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Kevin Keen’s friend has voluntarily committed herself to a mental institution for severe depression and self-harm and wonders what it means to be normal.
—
The hot summer heat had baked us into little meat pies. The late July warmth busting through the windows made the leather couch uncomfortable. A large can of Heineken and a Coors Light sat on the ashy coffee table. Nina laid on the couch, smoking a cigarette. The smell hung as heavy as the humidity. She sat up, her cut-up tee shirt revealing a patch of bandages across the chest, covered in medical tape.
“Uh, what’s that?” I asked.
“Nothing. It’s nothing,” she replied, tapped the cigarette in her ashtray, then laid back on the couch, grabbing her beer.
Nina and I knew each other through a friend of a friend, but began hanging out that May during a summer home from college. We became acclimated to each other’s presence. There were several occasions in which I would see scars across her wrists, but nothing fresh or alarming that would suggest a recent return to her nightmares.
If I was alarmed, her smile would immediately convince me otherwise. A bright set of pearly whites, the frequency in which she used them, made me wonder if the cutting or the depression may have become managed.
I knew she was in therapy, which is something we bonded over. A mutual experience of strangers sitting behind desks asking questions was something we could understand. So when she asked me to drive her to her psychiatrist’s office, a mere five minutes away from her apartment, I agreed.
We drove the five minutes and walked into a large building which contained several psychiatry offices. The inside was made to be warm and inviting. Among the things that were unashamedly bland. There were a few stand out things in this office.
The most striking thing in the office was the amount of people waiting for appointments. In previous experiences with offices of psychiatry and therapy, I had encountered maybe one or two patients at a time, where this one had nearly eight or ten at one moment. The age also varied significantly. There were children who could not have been much older than six or seven there, teens, and even the elderly.
No one was immune to the voice that starts in the back of the head and eventually works its way into the jaw; the simple, two word, two syllable sentence: help me.
***
Nor·mal adjective \ˈnȯr-məl\
: usual or ordinary : not strange
:mentally and physically healthy
Synonyms include ordinary, average, cut-and-dry, standard, run-of-the-mill, and my personal favorite, prosaic which is just a step away from Prozac.
The National Institute of Mental Health states that in America, 26.2 percent of Americans suffer from and are living with a mental illness. The best way to quantify this into real terms is to walk into a room with at least three other people in it and notice that one of you has a mental illness.
Using numbers from the 2004 Census, this roughly translates 57.7 million people in the United States alone.
In a 2010 survey, the National Hospital Discharge Survey had reported on mental patients that had inpatient (a stay at the hospital) treatment in hospitals around the United States. Of the number of patients that had been in the hospital for inpatient treatment, 1.5 million Americans were diagnosed, upon discharge, with psychoses.
The average stay for those in inpatient facilities was 7.2 days in 2010.
***
When I had been sitting in my room every night after school, the lights off, the television maybe on, my parents started to wonder. Three years later, I requested to be put on medication.
One friend said, “You don’t want to be reliant on that stuff forever, do you?”
One friend said, “Come on, you don’t need that! Just be happy!”
One friend said, “You know, I just don’t think you can’t just overcome it. Focus on the happy times, not the bad! Be optimistic.”
A doctor said, “It’s not going to be an end-all-be-all-be-happy-forever sort of thing. I just want you to know that.”
Two parents said, “Are you doing okay? We just want you to know that we love you and that a lot of people love you and care about you. We just want you to feel better, whatever that takes.”
The bottle of pills said nothing.
***
Nina’s psychiatrist stepped out of her office. I can’t remember her name, but I remember she looked good, very professional, and very tall.
“Your name is…Kevin, right?” she said.
“Yeah?”
“Nina and I are discussing some really important topics, some of this stuff involves you. Can you come in?”
“Absolutely, no problem.”
Suddenly, my face was flushed. I was transported back to a time when I was in fourth grade and I was called into the principal’s office and I walked in like I was a secret agent being called to service. I got up and turned off my music from my iPod.
The office-within-the-office-building was decorated in books. On the right wall was a giant certificate, offering proof of the psychiatrist’s service in Afghanistan. On the book shelf was a folded flag and a bunch of medals, still shiny, and lacking dust from the desert of far away.
