Sara Kirschenbaum
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First Chapter of Home Sweet Nuthouse

Posted Sunday, Sep 14th, 2008 at 5:54pm

Chapter One: Home Sweet Nuthouse

Beverly, Massachusetts

January, 1990

The first night in the nuthouse was starkly sweet. The motley crew of us patients lined up in our stocking feet and bathrobes at the medicine dispensary. Once we were handed our tiny paper cups holding colorful morsels of chemical hope, we headed back to our silent rooms. It was generously warm on the ward and no one needed much in the way of robes or covers. The lights were turned low but still offered enough illumination for the sleepless wandering that would keep our floor busy all night. My bare and simple room came as a relief. The empty walls left little for my obsessive thinking to work with.

As I tossed and turned in my little bed with the thin hospital-issue blanket, I noticed a nurse periodically tiptoeing into the room and peering at me. Shortly after her three a.m. tiptoes, I stood up and shuffled across the spotless shiny floor to the nurses’ station to find out what these silent forays were all about. I had become used to watching hours grind by at night - but I was not used to company. The nurse at the desk told me that when new patients come in, the nurses check on them hourly for at least the first 24 hours. I asked to see my chart and she turned her clipboard around so I could see the notations on my sleep and agitation levels. I was not alone with my misery; I had a witness. As I talked to the night nurse I heard how sane, coherent and intelligent my voice sounded. For months I had heroically put on a lucid front. Now in the dim night light both my suffering and my stamina were revealed. I was going to like it here.

The dependable rules were a relief from the ricocheting anxiety and impending disaster in my mind. It wasn't a locked "unit," but you had to earn privileges, incrementally, to walk past the double doors, venture down the hall, get into the elevator and step out into the cold fresh air of Massachusetts. It was a comfort not to be allowed out; it was about time someone reined in my world. The psych ward felt safe, secure, and even cozy, like a small Club Med for a troubled mind.

The trouble, it would be easy to say, was post-partum depression after the birth of my first baby, Sage. But in truth the pregnancy had been almost as bad as the post-partum. And the depression was conjoined with obsessive anxiety. My psychiatrist, Dr. Deborah Sichel, was a brilliant woman whose daily attention at the hospital was light therapy for the perpetual darkness. She had discovered a hormonally-triggered Obsessive Compulsive Disorder (OCD) and had, in the past two years, helped two dozen other new mothers with the disorder regain their lives. I was case study number 26. By the time I checked myself into the hospital, I was in a major depression in addition to the intrusive and sometimes violent thoughts caused by the OCD. I could not eat, sleep, hold my baby, or do anything of use. The night before I consented to go to the hospital, I was up all night on the phone, holding a full glass of milk in my hand that I couldn’t bear to drink, listening to my best friend tell story after story to distract me from the knowledge that I was too sick with anxiety to walk. At 6:30 in the morning I called my psychiatrist at home, in bed, waking up her husband, and then her, to say that I was ready to go in.

That morning, when we left to take me to the hospital, I put my favorite purple and green paisley scarf curled inside Sage’s cradle so that when he went to bed that night without me, my scent could hold him, if not my arms. Sage was two months old.

The idea of going to the hospital had been both a solace and a horror of last resort to my husband Bud and me. Bud’s mother had been swallowed up by a psych ward when Bud was born and it had only spit her out after shock treatments, Thorazine and the beginnings of a life-long dependence on hospitalizations. Bud had done everything in his power to keep me out of the hospital. But we had lost that struggle and now I found myself on a get-acquainted tour of the real thing.

This place was real: the textured weave of the white cotton blanket on my bed; the polite, discouraged, roommate; and the psych evaluations conducted by novice Masters of Social Work students. One pimply-faced intern tested my anxiety index. When he got to the section on abstract thinking he asked me to interpret the phrase: a rolling stone gathers no moss. I’ve never been good at adages but I knew he wouldn’t believe me if I told him that. The best I could come up with was “As long as you keep moving you won’t get in trouble,” even though this rolling stone philosophy hadn’t helped me much in the past 11 months.

After the psych evaluation came the medical work-up. The hospital architects must have known that Misery and the Body were old friends; they had an examination room right in the psych ward. The hands of the nurses were soft and gentle as they moved me through the exam, looking for a physical source of my anguish. When they took my temperature they were surprised that it was 95 degrees Fahrenheit. Even my metabolism was unraveling. The low body temperature helped me believe that wellness had long ago escaped the reach of my willpower.

