Let me introduce myself. You can call me Rosenhan.
I may be just like you. I'm eighteen years old, I go to college, I do many of the same things you probably do or will do. I went to an art school for creative writing with several scholarships and awards for my writing. Then I dropped out to become a psychology major. I currently work under the recreational therapist in the child psychiatry department at a local hospital, where I help run groups with children ages six through twelve.
I am training to become a psychologist myself. But I am also a patient.
In my freshman year of college, I was diagnosed with Bipolar Disorder, a genetic disorder of emotions characterized by abnormally high periods called mania and abnormally low periods called depression. I have been hospitalized two times since then. Being in a mental institution is, surprisingly, not the worst thing that could happen to a person. Like I said: I may be just like you.
The air was crisp and cool. It was September; school had just started and for freshmen, like me, it was the beginning of a brand new life. The atmosphere was a whirlwind of change. I was away from home for the first time, away from my parents and free to do whatever I wanted. I was living the dream.
Or at least, I should have been. In reality, I spent most of my September locked in my room. It began with a simple trouble: I couldn't sleep. I spent night after night staring at a wall. I quickly became anxious. Going to the crowded dining hall wasn't an option; I stopped eating and lost a lot of weight. My thoughts were racing faster and faster, and they were increasingly turning to morbid subjects.
My roommate became concerned. When they found out that I was cutting my wrists, they recommended that I go to the college counseling center. I agreed but stalled in making an appointment, figuring the episode would pass.
And it did: my thoughts slowed down, but then became so slow it was like my brain was stuck in molasses. I slept more and more. I stopped going to my classes. Eventually I didn't even get up to eat. Some days I was only awake for an hour.
One day I was taking a walk, looking for good places to hide so I could cry in peace, away from my roommate. Eventually I found a little space in between two slabs of gray concrete and shielded by tall yellow beach-grass. I sat down there and thought about ending my life.
After a while of that I began to walk back to my room. I stood in the middle of the academic mall for a moment, staring over the railing at the street below. The occasional car or bus would pass by underneath. I thought about throwing myself over it, to death below. No, I thought immediately; it's not high enough. I will probably survive.
And that was when I realized, I was really playing with my life. I would die, and soon. The reality of the situation hit me over the head and knocked all the air right out of me. I turned right around and kept walking straight to my room. I needed help, and I needed it fast. The next day I went to the counseling center.
I was evaluated by a kind woman named M, who took a brief look at the answers to my intake questionnaire, asked me some questions about them, and then decided that I was in serious shape and had to see a psychiatrist immediately. Appointments were moved to make room for me to see her that week.
So two days later, I did, and after a few more questions the psychiatrist decided that I had Bipolar Disorder, and wanted to put me on medication as soon as possible. There was one problem – I was only seventeen years old.
My parents have always been against psychiatric medications. When I was eleven, I was diagnosed with anxiety and depression and prescribed SSRIs by a psychiatrist that the school was forcing me to see. My mother ripped up the prescription and threw it away.
So when it came time for me to start mood stabilizing medication, I found myself in a bit of a crisis. I would have to tell them somehow. My hands shook violently as I held the phone and began to tell them about my diagnosis, knowing what their response would be – "I don't believe you." My throat began to sting as the tears ran down my face.
"You're doing this just to embarrass me," my mother said. That was her explanation for everything.
But they agreed to at least talk to the doctors, and ultimately agreed to let me do what I wanted, even though they didn't agree. So I started medication and slowly, things began to improve.
So maybe I wasn't living the dream. But at least I was living my life. For a while, anyway. I'd stopped taking my medication over spring break, and the consequences were disastrous.
I ended up buying 150% of the lethal dosage of antihistamine sleeping pills, and I was hospitalized the next day.
Why would I go off my meds, you ask? Well, I suppose I missed the euphoric happiness of being manic. And I was tired of being depressed most of the time, and frustrated with my psychiatrist for seeming to not care that I was; and I was sick of gaining weight, and struggling with my creative output.
