A Quick Trip to the Clinic
Recently a spate of personal and political hardship (impending divorce, and a healthy dosage of state repression) pushed me from what Freud calls “ordinary everyday unhappiness” to the domain of the crippling neuroses. Despite having a dependable network of reliable friends and comrades, I judged myself to be a burden to those whom I love, and decided to face the heartbreak and uncertainty on my own. Part of this was informed by a juvenile attachment to the stoic philosophy of Aurelius, Epictetus, the hellenophile Nietzsche, and co., according to which external phenomena must wash over one’s visage like waves breaking on a steadfast cliffside. Of course this metaphor, often evoked among in stoic literature, has no place for erosion. And facing down constant nervous exhaustion gives lie to the parable that what doesn’t kill one only makes one stronger; to the contrary, what didn’t kill me left me thoroughly fucked up.
I found myself sobbing uncontrollably, walking the streets with no destination, sometimes for hours at a time, even in torrential rain. Once indoors and alone I would be seized by pains in my stomach and chest inducing shortness of breath and mortal panic. I would summon to mind at once dozens of failures and shortcomings, competing with one another for primacy before becoming at last a deafening cacophonic chorus. I would picture my partner with her new lover and be overcome with grief and rage. The center of my chest became a wellspring of the most intense surges of self-destructive energy I have ever encountered with or without the aid of illicit drugs, and at times I would punch myself hard directly in the head or dig my fingernails into my hands to dull the unbearable onslaught of these hostile emotions.
Not incidentally, I have battled substance abuse for my entire adult life. I have dulled my influx of nervous energy — overflowing whatever scant outlets are available in our society for politically conscious and otherwise creative and romantic people — with booze, downers, uppers, hallucinogens, and the like, since I was old enough to get my hands on these things. Sadly enough it was during times of prolonged substance dependency that I felt myself to truly have a place in the world, as an addict. I woke up with a mission and I fucking succeeded. And being under the influence was the only time I could quiet down my mind sufficient to look at my life with detachment, admit its positive qualities, and like myself. Otherwise I was awash in self-doubt, self-hatred, and associated expressions of nastiness and hostility that continue to derail my adult relationships to this day.
Three years ago, after a decade of failed attempts at sobriety, I finally quit drinking and drugs cold turkey, without so much as a meeting. Instead I took to political organizing full time, and found comfort in the arms of the woman who would become my wife. For a time, the madness of recovery carried me through 6:30 AM yoga classes, manic explosions of writing, and tireless organizing (which, as always, gave way to tired organizing). I felt unstoppable. But about a year into sobriety I hit the plateau that any recovery addict will tell you about — the resurgence of the feelings once suppressed by drugs and booze, once the euphoria of beating addiction gives way to the banality of everyday life. This is when most relapses happen, at least according to recovery lore.
In this time I became hopelessly detached from the world around me. Falling off the wagon was not an option, but equally unpalatable was taking on the world with all senses engaged. In a very basic way I didn’t know how. I was good for a few hours each day of caffeine-fueled manic engagement — throwing myself with all engines blasting into projects, friendships, work, love. But after that I would soon burn out and need to be alone for protracted amounts of time. Of course this detachment would come at a high price: my marriage fell apart, my friends became acquaintances, my organizing work was inconsistent, and the friendships that I had forged around substance abuse revealed themselves to be baseless outside of mutually self-destructive activity.
When the bottom fell out this past week I was thoroughly unprepared to face hardship alone. I became obsessed with the thought of suicide, alternating only with the thought of just sitting down at a bar and ordering a drink. On Christmas Eve, completely alone, I attempted to enter a bar and found it closed. I will not attempt this bullshit again and expect to be so lucky. Two days later I came to the decision that it would be worse to fall off the wagon than it would be to take my own life, and that at least the latter would keep the greatest accomplishment of my life intact to the end. Seized with a surge of physical pain I was unable to bear any longer, I decided to do one or the other immediately. I didn’t feel that I could call anyone I knew except my wife, who didn’t want to hear from me and had been treating my emotional breakdown like the final burden she would ever have to bear for me (which to be fair, it surely is). I needed somewhere to go, where I could avoid killing myself or throwing away three years of sobriety. I needed a place where I could see someone besides my friends, whose pity had already worn thin and had begun to provoke my anger.