She sat in her desk chair. Nina sat in a corner chair right next to the desk and the psychiatrist had gone into a long speech about how Nina wasn’t safe. The psychiatrist told me that Nina was cutting, that she was thinking about killing herself, and that she should not be alone in the next few hours. She handed me her card with a personal line and an immediate line to the hospital if there were any hostile situations in which Nina would do harm to herself.
And then, the psychiatrist said that Nina really needed to be in the psychiatric ward of the hospital, and that Nina had to decide over the next 24 hours or so whether or not to be committed voluntarily or involuntarily.
***
“On paper it is called being 302’d[1]. When you are 302’d, you are involuntarily committed to a psychiatric facility. She was giving me the option to avoid the 302 on paper. The difference is when you’re committed, it has a lot of negative implications as far as your future, and what you’re allowed to do and what you’re not allowed to do based on your mental history. Voluntarily committing yourself obviously comes with its own backlash, but it’s not as bad as being involuntarily committed,”
“What are some of the restrictions when you are involuntarily committed?”
“You are stripped of your right to ever own or carry a firearm. Not in all cases, but in most cases, you are stripped of your right to enter the military. And then there’s a whole host of, obviously, job situations where your mental history can come into play.”
***
Nina showed me a picture on her phone of the deep cuts on her chest. They ran roughly five to eight inches from breast to center. The cuts were deep and would certainly scar. Where there were not long cuts in the skin, there were shorter, more varied cuts into the skin.
I spent the next eight hours sitting in Nina’s apartment, monitoring. We talked at length, sometimes about the idea of going to the hospital, about family, about nothing at all. I wondered if she was going to go to the hospital and what the experience would be like for her.
I began to wonder about how someone decides in 24 hours whether or not they would go to a mental institution. Coming from where I was sitting, in that apartment, I watched Nina go silent in several cases, staring off. The cigarettes and beer wouldn’t come quick enough, and her face showed, simply, “I’m scared, and I don’t know what to do.”
The windows were still open, the cool-ish summer air wafting through the apartment. Three or four cans of Coors Light joined the one that sat open a few hours ago before the original trek to the psychiatrist’s office. In hindsight, I probably should not have let Nina drink, but I don’t think I could convince anyone with this decision on their mind to not drink a little bit.
Plus, Coors, at best, is like water.
The next day we drove back to the psychiatrist’s office. Nina had agreed to be voluntarily committed to the psychiatric ward. The psychiatrist was very reassuring, even if there had been no guarantee as to what Nina was walking into. Even so, the three of us paced the parking lot, wondering what was on the other side of the ward doors.
***
“Well, I remember walking into the hospital, and they take you into a room. They take your vitals and get a baseline of where you’re at. Then, they have someone from the ward come down and talk to you and tell you what you’re about to do. You have a whole bunch of paperwork you have to sign after that. As soon as the paperwork kind of came into play, I freaked out and said ‘Never mind, never mind, I don’t want do this. I want to leave, I just want to go home.’ And the nurse told me that that wasn’t an option, that I couldn’t leave. Like my doctor said, if I didn’t go voluntarily, I would be taken involuntarily. So when she calmed me down, I signed the paperwork. I went upstairs, they showed me my room. They gave me a layout of where everything was and when we would have group and things of that nature. And in my first moments, I remember just being in my room, very weary of the people there. I didn’t know what I was dealing with. Then, obviously, being in a psyche ward you kinda have to be aware of the people you’re around, so I kept to myself and spent my first moments alone.”
“So, did you have any sort of expectations going in?”
“I don’t really remember what I was really expecting. As someone that suffers from panic issues, being restricted from going anywhere outside of the ward, including getting fresh air, being confined to a small amount of space, I knew that was really going to affect me greatly. I knew to expect a lot of panic, and a lot claustrophobia and things like that. In regards to the people that were there, I was expecting pretty crazy people. I certainly wasn’t expecting people that I would become very good friends with.”
“What kind of people were in the ward?”
“If I can remember correctly, it was mostly people that tried to kill themselves. You would be hard pressed to find a single human being on this earth who thought about ending their life. Even if it’s a passing thought, all it takes is that extra thought, that extra push, to send you over the edge. So it was mostly younger people who tried to commit suicide.”
“So it was mostly younger people?”
