In a Psych Ward on Suicide Watch: a True Story

by
Daulton Dickey.

“My passion was dead. For years it had rolled over and submerged me[…]” –Jean-Paul Sartre, Nausea

1.

23472755_508313162869436_3148584393869646739_nSuicides aren’t always dissatisfied with life. They’re certainly not cowards. Few people who consider themselves brave could commit the ultimate act. In the aftermath of suicide, those left behind search for answers or meaning. Sometimes they can find answers, sometimes meaning doesn’t exist, sometimes the suicide is the result of a brain wired differently and given free rein to act on its impulses.

If you reduce the physical universe to its most basic components, you’ll find most of the building blocks are comprised of empty space. When I experienced suicidal depression, I experienced the sensation of the emptiness of the physical universe. Every second of every day. Every atom contains emptiness. Since I was composed of atoms, I was mostly empty–physically and emotionally.

And that emptiness weighed on me. It strangled me. It assumed a three-dimensional form and embraced me, suffocated me, asphyxiated me. I was never more informed or aware of the emptiness of the universe than when anxiety and suicidal depression descended on me.

I can’t point to an origin for these experiences. There are no demarcation points in my autobiography I can cite as the beginning of depression or crippling anxiety. Always an awkward kid, a social leper even, I was high strung and dominated by ennui and anxiety. Those traits solidified into adulthood, along with explosive bouts of mania, depression, and feelings of worthlessness.

Those feelings consume me as write this now: I feel empty and worthless–a failure. The familiarity of these sensations has remained a constant throughout my life. In a strange way, they’re comforting. Feelings of worthlessness and melancholy, even full-blown depression, are feelings after all. They signify I haven’t lost what little value I attach to existence.

They signify a fighting chance.

When I admitted myself to the local hospital a few years ago, I was engaged in a battle in a years’ long war. And it terrified me. I didn’t think I’d last the night. The idea of grabbing the largest and sharpest knife in the kitchen and slicing up my forearms translated into chemical impulses. Those impulses mirrored the act of destroying myself. I’ve tried to articulate the sensation for several years now, but I’ve not devised a satisfying metaphor or simile. The best I’ve come up with is to relate it to phantom limb syndrome.

Those who’ve lost a limb experience sensations as if their lost parts are still present and functioning. Someone who lost an arm, say, might feel their arm moving, their wrist twisting, their fingers curling and unfurling.

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The author, c. 2013

I experienced something similar the night I was poised to lose my battle, something like phantom suicidal ideation. I felt my hands clasping knives while I moved my arms up and down back and forth, tearing into my flesh. Even if my arms were at my sides, or if I was holding a cigarette, I felt the phantom movements of my arms in the act of committing suicide.

 

It jolted me. Fear and anxiety consumed me. My sympathetic nervous system assumed control, preparing for a fight-or-flight response. But a response to what? Protecting the same organism determined to destroy itself?

The world hollowed. The universe vanished. Only my apartment existed. I was floating in a building in the void, waiting to vanquish myself–and the universe–to an eternity of nothingness. I felt it the way you might feel a quivering sensation when a crush asks you out: it consumed every inch of my body.

But here’s the thing: as much as my non-conscious self was determined to kill me, my conscious self wasn’t willing to die.

My wife was at the theater rehearsing a play. I sent her an ominous text. She enlisted a friend of ours–a levelheaded and kind dentist–and they raced to the apartment. They found me on the kitchen floor. I was leaning against the dishwasher, knees up, forearms resting on my knees, head resting on my forearms. Humiliation settled in when they arrived, but it couldn’t offset my non-conscious desire to die.

I told them to take me to the hospital. They complied. Leaving the apartment and sitting in the emergency room remains a blur to this day. Most of that night remains a blur, except for one image: my wife crying as the nurse loaded me into a wheelchair. She stayed behind in the room while the nurse pushed me down a corridor, to a service elevator, and delivered me to the behavioral medicine and sciences ward.

2.

Situations dictate someone’s perception of you. In a Psych Ward, the staff’s perception seemed to come in a limited assortment of flavors. They perceived you as either fragile or broken, a drug addict or violent. Years of spending large chunks of their days in such a milieu undoubtedly afforded them the opportunity to encounter a revolving door of similar personality types. It’s possible this personal experience translated to an inflated belief in their ability to read people on sight.

