During holiday visits to Columbus Dad and I sometimes saved our final talk until he drove me back to the airport, affording half an hour in the cocoon of the car. The streets and freeways faded in the intensity of the discussions. Ever more, I became initiated into the secret world of madness.
In one of our conversations when I was close to finishing college, it became clear that Dad wished to bring up additional information about the treatments he’d received. ECT was at the top of the list. Although stereotyped as barbaric in One Flew Over the Cuckoo’s Nest and other aspects of popular culture, ECT can be an extremely effective intervention for severe forms of depression. Yet during much of the twentieth century it was used indiscriminately and even punitively for almost any form of irrationality. Back then it featured overly long pulses of current, which often caused major side effects such as memory loss. In the earliest days, before anesthetics were used, patients might break a limb from the seizure-induced thrashing. It’s still not known exactly how ECT works. Placing an electric charge through a person’s skull and thereby inducing a brief grand mal seizure alters a great many neurotransmitters and brain processes. But which of these explains its beneficial effects on serious mood disorders remains a mystery.
Dad told me of his terror regarding the procedure back in the fifties. One such session at Columbus State Hospital, when Sally and I were quite young, stayed on his mind. The technicians, he told me, would place a steel arc on top of his head and clamp cold, metallic electrodes to his temples. After waiting—always the waiting—a surge of current would commence at his psychiatrist’s signal, sending his brain into a convulsion. His doctors had surmised that the medications he was taking weren’t doing enough. Talk therapy, such as it was, only scratched the surface. At the time, his diagnosis was chronic schizophrenia, but little matter: ECT was used indiscriminately during that era.
On the morning Dad was recollecting, he was lying flat on a gurney, listening to the squeak of its wheels echoing through the corridor. Pushed by an attendant, he was heading to the special room, the place he dreaded above all others. With his arms and legs strapped, he saw the globe lights glaring down from the ceiling, passing above his face every few seconds as the slow journey unfolded.
Above all, he must show no fear. Keeping his pride intact, he said, was essential. Once inside the room he’d be injected with medication, enough to make it impossible to sit up. He’d be powerless once more.
Finally inside the door, he braced himself. He saw the nurses, scurrying to record his vital signs. The technician entered, the one who would trip the switch to allow the current to flow into the wires attached to the clamps. Would the crackle of electricity produce smoke from the side of his skull? His head, in fact, felt like scorched earth each time he awakened.
Out of nowhere a question entered his mind: Where were Alene, Steve, and Sally? Did they still exist? The house on Wyandotte Road, the small kitchen where his son sat on his lap, the back yard framed by trees: They were all a faint memory, a film long since ended and the theater empty. Fighting panic, he wondered whether he’d ever see the brick and stone buildings of Ohio State again. Was he still a professor, or had that been someone else in a different lifetime? And what about Pasadena, his boyhood home with all his brothers?
How had he arrived in the hospital once again? He must have lost control in the classroom and at home. A vague recollection of flinging his golf clubs into the neighbor’s yard appeared before his eyes, but the medicines had clouded his memory, making his life a permanent, dull present. By now he was inhaling the sticky scent of electrode paste and the metallic aroma of the ionized air from the previous ECT session with another patient. After his own procedure, he would try to figure out where he was, the headache overwhelming. Could he face it once more, this surge of power that made him feel like a charred husk?
There was one ritual from deep in his past: The Lord’s Prayer, which had comforted him as a boy and provided relief during earlier times of despair. Lying flat, he began to move his lips, but the guttural whisper was barely audible.
Our father, who art in heaven, hallowed be thy name.
Thy kingdom come, thy will be done
On earth, as it is in heaven.
Several young doctors, undoubtedly trainees, were observing the procedure from a corner of the room, writing notes on clipboards. Glancing tensely at the patient, they heard his monotone, their expressions revealing sharp concern.
Give us this day our daily bread, and forgive us our trespasses …
“What’s he doing?” one of them called out to the lead psychiatrist, Dr. Southwick, who presided over the session. “Why is Hinshaw muttering?”
… as we forgive those who trespass against us.
