Excerpts from Must Read Books & Articles on
Mental Health Topics
Books, Part XXXXIII
The Center Cannot Hold
Elyn R. Saks (2007)
DURING SECOND SEMESTER, we were free to choose whatever classes we liked. I chose the mental health law clinic and another in criminal law. Steve was in both as well. As part of the mental health law clinic, students represented actual patients in psychiatric hospitals. Professor Stephen Wizner was the head of the clinic. Tall, with curly black hair, he was often moody and mercurial (sometimes, he gave advice one day that he contradicted the next); he nevertheless helped me feel confident in my early forays helping folks who often looked and sounded like me at my most vulnerable.
Joe Goldstein, a law professor who was also a psychoanalyst, taught the criminal law course. Joe looked like the quintessential "mad professor": baggy clothes that looked like he'd slept in them, plus wild, Einstein-like hair and a distinct, eccentric way of speaking. He only assigned a very few pages of reading for each class—and his syllabus made the course look like a breeze—but he wasn't fooling around. He expected us to read every page, every paragraph, and every sentence; to do otherwise could earn Joe's wrath, which was considerable.
Yale's Legal Services Organization—LSO—always had students work in teams, so Steve and I worked on our mental health law cases together, and from the beginning we represented psychiatric patients and children. One of our first cases involved the two young sons of a man then in prison for multiple rapes. The boys' mother didn't want them anywhere near the dad, an obvious psychopath with a certain quality of persuasive charm. While there's a significant body of evidence that argues that keeping ties to an incarcerated parent is good for a child, there's an equally strong argument on behalf of deferring to a custodial parent and in this case, the custodial parent was a very good one. The boys were healthy, happy, and well taken care of, in a stable home, by someone whose judgment could be trusted. In Connecticut, children are entitled to their own lawyers in custody and visitation issues, and as attorneys for the boys, we explored what would be best for them, drawing as well on the expertise of the Yale Child Study Center.
Increasingly, Steve and I and our small band of friends hung out at Yorkside Pizza in New Haven red vinyl banquettes, Yale memorabilia and team pictures on the walls, a jukebox upstairs, a Pac-Man machine downstairs. Over meatballs and sauce, or calzones, or endless slices of cheese-and-pepperoni pizza, we strategized our cases and talked about our classes. It was about as normal as I'd been, and felt, since college.
At the end of spring semester, the academic work grew more intense, and exams loomed. Possible grade range at Yale: honors, pass, low pass, and fail. For the in-class exams (which were open book), I always earned honors, except for my first. For the take-home exam in Joe Goldstein's criminal law class, we were given a choice of topics to write on, and I chose to discuss whether there should be a special law for mentally ill mothers who kill their children. I spent hours consulting with Steve (which we were allowed to do) and hours more putting it all together. When our exams came back, Steve's rated honors mine got a pass. Like most of the students around me, I cared intensely about my work. Unlike them, however, that work was all that I had. I didn't play sports, I didn't play a musical instrument, I didn't have any hobbies, and whatever social life I'd managed to construct was small and fragile. So the grades I earned were the only objective signal I ever received about how I was doing in the world. The task of setting and achieving academic goals operated as a sort of adhesive; I needed it to hold myself together. Failing (or, at least in this case, failing my own expectations) tore that adhesive off and further splintered my fragile sense of self.
After I retrieved my exam in the department secretary's office and noted the grade, I went directly back to my dorm room, closed the door behind me, and crawled into bed. There, I curled up in the fetal position and spent the rest of the day moaning and babbling, totally convinced that faceless, nameless beings were controlling ("interdicting" was the word I had begun to use in my psychotic ravings) my thoughts. I was in danger of daggers; they were aimed at my flesh, and would slice me in pieces if I dared go to sleep. Afraid to leave the room, afraid to stay in it, I dragged myself to my afternoon appointment with White, who took one look and knew immediately that something was very wrong.
"I only got a pass," I said. "They passed me up. From Jo Jo. Interdictions are flying everywhere and the other children ate the porridge. No news is good news, bad news brings a flap. Like flipper." The evil presences were in the room. "They're killing me! Tell them to get away!"
White tried to get me to explain what had happened, but it was beyond me, and I grew angrier by the second. "Murders are necessary and evil or necessary evils! The orders will come from elsewhere!" I was pacing frantically around the room, clenching my fists.
"We need to take this seriously," said White. "Do you think you need to be in the hospital?"
"No," I shot back. As if any other answer were possible. As bad as my devils were, the specter of the hospital was worse. Mrs. Jones, oh, Mrs. Jones, I need you, need you, need you, need you.
Dimly, I was aware that White was wrestling with his decision and my obstinacy. He could have insisted on hospitalization; in all likelihood, he probably could have had me locked up immediately. But he didn't do that. "All right, no hospital," he replied in a measured and thoughtful tone. "But I want you back on Navane, double your usual dose. And I'd like to meet twice a day until this levels off"
For the next two weeks, I shuffled back and forth to his office twice a day, head down, shoulders hunched, eyes on my feet. I spent the intervening hours sitting on the floor in my room or curled up in a ball on the bed, alone and muttering to myself, accompanied only by my demons, and the occasional knock on the door, which I didn't answer. Few showers, very little food. Gradually, the increased dose of Navane kicked in, the demons receded, and the fog lifted. I got up off the floor, cleaned myself up, and one more time I went back out into the world and started all over again.