With no palatable options remaining, I dragged myself to the psychiatric emergency room at Bellevue Hospital. I even managed to not step in front of the train that took me there, and walked past some very tempting drink specials on the way. In our society what I did is considered a really smart thing to do. Everyone there told me I did the right thing.
Now, as a longtime student of Foucault, Federici, Nappalos, as a slick critic of capitalist medicine, and as a founding member of the Florence Johnston Collective, there was absolutely no reason for me to expect this experience to be anything but a total nightmare. But I needed a place to go. Anywhere. A place to not kill myself and not have a drink (or fifteen, followed by a fist fight). Is that need really so far fetched? Is it too much to expect of a hospital synonymous with mental health that there should be a sanctuary for someone having a hard time staying on the safe side of the bumpy yellow line? Even in a society as fucked up as ours, where people are treated as things and things possess the importance denied to most people, such a place should be expected. What I found was beyond my wildest imaginings.
To run the risk of hyperbole, the psychiatric emergency room at Bellevue is the innermost circle of Hell. Voluntary admissions such as myself are immediately stripped of all their belongings, including the telephone by which you can let people know where you are and that you are OK. Jail is bad enough when you know you’re going there, but being suddenly imprisoned by my own hand took my already fragile psyche by a complete “shock-and-awe” ambush attack. Within seconds I had basically surrendered myself to be a prisoner. Everything I had ever read about the grey area between psychiatric power and juridical state power, which seemed to make so much sense as words on the page, came to life in three brutal dimensions when that door shut behind me and I was greeted by not one, but four police officers. An orderly was mocking the patients loudly right in front of them, while he and his police buddies texted under a big sign saying “no cellphones”. Thick plate glass separates the waiting room from the clinic floor, where a blurry television blasted a goddamned Harry Potter marathon to a foetid room of heavily sedated patients, many handcuffed to gurneys. I stared for a solid hour at a sign that reads “Employee’s Only”; at the time it summed the whole place up for me, though I can no longer recall that line of thought.
A largely incoherent patient next to me had brought himself in voluntarily, flanked by his partner, who embarrassedly explained to the orderly that he is usually not himself for a while after he gets out of prison. The orderly aggressively hit on her and openly denigrated her partner, who was simply terrified of being locked up. He begged the orderly not to imprison him, and repeated countless times that he had brought himself in voluntarily. One doctor came out and pedantically explained to him it was totally up to him whether he stayed or went, but they were recommending that he stay. He insisted that he wanted to leave. She said they were recommending that he stay. He refused. (I thought of Zizek’s “liberal parent”, who, unable to call the rules the rules, must cajole complacency by emotional coercion even more pernicious than the decree of law.) She stared at him for a solid minute and slunk away defeated. Shortly thereafter another doctor emerged and “to be blunt” told the patient that he was being held against his will. He stammered “This is prison!” and began to panic — prison, after all, being the trigger for his emotional breakdown in the first place. She corrected him that, unlike prison, there was a set amount of time he could be held, and that after that time he could see a judge if they wanted to hold him any longer. He replied “So its prison!” No doctor of medicine or logic could defeat the reasoning of this otherwise incoherent man. He was in prison.
In my own case, I hastily clarified to the orderly that I was simply trying to avoid hitting the bottle. I made sure not to mention that I was also trying to stay off the grill of a city bus, because I knew that admission would be grounds for involuntary admittance, and while I had intended to spend the night before arriving (considering the lonely room I was staying in as a cold grave) I had quickly reversed this decision upon getting a look at — to say nothing of a whiff of — the place. I would take my chances with the misery I didn’t know.