Dr. Southwick considered his patient on the padded table. Glowering at the trainee, he retorted with enough force that everyone could hear, including the patient. “What the hell do you think he’s doing—he’s praying! How else do you expect him to deal with his fear?”
Lead us not into temptation, but deliver us from evil.
For thine is the kingdom, the power, and the glory, forever.
Amen.
A rubber guard now coated his mouth, its bulky mass nearly making him gag. Maybe his teeth wouldn’t crack as he began to convulse. The final anesthetic was now administered and he began to drift off. Everyone held still for the signal. It was happening again, the white heat moments away from penetrating his skull. Not for the first time, everything went black.
Dr. Southwick nodded. The lights grew dim; the machine angrily hummed. The charged pulse held its beat for one full second, then another. His body gently writhed, and writhed again.
At least, Dad recalled from his study nearly twenty years later, no one was able to stop his prayer. He understood that Dr. Southwick had been his ally, standing up for him in front of the residents. As he ended his recollection his face revealed a combination of bitterness, fascination, and resignation I’d never before seen.
* * *
Staring alternately at the clock, each other, and the window that opened onto the Boston night, Mom and I sat on the orange-brown polyester hotel bedspreads and waited. Where could Dad be? The dinner reservation had expired hours ago.
Their weekend trip to New England had been marked by the informal tours I led around the Harvard campus and through Boston’s comically crooked streets. It was a chance, too, for Dad to visit his longtime OSU philosophy colleague, Manny Lebowitz. Manny had left Columbus to teach at Brandeis a few years before but was now undergoing cancer treatment. Dad had departed for the hospital in the late afternoon, saying he’d grab a cab afterward to meet us at the hotel before dinner. Yet visiting hours had long since ended. Always punctual, Dad had never stood anyone up for appointments or social gatherings. Exasperated, Mom and I dared not speak our ultimate fear.
Suddenly we heard a key turning in the door and saw Dad enter the room, panting despite the cool evening air. Startled, he glanced over at us.
“Where were you?” I asked as calmly as I could. Treading cautiously, Mom mentioned something about the time and our dinner plans. Dad’s gaze shot far beyond either of us, his look frantic.
“Where do you think?” he called out angrily. “Manny may not make it; the prognosis is grim. I decided to walk here afterward. What’s the matter? What time is it, anyway?”
It slowly dawned on me: Manny, brilliant and kind, a fellow pipe smoker, was one of the few people Dad had ever spoken with about his past. Dad had been bereft when his colleague had moved to Boston, even though he had told me matter-of-factly that academics often get better offers at other universities. Right now, on full display right in front of us, Dad was revealing his grief and confusion along with more than a touch of agitation. When he left Manny at the hospital, nothing else mattered to him than the need to keep moving, to let the night’s breeze and the pavement under his feet absorb the blow.
When I asked psychology professors about schizophrenia versus manic-depression—the older name for bipolar disorder—I received dismissive looks. Why bother with formal diagnosis, they nearly scoffed; it’s the underlying psychological conflict that’s of the essence. Even as late as the seventies, clinical psychology was dominated by earlier, completely environmental notions of diagnosis and causation, which denied any biological roots of serious mental illness. Given the general ignorance on full display, it’s safe to say that stigma permeated my very courses at Harvard.
Not that I mentioned my real reason for asking. I kept my interest general, academic. Courtesy stigma prevented me from raising the most important issue my family and I were facing: Dad’s accurate diagnosis and the potential for responsive treatment.
Every spring I got a couple of migraines, real ones with the flashing lights, throbbing pain, and nausea I couldn’t control. Eventually I went to the student health service. Any mention of the vomiting I forced on myself in order to sleep was too personal and too humiliating, so I left that part out. Self-stigma was part of my own curriculum.
The first doctor was decisive: I had a dust allergy and must clean my room regularly and change to hypoallergenic sheets. The second doctor, totally derisive, had obviously never been wrong about anything in his life. My migraines, he sniffed, had nothing to do with glare or genetics, even though Dad, all his brothers, my grandfather, Mom’s mother, and Sally showed nearly the identical pattern. “You might leave the darkness of a theater and believe that the glare outside is a trigger,” he declared, “or strive for biological causes. But the emotional content of the film is the true culprit.”