Many of my classmates spent the summer after first year in New York City, where impressive law firms paid them lots of money to be summer associates, all the while wining and dining and courting them for the future. That kind of summer was the last thing I could imagine—the stress of a big law firm and the dislocation of a frantic summer in the city seemed too much for me to handle. Besides, I needed to stay near White.
Through one of his clients at the mental health law clinic, Steve found out about a halfway house for the homeless mentally ill and decided to volunteer there for the summer as a live-in counselor. So we both stayed in New Haven and continued our work at LSO, representing mental patients and poor children for a few dollars an hour.
One of our clients that summer was a young anorexic woman, not quite twenty, who had been a patient at a private psychiatric hospital in Connecticut for almost two years. She wanted to get out—her parents wanted her to stay. Their concern was understandable; both physicians and the lay public were learning the truth about anorexia, that it was neither a disease of choice nor a case of weak will, but was real, and potentially fatal. But even that didn't automatically mean the young woman had surrendered her right to have a say in her own treatment. One of her old friends from high school, now a Yale undergraduate, called us about the case, and when we met the young woman, I quickly identified with her, not only because of my battle with my parents around my own weight loss, but also because of the great frustration that comes when your fate is completely in someone else's hands and you're helpless to exercise any control.
Psychiatric patients always have someone (or a whole chorus of someones) telling them what they're supposed to do. In my own experience, I had discovered that it was much more effective to be asked what I'd like, e.g., "If you could arrange things your way, what would that look like and how do you think we could help you get there?" Indeed, the young woman accepted that she did need treatment—she just wanted, and was entitled to have, a voice in the decision-making about where and how that treatment would happen. It was my job to help her get that. And as empathetic as I felt toward her, I also began to understand, as the case progressed, that as her legal representative, I was not advocating for myself I was using my skills to advocate for someone else. Ultimately, Steve and I were successful in finding a place for her at a different hospital, where we were hopeful that her disease would be well treated and her autonomy better respected.
I stayed on the increased Navane dose for the rest of the summer, and took an antidepressant as well. I had to concede that the medicine was working I could do my schoolwork, I was functioning reasonably well in the world—but I was still looking forward to the day when I'd be able to stop taking meds.
With September came the challenges of second year, and new classes, and a lowered Navane dose back to ten milligrams. The meetings with White were back to four times a week. But in spite of the meds and meetings, I was having some brief hallucinations, mostly at night—once of a large spider crawling up my wall, but mostly of people standing and staring at me. They're not there. They're not really there. And even if they are, they're not really looking at you.
Our work at LSO representing children and psychiatric patients afforded Steve and me easy access to Yale's Medical School and the Yale Child Study Center. We both did an "intensive semester" at the Child Study Center, participating in almost all the classes that the psychiatry fellows and psychology post-doc students were taking. For law students interested in the psychoanalytic approach, there was no more ideal setting. There were times, though, when reminders of my own history as a hospitalized psych patient popped up unexpectedly like walking past Dr. Kerrigan in the halls. He was the one who'd kept me hospitalized at MU 10; he was the one who'd ordered the restraints. Every time our eyes met, I wondered whose bad idea it was that this man come to the Child Study Center. I'm sure he wondered the same about me.
"I think I want to get off my medication now," I told Dr. White. Things were going well; I was feeling fine. I could manage without drugs. "I don't need it."
"Well," he said, and then paused for a moment. I was suddenly aware of trying to read his mind. "How about this: you slowly taper down, and we'll see what happens. Let's say we reduce by two milligrams a week."
Too slow at that rate; it'd be five or six weeks before I was done with them completely. But whatever I did, I knew it had to be with his knowledge and support. "OK," I said. "I'll start with that."
It wasn't just my usual reluctance to be med-dependent; it was the side effects. Until a new class of antipsychotic meds was developed in the 1990s, the drugs to treat psychosis carried the serious risk of tardive dyskenisia TD a neurological disorder that causes involuntary movements, first in your face and around your mouth, and sometimes through your entire body. People with TD twitch and jerk in short, they look like mental patients, and once they've got TD, it generally doesn't go away. I'd spent enough time in and around psychiatric hospitals to know I wanted no part of that.
The first week, I didn't feel any different. "This is working well, don't you think?" I asked White.
"We'll see," he said.
By week two, I was a little shaky. Tightrope walking. It's ordinary stress, everybody has it. Stop thinking about it. Stop. By week three, I was visibly fragmented and struggling to hide it, even from White. I was going to melt. I was about to be attacked and ripped apart. Stop. It's not real. It will pass. "I'm feeling a little stress," I told White, "but it's probably just my imagination. Pation. Which is related to being both patient and a patient. Don't you think? Pink?"
He raised an eyebrow "It sounds as if you're having a bit of a hard time," he said. "Should we up the Navane?"
I shook my head. "No. Too early. I'm doing OK. A-OK. I just need to try a little harder."