In the 1960s, David Rosenhan, a psychologist at Stanford University, sent seven healthy people to mental institutions. The volunteers duped the doctors and administrators into admitting them by claiming to suffer auditory hallucinations. On admittance, they behaved normally, as per Rosenhan’s instructions.

Despite their behavior, however, they were kept in the institutions for more than three weeks. All but one of them were diagnosed with schizophrenia.

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Since situations define others’ perceptions of you, you must behave cautiously in certain situations. Otherwise benign or innocuous behavior or affectations might reinforce their perceptions. These interpretations could prove detrimental in institutions of consequence, such as a psych ward or a prison.

Perceptual expectancy is a phenomenon each of us experience. Essentially, we perceive what we expect to perceive, overlooking or filtering out information which fails to meet our expectations.

Similarly, confirmation bias, a well-known cognitive bias, filters out information which might contradict our beliefs. Combined, perceptual expectancy and confirmation bias narrow our perception and understanding of things in order to prevent cognitive dissonance, which could threaten our worldview, thus thrusting us into emotional, even neurological, chaos.

These biases create problems in situations such as a Psych Ward. To those who work there, to those who have encountered a panoply of behavioral and mood disorders, from the depressed to the psychopathic, from those who feel empty to those who feel nothing to those who excel at manipulation, every person in such a situation, who isn’t an employee, suffers some form of mental affliction.

I knew this before I committed myself, and I knew to monitor and calculate my behavior. In a sense, I altered my personality to avoid a prolonged stay. I consciously aimed to manipulate people.

I had committed myself to avoid suicide, but since the situation dictated the employees’ perceptions of me, then my behavior might enable them to perceive me in new and different–clinical–ways. If, for example, I lost my temper or paced the corridors or fought for the television in the dayroom, then they might perceive me as unstable or as a person suffering from violent or aggressive tendencies. Or maybe schizophrenia or a variety of mental illnesses, the symptoms of which the situation would allow them to graft onto me.

Since the Rosenhan Experiment, hospitals and institutions put measures and regulations in place to reduce the likelihood of such interpretations condemning innocent people. Subjective bias, however, isn’t always easy to overcome, or even to acknowledge, because it occurs on a non-conscious level.

To behave innocently and politely–my goal. My only goal. From the moment I sat at a table in a room with locked doors, I felt as though I’d made a mistake. And I desperately wanted out of there. I’d waged a war with my mind before, I thought. I could do it again. Away from here.

Did I belong there? I mean, yeah, I suffered, I experienced emotional problems, but who didn’t? Right?

The other patients ranged from suicidal to violent, from heroin addicts to men who suffered a sort of withdrawal from reality. One man I’d later encounter refused to leave his room. He even refused to leave his bed. The employees tried to coax him out. He ignored them. They threatened him–you’ll lose visitation privileges, they’d say; we’ll exclude you from activities; we’ll prevent you from entering the dayroom; we’ll call so-and-so up here and force you out of this room.

 

psychward

This is a stock photo, but it resembles the psych ward at my local hospital.

These threats, of course, meant nothing to him. The staff gave up after a while. As a result, he stayed in bed during the bulk of my time there. I saw him only once at breakfast, where he moved almost in slow motion, chewed almost in slow motion, as if the rewards didn’t match or exceed the burden of initiating motor activities.

Witnessing such scenarios, and possessing at least a rudimentary understanding of cognitive psychology, I behaved as an angel might. I hated the place and wanted out. Calculating my actions, creating a persona–a benevolent, inward seeking monk–I aimed to manipulate the employees, to convince them to release me as soon as statute allowed. The state mandated they hold me for 72 hours on suicide watch. I meant to ensure not to stay a minute longer.

My understanding of psych wards didn’t extend beyond One Flew Over the Cuckoo’s Nest, Girl, Interrupted, and 12 Monkeys. Like so many people of my generation, I had derived much of my knowledge of the world from pop culture–something I had struggled to correct over the past few years. However, pop culture leaves powerful impressions. It embeds itself deep in your psyche, and whenever you think of a reference, whenever you infer it, the neural connections defining those references strengthen, further corrupting you.

