CHAPTER XII
Hope
Angel Starkey has had a rough time of it. The youngest of seven children, she comes from a family in which she was seldom touched or hugged; she went on to be sexually abused by the janitor in her school; she was raped when she was thirteen. “I’ve been depressed since I was like three years old,” she says. As a child, she used to lock herself in the closet under the stairs and draw tombstones on the wall. Her father died of pancreatic cancer when she was seven. At thirty-eight, “I can still hear him screaming sometimes. Like I’m laying in my bed or just sitting in my room and I hear it again and it scares the shit out of me.” Her closest friend when she was little was a neighbor who hanged herself, it was subsequently revealed, while Angel was knocking on the front door. Angel has been hospitalized more or less full-time since she finished high school seventeen years ago, with brief moves out into supervised community housing. She has a schizo-affective disorder, which means that in addition to profound depression, she has hallucinations and hears voices instructing her to destroy herself. Panic blocks her from ordinary interactions in the world. No one can even remember how many times she has attempted suicide—but since she has been in an institution for most of her adult life, she has been saved over and over again, even when she has thrown herself in front of a car. Her arms are knotty with scars from the countless slicings; a doctor told her recently that she was out of pliable flesh, and that if she kept cutting herself, there would be no way to close the wounds. On her stomach, her skin is patchworked together because she has set herself on fire so many times. She has tried to strangle herself (with plastic bags, with a shoelace, with a blood-pressure cuff)—until “my head turned purple”—and she has the marks on her neck to prove it. Her eyelids are puckered where she has held lit cigarettes to them. Her hair is thin because she pulls it out, and her teeth have partly rotted as a side effect of her medications—chronic dry mouth can lead to gingivitis. At the moment, her prescribed medications are Clozaril, 100 mg, five a day; Clozaril, 25 mg, five a day; Prilosec, 20 mg, one a day; Seroquel, 200 mg, two a day; Ditropan, 5mg, four a day; Lescol, 20 mg, one a day; BuSpar, 10 mg, six a day; Prozac, 20 mg, four a day; Neurontin, 300 mg, three per day; Topamax, 25 mg, one per day; and Cogentin, 2 mg, two per day.
I first met Angel at Norristown Hospital, the state facility I visited in Pennsylvania. She was a patient there. I was taken aback by the scarring, by the bloating her drugs caused, by the simple physical fact of her. But in a place where many eyes were as shallow as glass, she seemed to engage more. “She’s very needy,” one of her nurses told me, “but she’s also very sweet-natured. Angel is special.” Doubtless all people are special, but Angel has a moving quality of hopefulness that is extraordinary in someone with her biography. Underneath her suffering and its consequences is a warm, imaginative, and generous person, sufficiently appealing so that you are in the end distracted from the brutalized surface. Angel’s personality is obscured but not destroyed by her illness.
I was to become intimate with Angel and her patterns of self-mutilation. Her favorite implement for slicing herself is the top of a can. She once shredded her arms so badly that she required four hundred stitches. “Cutting myself is the only thing that gives me any pleasure,” she told me. When cans are not available, she has managed to uncurl the bottom of a toothpaste tube and use that to slice away ribbons of her flesh. She has done this even while she was going through a debridement—the surgical removal of devitalized tissue—for self-inflicted burns. In the small world of Norristown State Mental Hospital, “I’ve been going in and out of building fifty, the emergency center,” she told me. “I have to go in there if I cut myself. It used to be building sixteen, but now it’s building fifty. I’m living in building one, regular residential. For a break, I go to the karaoke nights in building thirty-three sometimes. I had to come into the hospital this time because I was getting these physical panic attacks constantly. And my mind wasn’t working good, you know? It was like I kept skipping; it scared me. And I had to keep running to the bathroom—it’s really weird the way my whole body reacts to just a little bit of anxiety! We went to the mall yesterday, and it was so scary. Even little stores. I had to take a bunch of Ativan and even that didn’t do it. I’m so paranoid about losing it. Yesterday I went in and out of the stores real fast and went to the bathroom about ten times. I couldn’t swallow. When I was leaving here to go there, I was afraid to go; but when it was time to come back, I was afraid to come back to the hospital.”
