November 26, 2013
11:03 a.m.
My younger brother and I are sitting in the waiting room at Arbour Hospital in Jamaica Plain, hoping to talk with Mom during visiting hours, but she’s refusing to meet and blames us for being a captive in this mental hospital, in this world, at this time. We want her to receive help, but she unfortunately doesn’t believe she needs any.
Time in a mental hospital feels simultaneously infinite and stagnant. I’ve visited enough of them to understand that time here has its own speed. I knock on the window of the intake specialist, and she doesn’t answer, even though I can see her shadow behind the frosted glass. I can hear her talking, and I assume she’s on the phone. Over the years, I’ve learned to not expect great customer service from mental hospitals, but Arbour lowers the bar even more. I just want to talk with someone, anyone, who can tell us how Mom is progressing. During our last phone conversation, Mom basically told me I was a part of a larger conspiracy to ensure she stays locked up for life.
Truthfully, the thought of her freedom terrifies me. When she’s manic, doors to other worlds open to her, and we lose her in seemingly different universes. I see these doors everywhere — perhaps because I’m creative (or just my mother’s son) — but I know how to keep them shut. Most days, I’m able to hold off those other worlds from devouring me like they do her, but today is not one of them.
World B, November 26, 2013
11:03 a.m.
A man in a white uniform leads my brother and me down a series of hallways that make the Arbour Mental Hospital, AMH, seem more like a labyrinth than a health center. I hope our guide isn’t lost, but I can’t be sure. The orderly hasn’t said a word since we entered the basement. Nevertheless, since I’ve been in countless asylums before, I already know why we must go through so many tunnels.
Architecturally, the hospital follows the Kirkbride Plan — a style used across the United States. The hospital is built like the wings of a bird, with an entrance at the bird’s center. Once patients enter AMH, they’re itemized by how violent or delusional they are, and they’re placed farther and farther from the entrance based on the severity of their illness. Patients considered clinically severe are stashed closer to the wing tips. Those who are nearing rehabilitation are nearer to the main entrance — or the exit — as they’re almost cleared to leave. Based on how far we have walked, I don’t think Mom will be leaving anytime soon.
The orderly points to a brown door with peeling paint. Once he pushes it open, I see Mom on a gurney in restraints. A doctor, scalpel in hand, is standing over her. He cuts an incision on the back of Mom’s forearm. She doesn’t visibly react as the scalpel slices her skin, which makes me feel like this has happened several times before.
The doctor moves Mom’s arm over a biohazard receptacle, and her blood drips into the container. As the blood hits the plastic bottom, it sounds like rain pelting a roof.
“Bloodletting removes the humors and bile from the body,” the doctor says, a beam of light bouncing off the scalpel. “In vogue in the 19th century. Went out of practice in the 20th. Now, doctors are rediscovering the medical benefits.”
“How much do you need?” my brother asks.
“As much as it takes,” the doctor says.
Mom’s blood is bright red as it hits the air, but as it pools in the plastic receptacle, it turns dark, resembling cough syrup. I can’t help but wonder how much of the disease is in my blood, too.
November 26, 2013
11:48 a.m.
I knock on the window again, and the intake specialist slides open the door. Her hand pops out and motions to the seats. I don’t move.
To a certain extent, Mom is right to blame us for her hospitalization. My brother and I begged her psychiatrist to issue a Section 12, a form of mandatory temporary hospitalization whose name varies depending on your location in the country. Baker Act is one of the more common, but in Massachusetts, people also refer to it as the “pink paper.” Suicidality, homicidal ideation, and markedly impaired judgment due to mental illness are examples of situations that warrant a Section 12. Mom fell into the impaired judgment category.
The point of issuing a Section 12 is to place a person on a temporary hold, observe her behavior, and see if the patient is a danger to herself or others. In our mind, Mom was certainly dangerous to herself, but this measurement is incredibly subjective. There are measures in place to ensure that people aren’t given a Section 12 for nefarious reasons, and sometimes, it complicates the timeline on when manic people actually receive the help they desperately need.
Before her psychiatrist filled out the pink paperwork, we supplied her with countless pieces of evidence that illustrated the essential need for hospitalization. The most significant fact was that Mom was making surprise appearances at her lawyer’s office wearing nothing but a trench coat and living out of her car in freezing temperatures instead of her warm home. It was not an easy process. At first, the psychiatrist didn’t believe us, because manic people have an uncanny ability to manipulate situations so they can stay manic. We’re lucky Mom has a good psychiatrist, someone who cares, someone who’s willing to listen to nuance. Others are not so lucky.