"I don't think it's a matter of trying, Elyn. I think it's a matter of whether you need the meds. But if you want to give it a little more time . . ." There seemed to be a question mark at the end of his sentence. Was he asking me?
"Yes," I said with whatever firmness I could muster. "A little more time."
I don't know why he was so accommodating. Maybe he thought I could really do without medication eventually; maybe he wanted to respect my wishes. Maybe he, too, didn't want to see me with the TD shakes. Whatever his reasons, this wouldn't be the last time White would agree to be my copilot while I tried to fly without the meds.
By week four, I'd arrived in the land of full-fledged psychosis. The people in the sky poison me. I in turn will poison the world.
"I think you're having thoughts that are scaring you because you need to be on more medication now," said White.
"No!" I was practically shouting. "It has nothing to do with drugs. It's a massive attempt at medical and physiological, not to say psychological, derailment which was a result of deregulation of the rail!"
"It's hard to admit you need medications," said White. "But you do."
Defeat, defeat. "There's no need. I'm not sick. I'm wicked. La di da. I'm ever so well, thank you, ever so well."
But we both knew I'd hit the damn wall again. And as soon as he increased the Navane, I started feeling better. But this has nothing to do with me or being sick. It's just about being able to study. I'm not sick, I just need some help so that I can study.
More than once while working with Steve on our LSO cases, I was struck with the absurdities of the mental health care system. Almost every time, there'd come a moment where we'd ask each other, "Wait a minute, just who are the crazy people here?" In one case, the patient's chart said he was restrained because he wouldn't get out of bed which was hardly an instance of "imminent danger to himself or others" as required by the laws of Connecticut.
In another case, we represented a young man who'd been in the hospital for months, refusing to take his medication for religious reasons. There was no question that our client was seriously ill (although he himself did not agree with that assessment); for instance, he'd severely mutilated himself because he thought the Bible required as much of sinners. At the time, Connecticut permitted forcible medication of involuntary patients, but we wrote strong and well-researched letters to the hospital arguing that our client should not be medicated if he chose not to be: Freedom of religion required as much. The hospital agreed.
Eventually, our client was moved to a new ward. There, he spoke to no one, most especially staff, because he didn't trust the doctors or anyone else. On the other hand, he would call us almost daily, or we called him, to discuss his case; in fact, there were some days we could barely get him off the phone, he was so engaged with the legal details.
After several weeks of back-and-forth calls, the hospital scheduled a hearing to appoint a guardian for our client. As preparation, Steve and I went to the hospital to meet with him and explain how the procedure would go. We were met by one of his nurses. "He's psychotic," she said with absolute certainty. "If you don't believe me, take a look at the record."
So we did. A typed evaluation, and entry upon entry, stating the following: "Patient is very bizarre. He is totally mute. However, we know that he's able to speak, because many times he's been overheard talking on the telephone about his legal rights with his imaginary lawyers." Steve began to sing under his breath the Temptations song "Just My Imagination."
No one had bothered to notice that in addition to making phone calls, sometimes our client received them; no one had bothered to inquire whether he actually may have had a lawyer or lawyers. He was crazy—ergo, his lawyers were imaginary. Imagine the staff 's consternation when the imaginary lawyers began introducing themselves to their client's doctors and nurses.
One of my favorite cases, involving someone I would end up working with on and off for six years, was Jefferson, a young man barely out of his teens. When we first met him, Jefferson had been on a back ward in a state mental hospital for many years, after spending even more years before that at a state hospital for adolescents. In addition to having been diagnosed as mentally ill, Jefferson was moderately mentally retarded. And therein lay the problem: Retardation is not equivalent to mental illness, and there seemed to be no current evidence that he was still mentally ill. And if he wasn't, a state mental hospital was absolutely the last place he should have been living.
After our first visit, it took Jefferson another three or four to recognize us and remember who we were; soon, he actually seemed to enjoy our visits, and seemed to have decided to trust us. Whatever his limitations, he had, we believed, "dignity interests" that required us to try to find out what he wanted.
"Do you like it here?" we asked. A stony face. "No. Don't like it here. It's a bad place." "why?" "John, he punched me once, but I whupped him." "Do you want to stay here?" "No," he said. "There's nothing to do here." "Do you have any friends here?" "No, don't like anyone here. The other people, they're not like me." "Have you met with any teachers? To do some schoolwork?" "What schoolwork?" he asked. "We don't get no schoolwork."
It was clear as day that Jefferson needed to be with people who knew how to help him; he needed a group home. But his long history of being in mental hospitals, together with his size (well over six feet tall and weighing more than three hundred pounds), made us cautious and concerned was there anyplace that would actually take him on now?
We started looking for someplace for Jefferson, and the search went on for weeks—this one was too small, that one too large, others had no openings (with long, long waiting lists) or housed residents who appeared neglected. The whole time we were looking, we kept going back to the mental hospital to check in with our client, just so he'd know we hadn't forgotten him. "Can I please leave yet?" he asked each time. Inside that large body was a lonely child who knew he was in the wrong place.
