THE CENTER CANNOT HOLD

ELYN R. SAKS

Contents

Prologue

ITS TEN O'CLOCK on a Friday night. I am sitting...

Chapter One

WHEN I WAS a little girl, I woke up almost...

Chapter Two

DURING THE SUMMER between my sophomore and

junior years in...

Chapter Three

IN SPITE OF the fact that Nashville's Vanderbilt

University was...

Chapter Four

AFTER GRADUATING FROM Vanderbilt University in

June of 1977, I...

Chapter Five

SET AMONG THE green and gently rolling hills of

Oxfordshire...

Chapter Six

ALL THROUGHOUT THOSE first long hours of my

second stay

Chapter Seven

I STUMBLED INTO Elizabeth Jones's office in a

desperate lunge...

Chapter Eight

FOUR YEARS AFTER coming to Oxford, I finally

completed my...

Chapter Nine

AS ALWAYS, MY family greeted me at the airport in...

Chapter Ten

I FULLY EXPECTED THAT someone from Student

Health would...

Chapter Eleven

ONCE WE'D ARRIVED at YPI, the EMTs took me by...

Chapter Twelve

FOR A PLACE that existed ostensibly to promote the

mental...

Chapter Thirteen

THE FIRST PATIENT I met once back at YPI was...

Chapter Fourteen

I RETURNED TO New Haven a few weeks before

classes...

Chapter Fifteen

DURING SECOND SEMESTER, we were free to choose

whatever classes...

Chapter Sixteen

AS THE END of law school drew near, I knew...

Chapter Seventeen

TAKING THE TEACHING job, even though it was not

at...

Chapter Eighteen

IN SEPTEMBER, I went back to my second year of...

Chapter Nineteen

I WAS BEGINNING to feel somewhat comfortable with

a few...

Chapter Twenty

KAPLAN WAS ASKING me to surrender. That's the

way I...

Chapter Twenty-One

THINGS WITH KAPLAN were not going well. No

matter what...

Chapter Twenty-Two

ONCE, BACK IN New Haven, White had told me that...

Chapter Twenty-Three

I WAS NEARLY forty years old, and for the very...

Chapter Twenty-Four

THE HUMAN BRAIN comprises about 2 percent of a

person's...

Acknowledgments

About the Author

Copyright

prologue

It's TEN O'CLOCK on a Friday night. I am sitting with my two

classmates in the Yale Law School Library. They aren't too happy

about being here; it's the weekend, after all—there are plenty of other

fun things they could be doing. But I am determined that we hold our

small-group meeting. We have a memo assignment; we have to do it,

have to finish it, have to produce it, have to...Wait a minute. No, wait.

"Memos are visitations," I announce. "They make certain points. The

point is on your head. Have you ever killed anyone?"

My study partners look at me as if they—or I—have been splashed

with ice water. "This is a joke, right?" asks one. "What are you talking

about, Elyn?" asks the other.

"Oh, the usual. Heaven, and hell. Who's what, what's who. Hey!"

I say, leaping out of my chair. "Let's go out on the roof!"

I practically sprint to the nearest large window, climb through it,

and step out onto the roof, followed a few moments later by my

reluctant partners in crime. "This is the real me!" I announce, my arms

waving above my head. "Come to the Florida lemon tree! Come to the

Florida sunshine bush! Where they make lemons. Where there are

demons. Hey, what's the matter with you guys?"

"You're frightening me," one blurts out. A few uncertain moments

later, "I'm going back inside," says the other. They look scared. Have

they seen a ghost or something? And hey, wait a minute—they're

scrambling back through the window.

"Why are you going back in?" I ask. But they're already inside, and

I'm alone. A few minutes later, somewhat reluctantly, I climb back

through the window, too.

Once we're all seated around the table again, I carefully stack my

textbooks into a small tower, then rearrange my note pages. Then I

rearrange them again. I can see the problem, but I can't see its

solution. This is very worrisome. "I don't know if you're having the

same experience of words jumping around the pages as I am," I say. "I

think someone's infiltrated my copies of the cases. We've got to case

the joint. I don't believe in joints. But they do hold your body

together." I glance up from my papers to see my two colleagues staring

at me. "I...I have to go," says one. "Me, too," says the other. They seem

nervous as they hurriedly pack up their stuff and leave, with a vague

promise about catching up with me later and working on the memo

then.

I hide in the stacks until well after midnight, sitting on the floor

muttering to myself. It grows quiet. The lights are being turned off.

Frightened of being locked in, I finally scurry out, ducking through the

shadowy library so as not to be seen by any security people. It's dark

outside. I don't like the way it feels to walk back to my dorm. And once

there, I can't sleep anyway. My head is too full of noise. Too full of

lemons, and law memos, and mass murders that I will be responsible

for. I have to work. I cannot work. I cannot think.

The next day, I am in a panic, and hurry to Professor M., pleading

for an extension. "The memo materials have been infiltrated," I tell

him. "They're jumping around. I used to be good at the broad jump,

because I'm tall. I fall. People put things in and then say it's my fault. I

used to be God, but I got demoted." I begin to sing my little Florida

juice jingle, twirling around his office, my arms thrust out like bird

wings.

Professor M. looks up at me. I can't decipher what that look on his

face means. Is he scared of me, too? Can he be trusted? "I'm

concerned about you, Elyn," he says. Is he really? "I have a little work

to do here, then perhaps you could come and have dinner with me and

my family. Could you do that?"

"Of course!" I say. "I'll just be out here on the roof until you're

ready to go!" He watches as I once again clamber out onto a roof. It

seems the right place to be. I find several feet of loose telephone wire

out there and fashion myself a lovely belt. Then I discover a nice long

nail, six inches or so, and slide it into my pocket. You never know

when you might need protection.

Of course, dinner at Professor M.'s does not go well. The details

are too tedious; suffice it to say that three hours later, I am in the

emergency room of the Yale-New Haven Hospital, surrendering my

wire belt to a very nice attendant, who claims to admire it. But no, I

will not give up my special nail. I put my hand in my pocket, closing

my fingers around the nail. "People are trying to kill me," I explain to

him. "They've killed me many times today already. Be careful, it might

spread to you." He just nods.

When The Doctor comes in, he brings backup—another attendant,

this one not so nice, with no interest in cajoling me or allowing me to

keep my nail. And once he's pried it from my fingers, I'm done for.

Seconds later, The Doctor and his whole team of ER goons swoop

down, grab me, lift me high out of the chair, and slam me down on a

nearby bed with such force I see stars. Then they bind both my legs

and both my arms to the metal bed with thick leather straps.

A sound comes out of me that I've never heard before—half-groan,

half-scream, marginally human, and all terror. Then the sound comes

out of me again, forced from somewhere deep inside my belly and

scraping my throat raw. Moments later, I'm choking and gagging on

some kind of bitter liquid that I try to lock my teeth against but

cannot. They make me swallow it. They make me.

I've sweated through my share of nightmares, and this is not the

first hospital I've been in. But this is the worst ever. Strapped down,

unable to move, and doped up, I can feel myself slipping away. I am

finally powerless. Oh, look there, on the other side of the door, looking

at me through the window—who is that? Is that person real? I am like

a bug, impaled on a pin, wriggling helplessly while someone

contemplates tearing my head off.

Someone watching me. Something watching me. It's been waiting

for this moment for so many years, taunting me, sending me previews

of what will happen. Always before, I've been able to fight back, to

push it until it recedes—not totally, but mostly, until it resembles

nothing more than a malicious little speck off to the corner of my eye,

camped near the edge of my peripheral vision.

But now, with my arms and legs pinioned to a metal bed, my

consciousness collapsing into a puddle, and no one paying attention to

the alarms I've been trying to raise, there is finally nothing further to

be done. Nothing I can do. There will be raging fires, and hundreds,

maybe thousands of people lying dead in the streets. And it will

all—all of it—be my fault.

chapter one

When I WAS a little girl, I woke up almost every morning to a

sunny day, a wide clear sky, and the blue green waves of the Atlantic

Ocean nearby. This was Miami in the fifties and the early

sixties—before Disney World, before the restored Deco fabulousness

of South Beach, back when the Cuban "invasion" was still a few

hundred frightened people in makeshift boats, not a seismic cultural

shift. Mostly, Miami was where chilled New Yorkers fled in the winter,

where my East Coast parents had come (separately) after World War

II, and where they met on my mother's first day of college at the

University of Florida in Gainesville.

Every family has its myths, the talisman stories that weave us one

to the other, husband to wife, parents to child, siblings to one another.

Ethnicities, favorite foods, the scrapbooks or the wooden trunk in the

attic, or that time that Grandmother said that thing, or when Uncle

Fred went off to war and came back with...For us, my brothers and me,

the first story we were told was that my parents fell in love at first

sight.

My dad was tall and smart and worked to keep a trim physique. My

mother was tall, too, and also smart and pretty, with dark curly hair

and an outgoing personality. Soon after they met, my father went off

to law school, where he excelled. Their subsequent marriage produced

three children: me, my brother Warren a year-and-a-half later, then

Kevin three-and-a-half years after that.

We lived in suburban North Miami, in a low-slung house with a

fence around it and a yard with a kumquat tree, a mango tree, and red

hibiscus. And a whole series of dogs. The first one kept burying our

shoes; the second one harassed the neighbors. Finally, with the third,

a fat little dachshund named Rudy, we had a keeper; he was still with

my parents when I went off to college.

When my brothers and I were growing up, my parents had a

weekend policy: Saturday belonged to them (for time spent together,

or a night out with their friends, dancing and dining at a local

nightclub); Sundays belonged to the kids. We'd often start that day all

piled up in their big bed together, snuggling and tickling and laughing.

Later in the day, perhaps we'd go to Greynolds Park or the Everglades,

or the Miami Zoo, or roller skating. We went to the beach a lot, too;

my dad loved sports and taught us all how to play the activity du jour.

When I was twelve, we moved to a bigger house, this one with a

swimming pool, and we all played together there, too. Sometimes

we'd take the power boat out and water-ski, then have lunch on a

small island not far from shore.

We mostly watched television in a bunch as well—The Flintstones,

The Jetsons, Leave It to Beaver, Rawhide, all the other cowboy shows.

Ed Sullivan and Disney on Sunday nights. When the Perry Mason

reruns began, I saw them every day after school, amazed that Perry

not only defended people but also managed to solve all the crimes. We

watched Saturday Night Live together, gathered in the living room,

eating Oreos and potato chips until my parents blew the health whistle

and switched us to fruit and yogurt and salads.

There was always a lot of music around the house. My dad in

particular was a jazz fan, explaining to us that when he was young,

claiming a fondness for jazz had been considered fairly rebellious. My

record collection overlapped with Warren's—The Beatles, Crosby,

Stills & Nash, Janis Joplin. We drew the line at the Monkees (I liked

them, he absolutely didn't), and he teased me mercilessly about the

poster of Peter Noone from Herman's Hermits up on my bedroom

wall.

And there were movies, which my parents attempted to supervise

by appropriateness: Mary Poppins and The Sound of Music were OK

for me, but one James Bond movie (I don't remember which one now,

except it was Sean Connery) caused a battle royal with my dad: I

wasn't yet seventeen, and Bond, with his martinis and his bikini-clad

girlfriends, was out of bounds.

For a while in high school, I worked at a candy counter at a local

movie house—"Would you also like a Coke with that?"—which meant I

saw every movie I wanted to see, and many of them more than once; I

think I saw Billy Jack more than a couple dozen times. It didn't take

long, though, to decide that I didn't like movies that were scary or

tension-filled—horror movies were out, and Clint Eastwood's Play

Misty for Me, with its crazy woman stalker, freaked me out for weeks.

When the theater manager was robbed after closing one night, my

parents made me quit the job.

I confess to an energetic sibling rivalry with Warren. As the oldest,

I did my best to stay ahead of him, working to excel at things a

younger brother couldn't yet do. I learned to ride my bike first. Once

he was riding one, too, I simply rode mine faster and farther. I

water-skied first, and then more furiously than he did. I got good

grades and made sure he knew it; he worked just as hard and made

the grades, too. Dad was not a praiser (he thought it would invite the

evil eye), so he never complimented anyone. But Mom did, and

Warren and I competed for her attention.

As for Kevin, there were enough years between us that for a long

time I thought of him as my child. One of my earliest, clearest

memories is when he began to crawl, and how thrilled I was about

that, to see him learn to make his way from one place to the other. Not

only was he younger than Warren and I, he was intrinsically more

sociable, too—easier to get along with and more interested in just

hanging around with us rather than competing with us.

As somewhat observant Jews, we went to Temple and observed the

High Holy Days. We kids were sent to Hebrew school, and we also

made our Bat and Bar Mitzvahs. Although it was never spoken in so

many words, I was somehow given to understand that in many places

and circumstances, Jewish people were not very popular, and one

needed to be both discreet and respectable in order to make one's way

in life. We didn't keep kosher (although my father's parents did);

another part of the mom-and-dad myth was that in order to impress

her future in-laws with how observant she was, my mother—whose

family had never kept kosher and didn't really know the rules—had

misguidedly ordered lobster on the evening my father introduced his

parents to her.

On the face of it, then, our family life was congenial—a Norman

Rockwell magazine cover or a gentle fifties sitcom. Indeed, my mother

was what today would be called a stay-at-home mom. She was there

when we came home from school and always made sure we had a

snack—to this day, cold cereal is my comfort food of choice. Our

family ate its meals together, and although my mother didn't cook

much (a housekeeper did, and in time, my father took it up, and

excelled at it), there was always cake in the pantry (albeit

store-bought), fresh fruit in the fridge, and clean laundry in our

closets.

Under that pleasant surface, however, things were more complex,

as family matters inevitably are. Like all parents, mine had their

strengths and their weaknesses. They were profoundly close to each

other; in fact, they've always enjoyed being with each other more than

they like being with anyone else, including, sometimes, their children.

In the style of many 1950s couples, they seemed not to exist in any way

independent of each other. My mother was always very physically

affectionate with my dad in public; he was less so with her, but never

dismissive or rude. It was just always clear that he was the boss. For

my mother, it was always "Anything you want, dear," just as it had

been for her mother. If she'd had any particular professional ambition

when she went off to college, I've never known what it was, although

she was a central part of a successful antiques business she and my

father started together. Still, nothing's changed much in their dynamic

in the intervening years. Recently, my mother announced that she'd

given up her own political opinions in order to share my father's.

For his part, in spite of a sense of humor that often verged on the

bawdy, my father could be quite absolute in his opinions and

reactions. There was also a touch of suspiciousness in his interactions

with others, particularly when the subject at hand was money. In this,

he was just as his own father had been.

My parents were both outspoken in their disgust for religious or

racial bigotry. For example, we could swear all we wanted, but the use

of racial or ethnic slurs was utterly and always forbidden. As

provincial as Miami seemed back in those days (my father often said

that it had all the disadvantages of a big city and none of the

advantages), the tension between the city's African-Americans and

Cuban immigrants, and the riots in 1970 (during which our

African-American housekeeper was harassed by the police), taught us

that even a familiar landscape could turn violent and unpredictable in

the fog of prejudice.

Whatever their faults (or ours), there was no shortage of "I love

you's" from my parents when I was a child, nor is there one now; to

this day, they're openly affectionate with all of us, and even my friends

are greeted with a hug and a kiss. My parents were never cruel or

punitive, and never physical in the ways they disciplined us; they

simply made it known from our earliest days that they had high

expectations for our behavior, and when we missed the bar, they

brought us up short.

Nor did we ever want for anything material. My family was solidly

in the middle class, and as time went on, our means increased. My

father's law practice dealt primarily with real estate, land deals, and

some personal/estate planning, all of which expanded as Miami itself

did. When I was thirteen, my parents opened a small antiques and

collectibles shop a five-minute trip from our house. It, too, thrived,

and they began to collect and sell items from Europe, which in time

meant two or three trips to France each year and a lot of time spent in

New York City as well.

So there were never any concerns about having a nice place to live,

or good food to eat, or missing our yearly family vacation. It was

expected that we would attend college; it was a given that our parents

would pay for it. They were loving, hardworking, comfortably

ambitious (for themselves and for their children), and more often than

not, kind. To borrow a phrase from the psychological literature, they

were "good enough"—and they raised three decent children, no easy

feat in that or any age. My brothers grew up into fine men; Warren is a

trader on Wall Street, and Kevin is a civil engineer in Miami. Both are

accomplished in their professions, with wives and children they love

and who love them in return. And my own penchant for hard work

and my drive to succeed is traceable directly, I know, to my parents.

In short, they gave me and taught me what I needed to make the

most of my talents and strengths. And (although I couldn't have

predicted or understood back then how vitally important this would

be to my life) they gave me what I needed to survive.

When I was about eight, I suddenly needed to do things a little

differently than my parents would have washed me to do them. I

developed, for loss of a better word, a few little quirks. For instance,

sometimes I couldn't leave my room unless my shoes were all lined up

in my closet. Or beside my bed. Some nights, I couldn't shut off my

bedroom light until the books on my shelves were organized just so.

Sometimes, when washing my hands, I had to wash them a second

time, then a third time. None of this got in the way of whatever it was I

was supposed to be doing—I made it to school, I made it to meals, I

went out to play. But it all required a certain preparation, a

certain...precaution. Because it was imperative that I do it. It simply

was. And it taxed the patience of anybody who was standing outside

the bedroom door or the bathroom door waiting for me. "Elyn, come

on, we're going to be late!" Or "You're going to miss the bus!" Or "You

were sent to bed forty minutes ago!"

"I know, I know," I replied, "but I just have to do this one more

thing and then everything will all be OK."

Not long after the little quirks became part of my life, they were

joined by nights filled with terror, which came in spite of all the

precautionary organizing and straightening. Not every night, but often

enough to make bedtime something I didn't welcome. The lights

would go out and suddenly it was darker in my room then I could

bear. It didn't matter (if I could just ignore the sound of my heart

thudding) that I could hear my parents' voices down the hallway; it

didn't help to remember that my dad was big and strong and brave

and fearless. I knew there was someone just outside the window, just

waiting for the right moment, when we were all sleeping, with no one

left on guard. Will the man break in? What will he do? Will he kill us

all?

After the first three or four nights of this, I finally drummed up

whatever courage I had left and told my mother about it. "I think

somebody has been outside my window," I said in a very small and

shaky voice. "In the yard. Waiting for you and Daddy to go to sleep at

night, so he can come in and get us. Or hurt us. You have to find

somebody to make him go away. Do you think we should call a

policeman?"

The expression on her face was so kind that it made it hard for me

to look directly into her eyes. "Oh, buby"—her term of endearment for

me—"there's nobody out there, there's nobody in the bushes. There's

nobody who would hurt us. It's in your imagination. Hmmmm, maybe

we shouldn't have so many stories before bed. Or maybe we're eating

dinner too late, and it's your tummy playing tricks on your brain.

Don't be silly now." As far as she was concerned, that was the end of it.

I tried to believe her, I really did. And I fessed up to my fear to my

brother Warren when the two of us were at home alone, and we tried

our best to reassure each other—together, we'd muster up our courage

to go see if someone was indeed standing just outside the front door.

And of course, no one ever was. But my feelings didn't go away, and

for a long time, falling asleep felt like sliding into a place of

helplessness. I fought it every night, my head under the blankets, until

finally, sheer exhaustion and a tired growing body just took me under.

I am seven, or eight, standing in the cluttered living room of our

comfortable house, looking out at the sunny day.

"Dad, can we go out to the cabana for a swim?"

He snaps at me, "I told you I have work to do, Elyn, and anyway it

might rain. How many times do I have to tell you the same thing?

Don't you ever listen?"

My heart sinks at the tone of his voice: I've disappointed him.

And then something odd happens. My awareness (of myself, of

him, of the room, of the physical reality around and beyond us)

instantly grows fuzzy. Or wobbly. I think I am dissolving. I feel—my

mind feels—like a sand castle with all the sand sliding away in the

receding surf. What's happening to me? This is scary, please let it be

over! I think maybe if I stand very still and quiet, it will stop.

This experience is much harder, and weirder, to describe than

extreme fear or terror. Most people know what it is like to be seriously

afraid. If they haven't felt it themselves, they've at least seen a movie,

or read a book, or talked to a frightened friend—they can at least

imagine it. But explaining what I've come to call "disorganization" is a

different challenge altogether. Consciousness gradually loses its

coherence. One's center gives way. The center cannot hold. The "me"

becomes a haze, and the solid center from which one experiences

reality breaks up like a bad radio signal. There is no longer a sturdy

vantage point from which to look out, take things in, assess what's

happening. No core holds things together, providing the lens through

which to see the world, to make judgments and comprehend risk.

Random moments of time follow one another. Sights, sounds,

thoughts, and feelings don't go together. No organizing principle takes

successive moments in time and puts them together in a coherent way

from which sense can be made. And it's all taking place in slow

motion.

Of course, my dad didn't notice what had happened, since it was

all happening inside me. And as frightened as I was at that moment, I

intuitively knew this was something I needed to hide from him, and

from anyone else as well. That intuition—that there was a secret I had

to keep—as well as the other masking skills that I learned to use to

manage my disease, came to be central components of my experience

of schizophrenia.

One early evening, when I was about ten, everyone else was out of the

house for a while, and for some reason I can't recall now, I was there

all alone, waiting for them to come home. One minute it was sunset;

the next, it was dark outside. Where was everybody? They said they'd

be back by now...Suddenly, I was absolutely sure I heard someone

breaking in. Actually, it wasn't so much a sound as a certainty, some

kind of awareness. A threat.

It's that man, I said to myself. He knows there's no grown-ups

here, he knows I'm here alone. What should I do? I'll hide in this

closet. Must be quiet. Breathe softly, breathe softly.

I waited in the closet, gripped with fear and surrounded by the

dark, until my parents came home. It was probably an hour, but it felt

like it went on forever.

"Mom!" I gasped, opening the closet door and making them both

jump. "Dad! There's someone inside the house! Did you see him? Are

you both OK? Why...why were you gone so long?"

They just looked at each other, and then my father shook his head.

"There's no one here, Elyn," he said. "Nobody's come into the house.

It's your imagination."

But I insisted. "No, no, I heard him. There was someone. Go look,

please." Sighing, my father walked through the house. "There's

nobody there." It wasn't reassuring so much as it was dismissive. My

feelings about imminent danger never stopped, but talking about it to

my parents did.

Most children have these same fears, in an empty house or empty

room, or even in a familiar bedroom that suddenly looks strange once

the lights go out. Most grow out and away from their fears, or manage

somehow to put their rational minds between themselves and the

bogeyman. But I never could do that. And so, in spite of the spirited

competitions I had with my brothers, or my good grades, or the

powerful way I felt when I was on water skis or on a bike, I began to

shrink a little inside, even as I was growing taller. I was certain people

could see how scared I felt, how shy and inadequate. I was certain

they were talking about me whenever I came into a room, or after I'd

walked out of one.

When I was twelve years old, and painfully self-conscious about

the weight that puberty was adding to my frame (and the height that

had suddenly come along with it, as I headed toward six feet tall), I

purposefully went on a crash diet. By then, my parents had given up

bread entirely; they spoke constantly about the need to count calories,

the need to maintain an attractive, healthy, and lean body. Being

overweight was considered a bad thing—it was unattractive; it

indicated that someone was either greedy or lacked self-control. In

any case, they monitored very closely every single thing each of us ate.

This was long before it became trendy or matter-of-fact to be as

conscious of what we put in our mouths (and where it came from, and

what the protein count was, and the carbohydrate count, or where the

item fell on the insulin scale) as people are today. And it was also long

before much was known about eating disorders; anorexia and bulimia

weren't on anybody's radar at the time, and certainly no one we knew

went to a doctor or mental health professional for weight gains or

losses—or anything else, for that matter. All I knew was I'd gotten fat

and I had to get skinny again. And so I set about doing exactly that.

I cut my portions in half. I pushed food around my plate so that it

looked like I was eating it. I said no to the potatoes and skipped

Sunday breakfast. At school, I skipped lunch. I cut my meat into small

pieces, then cut those pieces into even smaller pieces. I eliminated

snacks and never ate dessert. The weight started to melt away, and for

a while, nobody noticed. By the time someone did, I was five-ten and

weighed barely one hundred pounds.

At the dinner table one night, my father cleared his throat in what I

knew was an introduction to a serious parental discussion. "Boys, you

may be excused to do your homework now," he said, and I glanced at

Warren with alarm. What was this going to be about? "Your mother

and I need to speak with your sister about a private matter." The boys

left, but not without giving me that ha-ha-ha-you're-in-for-it-now look

that brothers are so good at. I folded my hands in my lap and braced

for whatever was coming.

"Elyn," began my mother, "your dad and I are a little concerned

with-"

My father cut her off. "You're not eating enough," he said. "You're

too thin. You have to start eating more."

"I'm fine," I protested. "I eat what you guys eat. I eat what

everybody eats. It's just that I'm growing."

"No, you're not," said my father. "You're getting taller, but you're

not growing. Your skin is pasty, you can barely stay awake at the table,

you don't eat enough to keep a mouse alive. You look like a war

refugee. Unless you're ill—and I'll be happy to send you to a doctor to

find out—I must insist that you eat three meals a day. Because if you're

not ill, you most certainly will be if this keeps up."

I protested; I argued. I defended my eating habits. "I know what

I'm doing, and I feel perfectly fine," I said.

"Your attitude is very disappointing," said my mother. "This

defiance, not to mention what's happening to the way you look. You've

lost control. This is not what we want for you; in fact, maybe that's

why you're doing this. Is it?"

Various versions of this conversation kept popping up again in the

days and weeks that followed. They watched every bite that went into

my mouth. They counted every bite that didn't. They woke me up

earlier in the morning, made me breakfast, then sat down at the table

and watched me attempt to eat it. On weekends, they took me out to

lunch, then took me out to dinner. In the face of my stubbornness,

they threatened to shorten my curfew and to reduce my movie quota.

They would, they said, have to "take certain steps!" They pleaded; they

offered bribes. I felt myself wilting under the intense pressure of their

combined watchfulness and the constant lectures.

Finally, I'd had enough. "You guys are driving me crazy!" I

protested. "I'm not sick, I'm not going to die, I'm perfectly fine. I know

what I'm doing. After all, I lost this weight on my own, I can put it

back on if I want to."

My father got a very calculating look on his face. "OK, prove it," he

said. "If you think you're so all-powerful, prove it. Put the weight back

on."

I was enraged. My father had finally (and deftly) maneuvered me

into exactly the position he'd been trying to get me into for weeks:

He'd called my bluff. And I had no choice but to comply with what

he'd demanded; otherwise, he could say I was out of control, and then

he'd be justified in doing whatever (he'd never said precisely what) he

felt appropriate.

So I just made up my mind to eat. Which wasn't so horrible,

because I'd always liked food anyway, all food, all the time—I just

hadn't wanted to be fat. In three months, I was back to my normal

weight. "See?" I crowed. "I told you I knew what I was doing! I said I

could do it, and I did!" It felt like a great triumph—I'd driven myself

hard in one direction, and then, once challenged, I drove myself hard

in completely the opposite direction. And the whole time, I was in

complete control—or so I thought.

I think of that young girl sometimes, that girl I was. Not yet a

teenager, she may well have had admirable willpower; she might have

been stubborn, or ferocious, or strong, or fearless—or maybe she was

just plain ornery. But one thing she did not have was complete control

of what was going on inside her. And she was going to have to learn

that the hard way.

chapter two

DURING THE SUMMER between my sophomore and junior years in

high school, I went, along with some other classmates, to Monterrey,

Mexico, for an intensive summer-term session in Spanish language

and culture at the impressively named Instituto Tecnologi-co de

EstudiosSuperiores de Monterrey—or as we all quickly came to call it,

Monterrey Tec. Although I'd often traveled with my parents, and had

been to summer camp alone, I'd never been so far away from home by

myself. And this trip was to a college campus, in a foreign country,

with relatively little adult supervision.

Part of me was excited about the trip, and the opportunity to be

out from under the close monitoring of my parents; another part was

apprehensive, even scared. It wasn't the challenge of an accelerated

language program; by then, I spoke and read passable Spanish and

was genuinely curious about this country that in some long-ago way

was connected to the Cubans who had come to Miami. But being in an

unfamiliar place, fending for myself, being away from the predictable

routine I took a certain comfort in—it made a kind of pit in my

stomach. The pit grew a little smaller as I settled into my dorm room

and began to find my way around, but it never entirely dissipated.

There were students at Tec from all over the world, and although

the days were filled with intensive classroom work and the occasional

field trip—to Mexico City's historic areas, for example—the evenings

and weekends were mostly our own. Little by little, we ventured out

for meals in little cafes or large, noisy cafeterias. Mornings often began

with cafe con leche and maybe a rich pastry layered with dark Mexican

chocolate. At night, we deciphered the menus and ordered tacos de

polio, empanadas, or burritos washed down with tart limeade (or, for

a few daring adventurers, with a cold tequila). Afterward, someone

might suggest an expedition to a local club, where I mostly stood to the

side; as much as I loved music, I always felt awkward on a dance floor,

and I didn't like the idea of being watched, especially by people I

didn't know.

Sometimes in the early evening, my friends and I would simply

walk through the parts of the city we'd been told were "safe" to stroll

in, near the main square, orzocalo. The girls eyed the Mexican boys;

the Mexican boys eyed the girls. There was a lot of flirting and

giggling, and every night a few kids stumbled back into the dorm

many hours past whatever their curfew might have been at home.

I was one of the only people in my group of high school friends

who'd never smoked marijuana. I had strong feelings that smoking

was wrong, that one ought not do it, that even trying marijuana could

end badly. But then the last remaining nonsmoker in our group

besides me tried pot. After many nights of looking on as they lit up, I

finally relented.

I watched as a friend took a lit joint from the person next to him,

put it in his mouth, and inhaled. "Hold it, hold it, don't exhale yet!"

someone instructed. "Wait a couple of seconds. OK, now." And my

friend whooshed out a small cloud of smoke. A few seconds passed,

then a few seconds more.

"Well?" I asked. "Anything?" I hadn't even tried it and already my

chest felt funny; it was as though I were waiting for my friend's head

to burst into flames.

"Yeah, something," said my friend. "It's...soft. I mean, it burns, but

it's kind of soft."

Oh, what the hell, I thought. "Here, give it to me, I want to try."

I'm not sure there's a particularly graceful way to inhale one's first

joint. It's on fire, after all, and there's ash, and smoke. And of course

it's illegal, so the whole production is vaguely clandestine, even a little

nerve-wracking—it's like you're being inducted into some kind of

secret society, and the tape loop that lists all the dangers of marijuana

keeps running through your mind while you're concentrating very

hard on trying not to look stupid or, worse, uncool.

The second I brought the joint to my lips, I was dead certain that

my parents were going to magically appear on the scene and—do

what? Never mind, I thought. It doesn't matter; they're thousands of

miles away. And then I inhaled. And, inevitably, I coughed, too, and

my eyes burned and watered. Then I inhaled again, and waited. And

yes, rough and soft described it perfectly. And then I heard myself

laugh a little. Because mostly, it made me feel like laughing. And with

that, the big marijuana question was solved. "It's all OK," I said to my

friends. "I'm OK." And then I passed the joint back to the person

who'd handed it to me.

Off and on for the next few days, I thought about what I'd done. I

didn't not enjoy it, but I didn't feel like I needed to rush out and do it

again anytime soon. It was OK, but oddly, that's all it was. Mostly, I

was glad to have done it.

No, I was much more interested in the boys (for all the good it did

me that summer), and in the dark, bittersweet chocolate, and in going

days at a time without having to answer to anybody for much of

anything. I made some new friends, I got some very good grades, and

I saw Mexico, which was beautiful. Experimenting with a couple of

joints was nothing more than a blip on an otherwise great summer.

One weekend night, a few months after I'd come home from Mexico

and was well into my high school junior year (thinking nervously

about SATs and ordering college catalogs), I was out with a group of

friends at a drive-in movie theater. We were in someone else's car; I

had my driver's license, but since I knew I was a terrible driver (I'd

almost hit a cat the first time I drove with my mother), I usually

preferred being someone else's passenger.

"I have some mescaline," someone announced abruptly. "Anybody

want some?"

One friend giggled; another one piped up with "Yeah, sure, why

not?" I just sat there for a minute, looking out through the windshield

at whatever the movie was on the big screen in front of me, trying to

decide what to do. Trying to decide what I wanted to do.

"Yes," I said finally. "I do. I want some."

I washed the little pill down with a swallow of warm Coke. There

was a weird kind of silence in the car (except, of course, for the movie

sounds coming through the speaker attached to the window). It

seemed like we were all holding our breath. Waiting. My stomach

turned upside down—from nerves? from the pill? from the prospect of

the unknown? Then suddenly, my stomach felt very warm, and the

warmth radiated back up into my shoulder blades. I'd been clenching

my fists; now, I felt my fingers uncurl, and the palms of my hands fell

open on my lap. And then, we all exhaled in a collective "Ohhhhhhhh,

looooook!"

The images on the big screen were slowly oscillating, like runny

watercolor paints. At least that's what I saw; everybody was reporting

something different. For me, blue green was running into orange pink,

yellow was slowly colliding with green and brown, and the skin on the

actors' faces had started to look like stretchy Play-Doh. The car

windows were all rolled down, and the night air felt liquid on my arms

and face, as though I were floating in a warm swimming pool.

Outside, swarms of bugs floated dreamily in the shimmery lights.

"I want something to eat!" one friend said urgently. "Let's go get

something to eat!" Hmmm, I thought. That seems like a good idea.

Slowly, I got out of the car and headed off in the general direction of

the snack bar, my friend walking a few feet ahead of me. Suddenly, I

shouted at her, "Watch out! Watch out for that fence!" She jumped a

little, looked around, then laughed. "There's no fence there,

Elyn—you're seeing things. I am, too, but no fences!"

When we got back to the car, we brought a second metal speaker

in, then watched one movie while listening to another. No one had any

idea what was actually going on in front of or inside us. It didn't

matter. The dissonance was astonishing to watch.

For the rest of the night and well into the next day, I saw bright

colors and changing patterns drifting in the air all around me—circles,

and strings, and some kind of rubber band-looking things, crystal

clear, and very intense, like shards of broken glass. The images, all

pulsating, seemed to have a kind of sound to them, as though they

were being heard from very far away. Maybe this is what sound waves

look like, I thought.

At first, I was fascinated, even comfortable, with all these different

sensations—everything around and inside me was so beautiful.

However, as the hours passed, it all began to change, to darken

somehow. Edges, where before there had been only curves. Something

impending, and not at all friendly. Soon, I just wanted it gone—I

couldn't turn it off, I couldn't turn it down, and it was exhausting me.

It was as though there were no room inside my head to see or hear

anything else.

By evening, the hallucinations seemed to have run their course and

dwindled away to nothing. My parents hadn't noticed anything amiss;

my brothers didn't pay much attention to me by then anyway.

Chastened, I promised myself that there'd be no more

experimentation with drugs like these. Being in an altered state was

no place for me. That was it.

And yet it wasn't. Even after the hallucinations stopped, I couldn't

seem to get my body and brain to work right. I'd never had a

hangover, but guessed that this was what one felt like. I was sluggish,

almost nauseated. I was out of sorts, even a little sad and down,

unable to work up much enthusiasm for school, social events, or

anything else. After a few days of this, I got scared. Very scared. Had I

damaged something inside me? Had something gone wrong with my

brain?

And so, with equal parts paranoia and bravado, I decided to tell my

parents about my drug use—just the marijuana, though; there was no

way I was going to confess to the mescaline. I don't know what I

hoped they'd do—reassure me, or calm me down, or maybe get me to a

doctor who would prescribe an instant remedy. I just knew I couldn't

manage feeling this way, and not being able to pick up a book without

getting dizzy looking at the sentences marching across the page. This

couldn't last; somebody had to stop it.

It was Thursday afternoon after school. On Friday, the family was

supposed to go to the Bahamas for the weekend (the trip from Miami

took less than an hour). My father wasn't home yet. I didn't know

when he would be, but I decided I couldn't wait.

"Mom," I said, fidgeting a little as I spoke. "I need to tell you

something, and you probably won't like it."

She looked appropriately apprehensive. "What's wrong?" she

asked.

"I...I used some drugs. In Mexico. I smoked some pot. I've used it a

few more times since coming home, too. I think it might have made

me sick."

Her eyes got very big. "What do you mean, sick? Pot? Marijuana?

Oh, dear, Elyn."

"Well, not sick sick. Just...not right, exactly. Not like I want to

throw up or anything like that. Just some weird feelings."

She nodded, a very concerned look on her face. I was surprised

that she didn't seem particularly angry. "This is serious," she said,

"and very upsetting. We need to talk further about it. But I think we

should wait until after we get back from the Bahamas to tell your

father. Let's have a nice family weekend, and then we'll face this and

discuss it when we all get back."

I was relieved; her plan made sense. We'd go to the beautiful white

sand beaches, swim in the beautiful blue ocean, and have a nice

relaxing weekend; by the time Monday came, maybe I'd feel so much

better that we wouldn't have to tell Dad at all.

But of course, it wasn't going to happen like that. No sooner were

we back home from our trip than my mother insisted that we had to

have The Talk, and she told my father why.

"Elyn, this is very serious business," said my father with a certain

urgency in his voice, the sort of urgency not unknown to come from

parents in the 1960s whose children they discovered were using drugs.

"Drugs are dangerous, they're nothing to fool around with. You have

no idea where something like this could lead. You must promise me

that you won't do it again."

By that time, the effects of the hallucinogen had completely worn

off. I was no longer scared or uncomfortable; I was sunburned, clear

as a bell, and in no mood for a lecture. And so I balked. "No, I won't

promise. Everything's fine now, Dad, really. It was just a little pot, no

big deal. I can handle myself."

He wasn't buying it. In fact, my attitude—the bravado, the casual

dismissal of his concern, the lack of respect in my voice—only added

fuel to the fire. "This is not acceptable!" my father said, and now he

was angry. "You clearly have no idea what's good for you. If I cannot

have your pledge that this will be an end to it, I will have to take steps."

For me, this had uncomfortable echoes of the diet discussion a few

years before—the vague threat of "steps" my father was going to take

to bend my will to his. And so instead of lying to him, or placating him

(or paying any attention to the growing look of horror on my mother's

face), I just stiffened my seventeen-year-old spine. "I can do whatever

I want, Dad," I said. "My grades are good, I don't cause any trouble

around here, and I'm smart enough to know what I'm doing. And if I

want to use pot, I will. There's not much you can do about it."

Understandably, all hell broke lose. Dad raised his voice; then

Mom raised her voice. Then I raised the stakes, by declaring that I

didn't even care anymore about getting good grades, it was all stupid

anyway.

This wasn't the sort of response that concerned parents hope to

hear from their child during the big drug confrontation, but in

retrospect I guess it wasn't atypical of a lot of kids—all bluff and

bravado, and no apparent concern for consequences. On the other

hand, it's not the kind of stance a girl with any common sense would

have taken if she'd truly intended to use drugs and /or wanted to get

her parents off her back. Besides, this was the late sixties; marijuana

had an almost mythic power to frighten and confuse parents. The

culture was imploding on so many other levels, and every magazine

and newspaper was running horrifying stories every day about the

effects of drug use.

Less than a week later, I was in my parents' car, sullen and nervous

in the backseat, my parents tense and silent in the front, all of us

headed for an open house at a place called Operation Re-Entry, a drug

addiction treatment center in Miami. It was Saturday night, and Don

McLean's "American Pie" was playing on the car radio. And I—well, I

was on my way to rehab.

Operation Re-Entry was run by "graduates" of the Synanon program,

one of the most notable "no-nonsense, tough-love" approaches to

substance addiction in the country. Synanon started in California in

the late 1950s, and was renowned for its success rate, although by the

late 1970s the original program and its founder, Charles Dederich,

had fallen into some disrepute. (Dederich had declared Synanon a

religion and had even been charged with a serious crime.) But that

didn't have anything to do with me, or with the place I soon learned to

call "The Center."

I couldn't quite believe how quickly my world had flipped upside

down. There was no bargaining, no wheedling, no reasoning with my

parents. The sad truth was, my own defiance had done me in, and the

subject was closed—no deals to be made, no recourse. The Center, a

nonresidential program, would be my after-school destination for the

next two years. I would go there every day at 3, stay until 8, and then

go directly home. During the summer, I would be there all day, every

day. And that was that.

By any reasonable measure, my parents' response to my confession

(or my "stupid little confession," as I began to think of it) was extreme.

Certainly, it was a huge stretch to claim that I was a drug addict;

besides, I'd already admitted, at least to myself, that I didn't much like

the effects of the drugs I'd used. But my parents were scared. And, in

the face of my adolescent bravado—my refusal to give up drugs and

my profession of countercultural values—they were perhaps right to

be scared, and right to look for a remedy. But an actual rehabilitation

center? Surrounded by people who'd actually used drugs? What had I

done!

Operation Re-Entry's name came from the early days of the space

program; the term described the process of a space capsule burning

its way through the atmosphere in order to get back down to earth. We

were told at that first meeting that most of the staff members were

former junkies themselves—they knew every single tactic, every lie or

con, that any of us might use to try to get away with anything. And by

the time they were done with us, they pledged, we were not only going

to be completely drug-free, we would never again do anything

unlawful, not even jaywalk.

You'd think that being yanked out of my comfortable routine and

slammed into a rehab center's restrictive regimen would have brought

me up short—taught me a lesson or, at the very least, bred some

caution into my tendency to resist authority. But no. After only a

month in the program, in a group session, I had to confess ("cop to," in

Center terminology) that I'd once again tried pot; in the same group, a

boy named Matt confessed as well, and we quickly become closest

friends (a case of misery loving company, I guess).

Anyone who broke Center rules (and there were many rules) was

promptly brought up sharp with a "learning experience"—a public

punishment specifically designed to humiliate and humble the

offender, and edify the others. My punishment, and Matt's, was swift

and painful: We each had to wear a sign around the neck that read, "I

bite the hand that feeds me. Please help me." Matt also had to have his

head completely shaved. Fortunately, girls were spared that indignity;

instead, I was given an ugly stocking cap to wear. In those days, and in

Miami, it was not a fashion statement.

My mortification wasn't limited to the sign and the ugly hat: I was

also sentenced to scrub the Center's stairs—with a toothbrush—while

everyone walked around and past me. "You've missed a spot," a staff

member would snarl. "Go back to the bottom and start over. This

place has to be clean. Every single step. I don't want to see a single

speck of dirt when you're through." And, since a key component of this

punishment was learning to keep my mouth shut and do what I was

told, it was forbidden that I respond to staff in any way—no excuses,

no defenses. Down on my hands and knees, hunched over, trying

desperately not to be seen, if I could have somehow willed the floor to

open up and swallow me, I would have.

Perhaps worse than any of this, I was officially shunned by the

other members of my program as part of the punishment. They were

told to turn away from me, to speak quietly only to one another, never

to me, until such time as the staff instructed them otherwise. I'd

always been happy to have friends, happy to be one; now, I was a

pariah, an outcast, isolated yet on display at the same time—the sinner

locked up in the stocks in the town square. And it would stay like that

until the staff was convinced I'd learned my lesson. Then and only

then would I have earned the right to be "restored to the community"

of the Center.

This hell lasted two weeks, a nausea-producing time of going to

"regular" high school during the day, trying to stay focused on my

schoolwork, then abruptly changing gears to go to the Center to be

humiliated, then going home at night, exhausted and tense and

unspeakably angry at what my parents had sentenced me to.

Ultimately, of course, the learning experience did what it was

intended to do: I never used illicit drugs again. And the underlying

process (which I didn't understand then, but do now) of breaking my

spirit and rebuilding it to someone else's specifications had begun.

Although I was back in good standing, I grew somewhat quiet and

withdrawn—"in myself," as I came to call it when it had become much

more extreme. Unless spoken to, I didn't have much to say; I wasn't

sure I even deserved to be heard. I'd started to believe (or, perhaps

more correctly, feel), that speaking was actually "bad." At one point,

after I'd been asked to make a brief presentation and did so, a staff

member remarked that I had spoken more in those few minutes than I

had in months. Perhaps this was the beginning of my estrangement

from the world, the very first inkling of my illness, something I'd never

really experienced before, and a habit of mind that would

intermittently mark me for the rest of my life.

It was around this time that I read Sylvia Plath's The Bell Jar. Even

though it was fiction, Plath described the central character's gradual

descent into shattering mental illness in a way that could only have

come from her own struggles. I identified with it. I identified with her.

"I saw myself sitting in the crotch of this fig tree, starving to death,

just because I couldn't make up my mind which of the figs I would

choose. I wanted each and every one of them, but choosing one meant

losing all the rest, and, as I sat there, unable to decide, the figs began

to wrinkle and go black, and, one by one, they plopped to the ground

at my feet." That's me, I thought. She's me!

I guess Plath affects a lot of teenage girls this way, depicting as she

does the sense of isolation and disengagement (and not a little fear)

that typifies this time of life, especially for those who are sensitive and

often lost in the world of their books. For days afterward, I couldn't

stop thinking about the girl in the novel, and what she went

through—for some reason it made me restless, distracted. One

morning in class, with Plath on my mind, I suddenly decided that I

needed to get up, leave school, and walk home. Home was three miles

away.

As I walked along, I began to notice that the colors and shapes of

everything around me were becoming very intense. And at some point,

I began to realize that the houses I was passing were sending messages

to me: Look closely. You are special. You are especially bad. Look

closely and ye shall find. There are many things you must see. See.

See.

I didn't hear these words as literal sounds, as though the houses

were talking and I were hearing them; instead, the words just came

into my head—they were ideas I was having. Yet I instinctively knew

they were not my ideas. They belonged to the houses, and the houses

had put them in my head.

By the time I walked through my parents' front door—one, maybe

two hours later—I was tired, hot, and very frightened. Immediately, I

told my mother what had happened on my long walk, and how scary it

had been, to have those thoughts from the houses inside my head.

Completely unnerved, she promptly called my father at work. He came

right home, and after I repeated what had happened, they quickly

drove me not to a doctor, but to the Center. I adamantly denied using

any drugs, the counselors believed me, and although everyone tiptoed

around me for a day or so, soon the incident passed with no further

comment.

The Center had become the place around which we had rearranged

much of our family life. I was driven there, dropped off, and picked up

each day. The parents of all the Center kids met there every two

weeks, for group meetings; there were occasional family picnics or

other social gatherings. And, in spite of feeling a consistent low-level

resentment that my parents had stuck me there until high school

graduation, I had settled in and I had come to feel comfortable there.

Most of us figure out, as we grow up, that we wall ultimately belong

to (or struggle with) two families: the one we're born into and the one

we make. For some teens, the beginning of the second family is the

football team, or the drama club, or the kids we go to summer camp

with every year. Gradually, those may be replaced or supplemented

with friends in a college dorm, or our colleagues and friends in our

first job. For me, the process of making the second family began at the

Center. We all had something in common—committing to live in a

world without using drugs, without, in fact, relying on anything

artificial or chemical in order to get through our days. We shared a

common purpose; we cared intensely about one another's well-being.

How we felt, how we were, how we would cope when we moved back

out into the world were the central topics of conversation: the fight to

be strong, the determination to stay clean. Refuse to give in. Fight like

hell. Succumbing is never, ever OK.

Although I was easily keeping up with my high school work (in

fact, my grades were excellent, and stayed that way), I felt less and less

connected to the place where I took those classes, or to the other

students. My whole day, figuratively and literally, was aimed at getting

to the Center, and being part of that community.

I learned to smoke cigarettes there—if the counselors (who seemed

to know so much, and be so worthy of my respect and emulation)

smoked, then it was cool for me, too. No one ever talked then about

nicotine being a narcotic, or about this being an addiction that was as

potentially dangerous as any other. It's just what people did in those

days. Very soon, being without a pack of cigarettes made me very

uneasy—it would be decades before I could break the habit altogether.

It was also at the Center that I had my first sexual experience.

Jack was twenty-one, I was seventeen. A big age gap, seventeen to

twenty-one—that's how long it takes to go all the way through high

school, to go all the way through college. Whole, massive

developmental leaps happen in those four years. Given my age, the

timing was probably right, but there are all kinds of legitimate reasons

why the location and the relationship itself were wrong.

There was something about Jack—an addict in recovery who had

traveled the world—that was incredibly attractive to a sensitive,

moody girl with a vivid imagination. He may well have been seriously

impaired by drug use and other life experiences, but that's not what I

saw. I saw a good-looking, older, "wiser" man who listened to me and

actually seemed to care what I thought. We were in some meetings

together, we passed each other in the halls, we had coffee a couple of

times, and when he asked me to the movies, it was a no-brainer.

Holding hands with him, kissing him, being kissed by him—it was

exciting. And since he'd been places I hadn't, and knew things I

didn't, when it came time to decide whether or not to go further, I let

him take the lead in that as well.

For me at seventeen, it was dizzying, exhilarating, as though we

were getting away with something (which, in a way, we were). Still,

even with all the excitement of one's "first time," I knew enough to

know it was bad sex. My suspicion is that hardly anybody has a good

"first time," but the whole production had loomed so large in my

psyche that just getting it over with was, frankly, a relief. Just as my

head didn't explode when I smoked pot, my heart didn't get broken

the first time I had sex, I didn't get pregnant, and I didn't come down

with a horrible disease. It could have been much worse.

My time at the Center ended when I graduated from high school,

convinced (as are many eighteen-year-olds) that the most exciting

part of my life was about to begin. There's no question I was stronger

than I might otherwise have been, strengthened by a community that

had invested a great deal in me. I'd come to love the people there—the

counselors, the other "patients"—and believed they felt the same

about me. I was determined never to disappoint them or let them

down.

As for the Center's antidrug mission, yes, that was a success,

too—but of course, I had never used drugs that much to begin with.

What my experience at the Center primarily did was drill into me an

unflinching attitude toward illness or weakness: Fight it. You can fight

it, and you can win. To be weak is to fail; to let down your guard is to

surrender; and to give up is to dismiss the power of your own will.

The fundamental flaw in all of this, though, is that it neglects

something intrinsic to the complex real world and to complex real

human beings. In fact, it is not necessarily true that everything can be

conquered with willpower. There are forces of nature and

circumstance that are beyond our control, let alone our

understanding, and to insist on victory in the face of this, to accept

nothing less, is just asking for a soul-pummeling. The simple truth is,

not every fight can be won.

chapter three

IN SPITE OF the fact that Nashville's Vanderbilt University was a

beautiful campus—old ivy-covered brick buildings, wide swaths of

green lawn—my freshman-year dorm room was more than a little

dilapidated and dingy. My bedroom at home had been peaceful,

orderly—the housekeeper kept it clean and neat, and my mom

over-saw the arcane details, like pretty curtains at the windows and a

bright spread on my bed. But once at Vandy, I was on my own,

dismally unprepared to think about how the furniture should be

arranged, whether the linens matched, and what was the optimum

position for my desk and the lamp upon it. Tall, geeky, and socially

uneasy—sporting scruffy jeans most of the time (years before

everybody else on this particular campus would wear them) and a

nondescript hairstyle—I was suddenly back to square one in terms of

fending for myself.

In the early seventies, Vandy was still happily stuck in the 1950s,

or maybe even earlier; in fact, it wouldn't be a stretch to say that I'd

ended up in the Old South. With rigid social mores, and hard-and-fast

roles for men and women, it was a far cry from some of the other

schools where I might have gone, places which might have been more

welcoming to a nice Jewish girl (albeit one with more than a few

moods and quirks). But those schools were in the North, my parents

wanted me to stay in the South, and ultimately, Vanderbilt was it.

My very pretty roommate, Susie, was everything I wasn't—a petite,

lively brunette with the requisite Southern drawl and charm to spare.

She was street-smart, socially adept, and popular from her first day on

campus, especially with the boys. When the phone rang, it was always

for her. She was nice enough to me, but she was always on her way

out, always on her way to someplace else.

One afternoon when I was studying, Susie came into our room and

said that she needed to ask my advice about another girl in the dorm.

"Sure," I said, a little flattered that someone who clearly had so

much on the ball would want to consult me about anything. "What's

up?"

"Well," she said, "this is kind of awkward, actually. There's a girl

here in the dorm who, um, kind of smells not very good. A bunch of us

were talking about it the other night. We're trying to decide what's the

best thing to do."

"Do about what?" I asked.

"About maybe telling her. That she really needs to take a shower

once in a while." She wrinkled her little nose. "And shampoo her hair.

You know? Nothing fancy or anything. Just—well, I don't know, what

do you think? Do you think we should just tell her straight out? Might

hurt her feelings, maybe. Or should we just leave little hints, or maybe

a note? Not a mean one, of course. But something that might help her

out."

"My gosh," I said. "That is a tough one. But how nice of you to be so

concerned about her. I think you should just straight-out tell her. It's

always best to be direct with people, at least in my opinion."

She nodded. "Yes, I guess so. But still, the idea of hurting

somebody's feelings...Well, anyway, thanks for talking to me about

this."

I wondered, afterward, what Susie and her friends decided to do

about the unfortunate girl, and what her response to them had been.

But it never occurred to me to ask. And it certainly never occurred to

me—then—that the girl in the dorm who needed to take a shower, the

one they'd been talking about, was, of course, me.

Even a casual observer will agree that many college freshmen

quickly become away-from-home slobs; after all, for the first time in

their lives, nobody's after them to hang up their clothes or straighten

out their messes. But I'll bet that even as the dirty laundry piles up to

the ceiling and dorm rooms start to look like hovels, very few of those

kids actually neglect to bathe or shampoo or brush their teeth

regularly—because that would almost certainly guarantee an instant

end to their social life. What, then, was happening to me? After all, I'd

been brought up by attentive parents, in a family with means, plus two

brothers who wouldn't have hesitated to tell me, "You stink!" So why

was I unlearning the most basic of lessons: simple cleanliness?

Schizophrenia rolls in like a slow fog, becoming imperceptibly

thicker as time goes on. At first, the day is bright enough, the sky is

clear, the sunlight warms your shoulders. But soon, you notice a haze

beginning to gather around you, and the air feels not quite so warm.

After a while, the sun is a dim lightbulb behind a heavy cloth. The

horizon has vanished into a gray mist, and you feel a thick dampness

in your lungs as you stand, cold and wet, in the afternoon dark.

For me (and for many of us), the first evidence of that fog is a

gradual deterioration of basic common-sense hygiene—what the

mental health community calls "self-care skills" or "activities of daily

living." Once away from my parents' watchful eyes, I grew inconsistent

about asking myself the taken-for-granted questions. Or maybe I was

muddled sometimes about what the right answers to those questions

should be. Are showers really necessary? How often do I need to

change clothes? Or wash them? Have I eaten anything yet today? Do I

really need to sleep every night? Do I have to brush my teeth every

day?

Some days, the answers were clear as a bell: Yes, of course. For

heaven's sake, Elyn, clean yourself up! And so I did. But other days,

the questions and the answers were just too hard to sort out. I don't

know, I don't know. Or, simply, I just couldn't remember: Did I do

that already? Did I do it yesterday? Taking care of myself meant doing

more than reading a book or finishing a term paper; it meant

strategizing, organizing, keeping track. And some days, there just

wasn't enough room in my head to keep all that together. I'd left the

Center, I'd left my parents, and everything slowly began to unravel.

Like most college freshmen, I'd gone off to school not entirely clear

about what I wanted to major in or what I wanted do with my life. But

I'd narrowed it down a little. Something having to do with English,

maybe, because of my great love for books and for WTiting. Or perhaps

the legal profession—I could picture myself being a lawyer, arguing

passionately for or against something crucially important in a

courtroom. Maybe I could even help someone. Maybe I could actually

improve someone's life.

Of course, this embroidered fantasy of my bright future and the

actual reality of those early days at Vanderbilt could not have been

farther apart. Sororities and fraternities were at the center of campus

social activities; even in the early seventies, when all kinds of anarchy

were springing up at other colleges all over the country, on our sleepy

Tennessee campus it was all about young Southern gentlemen and

their belles. And while I may have been socially klutzy, I was not

stupid—I was about as far from being a Southern belle as a girl could

get. Nevertheless, it hurt to find myself so quickly on the outside

looking in.

I usually ate my meals by myself in the dining hall, but eventually

(weary of feeling like some kind of alien and having people staring at

me), I went instead to the Campus Grill, a restaurant across the street

from the university library. And there, I actually managed to meet a

guy. A nice guy.

Peter was a Ph.D. student in political science. Tall (taller than I,

which most guys weren't), he had jet black hair, a warm, easygoing

personality, and great intelligence. And he actually liked me. We had

conversations, real ones, in which he asked me about books I'd read,

writers I admired, and what I thought about things. He was so open

and easy to talk to, it wasn't long before he overcame my excessive

shyness, and we began dating. We went to the movies, studied

together, and had our meals together. Happily, Peter lived in an

apartment off campus, and so we began spending our nights together

there as well. I'm not sure which I loved more—being with Peter or

being out of the dorm and away from Susie, who lived in a world that

had little or nothing to do with me.

I don't know why I had an easier time acquiring a boyfriend than I

did social friends; one would think my painful lack of social skills

would have hobbled me across the board. I certainly wasn't overly

sexual, and on the surface of it, I didn't really have much time to

invest in a "relationship"—the rules of courtship (at least at that time,

and in that particular place) were cumbersome and seemed like a

foreign language to me. Besides, I was mostly absorbed in my studies.

But in this case, connecting to a man came naturally. It also came as a

blessing.

In addition to being a dear friend and intellectual companion,

Peter taught me how to enjoy simple intimacy—time spent together

not doing much, holding hands, being held, being made to feel special.

Peter taught me how to enjoy sexual intimacy, something that would

later become difficult for me, even frightening, during the years my

illness was in full bloom. He seemed to sense a wariness in me, and he

responded with great tenderness and patience.

Often when making love with Peter, I would suddenly get

frightened, losing the sense of where I left off and he began. For a

woman who's sure of herself, that sense of abandon, boundary-

lessness, ceding control, is primal and thrilling; in fact, it's at the very

heart of the risk lovers take with each other. But for me, "becoming

one" with a man felt like a loss of self, and it was sometimes terrifying,

as though something unspeakable lay just on the other side of it, as

though I could fall into an abyss. I wanted so much to experience what

I'd read about in books—love, passion, the kind of deep connection to

another person that would make me walling to take any risk for it. But

first, I had to learn to trust my own body and my own mind. Learning

to trust Peter was a good beginning, and he helped me to do that, but

nonetheless, in those early days, sex could be a terrifying experience.

One winter night at school, I had a guest, the daughter of a friend of

my family. I barely knew Linda, but she was interested in attending

Vanderbilt herself someday, and after her parents had spoken with

mine, courtesy dictated that she stay with me in the dorm.

