Acute Paranoia

On the other side of the double doors, the hallway hit a T-intersection with another hall, narrower but still crisp and white. We turned left, then rounded a corner sharply ahead, and abruptly stood before another plexiglass window. The window was slightly raised, as was the cramped space behind it which served as an office of sorts. Through the window I could see a desk with phones, and a shelf filled with medicine bottles. A woman on the other side of the window loomed over us, her elevated position bestowing her power. The orderly who had escorted me handed over my paperwork, explaining while I stood quietly and sensed the control of my fate slipping away.

"New patient," she was saying. "Self-admitting..."

The nurse (for that's what she was) had her own papers, which she handed through the window in the opposite direction. "He needs to sign," she said, without further commentary. On the white papers were names, phone numbers, and verbiage stating that I understand my rights, which were posted somewhere. Though I did not really understand, I signed. I was at a point of no return.

"We must conduct an admissions search," the nurse droned.

The guard was summoned from the other side of the double doors. I emptied my pockets, handing everything over. The guard, a tall, friendly black man, gave me a brief and courteous pat down.

Most of my possessions were seized, including my two bottles of medication, which by some miracle of foresight I had brought with me. I signed for them on a yellow piece of paper: 2 bottles of pills, cell phone, cell phone charger, 1 small knife set and 4 keys, blue tooth for cell phone. My wallet was examined, and returned, but there was a problem. The guard held open the billfold to reveal the contents - a thick wad of twenties, totalling nearly three hundred dollars. "You can keep this if you want," he said. "But I wouldn't advise it."

It was the stash I had been accumulating for my big escape from the Conspiracy, when I would have to spend cash only to avoid detection. I could imagine that it wouldn't be safe to have it on my person here.

"I can take you to security and you can check it in. Is that what you would like to do?"

Once more I consented with a nod, feeling swept along by events. The orderly I had first talked to now excused herself. "I'll leave you in their capable hands," she said warmly, and left. It was the last I would see of her.

The guard walked me out of the wing, and down more maze-like hallways to a small office. Inside was a diminutive, older man, sitting at a cluttered desk and watching a tiny television. He was wearing a police officer's uniform and had a holstered sidearm. I imagined that he considered himself to have a cushy job. Wordlessly, he took the money, filled out a brief form, and handed it to me. The amount on the form looked right, so I signed. I got a stub to keep. The officer returned to his television and the two of us back to the mental health ward, where the guard left me at the window.

The nurse now gave me a brief tour of the unit, as it was called, as she took me to my room. Just across from the window was the kitchen, where meals would be taken. It really looked like a cafeteria, with plastic tables surrounded by plastic chairs. The room had a television mounted high on the wall, and some chairs arranged to face it. A few chairs were occupied by patients, and a few faces turned to look at me, sizing me up.

We continued down the hall. Not much further along was another set of double doors, which were propped open. On the other side of these doors another hall intersected at a right angle - along this one were the patients' rooms. Mine was across the hall from the double doors. As we approached I saw a young woman with long, unkempt blonde hair, going into one of the other rooms. She gave me a leering smile and gushed, "Hi, cutie!" I quickly turned my gaze away.

The nurse waved me into my room. "Lucky, you get it all to yourself," she said. There were two uncomfortable looking beds in the room, with thin mattresses and pillows, and a nightstand beside each one. There were no windows. I picked the bed furthest from the door and sat down on it.

"You missed dinner," the nurse said, "but there are snack machines in the dayroom." I didn't bother to tell her that I had no money for the machines. She left, closing the door.

I sat alone in the room, wondering what I had just done. I was now completely dependent on the staff of the unit, and completely unsure of my fate. Though I gathered that I was not being forced to stay in the bedroom, I was too wary to leave. Uncomfortably, I lay on the bed, fully dressed, and pulled the thin blanket over myself. In time, I was able to fall asleep.

At some point in the night, a nurse opened the door to check on me, but that was all that happened until morning.

In the morning I hid in my room. I was still too wary to leave. On the nightstand beside my bed I noticed a piece of white paper; I wasn't sure if it had been there the previous day.

On the paper was a numbered list of the rules of the unit, including the times of meals, how to get personal items like toothpaste or soap, where to shower (in my case, since I shared a room, I had to use the shower in the hallway), and where to wash clothes. There was always a staff person assigned to me. And there were smoke breaks, more often than the meals. To go on smoke breaks (which I did not plan to do), one met at the nurses' station. This must be the central area with the window, where the medication was kept.

The first order of the day turned out to be changing the temperature in my room. It was much too cold for me. There was a thermostat on the wall, but of course I wasn't sure if I had the power to adjust it. After awhile, I figured it out. This was a minor achievement which boosted my confidence.

I opened the door to the hall and stood in the doorway, appraising the situation. Across the hall there was another guy, about my age. He stood a few feet from his doorway, leaning on the wall. He looked a bit disheveled, with stubby hair growth on his face and rumpled clothing. He was where I was going to be if I stayed for a few weeks.