Finally, we heard of a vacancy in a very pleasant group home in west New Haven, where most of the other residents were both autistic and retarded. The right size, with competent staff and a good track record. Could this be Jefferson's new home? After several overnight and weekend visits in which he did very well (and was obviously very happy), Jefferson was finally released from the mental hospital, a warehouse where he hadn't belonged in many years if, in fact, he had ever belonged there. I wondered: How was that first diagnosis made, so many years ago? Who made it? And how many more Jeffersons were locked up inside places just like that—lost, or misdiagnosed, spending whole lifetimes waiting for someone to really see them and recognize them for who they were?
AS THE END of law school drew near, I knew only one thing for certain: I was never going to be able to stand up in court and orate like Perry Mason. And I probably wasn't ever going to deliver an impassioned closing argument to a jury on behalf of a good guy or in prosecution of a bad guy. Nor was I going to orchestrate the legal machinations of a Fortune 500 corporation as its counsel, or be one of many names on some prestigious law firm's fancy letterhead. But I was going to have to find a job. Finish school, navigate the bar exam, and then a job. Some job. Someplace.
This was . . . daunting. Aside from selling Cokes and popcorn at a movie concession stand, my brief stint as staff trainee at the Center, and summers working at LSO, I'd only ever been a student. And I'd had to battle some terrible demons even to be consistent at that.
I was excruciatingly uncomfortable speaking up in class, so I rarely, if ever, did. After one final exam, the professor called me on the telephone and said that he had no idea of who I was but that I'd written the best exam in class. Each time it happened, in spite of the grades I'd earned in the past, this kind of comment came as a surprise. I had to replay it repeatedly in my head, before I could effectively shut off the tape that ran almost all the time: There's been an unfortunate mistake, they've confused me with some other student, in fact my true performance was less than stellar, and it's only a matter of time before everyone finds out the truth.
Commenting in class was not the only thing almost impossible for me. I was also terrified of research papers, which scared me right up until the time I became an actual academic. One paper that still resonates for me today was for a class on Freud taught by George Mahl. I was so afraid of having to write a paper that I almost didn't take the class, and did so only after Steve managed to persuade me that it would be a wonderful course despite the paper I'd have to write—and it was, one of the best I've ever taken. The subject of the paper was Daniel Paul Schreber, who at one point in his life had been the chief justice of the supreme court of the German state of Saxony. Schreber had a schizophrenic breakdown, which he wrote about in A Memoir of My Nervous Illness. Freud wrote a case study of Schreber, and I constructed a somewhat different interpretation of his delusional system, his principal delusion being that he was being transformed into a woman to be fertilized by the Rays of God in order to bring forth a new race of man and woman. (When describing this in a job interview with Notre Dame Law School, I was met with a hilarious comment by one of the nuns: "What's wrong with that?")
When my paper on Schreber came back to me, it contained a note from Dr. Mahl, telling me that the paper was "publishable." (Later the professor wrote that my final exam was the best he'd seen in twenty-five years of teaching.) This meant a lot to me, particularly because I found Dr. Mahl one of the finest lecturers I'd ever heard, or have heard to this day. There were no class discussions in Mahl's course, but his lectures were so amazing nobody missed having discussions—and nobody skipped his classes, either.
Professor Mahl's feedback had an enormous effect on me—positive at first, then almost immediately negative: I stopped taking my medication again. I'm publishable, I'm not mentally ill at all which means I don't need to take medication for the mentally ill. I'm done with this. The last time I'd tried to stop the meds using White's "weaning" method, I only became more anxious as the weeks went by and the dosage went down. That was the wrong way. This time, I'll do it all at once. Just pull the bandage right off!
I felt fine for a day or two; ecstatic, even. By day five, I was completely and floridly psychotic, convinced that evil beings were about to destroy me. I gibbered; I cowered. I couldn't work, and the end of the final term was coming up. Finally, White insisted: back to the Navane, and increase it again. The effect was almost immediate, but instead of being relieved, I was angry. Pm sick of this. It all came down to supporting the patient's choice—didn't it? If I was competent when I decided to stop taking the meds, then it was a competently made decision. A decision made by a competent person. Wasn't it?
One tragic example of supporting a patient's choice was the case of my close friend Dan, whose first client in the mental health law clinic was an adolescent named Tony, who'd been institutionalized most of his life. When Dan took his case, Tony was at the state hospital for adolescents with mental illness, although oddly, his only clinical diagnosis at that point was attention deficit disorder ADD. Tony wanted out of the hospital, and Dan got Tony released to his reluctant parents, who only after much pleading had finally agreed to take Tony in.
Some months later at a point at which Tony would perhaps have been out of the hospital anyway--Dan got a phone call from Tony: He was being held in prison on a murder charge. He had burned down the family trailer with his mother, father, and seven-year-old brother still inside; they'd all died. Dan was devastated; indeed, the entire mental health law class was. For a bunch of idealistic law students, some lessons were harder to learn than others, and this one—that "helping people" isn't always a good thing (or, maybe, that "helping" translates differently from case to case, and must be cautiously scrutinized)—was tragic for all parties. The caveat, of course, is that there is no way of knowing whether Dan's intervention made any significant difference in how Tony's story turned out.
