In the Room of Mental Health First Aid™

By Heather Lanier

In the room of Mental Health First Aid™, we joke about bad therapists and the body parts we lost to cancer. We describe with lyrical precision the places where our panic attacks begin and whether they travel up or down. We compare notes on the panic attacks like we’re comparing notes on dining experiences at a new restaurant. Or we stay silent and listen, grateful to those willing to describe their panic attacks because we’ve never had one, or don’t remember a time when we did … although, now that someone describes them that way, maybe we have. We recant our understandings of manic depression, tell stories about doctors’ mental health misdiagnoses, and collectively laugh at the rawness of what it means to be human.

In fact, in the room of Mental Health First Aid™, we’re invited to talk about so many things the world beyond these walls does not want us to talk about that I start to lose touch with my usual filters. At the beginning of this day-long training, our facilitator Mandi said that if we ever need to leave the room for any standard reason—bathroom, phone call—we should give her a thumbs-up, so she knows we’re okay. “Otherwise, I’ll think you’re in crisis,” she explains. A few hours into training, I feel nature’s call, walk towards the door, make eye contact with Mandi, and lift my thumb toward the ceiling. She gives me a knowing nod. As I yank on the door handle, I have the uncanny urge to call out to the entire group of twenty-seven in a jolly, assuring voice, “Just need to change my tampon!”

I do not do this. But in the room of Mental Health First Aid™, I imagine the group warmly nodding and/or chuckling in a way no group of near-strangers ever has in response to the words, need and tampon.

Maybe we laugh so much here because there is nothing funny about why we are here. We are twenty-seven college professors at a south Jersey university that will, in four weeks, make national headlines for suicide. Three in two months. But we haven’t hit the New York Times or CNN just yet. It’s November 2019, and right now the University of Southern California is in the news. Two months before, it was the University of Pennsylvania. Last month, while south Jersey’s October languished in summer-like heat, the CDC released its report: Between 2007 and 2017, the rate of suicide among people age 10 to 24 increased a whopping 54%.[*] A 2018 CDC report found that suicide rates in half the states increased among all age groups by 30%. News outlets clambered onto the stats but couldn’t position them into a landscape of meaning. Like a Brancusian sketch, the numbers offered a clear if bare-bones portrait: We are a nation in crisis.

I’ve been standing in front of a college classroom for fifteen years. I’ve never had so many students write about suicide before—their thoughts of it, their friends’ acts of it.

In the second week of this semester, a young man I hadn’t seen before walked thirty minutes into my creative writing class and sat in the back. It was my first semester at this university. I was still learning where the bathrooms were. I found his name on my roster and marked him present. At the next class, he arrived on time but left halfway through. I never saw him again.

Nine weeks later, a voicemail from the Wellness Center sat on my cell phone. It was about an unnamed student, and would I please call back? Before I could, I read the official email from the university: the student I barely knew had died. The university was not legally permitted to disclose the cause. An online forum would later name it suicide. Before the student’s death, I’d considered myself too swamped for this all-day Mental Health First Aid™ workshop. Ten minutes after reading my student’s name in that email, I asked if there was an extra spot in this room.

Four weeks from now, when we lose our third student, the conversations in the media will center around our university’s wellness center, about whether there’s a waitlist for counselors, about how well our school is supporting students in crisis. We are not counselors, and we are not in charge of hiring counselors, nor are we in charge of determining the nationally recommended counselor-to-student ratio. We’re a department of writing professors, peeking out from mounds of essays and stories and projects in this, the busiest month of the semester. We are setting aside eight hours on a Friday so we can learn how to save lives.

“You’re earning a certificate, not a superhero cape,” Mandi reminds us frequently. We nod from our seats.

The Room of Mental Health First Aid™ is, in its usual operating hours, a sterile classroom filled with six long rows of tables. This is the same room in which many of us meet monthly to discuss the unsexy specifics of curriculum changes and policy requirements. It’s the room I stood in six months ago and convinced a committee to give me the assistant professor position I now hold. I wore a black suit, clicked through PowerPoint slides, gave confident answers. I wore the very persona of infallible competence that this room has, at least for today, invited us to disarm.

