Date: Wed, 24 Jan 1996 14:27:01 -0600 From: Juli Lawrence To: Multiple recipients of list MADNESS "Haunted" by Lauren Slater From New Woman Magazine, February 1996 Ms. Cogswell is a 37-year-old single white female who has had over 30 hospitalizations, all for suicide attempts or self-mutilation. Was extensively sexually abused as a child. Is now requesting therapy for bulimia. Client has been in outpatient therapy with over 70 (!) social workers, psychologists, and psychiatrists. She has "fired" them all. Recommendation: Psychological testing; behavioral therapy; possible admission as an inpatient. "So who wants to take the case?" Dr. Siley, the director of the out-patient portion of the unit where I work, asks. He folds the initial evaluation from which he has been reading back into its green file. None of the other clinicians offers. Ellen looks away. Veronica busies herself with the pleats on her skirt. The staff room stays quiet. "What about you?" Dr. Siley asks, looking in my direction. "Well," I say, "she sounds like a lot of work." "Who isn't," Veronica asks. "Why don't you take her, then?" I wonder aloud. "My schedule is full," she says. "And yours isn't," Dr. Siley adds, pushing the file toward me. The phone rings six, maybe seven times, and then I hear a tiny voice on the other end. "Hello," it whispers, and I announce myself, the new therapist. Let's make an appointment, look forward to meeting you, here's where the clinic is, in case you forgot-- "Can't," the voice weeps. "Can't, can't." I hear the sound of choking, the rustle of plastic. Sobbing breaks out over the line. "I've spent every last penny on frozen pizzas. There's blood coming up now." "You need to be in a hospital, then," I say, thinking quickly. "Oh, please!" the voice cries. "Put me in a hospital before I kill myself. I'm afraid I'm going to kill myself." I tell her to sit tight, hang on, and the I replace the receiver. I know the routine by heart. I call 911, give the ambulance company her name and address. Next they'll take her to an emergency room, and afterward she'll be placed in an inpatient unit somewhere in this state. She'll stay wherever she is put anywhere from three days to four weeks; enough time, probably, for her to forget I ever called, to forget she ever wandered into the clinic where I work. And I, lucky I, will be off the case. Or so I think. Two days later a call comes through to my office. "Ms. Linda Cogswell tells us you're her outpatient therapist. Could you come in for a team meeting next Monday?" "Well, I don't even know her, actually. I was assigned the case, but before i could meet her she had to be hospitalized. Where is she?" "Mount Vernon. I'm her attending psychologist here. Would you be willing to meet with us regarding her aftercare plans?" Mount Vernon. Mount Vernon. And even though it has been years, I see the place perfectly all over again: the brick buildings, the green ivy swarming the windows. The nurses who floated down the halls like flocks of seagulls, carrying needles in their beaks. My heart quickens; a screw tightens in my throat. "Mount Vernon?" I say. Of all the hundreds of hospitals in Massachusetts, why did it have to be this one? And another part of me thinks I should have been prepared. "Look, I don't know the woman at all," and I hear something desperate in my voice. I try to tamp it, assume a professional pose. A pause on the line. "But technically," the voice retorts, "she is under your care, yes?" "Yes," I say, "Well, yes." "Next Monday then, one o'clock. North--" "Two," I interrupt bitterly. "North Two." "Good," she says. "We'll see you then." What else can I do? Technically, I have been assigned the case. But this isn't any longer about the case. My hesitations now don't have to do with Linda but with ivy on brick; the shadow of a nurse, a needle; the way night looked as it fell beyond the bars, and the stars sliced into even segments. I remember looking out the windows on North Two. Liquid crimson medicines were served in plastic cups. The rooms had no mirrors. But what else can I do, having been assigned this case? I will go in, go down. Go back. I have to drive out of the city to get there, down roads I've avoided for the past seven years. Where there once was farmland, horses spitting sand as they galloped and wide willow trees that I would sit under when the nurses let me out on passes, there are now squat, square houses dotting the hills. But the building's bubbled dome rises unmistakably over a crest as I round the corner, floating there in a distance like a glittering spaceship. Walking back from passes I would see that domed bubble, that silver blister bursting against a spring sky, and I would count one, two, three, getting closer, my