I did become manic at first. I was incredibly energetic and quickly became bored and restless. At night I lay in bed, pretending to sleep and listening to all the thoughts that were buzzing around in my head. I couldn't sleep. They were just too loud.
In the second week of being off the meds, I became depressed. It wasn’t the foggy lethargy of most of my depressions; it was crystal-clear apathy. I had no motivation to do anything except lie in bed, fully awake, and stare at the ceiling. I didn't care enough to eat. It wasn’t that I wasn’t hungry; I simply couldn’t go through the trouble of deciding what to eat, and preparing it. I hurt myself just to see what it would feel like, if pain could fill the emptiness that had taken over my mind. And I became obsessed with suicide.
Mostly, I was bored. In retrospect, boredom seems like an odd excuse to commit suicide. But it was a way to pass the time: browsing through the variety of drugs sold in the supermarket online, looking up the minimum lethal dosage, calculating how many boxes I would need.
Those were the prominent questions on my mind when I went to see M. She listened calmly as I told her what had been on my mind, and explained that the previous day I had gone into a supermarket and purchased the sleeping pills. Subsequently, she looked me up and down and told me that I had left her with very few options. Then she asked me if I was ready. I was going to be hospitalized.
I was not surprised. I had planned my suicide for that coming Saturday.
“If I don’t voluntarily go, will I involuntarily go?” I asked.
M nodded with a slightly sad smile. “It’s for your own safety,” she said. “Rosenhan, your life is too precious.” She then left the room to talk with the head of the counseling center, and I called my friend P to ask her to pack a bag for me.
The counseling center became frantic and busy with police and EMTs arriving and waiting to transport me to St. Vincent’s Hospital. In all the frenzied chaos, I wanted to cry. But I didn’t. M offered to close the door; I said no.
I couldn’t cry now. I was going to the hospital. I didn’t want to go. But if I refused, I would be involuntarily committed; so I had no choice, and if I wanted to get out I had to be strong.
I was sent to St. Vincent's Hospital by ambulance escorted by campus police. The paramedics brought me to the waiting room where I waited and received panicked calls from my father. I filled out paperwork and was strip-searched and inspected. They took away my phone, keys, most of my money, and even my hat.
About two hours later I was escorted upstairs to 3 North, the adult psychiatric ward. 3 North had about twenty patients and only one psychiatrist. Her name was Dr. P, a middle-aged woman with short brown hair and kind eyes. I actually didn’t meet with Dr. P until my second day on the ward. My first day was filled with confusion and anxiety.
I discovered immediately that the place was boring. Our lives revolved around a schedule written on a whiteboard in front of the dining room. There were long stretches of nothing to do; the halls were white, dingy, and empty; and the food was bland and tasteless.
A male nurse showed me around the ward, taking me on a tour. First was my room and my nearly-catatonic roommate, whose depression was so severe that they never left their bed and never attended a single group while I was there. They even skipped their meals, and somehow got away with that. I never learned their name.
Next was the TV room down the hall, which was almost always empty, and had big windows that you could see out of and watch the cars down below, wondering if they were patients leaving. Then the dining room, which was relatively small. On the other corridor, there were pay phones and the art room.
At dinner, several people asked me what I was in for. To my surprise, this was a customary question to ask new patients. I told them that I’d told my therapist I was going to kill myself.
“Did you say that because you wanted to see what would happen, or because you meant it?” asked a male patient.
“Because I meant it,” I said, truthfully.
So there I was. I quickly learned the ropes: the patients were, by and large, there to support each other; everyone was kind, and we helped each other out. One patient, a schizophrenic with severe tremors from antipsychotic medications, couldn't hold utensils to feed herself. The nurse quickly lost patience with her and left her to her own devices, and another patient stepped in and helped her eat.
I spent about an hour on the pay phone with P that night, and then sat around until medications were dispensed and went to sleep. My dreams were tense and anxious.
On the morning of the second day, I dressed and went out into the hallway to find two girls power-walking in a loop around the two corridors. “Come join us,” invited one of the girls, and I did. We walked for a few minutes and then one of the girls gave me some tips.