Not quite public, not quite private, the room of Mental Health First Aid™ invites professionals to disclose, with promised confidentiality, all the ways it has been hard for us to be human. “We use Vegas rules here,” Mandi says, clicking to a slide that features the city’s iconic neon welcome sign. “What happens here stays here.” We can disclose adolescent-onset anxiety. We can explain how trauma might link across our years like beads on a string. We can say what we would otherwise never say in this room: “Nope, the textbook descriptions of panic attacks are incomplete. Mine begin in my arms, or my belly, or my dizzied head.”

It strikes me that if more spaces followed the norms of the room of Mental Health First Aid™, we might actually need less mental health first aid.

Mandi is a thirty-something woman with alto-voiced cheer. “How many of you have experienced depression?”

Hands go up.

“Anxiety?”

More hands. Nearly all the hands, including my own.

This is one of Mandi’s strategies: accessing our personal experiences. She has given us softcover textbooks, and she scrolls through infographic slides from the National Council for Community Behavioral Healthcare. But she also invites us to use ourselves as references, as wildly imperfect maps that might touch or even lay over and align with the maps of others, and which might, along with the textbook and slides, help us cobble together a fuller topography of what it means to be human.

We learn the official statistics: Twenty percent of young adults, ages 18 to 24, experience a mental health disorder.^[†] Two-thirds of students who need mental health support do not seek it. The average number of years between when a person needs help and when they receive it is eight. The age of a third grader, the time it takes for a typical human to go from drooling baby to sassy calculator of math problems. Suicide is the second leading cause of death for adults age 18 to 24.

“Why?” Mandi asks us to speculate.

“Social media?” someone calls from the front row.

“Climate change fears?” another person guesses from the side.

Mandi nods. “Sure. Those are all factors.”

But why, she says, is a question even experts haven’t answered. In our eight hours together, we will attempt to answer another: What can we do?

•••

It turns out that what we can do is remarkably simple.

She splits the twenty-seven of us into two groups. One group is labeled “Listening.” Another is labeled “Not Listening.” The groups must race each other to come up with as many outward signs of their designated label as possible. I am in Not Listening.

“Looking at your cell phone!” one of my group members calls out.

“Looking away!” another shouts.

“Not making eye contact!”

I’m not making eye contact. I’m looking at my notepad, frantically recording their ideas. A colleague grabs my list and runs to the whiteboard to scribble our answers. With equal urgency, members of Listening do the same.

“Time,” Mandi calls.

She tallies our lists. We of Not Listening have generated twenty-one outward signs. Listening only has nineteen. Not Listening wins!

But the whole point of the activity, of course, is that listening wins. It’s the “L” in our five-step Mental Health First Aid™ plan, which goes by the acronym ALGEE. We’ve skipped over the letter A for now. Mandi says it’s the hardest—we’ll get to it at the end.

Why ALGEE? “Because this program came from Australia,” our facilitator says to laughter. Maybe the others imagine what I do: surfers along the Gold Coast, aerial views of the Great Barrier Reef. Algae, the photosynthetic organisms that made the planet hospitable for life. Maybe it can help do so again.

•••

Sidenote: It is strangely freezing in the room of Mental Health First Aid™. I say this with zero metaphoric intention. I circle my hands around a mug of hot water. I wonder if I should slide my wool ski cap off my head, so I look more professional among my new colleagues. Then I remember: We’ll be talking about suicide here. It’s fine to strive for cozy.

“You are Anxiety,” Mandi calls out to three people clustered in the front row.

Their faces look up, stunned.

“And you right here,” she circles her hand around a group beside them, “are Depression.”

Nervous laughter erupts.

Another group is ADHD. A fourth is Schizophrenia. The laughter spreads, morphing from nervous to raucous. In a culture of person-first language, where we imply that people live with diagnoses rather than become them, her wording is jarring, but also hysterical.

So I am Eating Disorders, along with two men flanking me.

“Do you want to be Psychosis?” Mandi calls to a lone woman in the back. “Or you can join another group?”

The woman laughs. She’s fine with Psychosis.