As my three hours in the waiting room wore on, the environment became more hostile and aggressive. The orderly loudly complained about hating his work and how he couldn’t wait to punch out and get drunk. An apparently schizophrenic woman brought in for shoplifting rambled nonsense free-associatively (reminding me of a lot of chic Brooklyn poetry, actually) for two hours straight almost directly in my ear. A fat NYPD pig brought in an intoxicated and confused woman and was openly physically abusing her for no reason, despite (or because of) her being a third of his size. She complained to the doctors that he had been assaulting her all day, and she was afraid. One doctor spat impatiently “There’s nothing I can do about that.” I attempted to speak up, before realizing — based on the looks that I received — right, I’m just another crazy person. The brutal cop laughed and joked with some EMTs and the cop working the front desk, while his collar worried aloud about when he would assault her next. I began shaking, rocking back and forth, biting my fingers hard enough to leave deep imprints. I was earning unwanted looks from the doctors and the orderly. But I hadn’t been doing any of this before coming in! This place was making me crazier than I was when I showed up.
By the time they actually saw me I was a nervous wreck, bumbling through meandering sentences, choking back tears, and eventually sobbing. The triage nurse was nice enough, reflexively telling me in a somewhat annoyed tone “Don’t cry.” before correcting hastily “Oh but its OK to cry, go ahead and cry…” The doctor cajoled me to stay the night, but having seen the accommodations — gurneys lining a hallway, many patients handcuffed to them, and marginally housed and heavily medicated people filling a cramped room dominated by a broadcast of The 700 Club and smelling of human shit — I figured I’d take my chances on the outside. In my interviews with the doctors I downplayed my suicidal urges, and made myself off to be just some jilted Young Werther who probably needed to toughen up lest he be pummeled by reality. Basically I lied to get the fuck out of there. I got some meds that basically knock me out whenever I get anxious, and I’ve taken some prior to writing this and am having a hard time staying focused. After an agonizing wait, I got my person effects out of the property bags they were placed in behind a heavy locked steel door. I left and did not look back.
Once outside I immediately went ballistic. I responded, to the numerous concerned missed calls from my ex I had received while incommunicado, with unintelligible entreaties to take me back, mixed with demented invectives and accusations. I smashed my phone in a rage, only to improbably reassemble it and figure out how to call her even with a broken screen. She is a saint for not hanging up on me and going back to her new life without another thought. I raved madly and broke down crying on the street like a goddamned sap. It is a miracle of urban renewal that I wasn’t beaten or robbed while so vulnerable on the streets of NYC, or else maybe I looked too crazy to fuck with. In any case, I belonged somewhere safe. But that place was not Bellevue.
Thankfully the pills finally knocked me out and I managed to make it back to where I’m staying in time to sleep in a warm bed. I awoke in the haze in which I have remained to this moment, two days later. Whenever my heart begins to race as I process the implications of losing the love of my life under truly callous and otherwise insane circumstances, I take a pill, and become numb once more. This is a horrific way to process emotions and runs contrary to everything I cherish and valorize about the human experience, but its better than a bottle, and a lot less final than taking myself out. I have also begun to rely more on my social networks for emotional support, having to confront the masculinist aversion to others seeing my vulnerable in which I have been acculturated. It’s not easy, but as the American philosopher George Costanza says, pity is underrated. And mostly importantly, I’m still fucking sober …ish.
In this chemical fog I’m not lucid enough to etch out some great analysis or sweeping flights of prosody, and its actually quite nice to be relieved of the pressure to make every short topical essay the next 18th Brumaire. Generally I’ve been humbled by how vulnerable we all are, and have never felt less grandiose. I guess in the interest of remaining some pontificating Theory head in spite of it all, I can reach for some clever critiques and prompts for future discussion and extrapolation — something like:
1) Mental illness and criminality are hopelessly interwoven in low income health services, so that my broke ass seeking a place to not relapse was one of the only ones not handcuffed to the waiting bench. For the offense of not wanting to fall off the wagon I was placed under the guard of a police officer. The vestiges of criminality which have surrounded “madness” since the inception of confinement remain firm in low income care. This makes the battle against the criminalization of mental health a foreground of class struggle.