He acknowledged me with the briefest of glances, then spoke out loud to no one in particular, a general complaint about being stuck in the ward. Nervously, I ventured out into the hall. The girl with the blonde hair emerged from her room, apparently drawn by the speech of the guy across from me. She gave me a hard stare, smiling intensely and perhaps malignantly. She seemed like trouble to me.

I headed to the one place I remembered - the "kitchen" where I might find something to eat. There I found a few people, sitting and watching television. A clock on the wall informed me that it was late in the morning. I had missed breakfast, but didn't have too long to wait for lunch. I found a seat and joined in the TV watching - some soap opera was on. No one talked, and there was an air of anxiety in the room.

Presently a large and intimidating man entered - one of the patients. Two other men followed him in, like an entourage. Immediately the room filled with tension. I glanced quickly at the man, but did not make eye contact. He looked disapprovingly at the television, and someone deferentially handed him the remote. He changed the channel to a sports channel. Obviously, he was used to getting his way.

The anxiety in the room had risen to a level of palpable fear. I sensed that this big guy - I started calling him Big Boy in my head - was capable of violence. Probably it was part of his background, part of why he was here. Whatever his story, he was clearly an alpha in the social hierarchy of the unit. I sat, as still as possible, waiting for lunch to be served.

That lunch turned out to be conventional institutional food - bland and innutritious. There was no conversation as we ate. The atmosphere was subdued, ominous. As soon as I was done I returned to my room.

There I remained, with nothing to do.

At some point that day, I was visited by my attending physician, a psychologist whom I will call Dr. S. She was a short woman with an odd face and a nervous, mouse-like disposition. She was Eastern European and spoke English awkwardly. Hesitantly, we proceeded with the initial evaluation of my mental health.

I explained to her my paranoia, my thoughts about uncovering a conspiracy at my workplace, thus putting my life in danger. As she pressed me for details, it came out that my fears were intensified whenever I smoked marijuana.

"Do you often smoke marijuana?" she asked.

"Yes, I use it to relax."

"Do you think it might be connected to your feelings of paranoia?"

Well, obviously. I simply nodded.

The interview did not last long. I did not provide very much detail. She promised to return for a follow up tomorrow.

My other accomplishment on that day was to figure out how to take a shower. Unfortunately, I had to change into the same set of clothes again. But that night, when I slept, I removed my pants, for a little extra comfort.

Dr. S did indeed return for a follow up evaluation. Meanwhile, I grew used to the routine at the unit, and got to know my fellow inmates.

The layout of the unit put the nurse's station in the center, with a hallway wrapping around it. On opposite sides were two kitchens, which also served as day rooms. At the back of the unit were all the bedrooms. A set of double doors, the ones that had been propped open on the day I arrived, split the rooms into two wings which could be separated. At the front were the doors out, which were always closed. The whole place was shiny and white and clean, brilliantly lit by day and dark at night. There were no windows in any of the rooms, no trace of the outside world except for what could be seen on the TVs.

The most important ritual of the day was "vitals." This was when the nurses would record your temperature and blood pressure, and when your medication was dispensed. It happened in mid-morning and again in the late afternoon. A nurse would call out "vitals!" from in front of the station, and all the inmates would hurry out to assemble there. The first time it happened I sensed from the tone of the announcement and from the reaction of the patients that one had better be there for this crucial event. Everyone would crowd around the nurse in charge of taking vitals, who was invariably a large man. He would handle you roughly as he applied the blood pressure cuff, almost inviting you to resist. It was a humiliating experience, but you had to do it if you wanted your medication. I certainly wanted mine.

The other popular daily ritual was the smoke break, which happened five times a day. A large group of the patients would gather at a stairwell door, and then be escorted out. Presumably there was a courtyard or someplace where they went, but I never saw it. Big Boy and his entourage were always in the group, as was Blonde Girl, staring at me if I ever looked in the group's direction. Music Man would be there, too - I called him that because he mostly spent all day wandering the halls with earbuds hooked up to a music player, nodding his head and softly singing along.

Meals were another routine, but they seemed to be less popular. Many people, it seemed, just skipped them. Or maybe they were served in their rooms. I took to eating in the kitchen that was in the opposite wing of the unit from the first one. This one also had a TV, with seating around it in a more sociable arrangement. The alpha who controlled the TV programming I called Lighter Fluid, because she had doused her husband's girlfriend with lighter fluid and set her on fire, a story which she freely told anyone. She was scary, but not as scary as Big Boy.

Another feature of this second kitchen was a group of elderly woman who always dined together. There were nearly a dozen of them, sad, quiet and confused. I couldn't see why they belonged there - it was like they had been abandoned by their families. They were the most depressing thing about the place.

I spent most of my time in my room. I learned that the guy across the hall from me was named Earnest. He had been admitted by his wife on account of his drinking. He was counting the days until his release.

Earnest would sometimes hang out and talk with a another guy, nicknamed "Iz." He was a brooding type who was always getting into trouble with the staff. Something he did that day caused the double doors that separated the wings be closed and locked. I never figured out what it was.

The final ritual worth noting is one I have already mentioned. That is that every night, a couple of times in the night, a nurse would come by, open the door and announce herself. She was simply checking on you, I assume to make sure that you weren't up to no good. And that you were still alive.

