The fresh-air cage at the asylum is small and only visible from the street if you know where to look. I used to stick my fingers through the gaps in the bars just to flex a tendon on the other side and to wonder, sometimes, if I could be seen from the street, but there are large trees between the recessed second-story terrace and the sidewalk, and the hospital’s laundry facility is directly across the way. Both block incidental sightings from the crumbly tenant neighborhood that surrounds the newer brick and stone of the Providence inpatient facility. When I’m out and happen to pass by, I’m afraid to look for it. The memory of that cage is so strong I avert my eyes, as if I might see myself standing there behind the bars and realize that my path along the street is only a bipolar delusion. In the cage, we weren’t allowed shoes and the cement collected leaves and dirt and sometimes grass clippings from the canyon winds. The nurses always said it was better than no outside time at all, but after several admissions and many outings, I came to believe that it was better to have nothing.
My last admission was my eighth, and by the end of two weeks, I declined fresh air altogether rather than smell the tart autumnal flavor of mountain ash and the high mineral scent of wet pavement without being able to walk in it. I stayed in and read or paced the hall or lay on the bed, dozing, pretending to be somewhere else. Sometimes I stayed there until dark and watched the windows go black while early snow flustered around the exterior amber lights. The mountains were just behind the flurry, and next morning—as every morning—early risers like me would get our cup-ration of coffee and sit facing the east windows to watch the sun rise through the illusory touch between snow-covered hills. Someone said, “Keep watching.” Someone said, “See how it changes.” In those quiet times, I remembered that it hadn’t always been like this. I hadn’t always been there.
I live in the town where I grew up, and there’s a beacon in the canyon that illuminates the clouds. At nights, when I was small and afraid and my parents too tired to comfort me, its rotational pulse promised that I wasn’t alone. At the asylum, I could see only its reflection on the clouds, but it reminded me that my world still existed on the other side of the shatterproof glass, although sometimes I didn’t feel sure which world I could really call mine. Time and space inside Providence had become as familiar as the world I shared with family and friends: the cold beige halls, the cold beige tables, the smell of coffee and crayons, the immediate intimacy between patients that lasted only days and our mutual amnesia should we see one another on the outside as if we had never met and the asylum was just a dream.
There are about fifty people in town with whom I share this dream, perhaps fewer. If we ever run into one another at the bank or the store, we might exchange a quick glance, a moment of recognition, but in the shared world, it’s better to be as strangers with no bridge between our common internment and a chance encounter. I live in a small town. I run into others frequently, but only one fellow patient who’s recognized me has ever tried to say hello. In addition to being mentally ill, she’s developmentally disabled, but even so, I turned away. With the rest, our connection spawns furtive silence: we know nothing; we were never there.
In Providence, patients wore scrubs, but our real nakedness wasn’t covered. Each of us knew why the other was there. One had ingested antifreeze. Another had stopped eating. That one over there, she took a bottle of pills. But it was the cameras in every corner and the monitors in the nurse’s station that provided the most obvious proof of our transparency. We undressed and were watched. We cried and were observed. Our food intake was tabulated. Our offhand remarks recorded. At night, we were measured with blood-pressure cuffs and blood-oxygen gauges to make certain our vitals indicated minimum physical health. Sometimes, to get away, I lay on the floor between the bed and the wall with a pillow over my head. That might get me fifteen minutes but soon enough I’d feel hands on my back, patting me, and a soft voice asking me if anything was wrong. Did someone hurt my feelings? Was I having unsafe thoughts? The best answer always eluded me. What I wanted was to be left alone but couldn’t say it without a notation in my chart: patient isolating. So I allowed myself to be cajoled to craft class, to paint another box, to make another collage, to sit with ten or twelve others stringing beads doing our best to pretend we were clothed.
Outside the asylum, the nakedness follows me and I feel as if I’m still being watched. Sometimes I look for cameras and wonder if, like a goiter, my illness can be seen. I take care to dress so as not to call attention to myself. I wear plain jeans, plain tees, black shoes. I always wash and comb my hair even if I’d rather tear it out. I floss. I eat a balanced diet and engage in conversations about healthy living and the importance of a good night’s sleep as if someone with a clipboard is listening to me and taking notes. While others may have angels and devils on their shoulders, my psychiatrist is on mine. She watches my thoughts. She is looking for symptoms. When I get upset or cry, she makes her voice soft and says, “It sounds like you’re unmoored.” When I get angry and want to slam a door, she sternly admonishes me to work on impulse control. She asks how I’m sleeping and she asks, when I’m anxious, do I need a little something to take the edge off? I sometimes forget that anger and anxiety are normal and that most days I’m just like everyone else. I try to pass, afraid that someone will find me out. She’s pretending to be sane, officer. Pointing at me, locking me up. I feel these things, but so far, no one has caught on, and it’s been months since I’ve had my clothes taken away to be replaced by scrubs.
Three seasons have passed since my last confinement, and the great slowing of summer has begun. The gardens are ripe and the lawns are brown. The wind is soft but the air is dry, portending fires. I watch for smoke, for a red moon floating above the canyon, and remember the season a decade ago when the sky rained embers and ash. Along the water, any water, hawthorn, tansy, and chokecherry flourish. The tansy is brightest, with dense mustard flowers and a fragrance that takes me back to dusty summers when I ran through the tall weeds stirring bees and grasshoppers with each slap of my shoe. Hawthorn has spikes that can puncture leather. Chokecherry is laden with ruby fruit. Leaves crisp in the sun, and I can smell homesteads and horses from miles away, tall grasses, smoke-dimmed stars, white sage blooming in the scrub. I belong here, there’s no question, but I’m afraid I’m jinxed. I haven’t made it through an autumn in years. I’ve lost weeks of that season, three or four months of my life, and it’s just around the corner. I wonder if it’s inevitable, or if it’s just habit that keeps me behind locked doors when the leaves begin to turn.
