At the start of November 2015, I found myself, for the first time in my life, under lock and key in a psychiatric ward. I’m a professor in an American university who never in his most unhinged moments imagined he would end up in such a place. But I did, and that makes me think it could happen to anyone – particularly in academia.
The biggest shock was having everything taken away from me. Everything. The first things I surrendered were my clothes and shoes; instead they gave me paper scrubs. I even had to remove my watch and wedding ring, which had been on my finger since I married.
Confinement was devastating. For hours I looked out of the bedside window, from which I could see people going about their business far below – visiting the 7-Eleven, strolling through the neighbourhood, travelling to work. I could do none of those things, being locked behind a closed door for my own safety and that of others. In fact, I wasn’t even allowed as far as the exit; there was a red line on the floor next to the nurses’ station beyond which patients could not step.
The first day of my incarceration was one of my teaching days, and one of the more bizarre aspects of my situation was that I could see my workplace in a tower block some two and a half miles away. I imagined students going to the classroom where I was to teach and finding a notice saying I was “unwell”. It was unnerving.
Inmates are restricted to the day room (common room) and their own bedrooms. Bathrooms are shared, unlockable and constructed so that everything that occurs inside is audible, in excruciating detail. Throughout my time there I self-induced a form of constipation rather than use the lavatory. There’s no privacy: CCTV is everywhere, and nurses check your vital signs hourly.
Unlike a normal hospital department, you’re not allowed personal possessions, and have no access to metal cutlery, ceramic or glassware. Men shave only by permission of a qualified psychiatrist, and then with dispensary-packaged equipment under medical supervision. Food is delivered to and consumed in the day room, with other patients. For most of the day there is nothing to do other than lie in bed.
My first morning inside, as the enormity of my situation began to sink in, I cheered myself up by comparing my experience to that of flying: you lie down, look out the window, order lunch from a menu, share the bathroom, are locked in a confined space and wear institutional socks. The differences may be more revealing: no airline, even in first class, offers group therapy, psychiatric consultations or pharmaceuticals.
But these are superficial thoughts that conceal a deeper truth. As an inmate in a “behavioural unit” I was one of an elite, although in a surprising way: in 1955 there were nearly 560,000 psychiatric beds in the US; by 2010 that had fallen to a mere 43,000. The entire state of Texas, one of the largest in the union, has a meagre 10 facilities (into which visitors can now take guns). Where have all the patients gone? Many have been swallowed up by the prison system, others are among the homeless. Those in the few hospital facilities that survive are extremely fortunate.
Soon after arrival, having threatened suicide, I realised that I was surrounded by people with more serious problems than mine: drug addicts, the homeless, prostitutes or people who had committed violent acts against others. Most were black people, a group 20 per cent more likely to suffer serious mental health problems than the rest of the US population. Among them were several women. One – a drug addict – told me that her husband and daughter were now dead.
It was, I should add, a privilege to meet them: one young homeless man was highly intelligent, artistic and well read; an older man told me he that was a maths professor with a degree in civil engineering. Both wanted to be there and had been trying for some time to get themselves admitted. On the day of his discharge, the young man tried to persuade his psychiatrist that he should be held for another five days; patients are admitted for short-term assessment, so no one stayed for more than a couple of weeks. The average stay was three to five working days.
The nursing staff and physicians were as remarkable as the patients – for their compassion, perceptiveness and sound judgement. They were dealing with difficult people who could be abusive, sometimes threatening. Yet they went about their business in a manner that bespoke respect and humanity; I was deeply impressed by them.
I was at first minded not to bother with group therapy but, prompted by a nurse, joined the first available session and never stopped going throughout my time there. I tried to contribute as much as possible, speaking candidly about myself and the events that had caused me to be committed; encouraged by that, others responded in kind. I slipped comfortably into the role of therapy junkie because it was like being in the kind of class where students analyse works of literature, the difference being that our focus was life rather than art. It was important not to veer off into self-indulgent abstraction, theory or any other kind of bullshit.
Despite the consolations, I knew I had to get out. The experience was depressing and made me feel as if I were “mad”.
“It’s grim,” I told my wife, when I called her. “I don’t know how much more of this I can take.” She visited when permitted, between 5 and 7 o’clock in the evening. To the best of my knowledge, she was the sole visitor to any patient during my two days and two nights there. It may be that psych patients don’t welcome visitors in the same way that others do; they carry a stigma, and their surroundings are not congenial venues for entertaining guests.
When talking to my psychiatrists – who are often, after all, academics who happen to wear white coats and carry stethoscopes – I took care to speak in rational, lucid sentences on the assumption that it would make me sound less unbalanced. And, again, I strove to speak honestly, avoiding the urge to intellectualise. That came naturally because I’m not the kind of academic who loves to lose himself in hot air. What was difficult was the demand to analyse the self with clear-sighted honesty. Nothing about my academic career had prepared me for that, for it has nothing to do with logic, rationality or the ability to conceptualise. It’s not hard to analyse things external to the self: it is much harder to apply one’s intellect in a disinterested manner to one’s own vulnerabilities. Especially if, like me, you were brought up in England in the 1960s, when confessing to weakness or speaking of one’s inner fears and anxieties was enough to brand you a sissy.
I awoke on 2 November 2015 with no thought that I would end the day in a secure institution. I went about my business at the post office, the bank and the dry-cleaners until, during a “routine” visit to my doctor, he ordered me to take an ambulance to the emergency room and admit myself for treatment of major depression. I told the doctors that this was my first significant depressive episode, but since leaving hospital I have realised that it was one of many that spanned more than three decades. I now see that the outbursts of anger, panic attacks, mood swings, feelings of exhaustion and overwhelming sadness to which I have been subject since my teenage years were symptoms. Thoughts of suicide had increasingly seemed an escape, a means of control and a comfort. None of that was clear before I went to the hospital; now that it is, I am working with a psychiatrist to change those thought patterns. My biggest need is for time, in which to receive treatment, and I am grateful to my institution for granting it to me. I hope other sufferers are as fortunate.
Is there a tendency among academics to fall foul of depression? Many of us, especially those working in the humanities, often work alone rather than in teams, and that predisposes us to spend a lot of time inside our own skulls. That isn’t inherently harmful, but I’ve often reflected that those who ruminate intensely on their own might be prone to self-criticism and feelings of isolation and failure – all possible triggers. In my own case, I know how vulnerable I am to feeling alone and unable to cope as I drown beneath a seemingly endless avalanche of work, which precedes the sense of powerlessness before a depressive episode.
There is statistical evidence too. In May 2014, The Guardian reported a survey in which 83 per cent of academics admitted to anxiety, 75 per cent to depression and 42 per cent to panic attacks. At the time of my hospitalisation, I was experiencing all three. Anecdotal evidence in the blogosphere indicates that rates are high on both sides of the Atlantic (google “depressed academics”). Social attitudes still discourage us from admitting our feelings openly, which makes it harder to seek help. I will never forget the shame that made me fearful of talking about my own feelings while I pretended to be OK, and the isolation and helplessness that followed.
My time in the secure unit was valuable as well as terrifying. It prompted me to remember colleagues I have known over the decades: I now suspect that many suffered from depression, whether or not they recognised it. If I could continue in the erroneous belief that I had no problem, there may be others who suffer in the same way. I share this experience in the hope that it may help them to acknowledge their feelings and seek support before they too, perhaps, end up in the secure unit of a psychiatric institution.
The author has asked to remain anonymous.
后记
Print headline: On the inside looking in
