Is it logical to imagine that psychotic self-evaluations are cogent? The notion that we choose death over pain, fundamental to our current thinking on suicide, suggests that we choose at all, as if some part of us exists outside the illness, unaffected, taking in the situation and making rational decisions. A fickle person might say, on some Saturday night, “Part of me wants to go to the party, but part of me wants to stay home.” What are these parts, and where are they to be found? When I was sick in the hospital, there was no deciding on much besides how best to lie on the sofa, which side of my body to rest on, how to tuck and arrange the black canvas bag against the sofa arm, and whether to face the light or turn inward and press my face against the cushion. Asking for extra meds was never a decision or a choice. It was something that I did in order to stop shaking, to feel a little safe. I curled up or stretched out on the common-room sofa, but in every position, I felt panic. Where could I run? Where was I safe? I was trapped in the wrong hospital, I thought, but I took my meds, and waited and waited. I waited for nortriptyline to work, and after that I waited for ECT to work. I waited for dinner or fresh air or a minute of sleep. When I came too quickly toward my doctor, when, that day at the Institute nurses’ station, I charged forward and demanded that I be moved to another hospital, I was really only trying to talk to him, wasn’t I?
They drank and drank, my mom and dad. They drank through the night. I can see them, sitting in chairs with their cigarettes piling up in ashtrays beside them. She’s in the living room. He’s in the kitchen, pouring another martini. It’s late. The house is filled with cigarette smoke. The lights are out. My mother has been howling, screaming. Now she has her legs stretched out on an ottoman. Her toes curl and straighten, curl and straighten; it’s a tic. Soon she will pass out, but not yet. She has more cigarettes. She has more condemnations for my father, and even for me. “You can have a say around here when you pay rent!” she shouts. I am thirteen, fourteen, fifteen. She inhales from her cigarette. It flares, briefly lighting her face. She is haggard and gray. Her hair is wild. Her speech is slurry and hard to understand. She calls my father a motherfucker and a shit. She has at him for his affairs. He rarely defends himself. He laughs her off, goes to the kitchen, and opens the freezer for more gin. He tells Terry and me that our mother is just tired. “She needs rest,” he says. “She works so hard.” Our mother never struck my sister, but she struck me. On a very bad night, she might charge into my room with her arm raised. There were no hugs in our family; no hello or goodbye kisses on the cheek. I never saw my father put his arm around my mother’s shoulders or her waist. He gave her nice things for Christmas, but it infuriated her, as it might you or me.
Vocal constriction may be a symptom of suicidal illness. We all know the worrisome sound of the sick. The suicide’s distress may be audible. We might shriek. As heart and pulmonary distress increase, our fear may grow constant, and our posture droops, but we’re not merely lazy or weak; we feel that we are under a crushing weight—we can’t stand straight, except through exertion. Our muscles may tremble, and our joints might become inflamed. We may become short of breath. We don’t yawn, or we yawn all the time. But our fatigue is nothing like the tiredness that follows a busy day. When we panic, our hearts beat faster and then faster, until we are gasping. We feel cold, and may even evacuate our bowels. Our bodies might be saturated with adrenalin and cortisol, two hormones associated with the fight-or-flight response. Confronted with a threat, do we run or do we defend ourselves? In deep illness, we can neither fight nor flee. We are not facing a wild animal or an assaulter. But there is nonetheless great threat. Maybe the threat will come in the mailbox, or on a phone call, or during a meeting or an appointment, some terrifying outing. The threat might be a car backfiring, or a view from a height, or other people, and so we don’t step outside the house, or leave our bedrooms, or pick up the phone.
The illness itself is the threat. We might pace or sit motionless, afraid to move, unable to move. Don’t touch me, we might say. Are we playing dead? Are we paralyzed with everlasting fear? When I was sick, I felt that my body was poisoned and poisonous, and I felt that this poison had invaded every cell. I felt the poison as aching and burning. I couldn’t change my thoughts or lessen my pain. I believed that I saw the world and my situation clearly, that my thinking was good. Lying on the living room floor, on the tarp, with the knife and the pills, I had the sense that I was drying out, collapsing from within. I felt poisoned in my gut and my brain, and on the surface of my skin.
