“[W]hat is madness if not the horror of being misunderstood, of being unable to make a self comprehensible to another?”—Suzanne Scanlon, Committed After the wasted few days in rehab, I was discharged to follow up care at a facility attached to the hospital that ran the rehab program, but unlike the other rehab patients, I was able to be assigned to mental health care rather than substance abuse. I entered a group of people dealing with various psychological issues, mostly mood disorders. Having gained nothing from the time I spent among the recovering substance abusers (though both staff and patients were mostly kind and supportive), I was still miserable but at least I was shown some genuine caring even if I was unable to open up to it. I also fell into the hands of two new psychiatrists, one a resident and the other the staff psychiatrist. (I did have a couple of very brief visits with the shrink at the rehab but they were pretty routine and desultory.) These two, unlike many of the doctors I had encountered previously, were warm and seemed genuinely concerned and actually took the time to interview thoroughly, though they put me though the entire interrogation about past and current mental health concerns, substance use, possible trauma, etc. Despite their clear desire to be helpful, they still had to slot my life events and present symptoms into the categories they were trained to diagnose and treat. For example, my youthful experimentation with weed was labeled “marijuana use disorder—in remission.” My alcoholism (also in remission) was taken into account and together we searched for possible triggering trauma in my past. As I recall, the possibility of PTSD was raised. What the T might be was never unearthed. My parents’ divorce when I was fifteen (almost 50 before)? Another example of the powerful urge to classify and label emotional difficulties, of trying to fit a variety of square pegs into the same round holes. That one floated up and drifted away. I shuffled numbly back and forth between the psychiatrists’ office and the therapy group and I might have continued this two-step had it not been for an unfortunate slip on my part. One morning I admitted that I had occasionally taken a look at the array of meds on my dresser and wondered what would happen if took one of each at the same time. The doctors pounced on this as suicidal ideation and I found myself being bundled off to the psych ward—or behavioral health unit as they are now called. Technically it was a voluntary commitment but I did not have the mental or emotional wherewithal to resist. So I had now hit the lowest point to date of my journey. The hospital ward was as close to being a modern snake pit as one could imagine. It was hidden away on an upper floor, its physical condition was not great, though it was at least reasonably clean, and a number of the facilities—toilets, beds, et al.—were broken. The staff ranged from reasonably kind to indifferent/burned out to outright hostile. Once again I faced protocols and procedures more designed for the function of the place and not the individuals needing care. The true horrors of the American mental “healthcare system” were fully on display here. Even at its best, the patient is stripped of all autonomy, infantilized, deprived of privacy. We’re fed bad food, placed in small, open, inadequately climate controlled rooms with uncomfortable beds and decorated with dirty, fading institutional-colored paint. The windows, of course, are barred and filthy, admitting little light and affording tiny slivers of views of the outside. There are too many patients and too few staff for anyone to get much individual attention, except for those who are so deeply disturbed that they have to be isolated from the others. The patients could be frightening too. I remember a girl or very young woman who somehow contrived to cut herself regularly and who was often taken to the isolation room. A very large wild eyed man with tangled hair and beard strode quickly and relentlessly up and the hallway, seeming to dare anyone to get in his way. One often heard loud noises at night, shouting and what sounded like fighting. One night an actual fight broke out between one of the techs and a patient. The exact circumstances were never explained but there was some buzz that the tech had initiated the confrontation. The techs in general were the most consistently kind staffers, but one or two were clearly fed up with dealing with crazies and their manner showed it. I fell in the middle of one night trying to get to the bathroom and hit my head pretty hard. The tech on duty showed no sympathy and while I was lying on the floor waiting to be taken down for an EMR, I heard him loudly recounting the story of the fall with seeming relish. “Bam! His head hit the floor!” And then I was left in the hall with inadequate covers, strapped to a gurney for over two hours before I was taken down to be scanned, which fortunately revealed no damage. While it is understandable that extra security measures are necessary for patients and staff alike, the level of observation and control went well beyond what was required. And the fact that so many of the hospital employees seemed to regard the patients as annoyances at best and as the enemy at worst does not create an atmosphere where healing is likely to take place. The social workers who ran the various therapy groups were mostly burnt out cases, understandable enough, but again not conducive to good care giving. Worst of all was the staff psychiatrist who seemed to relish his power over the patients and exuded zero warmth or empathy. He received patients in a tiny enclosed space, lacking even the bland comforts of a medical office,  in which he was slightly elevated. There was a window in the door and every time someone went by I looked up and watched them pass. “Look at you,” he said, “so hypervigilant.” He had a smirk on his face and seemed delighted to have “caught me,” though at exactly what I couldn’t say. He seemed to be reveling in his superior position. The morning after the fight mentioned above I expressed my fear and concern and he laughed it off without expressing any concern for my unease. Given that my primary diagnosis was anxiety, one might have expected a bit more sympathy but none was forthcoming. As in the past, the only bright spot was the constant support and personal visits from a few very good friends and of course my incredible partner. They made the long trek out to the far reaches of the Virginia suburbs, sometimes in bad winter weather. As I noted earlier, the care and love I received from some people during my distress went well above and beyond the bounds of ordinary friendship. I can’t say I know how it was decided that I could be discharged when I was since I appeared to have made no progress toward recovery, but I was finally let go, much the worse for wear but at least still able to function at the minimum lever required to stay alive. Much more was to, a great deal of it very bad, but this episode I realize in retrospect was the absolute bottom. It did, however, take a long time to make the climb back to something like sanity.