The first morning in the nuthouse came too soon. I was surprised that I had fallen asleep after my 3 a.m. rendezvous with the night nurse. Getting to the hospital had dragged me through the resistance of half a lifetime; now I had to get up for a daily rap group? I found it hard to navigate through the peppy schedule of check-in, therapy groups and occupational therapy.

It was fun to check off the little boxes on the daily menus, assembling as many favorite things into each meal as possible: chocolate milk, corn muffin, lasagna, orange slices, kiwi slices, pickled beets, brownie, chocolate chip cookie. Uncharacteristically, I didn't worry about wasting food; I'd check off as many boxes as I felt like and only sometimes taste what came with my meal hours later.

At mealtime, a jury of anorexics hovered around as we all ate. They were charming, if tragic. Their caloric laser beams scanned each meal: their own and everybody else’s: "Does it taste good? How much did you eat already? How big was it? Does it have a lot of grease?"

The patients were the true salve of the nuthouse. We had checked our pretense, along with our winter coats, at the door. One bathrobed patient might say to another: "Good Morning, how are you?" and get the casual answer: "I was up from three till five with a panic attack but I finally got back to sleep. I’m still a little wigged out. And you?" Honesty was one benefit of the swamp we were all slogging through.

If the patients were at the core of our psych ward village, the low level staff (not including the psychiatrists who gave the orders) was peripheral. One day we ganged up on two meek-eyed workers who were running a rap group; we asked them why everyone kept telling us “Don’t cry. It will be alright.” After all, we reminded them, we were having a bit of a bad time of it.

Once a young Hispanic woman started screaming on the green vinyl couch in the lounge. She was the only other new mother on the ward and I felt some Postpartum sisterhood with her. She had been committed to our clubhouse when she tried to jump out a window. Now her slender brown body was curled up in a fetal position. She was moaning. The sight of her acute misery distracted me from my own and I went to comfort her. I held her hand and listened to her moans. Other patients gathered around and tried to help her feel more comfortable with pillows and blankets. Then someone went to tell a staff person, which is when the trouble began. A large female nurse entered the room but seemed more horrified by patients touching each other than by the moaning and screaming. We were firmly instructed not to touch each other and were shooed from the room. The crying mother was told to calm down. A full two days of moaning later, the young woman finally persuaded the staff to let her go to the emergency room, which was only nine flights down. The next day the staff informed us, only the tiniest bit sheepishly, that she had passed a kidney stone.

I wasn’t intimidated by any of the staff of the psych ward. I loved having someone assigned to me at all hours. I knew that the treatment marching orders came from my psychiatrist. She had trained all the nurses and doctors in this ward in how to care for the pregnancy-triggered OCD that she had discovered. On my first day there I asked her if I could let on to the other staff about my violent thoughts about my baby. I was still worried that they might try to have my baby taken from me. She said that the doctors and nurses understood my disorder but that it was probably prudent not to reveal anything to the interns.

Each day Bud and Sage came to visit. I still found it hard to hold Sage. His little spirit was so porous: so open, eager and searching. At two months old he was lifting up his head on that little neck and looking straight into the soul of whomever was holding him, with his fine gold hair standing straight up. His blameless eyes would catch and see into my pathetic ones. I couldn't stand my choice: let him see me this way or look away.

One morning Bud arrived looking terrible. He said that he had an awful cold and asked if I could take care of Sage while he found some place to rest. I found a nurse and asked if Bud could nap on my bed while I watched my son. The nurse said it was fine, but I wondered if I could manage. In the last few days before I came to the hospital I had not been able to hold Sage at all. I could still not make eye contact with him. I feared that my eyes, riddled with anxieties as they were, would damage him and scare him. Could I take care of him now, in the hospital?

Bud went to my room and slept for four long hours. Minute by minute I held my baby. Propped him up on the couch. Showed him off to staff and patients and willed myself to stay on time’s strong tracks forward. Nurses not only scrutinized me, but also encouraged me: “You’re doing a great job with your son, Sara.” I wondered what they were writing in their chart notes. Somewhere inside I felt deeply liberated to have handed over some of my secret self-scrutiny to others.

Bud slept deeply, drooling on my hospital-issue pillow. When he woke up he felt much better and thanked me profusely for my brief return to the land of the useful.