Before the hospitalization, I confronted Mom over the phone about showing up at her lawyer’s office naked. She offered an elaborate, Raymond Chandler-like plot, pinning her attempted murder on her ex-husband, my father, who was allegedly pumping poison into her condo through the propane system. The chemical particulates were covering the interior of her condo and clothes. It was necessary, therefore, to get rid of all her clothes and live in her car.
Unless her meds are recalibrated, she is a clear danger to herself, but the staff is stonewalling us from any information. Mom has refused to sign the documents that give the doctors permission to reveal any medical history to us. We’re concerned. I need to know what the treatment plan is, how long they’re going to keep her, and if she’s voluntarily taking her medicine during the hold or if she once again views her lithium as a microchip implanted in her skull to control her motor skills — a sort of Manchurian mother.
World C, November 26, 2013
11:48 a.m.
My brother and I are ushered into a room in the back of Arbour Mental Hospital. I have to remind my brother that there is no questioning the results of the data analysis. The numbers are what they are. Data is truth. Always.
While Mom is being medically analyzed, she’s not in the hospital. She’s back home. The Mental Illness Information Technology Unit (MIITU) put her in sleep mode, and they’re filling her neurons with memories to keep her mind preoccupied from waking up while the analysis is being processed. Mom is back home in a hibernation state, but the essence of her life, her information, is certainly here. The medical professional I talked with on the phone explained this facility as the heart of the MIITU, and we’re about to receive a status report on her progress.
We’re led to another room with countless computer monitors. On each screen, I can see different moments of Mom’s life. On screen one, Mom is scrubbing the floors to remove the insidious chemicals that she believes possesses agents of death sent by my father with as much intensity as Lady Macbeth trying to remove blood from her hands. On screen two, Mom is banging on the door of her lawyer’s office, demanding that they call the police and begin investigating her ex-husband. “He’s trying to kill me!” she screams. “Please, he’s trying to kill me!” The clip fades out, and another fades in. They’re all moments of her mania.
“The moment she showed up at the lawyer’s office was when we detected disturbances in her cortisol levels and alerted you,” the doctor says. “We have been monitoring her behavior closely now and have significant data to back our decisions for hibernation.”
He points to screen four, where a series of data visualizations are being updated in real time. A scatter plot shows the number of times the neurons fire in her prefrontal cortex compared with the amount of time she cleans her carpet. The MIITU is trying to track the chemical activity in her mind to her delusions. A histogram vibrates, with all the colors of the rainbow. It illustrates the level of her psychosis (the measurement on the mania scale) compared with the number of days between lithium doses.
“Obviously, the greater the distance between pill days, the higher the intensity of abnormal behavior,” the doctor says.
They even have a bell curve showing the normal range of times she visits her doctor’s office. Another graph shows how her brain activity changes on sunny days compared with cloudy ones. Then there is a line chart, perhaps one of the simplest graphs, showcasing the number of degrees away from destruction.
“After a thorough analysis, the story we’re seeing is grim,” the doctor says. “She believes your dad is trying to kill her. Our predictive model suggests that your mother has a high probability of harming herself or others. We need to keep her turned off until we find the right medication regiment.”
There is no questioning the data. The numbers are what they are. I have to remember that, too.
November 26, 2013
12:37 p.m.
I wasn’t expecting much empathy or strategy from the hospital staff, as the facility appears to be unorganized and apathetic. In fact, I recently picked up a <i>Boston Globe</i>, and there was Arbour Mental Hospital — right in a headline. The article alleged that abuse and neglect had been happening at the hospital before Mom arrived, and the journalist said that someone had died because of a lack of care. The state had opened an investigation.
I’m beginning to believe I need to relocate Mom for her own safety, but she won’t allow me to talk to her. I no longer have any control of her care (in truth, I probably never did), and my brother and I are just forced to sit in this waiting room, praying that Mom will find some sort of capacity to realize what’s right. She has no other family, no other person who can be her legal guardian. Beyond us, her children, anyone who can qualify for that role is long dead.
World D, November 26, 2013
12:37 p.m.
I pick up Mom’s ashes at Arbour Mental Hospital in an urn. As soon as they realized she had bipolar disorder (specifically, type two), they decommissioned her life.
November 26, 2013
12:38 p.m.
