It was a hot day in July, the summer of 2015, and I happened to be in New York. I was house-sitting for a friend, spending a week in her apartment at 145th and Broadway. It was the closest I’d been in years to the hospital that had once been my home. One morning, I decided to walk north. My best days are those that I walk the city, unfettered and directionless, and so it took me a minute to understand where I was going. We are drawn back, aren’t we? Even when we don’t mean to be and don’t want to be. The past is there, waiting for us. I walked the mile or so up Riverside Drive, until I reached my one-time address: 722 W 168th Street.
Of course nothing in this city remains as it was, and this is no exception: the building, with its grand architecture, is no longer the home of the State Psychiatric Institute. Now it is the School of Public Health.
This is where I lived, I want to say to someone, as I point up to the fifth floor. But who would care?
In the archway over the entrance, I can read the original name of the building, the Romanesque lettering etched in stone: new york state psychiatric institute + hospital. It is a vestige, for which I am grateful. I look for another: the benches out front. One stone bench etched with the Roman numeral mdccxcv, the year of the building’s founding. But it’s not there.
Just a year or so after I left for good, the State Psychiatric Institute moved into a new building, larger and grander than the original, with a walkway crossing Riverside Drive toward a second building, which looked out to the Hudson River. By then the program was defunded. No longer would anyone live there as we did.
I find the department of records. I ask a woman at the desk about the old building, the state hospital connected with the Presbyterians of Columbia University, the institute referred to as PI. She looks at me flatly, uninterested. Yes, she says. That’s the ‘old PI’.
I tell her I’d like to get copies of my medical records.
Were you an inpatient?
A long time ago.
How long ago?
Twenty years ago, I realize as I say it.
She considers, then explains the process of retrieving records. There are forms to fill out, fees to pay, permissions for release. Once this is approved, the papers will be copied. You’ll receive those copies in the mail.
I fill out the paperwork. I pay with my credit card.
It’s nearly a year later, I’ve almost forgotten, when I receive a packet of ten or fifteen pages. A summary of my stay. A stack of narratives, really. Different doctors write different summaries. Each doctor has his or her particular angle. Did I think it would be objective? No, but I hadn’t realized how subjective it would be. These character descriptions have much in common with the work of the students in my creative-writing classes. There are consistencies, recurring themes: dysthymia is used over and over again. I was told I had chronic depression, or major depression, or bipolar disorder, but dysthymia is the diagnosis that is repeated throughout the records.
I was disappointed by the stack of papers, which I put away in a drawer. On the one hand, these pages bring up the great shame I feel for the waste of those days, the extent of my abjection. At the same time, I wanted more – daily notes or details that could fill in the gaps in my notebooks, in my memory. I want the banal details. I don’t want the official language, the axis one or axis two, the list of medications and symptoms. What I want is the story of our long, dull days and years in that hospital. Those days, those years. It is the quotidian I want to recover.
Years after I was discharged, I found a photograph on the internet. It is a photograph of Allen Ginsberg from 1950, standing in front of that old building at 722 W 168th Street, near Riverside Drive. He’s been a patient there for one year. In the photo he stands next to Marilyn Monroe, who stands next to Arthur Miller.
I don’t know why I have such a clear memory of this photograph. I look for it now but can’t find it. No matter, I still see it: Marilyn Monroe leans into Miller and looks away from the camera. Ginsberg stares straight into the camera’s lens; a doctor stands on the other side of Monroe.
And one more trick of memory. I see now that the man standing next to Marilyn Monroe is Joe DiMaggio, not Arthur Miller. How I recognize him as DiMaggio I’m not certain, but I know that it is a husband who escorts her; I also know that it doesn’t matter much which – either one is viable in this photograph.
Anyway, I don’t want to talk about Allen Ginsberg, though he did dedicate Howl to Carl Solomon, the friend he met in that hospital. A friend who got shocks and a straitjacket. The way he and Solomon tried to decide if they were crazy or the doctors were crazy.
And he said something about leaving the hospital, about the self rejection, the way you’ve internalized all that you’ve been told is wrong with you; how you bring that out into the world with you. How he walked the streets after discharge, seeking validation everywhere, not finding it. How he had to get out of New York.