“Go to every group,” she said. “And don’t let them catch you with your bed unmade. The doctor is nice, but she watches everything.” She smiled. “Don’t worry, I’m sure you’ll get out of here in no time.”
And I did. In fact, my dad convinced them to let me go the next morning.
I've always had my ups and downs, but over time the highs got higher and the lows got so much lower. I first experienced depression when I was only eleven years old. Hypomania, a lesser form of mania, came much later – when I was about fifteen years old.
Perhaps at one time it resembled the normal mood swings of a hormonal teenager, but I think I had reached a clinical level of bipolarity by the time I reached high school. I was severely depressed in the tenth grade. By eleventh grade I was prone to episodes of hypomania. Mania came when I went to college.
My manic episodes are generally euphoric – I'm loud and talkative, and I feel like I'm on top of the world. I don't need much sleep and I can even stay up all night and still feel great. I'm much less shy than usual, although I am sometimes anxious. Everything seems beautiful and romantic and poetic. I love poetry when I'm manic. I both read it and write it; I love the taste of words. Sometimes I take on big projects, like research papers, stories, even full novels. Rarely do the more ambitious ideas take shape, because I find it hard to sit still or pay attention for too long.
Although a manic episode feels good, it's sometimes dangerous. I have very little impulse control, which leads me to spend a lot of money on things I don't need. I'll spend myself straight into debt without thinking twice about it. I've also sought out sex on Grindr, an app for gay men to find each other, without thinking much about safety. Everything is about the here and now when I'm in the grips of a manic episode.
On the other hand, during a depression, I am very slow and quiet. I'm constantly tired and very lethargic. I feel terribly alone in the world, and feel almost certain that nobody cares about me. I spend most of my day in bed. At this point, my depressions usually snowball into suicidal thinking.
A mood episode lasts anywhere from a few days to a few weeks. When I was younger my depressions were longer, sometimes several months, even a year, and they would creep slowly into me like a sponge soaking up water. Nowadays they are fast and hit hard, a bit like being slammed into by a truck.
In May I met R.
R was cute, sweet, funny – everything I wanted in a boyfriend. We started dating in June. Unfortunately, he went to spend a month in Bangladesh to visit his family shortly after we met. Still, we talked every day. When he came back, I was excited to see him.
But there was one problem. He never seemed to have the time to see me. A week passed, then another one. Finally I told R that if he couldn't sort out his priorities to make time for me, perhaps he had bigger things to think about.
He agreed. He broke up with me.
R had been feeling depressed himself, and had withdrawn from many people in his life – including me. He no longer felt any romantic feelings towards me, he said.
We had only been together for two months, and we remained friends, but I took the breakup hard. I plummeted into a dark depression. I fell into the trap of suicidal thinking yet again, and once more spent my time looking up lethal dosages and thinking about death.
R told me that it didn't seem right to do nothing. P told me to make an emergency appointment with my therapist.
Ultimately I was forced to agree – and this time I knew where I was going.
Mather Hospital was much nicer than St. Vincent's: it was clean, the staff were friendly, and the food wasn't bad. They took my shoes away as well as my wallet and my phone. It was boring, but all mental hospitals are. I was there for a week and spent a good deal of my time coloring, drawing, and I even had the opportunity to paint in art therapy. I also played board games and talked to the other patients. It's surprisingly easy to make friends in a psych ward, because nobody has access to electronics or anything much else to do but talk.
My mother, still suspicious of psychiatry, and angry that I hadn't come to her about my suicidal feelings, refused to visit me during my stay at Mather. But my father and my grandparents came.
There was only one thing I didn't like about Mather, at first: my doctor, Dr. F. He seemed very abrupt and spoke with me only briefly before deciding to change my medications, without asking for my input.
One day, however, he came into my room and started talking to me. He shook my hand, as he always did when he talked to a patient. "What's going on in your head right now?" he asked me.
I shrugged. "Not much," I said, because not much was happening in there; my thoughts were quiet.
He looked hard at me and said, "Rosenhan, I am a psychiatrist and you are a patient in a psychiatric ward. When I ask you what's going on in your head, what do you say?"
