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Crisis Care

 

By Mikita Brottman

 

Illustrations by Raven Reyes

 

When I was at college, I responded to an ad placed in the monthly student newsletter by a retired psychoanalyst, Dr. Beardsworth. He was offering analysis at no charge to students who could not afford the fee. I had no idea, at the time, of the difference between psychoanalysis and any other kind of psychotherapy, or what the treatment would have cost were I paying for it. I went to see Dr. Beardsworth because I was unhappy. I continued to see him twice a week for over two years.

In the pre-internet days, there was more scope for projection. Today it is almost impossible for a therapist to be a blank slate, or for a patient to restrain her curiosity. Before my first appointment with my most recent therapist, I had already scrolled through his wedding registry online. The wedding was almost a year ago, but the registry was still there. The couple had asked for twelve identical sets of Macy’s Hotel Collection Bath Towels. And each set contained twelve towels. One hundred and forty-four towels!

Now, over twenty-five years later, I have tried to find out more information about my first psychoanalyst, but there is not much to find. He died in March 2002, at age seventy. I still know nothing about his training or credentials. They do not matter. What matters is that something happened in that room. I can’t say exactly what it was, but it kept me going back even though I was terrified.

My appointments were early in the morning. I rode my bicycle to his home, a journey of around four miles. Dr. Beardsworth lived in a village north of Oxford. The door of his house was at the side, and to get there, I had to pass right in front of his living-room window, which was also the room where he saw his patients—though if he had others apart from me, I never noticed them. I was always embarrassed to walk past that window, and would push my bike with my eyes fixed firmly on a spot between the handlebars, frightened he was watching me, already judging and finding fault.

He was a gentle man in his sixties who wore house slippers and cardigans and seemed rather unhappy. His house was always cold. I lay on a couch and Dr. Beardsworth sat in a chair behind me. Mostly I lay there and said nothing, listening to the clock on the mantelpiece. Sometimes I chewed my fingernails. Sometimes I spoke about my childhood, my parents, or my dreams. Thirty years later, and I still can’t bear the sound of a ticking clock in a cold, quiet room.

The place terrified me, I later realized, because it forced me to face all my compulsions, fixations, and contradictions. I would always arrive with a bag full of books in the basket of my bicycle. Dr. Beardsworth wondered why I carried all those books four miles and back, rather than leaving them in my dorm room. I realized it made no sense, but I had a fear that, if I went back to my dorm, I would climb back into bed and sleep all day. Dr. Beardsworth made me see that my whole life was like that—a series of rituals I had created to punish myself.

One morning, I knocked on the door and there was no answer. I knocked again. Finally, Dr. Beardsworth appeared, unshaven, in his pajamas and dressing gown. His eyes widened when he saw me. It was a Monday bank holiday—a three-day weekend. He had assumed we would not be meeting. But I lived in the vacuum of university life and kept no track of the external world. I remember an awful, shuffling negotiation. We both apologized. Dr. Beardsworth insisted that I come in, and when I stepped into his consulting room, I caught a brief glance, through the kitchen door, of his wife disappearing swiftly from the table. They had been eating breakfast together, I realized, and reading the newspapers, and I had blundered in and spoiled everything.

Although, from the couch, I sometimes heard her washing dishes in the kitchen, I met Dr. Beardsworth’s wife on only one occasion. I was pushing my bicycle past the window of the consulting room on a warm, bright morning in late spring. My gaze, as usual, was fixed to the spot between the handlebars, so at first I didn’t see the woman on her knees in the front garden tending to her geraniums. She stood up and smiled when she saw me, saying something about the weather. Her face looked young, although her hair, which was long and loose, was white. She was wearing rubber boots and gardening gloves. I later discovered that she was a brilliant child neuropsychologist, and she died the following year, at the age of forty-one.

He didn’t have to spend two hours a week sitting with me. He was doing so because he could tell I was in pain.