Physical pain has always been indispensable to her. “I tell them not to stitch me up and make it so easy,” she said. “Make it worse. It makes me feel better when it’s hard. If I’m going to feel pain, I’d rather have physical pain than emotional pain. It’s a purging thing for me when I get so worn-out I can’t breathe. Stapling is nicer than stitches because it hurts more, but it doesn’t hurt long enough. When I cut myself, I want to die—who’s going to take care of me when I’m all ripped to pieces and burnt up and everything? See, I’m not a good person.” Angel was on one-to-one supervision—no privacy even to use the bathroom—for three years in a particularly acute period. She has had times when she had to be tied to a bed. She has been held on locked wards, and she has spent her share of time in a body net—a big piece of webbing that swaddles a violent patient into total immobility. She describes that experience as unutterably terrifying. She has learned all about the medications she takes. She is an informed patient. “One more thought about Clozaril,” she said, “and I’m going to start throwing them up, you know?” She has also had extensive ECT.
During a recent stay at Norristown, Angel told me she called her mother every day and went home to stay with her a couple of weekends every month. “I love my mother more than anything in the world. Much more than I love myself, you know. It’s hard for her. Sometimes I think, she’s got seven children, maybe she could do with six. It’s not like I’d be leaving her by herself. I’ve tortured her long enough. She doesn’t need me screwing up. I hurt her with the weight, the weight, and the embarrassment. My depression, her depression, my sisters’ depression, my brothers’, you know? It’s never going to end, I don’t think, until we all die. I just wish I could get a job and give her money. They say I worry about my mom too much, but you know, she’s seventy-three years old. I go there and I clean stuff. I go home in a frenzy and clean. I’m cleaning and cleaning and cleaning and freaking out. I get fanatic about it. I like to wash things. And my mom does appreciate that.”
The first time we met, Angel was clearly tense, and the memory problems that are endemic for her as a consequence of long-term ECT (she has had thirty rounds of treatment) and high dosages of medications were particularly disabling. She would forget herself halfway through a sentence. She talked about the little comforts of her small world. “I don’t understand why people are so nice to me,” she said. “I used to hate myself so bad. I hated everything I did. God must think something of me, because, I mean, I’ve gotten hit by two cars, and I’ve cut myself until I’d emptied out all my blood, and I’m still alive. I’m ugly. I’m very heavy. I can’t—my mind’s too messed up to even think sometimes. The hospital, that’s my life, you know? The symptoms, they’re not going to just end. The depression and the feelings of loneliness.”
Acutely aware of the difficulties in our communication, she sent me, a few weeks later, a letter “to be clear.” In it she wrote, “I’ve done so many things to kill and hurt myself. Everything is getting very tiring. I don’t think I have a brain left. Sometimes if I start to cry, I’m afraid that I will never stop. I have lost and lost endlessly. There are so many people that I would love to help, even if it’s just a hug. Just that in itself makes me happy. Sometimes I write poetry. It tells me and others how sick I have been. But it shows there is Hope. love, Angel”
In the year that followed, Angel moved out of Norristown, first to an intensive assisted-care setting and then on to a less intensive setting, in Pottstown, Pennsylv
ania. For more than fourteen months, she did not cut her arms. Her catalog of medicines seemed to be working to keep the dread voices away. Before leaving Norristown, she had told me, “What really scares me is that I’m not going to be able to get it together enough, do things like shopping, and the steps, three flights of stairs. And the people too. All of it.” But she made the transition with surprising grace. “Right now,” she told me about a month after her move, “I’m doing better than I’ve ever done.” And then she just went on getting better bit by bit, acquiring a confidence she had never anticipated. She continued to hear a voice that called her name, but it was not the demonic, torturing voice she had heard before. “Mostly, I don’t have any inkling of hurting myself. It was like a compulsion. And now, I think about it, but not like it used to be. Not at all like it used to be, the way if somebody sneezed, I’d cut myself. Now I feel like I want to be around, hopefully, for the rest of my life!” she told me.
