Loony Bins #lettersfromselvespas(t)sed

When I was admitted to Tara[1] (for the 3rd time, in 2007), I did not tell them that I had been taking the Xanor[2], simply because I did not think it was an issue. I did not realise that I was physically addicted to the drug and that I would have very, very serious withdrawals[3].

My blood pressure became dangerously high and I was exceedingly anxious. All of the time. The most disturbing symptom was that my skin, all over my body, was numb. You know when you play ‘dead man’s finger’? Or when you touch somebody else’s skin, and you can’t feel how it feels for them to feel you touching them? Well, that’s what it felt like. My whole body, when I touched it, did not respond to that touch. My face could not feel the hand touching it.

That freaked me out! And because I did not know the reason for these symptoms, I did not know how to handle them. And because the staff there did not know about the Xanor, they could not help me either. So I just became very disconnected, disassociated and thoughts of doing serious damage to myself entered my mind more and more. The staff had no option but to commit me.

Sterkfontein[4] was a nightmare. I was heavily drugged (Largactil)[5] for the transition from Tara to Sterkfontein, and upon arrival, after being cross-questioned, weighed and photographed, like a common criminal, I was yet again (heavily) drugged. As if being committed was not enough to strip me of my human right to choose, my very humanness; I had to be given very serious anti-psychotics – when I was not psychotic – and rendered even more powerless, less human, more animal, more manageable.

My cellphone, jewellery (the reason for this latter degradation was that it was ‘for my own safety from the other patients’) and all personal effects, including clothing, were stripped from me. Upon being woken from my drugged bewilderment the next morning, I was roughly bundled into a prison-type uniform (the irony of which was not lost on me) comprising of hideous navy blue sweatpants and sweatshirt with the words ‘Sterkfontein’ emblazoned on them in screaming yellow letters of search spotlight proportions. I could not even sms or phone my loved ones to tell them which ward I was in and when they could come and visit.

I felt like I had been abducted from my mother’s skirts and dropped somewhere very, very strange and very, very scary and my mother would never find me, ever again.

Auschwitz-like bath scenes where everyone was stripped, in a queue, awaiting a supervised shower; communal toothbrushes handed out after the shower; herded into a room after ridiculously early (6am) ablutions to await breakfast (7am), only to be herded into the same room after breakfast to await lunch (12pm), supper (the in itself maddening time of 5pm) and bedtime tea (8pm).

This purgatorial room was exactly what one would expect of a waiting room in hell. There was nothing in it. Nothing. Not even those sweetly-sick mental health propaganda posters so typical of government clinics and hospitals. Just chairs, four walls, you and about 50 schizophrenics. And cigarettes. This eating, herding, sitting, smoking regime fills – what an inappropriate word for what seems like a vacuum of eternity – the day. If Beckett had been institutionalised, he would have set Waiting for Godot in a mental institution.

I clung onto my toothbrush, roll-on, cigarettes and a pair of underwear that I washed each evening as the life-jackets that they really, really were. The other women had none of these luxuries, and it is no wonder that they could not regain or maintain sanity when all individuality and dignity was stripped from them.

There was no stimulation outside of the schizophrenics who, like goldfish, could not maintain enough concentration, or more to the point, sense of reality to talk to me. (This does not mean that they did not converse. They conversed alright, just with people that I could not see or hear). On approaching the nurses to request my notebook and pen, my only link with any sense of reality, I was ignored. (I later received Stephen King’s Insomnia from a visiting friend, and despite its abhorrent storyline and King’s even more abhorrent writing ability, it was my Bible, a tangible remnant, relic, symbol of reality, despite its theme being the subjectivity of reality).

The nurses – those beacons of normalcy and humanness in this foreign, surreal land – locked themselves up in their office to protect themselves from the patients and would not speak to me or even acknowledge a question or request. (Any psychologist will tell you: feeling invisible and unseen is a one-way ticket to a psychotic break, and here, in this very place where I was supposed to be avoiding psychosis and others were, supposedly, being coaxed out of theirs, we were treated with less respect and acknowledgement than a cockroach, a fly, a mosquito. At least a mosquito is acknowledged, recognised and affirmed in the act of shooing it, spraying it, killing it. We were offered no such privilege).