A slender, very pretty girl, Linda had a drug history and (my

parents had told me this) had been compelled to spend some time in a

mental hospital. As willing as I'd originally been to have the company,

her actual presence unsettled me—from the moment she arrived, I

was agitated, on edge. I don't know what ultimately set me off—the

knowledge of what had happened to her, or my own increasingly

convoluted inner workings—but what happened next came completely

out of nowhere. I suddenly grabbed a blanket from my bed, ran

outside, covered my head with the blanket, and then ran around

wildly in the ice and snow, arms stretched out, pretending to fly.

"What are you doing!?" Linda cried out, having followed me

outside the dorm. "Stop that, Elyn, you're scaring me!"

Even though I heard her, even though I registered the genuine fear

in her voice, I continued to run, as though powered by some kind of

engine. "No one can get me!" I shouted. "I'm flying! I've escaped!"

Eventually, Linda's plaintive cries moved me to stop; she was

genuinely frightened, and even in my odd frenzy, I knew it. Perhaps

she was scared because she recognized in me the kind of behavior she

had seen in the hospital. Or perhaps I was just out of control and

might well have scared anyone who saw me. In fact, I'd scared

myself—I had no idea what had come over me. I had no clue.

Some months later, I was in the dorm with Peter and Susie and

once again felt the way I had the night Linda was visiting. Abruptly, I

challenged them. "I'll do anything you ask me to!" I yelled. "Ask me

anything, and I'll do it!"

Laughing at first, they decided to play along. "Sing a song," one of

them asked.

I warbled something—a Beatles song, off-key and with all the

words in the wrong places. My audience seemed delighted.

"Dance the twist!" they said. I did.

"Come on, ask me to do anything," I pleaded. "You want me to

take my shirt off?" I did.

Glancing at each other nervously, my friends started to realize

something had gone seriously haywire.

"You want me to quack like a duck? I can quack like a duck!" And I

did.

"You want me to swallow this whole bottle of aspirin?" And I did.

Suddenly, the way they were looking at me sank in. They were

scared to death. And suddenly, so was I—the dangers of what I'd done

were staring us all in the face. I ran into the bathroom and quickly

made myself vomit, then couldn't stop shaking from fear. Peter took

me straight to the Vanderbilt Hospital emergency room, where the

doctors thought this had been a suicide attempt.

"No, no," I said weakly, "I was just playing around. It was stupid.

I'll be fine, really." They wanted to call a psychiatrist, but I assured

them there was no need, that I was perfectly OK. Ultimately, and

reluctantly, they allowed us to leave. Shaken and somewhat fragile

(and completely mystified at myself), I left the hospital with Peter,

both of us wondering what on earth had just happened. We talked

about it for days afterward, and then gradually the intensity of the

feelings and the experience seemed to fade. When I thought about it at

all, it was with confusion and a growing sense of unease: What was

that?

Each of these incidents was isolated and brief, lasting only an hour

or so, and I was able to bring them to a close on my own. They were

impulsive, even dangerous. My best guess is that my illness was

beginning to poke through the shell (for lack of a better word) that

helped me, indeed helps all of us, maintain a separation between what

is real and what is not. For the next few years, that's where things

would precariously balance—me unwittingly trying to keep the shell

strong, and my illness trying equally hard to break through.

At the same time that my mind was starting to betray me, it was also

becoming the source of enormous satisfaction. Beyond the narrow and

disappointing world of an undergraduate social system that had no

place for me, I discovered academia—great ideas, high aspirations,

and people (teachers and students alike) whose own intellectual

curiosity seemed to give them a real purpose in the world. In

particular, I discovered philosophy. I fell in love with it. To my great

delight, I found that I was actually good at it, too. My grades were

excellent; my classmates sought out my opinion; and my professors

welcomed me into their offices, to talk about what I was studying, or

to continue conversations begun in class.

Philosophy and psychosis have more in common than many people

(philosophers especially) might care to admit. The similarity is not

what you might think—that philosophy and psychosis don't have

rules, and you're tossed around the universe willy-nilly. On the

contrary, each is governed by very strict rules. The trick is to discover

what those rules are, and in both cases, that inquiry takes place

almost solely inside one's head. And, while the line between creativity

and madness can be razor thin (a fact that has been unfortunately

romanticized), examining and experiencing the world in a different

way can lead to sharp and fruitful insights.

Not only did philosophy give me a surprising joy, it also imposed a

structure on both my mind and routine that I'd been unable to provide

for myself. The rigor of the material, and the lively give-and-take of

the students and faculty in the department, imposed a kind of order

upon my days. Suddenly, I had attainable goals, a sense of

productivity and purpose, and tangible results against which I could

measure my progress. By the second semester of my freshman year,

the department allowed me to take courses in the graduate school. I

completed that year (and every year thereafter at Vanderbilt) with

straight As.

The summer after that first year, I returned to Miami and my family,

with a reading list, some work to do for an incomplete course grade,

and some assigned research for the following semester. But once away

from Vanderbilt, from the community I'd found there and the

structure that academic life imposed on me, I began almost

immediately to falter. I felt no enthusiasm for a summer vacation, or

spending time with family or old high school friends, and in spite of

the objective evidence of good grades, I couldn't summon any

particular pride in what I'd accomplished. Instead, I felt gloomy,

uncertain, and oddly depleted. Working in isolation, either in my

room at home or in the quiet coolness of the library, I found I had a

hard time concentrating. Nothing I wrote was original or good enough

to turn in to my professors. When I woke up in the morning, the

thought of muddling through the day filled me with dread. After a few

weeks of this misery, I decided to ask my parents if I could talk to

someone about it—maybe a therapist, someone who would help me

straighten out my mind and put my summer to better use.

I'd never before actually asked my parents for this kind of help (the

Center had been their idea), and it was a little awkward explaining to

them that I just couldn't get my mind to work right. To their credit,

however, they didn't get upset, or panic, or tell me to "shape up" on

my own. Instead, they took me seriously, and arranged for me to see

an acquaintance of theirs, a psychiatrist named Karen. She had a

reputation for sending people home after a first meeting with the

same one-size-fits-all diagnosis: there was nothing so wrong that a

few and probably minor lifestyle changes couldn't fix. In addition, she

was rabidly anti-medication. In fact, she was widely perceived as some

kind of maverick in her profession. She'd written a book which I found

and quickly read.

Even though I'd asked for this kind of help, there was nothing in

my short time with Karen that calmed, reassured, or enlightened me;

to the contrary, she scared the wits out of me.

"Elyn, I want you to go stand in the corner," she said at our first

meeting.

Confused, I looked at the corner and then looked back at her; was I

being punished for something? "I...I beg your pardon?"

"Yes, yes, go stand in the corner. And then, I want you to focus on

the feelings you have inside right now. When you're ready, yell them

out. Just yell as loud as you can."

I couldn't imagine what on earth this woman was talking about.

Yelling in a corner? There was no way. I didn't know her, she didn't

know me. I wasn't even sure that I trusted her; how did I know that

she wasn't going to relay every single thing I said and did to my

parents?

"Oh, well," I stammered. "I couldn't do that. I'm sorry, but I...Can't

we just sit and talk about this trouble I'm having, this concentration

problem? And maybe you could give me some tips or some ideas about

how to get my mind to work the way I need it to?"

Patiently, Karen tried to get me to reconsider, explaining that it

was a tactic she'd used before, and it often brought good results.

Really, I should try it, just for a minute or two.

"No," I said adamantly. "I can't."

After I returned home from an equally disconcerting second

meeting (nevertheless having scheduled a third), I underwent a sort of

debriefing with my parents. Was I feeling better? Not particularly.

Had she given me any exercises or new routines that might resolve the

problems I was having with my schoolwork? No, she hadn't. Did I

think she might be of some help soon? I didn't know. Maybe after

another meeting or two, we would figure out a way for me to fix

things. To fix myself. I could sense my parents' increasing anxiety that

there was no clear solution to this problem.

Also, I was uncomfortably aware that this was costing my parents

money, and that going further with it would cost them even more.

What was the point? Besides, I felt exposed in a way I didn't enjoy—it

seemed that the only thing that people wanted to talk about over

coffee in the morning and at the dinner table at night was the inner

workings of my mind. So I went off to my third appointment with

Karen and told her it would be our last meeting.

"And why is that, exactly?" she asked.

"My parents are upset that we haven't figured this out," I said,

"and that you haven't come up with some kind of plan. Besides, it

costs them too much money for me to see you." I braced myself for her

objection, but none came.

"All right, then," she said calmly. "We won't continue. But here's

what I think: You do need help. And I just want you to know that when

you decide you're ready to get it, you can and should come back to see

me."

Nonplussed, I thanked her and quickly left the office. It never

occurred to me back then (and if it occurred to Karen, she didn't say

so), that I was taking better care of my parents than I was of myself.

At the end of the summer, I left Miami and headed back to Vanderbilt

for my sophomore year. I was actually glad to be there, greeted by the

few friends I'd made the year before, and once again excited at the

prospect of living a life of the mind. I discovered the Saturday and

Sunday open hours at the library and dove back into my books. Sadly,

the relationship with Peter had come to an end. Nevertheless, I felt

confident enough to date other people, more at ease with that aspect

of my life than I'd been before.

Because I'd begun to take graduate-level courses, I soon made a

number of friends who were graduate students—often older than I by

only three or four years. They seemed a better fit, and appeared to

accept me for who I was, with all my flaws and quirks. And this is

when I came to know Kenny Collins, who had been my freshman

English teacher and was studying for his Ph.D. in English literature.

Eight years my senior, Kenny came from a small town in

Tennessee with, as he put it, "a population of one hundred eighty-four

and shrinking." He was married to his college sweetheart, Margie,

who was somewhat more reserved than Kenny, but sweet and

welcoming. Together, they presented a picture of the kind of life I

tried to imagine for myself someday—two people who obviously cared

deeply for each other, an apartment filled with books and music, in a

community of intellectual endeavor and excellence. Kenny had a

Southerner's manners and gentility (although his Southern accent

was barely detectable), but he could be tough and demanding when

the situation called for it. He was the kind of teacher who expected

much of his students not just because he cared deeply about them, but

also because he truly loved and respected what he taught.

Hardworking and incredibly smart, he demanded no less of his own

scholarly work than he did of his students', and so he spent most of his

waking hours in the library, as did I.

True friends help us chart our course in the world, and in my

case—with the earliest mixed signals of schizophrenia beginning to

fuzz my ability to think clearly—Kenny was like a guide in a forest. If

you are walking on a path thick with brambles and rocks, a path that

abruptly twists and turns, it's easy to get lost, or tired, or discouraged.

You might be tempted to give up entirely. But if a kind and patient

person comes along and takes your hand, saying, "I see you're having

a hard time—here, follow me, I'll help you find your way," the path

becomes manageable, the journey less frightening. For most of my

college career, Kenny Collins was that person. He didn't tolerate late

papers, so I was compelled to focus and finish on time. When I was

stuck, he'd lead me—as opposed to pushing me—into discovering

what I wanted to say. As time went on, he became more friend than

teacher, often asking to read what I had written for other classes,

gently showing me where I'd strayed or suggesting another direction I

might go. Occasionally, he even asked me to read his work, and paid

me the high compliment of listening to what I had to say and actually

valuing it.

Kenny, Margie, and I often hung out together with Pat, another

grad student in English, who had a wonderful sense of humor. We

spent our days in the library and our weekend evenings either at

Kenny and Margie's or at Pat's apartment. We had dinner parties

(happily for me, the others all knew how to cook), listened to music,

talked about our studies and our friends, and mostly laughed a lot.

Beer and wine were easily available, but I quickly decided (as I had

with my brief flirtation with drugs) that I didn't like drinking. I didn't

like the taste, I didn't like the calories, and I especially didn't like the

way it made me feel, either when I was doing it or the next morning.

Besides, life at the time seemed much more enjoyable on a clear head.

I'd never been a giggly girl, but something about these people

made me feel lighthearted much of the time. And since I thought just

about everything Pat said was incredibly funny, it wasn't hard to

collapse in a fit of laughing, at which point she'd crack up, too. It

began to be a game, in public places, to try to embarrass our dear

friend the Southern gentleman. We'd be laughing and giggling, cutting

up, being anything but ladylike, while Margie looked mildly

embarrassed and Kenny's face turned bright red.

"You've got to stop this now," he'd mutter in a restaurant. "People

are staring at us. Elyn, Pat, quit it, this is not acceptable!" The more

perturbed he was (or pretended to be), the harder we laughed,

stopping only when we'd run out of breath. Being at ease and willfully

silly with good friends was a wonderful kind of freedom for me, a rare

lack of self-consciousness.

At the beginning of my senior year, Kenny (who by then had

completed his graduate work) was offered a fine college teaching

position—but not at Vanderbilt. Instead of being happy for him, I was

heartbroken. Even worse, I panicked. Pat, too, had finished her

graduate studies and was leaving campus. Although I had other

friends, although I'd found a niche in the philosophy department, the

time I'd spent with Kenny, Margie, and Pat had felt like coming home

to me—they'd become like a family, and were often more accepting

than my actual family. They certainly knew me better at that point.

And now it was all over. How could I stay behind without their

friendship, without the laughter, and without Kenny's guidance and

wisdom?

Of course, he did his calm and caring best to reassure me, saying

that I was more than capable of finishing my undergraduate career

successfully, and besides, we'd always stay in touch. Our lives would

change, but the friendship would not, and in the meantime, there

were telephones, and letters, and vacations when we would visit each

other.

In part of my brain, I heard what he was saying and believed it. In

another, I started teetering. I was frantic during the day, sleepless

during the night. Quickly, my behavior began to resemble that chaotic

first year's—I got too loud again, too out-of-control, taking stupid

dares, doing stupid things, with my laughter frequently accelerating

into hysteria. I noticed, a time or two, people looking at me with

alarm. Let them, I thought. I don't care. Everything's going to hell.

The day Kenny and Margie actually drove away from Vanderbilt, I

sobbed for hours, inconsolable. For weeks afterward, I had no energy,

no focus; I kept imagining I saw him on campus, just ahead of me in a

crowd, or over there under the trees, in the shade. But of course I

knew it was a mirage. Life went on, but not easily, and that whole last

year in college, I never stopped missing him, never stopped being

aware of his absence, and the absence as well of a kind of emotional

order he'd brought to my life.

As my own graduation approached, I knew I had to make some

decisions. For four years, I'd had a perfect academic record; in fact, I

was named class valedictorian. Although I wasn't required to speak at

the ceremony, I was to be called up to the podium, introduced, and

applauded, which drew a mixed reaction inside me. Proud of being

acknowledged for what I'd accomplished, I nevertheless didn't like

sticking out, and I especially didn't like the idea of other people

looking at me. Plus, I was unnerved by the whole idea of the future

(and actually having to plan for it). A future meant change, and

uncertainty, and I had never been comfortable with either concept. I

felt a constant sense of uneasiness, as though the ground under my

feet were about to shift. Something had to come next, but what?

In my philosophy studies, I'd explored the work of Aristotle, and

continued to be enthralled by it—two thousand years ago, he was

deftly analyzing the human character and discussing the same moral

and ethical issues that we debate today. I'd taken sufficient Greek

language courses to read Aristotle in the original, and decided that I

wanted to do further study on him. So, after consulting with my

academic advisors, I decided to apply to Oxford for graduate study.

There were two scholarships that could get me there—the Rhodes and

the Marshall—but the application process for each was intensely

competitive and harrowing.

My interview with the Marshall committee was disastrous. The

meeting was held in Atlanta, Georgia, at the British Consulate, in a

large and very ornate room. We sat around a table, in old chairs with

high backs—there were perhaps ten of us gathered around the table,

and the other nine were looking at me. In an unfortunate side effect of

my increasing inattention to myself—my periodic lapses of self-care,

which always became worse during stress—my ears had become so

clogged with wax I could hardly hear a word anyone spoke.

"So, Elyn, tell us, why do you want to go to Oxford?" they began.

I delivered the speech exactly as I'd rehearsed it. "Oxford is

probably surpassed by none in its tradition of excellence in ancient

philosophy," I said. "I love reading and thinking about Aristotle.

That's one reason why I learned ancient Greek—so I could read him in

the original. I couldn't get a better education in ancient philosophy

than at Oxford. Also, it will be mind-opening to live in a new culture."

There, I thought. Every word exactly right. But my head was buzzing

with anxiety: Am I speaking loud enough? Too loud? Did I even hear

the question correctly?

There were long silences between their questions and my

responses, then more long silences after I spoke. Our voices seemed to

echo. Someone coughed; someone else shifted in a chair, and the chair

creaked. Was I boring them?

One question I did hear correctly was an inquiry about what I

thought about my physics class. My flippant answer was an indication

of my poor situational judgment: "This physics class was a gut!"

One woman on the panel asked me, "Have there been any changes

in your life since the women's movement began?" Without pausing to

reflect or consider the histories of the women in the room—what they

might have gone through to get there, what their struggles might have

been like—I quickly replied that no, I didn't notice any changes;

indeed, I hadn't ever encountered any discrimination at all. And then,

as though I were signing a high school yearbook, I cheerfully washed

all the women "good luck in your endeavors!" Another long silence.

Evidently, we were done. There was a polite round of thank-yous

and good-byes, and then I made an awkward departure, having no

sense whatsoever of what they thought or what my chances were.

Hapless. Hopeless. Why on earth would they want to support

someone so maladept?

Happily, the interview for the Rhodes proceeded somewhat more

successfully, almost as though the Marshall had provided me with a

dress rehearsal. The questions were similar; my responses seemed to

come more easily. I sound fine, I thought. I sound fine. However,

when asked if I participated in any sports, my judgment quickly went

sideways—I quipped that my primary exercise came from lifting sixty

cigarettes to my mouth each day. I knew the minute I'd finished the

sentence that it was precisely the wrong note—rather like a loud gong

at a tea party. The interviewers later wrote that they would have

approved me for the next round of interviews except for the total

absence of physical recreation in my life.

Fortunately, neither my nicotine habit nor my conversational

clumsiness was held against me by the panel deciding on the Marshall.

To my great surprise, I was accepted to do a B.Phil., a graduate degree

in philosophy. The Marshall scholarship would pay my tuition and

give me a stipend, to be paid in pounds—and at that point, the pound

was strong. If I planned correctly, I might even have a little left over.

In August, I would go to Oxford and become a member of the

University's Corpus Christi College.

As proud as I was, it was a measure of my constant tension

between wanting to be acknowledged and not wanting to stand out

that for the rest of the summer, whenever people thought I was talking

about going off to study at Corpus Christi College in Texas, I just let

them keep thinking that.

chapter four

AFTER GRADUATING FROM Vanderbilt University in June of

1977,1 returned for the summer to Miami and my family.

I was completely distraught on the entire flight back to

Miami—grief-stricken about leaving Vanderbilt, terrified of Oxford,

and horrified about having to go home. Transitions were always hard

for me—I was happiest with a predictable routine that I devised and

controlled—but this seemed overwhelming. The Vanderbilt libraries,

the Campus Grill, the buildings and sidewalks and trees, the places I'd

walked each day, the friends I'd finally made, the schedule that

prescribed almost every minute of my day—it all gave a precise order

and manageability to my life, and now it was over. And so, as the

summer days went by, with Miami simmering in the heat and

humidity, and the members of my family coming and going in

routines of their own, I began to unravel.

I re-created the regularity of my college life as best I could, by

heading for the public library right after coffee in the morning, and

spending the day there reading Aristotle and other philosophers;

there were some gaps in my philosophy training, and I needed to get

caught up. For lunch, I went to a local drugstore for a grilled cheese

sandwich and coffee; for dinner, I usually joined my parents and

brothers around the table, and struggled with the bare minimum of

social niceties: "How did your day go, fine, how was yours, fine." In

the evening, I listened to music in my bedroom, smoked endlessly,

and read some more. No one bothered me. The weekend family

outings had long since ended; my brothers were living their own lives,

my parents were equally involved in theirs. If anyone noticed that in

effect I'd taken my leave of them even while being physically present,

they said nothing. No one looking at me would have known there was

a storm going on inside. But there was a storm, and it was horrible.

With the routine of my academic curriculum gone, however, I

began to be regularly invaded by the strangest fantasies, very intense

and hard to escape—they weren't exactly hallucinations or waking

dreams, but they were extremely vivid and, for me, not entirely

distinguishable from reality. They'd come out of the blue, with no

warning, and no reason that I could understand. It was as though in

the absence of the familiar Vanderbilt routine, the fantasies had come

to fill the void, and I couldn't shut them off. Whole hours would go by

at night when I was stuck in this alternative universe, struggling to

decipher what was going on inside my head. Scenarios came and went

of their own accord—it was like being unable to get out of the theater

while demented movies ran endlessly through the night. I have been

falsely accused of using drugs and put into a residential drug

treatment program. Staff from Operation Re-Entry work there. At

the program I spend time with no one. I speak hardly at all. I carry

my Aristotle book everywhere. Staff call me in and tell me I must

start socializing more. I can't. I am called in again and staff order

me to start talking. They say my Aristotle is a crutch and that I must

stop carrying it around with me. "No," I cry. I will not give up my

Aristotle!" Staff take my Aristotle away by force. I lose control,

tearing the office up in a wild frenzy, shouting at the top of my lungs.

Staff restrain me. Several hold me down and they call 911. The

ambulance takes me to the emergency room.

I became convinced that I was not supposed to talk, particularly

about myself. I was not supposed to ask for anything, not even so

much as a coffee refill at the drugstore counter. Those houses that told

me I was bad on that long-ago day—maybe those houses had been

right.

And that man I'd believed had been looking in my window at night

when I was a girl...I began to think that he was back, that I'd just

heard something outside...Every single night, when the house was

quiet and everyone else was long asleep, there came a moment when

my heart would begin to race. I'd break into a cold sweat, and my

breathing would become shallow and very rapid. I didn't know these

events were panic attacks; I only knew my heart was about to burst

out of my chest, and it terrified me. That's it, I thought: Something is

wrong with my heart.

When I told my parents, they took me to a cardiologist

immediately; he performed a number of tests, none of which indicated

any heart problems. The doctor said he thought I was simply anxious,

and he advised against tranquilizers, concerned that they'd make it

even more difficult for me to concentrate. I wouldn't have taken them

anyway—if there was one thing I took away from Operation Re-Entry,

it was an absolute determination never to take any drug that altered

my mental state. So instead, the doctor prescribed Inderal, a beta

blocker which I believed was supposed to quiet my heart (it's also

prescribed for panic attacks, anxiety, and nervous tension). I didn't

know that the side effects of Inderal could include depression; indeed,

I felt both sad and sleepy fairly soon after taking it. But I stopped

feeling like I was about to jump out of my skin. The nights grew mostly

quiet, and I was able to complete my work.

At the end of the summer, I boarded a plane to Washington, D.C.

There I would meet the other Marshall scholars at the British

Embassy, and then we would continue on our way to Oxford. I didn't

really know how to act in this situation—what is the proper behavior

before a consul general, anyway? My anxiety began to ratchet up: I

had no idea how I was going to manage this, and then Oxford, and my

studies.

My mother had helped me find clothes, which was one of my least

favorite tasks; there were too many choices, I could never make up my

mind, and whenever I tried to picture circumstances in which I would

wear these new clothes, the thought alone made me anxious. Mostly,

we ordered sweaters and good pants from the L.L.Bean catalog, and

bought a couple of suits with blouses for dress-up occasions. I'd need

a coat, and a jacket. I'd need shoes that weren't sneakers. Perhaps I'd

need an umbrella—I was, after all, going to England. Somehow,

having the right kind of things seemed the armor one might need

when embarking on graduate studies in England.

The initial meeting-and-greeting in D.C. went past me in some

kind of haze. I forgot everyone's name as soon as we were introduced,

although I was gratified to see that almost everyone seemed as

nervous as I was. Of course there was protocol; to my great relief, I

didn't violate any of it, at least as far as I could tell. And then we were

off to Oxford.

Despite our common language, it's no secret that England and

America are vastly different countries, with perhaps the biggest

difference being the fabled British reserve. Many aspects of casual

conversation that feel quite natural to Americans are totally off-limits

in England, and it didn't take me long to learn that in my new

environment. One day, I asked a British friend where he planned to

spend his holiday, and he looked quite taken aback. I later learned

that such a question should never be asked, because the answer could

reveal someone's class background. The sunny, open, Latin-tinged

mores of Miami, combined with the Old South graciousness of

Vanderbilt, seemed a world away in the far older and more courtly

enclaves of Oxford. For example, cashiers never said, "Y'all come back

soon now!" or "Have a good day!" whenever we exchanged money for

goods. I often left a shop, food or package tucked under my arm,

wondering what I'd done wrong to be dismissed so coolly. Didn't it

matter to them what kind of a day I had?

The weather turned cool, the sunlight dimmed a little, the days

became shorter. Adding to my general disorientation was an

educational system vastly different from the one in which I'd done my

undergraduate work. Oxford's program consists of optional,

university-wide lectures and seminars, plus meeting alone with a tutor

or supervisor once a week for an hour or less. Exams come at the end

of two or three years. For the weekly tutorial, a student reads a

number of articles and then presents a paper, upon which the tutor

then comments. I was accustomed to writing two or three long papers

over a four-month period, not one short paper a week. I couldn't

imagine being able to do it.

I made one new friend from America, a woman named Jean, who

was studying in London; we met on a cigarette break in the bathroom

at the British Embassy. Tall—as tall as I—and very thin and pretty,

Jean had studied to be a nurse until she met her doctor-fiance,

Richard, who encouraged her to go back to school and finish her

college degree. She did well, and ultimately won a Marshall

Scholarship to study linguistics at University College in London. She

was warm and approachable. I liked her, and she seemed to like me,

too. But she was in London and I was in Oxford; although we spoke by

phone maybe once a week, she was an hour away.

From time to time I got together with another woman in the

dorms. She was from Canada, and initially our friendship looked quite

promising. But something was happening to me—something that had

begun the summer before—that short-circuited our budding

friendship: I was finding it difficult to speak. Literally, the words in my

head would not come out of my mouth. Our dinner conversations

grew increasingly one-sided, and I was reduced almost totally to

nodding in agreement, feigning a full mouth and trying to express

whatever I was thinking with my face. The friendship trickled away.

And I couldn't speak on the phone with my family or friends in

America, either—I'd decided that it cost too much, that it was

therefore "forbidden." By whom, I couldn't have said; there just

seemed to be some kind of vague but absolute rule against it. Of

course, my family would have gladly paid the phone bill, but my

distorted judgment told me I did not deserve to spend money on

myself, or to have others spend money on me. Besides, nothing I had

to say was worth hearing, or so said my mind. It's wrong to talk.

Talking means you have something to say. I have nothing to say. I

am nobody, a nothing. Talking takes up space and time. You don't

deserve to talk. Keep quiet. Within weeks after my arrival in Oxford,

almost everything I said came out in monosyllables.

As I grew steadily more isolated, I began to mutter and gesticulate

to myself while walking down the street, something I had never done

on my worst days at Vanderbilt or in Miami the summer before. When

I heard the sounds I was making, I felt neither disturbed nor

surprised; for some reason, it helped me feel calmer. It seemed to

provide an arm's-length distance between me and the people who

were walking past me. Oddly, it was soothing, much like clutching a

well-worn blanket might have been to a frightened child. And so, with

no reference point outside my head (friends, familiarity, being able to

accomplish anything at school), I began to live entirely inside it.

And the vivid fantasies had followed me across the ocean. My

doctor finds me huddled in a corner. He wants me to socialize with

other people in the program. I don't want to. They force me into a

room where there are other people. I am supposed to talk to them. A

man introduces himself, "Hi, my name is Jonathan." I do not

respond. "What's your name?" Again I do not respond. "Are you a

student here?" I mutter something to myself. My doctor comes over

and encourages me to talk to this young man. I start screaming and

run wildly about the room. Some of the attendants restrain me by

force.

What was real, what was not? I couldn't decipher the difference,

and it was exhausting. I could not concentrate on my academic work. I

could not understand what I was reading, nor was I able to follow the

lectures. And I certainly couldn't write anything intelligible. So I

would write something unintelligible, just to have a paper to hand to

my tutor each time we met. Understandably, my tutor was

flummoxed.

"This is not acceptable, Miss Saks," he said. He was neither angry

nor cold, but he was somewhat disbelieving. "Surely you can agree?"

he asked. "Because, you see, the work here is hard to make any sense

of."

Dumbly, I nodded, sensing the hard wooden chair beneath and

around me. I barely squeezed out a couple of syllables. "Yes," I said.

"Yes, I know." I just didn't know what to do about it.

Jean, my London friend who'd been a nurse, sensed from our

telephone conversations that something was going very wrong. I told

her I was just having a hard time doing the required work, but

evidently something else I said, or the way that I'd said it, let her know

I was struggling with thoughts of wanting to hurt myself. During one

phone call, Jean gently suggested that I talk to a doctor about seeing a

psychiatrist.

"Oh, no," I said, trying to force some levity into my voice. "I'm not

crazy or anything. I'm just kind of...stuck." Inside, another dialogue

was going on: I am bad, not mad. Even if I were sick, which I'm not, I

don't deserve to get help. I am unworthy.

A few weeks later Jean's fiance, Richard, came to town. A

neurologist, Richard was somewhat older than Jean and I, and had an

air of casual authority. He intrinsically seemed to understand that for

some people, it was harder to be a student than to be a professional

working in the world. His presence was reassuring, not at all

threatening; in fact, his looming height and excess poundage gave him

the appearance of a large and generous teddy bear.

"Jean and I are very concerned about you," he said quietly. "We

think you may be quite sick. Would you mind if I asked you some

questions?"

"I'm not sick," I responded. "I'm just not smart enough. But

questions, yes. Ask me questions."

"Are you feeling down?"

"Yes."

"Loss of pleasure in daily activities?"

"Yes."

"Difficulty sleeping?"

"Yes."

"Loss of appetite?"

"Yes."

"How much weight have you lost in the last month?"

"About fifteen pounds."

"Do you feel like a bad person?"

"Yes."

"Tell me about it."

"Nothing to tell. I'm just a piece of shit."

"Are you thinking of hurting yourself?"

I waited a moment before answering. "Yes."

Richard asked still more questions; I answered yes to each one. As

dim as I was, it wasn't difficult to see the alarm on his face.

"You need to consult a psychiatrist right away," he said in a

measured tone. "You need to be on antidepressant medicine. You're in

danger, Elyn." This was serious business, he explained. I couldn't

afford to wait.

I thanked Richard and Jean for their concern, and told them I

would think about everything they'd said. But I was not persuaded.

Pills? Something chemical to go into my body and muck about with it?

No, that would be wrong. That's what I'd been taught at Operation

Re-Entry, that's what I believed. My father's voice: Pull yourself

together, Elyn. There could be no drugs—everything was all up to me.

And me wasn't worth much. I'm not sick. I'm just a bad, defective,

stupid, and evil person. Maybe if I'd talk less I wouldn't spread my

evil around.

I needed to present another paper in my weekly seminar, but could

not write. A feverish all-nighter produced three or four pages of pure

drivel. Gobbledygook. Junk. Nevertheless, I read it aloud. Eyebrows

rose. But there was no laughter, only silence. I had thoroughly

humiliated myself in front of my Oxford colleagues. I have come to

Oxford and I have failed. I am a bad person. I deserve to die.

I suddenly knew, as sure as I'd ever known anything in my life,

that if I tried to kill myself, I would succeed. Richard's words came

back to me, and this time I really heard them: I was in danger. This

was serious. I could die. And so many others—my parents, my

brothers, my friends, the ones I'd allowed myself to actually care

for—they would be badly hurt. However much pain I was in, however

dimly attractive an ending to this might be—I could not bring that

kind of pain to the people I loved and who loved me.

There was no time left to think, or consider, or strategize my way

out of this. I called Dr. Johnson, a doctor I'd been assigned as my

general practitioner when I first arrived, and urgently requested an

appointment for that very day.

Once at Dr. Johnson's office, I said I was feeling depressed. He

asked me why, and to my monosyllabic answers he reassured me that

I could come and talk to him from time to time, as I felt the need. He'd

no doubt seen his share of stressed-out students; perhaps I was simply

another.

"I think I need to see a psychiatrist," I said.

"I think I can help you, if you allow me," he said. I hadn't slept in

days, or bathed, or changed clothes—even I knew that I looked like

hell, why couldn't he? Why wasn't he more alarmed? Couldn't he see?

Didn't he know?

Dr. Johnson started to ask the same questions Richard had asked.

Was I sad? Had I lost pleasure in usually pleasurable things? How

were my sleeping and eating? Even though my answers were as they

had been to Richard's questions, Johnson didn't yet seem much

concerned. And then he asked if I'd thought about hurting myself.

"Yes," I said.

"Have you actually done anything?"

"Yes." And I showed him a quarter-sized burn on my hand, which

had come from deliberately touching an electric heater.

The expression on his face underwent a subtle change. "What

about killing yourself?" he asked. "Have you thought about that as

well?"

"Yes."

He leaned in closer. "How might you do that?" he asked.

"I have a full bottle of Inderal. A friend said it would kill me," I

said. Although I'd stopped taking the drug, I'd never thrown it out. I'd

also given some thought to touching the bars of the electric heater in

my dorm room and electrocuting myself, I told him. "Or maybe douse

myself with gasoline, set myself on fire. That might be best, because I

am bad and deserve to suffer." Then I started muttering gibberish,

something which I hadn't yet done in front of anyone I knew.

Dr. Johnson asked me to wait outside for a few moments, then

called me back into his office to say he had made an appointment for

one o'clock that afternoon at the Warneford, the psychiatric division

of Oxford's medical school.

"Will you be able to get there?" he asked.

"Yes."

"Will you go?"

"Yes." I was desperate. I held my own life in my hands, and it was

suddenly too heavy to be left there.

I called for a taxi from my dormitory telephone. One of the

"scouts" (as Oxford cleaning people were called) overheard me

mention the Warneford. I cringed under her squinty gaze. Yes, yes,

you are right, I am a piece of shit, and I am going to the place for bad

people.

When I arrived at the Warneford, I was quickly ushered into a

small, windowless room with beige walls. There, a young woman with

sandy-colored hair and a hint of freckles introduced herself as Dr.

Smythe. She was not at all forbidding or official in her manner, and I

tried to calm down sufficiently to pay respectful attention to the

questions she was asking. But my head kept jerking in the direction of

the door, as though it wanted to lead me and my body out of the room.

Our talk went on for what seemed two or three hours. There were

many questions about my childhood, and even more questions about

my life right then. I remember thinking she seemed not to like me. At

that point, though, I was quite certain no one liked me. There is

nothing about me to like.

Finally, Dr. Smythe asked me to step out into the waiting room,

where I sat nervously for about twenty minutes, wondering what was

going to happen next. When she called me back into her office, there

were five or six other doctors present, mostly middle-aged to older

men. Suddenly, I was frightened, as though I were in the center of a

bull's-eye.

Dr. Smythe introduced me to Dr. Russell, the one speaking for the

treatment team. As he proceeded to ask questions (much the same as

Dr. Smythe had asked earlier), I grew increasingly uncomfortable with

his stern demeanor. There was a deliberate tone in his voice—of

judgment, of disdain. His language was formal and yet somehow not

respectful, as though to say, "I wall make the decisions here, and you

wall do as I say."

Finally, Dr. Russell said, "We'd like you to become a patient in our

day hospital."

Terrified (and angry, both at the suggestion and his manner of

speaking to me), I refused outright. I wanted help, not incarceration. I

looked at the door behind him; it led out. Out.

"It's a day hospital, Miss Saks. You would be able to go home and

sleep in your own bed at night."

"No," I said flatly. "I don't belong in a hospital. I'm not crazy. This

isn't the right place for me."

He was undeterred. "It is our opinion that you need the support

and help of a day hospital." The other doctors were looking at me as

though I were a specimen in ajar.

"I'll be fine," I insisted, "as long as I can see a psychiatrist once or

twice a week."

"That would not be enough," Russell said firmly. "You really need

to come into the day hospital."

"No way!" I said, springing out of my chair and running as fast as I

could out of the room, and out of the hospital. I kept waiting to hear

the sound of footsteps behind me, their angry voices, someone yelling,

"Stop that woman!" But it didn't happen. I'd left them behind.

When I hit the street, I couldn't figure out at first which direction

to walk in, and didn't see any phone booths to call a taxi. So I just kept

walking. My breath was coming hard and fast, my heart was pounding

so hard I was certain passersby could see it.

I walked another nearly two miles to get back to my dorm. Once

there, I called Jean and Richard and told them what had happened.

Immediately, they insisted that I needed to follow the doctor's

recommendation. "No!" I said, and hung up, defiant and scared and

completely at a loss for what to do next.

That night was terrible. I lay awake in a pool of sweat, unable to

sleep, a mantra running through my head: I am a piece of shit and I

deserve to die. I am a piece of shit and I deserve to die. I am a piece of

shit and I deserve to die. Time stopped. By the middle of the night, I

was convinced day would never come again. The thoughts of death

were all around me; I realized then that they had begun the summer

before, like a small trickle in a creek where I had gone wading. Since

then, the water had been steadily rising. Now it was deep and fast and

slowly threatening to cover my head.

The next morning, haggard and beaten, I managed to call the

hospital and reach Dr. Smythe. "I'm glad you called," she said.

"Please, come in as soon as you can."

That lonely night had served its purpose. No one had locked me up

against my wall. I entered the hospital voluntarily. If I were going to be

a mental patient, at least it would be by my choice and no one else's.

chapter five

SET AMONG THE green and gently rolling hills of Oxfordshire, the

Warneford Hospital could easily have been mistaken for the sprawling

estate of a British country gentleman—as nervous and distracted as I

was in the backseat of the taxi that was taking me there, I would not

have been surprised to see horses and hounds charging across the

lawns in pursuit of a frightened fox.

Built in the early 1800s (and once called the Warneford Lunatic

Asylum), the hospital was originally established "for the

accommodation of lunatics selected from the higher classes of

society." In those days, they used to routinely "bleed" the patients,

believing that the bad blood coming to the surface and leaving the

body would cool the overheated brain. If it were only that simple.

The day hospital was apart from the main building in an old,

tree-shaded house. At first, I expected a program like Operation

Re-Entry—intense, confrontational groups and a staff prepared to

sniff out and expose any duplicity among the patients. Within an hour

of arriving, however, I knew I was in the middle of something very

different. The daily routine consisted of a number of activities—group

therapy, one-to-one meetings with a psychiatrist, reading plays aloud,

board games (mostly Scrabble, which I played but could never win,

because I couldn't think straight). But much of our time was spent

sitting in a dayroom, furnished somewhat like a living room, where we

could talk, smoke, or just stare quietly off into space. But it was not a

living room. Anyone would have known in a heartbeat that this was a

place for mental patients.

Sitting in one corner was a young man rocking back and forth on

the chair, talking gibberish to himself, with a blank stare, hair that

hadn't been washed in weeks, and the remnants of his last meal on

and around him. I was told he was from an upper-class, wealthy,

accomplished family. All of his siblings had gone to Oxford; he'd

ended up here instead.

This was the first seriously ill psychiatric patient I'd ever seen. He

scared me to death. It was the first time I imagined that I could be that

sick. Will I end up like him?

The days at the Warneford turned into a week, then a second week.

I canceled my appointments with my tutor, using what no doubt

sounded like completely lame excuses (on the other hand, he was

probably quite familiar with the sporadically unpredictable comings

and goings of moody graduate students). There was no attendance

taken at lectures, so my absence there went unremarked. As for the

work itself, I was convinced I would be able to keep up with my

reading and somehow catch up...After all, this was temporary. This

was like a bad cold, or a bout of the flu. Something had gone wrong; it

was simply a matter of finding out what that something was and fixing

it.

I slept each night in my own bed, tried to read before shutting out

the light, then rose the next day and trudged back to the Warneford. It

was at this point, I think, that my life truly began to operate as though

it were being lived on two trains, their tracks side by side. On one

track, the train held the things of the "real world"—my academic

schedule and responsibilities, my books, my connection to my family

(whom so far I'd managed to convince, on a series of blessedly brief

long-distance phone calls, that everything at Oxford was going just

fine, thanks). On the other track: the increasingly confusing and even

frightening inner workings of my mind. The struggle was to keep the

trains parallel on their tracks, and not have them suddenly and

violently collide with each other.

Daily, my thoughts grew more disorganized. I'd start a sentence,

then be unable to remember where I was going with it. I began to

stammer severely, to the point where I could barely finish a thought.

No one could stand to listen to me talk; some of the patients made fun

of me. Disengaged from my surroundings, I sat in the dayroom for

hours at a time, jiggling my legs (I couldn't sit still, no matter how I

tried), not noticing who came in or out, not speaking at all. I was

convinced I was evil. Or maybe I was crazy—after all, I was sitting in a

mental hospital, wasn't I? Evil, crazy; evil, crazy. Which was it? Or

was it both?

One by one, each member of the staff tried to talk me into using

antidepressant medication. Their recommendation surprised me. I

thought they would encourage me to take something that would calm

my body or organize my speech. Either way, antianxiety or

antidepressant, I was adamant in my refusal. All mind-altering drugs

are bad. I am weak, I simply need to get stronger, try a little harder,

and all will be well. Was that the sentient part of my mind speaking,

or the fractured part? I could not tell.

I spent most of one desperate weekend walking alone near the

university, in a beautiful place called Christ Church Meadows. But the

beauty of my surroundings made no impact on me at all; for all I knew

I could have been walking in an underground cave. I felt only

desperation, and a profound isolation that every day seemed to

burrow more deeply into me. What a waste of oxygen it was for me to

draw breath. Suddenly, the solution presented itself: killing myself.

There it was again. And it seemed the best option. I'll douse myself

with gasoline and light a match. A fitting end for a person as evil as

I.

When I trudged back to the Warneford and reported to the staff

what my weekend stroll had consisted of, they upped the ante. "You

need to come into the inpatient unit now, Elyn. You need to come in,

and stay in. You're in serious danger if you don't." I didn't need much

convincing. Terrified of what I might do if left to my own devices, I

went back to my dormitory room, packed up my belongings, and

boarded the bus that would deliver me to a mental hospital.

I boarded the wrong bus. Confused about where I was, where I

needed to go, and how exactly to get there, I finally arrived at the

Warneford several hours late.

I had all the makings of an excellent mental patient.

When I'd first gone to the day hospital, I at least went back to my

Oxford dorm at night, and so could continue to tell myself I was a

student. Throughout each day, I often felt caught somewhere in

between. Was I a mental patient or a student? Where did I really

belong, at Oxford or at the Warneford? Should I spend my days in the

library or in group therapy? The choice always seemed to be mine.

But the minute I checked into the inpatient unit, the pretense of

being a student no longer held: I was a psychiatric patient, in a

hospital for the mentally ill. The in-sane. Unlike inpatient units in the

States, however, this one had no locked doors. I can leave anytime I

want, I told myself, trying for reassurance. After all, if I stayed, it was

because I decided to.

As part of my admission to the inpatient unit, it was necessary for

Dr. Smythe to give me a complete physical exam. At first, it was

comforting to feel her gentle touch, hear her voice soothing me, telling

me everything would be okay. Her entire manner was pure kindness;

when was the last time I'd even experienced kindness? When was the

last time another human being had even touched me, let alone gently

and with the kind of care that might be seen as a kind of affection?

But then my mind abruptly corkscrewed: I'm vulnerable, I'm open

to attack, I'm exposed in front of her and she's going to hurt me. Once

the exam was over, I sat up quickly and covered myself, staring

straight ahead as she completed her intake notes. Only the craziest of

the crazies come to a mental hospital. I am lazy. I have not fought

hard enough. If I had really tried, I wouldn't need to be here.

Most patients, including me, slept in a large dormitory, with ten or

so beds in a single large room, although there were a few single rooms

in each ward. The people I met, and ate with, and was in group with,

were not all that different from those I'd met at the day hospital. One

of them, a pleasant young woman named Lynn, was a nurse who

believed that people were sending her coded messages by the way they

parked their cars. She was typically British in appearance—fair skin,

fair hair, medium height, a bit plump. She had an approachable

manner, and I was so lonely. We became friends.

Lynn and I often took long walks around the Warneford grounds,

sometimes talking for hours. One of her favorite topics of conversation

was the many meds she was taking. "They're giving me placebos for

medication," she said, laughing, "not the real thing!" She then shared

with me her amazement and delight that they actually worked!

Months later, long after we'd both gone back into the world, I saw her

walking around Oxford in a daze, grown obese from the drugs.

Another patient, an older woman back at the Warneford for the

second time, relayed the information about her repeat status in a

matter-of-fact manner, as if it were not uncommon and might even be

a good thing. Simply, she had been "in" last year, left for a while, and

now here she was, back again. It gradually dawned me that many

other patients were here not for the first time, but for the second, or

the third. No, I thought. Not me. This is my first. My last. My only.

Dr. Smythe, along with the other staff, kept arguing on behalf of

antidepressants. I resisted; they kept the pressure on. "What you have

is not a fault of will, Elyn," the doctor explained. "It's biochemical.

Untreated depressions can last a year or more—do you truly wish to

wait that long? The meds will have you feeling better in a few weeks.

These are not street drugs, they're a way to get better."

I refused. "People ought to get better because they work at it, not

because they take some pill," I said. "Taking pills is cheating." The

words of the counselors at Operation Re-Entry rang in my head like a

big brass bell: Take responsibility for yourself The idea of putting a

pill in my mouth disgusted me. Just as disgusting was the idea that I'd

somehow become so weak of character that I needed a drug to get

better. "I'm not sick," I protested. "I'm bad."

Then one day something happened that changed my way of

thinking—that changed everything.

I looked into a mirror.

It was the first time I'd actually seen myself in weeks. And it felt as

if someone had punched me in the stomach. Holy shit, I thought. Who

is that? I was emaciated, and hunched over like someone three or

even four times my age. My face was gaunt. My eyes were vacant and

full of terror. My hair was wild and filthy, my clothes wrinkled and

stained. It was the visage of a crazy person on the long-forgotten back

ward of a hospital for lunatics.

I was scared of dying, but even more scared of what I saw in the

mirror. The woman looking back at me was in some kind of terrible,

terrible trouble. I vowed that I'd do whatever I needed to do to get her

out of this place in any way I possibly could.

The choice seemed clear: drugs or death. I went off immediately to

find Dr. Smythe. "OK, yes, I'll take your drugs," I said to her, the

words all running together in a panicky, clumsy mess that fortunately

she understood. She smiled at me in return.

"Oh, Elyn, I am so glad," she said. "This is best for you, you'll see."

Then she told me that she was going to be out of the country for

some time, and that Dr. Edwin Hamilton would be my new doctor.

The following day, I met with Dr. Hamilton for the first time. And for

the first time I finally took a prescribed psychiatric medication—

amitriptyline, an antidepressant. Three times a day, the hospital gong

would ring; three times a day, I queued up with the rest of the patients

for my pills.

Amitriptyline's most prominent side effect is sedation—

immediately, my speech slowed down, my agitation decreased, and

the world seemed to be operating in slow motion. And my mouth was

always dry and I was constantly dizzy. As uncomfortable as I was (and

as annoyed with how slowly my mind seemed to be working), I was

determined to finish what I'd started. The good news was that I

immediately began sleeping through the night, and I couldn't even

remember the last time that had been the case—the summer before?

In our first therapy session after the drug started to kick in, Dr.

Hamilton asked me how I felt. I mentioned the side effects, then

thought about it for another moment. "Strangely, I feel less angry," I

told him.

"That's very interesting," he said. "Indeed."

Not until that moment had I realized how much rage I felt,

directed mostly at myself. It was as though I had been carrying a large

sandbag on my back, and now some of the sand—just a little, but

some—had been let out. And with my load just a bit lighter, maybe

another kind of hard work could begin.

I trusted Dr. Hamilton immediately, and he was so easy to like, not to

mention easy on the eyes as well. His mother was foreign, so he didn't

look or act in a way I'd come to think of as classically British; he

seemed more open and approachable than anyone I'd met in Oxford.

He effortlessly made jokes; he spoke to me as though we were friends;

he seemed to care about me. I looked forward to our appointments, no

matter how difficult the conversations were. It was human contact,

and I craved that.

While he listened to my negative thoughts and feelings, Dr.

Hamilton showed little interest in knowing what they were about;

instead, he focused solely on how I might make them go away. Rather

than delving into my past or my unconscious, he focused entirely on

my present—what we could do to make things better "right now" and

how I might begin digging out of my depression. He offered some

simple, concrete suggestions, like making written lists and a schedule,

to keep me on track and not overwhelmed by what I had to do (and

things I kept forgetting to do, like washing my clothes).

His approach meshed well with the daily activity groups I was

attending, where I was encouraged to accomplish small things; for

instance, coming up with a good word in Scrabble or helping set the

table for a meal—simple achievements that I'd always taken for

granted before, but which now allowed me to feel some sense of

mastery and even pride.

I adored Dr. Hamilton, and I would have done anything to get

better for him. Freud had picked up on this phenomenon in the early

1900s; he labeled it the "transference cure." Like a schoolgirl with an

apple, I was eager to polish up my mental health and give it to my

wonderful doctor.

After just a week, I told Dr. Hamilton I wanted to get out of the

hospital, soon. And a week after that, I firmly announced that I was

officially ready to leave.

"Elyn, are you sure?" he asked. I could hear the skepticism mixed

with genuine concern. "There's no shame in being in a hospital while

you're being treated for an illness, you know."

Yes, yes, I was sure. "I want to get back to my studies," I said. "But

once I leave here, wall you continue to see me on an outpatient basis?"

I was grateful when he finally said he'd not only respect my wash to

go, but would continue to see me as an outpatient. The rest of the

staff, however, was visibly and vocally alarmed. The nursing staff

quizzed me about my plans and cautioned me about my expectations

for life back in the world. "Don't feel bad if you have to come back,"

they said. "That sometimes happens." No, not to me it wouldn't.

Just two weeks after arriving, I left the hospital, back to the dorm

and my academic work. I told anyone who asked that I'd been on

vacation and was eagerly looking forward to the new term. My old

tutor had gone on a sabbatical; happily, my new tutor seemed

amenable to working more closely with me. In my handbag, I carried

Dr. Hamilton's card with the time of our appointment the following

week. Everything was going to be just fine.

By my second outpatient appointment with Dr. Hamilton—four weeks

after I'd begun taking amitriptyline—it was clear to both of us that the

drug was doing what I'd agreed to take it for. I was brighter, less sad.

In spite of not having the kind of physical energy I'd have preferred, I

did feel more mentally alert, more focused, and the suicidal thoughts

had all but faded completely. I started to take pleasure in daily

life—food tasted good to me, outside air and even England's rainy

weather felt good to me, and, what's more, I could concentrate. I was

thrilled one night to realize that I'd been reading a complicated

textbook for three hours and hadn't once had to stop and begin again,

to try and unscramble text and meaning and hold my head in my

hands and weep from frustration. No, I was getting it. Slowly, I began

to speak to people in the dormitory and on the campus as I walked

here and there. I went to a few college events, and even out to dinner.

It was all falling into place again; I got up, I went out, I learned, I

spoke with people, they spoke with me. I ate, I worked, I slept. Simple

pleasures and goals, all seemingly possible. Despite my "training" at

Operation Re-Entry, I was beginning to have second thoughts—could

it be that drugs might have something to offer me after all?

Surprisingly, that whole academic term went very well. I did catch

up with the required reading, and ultimately wrote seven papers,

which impressed my tutor—at the end of that term, he wrote a very

positive evaluation for my records. The outpatient sessions with Dr.

Hamilton were proceeding nicely as well. I had no trouble

accomplishing the simple "homework" assignments he gave me, such

as preparing a daily schedule each morning and sticking to it; in the

evenings I was reading Aristotle's Metaphysics in the original Greek. I

was both the mental patient and the student, and was competently

balancing both, pacing myself, managing things.

And then, as the term was about to come to an end, I suddenly

stumbled. Mysteriously, I had trouble completing the final paper of

the semester. I'd read all the assignments, but couldn't come up with

anything to say. I made one false start after another, then crumpled

the paper and tossed it to the floor. A third sentence, a second

paragraph, a fourth page—nothing. I could not connect the dots. A

setback that might have been only simple frustration for someone

else—a slight case of writer's block, a change of plan that might have

meant taking a day or two off, going to a movie, having a beer—made

me wild with fear. Am I going backward again? Didn't Dr. Hamilton

and I solve this, didn't the amitriptyline fix it? Had it all been some

kind of chemical trick? I wanted to hit my head with something hard.

The very thought of meeting with my tutor to discuss the paper

reduced me to uncontrollable sobs. I don't have anything to say. I am

a failure. It is only a matter of time before people see I am stupid.

And crazy.

The Warneford staff had tried to caution me that I wasn't ready to

leave the hospital yet, but I hadn't listened to them—and now, it

seemed, all I could do was watch helplessly as once more, everything

began to slip out of my grasp. I started to lose weight again; in just a

few weeks, I was down to ninety-five pounds. I looked like a torture

victim.

Dr. Hamilton, however, did not want to focus on my weight loss.

"It's a red herring," he said calmly. "It's not what's really going on with

you."

I was disconsolate. "But what's wrong with me, that I can't eat? Is

this anorexia? Am I going to die?"

He said anorexia was a grab bag term. "We're not going to focus on

symptoms and labels, Elyn. Let's focus instead on you getting your

work done. And for now, just eat more, OK?"

His simple-sounding approach to my weight loss didn't help much,

but it didn't dampen my feelings for him, either. He was so smart, so

sensitive, so kind. He knows me like no other, I thought, and he

knows what's best. I would leave his office temporarily

reassured—well, if this is what he thinks, it must be true—but once

outside, I'd slam into the wall of the truth: It was all going badly

wrong. I started muttering again—I am a bad person, I deserve to

suffer. People are talking about me. Look at them; they're staring at

me. They're talking about me. In all likelihood, that part, at least,

wasn't paranoia. Given my appearance, it seems quite likely that

people were talking about me.

In all this time, I'd never told my parents about my illness or

hospitalization. I didn't want them to worry; even more important, I

didn't want them to think less of me, that I was somehow a weak or

crazy failure. I wanted to fix myself, and not have my problems in any

way leak into their lives. But the time for keeping the secret was

coming to an end. They'd let me know that they were traveling to

Paris—quite naturally, they expected that I would come join them

there and we would spend some time together.

In spite of the fact that I was thin as a rail, jumped at my own

shadow, refused to speak to virtually anyone, and went around talking

to myself, I hoped they wouldn't notice. Indeed, it was a mark of my

impaired judgment that I believed I'd actually be able to pull it off. But

as soon as we met, the stunned looks on their faces told me I wasn't

going to get away with it.

Nevertheless, it was four or five days of phony joie de vivre before

my father finally knocked on the door of my room and said he needed

to speak with me about something.

"Your mother and I are extremely worried about you," he said. I

could hear the intensity in his voice and see the effort he was making

to keep his face relatively calm looking. "We've tried to give you a

number of chances to tell us what's happened, but you're not saying.

We're so worried, Elyn, we're not sleeping at all. Please tell me what's

going on."

I took a deep breath and then plunged in. "I'm sorry I didn't tell

you," I said. "I got depressed during the year."

Was that relief on his face? It made me wonder what he and my

mother had been imagining the past few days. Had they been

discussing me each night in their room? "You're so thin," he said. "We

were convinced you had cancer."

"No," I said. "Just depression."

"How did they treat you for it?" he asked. "Because you are being

treated, aren't you?"

Here it comes. "I was in a mental hospital."

He paused a moment. "Did they give you any medicine or

anything? Don't they have medication now for depression?"

"Yes, they do," I told him. "I didn't want to take it, but finally I did,

and it has helped."

Yes, there it was—definitely, it was relief I saw. "Let's go and tell

your mother."

We walked without speaking to their room.

My mother was sitting on the edge of a chair, clearly waiting for

some kind of dire news that would no doubt involve my impending

death. When I told her what was actually going on with me (albeit the

same shortened, tidier version of the truth that I'd given my dad), she

initially flinched at the news, but relaxed when she heard about the

medication. It was a problem, there was a solution, and now it was

fixed. End of discussion. Each person's privacy and dignity was still

reasonably intact. And so, where shall we go for dinner? "Elyn, you

simply must eat more."

What transpired among us didn't much comfort or reassure me,

but at least my worst fantasies had not come true. They didn't disown

me, or tell me I was a failure, or accuse of me being weak by having to

take medication. In fact, they were kind, concerned, supportive. But I

was such a horrible disappointment to myself. How could I not be a

disappointment to them as well?

For the remaining days of our Paris trip, my parents pressed me to

eat. Have a bite of this, try a taste of that. And, as pleasantly as I could,

I took a tiny taste, faked a little bite, but in truth I continued to resist.

I am bad. Only good people get food. I deserve to starve. I deserve to

be tortured. Starvation is a fitting torture for me.

When I returned to Oxford from Paris, it got worse. I felt compelled to

go back to my first tutor, because he was the top person in ancient

philosophy at Oxford, and I wanted to study with the best. But it was a

complete disaster. His manner was distant, even dismissive; in my

view, he had a very low opinion of me. I felt doomed. I could not

concentrate. I did not write. I did not sleep, I did not eat. I did not

bathe.

I spent more and more time gibbering to myself, restlessly pacing

through the streets of Oxford, imagining what people were saying

about me. I narrated events to myself as I walked: Now she's walking

down the street. She's ugly. People are looking at her. People are not

to be trusted. Be careful. Be vigilant. They will hurt you That man's

face just turned into a monster face. Be inconspicuous. Don't let them

see you.

There were fantasies as well.

Dr. Hamilton finds me in my bed, emaciated and confused. I have

not been able to get out of bed for weeks. He is gentle and reassures

me that he can help. I want to believe he can help me. He helps me

get out of bed, but even with his help I can barely walk. I am too

weak. I am weak.

Thoughts of suicide came rushing back in, along with intense

fantasies of exactly how I'd do it. Throw myself into the river. Set

myself on fire. I was particularly drawn to the latter. I was, after all, a

witch; being burned at the stake seemed especially fitting. It was only

what I deserved.

Meanwhile, I was telling Dr. Hamilton some, but not nearly all, of

what was going on inside my head. He'd made it clear he didn't want

to delve into my darker self—and since I was still desperately trying to

please him, how could I tell him something so ugly? Please like me;

please want to help me. Please don't be disgusted with me. He

constantly urged me to eat more—and then suggested (or maybe went

along with my request, I can't remember now which it was) that

perhaps the medication needed review. Maybe it was the medicine

that was failing me, rather than me failing myself.

I'd barely had time to digest this possibility when he announced

that I shouldn't become too dependent upon him, since it was time

that we change the schedule of our meetings—to once every other

week.

I was horrified. I needed more therapy, not less—even in the midst

of my worsening state, I knew this was true. I was also baffled; in

effect, he'd cut our time together in half. Was this rejection? Was I

such a disappointment to him? Finally, Dr. Hamilton explained that

he was being rotated. As of the next month, he would be transferring

to another unit in the hospital. So the news was even worse than I'd

thought: He would no longer be able to treat me at all.