heart hammering half with fear, half with relief. Safe again. Trapped again. Safe again. Trapped aga-- And I have the same heart in the same socket of chest, and it hammers like it used to, and I find myself thinking the same words: safe again, trapped again. My palms sweat on the steering wheel. I remind myself: I am not that girl. I am not that girl. I've changed. I've grown. It's a long time ago. I am now a psychologist. How often, I've thought, I've marveled at the discrepancy between this current image of me and the tangled past it sprang from. Sometimes I've imagined shouting out in staff meetings, in front of all my colleagues, who know me as a spunky, confident doctor. How often I've wanted to say that once I, too... And what I would tell them goes something like this: on five separate occasions, spanning the ages 14 to 24, I spent considerable portions of my life inside the very hospital whose graveled drive I am now turning into. Until what could be called my "recovery" at 25 or so, I was admitted to this institution on an average of every other year, for up to several months. And even today, at 31 years old, with all that supposedly behind me, with chunks of time in which to construct and explain the problems that led me to lockup, I find myself at a loss for words. Images come, and perhaps in the images I can illuminate some of my story. I am 5 years old, sitting under the piano, as my mother, her face a mask of manic pain, pummels the keys. Beneath the bench I press the golden pedals, hold them all down at the same time so our house swells with raw and echoing sounds, with crashing crescendos and wails that shiver up inside my sink, lodging there a fear of a world I know is impossible to negotiate, teetering on a cruel and warbling axis. And later, lying in my bed, she murmurs a Hebrew prayer while I see her hands touching me, and a darkness sprouts inside my stomach. A pain grows like a plant, and when I'm 12, 13, I decide to find the plant, grasping for its roots with a razor blade. Stocked solid with the romance of the teenage years, I pranced on the lawn of my school, showing off the fresh gashes. I was removed to the hospital, then a foster home, the the hospital, again and again. Later on, in my late teens and early 20s, I starved myself, took pills to calm me down, wanted a way out. And finally I found one--or one, perhaps found me. I am not that girl any longer. I tell that to myself as I ride up the hospital's elevator. I found some sort of way into recovery. But I know--have always known--that I could go back. Mysterious neurons collide and break. The brain bruises. Memories you thought were buried rise up. I ride up in the elevator and the doors part with a whisper. Stepping off, I find myself face-to-face with yet another door, this one bolted. And now I am standing on the other side of that door--the wrong, I mean the right, side of the door, and I ring the buzzer. I look through the thick glass window and see a nurse hustle down the hall, clipboard in hand. I recognize her. Oh my God, I recognize her! I hunch, dart back. Impossible, I tell myself. It has been more than seven years. Staff turnover in these places is unbelievably high. But it could be her, couldn't it? And what happens if she recognizes me? My mouth dries and something shrivels in my throat. "Dr. Slater?" she asks, opening the door. I nod, peer into her eyes. They're the blue of sadness, thickly fringed. "Welcome," she says, and she steps back to let me pass. I was wrong, I've never seen this woman in my life. She bends a bit at the waist, in greeting, acknowledging the hierarchies that exist in these places--nurses below psychologists, psychologists below psychiatrist, patients at the bottom of the ladder. With a sudden surge of confidence, I step through. The reversal is remarkable and for a second makes me giddy. "Get me a glass of water," I imagine barking at her. "Take your pills or I'll put you in the quiet room." Then the particular kind of dense quiet that sits over the ward comes to me. I am me again, here again. I grip my briefcase and look down the shadowy hall, and it's the same shadowy hall, loaded with the exact same scents, as it was so many years ago. The paint is that precise golden green. The odor is till undefinable, sweet, and wretched. Another woman comes up, shakes my hand. "I'm Nancy," she says, "charge nurse on the unit." "Good to meet you," I say. And then I think I see her squint at me. I've the urge to toss my hair in front of my face, to mention a childhood in California or Europe, how I've only been in this state for a year. "We're meeting in the conference room," Nancy says. Clutching my briefcase, I follow her down the corridor. We pass open doors, and