Mandi has written age-ranges around the room’s whiteboards. “Go stand where you think your assigned mental health disorder, on average, begins.”

Substance Abuse stands beneath “13-17.” We of Eating Disorders sally up beside them. ADHD idles to our right at “8-12,” as does Anxiety.

Mandi asks Anxiety why they guessed eight to twelve.

“Personal experience?” a female colleague peeps with upturned uncertainty, then bursts into a low-bellied laugh.

She’s correct. So is ADHD, Substance Abuse, and we of Eating Disorders. Depression has planted themselves below “18-24,” but they’re off by a decade.

We return to our desks, and Mandi clicks to another slide. “Remember,” she says. “A mental illness is a physical illness. The brain looks physically different.”

I write these two sentences in my notebook. I box them and surround them with stars. Mandi’s quote gives new meaning to the dismissive phrase It’s all in your head. People hear this sentence in response to everything from depression to sexual harassment to autoimmune disorders. It means: What you’re describing, you’ve invented. It also means: Quit being inconvenient. But Mandi’s quote reminds us that the head is a powerful and real place in which to experience something.

The single greatest factor that contributes to mental health disorders, Mandi says, is trauma. Capital T trauma comes to my mind. The neglect of a parent. The fist of a spouse. A box for a bed. But she says no one can define trauma for a person.

“If anyone tells you that what you’ve experienced isn’t trauma, that’s bad counseling. In fact,” she adds, “everyone probably has trauma of some kind. Because everyone is alive.”

It’s the simplest mathematical proof:

Being alive causes trauma.

Everyone you have ever known has been, or is still, alive.

Ergo ….

I’m the stepdaughter of a chiropractor. If you fill out a form at a chiropractor’s office, it will likely ask you about your birth. Was it medicated? Were forceps used? A vacuum? The concern is for your neck and spine as it moved through the birth canal. But the implication is this: the very act of entering this world is traumatic.

•••

We break for pizza. We talk about our dogs, our cats, our Netflix binges, our children. We stretch cheese-covered triangles from our teeth and describe the things we love in this world. “I like your hat,” the man to my left, of Eating Disorders, says. I thank him.

•••

In 1990, I sat in a room with a judge and explained to him an ongoing experience of trauma. I was twelve. The judge dismissed my experience as not trauma. On my lap sat a composition notebook in which I’d written about my trauma. The judge wouldn’t read it. So mine was not, could never be trauma.

The details don’t matter—I’ve written about them elsewhere. (Thumbs up, reader. I’m okay.) What matters: Twenty-first century living sometimes affirms experiences that twentieth-century living denied. Not across the board, but in pockets of places, like in an op-ed that worries for the safety of transwomen needing to pee, like on a bestseller list where sits a memoir about a brown-skinned woman’s daily experiences with racism, like in a large discussion classroom on a patch of New Jersey that was once deciduous forest inhabited by the Lenni Lenape. We name at the onset of gatherings the tribes that inhabited the land we stand on. It’s a microscopic way of acknowledging Native people and the violence of white supremacy. It also ends up saying: Trauma brought us here. Trauma is embedded in the very birth of what we’re standing on.

Six months ago, when I stood at the front of this room wearing the black pantsuit, I described how I would structure my creative writing courses. I showcased my students’ work. Projected on the screen was a student’s poem about living in a female body in a country where the president bragged about grabbing female bodies. I talked about how I diversify my reading lists, distributed grading rubrics of varying complexity, and watched committee members nod.

Here’s what I didn’t say: When I ask my students to write, I sometimes invite them to excavate the ineffable little monsters in their guts. Just like I held a little monster in my lap in the form of a composition notebook when I faced that judge. I invite my students, however gently, to gather the courage to hold these little monsters up to their ears and listen to them. And what my students end up writing in response are often beautiful and strange and powerful songs about how they have managed to survive in this world.

But it is not always easy, handling these monsters. They can and do bite. If the student who died last month had been in my classroom, what would he have unearthed? Would my lessons have helped? Hindered?

