Just Like Someone Without Mental Illness Only More So: A Memoir

by Mark Vonnegut Md

Luck and circumstances make us as different from who we might have been as cats are from dogs and birds are from bugs.

There’s an unfortunate hustle built into medical care, which favors doing things over not doing things. Most medical care is delivered by a provider who doesn’t know the patient and will never see him again. Doing things is more comfortable than not doing things. Doctors have much more at stake in their relationships with insurers and business managers than in their relationships with patients.

Craziness also runs in the family. I can trace manic depression back several generations. We have episodes of hearing voices, delusions, hyper-religiosity, and periods of not being able to eat or sleep. These episodes are remarkably similar across generations and between individuals. It’s like an apocalyptic disintegration sequence that might be useful if the world really is ending, but if the world is not ending, you just end up in a nuthouse. If we’re lucky enough to get better, we have to deal with people who seem unaware of our heroism and who treat us as if we are just mentally ill.

I grew up thinking everything would be perfect if we just had a little more money. Instead the money just blew everything apart. Humans will money themselves to death the same way some dogs and fish will eat themselves to death. If the rich were truly so productive and useful, they wouldn’t have so many hired-gun talking heads with talking points, foundations, and institutes. Eventually most kings come to believe in the divine right of kings.

Paranoids are able to incorporate anything that happens into their worldview, which works against them. I swear I was trying to be cooperative, but it didn’t look that way from the outside.

Hollywood Hospital was the last hospital treating alcoholics with LSD. The alcoholics had much better rooms than I did. They had curtains and rugs. I needed to hallucinate and talk to God a little less, and they were supposed to hallucinate and talk to God a little more. I needed a little more bondage of self. They needed a little less. An alcoholic named Wally tells me I’m not in charge anymore. He says I did a good job and everyone is grateful. I can relax and take care of myself. I’m much relieved. I talked with Lincoln and Twain and Dostoyevsky and played saxophone with Coltrane. Van Gogh wanted to paint some more and was glad my hands were willing and available. Maybe it was all in my head, but where else is there for anything to be? As the person who bargained God down from nuclear cataclysm to a relatively mild earthquake and stopped Kurt Vonnegut from killing himself, and got to meet all those guys, it was a hard thing to come back to earth and be just a regular mental patient.

Writing is very hard mostly because until you try to write something down, it’s easy to fool yourself into believing you understand things. Writing is terrible for vanity and self-delusion.

I thought the fact that people could get well from serious mental illness was good news and worth writing about. It was good news that it was more about biochemistry and neurotransmitters. There should be no shame or blame. They were illnesses like other illnesses.

If you take good care of any disease by eating well, sleeping well, being aware of your health, consciously wanting to be well, not smoking, et cetera, you are doing all the same things you should be doing anyway, but somehow having a disease makes them easier to do. A human without a disease is like a ship without a rudder.

This was all pre–DSM III, the modern way to slice and dice mental illness. The only thing I really had come to believe in, more than any specific therapy, was the medical model itself, which got rid of shame, blame, and other hurtful voodoo. That was worth doing.

It was an advantage for me, over most of my classmates, to know that I was in medical school, at least partly, to save my own life.

Because inpatient stays cost insurance companies money and insurers control the vast majority of a hospital’s income, the push to get a patient home starts as soon as the patient hits the door.

An artist is someone who isn’t put off by how terrible his first tries are, who finds himself talking back and notices that he changes and grows when he makes art.

God Himself had told me everything was going to be all right. My version of “all right” did not include chatting with the voices and being chucked back into a psych hospital. I was so quickly in tatters, what was the good of all that overachievement? It should have taken longer for my proud crust of wellness to be so utterly gone.

I had no argument with the police wrapping me up in a straightjacket and taking me to the hospital. I had tried to jump through a window and was acting in an erratic manner. But they didn’t have to be so rough. I’m not very big and have never hurt anyone, and I had only tried to jump through the window to prove to God I was worth saving. I tried to explain: As soon as I proved my faith, all the bad stuff was supposed to stop. The voices and agitation and need to do things to stop worse things from happening was supposed to go away. It didn’t.

Part of what happens when one goes crazy is that there’s a grammatical shift. Thoughts come into the mind as firmly established truth. There is no simile or metaphor. There’s no tense but the present. The fantastic presents itself as fact. It would possibly be tolerable to feel like or as if one was on fire or like the CIA might be after you or like you had to hold your breath so that you could be compacted and smuggled to a neutral site in Mongolia to wrestle India’s craziest crazy. But there’s no like or as if. It’s all really happening, and there’s no time to argue or have second thoughts.