I hold my breath as we come to the one numbered six, because that was my bedroom for many of the months I stayed here. I slow down, try to peer in. Heavy curtains hang, just as they used to, over a large, thickly meshed window. Now, a blond woman lies in what used to be my bed. On that mattress swim my cells, the ones we slough off, the pieces of ourselves we leave behind, forever setting our signatures into the skin of the world. As she sleeps, my name etches itself on her smooth flesh, and my old pain pours into her head. And just as we are passing her by completely, the woman leaps out of bed and gallops to the door. "Oh, Nancy," she keens. "I'm not safe, not safe. Get my doctor. I want my doctor." "Dr. Ness will be up to see you at four o'clock," Nancy says. Suddenly the woman snarls. "Four," she says. "Dr. Ness is always late. Always keeps me waiting. I want a new doctor, someone who'll really care. A new doctor, a new--" Her voice rises and she sucks on her fist. "Stop it, Kayla," Nancy says. "Take your fist out of your mouth. You're twenty-nine years old. And if you want a new doctor, you'll have to bring it up in community meeting." Kayla stamps her foot, tosses her head like a regal pony. "Screw you," she mutters now. "Screw this whole fucking place," and then she stomps back into her bed. When we're a few feet beyond the scene, Nancy turns to me, smiles conspiratorially. I feel my mouth stretched into a similar smirk, and it relieves yet bothers me, this expression toward a patient. "Borderline," Nancy says matter-of-factly, giving a crisp nod of her head. I sigh and nod back. "They're exhausting patients, the ones with borderline personalities." I pause. "But I prefer them to antisocials," I add, and as I say these words I feel safe again, hidden behind my professional mask. I am back on balance, tossing jargon with the confidence of a Brahman in a village of untouchables. There is betrayal here, in what I do, but in betrayal I am finally camouflaged. Of all the psychiatric conditions, borderline personality disorder may be the one professionals most dislike to encounter. such patients are known for their overly demanding ways of relating to others. Described using adjectives like "manipulative" and "needy," their behaviors are usually terribly destructive. Borderlines are often thought to be hopeless, their condition "lifelong." I myself was diagnosed with, among other things, borderline personality disorder. In fact, when I left the hospital for the very last time, at 24 years old, I asked for a copy of my chart, and the write-u[s were full of all kinds of dark projections. "This young woman clearly has had a long career as a mental patient," my record read. "And we will likely encounter her as an admission again in the future." I recall those words now, as we enter the conference room, where several other nurses and doctors sit around a table with a one-way mirror on the far wall. I scan their faces quickly, praying that I look as unfamiliar to them as they do to me. Still, even if we've never met I feel I know them somehow, know them in a deep and private part of me. "Ta da!" I have the angry urge to shout out, bowing to the bearded psychiatrist at the oval's head, standing arms akimbo, twirling so my skirt swells out. "Here I am," I would like to yell. "Yes siree, encountered again. Guess who you're looking at; guess who this is! The Borderline! And sure enough folks, I did mature out, at least a little..." But of course, I wouldn't say such a thing, wouldn't dare. I recognize the conference room as the place where, when I was 14, I met with my mother and the social worker for the last time. My father had gone away to Egypt. My mother, abandoned by him--somehow always abandoned, even as she surrounded herself with people--was wearing a scarf around her neck and a heavy bronze Star of David wedged between the hills of her breasts. This is the same conference room where she, unstable, full of rage, even delusional at times, shot through with a perpetual anxiety that made her hands shake, told me she was giving me up, giving me over to become a foster child. "I can't handle you anymore," she'd said to me, spat at me. "I no longer want you in my house." I bow my head in deference to something I cannot name and enter the room. Things are screaming inside me, and my eyes feel hot. Nancy introduces me all around, and I take a seat, pull out a notebook, try to act as calm and composed as possible. "The patient, Ms. Cogswell," the bearded psychiatrist begins, "is not able to make good use of the hospital. She's an extreme borderline, wreaking havoc on the unit." He pauses, looks at me, clears his throat. I smile back at him, but my mouth feels uncoordinated, tightness