And if I say anything about Ginsberg and madness, I should say something about his mother, Naomi Ginsberg, whose story didn’t just begin in an institution but ended there, too. Naomi Ginsberg who was institutionalized, who was lobotomized, who died in a state hospital. If her son was the exception, the young man whose year inside led to the richness of a long life in literature, then she was the rule.
(Where It Began)
I arrived in January of 1992. New York City: all darkness and disinterest. Who the fuck cared that you arrived? Millions arrived here every day. The streets around the campus were empty, save for passing traffic, buses, the occasional bodega. Empty styrofoam cups, plastic tops, straws and McDonald’s bags floated in a wet slushy bath of ice. Piles of dog shit half frozen under the snow. A security guard informed me that my dorm was a few blocks away, on the other side of campus. I walked the long blocks, dragging a duffel bag.
My room was one in a suite, with a shared kitchen and bathroom. The floors were cold tile; the walls concrete; the only furnishings a metal twin bed, a desk and a small window with a view of a brick wall.
I dropped my bags, locked the door and walked to the deli next door.
When I returned, my suite mates were there, a triptych of young womanhood.
Hello, I said, stabbing a baked potato twice before putting it in the microwave.
Is that all you’re eating? a small chatty girl asked, giggling. I felt my body flood, and knew I’d turned bright red.
Yes, I said. I guess so.
A month later and I haven’t made a single friend. You can become strange from loneliness, from days and weeks without speaking to anyone. Occasionally someone from home will call, and I’ll pretend everything is fine. In my notebook, I chronicle my despair. Today is Valentine’s Day and David is coming into town. He asks me to meet him downtown.
On the train, I stand across from a stranger. We are close enough to make out, my face in his, but here’s the rule: no eye contact. Pretend you are not this close to someone’s humanity. Look away or at your feet but never at a face. Get off at Christopher Street, David had said. I hold my laminated Streetwise Manhattan like a prayer card. The train screeches and jerks out of the station. I smell urine and ham, rat shit and perfume. When I close my eyes I see the chickens again, dangling from their feet, moving toward me. I hear a woman cry. The train stops and starts again and again with a jerk, 72nd, 66th, my head against the green doors, red paint splattered across each, as if someone took a giant Sharpie to it. A scene from a movie: Six Weeks, the young sick ballerina collapsing on a New York subway, all possibility, all devastation.
Another train passes and I read the graffiti, big white bubble letters jumping out like demented ghosts, the words: one is you and is back legible in the splatter. one is you: I hear it over and over again, my head softly leaning against the train door. An announcement for Times Square. From one window faces speed past, and from the other more graffiti. The man next to me is only mildly threatening, in that serial killer way.
Excuse me, I ask.
He turns to look down at me, I see his sharply cut jaw.
Have we passed Christopher Street?
The train stopped so many times. How could I know?
He’s annoyed. Yes, yes I am a Midwestern idiot. No, I don’t know what I am doing here.
Look. He points to the map on the side of the train car. Now he looks me up and down, stopping at my breasts. I pull my coat tight.
23rd Street. A few more to go.
David is seated, holding the menu and shaking his leg below the table. Where were you? he hisses. This neighborhood is another world entirely. A few weeks in the city and it’s my first time leaving the environs of campus, from 116th to 120th, from Riverside Drive to Amsterdam Avenue. There was a darkness to the village, to every street. Peep shows. This was New York before the real estate investment, before Giuliani decided to sell it, to market it, before Giuliani cleaned up Times Square. This was the time of Aids, men were dying all around us, but we didn’t know. Alphabet City, which would later reach iconic status via Rent, then full of abandoned buildings, garbage floating in the water on the curb. Kathy Acker lived there, though we didn’t know. It would be a year or two before I read the way she channeled madness into artistic practice, and found the space she would open for me. Writing is like suicide, she wrote, only you don’t have to die.
David didn’t get up. I sat and he asked again what took me so long. I was overwhelmed by the gap between what I’d imagined for months, the possibility of a true connection with this man, and how I loved him. And now here he was and we were as far apart as two people could be. I heard it again: one is you. Now David is saying something I can’t understand; his face floating over the table like a fat balloon. is back. That gauzy feeling, a trap: everything could get in, no boundary between my body and the rest.