When Dr. Sichel came the next day we debriefed on how I had done taking care of Sage. I told her I was surprised and pleased that I had been able to do it for so long – for four hours. But I also said that I feared I was a toxic influence on my baby. I hated him to see, and be taken care of, by someone so preoccupied with misery. I was afraid to look at him, what with my gaze nearly bursting as it was with violent images of hurting him. My eyes, I thought were as penetrating as X-rays and as message-filled and damaging as a pervert’s. How could I not have scarred his soft impressions of the world?

To her credit, Dr. Sichel eventually stopped reassuring me. On my sixth day in the hospital she brought in a child psychologist to evaluate Sage.

Dr. Sichel, Bud, baby Sage and I were waiting in a small plain white evaluation room. Bud, who was still sniffling, held Sage in his lap. Dr. Sichel asked me how I did over the last night. There was not a single poster or sign in the room; just a single nail sticking out of the wall. I tried hard not to look at the nail, or think about it. But images kept intruding into my mind: the nail and Sage’s soft head bashing together. I’d successfully put it out of my mind and then the image would flash into my head again. When the psychologist, Dr. Fischer, walked in, he competed for my attention - with the nail. He was tall, about 6’2,” and in his early forties. He had some grey hair, but a youthful spring in his step. After greeting us, he started unpacking a case of professional diagnostic baby stimuli: bells, whistles, black and white patterns, and lights. Bud, of course, was holding the baby. In the middle of unpacking his suitcase the psychologist stopped for a moment and took one long look at this bright eyed baby in Bud’s lap. After a minute’s thought he said, “I don’t even need to test this baby. I can see he is a delightfully social and advanced baby – you say he is only 8 weeks old?”

I was relieved. But not completely. At least I hadn’t emotionally damaged the baby so much that he couldn’t relax in his father’s arms. But I still thought that Sage was different when he was with me – more subdued. Even though I knew it would sound neurotic, I pushed myself to tell the psychologist my feeling that the baby wasn’t the same with me – didn’t feel safe with me. I murmured, “But he’s different with me.”

Dr. Fischer wanted to know more. I had thought he might just brush it off – but he pursued his questioning. I told him, “When I hold the baby, it’s as if he shuts down. He doesn’t feel safe with me.” The psychologist surprised me: like Dr. Sichel, he took me seriously. “Okay,” he said, “let’s see, you hold him and I’ll see how he responds.”

OCD is a very private torture of self-consciousness. My secret was out and no longer mine alone. This audience of Bud, Dr. Sichel, and Dr. Fischer would witness my secret. They all watched as Bud laid the sweet baby in my arms. I peeked down at the baby. The baby peeked at me. And then he looked away. He turned inward, subdued. “See!” I said, “See what I mean? He’s shutting down!”

The child psychologist said, in a low thoughtful voice, “Yes, yes, I do see what you mean. He is shutting down. He is less responsive in your arms than Bud’s.”

I couldn’t believe someone, with his tweed jacket and suitcase full of baby testing gear, was agreeing with me – a mom in a psych ward.

The psychologist leaned in toward me, “This is what I see. You’re looking away from him. He’s turning toward you trying to make eye contact but you’re looking away. You need to accept his gaze.”

I explained, “I can’t. I simply can’t let him see me, not with the thoughts I’m having.”

“He can’t see your thoughts, but he does see you turning away from him. Now let me coach you through it. I want you to connect with him no matter how you’re feeling. It’s you he wants. However you’re feeling. There. Now accept his gaze. There, yes. See him looking for you? There, yes, you’ve got him; see him looking right at you. And he’s fine.”

The nuts and bolts of my insanity began, before all of our eyes, to dismantle. It was as if someone reached right inside me and began to unlock the cocked springs of my impasse. A midwife could not have been more sure-handed, easily releasing a stubborn shoulder stuck in the birth canal.

I looked at Sage.

Dr. Sichel and Dr. Fischer wrapped up the consultation with pleasantries. As they filed out of the consult room, I took one last look at the nail and carried Sage out cradled in my arms.

That night my mother called on the payphone. A patient picked up the phone and hollered, “Sara, it’s your mother.” This was the fourth time she’d called in the past two days. She wanted to visit me and I didn’t want her to. This time she announced, “I don’t care what you say. I am coming to visit.”