My psychiatrist suggested I get a Farmers’ Almanac to see when the light changed the fastest, because statistically, that’s when people with bipolar disorder run into trouble. The almanac could help me plan accordingly. Just as I could predict the best time to plant and harvest, I could predict the pitch of my moods. Old wives’ tales suggest the phase of the moon is relevant to sanity, and nurses confirmed this whenever the moon shone full through the asylum halls. They shook their heads and expelled great sighs of exasperation, awaiting eagerly the return of the waning gibbous.
Some of the orderlies were armchair astrologers and spoke of rising signs and moon signs and the myriad ways in which the stars screw with destiny. Others advocated submission to God and one nurse liked to touch my face gently and tell me I was loved. Everyone in their way promised answers and healing, but we patients languished in front of the TV watching for the third or fourth time Eat, Pray Love, Twenty-Eight Days, and A Beautiful Mind, giving to the universe our struggle for wellness, then taking meds and falling to bed in a stupor.
Under my thin blanket, I imagined myself a seed in a furrow waiting for the moon, the medications and the proper arrangement of stars creating in me a right mind, but the magic never seemed to work. My earth was fallow, barren. The Farmers’ Almanac couldn’t keep me out of the asylum; prayers couldn’t make me well. I was hospitalized four times in a single year, lost my job, and filed for bankruptcy. During the second round of that four-stay series, a nurse said God wanted me to be happy, and I told her to fuck off. If that were true, surely it could have been done by now. Maybe that was when I began to question the science—when so much of it wasn’t science at all.
During my eighth and last stay, I told the facility doctor that I didn’t think the additional medications he prescribed were working. I noticed that an hour after I took them, I’d start crying (one side effect listed on nearly every psychotropic medication is “worsening symptoms”) and couldn’t stop. It made me question not just the meds but even the accuracy of my diagnosis. I told him I’d been thinking. Before I went to a doctor and asked for help with my mood, before I was diagnosed and before I was treated, I’d never been hospitalized. But after taking medications and following a treatment plan, the hospitalizations had gradually replaced family vacations, and I only seemed to be getting worse. “Is it possible you’re wrong about me?” I asked. “Is it possible this whole thing is a mistake”? He said bipolar patients often question their treatment and described my illness as a hieroglyph of my existence, my medications a necessary sacrifice to its seminal stamp.
His poetry wooed me, such beautiful metaphor coming from a doctor’s mouth, but he’d known me for only twenty minutes a day since my admission, and I’d survived for decades without his romance. I wanted to say so. I almost did but stopped short. I had said too much already and didn’t want another notation in my chart: patient is resistant to doctor’s advice. Anyway, what did I know? I learned long ago that any opinion I held about myself and my sanity originated from an inherently unreliable witness. So I thanked him for his help, and he increased my lithium. Later, the social worker assigned to my case asked why I was questioning my treatment again. I said critical thinking was a habit I’d picked up in school. “Be careful,” he said. “That could get you into trouble.”
But things are different now. I hope they are. After I was allowed to go home, I lined up my meds on the counter, eight in all, and then threw them away. I rejected treatment in favor of my own judgment, and I haven’t taken prescriptions in months. So far, so good, in that I haven’t been back to the hospital, I haven’t tried to kill myself, and I can still pass for sane. Last night, I sat on the bank of the river with my dog and looked out across the water at a stand of cottonwoods. Their leaves glistened in the wind, fluttering green and silver as clouds and a bit of rain made patchwork of the sky. There was even a rainbow, which seemed clichéd, but I watched as it brightened then faded back into blue. It’s easy to see why people believe a rainbow is God’s apology. Its beauty seems like a magic thing or a note from heaven, when it’s really just physics breaking light into colors that are always present and embedded in each day whether or not we see them.
I’m not sure which is better. Physics speaks to me, but it seems God speaks to most everyone else. Though the asylum is a place of medicine, it was always easier to talk about God than it was about science.
On Sundays, there was a spiritual meeting led by a lay pastor. She asked us to describe our thoughts about God. I said I believed God is in the laws of physics, that there is majesty in the knowledge that I am made of the same stuff as a chair or table and that all our matter came originally from the stars. A patient growled and told me to shut up, that she was Catholic and didn’t want to hear about physics. The lay pastor asked why I couldn’t believe that God was God, and I asked why she couldn’t believe what I believed. We sat in silent impasse so I smiled and gave in. I apologized to the Catholic patient and promised to talk less. I decided I would do anything to get out even if it meant agreeing pleasantly with everything everyone said. In order to do this, I spent more time alone in bed watching through the window as another October ticked away toward winter. It would be the last time I watched autumn through the glass.
And now autumn is approaching again. Soon the leaves will start to change. Last night, as I looked across the river at the cottonwoods, I tried to imagine them in terms of gold. A vulture dipped in and out of the branches. Swallows caught flies above the water. I wanted to be there in two months’ time to see for myself whether or not the birds will have left or if they’d stay until the leaves were gone, their bodies flashing against the stark white trees, the blue of the sky, and the water that’s black in the shadows and green in the light. I stared at the river, its silence, and noticed a feather floating along the shore. My dog saw it, too, and pounced after it, trotting in the shoals, then sinking quickly to her ears as the riverbed dropped suddenly away. I jumped up and called her back. She turned toward me but the current took her downriver where the bank got steep and there was no way out. I called again and ran down the path to head her off. Forty feet down the channel I saw her in the water, dark head just above the surface, paddling patiently against the flow, waiting for me to get my shit together and come save her.
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