"More than that," I answered sheepishly.
So we talked for a few minutes about what had driven me to the brink of suicide: the breakup, and the subsequent feelings that nobody would ever love me and nobody cared about me.
"I have a question for you. What makes you choose suicide as a coping skill?" he asked.
It was an interesting question. I didn't know the answer.
"When you're suicidal, people get angry, don't they? Like your mother?"
"Why do you think that is?"
I thought about it for a moment. "Because they're worried?"
Dr. F shook his head. "It might be because they're frustrated," he said. "Because they see you hurting yourself. Imagine this: I hit myself in the head with a hammer, and then I come to you with the hammer in my hand and I tell you my head hurts. Of course you're going to tell me to stop hitting myself in the head with a hammer!"
"Most people who are suicidal think this example is a little extreme. Maybe it is. Now think of a glass of water. What's the difference between a person who says a glass is half full or half empty?"
"Their perception of the amount of water in the glass," I said.
"That is correct," he said with a wave of his hand, "A perfect answer. The key word is perception. They are both correct about the amount of water in the glass – the only difference is how they perceive it, whether negatively or positively. A person with depression perceives everything negatively."
I nodded again. I'd learned about that in my psych classes.
"But you can choose to change your thinking," said Dr. F. "You can choose to change the way you see things. Seeing something in a positive light doesn't make you wrong. If you don't change your thinking, you will be a patient forever. And you may say to me, why should I listen to you? I can do whatever I want! And you're right. It's your decision. My homework to you is to think about that for a while, and try to answer the question: what made you choose suicide as a coping skill?"
Then he shook my hand again, as he always did when he finished talking with a patient, and said "Good day, I'll speak with you again tomorrow."
I did think on his question. I still wasn't sure of the answer. I'm still not. But I know it has to do with my negative perceptions: my mistaken feelings that nobody had ever loved me and nobody ever would. If that was true, then what point was there in living? But those perceptions were false, a perfect trap laid by my depressed mind.
A patient – forever. I thought on that for a moment. A future flashed before my eyes: more hospitalizations, an inability to hold a job, disability, group homes, and maybe even the final destination. Pilgrim State Hospital. A fate worse than prison. Was this the future I was destined for? Was this what had been in store for me when I graduated high school, when I got scholarships, when I went to college?
I had been just like everybody else. Now I was staring down the possibility of being a patient forever.
The day I got out of the hospital I was invited to be an admin on a mental health blog with nearly eight thousand followers. I readily agreed. I had applied for this position months ago, and my application had finally gone through. The blog is a collection of people who suffered from a wide variety of mental illness, who answer questions about mental health. I have to answer fifty questions a week, as well as running support groups for depression and bipolar disorder. Many of the questions are quite interesting and I enjoy the job.
However, some of the most common questions we get are from suicidal people who refuse to call a hotline.
To be clear, we aren't a crisis intervention service. We aren't trained. We aren't professionals. We're just people with mental illnesses that want to help others like ourselves. Maybe we want to help ourselves, too.
In my first week I had three people overdose while chatting with me.
I quickly came to realize that some people were just too far gone, and not to feel bad about it when my interventions didn't work out. Trying to talk someone out of suicide is like playing a logic game where the other person gets to make up all the rules and doesn't tell you what they are. But it's a game worth playing.
I am still mentally ill. I always will be. But I'm in recovery now. I'm doing better. I don't want to be a patient forever; in fact, I want to play the role of the doctor. It's not that things will never be bad again – they will. But things are good, too. Some things are wonderful.
I love studying psychology, especially bipolar disorder. It's a beautifully powerful and seductive disease. It almost claimed my life the way it claims many others. I think I'm so fascinated by it because it terrifies me. I love mania; even now I seek it out. That's the seduction. There is no weapon more powerful than seduction.
I think that the point of life is different for each person, determined by the things they are passionate about and their aspirations. I want to spend my life studying mental illness and helping others who are struggling with it. That is my reason for being; the purpose I've carved out for myself in life.
I hope it is a good one.