Suzy? The balloon is saying something. What was this city, another planet, a nightmare. I told is back to shut up, I told myself: the balloon is real. This is real, I said. I am in New York. I am with the man I met a year ago in Los Angeles, a foreign country. Every choice that led me here, to this place, to this moment, was now revealed to be absurd, utterly random. I had told myself it was my choice, but maybe I did just follow David here. And now here we were but we weren’t here. I couldn’t follow him, how stupid to think so.
Sorry, I said. I apologized for everything, that way of young women.
I’m really sorry I’m so late. I had trouble figuring out the train.
I didn’t tell him that I’d gotten lost coming out of the Christopher Street stop. Every street became something else, circles into circles. My Streetwise didn’t help.
Well let’s order. I’m starving! Anyway, why are you so thin?
I mean, I’m into it, he added. It’s your Jane Austen look. It’s nice! It’s good, I like it.
I read the menu. I’d never had Indian food.
Do you like dal? We should get naan with mango chutney, okay? You’ll love it, I promise. I’ll order.
The food arrived: a feast of naan, dal, curries and biryani; David ate quickly, talking while he ate, talking in between large bites, all the while explaining what he was doing at Sarah Lawrence, directing a stage adaptation of Bergman’s Persona. It wasn’t going well.The actors didn’t understand the tone. It was going to be a failure, he was sure of it.
Why aren’t you eating? He finally noticed.
I took a few bites. I tried the chutney on the bread and it was delicious, flavors I’d never tasted.
The waiter came back, asked how it was.
I can’t eat this, I said, pointing to the food in front of me.
There’s oil in it.
I leaned toward David and whispered: There are things in it. I’ve read about it.
David laughed, then looked at me like I was crazy. The waiter nodded and said he would see what he could do.
You’re insane! Who doesn’t eat OIL?
I watched David eat, samosa after samosa. I listened to his loud smacking noises, watched him shove the food down, as if in a competition.
Do you want a beer?
No, I said. I don’t drink. I’ve been reading a lot about all the poisons in food and alcohol. There’s a lot you don’t know. I’m trying to purify.
The waiter never returned. I would go home hungry that night, but it was better that way. David moved to say goodbye, a kiss on the cheek. My hair stayed in my face and I held my arms tight.
On the subway, I opened As I Lay Dying. The body as meat. The mother’s body is meat. I read the same page over and over again. That was when I learned that words are no good; that words don’t ever fit even what they are trying to say at. I heard voices, saw people, friends and family, my mother. Say it. My mother is a fish. Say it, this trap, I see it now, my life.
The next day I went to the student health center in the basement of campus, winding through tunnels to find the office. I spoke to a nurse. I explained what was happening: my hair, the poisons, the voices, the visions. The nurse said, You need to see the doctor. Dr Goldberg. She asked me to explain. I don’t know what I said. I do remember she was the first to ask me this question, the first person besides David to use the words in conversation (it wasn’t like now, with the word, the idea, the act all over the internet – back then, few people spoke of it). Dr Goldberg asked me: Do you want to kill yourself? Or did she say, Do you want to hurt yourself ? Or, Do you have thoughts of hurting yourself or someone else? Or, Do you want to commit suicide? Was that it?
Whatever it was, I said yes. It was true, and no one but David had asked. Yes, I said. I think about it all the time.
It began there, that yes, saying yes out loud to a person who seemed to care – and that first yes became an opening, the word a possibility.
She said, I’m going to give you a prescription. I want to see you in a week.
I don’t think I’d heard of Prozac before, it was still so new. There was nothing like the so-called direct-to-consumer advertising we’re so used to now. A few years later there would be books: Peter D. Kramer’s Listening to Prozac and Elizabeth Wurtzel’s Prozac Nation. And soon after, those creepy commercials. Ask your doctor if Zoloft might be right for you. Etc.
Yes, that’s where it began: that question. That prescription. The next day, or two or three days, when I didn’t sleep. I could stick with the program. The program enlarged, more to do, more hours of walking through the city, the sense of possibility.