And all of this in the face of the knowledge that you cannot sign yourself out or get a family member to sign you out. You are there until a psychiatrist thinks you are sane. And when you’re fresh from a university education and thoughts of Foucault and Derrida float in your head and you know that ‘sanity’ and ‘normality’ outside of these walls are very tenuous – if not non-existent – concepts, let alone realities, the thought (no, deathly certainty) that you’re in there until someone within those walls declares you ‘sane’ or ‘normal’ is not very comforting. Sheer panic was a feeling I lived with each second of each minute of each hour of each day of each week of the five very, very long weeks I was there.

***

I still have post-traumatic –like flashbacks to that time. I cannot bear the smell of a burning cigarette butt because the patients were so desperate for cigarettes they smoked even the filter. But mostly, my stay there is a highly original and show-stopping anecdote over a couple of drinks.

But to myself, when the shared smiles and guffaws about my mental history lie on the table with the dregs of beer, wine and cigarette butts, I know that I survived. I overcame. And I am a better person for that stay.

***

I found a story I wrote while I was in Helen Joseph’s psychiatric ward (very similar to Joburg Gen’s[6] psych ward and Sterkfontein) and the immediacy of what I wrote that night in that ward might be more indicative of the experience of a government psych ward, as the piece about Sterkfontein was written from memory years later (yes, post-traumatic memory, and thus as-if-yesterday memory, but memory nonetheless):

‘In Phenigan’s Wake[7] (03.03.2007) *

Journal Entry from the Bed of a Psych Ward       

The difference between crazy people and normal people is not what you might think. It’s some of those things: yes, they see reality in ‘distorted’ ways; yes, they take blades, scalpels, knives, broken CDs to their wrists, throats, faces, arms, legs, breasts, genitals and stomachs; yes, they burn themselves down to the bone with cigarettes, scalding irons, boiling water, open flames; yes, they hear the voice of Jesus and answer only to the name ‘Mary’; yes, they experience life mostly as a constant and unremitting shit-storm. Yes, they experience all of these things, and that’s what makes them insane and you normal.

But the real difference between the sane and the mad is the language they speak: the sane speak English, French, Mandarin or Zulu; the crazy speak in the language of cigarettes. The societal structures, roles and conventions of the ward are much like society outside of these barred windows and doors. The power-play is just as present. Just as insidious.

The hierarchy in this place is based on two criteria. The first, from the outsider’s perspective, seems to be the most distinctive. There are those of the frothing-at-the-mouth variety who are in a constant state of legal, governmentally induced intoxication. They come off the street, their schizophrenia, paranoia and psychosis induced or triggered by Heroin, Tic, Crack, Alcohol or Marijuana. Here, their schizophrenia, paranoia and psychosis is aggravated, perpetuated and – in some cases – rendered untreatable by the ‘treatments’ of Seroquel[8], Risperdal and Lithium. (And in yet other cases – as I have personally experienced – these drugs induce or trigger some patients’ very first, and last psychotic break).

You can tell the mouth-frothers apart from the others by the look in their eyes: the glazed, dead-pan marble. They have that constant look of being perplexed. As if someone has just asked them the meaning of the universe: their mouths open, their heads down and slightly askew. They shuffle endlessly around the ward in shoes they’ve stolen from someone outside, or some unwitting and even more doped-up inmate inside. Or they walk around barefoot, their heels cracked and crusted from robotically pacing the sleekly polished ward floors.

Then there are the garden-variety of the personality disordered depressives, bipolars, failed suicides: people who are just “Taking a bit of a break, a rest, to get their medication stabilised.” You can tell them from the street-clothes they wear. They only don their pyjamas at the civilised and agreed upon hour – which in these hospitals is neither civil, nor agreed upon (supper is at 4pm, for example).