2) No attention is given to the setting of low income mental health care, especially the possibility that it will induce further trauma. Most mental illnesses are hopelessly bound up with the alienated conditions of life under capitalism, and a failure to recognize (or care about) this produces mental health care that replicates and even amplifies this alienation. Low incomes services are depressing enough with a little tatterdemalion window dressing, but at Bellevue, they’re not even fucking trying.
3) Under capitalism, informal social networks are not an acceptable compensation for the lack of a reliable and coherent system of care, by professionals, for working class people. This is not because it is impossible to live in a society where a vast amount of medical care is socialized (especially preventative care and affective care), but because in our contemporary world everyone is so already maligned by alienated life that it is unfair to expect all but the most privileged (either economically or in terms of an equanimical disposition) to care for you in times of serious emotional need, for a sustained amount of time, and especially when your life is on the line. There is also a place for specialization in any society, and nobody in need of brain surgery would dispute this.
4) It is only to be expected that the care workers I met, who were so callous to the patients and numb to the human misery surrounding them, should adapt this way to the hospital setting. It is an assembly line. The patients are the raw material standing between them and the time clock. A patient screaming or crying simply makes the day’s work more difficult, like a trash bag that rips on the way to the dumpster. Any care worker who allows empathy to emerge in a setting like this will quickly be steamrolled by the inhumanity of the conditions under which humans meet each other. And on a very basic level, its a dangerous job, and the patients are often assailants. So it is only expected that workers will be callous. This does not mean people are inherently callous, or that human care is not possible; only that they are impossible under capitalist medicine.
5) Addiction is a serious health problem. But so are the conditions which give rise to it. Part of the purpose of my self-indulgent personal essay above was to demonstrate that for many people addiction doesn’t start with Spring Break parties and tons of cool fun. It starts with real problems of alienation, anxiety, and in my case, being overwhelmed with surges of energy which have no healthy outlet in a society like ours. This is why addiction and recovery are not only health issues, and not only holistic bodily issues, but are also political issues.
6) The criminalization of suicidal impulses will keep suicidal people from being honest about their situation and getting the help they need. Nobody on the verge of taking their own life wants to subject themselves to a place that’s even worse than the world that is forcing them off a cliff. This is only the tip of the iceberg on the question of the criminalization of suicide (which the police can justifiably shoot and kill you to prevent you from doing), but it is as good a starting point as any.
7) As Comrade Lenin might say of my situation, “There’s drugs, and then there’s drugs.” But drugs are still just drugs. I am sober, but I am on drugs. What else is there? I know of meditation, yoga, all the vogue spirituality. I wept through a yoga class the day before (what I hope to be) the final breakdown happened. Is freedom from this kind of anxiety possible in our society? Are there individual remedies which can be effective in tandem with collective struggle? Ultimately this is a question for praxis.
In any case, no matter how I have kidded myself with macho philosophy, there comes a time when everyone, perhaps especially those who fancy themselves tough and resilient, needs a place to go to avoid serious self destruction. And this is not simply a call for “mutual aid”. There needs to be a place that’s not the living room of people dealing with their own shit (in my case, my friends all facing arrest and harassment by the NYPD). And the jail of an emergency room that makes you crazier than when you went in, which is something that most places in the US don’t even have, is no model for how to care for each other and ourselves.
In order to institute truly human relations, we must build a culture of resistance to capitalism based on strength and courage, as these are vital components of action and decisive moments. But the underside of this is providing for the vulnerability that strength and courage bring in their wake, and which definitely emerges once an upsurge of class activity has receded. We can’t forget that the horrors of our society are not something we observe from without and attack in a heroic way. They are seared into our flesh, and make us who we are. And most of all, we are humans — nothing more, nothing less.