Get some coffee, this’ll be a long post. Mine’s milk no sugar thanks.
My mother used to say that she’d end up
at Bellevue if we didn’t all behave
Of course, she wanted to go to Bellevue
where the world was safe, the grates familiar,
the howling not unlike her stifled sobs.
(from ‘Bellevue’ by Julia Alvarez, 2002)
There is a culture surrounding psychiatric facilities. In mainstream terms, it translates to historical and hysterical notions of stark places filled with cruel staff and demented patients. While there are certainly traces of accuracy in that (past and present), Halloween costumes and general perceptions get it incredibly wrong. A look into the subculture (that’s us) tells a whole new truth, far from utopian, but far from the horror film version too. The mainstream has no clue of the goals, populations, staff, equipment, methods or variety of psychiatric in or outpatient psych treatment and they don’t seem interested in its reality either. There’s little point in sugar coating things for the sake of battling stigma (as important as that battle is), but there’s a dearth of knowledge the size of a black hole and some people just never get it.
“Sanism,” an irrational prejudice against people with mental illness, is of the same quality and character as other irrational prejudices such as racism, sexism, homophobia, and ethnic bigotry that cause (and are reflected in) prevailing social attitudes. source
So here we are in our psychiatric subculture and I can’t help wondering if every single member of society would need to be officially diagnosed and treated for mental illness, before attitudes change at all. The other discriminatory isms seem to be alive and thriving after all. The good news is that this particular segment of society does a pretty good job of standing together; I don’t have to look further than my WordPress friends for proof.
I watched ‘Bellevue Inside Out’ the other day. It pops up at or near the top of most of the searches I do on YouTube, relating to
mental illness neurobiological disease, but I’d avoided it till then. I’m wary of psych stuff that gets comments along the lines of SHOCKING ZOMG OOOOH LOOK AT THE NUTTERS and the like. There’s a very thin line between that shit and the WOOOO SPOOKY TORMENTED GHOST tours of LUNATIC ASYLUMS OMG OMG STRAITJACKETS LOBOTOMIES NOM NOM NOM* shit. I watched the first few minutes last year and was too fragile to cope. So much pain, so much screaming, so many physical restraints. I totally missed the fact that it’s actually a very kind fly on the wall documentary, narrated calmly and without sensationalism. Here it is, a year in the life of a public psychiatric institution in New York (“an ordinary year in an extraordinary place”).
That one is 1hr16, there’s a 2hr version, which I only found after I’d watched the one above. I haven’t watched it.
Bellevue was always a zoo. Never enough rooms, never enough space for people to be waiting—and the people who were waiting were not exactly calmly sitting around until they could be interviewed. When patients came up the 29th Street ramp to the first-floor admitting area, the majority were probably brought in by the police, since severely mentally ill people don’t have the insight to know they’re severely mentally ill. So usually you’d have cops all over the place in the psych ER. (Frederick Covan) source
It did indeed look chaotic, but the proverbial order within the chaos too. Barring the prisoners and the wailing old lady, shackled hand and foot in aged metal cuffs and chains, it could easily have been the state hospital that I go to.
People who suffer from mental illness are are suffering from pain. (Cheryl)
Cheryl, who yelled that quote, in a hoarse, agonised voice, looked like a lot of muggles’** ideas of a lunatic (fuckem). Schizophrenic in a heartbreakingly treatment resistant way, she wore spectacles held together by tape and wishes and spit gathered on her lip while pain and confusion took over her eyes. Her story was the only continuous thread, because on the whole, people (and prisoners) passed swiftly through psychiatric ER on their way to wreck or recovery. It was very fucking tragic, by the end I wanted to put her on a beach with a dog to cuddle. Her spectacles became increasingly symbolic, there’s a touching scene where she’s given new ones, she looked quite panicky when asked whether her old ones, along with “the old you,” could be thrown away. We always wait and hope for a happy ending, don’t we? What happened though, was that her new glasses ended up even more fucked than the previous pair, and her previous residential home refused to take her back.
It takes a lot to get into Bellevue,” says Frederick Covan, who arrived at the hospital in 1980 and served as its chief psychologist until 1994. More accurate, it takes the absence of any alternatives. Bellevue is not for “some Upper East Side suicidal neurotic or whatever”—they’d go to NYU Medical Center next door. Our patients were the ones with no money, no resources, and multiple stressors. source
There was a dude who was brought in for yelling:
Where were you yelling?