What is psychotic rumination? We may say that we are spinning and spiraling. Or that we are cycling, or in a loop; our thoughts, we say, are intrusive, inescapable—bad imaginings that we try and try again not to have, to see. Or can rumination be imagined as something concrete and organic, like alcoholic perseveration, the drunk’s fixations and repetitions? Whatever they seem to be about, are suicidal ruminations ideas about dying, or do they describe a natural history, straightforward symptoms of a fatal disease that requires the hand? Does the suicide have ideas about death, or might the ideation in fact belong to all of us, to you and me, society’s collective fears and beliefs about suicide and the sick individual? Why do people “kill themselves?” we wonder, grammatically imparting will in dying. My drunk father said about my drunk mother, “She’s tired, she’s tired,” and then insisted on his love for my sister and me, after which he sat into the night in his underwear, weeping in the dark. Alcoholics repeat themselves, say the same irrational things over and over, but we do not call alcoholic perseveration intrusive thought or ideation. We politely say that alcoholics like to drink, or that they drink too much, or that they should stop. In the nineteenth and early twentieth century, before AA, during the temperance movement, alcoholism and its effects on the body and society were blamed on temptation, preference, and irreligion, not addiction. No alcoholic ever got sober from shame, and no suicide gets well from prejudice or pity.
After I left the hospital, friends joked that I was crazy, and I laughed along. Some suggested that a psychiatric history might enhance my literary reputation. Had you met me then, I might have cracked that I’d had “a lot of ECT,” in order to make comedy of my difficulty finding words or remembering names, as if it were my responsibility to make others comfortable with my new disability. I was thirty pounds heavier, and then more. I haunted department stores, getting to know imported brands that I sometimes bought on sale, wool and silk to hide my body. My mother was a textile artist and fashion conservator. She’d studied tailoring in the 1950s, and built a suit for my father in the seventies. Years later, in the nineties, she promised to make me one, but I guess we forgot about it. I felt communion with her on the sales floors, pulling hangers off racks and putting them back.
Once every month or so, Christa drove to Brooklyn. Sometimes she told me that she wanted to marry me. She promised that she’d be a good partner. She wanted children. She was underweight, had circles around her eyes, and cried over the loss of her sister. She came up the stairs breathless from the climb. It was the spring of 2007, and then summer. Little by little, we began a relationship. I cooked for her, and she told stories of her divorce. We drove around in her car, and had picnics in the park. Was she in danger of suicide? Caretaking was reassuring to me. When I’d been sick, I’d been afraid of poverty, sure of it coming, but it turned out that there was enough in the bank to last awhile, money from The Afterlife, and for an unfinished novel that seemed, after everything that had happened, irrelevant. The novel concerned a family living on a hilltop in the south, someplace resembling the Blue Ridge Mountains in Virginia. The father is an autodidact T. S. Eliot scholar, and, in a basement workshop full of leather and lasts, makes special shoes for the mother. The shoes are too tight. They’re made that way on purpose. The shoes are designed to make the mother stop drinking. Upstairs, the sister lies in a bed covered with stuffed animals. She breathes through an oxygen tank. A sorceress with a magic parsnip lives in a trailer on the mountainside; and a vete
rinary doctor treats the narrator for his problems of living. That’s about as far as I got. Was writing over? I didn’t try for a long time.