Those expert doctors, so confident and sure of themselves! I railed at them, if only in my mind. Who among them had a clue—especially those who’d treated Dad, years before, by tying him to his bed at Norwalk, providing insulin coma therapy at Byberry, or dispensing antipsychotic medicines and shock treatments when Sally and I were young? The all-biological types were as bad as the all-psychological ones. Then and there, I made a vow. Whatever I ended up doing in this field, I would always remember that what we know in social sciences, psychology, and medicine is a tiny fragment of what needs to be learned. The only accurate stance is one of humility—and integration of diverse perspectives.
I feel the same way today. The human brain is made up of trillions of synapses receiving and firing signals every second; the miracle of human consciousness somehow emerges from those chemical actions. Those who bask in their supreme knowledge are deluding themselves, their patients, and the scientific community.
* * *
On a bright spring day near the end of my junior year I took the Red Line into downtown Boston and then the Green Line to the Museum of Fine Arts, one stop past Harvard Medical School. Pitch-black clouds loomed on the far western horizon, though the sky was bright and full of glare straight above. Once inside, I kept returning to a van Gogh painting, with spiraling blues of the sky and vibrant golds of the field, surrounding a building in the town where the artist had been recovering after his stay at the St. Remy asylum. The swirling, jagged paint strokes were electric, the colors and shapes mesmerizing. Staring, I tried to grasp the essence of the painting.
Near closing time peals of thunder boomed through the museum as the air pressure plummeted. Rushing out to the train with the crowds, barely ducking the squalls, I swayed in the steamy air of the crowded car. Almost back to Harvard Square, my heart sank: The initial zigzag of the aura now shimmered in front of my eyeballs. I futilely prayed that it was just some kind of afterimage but knew better. After I made my way back to the dorm, all I could do was lie down, helpless, until the crushing pain and waves of nausea took over. What was the trigger—the sudden drop of air pressure from the storm, accompanied by the sky’s alternating glare and gloom? The emotions incurred by van Gogh’s brushstrokes and madness? Or the genes permeating every cell in my body? The reasons crowded my mind as the throbbing intensified.
Things weren’t as simple as I sometimes thought. They still aren’t.
* * *
Back home during spring break of my junior year, I drove to see Sally at Ohio Wesleyan, a half hour north of Columbus. She’d decided not to go East for college; Ohio Wesleyan would be safer and not as far from home. She had a boyfriend and talked about her classes, excited but a bit overwhelmed to be on her own.
I took a risk and told her what I’d learned from Dad. As easily as we talked about most anything, the conversation became strained. It was hard for her to feel close to him or the whole situation. “He’s never talked with me the way he does with you, Steve. Besides,” she went on, “he’s so distant from Mom, and she really needs support.” I felt privileged but half guilty that he’d chosen me. I’d entered a selective club, one to which Sally and Mom hadn’t been invited.
Sally went on to say that Grandmother lectured her when she was home, believing that she shouldn’t have boyfriends and that she was acting entirely too modern. Her own migraines were getting worse. Following the aura, headache, and nausea, half her body sometimes went numb as she became semi-paralyzed for a few hours.
“I can’t relate to the problems Dad’s telling you about,” she continued; “I don’t feel part of it. He doesn’t get who I am.”
The gravitational pull to stay in Columbus had been strong but I’d followed my instinct. Yet from afar I kept an eye on everyone, the tug enormous. I wanted to rescue Sally, to push her toward freedom; but she didn’t have the support from Dad she needed. I wanted to rescue Mom, who had spent her marriage keeping Dad’s episodes from ruining the family—and walling off her own emotions from the complete irrationality of his illness. And I wanted to rescue Dad, getting him an accurate diagnosis, now that I was increasingly sure the doctors had been wrong his whole life. But how might I break through my own locked-down style?
* * *
“I’ve learned to love the Midwest, Steve,” Dad said, back in his study. “We never had true seasons in Southern California. I couldn’t get over the fall out here when I first arrived, the changing leaves. I love the winter and find the snow exhilarating. And the spring is gorgeous. Actually,” he continued, “if you’re happy with your life and work, you can be fine just about anywhere.”