Are you a student there?
Why were you there?
And he yelled it on repeat for 45 minutes (in a monotone) every morning:
Nothing works here. I hate this place. The medications don’t work. I’ve been here for seven years. Nothing works here.
He hadn’t been there for seven years; seven years ago, he got ill and couldn’t study psychology anymore. It would have been blackly funny if only it were fiction, but watching him enter the seclusion room, compliant and handing the nurse his glasses in a fluid motion as he did so, was desperately sad. He railed against what seemed to be a depressingly routine and regular plunge into mental pain, yet succumbed even as he rebelled by yelling.
There was the homeless guy, intelligent and refusing treatment, who left to live rough, marking his territory with his faeces. There was the annoyingly grandiose actor, the suburban husband, the pretty girl, the old one who claimed that the CIA kept zapping her, the man who said he was god… the whole spectrum of humanity in a dogeared and deaperate environment full of tough, tired and compassionate staff. Of course, the veritè part of cinèma vèritè is problematic as soon as the cameras are visible to the subjects, but the documentary felt authentic. I liked Ze’ev Levin, the South African psychiatrist (yup I’m biased) who is currently the Clinical Professor at NYU’s Department of Psychiatry. I liked the one who was utterly matter of fact about her cancer, showing no change in her attitude even as her hair was replaced by turbans. (Sadly she died in 2001.) Ultimately, the empathy I felt towards both staff and patients seems to me to demonstrate humanity’s compassion. The darker reaches of my mind suspect hidden horrors and abuses. See if you can make sense of this for example.
Are these documentaries (at least some of them) simply television’s version of the old Coney Island freak shows? They are unnerving because we are invited to peep without being proselytized. This unvarnished voyeurism doesn’t try to legitimize our prurience with a call to action. They seem to say: peeping itself can be a valuable exercise. Much of the human condition is vile (or difficult or weird). Why pretend otherwise? source
Interviewed just before the film first aired, director Maryann DeLeo had this to say:
I was amazed at the patience and continued care. So many people would return to the hospital with the same problem again and again, and [the doctors] never gave up. They told me, “Maybe this will be the time that this patient says, `Now I really want help.’ source
Made in 2001, it all seems rather dated in 2015, but realistic and relevant nonetheless. Bellevue itself is (naturally) far, far older and has a really fascinating history. In fact, it’s the oldest public hospital in the USA.
The idea of being alone in a padded cell has less psychic heft now. “Nervous breakdown” is antique. source
(‘Psychic heft’ has me picturing people with very heavy brains on their shoulders, like shot put. A fairly decent interpretation, I think.)
Bellevue has had some illustrious patients; Eugene O’Neill, Norman Mailer, Edie Sedgwick, Charlie Parker, William Borroughs, Charles Mingus, Allen Ginsburg, Mark Chapman…
It is very important to me not to be sent to some mental institution, I’m a sane man. If this happens, for the rest of my life, my work will be considered as the work of a man with a disordered mind. (Norman Mailer) source
Saul Bellow, not a patient himself, wrote the following..
To me, Bellevue was like the Bowery, it gave negative testimony. Brutal Wall Street stood for power, and the Bowery, so near it, was the accusing symbol of weakness. And so with Bellevue, where the poor and busted went … And poets like drunkards and misfits or psychopaths, like the wretched, poor or rich, sank into weakness—was that it? (Saul Bellow, Humboldt’s Gift) source
I’m very glad I watched it, but not for its voyeurism. I’ve been the person whose screaming propelled them to ER, I’ve been the person threatened with committal by the police and I’ve also been the person waiting voluntarily at a clinic late at night, desperate for help. I’m fucking lucky, I’ve never been near any physical restraints (apart from a rugby player sized dyke who threw me into a car many years ago, when I was going batshit on a pretty dangerous road in the middle of nowhere. I said thanks afterwards. I drove that road a lot back then and recently without any memory of that day until now.) I hadn’t realised it before I started writing this paragraph, but I am those people, those people are me and we’re all just human beings who have already endured more pain than most people feel in a lifetime. I intend no sensationalism at all, the memories are a heavy cannonball in my gut – or perhaps my brain is a shot put after all. My therapist asked me at my first session, how the hell I’d managed to fly under the radar and avoid the inpatient psych ward. It’s simple; lack of money, fear of public sector options, a very clenched jaw with firmly gritted teeth, solitary confusion and dread, the urge to hide and the existence of my mother. Nobody else ever stuck with me through a breakdown and I don’t bloody blame any of them. And to those of you who have trodden a less dramatically violent path, there but for the grace of whatever, right? We’re all in this together, from neurotypical to nuts.