I tried to cling to the logic of his explanation, but it only felt like

loss. It was Dr. Hamilton who'd led me out of the dark woods the last

time—how would I ever get out of the woods now? By the time I

arrived for my next appointment, I had deteriorated badly; I could

barely speak, I could not meet his eyes.

Years later, after I received my records from the Warneford, I read

the note Dr. Hamilton wrote upon seeing me that day: "Looks

ghastly."

He asked if I was thinking of killing myself.

"Yes." Hunched over again, eyes to the floor. Don't look at me,

don't look at me.

"You have to come back into the hospital, Elyn. Right now."

And so, eight months after my first hospitalization—where I had

had the vain hope for a quick fix and had begun to experience the "am

I a student/am I a crazy person?" two-trains-running conundrum—I

wearily checked back into the Warneford for my second

hospitalization, officially one of those patients who had "come back."

The admission note summed things up pretty well: "Thin, tall,

chain-smoking, sad, inappropriate laughter at times, seems physically

and mentally retarded."

I hated myself.

chapter six

ALL THROUGHOUT THOSE first long hours of my second stay at

the Warneford, I stood alone in the dayroom and rocked back and

forth, my own arms wrapped around me like a straitjacket, rocking

myself much as a mother will quiet a distraught baby. The even

regularity of the movement comforted me. Skeletal, dirty, and

gibbering disjointed syllables under my breath—and unceasingly

rocking—I slid deeper and deeper into my head with each passing

moment. Doctors, hospital staff, and other patients moved in and out

of the room and along the corridor outside it: I could barely see or

hear any of them, and I cared even less.

Finally, a nurse carefully walked up to me and positioned herself

directly in front of my face. "You seem so agitated, Elyn," she said, in

that deliberately moderated tone of voice one might use to approach

an animal chewing its own foot. "I would like you to see the doctor on

call."

I shook my head, and the room spun around me. "No. That's not

necessary," I muttered. "I'm fine. Thanks anyway."

As she quickly left the room to search for a doctor (evidently, she

didn't think my self-diagnosis very credible), I just as quickly headed

in the other direction, to go outside and wander about in the hospital

courtyard. It was January—cold and damp and raw, with light patches

of hoarfrost on the ground. I was wearing only jeans, a T-shirt, and

sneakers, and I was cold to my bones; given the circumstances,

however, I might have been just as cold if I'd been wearing a down

jacket, wool hat, and heavy winter boots.

My legs gave way beneath me, and I slowly crumpled to the ground

in a heap. There I stayed, curled up in a ball, for at least an hour. What

was happening to me? Why had it happened? And who would help

me? But no one came. No one will ever come, I thought. I am

worthless, I cannot even control my own mind. Why would anyone

want to save me? Eventually, I pulled myself up and wearily went

back inside, stumbling around until someone directed me to the place

where I was to sleep. I never did see a doctor that night.

The following day, I met with a group of half a dozen doctors for

what they told me would be an intake evaluation. The meeting was

held in a very large and intimidating office. I was relieved to see Dr.

Smythe, who smiled and acknowledged me in a reassuring way. Then

the inquisition began.

"You're very thin, Elyn. Can you tell us why you've lost so much

weight?"

"I think it's wrong to eat," I told them. "So I do not eat."

"But why?" they asked.

"Food is evil," I said. "And anyway, I don't deserve to have any. I

am evil, too, and food would only nourish me. Does it make any sense

to you to nourish evil? No. It does not."

After a few more rounds of questions, the doctors carefully

explained their recommendations to me. In England, treatment

recommendations were always just that—recommendations. To leave

a hospital, to stay in it, to take medications, to participate in group

activities or not—they never forced any of it on me, and each time the

decision was mine. Even at my craziest, I interpreted this as a

demonstration of respect. When you're really crazy, respect is like a

lifeline someone's throwing you. Catch this and maybe you won't

drown.

First, they wanted me to go back on the amitriptyline; I agreed.

Second, they wanted me to stay in the hospital for a while—how long,

they weren't yet certain. This, too, was fine with me; as befuddled as I

was, I knew I couldn't be away from the hospital now. But when they

suggested that I drop out of Oxford altogether after my hospital

stay—and then questioned whether it might be best to call my parents

and let them know what was going on with me—they had crossed a

line.

I came back in full force.

"I will remain enrolled at Oxford University. I will receive my

degree in ancient philosophy. I will not return to the United States

before I have completed my academic work. And under no

circumstances shall you contact my parents." This was more linear

speech than I'd been capable of in weeks; I wasn't quite sure where it

came from, but it was exhausting. And, surprisingly, the doctors

acquiesced to my conditions.

Perhaps I should have wanted or even needed my parents to know

what kind of shape I was in. Maybe I should have been hurt that they

hadn't seemed to pay much attention to my health after our last visit

together in Paris, after I'd "confessed" my struggles. And yet it's not as

though I'd been entirely forthcoming with them, either. My brother

Warren, who was living in Paris at the time, came to visit me at

Oxford, but I made him swear he'd not tell my parents how badly I

was doing. Once a week or so, I walked to a phone booth a few minutes

down the road from the hospital, and from there called them in

Florida, collect. The conversations were always brief, even skimpy, but

evidently sufficient not to raise any alarm bells. The basic script from

my end: "I'm fine, my studies are going well here at Oxford, and how

are all of you?" Aside from that, my parents usually did most of the

talking and I just leaned on the booth for the duration, responding

where appropriate, mostly in single syllables. As I watched everything

I valued disintegrate, I nevertheless fought to somehow hang onto my

autonomy—my self. Whatever this was I was fighting, it was my

problem; I would have to find a way to solve it without either asking

for my parents' help or incurring their disapproval.

My readmission to the Warneford coincided with Dr. Hamilton's

rotation and departure to another ward. Although I'd known it was

coming, I could not control the anxiety and sadness during our last

meeting, when he introduced me to Dr. Barnes, the young woman who

would now be treating me. "I'll come back and say good-bye before I

leave, Elyn," Dr. Hamilton promised. "Just to check in with you and

see how you're doing."

Being passed along to his replacement made it real—he was

leaving me. And even though he'd be just a few rooms away, he might

as well have been going across the ocean, since his move precluded

our having any further relationship. To make things even worse, the

good-bye visit he'd promised me never happened. He never came

back. When I thought of him, I thought my heart would crack in my

chest.

Unlike during my first hospitalization, this time around I was

completely unable to participate in anything that was going on in the

ward; the group activities that had seemed at least mildly helpful

before, such as ensuring that the table was properly set, were useless

now. I was in such terrible pain, physical as well as emotional. My

head ached, my arms and legs ached, my back ached; there was

nothing in or on me that didn't hurt. My sleeping patterns were so

erratic again that I was exhausted all the time and couldn't

concentrate—what earthly difference could it have made to me if

spoons and forks went on the right or left side of the plate? Instead, I

gravitated to the music room, where I passed hours on end listening to

classical music. Sometimes I was joined there by a somewhat

overweight woman ten years or so my senior. Like me, she barely

spoke, other than an occasional word or two about her mother, who

had died many years before. When she did speak, the content was

slim—she had what psychiatrists call "poverty of speech." Still, we

shared a kind of companionship; listening to Mozart or Brahms

seemed to calm and comfort us both. At particularly stirring passages,

our eyes would meet, and we would nod in a kind of recognition.

The other patients seemed afraid of me—or maybe, seeing me

every day with my face buried in my hands, they just thought it best to

leave me be. The disheveled young man from Oxford whom I had first

seen at the day hospital was now on this ward as well, in much worse

shape than before; he believed he was a baby, and would vomit after

meals and babble nonsensical syllables. That's going to be me, I

thought. That's where I'm going.

One day, a good looking, middle-aged man was admitted to the

ward, but then quickly disappeared. I later learned in an offhand

comment from staff that my appearance especially had unnerved him.

Thereafter, he refused to spend the night at the hospital, agreeing to

be a patient on the day unit only and refusing to be with patients as

sick as I. There was, it seemed, a hierarchy of fear at the Warneford:

sicker patients unsettled me; I, in turn, unsettled less sick patients.

For a time, I was friends with a woman named Lucinda. She was

my age and was battling anorexia. The hospital had put her on a

behavioral system whereby, if she hadn't gained a certain amount by

designated days, she had to spend that day in bed. I, too, was very

thin, but my doctors had decided that the weight loss was due to my

primary diagnosis (severe depression) and not simple anorexia.

Lucinda had been treated by Dr. Hamilton at one point and told me

she'd taken a great dislike to him. This amazed me. How could

someone not like Dr. Hamilton?

A month after I'd been admitted, the staff moved me from a

private room to a dormitory with more than a dozen other patients,

explaining with classic British understatement that I "kept myself to

myself' too much, and that perhaps being with other patients would

resocialize me. The move did not have the desired effect—I simply

retreated to the bathroom, where I spent hours sitting on the floor,

smoking, rocking back and forth, and moaning softly to myself. The

bathrooms were filthy, as bathrooms can be in psychiatric hospitals,

but I didn't care. All I wanted was to be alone. If I needed to sit on

floors and lean against walls spotted with human feces in order to do

that, so be it.

Once, there'd been a time in my life when thoughts were

something to be welcomed, and pored over, like pages in a favorite

book. Just to idly think about things—the weather, the future, the

subject of a paper I needed to write for a class, the friend I was going

to meet for a cup of coffee—these things felt so simple, so

taken-for-granted. But now thoughts crashed into my mind like a

fusillade of rocks someone (or something) was hurtling at me—fierce,

angry, jagged around the edges, and uncontrollable. I could not bear

them, I did not know how to defend myself against them, and I could

not bear to be near anyone when I was experiencing them. You are a

piece of shit. You don't deserve to be around people. You are nothing.

Other people will see this. They will hate you. They will hate you and

they will want to hurt you. They can hurt you. They are powerful.

You are weak. You are nothing.

Dr. Barnes seemed to be working very hard on my behalf. At our

meetings, her manner was earnest and dogged, as though we were

archaeologists together digging for truth. But we simply could not

connect. She was so formal in her personal manner, somewhat

distant, even unsympathetic, and apparently I made her anxious as

well—she was obviously uncomfortable when we were the only two in

a room together. I didn't trust her, and I certainly didn't believe she

had any idea of what to do with me. Useless, useless.

Of course, it wouldn't have mattered how competent Dr. Barnes

truly was, given how harshly I compared her to Dr. Hamilton and

found her wanting. I was actively pining for him, and would stand in

the doorway of my ward for hours, mute and rocking, hoping to catch

a glimpse of him in the hall, walking to or from a meeting.

I was surprised to find that I had a partner in this obsession,

another patient, in her twenties or early thirties. Dr. Hamilton had

treated her for a long time, and like me, she had developed a strong

positive transference toward him—in fact, she'd clearly fallen in love

with him. A day patient on the ward from eight in the morning to eight

in the evening, she was considered one of the most disturbed patients

there. One night, at home, she abruptly shaved her head for no reason

anyone could ascertain. Although she did not speak (at least to me),

we had more than our Dr. Hamilton obsession in common; she, too,

spent most of her day rocking in place.

Sometime after Dr. Hamilton had left the ward for good, my

companion-in-thought seemed even more agitated than usual. All day

long, I watched her frantically pace the corridors. The next morning,

my friend from the music room offhandedly informed me that the

woman had hanged herself the night before. I was stunned, as much

by my friend's tone as by the news she'd so calmly passed along to me.

This patient had killed herself, I thought, over Dr. Hamilton. Why

hadn't staff noticed what was driving her and done something about

it? Why hadn't I done something? Didn't anyone realize that she could

have been me?

In my fog of isolation and silence, I began to feel I was receiving

commands to do things—such as walk all by myself through the old

abandoned tunnels that lay underneath the hospital. The origin of the

commands was unclear. In my mind, they were issued by some sort of

beings. Not real people with names or faces, but shapeless, powerful

beings that controlled me with thoughts (not voices) that had been

placed in my head. Walk through the tunnels and repent. Now lie

down and don't move. You must be still. You are evil. The effect of

those commands on me during those nights and days was powerful. It

never occurred to me that disobedience was an option, although it was

never clear what might happen if I disobeyed. I do not make the rules.

I just follow them.

It was quiet and dark down in the old tunnels, with just enough

ambient light that I could find my way around corners. The air was

musty and damp, and although I couldn't hear any of the sounds from

the busy hospital above my head, I was aware of the building; it often

seemed to groan above me. I wondered how many hundreds, maybe

thousands, of patients had been here. I wondered what had happened

to them.

Another command (or thought, or message) I continually received

was to hurt myself. To inflict pain on myself, because that was all I

was worthy of. So I burned myself—with cigarettes, lighters (easily

come by—everyone smoked then, as I did), electric heaters, boiling

water. I burned my flesh in places on my body that I thought people

would never see. I'd do it in the bathroom when no one was there, or

down in the tunnels, or out on the grounds. Once in the music room,

when I was trying my best to set my sock on fire, an attendant went by,

saw what I was doing, and tsk-tsked in a mild tone, "Elyn, really, you

mustn't do that, it's simply not on, you know."

In fact, many staff members knew what was happening; after all,

they dressed my wounds, putting salve on the burns, noting the when

and where in their charts. "Aren't you concerned," one said to me

during a repair session, "that in summer, when you wear a bathing

suit, these scars will show?"

"I don't think you understand," I said patiently. "I'm not going to

survive the year. I have no concerns about future swims, or what I will

look like in a bathing suit."

Although the staff and Dr. Barnes knew what I was doing, no one

seemed to know or understand why, and there was no way I could tell

any of them that the impetus for my behavior, the commanding

impulse, came from inside my head but was not mine. It was someone

else commanding me. I was afraid the staff would laugh at me—and as

frightened as I was, the thought of derision frightened me even more.

In retrospect, it was a life-threatening deception, somewhat along the

lines of hiding recurrent chest pains from one's cardiologist from

embarrassment.

Nearly four months in the hospital passed like this, and I did not

get better; in fact, I only got worse. At twenty-one, I was convinced

that I would die soon, so much so that I refused to discuss anything

about the future. I spent most of my time alone in the music room or

the bathroom, burning my body, or moaning and rocking, holding

myself as protection from unseen forces that might harm me. When I

was able to stir at all, I roamed the hospital tunnels.

Although they were aware that my health was not improving, the

doctors at the Warneford began suggesting that it was time I leave the

hospital. Maybe they were fearful that if I didn't go soon, I never

would. With this in mind, they referred me to Dr. Anthony Storr, a

well-known psychiatrist and psychoanalyst who consulted to the

Warneford.

Initially, Dr. Storr and I went through the usual question-and-

answer session, but there was something a bit different about this

conversation and, indeed, about the doctor himself—he seemed more

alert than I was used to, and genuinely interested in hearing

everything that was on my mind. I had a palpable sense of actually

being heard, but not judged. And so, instead of keeping my darkest

thoughts to myself, as I'd done with Dr. Hamilton, I told Dr. Storr

everything, and edited nothing in the telling. His eyes didn't widen in

surprise or horror; he didn't tsk-tsk, he didn't shake his head in

dismay. He simply leaned forward, kept eye contact with me, and

listened intently, without flinching, to every word.

Dr. Storr's subsequent recommendations were not only simple,

they were in direct contradiction to those made by the doctors who

four months before had suggested I leave school and be hospitalized.

"Your mind is very sick," he said calmly, "and just as I'd advise with a

sick body, it needs a specific kind of exercise to help it heal. That

means resuming the work you love. It makes you happy, it gives you

purpose, it challenges you. And so you need to stay at Oxford, in your

program."

I was overjoyed, and relieved. In addition to hearing me, he'd

somehow seen me as well.

"But there's a slight catch to this," he said, and I held my breath.

"You need to be in intensive talk therapy. Intensive, Elyn. Rigorous,

often difficult, and, if we can arrange it, every single day. And not

short-term, either, but for a long time. For the foreseeable future. Do

you understand what I'm telling you?"

Yes, yes, yes, whatever you say. I'm sure I was nodding like a

string puppet. In fact, at that point, if he'd said, "I recommend that

you walk barefoot on broken glass for an hour each day," I'd have

happily done it.

Dr. Storr quickly compiled a list of five psychoanalysts who might

be able to treat me, but a certain Elizabeth Jones was the only person

on his list who had time immediately available.

I repeated her name to myself. Elizabeth Jones, Elizabeth Jones. I

desperately hoped that this Elizabeth Jones might be someone who

would help me reclaim whatever was left of my life.

I had come to Oxford an ambitious and even idealistic young

woman. I'd wanted to make new friends; I'd wanted people to like me.

I'd wanted to study what I loved, do well, earn my degree, and move

full-fledged into the community of scholars I so respected. But none of

that had happened. For all my efforts, I had earned only the stigma of

a mental patient. Many years later, the words in Dr. Storr's report

seem prescient: "For a person like this, it is analysis or nothing."

Elizabeth Jones's office was actually a room on the second floor of her

home, a typical old and somewhat fusty Oxford house, more than a

century old. Mrs. Jones herself—who greeted me at her front

door—was, tall, large-boned, and stately, wearing a long flowered

dress that touched the tops of her shoes. She was, without question,

the ugliest woman I'd ever seen.

"Hello, Dr. Jones. My name is Elyn Saks." I heard myself as one

might hear a voice echoing back from the bottom of a well. My hands

were damp and shaking; I was halfway between hoping she could help

me and fearing that she wouldn't be able to. Or even want to.

"Please come in," she said kindly. "Let's sit down and talk. By the

way, I'm a psychoanalyst, Elyn, I'm not a doctor. Please call me Mrs.

Jones."

Not a doctor? This was a little alarming; did the woman know

what she was doing? And if she didn't, what were my other choices? I

wasn't sure I had any.

Mrs. Jones led me up into a small sitting room that was all browns

and greens. It wasn't messy, but wasn't precisely neat and tidy, either.

I learned later that she had a second office (within a second home) in

London; this one, in Oxford, was modest and obviously well lived in. I

felt as though she'd welcomed me into a private place, which made me

think I could trust her.

As Mrs. Jones and I sat down, she explained how the

psychoanalysis would work. After my discharge from the hospital (in a

few weeks), we would meet three times a week. When two additional

openings became available in her schedule, I would then see her five

times a week, paying eight pounds per session—roughly the equivalent

of twelve dollars in the late seventies. An analyst of equal stature in

the States would have charged many times as much. She made only

one rule for our working together: I was to say everything that came to

my mind, no matter how embarrassing, trivial, or inappropriate it

might seem. In the years we would spend together, I'd break this rule

only once: I never told Mrs. Jones how ugly I thought she was.

Three weeks later I was officially discharged from the Warneford.

My official prognosis: "Very poor." I returned to my college house and

my courses after four months away. Not one person inquired as to my

whereabouts.

chapter seven

I STUMBLED INTO Elizabeth Jones's office in a desperate lunge for

salvation, and in the process began one of the most extraordinary

experiences of my life. At the time it was often unmitigated hell. The

work I was beginning with Mrs. Jones was not "counseling" or

"therapy" as many Americans think of it or experience it themselves.

No, this was talk therapy of the densest, most intellectually rigorous,

challenging, and unsettling sort: Kleinian analysis, a treatment

method that found its origins in the work of Sigmund Freud.

Freud built his theory of mind and method of treatment upon the

concept of the human "unconscious"—the idea that we all think, feel,

and do what we do for reasons that we are not entirely aware of. He

believed that the unconscious was a "seething cauldron," filled with

primitive forces at war with one another, forces that literally drove us

to act. Central to Freud's thinking about psychoanalysis was the

powerful relationship between the analyst and the patient, or

analysand. From that relationship developed the "transference"—the

name Freud gave to the intense feelings, beliefs, and attitudes the

patient unconsciously recalls from early life and then directs toward

the analyst. It was the transference itself that was the thing to be

analyzed; it provided the raw material that would then be mined by

the analyst and analysand for many years.

Freud had many reservations, however, about what could be

accomplished with a psychotic analysand. He believed that psychosis

was too narcissistic, too inward-looking, to allow the patient to

develop a transference relationship with the analyst, and without that

transference, there would be no grist for the psychoanalytic mill. Now,

no one had diagnosed me as schizophrenic; indeed, even the word

"psychosis" hadn't yet been mentioned. Still, I was depressed, I was

behaving oddly, and people had a strong suspicion that I was

delusional. I'd read enough Freud at this point to know that with this

new psychoanalytic relationship, I was about to launch into uncharted

and potentially troubling waters.

Elizabeth Jones, however, was a "Kleinian"—she practiced an

offshoot of Freudian analysis developed by Melanie Klein, an Austrian

psychoanalyst who immigrated to London in the late 1920s. Unlike

Freud (and later, his daughter Anna), Klein believed that people with

psychosis could benefit from analysis and that the necessary

transference would develop. It was her theory that psychotic

individuals are filled with (even driven by) great anxiety, and that the

way to provide relief is to focus directly on the deepest sources of that

anxiety.

Because most human anxiety stems from very primitive (read:

infantile) fantasies about bodily parts and bodily functions, the direct

nature of Kleinian interpretation calls for using the same kind of

language that the patient's fantasies are couched in. To do this,

Kleinian analysts employ the same words and images that the

analysand uses—and as a consequence, Kleinian analysts can

sometimes sound just as crazy as their patients do. These simple yet

often startling exchanges between doctor and patient operate

something like arrows shot directly at whatever it is that's upsetting

the person being analyzed. If the arrow hits, it punctures the target;

what results is something like a valve opening and long-pent-up steam

being released.

A central tenet of both classical and Kleinian analysis is that the

treater must remain fairly anonymous to her patient—she does not

answer questions about herself, have pictures of her family on the

wall, tell you where she went to school or where she is going on

vacation. Indeed, you don't even see your analyst during your

sessions—how she looks as she reacts to you and what you are saying.

You're on the couch. There is a simple reason for this: If the analyst is

a so-called blank slate, the traits the patient attributes to her come

primarily from the patient rather than the analyst. That's where

transference develops, and the patient becomes better able to see how

her mind works. And it was that process—and, ideally, reaping the

fruit of it—that Elizabeth Jones and I embarked upon.

Though I never knew much about Mrs. Jones's life, I came to know

her well from the way she reacted to me in the consulting room: with

tolerance, patience, and understanding. Her voice was calm and

soothing; she clearly didn't frighten easily. At the same time she was

both extremely empathic and rigorously honest. She was also the first

accomplished professional woman I had come to know.

During my sessions with Mrs. Jones, I whispered—because I was

convinced that people in the house next door or across the street were

able to hear what I was saying. Soon, some of the beliefs that had

begun at the Warneford (for example, that beings in the sky controlled

my thoughts and were poised to hurt me) took center stage in my

thinking again. I would mutter complete nonsense, disconnected

words and rhymes, which even as I whispered them out loud gave me

great shame. I didn't want Mrs. Jones to hear them, in spite of her

absolute "tell everything" rule.

Me: "They're messing with fetuses. They think it's us whereas the

truth is God. Voices went, tabernacle, out to the edge of time. Time.

Time is too low. Lower the boom. The TV is making fun of me. The

characters are laughing at me. They think I am a failure and deserve to

suffer. Everyone watching knows. The TV is telling the story of my

life."

The doctors in the hospital had been stiff and formal when they

dealt with me, seemingly more interested in giving me advice—"Eat

more, Elyn!"—than in figuring out what was going on inside my head.

Mrs. Jones was different. Her training had prepared her well for me,

and she went directly to the heart of the matter, in the process sparing

neither my feelings nor my assumptions about how a proper British

matron should speak.

Mrs. Jones: "Tell me about your difficulties at university."

Me: "I'm not smart enough. I can't do the work."

Mrs. Jones: "You were first in your class at Vanderbilt. Now you're

upset about Oxford because you want to be the best and are afraid you

can't be. You feel like you are a piece of shit from your mother's

bottom."

Me: "I'm closing the curtains from now on because people across

the street are looking at me. They can hear what I'm saying. They are

angry. They want to hurt me."

Mrs. Jones: "You are evacuating your angry and hostile feelings

onto those people. It is you who are angry and critical. And you want

to control what goes on in here."

Me: "I am in control. I control the world. The world is at my whim.

I control the world and everything in it."

Mrs. Jones: "You want to feel in control because in fact you feel so

helpless."

Me: "I had a dream. I was making golf balls out of fetuses."

Mrs. Jones: "You want to kill babies, you see, and then make a

game out of it. You are jealous of the other babies. Jealous of your

brothers, jealous of my other patients. You want to kill them. And then

you want to turn them into a little ball so you can smack them again.

You want your mother and me to love only you."

While the content of what Mrs. Jones said to me was not always a

comfort (more often than not, it was startling, and had the effect of

catching me up short), her presence in the room was. So calm, so

reasonable, no matter what bizarre words and images she or I used.

No matter what I said to her, no matter how disgusting or horrible,

she never recoiled from what I said. To her, my thoughts and feelings

were not right or wrong, good or bad; they just were.

I must have looked an odd sight around the Oxford campus,

making my appointed rounds in solitude, still occasionally muttering

to myself, still lapsing (badly) in self-care, forgetting to eat, thin

enough for a good strong wind to blow me away, and always, always,

burdened with a large bag of books. In the bag were the texts I needed

for my academic studies, of course, but others as well: psychiatry

books; abnormal psychology books; a book on suicide that Dr.

Hamilton had recommended months before; a book by Dr. Storr on

the personality types that often were the underpinnings of actual

mental illness ("depressive" and "paranoid" were two that particularly

resonated with me).

Because the odd thing was, I didn't think I was particularly crazy,

or that what I often thought or felt was unique to me. Instead, I had

come to believe that everyone had these thoughts or feelings, this

sense of a force or evil energy pushing on them to do evil or be

destructive. The difference was, they all knew how to manage it, how

to hide it, how to control it, because that was the socially appropriate

thing to do. They had stronger wills, and better coping skills, than I

did. They knew how to keep their demons in check; I did not. But

perhaps I could learn.

As my sessions with Mrs. Jones increased, and I became

accustomed to spooling out the strange products of my mind, my

paranoia began to shift. Although the nameless, faceless creatures

from the sky had no less power over my fears and thoughts, the actual

human people in my daily comings and goings seemed less scary and

more approachable. No longer a faceless, threatening mass, existing

only to judge or possibly harm me (or be targets for me to harm), they

were becoming individual persons—human beings, as I

was—'vulnerable, and interesting, perhaps with something in common

with me, possibly even friendship. Slowly, I made one friend, and then

two. One evening, I had a companion for a lecture; a few days later, I

went to a small dinner party. Blinking and shaky (as though I'd been

in a cave, and the light, as welcome as it was, was something I'd have

to get used to), I began to move back into the world again.

In time, I found myself involved in actual friendships, in particular

with three other students: Dinah and Patrick, both Brits, and Sam, a

fellow American. Dinah was tall and very thin, like me, although she

was often dressed more like a hip undergraduate than the Oxford

scholar she was. She had been hospitalized briefly after college for

depression; that made me feel closer to her, and less weird. Patrick, on

the other hand, was charming, at ease, and apparently very well

adjusted and comfortable with himself.

Sam—also quite tall, and handsome as well, with huge, expressive

eyes—was often anxious about money and even more neurotic than I

was about the workload. In spite of long, slogging hours, he wasn't

convinced he would be able to do the work and finish out his degree

program in time. Although he had a girlfriend in London, he seemed

more like a loner than I was; he played the guitar (he wrote music),

and often spoke to himself as he walked through our college house,

behavior which (like Dinah's earlier treatment) reassured me that I

wasn't the only nutty one.

The four of us were soon inseparable. We would cook our meals

together, or go to Brown's, a north Oxford restaurant that served

passable American and British food. We didn't see movies, or watch

any television; in an effort to be culturally responsible, I did go off to

the opera a couple of times, but didn't like it much. Instead, we spent

endless hours talking late into the night, sitting together in our college

house or, when the weather permitted, up on the house roof, near the

chimney.

As friends wall do once the newness of friendship becomes

something more comfortable, I finally told them more about myself,

confessing my history, even the more difficult part—it was only fair,

after all, as they'd done the same with me. Learning to trust, learning

which secrets were safe to tell—this was all part of the difficult terrain

I was learning to navigate.

So they knew I had intermittently been hospitalized, and was now

struggling through psychoanalysis. Nevertheless, there were whole

parts of myself I tried desperately to keep hidden. I knew, for instance,

not to share my ongoing delusions of evil, in particular the part about

my being evil and my total certainty that I was capable of horrible acts

of violence. Not that these thoughts were wrong; I believed everyone

thought this way, but just knew better than to talk about it, much as

everyone passes gas, but not in company. But as hard as I tried, I'd

sometimes find the wrong words coming unbidden to my lips—for

example, the memorable night we all sat on the roof and I casually

mentioned having killed many children.

"It's a joke!" I quipped as fast as I could, noting with alarm the

expressions on their faces—uncertainty at first, and then, slowly, a

hint of horror. "A stupid joke! Oh, come on, everybody wants to kill

kids once in a while, don't they? Except of course they don't—hey, it's

not like I actually did that! Or would do that, you know that, right?

Don't you?" Yes, they all said, they certainly did, don't be ridiculous,

Elyn. They knew I'd been kidding around with them, they weren't

worried about me, I hadn't frightened them. But of course, I had, and

I knew it. Got to keep control, I thought. Get a grip. Keep a grip.

In spite of my occasional lapse, these three dear friends made me

happy, when for so long, nothing much had. They filled a place in my

heart that needed filling; it was just like Kenny and Margie and Pat all

over again—a small group of friends, laughing together, studying

together, sharing a life that was focused on (indeed, held together by)

our books, and our deadlines, and an emphasis on intellectual rigor. If

I could make friends like these, I thought, then I could find a way to

save myself.

Despite sometimes being too sick to work, I was making progress

on my degree. Some days, it was so slow and difficult that it felt like I

was carving rocks, and there were times I lost faith that I'd ever be

happy with my work, or produce enough of it to finish in an acceptable

manner. But the daily routine kept forcing me to concentrate my mind

and push the evil presences to the side. I had no required classes at

this point—my only fixed appointments were with Mrs. Jones—so I

had large chunks of time to write. I switched my program to a thesis

degree, so I was required to write one long paper instead of many

short ones and I wouldn't have to take an exam. I decided to write

about Aristotle's philosophy of mind, and taught myself French so

that I could read an important medieval commentator on the subject.

I wasn't always up to the task, but each time I slipped backward a

step, I'd simply resolve to move forward two more. Work harder,

work longer, keep working.

As helpful as my relationship with Mrs. Jones was proving to be, the

intensity of what I was feeling for her opened some kind of door, and

the psychotic thoughts marched right through it, growing more and

more violent every session.

Me: "I had a dream. My mother and I are standing outside. We

hear an explosion and look off into the distance. We see a mushroom

cloud. My mother and I embrace, crying, telling each other that we

love each other. Then we are both killed."

Mrs. Jones: "Your rage is so great that you destroy the planet. And

your mother—and I—we do not protect you. You hate us for that. Your

hateful feelings cause the world to explode. You tell your mother that

you love her, and you want to make contact with her and with me. But

then your rage kills everyone off."

Soon, Mrs. Jones herself became the overt object of my fantasies.

Notwithstanding Freud, my psychosis had not gotten in the way of my

developing an intense transference to her, and that transference was

not pretty. "I know you say you are my analyst," I snarled at her one

afternoon. "But I also know the truth. You are an evil monster,

perhaps the devil. I won't let you kill me. You are evil, a witch. I'll

fight."

She never even stirred in her chair, and her reply was measured in

tone. "You have hateful feelings toward me, Elyn. You hate that I know

things that you don't know. You hate that you feel you need me. You

put your hateful feelings in me and that's why you think I am

dangerous. You fear that bad part of yourself."

"Are you trying to kill me?" I hissed. "I know about the bombs. I

can make a bomb, too. You are the devil. You are trying to kill me. I

am evil. I've killed you three times today. I can do it again. Don't cross

me. I've killed hundreds of thousands of people with my thoughts."

Psychotic people who are paranoid do scary things because they

are scared. And when you're both psychotic and paranoid, it's like

that sweaty midnight moment when you sit bolt upright in your bed

from a nightmare that you don't yet know isn't real. But this

nightmare went on all through the daylight as well. The closer I felt to

Mrs. Jones, the more terrified I became: She was going to hurt me.

Maybe she was even going to attempt to kill me. I needed to take steps

to prevent that from happening.

Walking by kitchen stores, I stared through the display windows at

the knives, thinking that I should buy one and take it to my next

session. Once, I even went into a hardware store to look at the axes,

wondering which one, if any, might protect me. For a while, I carried a

serrated kitchen knife and a box cutter in my purse to my

sessions—just in case. She is evil and she is dangerous. She keeps

killing me. She is a monster. I must kill her, or threaten her, to stop

her from doing evil things to me. It will be a blessing for all the other

people she is hurting.

At the very same time I was terrified of Mrs. Jones, I was equally

terrified I was going to lose her, so much so that I could barely tolerate

weekends when I would not see her for two days. I'd start to unravel

on Thursday and be nearly inconsolable until Tuesday. In the

intervening time, it took everything I had to protect myself—and my

friends—from what was going on in my head: "Yes, of course, let's get

a hamburger, OK, let's discuss that book we both read," all the while

plotting ways to keep Mrs. Jones from abandoning me: I will kidnap

her and keep her tied up in my closet. I will take good care of her. I

will give her food and clothes. She will always be there when I need

her to give me psychoanalysis.

And then, once back in her office again, I'd tell her every single evil

thing.

Me: "I will not let you go on vacation this year. I have a weapon. I

wall take you to my room and put you in my closet. You wall stay wdth

me. You wall not have a choice. I won't let you go. Throw. So."

Her: "You feel absolutely dependent on me, like a baby, and that

makes you angry. You imagine ways to keep me near you, and some of

these ways have violence in them, so that you wall show me that you

are stronger than I am."

Her tolerance and understanding seemed endless, and her steady

and calm presence contained me, as if she were the glue that held me

together. I was falling apart, flying apart, exploding—and she gathered

my pieces and held them for me.

Psychosis is like an insidious infection that nevertheless leaves some

of your faculties intact; in a psychiatric hospital, for example, even the

most debilitated schizophrenic patients show up on time for meals,

and they evacuate the ward when the fire alarm goes off. So it was for

me. Completely delusional, I still understood essential aspects of how

the world worked. For example, I was getting my schoolwork done,

and I vaguely understood the rule that in a social setting, even with

the people I most trusted, I could not ramble on about my psychotic

thoughts. To talk about killing children, or burning whole worlds, or

being able to destroy cities with my mind was not part of polite

conversation.

At times, though, I was so psychotic that I could barely contain

myself. The delusions expanded into full-blown hallucinations, in

which I could clearly hear people whispering. I could hear my name

being called when no one was physically around—in a corner of the

library, or late at night, in my bedroom where I slept alone.

Sometimes, the noise I heard was so overwhelming it drowned out

almost all other sound. Stop, stop, stop. No. Stop. Days went by when

I simply could not bear to be around anyone; unless I was with Mrs.

Jones, I stayed alone in my room, with the door locked and my lights

out.

"Elyn, are you angry with me?" asked Sam one afternoon.

"No," I said. "Why?"

"Because you're avoiding me. You didn't come out to dinner with

us, you didn't answer your door last night or the night before, and

right now, you're scowling at me."

It's because I can't hear you, I wanted to tell him. It's louder than

you, and if my energy goes to you, I won't have any left to fight it. I

will not be able to keep it at bay. You will be in danger. We will all be

in terrible danger. I was just enough in the real world to know that

what I was thinking much of the time wasn't real—or at least it

wouldn't be real to him.

Think about having a bad flu, on a day when you can't stay home

huddled under the covers. You have business, you have

responsibilities. And so, summoning up reserves you didn't know you

had, you somehow make it through the day, sweating, shaking,

nodding politely to colleagues while barely controlling the

nausea—because you know that if you can just pull it off, then you can

go home, where your couch (or your bed, or a hot bath, or whatever

you define as comfort and safety) is waiting. You hold it together, and

then, once you're home, you collapse. For two straight years, I did my

work, met my obligations, made it through the day as best I could, and

then fled to Mrs. Jones, where I promptly took the chains off my mind

and fell apart.

chapter eight

FOUR YEARS AFTER coming to Oxford, I finally completed my

graduate degree in 1981. The whole endeavor had taken twice as long

as I'd thought it would, on that long-ago day when I first walked

around the ancient campus. I'd lost two full years to my illness.

Although (to me at least) the jury still seemed to be out as to

whether or not I was sane, there seemed to be some consensus that I

was reasonably intelligent: The examiners' response to my thesis was,

by Oxford standards, excellent, much more than I could've hoped for.

Their report said that while the extent of my thesis was appropriate to

the degree I would receive (a Master of Letters, or M.Litt.), the quality

of it was equal to that of a Doctor of Philosophy, or D.Phil., the highest

degree that the university offers.

Happily, I had enough presence of mind to be proud of myself and

what I'd accomplished. I hadn't given up. I'd managed to stay out of

the hospital for two years, and the academic work I did during that

time had been judged better than good, by objective critics who had

no reason to be kind to me in their criticism. And there was no

denying that Mrs. Jones had been the determining factor in all of that.

And so, after giving the matter careful thought, I decided it would

be best for me at this point to stay on in England for one more year, so

that I could continue my sessions with her. I had the financial means

to do so—my parents gave each of us gifts each year, and how I spent

that money was up to me. At that point, I couldn't imagine a better

investment than my own mental health. In addition, the rate for my

treatment was so much cheaper in England than in America—$12 an

hour vs. $60, at that time—that it just made sense to stay right where I

was, to continue with an analyst who knew me, knew my history, and

had earned my trust.

However, since I was not a student anymore, I had to move out of

my college house and find someplace else to live. Through a friend, I

heard about a young, divorced mother, Janet, who lived in an old

house with her four-year-old daughter, Olivia, and was looking for a

tenant. I met with Janet and liked her immediately. The house was

warm and comfortable, and the part of it in which I would live was

exactly what I'd hoped it would be. We agreed—I would move in. In

an unlikely gesture of bravura at the time, I'd bought a moped a

couple of years earlier, so now I had friends, some measure of

freedom, and a lovely, peaceful room of my own—there had been a

time, not too long before, when I could not have imagined having any

of it.

In fact, as I began that third year of working with Mrs. Jones, it

was encouraging to me to see that some areas of my life improved a

little each day. Dating was out of the question, of course—I wasn't

sure if or when I'd ever be able to think about a romantic relationship.

But I had friends, good ones. I had a nice place to live, with the

occasional added bonus of an endearing little blond girl named

Olivia—Livy—who brightened up every hour of every day I spent at

Janet's house. And I was beginning to make an actual plan for my

future.

Even though I was no longer taking classes at Oxford, I often went

to lectures there, and drew up my own self-imposed reading list as

well. I'd decided that going any further with philosophy was out of the

question—too many bad memories from the previous four years,

struggling through the densest of that literature while in the grip of

psychosis. Instead, I was increasingly drawn to the study of

psychology and law. I was fascinated by the insanity defense, for

example, and the complicated civil issues in mental health law, such

as involuntary commitment. As I paged through psychology,

psychiatry, and law texts, the case histories on the pages often seemed

eerily familiar to me—how easily I could have been any one of them.

How easily I could have slipped beneath the waves and simply never

come back up again. I wondered if there were a role I could play in the

lives of people who suffered in a way that I understood only too well.

My living circumstances created an environment in which it was

both easy to think and easy to heal. I hadn't spent anything remotely

approaching "quality time" with my own family in a very long time,

and Janet went out of her way to include me at mealtimes and

holidays. Sometimes in the evening, we'd sit together in the living

room and watch television—good British TV, something I'd not taken

much advantage of until then. Often, her artist mother, Katherine,

would join us.

Janet was soft-spoken and kind, with wonderful natural instincts

as a mother. Although she didn't talk much about herself, I learned

enough about her life to know that things hadn't always been easy.

Olivia's father was not in the picture at all, and Janet's own father had

died when she was young. She was very close to Katherine, who'd

struggled with bouts of depression. It was two or three months before

I told Janet about my own hospitalizations, but when I finally did, I

characterized them as being for depression; I never hinted at the

psychosis or the terrifying fantasies. I was too ashamed of what she

might think, and afraid that she might see me as some kind of threat

to her daughter. I know now I could have trusted Janet with anything,

and on that day, when I sat nervously in her living room and risked

telling her as much truth as I could, she was understanding and

compassionate, with no judgment whatsoever in her response.

And of course, every day, there was sweet Livy. Affectionate and

bright, she loved to draw and color, or play in make-believe scenarios

where I was the teacher and she was the student. She couldn't wait to

learn to read, and go off to school like the bigger kids in the

neighborhood. She was quite content to snuggle in my lap while I read

to her, but was just as happy if I was being the Wicked Witch of the

West—she'd insist that I do the witch's cackle-laugh while chasing her

around the room, and then she'd fall down on the carpet in a giggling

heap. Unscheduled silliness, with no goal except to enjoy the moment

and the little girl who was sharing it with me—it felt exactly like the

sun coming out after a long, long rainy season.

Even with my daily appointments with Mrs. Jones, and the research

and reading I was doing to prepare for the next phase of my life, I still

had way too much free time on my hands, something that I knew had

never been good for me. I needed to find a way to fill the empty hours.

I decided I wanted to make some sort of contribution, to repay my

debt to the professionals who'd taken such good care of me, hoping

that in the process I might be able to help others. I believed that I

understood the experience of being in a hospital for the mentally ill in

a way that the staff (or at least most of the staff ) might not—which

logically, I thought, would make me a good volunteer.

I'd been away from the Warneford long enough that I believed I

could go there without being recognized. And so, one morning after I'd

taken great pains with my appearance and rehearsed my best

interview behavior, I met with the Warneford's head of volunteers,

and we began what seemed like a very promising conversation.

"Thanks so much for meeting with me today," I said.

She nodded and smiled. "My pleasure," she said. "Now, tell me all

about yourself, Miss Saks, and why you want to volunteer here."

"Well, I'm an Oxford graduate trying to decide whether to go on in

psychology or law when I go back to the States," I said. "Whatever I

ultimately do, I would like it to be something about helping people

with mental illness. So I thought that volunteering here might be a

good place to explore this, and also get some valuable experience."

With a kind of understated enthusiasm—she seemed to convey the

idea that she thought I was a good catch—the woman began to discuss

some possibilities at the Warneford where I might be of use. As we

talked, I felt encouraged, even optimistic; it would be my first

experience in any kind of "professional" capacity, and it just seemed

right that it would take place at this particular hospital.

And then she mentioned the hospital unit where I'd actually been a

patient. At a momentary loss for words, I sat up straighter in my chair.

"Well, I'm not certain that would be the best place for me," I finally

said. "I was a patient there myself, not so very long ago. First I was in

the day hospital, and then later I stayed for a while, as an inpatient,

hmmm, well, I just don't know how staff would feel about that. I

mean, maybe it would work out, but on the other hand I suspect that

another unit would perhaps be better, at least in the beginning." Stop

talking now, Elyn. It's not going at all well.

An expression flitted across the woman's face, and then it was

gone, replaced by a tight attempt at a smile. "I see," she said, moving

some papers on her desk from one stack to another. Then she folded

her hands. In my experience, this was rarely a good sign. "You know,

Miss Saks, I'll have to look into this further," she said. "It's not entirely

clear to me at this point that there are any actual volunteer vacancies

right now, you understand, I'm sure. In any case, thank you for

coming in, I'll be in touch just as soon as I know more."

I tried to hold on to my original optimism as I left the building. I

replayed the conversation in my head—that went well, didn't it?—then

got on my little moped and motored home. And I waited.

When she hadn't called in a couple of days, I called her, and left a

message. The following day, I called again, leaving another message.

Still nothing. After I called a third time, and once again heard nothing

in response, it finally sank in what my revelation had done. It was a

painful way to learn a lesson, but it's one that I've carried with me for

the past twenty-five years. Never tell them anything you don't have to

tell them. Never volunteer any information they don't ask for.

I licked my wounds for another day or two, raging and muttering

about my disappointment to Mrs. Jones. Then I applied again for a

volunteer position, this time at Littlemore Hospital, another

psychiatric institution in Oxford. Littlemore, too, was built in the

mid-i8oos, but for poor people, and the buildings had a similar sense

of gloom and doom. During the interview and on my application, I

said nothing whatsoever about my own psychiatric history. They

accepted me immediately, and scheduled me to be there five to ten

hours each week.

At Littlemore, I worked primarily on the Activities Unit, where the

patients, most of them chronically ill, came to spend time every day. I

led exercise groups and art groups, and sometimes I just sat in the

dayroom and chatted quietly with the patients. From the very first, I

had no nervousness or anxiety whatsoever about being with them; it

seemed completely natural to me to be there, to do whatever I could to

make someone's burden of illness even a little bit lighter.

One of my favorite patients was Tom, a tall, nice-looking man,

somewhat overweight (probably from the meds he was taking, which

were notorious for this side effect). He'd come from a fine family and

was a former patient of R. D. Laing, the prominent "anti-psychiatry"

psychiatrist of the sixties. Intelligent and articulate, Tom regaled me

with stories of the LSD parties Laing used to stage in the woods for his

patients. I wondered exactly why he was in this unit, but I presumed

that he needed this kind of structure to remain as intact and coherent

as he seemed to be.

There was another patient, Robert, a short, muscular man, who

initially didn't seem ill at all to me. Then I learned that before he came

to the Littlemore, he'd been a patient at the fabled Broadmoor in

London, one of the British hospitals for the criminally insane. One

day, as I was rounding up patients to go on a day outing into town,

Robert walked up to me, his fists clenched, his face quite red and

angry, and he muttered something unintelligible in a way I can only

characterize as a threatening snarl. What on earth? Somewhat

alarmed, I asked the staff what was going on.

"Oh, Robert killed his first wife," they said casually. "That's why he

was in Broadmoor in the first place. And now he's just gotten engaged,

so he's probably a bit wound up."

Oh, so it wasn't just that the man was crazy—he'd actually killed

somebody. I wondered if maybe I'd momentarily reminded Robert of

his wife. And the next day, when he was the only one who wanted to go

into town with me, I felt a sinking sensation in my stomach. Was he

angry at me? Was I in some kind of danger from this man who'd killed

one woman, and perhaps could be provoked by unseen forces to kill

another?

He was just fine on the trip, both going and coming. That was

when I learned that for all my good intentions, I could be

simultaneously on the receiving and the giving end of the stigma that

goes along with mental illness.

One afternoon on the unit, one of the patients, Henry—suddenly

and without apparent provocation—jumped full-body on another

patient, screaming wildly as he did so. Staff and some other patients

pulled him off and away, taking him to a different part of the unit,

where he sat and calmed himself. An hour or so later, a doctor came in

and sat with Henry, quietly telling him that what he'd done wasn't

appropriate and couldn't happen again. There was no punishment for

Henry's infraction, no beefy orderlies standing ready to mete out some

kind of response, and no physical restraints. No straitjacket, no

leather straps to hold Henry in his bed or on a chair. In fact (and in

sharp contrast to most American hospitals, even now), British

hospitals rarely use any kind of mechanical restraint, and have not for

over two hundred years. Save for a small percentage of extreme cases,

there was rarely anything dramatic that happened after the kind of

scene Henry had just created other than a simple, humane, and clear

response, with the basic message addressing the inappropriateness of

the behavior, instead of the damaged mental capacity of the patient.

In spite of being perceived by the patients as some sort of authority

figure—"on the other side of the medication counter," so to speak—I

usually empathized more with them than with the hospital staff. In

truth, I sometimes felt oddly competitive with the patients, weighing

in my mind which of us was sicker, they or I. After all, I was seeing

Mrs. Jones every day, and I was having ongoing psychotic thoughts.

Yet here I was, operating autonomously, seemingly in perfect control

and perfectly qualified to operate in the "outside"—that is,

sane—world. Yes, part of me was proud of being a caregiver, but

another part of me wanted to be taken care of, as the patients were.

Their moods and emotions were all over the place, all the time, and

the hospital accommodated that. I, on the other hand, was expected to

stay focused, disciplined, and measured in my behavior, in spite of the

soundtrack in my head that told me I was evil and potentially

catastrophic. It occurred to me each time I left the hospital that I was

something of a serious fraud.

And yet I did my job there conscientiously and well, and took a lot

of satisfaction from it. After all these years of being buried in books, or

being enmeshed inside my own head, connecting like this to other

people gave me a purpose. I was doing something worthwhile, and I

knew it. It wasn't arrogance I felt, it was pride, as much pride as I'd

ever had bringing home a report card of As to my parents. And when,

inevitably, it was time for me to leave Littlemore, the patients there

made a farewell card for me, which each of them signed. Many wrote

small notes thanking me for spending time with them. In my room

later that night, I turned the card over and over in my hand, reading

their words and marveling that it was me they were writing to, and not

the other way around.

Partway into that third year of analysis with Mrs. Jones, I noticed,

somewhat to my dismay, that I was becoming something of a

hypochondriac. Nearly everything that happened to me physically—a

cold, a paper cut, a headache, a stubbed toe—became an immediate

cause for serious concern, a reason to go see the doctor, a potentially

fatal illness. One day, I was riding along on my moped when a car cut

me off sharply, and I fell to the street, hitting my head. I was knocked

unconscious, and the hospital where I was later examined insisted on

keeping me overnight for observation. I was nervous about all the bad

scenarios that a head injury presented (death, amnesia, blindness,

brain damage, seizures...) but also, oddly, exhilarated that I'd survived

at all. Overall, the hospital environment—the smells, the sounds, the

overhead lights that never go out, the faceless, uniformed people

walking around and talking to one another in a code only they could

understand—completely unnerved me. All I could think of was that I

had to get out of there, before something else happened.

Well, now, this is pretty interesting, I thought. If I fear dying so

much, maybe that means that I don't want to die anymore. Maybe it

means that I actually want to stay alive, and find out what happens

next.

Near the end of my third year with Mrs. Jones, my former college

housemate, Patrick, was to be married, in Manchester. A small group

of us traveled together in one car to the wedding. I don't quite

remember how I ended up with this group, since I didn't know

them—it was probably a result of one of those you-call-so-and-so and

somebody's-putting-a-group-together kind of things.

I don't think I spoke more than ten words on the entire trip; I was

completely in my head, lost in one fantasy after another about Mrs.

Jones, and how to keep from leaving her. Mrs. Jones and I had agreed

that it was time for me to go back to the States, to get on with my life

there. We had agreed that our work together was coming to a logical

end. And yet the mere contemplation of that "end" had started my

mind and my anxieties on a collision course with each other.

In the car, everyone else was chatting merrily—on the drive up to

Manchester, it was with anticipation for the wedding and the

celebration, on the way back, it was retelling various moments and

events of the day—but I was completely silent. That was my way.

When the fantasies took over, I could see only them. And while lost in

them, I would exert as much of my will as I could summon to keep

anyone from knowing what was going on.

The ceremony, in a beautiful old church, was somewhat more

religious than I'd expected, and I was surprised to find myself in tears

as the bride and groom exchanged their vows. Not tears for myself,

but for Patrick, who had always been quite dear to me, a good and

kind friend. He deserved happiness, and I truly wished for him to have

it. But for the most part, the wedding, and the reception afterward,

went by in a blur. It simply felt like an endless passage of time in

which I could not engage and could play no part.

I go to my session. I threaten Mrs. Jones with a knife. I am very

psychotic and out of control. Mrs. Jones is kind and gentle. She asks

me for the knife and I give it to her. I start screaming. I throw myself

against the wall. Mrs. Jones and her husband restrain me. The

ambulance arrives and takes me to the hospital. I become out of

control again and am subdued. I am crying and sobbing that I will

be leaving Mrs. Jones.

With psychosis, the wall that separates fantasy from reality

dissolves; inside my head, the fantasies were real, and everything was

actually happening. The images I saw, the actions I took, were all real,

and it made me frantic. Mrs. Jones had been the glue that held me

together. With that glue soon to be gone, would I not shatter into a

thousand pieces? The anxiety was overwhelming, and our sessions

became more intense and hallucinatory:

Me: "You can't leave. I won't let you. Plupenitenary issues must be

addressed. That's a dress. Come home with me, please?"

Her: "I think, you see, that you make yourself confused because

you want to avoid the pain of separation. It's upsetting to think I have

a life of my own, apart from you. You are trying to live inside me."

Me: "I am inside you! Your organs are slimy, just like you are. You

think you own me, but I own you. My every command is your wish.

You don't exist."

Her: "You would rather kill me off than think I am separate from

you."

Me: "I see truth. You see lies. In my mind I'm going to Carolina."

Her: "You are so upset about leaving because it disrupts your

fantasy that you own me. You have had the fantasy that I was totally

under your control. Your possessiveness then spoils me. But I must

remain under your control at all costs."

Me: "You are under my control! You go where I go. There will be

no separation. I've killed people before and I will kill them again. I

give life and I take it away. You have no choice. I am God. Nothing

comes from nothing. Nothing. God. Taken away."

Her: "Your fantasies help you avoid the pain of separation."

Me, raising my voice: "They are not fantasies! It's real. I am God. I

am the One. One. Two. It's a mess."

It was indeed. I left each session completely drained, and

wandered around for hours trying to summon enough calm (or

enough energy to fake it) to go back to Janet's house, where I would

have tea, sit on the floor, and read a fairy tale to Livy.

After a lot of thought and research, I finally decided to apply to law

school, rather than to graduate school in psychology. My list of schools

was ambitious—Yale, Harvard, Stanford—and in preparation for the

upcoming LSAT exam, I was reading more intensely than ever, plus

attending the lectures in law, psychology, and one that combined

psychiatry and the law. But I was getting only a few hours of sleep

each night, and it was making it difficult to concentrate the next day. I

needed to calm down, to rest, and to somehow focus my mind. For the

first time in my life, I actually wanted to take drugs. I went to my

doctor and explained what was going on, and he gave me Halcion to

help me sleep. This time around, no one needed to convince me to take

meds; in fact, each night, when the drug kicked in and I felt myself

falling into unconsciousness, I was, for just a moment, deeply grateful.

The exhaustion may well have been a factor in what happened

next: another moped accident. Two days before I was to go to London

to take the LSAT exam, a cyclist came around from behind me, then

turned abruptly in front of me. I hit his bike and fell again to the

ground, this time breaking my collarbone. If there was a worse pain

than this to be had, I could not imagine what it might be. The doctors

said I would be in a sling for six weeks. It meant postponing the

LSATs, and doing my best to keep my restless body as still as possible

while the bone knit itself back together.

Things with Mrs. Jones were going from bad to worse. During

session, I paced restlessly back and forth, or sat curled up in a corner,

moaning in pain and grief. At times, I lay on the floor and clutched her

legs, muttering that I could not live without her. When would I see

these rooms again, how would I cope? I even took to locking myself in

the bathroom. That problem was quickly remedied when Mrs. Jones's

analyst-husband, a transplanted American named Dr. Brandt, simply

removed the lock from the door.

Often, I couldn't leave the office at all when our sessions were

over. Mrs. Jones would say a very calm good-bye, then Dr. Brandt

would walk me out the office and out of the house. More than once, I

stood out front, rocking back and forth, keening and moaning quietly.

Inevitably, Dr. Brandt came out and asked me, gently and firmly, to

please go home.

Finally, the time came to go to London for the LSATs. The night

before, I stayed in a bed-and-breakfast, where a couple on the floor

below me managed to argue with each other, loudly, throughout the

entire night, the ebb and flow of their fight rising through my

floorboards like some kind of toxic air. At the most, I got two hours of

shredded sleep, and felt stupid and clumsy all during the exam the

next day. I was convinced I'd done poorly. Yet when the news came, I

learned I'd done as well as I needed to. All my schools accepted me. I

chose Yale.

I felt enormous, if momentary, relief. My plans were set for the

following year. I needed the structure and the challenge, I knew that

much about myself, and now, once again, I had set the bar high for

myself. This is the right thing to do, I thought. I'll be fine. I have to be

fine.

My final session with Mrs. Jones arrived. In stunned disbelief, I

remained silent for most of that last hour, and when the end of the

session came, I ran out into the waiting room and sat down, sobbing.

Mrs. Jones came through the door right behind me.

"Elyn, you must go now," she said. "Another patient is coming

soon, and our time together has come to an end." She and her

husband must have been prepared for this, as he was suddenly there

as well—he was a chain-smoker, and the scent that came from his

body and clothes filled the room. I felt as though I were fighting for

"It's time to leave us now," said Dr. Brandt. "Come now, Elyn, this

won't do. We'll just say good-bye here, shall we then?"

"No," I said, hunching my shoulders as though I expected them to

hit me. How could they be so cruel to me? "I'm not leaving here. I

can't."

"Yes. Yes, you can." The two of them, in chorus now.

I shook my head. I looked up at them, pleading with my body and

my eyes. "I can't, don't you understand? I cannot leave her. I will not

leave her."

"Other patients are coming, Elyn," said Mrs. Jones, gently but

firmly. "You'll upset them. Just imagine if you arrived for your

appointment, and came upon a scene such as this between me and

another patient. That would not be fair, would it? You can do better

than this. Come now, it's time."

Dr. Brandt stepped toward me, gently but deliberately, and just as

he was about to take hold of my arm to walk me out of the room, as he

had done many times before, I lunged for the pipes lining the wall and

grabbed onto them as tightly as I could. Luckily it was summer, since

they were heating pipes, and I would have been badly burned. Cool to

the touch now, they provided a kind of ballast that made me equal to

the strength of both Mrs. Jones and Dr. Brandt. How could Mrs. Jones

do this, after all we had been to each other? Surely there was

something I could do or say that would sway her, and draw her back to

me?

"I'm not going!" I cried, and tightened my grip.

In a gesture that made me feel like I'd been struck by lightning, the

two of them suddenly grabbed hold of me and tried to pull me away.

But I was taller than both of them, and had the added advantage of the

pipes. Dr. Brandt was trying to loosen my grip, and Mrs. Jones was

pulling me by the hair. We were all completely out of control, and I

was sobbing and screaming wildly. How could this be my Mrs. Jones,

yanking at my hair and ignoring my cries for her to stop being so

unkind?

"We need to call the police," she said to her husband. Police? For

me?

"No, no," said Dr. Brandt. "No, they'll only take her to a mental

hospital."

"I'm not leaving!" I screamed at the top of my lungs.

Finally, defeated, Mrs. Jones left the waiting room for her next

appointment. "This is a shame, for you to do this to her, Elyn," said Dr.

Brandt. But I wasn't having it. Stunned at her betrayal, I nevertheless

could not leave Mrs. Jones behind.

Ultimately, they decided to leave me be. They each saw several

rounds of patients, with me all the while sobbing quietly in the waiting

room. Several hours passed, and near the end of the day, Dr. Brandt

came back to me.