Generally, though, helping psychiatric patients felt pretty good to me. There were so many factors in their various hospitalizations, and so much potential for error and neglect in the way they were treated. Some damage could be undone; some lives could be changed for the better. I realized early on that going to the mental wards sometimes set me off emotionally it probably aroused my own dependency needs, as well as my anger at how I had been treated when I was being held in the hospital. But I was convinced I understood more than most people did (medical professionals as well as man-on-the-street people) about what it was like to be the helpless patient in that bed, or the terrified patient in four-point restraints.
And yet, even as I adamantly denied my illness, I understood all too well my limitations. If I couldn't even speak up in class, it wasn't likely that I'd be capable of being an impassioned advocacy soldier slugging away in the courtroom trenches, trying to get either a hospital administrator or an intransigent legal system to pay attention to me. If I were really going to make a change in lives of mental patients, I had to find a different way to do it.
The Yale Law Journal, established in 1891, published (and continues to publish) "original scholarly work in all fields of law and legal study." Its articles and essays have always been contributed by the leading professors and legal minds throughout the world, but the Journal also includes shorter pieces, called "Notes," written by student-staff members. In order to be a member of the Journal, I had to submit a topic statement on the subject I wished to write about in my Note—the use of restraints in psychiatric hospitals. When my statement was accepted, I asked Steve if he'd help me revise and prepare the Note for publication, and of course he said yes. I wanted my argument to be as cogent and powerful as possible; in fact, on some level, I wanted the words on the page to do the impossible go back and change the outcome for that young woman tied to a bed at the Yale Psychiatric Institute and Yale-New Haven Hospital's MU 10. I wanted my words to change the minds of all the doctors who had ever treated me and gotten it wrong. It might have been too late for me. But perhaps it wasn't too late for somebody else.
The research I did showed that restraints hadn't been used in England for more than two centuries; certainly I'd never seen any sign of them when I was there (and I'd been neither a docile nor a particularly cooperative patient). Yet they were used liberally in the United States. Was this truly the best we could do? What were the rules, what were the parameters, what was reasonable (and unreasonable) care when treating patients who were already terrified at that moment when someone in authority forcibly tied them down? In my Note, I proposed a Model Statute (a statute that could serve as a model for legislation in individual states); in addition, I argued for a greater degree of negligence before a doctor could be held liable for not restraining someone—in short, I wished to change the incentives for doctors. My doctors, everyone's doctors.
While I was preparing my Note, I spoke to one mental health professional then on the Yale faculty. "Wouldn't you agree that being restrained is incredibly degrading?" I asked. "Not to mention painful. And frightening." The professor looked at me in a knowing way. "You don't really understand," he said kindly. "These people are different from you and me. It doesn't affect them the way it would affect us." If only he knew, I thought to myself.
My Note, 'The Use of Mechanical Restraints in Psychiatric Hospitals," was published in the Yale Law Journal in 1986. The pride I felt was almost too enormous to be borne. A few months later . . . after graduation, I received a call from a lawyer at the Bazelon Center for Mental Health Law, then and now considered the premier public interest law firm representing people with mental illness. Bazelon, located in Washington, D.C., advocates in both the courts and in Congress on behalf of a constituency that in most cases is unable to advocate for itself. "I read your Note with great interest," she said, and then went on to explain that she'd used the information in it to form and bring a major class action lawsuit challenging the use of restraints in a certain Midwestern hospital. My Note helped someone. My work had made a difference. It helped another attorney and it helped patients who were no different from me. No different at all.
Graduation was (as it is, I suspect, for almost everyone) a time for reflection. For me that meant asking how I had gotten here, what had kept me out of the hospital and in the classroom, and how I could ensure that safety in the uncertain time ahead.
First, I was in consistent talk therapy, with a psychoanalyst who understood me and treated me with respect. With his painstaking interpretations of my behaviors, White helped me open a window onto myself, showing me that my psychosis served to protect me from painful thoughts and feelings. My psychosis actually played a role in my psychological life the unconscious mind serving as a defender of the conscious mind. For some reason, knowing that made everything less toxic, more malleable. I may not have been in complete control of my psychosis, but I wasn't totally at its mercy, either.
In addition (as with Mrs. Jones, but unlike all the medical doctors to date), White did not recoil from me. He never put me in the hospital (under the guise of protecting me while actually protecting himself), but stood his ground when I was most frightening, and vowed to protect me. He knew better than anyone that most of the time, I was literally scared out of my wits.
When it came to the difficult issue of medication, White encouraged but never forced me. For all my intense ambivalence about taking drugs, I nevertheless did take them most of the time—because in White, I had a medical professional who actually listened to me, trusted me, and rewarded my trust in him.
In Steve, I'd finally found a true friend, almost a soul mate, who saw and accepted my illness, yet viewed it as not at all central to who I actually was. That connection to a good person, a smart person, an affectionate, funny, and accepting person—made me feel truly human. And it made me feel hopeful that I'd find other people like Steve, and that they, too, would see past my illness and value the real me.
I'd been in an academic program that offered equal parts structure (which I needed) and unstructured time (which I needed to learn to manage). Everybody, on some level, needs a good day-care program: Mine was the Yale Law School.