For this is the day you know too little,
against the day when you will know too much
For you will be invincible
and vulnerable in the same breath
which is the breath of your patients.
For there will be addictions: whiskey, tobacco, love
For they will be difficult to cure
For you yourself will pass the kidney stone of pain.
For there will be days of joy
For there will be elevators of elation
and you will walk triumphantly
in purest joy
along the halls of the hospital
and say Yes to all the dark corners
where no one is listening.
(from ‘Gaudeamus Igitur’, by John Stone, 2002) Read the whole (very long and lovely) poem here.
The best solution is probably money and even that is no solution at all. If you host a severe enough psychiatric disorder in your brain, you host hell there too.
Apropos of nothing much, situational depression can kiss my ass.
* CAPSLOCK™ graciously donated by the shouty sweary Queen of Capslock herself.
** Use of the term ‘muggles’ to denote people on the neurotypical spectrum¤ thieved without conscience, from the Potterverse™.
Footnotes on footnotes
¤ Wait a minute, we’re on the neurotypical spectrum too, mugglefuckers.
Links & References
Ive listed the articles below in chronological order, from 2001/2, when the documentary was being filmed and released, to current.
Behind Closed Doors: Interview with Maryann DeLeo, director. (2001)
Critic’s notebook: Safe on the Outside (Or So You Think)
W. A. Rives, Section Head At Bellevue, Dies at 39 (2001)
A literary review at Bellevue? Believe it. (2002)
I usually Google ferociously after I watch a documentary I enjoyed and “Bellevue Inside Out” is no exception. Unfortunately I couldn’t track down any updates about the patients in the film (only the staff, which is fair enough I think), but I became completely fascinated by many, many, many other related matters. The rabbit hole was more of a rabbit warren, someone must have spiked my coffee with The Red Pill. I blame the morguewoman. So this is the shit ton of links I read, I haven’t watched the videos though – that’d be overkill, even for me.
Bellevue: Tales of Despair
Inside The Bellevue Mental Hygiene Clinic (2007)
Checkout Time at the Asylum (2008)
John Stone (obit) (2008)
A staff member’s views. (2013)
Venturing Inside Bellevue’s Psychiatric ER (podcast)
Julia Alvarez (poet)
There’s a lot more; the floods, the ebola patient, Jimmy Fallon’s finger… but enough is (more than) enough. In case you wondered, I don’t have OCD, but I am rather obsessive. No shit, Sherlock. Idk why I’m not a paid researcher. Oh yeah, fear of applying for jobs. This isn’t even comprehensive, I fought off that urge like it was demons. I read my eyes raw during this foray into stories of a faraway place, but I learned more about myself than anything else. For someone on the run from reality and mindfulness, that’s a pretty momentous event.
Ringling Brothers Circus visits the hospital in 1967.
Fireman saves life of suicidal patient, idk what year, but it’s in b&w.
2010: the psych unit of the old hospital (before moving to new premises) is a homeless shelter. Opened in 1984, it has since closed.
A close look at Bellevue’s isolation procedures.
How to transform medicine with empathy and stories (props to Danielle Ofri, attending doctor at Bellevue, for her part in it.
Also of interest:
Physicians and Writers: Oliver Sacks in conversation with Danielle Ofri.
Danielle Ofri: why doctors write.
You’ve probably already read Nelly Bly’s Ten Days in a Madhouse (she went undercover in Bellevue to investigate and then publicise the plight of its
inmates patients), but did you know that there’s a film coming out in September this year? Nope, me neither; here’s the trailer.
The startling history of Bellevue Hospital, beyond the horror stories, the last resort for the New York unwanted. (The Bowery Boys) audio
The hospital’s enduring reputation for treating alcoholics — and the less-than-glowing reputation of its psychiatric ward — were featured in the Billy Wilder film ‘The Lost Weekend‘, which won the Oscar for Best Picture.
“So, you just sit there in judgment of me. You think you can decide who is crazy and who isn’t,” he [the patient] says.
I picture myself standing on the corner of Sane and Insane directing traffic. You’re in, you’re out. Step over the invisible line and see what happens.
“Actually, that is exactly what I do here.”
Julie Holland M.D. in ‘Weekends at Bellevue’