I felt empty, a shell, a mound of meat and bones as I sat at a conference table inside a kitchen. This, I assumed, was my intake. A refrigerator, a sink, and computers on rolling kiosks littered the room, itself cold and yellow-walled and benign.

When they ushered me into the psych ward, which required moving through locked and secured doors, a different nurse took the reins and wheeled me into this room. She muttered something and left, closing the door behind her. I wrapped my arms around my stomach and leaned into the table and glanced around the room. A kitchen. Of all the places I expected to end up, this didn’t even make the list of possibilities.

salvador-dali-paintings-14It seemed surreal. I imagined myself as an amorphous blob in a Dali painting melting over an asymmetrical table in a kitchen with boulder-sized eggs hovering over frying pans.

A clock somewhere in the room ticked, ticked, ticked. Each tick jolted my nerves. My anxiety deepened. Tick, tick, tick. I scanned the room but I couldn’t find the clock. Did they hide the fucking thing? Tick, tick, tick. Was it actually a clock or was this some elaborate experiment? Tick, tick, tick. My muscles tensed. Tick, tick, tick. My head throbbed. Tick, tick, tick. The urge to leap out of the chair and flip over the table and throw every object against every surface until I uncovered that goddamn clock–tick, tick, tick, tick, tick, tick–overwhelmed me.

But I resisted it. Instead, arms still wrapped around my stomach, I rocked back and forth, back and forth. Tick, tick, tick. Where was that woman? Tick, tick, tick. This was fucking absurd.

A short woman with curly hair ambled into the room and sat across from me at the table. She spoke with tenderness and kindness, but something about her tone, something I can’t articulate, felt forced. Fake. She slid a pen and a packet of papers across the table and asked me to fill them out. Reading and writing in that moment appealed to me as much as breeding a brown recluse in my ear canal. But I tried. The questions ranged from my name, address, and social security number to my family and medical history to my psychological history.

My hand trembled as I wrote. My sense of time vanished, so I don’t know if five minutes

selfportraitdaultondickey2013

Self Portrait by the author, c. 2013

or three hours passed, but I eventually completed the paperwork. It had exhausted me. After a brief chat with the woman, I stumbled to the wheelchair and she pushed me into a darkened room. My roommate was sleeping, she said. She had warned me earlier that he was a heroin addict suffering withdrawal, possibly prone to night terrors.

 

In the room, she told me–in a whisper–to try to ignore whatever might occur in the other bed. Just try to get some sleep, she said. Fear replaced my emptiness, but I think I fell asleep before the woman–Christ, I wish I could remember her name–left the room.

Darkness.

Moaning woke me. I lay still, pretending to sleep, and narrowed my eyes. The bed across the room was empty. My roommate was gone. The moan erupted again, reached a crescendo, then faded. I glanced at the door to the hall. It was open, firing a cone of light into the room. The light silhouetted a man pacing the hallway in front of my door. He muttered something about pain and voices–or choices, I couldn’t discern which.

Darkness.

I woke in the middle of the night with two nurses standing over me. I remember the image now as if it’s a shot from a Terry Gilliam film: two warped faces too close to a fish-eye lens. They nudged me awake and told me to sit up. I glanced at the other bed. It was empty.

“Don’t worry about him,” one of the nurses said. She handed me two pills and a paper cup of water no larger than a shot glass. I swallowed both pills in one gulp.

The other nurse ordered me to hold out my arm, then she pricked me with a needle.

“This’ll vaccinate you against Hepatitis B,” she said.

Hepatitis B? What the fuck weren’t they telling me about this place?

With another needle, she poked the crook of my elbow and told me it was to test me for tuberculosis. Then both nurses ordered me to sleep, spun on their heels, and left the room.

Darkness.

Whatever pills they gave me knocked me out. Daylight reflected on my bedpost–actually an old military-style cot–when I woke. I dragged ass out of bed and scurried to the bathroom, in my room, and took the longest piss in human history. I trembled as I lumbered out of the room. My head hurt and my stomach and mouth felt acidic, as if I’d spent the night downing too many screwdrivers.

A nurse poked her head in the door and handed me a satchel with personal hygiene products–a bar of soap, toothpaste and toothbrush, deodorant, and a comb. She also handed me folded scrubs, the kind nurses and doctors wear, and told me to take a shower.

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The author, c. 2013

“Let me wake up first,” I said. “I feel groggy.”

