Ashes and Boxes (Welcome to the unit, p. 5)

Your impressions of mental institutions were not always good ones, and the following knowledge doesn’t help: for years, mental hospitals were known for treating a wide array of conditions, often without nuance to the particulars. Treatments sometimes involved older, more harmful versions of EST (electro shock therapy), as well as the lobotomy, a cruel procedure that essentially removes human personality by damaging the the brain’s internal communication routes. This nightmare was performed, rather inelegantly, by ramming a sharp metal rod into someone’s brain until the desired affect was intended. Say goodbye to all practical uses of the prefrontal cortex, kids!

And here you are, complaining that staffing issues cut your time short by the waterfall.

The nerve of you.

You wake up to the news that the weekend psychiatrist is in attendance. Based on what others have told you, you’re not given optimistic feedback about how much time this clinician will spend with you.

You are not disappointed by this prediction. The doctor, a short, dark-skinned man, enters with a clipboard. You answer his questions with mechanical precision, as this is not the first time you’ve given such data to this medical team of amnesiacs. No, you say, you are not planning on hurting yourself at the moment. Death by squiggly pen sounds rather ineffective, slow, and painful.

You tell the doctor, once again, that the symptoms that you have been dealing with are consistent with Borderline Personality disorder, a mental condition that has 9 criteria and a whopping 256 possible clinical presentations. The doctor mentions something about patients who “read about the diagnosis and then try to fit the symptoms.” He looks at you as if expecting some kind of confession.

As if you want any of these symptoms.

You think to yourself, insulting this man is not going to earn a sooner discharge date and time. You reflect on how you didn’t come up with the idea of BPD yourself at all. You once read about it when your wife mentioned it, and you felt positively seen by much of the literature.

You hear that? You felt absolutely seen. 100 percent.

With this information practically spilling out of your brain in the present, you stare at the doctor and think, “When my nose is running and I think I have a sinus infection, I am not treated as if I am an imposter. Why am I being treated like one now?”

You want the dignity of having your brand of crazy recognized. This is not so much to ask. You are literate. You know where to find peer reviewed literature, and you know how to, within reason, consider yourself against diagnostic criteria most of the time. Sometimes you read something in medical literature that makes no sense at all, so you ask someone or do some research. You realize that people are mindful of their own physical health and pay attention to it. The mind deserves love too.

Some form of self-diagnosis is not only possible, but necessary. You will later realize, after you have flown up and over the hospital walls, that you probably weren’t getting a diagnosis without some good old fashioned advocacy.

The doctor leaves after a few minutes. You are certain he was not interested in a single thing you had to say.

There are moments when you go through medical care, and there are moments when you go through the system; in this moment you are in the system. You feel more like something on the itinerary than a human, but that’s ok. You already know that you are not going to get along with every doctor that crosses your path. It was only a year and a half ago, you remember, that your PCP fired you on account of your deep and irrational fear of blood draws.

He even wrote an official letter an everything. Yikes! You must have been a real bummer.

Hey doc! Sorry about that!

The day unwinds for you as the other ones have done, with lots of mass produced food, long walks around the unit, and classical music. The local arts station plays opera on the weekends. This would ordinarily displease you, but you remind yourself that opera is better than nothing, and that walking around this space in silence might actually be the end of you. You turn on the station and hear opera and decide that, in that moment, those gloriously overdramatic performances are just what you need.

Why not? You do have a “dramatic” personality disorder after all. Cluster B in the DSM 5 to be specific. This sort of puts you in the same club as those who have narcissistic and anti-social personality disorder.

To quote the jovial pirates of Penzance: Hail hail! The gang’s all here!

There is enough room for everyone. The floor you’re on is considered the relaxed unit, the calm unit, the bi-polar unit. You’ve been put here because there is apparently nowhere else to classify the borderlines, and you recall the words of the intake psychiatrist several days ago: Inpatient really isn’t used to treat BPD.

You chuckle at this thought, because you can’t leave until 72 hours have passed from the signing of your “Get me the Hell out of here!” form. As far as you can tell, you’re an inpatient, and you are being treated for borderline personality disorder.

Who says that doctors know everything?

In the evening there is bingo. One client agrees to attend, but immediately becomes nervous that they will commit a mortal sin by gambling. You learn that this person recently converted to Christianity in recent months. The look in their eyes is serious. They do not want to gamble.

You explain that gambling requires the player to risk their own assets. Here, you say, we are only risking our minds. You point to your head. The client smiles and nods, understanding that bingo is kosher today.

You generally dislike bingo, but you enjoy fidget toys and wouldn’t mind getting your hands on one of the “grown-up” coloring books on the prize table. Once the game is going, you realize that you don’t mind bingo at all, at least here. For the next half an hour, you and your peers will forget about your problems as you watch those tiny white balls pop out of the machine, one by one. It is an old machine, made of metal wires and a simple crank. There is a joy in this sudden break of the monotony; hearing “G this!” And “B that!”

The joy is simple: you are playing a game you haven’t played in years, and on the inside of unit, 11, the activity is exciting. The games are fun. The prizes are magnificent.

As your favorite writer, Kurt Vonnegut would say in this situation, “If this isn’t nice, what is?”

You watch a peer eat a prize; a 6 pack of Oreo cookies. This snack is fine to you but it suddenly looks like a delicacy now. Never before have you wanted so much sandwiched crisco.

You win, selecting the oversized coloring book instead.

The game disbands. It is time to go to the med counter. A client in front of you leans against the med counter door. You can hear words, but are unable to make much out. The client is unhappy. It sounds as if they were denied a refill on important medication.

You know what this is like too. Sometimes you think pills are more like dog treats, only dispensed when you have truly been a good boy.

It is near lights out and you are reading your history book on the American Revolution. You think about the very real fact that every single person that book was about is dead and gone, their bones turned to ashes or boxed in the ground. You wonder about all of the stories that the book couldn’t possibly tell but were stories all the same; tales of wickedness and bravery, generosity and theft, destruction and salvation. This book is massive and the author has done the best job he could, but there are so many untold stories in there, so much spilled blood and shattered dreams between the lines.

Some people get their stories told, and some don’t.

It is lights out. You don’t know how you’re doing to do it yet, but you know that you’re going to tell your story.

Because you won’t be able to when you’re made of ashes or boxed in the ground.

Yours Mentally,

Nathan