During that interview six months ago, I was required to read my own work. I read a piece of nonfiction that excavated a little monster of my own. But the prose was polished, the structure artfully arranged, pressed into shape as neatly as my dry-cleaned suit. And when I was done, my future colleagues asked about professional things: how to craft a sentence, how an essay becomes a book. This is the professionalism of my field. This is also the gift I give my students: I take seriously the craft of their writing. Which means I also assume they, as people, are okay.

But Mandi’s ALGEE requires more. She’s still reserving the hardest letter, A, for the end. And we covered L, for listening. The G stands for Give reassurance and information. The two E’s stand, respectively, for Encourage appropriate professional help and Encourage self-help and other support strategies. As a writing professor, I not only need to help my students with syntax and diction and structure and voice and revision. I also need to help them stay whole.

It’s a daunting new job responsibility in the role of twenty-first century professor: to worry about how an absence of eye-contract might trigger isolation; to keep dibs on a student’s possible need for professional counseling; to make note of any mentions of suicidal ideation (so far this semester, three) and have the follow-up conversations: Are you okay? Are you getting the help you need? I feel the weight of my students’ well-being on my shoulders.

•••

What are signs of an eating disorder? What is the difference between substance abuse and addiction? How do PTSD triggers work? Much of Mental Health First-Aid™ training requires us to understand the range of mental health disorders, so we can identify signs of them and guide people toward appropriate help. We’ve become, in eight hours, like mobile triage rooms.

We tackle letter A, as promised, at the very end. And I too will get to it at the very end. For now, know that the light from the classroom windows eventually turns pink. The sun eventually falls below the horizon. And all twenty-seven of us eventually complete our training. Mandi reminds us to do something kind for ourselves tonight: a glass of wine, a bubble bath. Every flight attendants’ emergency instructions are both clichéd and true, and Mandi reiterates them: “Put the oxygen mask on your own face first. You can’t help anyone unless you also help yourself.”

The next morning, I am ensconced in a scene the Internet might call self-care: cocooned in bed beneath a weighted blanket, supine and turning pages in a book. My children are miraculously at their grandmother’s. I am burritoed in bed past ten. I have nowhere to go for two hours.

It will make every bit of sense if I want to stay in this place forever. It will make absolutely zero sense if I start to long, ever-so-slightly, and then very much so, to return to the room of Mental Health First Aid™.

It’s the book’s fault. A memoir about being gay and Black in the south, it’s one I planned on assigning next semester. But as I turn the pages, the author’s mother is unexpectedly diagnosed with a terminal illness, and it’s the very same illness that a student’s mother has recently been diagnosed with. This student has already registered for next semester’s class.

I want to go back to the room of Mental Health First Aid™. I want to raise my hand and ask the question I haven’t figured out how to answer. Not the first question perched on top of my head (Should I assign this book?). The question buried underneath it: How responsible are we for each other? Exactly how much are we in each other’s care?

The boundaries in the room of Mental Health First Aid ™ were clear. The doors were closed. The personal stories were confidential. People gave thumbs-up. We were okay, we were okay. The only signs of the outside world showed through the windows. By training’s end, the sky was nearly indigo, and we drove home in the dark. There are only so many questions you can answer in eight hours. How responsible are we for each other? It’s a question I’ll keep carrying.

•••

The answer I left with, though, is this: At least a little bit. We are all, every one of us, at least a little bit in each other’s care.

Over the next days, I catch up on grading, read a few dozen short stories, return them to my students with comments. Ten minutes into a lesson, a student is openly weeping. She can’t be upset about my comments—she didn’t turn in any work. I assign the class a short writing activity and whisper to her: “Do you want to talk?” She shakes her head no. I say okay. Five minutes later, she’s still wiping her face with her sleeve.

“Come on outside,” I say. She follows me into the hall. It’s a night class, and the hall is lined with bluish-black windows.

She chokes on a sentence. It cracks past her vocal cords. She’s in a domestic violence situation. It’s bad. What follows is another Vegas moment. The details of her story stay with her. But the all-day Mental Health First Aid™ shifts me into gear. I listen closely. I ask questions. I hug her for as long as she wants, which is much longer than I expect, and she weeps into the crook between my neck and shoulder. She holds tight, until she lets go.