 

“It’s the medication. You’ll be fine. And showers aren’t optional. They can’t wait. Breakfast is in fifteen minutes. If you miss it, you won’t get any food until lunch.” She slipped into the hallway and re-appeared a second later. “And drop your soiled clothes into the receptacle outside.”

The “receptacle” was a fabric hamper with a PVC skeleton located in the hallway. I dropped my dirty clothes into it after the shower and wandered down the hall. I found the dayroom and lingered in the hallway, peeking in, observing. People sat in chairs, watching daytime talk shows. Others flipped through paperback novels. One man repeatedly shuffled a deck of cards. Near the back of the room, a woman paced the corner, clenching and unclenching her fists. She pursed her lips. Her masseter rippled.

No one congregated in groups. No one chatted or even glanced at one another. We were ethereal freaks in a corporal madhouse, blissfully unaware of the people-shaped ether drifting through the rooms and hallways.

4.

Behavioral medicine and science wards operate under the assumption of therapeutic structure. They’re predicated on routine: wake up, take a shower, attend to personal hygiene, and dispose of your dirty scrubs; eat breakfast and go to the dayroom; go to your room; go to the dayroom; then eat dinner and spend a short period in the dayroom again; and, finally, go to sleep.

The nurses drift in and out, changing shifts and feigning interest or empathy–while betraying judgment through subtle shifts in body language or facial expressions or tone of voice. You’re here, they seem to think, for a reason. We assume the veracity of those reasons and so we must deal with you until it’s time to discharge you.

They’re not necessarily cold but they’re not warm and inviting, either. They’re ambivalent–at least in my experience. Don’t take this as a proposition asserting the truth value in regards to everyone who works in every psych ward in the country. However we might interpret their behavior or their intentions for entering this field, the fact remains that this is their job. They perform it day-in-and-day out. After months or years, immunity settles in. Then they follow rules and regulations and procedures to maintain long-established routines.

We are creatures of habit, to invoke a cliché, and once we fall into routine it’s difficult to recall the reasons–or the passions–that had set us on our course. The medical industry is no different. Who hasn’t encountered a doctor or a nurse with the personality of Strother Martin in Cool Hand Luke?

In a heavily fortified and locked ward filled with people of all ages and genders battling23376585_508313269536092_7200385012861856558_n mental illnesses, such coldness or ambivalence, such feigned compassion or empathy, might work against helping the patients. So, too, might the artificiality of the environment itself, most notably the routine enforced in a sealed floor. Nurses spend the bulk of their shifts in panopticon-style stations behind bulletproof glass and speak to you through rectangle-shaped holes. They cut you off from friends and family, as well as the outside world–cell phones were prohibited in my ward. While spewing platitudes, they ply you with sedatives and other drugs–many of them opioids–and herd you like cattle while treating you as if you’re a toddler.

These routines, of course, aren’t accidental. They’re based on years of theories and research and recommendations by people who receive compensation for developing these models. Capitalism also plays its parts as lawyers and accountants and cost-cutting executives and CEOs add their demands to the mix. In the end, the routines established are predicated more in putting theories into praxis and on cost-benefit and ROI analyses than they are in addressing the individual needs of disturbed human beings.

The structure, the routine, the drugs, and the clearly disinterested nursing staff didn’t soothe me. The entire situation set me on edge. In lieu of feeling the comfort and safety of a place designed to help me, I felt like Winston Smith shoved into a microcosmic totalitarian state. I called the ward, which was located on the third floor, Room 101.

Nurses dictated every second of my stay there as they pumped opiates down my gullet. Midway through the second day, I was informed I’d see a doctor. Time dragged. Then they pulled me into a room and I talked to a social worker. She sent me away. A couple hours later, they pulled me back into that room, where I talked for an hour or so with a nurse practitioner.

I met the doctor the next day–in that same room. His physiognomy read like a Kanji character: bent, contorted, baffling. He sat on a couch on the other side of the room and leaned into the couch arm, twisting his body away from me. He rested his elbow on the arm of the couch and his chin in his hand. Two fingers covered his cheek, two curled over his mouth, and his thumb provided support for the bottom of his chin.