From what I can gather, all signs point to Mom being released after the 72-hour hold, and it doesn’t sound like there is any treatment plan. In fact, many of the staff members seem to think Mom is in good enough shape to be released on her own, but my instinct is they’re ignoring her. They’re simply trying to move her out of the hospital due to overcrowding. This all seems absurd. Not only do I need to find a way to get Mom help, but I have clean up the mess she left in her manic wake and talk to the police on the whereabouts of our dog, Buddy, who she was living with in her car. I also need to find her car and clean her house.
I knock again. This time, I forcibly say, “Excuse me.”
She opens the reception window again and stares at me as if I’m a telemarketer who’s decided to visit her at home after she didn’t pick up her phone at work.
“I’m here to see my mom. We’ve been waiting awhile.”
“Name?”
I gave her Mom’s name before, and I’ve seen her almost three times in the last 24 hours. Instead of getting upset, I simply inhale deeply and tell her again.
“I have a couple concerns, too,” I say. “Can I talk to her doctor?”
Big trouble is ahead for Mom if this isn’t handled right. I’ve seen it happen before. If she’s released without having her medicine adjusted, she may die. Not that she would die from any medical complications, but I believe death can take any form and meet her on the street like a friend she hasn’t seen in years. Death can show up in the form of hyperthermia while she’s living in her car until the freezing weather stops her heart. Death can take the form of a stranger who sees her car parked on the side of the highway outside of the Leominster Hospital and decides to throw zip ties around her arms and drag her into a basement to try out his new Japanese cooking knife on her skin. Death can appear when she wanders into traffic, taking the form of a Nissan Maxima driving 45 miles an hour without expecting a woman to run into the street. The different worlds can come quickly or slowly, in bursts of images or scenes.
“Sir,” the intake specialist says, shocking me out of my worlds.
The other worlds are sometimes so vivid I can smell them, almost touch them. I may have inherited that from Mom, and it scares me how easily these worlds can consume me. I try to write them down to control them. I carry a journal everywhere, putting those worlds to paper, believing that if I can just keep them in my notebook, then, perhaps, they won’t consume me. Perhaps chronicling, documenting, scrutinizing these vivid worlds is the only way I can stay attached to reality.
“Can we go up now? I have some severe concerns about how she is being treated.” I pull my phone out of my pocket and face the article toward the window. “You read the <i>Boston Globe</i> piece?”
“She doesn’t want to see you.”
The blood pulsates in my forehead like it’s trying to leap from my skin. “Then I need to talk to her doctor. Or the medical director.”
“She has refused to allow you to speak to her medical specialists.”
“Then what am I supposed to do? You realize she is sick, right?”
“I’m sorry, sir.”
My brother is watching the conversation from his chair. He’s a bit younger than me. Seven years, actually. So a lot. He’s 20-years old, and he begins to laugh. He knows nothing can be done for Mom, but by the way he is holding the arms of his chair, it seems as if he is trying to hold himself in place. The anger is behind his eyes in the whites that are turning red, a fire burning from within that needs a place to escape. One day, I imagine he will explode like a star collapsing in on itself, warping the love of those around him.
World E, November 26, 2013
12:38 p.m.
The Arbour Mental Hospital is a forced labor camp for artists. Some would say it’s not the worst gig in the world, but others have a different opinion. After a series of sessions, psychiatrists can determine what artistic form of expression is best suited for each patient.
For instance, patients who have been dealing with schizophrenia and complex hallucinations have access to a room for painting so they can translate their visions into art. Patients who are dealing with obsessive compulsive disorder often receive a camera and lighting equipment, as their attention to light in post-production creates uncanny cinematography. Patients with histrionics are encouraged to produce a vlog.
Most people in the United States have no idea that the songs, art, and movies they consume were produced in mental hospitals. It’s the engine that powers digital content and meme culture. Without these fine people, the doctor explains to me when I inquire about Mom’s treatment plan, there would be no content for the internet.
“They’re exhausted,” the doctor says, “but that constant artistic stimulation is the only way to control the illness.”
When my brother and I are brought to Mom, she is behind a piece of glass in front of an electric piano. She has a beautiful voice and a history with music. There must be some sort of exam when patients arrive. She’s wearing a pair of headphones, and her mouth is wide open. She seems to be holding a note. The psychiatrists try to ensure me that she’s singing. When I see her stop and take a breath, though, I think she’s screaming.
November 26, 2013
3 p.m.