“Actually kind of split into very young and very old. The younger crowd was mostly people who tried to commit suicide. One person I met, ‘James’, had tried to kill his step father, and that’s why he was in there. There was an older woman that had voluntarily committed herself, because she had expressed that if she did not immediately go to the hospital that she was going to kill her husband. I was actually, from what I could gather, the only person at the time out of about maybe 10 of us that struggled with self-harm. I didn’t really think that anyone else had that issue in there. There were a lot of drinkers, but nobody that was rocking back and forth and talking to themselves. We would think they were all coherent. We would sit together in the common area and watch TV and laugh about NCIS and everyone was pretty much completely coherent.”
***
The ward hallway was long and filled with lockers on the left and right sides. The receptionist down the stairs on the first floor of the hospital notified those on the ward that I was coming up to see Nina. I locked my iPod, phone, and wallet in the lockers. In hindsight, I should have left my keys in there, with the fake key pocket knife attached. I took a deep breath and stepped through the doors.
Immediately, Nina met me at the door and hugged me tightly. To my right, there was a room that I would come to learn was the common room. Several rooms straight ahead of the entryway were where patients stayed. Those doors remained unsurprisingly closed. The area was quiet and peaceful.
Upon further inspection, there was another room that was just chairs and a table used for group therapy, a living room, and kitchenette. The only difference, really, between the furnished, borderline cozy ward and the average YMCA was the giant glass nurse’s station. Nurses came in and out of the station, roamed around the area, checking on patients, checking their vital signs.
“I can’t even smoke,” Nina said. “They gave me this patch,” she lifted her sleeve to reveal a nicotine patch, “which doesn’t do anything.”
I arrived with sweatpants and several other items from Nina’s apartment. The sweatpants were immediately de-laced.
“You’re not allowed to have laces?” I asked
“No. You can use them to hang yourself,” Nina replied.
A nurse walked by with tie-on scrubs. She wasn’t happy with me when I asked why she was wearing tie on scrubs and seemed to be even more put off when I suggested that someone could forcefully take them if they wanted to.
We watched television and ate junk food. Several other patients, which Nina would convey to me later that had tried to kill themselves, came and sat down. They watched television with us, talked with us like every day individuals.
I don’t know what I was expecting but I knew what I saw on television and movies. I pictured Jack Nicholson in ‘One Flew Over the Cuckoo’s Nest,’ in group, making an ass out of himself, Nurse Ratched delivering medication to mental patient. And really, what do we know about mental facilities other than Hollywood horror movies and movies like ‘One Flew Over the Cuckoo’s Nest’ and ‘It’s Kind of a Funny Story’?
But, these were not only people that were friendly, they were people that I felt I could get to know if we had more time together. But more importantly, they were still people. In fact, if a director from Hollywood came into an actual ward, he might find himself hard-pressed to make a decent movie out of the footage.
It was nothing like I would have ever guessed it would have been. Not only was the ward nice, but it was somewhere I would want to stay. No worries, no cares, and someone to listen to you whenever and about whatever you would want to talk about.
***
Nor·mal adjective \ˈnȯr-məl\
: usual or ordinary : not strange
:mentally and physically healthy
One in four Americans suffers from a mental illness. Normal is still defined as someone that is not only physically well but mentally well. The amount of those that are living with a mental illness that is reported is growing and engulfing the suspected “normal” group.
And yet, there are questions about those that attend therapy, those that take medication, and those that attend inpatient programs in hospitals over the United States. For an example, is someone that has attended therapy considered mentally ill? Probably not. Or what about someone that has taken medication, bus is no longer using it because they’re better? Again, probably not.
Are those that are seeking treatment or that have once sought treatment unfit to hold specific jobs? Or should they be kept on a list with the federal government, a searchable database, similar to criminals?
What happens when mental illness becomes normal?
***
“I think people are afraid of what they don’t understand. I think that’s really what it really comes down to. Humans are very afraid of the unknown, especially when it comes to things that are already very unstable and unbalanced. When you look at them from the outside, you just have no idea what to expect, and you are very weary of it. When people don’t understand things, they put them in boxes. And the boxes they choose for the mentally ill are negative, just because they don’t understand them.”
[1] This is purely Pennsylvania state law only. The number or regulation may be different in different states. If one is 302’d, they are given a 120 hour time limit to keep the patient in the care of a psychiatric facility, unless a petition is filed, at which a petitioner may appeal for a longer time limit, which, still, can be no longer than 20 days. More information can be found here: http://www.pitt.edu/~kconover/ftp/302-text.pdf
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