I was struck that Angel, unlike many self-destructive patients, never sought to destroy anyone else. She never hit anyone in all her years in the hospital. She described once setting herself on fire by lighting her pajamas. Then she panicked that as she burned, she might set the building aflame. “I thought of the people I’d burn up and I put myself out real fast.” She got involved with the Consumer Satisfaction Team at Norristown, the hospital’s internal advocacy group for patient rights. She went out with her doctors, terrifying though she found it, to speak at schools about what life in the hospital was like. When I came to spend time with her in her supervised housing, I observed that she was the one who taught the others how to do things: she showed them how to cook (peanut-butter-and-banana sandwiches) with an almost infinite patience. “I’ve got to live life,” she said to me. “I just so badly want to help people. And maybe in time, I’ll feel, I’ll be doing something for myself too. This woman who I’m sharing a room with now, she’s got such a good heart. When you call and she answers, doesn’t she sound like a little sweetheart? She’s got a lot of problems; she doesn’t even cook or clean. She doesn’t do much at all. But she’s sweet, you can’t be mean to her. I’ve been trying to teach her for like two months how to peel a damned cucumber, but she can’t get it.”
Angel writes poems and is a true devotee of trying to give voice to her experiences:
I wish I could cry
as easy as the sky. The tears don’t come
as easily now. They’re
stuck inside my soul.
It’s empty and I am afraid
Do you feel the emptiness? I guess
it’s my own fear from within. I should
be brave and battle that fear
but it’s a war that’s gone on
for so damned long. I’m tired.
The children are growing and the tears
in my eyes are flowing. Missing the
growth of them is like missing the seasons
change, missing the roses that bloom
in spring and missing snowflakes falling
in winter. How many more years
do I have to miss? The years won’t
stop for me or for them and why
should they? They will continue to
blossom and
bloom and my life will continue
to stand still like a silent pond.
I went to see Angel just before she moved from her supervised housing to her lower-supervision housing. She had made me a present—a birdhouse painted bright blue with a note tacked on the back that said, “Rent Due.” We went for lunch at a Chinese restaurant in the shopping mall in Pottstown. We talked about Pippin, the show she had seen the one time she traveled to New York. We talked about her application for a job, part-time, helping out with sandwiches in a deli. She had been turned down and she was crestfallen; she had been so excited by the idea of working, though she was afraid of the cash register and of having to do the arithmetic of giving people their change. “I’ve got a third-grade math level,” she confided. “It’s horrible. And a pretty short attention span too, like a three-year-old. It’s the medicines doing that I think.” We talked about her favorite book—The Catcher in the Rye. We talked about the dreams she was having. “I dream about the ocean all the time,” she said. “It’s like this room, and there’s a wall. And in back of the wall, there’s an ocean. And I can never get over on the beach in there, to the water. I struggle and struggle to get to the water, and I can’t get in it. Other times I dream about this heat. The sun is starting to burn me and my hair is getting singed. I’m afraid of the heat of the sun. You know, even in real life I try to go to places where there are no windows during sunset, when the sun turns red. It terrifies me.” We talked a little bit about the flaws in her memory. “I am godmother to one of my nieces,” she said, “but I can’t remember which one, and I’m too embarrassed to ask.”
After that, I was in and out of touch for six months, and when we next met, Angel asked me what had been going on. I told her that I had had a little bit of a relapse. It was not long after the dislocated shoulder and my third breakdown. We were back at the Chinese restaurant. Angel rearranged the wilted bok choy on her plate. “You know,” she said after a minute, “I was really worried about you. I mean, I thought you might have killed yourself or something.”