I decided to leave the hospital, as we weren’t making any progress. I still haven’t heard from Mom or the team at Arbour Mental Hospital, and in the next 24 hours, they will most likely release her. She will head back into her car, running from the phantom of my father trying to kill her and straight into the frigid arms of hyperthermia. I stop myself from wandering into the worlds where she ends up dead and try to focus on this one.
Having received no news about Mom from the staff, I email the reporter at the <i>Boston Globe</i>. I’m hoping some outside pressure can force the staff’s hand. In the subject line, I write: “My mother is at the hospital you wrote about. Can we talk?”
The body of the email reads as follows:
Chelsea, I just saw your report on the Arbour Hospital in Brookline. My mother is currently staying there, and I’m very concerned about her condition. How can we help each other? Best, Joe
She writes back nine minutes later:
Hi Joe — I’d be happy to talk with you. I’m at the office today until 6 and back again Friday: 617-XXX-XXXX
For a moment, I feel like I have power and almost instantly dial her number and begin telling the reporter Mom’s story, describing how this hospital hasn’t stopped to think about the danger it’s putting my mom in if they let her go. I imagine telling her about the injustice of our own inability to know what’s going on with her treatment — riffing on the issues of the mental health system.
But for some reason — perhaps the other worlds were ringing in my mind or that Mom’s story is not my story to tell — I decide to think about it more before calling. My brother and I have some things we need to take care of. Our first stop is the CVS parking lot in Leominster to pick up her car.
The skies are gray. It’s one of those New England days that are as dreary as a bowl of oatmeal that has been left in the kitchen sink. My brother isn’t talking much, and we listen to the local radio.
World F, November 26, 2013
3 p.m.
When we arrive at the Arbour Mental Hospital, I meet Mom’s entire treatment team: a social worker, a psychiatrist, a spiritualist, a therapist, an art therapist (Mom likes music), and a lawyer. They’re sitting in a circle, and the social worker hands me a stack of pink paper with her specific treatment plan. It’s incredibly detailed, about 18 pages, and includes several stages.
They plan to try two weeks of talk therapy after her Section 12, alongside cognitive skills training and art therapy. If they find that the therapy is not working, they will introduce pharmacological help, even though it’s stated clearly in the treatment plan that the pharmacological solution would be a last attempt.
“Your mother keeps referring to a trauma around your father,” the psychiatrist says. “While it must have been difficult to hear that about your own family, your father is clearly neither a murderer nor an arsonist, and we believe this is part of her psychosis.”
“However,” the social worker says, “it’s clear that the psychosis is a callous hiding a deeper wound that is harder to unearth.”
“What do you mean?” I ask.
“We’re not entirely sure yet, but we’re hearing her begin to talk about some abuse in college,” the psychiatrist says.
“It appears she might have dealt with repeated sexual assaults,” the social worker says, “and we’re beginning to draw some preliminary conclusions that she may have been burying the trauma. Now, during stressful situations, she uses your father to mask the pain. We’re beginning to see this pattern as a deep-seeded coping mechanism.”
“Until she gets to the bottom of her trauma, we can’t imagine her ever learning how to process stress and avoid these repeat hospitalizations,” the psychiatrist says.
“Coupled with a genetic disposition to bipolar disorder, her trauma is almost kicking her mind into a situation similar to soldiers dealing with PTSD.”
“We feel confident that she can overcome this issue,” the art therapist says. “And find a way to live a more enjoyable life.”
I look outside of the conference room, and I see the green fields where the patients walk the campus. I see the birch trees and the garden where patients help grow and pick cherry tomatoes, lettuce, kale, and all the other food used in the dining experience. I see a world that protects and cares for the health of the mind, and I already know that it’s a ridiculous world that no one can believe is real.
November 26, 2013
5:08 p.m.
When we arrive, we see Mom’s car parked in the CVS parking lot. It’s a purple Ford Taurus, and her tires are way over the parking line.
The police said they found her in the CVS, trying to buy some products. I didn’t hear what she was trying to buy, but they also found our Labrador in the front seat of her car. I have the keys, and when we open the door, the car is a mess. She has some clothes in a plastic bag, and the front seat is covered with trash: water bottles, candy wrappers, McDonald’s wrappers. A bag is on the floor, and when I pick it up, it smells like she was going to the bathroom in it. We remove all the trash from the car, and I jump into the front seat to drive home. I put the key in the ignition, and I realize the battery is dead. It’s late, and I’m concerned we might have to wait to the morning to find our dog.