So I'd made it through, and managed to construct some survival tools. I'd found a school that helped me flourish, a psychiatrist who made me feel life might well be worth living, and a friend who made me feel human. And while it might be a long time before I'd find a man who made me feel like a woman, what I had on graduation day was not half bad, given all I'd been through. Graduation was a victory and in fact, the administration chose me and another student to be class marshals, the students who go up on stage to receive a diploma on behalf of their graduating class. My entire family was present when I made that walk, and I couldn't help but think how far we'd all come. It was a very good day.
And yet. There was the not-insignificant matter of the law boards, and the job hunt, and having to move out of the dorm, and finding a new place to live. The day after graduation was all about change, and I'd never been good with change.
I decided to stay on in Connecticut for a while; I wasn't yet ready to leave White, and he concurred. And Steve was staying around, too. He was intending to apply to graduate schools in clinical psychology, but needed to get some more experience with clinical work first. So he took a live-in job at the halfway house for the severely mentally ill where as a law student he had worked with the residents.
My law board exam was scheduled for July; the job hunt had to wait until I passed. I was somewhat sleepless in the days leading up to the exam, and just a little nervous anyone would have been, not just me. But I'd done well in the practice exams, and besides, for three years everyone at Yale had reassured us, "Don't worry, the bar review course will teach you everything you'll need"—I had no choice but to trust that they were right. I did receive one additional piece of advice: don't think. So I didn't, and managed to score in the ninety-ninth percentile of those taking the exam that day.
Steve and I had a few more cases at the Legal Services Organization to finish up. One day soon after the bar exam, when the structure of exam preparation and the anticipation of the day itself had passed, I walked into the LSO office and greeted Sally, one of the secretaries there who'd become a friend.
"How's everything?" I asked. "Do you want to vandalize the law school with me? I don't know who's listening to this, but it's a master plot to do with the questions. Points. Points of view. Should I jump out the window?"
"What are you talking about?" Sally asked, half laughing.
"I'm just kidding around," I said. "Kidding has to do with sheep. I'm sheepish. Have you ever killed anyone? I've killed lots of people with my thoughts."
The smile left Sally's face. "Elyn, you're scaring me a little here." "Don't be scared," I said. "I'm just a cat. The fish is delicious. I'll just go do my work now"
"Oh, no, wait," she said. "I think you should stay here for a few minutes . . ."
I sat down, then started singing, then stopped. "Do you mind if I make a hat out of that clothes hanger?" I asked Sally. "And after that, I think I might jump out of the window"
Quickly, Sally and another secretary, Maria (who'd become a friend as well, thankfully), called Steve Wizner, the Legal Services director. Wizner came immediately from wherever he'd been, was briefed by the others for a few moments, and then called me into his office. "So what's going on, Elyn?" he asked. "You seem to be a little upset—everything OK?"
"I'm ever so well, thank you, ever so well," I chirped. "I've been making up songs for the films. There's a bootleg traffic in legal briefs going on. We'll be sued, but my name is not Sue, thank you very much. How did you get to be so tall? Don't fall." I was laughing hysterically, and having trouble not falling off my chair onto the office floor.
Nearly two years before, I'd told Wizner about my illness and my history, and he'd known all along about the treatment I'd been getting. "I'd like to call Dr. White," he said.
"I don't think that's necessary," I said, "but you can if you want."
When he'd reached White, Wizner told him what had been going on, and then handed me the phone. "Up the Navane to twenty milligrams, Elyn," said White's calm voice. "Now, please."
Handing the phone back to Wizner, I reached into my bag, pulled out the bottle, and obediently popped the appropriate number of pills. "All better now!" I cheerfully informed Wizner--and we both started laughing, him with relief, me still delusional but cogent enough to be embarrassed at the scene I'd caused. My actual recovery, however, took a little longer.
In the three years since I'd last been hospitalized, this was only the second time I'd become overtly psychotic with anyone other than White or Steve, and it was part of the pattern: I'd set goals for myself, meet them successfully, then fall apart at the seams. Once again, everything familiar and comfortable in my life was going away or being left behind. What was ahead was new and frightening. The scaffolding had been removed, and I wasn't sure that I could sustain the structure all by myself.
When I become psychotic, a kind of curtain (of civilization, of socialization) falls away, and a secret part of me is revealed. And then, after the psychosis passes, I suffer overwhelming shame: I have been seen. Now they know. But something about this episode was intrinsically different from the ones that had come before. I'd worked with Sally, Maria, and Wizner for three years; I trusted them, and they trusted me—as a friend and also as a professional who'd been judged competent to handle patients and cases in a responsible manner. So, in retrospect, I think it was somehow almost normal that I'd go to that office to fall apart. When you're scared, on the verge of a meltdown, you instinctively know to head someplace where you'll be safe; when you reveal something so intimate as psychosis, you want the witnesses to be people you trust.
In the days to come, I was oddly reassured to realize that my instinct for survival seemed to have gotten better over the years instead of having the episode in the street, or the grocery store, or in line at the bank, I'd somehow managed to stave it off until I could get to a safe place. Although my colleagues there were not necessarily prepared for what happened, the relationship we'd all formed gave them the tools to manage it, and manage me as well. They were calm, they did the right thing, and the moment passed.