Then one day I went to class, Death in Modern Fiction, and I heard a girl say, If you go to the health center and tell them you’re sad or whatever, they’ll give you Prozac. If you say you broke up with your boyfriend, they’ll give you Prozac. Everyone around her laughed. She was so cool, sophisticated in that raised-in-Manhattan way so foreign to me. They hand it out like candy, she said.
She was talking about me. I knew it. Now I knew that it meant nothing, that the doctor didn’t know me, she knew Prozac. It was just one more poison.
I stopped taking the pills. I was done.
But nothing stopped. Everything was so bright.
David and I spoke by phone, often for hours at a time. We spoke of suicide as a matter of course. It was what we needed to do. He grew up in the city, he’d been in analysis since high school. He hated the analyst, didn’t trust him. He had been through the whole system. All the psychiatrists suck, he told me, never trust them.
Let’s just do it, he would say, before hanging up. I’d agree. Of course, I said. We have to. I want to.
When I read the official medical records, I see that this is where the story begins. No matter what, you need a beginning. And this became mine. The narrative over and over again in these pages: the night David called me. I was at my desk studying for midterms. Reading my notes. David called, he was upset, he said he couldn’t take it anymore, it was something about his dad, his play. He was in his car, he said, the college had forced him to see a disgusting psychiatrist and he’d been saving up the pills. He stole a few bottles from his mother’s bathroom. He had enough for both of us. You want to do it, right? he asked me. I’m coming to get you now. We’ll take all of the pills. I had two bottles. We have enough, he said. I wasn’t sure. I have to study, I said. Nothing’s going to change, he said. You know that right? It’s all the same. It doesn’t matter if you study.
I said no, I can’t, maybe tomorrow I’ll do it. Not now, I said. He hung up on me.
And the day after that phone call, when I didn’t hear from David. When he didn’t answer the phone, when his roommate said no one had seen him in days, when his mother said he was at school as far as she knew, when I became sure that he was dead.
And the next day, after the exam, after I spent those hours writing in my blue books. It began when I left class, and it became clear. The screw. The faces. I knew I was shut out and it would always be this way. I would never be close to anyone and I would live in this trap for the rest of my life. David was right.
I went back to my desk that afternoon and took out the pills, two bottles, lining them up in a row, one after another – green and orange capsules stamped E 92. It meant something. Yes, I said. The space opened, the Yes.
It was as easy as this, a breaking down of all boundaries, it was David who showed me. I felt happy.
The desk was long and wooden, with a laminated plastic covering and metal legs. My books sat there, a presence. The screw. I couldn’t keep up with the program. It was there when I woke, the imperatives: do this and this then this and this do not stop you suck you will fail you are ugly you have so much to learn you are so far behind you will never succeed you will always be alone your loneliness will never be rocked you will never write the way your heroes do.
I imagined David counting the pills and I could do this too, one after the other, a row or two rows, a line or two lines, counting and it would be enough, I swallowed each row, one and another, stuffing my mouth full, swallowing until I choked. I sipped from my water bottle and lay on my bed: metal frame, thin mattress, one blanket, a crunchy pillow. I waited. I saw the faces on my wall. I could hear one or the other laughing. I heard Leonard Lopate’s voice on the radio. The window. The brick wall. I couldn’t see out but it all got in: the incessant sounds of that city: an ambulance, birds screeching, garbage trucks, shouting, car horns. I was going to vomit, I was too awake it was all taking too long. I turned into a fetal position. A loneliness that can be rocked. The great female tragedy. My mother my love. It was too late. I ate books, I could live here.
(The New York State Psychiatric Institute)
I was led onto the elevator by a nurse. I was brought to an office.This was August, 1992. I took off my shoelaces and handed over sharps: my eyeliner, pencil sharpener, a compact mirror, a spiral notebook. I met a doctor. He may or may not have asked questions. He said it would be six months. Wasn’t it three? I asked. He nodded. We’ll see, he said, it usually takes longer than that. I signed papers, I agreed to something. They were not forcing me to be there, not really, though what else would I have done? If I say now: that was the moment – I should have said no thank you, I should have walked out – it wouldn’t mean anything to the person I was then. She could not imagine leaving, she could not imagine being anywhere else.
By then I had been in the hospital for months, since that night in March. They needed me to get better and instead I got better at being sick. I got better at being a mental patient. I got better at planning my death and better at speaking to psychiatrists.