at its corners. I won't cry, won't cry, even though in the one-way mirror, in the crisscrossing of the creamy branches beyond the ward's windows, I see my mother again, her face coming to me clearly, her eyes haunted with loneliness and rage. "We think," a social worker named Miss Norton continues, "that we'll be discharging her in a matter of days, as soon as we get her stabilized on some meds. We take it you'll be picking up her case on an outpatient basis. Any ideas on how you'll work with her?" I nod, pretending to make some notes on my pad. As my voice rises in my throat, I'm surprised at how smooth it sounds, a sleek bolt of silk. "Lots of limits," I say. "We know borderlines do well with lots of limits." The bearded doctor nods. In the tree, my mother tongues her teeth and wind lifts her lovely skirt, embroidered with fragile flowers. And then she is not my mother anymore, but a little girl whose legs are white, a single ruby scar on a scrubbed knee. And while part of me sits in the conference room, part of me flies out to meet this girl, to touch the sore spot, fondling it with my fingers. For I have learned how to soothe the hot spots, how to salve the soreness on my skin. I can do it so no one notices, can do it while I teach a class if I need to, or lead a seminar on psychodiagnosis. I can do it while I talk to you in the evenest of tones. "Shhhh," I whisper to the hurting part, hidden here. You can call her borderline--call me borderline, or multiple, or heaped with post-traumatic stress--but strip away the language and you find something simple: you find me, part healthy as a horse and part still suffering, as we all are. What sets me apart from Kayla or Linda or my other patients--what sets me apart from these "sick" ones--is simply a learned ability to manage the blades of deep pain with a little bit of dexterity. It's only that my muscles to hold things in check--to channel and funnel--are stronger. Still, I wonder, why--how--have I managed to learn these things while others have not? Why have I managed somehow to leave behind at least for now what looks like wreckage and shape something solid from my life? My prognosis, after all, was very poor. In idle moments, I still slide my fingers under the sleeves of my shirt and trace the raised white nubs of scars that track my arms from years and years of cutting. How did I learn to stop cutting and collapsing, and can I somehow transmit this ability to others? I don't know. I believe my strength has something to do with memory, with that concept of fluid time. For while I recall with clarity the terror of abuse, I also recall the green and lovely dream of childhood, the most membrane of a leaf against my nose, the toads that peed golden pools in the palm of my hand. Pleasures, pleasures, the recollections of which have injected me with a firm and unshakable faith. I believe Dostoevsky when he wrote, "If man has one good memory to go by, that may be enough to save him." I have gone by memory. And other things too. I had the extreme good fortune to be placed in a foster home, where i stayed for four years, until I turned 18, where i was lovingly cared for and believed in. Even when my behavior was so bad that I cut myself in their kitchen with a steak knife--or when, out of rage, I swallowed all the aspirin in their medicine cabinet and had to go back to the unit--my foster parents continued to believe in my abilities to grow and showed this belief by accepting me after each hospital discharge as their foster child still. That steady acceptance must have had an impact, teaching me slowly over the years how to see something salvageable in myself. Bless those people, for they are a part of my faith's firmness. Bless the stories my foster mother read to me, the stories of mine she later listened to, her thin blond hair hanging down in a single sheet. The house, old and shingled, with niches and culverts into which I loved to crawl, where the rain pinged on a leaky roof. Bless the night there, the hallway light they left on for me, burning a soft yellow wedge that I turned into a wing, a woman, an entire army of angels who, I learned to imagine, knew just how to sing me to sleep. At a break in the conference, a nurse offers me a cup of coffee. "Sure," I say, "but first the ladies' room." And then I'm off, striding down the hallway I know so well, its twists and turns etched into subterranean memory. I go left, then right, swing open the old wooden ladies' room door, and sit in a stall. When I come back, the nurse is ready with a steaming Styrofoam cup. She looks at me, puzzled, as she hands me my hot coffee. "You've been here before?" she asks. My face must show some surprise, for she adds, "I mean, the bathrooms. You know