My first "real" job interview was with New Haven Legal Assistance, probably the best such job in Connecticut. I was nervous, but no more medicated than usual. My record was good; I thought I had a decent shot at it. Afterward, the office's lawyers called Steve Wizner to say that notwithstanding my strong record and my seeming to be a nice person, they couldn't offer me the job. Basically, I'd flunked the interview I was, they said, "practically comatose."
At my next appointment (with Connecticut Legal Services CLS in Bridgeport), I was advised by the staff attorney who first interviewed me to "act perkier" when I met with the executive director. Now, "perky" had never been in my playbook—and I'd never seen it listed anywhere as a job requirement. Maybe I just needed an extra cup of coffee. Whatever the case, I managed to make a credible impression and was offered and accepted the position at CLS.
The office was in an old, run-down house in what had been a nice part of Bridgeport years earlier but was now in the heart of the slums. I began representing clients immediately, half-time on family law cases, half-time on housing cases. At a typical legal services office (and Bridgeport was that), there's little time to reflect, to learn, to think or strategize. Resources and staff are minimal, and the clients themselves are usually in such dire straits by the time they make contact with the office, there's often very little the lawyers can do for them. My first day on the job, I was asked to go alone to Father Panik Village, at the time the sixth-largest public housing project in the country, and notoriously one of its worst, with forty-six brick buildings on forty acres, and a population of nearly five thousand people, low-income families who grew more embattled every day: with guns, drugs, domestic abuse, and overall mayhem and chaos.
Panik was the name of the priest who'd originally championed this Bridgeport Housing Authority project during the Depression; nevetheless, the word's connotations were apt. I said I would go there only if someone else accompanied me, which was quickly arranged. I was also assigned a case that first day that was scheduled to go to trial in just a week. No preparation had been done. No one had actually seen the client. The case settled.
I quickly realized I'd been spoiled at LSO. We handpicked our cases there, and chose only the most interesting ones, or those that might elucidate some point of law. We worked with experts in the various fields (who were happy to return our phone calls when we identified ourselves as Yale students), we had ample time for research and strategizing, and we had staff support. We had time to work, and time to think; in fact, thinking was actually prized.
At CLS, I spent most of my time negotiating with slick lawyers who represented sleazy slumlords or wife-batterers. I had no time to make or return phone calls; I had no time to research or think about the law, and it was the thinking part that was so integral to my love for the law Though I liked and even admired many of the people I represented (when I could find the time to really talk with them), I found the work itself unrelentingly grueling, and was soon overwhelmed. I wasn't Perry Mason, I certainly wasn't Joan of Arc, and at the end of each day, I was barely sentient. I worried that I wasn't helping my clients as I should. Frantically, I began to look for some other place, any other place, that would have me. I felt somewhat guilty about wanting to go, but not guilty enough to stay.
In 1993, the last of the Father Panik Village residents were relocated. A year later, the buildings were demolished, a fitting end to the overly optimistic idea of high-rise, high-density communities as the solution for low-income housing now recognized by contemporary city planners as an unworkable (and often inhumane) nightmare. On the site now, there's a sprinkling of new, single-family homes and duplexes, with recently planted yards and young sapling trees. The word is, Bridgeport's on its way back. I sometimes wonder if any of my clients made it back as well.
I did continue pro Bono with one mental health law case: that of Jefferson. Once Steve and I got him into a group home, we turned to the task of getting him education. Trouble was, he was already twenty-one, and the relevant laws only provided for special education for kids under twenty-one. So we tried a novel theory: Since Jefferson had received no education at all when he was at the mental hospital for five years, he was owed "compensatory education" for that time. That theory is now well accepted in special education law, but it was new when we brought it. And we prevailed, through a complicated and circuitous route. Jefferson received five more years of education, at the premier special ed facility in the state.
During the time I worked in Bridgeport, scheduling analysis appointments with White became difficult. We tried to work around both my schedule and his, but it was often hard to meet all four days. And then one day, the question of my diagnosis came up.
We'd discovered that the medical insurance from my CLS job would pay for some of my analysis. In order for that to happen, however, White had to fill out a form that specified a diagnosis. I'd hoped he might write something innocuous neurotic anxiety disorder, maybe—so that I could avoid having an official record of serious mental illness. There would be other jobs in my future, I hoped, and I wanted access to them without being hobbled. But White made it perfectly clear to me that it was his intention to complete the form with integrity, and tell the truth. And I quickly understood there'd be no negotiating with him on this point.
When we first began our work together, White had discussed my diagnosis. He thought then that I suffered primarily from depression, not schizophrenia, which was a huge relief to me. "But let's put aside the labels for now," he'd said. "They're a distraction, and we have more important work to do."
Of course, I'd remained intensely interested in his ultimate diagnosis—depression, even psychotic depression, was still prmarily a disorder of feelings, and that much I could accept. Schizophrenia (or some variant) was a "thought disorder"—a disorder that was psychotic at its core—and that was another matter entirely.
Within a day or two, White returned the form to me. I could feel my pulse pounding in my ears when I saw it in his hand, stretched out to me. I took it from him, and read the words: "schizoaffective disorder, depressive type." A psychotic illness. An illness only once removed from schizophrenia. Seeing those words—coming from someone I knew, someone whose clinical judgment I couldn't dispute felt like death. And so, as if to fully inhabit the diagnosis, I quickly started to unravel.