I ask about her safety. I ask whom else she has told. We return to class, and I finish teaching, and then we sit together on a bench in the hall as she calls campus safety. She speaks to the counselor on call. The counselor gives her good advice. There are next steps. A way to feel safe tonight. An expert to talk to tomorrow.

I walk her to her car, which is right in front of the building—a spot she tells me she waits for each night that we have class. This is why she’s been late, she says. I watch her close her car door and hear the click of the lock, and she drives away. It’s raining, almost seven p.m.

Reader, I’ll tell you this: She won’t pass the class. But she’ll get counseling and a safe place to live.

On my way to the parking garage, someone behind me shouts with all their might: “FUCK!” During my ascent up the garage’s concrete stairwell, two men pass me. They are very tall, and loud, and seem amiable and they could also crush me against the wall, and they could be carrying something that crushes them from the insides, and they could be perfectly fine.

We’re all a little in danger, we’re all a little in each other’s care.

When I get inside my own car, I lock the doors, relieved to create a room of just myself.

•••

It is only at the tail end of the daylong training, when my blood sugar is low and the sun is threatening to set and I have the uncanny urge to scroll mindlessly through social media, that we tackle the hardest letter: A.

Assess for risk of suicide or harm.

In other words, ask a person if they’re planning to kill themselves. If we ever suspect someone is thinking of it, we need to ask.

We practice as a group, repeating the questions in unison:

Are you thinking of killing yourself?

Are you having thoughts of suicide?

We get the words right. We commit them to memory. Mandi tells us that it can be scary to ask, which is why we’ll practice in pairs.

“And if they say yes,” Mandi asks, “then what do you do next?”

A voice pipes up in front: “Ask if they have a plan.”

She nods. “And if they do?” she asks.

“Stay with them,” another voice says.

“Do not leave them,” Mandi adds. “Call campus safety. Call 911.”

Then it’s time. I turn to the male colleague next to me. I met him two months ago.

“Are you thinking of killing yourself?”

He knows it’s coming, and still he winces. His eyebrows relax, and he assumes the role. “Yes,” he says calmly.

“Do you have a plan?” I ask.

He pauses. “Yes,” he says.

The end of the role play is remarkably stark, like a cliff-edge. We switch roles.

“Are you considering suicide?” he asks.

I’m a terrible role-player. I give him the true answer. I give him the only answer I hope people will always give me, the answer I hope every person on this planet can give every day of their lives. It’s a hopeless hope for the world’s eight billion people, all of whom have been born and have lived years and are still alive. I say “No.”

[*] From Sally C. Curtin, M.A., and Melonie Heron, Ph.D., “Death Rates Due to Suicide and Homicide Among Persons Aged 10-24: United States, 2000-2017,” NCHS Data Brief, No. 352, October 2019. https://www.cdc.gov/nchs/data/databriefs/db352-h

^[†] All statistics in this paragraph come from the presentation literature from the Youth Mental Health First Aid ™ USA training.

•••

HEATHER LANIER is the author of the memoir, Raising a Rare Girl, a New York Times Book Review Editors’ Choice. Her work has appeared in The Atlantic, The Wall Street Journal, TIME, Longreads, The Sun, and elsewhere. She writes about parenting, disability, spirituality, and what a kindergarten teacher would call “big feelings.” Her TED talk has been viewed over two million times.

The Consequence of Losing My Damned Mind

By Eze Ihenetu

I knew that he’d emphasized our similarity so that he could disarm me.

“We are both Igbo,” he’d said, through a forced smile.

My thought response: So what.

Despite our shared heritage, he and I were still adversarial strangers because he had gone back on his word. This “brother” of mine was one of the people responsible for my extended confinement to the psychiatric ward. I was not in the mood to extend any form of good will.

I positioned my wheelchair so that I was directly in front of him, and I slowly looked upward until my eyes met his. Arrogance wafted off of him like the heat from my rusted bedroom radiator.

I made ready to make my demand.

“What did I do to make you think that I should spend more time in this place?”