Psychotic people almost always disavow suicide, believing without ambivalence in the need for secrecy. We may believe that our worldview is the correct one. We do this even when we are close to dying. We do this in horrible pain. Is suicide our refuge? I couldn’t imagine, sitting before the doctors in the Institute dining room, that day in the summer of 2006, that I was psychotic, even though I’d nearly dropped from the fire escape, and had been in anguish in the hospital, and had seen my face disfigured in the bathroom mirror. “You’re psychotic,” the head ECT doctor told me, that morning in the ward dining room. She said, “You’re sick,” and I cried that I wasn’t, not in the way she meant. It was only that I’d ruined everything, would lose everyone, no matter what she said, or what the others holding clipboards scribbled down. I was crying, and then wailing. The tears ran down my face. I’d been condemned, and would be branded, marked deficient, and discarded by everyone, friends and colleagues and the people I might one day meet.
Those fears and certainties were with me a long time before I got so sick, though only intermittently and less floridly. They’d been my fears since I was a child, and they have shaped my life. To the sick, fears are perceptions of reality. There is discrimination that we see, or should see, like unequal salaries for women and people of color, and there is discrimination that we don’t see. We might not immediately feel the wariness of others, or notice the slow dwindling of invitations and social opportunities, or understand the denial of promotions at work. Groups that suffer discrimination, ethnic minorities, people of color, and persecuted religious congregations, can nonetheless make communities and traditions, however dangerous this might be. Coherent bonding is difficult for those of us who “lose our minds.” For us, the loss of community is a symptom of an illness that only grows as personal isolation intensifies. After I left the hospital, people looked at me with skepticism, and stood at a slight angle, as if objectively appraising me. In conversations, my partners leaned backward rather than forward. Was it safe? Was I safe? Maybe my friends were worried that I’d flip out. Small talk was an ordeal. Misunderstandings were common. There was the time when I was on the phone to an old friend, Jo, in New Hampshire. “That makes me want to jump out the window,” I said about something or other. It was a provocative remark, but not a threat. But how was my friend to know this? I said, “That makes me want to jump out the window,” and then my phone battery died, and a short while later, two police cars screeched up the street. I heard their car doors slamming. I was in my underwear. The buzzer rang, and I pulled on my pants and let in the cops, who charged up the stairs and banged on the apartment door. “Hang on, I’m getting dressed,” I shouted. My pants were unbuttoned. There were four policemen. They came into the apartment. I buttoned my pants, got my phone and my keys, and then the police handcuffed and walked me down the stairs. A policeman put his hand on my head and eased me into the back seat of his squad car. At the hospital, another policeman unlocked my right hand from the handcuffs, and then fixed that cuff around a metal railing on the wall. I said that I was a writer, but the doctors weren’t impressed. I asked if they’d tried any of the numbers on my phone. Had they called Jo? An older doctor was in and out, and younger ones, the residents, came to ask questions. I told them my history, but added that I was all right, that today had been a misunderstanding. Four hours later, I was allowed to go.
Jo was afraid to talk to me. She thought that I would scold her. I told her that she’d done the right thing, and that the cops and the hospital had too, that no one got hurt. My friend had had reason to worry for me. She protected me. But her worry, and that of others, effectively compounded my own, as if I were being reminded that I was sick. I pretended that my life was in order, and, in 2008, went off my medications. My doctor resisted, but I told her that I felt better without the meds. And, for a while, I did. I tried riding my bike, but was awkward and unbalanced, and couldn’t get up hills. I preferred sitting on benches. I wrote a story about a man in a failing marriage, who, after discovering that his bank account is empty and his credit cards canceled, runs from a florist’s shop with a bouquet of stolen flowers for his alcoholic wife. What did I know about husbands and wives? It felt good to write, but the feeling didn’t last. Christa came and went, and I taught workshops in writing. I told my students that each of them had stories that no one else in the world could tell. I told them that it didn’t matter where they came from, or from what kind of people. I suggested that trauma informs all our writing, and told them to describe the world, so that they and their readers could see, and to write their characters’ predicaments as realities. I told my students that their solitude in writing need not become loneliness in life. But I felt treacherous, as if my teaching would lead them into danger.
