bipolar, help me to believe that we are heading in the direction of honesty – an honesty that opens up the dialogue on mental health to conversations about the ineffectiveness of some treatments and the merits of some courses of healing. In these honest spaces, we can joke about the trivets and birdhouses while affirming that group therapy with twenty participants all clamoring to be heard is not the way to genuinely offer help.

For the most part, I am still unsatisfied with the presentation of mental illness in fiction, so my interests have shifted to essays and memoirs. I need stories of truth to keep me afloat as I navigate my own path of healing. A literary landscape that accepts accurate depictions of illness and wellness is on the horizon, and a broadening of the field, will only do good for writers and readers. As more brave writers challenge their literature to reflect the intricacies (and absurdities) of mental illness and health care, the stigma will erode further; and maybe those more accurate depictions and that erosion will give individuals suffering from mental illness the courage to demand the healing that they deserve.

 

Jenna KahnJenna Kahn was born in Germany and lived in Europe until she was sixteen years old. She currently studies English and German at Towson University where, last year, she was the web editor for the college’s literary journal, Grub Street. This summer, she has worked as ASF‘s summer intern, working on digital marketing, web initiatives, and SEO optimization. In her free time, she blogs about mental health and offers insight on her attempts at living well with mental illness.

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