Eventually, I learned to tolerate the anxiety of these visits, although they were always a struggle. It took more than a year for me to begin to trust the doctor, to open up, to offer my thoughts voluntarily. There was still a lot of silence, but gradually, Dr. Beardsworth came to seem more benign, less omniscient and threatening. I realized he was a person with a life of his own. He didn’t have to spend two hours a week sitting with me. He was doing so because he could tell I was in pain, and he wanted to show me that he cared for me as a fellow suffering human being. He cared enough to make himself invisible, a kind of cipher, and it was this that created the conditions for transference and projection. His quiet persistence taught me how to be resilient, how to calm my anxiety and cultivate an interest in my own inner life.

 

After I finished college, I saw an earnest cognitive-behavioral therapist named Candy. She was a woman in her mid-sixties who dressed, like many therapists seem to, in flowing Indian shawls and chunky jewelry. It was pleasant to have someone to talk to every week. Her office was bright and full of plants and discreetly placed boxes of tissues; I sat on a sofa and she sat opposite me in an armchair, but nothing about our sessions felt as though some painful magic was happening, as it had with Dr. Beardsworth. On the contrary, Candy was very open and friendly with me. She told me about her own life. She said she thought I was an interesting and unusual person. I believed her, and felt grateful. I felt as though we had a bond. Many years later I applied for a copy of my records from these sessions, and saw the brief notes Candy had made after each meeting. I was shocked at how judgmental she was. “Patient greeted me with superficial and inappropriate smile,” she had written on one occasion. On another: “Patient looks significantly older than stated age.” Cheeky! She was the one wearing yoga pants at sixty-five.

After Candy, I began medication. After trying various drugs with intolerable side effects, I settled on Paxil, which provided temporary relief. It enabled me to disguise my depression behind a façade of capable professionalism, but I was repressing the problem, and it was bound to return.

It did, shortly after I moved to the United States. When I was thirty-one, I was offered a visiting professorship at Indiana University in Bloomington. Here, I lived alone apart from a black-and-white cat I had adopted from the animal shelter. I had not been in Bloomington long enough to make more than two or three friends.

During the winter break, I holed up, saw no one, wore the same clothes every day for two weeks, and ate almost nothing. I felt as though I were descending into a black hole. It was so different from any previous episode of depression that at first, I did not recognize what was happening. I was drinking a lot. One night I got pulled over for a suspected DUI. If you are going to get pulled over for a suspected DUI, let it happen anywhere but in a college town on a Friday night during football season. I spent the night in a jail cell with four sobbing sorority girls, arrested for drinking underage, who took turns holding each other’s hair as they vomited, one by one, into the primitive toilet.

The next day I was told that, since my blood alcohol level was on the line, I would be released without charge. Incidentally, one of those vomiting girls turned up in a class of mine the following semester. She had an unforgettable operatic name. Our eyes met on the first day of class, but our secret stayed unspoken.

All that winter, I thought about suicide. I even made inquiries about purchasing a gun. I learned that neither permit nor license were needed to buy handguns in Indiana. Guns didn’t even have to be registered. All you needed, I learned, was a state ID and a credit card (cash, I’m sure, would also do the trick). I spent hours deep in the library stacks reading articles from journals like “Suicide and Life Threatening Behavior,” and “Current Issues in Suicidology.” I read books called Final Exit, The Ethics of Suicide, Or Not To Be, and The Suicidal Mind. I read Madame Bovary for the first time. I read a lot of novels with “night” in the title: Mother Night, Night Train, Tender is the Night, and, naturally, Night. Just as some forms of art leave you drained and irritable and others leave you energized, this reading gave me strength and brought me comfort.

It also filled in the time when I couldn’t sleep. Sometimes I would spend that time driving. On one occasion, I went out late at night to one of the abandoned limestone quarries on the edge of town, an immense ghostly rectangle carved out of the earth. There was nobody around. The depth of the pool and the minerals from the limestone give the water in these quarries a strange green color; in the light of the full moon, it had an unearthly glow, like the surface of a distant planet. I could feel the lure of this otherworldly landscape pulling me towards the edge of the quarry.