Others in the short-term ward would come and go, most older than me. They’ll keep you thirty days or until your insurance runs out, one or another would say. Then you’re cured.
It was a joke. The system was rigged and they told me so.
Still, I believed in it. It was saving me. I was lucky. I was on student insurance until I dropped out of school, and by then I was in a state hospital. Everything was free. I did not have to leave.
You sit in an office until a nurse comes to tell you, We have a bed. You walk down a hallway, pass a kitchen, a service elevator, more offices. Locked doors, vinyl couches, a television. Now your room, a bed, no door. One window of laminated glass, unbreakable. A chair. Metal bars behind the plastic. Your room. You have a bag of clothes and a bag of books. You see into the room of the girl across the hall, pink and purple bedding and stuffed animals, a poster from an Anne Rice movie. Clothes on the floor, books. She doesn’t look at you, doesn’t say hi.
I fall asleep there, thin sheets pulled over me. Sheets marked with a stamp: property of the new york state psychiatric institute. Whatever they gave me – clozapine, thorazine – has made me dizzy and sick. A nurse named Nevada walks down the hall, knocking on the wall where the door would be. Dinner! she repeats over and over, cheery robotic, too loud. It’s dark out. I don’t know what day it is, and soon enough it will mean little, days and time itself become insignificant. I have to hold the wall, walking to the dining area. Dinner trays stacked on the shelves of a silver cart.
Take one! Nevada calls from behind me. We don’t serve you here!
I take my tray and walk into the shared dining room. I can feel the cold concrete through my hospital socks. Rows of tables. A view of the Hudson River. At the back corner table I see a woman, older than the rest. She wears a long dress, unlike the others in hospital gowns or scrubs. The dress is lace, a threadbare Laura Ashley dyed black, fishnet tights and jewelry: bracelets, earrings, long beaded necklaces. When I sit alone at a table, she is the first one to greet me. Hello, she says, my name is Jennifer. Hi, I say. She looks at my tray: a scoop of mashed potatoes, slices of beef, green peas and a roll. A cup of pudding on the side. You don’t have to eat it, you know. I wasn’t planning to. Well, I get people to bring me food. You can do that, you know? There’s a refrigerator here, if you want, my husband can get you something, I’ll tell him. Whatever you need. I thanked her. Well. When you’re done eating or getting settled in you should come back and see my table. My jewelry table. I see the assortment of beads, stones, jewelry cutters. Now I notice the woman next to Jennifer, standing near, walking where she walks, always by her side, close enough to hold her.
Now a nurse named Maxine walks into the room, calls me by my full name: Suzanne. She holds a Dixie Cup filled with more pills. Suzanne? She looks around, then at me. Are you Suzanne? I say no, I’m Suzy. She replies, It says here your name is Suzanne. I say yes, but no one calls me that. It’s your name, she says, flatly. I’m not going to call you Suzy. That’s a cheerleader name.
The next day she’ll call me Suzanne and I won’t correct her. I know what your problem is, she’ll say, you think you are special. Look around you. She makes a grand sweeping gesture indicating all the sad young women in the dining room. Everyone here thinks she is special.
I make a call back home on the payphone. Get me out of this place, I say to my father, my sister. But of course it is too late. You are not ready, they tell me. You are very sick. It will take time. It gets worse before it gets better.
I lived in that hospital for three years. When I think of the other women in the hospital, I don’t think of madness, or insanity, I don’t even think of mental illness, though of course it was there, it was the story we were told and we were learning to tell about ourselves. Instead, I think of mothers. Some of these women were mothers; some had a mother; some had lost a mother. I watched these women closely, hungry to understand what I did not have.
I’m eight years old. My third-grade teacher tells me that she’ll be bringing me to the hospital after school. I love third grade: equations and parts of speech, affixes and prefixes. I love Shel Silverstein’s ‘Sick’. I love sitting in my own triangle pod with two boys named Eric Twitt and Brian Salerno. I like my teacher, Mrs Achim, with her smoker’s cough and side-eye; I like my distance from her, too. I like that she stands at the front of the classroom and that we sit in seats about the room. I like that I can be one of the crowd, not really an I.