I tried to comfort her. “Well, it wasn’t really quite like that, Angel. It was horrible, but it probably wasn’t that dangerous. Or at least it turned out to be not quite that dangerous. You know, I took the Zyprexa and shifted around a bunch of stuff and they turned it around really quickly.” I smiled and spread my arms. “You see, I’m fine now.”
Angel looked up and smiled. “That’s great. I was so worried.” We both ate. Then, “I’m never going to be fine,” she said doughtily. I told her it was one step at a time, and that she was doing awfully well. I told her that she was a thousand times better than she’d been when I first met her two years earlier. I said to her, look, a year ago you couldn’t even have imagined going out and living in a place like where you’re going. “Yeah,” she said, and for a minute she was bashfully proud. “Sometimes I hate the drugs so much, but they help me.”
We got ice cream and went to a dollar store next to the restaurant. Angel bought some coffee and a few other things she needed. We got in the car to drive back to the place where she was living. “I’m really glad you came,” she said to me. “I didn’t think you’d come out here today. I hope you don’t feel like I’m dragging you out here.” I said that it was kind of exciting to see what was happening to her, and that I too was glad I’d come. “You know,” she said, “if I could only get well enough to do stuff, I’d like to go on one of the big shows, like maybe Oprah. That would be my dream.”
I asked her why she wanted to be on a talk show.
“I just want to get my message out to people,” she said as we got back in the car. “I want to tell everyone: don’t cut yourself, and don’t hurt yourself, and don’t hate yourself. You know? It’s really so important. I wish I’d known that much sooner. I want to tell everyone.” We drove for a little while in silence. “Will you try to tell people that when you write your book?” she asked me. And she laughed a little nervously.
“I’ll try to tell people just what you said,” I replied.
“Promise? It’s so important.”
“I promise.”
We went to her new place then, the lower-supervision housing, and toured around it and looked through the windows, and I climbed a flight of outdoor stairs to see the view from a terrace affixed to the back of the building. It was so different from the slightly dilapidated place where she’d been living. Recently refurbished, it looked like a hotel: each two-bedroom apartment had new wall-to-wall carpeting, a big TV, an armchair and a sofa, a fitted kitchen. “Angel, this place is pretty great,” I said, and she said, “Yeah, it’s really nice. It’s so much nicer.”
We drove back to the location she was soon to leave. We both got out of the car, and I gave Angel a long
hug. I wished her good luck, and she thanked me again for coming down to see her and told me how much my visit had meant to her. I thanked her for the birdhouse. “God, it’s cold,” she said. I got back in the car and watched her trudge slowly from the parking lot to her front door. I pulled out to go. “Good-bye, Angel,” I said, and she turned around and waved. “Remember, you promised,” she called to me as I left.
It seemed a happy picture, and it remains one in my mind—but within six months, Angel had lacerated her wrists and stomach, been returned to the hospital, and gone into intensive psychiatric care. When I drove down to see her back at Norristown, her arms were covered in volcanic-looking blood-filled blisters, because she had poured boiling coffee onto the gashes to alleviate an anxiety overflow. While we talked, she rocked back and forth in her seat. “I just don’t want to live at all,” she said over and over. I dug up every helpful remark I could think of from this book. “It won’t always be like this,” I said to her, even though I suspect that, for her, it will be like this much of the time. Heroism and light in your eyes are not sufficient in the depression business.
A schizophrenic woman kept joining our conversation, protesting that she’d killed a ladybug and not a lady and that her family had raped her because they’d misunderstood and thought it was a lady. She wanted us to set the record straight. A man with weirdly large feet kept whispering conspiracy theories in my ear. “Go away,” Angel finally yelled at them. Then she wrapped her disfigured arms around herself. “I can’t stand this,” she said, angry and miserable and abject. “I’m never going to be free of this place. I want to just bang my head against the wall until it opens up and spills, you know?”
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