That night, while Steve and I were taking a walk, I told him that I'd seen White's diagnosis and it had startled me. "Mild mental retardation in the presence of overachievement, as manifested by successfully completing Yale Law School," I said quietly, sneaking a look at him out of the corner of my eye, waiting for the reaction.
Steve flushed and began to stammer, knowing how important White's opinion was to me. "Elyn, I realize White is really smart, but isn't it possible he's wrong about this? I just don't think you're mentally retarded." He looked up to see me smiling.
"Gotcha!" I said, and laughed. I could tell from the look on his face that he couldn't decide whether to laugh with me, or turn and walk in the other direction.
Despite my laughter, there wasn't much funny in this situation; any diagnosis starting off with "schizo" damned me, and I knew it. Why does White think that about me? Am I really that sick? Is everything I've done, all the progress I've made, a joke? Do I really belong in a mental hospital after all? As if to mock me, the universe dropped me into the dark hole again, and the delusions came back for a visit.
At White's urging, I again increased the Navane; within days, I was on an even keel. But still his diagnosis haunted me. I was so certain that I'd made real progress; I believed I'd moved past that first diagnosis in the hospital. But now the weight of White's verdict was palpable, even ominous, my own private Sisyphus's rock I rolled it up the hill, it rolled back down, I rolled it up, it rolled back down. It had all the potential to crush me entirely.
I continued to spend a great deal of time with Steve, who had come to love his work and shared it with me; I found our time together soothing. Steve found the work he was doing at the halfway house enormously rewarding, and compared living there with living in the monastery. I often went over to the house for dinner, or just to sit around the kitchen table and talk to the people who were in residence. One day, I came in the door to find that the newest tenant was a patient I'd known on the ward at YPI. There were a few minutes of awkwardness between us until we realized that the coffee and the conversation meant exactly the same thing to both of us, and for the same reasons.
Spending time at the halfway house reminded me that being ill had its advantages. Staff in ERs and hospitals pay close attention to very ill patients, and people at the halfway house almost always had someone to talk to. But "getting well" means giving up that kind of attention, or finding other, better ways of getting it. It was the familiar lesson: Leaving home is great, but few people make the journey without looking back, at least a few times in the beginning.
That summer I learned of a two-year position at a local law school (now Quinnipiac University School of Law) teaching legal research and writing. The position held no prospect for tenure, but it made my escape from legal services possible; lawyering had never come easily to me and in Father Panik Village I had found myself completely overwhelmed. Plus, with this job, I could stay in New Haven, and continue my analysis with White. And so I applied for it.
In my interview (a vast improvement over the ones I'd bumbled through at the two legal services offices), the very nice dean, as subtly as possible, warned me that this teaching job might be well beneath my talents. I didn't care. I needed to work and I wanted to work; besides, he didn't have all the information about me. And I wasn't going to give it to him, either. When I received the offer, I accepted it on that very day.
"I have to tell you something." This was Steve, in his gentlest voice. I braced myself, half-knowing already what was coming. "I'm leaving New Haven, and moving to Washington." He'd become involved with a woman a woman I liked a lot, someone gentle and kind, who made him smile. She'd completed her degree at Yale and had been accepted into a doctoral program at the University of Virginia in Charlottesville. Steve wanted to be near her, I understood that, I supported it; in fact, I'd known for a long time that it was only a matter of time before there would be actual miles between us instead of only minutes.
Nevertheless, it hurt, deeply. He was my colleague, my confidant, my best friend, and in a complex way, my best witness to my illness, my darkness, and my struggle to stay in the world and become a contributing member of a professional community. He critiqued my papers, he helped keep my fragmented mind together, he charted my progress (and reminded me I'd made some)—he even finished some of my sentences. And I often finished his as well. There was nothing he didn't know about me. There was nothing we didn't talk about, nothing I didn't want his counsel on, no matter if it was personal, professional, or academic. And now he was leaving me? No surprise that my first response to his news was "No!"
"Yes," he said. "It's time."
"I don't think I can manage without you near," I said. My voice was shaking.
"Yes, you can," he said. "Elyn, your whole life has been the story of you fighting to get whatever you need, and getting it. You're the quintessential survivor you've found friends, therapists, professors who believe in you. And now you're about to begin your professional life. I didn't do that for you; you did it!"
"But I had your help," I said.
"And you always will have it," he said. "This isn't the end of the friendship—nothing could make that happen. Come on, admit it, you'll be going someplace else someday soon as well. You have important work to do, and where I'm living when that happens won't make any difference."
We had brunch together on the day he left. I barely got my omelette down, one slow bite at a time, and the coffee tasted like it'd been made the week before. Afterward, Steve climbed into his car, a Ford Pinto he'd bought for $500, and drove away, headed for 1-95 South. I stood there watching for a few minutes, thinking back to that long-ago day when Kenny and Margie Collins had driven away from Vanderbilt, and away from me. My heart broke that day; and it was breaking now, but I'd survive as sad as I was, I knew that. So I got into my own car and drove (crying all the way) back to the law school for a meeting. I parked the car and pulled myself together. Steve was right; I had things to do. It was time to go to work.