Mrs Achim is my mom’s friend. My mom had many friends. I can see them now, a few months later: the women in the church, rows and rows of nurses in uniform.
I dread staying in the classroom after my classmates go home; I dread getting in the car with my teacher – a violation of some sacred boundary. Teacher and student. It feels wrong to be this familiar with her, to get into her brown Buick, smell her stale cigarette smoke. I look out the window as she drives past Abraham Lincoln Park, past Holy Angels Church, past the old library, past Phillips Zoo, past the American Legion headquarters, past the Healy Chapel Funeral Home. The bridge over the Fox River. We are over there, over the river, another few miles and we reach the hospital.
This hospital was built in 1888. A Queen Anne revival with twenty-five beds. Three decades later, after the Depression, a utility tycoon, politician and resident of Aurora named Ira Clifton Copley donated two million to its expansion. By the 1970s it was expanding still, each addition in a different architectural style, side by side, awkward markings of time.
We take the elevator to the second floor. My teacher carries a peace lily.
The room has a window facing west, flooded with afternoon light. There is a table full of flowers, plants, Get Well Soons everywhere. My mother is sitting up with difficulty. A nurse places a gentle hand on her back. My mother wears a scarf wrapped around her head. She was bald, I think, she would sometimes wear a wig but now just a scarf. She was no longer beautiful, or not in the way I remembered or needed her to be. The nurse held the straw to her mouth, a styrofoam cup of ice water. I stayed near the door, watched her struggle to sip. There was a moment, seconds really, before she saw me, and that was when I saw her despair. The despair of the woman in that bed, my mother in great pain, knowing that she was dying, was imprinted on me for life.
When she saw me there, she forced a smile, said my name. Everyone left the room, the nurse and my teacher, left me alone to climb into the hospital bed with her, to cry in her arms. With effort she tried to turn back into my mom, to move beyond her suffering, to be there for me. But it was too late: I’d seen her face. I knew she wasn’t that person anymore. She was leaving, her body in pain, immense pain that made no sense to me in those days, her body, my origin, was failing and taking her away from me. The mystery of her deep love for me and her simultaneous disappearance shaped my girlhood more than anything else. The early knowledge of love and death as inextricably linked.
A week later was Easter. My dad took us to church and then again to the hospital to visit my mom. When we arrived, the nurses greeted us, told us how pretty we looked in our dresses and bonnets. My dad went in first, and we stood in the doorway. Again, that pain. The horror in her eyes. Something I wasn’t supposed to see. My dad hugged her, leaning down, and when he did, she grabbed him, held him and begged, a desperate, rage-filled hiss: Get me out of this place.
Witnessing my mother’s need that day, her desperation, I surely recognized my own. Her fear was mine. I knew the depths of it, that it would never be fulfilled. I was eight years old, and I was learning that there is no end to need, no cure and no comfort. Get me out of this place.
(Something About How to Be a Woman)
Some weeks later. I’ve just turned nine years old. I’m sitting on my mother’s bed. It is as if she has been told that it will be important, to teach me this before she dies. A laundry basket on the floor. Something about how to be a woman. She lifts two socks into her hand. Show me, I say. She can hardly speak, she is so tired. I hate her for giving up. You hold it this way. Fingers at the top, two socks next to each other. I’m ashamed she’s my mother, this woman who can barely live. You hold them here, at the cuff, and then you put your thumbs inside. Like this, she says. She holds the cuffs, tries to put her fingers inside. I watch her hands, white and limp. She tries to pull the cuffs over and down, the legs through to the toes, or halfway. I hold my father’s black dress socks. I watch carefully. I watch her try: you have to keep the fingers on one hand with pressure against the sock and you have to use your thumbs to fold the top of the socks back over the fingers. You have to do that, that pressure at that moment, two hands ten fingers working together, you have to do that in order to make the socks into a ball. That pressure at that moment. She can’t do it, it’s a failure, the whole thing. There’s another way, she whispers. She folds one into the other, side by side, but this is not a ball that will remain intact. I do not want to know how to do this, that is obvious. This is not a kind of trick. She lies back now, closes her eyes, it is all too much.