"Elyn, Mrs. Jones is downstairs, waiting to say good-bye to you,"

he said. "If you are not able to leave on your own, we will have to call

the police. This must end now. Are you ready to go?"

In all my confusion and pain, I knew that he meant it. I knew I'd

pushed things as far as they would go, without something or someone

getting badly hurt. "Yes, I'm ready," I said quietly, and went

downstairs with him, my shoulders hunched over and my legs

weighing a thousand pounds apiece. When I put my arms around Mrs.

Jones, though, I began to cry uncontrollably, soaking her shoulder.

She had been the tether that held me to the outside world, the

repository for my darkest thoughts, the person who tolerated all the

bad and evil that lay within me, and never judged. She was my

translator, in a world where I felt most often like an alien. How could I

survive in this world without her?

Mrs. Jones pat-patted me on the back and stepped out of my

embrace. "Take courage, Elyn, take courage."

I don't know how I got home, but once I got there, the lights were

all out, and Janet and Livy were long since in bed and asleep. I sobbed

throughout the night.

My flight back to the States left the next day. In the long hours of

the trip, with the stale air and the bad food and the transient sounds

of fussy babies and coughing passengers, I was cold, and alone, and

awash in fantasy and grief. Over and over, I replayed the previous five

years, trying frantically every single moment to keep the demons in

my head from invading the plane and savaging the other passengers.

From time to time, I considered asking the flight attendant whether

she would mind if I jumped out the emergency door. Other than that,

it was an uneventful flight.

chapter nine

As ALWAYS, MY family greeted me at the airport in Miami. I noted,

barely, that my parents had aged somewhat since our last visit

together, although I suspected that to an outside observer, they looked

far more hale and hearty than I did. The number of tan and healthy

faces that swirled around us as we waited to retrieve baggage and deal

with customs felt like a personal rebuke—I knew I had the pallor of

someone long indoors, nose in a book, spirit in a turmoil.

Although I would tell my mother and father about my second

hospitalization soon after I had arrived back home, I would be

intentionally scarce with details. So they didn't know any, didn't ask

for any, and in any case I wasn't going to give them any now. What

purpose would it serve, except to heighten their anxiety and add to my

self-consciousness and shame? So the talk on the ride home floated

carefully on the surface: Congratulations on the fine academic work.

Glad to have you back in the U.S. finally. Yale for law school, this is so

exciting. You're terribly pale and thin, Elyn, it will be good for you to

spend some time in the sunshine.

My parents had apparently decided that I could chart my own

course and didn't need any help. On one hand, I was always relieved

when our conversations turned into nothing; on the other hand, I

sometimes wondered what it would have been like, just once, if they'd

turned into something. But there was a wall of appropriateness

between us at all times; in fact, we'd spent years carefully constructing

it, I on one side with my particular set of tools, they on theirs, with the

tools they'd chosen. As long as nothing gratuitously unpleasant

happened (as long as I managed to keep myself sufficiently pulled

together to interact with them without making some kind of mess), all

was calm, on that first day together, and on all the rest of the days

throughout that endless summer.

"How was your day?"

"Oh, it was good, I got a lot done, how about you?"

"Oh, the usual. Here, have some of these wonderful tomatoes."

Nothing, nothing, nothing.

I didn't have any classes that summer; in fact, I didn't have any

commitments at all—and the absence of a calendar and an organized

structure quickly knocked me sideways. In addition, I was taking no

medication, except for sleep, and sometimes I wouldn't even take that.

So most of my days were spent burrowed in my room, frantically

clacking away on my typewriter as I wrote Mrs. Jones one grieving

letter after another. Ten, fifteen pages at a time, and sobbing all the

while, with the classical music turned up so no one in the house could

hear me. There were moments when I thought the grief of the distance

between us would leave me doubled over on the floor. The blinding

Miami summer sunshine, the weight of the humidity, the bright

chatter and busyness of the people I passed by whenever I ventured

out—what could anyone know of the fantasies I had? Or the demons

that I wrestled with in the night, and the way I needed to grit my teeth

together during the day in order to summon the simplest pleasantries

of excuse me and thank you and I beg your pardon? Please, Mrs.

Jones. Please, please.

Occasionally, I received a letter back from her, measured and kind

and cautionary in tone—recognizing most probably that we needed to

keep a certain boundary, because we were no longer in an analytic

relationship. I was profoundly relieved each time she wrote; it meant

that she wasn't dead, and that I wasn't, either, at least in her mind.

Her words attempted to soothe me, acknowledging that I was having a

hard time in this transition, and that she washed it would all be better

soon. She knew I missed her. Steady on, and all would be well.

And then, suddenly, there was a cluster of news stories about a

workplace shooting, a disgruntled postal worker, and dead coworkers

left in the wake of his rage. The postman left a tape recording of his

thoughts; disjointed, psychotic ramblings that didn't sound so very

different from my own. The man sounded crazy. Could I do that?

Have I done that? Am I a mass murderer? Am I him? Did I shoot

those people? Was the wrong person killed? It haunted me for weeks,

worrying that somehow I'd had a hand in the carnage. Was the wrong

person accused? Should I go to the police and confess? I'm evil. There

are voices and commands. One must do what they say. Tell them to

get away!

Kenny and Margie Collins, my old friends from Vanderbilt, were living

in Carbondale, Illinois, where Kenny had been teaching English at

Southern Illinois University for six years. We'd stayed in close touch,

and they invited me to come and visit them. Desperate for a change of

scene, and nostalgic for the kind of simple certainty their friendship

had always given me, I packed up and left Miami for what I hoped

would be a good trip.

The initial stage of the flight was direct to St. Louis; from there, I

had to take a prop jet to the airport nearest Carbondale. The plane was

smaller than I was used to, and far noisier. It also flew much lower to

the ground than the transatlantic jets did, and I was hyperconscious of

the land passing below us, with the farms, rivers, roads, and vehicles

clearly visible. As the minutes went by, I became convinced that

something terrible was going to happen, that the plane would crash

and burn, and only my sheer force of concentration and will could

prevent it. Perhaps if I held my breath. Perhaps if I closed my eyes and

counted. No, closing my eyes in the middle of death-and-destruction

fantasies was never a good idea; I needed to be alert.

Nothing happened, of course. The flight was uneventful, we landed

in good order, and the smiling faces of my dear friends when they

greeted me managed to subdue the fantasies. As I began to reclaim

myself a little, I did my best to participate in the kind of rambling,

catching-up conversations old friends take for granted when they're

together after a long time apart. I chattered like a magpie about

Oxford, my years in England, the difficulties of the relocation, the

upcoming challenges of Yale. It was as though I were scared of what

might happen once I shut my mouth.

Kenny and Margie lived in a big, comfortable old house, and did

everything they could to help me be relaxed and at home there. Their

life together seemed to be so peaceful, so normal. Kenny seemed to

enjoy his job and his students and colleagues; Margie seemed equally

happy teaching at a local nursery school. They'd known about my

hospitalization, but I never did tell them about being psychotic. I

wanted them to think well of me. I didn't want them to look at me and

see a crazy person. Most of all, I wanted to stay with them longer,

hoping to absorb their normalcy, to take courage from their intrinsic

trust that I was a good friend and a decent person. But I couldn't stop

writing Mrs. Jones, and at night, I couldn't stop crying.

Soon after my return to Miami, it was time to prepare to head

north to Yale. As much as I'd anticipated this, when it actually came to

making the necessary plans and decisions, I was completely

flummoxed, and panicky as well. I made lists of what I thought I

needed to do, then just as quickly scratched things off and replaced

them with others. Should I fly into New York's LaGuardia Airport,

even though New Haven was two hours away? If so, then how would I

get to school? Or should I fly into Hartford, which was closer, but had

fewer flights? What time of day should I fly? Should I carry everything

with me, or should I send luggage and winter clothing on ahead? And

what about clothes? Law school, an Ivy League college...The thought

of a shopping expedition with my mother horrified me (I suspect it

horrified her as well), so once again I went to the L.L.Bean catalog for

mostly dark and sturdy pants, shirts, and sweaters. My mother raised

her eyebrows almost imperceptibly, but I brushed away her concern.

I'd never cared much how I looked, why should I start now? Besides, I

had no energy to waste on my exterior, when so much of my focus was

on the barely managed chaos inside my head.

The Yale Law School—the Sterling Law Building—sits on an entire city

block in downtown New Haven, across the street from the main

University Library. Built during the Depression, it's a group of

imposing gothic structures, with the requisite carvings, sculpture, and

stained glass windows, many adorned with brightly colored glass

medallions. As grand as that sounds, though, at the time I was there,

the complex was drafty, run-down, and very poorly maintained—not

until 1995 would there be a badly needed, multimillion-dollar

renovation that took five years to complete.

I would be staying in a two-bedroom suite, with a common living

room which I'd share with Emily, a vivacious redhead from a wealthy

family who was so excited to be there that for anyone else, her cheerful

enthusiasm might have been contagious. But not for me. I was in no

shape to start all over anyplace, let alone someplace so daunting as

Yale Law School.

Once classes began, the amount of work I had to do required that I

stop writing letters to Mrs. Jones. We were in class nearly twelve

hours a week, with additional hours in the library before, after, and

well into the night. The law school and the living quarters formed a

sort of quad, so for most of us, it was almost a case of rolling out of bed

and right into a classroom. Although Oxford had been challenging,

there hadn't been such constraints on my time and efforts there.

Within days of beginning my classwork at Yale, I was on a treadmill

that seemed to have no "stop" button.

My social life was as it had always been when I arrived somewhere

new. I was meeting people, but not really making friends. I could not

risk anyone knowing the truth. There was no one to trust, no one who

would not be repelled by the workings of my mind. And, as much as

I'd always felt like an alien, it was particularly pronounced those first

months in New Haven. It was 1982, and I'd been out of the country for

five years. I knew almost nothing about American culture, or the latest

trends and celebrities, and cared even less. Political conversations

went right over my head; someone had tried to assassinate President

Reagan while I was away, and it had barely entered my consciousness.

People on campus were listening to music on small tape cassette

players with headphones, and talking about rock videos. I'd never

seen or heard of rock videos (or the fledgling rock television station,

MTV, let alone cable television), and I'd missed five years of movies—I

don't know why my friends and I didn't go to any at Oxford, but we

didn't. I was still wearing navy blue docker-type sneakers, while

everyone else had moved on to running shoes, the fashion at that time.

I spoke with a slight British accent (which many Americans

recognized as British, but which a Brit would immediately know as

American), and no doubt it made me sound like I was putting on airs.

In fact, I'd unconsciously adopted a lot of British behavior—I was

arm's-length with people I didn't know, and was somewhat taken

aback when students addressed some faculty members by their first

names, or asked personal questions or made casual comments that

seemed rude or invasive to me. For the last five years I'd been referred

to as "Miss Saks" in any professional setting; the shift to "Elyn" felt

odd and a bit disorienting.

My correspondence with Mrs. Jones had provided me with a kind

of safety valve or repository for all my ravings. I knew that the person

who was reading my letters knew me, understood me, and understood

the context in which I wasWTiting. But once I had no time to write her,

there was no place for the craziness to go, and the pressure slowly

began to build. In addition, I wasn't in any sort of treatment or

therapy, or taking any kind of medication. There were plenty of

indications that I should do something—talk to somebody, take some

kind of pill. I knew that much; I was not, after all, stupid. But pills

were bad, drugs were bad. Crutches were bad. If you needed a crutch,

that meant you were a cripple. It meant you were not strong enough to

manage on your own. It meant you were weak, and worthless. For me,

my worth was defined in and by work.

I need to work. I tried to ignore the fact that I was convinced the

person teaching legal research was making derogatory comments

about me during lectures. I tried not to pay attention to the other

students, who of course believed me evil and defective, and talked

about me when I was out of earshot. There was no peace or respite to

be found in my living quarters—that's where my endlessly cheerful

roommate studied. I wanted to call Mrs. Jones, but Emily was always

there, and the thought of her overhearing that conversation appalled

me. If I just tried hard enough, concentrated hard enough, I could

defeat this thing by myself.

And then I started to have intensely psychotic thoughts about my

contracts professor, a young, smart, and funny woman, full of verve,

whom I quickly grew to idealize. She's looking after me. She's God. She

has the power to make everything all right for me. She knows about

the killings and wants to help. I won't let her kill me, though. She

wants to help me. She'll take care of me. She has the power because

she's God. I will bask in her God-like glow. I spent hours each night

awash in these thoughts, wondering if I should thank her for

everything she was doing on my behalf. Should I bring her a gift of

some kind? Or should I write a note instead?

And always, my head hurt from thinking these things—a pounding,

searing, real pain, not like the physical pain of a headache, but an

intense throbbing inside my skull someplace; sound waves. There

were days that I feared that my brain was actually heating up and

might explode. I visualized brain matter flying all over the room,

spattering the walls. Whenever I sat at a desk and tried to read, I

caught myself putting my hands up to either side of my head, trying to

hold it all in.

One day, as Emily and I were talking, I turned away from her to

see a bearded, scrawny, wild-eyed man behind me, holding a large

knife and poised to pounce. Terrified, I gasped. The hallucination

immediately disappeared.

"Elyn, what's wrong?" Emily asked.

"Nothing," I said. "Nothing's wrong."

Only two weeks into the semester, I couldn't bear it anymore, and

decided I needed to take myself off to Student Health Services. At my

first appointment, I met the American version of Dr. Barnes, the

rather hapless young psychiatrist who'd treated me in Oxford. A

beginning intern, Dr. Baird was visibly taken aback at my

near-incomprehensible blabbering. The technical term for what I was

doing (where one says words that sound similar but have no real

connection with one another) is "word salad"—although in my case,

"fruit salad" might have been more apropos.

"My name is Elyn. They used to call me 'Elyn, Elyn, watermelon.'

At school. Where I used to go. Where I am now and having trouble."

"What kind of trouble?" she asked.

"There's trouble. Right here in River City. Home of the New

Haveners. Where there is no haven, new or old. I'm just looking for a

haven. Can you give me haven? Aren't you too young? Why are you

crying? I cry because the voices are at the end of time. Time is too old.

I've killed lots of people."

"Well, er, now then, Elyn," she began, looking first at her

notebook, then back at me. "I think you're having some psychological

difficulties. There's a word called 'delusion,' which refers to a fixed

and false belief that's not based on evidence. This appears to be what

is going on with you."

I thanked her for the lesson. She closed her notebook and said she

would see me the following week.

When I left that appointment, I left scared. Things were out of my

control and I didn't know where to turn for help. The one person who

I knew could make me feel better was an ocean away. I became

especially concerned with who might get hurt if my head literally were

to explode. The innocent bystander problem.

A couple of days later, on a Friday afternoon, I became convinced

that I couldn't last the weekend, and went to see the on-call person at

Student Health Services. The psychiatrist on call there was nice, and a

bit more with-it than the first young woman I'd seen; this young

mental health professional spoke with a Latino accent and seemed

extremely empathic. Within minutes of meeting her, however, I

quickly decided that I needed to conduct my end of our conversation

from inside her small coat closet. I stood up and walked over to it,

then squeezed myself in. She wasn't having any of it.

"If you don't come out now and talk with me, Elyn, I'm going to

have to hospitalize you."

Dutifully, I came out of the closet and sat down. "There's a war in

China," I said. "One needs to be heavily armed. Are you God? Have

you ever killed anyone?"

"No, no, I haven't," she said quietly. "Elyn, after we speak for a

while, if you go back to your room, how do you think you will manage

for the rest of the weekend?"

I shook my head. More gibberish came out of my mouth.

She called another therapist into the office, a young male social

worker, small and wiry, with a no-nonsense manner. He's nice, I

thought. Not scary. Not scary yet.

After asking me a few more questions, and basically getting

nothing for their trouble, they announced that they thought it best to

give me a little medication.

"It's called Trilafon," the woman said. "It's a neuroleptic. It'll help

with your confused thinking."

I knew exactly what a neuroleptic was—antipsychotic medication,

with terrible side effects, like heavy sedation, arms or legs that won't

stop trembling (sometimes irreversibly), and a worst-case scenario

that included death. There was no way I was going to take their stupid

drug. Why should I take a drug, when all I'm doing is saying what

other people think but for some reason don't say? We all think like

this, our brains are all like this; it's not as though I'm psychotic or

something. Did I say this out loud? I wasn't sure.

The two of them called in a third person—the chief of psychiatric

sendees, a short, older man with white hair. Somber. Distinguished.

All three urged me to take the medication.

"No, no," I said. "I can't do that. Call my friend Jean's husband.

Richard. He's a neurologist. They used to know me in England, but

they're in Washington, D.C., now; they'll tell you. Richard knows all

about my brain, he will know what's best to do."

They shook their heads. They began to look like dolls to me.

Puppet dolls. "Elyn, if you don't agree to take the medication, we

might have to put you into the hospital."

That sent a shock through my body that forced me to focus my

mind, forced me to tighten my speech and manage the words that

came like marbles out of my mouth. "None of this is necessary," I said

as firmly as I could manage. "Simply being here, talking to you—I'm

feeling better now. If you take me to a hospital, they'll let me go. You

can't hold someone who's doing as well as I am. I'll get out right

away."

It was an act, but it worked. They agreed to let me spend the

weekend in the Student Health infirmary instead. And while they kept

arguing for the Trilafon, they promised not to force it on me.

I'd won the battle. But I was about to lose the war.

The social worker accompanied me back to my dorm room to get

my things; then we walked back and I checked into the infirmary, on

the highest floor of the Student Health building. I wasn't happy, but I

tried to comfort myself as best I could. At least you're not in the

hospital. That was a close call.

I sat on the edge of the bed for what seemed like long minutes,

then decided I ought to take a look around. To my surprise, I

discovered that I could easily walk to the elevators with no

interference from anyone, and take them all the way down to the

ground floor, which is exactly what I did. I stood outside on the front

steps of the building for at least a half hour, smoking a cigarette and

thinking about what I should do next.

It was a beautiful New England autumn evening, with a clear sky

full of stars. The air was fresh and bracing, and there was a sense of

peace and order on the campus. I don't belong here, I thought. I

should be in the library working; this is all a big mistake, a

regrettable misunderstanding. But it's at least ten o'clock, too

dangerous to be walking around this neighborhood alone. They

might get upset or angry if they notice me missing. Oh, what the hell,

best to go back upstairs and spend the night here. Sighing, I went

back inside and headed for the elevators, leaving the lovely night

behind.

As I walked back onto the unit, one of the nurses saw me. "There

she is!" she shouted.

Startled, I bolted like a fox who'd heard the bay of the hounds.

Hurtling through the nearest door, I ran down the fire stairs, and

heard them running after me. Their voices echoing down, their shoes

thumping on the metal steps. Barely one flight ahead of them, I made

it down to one of the lower floors, where I found an open door. It

seemed to be a child's playroom. Panting, I crouched down and

crawled under a tiny table, folding myself into the smallest ball I

could. I heard the commotion outside, people calling out my name,

running back and forth down the halls looking for me. Eventually,

someone came into the room where I was hiding and switched on the

lights.

"I found her!"

I pleaded with her, incoherent. "Masses of mastiffs are coming!

These masses, diseases! Why are they doing this to me? Why?"

The staff quickly gathered to confer with one another, and stayed

close to make sure I didn't get away. By the time the on-call clinicians

arrived, I was back in my room, sitting calmly on the bed, and able to

form an intelligible sentence.

"What's going on, Elyn?" asked the social worker.

I shrugged. "I was bored, I decided to take a walk."

"I see," he said. "And were you thinking of leaving while you were

taking this walk?"

"I was thinking of it," I admitted, "but I decided to stay."

"A good decision," he said, and then he smiled. "And how are you

feeling now?"

"Fine. I'm fine. It's all OK."

"Yes, you do seem OK to us now," he said. "But the infirmary staff

think you're too difficult to manage, so you can't stay here."

As nice as he was, his message was clear: I was being kicked out of

Student Health. Shameful. I couldn't decide whether to burst into

laughter or burst into tears.

The psychologist and social worker instructed me to spend the

night at my dorm and come back the next morning, so they could see

how I was doing. I agreed. They gave me a small packet of Trilafon,

with the encouragement that it would make me feel better.

I would never take any of that Trilafon; the only time I really even

thought about it was days later, when the packet fell out of my pocket

after constitutional law class, and my professor, rather embarrassed,

returned it to me the following day.

However, I was dutiful about returning to Student Health the next

morning. I hadn't slept, my fantasies filled the room, and I couldn't

seem to get my mouth to work when it came time to meet with my

psychologist and the social worker.

"One. Tempo at the time. Time is a number," I told them.

"You seem upset today, Elyn. Can you tell us how you're feeling?"

"There's the killing fields," I said. "Heads exploding. I didn't do

anything wrong. They just said 'quake, fake, lake.' I used to ski. Are

you trying to kill me?"

"No, of course not, we're only here to help you. Have you thought

any more about taking some of the medicine?"

At that point, I crawled under the desk and started to moan and

rock. The faceless creatures hovering near, invisible to everyone but

me, were about to tear me to pieces. "They're killing me. They're

killing me! I've got to try. Die. Lie. Cry."

"We want to get you some help, Elyn." The psychologist said she

was going to her office to make some calls and that the social worker

would stay there with me. I huddled right where I was, rocking and

moaning under the desk. The creatures wanted to kill me, and the

doctors wanted to send me to a hospital. I knew this for an absolute

fact. I had to get out of there.

Crawling out from beneath the desk, I quietly told the nice social

worker that I needed a drink of water. He followed me out of the room

and toward the water fountain. Suddenly, I darted for the side door,

hoping to make my way down the stairs, but he moved fast, caught me

in a few steps, and put me in a restraining hold. Although small, he

was very strong, and I couldn't move in his grip as he brought me back

into the room.

"I'm sorry I did that," he said apologetically. "It had to be done,

you know, but I do feel bad about it." As fragmented as I was, I

believed him. He wanted to be kind to me, but for some reason I was

making it hard for him.

The psychologist came back into the room and reported that it was

difficult to find a hospital bed on the weekend. The social worker then

replied that maybe he could make a couple of calls and see if there was

anything out there. He left to make the calls. The psychologist stayed

with me.

I was going to the hospital for the third time, I knew it. I was going

to be an inpatient again, and they would make me take drugs. Every

nerve in my body was screaming. I didn't want a hospital. I didn't

want drugs. I just wanted help.

Struggling to control the terror in my voice, I politely asked the

psychologist if we could go into the hall so I could get a drink. She

followed me out of the room and toward the water fountain, and once

again I darted for the side door and the stairs. The psychologist called

out to me, "Stop, Elyn. I won't be able to catch up with you. Please stop

now." No no no no no. Unseeing—of obstacles, of other students, of

anyone who might have been staring at me—I ran all the way across

campus back to my room. Thankfully, my roommate was not there.

It was an inauspicious beginning to my legal career.

chapter ten

I FULLY EXPECTED THAT someone from Student Health would

send the campus police after me, and I braced myself for their arrival.

They'll take me away. They'll lock me up. I cowered in my room for a

long time, waiting for the inevitable knock on the door. But no one

came. Scared, but restless, I decided that I could remain hiding in my

room or take my chances out in the world. And knowing exactly what

would calm me down, I did what I always did whenever my back was

against the wall—I gathered up my books and headed for the library.

I began to breathe easier the minute I walked through the doors. I

spent the entire day there, reading and going over my notes, trying to

focus my thinking about the coming week's classes. Every so often, I'd

glance over my shoulder, but nobody was paying any attention to me.

By the day's end, I'd managed to calm myself down.

When I returned to my room that evening, I discovered a

telephone message that Emily had left for me. The psychologist from

Student Health Services had called, and I felt it both professional and

kind that she had not identified herself. She asked that I call her back.

I thought about it for a few minutes—what's the worst that could

happen if I didn't do as she'd asked? But then I decided that given the

state I'd been in the previous few days, it was probably a good idea to

make the call.

It turned out that I'd been reassigned to another doctor: Hans

Pritzer, a senior psychologist and psychoanalyst who, I discovered

later, had a formidable reputation for tackling "the most difficult

cases" at Student Health.

Dr. Pritzer was Austrian, with a compact frame, reddish hair, and

fair complexion; he spoke with a thick accent, where ssss's often came

out as zzzzz's. "You caused quite a commotion this weekend," he told

me at our first meeting, shaking his head slightly, a concerned father

to a truant daughter.Zis veekend. For some reason, I relaxed a little.

"We need to try to work together now, Elyn, so that we can avoid that

kind of thing. How are you feeling today?"

As I almost always did when someone I didn't know asked me that

question, I quickly responded, "Better. Much better, thank you."

"No, I don't think that is quite the truth," he said. "I think that

there are things going on inside your head, and that you must tell me

what you are thinking, so that we can work through this and address

the problem."Ve can vork zzzrooooo zis. I wondered if this is what

Freud sounded like, with his vww's and his zzzzz's eliding as he led

his patients through the thickets of their own minds. My own mind

was again speeding up to such a degree that I could barely sit still.

"People are controlling me, they're putting thoughts into my

head," I told him. "I can't resist them. They're doing it to me. I'll have

to kill them. Are you controlling me? They're making me walk around

your office. I give life and I take it away."

Pacing as I muttered, I suddenly stopped in midsentence,

transfixed by something or someone unseen, and then I began to rock

and moan. I wanted to lie down on Dr. Pritzer's couch, but I was

astonished to discover that he wouldn't allow that. "Lying down

causes people to regress," he said. "You're too regressed already."

Surprisingly, he told me that he didn't think I was schizophrenic.

"You seem to be working very hard to connect with me," he observed.

"And you've been operating successfully in the world, whereas one of

the chief markers of schizophrenia is not connecting, and not being

able to function. At least, this is what I think so far."

"What about medication?" I asked. "Are you going to make me

take pills? Because I don't want to do that. I cannot do that. Drugs are

bad, you know."

"We'll see how it goes," he answered. "We will discuss it, and as I

learn more, we wall come to that decision together."

I wanted so much to trust him, this straight-talking old-world

gentleman whose only crime, so far, was that he was not my beloved

Mrs. Jones. We agreed that we would meet twice a week.

And then Dr. Pritzer said it was time for me to go.

"I...I can't," I said. My legs, so restless before, had turned to stone.

Again, the slight head shake. "Ah, Elyn, you must. It is time now. I

have another patient, we wall meet again quite soon."

Very reluctantly, I trudged slowly out to the waiting room and sat

down. Forces were keeping me from leaving, I could not get to the

door that led back outside. A few moments later, Dr. Pritzer came into

the waiting room to greet his next patient and usher her into his office.

Then, suddenly, he reappeared. "Do you think you can go now, Elyn?"

he asked. I was relieved to discover that if I put my mind to it again, I

could. And so I did.

Every appointment after that, I spent extra time in the waiting

room by myself when our session was finished. It was as though I

needed to marshal my forces to leave a safe place. But Pritzer allowed

me to judge for myself when I was ready to go, and each time, I

managed to make that decision on my own.

In the meantime, I continued going to my classes, straining to

focus my mind sufficiently to get my work done. But I was still

convinced my contracts teacher was taking special care of me.

Perhaps she and Pritzer are working together on my case. Are they

married? Perhaps there's something sinister. That's it, it's an

experiment! Contracts teacher works with psychologist. They have a

contract on my life. Experimental therapy with messages sent via

contracts cases.

In one session with Dr. Pritzer, I was frantically pacing from one

side of his office to the other, growing more agitated as my thoughts

became more violent. "I've killed people and I will kill again," I

announced. I was almost growling at him. "Who else is in the office

with us? Are you human?" I walked over to a big, leafy plant in the

corner and snapped off one of its leaves. "See? This is what I can do to

people!"

"You should not have done that, Elyn," Dr. Pritzer said sternly. "I

like that plant. You are not to do that again."

Chastened, I sat down, and tried to be still for the rest of the

session. He was setting limits; I was trying to observe them. But the

limits never held, at least in my mind. As the days passed, I felt more

and more in peril, as though I were hanging from a ledge as my grip

weakened.

In class, I was assigned to prepare my first legal memo. Its

purpose was to explain a very specific area of law, in a succinct, cogent

manner. In a memo, you address a question from both sides; in a

brief, you argue only for one side. The assignment was announced two

weeks before it was due, with a prescribed format, and the length was

to be no more than fifteen pages. As with all my other limits, I went

right past this one, too—in addition to the course work for the three

other classes, I worked on the memo day and night, for hours, without

sleeping. And when I was finished, my paper was nearly fifty pages in

length. I later learned that the person in charge of grading papers

thought that it was one of the two best pieces of work turned in by

anyone that year. But it was not what I was assigned to do. "It's very

good," said the teaching assistant. "But it's not a memo—it's more of

an article than anything else."

The law is precise; I was expected to be precise as well. And I

wanted to be. But each time, something inside me pushed me farther

than I was supposed to go. The work was unacceptable. I was

unacceptable.

And then I was assigned a second law memo. At this point, it was

like being instructed to climb Everest in sneakers. Too anxious to read,

I saw only words jumbled on the page, with no coherence. What's

worse, I couldn't remember anything I'd read up until this moment,

and when I tried to write, only gibberish came out—threads of

nonsensical words and phrases that meant nothing, in or out of

context, exactly the same way it had happened at Oxford when I was

at my worst. Mrs. Jones, where are you? I need you. We've been in

this place before, and you led me out. Where are you?

All my life, books had been the life raft, the safe haven, the place I

ran to when nothing else worked. But now books revealed only page

after page of nothing that made sense. Panicked, I picked up my worn

copy of Aristotle, but even it betrayed me. Nothing, nothing.

I greeted my two classmates in the Yale Law School Library. It was ten

o'clock on a Friday night.

One of them was an Alabaman named Rebel ("because I was a

breech birth," he'd explained), and the other was a woman named Val.

They were both in my "small group"—the only small class a first-term

law student has at Yale. And neither of them was particularly happy

about being in the library; it was the weekend, after all, and there were

plenty of other things they could have been doing at ten on a Friday

night. But at my insistence, we'd made the date to work on the second

memo assignment. Although each of us was responsible for his or her

own memo, we were allowed to strategize together. We had to do it, to

finish it, to produce it, to...

"Memos are visitations," I informed them. "They make certain

points. The point is on your head. Pat used to say that. Have you ever

killed anyone?"

Rebel and Val looked at me as if they, or I, had just been splashed

with ice water. "A joke, right?" quipped one. "What are you talking

about, Elyn?"

"Oh, the usual. You know. Heaven and hell. Who's what, what's

who. Hey!" I said, leaping out of my chair. "Let's all go out on the roof.

It's OK. It's safe."

I hurried to the nearest large window, opened it, then climbed

through and stepped out onto the roof, a flat surface and not at all

scary. A few moments later, Rebel and Val followed me. "Course, the

police may see us and bring in a SWAT team," I said, laughing. "Can't

you just imagine? 'One-niner-niner, one-niner-niner, there's an APB

out for people trying to break into Yale Law Library.' Yeah, like there

are lots of valuable things there"

They couldn't help but laugh back. They asked what had gotten

into me.

"This is the real me," I announced, waving my arms above my

head. And then, late on a Friday night, on the roof of the Yale Law

School Library, I began to sing, and not quietly, either. "Come to the

Florida sunshine bush. Do you want to dance?"

The smiles quickly faded from their faces. "Are you on drugs?" one

asked. "Are you high?"

"High? Me? No way. No drugs! Come on, let's dance! Come to the

Florida sunshine bush. Where they make lemons. Where there are

demons. Is anyone else out here with us? Hey, wait a minute, what's

the matter with you guys? Where are you going?"

Rebel and Val had both turned away and were heading back

inside. "You're frightening me," said one.

I shrugged. "OK, I'll come in, too. But there's nothing in there.

Nothing."

As we clambered back through the window, one of my classmates

said something about the Student Health Center. "Maybe you should,

um, go see someone there."

"I'm already seeing someone there," I said. "Twice a week."

"Oh. Well. What about maybe going over there right now,

though?"

I shook my head. "No. Not now. I need to work. We've got this

memo thing."

Once we were all seated around the table again, I began to

carefully stack my textbooks into a small tower. Then I rearranged my

note pages. Unsatisfied, I rearranged them again. "I don't know if

you're having the same experience of words jumping around the pages

as I am," I said. "I think someone's infiltrated my copies of the cases.

We've got to case the joint. I don't believe in joints. But they hold your

body together."

This was more than either of them had bargained for. "It's nearly

midnight, we're not getting anything done here. Let's get out of here;

we can try it again sometime tomorrow."

"No, no, I can't go home yet. I need to work. Quirk. Of nature."

"Elyn, we have to leave," they said, gathering up their books and

looking nervously around the room. Something was obviously scaring

them. "Please. And you need to come with us."

"No, I can't. I have to work. I'll stay here, and hide in the stacks."

I stayed long after they'd gone, sitting alone on the floor between

two towering stacks of books, muttering to myself. The library grew

even more quiet; section by section, the lights were being turned off.

Finally, frightened of being locked in overnight, I got up and left,

keeping my head down so that I wouldn't have to make eye contact

with any of my classmates, which wasn't likely at that hour, since the

last remaining person seemed to be the clueless security guard at the

front door.

Of course, it was completely dark outside. I'd never been

comfortable in that kind of dark—at least not on the ground; the roof

had been much more pleasant. My whole body shook as I made my

way back to my room. And once there, I couldn't settle down. I

couldn't sleep. My head was too full of noise. Too full of lemons, and

law memos I could not write, and mass murders that I knew I would

be responsible for. Sitting on my bed, I rocked back and forth,

moaning in fear and isolation.

I had finally done it: cracked in public, in front of colleagues, my

law school classmates. Who I was, what I was, had been revealed.

Now everyone would know the truth—of my worthlessness, my evil.

When things were this bad at Oxford, knowing I would see Mrs. Jones

each day helped me contain my psychotic thoughts when I was with

other people, or when I needed to get work done. But with no Mrs.

Jones to take my craziness to, and no comfort to be found in my

studies, there was no balm in Gilead. Something was prying my grip

loose, finger by finger, and very soon now, I was simply going to fall

through space.

After a sleepless night, I doggedly went back to the library and tried

again to tackle the memo, but I could not make my head work.

Panicked, I practically ran to my professor's office. There was no one

there. I waited. When Professor M. arrived, he looked at me askance.

"I've come to talk to you about my memo," I said. "I'm sorry, but I

need an extension."

"Why don't you come into my office and we'll discuss this," he said.

When I sat down in the chair in front of his desk, I hunched over,

drawing my shoulders up to my ears as though I expected to be hit.

"The memo materials have been infiltrated," I said, looking at my

shoes. "Jumping around. I used to be good at the broad jump. Because

I'm tall. I fall. Is anyone else in this room? It's a matter of point.

There's a plan. People put things in and then say it's my fault. I used to

be God but I got demoted. Are you God?"

Professor M. stayed perfectly calm. "You seem quite upset, Elyn."

My head was buzzing. Lemons and memos and mass murders.

"Well, with all the killings, it makes sense that I'd be upset," I said.

Then I launched into my little Florida juice jingle, twirling around his

office, my arms thrust out like bird wings. Then I went to a corner in

his office and sat down, continuing to sing.

Professor M. looked at me. It was hard to decipher the expression

on his face. Was he frightened of me? Was he confused? I couldn't

decide. Maybe he couldn't decide, either.

"I'm very concerned about you, Elyn," he finally said. "I have a

little work to do here at the office, and afterwards, perhaps you might

want to come and have dinner with me and my family. Do you think

you could do that?"

How reasonable that sounded. "Yes," I said. "That would be quite

pleasant. But if you don't mind, I think I'll just go through this

window and wait on the roof for you, until it's time for us to go." If that

didn't seem a good idea to Professor M., he didn't let on. I proceeded

out his window onto the roof.

I spent the next hour or so laughing and singing and gibbering

away on the roof of the Yale Law School. I found several feet of loose

telephone wire up there, and made myself a kind of belt. I picked up

all sorts of metal objects lying around on the roof and attached them

to the belt. The best find was a rather long nail, six inches or so. I put it

in my pants pocket, just in case I needed protection. You never know

when you might need protection.

"Elyn? Can you come back in the office now, please?" It was

Professor M. at the window again. "I've spoken with my wife," he said,

"and we'd like not only to have you join us for dinner, but perhaps to

spend the night with us as well."

I thought the offer was exceedingly generous, and told him how

very much I appreciated their kindness. Having a home-cooked meal,

having nice people to talk to, to spend time with...perhaps that might

prevent my head from exploding and splattering the walls.

And so Professor M. and I took a leisurely walk across the Yale

campus that lovely fall Saturday afternoon, me wearing my

telephone-wire belt. Dinner at his house didn't go so well, so Professor

M. decided to phone the Student Health Center to speak with the

psychiatrist on call—whom we'll call The Doctor.

When Professor M. handed me the phone, The Doctor briskly

informed me that he'd received a call from someone at the law school

last night who reported that I seemed extraordinarily disturbed. He

then asked me a number of questions, to which I gave irrelevant

answers, and then he suggested that I might want to come in and see

him. He sounded like the kind of person who was looking at his watch

and tapping his foot while waiting for my answer. "I don't know," I

said. "No, actually, I don't think I do."

I think The Doctor was surprised, and suggested I might want to

reconsider. (And by the way, in my experience, the words "now just

calm down" almost inevitably have the opposite effect on the person

you are speaking to.) "You know, you really are a jerk," I said, and

hung up the phone.

"I don't think he handled that particularly well, either, Elyn," said

Professor M, referring to his own interactions with The Doctor.

"I think I need to talk to my friend Richard," I said. "He's a

neurologist, you know." Something was about to happen to me; I

wasn't sure what it was, but I knew it wasn't going to be pleasant. It

seemed imperative that I start marshaling my forces.

When Professor M. put the call through, and my old friend Jean

answered the phone, I said, "It's me, I've called to talk to you and

Richard."

"Your voice sounds funny," said Jean. "What's going on? How are

you?"

"Oh, well, I'm up. And down. And all around," I said. "It's a matter

of the commands put in my head." I then whispered to Jean as quietly

as I could, but with great urgency, that I was trying my best, I really

was. "But nefarious things are going on. I've been cornered and the

points are pointed. There's an effort under way to kill me." I put my

hand in my pocket; the nail from the law school roof was still there.

Richard's voice came through the phone. "Elyn?" he said. "Is

something wrong?"

"Come to the Florida sunshine tree," I greeted him.

A moment's silence, then, "What do you mean?" he asked.

"Fresh tasting lemon juice naturally. There's a natural volcano.

They put it in my head. It's erupting. I've killed lots of people. I've

killed children. There's a flower on the bookshelf. I can see it

blooming. Have you killed anyone, Richard? My teacher is God. I used

to be God but got demoted. Do you think it's a question of

Kilimanjaro?"

"How long have you been feeling like this?" Richard asked.

"It's not a matter of feeling," I told him. "It's a matter of things

happening to me. I give life and I take it away. Don't try to fuck with

me, Richard, I've killed better men than you. Children. Lemon juice.

Point."

"Elyn, you should know by now, there's nothing to fear from me,"

he said. "Jean and I want the best for you, we'd never hurt you, or

allow anyone else to do so, either."

"But people are trying to kill me," I moaned. "What am I going to

do? They're in the sky. They're killing me. I didn't do it."

In a kind and tender voice, Richard said that he understood how

upset I was. "Let me speak to your friend Professor M. now, please."

Dutifully, I handed the professor the phone.

I could tell from the look on his face that what Professor M. heard

from Richard was unnerving. I was having a psychotic break, Richard

said, and needed to go to the hospital as quickly as possible. There was

a chance I could be dangerous, possibly even to Professor M.'s child. (I

have never harmed anyone. Still, it was not unreasonable at that point,

given what I had been saying on the phone, for Richard to fear that I

might.)

Not surprisingly, Professor M. immediately called The Doctor and

told him he was going to bring me to the emergency room right away.

"Please, no, no," I begged. "Don't take me to the hospital. It'll

make me worse, please don't make me go there. I'm fine. I felt a little

upset before but I feel fine now. Please don't take me to the emergency

room."

Professor M. was reassuring, but adamant. "No, I think we have to

go to the emergency room, Elyn. You're a smart young woman, and

you're not yourself. And Richard, who knows you and cares for you,

believes you should go, too. At any rate, you can't be alone, and I'm

sorry, but I can't allow you to stay here. At the hospital, you'll be able

to talk to someone who can help you."

I tried to calm myself, to focus on convincing him to see it my way.

"Thank you, but no, I don't think so. I'd like to call a cab now, so I can

go back to my room."

But he was determined—he walked me out to the car, opened the

door on the passenger side, and gently but firmly put me inside.

I chattered nervously all the way to Yale-New Haven Hospital. "My

goodness, it's so late, you needn't stay with me," I said. "But maybe

could I borrow some money from you? I'll need to take a taxi home as

soon as this appointment is over. It will only be five, ten minutes at

most, they'll tell you I'm perfectly fine, I'm certain of it."

"Yes, of course," he said. "I'll loan you the money."

When we pulled up to the ER entrance, before Professor M. had a

chance to shut the car off, I jumped out and took off running in the

other direction. I hadn't planned to run, but I was scared. Everything

was closing in. Students knew, teachers knew, Richard knew. This is

the end. The end.

It was not the kind of neighborhood where a woman—or anyone

for that matter—should have been running around alone, in the dark,

without money or any sense of where she was going. Thankfully,

Professor M. caught up with me by the end of the block, placed his

hand firmly under my arm, and steered me back to the ER. "This is

best," he said.

We both sat down with the admitting nurse to do the necessary

paperwork, and I quickly explained that my friend, Professor M., was

having terrible stomach pains and needed to be admitted

immediately. I laughed hysterically.

A few minutes later, I found myself in a small private room,

waiting for The Doctor. Professor M.'s role as guardian angel was

over, and he'd gone home. In his place was a hospital attendant, a

massive man with a gentle face and a softly moderated voice. "It wall

just be a few minutes, miss. Don't worry now."

"Would you like to dance?" I asked him. Smiling, he declined.

"Well, then, I'm going to, if you don't mind," I said, and while I

pranced around the room, I attempted to explain my situation.

"People are trying to kill me. They've killed me many times today

already. It might spread to you." I unwound my telephone-wire belt

and started to snap it through the air. "This is a very powerful

weapon," I said.

"I see that," the attendant said. "You know, miss, I think I have to

take it from you. Probably not a good idea for you to have it in here."

I stepped back. "No," I said.

"Yes," he said. "I'm sorry. May I have it, please?"

Reluctantly, I gave up the belt. "But you can't have my nail," I said,

patting my pocket.

The attendant asked what I did in New Haven.

"I'm a law student," I said.

"Oh, that's interesting," he said. "Must be very hard work. You

know, we had another law student in here the other night with mental

problems, his name was---

Would this nice man soon be telling someone about me? If my

head exploded, its contents blown all over the room, would that be

someone's idea of idle chatter? I thought health stuff was supposed to

be confidential. (And indeed, even Professor M.—though no doubt out

of good motives—would reveal to my seminar classmates that I had

been hospitalized with a breakdown.)

"What happened to him?" I asked. "The law student, I mean?"

"Oh, they just gave him some medication and sent him home." The

answer almost erased my confidentiality concerns: The student wasn't

admitted to the hospital? He just took some meds and was then

allowed to go? It had never occurred to me to think about it like that. I

hadn't been in a hospital for three years and didn't intend to end my

streak now; if taking medication were my only bargaining chip, I'd

consider it.

Then The Doctor arrived.

He was everything I'd imagined in our telephone conversation:

short, bureaucratic (right down to the ballpoint pen he kept clicking),

authoritarian, and short on patience. The man who makes the trains

run on time. I slipped my hand into my pocket and wrapped my

fingers around my weapon nail. His eyes followed my hand.

"Give that to me," he said.

"No," I said.

He immediately called for security. Another attendant came in,

this one not so nice, with no interest in letting me keep my nail. And

once he'd pried it from my fingers, it was all over. Within seconds, The

Doctor and his whole team of goons swooped down, grabbed me,

lifted me out of the chair, and slammed me down on a nearby bed with

such force that I saw stars. Then they bound both my legs and arms to

the metal bed, with thick leather straps.

A sound came out of my mouth that I'd never heard before.

Half-groan, half-scream, barely human, and pure terror. Then the

sound came again, forced from somewhere deep inside my belly and

scraping my throat raw. "Noooooo," I shouted. "Stop this, don't do this

to me!" I glanced up to see a face watching the entire scene through

the window in the steel door. Why was she watching me? Who was

she? I was an exhibit, a specimen, a bug impaled on a pin and helpless

to escape. "Please," I begged. "Please, this is like something from the

Middle Ages. Please, no!" Somewhere in the midst of the chaos, a

single thought occurred to me: If Mrs. Jones were here, this would not

be happening. She would never have allowed such a thing. With Mrs.

Jones, the tools we worked with were words, not straps. She never

would have stood by while someone hurt me, terrified me, or made me

feel helpless and alone.

"I want you to count backwards by sevens, starting from one

hundred," intoned The Doctor. I looked at him as though he were

nuts. Count? For him? Do anything for him? I had come to the

hospital frightened, confused, and paranoid. Nothing he'd done so far

had improved the situation. And look, there it was again, the face on

the other side of the window. Had someone paid admission to see the

crazy woman?

A nurse came into the room with a tray, and a tiny little paper cup

on the tray. "Please drink this," she said.

"No," I answered. "You drink it."

"If you don't drink it, I'll have to inject it instead," she said, her

face impassive. Bound hand and foot, I had no choice. Choking and

gagging, I tried to lock my teeth against the liquid, but could not. It

was my first dose of an antipsychotic drug.

Terrified that I was disappearing, I struggled against my

restraints, needing to convince myself that I was still there. I'm

shrinking, I'm shrinking. Being restrained hurt, a lot. But at least the

pain meant I hadn't vaporized yet.

The Doctor was as understanding and insightful as ever; he made

one of those school-teacher tsk-tsk clucking sounds and rolled his

eyes in disapproval. I wondered why he'd gone into psychiatry. "You

are acting like you want to be in the hospital," he said, "so we are going

to find you a hospital bed."

So, then—it was all a matter of simply behaving myself? He spoke

as though the most I had to fear was being sent to bed without milk

and cookies. "No, thanks," I replied. "And can you please remove these

restraints? They hurt. And they're degrading."

"No," he said. "I want you to admit yourself into the psychiatric

hospital."

"Are you nuts?" I shot back. "You're the one who belongs in the

hospital. I'm fine. And I'd like to go home now. I have work to do. Let

me out of these things."

The Doctor said that he was about to write out a "Physician's

Emergency Certificate," which allowed the hospital to hold me fifteen

days. I would later learn that on that certificate he called me

"dangerous to herself and others"; he also described me as "gravely

disabled." His reason? I was not able to do my law school homework.

After the fifteen days had passed, I would be entitled to a commitment

hearing, if I wanted one.

Of course, I didn't learn about the ins and outs of all this until

later. All I knew at that moment was that I was going into a hospital.

No matter what.

However, it turned out that there was no room for me at the

psychiatric unit in Yale-New Haven Hospital, so they were shipping

me across town—to Yale Psychiatric Institute. YPI. "You'll be safe

there," said The Doctor.

"I'd be just as safe at home. Safe from you, anyway," I said.

When the EMTs came in to take me to the ambulance, I was struck

by how handsome one of them was. "Are you a movie star?" I asked.

"I'm quite sure you're a movie star. Your name's on the tip of my

tongue, I just can't think of it right now."

My relief when they undid the bed restraints lasted about ten

seconds; they immediately strapped me down on the ambulance

gurney.

"Why?" I asked the young and handsome EMT. "Why do you have

to do it like this?"

He looked a little embarrassed, and turned away from my gaze.

"It's the rules. I'm sorry."

The rules. New rules. I would have to learn so many new rules.

"Can you put a blanket over my face before we go out there?" I

pleaded. "I don't want anyone to see me like this."

Very gently, he covered my head with a white sheet, and the gurney

left the ER and rolled toward the ambulance. Maybe this is what it

feels like to be dead.

chapter eleven

ONCE WE'D ARRIVED at YPI, the EMTs took me by stretcher

upstairs, where nurses and attendants were waiting. The hallways

were narrow and dingy, classic institutional interior decorating. The

people here are all crazy, so who cares if it's ugly?

I was taken to the "seclusion room"—empty except for a lone bed.

Observing the surroundings, I only barely reacted to them, since it was

long past midnight, and I was woozy with the effects of the drug. All I

wanted to do was go to sleep; this bed looked as good as any.

The psychiatrist on call that night, Dr. Griffith, was a young

woman with light brown hair, and an attitude light-years removed

from The Doctor's. A gentle smile, a reassuring manner. That is, until I

actually heard what she was saying. "We'd like you to put yourself in

restraints, Elyn." Dr. Griffith motioned toward the bed.

No. I can't. "Please, it's not necessary," I begged them—a group of

strangers, in a strange place, in the middle of this strange night.

A rather large man, who I would later find out was a divinity

student, sort of loomed over me and grumbled, "Either put yourself in

restraints or we'll put you in them. It's up to you."

I may have been psychotic, but my antennae for where danger lay

were still pretty good. "Are you the heavy here?" I muttered.

"OK, OK," Dr. Griffith said, motioning for the enforcer to step

back. "Just lie down then, and we can talk. No restraints."

A wave of relief came over me, and I sagged back on the bed,

thinking only of getting my head on that pillow—at which point

everyone in this room did exactly as the others had done in the

hospital emergency room. In seconds, my arms and legs were

grabbed, pinned, and bound to the bed by leather straps.

I screamed at the top of my lungs and struggled against the group

of hands pinning me down, but I was no match for them, and soon the

bands were fastened tight. Then it got worse, since apparently binding

my arms and legs wasn't enough. They arranged a net over me—an

actual net—from the top at my neck to the bottom at my ankles,

covering my legs, my torso, my chest. And then they pulled it snug at

the four corners. I couldn't move at all, and felt like all the breath was

leaving my body.

"I can't breathe, I can't breathe!" I cried.

"Yes, you can," said the voices in unison. They were standing over

me, watching. I continued to gasp and beg, and eventually they

loosened the net somewhat, and I could actually inhale. (I later

learned that a hundred or so people die each year in the U.S. while

being put or kept in restraints.)

After I was secure—"made safe," as The Doctor might have

phrased it—people left, even Dr. Griffith. The divinity student stayed,

sitting sentry outside the open door to my room.

Nothing at the Warneford had horrified me as much as this did.

No single hallucination, no threat of demonic forces or impulses I

couldn't control had ever held me hostage like this. No one I knew, no

one who loved me, knew that I was here, tied to a bed with a net over

my body. I was alone in the night, with evil coming at me both from

within myself and from without. It was unimaginable to me at that

point that the ancient meaning of the word "hospital" is "shelter."

Refuge. Comfort. Care. No.

As frightened as I was, I was equally angry, and frantic to find a

way to show defiance—not an easy task, when you're in four-point

restraints and pinned under a tuna net. I was bound...but not gagged!

So I inhaled as deeply as I could, and started belting out some beloved

Beethoven. Not, for obvious reasons, "Ode to Joy," but rather

Beethoven's Fifth Symphony. BABABA BA! BABABA BA! Look, there,

see how he created such power out of those four simple notes! It

echoed nicely down the halls, so I did it again.

For hours, I sang it and shouted it and hollered it with all the

power remaining inside me. I fought off the beings who were attacking

me, I yanked against the restraints, and I sang my heart out. Every

once in a while, a nurse came by with another little demitasse of

antipsychotic liquid. I swallowed it passively, then fought to swim

above the fog it created. BABABA BA!

Finally, exhausted, I slept, sweaty and fitful and sore. I may have

slept an hour or so when Dr. Griffith returned with her supervisor, Dr.

Green. He looked surprisingly young to me, for someone who clearly

had power over what happened next. "How are you feeling now?" he

asked.

I wanted to snap, "Hey, it's tough to feel perky when a room full of

people tie you to a bed and pour drugs down your throat." But I didn't

do that.

"I feel much better," I said, struggling for the appropriate tone of

subservience and penitence. "I'm so sorry for causing such a ruckus.

Do you think I might be able to be untied now? Because these hurt."

No. "We'd like you to stay in them a little longer," came his cryptic

reply.

At that point, I'd been restrained for six hours. My muscles ached

and my skin was chafed from struggling. I longed to stretch an arm, a

leg, anything. I couldn't even wiggle my feet. The light inside the

building seemed gray, almost as though it were leaking in from

someplace else. "What's wrong with me?" I asked.

"You were very psychotic last night," Dr. Green replied.

"But what kind of psychosis? Why is this happening?"

He shook his head. The institutional head shake was becoming

very familiar to me. "It's really too early to tell," he replied.

"But couldn't I please get back to my work, while we figure it out?"

I asked. "Like an outpatient thing? I've done that before. I need to get

back to school, I'm losing valuable time here."

"It's too soon," Green said. "You're still quite sick. And we need

more time to monitor how the meds are doing."

"I think they're working," I said, ever the good student. "Because

my thinking really is clearer." And, in fact, it was.

He agreed—it seemed to be the case that I was improving. The bad

news was, he thought it was time to contact my parents.

"What? Why? No, under no circumstances! It's not OK with me to

call them, do you understand? It's not OK to tell them about this! They

don't need to know this!"

I thought Green understood, I thought he agreed to respect my

wishes. But the hospital did call them; as it turned out, Connecticut

had a law that required it.

The two doctors asked me some more questions—about my

feelings and my history—but repeated that they weren't willing to take

me out of restraints yet; I had to demonstrate an ability to stay calm.

Then they left me alone.

For the next three hours, I stared at the ceiling, felt my pulse

beating in my wrists and ankles where the straps held me down, and

managed to keep myself from shrieking like a banshee. I somehow

managed to control my demons as well. Any sign of weakness, there

was no telling how long the hostage situation would last.

When Dr. Griffith finally returned, it was with good news. "We're

going to release your legs from the restraints, Elyn, and see how it

goes," she said. It went, by their lights, just fine. I managed to stay

acceptably calm, and by seven that night I was finally untied

altogether. I was moved to the Intensive Care Program, a room with

staff and a small number of patients who the hospital felt needed

constant monitoring. Ever conscious of the eyes on me, I stretched

and moved my arms and legs. Freedom of movement, once it's taken

away from you and then restored, is a remarkable gift. Why didn't I

ever realize this before?

Not knowing the hospital had already called my parents, I asked if

I could call them myself. I needed to try to tell them what was going

on—or, at least, a version of events that I thought they might be able to

accept. I was allowed to go to the nearest phone on the floor and call

Florida collect. Monitoring my own language and tone of voice, I

cautiously told my mother and father that I'd had a bit of the old

trouble, much as I'd had in England, and that I was in a hospital for a

few days, being treated by competent physicians, very nice people,

really, it was all going well, and I was very confident that the situation

would right itself soon.

"No, really, it was just a small setback. Probably because of all the

pressure; it's very rigorous at the law school, you know. Maybe I just

needed a rest, a chance to get my bearings."

In response, my father was calm and logical. He asked me a few

practical questions, and seemed satisfied with my answers. But my

mother's voice wavered a bit, and I could hear the uncertainty there.

Her younger brother, my uncle Norm, had been struggling for

some time with serious psychological problems. He'd gotten his

medical degree in his thirties, but was unable to pass the boards and

never practiced. He had been diagnosed with depression. He was a

handsome, sweet man, very shy and quiet. Although I had never

discussed his illness with my mother to any great degree (it wasn't

then in either of our natures), I knew she worried a great deal about

him. Now, hearing that I'd once again been ill myself, she sounded

fragile, and frightened—at which point I became even more upbeat,

determined to comfort her and keep the anxiety from climbing any

higher. "Really, I'm feeling so much better now," I said, "I'll probably

be released in another day or two."

Nevertheless, my parents said they were going to come and see

me, at which point my own anxiety shot ceiling-ward. "No, no, there's

no need for that, it's not necessary, everything here is fine." But they

were insistent. So was I.

Oddly, however, I was becoming aware of a kind of yearning inside

me. I did need them, I did want them to come, I did want to see them.

I needed somebody to be here, someone on my side. But if they came,

then it meant there was an officially declared medical and

mental-health crisis—and so far, I'd avoided looking that reality in the

face.

Since the earliest days of my illness, I had kept most of the details

(of my behavior, of the various diagnoses, of all the doctors' opinions,

of my therapy sessions) away from my parents. The reasons were, and

remain, complicated. First, I was ashamed; surely someone of my

intelligence and discipline should be able to exert more power over

herself. Second, I didn't want to worry them; they had two other

children, a business to run, and their own lives to lead. After all, I was

an adult, and so far I'd managed not only to handle things on my own,

but also to accomplish two fairly rigorous academic degrees.

Third (and this is the most sensitive of my reasons), I did not want

them interfering in my life. I already had many more people than I

could handle weighing in on the state of my brain and all the possible

treatments and outcomes, and there hadn't even been a clear

diagnosis yet. Why increase that burdensome cast of characters if I

could possibly help it? Why do that to myself? And besides, what could

they do to help?

So—up until now, by my own choice, my parents had been on a

need-to-know basis about my illness, which both shielded them and

protected my privacy and autonomy. Now that was over.

Later that day, as I was getting ready to leave the Intensive Care

Program room, I asked one of the attendants if I could get a pack of

cigarettes from my purse; it had been more than twenty-four hours

since I'd had one, and I was craving both the nicotine and the physical

feeling and ritual of lighting up. The nurse said that was fine.

Maybe it was the nicotine craving; maybe it was the aftereffects of

the phone call with my parents. Whatever the reason, I was suddenly

overcome with fear again, and when I opened my purse to get my

cigarettes, I spotted a small piece of metal, in the shape of a ring,

about the size of a Life Savers candy, something I'd retrieved in my

rooftop ramblings with my telephone-wire belt. Not sharp at all, not

weaponlike in the least. More a talisman, if anything. Quickly, I

slipped the metal ring from my purse into my pants pocket, and, after

smoking one cigarette, I slipped another—together with my

lighter—into my pants pocket as well. All of these, of course, were

contraband given my status at the hospital.

A short while later, I was told it was time to prepare for bed, and

instructed to change my street clothes for a hospital gown. As I was

getting undressed, the piece of metal and my lighter dropped out of

my pocket to the floor, catching a nurse's attention. Panicked, I

stooped down and grabbed them, then ran to the back of the small

room where I'd slept the night before.

"Give me the metal and the lighter, Elyn," the nurse asked.

Oh, God. "No," I said. "I need to keep them, for protection."

"You won't need them," she said. "We'll protect you. Hand them

over."

"No!" I insisted. "You're not going to get them unless I want to give

them to you, and I don't want to. Actions will be taken if you try to take

them away."

I don't know where this came from. I don't know why I felt about

the metal ring and lighter as I did, or why I threatened the nurse. I

had no intention of hurting her, or anyone else; in fact, I felt small and

helpless, unlikely (and unable) to hurt anyone. Nevertheless, out of my

mouth came the words, unbidden and scary, and I'd pulled myself up

to my full height while I spit them out.