World F, 2013
5:08 p.m.
Mom was sitting on a park bench in the Boston Commons. People are paddling on swan boats in the pond, and the leaves are changing colors. We haven’t seen Mom in almost three years, but we’re beginning to suspect she follows a similar migration pattern as the geese that are honking overhead. We approach her carefully, like a lost dog that might run away if startled. She doesn’t seem to have showered in some time. Her hair is long. She always had a short, Hilary Clinton-like haircut. When I walk into her line of sight, she doesn’t acknowledge me. Her eyes are glass.
“What is your question?” she asks without looking at me.
“It’s Joe,” I say and point to my face. “Your son.”
She doesn’t seem to hear my name, and the part of her brain that connects words to memory fails to activate our history. She looks from right to left as if she were watching the flight pattern of a fly before attempting to squish it between her fingers.
“What do you want to know?” she asks. “I have all the answers you want.”
I see the tattoo on her neck: 00148765. It was once her social security number, but it’s now her mental health identifier. The tattoo ink is composed of nanoparticles that can be tracked, similar to the way that oceanographers track great white sharks. I remember the day she came home from her psychiatrist with the number. It was like they had branded her with a red A. The Mental Health Bureau said she had a duty to her country. She was going to be one of the wandering angels, belonging nowhere and to no one.
“You don’t recognize me?” I ask.
“You are the one who wants to find an answer from someone who loves you. I can’t be your protector. I can’t be the celestial trumpet sound you need heralding the truth you seek. I can’t be the one who shows you that life has a purpose or a plan. That is the answer you are seeking.”
My brother sits down on the bench next to her and places her hand on his. When she smiles, it’s clear that this woman is our mother, not some imposter. I would have liked to believe something different. Perhaps she was kidnapped. Or aliens were using her body as a vessel, and they had already destroyed any remnants of her brain. Anything besides the fact that her mind rebelled against her, forcing her to forget that she is a mom, a wife, a woman in the world.
“I miss you,” my brother says. His hair is short, a buzz cut, as he signed up for the Marines.
“Where is there a miss?” she asks. “Everything you is in front of you.”
She waves her hand over the Boston Commons, and the Prudential Tower reflects in the water, mirroring the drooling willow trees. Suddenly, she stops.
“You are maniacs. You are angels. You are bright stars that will eventually burn back to stardust. You are the brilliant buzz.”
I have no control over her mind and decide to walk away. Maybe one day she will return and remember who she is, but I can no longer try to help her change.
November 26, 2013
11:08 p.m.
We drive out to Fitchburg in a part of the town I’ve never been to before, and I’m still considering calling the journalist and trying my best to make a scene, turning Arbour Hospital into a character in the larger battle for mental health. First, I need to find our dog.
We’re looking for an address. I’m not sure if it’s the dog catcher’s house, but it’s the personal address of someone who helped the police deal with the situation. When we pull up to the side of the house, we can see our dog, Buddy, tied to a tree. He’s barking, and his voice sounds like it’s about to go hoarse. It’s late, and we realize he must have been out here since they issued Mom’s Section 12. Buddy begins to whimper when he sees us, and I can’t wait to hold him and get him in the car. He jumps into my brother’s arms and licks his beard as if he’s trying to shave him.
On the way home, Buddy and my brother are in the backset together. Jason is holding the dog as if it were a child. Buddy is so excited to see Jason, and I look back through the rearview mirror, imagining Mom looking into this same mirror at her dog and believing that her ex-husband wanted her dead. I can see her world so vividly, and I want to do anything I can to stop myself from entering it. I grab the phone. It’s time to make the phone call. It’s time to make things right and bend this world for the good of our family.
“Hello,” I say. “This is Joe Lapin, calling about my mom.”
I wait to hear the voice on the other end of the line: “How can I help you?”
It’s the same intake specialist I talked with earlier. I can tell by the apathetic tone of her voice.
“I just want you to know that I’m about to talk to the Boston Globe about how you’re treating my mother. If I don’t get the medical director on the phone in two minutes, I’m going to share my entire story.”
There’s a pause on the other end. Then the voice says, “One second, sir. I’ll call him at home.”
Five minutes later, my phone rings from a number I don’t recognize, and I assume it’s the medical director before picking up. It hits me: There is still time to point our family toward the real.
Photo at the top of the page: “Western Mental Health Institute—Bolivar, TN” by SeeMidTN.com (aka Brent) is licensed under CC BY-NC 2.0.