Without prelude or explanation, I’m in four-point restraints in my boxer shorts on a gurney in a side hall of the hospital where I once trained and currently still work. I’m HMS alum, HMS faculty—I actually teach Introduction to Clinical Medicine and the Newborn Exam—and I didn’t even get into McLean’s? “Don’t worry about me,” I explain to strangers passing by. “The police way overreacted. As soon as my doctor gets here they’ll undo these silly restraints. Do you know that in a well-run hospital, restraints are almost never necessary?” Without being too self-centered and petty, I couldn’t help wishing that they had either let me get some clothes or not taken me to the hospital where I was on staff, or if they had to take me there, why couldn’t they have put me in a quiet little room somewhere, anywhere but the hall, please? A nurse whose kids I had taken care of for years passed by looking afraid and like she might cry. “Don’t worry,” I tried to tell her. “This will turn out okay.” It’s probably possible to gain humility by means other than repeated humiliation, but repeated humiliation works very well.

I had prayed and God said things would be okay and I assumed it meant okay without my having another breakdown or having to go to the hospital. God was a lot less wordy than the voices.

forever. I wished I didn’t have the feeling there was something I was supposed to do about everything.

I became convinced that my being willing to wrestle the Russian Bear could avoid a nuclear exchange and save millions upon millions of lives, not to mention the planet, from nuclear winter.

In the seclusion room I was riding a pendulum that would swing from the past through the present into the future and back again, though that wasn’t all there was to it. There would be times, very brief times, when I was okay and could understand and make myself understood and where it wasn’t all lurching gobbledygook. Before I swung out of the present and was really nowhere again, I wanted to wake people up and tell them I was okay so that they wouldn’t give up on me.

My hospitalization was all black and gruesome punctuated by daily moments of peace and light when they gave me pathetic little fragments of Xanax around 5 P.M. For twenty minutes or so there would be hope in the world and color and then it would fade and I’d wait for 5 P.M. the next day.

I was not addicted to Xanax. That would have made me a drug addict. I just needed it to breathe.

At any given point there are several million people in this country who are psychotic. As a matter of law they are exempt from being judged responsible for their actions while crazy. They are also 99 percent invisible. Most won’t get better enough to be as well as they were before. Many won’t really get better at all, just another part of life to not look at if you don’t want to get depressed. I’ve read studies indicating that 90+ percent of the homeless are mentally ill. Things do not even out.

I had come to live in a small space where my feelings were very big and scary.

Maybe I just had to learn to be comfortable with being uncomfortable, with being scared out of my mind, and to let it go past like it wasn’t about me.

The place I felt most welcome and comfortable was AA meetings, even though there was a sticky-sweet optimism there I found insufferable. “The grace of God won’t take you where the grace of God can’t keep you.” “You never get more than you can handle.” “You won’t die from not drinking or not sleeping or being afraid.” “Ha.” The people who had died from not drinking or sheer fright were respectfully dead and quiet and unavailable for comment. I was quite sure I was going to be one of them. I had slowly and carefully consumed a lethal dose of alcohol and alcohol equivalents and would eventually die from either drinking or not drinking. My biggest problem was figuring out how to get word back to these cheerful pabulum peddlers when I died from not drinking. I wanted to have a gravestone carved: “Mark got more than he could handle.”

Happy Joyous and Free, the fine print. It’s only fair to inform you that if you manage to not drink, your capacity to suffer and endure is going to be increased by several orders of magnitude and you are going to need it.

An earnest, bright-eyed young man at an AA meeting told me that to stay sober most people couldn’t keep doing whatever it was they had been doing for a living before they got sober but that perhaps I could work in a bookstore until I figured it out.

At a certain blessed point you are able to just not drink without thinking about it all the time.

I was acutely aware of a gritty stiffness twisted into every muscle of my body, as if I was on a spit being roasted over a slow fire. It came and went without there being anything I could do about it. I was painfully aware that I couldn’t drink, which is what anyone in his right mind would have done. God bless the moments when I felt all right.

With mental illness the trick is to not take your feelings so seriously; you’re zooming in and zooming away from things that go from being too important to being not important at all. So I was watching my thoughts in a detached way. I could zoom in or out to see how they looked without trying to change them. If I was lucky, I might find things that could be part of how I try to tell the truth. The first truth is that none of the thoughts going by are worth drinking over.