The nurse turned and left the room. When she returned several

minutes later, she had a number of staff with her. A posse of four or

five in fact.

"Elyn, we want you to put yourself into restraints," the nurse said

firmly. "And if you don't do it willingly, we'll put you in them."

I couldn't believe it. "I'm sorry, I'm sorry," I begged. "Please don't

tie me down again. I'll be good. Anyway, I was just kidding. Please!"

But I'd already lost the battle, and I knew it. So I passively lay back

on the bed while the staff did their handiwork. This second round was

almost worse than the first, because now I knew what the next hours

would bring.

Despite being given dose after dose of Trilafon, I was attacked by

my delusions, which swarmed thick and fast. The creatures in the sky

wanted to kill me; the creatures here on the ground were on the

attack. No one protected me. No one helped me. And as the night wore

on, my psychosis deepened. I sang, I shouted, I cried out in terror. I

was being attacked. And I struggled against the restraints until my

back ached and my skin was raw. All the while, the door to my room

was left open; anyone who walked by could look in, and a lot of people

did.

Eventually, exhaustion and the drug dropped me into sleep—a

black pit of dreams and nightmares and a lonely, aching body.

By the time daylight staggered in, I'd been in restraints for the

better part of thirty hours. "Please let me out," I wailed, but the

answer was a flat no. If they had a timetable as to when I might be set

free, they weren't sharing it with me. The day passed, and at eight

o'clock that night, I was still bound hand and foot.

Finally, the nurse I'd threatened the night before came in, again

with a stern-looking posse. Or maybe, in this instance, a jury.

Summoning whatever will I had left, I picked my way through an

apology—because I was learning that an apology for bad behavior,

made specifically to the person one had threatened (or insulted or

offended), was the down payment on a ticket out. And indeed, they

released the restraints. I struggled to sit up, and the room swam

around me.

"But you cannot leave the room," I was told. "We're waiting for a

bed to open up on the evaluation unit at Yale-New Haven Hospital.

When it does, we're sending you back there."

Was this all a dream? Was I doing this to myself, for some reason

that up until now had been so deeply buried that no one could

pinpoint it? Or was I, finally, just another crazy person? Would my life

be spent going in and out of mental hospitals, tied to a series of beds,

trying to fend off attacks from both without and within, and inevitably

losing on both fronts?

Fifteen hours later, I arrived once again at Yale-New Haven

Hospital, this time at the Psychiatric Evaluation Unit. Memorial Unit

10, aka MU10. One more stop on a journey that had become, on every

level, completely beyond my ability to comprehend.

chapter twelve

FOR A PLACE that existed ostensibly to promote the mental health

of the vulnerable people in its care, YPI had been a brutal experience

for me. I'd spent the better part of two days locked up, tied down, and

forced to swallow a medication that (while not without its benefits)

quickly made its side effects apparent: my face felt wooden and looked

like a mask; my gait had slowed until it resembled a stroke victim's

shuffle more than my own long-legged stride. And I couldn't track

even the simplest conversation. "How are you feeling today?" might as

well have been coming from ancient Sanskrit.

I desperately hoped that MU10 would be an improvement. The

hospital itself, New Haven's largest teaching hospital, was new and

modern, and the unit (on the tenth floor) was small, usually holding

fewer than a dozen patients. I was placed in a room directly opposite

the nurse's station (where anyone in it could be easily observed), and

there I waited to meet my doctor. For hours.

Finally, I was directed down the hall to the office of Dr. Kerrigan.

"Our plan is to work up a full evaluation and come to an actual

diagnosis," he said. "I know this has been a very difficult and

confusing time for you, Elyn, and we want to answer some of these

questions. And then get you referred as quickly as possible to a facility

that can help you." He gave every sign of someone warm and

encouraging, but appropriately authoritative. I wanted to trust him—I

wanted to trust someone—but I was learning to bide my time until

people showed their cards. So I listened as best I could (not easy to do

inside the fog of medication). But he seemed to be saying my future

meant only more hospitalization.

"No, you don't understand," I said. Inside my head, my voice

sounded like an old LP record on a very slow speed. "I need to get back

to law school. I'm losing valuable time. I agree about evaluation and

figuring out a treatment plan, but I can't stay in a hospital." I could

have both treatment and school, right? After all, that's the way it had

worked with Mrs. Jones. And we weren't talking junior college or adult

extension courses, either—I'd managed Oxford. Graduate school. And

I'd done well.

Dr. Kerrigan responded with what I quickly learned was his

favorite verbal tic, the highly annoying "I hear you"—in spite of the

fact that either he did in fact not hear me, or he did and didn't much

give a damn. "I hear you," he said, nodding solemnly. "And I

understand your concerns. But going back to school, I don't think

that's going to happen, Elyn, at least in the foreseeable future. You're

very sick."

"I'm feeling much better now."

"We can talk about it." The tone of his voice and the expression on

his face made clear that the subject was closed.

It felt like Kerrigan had taken his thumb and forefinger and

extinguished my single remaining flicker of hope. I was a student, not

a mental patient—why couldn't he see that? As the interview

continued, his words only made me more frantic and disorganized,

and I began to talk over him. "I can go back to school anytime I want,"

I insisted. "Did you know I was God? But I'm not anymore. What I am

now, I can't tell you. Have you killed anyone? I've killed hundreds of

thousands of people with my thoughts. It's not my doing. Someone

acts through my brain. I give life and I take it away." I stood up and

started to pace. "I'm almost as big as you. You can't hurt me. See that

hanger with your jacket on it? I can make that into a weapon to

protect myself. Do you mind if I take your hanger, please?"

"Sit down," he said.

"I don't want to sit down," I said. "I would like that hanger,

though."

"I don't think so," he said. "Please sit down now."

"No, I'd like to go back to my room now."

"I think that's a good idea," he said. "Another good idea is for you

to spend some time in restraints. We believe they help patients feel

safe, more in control."

I couldn't believe what I was hearing. "Restraints don't make me

feel better." I was pleading, but I was angry, too. At the very least,

somebody could have asked me what made me feel better.

"There's no need for alarm," he said. "MU10's policy on restraints

is a little different from Yale Psychiatric's. You can get out of them in

as little as half an hour, if all goes well."

Who defines what "goes well" is? I wondered. Kerrigan's tone and

expression belied any hope of negotiation—once again, I had no

choice but to run, which I did, right into the arms of the unit's staff. I

struggled, but again was tied to the bed, with a sheet pulled tight over

my chest.

MU10 considered tying people up a form of therapy. In fact, in my

chart, Kerrigan had written, "Use restraints liberally." And for three

weeks, they did.

Since I was considered too disruptive to be in any therapy groups, I

had very little to do with other patients, and was mostly kept apart

from them. I'd often sit under the little desk in my room and rock and

moan, gibbering away under the grip of fearsome delusions.

Much later, when I had the opportunity to read my own chart, I

discovered that the staff had actually been frightened of me; in fact, I

was so scary that I was "staff specialed," which meant that a staff

member was with me all the time, watching my every move. Staff

stood outside when I was using the bathroom, and the door was left

unlocked. I could shower with a curtain, but my "minder" could come

in at any time and pull the curtain back to see that I was OK. Which

she did. Which horrified me.

When I was allowed to wander around a little, I met a young

college student named James. He'd evidently had a very bad drug

experience, which spun him into a manic episode; he said they'd kept

him in restraints for three days. When I told him this wasn't my first

hospitalization, he reacted almost as though, in our brief friendship,

I'd somehow betrayed him.

"Wasn't once enough?" he asked angrily.

"It was, at least for me. I'm not here by choice, you know. I hate

hospitals. I hope you have better luck than I did and never come back.

At least there's something concrete you can do: never take drugs

again."

"I just can't believe you let this happen to yourself," he said.

I shrugged. "The killings were just getting me down. The ones with

my thoughts. The brain explosions which the crimes caused. Have you

killed anyone lately?"

James visibly recoiled. "Please don't talk that way. It really upsets

me."

"OK," I said, and thereafter, I tried to stick to it.

I was allowed only plastic utensils to eat with, and at one meal, I

jokingly held up my plastic fork and told a staff member I could stab

her if I wanted. I was immediately restrained.

When I became agitated and paced the corridors, I was restrained.

I kept careful watch whenever someone came onto or left the unit;

an open door was always an opportunity to make a run for it. Each

time I did it, staff caught me. And each time I was restrained.

When I voiced my violent delusions (which in spite of my best

efforts included thoughts about hurting staff, among others), I was

restrained.

In fact, any expression of anything that I was feeling—fear,

anguish, restlessness, disorganized and delusional thoughts—led to

immediate restraints. Even humor wasn't a good idea. My tendency to

bluff or make a wisecrack in difficult circumstances was

misinterpreted time and time again, and landed me in restraints.

My friend James couldn't understand why I kept setting myself up.

"Just do what they say," he said. "What's so hard to understand about

that? Do you want to be put in restraints?"

"No," I said. "What I want is to get out of here. That's why I keep

running for the door. Last time I made it down a whole flight of stairs.

I won't stop until I succeed. Massive unemployment and

introjections."

He sighed. "Please don't talk like that."

Part of the problem was that I was behaving like a patient in

psychoanalysis. When Mrs. Jones and I were working together, I was

encouraged to say exactly what was on my mind, always, no matter

how crazy it sounded—that was how analysis worked. That was the

point. Otherwise, how would she know what was going on inside me?

But the people at MU10 didn't want to know. If they couldn't tolerate

what was in my head, why were any of them in this business? When

my scrambled thinking revealed itself, they put me in the hospital

version of "time out." Where was the "treatment" in this? Were they

wanting to help me get better, or did they just want me to be socially

appropriate? Overall, the sole message they seemed to want me to get

was "behave yourself!"

This is a classic bind for psychiatric patients. They're struggling

with thoughts of wanting to hurt themselves or others, and at the

same time, they desperately need the help of those they're threatening

to harm. The conundrum: Say what's on your mind and there'll be

consequences; struggle to keep the delusions to yourself, and it's likely

you won't get the help you need.

Staff decided that my drug regimen wasn't sufficient, so Kerrigan,

not wanting to exceed the maximum recommended dose of Trilafon,

put me on Valium as well. I hated Valium—it made me feel dopey, and

dulled whatever thought processes I had left. I could almost see my

cogent mind waving at me from the shore.

One day, I simply refused to take the Valium. Staff held me down

and gave me a shot. I later read in my chart that Valium is not effective

when given by injection. It just doesn't work that way. Even without

knowing that, I wondered whose needs were really being met on this

unit.

Contacted by Dr. Kerrigan and the MU10 staff, my parents came to see

me. (I had been embarrassed one afternoon when I overheard a

couple of nurses talking about their absence: "Where are Saks's

parents?" Despite having told me of their plans to visit, it had taken

them a week to appear.) To my surprise, they brought my two brothers

with them. As comforted as I was by their arrival, I was also

completely horrified that they were there. None of them had ever seen

me like this. I felt worthless, a failure. But I couldn't tell them what I

was feeling and they of course couldn't ask. And as hard as they tried

to put a good face on our time together, they, too, seemed stunned

that my law school life had come to this, a scant two months after I'd

first arrived at Yale.

We were allowed to have our Thanksgiving dinner together, in a

small dining area that had been "reserved" just for our family. As we'd

done during our summers and vacations together, my parents and I

coped as best we could, keeping conversation light and limited to easy,

even humorous subjects, while the gravity of my situation ran beneath

us like a furnace that held the potential for blowing me apart. We

joked that the fixtures on the wall were bugged and we were probably

being listened to, and our laughter echoed down the hall. My brothers

were somewhat quieter, and I could see by the look in their eyes that

they were confused and frightened.

The family therapist would later write that my parents had made

light of my illness and didn't seem walling to accept its seriousness.

The fact is, until this time, they'd only known as much as I'd told

them, and whenever we were together, including this time, I always

did everything I could to hide its seriousness: I cracked jokes, and

laughed, and was gratified when they did the same. It was our way of

handling it; it was our habit—and every family has its habits. The

levity and irreverence made it possible for us to be together without

everyone falling completely apart.

I had other visitors as well. Two of my law school classmates,

who'd heard what had happened, came by one afternoon, and

although it was obvious to me that they were struggling for the right

things to say, I was both comforted and moved that they'd come at all.

And my dear friend Sam from Oxford, who was now living in New

York, came to see me, too. When I showed him the leather straps on

my bed that were used to tie me down, he winced and shook his head.

He got it. And that gave me courage. It was so easy to feel isolated and

alone here; each one of these people who cared enough about me to

come and visit gave me reason to hope that I was worth saving.

Of course, visitors were turned away when I was in restraints

(although for obvious reasons they were not informed that was the

case). So some people went away believing I didn't want to see them,

when nothing could have been further from the truth. That said,

having company was sometimes exhausting and even confusing. I'd

summon focus and energy to keep the demons away during a visit,

and then go to pieces after friends and family were gone.

Young James left after my first week on MU10, and I then met two

new patients, Susan and Mark, and we spent a little time together

almost every day (that is, when I wasn't in restraints or trying to run

away). Susan, about my age, was bulimic. This was a condition only

recently recognized by the medical community, but it was far from

being understood—mostly, treatment seemed to consist of variations

of "mind over matter."

"My doctor says I should just stop binging and purging," Susan

said. "There's a simple solution to my problem, she told me—just stop

doing it."

I remembered when my parents, and Dr. Hamilton, essentially

said the same thing about my anorexia. "You know, it's my opinion

that 'just don't do it' is usually said by somebody who just doesn't get

it."

She nodded. "Now they're going to put me on the ward with older

people, the one-month-maximum unit. Do you think that might help

me?"

"The people here suck!" I said. "So it's got to be better on the other

ward. I hope you'll get what you need over there, I really do."

Mark was barely eighteen, and clearly had some kind of organic

impairment, although I didn't know the cause. He had no short-term

memory (I had to reintroduce myself each time we ran into each

other), was in a state of perpetual confusion, and had difficulty both in

speaking and comprehending what was said to him. He was so

endearingly (and vulnerably) young, it was hard not to feel maternal

toward him. This is a child, I thought, feeling angrier and more

protective each time I spent time with him. Isn't there anywhere else

he could be—someplace gentler, with professionals who might take

better care of him?

One day, Mark told me he was scheduled for an overnight EEG,

which would give the doctors a more detailed picture of his

brain-wave patterns. He barely understood this, and for days he'd

fought having the procedure. (Where were his parents? I wondered.)

There was no way he understood the doctors' rationale. All he knew

was, they were going to stick electrodes all over his head, do

something scary to his brain inside, and not stop until the next

morning.

"Don't worry," I said, comforting him as best I could. "The things

on your head aren't needles—they won't hurt at all, you won't feel

anything. It's like they're little cameras, and they're taking pictures

that the doctors wall look at, to help you feel better."

"But why are they doing this to me?" he asked in a tremulous

voice. "What if they make a mistake and do it wrong?"

"That won't happen," I said. "They know what they're doing; this

wall help them fix whatever's wrong." I felt a little hypocritical—I was

pretty sure that they didn't know what they were doing. "Hey, let's go

play cards, OK? We can play any game you like."

Meanwhile, the Physician's Emergency Certificate that had been

signed when I was admitted to YPI was about to expire. The certificate

allowed the hospital to keep me against my wall for fifteen days; once

that time was up, one of three things had to happen. The hospital

could let me go, which is what I wanted, but that wasn't going to

happen. I could agree to stay in the hospital, by signing a piece of

paper called a "voluntary," which would be the equivalent of me

saying, "Yes, I agree to stay here and get treatment." But that wasn't

going to happen either.

The third option was for the hospital to request a formal

proceeding called a "civil commitment hearing." When a patient

insists upon leaving the hospital, and the hospital insists that the

patient needs to stay, a civil commitment hearing is held before a

judge, and it's the judge who makes the ultimate decision. The choice

seemed very clear to me: I would demand a civil commitment hearing,

ask to be released, and the judge, seeing the absurdity of the whole

situation, would of course send me on my way back to school.

My parents talked me out of that one, because they understood

more clearly than I did that the hospital would prevail. "No, go with

the Voluntary,' Elyn," advised my dad. "You can't be on your own

quite yet, but you certainly don't want anything in the record where a

judge orders you to stay."

Unbeknownst to me then, the consequences of being civilly

committed to a psychiatric hospital are severe and can be long-lasting.

For instance, many application forms (such as an application to sit for

the bar exam) ask whether one has ever been civilly committed. I

didn't know it then, but there would a come a day when I would be

very happy that I wasn't compelled to check the "yes" box. So,

following my dad's advice, I signed the voluntary.

Then I discovered some stunning news—MU10, without my

permission or knowledge, had called the dean of students at the law

school, to confirm that I couldn't return that year, or possibly ever. In

effect, MU10 withdrew me from law school.

When the staff told me this, I was overcome with such a sweeping

feeling of betrayal that I could barely catch my breath. What had

happened to the assurance of confidentiality? What had happened to

their sense of my own autonomy? All right, I was certainly somewhat

compromised, but I wasn't comatose—surely someone could have

spoken to me first. Who had done this? Who had taken it upon

themselves to release information that was mine alone, and that now,

no doubt, had settled into my academic file, probably in big bold black

type.

Completely overwrought, I begged my parents to call the dean, to

plead my case that I be allowed to return to and resume my classes.

And they did. They may not have believed that I was completely ready

to return—they weren't unrealistic people, after all—but in this gesture

they demonstrated that they absolutely believed in me, which was a

powerful message for me to get at that point. Their support

notwithstanding, of course the dean had no choice but to reject their

pleas. Nothing was permanent; I could always try again the following

year.

And for the first time, as Kerrigan had promised when I was first

admitted, I received an actual diagnosis: "Chronic paranoid

schizophrenia with acute exacerbation." My prognosis, I was told, was

listed as "Grave."

So then—there it was. A part of me had been waiting for those

words, or some version of them, for a very long time, but that didn't

lessen the overwhelming impact of them, or what they signified for my

life.

In spite of my ongoing difficulties ever since undergraduate school

(and, in all likelihood, even before that), I hadn't ever really thought of

myself as "ill"—not at Vanderbilt, or even at Oxford, when I was

obviously delusional. I truly believed that everyone had the scrambled

thoughts I did, as well as the occasional breaks from reality and the

sense that some unseen force was compelling them to destructive

behavior. The difference was, others were simply more adept than I at

masking the craziness, and presenting a healthy, competent front to

the world. What was "broken" about me, I thought, was my inability to

control my thoughts and fantasies, or to keep from expressing them.

In reading everything about mental illness that I could get my hands

on, I wasn't looking for a diagnosis per se as much as I was looking for

an explanation for my behavior, which obviously wasn't acceptable. I

thought that if I could figure it out, I could conquer it. My problem

was not that I was crazy; it was that I was weak.

The summer before I first came to Yale (when I'd returned from

Oxford and had too much time on my hands), I had discovered the

Diagnostic and Statistical Manual of Mental Disorders, aka the DSM,

in the Miami library. I read it cover to cover. Knowledge had always

been my salvation, but with my immersion into the DSM, I began to

understand that there were some truths that were too difficult and

frightening to know. I was smart enough to read the text—the

definitions, the ramifications—and I understood what the words

meant. And to a certain extent, I even understood some of the science.

But understanding and believing are not the same; I simply refused to

accept on any conscious level that this had anything to do with me.

And now, here it was, in writing: The Diagnosis. What did it mean?

Schizophrenia is a brain disease which entails a profound loss of

connection to reality. It is often accompanied with delusions, which

are fixed yet false beliefs—such as you have killed thousands of

people—and hallucinations, which are false sensory perceptions—such

as you have just seen a man with a knife. Often speech and reason can

become disorganized to the point of incoherence. The prognosis: I

would largely lose the capacity to care for myself. I wasn't expected to

have a career, or even a job that might bring in a paycheck. I wouldn't

be able to form attachments, or keep friendships, or find someone to

love me, or have a family of my own—in short, I'd never have a life.

At that time, there was little encouraging medical news about

treatment for schizophrenia; certainly there were no cures, and

effective treatment was rare. Save for a few antipsychotic medications

that carried terrible side effects in the short term and horrible physical

risk in the long term, there was little in the way of medication to offer

a person suffering from schizophrenia. The medications worked for

some people; they didn't work for others. They had to be constantly

monitored by medical professionals and readjusted. What had been

an essential part of treatment for me—intensive talk therapy—was

falling out of favor.

I'd always been optimistic that when and if the mystery of me was

solved, it could be fixed; now I was being told that whatever had gone

wrong inside my head was permanent and, from all indications,

unfixable. Repeatedly, I ran up against words like "debilitating,"

"baffling," "chronic," "catastrophic," "devastating," and "loss." For the

rest of my life. The rest of my life. It felt more like a death sentence

than a medical diagnosis.

And then there was the whole mythology of schizophrenia, aided

and abetted by years of books and movies that presented people like

me as hopelessly evil or helplessly doomed. I would become violent, as

the delusions in my head grew more real to me than reality itself. My

psychotic episodes would increase, and last longer; my intelligence

would be severely compromised. Maybe I'd end my life in an

institution; maybe I'd live my life in an institution. Or become

homeless, a bag lady whose family could no longer care for her. I'd be

that wild-eyed character on the city sidewalk that all the nice baby

carriage-pushing mommies shrink away from. Get away from the

crazy lady. I'd love no one; no one would love me. For the first time in

my life, I truly, deeply understood what people meant when they said,

"It broke my heart."

At much earlier times, people suffering from schizophrenia were

viewed as either cursed by the gods or blessed by them. In some

cultures, "seers" were revered and given the privileges of high station;

in others, they were shunned and driven away from the community

like lepers. More recently, one nursing textbook from the 1930s gave

an impressive (if unlikely) laundry list for what caused schizophrenia:

war, marriage, masturbation, and religious revivals.

The history of schizophrenia is rich in blame for families.

According to the crushing weight of a century's teaching, my illness

was an indictment of my parents. Years ago, one respected

psychoanalyst coined the phrase "schizophrenogenic

mother"—literally, the mother who creates a schizophrenic. Such a

mother (no surprise) was described as cold, aloof, hostile, and

rejecting, which in no way describes my mother or my lifelong

experience of her. Yet another theory held that parents caused

schizophrenia when they subjected a child to the so-called "double

bind," a condition where a child receives intensely contradictory

messages such as "Come here, go away," or "You're a good little girl,

but you're really bad."

More current theories about the origins of schizophrenia discount

or even refute entirely the family-transmission view, focusing instead

on the patient's brain chemistry. The rapid expansion of research into

the workings of the human genome has helped shift the focus to a

genetic predisposition for the disease. As with many families, there is

serious mental illness in my extended family as well.

Schizophrenia tends to emerge at different times for men than for

women. For men, the first "breaks" tend to happen in the late teens or

early twenties. For most women, things begin to fall apart later,

usually in the mid-twenties. But before the illness truly manifests,

there is a stage—called the prodrome—when it slowly becomes

apparent to anyone paying attention that all is not well. It's possible

that my own prodromal stage happened during my time with

Operation Re-Entry. Certainly, my experience of the houses giving me

frightening messages on that long walk home from school was a very

loud preview of coming attractions. But the length of time between the

beginning of the disease and its diagnosis (and treatment) can range

from mere weeks to several years, as it had for me. And recent studies

indicate that earlier diagnosis (which could result in treatment at

lower symptom levels) may contribute to a more positive outcome.

Researchers are beginning to explore the benefits of intervening with

young people before the behaviors become destructive and

isolating—perhaps even intervening before a first psychotic break.

The problem is that prodomal symptoms, viewed separately or

together, mirror what many healthy teenagers experience in their

routine passage through adolescence: sleep irregularities, difficulty in

concentrating, vague feelings of tension or anxiety, a change in

personality, and perhaps a withdrawal from the social life of their

peers. Often, parents will realize (after their child has been diagnosed)

that there had been an identifiable period of foreshadowing, during

which time they'd wondered if their child was struggling with

depression. Indeed, these days, teenagers and adults alike are

sometimes prescribed antidepressants to combat this part of their

illness. As I reflect back, Operation Re-Entry may have served a

similar function for me, by giving me enormous amounts of

stimulation and attention at a time when I otherwise could easily have

retreated into my own world, under the guise of being a sullen or shy

teenager.

To make the picture even more complicated, schizophrenia is often

clinically confused with bipolar disease (what used to be referred to as

manic-depressive disorder) or popularly confused with dissociative

identity disorder (also known as multiple-personality disorder). But

treatments for these illnesses range widely. And the potential for no diagnosis at all, or the wrong one, is vast.

I wasn't diagnosed early; I wasn't treated early. I stumbled around

in the dark for years, clutching my Aristotle and negotiating my life as

best I could, until I was blessed by the wisdom and guidance of Mrs.

Jones, and given reason to hope in the future. But with Dr. Kerrigan's

announcement, those days had officially come to an end.

Everyone at MU10 believed that my next hospitalization would be

measured in years, not weeks or months. I didn't believe them, but I

kept quiet about that—there seemed to be no benefit for me in being

candid about my thoughts. My parents and I considered medical

facilities in Boston and New York, but in the end, I argued for going

back to YPI. It would keep me in New Haven, close to school; in fact,

from YPI to the law school it was only a short, pretty walk down a hill.

Maybe I'd even be able to audit a class or two in preparation for

returning the next year; maybe I could even nurture the few slight

friendships I'd begun to make before I had to leave.

It had been a rough three weeks at MU10. I was exhausted and

druggy, and deeply terrified about what would come next. But when I

climbed into the ambulance that would take me away from there, I

was relieved to leave the place behind. Nothing had happened to me at

MU10 that was encouraging or helpful; in fact much of what had

happened was inhumane and ineffective. But Yale Psychiatric offered

a tether to the life I still, somehow, hoped to lead. Thin as it was, that

tether was all I had.

chapter thirteen

THE FIRST PATIENT I met once back at YPI was Eric. An Ivy

League graduate slightly older than I, Eric, too, had spent time on

MU10. "I was there a little over a year ago, but they let me go," he told

me. "I wish they'd made me stay, and then maybe moved me here, like

they did with you. I fooled them into thinking I was OK. And I went

home. And then I killed my father."

Surely I'd misheard him. "I'm sorry, you did what?"

He nodded. "I strangled him."

I was dumbstruck. And horrified. To actually strangle your father?

A laying on of hands that actually kills someone? That was very

different from having thoughts that could kill. Besides, entities worked through me; Eric, it seemed, was his own agent.

My parents came back from Miami for the first meeting of my YPI

care team—doctors, psychologists, social workers, and nurses. When

asked about my relationship with my brother Warren, I stopped

rocking and humming long enough to correct the inquiring doctor's

grammar. "No, it's 'between you and me,' not 'between you and I.'" I

can only imagine now (but was completely oblivious at the time) that

it must have been sheer torture for my mother and father to witness

the worsening disintegration of their daughter.

I was placed in YPI's Intensive Care Program—ICP. My days would

be spent in a small room with a staff member and one or two other ICP

patients. I would take my meals apart from everyone else (no

socializing for me in the cafeteria) and sleep in a locked seclusion

room at night. And I was not allowed to wear shoes. That way, if I

escaped the building, staff could be certain I wouldn't get too far. The

New England autumn was deepening outside, and it was getting

colder every day.

For the first three weeks at YPI, I remained as floridly psychotic as

I had been at MU10. My medication was increased, putting me over

the maximum recommended dose forTrilafon. No Valium, though—it

seemed that staff wanted me on meds that actually helped my

psychosis.

Nevertheless, the hallucinations never stopped. Walls were

collapsing, ashtrays were dancing; at one point I went into a linen

closet and invited the other ICP patients to join me in there for a

"housewarming" party, as I laughed and gibbered the afternoon away.

Totally lost in my delusions, I warned of the great horrors and

devastation that I could inflict upon everyone (most notably the ICP

staff) with the power of my mind.

Incredibly, no matter what I said or threatened, I was never

restrained. If I expressed a violent impulse, staff encouraged me to rip

out the pages of a magazine; if I kept it up, staff steered me to the

seclusion room, away from other people. My behavior was no different

from what it had been in the ER, or on my initial visit to YPI weeks

earlier, or during my three weeks at MU10. But the hospital's

response to the behavior most certainly was. Evidently, the question

of whether I was to be restrained or not had more to do with where I

happened to be than how I behaved.

What I'd gained in freedom, however, I lost in privacy. I was kept

apart from almost all the other patients, yet never left alone. Maybe it

was ICP policy—I had my own special staff person, my shadow,

watching and listening, right beside me, all the time. When I ate.

When I slept. When I spoke on the phone with a friend. When I met

with my family. A slight reprieve came when I went to the bathroom;

the staff member lodged a sanitary napkin in the door to hold it

slightly open, then sat down just outside. A staff member even

watched as I took a shower.

Not only did they take my shoes away, they wouldn't allow me to

wear socks at night, no matter how cold it was on the ward. I couldn't

imagine how I could hurt myself with socks, but evidently staff had

seen otherwise with other patients. So no socks, even when it meant I

shivered through the night.

I was on a high dose of antipsychotic medication, attending a few

therapy groups, and in individual session three times a week—total

saturation. But there were no miracle cures; instead, there was only

the dreary sameness of day-to-day life on a psychiatric ward, and this

one was particularly grim. Old, run-down, with shabby, narrow halls,

yellowed paint, and grate-covered windows which never drew in any

sun (and a pathetically weak sun it was, too). I was followed day and

night by my minder, and never allowed to go outside to fill my lungs

with some fresh, cool air, or for a change of scenery. I'd made no

friends on the ward; other patients never tried to socialize with me at

all, no one broke through my isolation, and even Eric, the

father-killing Ivy grad, shunned me-who was he, I wondered, to shun

anybody? I hadn't been this bone lonely since my early days at Oxford.

Every day was the same, and would be for a long time. The years

yawned out ahead of me; my hair would turn gray here, I knew it,

while every dream I'd ever had would be absorbed into the ugly

yellowed walls.

And then something threw a switch in my head, and I got it. I got

it. The only barrier between me and the door out was me. I simply had

to stop it. Stop voicing the hallucinations and delusions, even when

they were there. Stop babbling incoherently, even if those were the

only words that came to my lips; no, no, it was better to be quiet. Stop

resisting; just behave. Being in a psychiatric hospital is nonsense, I

thought. I'm a law student, not a mental patient. I want my life back,

damn it! And if I have to bite my tongue until it bleeds, I am going to

get it back.

What was happening, of course, was that after weeks of steady

medication, the psychosis was beginning to lift. Maybe I couldn't keep

the thoughts from coming into my head, but I could organize them,

and keep them from getting out. OK, here I go.

It took staff a week or so to notice—much too long, it seemed to

me—and when they finally did, it took another week before I was off

the Intensive Care Program and allowed more privileges. I could sleep

with socks. I could use the bathroom in peace. I could shower without

company.

Yes, yes, I absolutely agreed with them that I needed treatment.

"But not here and not this kind. I want to go back to England," I said.

"Mrs. Jones knows what I need to get well again. I can go back into

treatment there with her."

The request was met with stony faces and heads shaking "no." YPI

didn't like that idea; YPI wasn't going to relinquish control of my

treatment to some woman in England who in their estimation likely

didn't know what she was doing.

As sudden (and effective) as I thought my change in attitude had

been, what happened to me next was just as sudden, only in the

reverse direction. In fact, it's a case study—partly—in the ups and

downs of heavy drug loads and the complicated biochemistry that

results: Soaked in antipsychotic medication, with the psychosis

actually clearing, I became profoundly depressed, and felt the brief

flash of energy and focus leak right out of me. Suddenly, I couldn't

follow the simplest sitcom on the unit TV, or decipher the lines in a

book I'd been reading just days before. I was given an IQ test and

scored "dull normal" in the verbal portion and "borderline mentally

retarded" in the quantitative section. It's not that I wasn't trying—I

just couldn't function. I had no way of knowing that depression

following a psychotic period is not unusual; I only knew I was sliding

backward. I called my parents and pleaded with them to get me out.

"It's all going wrong again!" I cried.

They promised to help, and once again we began the search for

another hospital, where a stay might be shorter. My parents even

contacted Karen, the therapist whom I'd seen the summer after my

first year in college, and she suggested a hospital in Philadelphia,

where she was now living. I remembered what she'd said to me so

many years before: "You do need help. And I just want you to know

that when you decide you're ready to get it, you can and should come

back to see me."

The staff at YPI did everything they could to dissuade me from

leaving, from either going to Philadelphia or back to England. They'd

move me to an open ward, they said, with more privileges. I could

even have my shoes back. I politely declined.

Five weeks after I had arrived at YPI, my parents came to bail me

out. They pulled up the driveway, loaded all my stuff in the trunk of

the car, and together we headed out of New Haven. I felt safe, relieved,

even a little optimistic; if I closed my eyes, I could almost imagine I

was a girl again, safe in the car, on a trip with my mom and dad. But

the trip wasn't to Disneyland; it was from one hospital to another

hospital, and I was leaving law school behind. Nevertheless, it was still

a good day.

The Institute of Pennsylvania Hospital—IPH—was a much more

physically attractive place than YPI, in spite of being the oldest mental

hospital in the country. Located smack in the middle of a

neighborhood in serious decline, the building literally shone, with

high, vaulted ceilings and marble floors that were polished daily. I was

taken to my private room, with its own private bath. If there was a

food chain of treatment centers, it appeared as though I'd moved up.

Although I was still trying to get out from under the depression, I was

nowhere near as psychotic as I had been (thanks to the hefty dose of

Trilafon). I was convinced that I'd only be at IPH a couple of weeks. In

the end, it would be three months.

The doctor I'd be working with, Dr. Miller, was a short, round

psychoanalyst who had a welcoming Midwestern openness and used

words like "swell." It was easy to like him—a good thing, since we met

six times a week. In addition, I'd meet with Karen, the former Miami

therapist, once a week for several hours. And that meeting would take

place off-site, which thrilled me; in fact, I was granted the highest

level of privileges, which meant I could even walk the grounds alone.

As is usual in psychiatric hospitals, IPH offered many group

activities for patients. On my second day, I went to my art therapy

assessment. Not being an artist, I drew what I knew how to draw—a

stick figure and a tree. "This is wonderful, primitive work!" exclaimed

the therapist. I went to very few groups after that.

Instead, I read my law books in preparation for getting back to

school the next year. I'd gotten the course requirements and assigned

readings before I left New Haven, and every day I pored through the

material so I could be ready when the time came. Because I was going

back. Diagnosis or not, I was going back.

Having two therapists would likely confuse many people, because

even with the best intentions and the most open communication,

they'll probably trip over each other's feet. But I liked the

arrangement, and I liked the two of them both as well. And I quickly

figured out that it was an arrangement that would work to my

advantage. Miller was the one to decide when I could leave the

hospital, so I tried to be as circumspect as possible in terms of what I

revealed of the inner workings of my mind: I wanted out, and he was

the judge and jury. Karen, however, had no such role or authority. As

a consequence, I felt freer to tell her what was going on—my bizarre

and frightening dreams, and my ongoing violent thoughts.

The first time I tried to get to Karen's office, however, was a

comedy of errors that was far from funny. The cabdriver couldn't find

the house, and I certainly couldn't help. We went round and round

Philadelphia, stopping for directions at several gas stations, and when

we finally arrived, I was more than an hour late and completely

discombobulated. Shaking, I knocked on Karen's door.

"Thank goodness you're here!" she said. "I just got off the phone

with your parents saying you must have eloped"—hospitalese for

escaped. "Now I have to call them right back before we start our

session, they're frantic!"

In the beginning, Dr. Miller and I spoke mostly about how I was

experiencing and managing daily life, but soon our sessions became

more psychoanalytic. I even started lying on the couch and working

with dreams again. And I talked a lot about Mrs. Jones, and how

much I missed her.

"Why don't you write her?" he suggested one afternoon. "Or

perhaps even talk to her on the phone? Would you like that?"

I couldn't believe it. For some reason, I'd thought that he would

put up a barrier to that, as they'd done at YPI. "Not at all," he said. "I

think it's a good idea."

With his support, I wrote a carefully crafted letter asking Mrs.

Jones if she'd consent to our scheduling a transatlantic telephone call.

To my great relief, the letter she sent back to me in reply said yes.

When I actually heard her voice on the phone, my heart leapt—and

then I immediately felt overwhelmingly sad. So much had happened

since I last saw her, most of it bad. I felt as though I'd failed her. I told

her how terribly much I'd missed her; she said she'd missed me, too.

"Mrs. Jones, do you think I might come over and see you? Maybe this

summer?"

There was no hesitation in her answer. "Why, yes, Elyn," she said.

"I think that would be perfectly acceptable and fine."

The elation returned—now I had something to look forward to,

and someone I knew and trusted who would help me formulate my

plan. I began to understand the deep ache I felt in my heart each time

I thought of her; I'd been so sad when I left her, so unhinged that day,

that we hadn't really shared a proper good-bye. I had not been ready

to let go, and wasn't able to find the right words. Perhaps this time, I

would be able to do it in a way that I could live with, something that

would help me stop looking back and start me moving forward again.

In spite of the side effects, I had to admit that the Trilafon was

helping. Nevertheless, I was, as always, anxious to get off meds. Karen

was rabidly anti-medication as well, and my parents were, too, so

Miller agreed that we could give it a try, but very slowly.

As cautious as he was in reducing my intake, I felt the effects

almost immediately. My blank, masklike face relaxed into its familiar

appearance, and I stopped doing the invalid shuffle down the hall. I

felt less fuzzy, more aware of what was going on around me. "You

seem angrier to me, though," said Miller. I'd walked out of a couple of

sessions before we'd officially ended, which concerned him.

"I can handle it," I said, impatient. "Let's keep going."

In two months, I was med-free, except for something to help me

sleep. At three months, I was one of the old-timers on the ward. In

fact, the staff sometimes consulted me in ward meetings about newer

patients—which one was doing OK, which one needed watching, and

who might deserve more privileges. I wasn't comfortable with this

role: Was I a colleague to them? Was I still a patient and, if so, why

did they trust me? And which of them could I trust? I'd have preferred

being left out of it entirely. But I knew that every move I made was

still being closely watched; if I was nonresponsive when asked my

opinion, I knew I'd pay some kind of price. Once, walking down the

hall, I jumped up to touch the ceiling, just to see if I could—and then

caught myself, panicky about what would happen if I'd been seen. I'd

be written up. My fear of being scrutinized wasn't paranoia. Others

really were watching me, and the risk was real.

By early April, I was more than ready to leave IPH, and once again

I asked my parents for help in getting out of a hospital. "Don't you

think you should stay until Dr. Miller thinks it's time?" my dad asked.

"No," I said. "Besides, he just told me he's going away on vacation

for two whole weeks. I want out of here now."

Miller suggested that I might think about going home during the

time he was gone—kind of like an R & R, I suppose—and then return

to IPH for another month or two in the open ward. There was a nurse

on the ward I trusted, and I asked her about this. "Why should I come

back if I'm well enough to leave?"

She pondered this for a moment. "In my experience, doctors know

much more than patients about what's best for them," she said finally.

"So I think I'd come back, if I were you."

My parents, on the other hand, agreed with me—if Miller truly

thought I was well enough to be on my own at home for two weeks,

then I was well enough to leave the hospital for good. No one else on

staff was very enthusiastic about this. Nevertheless, it became the

plan: I'd leave the day Miller did. My discharge papers read

"AMA"—Against Medical Advice.

As I walked down the hall on my last day, suitcase in hand, one of

the custodians who came to the ward daily, a good-looking, wiry man,

saw me. Although we'd never had a single exchange during my entire

stay, this time he smiled warmly and nodded at the suitcase. "Good for

you, getting out."

My own smile stretched as wide as his did. "Thank you," I said,

and walked out into the late spring sunshine.

In the taxi on the way to the Philadelphia airport, however, the

sense of having made my escape and leaving the hospital behind was

more than I could handle. I was alone, and unguarded, and as the

emotions piled on top of one another, I was quickly overwhelmed by

them. As though they'd slipped by a guard at the gate, the delusions

marched in—paranoid thoughts and a strong message from someone,

something, insistent upon being heard. I was the center of a massive

and intricate plot involving the creatures in the sky. It would somehow

involve the plane I was about to take. But the idea of returning to the

hospital never crossed my mind. Gritting my teeth, and trying with all

my might to focus on what I knew to be real, I grimly boarded the

plane for Miami. Hold it together. Hold it together. It was, as usual,

an uneventful flight.

It was May and I was home, just as a lot of other young people were at

the end of a year away at school. September to May—one full academic

year since I'd walked across the Yale campus sporting a

telephone-wire belt and babbling about my complicity in the

impending end of the world. And now here I was back home again,

completely off antipsychotic meds and somewhat functional, although

just barely on some days. Good days, bad days. More bad days. I went

to the beach with my brother and sister-in-law, and the light and heat

almost made me cower. In minutes, I was convinced that everyone

there had come to the beach to ambush me—they thought I was evil,

that I had killed many people. I was certain that if I moved suddenly,

they'd leap up and kill me. I sat stiff as a board on my towel down near

the water, silently begging not to be noticed. I wished I had brought a

gun with me to protect myself in case I was attacked.

Years of this illness had taken a toll. The constant effort to keep

reality on one side and delusions on the other was exhausting, and I

often felt beaten down, knowing that the schizophrenia diagnosis had

ended any hope I'd had of a miracle cure or a miracle fix. I'd

disappointed my family; I'd shamed them. I wondered aloud if I

would ever amount to anything. "Maybe it's too late," I said. "Maybe I

need to be realistic about my life."

"You have to stop thinking like this," said my father firmly. I knew

before he'd gotten to the next sentence that I was in for the familiar

"buck up—get tough" speech, variations of which I'd heard much of

my life. "This isn't terminal cancer, Elyn—and people have come back

strong even from that diagnosis, you know. What you've got, that's a

piece of cake by comparison. You can beat it with the right attitude.

Stop feeling so sorry for yourself!"

I wondered what I would have done in my father's place—if I

would have, or could have, given a child of mine that same speech

under the same circumstances. I had an illness, it was real, and it was

ruining my life—how could he make it all about (or only about) pulling

up my socks and getting tough? Didn't he get it?

But then I had to concede that yes, I probably would have given my

child a near-identical speech—because it reflected what I'd been

taught all my life: Intelligence, combined with discipline, could

overcome any challenge. And mostly, that belief had served me well.

The problem was, it assumed that the intelligence at hand was fully

functional, fully capable—but I'd been told by experts that my brain

had serious problems. Was my brain the same thing as my mind?

Could I hang onto the one while conceding that there was a big flaw in

the other? I resented my dad for setting up a standard that I might not

be able to meet, yet his opinion meant everything to me—and he

believed I could beat this.

I sought comfort in reality as I knew it: I was out of the hospital,

off medication. I was reading Aristotle again, and it was even making

sense. And I was going back to law school. My determination to go

back to school was not part of my delusional thinking; it was part of

my self. I believed myself to be the person who would go back to law

school and finish it. That's who I believed myself to be, and that

wasn't delusional.

In order for me to be readmitted, university policy required that I

meet with the head of the University Health Psychiatry Department.

And just as I'd done all my life, I studied hard before "the test": I

researched the director, and every single article he'd written. In a

wonderful coincidence, one of his published articles concerned the

questions university officials should ask people who've had psychotic

breaks and are applying to be readmitted to school. I couldn't believe

my luck—or was it fate? I didn't care what it was; I simply rehearsed

my answers to the questions in the article, and sure enough, they were

the ones he asked.

I was relieved to hear that my medical records weren't forwarded

from the hospital; no one from Yale, to my knowledge, had asked for

them, and I certainly didn't volunteer them. Did I have any

symptoms? he asked. Did I think I could take the stress of school? And

what might I do if I started feeling poorly? As nervous as I was (I

didn't sleep well the night before, and I had to fold my hands tight in

my lap to keep him from seeing me shake), I didn't actually have to tell

a single lie. Instead, I simply strategized, by staying as close to the

truth as I could without hurting myself. And in any case, I told him,

"With an analyst four days a week, I'm sure I'll be able to handle

everything very well." I was readmitted.

The next hurdle would be my upcoming trip to England to see Mrs.

Jones. As difficult as travel was for me, and as many challenges as

getting well and staying well would present me with, there was no way

I could see the trip as anything but promising. Maybe our time

together would prove to be exactly the booster shot I needed.

It was a little odd, being back in Oxford again. Summer there was

green and leafy and still; it looked and felt as different from Miami as

anyplace could have. Janet was renting my old quarters to a lodger, so

I stayed in a little bed-and-breakfast near her house. It was a joy to

spend time with her, and visit with bright and beautiful young Livy.

For the next couple of months, I met with Mrs. Jones three times a

week. It was such a relief to be in that familiar office in her shabby

little house, to stretch out on the couch and have no care for what

came into my head or out of my mouth. I told her about the restraints,

and the drugs, and about my fear that with each episode, I was losing

more of myself. I reported my delusions, and the forces beyond my

control that were unbearably evil. I was malicious, I was bad, I was a

destroyer of worlds.

She was not afraid; she did not look at me with alarm in her eyes.

She did not judge, she only listened, and reflected back to me what she

heard, telling me what she thought it meant. And she did not embrace

the schizophrenia diagnosis, either (although she acknowledged the

existence of the symptoms and behaviors; after all, it was impossible

to deny them). "Don't focus on it," she said. "Don't define yourself in

terms of something which even many highly trained and gifted

professionals do not fully understand." To her, the best road to

understanding was psychoanalytic. There was little room for biology

and therefore little room for medication.

When at last it came time to leave Oxford again and return to New

Haven, my faith in myself was shored up. This time, I didn't feel the

overwhelming grief at leaving Mrs. Jones behind; she was there for

me, we would stay in touch, and I could come back to see her. For

now, it was time to get back to my intended life.

I had no way of knowing then that it would be the last time I'd see

Mrs. Jones in good health. The following year, she was in a terrible

automobile accident that required a tracheotomy and left her in a

coma for months. When she regained consciousness, her mind and

body were badly damaged; in fact, she was diagnosed with traumatic

Parkinson's. When her husband, Dr. Brandt, wrote me about what had

happened, I returned to Oxford as soon as I could, and what I saw

there frightened me. White as a sheet, frail and trembling, she reached

out her hand and said my name. "I love you," she said.

A year after that, I visited again, devastated at how fragile and

small she'd become. She wasn't ever going to be well again; she would

never be who she once was. Nervously, I began talking about my

successful second year at law school and my plans for the future. To

my great sorrow, she began to weep. "Oh, Mrs. Jones, what's wrong?"

I asked. "Did I say something to hurt you?"

"I'm sorry," she softly cried. "But I just don't remember you."

As I turned away, to leave our brief meeting, it occurred to me how

truly beautiful she was.

A few months later, she died. The grief at her loss burrowed deep

into my soul; this was, in every way that mattered, a death in the

family. For so long, through everything that had happened to me, I'd

taken courage in knowing that Mrs. Jones was there, in her house, in

that office. She knew me like no other.

chapter fourteen

I RETURNED TO New Haven a few weeks before classes were to

start, in order to begin treatment with a doctor who would be new to

me—Dr. Joseph White, a senior member of the Yale faculty who'd

been recommended to me by one of the doctors at YPI. White had a

widespread reputation for his work in psychiatry, but his scholarship

also extended to the humanities. He had a great deal of experience

working with very sick patients, and he was also a well-known believer

in "talk therapy." In short, there was every reason to think I'd be in

good hands.

Psychoanalysis was by no means the obvious treatment for my

illness; indeed, most of the professionals at YPI cautioned against it.

Psychoanalysis, they explained, causes regression, and I was already

too regressed; supportive psychotherapy, combined with medication,

was the way to go. I needed, in their view, to shore up my

psychological defenses, not to delve behind or take them apart.

But to me, psychoanalysis was the only treatment that made sense.

I had been cripplingly ill in England. Psychoanalytic treatment kept

me out of the hospital while I actually completed my Oxford degree. In

the States, in exactly the same situation, I was hospitalized, tied up,

and forced to drink foul antipsychotic meds—a year of my life wasted,

at a cost to my parents of thousands of out-of-pocket dollars, since the

thirty days' worth of inpatient care that my insurance covered hadn't

even scratched the surface. I may have been crazy, but I wasn't

stupid—I was going with what had worked before.

I met with White at his office at a community mental health center

(for those who couldn't afford private care, although I'd be seeing him

as a private patient) affiliated with Yale Medical School. White was

head of one of the divisions, supervising residents in their placements

at the center.

A two-story, nondescript gray building, the center was not

particularly inviting, and neither was the doctor's office, which was

equally gray and nondescript. Nevertheless, I took to the occupant

immediately. White was distinguished-looking, with an almost

patrician reserve. Then, as now, he struck me as the quintessential

Yale professor. For the time being, we would meet four times a week.

White was more classically Freudian than Mrs. Jones. Kleinians go

deep and fast, wasting no time to get to the heart of the matter,

whereas White's style was to be more attentive to my defenses, those

psychological tools we all use to protect ourselves from painful

thoughts and feelings. Mrs. Jones quickly focused on my thoughts and

feelings; White examined instead the ways I kept certain parts of my

mind at bay. Where Mrs. Jones might discuss my envy, White

discussed how my being overly admiring of someone allowed me to

avoid my envy of them. He'd wait, listen, say a word or two, then wait

and listen some more. Despite his relative silence, nothing escaped his

attention. And he set limits.

"Elyn, I need you to stop pacing," he said one afternoon.

"Why?" I asked. Part of me was genuinely curious; another part

felt my hackles rise in defiance. "We can talk just as well if I'm

pacing."

He shook his head. "No," he said. "I need you to talk about what

you are feeling, I need you to not act." His voice wasn't harsh; his

manner wasn't angry. He was calm and knowing, and spoke as a

teacher might to a student who was restless in class and therefore

likely to miss the lesson. White recognized early on that my own

powers of wall, which had often served me well, were just as likely to

serve me badly when they pushed me to behavior that was destructive.

Once I was set up with White, my next order of business was

school, and how to deal with the awkward "story" of my abrupt

departure the year before. I'd learned an unpleasant lesson that

long-ago day when I'd tried to volunteer at the Warneford. Any

attempt at telling the truth would condemn me, both socially and

professionally. So I made up a story about how I'd taken a leave of

absence to decide if law school was really for me. The story worked

well enough, but whenever a classmate said how impressed she was

that I'd actually taken time away to consider this decision, I felt like a

fraud. Piling a lie on top of a secret didn't feel particularly good, but

mental illness comes with a price tag—and I was willing to pay it.

And then classes began. I walked into my first class of the new year

and sat down with a quiet, almost fragile joy and a near-audible sigh

of relief: I was back.

I especially liked the professor of my "small group," the

semi-narlike class of about fifteen required of all first-years. His name

was Bob Cover. At the age of forty, he'd won the Ames Prize (given by

Harvard Law School for a book deemed of profound legal scholarship)

for Justice Accused: Antislavery and the Judicial Process. In addition

to being a wise and compelling teacher, he was also a scholar of

philosophy, literature, and Jewish history, as well as a civil rights

activist—a leading supporter of the unionization efforts of Yale's

clerical and technical workers, and active in the movement to get Yale

to divest itself of South African investments before the end of

apartheid. Engaged, passionate, and genuinely humane—everything I

hoped someday to be. Later that year, I'd be fortunate enough to be

Cover's research assistant on an article for the Harvard Law Review

entitled "Nomos and Narrative" (nomos is the Greek word for "law"); I

was thrilled to see that he'd thanked me for my efforts in the article's

first footnote. (Sadly, at the end of my third year of law school, in

1986, Cover died of a massive heart attack at forty-two. His loss

profoundly touched the legal community at Yale and far beyond.)

With years of practice, I'd learned to keep my symptoms mostly

hidden from view; I was becoming adept at acting normal even when

I wasn't feeling it. Perfecting this acting, this seeming, was vitally

important if I were going to make my way in the real world. Yet in

spite of my vigilance, periodically my psychosis surfaced. One day, a

classmate received high praise from one of my professors; fortunately,

I had a session with White shortly after. "Someone's trying to kill me,"

I said. "He's a friend, he's an enemy, and he sent soldiers to the front

where I was to explode my brain. I'm scared."

"I think you're talking about your competitive feelings toward your

classmate," White said. "You sort of started there, but then you felt

scared to have such strong negative feelings about a classmate—so in

your mind, you made your classmate attack you. It's sometimes easier

to feel attacked than to feel angry or sad."

He also helped me understand that I retreated into thoughts of my

own violence when I felt cornered or upset; even to me, that made

some sense. "I think you're talking about threatening and scary ideas,

because you feel threatened and scared yourself," he said. "The

violence is your defense against fear. You are safe here."

So I went back out into the world, shoved the violence and the

delusions into a closet, and leaned against that closet door just as hard

as I could. I was determined not to lose any more time, not to lose any

more of my self...and then Professor Cover assigned our small group

its first memo. I was startled at how quickly my body reacted: hot,

cold, clenched fists, some trouble with concentration. Memos are

what threw me the last time. For two weeks, I worked on my

arguments, burrowing down into the research while managing my

other classes. It's OK. Calm down. Focus.

My memo came back with only three words on it: "Generally very

good." I had no way of knowing that this was high praise indeed

coming from Bob Cover. Some students were required to completely

rewrite their memos; all I had to do was fix a few footnotes. But those

three words weren't enough; to me, they meant I wasn't enough. By

nightfall, I was more disorganized in my thinking and behavior than

I'd been since early in the summer. The library's the only safe place, I

thought. I'll go work.

Once settled in, I looked up to see a classmate approaching. "What

year is it?" was my greeting. "Do you know where your schoolchildren

are? Who's in the library with us? Have you ever killed anyone?" It

had simply never occurred to me that others didn't also kill people

with their thoughts. My classmate (with impressive practicality, not to

mention quick thinking) asked if there was a doctor or therapist she

could call for me. I gave her White's name and number, then revealed

that the law book I was carrying had no "no's" in it. Then I started

reciting Aristotle in Greek.

"Elyn, stay here. Stay right here, I'll be back as soon as I can."

When she returned, she told me that White was on the phone; then

she led me to the phone itself.

"What's going on?" White asked.

"There's cheese and there's whizzes," I told him. "I'm a cheese

whiz. It has to do with effort and subliminal choice. Vertigo and

killing." Suddenly, I was terrified.

White's voice was calm. "You sound as if you're not feeling too

well," he said. "Your friends are concerned about you."

"Oh, they're nice. Do you like spice? I ate it thrice. They're all

hurting me! They're hurting me and I'm scared!"

"I know," White said. "But it's not you, Elyn. It's your illness acting

up. Everything is going to be OK. I want you to go to the ER now, the

doctors there will be able to help you."

Like a laser beam, his suggestion focused my mind: the ER? No.

I'd been given a second chance, I wasn't about to repeat the events of

the previous year. "No way," I told him. "No way in hell am I going to

the emergency room."

"But I think you need to," he said. "They won't hurt you, and they

may be able to give you some medicine that wall help."

"Or they may tie me down and lock me up," I argued. "No

emergency room."

"I know you're frightened because of last year," White said. "But

that's not going to happen this time. And I think you need their help."

"I'll think about it," I muttered. I was fragmented, leaking out at

the edges, but I was determined: It'd take police and significant force

to get me back into an ER again.

I left the library in a panic, headed back to my room, and

attempted to sleep, but it was futile; the very air in the room seemed to

swirl around me with threat. Danger. Evil. Exhausted, I headed for

the Student Health Center the next morning, and once again found

myself sitting with a doctor whom I didn't know and who didn't know

me. "I've been talking funny," I told him, along with only the

barestbones medical history. He gave me some Trilafon, which I

slipped into my pocket. YPI had loaded me up on Trilafon to the point

where I couldn't walk and couldn't read—why should I take it now? I

had a standing appointment with White the next day; we'd talk about

it then.

By the time my appointment rolled around, I was deep in

psychosis and almost speechless. I rocked in his chair, rolled my eyes,

and stared at the floor.

"How's everything going today, Elyn?" White asked.

"Two and the division of time." Silence.

"Can you tell me what you mean?"

No. More silence, more rocking and gesticulating.

"Everything's going to be OK," he said. "It's good that you went to

Student Health; I was concerned that you were going to resist

treatment when you didn't go to the ER."

There was a drug, he said—Navane, an antipsychotic whose side

effects were milder than Trilafon's. We'd start at a low dose, ten or

twelve milligrams. "No," I said. "Not a good idea."

"It wall help you concentrate," he said. "It's milder than the other, it

works quickly, and please, it wall help."

Finally, desperate, I agreed. Only one memo and I'd already

crashed. How on earth would I make it through all the memos to

come?

The Navane worked as quickly as anything I'd taken. Within a few

hours, my mind had calmed. I could read. I could think.

Different bodies respond differently to different medication;

finding the magic potion is pretty much hit-and-miss. This seems

obvious, even simplistic, but it's the only consistently true fact in

treating mental illness. This time, Navane worked. I stayed on it for

about ten days, got a lot of work done, then decided that while it was

helpful, it was making me a little druggy, and besides, it probably

wasn't necessary. I'll take it when I get sick, but not for long; I don't

want to be drugged. Within two days, I'd stopped altogether. I'd

fooled them. Which of course raises the question: Fooled whom?

It would take me another fifteen years to learn the lesson of what

happened each time I withdrew from drugs. It had been much easier

to learn ancient Greek, and not nearly as self-destructive.

One of the worst aspects of schizophrenia is the profound

isolation—the constant awareness that you're different, some sort of

alien, not really human. Other people have flesh and bones, and

insides made of organs and healthy living tissue. You are only a

machine, with insides made of metal. Medication and talk therapy

allay this terrible feeling, but friendship can be as powerful as either.

Steve Behnke was a first-year student, with a boyish face, a head

full of thick sandy hair, and a runner's body. We first talked in the law

school cafeteria sometime in early November, on one of those New

England evenings when leaves are turning colors and you can taste fall

in the crisp air. A group of seven or eight of us sat down to dinner on a

Friday.

Steve and I were in contracts class together, and a couple of times

he had asked me about an assignment. Other than that, we'd never

really spoken. The dinner conversation that night was casual and

pleasant, drifting from one subject to another—classes, and law

journal, and summer jobs. I noticed that Steve seemed engaged

enough—he nodded, he smiled—but after a while, it began to look

more like simple politeness. As the others got up to leave, I realized I

wasn't ready to go just yet.

And there began one of those conversations that last for a lifetime,

one in which there is immediate comfort and acceptance, the

equivalent of someone's strong hand offered to you when you most

need to grasp it. That first talk flew far and wide: how we got to Yale,

who our families were, how we felt about them. Then philosophy, then

religion, and what mattered to us, and why. Steve had majored in

classics at Princeton, where he was named salutatorian of his class

and spoke, in Latin, at graduation. The summer after graduation, he'd

worked as a janitor at a small-town airport, then gone to Rome, where

he lived with a group of Benedictine monks and read Latin at the

Vatican, with a monk who served as the Pope's Latinist. He'd

considered entering the monastery and studying medieval philosophy,

but decided against it—because he couldn't marry as a monk (he very

much wanted a family) and because medieval philosophy had ceased

to hold his interest, at least as a life-long endeavor. Instead of

becoming a monk, Steve came to Yale Law School. And so did I. And

neither one of us was quite sure why.