He spoke in clipped sentences, producing a staccato rhythm. Without setting eyes on me, he read from a legal pad–the notes, recommendations, et cetera, of his nurse practitioner–and asked me a few questions. “What’d you do this morning?” “Did you drink any decaf coffee?” He articulated his faith in his nurse practitioner without prompting or context. Then he stood and shook my hand, touching it as if it were the rotting corpse of a tarantula. Without so much as saying goodbye, he traipsed to the door. Our interaction lasted perhaps five minutes. Probably less.

5.

Bipolar Disorder I, Generalized Anxiety Disorder (GAD), and, potentially, PTSD–my official diagnoses. I currently take anti-seizure medication for my bipolar disorder and a benzodiazepine for my GAD. Since my PTSD was considered probable and not officially diagnosed, I’m not on anything for it.

6.

23517836_508313252869427_858379167914240064_nAs a writer of fiction, I’m occasionally asked where my ideas originate. I don’t know a single writer who can answer that question. I usually tell people, “I don’t know and I don’t want to know.” Sometimes ideas arise, sometimes as fragments or images–but sometimes they’re fully formed. Whenever someone–a friend or a family member, a stranger or a shrink–asks me where my suicidal ideation originates, I answer as if they’re asking Daulton the writer where his ideas originate: “I don’t know and I don’t want to know.”

“There are many causes for a suicide,” Albert Camus wrote in The Myth of Sisyphus, “and generally the most obvious ones were not the most powerful. Rarely is suicide committed (yet the hypothesis is not excluded) through reflection. What sets off the crisis is almost always unverifiable. Newspapers often speak of ‘personal sorrows’ or of ‘incurable illness.’ These explanations are plausible. But one would have to know whether a friend of the desperate man had not that very day addressed him indifferently. He is the guilty one. For that is enough to precipitate all the rancors and all the boredom still in suspension.

“But if it is hard to fix the precise instant, the subtle step when the mind opted for death, it is easier to deduce from the act itself the consequences it implies. In a sense, and as in melodrama, killing yourself amounts to confessing. It is confessing that life is too much for you or that you do not understand it.”

We can and should object to Camus’s assertions in the above excerpt, but his inference on the act of suicide is interesting. Committing suicide, he argues, is a confession that someone either can’t handle life or they don’t understand it. It’s a narrow and, to be honest, unimaginative conclusion. It implies that every act performed by humans–despite the nature of the act–is predicated on conscious decisions. He discounts non-conscious processes that dictate so much of our experience and behavior. If consciousness is the tip of an iceberg, then the non-conscious processes are the unseen bulk of the berg, submerged far below the surface. This iceberg analogy breaks down on scrutiny, of course. If modern cognitive science has determined one thing, it’s this: we rarely have conscious access to the decisions our non-conscious processes make. In some cases, our consciousness is informed of decisions ex post facto.

Stripping humans down to unromantic and unsexy terms, we’re essentially meat machines that evolved self-awareness. Sometimes these machines are wired to malfunction or implode. Sometimes they’re wired to self-destruct or shut down their mainframe. Another principle determined by cognitive science–and discussed by philosophers for millennia–is the nature of reality itself. In a sense, reality is a product of the slabs of meat we call our brains. Everything we see and hear, touch and feel and think originates as models constructed by the meat in our skulls. When we die, we cease to be. We cease to perceive or to experience. In a sense, and as far as we’re concerned, when we die the universe dies with us. It blinks out of existence–in a subjective sense–the moment we do.

The consequences of suicide may or may not equal a confession that life is too hard or confusing or not worth living. To someone suffering suicidal depression, to someone who succeeds in committing suicide, they’re not only ending their lives. They are, for all intents and purposes, destroying the universe itself. Suicide isn’t simply a tragedy or an act of desperation or cowardice. It’s the most destructive act on a subjective level. It not only ends a life. It also destroys the universe.

Visiting hour occurred once during my stay there. They turned the dayroom into a makeshift dining room. My mother, brother, sister, and wife showed up. I had anticipated it with dread all day. Shame and embarrassment consumed me. I didn’t want them to see me like that in there. I looked and felt broken.

Seeing my family didn’t assuage my feelings of shame. They heightened it. My father had died two months earlier and my mother–still reeling from his death–assumed a vacant gaze as we spoke. No one–my wife, mother, brother, or sister–discussed the reasons for my admittance. Maybe they felt shame or embarrassment, too. We made small talk, shared anecdotes, tried to figure out the logistics of handling certain items left behind by my father.