(How to Be)
The philosopher Ian Hacking once described the shifting classification of the mentally ill as a ‘moving target’. A disease is recognized and named. A doctor or doctors come up with ways to treat the disease. More patients arrive with the symptoms of the named illness. More patients and more symptoms. Soon enough, there’s a cause linked to the illness.
Take, for example, hysteria: the first disease attributed to women, and first defined by Hippocrates in the fifth century bc. Hysteria was caused, or so the theory went, by the movement of the uterus throughout the body. The word means ‘wandering uterus’. As a modern physical ailment, hysteria was redefined and medicalized in the 1870s by a French doctor named Jean-Martin Charcot. Charcot identified symptoms of the disease, naming and defining and classifying it.
The ‘wastebasket’ diagnosis of hysteria remained in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders until 1980. The removal was a result of feminist activism and the emerging critical perspective on women’s health care. (In 1973, the diagnosis of ‘homosexual’ was removed from the DSM and replaced by ‘sexual orientation disturbance’. It wasn’t until 2013 that sexual orientation as a pathology was completely removed from the DSM, the result of years of pressure from LGBTQ activists.)
Ian Hacking is specifically interested in the epidemic of multiple personality disorder, or MPD as it was called when I lived in the hospital. Charcot was instrumental in naming and identifying the disease in the 1880s, but it wasn’t until the 1970s in the United States that the disease was recognized and treated by the medical establishment. Around that same time, MPD entered the public imagination. Most powerful among the representations was Sybil, the novel and subsequent television film. A ‘true story’ (as the cover of the internationally bestselling book boasted) based on a psychiatric patient named Shirley Mason. Sybil helped create the diagnosis of MPD.
In 2011, a book about Mason, her doctor and the author of the novel revealed that the diagnosis, and the accounts of early childhood abuse Mason had reported, were false. Mason had acted out the personalities as a way of giving her doctor what she wanted. She made up stories of her mother having abused and tortured her. For decades the disease was linked to childhood abuse. More and more doctors looked for this cause in presenting patients.
Of course, Mason had been an unstable, troubled young woman. At the same time, Dr Cornelia Wilbur, the doctor to whom she was entrusted and upon whom she became dependent, was eager to diagnose and cure this sensational case of multiple personality disorder. Dr Wilbur teamed up with Flora Rheta Schreiber who would publish the book. Before the book’s publication, Mason wrote to Dr Wilbur, admitting that she didn’t have multiple personalities. The doctor ignored this.
The cause of the illness mattered to the narrative structure. In the book, as in life, it was only after the doctor coaxed Mason into remembering her torture that she was cured. After revealing the secret of her mother’s abuse, she was able to integrate her sixteen personalities and live a happy life. Therapists like Wilbur found ways to define and explain the disease. By the 1970s, the presiding theory or explanation was that MPD was caused by an early trauma, most commonly physical or sexual abuse.
After the publication of Sybil there was an exponential increase in cases of MPD, which continued throughout the 1970s, 80s and well into the 1990s. It was only in 1994, and rather abruptly, that the disease was eliminated from the DSM. The diagnosis had become controversial, with many patients and families reporting that doctors had coached them into revealing ‘alters’. While the disease is said to have been ‘renamed’, it seems more accurate to say that the bizarre specificity of MPD was absorbed into the more comprehensive diagnosis of dissociative identity disorder. After a decade of explosively high numbers of reported cases, the MPD diagnosis quietly returned to its status as a rare and highly unusual syndrome.
Here was Hacking’s moving target: a patient is suffering, seeks medical help, the symptoms of that suffering are named, noted and treated, if not cured. (There was usually no expectation of a cure for MPD, as with many personality disorders.) The disease is represented in popular culture; more patients (mostly women in the case of MPD) present with these symptoms. Soon patients present with other symptoms, the disease is then reclassified to include more and more symptoms. The parameters of the illness itself adjust and expand.
When I was in the hospital, the belief in ‘recovered memories’ was at its peak. By the early 1990s, increasing numbers of patients recovered memories of childhood sexual abuse. Doctors encouraged patients to find such memories. I know that many of the women I lived with had been sexually abused, tortured or raped. I know that many had not been. I don’t know who was telling the truth, who was lying, who was creating memory through imagination and expectation. I’m sure we all did some of this.