Sometime later, it occurred to me that at the very moment I was

being tied to a bed in a psychiatric ward, screaming bloody murder

and afraid for my life, Steve was singing Gregorian chant in a

monastery overlooking the ancient city of Rome. And here we were

now, come to the same place, from two very different directions. It

was past midnight when we said good night, and as I walked back to

my room, I had the distinct feeling, in the middle of my usual muddle,

that I'd been unexpectedly blessed.

I don't know why I decided to tell Steve the truth about myself; I don't

know why I thought I could trust him. But I did. I believed from our

very first conversation that this man would be a significant friend and

a force for good in my life. Once the possibility came to my mind, I

realized how very much I wanted it to be so. But I didn't believe that

could happen unless I revealed the truth about myself and let him

"see" me in full. So much of what I did on a daily basis was about

faking it; I knew that I would never fake it with him.

And so, on a rainy Sunday afternoon, at a pizzeria in New Haven, I

shared my history. Aside from doctors and therapists, it was the first

time I'd ever done this with anyone, anywhere.

Steve's a naturally curious man and a gentleman as well. So he

asked a lot of questions, but in a very gentle and noninvasive way. He

told me he didn't know much about mental illness; there'd never been

much of a reason to study up. But he listened, and he was empathetic,

and little by little, every detail came out. Speaking as a Jewish woman,

I suspected he probably would have made a fine priest.

When Steve and I first came to know each other, romantic

relationships were so far off my radar that it never even crossed my

mind to look for one or, more particularly, to look for one with him. As

our friendship progressed, I realized it was becoming exactly what I

wanted. He was, for lack of a better term, brotherly—that is, if you can

find a brother (or a sister, for that matter) who reads the same authors

you do, has the same political and philosophical beliefs, is staggering

under the same load of books, and is comfortable making tactless

jokes about mental illness. Specifically, mine.

It was late one blustery fall night, in the bowels of the law school,

when I was struggling badly, not so long after I'd told Steve about

myself. "You can't imagine what it's like in an emergency room—it's

god-awful, the way they tie you down and make you wait all night till

someone has time to see you. They walk into your room at the crack of

dawn, because they're ready to talk. What do they possibly expect you

to say except'Let me f'ing go! "'

Steve looked at me with an impish grin. "Quote Hamlet, perhaps?"

And in his best Shakespearian accent he intoned, "Lo, noble physician,

the 'morn in russet mantle clad walks o'er the dew of yon high

easterward hill. So loosen my chains, kind sir, for the tasks of the day

await me."

He smiled. I laughed. He got it. I knew this man, whose depth of

heart was equal to the speed of his mind, would be a lifelong friend.

chapter fifteen

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 wall, 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 MU10; 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?

chapter sixteen

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. I'm 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

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 MU10. 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;

nevertheless, 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 primarily

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 I-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.

chapter seventeen

TAKING THE TEACHING job, even though it was not at all

prestigious (as the dean himself had intimated), was one of the best

professional decisions I ever made.

It was one of the smaller schools I had been in, with less pressure

and tension than Yale; the students were hardworking and

aspirational, eager to listen and learn (there was, however, a

significant flunk-out rate, unlike Yale). My major responsibility-

grading their memos and briefs—was time-consuming, but

straightforward, and on some days mostly easy. In spite of my

awkwardness about speaking in public, the give-and-take I had with

these students helped shore up my confidence. I began to think of

myself as a real teacher.

One of my colleagues there was a professor named Sandy

Meiklejohn, a grandson of the famous philosopher and First

Amendment scholar, Alexander Meiklejohn. Sandy had been a tennis

pro in between graduating from law school and practicing law, and

had been surprised that he was able to land a teaching job. Once there,

he discovered that the family tradition of teaching (Alexander senior

had been dean of Brown University from 1901 until 1912 and

president of Amherst College from 1913 until 1923) ran deep in him as

well. Sandy loved teaching, and in spite of having a reputation of being

hard on his students, he was also the favorite professor of many—he

didn't patronize and he didn't pander. And he was a wonderful role

model for me.

Sandy and I became good friends and shared many working

dinners together; he was a kind and intuitive "coach" during my

wobbly early days as an academic, and helped me with a paper I was

trying to put together for publication. For obvious reasons, I'd become

interested in what attributes or characteristics comprised

"competency" for people who wanted to decide for themselves to take

(or not to take) medication for psychosis. How did the law define it?

How did the medical establishment understand it? And how should

we understand it? Since Sandy had studied contractual capacity, his

feedback on another competency topic was vitally important to me.

That teaching year seemed almost to fly by, and I was doing

well—better, certainly, than I could have expected. I'd adjusted to the

many changes in my life as trouble-free as I'd ever done. The teaching

job made it easier for me to schedule my appointments with White,

and although I longed to be drug-free, I'd stayed on the Navane and

an antidepressant, Elavil (amitriptyline) (but occasionally tinkered

with the dosages, of course). I felt confident about my teaching, I'd

made some new friends, and my article on competency was coming

along nicely, with Sandy reading the drafts and giving me some ideas

about where I might send it. My hope was, if I could get the article

published in a law journal, maybe (after another year working with

White), I'd feel safe enough to apply for a position someplace else and

leave New Haven behind.

And then White told me he was going retire very soon—to be

precise, in three months.

As though someone had hit a switch, I was almost immediately in

terrible shape—worse than I'd been since Oxford and those first few

horrible months at Yale. Within days, withdrawn and almost mute, I

began rocking and gibbering again, whether I was alone or in White's

office. I was surrounded by destructive energy and unspeakable fear.

"Please don't go," I begged White. "You can't. The world is coming to

an end."

Fortunately, the law school was in moot court competition, so I

really needn't do anything other than show up—which was a good

thing, since I was incapable of speech. One day, I brought all my

jewelry into White's office, along with a check for a large amount of

money—nearly all I had. "I want your wife to have this jewelry," I told

him. "I won't need it anymore. And I won't need the money, either, so

you take it."

"Elyn, you know I can't accept this. Do you think it's time to go to

the hospital?"

No! No hospital. Mostly, I stayed in my apartment, curled up and

muttering on the couch. Friends brought me cigarettes and food, but I

couldn't eat. I started to talk about violent things whenever someone

was with me. "I've killed many people," I said. "And now that White

has been taken over by the devil, I might have to kill him as well. And

he's not the only one."

Steve was traveling to universities around the country,

interviewing with various psychology doctorate programs. He'd called

many times to check up on me, but I wasn't picking up the phone, so

he called our friends, who told him what had happened. He

immediately returned to New Haven.

I opened the door of my studio apartment. Steve would later tell

me that for all the times he had seen me psychotic, what he saw that

day shocked him. For a week or more I had barely eaten. I was gaunt,

and moved as though my legs were wooden. My face looked (and felt)

like a mask. Since I'd pulled down all the shades, the apartment (in

the middle of the afternoon) was in near total darkness. The air was

fetid, the place was a shambles. Steve has worked with many patients

who suffer from severe mental illness. To this day he'll tell me that on

that afternoon I looked as bad as any he'd ever seen.

"Hi," I said, then returned to the couch, where I sat in silence for

about five minutes. "Thank you for coming, Steve," I finally said.

"Crumbling world. Word. Voice. Tell the clocks to stop. Time is time

has come."

"White is leaving," Steve said somberly.

"I'm being pushed into a grave, the situation is grave," I moaned.

"Gravity is pulling me down. They're all trying to kill me. Tell them to

get away. I'm scared."

Steve spent several days with me as I listened to music and

alternately muttered unintelligibly and threatened to commit violent

acts. I didn't want to leave the apartment, except to see White and put

in an appearance to try and hold on to my job, but Steve gently

insisted that I needed to get out more. I needed to shower, and brush

my teeth, and put on some clean clothes, and eat something. In fact,

we actually met with friends for dinner one night; blessedly, there was

little reaction from anyone as I babbled quietly at the table while

everyone else enjoyed their meal.

And then everything changed again. It turned out that White

wasn't leaving, at least not yet. Yale had convinced him to stay on an

additional year, since it was taking them some time to find his

replacement. The cloud lifted. The devils receded; my head cleared.

When I had settled, White went back to interpreting. "You are

harboring fantasies that this situation has something to do with you,"

he said to me in session. Of course I was. He was staying for me.

Wasn't he?

How do I understand why I fell apart so badly at White's telling me he

was leaving? Right now, wherever you are—in your room, in a library,

on a park bench, on a bus—literally hundreds of things clamor for

your attention. On the outside, there are sights, sounds, and smells;

on the inside, you have your thoughts, feelings, memories, wishes,

dreams, and fears. Each and every one of these, both inside and out, is

knocking at your door, all at once.

But you have the power to choose which thing, or combination of

things, to give your attention to. Maybe it's the feeling of the book in

your hand, or the temperature of the room you're sitting in. You shift

and reposition a pillow at your back. You reread the last paragraph on

the page, then turn to the next one. You think about getting up and

walking into the kitchen, maybe preparing a snack. Even though these

actions address only a tiny fraction of what's actually going on inside

and around you, you are able to choose them and relegate the others to

the background.

Now consider this: The regulator that funnels certain information

to you and filters out other information suddenly shuts off.

Immediately, every sight, every sound, every smell coming at you

carries equal weight; every thought, feeling, memory, and idea

presents itself to you with an equally strong and demanding intensity.

You're receiving a dozen different messages in a dozen different

media—phone, e-mail, TV, CD player, friend knocking at the door,

ideas inside your head—and you're unable to choose which ones come

to the front and which are relegated to "later." It's the crowd at the

Super Bowl, and they're all yelling directly at you.

Or try this: Place yourself in the middle of the room. Turn on the

stereo, the television, and a beeping video game, and then invite into

the room several small children with ice cream cones. Crank up the

volume on each piece of electrical equipment, then take away the

children's ice cream. Imagine these circumstances existing every day

and night of your life. What would you do?

First, you'd desperately look for clarity, a way out of the

din—something to focus on, something to hang onto. Medication

could be one solution, if your body chemistry tolerates it. You might

also strive to make your life as predictable and orderly as possible—to

literally control the various ingredients that make up your life—so that

you knew ahead of time what was expected of you, what was going to

happen, and how to prepare for it. Your basic goal would be to

eliminate surprises. Slowly, painstakingly, you would rebuild your

own internal regulator, with structure and predictability. What you

lose in the way of spontaneity, you gain by way of sanity.

I'd made it through graduation, a difficult public sector job, the

switch to teaching, and the learning of new skills. And Steve's

departure. And mostly, I'd stayed on my feet. And then, I formulated a

plan for getting on with my life. White was central to that plan, and

the plan was working. I knew how to work with him and what to

expect from him—that provided me with the "something to hang onto"

that gave structure to my life. Of course, I knew change was inevitable;

I'd learned that. But I was also still learning how to navigate it.

White's retirement announcement came as a catastrophic surprise, in

the way that a lightning strike is a surprise. In the time it took for him

to say the words, the structure and predictability I'd built my life

around simply blew up in my face. The regulator—the one I'd created

so carefully in order to replace the missing regulator—was destroyed.

Every sight, sound, smell, taste, memory, emotion, thought, and idea

roared in at once and ovewhelmed me.

I had always believed that the breakdown I'd suffered in my first

months at Yale came about partly because I hadn't been able to

successfully complete my work with Mrs. Jones—now, with White's

announcement, something inside told me that history was repeating

itself. But that worst-case scenario didn't happen. Steve came as a

messenger from the outside world, and White's changed plans

restored order to my interior world.

However, had White kept to his original plan of retiring and not

been able to treat me for the one additional year I'd counted on, I'm

certain I would have ended up in the hospital again. I knew full well

that the time would come when White and I would agree that our

work together was at an end. But for me to stay sane, our "end" had to

come at the right time and place. Now that was back to being possible.

It was a frightening slide, however, and my recovery from it,

although a relief, was almost as unnerving. I began to understand that

my continuing well-being depended not only on my own focus and

resolve, but equally on random luck. For someone whose very survival

hinged on structure and predictability, this was not good news.

In the summer of 1988, I'd finished my teaching year and was gearing

up for my plunge into the law-school teaching market. I'd completed

the manuscript of my journal article on competency to refuse

medication and was confident that the article was good enough to use

for my "job talk" in upcoming interviews. The plan was back on track.

That Fourth of July weekend, I'd planned a quick trip to Miami to

visit my family. But the night before my flight, I suddenly had a

horrible headache.

As many medical problems as I'd had, headaches had never been

on the list. And this one didn't seem to want to go away. It lasted for

two whole days. My head hurt, my neck hurt, my back hurt, and I was

on the verge of nausea much of the time.

I tried to be philosophical, and patient with my body. I had friends

who got migraines; maybe now it was my turn. Maybe, for once, what

I was experiencing was normal—garden variety stress. Or maybe it

was the heat. Or the humidity. In any case, just as suddenly as it came,

the headache was gone.

Two weeks later, it was back. I was stunned at the pain, and my

inability to get above it. A friend whom I'd made through Steve—a

man named John, who was not only a wise priest but also a gifted

psychiatrist—finally convinced me to see my doctor. I learned later

that John's mother had died young after experiencing symptoms

similar to mine.

The doctor concurred with me—yes, the problem was migraines,

possibly brought on by stress. He gave me a prescription for Tylenol

with codeine. After my appointment, I drove back to Yale to see my

friends at Legal Services; the last thing I remember was violently

throwing up. Even now, I remember nothing else that occurred for the

five days that followed.

According to what I've since pieced together, after I was sick,

Maria and Sally drove me home and told me I needed to go straight to

bed. The following morning, they called to check on me, but the line

was busy. For hours. By noon, they were concerned enough to come

back to the apartment, where they found me in the same clothes I'd

been wearing the day before. My bed had not been slept in, and I kept

repeating one sentence—"Why are you here, why are you here?"

They'd tell me, and a few moments later I was asking them again,

literally unable to keep the thought in my head from one moment to

the next.

Quickly, they bundled me into their car and took me to the

emergency room. Where a completely predictable disaster happened:

The ER discovered that I had a psychiatric history. And that was the

end of any further diagnostic work.

Stigma against mental illness is a scourge with many faces, and the

medical community wears a number of those faces. A psychiatric

patient at a program where Steve once worked went for weeks with a

broken back; none of the medical people the patient saw took the

man's pain seriously—he was a mental patient. So once the ER learned

I had a mental illness and was on antipsychotic medication, the

diagnosis was written in stone: I was "just" having an episode. Poor

Maria was literally jumping up and down, trying to tell anyone who'd

listen that she had seen me psychotic before and that this was

different. But her testimony didn't help—I was a mental patient. The

ER sent me away.

Maria decided that I needed to come home with her; whatever was

going on with me, it was obvious to her that I wouldn't be safe alone.

By the time we arrived at her place, I had no recollection of going to

the ER and didn't know where we were, or why. Trying to get me

settled, she called my parents. My mother flew up from Miami

immediately—my father was recovering from eye surgery and would

follow as soon as he could.

My mother came directly to Maria's, spent half an hour or so there

with us, and then drove me back to my little apartment. She stepped

out for a few minutes to pick something up for us to eat at a

neighborhood store. When she came back and knocked at the door, I

opened it and was surprised to see her and her groceries. "What are

you doing here?" I asked.

"I just went out to get groceries," she said. "Don't you remember I

picked you up at Maria's and drove you home?"

"No. But why are you here? Is someone in the family sick?"

"No, Elyn, no one's sick. Except maybe you. So I'm here to see

what's happening with you, and if I can help."

Five minutes later: "What are you doing here, Mom?" And five

minutes after that: "What are you doing here?" And then again: "What

are you doing here?"

My mother took me back to my internist. At first, he seemed not

terribly concerned—until he realized that I had no recollection of

coming to see him before, discussing my headaches, or picking up a

pain prescription. Immediately, he told my mother to get me back to

the hospital.

So we went to the ER. For several hours, I sat on a gurney in the

hall. Eventually, I answered the standard questions, and once again, it

appeared as if they were going to send me home. But then the

attending physician asked if it hurt when my legs were raised and I

tried to touch my toes with my fingers at the same time. It did.

The spinal tap he quickly ordered came back yellowish, with dried

blood. I was diagnosed with a subarachnoid hemorrhage—my brain

was bleeding.

The mortality from this kind of hemorrhage is about 50 percent,

although I didn't know this at the time. I was thirty-two years old, and

so far, my brain had been both very good and very bad to me.

It was three o'clock in the morning when the brain surgeon walked

into the examination room. He wanted to do a procedure, called an

angiogram, which would allow him to look at the blood vessels in my

brain. Angiograms are risky procedures in any case, but this time it

was absolutely necessary. If the angiogram revealed an aneurism, I'd

need immediate brain surgery.

I do remember hearing those words—with the overhead lights

glaring, the institutional smells and sounds of the hospital, and both

my mother and me in tears. "If anything happens to me, please, you

and Daddy should go on with your lives, and have good lives. That's

what I want." My mother's sobbing became louder. As scared as I was

for myself, I was even more frightened for my parents. If I died...

The angiogram was inconclusive. Often, an angiogram can't detect

the cause of a bleed, at which point the doctors assume that some

structural abnormality—such as a very tiny (thus undetectable)

aneurism or an arterial venal malformation (AVM)—has bled out and

destroyed itself. In any case, I wouldn't need surgery after all. When I

heard that news, I was so relieved I cried almost to the point of

hysterics.

My dad arrived soon after I was admitted to the hospital. I stayed

there another three weeks; within a day or two, my memory had

improved, although it took longer for the headaches to go away. There

was an endless round of tests—CAT scans, MRIs, one more

angiogram, and a spinal tap every day, until at last my spinal sac

simply collapsed, and they could do no more taps.

While I was hospitalized, they took me off antidepressants; with

all the other sedatives I was taking, the doctors believed that an

antidepressant would be too much for my system. So in the midst of

being poked and prodded and having medical personnel standing

around going "hmmmm" and "well, on the other hand, it could be thus

and so," I was incredibly sad and frightened. And, inevitably,

psychotic.

One night, I came to believe that I was the so-called "wood chip

murderer," a man then on trial in Connecticut for dismembering his

wife with a chain saw and putting her body parts through a wood

chipper. Hooked up to the IV pole, I wandered down to the nurse's

station and told the nurses there that they needed to call the police

and tell them my whereabouts. Very gently, they walked me back to

my room and put me back to bed.

The next day during rounds, one of the resident doctors asked me

about what had happened. "I heard you were upset last night, what

was that about?"

"Actually, I thought I was the wood chip murderer," I told him.

"I'm still not sure whether I am or not. In any case, I'm a very bad

person—evil, in fact."

The doctor's response was a burst of laughter so loud that the

nurses down the hall could hear him, and it immediately made me feel

ashamed. He thinks I'm crazy.

It was summer, and Dr. White was out of town on vacation;

luckily, he'd asked a colleague, a consultation-liaison psychiatrist at

the hospital, to stop by and see me. Dr. Feinstein came by my room

almost every day, and was very gentle and soothing, which was exactly

what I needed.

"I'm really scared," I told him. "I see now that life can be snatched

away just like that" and I snapped my fingers in the air.

He nodded. "That's true. And it's very sad. But you know, Elyn,

most people come to that realization when they're in their

fifties—you've just learned it early."

Feinstein's visits, along with the frequent presence of my parents,

who came to visit each day for the three weeks I was in the hospital,

helped immensely. My New York brother and his family came up to

spend a little time with me as well; we all went together to the

cafeteria for an occasional snack or for meals. Late at night, after

everyone had gone, I'd wander down to the lounge while hooked to

the portable IV pole. There, I'd have a cigarette and listen to classical

music on the music channel on the lounge TV. My parents tacked a

sign on my door that read, "AWOL risk," and while it made us laugh,

the doctors were obviously annoyed. We were treated as though we

weren't taking this hospitalization, and the event that had caused it,

with sufficient seriousness, when in fact we'd been terrified, and jokes

were our way of protecting ourselves from that terror.

As the days went by, the memory impairment lifted somewhat, but

it lingered, as did the headaches, so the hospital ordered some

psychological testing—the results were handwritten in my chart and

quite easy for me to read. Several people, from different disciplines,

weighed in on my condition and status, and the variety of opinions

fascinated me. According to one, the testing suggested that I "may be

bothered by consistently delusional thought and self-persecutory

processes." No news there.

Another tester, who gave me a lengthy memory test, a

master's-level psychologist who signed "MA" after his name, came up

with an odd formulation: The results suggested I was deliberately

intending to appear impaired, particularly around memory loss. His

supervisor noted that rather than suggesting that I was trying to look

impaired, the test results might also be read to suggest that I was

indeed impaired. The MA also suggested that my headaches could be

due to poor nutrition, while another person opined that the headaches

were due to my "disturbed thought processes." So: I was either faking,

or crazy, or not eating properly. Somehow, the existence of an actual

brain hemorrhage had disappeared in its importance.

The MA also questioned my ability to care for myself in my own

apartment, "nutritionally and hygienically"; a third person kindly

referred me to the social sendees department "for assistance with

long-range care needs." I would have loved assistance with my

long-range care needs, since my long-range plan was to publish many

books with major presses, write a dozen or so law review articles, and

obtain a tenured faculty position at a major university's law school.

Even under the best of conditions, and in the best of health, anybody

setting out to do that could probably use all the help they could get.

At the end of three weeks, I was finally discharged from the

hospital, without any clear conclusion about what had caused my

bleed. Although my memory never filled in the blanks of the days

before the hospital, the headaches receded. My parents returned to

Miami; I returned to my life, as flawed and confounding and

mysterious and promising as it was. I felt fragile for a while; I knew

that what had happened had been genuinely frightening, even

threatening. But the fact is, I didn't die; I survived, and I told myself

that fact every single day. It's a little like having a meteor land in your

backyard without hitting the house. You can either focus on the

meteor, and what almost happened, or you can focus on the fortunate

miss and what didn't happen. I decided to do my best to focus on the

miss.

chapter eighteen

IN SEPTEMBER, I went back to my second year of teaching at the

small law school and prepared my application for a tenure-track

teaching position elsewhere. In spite of my not having gone the

traditional law-school route to an academic position—clerking for a

judge and working as a summer associate at a large law firm—I was

gratified when the reaction to my applications was overwhelmingly

positive, with over 35 law schools responding with interest.

I wanted to be optimistic—and on paper, there was every reason to

be optimistic—but there was a small biochemical obstacle. Since my

hospital adventure, I still hadn't resumed my usual drug regimen.

Within days, I'd gone from feeling a little blue to being seriously

depressed, and then I started sliding toward suicidal. White

recommended that I immediately go back on the amitriptyline (Prozac

was still a few years away), and Steve gave me a stern lecture on the

phone about the stress I'd encounter during the job hunt, and how I

needed to be focused and steady. "I know you, I know what you're

thinking," he said. "But this is no time to fool around with your meds."

As much as I longed to be totally drug-free, I had to accept that he was

right.

It was too easy for me to slip up in other ways, though. On the brief

trip to the University of Miami for a day-long interview, for example, I

was so distracted and stressed out that I didn't eat well, and during

the interview and job-talk I did very poorly. "Practically comatose"

again. Even worse, I fainted as I tried to leave the plane when it

landed in New York, and had to be taken out in a wheelchair. Horribly

embarrassed, I filed the experience under "poor self-care—Elyn, pay

more attention!"

The rest of the interviews went considerably better, and ultimately

I received a number of attractive offers. The one that appealed to me

most came from the University of Southern California in Los Angeles.

Academically, USC's law school had a wonderful reputation, ranked

among the top fifteen to twenty in the country. My interview visit

there was comfortable and surprisingly tension-free; the faculty I

spoke with were friendly and easygoing, given how brilliant they were

(I'd done my research—I knew to the person what each one had

published, and in what journals). And (no small factor), the campus

was lovely, sunny and warm, and kind to my body. So when the offer

came from USC, it was a quick and easy decision—I accepted.

But the actual move remained months away. In the meantime, I

still had teaching responsibilities in New Haven, and the ongoing case

of Jefferson, whom I'd continued to represent as he made his way

through the state system.

I tried to visit him about once a week—we'd meet at his group

home and go off to a local soda shop for ice cream and a good talk. As

a big man with obvious impairments and limited judgment, he often

scared people, but with me, he was always gentle and soft-spoken. He

was doing well, and he was happy.

In fact, he'd been making such good progress in his group home

and with his schooling that the staff in both places thought he was

now able to move to a higher-functioning group home. Since it would

take a while for there to be an opening for him, I had ample time for

some due diligence on his behalf, with many long and hard

conversations with the staff at both houses and at his school. I also

spoke with his mother, who'd recently come back into his life. And I

had serious conversations as well with Jefferson, who'd not only come

to trust me, but saw me as friend and confidante. He'd had a few

successful overnight and weekend visits to his potential new home; he

liked it. Yes, he told me, he wanted to make the move.

On paper, it looked good. Nevertheless, I had to battle

skepticism—my own. Mentally retarded adults with the same

behavioral dysfunctions as Jefferson's are well known for trying to

please others, especially those who carry some power in their lives;

basically, they want desperately to say the right thing and make

everyone around them happy. He seemed preoccupied with what

would please me, and please the staff as well. So I worried: Was I

seeing the situation in its true light? Was this really the right thing for

him to do? Was it the right time, and was that the right place? Yes,

yes, yes, everyone kept saying. Finally, I agreed—OK, it's the right

thing to do. And so we moved him.

Things went well for a few weeks; everyone began to relax. And

then, something set him off. It was never quite clear what the trigger

was, but in any case, it made him mad. He began shouting and

screaming, and making threats to his housemates and staff. The police

were called—and when confronted with a large angry black man,

inarticulate and out of control, the cops forcibly subdued him and

hauled him off to the local mental hospital. There, the worst-case

scenario actually happened: restraints, forced medication, and

isolated confinement—everything we'd managed to spare him since

Steve and I acted to move him out of the state mental hospital.

Everything in my own experience that had terrified me had now

happened to Jefferson.

Sadly, it set off a chain reaction and downward momentum that

for a while seemed irreversible. His stay in the hospital was brief that

first time, but it wasn't his last. He couldn't go back to the old group

home; his spot had been taken by someone else. And he couldn't

return to the new one—it clearly hadn't worked and they didn't want

him back. The word "violent" started showing up in his chart; he

bounced from group home to group home, until something would go

wrong and he'd have to be hospitalized again. By the time I moved to

Los Angeles to begin my new teaching job, Jefferson still wasn't

stabilized.

Eventually, things settled down somewhat—a few years later,

when I visited him, he was in a group home situation that appeared to

be working. But for a while it was as though some kind of switch had

been tripped in him, and he would never again do as well as he'd done

in that first group home. All of us do-gooders—had we let him down?

"Did I do this?" I asked Steve. "Did we do this, is it our fault?"

No, no, he said. We'd used our best judgment and done what

seemed right at the time. But I feared we'd fought for what seemed

best from our point of view, not necessarily from Jefferson's. Maybe

what happened with Jefferson would have happened anyway, there's

no way to know. Once again, a hard lesson for fledgling lawyers to

learn.

As spring came and my time in Connecticut was coming to an end, I

scheduled a trip to Los Angeles for April spring break, to meet with my

future colleagues, familiarize myself with the campus and the city, and

find someplace to live. In addition, I had some names of

psychoanalysts on the West Coast, so that I could continue my

treatment with no interruption. I was determined to build a good solid

structure for what would be my new life.

Just before I was to leave for the trip, a phone call came from my

father. "Your uncle Norm has passed away, he's taken his own life," he

said. Uncle Norm, my mother's younger brother, was just forty-seven

when he died. It was no secret that he'd had psychiatric problems for

much of his life—seriously depressed, he'd spent a year in the

Menninger Clinic in Topeka, Kansas. At one point, at my

recommendation, he also spent some months at the Institute of

Pennsylvania Hospital with my doctor there, Dr. Miller; when he left,

it was Against Medical Advice. And now, it had come to this—death by

his own hand, from an overdose of pills.

I was stunned and sad, yet somehow not surprised. And as calm as

my father had been, my mother was another story. She was

overwhelmed with grief—her own father had also died not long before,

but this loss of her brother, after so many years of struggle, was worse.

My handsome, sweet young uncle, gone. Just like that. But I couldn't

go to Florida to mourn him; I was scheduled to leave the very next

morning for Los Angeles, booked solid with appointments there, and

had only this small window of time to get everything done. I wanted to

go to his funeral; I regretted (and continue to regret) not being there

for my mother, and to honor my uncle's fight.

Suicide almost always leaves shipwrecked survivors in its wake,

feeling as though there were something else they could have done,

should have done, to keep the one they loved alive. "If only I'd said

this, if only I'd done that...What did we miss, how did we fail?" In

those first awful days, there's nothing anyone can say or do to ease

that kind of sorrow, and any suggestion that it was "inevitable" gets

pushed away.

Even worse, I found myself identifying too closely with Uncle

Norm. Was that going to be me someday? Would I ever reach a point

where the idea of one more doctor, one more test, one more pill, one

more episode, one more hospitalization, would simply flip me over the

edge?

After I hung up the phone, I stood alone in my tiny apartment,

with suitcases packed and the rest of my life about to begin, and I

balled my hands up into defiant fists. No! No! That was him, in his life,

for his reasons; this was me, in mine.

A vital step in my survival, and a key reason for this trip, was to find

myself a good analyst. I'd learned, with the guidance of Mrs. Jones

and Dr. White, that without the fail-safe of talk therapy securely in

place, the rest of it wouldn't matter. I interviewed four (they'd been

recommended by friends, by colleagues, and by White), and in the

end, my choice was the one whom White had suggested. His name was

Kaplan, and his impressive professional resume included working

with many seriously ill patients at a Los Angeles-area hospital.

My initial visit to Kaplan's office was reassuring—it was

haphazardly decorated, with a collection of objects that didn't seem to

go together (lopsided stacks of books and papers and notebooks

everywhere, mismatched lamps, nondescript furniture). To me, it gave

ample evidence of his standing as a busy academic doing many

things—teaching, writing, and treating patients. Since my own office,

then and now, has always been a chaotic mess, I took heart in finding

Kaplan's to be almost the same. And it reminded me somewhat of

Mrs. Jones's—there was an implicit suggestion here that exterior

things didn't much matter, but that the journey to the interior

mattered a great deal.

It became clear in our first minutes together that Kaplan not only

understood my illness but was also comfortable with blending a

psychoanalytic approach with medication (which is not the case with

all analysts). But I wondered if he was prepared for the kind of

intensity and violence my episodes sometimes contained. Maybe the

man was getting more than he bargained for. "Don't worry about

that," White had told me. "Don't be too scared of her," he told Kaplan.

The rest of the to-do list—lunches and dinners with the people

soon to be my colleagues, and the search for a place to live—went

better than I could have hoped; in fact, I managed to get through it

completely intact. Heeding Steve's admonitions, I took my medicine,

ate the right food, got the necessary rest, and actually had a nice time.

The apartment I found—a largish one-bedroom—was in a modern

four-story stucco building, typical for the west side of LA, and about a

half hour to forty minutes driving time from the campus. Since I'd

determined long ago to never live on a ground floor—because who

really knew what was on the other side of the window?—I was

comfortable up in the air. After my high school experience of the

talking houses (a memory which unnerves me to this day), I had no

interest in a tidy little bungalow or cottage. And no yard, terrace, or

balcony, either, with trees I couldn't see around and odd shadows

lurking in the corners. I wanted only to be safely sheltered within four

inaccessibly high walls.

As for my future colleagues, everyone seemed eager to make me

feel at home, and they did. As we walked around the campus and I

began to get my bearings—here's the law school building, there's the

library, here's the faculty parking garage—I was acutely aware of the

warm sun on my shoulders and a kind of softness in the air. This will

be good, I thought. This will be very good. Every thing's falling into

place.

Except, of course, for the not-incidental matter of my

unpredictable brain. In spite of my history, in spite of the diagnoses

and the prescriptions, the frequent delusions and the evil

visitations—and Kaplan notwithstanding—I still wasn't convinced that

I had a mental illness. Nor was I convinced I really needed

medication. To admit to any of it was to admit that my brain was

profoundly broken, and I just couldn't do that. And I couldn't let

others in on the secret, either.

I had decided not to tell people about my mental health status in a

professional situation (as opposed to a personal one), unless not

telling people would be an outright lie. For instance, in the law school

applications, every school except one asked if I'd ever been forced to

take a leave of absence from another school as a result of emotional

difficulties. Technically, I did not have to withdraw when I was ill at

Oxford, because I was doing a thesis degree, not attending classes. So

the answer across the board was no, and I was comfortable with that.

Stanford, however, asked if I'd ever had to take a leave, or reduce my

workload, because of emotional problems. There, I had to answer yes,

although in my explanation I focused on the depression, not the

psychosis. To do otherwise would reduce my hopes of ever having a

career—once it was on the record, all of my thoughts and writings

would be seen as merely the musings of a madwoman. Ignore her,

she's crazy. I could not allow that to happen.

My brain was the instrument of my success and my pride, but it

also carried all the tools for my destruction. Yes, the pills helped, but

each time I put them in my mouth, it was a reminder that some

people—smart people I trusted and respected—believed that I was

mentally ill, that I was defective; every dose of Navane was a

concession to that. More than anything, I wanted to be healthy and

whole; I wanted to exist in the world as my authentic self— and I

deeply believed that the drugs undermined that. And so I kept backing

away from them, tinkering with the dosage, seeing how far I could go

before I got burned. And of course, I got burned every time—even in

my denial, I knew that. But if the fire that burned me signaled my

destruction, it was also the same fire that got me out of bed in the

morning and sent me to the library even on the most frightening days.

Steve called me "The Little Engine That Could," and I was proud of

that moniker. Every time I'd been knocked down, I'd gotten back up

again. There was no reason why I couldn't keep doing it. I just had to

control my mind, not vice versa, and if I was careful, I would be able to

claim and fully inhabit the life I wanted.

When my years in New Haven finally came to an end, I said a

bittersweet good-bye to all my friends there, and to Dr. White in

particular. We'd made a good team—I was not only still upright, I was

moving forward. And so, on July 4 weekend, 1989—one year to the day

from the first symptoms of my brain bleed—I boarded the plane for

LA, this time for good. And this time, it was a much smoother ride.

The question, of course, was not so much if I would have a psychotic

episode as when.

Packing up your whole life and starting all over again is high on the

list of major life stressors—it ranks right up there with divorce,

diagnosis of serious illness, being fired from an old job, jumping to a

new one, and grieving a death in the family. And then there was the

smaller list, the everyday list: Where's the grocery store? Where's my

bank? Where's the best place to buy toothpaste, or lightbulbs, or fresh

fruit, or to rent a movie on Friday night? When is the telephone guy

coming, and where's all my forwarded mail?

Add to this the schizophrenic's "regulator" and the need to rebuild

it once again. How, in a new and unknown landscape, does one

construct a completely predictable, familiar, manageable life, one in

which there are no surprises? And construct it quickly, because your

life literally depends on it.

Well, it helped that Los Angeles reminded me of home—the

suburban sprawl, the palm trees, the blue sky, the proximity to the

ocean. In fact, I soon decided that Los Angeles was a better Miami

than Miami was: better weather, better food, better movies, better

theater, no hurricanes (albeit an occasional earthquake), and (often)

less humidity. That said, everything else was a mess.

Steve was two thousand miles away; he'd begun his graduate work

at the University of Michigan in Ann Arbor. We spoke on the phone

almost every day, but that wasn't the same as sitting across from him

over pizza, talking away the whole afternoon. I missed him, and the

way he'd put his hand on my shoulder or gently pat my back, telling

me that everything was going to be fine. When was the last time that

anyone had touched me, or been able to reassure me, as he did, as

only he could?

And while Dr. Kaplan was good, he wasn't White (any more than

White had been Mrs. Jones). Everything about him was different;

particularly disconcerting was the fact that the chairs in his office

weren't in the same position as in White's—trivial to some, but the

effect was as though I were blind, had walked into a familiar room,

and discovered, by stumbling over it, that all the furniture had been

rearranged.

My colleagues on the faculty were friendly and welcoming, but

basically, I didn't know any of them. USC Law's faculty is relatively

informal and collegial on any number of levels—I watched with envy

as they greeted one another in the halls, read one another's papers,

and scheduled workshops together. When would that be me? Would

that ever be me?

I needed a strategy. I needed to get organized. I needed to make

another list: my goals and the steps I needed to take to achieve them.

First, there was the issue of tenure: USC required at least three

lengthy published articles; I would have four years to write them. That

part was simple—I'd spend most of my time in my office, working. I

knew that work, more than anything else I could do, would steady me.

In fact, four years seemed more than enough—in that time, I could

easily write four and probably even five papers. It didn't have to be

brilliant, it only had to be good, adequate, challenging work, of a

quality sufficient to get tenure. And if I worked hard enough and long

enough, I'd be able to get ahead a little and give myself some leeway in

case I got sick and needed time off—which was almost sure to happen.

It would be like putting work in the bank for a rainy day.

USC requires first-year faculty to teach one course each semester;

in an academic year, that worked out to one small seminar-type class

and one large class. As luck would have it, my first class was the

seminar, in mental health law, with only eight students. I knew the

material better than any of my students could have imagined; we

would consider such issues as civil commitment, the right to refuse

medication, confidentiality, and competency. So that was my plan.

When I wasn't preparing for or teaching that class, I'd be writing. No

problem.

From the very beginning of our first class meeting, I could tell that

the students were bright, lively, and engaged—overall, a good group.

Being with them would be an excellent use of my time, and theirs as

well, I hoped. Our discussions were wide-ranging, as I strove to find

the balance between the headlines, the history, the theory, and the

canon of law that applied to the mentally ill. One of the cases we read

was that of a medical student with a mental illness who'd been

expelled for scratching and cutting herself when she was upset at

administrators. Sometime afterward, she sought to be reinstated as a

student at medical school.

"Should expulsion even be allowed in this kind of case?" I asked.

"Or is this impermissible discrimination?"

Some students pointed out that in the interim since this person's

expulsion, she'd managed to get a Master of Public Health degree and

hold a responsible job. In addition, it wasn't a given that if she became

a medical professional she'd automatically pose a risk to patients—for

instance, she could choose to go into research. Indeed, even being a

hands-on doc was not out of the question: There's little evidence that

impulsively hurting yourself puts you at significant risk of hurting

others—that's an entirely different psychodynamic.

One student (a psychiatric nurse) made an observation that hit me

hard. "Of course mental patients should not be doctors!" she said.

"Particularly if they injure themselves. Plenty of people who hurt

themselves do go on to hurt others, even if not everyone does. What

would stop this patient, so impulsive, from injuring her patients?"

I gathered my wits for a moment, then asked, "Do you feel the

same about lawyers, who don't hold others' physical integrity in their

hands?"

"Would you go see a lawyer who was on psychotropic

medication?" she said incredulously. "Because I certainly wouldn't."

"Yes," I said. "Yes, in fact, I would." And what would you think

about taking a class taught by someone on psychotropic medication?

I wondered.

And then there was the question of competency. "Should patients

have a right to refuse medication when they are in the hospital?" I

asked the class.

"It would be sort of silly to hospitalize someone in order to treat

him," one student responded, "and then not be able to treat him. It

would also cost a lot of money."

"But," another student chimed in, "don't we allow competent

people to make all sorts of costly and risky choices—for example to

sky dive?"

Now we're getting someplace, I thought.

So class started well and I was making progress on my first paper,

on the concept of competency. But that didn't guarantee anything,

and one weekend early in the fall, after the adrenaline of the first days

had worn off, I felt myself slipping. I was in my office, alone, working

on an article. I started to sense that the others—the beings who never

seemed far off when I got sick—were in the office with me. An evil

presence, and growing stronger. Why are they here? Are they trying

to take over my mind? Why do they want to hurt me?

The thoughts grew more insistent; within minutes, I couldn't push

them away anymore. It was afternoon; I knew Steve's schedule, and I

knew it'd be hours before I could track him down. So I called Steve

Wizner in New Haven instead.

"Elyn!" came his voice on the phone. "How nice to hear from you!"

"How are you doing?" I asked. "I'm a her-o, not a him-o. Heroic

efforts. Put in one's time. Like prison. I see through the prism of life.

I've killed lots of people."

"You need to call your doctor, now," he said. He knew about

Kaplan; he knew that Kaplan had taken over my treatment at White's

recommendation.

"All right," I said, and called Kaplan's answering sendee. While I

was leaving the message on one coast, Wizner called from the other,

leaving an urgent message with Kaplan's sendee that my situation was

indeed an emergency.

Within the hour, Kaplan called me back. "Steve Wizner tells me

you're not doing too well this afternoon," he said. "So what's going

on?"

"On is a manner of speaking. Off may be more like it. I don't like it

at all, thank you very much. I refuse to be killed. I'll kill back. Are

people trying to kill me?"

"I'd like to meet with you at my office in an hour," he said. "Can

you come?"

"Yes, but it's Sunday," I said. "The Sundance kid. Bearded and

gray. With all the interferences."

"My office in an hour, OK?"

"OK," I said. "OK." Only terrible patients must be seen on a

Sunday. Will Kaplan terminate me and make me get lost? He could

do better. Who is interfering with my thoughts? What do they want

from me? What will they make me do?

Kaplan was already in his office when I got there. "Come in, Elyn."

I sat down. I was holding myself, rocking and scared.

"You seem like you're having a hard time," he said.

"I'm doing hard time. For all the crimes. They're doing them

through me, though. The ones in the sky. I'm an instrument. An

instrument of the devil. Please don't let them kill me. My head is so

hot on the inside. I'm afraid it might explode."

"You're having psychotic symptoms now," he said. "The things

you're afraid of aren't really happening."

"I know they're real," I said. "They seem crazy to you, but they're

real. I'll reel them all in. Tell them to get away!" I was rocking and

grimacing, flailing my arms as though I were fighting interference

from the beings.

"White used to raise your dose of Navane when you were feeling

like this," he said. "So I'd like you to go up to thirty-six milligrams for a

few days."

"It's not a medical problem," I moaned. "It's a matter of good and

evil. Innocent children are being hurt. There's the store and what's in

store. Cries and whispers. Fear and trembling and sickness unto

death."

"Yes, I know you are in terrible pain," he said. "Do you have

Navane with you?"

"Yes."

"Then count out eighteen pills and take them right now, OK?"

"OK." I reached into my bag, fumbled for the pill container, and

carefully counted out eighteen on the desk. Then my paranoia turned

to Kaplan. "Which side are you on?" I asked. "Are you trying to hurt

me or help me?"

He handed me a glass of water. "I'm trying to help," he said.

"You're having a hard time now, but you should be feeling better soon.

I'll see you tomorrow for our appointment in the morning, and I'll call

you at home tonight to see how you're doing. OK?"

"OK," I said, then dutifully took my pills and went home.

Kaplan called that night as he'd promised; I was still having fears,

the beings had not entirely receded, so I was reassured to hear his

voice. By the next morning, I felt measurably better.

So—now he'd seen it. He didn't get scared or try to put me in the

hospital; he did exactly what White would have done, and he talked

me through it. I felt comforted in that continuity. They'd both said we

would be able to make that transition, but I'd feared it wouldn't

happen, and now I saw that it would.

On the other hand, Kaplan was already taking a firmer line on

medication than White. This became the theme of our next few

appointments. He wanted me on a higher dose of Navane; I resisted,

believing that the less medication I took, the less defective I was. I

stayed at thirty-six milligrams, just long enough to feel better, and

then I started sneaking my way back down again. I didn't miss a class,

and was able to get back to my writing in a couple of days.

So, right off the bat, Kaplan and I laid the groundwork for our

years-long battle—how much medication he thought I needed vs. how

little medication I thought I needed. Our relationship would become

similar to almost any other relationship between two strong-minded,

stubborn people who see each other often. Some days it worked well,

even happily. Other days, it was an unmitigated disaster.

chapter nineteen

I WAS BEGINNING to feel somewhat comfortable with a few of my

new colleagues, and when I met with them one-on-one, or in a small

cluster of three or four, for coffee or a meal, I thought I managed

myself just fine. In fact, I soon became the person who gathered

people up to go out for lunch every day. I pushed myself to start doing

this because I was so scared that if I weren't the one doing the

gathering, I'd be left out entirely. (In fact, I continue rounding up

everybody to this day, and have become known in the law school as

"the Lunch Mother." I think I should get committee credit, but the

dean will have none of it.)

With more than a handful of people at a time, however, I was in

agony—the term "painfully shy" was apt. Speaking in or to a large

group of people struck terror in my heart. I was convinced I didn't

have anything interesting to say. Maybe USC had made a mistake in

hiring me; maybe other people were beginning to wonder about that

as well. I'd acquitted myself well enough in my interviews, but

sustaining that first impression over the months and years it would

take to get tenure—I worried that I wouldn't be able to handle it.

Perhaps sensing my struggles, one senior colleague, Michael

Shapiro, took a special interest in me and my work. Though he had a

gruff exterior, I quickly discovered that Michael had a great capacity

for empathy and old-fashioned friendship. A noted scholar in the

fields of bioethics and constitutional law, he wrote the first casebook

on bioethics, Bioethics and the Law: Cases, Materials, and Problems

(with Roy G. Spece, Jr.). Michael began to read the drafts of my

papers, and he talked with me about ideas for writing. Once every few

weeks, he invited me to his home for dinner with his then-wife and

little boy (ultimately, there'd be two little boys joining us). To sit

around a table with a family—"would it even be possible that I might

have something like this in my own life someday? I hadn't realized

how starved I'd been for the human connection until Michael

extended his friendship, and what a timely gift it was. As a tenured

professor, he certainly could have spent his time in other ways, but he

chose to spend some of it with me. If someone like this finds value in

me, I thought, then perhaps there is value in me.

Edward McCaffery was another colleague who went out of his way

in those early days to be kind and inclusive. Ed was my "classmate" at

the law school—we started at the same time, our offices were next

door to each other, and we ultimately received our endowed

professorships in the same year. As the "new kids," Ed and I spent

hours trying to figure out our senior colleagues, strategizing about

how we'd get tenure, and sharing ideas about how to develop good

reputations in our respective specialties—his was the federal tax

system and its Byzantine code. He's widely published, and widely read

and respected by legal scholars across the country.

As that first semester went along and I seemed to be managing OK,

I began thinking about my second law journal article. One of my

colleagues mentioned seeing an article in the newspaper about a man

with multiple personality disorder (MPD) who was then on trial for

murdering his parents. I was immediately intrigued by the legal issues

raised by such a case: How could a court assess criminal responsibility

for someone with multiple personalities? If the person had ten

personalities, would all ten have to be guilty to put the person in jail?

Or would one guilty personality be enough to convict? If there were

ten personalities, and only one was cognizant of having committed a

crime, what rights to a defense and subsequent protection did the

others have?

The more I thought about the case and its practical complexities,

the more fascinated I grew with the philosophical questions as well:

What is a person? What's the difference between a person and a

personality? Can a person have more than one alternative personality?

I quickly discovered that while this situation may have been a staple in

daytime television soap operas over the years, very little scholarship

had actually been written about it. Even before I started any serious

research, I drew up a working outline in my mind. If I really work

hard, I thought, I could have a completed draft by the end of the next

summer. My article on competency would be ready to submit to law

journals by then, too.

Thinking about MPD, of course, led me to ask similar questions of

myself: Who was I, at my core? Was I primarily a schizophrenic? Did

that illness define me? Or was it an "accident" of being—and only

peripheral to me rather than the "essence" of me? It's been my

observation that mentally ill people struggle with these questions

perhaps even more than those with serious physical illnesses, because

mental illness involves your mind and your core self as well. A woman

with cancer isn't Cancer Woman; a man with heart disease isn't

Diseased Heart Guy; a teenager with a broken leg isn't The Broken Leg

Kid. But if, as our society seemed to suggest, good health was partly

mind over matter, what hope did someone with a broken mind have?

My class for the second semester was criminal law, and I was greeted

on the first day with what seemed to be a large, yawning auditorium

filled with seventy students, every single one of them looking straight

at me. Although it was a lecture class, I was so weak from anxiety that

I couldn't stand, and a few minutes in, I just had to sit down. I sat

down for the rest of the semester.

I knew going in that I wasn't as adept with criminal law as I was

with mental health law, and from the very beginning I fell behind

almost as fast as any clueless student. Most of the questions I was

asked in class, I had to research afterward on my own. Often, I found

myself so anxious and distracted that I missed most of what the

students were asking or answering. I didn't like the performance

aspects of lecturing to a large class; I knew I'd never be able to master

that. And I really didn't want all those people looking at me.

At the end of that semester, the course evaluations (unlike the

positive ones I'd gotten from the mental health seminar) showed that

I wasn't the only one who felt the whole experience had been

torturous. One student wrote, "Professor Saks is a very nice person,

but a very mediocre teacher." Another comment was even more

painful: "Didn't anyone ever interview this woman before hiring her?"

When I first read that, I wanted to put my head down on my desk. In

time, I could read it again and find some humor in it. He was right; I'd

been just terrible. He'd applied to a good law school, he (or someone)

had paid good money to be there, and for all that, he got me.

For the end-of-the-year humor issue of the Law Review, my

lecture class got a send-up all its own: "Elyn R. Saks, the sitting

Socratic method: lessons in dynamism."

I taught criminal law class four years, and although I became a

little better at it each time, I never got comfortable there, and

approached the evaluation period each time with the same dread. My

reviews got better, but I always disliked teaching first-year students.

As I liked to say, the neuroses of first-year students conflicted too

much with my own.

I was battling my usual demons outside the class as well. I still

wasn't talking much, except to the three or four people I was gradually

becoming close to. After one particularly difficult faculty workshop, a

colleague took me aside and said I really needed to take more part in

faculty discussions, both formal and informal. "I don't mean to be

insulting, Elyn," she said, "but you're practically comatose in there." If

I hadn't been so mortified, I might have laughed out loud at the

familiar terminology.

"Thanks," I said, and I meant it. "I appreciate your coming to me

with this." I could hardly tell her how hard it was to relax and enjoy a

meal or a meeting with colleagues while your demons bang on the

closet door and demand to be let out.

When that first year finally came to an end, I was hugely relieved,

and Ed and I went out for a nice dinner to celebrate. We each had a

drink (something unusual for me, as I don't like the effects and,

besides, drinking doesn't go well with psychotropic meds) and toasted

each other's success: We'd made it through year one.

With classes ended, I had nearly four months ahead of me to work

away at my game plan. And of course, I couldn't let well enough alone.

No longer responsible for students, I decided it was time to get serious

about stopping the Navane. Kaplan reluctantly agreed to cooperate,

and slowly I started reducing my dose. A month later, my psychosis

was in charge.

Except for my appointments with Kaplan, I kept to myself. "I'm

having headaches," I told him. "Head Aches, Aching Heads. Maybe

another bleed. Blood simple. Ha ha ha. Laughter occurs behind the

scenes. I'll take the scenic route."

Kaplan knew immediately what was bothering me. "You're worried

about your health," he said. "That's understandable, given your

history. So why not face that fear head-on and go see a doctor to

reassure yourself? I highly recommend an internist, Edwin Jacobson."

"The blood is all over. It's all over for me," I said. "OK, I'll go to see

Dr. Jacobson."

When I got to Jacobson's office, I explained that I'd had a bleed

and was having terrible headaches. He asked questions; I answered as

best I could. Some of what I said made sense; much of it didn't. "I'm

worried about my headaches. My brain may come out of my ears and

will drown lots of people. I can't let that happen."

Obviously he'd spoken with Kaplan, and the way in which he

responded could not have been more on point. "You don't need to

worry about drowning people with your brain, Elyn. That can't

happen." His voice was calm and reassuring. "It sounds like Dr.

Kaplan is right, that you need to go on more medicine. It's just like if

you had something like diabetes; you need to be on enough medicine

to keep your balance."

He hadn't argued with me; he didn't try to out-doc me. Rather, he

reassured me that there was nothing for me to worry about. That is

what I needed most—for my medical doctor to quell my anxiety—and

he did. And he'd used a metaphor that I could understand. As with

diabetes, my illness was treatable; as with diabetes, I simply needed

to treat it. I'd heard this metaphor before, but it stuck with me this

time.

In our next session, Kaplan made it clear that he wanted me to

increase my Navane. That session really disturbed me. It just didn't

feel good, on two counts: first, because Kaplan was telling me what to

do; second, because the increase made me feel like a failure. I resented

both things, but grudgingly agreed to go back up to thirty-six

milligrams.

Soon after that, I left for a few days of vacation in New York, where

I visited with my parents and spent some too-brief time with my little

niece and nephew. I didn't expect children of my own, so to have these

two as part of my life always gave me great joy.

And I made a special point of getting up to New Haven and seeing

Jefferson, who was now in a somewhat more stable position in a group

home.

"Hi, Elyn," he said, and there was the beautiful smile I

remembered. "I remember you, you're my friend. It's going good. Can

we get some ice cream? Where you been?"

"I moved to California," I told him. "It's on the other side of the

country so it's tough to come and see you more often. How have you

been?"

"Good," he said. "Got a job now. I put things in a box. It's good."

It sounded good; I hoped it was. "Let's go get that ice cream, OK?"

I said. "And I'll come and see you next time I come to Connecticut.

And you know, you can call me if you want. Your house has my

number."

"OK," he said. "Ice cream, and then you'll come see me soon."

I was pleased that he seemed to be doing better—I wanted him to

thrive. Given his vulnerability to the vagaries of the system, it was easy

to see myself in him. If he was safe and happy, it meant that maybe I

could be safe and happy someday, too.

And the news over time got even better: I recently learned that

Jefferson had been featured in a local paper for certain artistic

achievements, and that gave me a modicum of comfort that perhaps

our involvement had been a positive one in Jefferson's life after all.

When I returned to LA, there was still plenty of summer left. I went

back to my office, where I spent nearly every waking hour. As long as I

stayed on my meds, I was able to concentrate, and by summer's end,

I'd completed a first draft of my multiple personality disorder paper.

My article on competency, the first piece in my tenure portfolio, was

finished. It was ready for law journals to review for publication.

Bob Cover's memo had been my first test as a law student; the

competency article would be my first test as a law professor. I put

forty copies of the article and a cover letter in the mail, crossed my

fingers, and wished them luck.

Law journals accept articles by phone; rejections come in the mail.

Within a couple of weeks, my mailbox was full and my phone wasn't

ringing. Not having my first article published would end any realistic

chance for tenure and crush any hope of my becoming a real

professor. I felt as if I had been tested for some fatal disease; at any

moment, the doctor of doom would call with the bad news. I watched

the phone as though it were alive. And then one day, it actually rang.

The call was from a law journal whose standing was not very

strong, and acceptance into which would be little help to me in the

tenure process. By the following day, without having heard from

anyone else, I was convinced my project to be a law professor was

lurching toward failure. I'd end up on the streets, alone and disgraced.

In a matter of hours, my disappointment turned psychotic. They're

trying to kill me with faint praise and my head is so hot on the inside

it hurts.

I called Steve and left a message, then headed for Kaplan's office.

With laserlike speed, he went directly to the heart of the matter.

"You're afraid you'll end up like your uncle Norm who committed

suicide, aren't you?" he asked. "If you don't get tenure, you'll have to

kill yourself. Or at best end up a chronic mental patient in a back ward

of a hospital for the rest of your life."

Steve was equally direct, in a different way. "What the hell's the

matter with you, Elyn?" he said, clearly short on patience that day.

"You've still got fifteen or twenty places to hear from. It's a great

article, it's going to get published in an excellent law journal. You've

convinced yourself you're going to fail, you simply need to stop this!"

Rather than wilting me, his words picked me up. If he thought so,

maybe it was true.

Nevertheless, I was stuck in mild psychosis for the next week or so,

during which time I increased my medication. Ed, who'd gotten a

good offer right away on his first article, understood exactly what I

was going through (although he wasn't aware of the demons swirling

around my head). He could have been competitive, even gloating, but

instead he was, and has always been, kind and supportive; I saw that

he genuinely cared. "It'll happen, Elyn, anytime now. Just wait, the

call's coming any day."

About ten days after I fell apart, I received an offer from the North

Carolina Law Review, a well-respected law journal. Publishing there

would count in my favor for tenure. I'd done it. The paper had been

accepted. I'd been accepted. I could breathe easy; I wasn't going to be

Uncle Norm, at least not now.

By second semester that next year, I'd accomplished one more small

seminar and was a little more relaxed in the criminal law lecture

course. I could actually hear the students; I could actually respond to

them. The MPD article was coming along. In March I presented it at a

faculty workshop. The response was encouraging; people liked my

work.

And then another colleague—one who hadn't had a particularly

easy tenure time—quietly took me aside and suggested that maybe I

needed another year to work on the paper.

"But I don't understand," I said. "Everybody else says the paper's

ready to go."

"They may be saying that to your face, but you can't always believe

them."

I was stunned; had I misread the other responses? Did they have

some kind of weird agenda, encouraging me to submit substandard

work? And speaking of agendas, why would a senior person drop this

nasty little bomb on an obviously struggling junior person? The more

I thought about it, the more transparent it became. Trust your gut,

Elyn, I told myself. It's good work. Your friends told you so.

I began working on what would become my third article, another

on the conditions under which people were incompetent to refuse

antipsychotic medication, especially people whose difficulty came

about as a result of noncognitive impairments, that is, impairment

from something other than disordered thoughts. It was my argument

that many people (more than we might think) should be allowed to

refuse medication. As someone who benefits from medication, I know

that the question of when one should be allowed to refuse is a

complicated one. But I also believe that individual autonomy is vitally

important, even precious—after all, it's central to who we are as

humans on the planet, with free will and self-ownership.

As the work progressed and the time went by, my faculty

friendships came to mean a great deal to me. The lunches, the dinners,

the casual greetings in the hallway—I was grateful for all of it. I felt

less lonely; I felt more competent. Maybe the time was coming when I

could even tell my friends the truth about myself.

And then there was Kaplan. Just as I'd always done, I was

tinkering with the med levels, lowering them whenever I could, and

feeling the effects, to his increasing and obvious annoyance. One

evening, late in the summer, I called Kaplan to tell him that the earth

was caving in and he needed to take cover. He sighed. "Elyn, take

more medication." That seemed to be his answer whenever I became

psychotic.

Later that year, Kaplan was preparing to take a long vacation

trip—to China, as I somehow knew. Suddenly, I began slipping.

Demons were everywhere, and evil began oozing from the walls. I

couldn't focus my thoughts, I couldn't write. Within days, I was

huddling on the couch in my office, muttering senselessly into the

telephone to Steve, who could tell I was in trouble and tracked Kaplan

down—not the kind of thing he'd ever been enthusiastic about doing

or felt comfortable with. But he thought, in this instance, it was called

for.