During our continuing talks, I envisioned him during his early days in Columbus, going to and from campus as the seasons changed, playing volleyball, badminton, or golf after work and on weekends. But now he viewed the seasons mainly through the windows of his study. Too often he seemed passive and listless, always needing a nap in the afternoon. So much of his life now seemed to take place solely in his mind. What had happened over the years since his promising start? Had the accumulated episodes taken an eventual toll, or was the cost linked more to the misguided, even barbaric hospitalizations and treatments he’d received?
His half-year delay in starting twelfth grade, I now understood, resulted from his involuntary stay on the back wards at Norwalk. His weak left hand and wrist—evident when he slammed the door on his hand as he hurried to pack the car for our long-ago California trip—also stemmed from his leap to near-oblivion. But I was seeing the pieces one at a time, long after the box had been overturned. When I thought about my first 17 years, my anger smoldered, especially over the silence, role-playing, and constant low-grade fear that accompanied me each day.
Yet a central question was now preoccupying me. Did Dad really have schizophrenia, or had he been misdiagnosed for the better part of 40 years? Didn’t bipolar disorder serve as a better explanation? Another puzzle to solve, once again on my own.
I began to take summer positions on the East Coast, working with kids with learning disorders or serious developmental disabilities. Following my junior year I landed a counselor slot at a residential summer camp in New Hampshire for children with autism and other disorders. Camp Freedom stood on the shores of Ossipee Lake, the deep-blue water glistening between silver birches. The far point of the land afforded a head-on view to the north of Mt. Washington and the Presidential range, looming majestically in the distance. The best perspective was from a canoe while the oars dipped in the still waters. To the east lay the long, dual humps of a low mountain, symmetrically framing the horizon. The pay for counselors was miserable but the experience unmatched. I couldn’t get over that my young Harvard professor, Bruce Baker, had founded the program to study and treat kids everyone else had given up on. Shaping language skills and reducing self-destructive behavior were grueling but the learning was nonstop. We might just change the world—or a part of it.
At the end of the intensive orientation, it rained for three days straight and the lake overflowed, delaying the opening. After canoeing to our raised platform tents to retrieve our damp backpacks and moldy clothes, a group of us drove down to Cape Cod until the camp dried out. Swimming in the moonlight in a lagoon not far from the ocean, I saw something I’d never witnessed, yellow-green traces in the water and sandy shores, in the form of phosphorescent microscopic animal life, a seeming reflection of the infinite stars above. On rare occasions the world could be magical.
Once camp opened, if I wasn’t on night duty with the kids in the bunkhouse, I would sneak off and get high with a co-counselor or two. I was paired with John Whyte, a brilliant Swarthmore student totally into psychology, about to enter a dual M.D.-Ph.D. program. The first openly gay man I knew well, he talked with me about everything in his life. Instantly trusting him, I reciprocated, discussing my insights about Dad. I continued to scrutinize my every mood. Would my future mirror Dad’s past? If my mind went too far, would I end up insane myself? Did Dad have schizophrenia or manic-depression? Having someone to communicate with lifted my burden, if only temporarily.
I arose one Saturday morning to the clangs of the wake-up bell to join John, coming from another tent, and Sheri, the third of our trio, who’d been on night duty with our kids, who exhibited a mélange of severe behavioral problems. I felt both light-headed yet heavy on my feet. I must have looked pretty bad, as John and Sheri ordered me to the infirmary. The former nurse, with tons of experience, was up for the weekend, watching as the new nurse placed a thermometer under my tongue. Taking it from my mouth, she studied the mercury reading, her eyes disbelieving. A second later she fainted straight away, fearful for my life. Mary, the old hand, deftly recovered the thermometer, which fortunately hadn’t shattered, and read it out loud: 105.7.