Unless they smoke, or one of them is in your section of the ward, you only see them at communal gathering times: meal times or pill times. They seem strangely incongruous here, in this place, as if they’re undercover nurses, gathering info on the other patients for the matron. They are (alarmingly) friendly, but quiet (even more alarming) and keep to themselves (most alarming of all. These were the types that scared me the most. As if they were friendly-ly, quietly and while keeping to themselves plotting to murder us all in our sleep).

There are, of course, the liminal – those that are difficult to distinguish and place in one of these two categories. You warily strike up a conversation, trying to determine whether you’re dealing with a pseudo-nurse or a psychopath. And trust me, its fucken difficult! If someone in a nuthouse tells you their name is Andrew and they’re a librarian or a fashion designer, how do you know he’s telling the truth? You don’t. There is no truth in here. The only truth, the only meaning and stability is the Brooklax-induced certainty of meds and mealtimes.

It is the second criteria for the hierarchy of this place which is the more powerful, the more insidious in the hierarchisation of the ward. It is this criterion that determines your place in the caste system. It is the same criterion as in the larger society – the haves and the havenots: those that have cigarettes, and those that don’t.

It is this 5cm cylindrical carcinogen that wields the power, regulates the ward, determines the rules. It’s the same as in prison. Cigarettes become the power tool, the bartering chip, the only intelligible language.

(It’s strange, isn’t it, this common element of cigarettes in government institutions of jails and nuthouses? I have my own little anthropological theory about that. My meds make it difficult to concentrate, think and remember, but I know my little theory had something to do with the prison and the loony-bin as microcosms of societal structure and human interaction. I remember some ingenious thought I had about cigarettes being the lowest common denominator of the unhappy, the rejected, the scapegoated. I remember thinking that Claude Levi-Strauss and Foucault would have been proud).

Upon entering the ward, it is not your name, or even your reason for being there that is important, or of any concern. It is your cigarette status:

1.      do you smoke?

2.      if so, do you have any?

3.      if so, will you give/sell – overwhelmingly option a) – them to me?

Your status is determined within seconds. And word spreads. If you’re known as a carrier, you are approached constantly, even in the middle of the night when you’re asleep (and being woken up in the dark from a drug-induced coma in an unfamiliar, threatening place by an unfamiliar, threatening nutter is not recommended to the feint of heart). Whether you say yes or no is inconsequential. They will keep asking, more so if you make the mistake of saying yes the first time you’re asked. It’s like feeding a dog off your plate one time. Just that one time. From then on, that dog will sit at your feet, staring pleadingly, then barking, sometimes ferociously, until you feed them again.

More than any sedative or mood stabiliser, it is the cigarette that determines the catatonia or paroxysms of madness in the inmates. The first rule is, do not, under any circumstances carry more than two cigarettes with you. You learn this rule within the first half an hour from one of the arse-licking pseudo-nurses. So you walk into the cramped, un-airconditioned smoking cell and you light up.

The vultures appear from their wards, as if the meal-time bell has been rung, scurry, then settle, begging you for just one cigarette. ‘Just one gwaai[9] one skyf[10] net ‘n eintjie[11] my sister just one my people are coming tomorrow and its been so hard without a smoke so hard so hard theyre coming tomorrow and Ill give you a cig sister and theyre bringing coke too and Ill give you some coke too thank you sister thank you so much they just left me here with no clothes no cigarettes but they promised theyre coming tomorrow tomorrow or the next day maybe saturday but they definitely coming sister and then Ill give you something sister godblessyou.’

Depending on your mood – or more to the point – just to shut them the fuck up, you either give them the cigarette you’re not smoking, or you break it in half so that you can get rid of two crazies at one time; or, you simply shake your head, let them watch as you smoke both, leaving them behind to fight over the smouldering butt.

Which group do I belong to? The mouth-frothers or the garden-variety pseudo-nurses?

Well, I have cigarettes. I don’t hear voices (William Burroughs’ doesn’t count. If it were Jesus’ or Alistair Crowley’s, that would be a different matter). I realise that the fact that I’m in a loony bin might be a bit incriminating in terms of my sanity status. And I know what you’re thinking. Unfortunately you’re just going to have to take my word for it.’