Later, Steve recited the call to me verbatim: "Dr. Kaplan, I'm very

concerned about Elyn. She seems more psychotic than she's been in a

very long time, I thought you needed to know. For instance, she told

me that she was going to China in advance of your trip, to clear it out

of all the bad persons."

"How very considerate of her!" Kaplan dryly responded. And then

he suggested that I increase my medication.

There were, in Kaplan's way of thinking, three different lenses through

which I viewed myself—three "me's," as he put it, although without

any implication that these were actual selves or personalities or

people or anything of that sort—it was purely a heuristic device. One

me was Elyn, one me was Professor Saks, and the third me was "the

Lady of the Charts"—the person who was a mental patient. I couldn't

argue with the metaphor, since it pretty much summed up the way my

life worked: I was Elyn with my family and friends, Professor Saks

when I was teaching or writing articles, and the Lady of the Charts

when I was ill. Kaplan believed that it was Elyn who was the most

neglected of the three.

There were many days when I believed I was nothing more than

the Lady of the Charts—a crazy woman who'd faked her way into a

teaching job and would soon be discovered for what she really was

and put where she really belonged—in a mental hospital. Other times,

I denied that the Lady of the Charts even existed, because my illness

wasn't real. If I could just successfully get off medication, the Lady of

the Charts would disappear. Because how could I reconcile the Lady of

the Charts coexisting alongside Elyn and Professor Saks? Either I was

mentally ill or I could have a full and satisfying personal and

professional life, but both things could not be equally true; they were

mutually exclusive states of being. To admit one was to deny the other.

I simply couldn't have it both ways. Didn't anyone understand this?

During the spring of our second year together, the relationship

with Kaplan really got rocky. As I'd always been somehow able to do, I

saved most of my psychotic thinking for my sessions. On the couch, I

could lie down and relax; there, I felt safe. If the closet door that kept

my demons in check burst all the way open, and they all came

exploding out—well, that was OK. I was in analysis, where that sort of

thing was supposed to happen. Say what's on your mind—or so Mrs.

Jones and Dr. White had taught me.

But Kaplan had decided that my way of using analysis had itself

become a problem; it was my way of not dealing with more pressing

issues. The Lady of the Charts was taking up all his time, and Elyn was

getting nowhere. I was filling my hours on the couch with psychotic

gibbering. I hadn't had a date in years, and certainly had no

foreseeable prospects for a relationship or marriage, something I now

insisted that I wanted badly. Kaplan thought the analysis had become

too unstructured, and he let me know it.

Then, for some reason, he had to be away; during his absence, I

saw another psychiatrist, Kaplan's backup, whom I'd come to know

and like. When Kaplan returned a couple of weeks later, he told me

the backup doc had reported that he'd noticed what appeared to be

trembling movements around my lips, a possible first sign of tardive

dyskinesia—TD—the movement disorder caused by antipsychotic

medications. Perhaps you've seen it among street people with mental

illness: lip smacking, tongue lolling out, limbs shaking uncontrollably.

TD's an unmistakable sign that something's wrong; it might as well be

a placard stuck to your shirt: "crazy person here." Even worse, there's

ample evidence that it's progressive and irreversible.

Quickly, Kaplan referred me to an expert, Dr. Stephen Marder, an

internationally known schizophrenia researcher. He did indeed

diagnose me with a mild case of TD. On what's called the AIMs test

(Abnormal Involuntary Movement), my lips were involuntarily

moving; my eyes were blinking too hard and too often. Although the

movements were subtle, there was no assurance they would stay so.

Friends at the law school had noticed something, too, they told me

later. But out of kindness (and not knowing what the cause was), they

hadn't said anything.

In spite of Marder's diagnosis, Kaplan insisted he'd never seen the

movements. "I'm not convinced you have TD," he said firmly. Marder

was the TD expert; nevertheless, Kaplan refused to confirm the

diagnosis, which felt dismissive of my very serious concerns that had

been raised by the expert Kaplan himself had sent me to. Thanks to

my doctors, whom I'd trusted, it seemed that I'd been taking

medication the side effects of which would now remove any doubt to

the outside world of who I really was: the very shaky, mentally ill Lady

of the Charts.

I could not remember the last time, if ever, I had been so angry

and frustrated. White and Kaplan had betrayed me with their

constant insistence that I take the medication. Of course I'd been

aware of the risks, but still, the word "betrayal" rang in my ears. I was

pretty good at hiding what I was thinking, but once TD set in, how was

I supposed to hide how I looked?

And then Kaplan added insult to injury. "You can't lie down in

session anymore," he said. "From now on, you have to sit up, in a

chair."

What the hell? To my mind, he'd just said that I wasn't well

enough to be in psychoanalysis. While Kaplan insisted that effective

analysis could occur on or off the couch, to my ear he was telling me I

was unanalyzable. I was the Lady of the Charts. Good-bye, Elyn.

Good-bye, Professor Saks.

"I'm seriously thinking of quitting with you," I fumed to him, and I

said as much to Steve on the phone before and after the sessions.

"There's no point to working with him anymore, Steve; he doesn't

want me there anyway, that's clear. I annoy him, I don't do what I'm

told. Besides, he's not paying any real attention to me—other people

see my lips trembling, he doesn't. Other people see my eyes jumping

and blinking, he doesn't. What's the point of him?"

"What's the point of you?" I asked Kaplan. "Not only do you think

I'm only the Lady of the Charts, you seem determined to expose me to

the world that way!"

My anger alternated with complete despair. My analyst, the one

who was supposed to know me the best, the one whose job it was to

help me navigate and understand my world, obviously thought I was

ultimately slated to be nothing more than a street person. Well, then,

maybe I should just move to the streets and be done with it. I'm

destined for degradation. I belong on the streets. All else is pretense.

My fantasies of actually living as a street person grew more intense

every day; after all, it wasn't the first time the possibility had been

raised. The experts at MU10 had predicted as much when I was

hospitalized in New Haven. Maybe they'd been right about me all

along; maybe I'd been wrong.

Kaplan was immovable, but Steve was my consolation. We spent

hours on the phone every day, as he listened to me rant and rave, and

tried his best to talk me down from the ceiling. "I think there's method

in his madness," he said.

"His madness?" I said.

"Yes. It's as though he's setting up a different construct, a different

dynamic between the two of you than you're used to. Stay in analysis,

Elyn, and sit up if you have to. Would that truly be so terrible? You've

been writing, you've been teaching, it's all been going well. Everything

you've ever wanted is in your grasp, if you can just get through this

hard phase with him. Are you going to throw everything away just

because you're angry?"

Then Kaplan delivered the coup de grace: his diagnosis.

Schizophrenia. "In the past, I've diagnosed you as 'atypical psychosis.'

But that's only allowed you to minimize your condition. Now I think I

was wrong." His delivery was chilling and abrupt, as though he were

serving his diagnosis up with a carving knife. Here's the deal, take it or

leave it. "When you're ill, you're totally indistinguishable from the

worst kind of schizophrenic. It's not going to change, it's not going to

get better, and it's not going to turn into something else. It's time for

you to stop fighting, and accept it."

"Stop fighting?" If I was angry before, now I was raging. "Stop

fighting? I thought I was supposed to be the crazy one in this room."

I'd show him; he'd left me no alternative. I'd show Kaplan and the

whole world that I was not mentally ill. I was Elyn and I was Professor

Saks, but I was not the Lady of the Charts; she was figment of his

imagination, not mine. I'd show them all—I'd get off the damn meds

once and for all. And then they'd all see what was what.

chapter twenty

KAPLAN WAS ASKING me to surrender. That's the way I heard it,

and that's the way that it felt, deep inside my core. Asking, hell—he

was telling me to surrender. I'd never surrendered to anything in my

life. If the doctors up to this point were right, wasn't I supposed to be

in an institution by now? Virtually every single expert, at one time or

another, had suggested that this was my destiny. If I had ever truly

believed them, if I had ever surrendered to their version of me

(instead of doggedly hanging onto my version of me), I'd still be

crawling around the tunnels under the Warneford, burning my arms

and legs with a lighter and waiting for devils to blow the world up by

using my neurotransmitters in some inexplicably evil way.

But I didn't believe them, and look where I'd ended up: a lawyer, a

scholar, with multiple academic degrees and honors, the promising

beginnings of both a publishing career and a teaching career. I was

living on my own, making friends, feeling the warm California sun on

my back every day and being grateful for it. So—surrender? Quit? Stop

fighting? I couldn't. My parents had taught me, Operation Re-Entry

had taught me: No surrender. Fight back. Fight.

The idea that there's any victory in surrender is totally foreign to

almost everyone I've ever known, rich or poor, sick or well, happy or

sad. Surrender feels like failure, it feels like defeat. Even worse, it feels

like loss—of self, of autonomy, and of hope. To surrender is to fold up

your tent and slink off the battlefield. It's to say, "I'm not enough. I

quit." And it simply was not in me to do that. Yet.

So I made a plan. First, I found a cognitive-behavioral

psychologist, Dr. Benson, and asked for some suggestions about how

to keep my psychotic thinking in check while I was cutting back on the

drugs. That appointment and our discussion reminded me so much of

Dr. Hamilton at Oxford—he'd helped me get through those first

months of severe illness intact, and Dr. Benson had the same

theoretical orientation that Hamilton did. Cautiously but clearly, she

did her best to explain what might happen in the ensuing weeks. "It

wall be hard," she said, "and there are no guarantees it wall work."

"But I have to try," I told her.

"Yes," she said. "I suppose you do."

I ran through my plan endlessly with Steve, who tried to be as

patient as he could, but who couldn't disguise his skepticism. As

always, he was willing to support me in whatever I decided to do, but

he made it perfectly clear that he thought what I was proposing was a

bad idea. Neither of us saw anything contradictory in his holding both

positions; it was simply the kind of conundrum that our friendship

had always contained—if, in spite of evidence to the contrary, I wanted

to do something the equivalent of jumping off a ledge, he'd caution me

first and then pledge to be there to catch me. "Be careful, Elyn," he

warned. "This isn't like adjusting aspirin levels for a headache."

Since I knew Kaplan would never go along with what I intended, I

told him in a vague, general way that I planned to reduce my

medication, primarily because of concern for the side effects. I hoped

eventually to be off altogether, but would proceed cautiously, I said,

making the smallest adjustments possible; nothing major, nothing

abrupt.

Finally, I talked to Marder, the TD and schizophrenia expert. He

said that if I were determined to lower the meds, I should do so at

about the rate of one milligram every six months. I'd already taken

myself down to six milligrams; at the rate Marder suggested, it'd take

three years for me to be off entirely. Not fast enough. Not clean

enough. I decided to drop one milligram each month—six times faster

than Marder advised, but much slower than I'd ever dropped in the

past. Ideally, I'd be med-free by mid-summer.

And so I began. I was on a mission. At the end I would either be

the Lady of the Charts, or a reasonable combo of Elyn and Professor

Saks. But somebody had to go.

At Dr. Benson's suggestion that spring, I'd joined a support group, the

Manic-Depressive and Depressive Association of Los

Angeles—MDDA. I had looked for a support group for people with

schizophrenia, but came up empty. MDDA was the next best thing. It

met once a week at a nearby hospital.

As apprehensive as I was about what being in a support group

might entail—full disclosure, the presence and opinions of people I

didn't know, men and women who were battling their own demons—it

was surprisingly easy to be there. Nearly everyone in the room was on

medicine, or a combination of medicines, and most of them (even

those who accepted their illness) deeply resented that fact. We were

flawed, we were less, we were not enough. As many problems as we

each had, nobody in that room liked knowing that the solution was in

a little plastic prescription bottle. Or two bottles. Or three. "I'm just

not me when I'm taking those," said one person. "They turn me into

someone else."

Several of the folks at MDDA didn't believe they had an illness at

all, much less one that required constant vigilance and medication.

Every once in a while, someone would come to meetings in a manic

state—for two or three weeks at a time—and then, for whatever

reason, he'd decide to take his medication; by the following week, he'd

look and feel much better. Nevertheless, he'd say, "Next time, I just

have to try harder. I know I can do it next time." I nodded; I knew

exactly what he was talking about.

My dogged insistence on "resistance" wasn't always welcomed by

others in the group, however. One of my closest friends in MDDA was

a man of great intelligence, about my age, who'd been struggling with

his illness for years. Although his intelligence and capability seemed

largely intact to me, he'd virtually relinquished any hope of achieving

anything further in his life. Instead, he'd gone on disability and

worked at various jobs, as he felt the need or desire. Although I

enjoyed the time I spent with him, I found myself increasingly

intolerant of his attitude toward his illness and his work. "I think

you've given up," I said one night at dinner. "I think you've given in.

You're way too comfortable in the role of a mentally ill person."

The minute the words were out of my mouth, I wanted to call them

back. The look on his face was one of transparent hurt, even sorrow.

He had trusted me; now he regretted it.

Kaplan sometimes said that I had a Republican superego when it

came to mentally ill friends. I'd pushed myself for years; that pushing

had helped me survive. So I wasn't yet ready to allow for someone else

what I could not allow for myself. In retrospect, of course, my

intolerance said more about me than it did about my friend. It caused

him pain. And it cost me a friendship.

My first month with a lowered Navane dose went by. I felt...uncertain.

Are other people in the room with me and Kaplan? Things seem kind

of strange. I don't know which side Kaplan is on.

The second month came and passed. Now I was down to four

milligrams. Classes had ended. I could write, but just barely—it's

difficult to concentrate when inch-high men are waging a nuclear war

in your head. Someone is slipping anti-antipsychotics in my blood

and making me look psychotic. But I'm not. By God, I'll tell you when

I'm psychotic, thank you very much.

With intense effort, I masked my symptoms with Kaplan. To do

otherwise would only prove his point. I sat up in the chair; I controlled

my ramblings.

Yet another member of the MDDA group had tried and failed to

stay off her medication. Yes, yes, she felt better now that she'd taken

her pills. "But I think maybe it just wasn't the right time for my body

chemistry," she said. "I'll handle it differently the next time I try."

That night, talking to Steve on the phone, I said, "I know the

illnesses are different, and the meds are different. But you know, I'm

beginning to think there are some interesting parallels between what

I'm trying to do and what the people in group are trying to do."

"Gee, ya think?" Steve said. I could almost hear the smile on his

face.

"Oh, shut up."

I was down to three milligrams a day. The days and nights were

harder now. The sheer physical effort of containing my body and my

thoughts felt like trying to hold back a team of wild horses. Sleep was

spotty, and filled with dreams that left me awake and sweating in

terror. Nevertheless, I dropped down to two milligrams.

Months before, when I'd been invited to attend a workshop at

Oxford, I'd accepted. It was too late now to change my mind without

making people angry, significantly inconveniencing them, and making

myself look professionally irresponsible. As unhinged as I felt, I had to

go. Once there, somehow, I held on by the skin of my teeth, although

I'm sure everyone at the workshop thought I was one of the strangest

people they'd ever met. By the time I boarded the plane for home, I

was a complete wreck.

When I walked into Kaplan's office my first day back, I headed

straight for the corner, crouched down on the floor, and began to

shake. All around me were thoughts of evil beings, poised with

daggers. They'd slice me up in thin slices or make me swallow hot

coals. Kaplan would later describe me as "writhing in agony."

"Elyn, you need to increase your meds," he said immediately.

"You're acutely and floridly psychotic."

"One. Effort. Number. Explosion."

"Will you take more meds?" Kaplan asked.

I was shaking, but I was also shaking my head. I couldn't take

more. The mission is not yet complete.

Immediately afterward, I went to see Marder. He'd never seen me

ill before; he'd been under the impression (and I hadn't disabused him

of it) that I had a mild psychotic illness and that my primary concern

was avoiding TD. Once in his office, I sat on his couch, folded over,

and began muttering. I was disheveled—I couldn't remember when I'd

slept, or what I'd eaten. When had I bathed—in Oxford? Before

Oxford? Did it matter, if we were all going to die anyway? Anyone who

walked into that room would have thought Marder was treating a

schizophrenic street person. Weeks later, he told me that's exactly

what I looked like.

"Head explosions and people trying to kill. Is it OK if I totally trash

your office?"

"You need to leave if you think you're going to do that," said

Marder.

"OK. Small. Fire on ice. Tell them not to kill me. Tell them not to

kill me! What have I done wrong? All the explosions. Hundreds of

thousands with thoughts. Interdiction."

"Elyn, do you feel you're dangerous to other people? Or to

yourself?" he asked.

"That's a trick question," I said.

"No, it's not," he said. "I'm serious, I think you need to be in the

hospital. I could get you into UCLA right now, and the whole thing

could be very discreet."

"Ha ha ha. You're offering to put me in the hospital? Hospitals are

bad, they're mad, they're sad. One must stay away. I'm God. Or I used

to be. I give life and I take it away. Forgive me for I know not what I

do."

"I really think a hospital would be a good idea," Marder said.

"No, thank you oh so very much," I said.

"All right, then, but if I were you, I'd stay away from work for a

while. You don't want your colleagues to see this."

"Thanks, banks, bang, bye. See you soon." Oblivious to the look on

his face, I left.

That night, Kaplan called me at home. "Elyn, Dr. Marder told me

about your conversation. He's worried and so am I. This is serious,

even dangerous. If you want to prevent hospitalization, you have to

take your meds now."

"Oh no, oh no, oh, no," I prattled. "I know that if I just try harder, I

can get off the meds. Meds and beds. I'm going to sleep now."

Somewhere inside my head, it registered that Kaplan was as upset

as he'd ever been. But my mission was not yet over. The Lady of the

Charts was still alive and kicking.

I don't know how I slept that night. It felt as if my arms and legs

were going to fly off in four different directions. Maybe I just passed

out from exhaustion. The next morning, I dragged myself to my

office—my hideout, my refuge.

But I ran into Ed McCaffery in the hall. A few months earlier, I'd

told him about my illness, but only in the simplest terms. Nothing

could have prepared him for the person standing in front of him,

fidgeting wildly and looking as if she'd been caught up in a tornado. I

tried to hang onto coherent thought, with some vain idea of fooling

him, but that thought disintegrated into complete nonsense.

"There's these little people with the explosions. In my head. Voice

mail and interdiction and something must be done. Is someone else in

here? I went there, and then they said 'x, y, and z,' and there's the

killing fields, but who knew about the conviction?"

At first, Ed had smiled a little, thinking I was making some kind of

joke, but as I got more wound up, he figured out what was happening.

"Elyn, what the hell's going on? I thought you were kidding at first,

but you're not, are you? Does anyone else know about this? Is it OK

for anyone else to know?"

"I wouldn't mind telling Michael," I said. "Not the Archangel one.

The other one."

"Stay here," he said firmly. "Stay here. I'm going to call Kaplan.

And Donna." Ed's then-wife, Donna, was a physician.

In a few moments, Ed came back, and as he did, the phone rang. I

picked it up and heard Michael Shapiro, my kind bioethics colleague,

on the other end. "Elyn, how are you?" he asked.

"Oh, ever so well, thank you. But there's interdiction here, and I'm

responsible for many deaths. Have I killed you yet?"

"Give the phone to Ed now, please," he said simply.

I listened attentively to Ed's side of the conversation. "No, no, we

can't call the vice dean," he said urgently. "I've talked to her doctor,

he's going to call here in a couple of minutes. We'll do whatever he

says. But this is serious, let me tell you." Just as he put the phone

down, it rang again. Kaplan.

"I'm not going to take more medicine," I told him. "I can do this, I

just have to try harder." And then I hung up on him.

If I could just exert control over my wayward brain, if I could just

hang on a little longer, my mission to dissolve the Lady of the Charts

would not fail. I was fighting for Elyn and for Professor Saks. I had

never failed anything, I wasn't going to start now.

"I'm going to drive you home," Ed told me. "And I'll stay with you

for a while there. Elyn, you have to take your medicine."

"No," I said. "And yes. No to the medicine, yes to the drive home."

"You're not going to jump out of the car, are you?" he asked.

"No. I'm not. Off we go, into the wild, blue yonder."

Throughout the ride from school to Westwood, Ed kept talking. "I

don't understand," he said. "Your career, your writing—it all works

when you take your medicine, doesn't it? So isn't it obvious? I mean,

that you have to take it?"

I shook my head. "No," I said. "That is not clear. Clear, fear, near,

dear. Deer in the headlights. I can't fail."

Once we got into my apartment, Ed called Donna to let her know

where he was, and how I was. "What do you want me to do, tackle her

to the ground?" he hissed into the phone. He didn't sound happy. I

wasn't, either.

I called Kaplan. "I want off the stuff!" I moaned.

"I know you do," he said. "But what you're doing is going to land

you right in the hospital instead. You need to accept that you have an

illness and need to take medicine to control it. It's not fair, it's not fun,

but that's the way it is."

No, no. I can't take the meds and I can't be in the hospital! The

room was full of swirling, taunting demons, forces coming through the

walls and ceiling. Ed couldn't see them, but I knew they were there.

Any minute now, something terrifying would happen to us both.

"I'm being interfered with," I cried to Kaplan. "I'm so scared. Help

me, please!"

"Do you have your medications there?" he asked.

"Yes," I said.

"Then it's time to take them. Thirty-six milligrams—eighteen of

your pills. Do that now."

I looked up. Ed was staring at me. Steve would be calling soon, as

he'd done every day, to tell me it was time to take my pills. Marder was

telling Kaplan to put me in the hospital. Kaplan was telling me that

without meds, the hospital was my next stop. "OK," I muttered into

the phone. "OK."

I'd failed.

I took the whole dose at once. In minutes, I was limp and sleepy.

Ed left, I went to bed, and except for my appointments with Kaplan, I

stayed at home for the next several days.

I could no longer deny the truth and I could not change it. The wall

that kept Elyn and Professor Saks separated from the Lady of the

Charts was smashed and lay in ruins around my feet. The Lady of the

Charts was real. That was the truth.

For days afterward, I felt like the survivor of an automobile

accident: sore and spent, as if the slightest breeze would knock me to

the ground. I tried my best to avoid the mirror in the bathroom, but

there she was again, the wild-eyed woman I'd first seen in the mirror

at the Warneford: hair matted and dirty; skeletal face, body mostly

bones. Anyone guessing my age might have added twenty years to the

real number. Failed, failed. Hope was dead, and I was in mourning. I

wanted to rage, to storm through the apartment, but I was too tired to

do much more than pick up the toothbrush and, eventually, the

hairbrush.

Psychosis sucks up energy like a black hole in the universe, and I'd

really outdone myself this time. When I walked, haltingly, down the

sidewalk—one careful foot at a time, testing the pavement as though

any minute I'd fall through and be swallowed whole—all I could think

of was old ladies who walked like this, and how I'd pitied them. The

idea of shopping—making lists, getting into the car, actually going

someplace and accomplishing something as simple as butter, eggs,

bread, and coffee—was overwhelming. Thank God for good friends.

After a loss, people naturally gravitate toward the familiar for

comfort. Like a wounded animal, I burrowed into my cave and

surrounded myself with familiar objects and voices. I talked on the

phone with Steve for hours, replaying every decision I'd made, picking

through the mess, second-guessing what I'd done, how I'd done it,

and trying to get the ending to come out different each time. I had

sessions with Kaplan, where "I told you so" hung in the air but was

never spoken. I spent time with my friends who had seen me sick,

hadn't been repelled, and oddly seemed to still care about me.

And, eventually, I went back to my office at the law school, where I

tried to work on an article and prepare for my fall classes. But mostly,

I listened to classical music and took long naps on my couch. After all,

the couch was still mine; the walls were mine, the books and papers

were mine, and the office door had my name on it. When you're

worried about falling, you grab hold of whatever you can.

By the time classes began that fall, I was somewhat back on my

feet, able to concentrate and genuinely looking forward to greeting

students and colleagues who'd been away for the summer. The easiest

way to explain things, I guess, is that it was as though I'd had a very

bad flu; it took a while to get over, but each day, I felt a little better.

Even in sunny two-season California, September always feels

especially promising.

In spite of my ugly misadventures with medication, I'd been able

to stick to my original plan for tenure—to write and publish enough

papers that I could "stockpile" in case I had to take time off for illness.

I'd already published several law journal articles on competency to

refuse treatment, and the paper I'd written in George Mahl's Freud

class at Yale came out in a psychoanalytic journal. I'd also completed

my first paper on the criminal responsibility of individuals with

multiple personality disorder, and had begun to sketch out several

more exploring MPD and the law. For obvious reasons,

psychoanalysis and the law had become my main area of interest and

academic research.

Certain faculty members at USC's medical school had noticed my

published work, and I was gratified and flattered when I was offered

an academic appointment there. I happily accepted, but felt that I

needed to leave my MDDA support group—the med school

appointment was in the psychiatry department, and I couldn't risk my

illness being somehow exposed, certainly not before I'd achieved

tenure. I called Steve Wizner at Yale and told him that I'd risen above

my lifelong status as patient and become a colleague to an entire

medical school. "I've infiltrated the enemy!" I said. The sound of his

laughter was gratifying.

chapter twenty-one

THINGS WITH KAPLAN were not going well. No matter what I did

or said, I tested his patience. For example, I'D had a physical, during

which the physician found a thyroid nodule which needed to be

biopsied. Subsequently, an endocrinologist examined me and said I

probably had Marfan syndrome, a genetic connective-tissue disease

with a life expectancy in women of about forty-five (in recent years,

that's been revised upward, to mid-sixties). At the time, I was

thirty-seven. I was devastated, and wild with anxiety.

So I did what I always do—found articles referencing Marfan,

frantically read them all, and saw myself on every page. I certainly had

a lot of the physical characteristics: tall and thin, highly flexible in my

joints, with a fast heartbeat and a brain bleed. I was doomed, I just

knew it. My demise was imminent.

"Lincoln had Marfan," I wailed to Steve.

"But that's not what he died of, Elyn. Come on, get a grip. Just

don't go to the theater."

Kaplan wasted no time in letting me know that he thought the

whole thing was baloney, and dismissed it out of hand. "The doctor's

hearing zebras when he should be hearing horses," he said.

"He's an expert," I protested. "A full professor at UCLA. And he

said he'd be 'surprised' if I didn't have Marfan. Why aren't you taking

this more seriously?"

The results of the intensive medical workup showed that I did not,

in fact, have Marfan syndrome. That didn't stop my psychosis from

bleeding in around the edges of my life for the next several days. I had

to admit it: I was a full-fledged hypochondriac. My body had betrayed

me so many times in the past, why did Kaplan expect me to behave as

though it would never do so again?

And then one day soon after, I retreated to a familiar theme: "I've

been thinking," I said. "Maybe if I were on an antianxiety medicine, I

could get off the antipsychotic medication."

Kaplan blew a gasket. "I've repeatedly told you that you'll need to

stay on meds the rest of your life, that trying to get off them keeps you

stuck in the same place—going from well to symptomatic to well

again." He was practically shouting. "I'm just not going to put up with

this anymore! If you reduce your meds again, you cannot stay in

treatment with me. In fact, you can't even talk about reducing your

meds and stay in treatment with me. This stops now."

The look on his face registered as pure anger. That was it. There'd

be no more discussion of medication with Kaplan. The issue was off

the table.

Steve agreed with him. As far as he was concerned, after the last

episode, the data were in. "When you lower your meds, your judgment

is compromised," he said. "Every time, you go into the downward

spiral, one bad decision after another, none of them in your best

interests. It's...tiring. Aren't you tired of it, too?"

Oh, God, yes, I was tired—tired of being alone, tired of flailing

away, tired of beating my head against the wall. For so many years, I'd

resisted the "crutch" of the meds—to use them meant I was weak of

will, weak of character. But now I began to question my own

absoluteness. For instance, if I'd had a broken leg and a crutch was

required, I'd have used it without ever thinking twice. Was my brain

not worth tending to at least as much as my leg? The fact was, I had a

condition that required medicine. If I didn't use it, I got sick; if I used

it, I got better. I don't know why I had to keep learning that the hard

way, but I did.

A friend used the riptide analogy: You get sucked in, and your first

instinct is to fight it. The harder you fight, the more energy you spend.

But the simple truth is, a riptide is stronger than you; you cannot

outmuscle it, and if you continue to try (if you exercise, as I

continually did, "maladaptive stubbornness"), you drown. The simple

lesson (as California surfers learn over and over every year) is to stop

fighting and go with it. Save your strength, stop fighting, and the

riptide itself will quickly propel you out of harm's way, into calmer

waters. At that point, if you've preserved your energy, you can make it

back to shore on your own. But first, you have to give in.

As exasperating and frightening as my years-long process of

tinkering with my meds was for my friends and physicians, I

understand now that it was hugely important for me to do it; it was a

necessary stage of development that I needed to go through to become

my full-fledged self. It was the only way I could come to terms with the

illness.

So I vowed I'd take my Navane and do no more experimenting.

What happened next was a pleasant surprise: Almost immediately, I

actually felt quite good. Once again, I'd learned that it wasn't my

stubbornness or discipline that kept the demons at bay; it was the

medicine. I knew the demons were there; every single day, they found

ways to remind me, however subtle those reminders were. But

nevetheless, they were behind the door, and it was firmly closed, at

least for now. And besides, I decided that there were other, better,

more interesting parts of my life worth tending.

I'd met someone, a nice someone. His name was David and he was a

microbiologist—and he seemed to like me. He asked me out on an

actual date, my first since law school. The first date went well. The

second date went OK. Soon, though, he was beginning to press me to

be sexual. I wasn't ready for that with him, or with anyone, and things

continued, but not easily. After a while, instead of being fun, being

with David was tense, and tension was the last thing I wanted.

We stopped dating, but remain good friends to this day. He is kind

and smart and funny, and someone whose friendship I cherish.

Ending the relationship was right, but it made me sad. Not because I

was no longer romantic with David, but because of a bigger question:

Was there anyone out there for me? Many of my female colleagues

had put their personal lives on hold while they pursued educations

and careers, but lately, it seemed, many of them were finding

partners, falling in love, having children—living the kind of life I could

only imagine. I watched movies in which people met and fell in love,

and sat there feeling as though I'd come from another planet. Damn

it, I want that. Intimacy, and love, and trust, and the touch of

someone's arm around my shoulders, someone's hand in mine. The

Lady of the Charts was quiet these days, and Professor Saks was

humming along just fine. So what were we going to do about Elyn?

The more I explored multiple personality disorder, the more intrigued

with it I became, and since the MPD article had been well received, I

thought I'd try my hand at writing a book about it. As part of the

preparation, I needed to get up to speed on the clinical presentation of

the disorder. So I went to a local hospital once a week for several

months, and there I met with people actually diagnosed with and

being treated for MPD.

The first young woman I spoke with was completely

lovely—high-spirited, charming, and committed to therapy and to

getting better. She'd recently married, she told me, but only after a

two-year engagement, during which her then-fiance, at his insistence,

proposed to and got the consent of each of her alternate personalities!

I also watched a hundred hours of videos of patients being

administered a diagnostic instrument called the Structured Clinical

Interview for Dissociative Disorders (SCID-D). Even though a good

case can be made that MPD is overdiagnosed—and sometimes created

by the treaters themselves—it seemed utterly clear to me from the

evidence on those tapes that MPD was a genuine phenomenon.

Oddly (but happily), being in the hospital and watching patients

being interviewed on the SCID-D did not get me all stirred up, nor did

it awaken any of my demons. I didn't have much in common with

these patients, although I observed a few who obviously had MPD and

completely denied it (now that behavior I was intimately familiar

with). Watching the process really opened my eyes to some

commonalities shared by most mental illnesses; it turns out that we all

overlap with one another a little bit.

I did have a very funny telephone conversation with one of my

nephews while I was working on the MPD book. He was about ten at

the time, and asked what I was doing in my office that day.

"Writing a book about multiple personalities," I told him.

"What is that?" he asked.

Oh dear, I thought; how do I get out of this one? "Well, some

people think they have lots of other people inside themselves," I said.

"And if one of those other people does something wrong, should all of

the people have to go to jail?"

He mulled that over a bit, we chatted a little more, and then we

said good-bye.

A few days later, my brother called. "What have you been telling

this kid?" he asked, and he didn't sound very happy with me. "He was

misbehaving the other day, and his mom told him to stop it. He just

wouldn't settle down, and finally she asked, 'What on earth is wrong

with you today!' And he told her, 'I didn't do anything, it was someone

else inside of me!'"

In the fall of my fifth year at USC, I submitted my tenure packet: five

long articles, four shorter articles, and a lengthy book proposal. Ed

and Michael were both very encouraging. A subcommittee of three

would read my work and send it out to a dozen or so reviewers; when

the reviews came back, the subcommittee would meet and then vote;

then it would go before the entire tenured faculty of the law school.

The faculty would be given a ballot and a week to return the ballot to

the dean's office. The ballot would decide whether I would be made

professor.

The year went by quietly, even smoothly. I taught class and I

wrote. I spent time with friends. I visited Steve in Ann Arbor, where he

was finishing up his doctorate in clinical psychology. I stayed on my

medication, on a dose Kaplan found acceptable. Although there were

no more dates, someone else did catch my eye, a librarian in the law

library. He was blond and attractive, in an open, unprepossessing

way—flannel shirts, a ponytail. He wasn't as intense as many

students; he wasn't as businesslike as many faculty. He was

someplace in between, and seemed calmly at home there. His name

was Will, I discovered. He'd been around awhile. He made furniture

and gardened in his spare time, somebody told me. After a time or

two, he smiled when he saw me. It was a very nice smile. Well, I

thought. I might have blushed. I'm pretty sure I blushed.

I'd once complained to Kaplan that at lunch earlier that day, I'd been

the most senior person at the table and I didn't much like it.

"Oh," he said. "You mean you're a duckling who doesn't want to

become a duck!" I told some of my friends this story. Getting tenure

around USC then became known as "becoming a duck."

The tenure ballots went out from the dean's office on a Friday in

February, four-and-a-half years after I had arrived at USC Law

School. A full week passed. The following Friday I sat in my

office—somebody knock, please. Or call me. Or e-mail me. Or send a

carrier pigeon through the window. Something, anything. Midway

through that afternoon, the phone finally rang. Shaking, I answered it.

"Congratulations, Professor Saks," replied our dean.

Professor Saks. I'd made it; I was a tenured professor at the

University of Southern California Gould School of Law. I'd become a

duck at last. A colleague gave me a Mighty Ducks T-shirt to show for it.

At which point, I did what by now had become predictable: I

became psychotic. Change, good or bad, is never my best thing. "A

jumbo jet can sail smoothly through strong and gusty currents," says

Steve. "But a small plane bounces in a small breeze." Mine was a very

small plane; getting tenure was a big, albeit pleasant, wind, and for a

few weeks, it threatened to blow me right over.

That night, my colleagues took me out to dinner to celebrate. I

didn't want to disturb them with the news that beings in the sky were

using my brain to spread death and destruction across the earth—that

would have put a damper on the evening (not to mention making

them second-guess their votes). I talked to Kaplan, willingly went up

on my meds, and bounced around for a while, while the demons

danced at the edge of every room I was in. Then everything settled

back down again. The Lady of the Charts withdrew; Professor Saks

had tenure. Time to turn my attention back to the most needy member

of the trio, Elyn.

"With tenure," Kaplan told me, "the central issue in one's life

moves from survival to desire."

OK, I'd survived. Now, then—what did I desire?

It had taken five years to learn how to use my time with Kaplan

well. At first, I'd brought my psychosis into our sessions, as I'd done

with Mrs. Jones and White. In the meantime, I worked to keep my

symptoms out of view from all but a few of my LA friends—even with

them, I shared my psychotic thoughts sparingly, or when I was at my

worst and simply couldn't help myself. But with Kaplan, I could let my

guard down, much the way one would rest on a shady bench during a

long, uphill walk.

But as he'd stated over and over, Kaplan had come to believe that

I'd grown too comfortable on that bench, and he finally issued an

ultimatum: I couldn't sit there any longer. Filling our hours with

nothing other than my psychotic ramblings was no longer an option.

Instead, we'd talk about the life I wanted, and how my illness had so

often gotten in the way of my having it.

It was a hard line for Kaplan to take, and at first I was frightened.

If I couldn't bring my psychosis into that room, where could I bring it?

But he helped me through it; he'd interrupt the ramblings, stop them,

and then redirect my thoughts—to my teaching, my students, my

WTiting, my friends. Less and less, our sessions revolved around

psychosis; more and more, they were about my "real" life. By our sixth

year together—the year following my tenure—the Lady of the Charts

made only sporadic cameo appearances and no longer held center

stage. It was time to take care of other things.

For the most part, schizophrenia is an illness that strikes young

people, in their late teens and early-to mid-twenties—a time when

we're supposed to be learning to make friends, keep them, and

navigate our way through the world. But schizophrenia can knock you

out of the loop for as long as three or four years—and for some,

forever. In fact, as far as we've progressed in research and treatment,

recent statistics indicate that only one in five people with

schizophrenia can ever be expected to live independently and hold a

job.

Dropping in and out of your own life (for psychotic breaks, or

treatment in a hospital) isn't like getting off a train at one stop and

later getting back on at another. Even if you can get back on (and the

odds are not in your favor), you're lonely there. The people you

boarded with originally are far, far ahead of you, and now you're stuck

playing catch-up.

A key part of forming a friendship is sharing personal histories,

which can be a precarious rite when you're schizophrenic. The gaps in

your life—how do you explain them? You can always make up stories,

but beginning a friendship with a lie about your life doesn't feel very

good. Or you can say nothing about how you've spent the last few

years, which strikes people as odd. Or you can choose to tell them

about your illness, and find out the hard way that most people aren't

ready to hear about it. Mental illness comes with stigma attached to it,

and that stigma can set off a negative reaction, even from the nicest

people, with good intentions and kind hearts. Even for many of these

people, those with mental illness are other; they're not like "us."

Sometime late in my fifth year at USC, I was on my way to dinner

with an administrator at the law school and telling her about an article

I was WTiting, on the right to refuse psychiatric medication.

"I'm afraid of mentally ill people," Leslie said. "They can be violent

and end up hurting lots of people."

Somewhat taken aback, I patiently explained what the research

told us. "The vast majority of mentally ill people are no more

dangerous than anyone else," I said, "and less prone to violence than

many."

"I don't know," Leslie said. "I can't help believing that they're

capable of who knows what. Maybe I'm prejudiced. I mean, I've never

known anyone who had a mental illness."

I smiled mischievously and said, "You mean you've never known

anyone you knew had a mental illness."

Leslie returned a mock look of nervousness and shot back, "Could

you please take me to my own car now?" We both laughed.

"Crazy people" don't make the evening news for successfully

managing their lives; we only hear about them when something

horrible happens. The woman who drowned her kids; the man who

parked his car on the train track in order to kill himself, but jumped

out and watched people on the oncoming train die in the collision

instead. The man who shot John Lennon; the man who shot President

Reagan. John Nash, the Nobel Prize-winning mathematician whose

life was told in the film A Beautiful Mind, is the exception that proves

the rule.

There's a powerful urge in each of us to talk about our traumas. "A

psychotic episode is like experiencing trauma," Steve says. I think

Steve's right when he talks about psychosis as being like a trauma.

Psychosis does traumatize you, in much the same way that ducking

gunfire in a war zone or having a terrible car crash traumatizes you.

And the best way to take away the power of trauma is to talk about

what happened.

If and when they can, people who have been traumatized wall tell

what happened to them, over and over. The telling and retelling may

become tedious for friends, but it's healthy and important, and good

friends encourage it. With psychosis, however, you must carefully

balance the urge to tell with the inevitable consequences of telling.

Revealing your truth, even to someone you've come to know and trust,

brings its own complications. People with schizophrenia—people like

me—read the papers and watch the evening news. We see how the

illness is portrayed and how a friend-in-the making is likely to

perceive us, once they hear the truth. We move forward with great

caution because we must. We'd have to be...well, crazy to do

otherwise.

To bring this point home, fast-forward to September 11, 2001.

Steve called me early in the morning from Washington, D.C., to tell me

about the horrific attacks on New York City and the Pentagon. It was

three hours earlier in Los Angeles. He knew I'd still be in bed, and he

wanted me to hear the news as gently as possible, rather than be

blindsided by a blaring clock radio or someone in the school parking

lot.

That day, I had an early morning appointment with Kaplan; it was

still too early for him to have heard the news. I started the session in a

high emotional state, talking about how the nation was under siege by

terrorists and thousands of people were dead or dying. Carefully,

Kaplan began to steer the conversation in another direction—at which

point it was announced on the loudspeaker system that we needed to

evacuate the building. Until that moment, I am convinced Kaplan

believed I was in the middle of a psychotic episode.

Aside from those two years of isolation in Oxford, I'd managed against

the odds to make and hang onto some good friends, who'd stayed in

touch, loyal and loving. But my romantic life, such as it was, wasn't. I

could count on the fingers of one hand the number of dates I'd had

since freshman year at Vanderbilt. I had no clue about getting

someone's attention. I didn't know how to flirt; I didn't know how to

show someone that I was interested; I didn't know how to figure out if

he was interested in me. It was as though I'd been absent from class

when they were teaching "how to be a girl."

For instance, there was Will, the nice librarian. His smile when he

saw me was genuine, but I wasn't sure how to respond to it. So,

tentatively, I smiled back. The next time I came into the library, I

swallowed, took a breath, and said, "Hi."

He said, "Hi" back.

OK, now what do I do? What's supposed to happen next? A few

days pass. I go back to the library. I smile, he smiles. "Hi," I say. "Hi,"

he says.

"I, er, I heard you build furniture," I managed to stutter one day.

"I'd really like to see it sometime. I barely have any furniture in my

apartment at all; maybe that's because I mostly live in my office." Shut

up, Elyn. Just shut up.

"Sure," he said. "I'd be happy to show you. It's not much, but I like

doing it."

I nodded. "Oh, well, fine," I said. "Maybe we can have lunch

sometime."

"OK, great," he said. "Let's do that."

I left the law school library as though the building were on fire.

Time went by, and eventually Will left his position at the law

library. But we occasionally ran into each other, and one day my office

phone rang.

"Hi," said a man's voice on the other end. "This is Will. From the

library? I was wondering if you had a day free for lunch this week."

We went to a small Italian restaurant near campus, and I actually

managed to swallow some food. He told me about the furniture, how

much he loved working on it, how he used the best woods and stains,

and took days and days to design and finish a piece. And he had a

parrot that he'd trained and loved. And then there was gardening, too,

a source of great pleasure to him. Entranced, I think I mostly nodded.

The next day, Will unexpectedly dropped by my office. In his hand,

he held a beautiful multicolored bird feather. He walked over to my

desk, took a piece of tape, and placed the feather on my computer.

"It's from my parrot," he said, and then he left.

I sat there for a good fifteen minutes, transfixed by the feather. It

was the only decoration in the office—I had no pictures, no drawings,

no attempts at ambience or personal aesthetic; the walls were bare. I'd

never had any decoration in any office I'd ever occupied; I didn't think

I deserved it, it seemed fitting that there be nothing. And now here

was the little feather. It practically glowed.

That night, I was talking on the phone to Kenny, my friend from

Vanderbilt. "Kenny, I have a question. Do you think a guy who plucks

a feather from his bird and gives it to me might actually like me?"

He laughed. "I don't know, Elyn, but one thing for sure—he likes

you better than he likes his bird!"

A week or so later, I received a letter from Will—an actual letter,

handwritten, and illustrated with hand-drawn flowers. He asked if I'd

like to take a day to drive to the Antelope Valley Poppy Reserve near

Lancaster, California. The poppies were in their spring bloom, and it

was really beautiful there now. Would I like to go?

"Yes," I said when I called him. "I'd like that very much."

It was beautiful there, and it was wonderful to be off campus for a

day. The flowers were glorious—acres and acres of poppies, in shades

of deep blazing orange, and ivory, and butter yellow. But in spite of

the sunshine overhead, it was chilly; spring was having a slow time

getting started that year. Astonished at myself, I kept dropping hints

that I was cold. I wanted this man's arm around me. I really wanted

his arm around me. But it didn't happen.

At the end of the day, as he was dropping me off, Will hesitated a

moment as we were saying good-bye. Then he leaned in and kissed

me. It was a long, lingering kiss. It was great. It was fantastic. It was

even better than getting an article published.

chapter twenty-two

ONCE, BACK IN New Haven, White had told me that achieving

tenure frees up academics to do their best work. I hoped he was right,

because there was so much out there I wanted to do, and now I had

the freedom to do it. For the first time in years, I could take a breath,

survey my landscape, and be excited about the future. In fact, I'd

anticipated tenure in the way a teenager looks forward to a

twenty-first birthday: Congratulations, it's official, you're now a

grown-up! So—what's next?

When it came to my personal life, I was nurturing a fragile but

growing hope for a relationship with Will. Our early times together

were tentative and sweet; he was gentle and kind, and more than

anything else, he was fun. In spite of having what I think is a pretty

good sense of humor, I hadn't had much fun since I became ill.

Whenever I was out someplace and heard people laughing together,

I'd turn toward the sound in much the same way a flower turns to the

sun. To laugh, to tease; not to be afraid of saying or doing something

stupid or clumsy, because even if you did, you'd be loved anyway, and

you'd always know it. What might it be like, to be completely at home

in one's life, and not be alone? To walk across campus and see the one

I love coming toward me, and to think, There he is—that's my person?

I wanted that, and slowly I began to believe that it actually might

happen. I hadn't told Will about myself yet, although I knew I would

have to; in fact, I wanted to. It would be a relief, but I wanted to be

sure of myself when I did it. The question of intimacy was scary to me;

the question of commitment possibly even scarier. I vowed to be

realistic and patient, with both of us. This wasn't going to be simple, I

knew that, but there was no hurry. We agreed to take our time and

figure things out as we went along.

In the meanwhile, Will brought flowers to me at work, and he

made me a cake for my birthday. I'd barely figured out which buttons

to punch on the microwave in my apartment (let alone how the oven

worked), but Will not only knew how to cook, he loved to do it—and

actually produced a homemade coconut cake to celebrate the day I

was born! It was delicious, and I was amazed—how did I luck into

this? I wondered.

And, once again, Will added something sweet to the decor in my

formerly bare office—a snapshot of me from our Lancaster trip,

looking out over a wide field of brilliant orange poppies. He'd even

given it a caption: "Persephone calls forth the flowers of spring to

brighten a winter weary world."

If Steve's friendship had made me feel human, Will was making

me feel like a woman.

The direction of my professional life was changing as well. Everything

up until now had been carefully calculated toward tenure. Most of my

published work concerned the legal status of people with severely

compromised mental states, as I examined the relationship between

mental illness and law in the context of important medical decisions,

like consenting to surgery or refusing psychiatric medications. I was

interested in the ethical dimensions of psychiatric research, and

initially focused on the issue of capacity in that context. In fact, in

collaboration with colleagues at University of California, San Diego,

School of Medicine, I developed an instrument to measure such

capacity, which we then used to study patients with psychosis. (I was

touched and honored when I was offered an adjunct professor of

psychiatry position at the UCSD School of Medicine.) Maybe an

objective critic could have criticized me for tackling subjects too close

to home. On the other hand, who better? I'd been drugged against my

wall, I'd been held in restraints, screaming and pleading to be released.

This wasn't an academic exercise for me; it was about my life.

However, once tenure was safely accomplished, I wondered if

maybe it was time to explore something a little different. I

wondered—if the Career Fairy were to grant me one perfect wish,

what might that be? The answer was immediate and obvious: I wanted

psychoanalytic training.

Freud and his teachings had always fascinated me, even in high

school. For a while in college, I'd even thought of getting

psychoanalytic training. But that was before I got sick. Afterward, I

didn't give it much thought. My yearlong Freud class at Yale resulted

in my article on the Schreber case, so I didn't feel like a complete

novice. I knew I didn't want to change careers—I loved my job at USC

(and I still do, every single day). But when I reflected on the work I'd

already done professionally (and the simultaneous personal journey

I'd been on), it just seemed obvious to me what my next step should

Law is based on a theory of personhood; that is, the concept of

someone who can make choices and suffer consequences, and who

understands the threat of sanction. The doctrine of informed consent

(indeed, most of American political theory) presumes that we are not

just subjects to be directed, but rather autonomous beings capable of

making independent decisions. And for me, psychoanalysis provides

the most interesting route to understanding what that truly means,

because psychoanalysis asks fundamental questions: Why do people

do what they do? When can people be held responsible for their

actions? Is unconscious motivation relevant to responsibility? And

what renders a person not capable of making choices?

I wanted to know how and why psychoanalysis had worked for me.

I wanted to know what was in my analysts' minds when they treated

me. I wanted to experience being on the other side of the couch. And if

possible, I wanted to find a way to give back—to use what I'd learned

and experienced, combined with professional training, to perhaps

help someone else the way I'd been helped.

However, I wasn't certain if my illness (no matter how well

controlled) could even allow for such a thing. As time passed, and my

life was less tumultuous, and my work (and relationship) with Kaplan

became more satisfactory, I carefully lifted the idea out of the little

box I'd put it away in so long before, and took another good look at it.

After all, I'd managed to accomplish a lot of things I wasn't supposed

to. Why couldn't psychoanalytic training be one more challenge to add

to that list?

The first time I mentioned the possibility of being admitted to the Los

Angeles Psychoanalytic Society and Institute (LAPSI) to Kaplan, his

response was negative. Out of the question. Perhaps even

inappropriate. Besides, my own history might be cause for rejection,

and we both knew what my emotional response to that rejection might

be. Nevertheless, we just kept talking about it, and slowly Kaplan's

position softened. Maybe...maybe, just maybe, it might work.

Encouraged by his change of attitude, I called LAPSI's director of

admissions, asking if I might meet with him. Fortunately, my

professional credentials kept him on the phone, and he agreed to meet

with me for lunch, where we talked about my prospects for admission

to the program. He asked about my reasons for seeking

psychoanalytic training, about my academic work to date, and about

my experiences with psychoanalytic treatment. He did not, however,

specifically ask about my psychiatric history. Needless to say, in the

absence of the question, I didn't volunteer the information. As we

finished our coffee, he encouraged me to apply and hinted that if I did,

I would likely be admitted.

Up until now, the decision to either disclose or withhold

information about my illness had always been primarily about me

protecting me—that is, not allowing anything to get in the way of

completing my education, doing serious work, and belonging to a

respected profession. I knew full well that the stigma that travels with

mental illness could trip me up one of these days, but I certainly

wasn't going to collaborate in my own "demise" if I could help it. Even

Congress recognized the potential for the damage, when it passed the

Americans with Disabilities Act, which prohibits employers (and

schools) from even asking about a psychiatric history.

Now, however, the issue was more complicated than my own goals

and ambitions. If I had the opportunity to treat patients, would my

illness put them at risk? Would my delusional periods, however brief,

make it difficult for me to know what (and who) was real? Kaplan

suggested that the more important questions were: Did I have the

capacity to know when I was in trouble? Did I have the judgment to

know when I was impaired? And did I have the integrity to take

protective steps? Both Kaplan and I believed that I did.

So, on the application for admission, I dutifully sent up a red flag

that I had psychological problems—referring to a "turbulent period" in

my earlier life that "spurred my interest in issues of mental health." I

decided I would not say anything more unless someone asked. In

other words, although I didn't straight-out lie, I did deliberately

withhold information that someone else might have thought was

vitally important.

Through years of trial and error, I'd learned to manage myself and

the way I appeared to others, as anyone with a chronic illness or

disability attempts to do in order to be out in the world. In any case, I

knew there would probably never be a time when I would not be in

treatment myself, which in and of itself would be an effective fail-safe.

That's not to say the ethical issue was clear-cut; it wasn't. And it isn't.

It's complex, perhaps even controversial, and always will be. But I

have never come to these decisions—to teach, to go to the Institute, to

treat clients—in a vacuum. I discussed the issues involved in my

training extensively with both White and Kaplan.

Happily, LAPSI seemed much more interested in my talents and

training than in my "turbulent period," and in my sixth year in

California, I became a first-year candidate at the Los Angeles

Psychoanalytic Society and Institute. As I prepared to begin training

to become a psychoanalyst, I marveled at the confluence of events that

had brought me here: While medication had kept me alive, it had been

psychoanalysis that had helped me find a life worth living.

We met as a class the night before our classes actually began—a small

group of five people who knew they'd see one another every week for

the next four years (six, for those of us who decided to pursue

doctorates).

Unlike most other big changes in my life, this one came

accompanied by very little stress; I was excited, and completely

certain that it was the right place to be. Happily, I had the support of

my law school colleagues and dean; a few colleagues had even offered

the opinion that what I was doing was "cool." In many ways, I felt like

my whole journey had led me here—between the Institute and USC, I

felt like I now had the best of at least two worlds. In fact, I felt so at

home in that first gathering that I made a quip about how we'd all be

staunch rivals, then quickly said, "Just kidding!"

"Oh, no, you're not!" someone retorted with a laugh, and that was

my introduction to Alicia. (When I relayed this to Kaplan the next day,

he said, "There should be a sign on that door: 'No Smoking and No

Interpretations!'") Now in her seventies, Alicia looks like she's barely

in her fifties—fit, energetic, completely engaged in her life. I love to

hear the story of how her dad gave her boxing gloves when she was

just three, telling her, "Never let anyone take you down!" The word

"feisty" is probably overused these days, but in this case, it fits.

Alicia lost her husband to cancer some months before I met her.

She managed to turn that sorrow into a kind of wisdom about the

human condition—it's no accident that both of her daughters are

physicians and that she's a gifted clinician herself.

Janet's some years older than I; she's bright and funny, married

(with children and grandchildren) to a man who has his own private

practice, too. She specializes in addiction and eating disorders, and it

was easy, early on, for me to talk to her about my own illness. I was

amazed to learn that she'd been in analysis with someone who actually

knew my Mrs. Jones; I like small-world coincidences like that.

For much of my life, I'd thought of myself as a shy, ungainly

person, turned in on myself by my illness and with my books. I knew

that time and circumstance had changed my outer life, but I wasn't

truly aware that my inner life had changed as well—that instant

friendships were not only possible for me, but could become precious

and lifelong. Alicia brought that lesson home, and right beside her in

that same class was Janet. As many gifts as LAPSI has given me in the

past few years, these two women were the most unexpected and

ultimately the most precious.

Our group met on Wednesday mornings, for two classes, two

hours apiece. The building, attractive and ivy-covered, has four

seminar rooms in a row; in an interesting exercise in "concreteness,"

you move up the row for each year you complete—first room for first

year, second for second year, etc. On the very first day, I suggested we

have lunch together after class, and thereafter we always did, at a

casual Japanese restaurant right across the street. We all quickly

became close enough that we often saw one another on weekends for

dinner or a movie as well.

Our classes ranged from historical to theoretical to clinical; there

was an "early Freud" class, one on "object relations," some on

technique, and presentations of continuing cases. All the

psychoanalytic schools were represented—classical, self-

psychological, Kleinian. As in all teaching/learning situations, some of

the teachers were terrific; others couldn't have gotten the lesson

across if their very lives had depended on it. Since I'd incurred more

than a few bruises discovering how hard it is to teach, I withheld

judgment; it's not as though there was ever a shortage of knowledge in

the place.

Because these classes were small and often quite intense due to the

subject matter, it was conventional wisdom that inevitable conflicts

might arise among classmates. One evening at a dinner, the dean

made some comment to this effect.

"Our group's never had to go through that," I said. "It's amazing

how well we all get along!"

"I know," said the dean drolly, "and we're all very suspicious about

that!"

After I was far enough into my training to actually begin treating

people—in the late part of my first year of classes—I saw patients for

several years while under close supervision. I found the work

challenging yet rewarding. It is hard to understand analysis fully

without the experience of being on the "other side of the couch." I do

not intend to continue with clinical work, since analysts are supposed

to be "anonymous" to their patients and this book will complicate that.

The longer I was working with everyone at the Institute, the more

I came to believe that it was important (to all of us) that I tell them

about my illness; I eventually went to Jean, the head of the Institute's

"progression committee" (which monitors your progress and allows

you to pass from grade to grade and case to case) and started to give

her the details.

"Wait, wait," she said, and my heart sank for a split second. I'm

out, I'm out. But that wasn't it at all. "Do you mind if I take notes?" she

asked. "Because this is surprising!" She became my advisor that day,

and both she and the committee have remained supportive and

positive about my work. Although my clinical work may have to stay in

abeyance for now, I've already made significant progress on my Ph.D.

dissertation—the subject is "informed consent to psychoanalysis."

LAPSI recently merged with the Southern California Psychoanalytic

Institute, and we're now called the New Center for Psychoanalysis.

Kaplan, of course, followed my progress very closely; obviously, it

provided much grist for our psychoanalytic mill. Psychoanalytic

candidates usually have plenty of beefs with their institutes, he told

me, "but you seem like a happy camper there."

"That's exactly what I am," I said. "A very happy camper."

It's worth noting that Steve and I did far more than talk about my

crises in our frequent phone calls; we often worked, and very hard.

He'd been an adept, creative, and endlessly patient coach on my

restraints article, and also collaborated with me on Jekyll on Trial:

Multiple Personality Disorder and Criminal Law, published by New

York University Press in 1997 to positive reviews.

From Michigan, Steve had moved on to Harvard, where he took a

position as chief psychologist at the day hospital unit of the

Massachusetts Mental Health Center, working with patients much like

those who'd lived at the halfway house in New Haven. Increasingly,

his primary interest had turned to ethics, and he was named a faculty

fellow at Harvard's Center for Ethics and the Professions. He also took

a position at Harvard Medical School, in the Division of Medical

Ethics, and would eventually become the Director of Ethics at the

American Psychological Association, in Washington, D.C. In spite of

being on different coasts, our friendship had only grown stronger. We

talked often, wrote papers together, saw each other at professional

meetings or whenever I traveled east to visit my family.

It is interesting that (and in spite of his collaboration) Steve

disagreed with the key tenet of my MPD book—that someone with

multiple personality disorder whose alter commits a crime should be

found not guilty by reason of insanity because innocent alter

personalities should not be punished. ("Better to let ten guilty people

go free...") Steve believed that the "total person" should not be

absolved of responsibility. He asked if I minded if he wrote an article

in which he'd essentially debate my argument. Laughing, I said, "Go

ahead!" Once his paper was published, we appeared on Dateline NBC

together to argue our opposing legal positions.

Steve's friendship, support, and intellectual companionship have

taken me on some interesting journeys over the years, but this was a

first. It was high-intensity, somewhat stressful, and on some level a

little surreal. They interviewed us for four or five hours, but ultimately

used about three minutes. Crossfire it wasn't. We were credibly

professional, reasonably lucid, and didn't exchange personal barbs,

although at a couple of points, Steve did say, "There you go again." I

guess I could have commented on his need for a haircut, but then he

might have teased me for buying a new blue suit for the occasion. It's a

tricky business, debating an old friend who knows you as well as Steve

knows me—and in fact, it belatedly occurs to me now that Steve was

entirely capable of arguing both sides of the question, and I could have

comfortably stayed home with Will.