In 2009, just days before Christmas, in the Madrid airport, my father died. He and my stepmother were on their way to Venice. My father fell asleep and didn’t wake up. My stepmother’s voice on the phone was a scream. His head had been resting on her shoulder. She’d felt his breathing stop. It was his heart. The medics tried but failed to revive him. My stepmother was alone, and the body needed to be sent to America. I remember my father’s face, his grin, and the warm and affectionate look in his eyes when he took his first drink of the night.
It’s illogical to think that the suicide wants to die. We say that we do, but do we? I believe that we can reverse our thinking about the suicide’s apparent desires and intentions, and follow an opposite thread; we can consider that the suicide wants to live, and begin to think more concretely, rather than scratch our heads about what causes suicide. Ruminations on dying might seem less like fantasies or wishes. Our claims of our worthlessness might be heard as disease markers rather than sentimental pleas. Do we imagine the pain in our bodies, or are our bodies, flooded with stress hormones, sleep-deprived, motor functioning failing, in a kind of toxic shock? Is rumination a form of isolation? Are our plans for dying forestallments of dying? I have a friend who saved prescription pills for two years. She lived in Greenwich Village, on a high floor of a large apartment building. Her father had raped her when she was two. She never thought of the window, and never swallowed the pills. She told me that collecting them comforted her. She is alive now.
Was my friend trying to die? Have you tried to die? Have you found how difficult it is? Maybe you’ve stayed alive for months, or years, and gone to therapists, and tried medications. Maybe you’ve been in a hospital already, maybe more than once; maybe you admit and discharge, admit and discharge. Your friends know the sound of your voice when you’re not well, and ask if you’re all right. Do you say that it’s a hard day? Are there friends to tell? Do you move about the house like an invalid, not dressing or picking things up off the floor, not eating or reading the mail? Do you sit without moving, your muscles tight? Is this fight-or-flight, or is it a fear that we feel more deeply than that, older in our history, the anxiety not of the threatened animal but of the dying animal? Helplessness is perpetual for the suicide, a chronic condition, and makes a new sort of everyday life.
For the suicide, these are material concerns, not musings. In late 2010, Christa told me that she had met another man. It was sudden news, and winter was coming. Soon it would be Christmas. My father had been dead a year. I was in grief, and then terror. Almost immediately, the symptoms that I had felt in the spring of 2006 returned. I lay in bed at night, awake in the dark, scared of the dark. I felt my heart pounding. I couldn’t eat. Every night, I was afraid of going to bed. I took Ativan. I stopped sleeping. Dying felt close again. The pressure in my chest returned. I felt that my anxiety had somehow moved to a place deep in my body, had become a hum, a vibration. I walked around the city without knowing where I was. This happened in places with which I was familiar. It happened in my own neighborhood. Sometimes, I had to look up at the street signs, and then ponder over the direction th
at I should take to get home. I rode in cabs, and came upstairs to my apartment and sat and trembled. After a month of this, I told Dr. T that I needed to hospitalize again. Dr. T wanted to know whether I was having a fantasy of care, a desire for someone to watch over me. Did I really need the hospital again? I told her that I must admit, that I knew this from the symptoms that I was feeling, so like those that I’d felt before. She arranged for a bed. I called a car and rode up the West Side Highway, just as I had in 2006. The Hudson was to the left, and the city to the right.
It was November. I thought that I might have ECT and then go home. Instead, I spent another four-month period as a patient, first at Columbia Presbyterian, and then back at the Institute. But it wasn’t like before. I had thirty-seven rounds. There was no euphoria this time, no steady improvement, no turnaround. I lay on the operating table, weeping over Christa. I urged my fellow patients toward ECT, and then watched them go home. I thought about sharp objects, and pictured myself bleeding, or hanging from a knotted sheet. The nurses kept me company on walks through the halls, like in the old days. I asked them who would ever want me. Who could accept me? “Look at me,” I said. I begged for reassurances, and they told me that I was loved, and that people needed me to survive and live a good life, and that the doctors would never give up. I would get better, they said. At night, before my medicated sleep, I read the poems of Robert Lowell, who writes of his own times in psychiatric hospitals.
One Friday in April Page 8