where they are." "Oh," I say quickly. "Right. I've visited some of my patients on this ward before, yes." "You don't have to use the patient bathroom," she says, smiling oddly, looking at me with what I think may be suspicion. "We don't recommend it," she adds. "Please use the staff bathroom, through the nurse's station." "Okay," I say. I bend my face into the coffee's steam, hoping she'll think the redness is from the rising heat. Of course, how stupid of me. What's she thinking? Can she guess? This time, memory has led me astray. The conference resumes. I pay little attention. I'm thinking about the faux pas with the bathroom, and then I'm watching the wind in the tree outside the window. I am thinking about how we all share a similar, if not single, pain, and the rifts between stalls and selves are their own form of delusion. And then I hear, through the thin ceiling, wails twinging down, a sharp scream, the clattering of footsteps. I sit up straight. "Delivery rooms," the social worker says, pointing up. "We're one floor under the maternity ward." I smile and recall. That's right. North Two is just one floor of what is an old, large public hospital. The psychiatric unit we're on has always been wedged between labor rooms upstairs and a nursery downstairs. When I was a patient I could often hear, during group therapy or as I drifted into a drugged sleep, the cries of pushing women as their muscles contracted and in great pain as their pink skins ripped, a head coming to crown. "Why don't you meet with Linda now," the psychiatrist says, checking his watch and gathering his papers. Everyone stands, signaling the end of the conference. "You can take one of the interview rooms," Nancy adds. "They're nice places for doing therapy, comfortable." I nod. I've almost forgotten about Linda and how she is the reason for my return here today. Now I walk out of the conference room and Nancy points down the long hall to a door on the left. "There," she says. "We'll bring Linda to you." And then, to my surprise, Nancy fishes deep into her picket and pulls out a large steel ring of keys, placing them in my hand. They're the same keys, I know, from all those years ago. Keys I was not allowed to touch but that I watched avidly whenever I could. They are what every mental patient must dream of--the heart-shaped holes keys fit into, the smart click as they twist the secret tumblers and unlatch boxes. Keys are symbols of freedom and power, and, finally, separateness. For in a mental hospital, only one side has the keys; the others go to meals with plastic forks in their fists. Slowly, I make my way down the hall to the interview room and stand outside the locked door holding the key ring. It feels cook, and I press it to my cheek. A woman who looks far older than her 37 years is now making her way down the hall. As she gets closer I see the dark ditches under her eyes, where years of fatigue and fear have gathered. I would like to put my finger there, sweep away the microscopic detritus of suffering. We stand in front of the locked interview room, and I fumble for the correct key. I start to insert it in the lock, but then halfway through I stop. "You," I say to my new patient Linda. "You take the key. You turn the lock." She arches one eyebrow, stares up at me. Her face seems to say, "Who are you, anyway?" I want to cry. The hours here have been too long and hard. "You," I say again, and then feel my eyes actually begin to tear. She steps forward, peers closely, her expression confused. Surely she has never seen one of her doctors cry. "It's okay," say. "I know what I'm doing." And for a reason I cannot articulate at the moment, I make no effort to hide the wetness. I look straight at her. At the same time, for the first time today, my voice feels genuinely confident. "Take the keys, Linda," I say, "and open the door." She reaches out a bony hand, takes the keys from me, and swings open the door. The interview room is shining with sun, one wall all windows. I've been in this room too, probably hundreds of times over the years, meeting with the psychiatrists who tried to treat me. I shiver with the memory. Ultimately it was not their treatments or their theories that helped me get better but the kindness lodged in a difficult world. And from the floor above comes the cry of a protesting baby, a woman ripped raw in birth. We are her. As my mother used to say, rocking over the Shabbat candles, chanting Jewish prayers late, late into the night, "Hear O Israel. The Lord is God. The Lord is one, and so are we as a people. As a people we are always one." Sometimes I miss her. My patient and I sit down, look at each other. I see myself in her. I trust she sees herself in me. This is where we begin.