Like every medication, Navane (which I'd been taking for a dozen

years) has side effects. Some are dangerous, such as neuroleptic

malignant syndrome, a potentially lethal condition in which the

medication literally becomes toxic to your system; others are

extremely unsightly and uncomfortable, such as TD. And then there's

the sedative effect, the grogginess, which I combated with ample vats

of black coffee.

In women, one common side effect of Navane is an elevated level

of prolactin, the hormone that induces milk production for newborns.

Thirteen is a normal prolactin level. Most women on antipsychotic

medication go up to 30 or 40. I was consistently running 130 to 140.

There's reason to believe (although the research is not without

controversy) that breast cancer is associated with an elevated level of

prolactin. My gynecologist agreed that elevated prolactin was a risk

factor for me, at which point I told Kaplan I wanted to consider other

medications.

He suggested Zyprexa, one of a new class of antipsychotic

medications that showed great promise and had come on the market

only recently. Despite the good things I'd heard, I was wary of new

drugs and would have liked to wait awhile, to see whether Zyprexa and

its cousins would continue to be safe and effective. But a prolactin

level of 130-140 convinced me that now was the time to make the

change, and I began to take Zyprexa in place of Navane.

The change was fast and dramatic. First, the side effects were

much less than with Navane. Instead of being groggy or feeling tired, I

felt alert and rested, energetic in a way I hadn't felt in a long time—so

long, in fact, that I'd almost forgotten what those good feelings were

like. On the other hand, I quickly gained a lot of weight—thirty

pounds. However, in recent years I'd been quite thin, so aside from

the dismay I felt at suddenly tight waistbands, I just decided I'd have

to find a way to exercise more and get that number down a little.

The clinical result was, not to overstate it, like daylight dawning

after a long night—I could see the world in a way I'd never seen it

before. While Navane had helped keep my psychosis "tamed," I'd

always had to remain vigilant. The psychotic thoughts were always

present, and I often experienced "breakthrough symptoms"—fleeting

psychotic thoughts—many times each day. With Zyprexa, though, I

shut that door and, for the first time in years, it stayed shut. I could

take a break, go off duty, relax a little. I couldn't deceive myself—the

illness was still there—but it wasn't pushing me around as much as it

once did. Finally, I could focus on the task at hand, unencumbered by

the threat of lurking demons.

The most profound effect of the new drug was to convince me,

once and for all, that I actually had a real illness. For twenty years, I'd

struggled with that acceptance, coming right up to it on some days,

backing away from it on most others. The clarity that Zyprexa gave me

knocked down my last remaining argument.

In spite of my intelligence and education, in spite of all the doctors

and the psychotic breaks and the hospitalizations and the lessons so

searingly learned, I'd nevertheless managed to hold on to the belief

that basically, there was nothing unusual about my thoughts.

Everyone's mind contained the chaos that mine did, it's just that

others were all much better at managing it than I was. All people

believed there were malevolent forces controlling them, putting

thoughts into their heads, taking thoughts out, and using their brains

to kill whole populations—it's just that other people didn't say so. My

problem, I thought, had less to do with my mind than it had to do with

my lack of social graces. I wasn't mentally ill. I was socially maladroit.

Of course, that wasn't true. Most other people did not have

thoughts like mine. They weren't more disciplined about hushing their

demons, they simply didn't have any (or at least none that might lead

to a diagnosis of psychosis). Thanks to the new chemicals coursing

through my body, I experienced long periods of time in which I lived

as other people did—with no psychotic thinking at all. The Zyprexa

did that.

There's no way to overstate what a thunderclap this revelation was

to me. And with it, my final and most profound resistance to the idea I

was mentally ill began to give way. Ironically, the more I accepted I

had a mental illness, the less the illness defined me—at which point

the riptide set me free.

Happily, I'd discovered that writing on subjects I knew well and that

genuinely interested me—mental illness in various legal

contexts—interested other people, too, including publishers and

journal editors. Refusing Care: Forced Treatment and the Rights of

the Mentally III was published in 2002 by the University of Chicago

Press. The topics were ones close to my heart: civil commitment, right

to refuse medication, restraints and seclusion. The book was well

received, getting a good review in the Times Literary Supplement and

an especially good one in the New England Journal of Medicine.

While I still found teaching stressful, I was well liked by students

and had become particularly close to some, especially those who did

research for me. While not "out" about my illness to my classes, the

students knew I had a special empathy for the mentally ill. Not

surprisingly, some students taking mental health law have personal

issues of their own; one young woman brought me a note in the

middle of class one day which read, "I'm suicidal," and I quickly got

her to the student counseling sendee. Another student, an

undergraduate, revealed to me that she had been incorrectly

diagnosed, heavily medicated (with narcotics, not just the usual

psychiatric medications), and hospitalized, at which point her

therapist had seduced her. She believed that she'd been somehow

programmed to commit suicide by a certain date. Being in my class,

and being able to talk to me about her terrible experiences, she felt,

had kept her from that.

I was able to refer her to another, ethical therapist who'd had a

great deal of experience working with patients with her sorts of issues.

The student instituted a case for disciplinary action against her earlier

therapist. These days, I talk to her from time to time, and watch her

progress with great pride. She has recently passed the bar exam. In

her refusal to be dismissed or defeated, I can see a little of

myself—and I like that.

chapter twenty-three

I WAS NEARLY forty years old, and for the very first time in my life,

I was in love.

Even looking at that sentence now gives me a feeling of such

astonishment and joy. I knew I cared for Will; I knew he cared for me.

But it wasn't until we had a huge fight and made up afterward that I

actually said the words. "You're the first person I've ever been in love

with," I told him.

"That makes me very sad," he said, and took me in his arms.

As we'd pledged from the beginning, we'd taken our time getting to

know each other well enough to relax into closeness, which then led to

something deeper and more complex than any relationship I'd ever

known. We decided to live together; he moved into my high-rise

apartment, where we tried together to decipher the symbols on the

fancy European stove that I'd never once tried to use.

And Will was a different kind of man than I'd ever known, too. Far

from being "not much," the furniture he built was beautiful, each piece

one of a kind, carefully and lovingly crafted by his own hands;

museum pieces, I thought. He'd made a garden lantern of hammered

copper, with inset cut glass that reflected a blue green light much as

the ocean did. He had a gigantic collection of music, all kinds, and a

gigantic sound system as well. Gardening was a creative act; so was

baking a chocolate cake, or a meringue or a torte. He had, in short, the

curious, insatiable soul of an artist, and something in that soul had

made a decision to care for me.

Kaplan had told me that often women feel like they don't have a

choice in sex, and in our time together he helped me to understand

that I did have choices—about when, and with whom, and under what

circumstances. I knew all too well that my illness complicated

things—it made certain risks much bigger than they might have been

for someone else. Taking off your clothes can feel like taking off

armor; revealing vulnerability feels dangerous. And even the sanest

person has to admit that the physical experience of orgasm is

disorienting, even somewhat hallucinogenic—for me, that letting-go,

falling-through-space feeling hadn't always been good. When space

looks suspiciously like an abyss, and "losing yourself' can equal

psychosis, ceding control can be terrifying.

I'd been disappointed in sex enough over the years to know that

the next time I took the risk of a physical relationship, I needed it to be

about love. And while like every couple, Will and I had had our ups

and downs, he knew intuitively how important this was to me, and

when the time came it happened in the most tender and loving way.

What happened between us there was everything I'd hoped it would

be. I felt safe in his arms, and loved, and fulfilled. (And when I walked

into the bathroom the next morning, there was a big toothpaste heart

on the mirror, which sealed the deal.)

But still, there was one last truth for me to tell, and many months

into our relationship, I still hadn't summoned up the courage to do it.

How would he react? Would he be horrified, or disgusted? Would he

physically recoil? Would he leave me? Over and over, I rehearsed the

scene in my mind: "Will, you know I see an analyst, but actually, my

mental health situation is a bit more complicated. I have a pretty

serious mental illness..." And then, by happenstance, the man got a

little ahead of me.

One day, he handed me a magazine article. "There's something I

want you to read," he said. The article was about Asperger's syndrome,

a high-functioning form of autism. Will had underlined parts of it.

"Some of this sounds like you, don't you think?"

"It does sound something like me," I said. "And that's because it is,

sort of. Will, there's something I've wanted to tell you for a long time,

but I've been afraid. Afraid of your reaction, afraid that you might

leave me. I actually do have a serious mental illness, I've had it for

years, and it's not ever going to go away." I carefully watched his face

as I delivered the news. So far, I didn't see anything that alarmed me.

"Really?" he asked. "I sort of suspected that it was something like

that, but I didn't want to ask. I figured you might get around to telling

me at some point. What illness do you have, actually?"

"Schizophrenia," I said. "Do you know what that is? It's not split

personality."

"I think I do," he said slowly. "It's when people get out of touch

with reality. That's a bit scary to me. But it doesn't change how I feel

about you. How often does it happen? Is there medication for it?"

"I still sometimes have episodes," I said. "And yes, there's

medication, fairly effective medication. But I have transient symptoms

sometimes. Different things can set me off. Stress, stuff like that."

"Will you tell me when it's happening to you?" he asked. "I want to

know."

Interestingly, most people I've revealed my mental illness to—and

this includes mental health professionals—have been surprised to

learn the truth, or perhaps the extent of it. The fact that Will wasn't

surprised, and said he'd suspected something all along, was very

telling. Either he'd come to know me more intimately than anyone

else, or he was more willing to be frank about what he suspected, or

he'd read more into my quirkiness. "How did you know?" I asked him.

"Well, you've always been a bit more than minimally eccentric," he

said gently. I could tell he was mulling over his words. "And you've got

a lot of blank spaces. Culturally, I mean. Almost anything from about

1965 to 1980, if I make a reference to it, you give me a blank look.

Almost like you'd been somewhere else during that time. A lot of baby

boomer stuff just goes right by you, you know?"

Yes, I did know. He'd paid attention, he'd intuited something, and

he was right. It's hard to explain now, but something in the way that

he was completely present in the room that night—something in his

body language, in his eyes, in his voice—told me that we'd stay

together. He didn't flinch, he didn't laugh, and he didn't leave. Of

course, he hadn't seen me be "floridly psychotic" yet, but I had a

feeling that when that happened, he would stand his ground.

One night, I came home after having had dinner with someone who

had presented a paper at our workshop series. "I'm really envious of

her," I told Will.

"Why?" he asked.

"Well, she's got a great position at a great law school, is very

bright, and has a happy marriage. What more could anyone ask?"

He went out of the room for about ten minutes, then came back in.

"So, wait a minute," he said. "You mean being married is something

good in your eyes? Something you would want?"

"Yes, absolutely." I thought my heart was going to flip itself right

out onto the living room floor.

"So, then—do you want the two of us to get married?"

I didn't have to think about that for one more second. "Yes!"

And then the circus began, the one which is so familiar to engaged

couples everywhere: The Arrangements. Months and months of The

Arrangements. For a while, I dismissed it—it felt entangling,

complicated; it gave me anxiety attacks, it gave me headaches. Where

to have the ceremony, what kind of ceremony to have, when to have it,

what to eat, what to drink, whom to invite—very quickly, it all seemed

overwhelming. And then the air simply cleared. Yes, yes, I wanted all

of it—the ceremony, the party, the celebration, the family members,

the friends and colleagues, the public acknowledgment of our

commitment to each other. I wanted the whole damn thing.

I called and told my parents what was going on, and when I asked

my mother if she wanted to come west and help out with the

preparations, she hesitated for a moment and then haltingly replied

that it might be best if I took care of that end of things. I was stung for

about a minute, then quickly decided that it was probably better that

way. Will and I took over the job of wedding planners—and Will had

claimed one job as his. "I'm going to make the cake," he declared.

A funny thing happened when we went to meet Rabbi Julie, who

had agreed to perform the wedding ceremony. After driving about an

hour deep into the San Fernando Valley, we finally arrived at her

house. Ushering us into the foyer, her husband asked if we'd be so

kind as to remove our shoes, so as not to dirty the white rug. We then

spent about an hour with Rabbi Julie, retrieved our shoes, and drove

the hour back home. As we were walking through the lobby of our

apartment building, I looked down at my white Reeboks and asked

Will, "Didn't I wear black Reeboks to the rabbi's?" I had actually

managed to wear our rabbi's husband's shoes home!

Shortly after Will and I became engaged, we received some difficult

news: My dear friend Alicia had been diagnosed with breast cancer.

The minute she'd heard about our engagement, Alicia had offered

to have the wedding at her house, in her shady, flower-strewn

backyard. Now everything had turned upside down. How could I

make all these happy plans while Alicia was in the fight of her life?

We'd find another place to get married. Or no, wait, maybe we

wouldn't get married right now at all.

"Out of the question," she said. "This will be wonderful, to put

together such a beautiful party. Come on, it's going to be fine, and it'll

give me something happy to look forward to!"

I looked at my calendar and realized it was time for me to get my

own mammogram. And there, events took another nasty detour. The

technician took slide after slide, and in between there seemed to be

some discussion going on in the other room. When Dr. Giuliano

finally came in to tell me there were "anomalies" that were cause for

concern, I completely fell apart. All my defenses were swept away, and

the room flooded with psychosis.

"Fleeces and geeses and astronomical proportions with the people

growing tumors. It's a growth industry."

"What do you mean, Elyn?" Dr. Giuliano and nurse Becky Crane

said almost in unison.

"The tides have changed. There'll be nothing for it. There's the

drowners and the downers. One will never survive."

"Your friend Alicia is in the other office," said Giuliano. "Would it

help if you talked to her?"

Alicia knew I had a mental illness, but didn't know the details and

had certainly never seen me ill. When I went into the examination

room she was sitting in, I started babbling in a scared and anguished

way. Alicia responded with enormous kindness and comfort. "Oh,

sweetie, what's wrong?" she asked. "Now, now, everything's going to

be OK. No, your head isn't going to explode." She wrapped her arms

around me and held me tight. And I held on to her as well.

I had the biopsy the next day. The day after that, Will, Alicia, and I

went to get the results: I had breast cancer, too. There were some large

in situ regions (so-called DCIS—ductal carcinoma in situ) and a small

microinvasive part. That meant that only a small part of the cancer

had breached the boundaries of the ducts; the rest of the cancer had

been contained. When Guiliano and Becky gave me the news, I lost my

grip and started muttering again. Will had never seen me like this;

months later, he finally confessed how freaked he'd been by what he'd

seen.

Although the cancer was in a fairly early stage, I needed to have

surgery, followed by weeks of radiation. The stress of it all

overwhelmed me—once again, my little airplane had been swallowed

by a gale. I'd learned to expect disaster around every corner—I guess I

thought it was my fate—but Will is basically an optimist, and he

calmly continued to behave as one.

Kaplan was out of town at the time, and I had been seeing his

backup. The backup's daughter, I knew, had died in early adulthood

from cancer. When I told him my diagnosis, tears came to his eyes,

which touched me. When Kaplan returned, he saw me immediately,

and let me know he'd be available whenever I needed him.

The initial intensity of fear and anguish gradually lessened, but for

several days after the diagnosis, I could do little other than sit at home

and listen to music while I tried to keep a grip on what was real. Will

instinctively knew that I couldn't tolerate any other intimacy than

being hugged. Later, he also, somehow, knew when I was ready again

to be loved.

My parents came as soon as they could. Friends and colleagues

rallied around as well. And many people sent flowers. When Steve

arrived, he looked over my shoulder past our embrace, to my dining

room table, and remarked on the many bouquets of flowers sitting

there. When you have cancer, people send flowers; when you lose your

mind, they don't.

There's nothing like a cancer diagnosis to focus the mind, even a

frayed one. While I was undergoing radiation—five days a week for

eight weeks—it was hard to think of anything other than where I was,

what I was doing there, and why. I worried that my friends were

unnerved to be around me; maybe I reminded them of their own

mortality. There wasn't a pill for this—it was all a roll of the dice, and I

prayed every day that the luck would swing my way.

I live on top of one of the world's largest earthquake epicenters,

but I'm not afraid of earthquakes. I'm not afraid of automobile

accidents, and I'm not afraid of being attacked or robbed when I'm on

the way from my office back to my car in the dark of evening. But my

health, my inconsistent body, scared me to death. How many times, I

wondered, would I have to deal with the betrayal of this mass of

nerves and blood vessels and muscle and skin? It made me wild with

anxiety, even anger.

My dear friend Janet (from LAPSI) had once worked at a Los

Angeles chapter of the Wellness Community, a support group for the

benefit of cancer survivors that was founded in the mid-eighties (and

became notable due to the visibility and participation of one of its

earliest members, Gilda Radner). At Janet's strong recommendation, I

decided to check it out. I couldn't have said what I needed when I first

went there, but whatever it was, I found it.

The empathy between people who are fighting cancer is a powerful

thing; there's strength in it, and solidarity, and an innate

understanding that "well" people don't have, in spite of their best

efforts. I made some very close, very dear friends in the Wellness

Community. Inevitably, given the nature of what brought us all

together, I also lost friends. Sometimes, I was asked if it wasn't more

stressful to spend time with a roomful of people with cancer than it

might have been to skip a meeting once in a while. But I needed to see

them. There were people there far sicker than I, and people who'd

been sicker longer, and they were living their daily lives with

equanimity, dignity, and even humor. How could I deny myself the

comfort and the teaching they so freely offered? And, as time passed

and "new" people came in behind me, how could I not then turn

around and share what I'd learned with them?

Battered but unbowed, Alicia and I (and our respective families) made

it through our cancer battles. We were tired and shaky and a little

ragged around the edges, but by God, we were going to throw a

wedding!

For weeks in advance, Will baked cakes and tested recipes, and

every few days there was another confection. Remember when you

were a kid and said something like "Someday, when I grow up, I'm

going to eat all the cake I want!"? Well, that's what we did, every night

after work. A French cake, with beaten egg whites and ground nuts. A

ginger-flavored one, with fresh raspberries. A creamy lemon one,

which Will then switched to orange. Yes, we both agreed—that's the

one! Happily, we then hired a caterer to prepare and serve the rest of

the food. If Will had tackled anything beyond the cake, both the

kitchen and our relationship would have been at risk.

He'd also been taking a computer animation course, and was

about halfway through the "advanced editing" section of the class

when he came up with an ingenious and very funny form of wedding

invitation. It was a video, which opened with the theme music from I

Love Lucy, the familiar typeface that the show always used, and a

black-and-white scene in Lucy and Ricky Ricardo's living room—with

Will and me appearing as Ricky and Lucy, complete with scripted

dialogue. For the background, he'd done some "screen captures" from

Nick at Nite, then matched the video frame by frame, substituting

pictures of me and Will into the "portraits" of Lucy and Ricky on the

living room wall. When he dropped the driving directions into the

video, he used the theme music from the old Route 66 TV series, and

to end the invitation, he closed with the theme to the Jackie Gleason

show. We sent out fifty copies all over the country. Not for me the

heavy ivory bond paper from Tiffany's; no, this wedding was being

announced with a contemporary cultural artifact!

We were married in June, on a beautiful sunny day. Janet and her

husband Al, and Michael and Ed, from the law school, were my

witnesses; Steve and Alicia were my people of honor. Afterward, Steve

gave a loving and hilarious toast.

In spite of the free-form nature of the event, there was just enough

tradition to fit my sense of what a proper wedding should be. My

family was there. My brother, who had been struggling with a terrible

phobia of flying for some time, managed to make the trip. It was the

most generous gift he could have given me.

That's not to say the day was without a bump or two: Earlier that

morning, after I'd had my hair done, Steve and I were out sitting in my

car, talking quietly, away from the din of preparations. A serious

question had been troubling me for hours, and finally I just had to ask

it. "Will aliens be attending the reception?"

"No," he said calmly, and he reached out to hold my hand. "There

won't be any aliens there, Elyn. Don't worry about that."

I needed to hear that reassurance from him, and having heard it, I

happily went on with the day. It was as beautiful as I ever could have

imagined, and it left me feeling quite fragile, as though a sudden noise

or movement would blow the dream wide open. It was true, then: I

was married, to the man I loved.

Will and I went on a honeymoon trip to France and England.

There, we met up with old friends from my Oxford days—Patrick,

Dinah, and Janet—and had great fun reminiscing. Janet was

romantically involved with a nice American man, and her lovely

daughter, Olivia, was now the age I had been when had I lived in

Janet's house. Though many miles away, I had continued to love and

value these people who'd stayed my constant friends, and I always

believed that they felt the same about me. And now we could add Will

to the mix. Will, my husband.

Within a few years, with two dozen articles and three books published,

I was deemed deserving by the law school to receive an "endowed

chair," one of the highest honors that a university bestows on a faculty

member. On a spring afternoon, with friends and family gathered, the

University of Southern California Law School named me the Orrin B.

Evans Professor of Law and Psychiatry and the Behavioral Sciences.

Ed McCaffery—my "classmate" and dear friend—was similarly

honored with his own chair. It wasn't hard to remember our first days

wandering the law school halls together, trying to figure out what we

were supposed to be doing in order to be successful, and half worried

that any minute we'd be "discovered" as poseurs. I was so happy that

Ed and I were honored in this way at the same time. In my acceptance

speech, I even dared to make a small joke, suggesting that perhaps a

couch would've been more appropriate for me than a chair. Afterward,

there was a lovely luncheon reception at the Town and Gown (often

referred to as the "living room" of the university), and that was

followed by another party that my family threw for me that night. It

was a beautiful day, and a night full of great fun and strong emotions.

It seemed that I had come at last to a time in my life when there were

more good days than bad ones.

chapter twenty-four

THE HUMAN BRAIN comprises about 2 percent of a person's total

body weight, but it consumes upward of 20 percent of that body's

oxygen intake, and it controls 100 percent of that body's actions. So in

terms of how much territory the brain occupies vs. how much power it

wields—well, it is mightily powerful indeed. And as much as we've

learned about the brain over time (especially in the last two decades),

we're nowhere close to knowing everything. Each revelation opens the

door to a new set of questions; each mystery solved leads to another

mystery. For a research scientist whose primary focus is the brain, it

must sometimes feel like the laboratory is more akin to a hall of

mirrors; for me and my somewhat ad hoc exploration of the brain, it

feels on some days like I'm walking on the edge of the Grand Canyon,

constantly at risk of taking that one big wrong step. And always, just

before I fall, comes the same question: How did I get here?

As successful as I'd been on the Zyprexa regimen, I had my usual

concerns about side effects; after all, it was still a relatively new drug.

And then there was the annoying weight gain, which I was having a

hard time reversing. So once again I wondered about lowering the

dosage. Could I do it, and, if so, how far could I take it and still be

safe? When I discussed it with Kaplan, he agreed to go along with me

this time, on one absolute condition: If, in his judgment, I was in

trouble and he decided I needed to go back up on my dose, I'd do it,

immediately—no bargaining, no equivocation.

"You have to promise me," he said firmly.

"OK," I agreed. "That sounds fair."

As I dropped my levels over the next few weeks, I faintly sensed the

fog drifting in, the early signs of disorganization beginning. I gritted

my teeth and concentrated on work. I can adjust to it, I thought. It'll

get better. Just wait. I flew east for my tenth law school reunion

(accompanied by the familiar horrors on the plane flight), and for

most of the evening's program at Yale, I sat next to Steve and

struggled with the urge to jump out of my chair and scream at the

terrifying creatures hovering in the air around me.

When I returned home and reported in to Kaplan, he quickly

invoked our pact: I needed go back to a regular, healthy dose of

Zyprexa. We settled on my usual dose of forty milligrams, double the

maximum dose recommended by the manufacturer but one that had

worked well for me before.

Soon afterward, I went to San Francisco, where I was scheduled to

present two papers at a weeklong conference on dissociative

disorders. Evidently, the Zyprexa withdrawal had been rougher on my

system than I knew, leaving me vulnerable and even a little frail. I

began to feel "off' soon after I arrived at my hotel. Once again, I

gritted my teeth and narrowed my focus to work and my obligations at

the conference, hoping no one would suspect anything was wrong. But

the delusions and the disorganization accelerated; I was coming apart

at the seams. I called Kaplan.

"If you can, why don't you deliver your Saturday paper, as

scheduled," he said, "and come back here. Then you can fly back up

early Wednesday morning to deliver that one."

On some level, his suggestion made sense; I was never very good in

unfamiliar territory, but maybe I could regain control once back in LA,

in my own apartment or in the haven of my office. But as I mulled over

Kaplan's suggestion, I decided that having to leave the conference

would signal that I was a failure. Of the two scenarios—being sick vs.

being a failure—I could more easily accept the first one. So I decided

to stay.

At which point my sickness took a new, horrific turn. For some

reason, I decided that Kaplan and Steve were imposters. They looked

the same, they sounded the same, they were identical in every way to

the originals—but they'd been replaced, by someone or something.

Was it the work of alien beings? I had no way of knowing, but I was

terrified.

Much later, I learned that what I was experiencing was called

"Capgras syndrome." The scientific literature about Capgras likens the

sensation it produces to the cult film Invasion of the Body Snatchers.

In my mind, the people I so depended on were simply gone, and the

two who remained were not who they said they were. Therefore, I

could not trust either of them.

It was a struggle, but I delivered my Wednesday paper and fled

back to Los Angeles, shaky and completely paranoid. In nearly ten

years of treatment, I had never missed an appointment with Kaplan.

Now I didn't go to my next two scheduled sessions, and didn't call him

to tell him why. So he called me. "Elyn, you're not at your

appointment. What's going on?"

I did not respond. It's not him. Don't say a word, it's not him.

"Elyn, what's happening?"

Nothing.

"I think it's important for you to come to your sessions," he said. "I

expect you to be here tomorrow. Is there something I can do?"

"I know what's going on and who you are or are not," I said finally.

"That doesn't get us anywhere," he said. "Talk to me straight."

Nothing. No answer. Because you are not you.

"Okay, then, I'll see you tomorrow." And he hung up.

I did not attend our next session.

Steve, sensing that something was very wrong, was calling

frequently. I didn't return any of his calls.

Will, of course, recognized that I was very agitated, but he didn't

know why. "What's going on?" he asked.

"The two who call themselves Kaplan and Steve are imposters," I

said. "The real ones are gone, and they've been replaced; the ones who

are leaving messages on the answering machine are fake."

To his everlasting credit, Will stayed calm. I'd warned him that this

might happen, and now it had. "Maybe I should call Steve," he said.

"I don't see the point, since Steve's not there anymore," I said.

"But go ahead, if it wall make you feel better." He thought it over for a

while, then called Steve in the middle of the night. Steve awoke early

to find the message on his machine and called back. As best he could,

Will explained what was going on.

Steve began to call and leave messages for me on the machine ten,

sometimes twelve times a day. I ignored them—because he wasn't

Steve. And I got angry—because he was treating me like a recalcitrant

child. In analysis, there's a term for this: infantilizing. How dare he, I

thought, looking at the answering machine as though it had been

manipulated by aliens as well. But of course, he was in an impossible

situation.

I was frightened and isolated. Even though I somehow knew that

Will was the real Will, I found no comfort in that. I couldn't sleep, I

couldn't work, and I couldn't make the connection between what was

real and what wasn't.

The next day, after my third missed appointment with him, Kaplan

called and insisted I go up on my Zyprexa. Although I knew in my soul

that he wasn't really Kaplan, I paid attention to him, because I was

just that desperate and miserable—and over the next several days, the

delusion slowly passed.

If I was still harboring any hope that I would someday be free of

the need to take antipsychotic medication, losing both Kaplan and

Steve to my psychosis convinced me utterly.

This was Will's first major experience of me as wildly delusional.

He didn't get too scared, he didn't go away, and he never treated me

with anything less than kindness and tender care. Afterward, he did

admit to being shaken to see me so disturbed and unhappy, and being

frustrated at not being able to comfort me or calm me down. "But I

still want you to tell me when you start to feel like that," he insisted.

"I'm not much use if you don't let me know what's going on."

Sometimes, even now, when I'm going into an episode, I don't tell

him—not to keep secrets, but so as not to burden him. Nevertheless,

he almost always knows. He can tell from my silence—or a certain

kind of silence. It's a gift to have someone know me so well.

Dr. Kaplan and I had done years of good work together—thirteen

years, to be precise. And I'd accomplished many successful life

changes during that time. But he'd often been hard on me, and over

time (Kaplan's many strengths and his humanity as an analyst

notwithstanding) it had come to feel too hard, even punishing. He'd

become more restrictive somehow—for example, he didn't want me

moving around the office; he didn't want me to cover my face with my

hands during our sessions, something I'd done with all my analysts to

help me feel safe and contained. He kept saying that if things didn't

change, he'd "terminate" me. "I'm going to terminate you." It was

brutal to hear that, brutal for him to keep saying it. Was he doing it to

elicit some kind of response from me? I didn't feel safe with him

anymore; he was unpredictable, mercurial, even angry. Some days, I'd

walk out of session feeling like I'd been beaten up.

"We're not getting anywhere," he'd say. "This isn't even therapy

we're doing." It had been going badly for two years, he said—since

around the time of my diagnosis with cancer and my engagement to

Will. I'd been aware that we were somewhat at odds, but I'd thought it

had only been for a couple of months.

And then Kaplan threatened to tell the Institute that I was no

longer having analysis. My Institute (like most these days) is

"non-reporting": that is, your analyst does not report on your progress

(in analysis) to the Institute's Progression Committee. But he does

report "analytic hours" to the Institute, so he holds in his hands a

roundabout way of signaling that you're not quite up to standard.

Eventually, I told my advisor at the Institute what Kaplan had

threatened to do. A few sessions later, he told me he no longer needed

to do what he'd threatened. Still, I wasn't reassured. I couldn't jump

through the right hoops for him, and finally, I couldn't handle it

anymore. I decided I needed a consultation with someone who might

be able to be objective, and scheduled an appointment with Dr. Freed,

whom I had seen as Dr. Kaplan's backup once and whom I knew from

the Institute.

"You've done years of good work with him, Elyn," Freed said.

"Relationships go through transitions; perhaps this is one. You really

should try to work it out with Kaplan. It's vital that you do."

I wasn't sure I could; I wasn't sure I wanted to even try. "If we

can't—if I can't—would you consent to be my analyst if I can't continue

with Dr. Kaplan?"

He shook his head. "It's unethical for me to even discuss that with

you, as long as you're in treatment with him. Go back and discuss this

with him, Elyn. You need to come to a resolution."

I went to my office to draw up a plan, some kind of negotiation.

What had to change, I wondered, in order for me to stay with Kaplan?

I made a list: I needed him to stop saying we weren't getting

anywhere. I needed him to stop threatening "termination." I needed a

lessening of the physical restrictions. None of these seemed onerous. I

told Kaplan I would need these things to change in order to keep

working with him.

Kaplan flat-out refused to change a thing.

I was stunned. "I'm sorry," I said. "I guess that means we'll have to

end our work together."

For the rest of that session, it was as though there were an EXIT

sign hanging just over the door. Once we'd finished and I prepared to

walkthrough that door, I turned back and looked at him. "Good-bye,"

I said. "Thanks for everything. I'll see you around." And then I saw

Kaplan flinch.

I then called Dr. Freed and told him that I'd left Kaplan. I don't

know what I might have done if Freed hadn't agreed to become my

analyst, but he did.

A few days later, Kaplan called. "Where have you been?" he asked.

"You've missed two scheduled appointments."

I took a deep breath. "I told you that I was terminating with you,

and I meant it," I said. "I've transferred myself to Freed."

There as a moment of silence at the other end of the line. Of

surprise? Of anger? "I think you need to come and speak with me

about this," Kaplan said.

"No, I don't," I said, but I already felt myself starting to shake. I'd

never been very good at confrontation. Maybe I'd moved too fast.

Maybe I wasWTong.

"We can negotiate the changes you asked for," Kaplan said. "In any

case, this is too abrupt. If we're going to end our time, it should be

with some resolution, some agreement."

I agreed to meet with him twice a week while we wrapped up;

simultaneously, I met with Freed. Maybe it was overload, or the pain

of the transition, but for the next four weeks, I spent every session

with Kaplan weeping—which, in spite of being a fairly emotional

person, I don't do. I'm just not a crier. But something about being in

that room with him tore me up, every single session. I felt sad, and

vulnerable; I was leaving someone important, something important,

and what I felt was grief.

To his credit, Kaplan didn't use the time to try to coerce me into

coming back, and when I told him I was indeed going to continue to

see Freed, he told me Freed was a wonderful clinician and he wished

me well. And then it was over.

Dr. Kaplan probably helped me more than anyone else in my life,

and I love him today as much as I have ever loved anyone. For a long

time, I carried inside me a palpable sense of loss. The decision to leave

him was so awful, but I couldn't see any way around it; besides, it

always felt like he'd made that decision first. By refusing to negotiate

with me, by threatening me and pushing me, he had in fact fired me.

He'd rejected me, he'd betrayed me. And why I didn't end up

hospitalized as a result of the upheaval, I don't know to this day.

Yet even now, when I am in a bad way, the first thing I think of is

to call Kaplan. In fact, I often call his answering machine still, just to

hear his voice. But I don't leave a message. That time is over.

Dr. Freed is about sixty, I would guess, and kind-looking. Unlike

Kaplan (who, like my father, has a very strong personality), Freed has

a certain softness and gentleness about him. At the same time, he

stands his ground. He doesn't pull his punches with me; he homes

right in on what I'm feeling, and helps me to understand how I

sometimes use my psychotic thoughts to avoid the ordinary bad

feelings that everyone experiences—sadness, rage, garden-variety

disappointment.

Freed also has more faith in the analytic process than I do; he even

thinks I might be able to get off meds entirely someday. In addition, he

tries to understand my psychotic thoughts as unconsciously motivated

and meaningful (which of course they are). Sometimes, interpreting

them, he refuses to discuss a diagnosis. "Schizophrenia is just a label,"

he says, "and it isn't helpful."

Both of these views stir me up quite profoundly. I spent years

fighting the idea that I was schizophrenic and needed medication.

Now that I acknowledge that I am and I do, he raises the possibility

that things may not be so clear. I believe that Freed is, in part, trying

to give me hope and, in part, not appreciating the very real biological

component to my illness. His primary area of concern is the

psychoanalytical side; because of this, he referred me to a

psychopharmacologist, Dr. Gitlin—internationally known in his

field—to manage the medicine-cabinet aspect of it. Gitlin believes that

I wall need to be on medication the rest of my life.

Recently I've had to change drugs again. Zyprexa became

somewhat less reliable, and I started having a lot of "breakthrough"

symptoms. Raising the dose wasn't an option; as it was, I was on twice

the highest recommended dose. So Gitlin suggested clozapine, a drug

usually prescribed to those who are, to some degree or another,

treatment-resistant, and he put me on a hefty dose, six hundred

milligrams. Clozapine's a cumbersome drug to use; at the beginning, it

requires a weekly blood test to monitor side effects and watch for signs

of agranulocytosis, a precipitous drop in one's white blood count that

can be fatal. However, it works, and it works well; there are days now I

feel almost guilty for feeling so good.

But that did not happen overnight. Indeed, transitions from one

drug to another can be difficult, as happened when I first started

seeing Gitlin and we tried to switch meds. In short order I was very

psychotic.

"Elyn, what's going on?"

"Are you the real Dr. Gitlin or the marionette Dr. Gitlin?"

"Why, I'm the real Dr. Gitlin," he said.

"That's just what the marionette would say."

Dr. Gitlin later told me he seriously considered hospitalizing me as

a result of this episode. Thankfully, instead of doing the easy thing, he

did the hard one, and waited me out.

So: Medication changes can set off psychosis, because the

biochemical transition in my body from one drug to another can take

time. Abrupt change can set it off as well; that's why familiarity is my

touchstone. And stress—from outside sources, pressure, or events I

can't control—can have the effect of someone hitting the evil "start"

button that reignites my symptoms.

As had happened with the breast cancer diagnosis, a routine

checkup indicated there was a possibility that I had ovarian cancer.

And once again, quickly, reality receded and the devils came in. There

was a two-week wait before surgery; after surgery, I'd have to wait

another two weeks for final results. I'd heard that there was only a 20

percent survival rate after three years with this kind of cancer. I was

desperately afraid, even sad; had I come this far, fought this hard, only

to be defeated again by my unreliable body?

Once again, the apartment filled with flowers; once again, Will

never wavered in his tenderness and his steadfast belief that all would

be well. My friends rallied around me; Steve came from Washington;

even someone I'd dated briefly at Yale—a psychiatrist and lawyer who

continues to be a good friend—came to see me and offer support. But

my parents were among the missing.

Well, not technically; they were on the phone. My father did not

want to come and would not explain why. My mother said, with a

notable lack of enthusiasm, "Maybe I can come for couple of days. And

Dad will come if the diagnosis is a bad one."

My parents not coming to see me was a major blow. All my life, I'd

idealized them, even though there were many complexities to our

relationship. When I felt at death's door, and their first and last

impulse was to stay where they were, I was crushed. I could no longer

deny they're flawed (as are we all), and that sometimes they've

deliberately chosen to be unavailable to me. Maybe that's part of their

own coping mechanism; maybe it's that the disease itself is just too

enormous for them. Or maybe it's a result of the signals I send them:

I'm fine, I'm strong; I don't need you. I'm not sure; we've never really

had that conversation.

It occurs to me that there are often two sets of trickery going on in

my life. The illness—the entity—is always just off to the side, just

barely out of my sight. But I know it's there. And it tries to trick me

into believing this isn't the real Will, this isn't the real Steve, that

reality isn't reality, that I can kill thousands of people with my

thoughts, or that I'm profoundly evil and unworthy.

At the same time, I'm trying to trick the people around me. I'm

OK, I'm functional, I'm fine. And maybe, sometimes, this determined

effort to trick them tricks the illness itself. It's like one big con. Steve

says he's never seen anyone who fights as I do. I don't consider myself

a fighter (and I certainly don't come across as ferocious). But if he's

right, then perhaps in my childhood, and in this push-pull with my

parents, one can see not only the beginnings of my illness, but the

seeds of my health and strength as well. If I'm a fighter, perhaps it's

because that's who they taught me to be.

"Never mind," I said to my mother. "Don't come. We'll call you

when it's over."

The final results were very good, although all the warning signs

were there; as a result, I had a complete hysterectomy and

oophorectomy (removal of ovaries). Unlike the sadness and loss that

many women might feel after such an overwhelming procedure, what

I felt was almost relief. The danger was gone. And since I'd long since

come to terms with the reality that I—and Will and I—would never

have children, I was at peace with it.

What is schizophrenia? In the United States, diagnoses are mostly

made according to categories established by the American Psychiatric

Association's Diagnostic and Statistical Manual of Mental Disorders.

The DSM makes a rough distinction between disorders of thought and

disorders of mood. Schizophrenia is an example of a disorder that

affects thinking, and so it is referred to as a thought disorder. Bipolar

disorder (what used to be called manic depression) is an example of a

mood or "affective" disorder—a disorder that rests primarily in how

one feels.

The DSM places schizophrenia among the thought disorders

characterized by psychosis. Psychosis is broadly defined as being out

of touch with reality—'what one of my professors at Yale once referred

to as "nuts."

Schizophrenia, the most severe of the psychotic disorders, seems

to affect about one out of every hundred people. Some researchers

think that it may actually be a whole set of diseases, not just a single

disease, which would explain why people with the same diagnosis can

seem so different from each other. In any case, whatever

schizophrenia is, it's not "split personality," although the two are often

confused by the public; the schizophrenic mind is not split, but

shattered.

A common misunderstanding is that people with schizophrenia

are wildly psychotic all the time. Most, like myself, are not. When I am

symptomatic, I suffer from delusions and hallucinations, and my

thinking becomes confused and disorganized. Though I do not

hallucinate much—sometimes I see things, sometimes I hear things—I

often become frankly delusional. The disorganized thinking I suffer is

also a core feature of schizophrenia.

These symptoms are examples of "positive" symptoms of

schizophrenia, i.e., things you have but don't want. Many people with

schizophrenia also have "negative" symptoms, some sort of deficiency

or lack, such as apathy and withdrawal, a profound "not caring," or

perhaps more to the point, not caring about not caring. Save for my

first few years at Oxford, I've been fortunate largely to escape the

negative symptoms.

What's important in all of this is that I have a thought disorder. I

am not someone whose illness consists primarily of having high and

low moods. And that aspect of my illness—its cognitive nature—was

central in my decision to write this book.

Many people who suffer from manic depression and depression

lead full and rich lives: Journalists Mike Wallace and Jane Pauley, the

writer William Styron, and the psychologist and writer Kay Redfield

Jamison are just a few prominent examples. Famous historical figures

may have suffered from mood disorders as well—Abraham Lincoln,

Vincent Van Gogh, Virginia Woolf, and Samuel Johnson. Go to any

support group of people with mood disorders and, with some

understandable sense of pride, they will name their famous forebears

and their contemporary heroes.

However, people with thought disorders do not keep a list of

famous and successful people who share their problem. They can't,

because there is no such list. Comparatively few schizophrenics lead

happy and productive lives; those who do aren't in any hurry to tell the

world about themselves.

That said, some people with a thought disorder accomplish great

things before they become incapacitated by illness. John Nash, for

example, received the Nobel Prize for discoveries he made early in his

career. He then spent much of his ensuing adult life delusional,

wandering the Princeton campus, drifting aimlessly in and out of the

university library. In time, Nash (and his family and his doctors) built

a support system sufficient for him to largely manage his disease and

even "recover" from it, which was movingly captured in A Beautiful

Mind.

However, a more typical example of the way people with a thought

disorder find their way into the media is the tragic example of Michael

Laudor. Like me, Laudor attended Yale Law School. In 1995, shortly

after his graduation, the New York Times ran a story about Laudor,

focusing on how someone with schizoaffective disorder managed to

make it through arguably the finest law school in the country. Yale

Law School, Laudor told the Times, was "the most supportive

mental-health-care facility that exists in America." After graduation,

he contracted to write a book about his life, his travails and his

successes.

And then, in 1998, for some reason—no one is quite sure what set

him off—Laudor went off his medication. When his pregnant fiancee

tried to convince him that he needed both the meds and possibly even

hospitalization, he stabbed her to death at their kitchen table.

I had been thinking for a long time about writing a book about my

life when Laudor's story became public. I already had mixed feelings

about putting everything down on paper. The heartbreaking story

happening on the other side of the country only increased my

ambivalence. Maybe coming out about my illness would change the

way friends, colleagues, and students perceived me. Maybe, once they

knew the truth, they'd see me as too fragile or too scary to trust as a

professional colleague or an intimate. Maybe they'd believe that a

tragic, violent breakdown was inevitable.

In the end, though, it was Laudor's story that convinced me to go

ahead. The media frenzy that surrounded it only added to the

mythology that fuels the stigma: that schizophrenics are violent and

threatening. In truth, the large majority of schizophrenics never harm

anyone; in fact, if and when they do, they're far more likely to harm

themselves than anyone else.

Another reason I was compelled to write about my life was to give

people hope: A mental illness diagnosis does not automatically

sentence you to a bleak and painful life, devoid of pleasure or joy or

accomplishment. I also wanted to dispel the myths held by many

mental-health professionals themselves—that people with a

significant thought disorder cannot live independently, cannot work

at challenging jobs, cannot have true friendships, cannot be in

meaningful, sexually satisfying love relationships, cannot lead lives of

intellectual, spiritual, or emotional richness.

Medication has no doubt played a central role in helping me

manage my psychosis, but what has allowed me to see the meaning in

my struggles—to make sense of everything that happened before and

during the course of my illness, and to mobilize what strengths I may

possess into a rich and productive life—is talk therapy. People like me

with a thought disorder are not supposed to benefit much from this

kind of treatment, a talk therapy oriented toward insight and based

upon a relationship. But I have. There may be a substitute for the

human connection—for two people sitting together in a room, one of

them with the freedom to speak her mind, knowing the other is paying

careful and thoughtful attention—but I don't know what that

substitute might be. It is, at the heart of things, a relationship, and for

me it has been the key to every other relationship I hold precious.

Often, I'm navigating my life through uncertain, even threatening,

waters—I need the people in my life to tell me what's safe, what's real,

and what's worth holding on to.

I write, then, because I know what it's like to be psychotic. And I

know, better than most, how the law treats mental patients, the

degradation of being tied to a bed against your will and force-fed

medicine you didn't ask for and do not understand. I want to see that

change, and now I actively write and speak out about the crying need

for that change. I want to bring hope to those who suffer from

schizophrenia, and understanding to those who do not.

I now have almost everything in life I could have wished for, but

my illness took an enormous toll. I lost years of my life. I missed

countless relationships—intimate friends, cherished lovers. I never

had children. I never enjoyed the excitement of working in a

high-powered law firm, with challenging cases and extremely

hardworking and bright colleagues. Even now I can't travel the way I'd

like to—spontaneously, for weeks at a time in a strange and new place.

I can speak Spanish, but I can't go to Spain. My comfort limit for

out-of-town trips, even with Will, is about four days. He threatens to

make me a "virtual office" computer program so we can go away and

yet I'll feel like I'm safely in my office at USC. Work is both my solace

and my mirror—when I lose track of who I am, it is there on the page,

to remind me; when I'm away from it, I lose my bearings.

For years, I'd seen my body as the place that I lived, and the real

me was in my mind; the body was just the carrying case, and not a

very dependable one—kind of dirty, animal-like, unreliable. Will has

changed much of that for me, and so has surviving cancer. I'm more

comfortable with my body lately, maybe even more possessive of

it—but I'm wary at the same time. It has, after all, let me down more

than a few times.

So I fight the lethargy that comes from being buried in books while

on sedating drugs. Exercise has always provided a challenge—I've

never taken to treadmills, or stationary exercise bikes; they bore me.

And unlike most of California, I was certainly never a runner. So I

roller skate. My parents started skating in Central Park years ago, and

one time they asked me to come along; I thought they were maybe

losing their grip a bit, but I went with them, and loved it, immediately.

So now I roller skate and I take lessons—artistic skating, dancing, plus

the basic steps and forms. For a while, I did it twice a week; now I can

manage to protect the time for only one session a week, with a

professional coach. It's focused, and disciplined, and predictable and

invigorating. And most of the time, it's just plain fun.

Writing this book meant that I needed (and wanted) to start telling

people I hadn't told already the truth about my illness. Some of these

were quite close friends, but friends whom, for some reason or other,

I'd been hesitant to disclose to before. For instance, one of my friends

used to joke around about the mentally ill a lot; I thought he would

look down on me when he heard the truth. Other friends were

professional colleagues of fairly recent vintage, and I didn't want them

to lose faith in my academic abilities.

My experience of revealing my illness to all these people has been

eye-opening. Most people have been very accepting; many said they

had no idea and were shocked. Did this happen long ago and was it

not an issue now? One person, a law professor, revealed in turn that

he struggled with bipolar disorder; with that revelation—together with

our mutual support over the years—we have become close friends.

Another friend, a psychiatrist, urged me to use a nom de plume when

writing this book, but I thought that that would send the wrong

message—that all of this was too awful to say out loud. She then said

something that made me think: "But, Elyn, do you really want to

become known as the schizophrenic with a job?" I was taken aback by

her question. Is that who I am? Is that only who I am?

Ultimately, I decided that writing about myself could do more

good than any academic article I'd ever pen. Why do it under a

pseudonym if what I intended was to tell the truth? I don't want to be

marginalized; I've fought against that all my life.

I needed to put two critical ideas together: that I could both be

mentally ill and lead a rich and satisfying life. I needed to make peace

with my demons, so I could stop spending all my energy fighting

them. I needed to learn how to navigate my way through a career and

relationships with a sometimes tenuous hold on what was real. I

needed to understand what lay behind my terrible thoughts and

feelings and how my psychosis served to protect me. Through years of

hard and intense work, Mrs. Jones, White, Kaplan, and Freed had

helped me find my way to a life worth living. My last two

hospitalizations left me with "very poor" and "grave" prognoses. Those

are the prognoses I would have lived out had I not had very skilled,

very dedicated talk therapists—psychoanalysts—by my side.

I believe (at least I have no reason not to believe) that skills and

talents are distributed among the mentally ill more or less as they are

among the general population. Everyone has a niche. Of course,

resources are heavily skewed against the mentally ill, and the majority

never have a chance to realize anywhere near their potential. That

said, I'd feel terrible to learn that anyone had read this book and said

to a family member or friend, "She did it, so can you." I'm not saying

that everyone with schizophrenia or a psychotic disorder can become

a successful professional or academic; I'm an exception to a lot of

rules, and I know that. But much of that is about the ticket I drew in

the lottery: parents with resources, access to trained and talented

professionals, and a frequently unattractive stubborn streak that's

worked in my favor as often as it has against me.

My life today is not without its troubles. I have a major mental illness.

I wall never fully recover from schizophrenia. I wall always need to be

on antipsychotic medication and in talk therapy. I wall always have

good days and bad, and I still get sick.

But the treatment I have received has allowed me a life I consider

wonderfully worth living. USC Law School is an ideal place for me to

write and teach. I have smart and generous colleagues there who have

nurtured me through difficult and trying times. I count the school's

dean and associate dean as my good friends, and they have been kind

to me. The school has supported me as I've ventured to work wdth

other disciplines, psychiatry and psychology, and have found grants to

do empirical research relevant to my legal scholarship. In 2004,1 was

awarded USC's Associate's Award for Creativity in Research, given to

two professors each year—the highest honor the university bestows

for scholarship. At the same time, my Refusing Care was honored

wdth a USC Phi Kappa Phi Faculty Recognition Award. According to

the administration, no one has ever won these two awards in a single

year.

Recently my work life has gotten even better. Apart from the first

few years teaching criminal law, I have always been a reasonably

popular teacher. But over time (and it should have been going in the

opposite direction), I began to find teaching more and more stressful.

Blessed with a dean who has always tried to be supportive and

accommodating, I was offered a new job: Associate Dean for Research.

Instead of teaching, I now help colleagues obtain research grants. Of

course I love most doing my own research, but given all the

responsibilities one might have on a law faculty, helping my colleagues

find support for their work is an excellent second best.

My studies to be a research psychoanalyst have also taken place in

a rich environment and given me lively and interesting colleagues,

many of whom have become my closest friends. I am actively involved

in committee life at the psychoanalytic Institute. I still talk

often—pretty much every day—with dear Steve, and I enjoy our work

together. I am in love with and married to a kind and funny man who

understands and accepts me and makes me feel like a woman. So—it's

a good life, all in all.

Recently, however, a friend posed a question: If there were a pill

that would instantly cure me, would I take it? The poet Rainer Maria

Rilke was offered psychoanalysis. He declined, saying, "Don't take my

devils away because my angels may flee too." I can understand that.

Mania in manic depression has been described as a sometimes

pleasurable high that brings with it feelings of omnipotence. But that's

not the experience of schizophrenia, at least not for me. My psychosis

is a waking nightmare, in which my demons are so terrifying that all

my angels have already fled. So would I take the pill? In a heartbeat.

That said, I don't wish to be seen as regretting that I missed the life

I could have had if I'd not been ill. Nor am I asking anyone for pity.

What I rather wash to say is that the humanity we all share is more

important than the mental illness we may not. With proper treatment,

someone who is mentally ill can lead a full and rich life. What makes

life wonderful—good friends, a satisfying job, loving relationships—is

just as valuable for those of us who struggle with schizophrenia as for

anyone else.

If you are a person with mental illness, the challenge is to find the

life that's right for you. But in truth, isn't that the challenge for all of

us, mentally ill or not? My good fortune is not that I've recovered from

mental illness. I have not, nor will I ever. My good fortune lies in

having found my life.

acknowledgments

LIKE MY LIFE, this book is a collaborative effort, the result of the

contributions of my many friends and colleagues.

In terms of the actual writing of the book, two people have played

central roles. Through her writing, Larkin Warren helped bring the

book to life, in a way that wall allow me to "speak" to more people in

these pages. Stephen Behnke, a gifted writer and my closest friend,

knows me and my psychotic states—"spells," as Steve sometimes calls

them when teasing me—better than anyone. Steve suggested many of

the metaphors in the book to help convey the experience of my illness.

I wish to thank the publishing people who made this book happen:

my agent, Jennifer Joel, and my editor, Leslie Wells. Each is brilliant

at her job. It is their efforts that made The Center Cannot Hold: My

Journey Through Madness possible.

I would also like to thank my publisher, Robert Miller, for coming

up with a great title.

Other writers played a part in creating this book: Tristine Rainer,

my initial "memoir" teacher; Samantha Dunn, teacher of two memoir

writing classes; and Gladys Topkis, an editor friend who read and

made comments on the manuscript. Many others have read and made

suggestions on the manuscript. I thank especially Scott Altman,

Judith Armstrong, Gregg Bloche, Catherine Broger, Dinah Cannell,

Kenny Collins, Gerald Davison, Susan Estrich, Esther Fine, Susan

Garet, Michael Gitlin, Janet Hall, James High, Lissy Jarvik, Dilip

Jeste, Shannon Kelly, Stephanie Losi, Edward McCaffery, Alexander

Meiklejohn, Thomas Morawetz, Stephen Morse, Michael Shapiro,

David Shore, Larry Simon, Janet Smith, Matthew Spitzer, Philip

Stimac, Nomi Stolzenberg, Randy Sturman, Carmelo Valone, Marlene

Wagner, and June Wolf.

I would also like to thank those at USC who have helped me

administratively, so I could devote myself to writing: my assistant,

Keith Stevenson, and reference librarians Brian Raphael and Jessica

Wimer.

Over the course of my university studies, certain people opened

my mind. In retrospect, it was they who started me on the journey of

using my mind to heal my mind. John Lachs, my philosophy professor

at Vanderbilt, awakened me to the joys of thinking and learning.

Joseph Goldstein and Jay Katz of Yale Law School underscored that

lesson in the context of my interest in mental health. Stephen Wizner

helped me put my ability to think in the sendee of helping

undersen'ed people, a lesson Steve has taught to generations of Yale

law students, not just through his words but in how Steve lives his life.

George Mahl gave me a course in Freud that was among the best

classes I have ever taken and helped spur my interest in

psychoanalytic training.

Friends are a group of people who make life worth living, and I

have been blessed with many. Among my closest are: Russ Abbott,

Scott Altman, Judith Armstrong, Meiram Bendat, Gregg Bloche,

Catherine Broger, Dinah Cannell, Joel Chesler, Maria Chvirko, Kenny

and Margie Collins, Paul Davis, Patrick Dennis, Esther Fine, Paul

Forbath, Ronald and Susan Garet, Elizabeth Garrett, Thomas Griffith,

Janet Hall, Norah Heenan, Carrie Hempel, Joshua and Tamar Hoffs,

LissyJandk, Ehud Kamar, Ken Kress, Martin LeVay, Andrei Marmor,

Edward McCaffery, Alexander Meiklejohn, Thomas Morawetz, Craig

Parrish, Allan Rabinowitz, Noel Ragsdale, Daria Roithmayr, Catherine

Sabatini, Sam Scheer, Jean Scott, Michael Shapiro, Larry Simon,

David Slawson, Janet Smith, Edward Sokolnicki, Matthew Spitzer,

Nomi Stolzenberg, Christopher and Ann Stone, Randy Sturman,

Jennifer Urban, Robert Von Bargen, Catharine Wells, Richard

Wittenborn, Stephen Wizner, John Young, and Mark and Martha

Youngblood.

More generally, I wish to thank all of my colleagues on the USC

Law faculty. You know who you are, and I deeply appreciate your

friendship and support.

I have also developed good friends at the Wellness Community, a

group for cancer survivors. Our group leader, Carla, has helped me

and many others in our struggles, and I have forged close bonds with

many in the group, including Alex, Ann, Bracha, Carl, Christina,

Hiam, Janet, Julia, Margie, Mira, Sarah, Tracey, and Trudy. No one

understands cancer better than other cancer patients, and my

group-mates have often been inspirational to me.

My most important mentors at the New Center for Psychoanalysis

have been Gerald Aronson, Helen Desmond, Maimon Leavitt, and

Heiman Van Dam. They have helped me appreciate what

psychoanalytic thinking tells us about the complexities in every

human interaction.

My psychiatrists and therapists saved my life. I am enormously

grateful to the psychiatrists who focused on the biological aspects of

my illness, including Michael Gitlin and Stephen Marder. They have

helped me manage in the face of horrible symptoms and have brought

me to a place where I can most benefit from psychoanalysis. I do not

name my four analysts (I use pseudonyms in the text), because doing

so could complicate their relationships with past and current patients.

I owe my success and well-being—a debt I can never truly repay—to

the work in psychoanalysis we have done together.

I want to say a final word about those dearest to me. My parents

and brothers gave me the love and support that allowed my life to

proceed. I have kept things from them, for complicated reasons that

have served all of our needs, but I couldn't love them more. Steve has

been my colleague, my confidant, and my closest friend, the true

witness of my struggles. Steve understands me as well as anyone and

has given me the strength to go on many times. Will—well, what can I

say about Will? He is my true love—he gives my life a meaning that I

never thought possible. I go to bed every night and wake up every

morning thinking how lucky I am to have found him.

From all of these people, and others too numerous to mention, I

have gotten what I need to lead a life worth living. I hope that by

writing this book I help others to take some of what they need to make

their own lives a little better, too.

About the Author

Elyn R. Saks is a professor at the University of Southern California

Law School and the University of California, and Research Clinical

Associate at the Los Angeles Psychoanalytic Society and Institute. She

graduated from Oxford as a Marshall Scholar and received her J.D.

from Yale Law School. She has published three books and more than

two-dozen articles, and serves on the board of several mental health

foundations. She lives in Los Angeles with her husband, Will Vinet.

Copyright

THE CENTER CANNOT HOLD. Copyright © 2007 by Elyn R.Saks. All

rights reserved under International and Pan-American Copyright

Conventions. By payment of the required fees, you have been granted

the non-exclusive, non-transferable right to access and read the text of

this e-book on-screen. No part of this text may be reproduced,

transmitted, down-loaded, decompiled, reverse engineered, or stored

in or introduced into any information storage and retrieval system, in

any form or by any means, whether electronic or mechanical, now

known or hereinafter invented, without the express written

permission of Hyperion e-books.

Mobipocket Reader September 2007 ISBN 978-1-4013-8931-4

10 987654321

Table of Contents

Prologue

Chapter One

Chapter Two

Chapter Three

Chapter Four

Chapter Five

Chapter Six

Chapter Seven

Chapter Eight

Chapter Nine

Chapter Ten

Chapter Eleven

Chapter Twelve

Chapter Thirteen

Chapter Fourteen

Chapter Fifteen

Chapter Sixteen

Chapter Seventeen

Chapter Eighteen

Chapter Nineteen

Chapter Twenty

Chapter Twenty-One

Chapter Twenty-Two

Chapter Twenty-Three

Chapter Twenty-Four

Acknowledgments

About the Author

Copyright