As I was driving back to Bloomington, I suddenly realized in a moment of great clarity that not only was I capable of suicide, but I was half-consciously preparing for it. If I went on this way I knew at once that I would kill myself. It was as if I had woken up out of a dream and I knew it was going to be difficult to stay awake. It would be easier to go back to sleep. I would have to keep pinching myself.

It would not have comforted me at the time, but now I realize that Camus says exactly this in his essay on The Myth of Sisyphus. “Suicide,” writes Camus, “is prepared within the silence of the heart, as is a great work of art. The man himself is ignorant of it. One evening he pulls the trigger or jumps. [...] Beginning to think is beginning to be undermined. [...]The worm is in man’s heart. That is where it must be sought.”

 

To get rid of the worm in my heart, I would have to take action. The following morning, I had to teach, but before I went to work, I managed to make an appointment with a psychiatrist. I had no problem teaching. I never do, even when depressed. Like writing, it helps take my mind off my problems. That day we studied a poem by Thomas Hardy called “The Voice,” in which the poet imagines he hears the ghost of his dead wife calling to him from beyond the grave. After my class I drove directly to the psychiatrist’s appointment. I intended to ask for a change of medication, but I also knew I needed something in the meantime to tide me over—something I had never tried before, that acted at once, like Valium for example. I reminded myself that I could not conceal anything.

I thought of myself as a ‘normal person.’ I did not think I could be taken out of the back door of a psychiatrist’s office by the police, handcuffed, and then put in a locked ward against my will.

The psychiatrist looked as though he was in his early thirties, the same age as me. His name was Dr. Brian McCall. He took a long history, asked about my experience of depression, whether I ever thought about suicide, the usual questions. He asked whether I had a specific plan. (I would buy a gun, I said.) He asked questions about my job, my drinking, my living situation. I answered frankly and honestly. Then he left the room. A long time passed. I grew restless and went back to the lobby. The receptionist told me that doctor had been called to deal with an emergency but he had called to say he would be right back at any moment, and could I wait just a little longer?

I went back into the office, and a man came to sit with me. I think he mentioned that he was a social worker. He told to me about a friend of his who had made a failed suicide attempt when he was young, and now he was very happy with a wife and family, and was very glad his suicide attempt had failed.

“You see, here’s the thing about suicide,” he said, as if he were about to tell me something deeply profound he had learned himself over many years, not a cliché he had picked up from somebody else. “It’s a permanent solution to a temporary problem.” I was already impatient and upset, and I am afraid I was not very kind to this man. I do not recall exactly what I said to him, but I know I did not mince my words.

It is difficult for me to believe I could be naïve enough not to know what was coming, but for some reason I did not. I had heard of people being institutionalized, but when I thought of the word, what came to mind was delusional schizophrenics, people with dementia, people who have been seriously ill for years and years, not someone who has just got up in the morning, taught a university class, then gone to a psychiatrist’s appointment. I thought of myself as a “normal person.” I did not think I could be taken out of the back door of a psychiatrist’s office by the police, handcuffed, and then put in a locked ward against my will. It never once struck me as a possibility.

At the time and for many years afterwards I was very angry with Dr. Brian McCall, but now I realize he was doing what he believed was in my best interest. He had never met me before. I had come to him in great distress with a long history of depression. I was drinking heavily and I had been in trouble with the police. I was having suicidal thoughts and I had a definite plan. I lived alone and had no friends or family to take care of me. What difference did it make that I had taught a class that morning, or that my cat was hungry, or that I had made the appointment believing that a change of medication and a sedative were what I needed to get me out of the crisis? Perhaps they were. And perhaps not.