I waited for his answer, radiating irrational anger. I was still under acute influence of my disease, and I was still in denial of this truth.

I lost my patience when he failed to respond, which precipitated the relinquishment of my remaining composure. I bellowed up at him, “You told me that I would only have to stay here for a period of two days. That is what you said to me, right? Now you are telling me that I will have to stay here for two weeks! Two weeks?! Why are you unable to keep your word?!”

He pursed his lips. Then he folded his arms without speaking a word. Was that going to be the extent of his response to my question?

I slammed my right hand down on the wheel of my chair and said, “Promises were made to me and I should expect that you would make sure that these promises will be kept!”

I knew that arguing with the doctor was probably useless, but I needed to say my piece. One of the only positive offshoots of my disease was that I wasn’t afraid to speak my mind. I was standing up for myself in a way that I never had before. Why had I suddenly become so outspoken and brave? Because I was more than certain that I was in mortal danger.

The doctor looked as if he was staring down at a cockroach. He made ready to squash the unpleasant thing that was waiting him to answer.

“Your condition has been deemed more severe than we first thought. And we need more time to observe you,” he said. His accent was thick, more pronounced than the one my father spoke with.

“But I don’t want to have to stay here any longer. I’ve already spent two weeks at this hospital. I need to go.”

“You have been diagnosed with schizoaffective disorder, a very serious psychological condition. We have to treat you and see how you respond. You will be released when we are confident that you are showing progress.”

My heart sank.

While still within the psychiatrist’s purview, I conducted a quick reconnaissance of the dreary, monochrome, and cramped ward. It was divided into two corridors, with the nursing station acting as the point of demarcation. A half dozen uniformed police officers roamed the two corridors and manned the exits. Any attempts to cross the established border that linked the two sides would be dissuaded by the officer who acted as the border’s sentry. The police officers were obviously there to assist the clinical staff with maintaining some semblance of order, but seeing so many armed members of law enforcement cobbled together in such a constrained location rankled my nerves.

The hospital’s inmates walked among these officers, most of whom had spent almost the entirety of their lives existing on society’s edges; a portion of them had spent some time in the New York City prison system. There was a charge that ran through this place. And it could be ignited by anyone here, and at any time.

Prison stints and extended stays in hospitals had not been a part of my past. Why transfer me to this place? If the hospital would have performed some research they would have discovered that I was a graduate of the Boston University School of Business, a trained professional actor, and came from a good family. Every member of my family had either graduated from college or was planning on matriculating into a university. I knew that I didn’t belong in this place, but the gatekeepers who held the keys to freedom obviously thought differently.

“Whatever,” I said, shaking my head.

Now he was looking at me as if he was ashamed. I wanted to dig my fingernails into his sand-colored face and add a few more divots to the hundreds that had already ruined it. I steered my wheelchair away from the doctor in a huff instead, making sure to hold my breath as I passed by the open door of the room that stank of urine and cigarettes.

•••

When it was time for sleep, I lay awake on my hospital bed instead, my diagnosis bouncing around my head.

To his credit, the psychiatrist had tried to take away some of the sting of this life-long sentence when putting forth his diagnosis, saying that I was susceptible to periods of mood instability and mania, and that I was not the only one who was suffering from that particular disease. That explanation was lost on me though, for all I could focus on was the word “schizoaffective” and all of the horrific images that my mind was associating with the term.

Momma had always said that I was the special man in her life. I’d thought that I was special too, believing at one time that I was gifted with a special insight into the whims of others. The psychiatrist had taken the wind out of that sail by handing down the life sentence. If I were to believe the doctor’s words, then it would mean that my extra-sensitive perspicacity was a stain instead of a gift. This fact alone had a shattering effect on my confidence. The diagnosis, in addition to the fact that I was the only person on the unit who was sporting a cast around a recently repaired broken leg, made me feel very vulnerable. When the pain from this realization became too much I stopped resisting the pill, and downed the twenty milligram Zyprexa for the first time.