[1] The Tara H. Moross Centre, in Johannesburg, South Africa, is a voluntary (although you can be involuntarily admitted) private/government psychiatric hospital with separate wards specialising in Borderline Personality Disorder/Addiction/Depression/Bipolar Disorder, Child Psychiatry, Eating Disorders and Psychotic Disorders (Schizophrenia and the manic/psychotic phases of Bipolar). Up until 2008 it was the foremost psychiatric/rehabilitation clinic.

[2] Xanor (a benzodiazepine – a group of compounds having a common molecular structure and similar pharmacological activities, including antianxiety, muscle relaxing, and sedative and hypnotic effects) is prescribed in the treatment of anxiety disorders or the short-term relief of the symptoms of anxiety. Also known as Xanax, Apo-Alpraz, Novo-Alprazol, Nu-Alpraz. Xanor is highly addictive, butgrossly over-prescribed by GPs and psychiatrists. (cf. Benzo withdrawal in next footnote).

[3] Benzodiazepine withdrawal: often abbreviated to benzo withdrawal, is the cluster of symptoms which appear when a person who has taken benzodiazepines long term and has developed benzodiazepine dependence stops taking benzodiazepine drug(s) or during dosage reductions. Benzodiazepine withdrawal is similar to alcohol withdrawal syndrome and barbiturate withdrawal syndrome and can in severe cases provoke life threatening withdrawal symptoms such as seizures. The most serious side effect of benzodiazepine withdrawal is suicide. Severe and life threatening symptoms are mostly limited to abrupt or over-rapid dosage reduction from high doses. A protracted withdrawal syndrome may develop in a proportion of individuals with symptoms such as anxietyirritabilityinsomnia and sensory disturbances. In a small number of people it can be severe and resemble serious psychiatric and medical conditions such as schizophrenia and seizure disorders.

[4] Sterkfontein is a South African state psychiatric hospital in the Johannesburg area for involuntary patients and the criminally insane; patients are committed there by the state (a psychiatrist and/or judge) or by their parents/guardians. (This is where the mentally ill homeless of the Johannesburg streets are committed).

[5] Largactil, also known as Thorazine: a phenothiazine used in the form of the base or the hydrochloride salt as an antipsychoticantiemetic, and presurgical sedative, and in the treatment of intractable hiccupsacute intermittent porphyriatetanus, the manic phase of bipolar disorder, and severe behavioral problems in children.

[6] Helen Joseph and Joburg Gen (Johannesburg General, now Charlotte Maxeke General) are government hospitals in Johannesburg, South Africa with dedicated psychiatric wards.

[7] Phenigan (promethazine): an antihistamine and anti-nausea drug which, in large doses, is used as a tranquiliser in psychiatric wards, rather than Xanor and its benzodiazapene cousins, as it is non-addictive (as opposed to Xanor). It is also cheaper, hence its ubiquity in South African governmental institutions. When taken for a short period of time and in small doses (as recommended by GPs) the side-effects are mild (in non-psychotic/clinically anxious patients the most common side-effect is severe drowsiness – 1 tablet will lead to most people being knocked out for 8-10 hours of sleep. I was on 4 tablets three times a day).

[8] Seroquel (quetiapine fumarate): a dibenzothiazepine derivative, an atypical antipsychotic. Risperdal (risperidone): a benzisoxazole derivative, an antipsychotic.Lithium (lithium carbonate): a soft, highly reactive metallic element whose carbonate form is used in psychopharmacology. A go-to drug used to treat and prevent manic states in bipolar disorder. Highly transmittable through breast milk.

[9] gwaai: South African slang for a cigarette.

[10] skyf: South African slang for half of a cigarette.

[11] net ‘n eintjie: Afrikaans, meaning ‘just the end of the cigarette’.

* ‘In Phenigan’s Wake’ was published under the title ‘In Phenergan’s Wake’ in Brainstorms: Expression of Depression; Volume II.

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