My mother and father lived a few hours away in New York City, but I had been holding them off at arm’s length. My mother was the last person I wanted to see. Wasn’t it some strange occluded transgression from my childhood that had landed me here in the first place? In my heightened alarm, I didn’t trust her. Since my baby had been born I had developed a protectiveness that did not include her in its field of safety. She knew it and it pained her. Talking to her that night at the payphone, she finally lost her cool – one of the only times she ever did so with me.

I pulled on the coiled metal phone cord and looked at all the graffitied phone numbers that other patients had scrawled around the phone. “Mom, I’m telling you. I don’t want you to come. It will make me worse.”

“Fine,” she said, “You’ll get better, and I’ll get worse.” And then she hung up on me.

Standing at the greasy stainless steel pay phone cubicle, I blinked with surprise. In most conflicts, my mother was the martyr, the door mat, the long-suffering wife. But just now a bit of anger had gained an upper hand.

My mother is a small woman - five, two – and she is a survivor. She was burned when she was eleven-years-old in a boat that exploded and trapped her and her brother inside. Her brother didn’t make it. She is covered head to toe with scars. You can still discern where the Mary Jane party shoes she was wearing that day protected her feet from fire and see the scar where the sloppy part she had made in her hair exposed her skin to fire. In some ways my mother was the unlikely survivor of the fire. She had always been the quiet and meek child to her big brother’s genius and bravado. But on the morning of the fire, when their father told the children to put on their coats while they were waiting in the boat, it was only my mother who put on her coat. An act that family lore said saved her life. Being good is something she can’t readily turn her back on.

When my mother was 14-years-old she had a painting teacher who watched her draw a tiny drawing of a rooster in the middle of her paper. He then told her to make a new drawing of a rooster that filled the entire piece of drawing paper. He had her close her eyes, feel for the edges of the paper and draw large enough that the drawn rooster touched all four edges of the paper. When she opened her eyes she saw the bold wiggly rooster and decided then and there to become a painter. Which she proceeded to do - hanging in there through decades of trying to make it in a male-dominated art world, once even picketing outside a prominent gallery that had zero women artists. And here I was, as only a daughter can do, telling her she couldn’t visit me and practically implicating her in my infirmity.

I hung up the phone and went to find whoever it was who was assigned to me at the moment. It was a nurse named Adele who was at the end of her shift. At my request, we went into a conference room (this one had no nails sticking out of the wall but the metal edges of the table still looked lethal) and I told her what happened on the phone with my mother. She reassured me that I had done the right thing by looking out for my needs and that my mother should not come and visit if I really didn’t want her too. I felt vindicated but childish for telling on my mother. I knew that she really did screw up with that last, transparent, “I’ll get worse” threat. But on the other hand it may have been the first time she stuck up for herself with me.

The psych ward was comforting with its steady company of those worse off than I, as well as those almost all better. It was a relief to be in the middle of a bell curve. The drugs that my doctor hoped would work for me were kicking in. The obsessive thinking no longer had to be wrestled and subdued second by second. There were now huge breaks at times -- maybe five minutes long -- in my battle with obsessive fears and horrible thoughts. Each morning when I showered, I could measure the waning vigor of my OCD by watching how superstitious I was about turning the water off at just the “right” moment. Life was getting easier but was not yet free of the shimmers of fear and obsession. What would happen when I left this safe, circumscribed, haven?

After nine days, they felt that I might be ready to leave but the Discharge Nurse was concerned. I planned to leave on Wednesday afternoon and start back to my new job two days later on Friday morning. I had recently been hired as a Northeast Regional Director of Greenpeace, responsible for over 200 employees. I had only been on the job one week when I had checked into the psych ward. The discharge nurse wondered if I wanted to work in the day and come back at night to sleep at the nuthouse. I was always welcome back. She said that it didn't need to be a big deal if I wanted to come back for a few days, and I secretly appreciated the offer.

The next day Dr. Sichel signed off on my discharge and said that she thought I was ready. I walked out of the ward holding my tiny son in his car seat, through the double doors, down the hall, to the elevator and into the bracing Massachusetts cold.


  1. River Wolfe Wrote on Thursday, Sep 25th, 2008 at 5:47am


    This is absolutely wonderful. What a gifted writer you are, and what a remarkable story to be told. Are you working with a publisher? To my (albeit limited) knowledge such an honest and fearless telling of post-partum depression has never been done.

    Thank you for your comments regarding my BO jewelry etc...I'm thrilled to be doing this work. I'm busier than ever and fortunate to be able to donate some of my proceeds to the campaign. Obama is a gem and so needed right now.



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