•••

I awoke later than usual the next day, unable to raise my head from the pillow. I attempted to move my limbs but was unable to because it felt as if the muscles and bones had been filleted from the inside of my skin. My mind was covered in a fog. After a few minutes I was on the verge of tears, thinking that I was going through the first stages of my death.

By early afternoon I realized that I’d overreacted in the morning. My condition was improving slightly with the passage of each subsequent hour. By late afternoon I was sure that I was going to live, though I would remain mired in a Zyprexa-induced stupor for the rest of the day. I went to bed on an empty stomach in the early evening—I’d been too tired to eat anything during that day—vowing never again to ingest another Zyprexa pill before closing my heavy eyelids.

I was myself again the next morning, although still a bit groggy from the day before. My roommate, who stood at an imposing six feet three inches and weighed two hundred fifty pounds, was still soundly asleep in his bed. He had been a docile fellow during the time I’d known him, a fact for which I was extremely grateful.

I exhaled a breath before I sat up and swung my legs from the bed onto the hospital floor, an action that required an inordinate amount of exertion. I encircled the circumference of my wrist with my hand and gasped in surprise—my wrist was replete with bony protrusions. Distraught from my extreme weight loss, I slid down from my bed until my butt hit the floor, then got down on all fours and started some push-ups. I maxed out after ten repetitions and stayed on the floor for few minutes, exhaling deeply. After catching my breath, I pushed myself off from the floor and got to my feet and used my good leg to hop on over to the foot of my bed, where my wheelchair was waiting for me. The light from the corridor was spilling into the open doorway. I steered the wheelchair towards it.

•••

Mental illness is defined by its abnormalities and vicissitudes; the functioning of the mind and body is thrown into complete disarray. One clinician’s proffered reason for this instability was an ongoing “disconnection” between brain cells. His words felt abrasive and accusatory. It was “you” are this and “you” are that. I bristled at the explanation. He had basically asserted that I was the only one responsible for my condition. He’d made no mention nor alluded to other factors that may have been contributed to my behavioral inconsistencies.

When allowed to thrive, the mental illness makes it almost impossible for the afflicted person to establish and adhere to a routine. The people who ran the psych ward made establishing a routine a vital component of the patient’s recovery. Breakfast, lunch, and dinner were served at the same times every single day—my favorite times of the day. Psychotropic medications were distributed at the same time in the mornings and evenings. There was an activity room where the groups were held, although I preferred to watch movies on cable instead of talking about my issues.

•••

Fearful that I could add even more time to my original sentence, I set out to be the good patient, going out of my way to prove that I was quiet, affable, and well behaved. I adhered to all of the standardized rules that had been set, except for the ingestion of the psychotropic medications. I’d hide the pills below the base of my tongue before making sure they met their ultimate fate at the end of each evening: circling down the drain of the bathroom sink.

I was the only patient who roamed around that wing of the hospital in a wheelchair. So I strove to avoid getting into any type of confrontation with the other denizens of this crazy place. My leg always drew attention to me though—the entire bottom half of it was encircled by a neon green cast. The others couldn’t help but be curious about what happened.

When the other patients asked what had happened to my leg I responded to their questions with most of the truth, one that was in direct contradiction to the story that I’d relayed to my care team. I’d told my care team that I’d tried to kill myself because I thought it was what they wanted to hear, and because I was trying to escape being branded with a more severe diagnosis.

Killing myself hadn’t been an option because I was afraid of the consequences. Although I wasn’t a devout Catholic, I was cognizant of the fact that taking my life would result in my being transported to hell for an eternity. And for a man who had been walking along the path that God had created for him, suicide was not a viable option.

•••

What were the actual events that had led to my hospitalization?

I’d locked myself in my room during the last few days of December, 2003, my brain on fire with delusions of persecution and conspiracy. I would try to douse the fire by spending time alone in the darkness, removed from everything and everyone. But the conflagration in my mind would only become more incensed.

My bedroom became a dark cave. The air in the room became stale, but I was content to breathe it in. During those two days I hardly shifted positions while supine in my disheveled bed, staring up into the darkness, while the paranoia, anger, and sadness gripped me. My bedroom, a shambolic mess, was the embodiment of disorganized thoughts.