Alcoholism and mental illness aren’t very different and I had both.

When I could hear music again I noticed Coltrane, Monk, Professor Longhair, Billy Strayhorn, Stevie Ray Vaughan, Aaron Copland, and some others like I had never heard them before. They too seemed to be trying to tell the truth to save their own lives, and I was intensely grateful.

The problem with trying to comply with quality-improvement initiatives and worrying about lawsuits and coding guidelines and all the other stuff we have to do is that doing the right thing for the patient gets buried in all the muck. It’s like trying to be an Olympic high jumper with ankle weights.

The reason to try to be good, smart, kind, and on the side of angels is because it’s more fun and because there really aren’t any angels.

Gavin Archibald, a dentist from Texas who had recently married his office manager, was in charge of the mission.

Lorenzo James, a midsized dentist from Texas

When I became a pediatrician, a short visit cost ten dollars, a checkup was twenty. People paid cash. Our overhead was 27 percent. Our books were kept on a yellow pad. We were free to determine the content of the visit, which mostly consisted of asking patients or parents what we could do for them and taking it from there. When medical insurance came into pediatrics, it seemed like a good deal because we would suddenly be paid twice as much for visits and procedures and our patients wouldn’t be paying anything out of pocket, since it would all come out of the insurance that was taken out of their paychecks. We also realized we had no choice, since no matter how much they loved us, most families would take their kids where the care was covered by their insurance. We also had to get computers and hire people to track whether or not we got paid and do a bunch of other stuff. There goes the overhead. In the fine print it became illegal for us to charge the uninsured or anyone else less than we charged our insured patients and it also stipulated that the insurer would pay us at a discounted rate for our charges. The net effect was that my professional services went from something my patients could easily afford to something that, without insurance, they couldn’t. When I ask pharmaceutical salespeople what a new drug costs, they hasten to reassure me that it’s covered by insurance and will only cost the patient a ten- or twenty-dollar co-pay. Co-pays are the tip of the iceberg. ...

What situation could possibly be made better by unleashing war, pestilence, famine, and death?

I could pass off the things that happened to me when I was crazy as just a bunch of craziness, but the problem is, when I’m trying my best to tell the truth to myself, I’m not sure I didn’t bargain God down from nuclear cataclysm to a relatively mild earthquake and stop my father from killing himself. I’m glad I got to meet and talk to Dostoyevsky, van Gogh, Beethoven, Freud, and Abraham Lincoln and continue to count them as good friends.

It hasn’t escaped Barb that I go to my psychiatrist mostly to see how he’s doing. She’s not sure I shouldn’t see someone else. “They’d have problems too,” I point out. “Then I’d have two psychiatrists to worry about.”

A world without prejudice, stigma, and discrimination against those who have or who are thought to have mental illness would be a better world for everyone. What so-called normal people are doing when they define disease like manic depression or schizophrenia is reassuring themselves that they don’t have a thought disorder or affective disorder, that their thoughts and feelings make perfect sense.

Addictive drugs take all your little problems, like having a difficult family or feeling insecure, and trade them in for one big problem, having to have drugs.

Bye-bye pain and fear; hello addiction.

Most of life is a soggy mess, but you can make the world a very different place. As hard as addiction is, it’s always possible to quit and change your perception of the world from one where you do drugs and just about nothing good is possible to one where you don’t do drugs and good things can happen.

Twenty-five years ago, when I had a patient with a drug problem it was a big deal. I called people and they returned my calls and my patients got treatment. Treatment doesn’t exist now, not because it wasn’t effective, but because it’s less expensive for insurers to let addicts and their families drift into poverty and join the ranks of the uninsured. If not helping a fourteen-year-old addict won’t come back and bite us in the ass, what will?

My generation should be given credit for proving beyond all shadow of a doubt that drugs are bad for you.

fiercely defended and exercised his right to be a pain in the ass on a regular basis.

My father gave me the gifts of being able to pay attention to my inner narration no matter how tedious the damn thing could be at times and the knowledge that creating something, be it music or a painting or a poem or a short story, was a way out of wherever you were and a way to find out what the hell happens next and not have it be just the same old thing. It’s better to live in a world where you can write and paint and tell a few jokes than one where you can’t. All the arts are ways to start a dialogue with yourself about what you’ve done, what you could have done differently, and whether or not you might try again. Whether or not you want to make a living or can make a living at it, people who consistently bother to try almost always get good or at least better.