Whether or not these things happened, it doesn’t take away from the authenticity of suffering. That was real, even if performed, or especially when performed. As Leslie Jamison put it: Pain that gets performed is still pain. It was our way of being in the world. It was a way to please the doctor, and, by extension, to receive care. It was clear enough that if the diagnosis of MPD hadn’t existed, many women in the hospital wouldn’t behave as they did, and wouldn’t have those symptoms; but that doesn’t mean they wouldn’t have other symptoms, other behaviors, other reasons to be there.
I did not ‘have’ MPD, but I do vividly recall meetings with doctors who suggested that I try to remember what I had forgotten or repressed or blocked out of my childhood. What else happened? I was asked repeatedly. Take your time, I was told, day after day. Did someone hurt you? I was asked. What about your brothers? Your father? I recall a young resident in particular pushing me to remember something about the men in my family, something that happened after my mom died. I said no. I was shy, I could not make eye contact. She was gentle, kind. Take your time. I knew if I said yes, she would be pleased. I could give her what she wanted. If I had been traumatized by my mother’s death, by the subsequent chaos and neglect of the years that followed, it was not enough. Of course, I knew that I had not been abused, not by my father or my brothers. It scares me now to imagine what would have happened had I said yes, had I created a fantasy trauma to please the doctors. They were, after all, so seductive, and I was so young and susceptible, with complete and naive trust in the authority of the medical establishment, wanting to please them, to give them what they wanted. To say yes would have been another way to perform, to be a person. It was clear, if I said yes, if I recovered a memory or two, it would explain everything: my attempts to die, my rage and my self-destruction. If I could make this admission – Tell us your secrets was the motto of the treatment plan. You are only as sick as your secrets! – then they could heal me, treat me. A kind of reward.
In the 1890s, Jean-Martin Charcot held open visits to the Salpêtrière Asylum in Paris. Doctors and health professionals, mostly men, came from all over to attend. In these public sessions or performances, Charcot would hypnotize his patients in order to produce their symptoms, tics, fits and vocal outbursts. Some women became highly sexual, touching themselves or gyrating. The women on display were mostly poor, disenfranchised. They came to the Salpêtrière for care, and there they learned to perform in order to receive that care. Some of his most famous patients performed over and over again. As Charcot’s treatment and methods became popular and celebrated, more women in France were diagnosed as hysteric.
That Charcot’s most famous patient was later revealed to be a ‘fraud’ (as in the Sybil case) seems beside the point. She was, rather, performing in a way that would get her care and attention. She was learning how to be in a historically specific time and place.
It would also miss the point for me to call my friend Jennifer a fraud. Jennifer was there when I arrived and still there when I left. She spent seven years institutionalized (and the rest of her life in halfway houses or supportive housing, which is where she was when her roommate started a fire, and pushed her into the flames). She was diagnosed with MPD, and we often witnessed her moving in and out of character. Some of her alters were more entertaining than others. (Jessa Crispin noted somewhere that for patients with MPD, one alter was always a slut. This says at least as much about what it is to be a woman as it does about pathology or madness – what Chris Kraus might call the dilemma of being female.)
It would miss the point, too, to call myself a fraud for cutting myself after I saw other girls doing it, first in college, and then in hospital, and after I saw how the girls in hospital could do it, how intense and extreme it was, how it entered my imagination – they could find a device anywhere, a loose screw or a broken bit of plastic, how then I would imagine new ways to do it, to compete, how we fed on each other that way, how we learned to be patients. I could scream or go mute, I could rage or disappear. There were things we could do and we learned how to do these things and the context made it meaningful. Is this performance theory? Is this why so many people in Germany killed themselves after reading Goethe’s The Sorrows of Young Werther in 1774? Or why so many people in Sweden filed for divorce after Scenes from a Marriage appeared on television in the 1970s? Or why I and so many girls I knew started binging and purging after reading a Judy Blume novel or watching an after-school special or reading Cosmopolitan?
I don’t want to say (or at least I don’t think I want to say) that I was not sick. But I want to say that nothing is isolated, especially not what we call pathology; that we exist in context, of the moment and of each other, that we are fragile and fluid. We learn how to be.
Photograph courtesy of the Library of Congress
Payne Whitney Psychiatric Clinic, New York Hospital, New York, USA