Lowered into a tepid bath to bring down the fever, I saw visions of campers and the surrounding trees dancing and shimmering. It’s as close to a hallucination as I’ve ever experienced. The hospital was 45 minutes away over two-lane roads, but no doctor was on call at the rural setting. Probably from the force of the fever, I began a migraine aura by that evening, followed by dry heaving, as I lacked enough fluid to actually throw up. The next morning, a nurse arrived early. “98.6,” she said, peering at the thermometer. “How did you get back to normal?”
Back at camp, I needed a day or two to regain full strength. John had become ill, too, along with several other staff. One theory was that the flood waters yielded breeding grounds for mosquitoes that caused a slow-onset viral pneumonia, though I had no other symptoms. John and I stayed in a drier, wooden structure to recuperate, where we smoked some really good weed. After we reached a peak buzz, he went to the dining hall to get us leftovers, the campers long asleep. We walked out to the shore, the sand still warm, hazy starlight above us.
“John,” I said, “you’re not going to believe what I just saw in front of my eyes.”
“With that grade-A stuff we’ve been smoking, I wouldn’t be surprised with anything you told me,” he noted sarcastically.
“Well, I saw the image of a postage stamp, with the profile of Abraham Lincoln.”
His response was dry. “That’s not too exciting.”
Yet I replied straight back: “Right before my eyes, though, the profile of Lincoln changed to the Easter Bunny.”
“Now that’s trippy,” John retorted.
“But the Easter Bunny and Lincoln merged into a profile of my dad’s face!”
John summed up. “When you’re high, Steve, you would make a psychoanalyst very happy.”
The next year I wrote a senior thesis on the community mental health movement, surveying how professionals implemented the latest treatments for youth with developmental disorders around the country. I served on a multidisciplinary team at a community mental health center that used undergrads as in-home therapists. I was assigned to a 14-year-old boy who had never spoken outside his family’s house. He gradually opened up, revealing worlds of emotion and insight. The debates raged at case conferences: Did he have aphasia, extreme social anxiety, or a closed-off family system? The mental health field seemed divided rather than integrated.
At group supervision sessions, the topic one day was anger. The leader, an astute African American psychologist, sagely commented on its uses as a signal for change. But I was sure that she was speaking in tongues: anger as a signal? For me, any sign of irritation erupted instantly into white heat. Once a feeling started, it couldn’t be contained. No wonder I’d worked so hard at keeping my emotions in check.
By day ideas went off in my mind like little firecrackers, as Sylvia Plath put it in The Bell Jar. I might find a calling in psychology one day. But at night, ever more often, things ground to a halt as the sense of doom overtook me. I ended up back in the bathroom, the forced vomiting harder to enact each time.
I had a new girlfriend, Penelope, a Wellesley student. Intense but fun, with huge, sparkling eyes, she had the kind of warmth I craved. I even brought her back to Columbus for Christmas holiday. We were getting closer, but how close? I told her about Dad but kept my torturous evenings private as long as I could. How did I expect to receive emotional intimacy if I wasn’t even open with myself?
One evening in the winter, in the library until late, I missed a phone call from Dad. My roommate Tim had taken it, reporting that Dad said he wasn’t at home, but left no specific return number. “Your dad seemed really eager to talk with you,” he noted. But when I called Columbus the next day, and the next, there was no answer.
My honors thesis drafted, I returned to Columbus for spring break, three Aprils after my fateful journey into Dad’s study. Back in the same room, he told me that that he’d phoned, a couple of months before, from a partial hospitalization program at OSU. He’d lost control during the winter. Paranoid ideas had taken hold. His dosage of Mellaril was increased.
My mind reeled. Dad’s episodes were still happening! How would he have sounded on the phone that night, if only I hadn’t been buried in the library? Something needed to be done, and fast. But how? The information he’d been imparting to me had lifted me beyond my closed-off childhood but also burdened me like an iron suit, stifling any movement. My arms and body were wilting from the strain.
At a high school friend’s house the next day, I heard his mom ask how I was doing. “Great,” I told her, trying to believe it myself. “My senior thesis is done; the sky’s the limit for me.”
“Well, you don’t look so great,” she replied, eyeing me carefully. “Actually, I’ve never seen you so tense.”
Graduation was coming up in two months. It felt like a walk down the gangplank.