The hour roared past us. I had felt empty for months, empty still in the psych ward, but I felt non-existent as I stood in the hallway and watched a nurse escort my family to the security doors. Emptiness defined me as I watched them slip into the hallway. As the doors closed, nothingness filled me.

I felt ashamed and foolish and heartbroken–but I didn’t cry. I don’t know why I didn’t cry. Something somewhere deep inside me told me to cry. It’s okay to cry. Crying might relieve the tension. But I didn’t do it.

As I stood in the hallway, staring at the security doors, I saw myself outside myself, as if viewing images from a camera mounted in the corner, near the ceiling. A sentient meat machine had malfunctioned. Now, he was standing in a corridor in a honeycomb of rooms in a building filled with other sentient meat machines. Like him, some had malfunctioned. Some would get better and some would get worse. Some would find happiness and some would kill themselves. Some would live for decades more and others would die within months or a handful of years.

selfportraitdaultondickey2013a

Self Portrait by the author, c. 2013

The earth would still spin. Fixed to the sun, it’d rocket through space. Sooner or later, all sentient meat machines die. The planet on which they grew and evolved would die, too. In the far future, the sun would die; it’d expand and devour the planet and everything in it, erasing it–and the history of everything on it–from the universe.

 

I spun on my heels and ambled to my room and dropped onto my cot and stared at the ceiling. Nothing means anything, I thought. Meaning is something we attach to things, actions, people. I knew I had to somehow find meaning. Find meaning again. I had to find it. Find it. What inspires me and you and everyone to map meaning to concepts or objects? I’d done it before but I didn’t know how I’d done it–the act was entirely non-conscious. Lying on that cot, staring at the ceiling, I tried to figure out how to consciously map meaning to things to such a degree that the process transfers to non-conscious, automatic actions.

I’m still trying to figure out how to do it in some cases.

8.

Years ago, as some friends and I played poker, one friend dropped his cards and, gesturing to me, said, ‘I can’t read him at all. This is fucking ridiculous.’

A strong poker face and an ability to bullshit goes a long way if you know how to use it. I plied my abilities in that ward, playing saint to everyone who worked there. I spoke in an even tone, altered my physiognomy and gait when around nurses or staff. I portrayed a character while in the Psych ward, a levelheaded and well-adjusted individual. I consciously executed a performance no one could have interpreted as reinforcing biases inherent in the situation.

Even the nurse practitioner bought it. It’s hard to articulate, but she impressed me as a woman with a finely tuned bullshit detector. It’s shameful to admit now, but I felt a sense of pride in knowing I had manipulated her–and I had unequivocally manipulated her: she had observed such progress, and such a contrast to my behavior a day ago, that she was going to let me out early. Twelve hours early, in fact.

It was December 23, 2013. I wasn’t scheduled for release until the morning of Christmas Eve. Taking the holiday and my improvement into account, she told me to expect discharge within a few hours.

Elation overwhelmed me but I didn’t drop my poker face. I reluctantly accepted the idea, assuring her I’d only go along with it if she felt it was the best move.

Of course, it wasn’t the best move. I needed help. But I was mired in shame and wanted to go home.

23376478_508313259536093_7841145397673604147_nThey loaded me with prescriptions and set up an intake appointment for a health center for people without insurance. A few hours later, my wife picked me up. Our behavior had shifted. The ride home felt awkward, strained; our conversations, contrived. Both of us wanted to discuss the situation but neither of us mentioned it. I saw it in her eyes for days–a desire to discuss he situation. But neither she nor I brought it up or explicitly discussed it.

It’s not easy to look into your spouse’s face and tell her part of you wanted to destroy the universe.

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The author, c. 2017

Daulton Dickey is a novelist, poet, and content creator currently living in Indiana with his wife and kids. He’s the author of A Peculiar Arrangement of Atoms: StoriesStill Life with Chattering Teeth and People-Shaped Things, and other storiesElegiac Machinations: an experimental novella, and Bastard Virtues, a novelRooster Republic Press will publish his latest novel, Flesh Made World, later this year. Contact him at daultondickey[at]yahoo[dot]com.

 

 

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