On my second full day in the unit, I had a visitor. My sister came to see me. She had heard I was in the institution from our mother. She was escorted into my room, and from there we went into the kitchen where I ate. There on one of the tables we played a game of Scrabble. Some of the elderly women sat silently at the same table, doing nothing, and looking jealous that I had company.

I was grateful to my sister that she came to see me. It was clear that it was unusual for a patient to be visited, to have that connection to the external world. It felt like a lifeline. It was good to know that the other inmates, and the staff, realized that there were people outside who knew I was there and who cared about me. Because I was starting to get a sense of how dangerous this place was.

On my third full day in the unit, in the morning, I spent some time chatting with Earnest, just outside his room where he hung out. He insisted that he didn't have any behavioral problems, that his wife was just punishing him for drinking. It was like a game she played; apparently, this wasn't his first time here. He knew exactly what day he was eligible for release, and that his wife had no grounds for requiring him to stay. He had never been violent with her, not once. He said I was lucky that I was self-admitted, because that meant I had more control over when I was released.

Iz came over and joined us for a bit. He was his usual nervous and embittered self but spoke with some bravado about how he wasn't worried about the others, and that he knew he could survive. He could make a weapon if he needed to. He insisted that of all the people there, the one that he feared the most was Blonde Girl. I surmised that what he feared about her was her sexual aggression.

I wasn't long back in my room when a young intern came to see me to perform her own evalution. She was bubbly, enthusiastic, and seemed incredibly naive. Her attitude was in stark contrast with the indifference or menace displayed by the other staff. She obviously knew nothing of the place and was simply there for training. I humored her as she gave me patronizing and useless advice, and was relieved when she left.

I was next summoned by the social worker. She had a brief write up about me, stating that I spent too much time avoiding the other patients. I had to go to the day room for "social bingo."

This turned out to be a game where you had a card like a bingo card, but with prompts in the squares, so that when a square was called, you had to talk about something or do something. Like "compliment the person to your left", or "share something about your family." A small and sullen group of patients had been gathered to play.

The energy was muted and everyone held back, as was usual in the ward. Luckily Lighter Fluid was participating, one of the few assertive personalities in the patient mix. She actually was somewhat encouraging to the other patients. I get the sense that she liked me, and could feel myself gently slipping into a comfort zone. Was this my future - to join Lighter Fluid's entourage and spend my hours watching her choice of TV programming in the day room?

When I had my follow up with Dr. S, I made sure to bring up the question of when I would be released. Were there any more steps to my treatment? Was there any reason I needed to stay? It seemed odd, objectively, that I would admit myself and then simply request to leave, when there had been no resolution of my case, no actual therapy. But that place was scary. I wanted out.

Dr. S said she would consider it and let me know. This was our shortest interview.

There was one more surprise for the day - a visit from my roommate Fred and our mutual friend Tom, who had travelled a long way. Fred seemed completely oblivious to recent events, and to my paranoia about him. We did not discuss this, just talked a bit about my state and about life in the facility. They brought a few history books. They were new books, not my favorites. Not the ones I had pictured myself with when I was finally locked away, along with the secret to the Conspiracy. But they might do.

Again I was grateful to be reminded that I had friends in the outside world. And more determined now to rejoin them.

On the morning of my fifth day I was told I had to eat breakfast in the first kitchen, because that was the one on my side of the unit. Apparently my favoring of the other kitchen was against the rules. Big Boy was there, of course; the reason I stayed away.

There was a preacher sermonizing on the TV, exuberant and intense in the manner of evangelicals. He held the rapt attention of everyone in the room, which suppressed the usual air of dread which hung over any group of people in that place. It was a nice respite, and I watched along with the rest while I ate my meal.

When I had my meeting with Dr. S I again asked about being released. She said that if I felt good, she was willing to discharge me.

"Yes," I said. "I feel good."

She had my diagnosis written down and shared it with me. I had suffered marijuana-induced psychosis. I was to continue taking my medications, Topamax and Zyprexa. I was to avoid marijuana. And I was to see a psychiatrist, whose name and contact info were on my discharge papers, along with a date and time already established for my first appointment. It was in one week.

She wished me luck, and said good-bye, and I never saw her again.

Holding the papers and the books my friends had given me, my only new possessions since my admission, I walked down the hall to the nurse's station. My mood was lightening with every step. There was hardly anyone around. Vitals and the next smoke break were both a ways away. I just saw Music Man, shuffling along, swaying to his music. I passed him and arrived at the window, and then he passed me after I stopped to hand over my papers.

An expressionless nurse took the discharge papers wordlessly. While waiting for her to process them, I noticed that by the window was a suggestion and complaint's box. It was stuffed with slips of paper, to the point that the box seemed to be bursting at the seams, the paper poking out in all directions.

The nurse handed me my possessions in a ziploc bag - my keys, cell phone and accessories. Then I was escorted to security, and the same police officer handed over my money. Everything was there. Just down from the security office was an exit from the building. Bright sunlight shone through the glass door - the first I had seen in days.

I took the exit out. It was at the side of the building, so that I would have to take a long walk around to get to my vehicle. But there I was, on the outside.