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According to federal law, everyone has the right to access his or her medical records, and, for a fee, to request copies. A year or so after the fact, I had ordered copies of the documentation relating to my hospitalization. A week ago, I unearthed this paperwork. I had not looked at it for five or six years. Before now, I had seen in it only the psychiatrist’s blindness and the system’s absurdity. I had kept it out of a kind of bravado, the way I kept my backpack that was torn open by an animal one night outside my tent. For the first time I felt a touch of shock on reading the documents. The first page is entitled “Application for Emergency Detention of Mentally Ill and Dangerous Person.” It was filed on February 1, 2000. The name of the “person to be detained” is written as “Makita Brottman,” and my identifying data is given as “white female, 32, thin, blonde, English accent. Worsening depression. Has severe ruminations about suicide. Plans to buy handgun. Unable to conduct to safety.” By “Applicant believes that the person named above is DANGEROUS,” Dr. McCall has checked “to self,” and after the word “because,” he has written, “Obsessive thoughts about suicide. Unable to understand why anyone wants to live. The patient described her thoughts of this nature in relation to ‘rational suicide.’ The patient denied any homicidal or suicidal ideation.” Finally, beneath the printed phrase, “Applicant believes that if the person named above is not restrained immediately, then the person will...” Dr. McCall has written, in small, neat handwriting, “Shoot herself.”

At 3:40 pm, according to my paperwork, I was taken to the Crisis Care Unit, a locked ward on the top floor of Bloomington Hospital.

Dr. McCall said he wanted to send me to “Crisis Care.” He asked if I would sign the papers voluntarily. I refused. He said he was going to commit me because he believed I was a danger to myself and I could not be “conveyed to safety.” He had arranged to have me held for seventy-two hours, he told me. I asked him if I could go home and feed my cat. He shook his head, picked up the phone on his desk and called for a receptionist to come in and “accompany the patient through the rear exit.” The receptionist arrived and asked me to follow her. She led me out of Dr. McCall’s office and out of the back door of the psychiatric clinic where two cops, one old and one young, were waiting for me in front of a police car.

The older officer was wearing a dark green sheriff’s hat. He took me by the shoulders and asked me to put my hands behind my back. I told him there was no need to handcuff me. I was not going to resist. The cop was extremely sympathetic and polite, but he said he had to handcuff me because it was the law. He snapped the cuffs on my wrists behind my back and asked me to tell him if they were too tight. The younger cop then got in the driving seat of the police car while the older cop opened the back door and helped me to get inside. When we started heading out of town, I began to feel extremely anxious about my cat. When I returned from campus every afternoon, he would be sitting on my front steps waiting for me to feed him. I had found him in an animal shelter a little more than a year ago. At the time, I’d been reading Moby-Dick, and I’d named him Queequeg after Ishmael’s exotic harpooner, not only because his black-and-white markings resemble tattoos, but also because, like Ishmael’s Queequeg, he was my closest friend. Now it was February, and freezing outside. I tried not to picture the small creature shivering on my front porch.

At 3:40 pm, according to my paperwork, I was taken to the Crisis Care Unit, a locked ward on the top floor of Bloomington Hospital, where I was released from my handcuffs and relieved of my clothes and possessions. A kindly middle-aged nurse named Debbie gave me a blue hospital gown, a beltless robe to wear over the top, and ankle socks with plastic pads on the bottom. I asked if I could at least have my bra back, but was told that would be against the rules. I am horribly uncomfortable without a bra. I begged Debbie to make an exception in my case, but she would not. You could hang yourself with a bra, she said.

Before being taken to my room, I was allowed to use the phone. I did not have any close friends in my academic department, where my position was very junior and categorically impermanent. My closest friend in town was a woman named Pat who worked for a real estate company. We had met at a party. Although she was twenty years older than me, Pat and I had become close. She had a slightly cruel way of teasing me that I liked because it was so rare to find in an American.

I had Pat’s work number. I called and told her that I had been taken into a psychiatric hospital and asked her if she would go over to my house later. She was shocked at first, but quickly stopped asking questions and went into practical mode. I was very grateful for that. I told her where I left my spare key and asked her to let Queequeg in and leave him enough food for the next three days. Then I called my department secretary, and, told her I needed to stay in the hospital for the next three days for “tests” (Debbie’s suggestion) and asked her to cancel the rest of my classes for the week.

After I had finished using the telephone, Debbie took me to a large room with two single beds, two bedside tables, a wardrobe, and no windows, unless you included the observation window in the door. The lock and light were controlled from outside the room. When Debbie left, she locked me in the room with the overhead light on. On the side of the wardrobe was a mirror, made not of glass but of some plastic reflective material that made me look a bit crazy, but I knew I was no different than I had been three hours ago, when I had been teaching my class. Had I been a “mentally ill and dangerous person” then? If not, when had I become one? I was certainly “mentally ill and dangerous” now, since a psychiatrist who had been trained and qualified to recognize such people had signed a court order attesting to the fact. It would be on record, I realized, for the rest of my life.

It is true that I had been suicidal. What I had wanted was a change in medication. In the hospital, I got what I wanted. My dose of Paxil was increased, and I was also put on Xanax as well as Zyprexa, an anti-psychotic that made me extremely sleepy. Would I be allowed to sleep for three days—to take a “rest cure”? Not a chance. Now I was officially one of them, I was expected to take part in the rituals of the mentally ill. The next morning, about an hour after I had been handed a breakfast tray containing a rubbery omelet, a voice on the public address system announced “Medication,” and I was told to join the shuffling line of patients in dressing gowns and socks. Worst of all, twice a day I had to go to group therapy.

On the side of the wardrobe was a mirror, made not of glass but of some plastic reflective material that made me look a bit crazy, but I knew I was no different than I had been three hours ago.

The director of the unit was a psychiatric nurse named Phil. He introduced himself as “Phil from the Philippines.” In group therapy, I sat on an orange plastic chair in a circle with the other eight or nine patients in Crisis Care while Phil did almost all the talking. He told us about his family’s struggle with poverty, his brother’s drug addiction, and the death of his father.

Whenever anyone else began speaking about their own difficulties, Phil aimed a jet of clichés in their direction. Never judge another until you have walked a mile in their shoes. Life has a way of taking you by surprise. See the glass as half-full, not half-empty. This too shall pass.

The medication made it difficult for me to keep my eyes open. I tried to stay awake by taking stock of the other patients on the ward. I wondered what might have brought them into Crisis Care. Might they have been living busy, stable lives two days ago? It did not seem likely. At least three of them had severe physical tics—eyes that blinked unreasonably, heads that jerked violently, shoulders that shrugged without purpose. One gentleman, who spilled out on both sides of his plastic chair, always slept through the sessions, a stream of drool trickling gently out of the side of his mouth. His somnolence never seemed to concern Phil, unlike the repeated questions posed by a young man with a wild bush of dark hair who would constantly interrupt Phil’s stream of platitudes to ask whether events he had seen on the news that day had “happened before.” I wasn’t sure whether the young man believed the newscasters were trying to trick him, or if watching the same news broadcast twice a day had confused him.

There was only one other woman on the unit. Her name was Robin. She looked to be around my age, and her hair hung so far down her back that I first assumed she was a Mormon. She kept squinting and bumping into things—they would not let her have her glasses, and she was legally blind without them—though eventually someone brought her a thick pair made of pink-tinted plastic, which were permitted. Robin told me she was afraid that being in the Crisis Care ward would count against her when it came to getting custody of her children. She was in the middle of a terrible divorce. Like most of the other patients on the unit, Robin smoked all day, and would invite me to come with her on her “smoke breaks.” But I couldn’t take more than thirty seconds in the “smoking room,” a large glass booth that smelled of stale tobacco. Whenever two or three people were in there together, the glass on the outside turned white with smoke and the patients within became spectral apparitions that gradually disappeared from view, as if the booth were a portal to the spirit world.

If I said ‘no’ to the suicide question, would the psychiatrist think I was faking it, trying not to appear depressed? Would that count against me?

The most harrowing part of each day was when I was shaken awake from my drugged sleep by whichever psychiatrist happened to be on call. It was a different one every time. These interviews were brief—fifteen minutes or less—but I knew that if I wanted to get out of the hospital I had to show that I was rational and clear-headed. The psychiatrists would make steady eye contact and ask me questions about the date, month, year, the name of the president, and so on to see if I was focused and oriented. Then would come the critical question: do you still feel suicidal?

I had never actually told Dr. McCall—whom I never saw again—that I had “felt suicidal”; in fact, his notes from our encounter say clearly that I “denied suicidal ideation.” I had realized I was going to commit suicide if my medication was not changed. I assumed the answer I was supposed to give was “No, not at all,” but I thought it might be a trick question. Surely no reasonable person would believe that being locked up in a psychiatric ward for two days had suddenly cheered me up enormously. If I said “no” to the suicide question, would the psychiatrists think I was faking it, trying not to appear depressed? Would that count against me? It was difficult to think clearly when I had just been shaken out of a drugged stupor and was sitting up in my bed with my arms folded in front of my chest because I was not allowed to wear a bra. Nevertheless, when I gave the answer—no, I was not suicidal—they seemed to be satisfied.

On the evening of my second day on the ward, I had two visitors: Pat, and my teaching assistant, Thomas. They stayed for an hour. Both found the place intriguing. Pat brought me some books and a huge bag of candy. Later, she told me that when she had gone to smoke a cigarette in the smoking room, Robin had slipped her a letter, begging her to take it to the police; she said it “finally told the whole truth about the children.” Thomas confessed to a certain amount of jealousy: He had always wanted to be committed to the psych ward himself. He saw it as a badge of genuine suffering. He had made me a pink and glittery get-well card, adapted from a cheesy one he had bought at Hallmark. On the front was an illustration of a poodle sitting under the hooded dryer of an old-fashioned beauty salon getting her hair set into a huge beehive. Thomas had drawn electrodes coming out of the poodle’s head, and above the illustration, he had typed, “Vintage electro-shock therapy machine, circa 1950.”

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On the morning of the fourth day, I was released with a pile of prescriptions and told I could fill them at the Rite-Aid in the strip-mall opposite the hospital. I realized I would have to call a taxi—my car was still in the lot outside the psychiatrist’s office where I had left it four days earlier. I found the Rite-Aid. In the strip mall was also a Goodwill Store, a chinese buffet, a party supply store, and, right next to it, a gun dealership. While I was waiting for my prescriptions to be filled, I bought a gun.

The gun dealer said it was their most popular ladies’ handgun. I filled out the paperwork on the spot and paid with a credit card. I cannot remember how much it cost, or what type of gun it was, I just knew that next time I fell into a depression, it might be even worse than the one I was currently experiencing, and if that happened, “Crisis Care” was not something I wanted to experience again. I kept the gun and ammunition in a box in a closet. After a few weeks, I forgot about it. Later, when I was moving, a friend who was helping me pack came across it. He said it looked like a pretty nice gun.

This happened seventeen years ago. I now know how to keep track of my depression, and I know the signs that show me when things are going off track. I still have the gun, and a box of bullets to go with it. The box of bullets is unopened; the gun has never been fired. I keep it not because I think I will ever use it, but as a sort of memento mori. It reminds me of the impulse that led me to buy it: my disillusion with Dr. McCall, whose interest in my crisis was limited to his own liability exposure. But it also reminds me of what stopped me from using it—the resilience I acquired from Dr. Beardsworth, a lifelong gift I had not known I was being given.


Mikita Brottman is an author, psychoanalyst, and full time faculty in the department of humanistic studies at the Maryland Institute College of Art. Her most recent book is An Unexplained Death (Henry Holt, 2018).