Mom, Dad, and other family members kept on calling. Their calls brought short stints of reprieve from the loneliness and isolation and provided me with a temporary reminder of who I was. I wouldn’t return their phone calls though. I’d ignore my roommate’s entreaties about my health and eschewed the phone calls of the friends I’d made. I suspected everyone that I knew was working for my enemies.

After I decided that it would become untenable for me to remain in my room for perpetuity, I devised a plan—it was emblematic of my desperation. I jumped up from the bed to dress and gather everything that I could carry, then entwined three sets of sheets together, creating a makeshift rope. I tied one end of the rope to the radiator, parted the curtains, and opened the window. I adjusted my eyes to the sun and threw the makeshift rope through the open window.

I looked down the length of the sheet as it swung to and fro and against the brick wall of the four story apartment building. There were three stories separating me from the concrete floor below, the makeshift rope spanning the length of about two of those stories. No problem. I would scale down the first twenty feet of rope before attempting to jump the last ten.

I was still three stories above the ground when the rope snapped, leaving me to fall the rest of the way. When I crashed down on the cement street that had been made harder and colder by the sub-freezing temperatures, the wind escaped from my lungs. I couldn’t make a sound, but my entire body was screaming from the pain.

When I regained my wind from the fall and the wracking pain had morphed into dull and persistent throbbing, I took inventory of my current situation. The paraphernalia that I’d been hauling on my back was strewn all across the alley way, but my body seemed to be intact at first glance.

My mind was still feverish, and I desperately needed to get away. I thought I could miraculously walk away from this catastrophic fall; I started the process of gathering my things together when I noticed that my right leg was bent back awkwardly. There was also a rip in my jeans, from which escaped the calcified bone of my knee. Blood was upwelling through the hole that had been made by the exposed knee bone, and spilling down the sides of my jeans.

I burst out crying at the sight of my new deformity before desperately flagging down a startled passerby.

“Can you please help me?” I said, sobbing. “Please, please help me.”

•••

I told the story of how I arrived at the facility in Daniel’s room. Daniel, a bearded and excitable young man who had spent a significant amount of time in hospitals, rolled his eyes after I had completed my tale of woe.

“Come on, man,” he said. “That’s nothing. One time I got fucked up so bad that I had to spend four months in a hospital bed.”

Geoffrey, a large man with two missing front teeth, was sitting next to me. Like my roommate, he was a gentle and calm; a smile came easily to him. His wide grin and kindness were gifts of welcome respite from a continuous flood of despair. If you were to run into Geoffrey on the street, you would never have guessed that he was a schizophrenic who had spent six years in a real New York City prison facility.

•••

Geoffrey was with me when my father arrived for his visitation. Dad’s wide eyes revealed his absolute shock at my appearance: I’d sustained a nasty shiner in addition to the broken leg and weight loss. His reaction upon first seeing me in the hospital distressed me, though it wasn’t a surprise. Nothing could have prepared him for the sight of his first-born being confined to a wheelchair, body broken and spirit twisted by demons both real and imagined.

My father’s visit proved to be my saving grace. His presence provided a temporary uplift for my spirit and acted as a precipitating event. A few of the ward’s employees had developed a fondness for me during my confinement; their eyes practically lit up at the sight of the family reunion. The hospital staff knew that my father—dressed in a plaid jacket and carrying a briefcase—would act as my responsible guardian, which placated their concerns about my well-being when I was eventually released from the hospital. There was an up-swelling of hope within me that felt foreign, which contributed to the ward feeling a lot less dreary and depressing on that day.

Dad’s visit had the opposite effect on Geoffrey, though. We were hanging together, watching the first Pirates of the Caribbean movie—the best of the five—in the activity room when he let out a sigh and said, “That’s cool that your dad came out all this way to see you. My family lives right here in the city and ain’t none of them came out to see me.” I could only respond to my friend Geoffrey with silence because I was too absorbed in my thoughts and situation to really consider what he was saying.

•••

A week and a half had passed without my having been involved in some major incident on the floor, another fact for which I was extremely grateful. And I was actually starting to get used to life on the ward. I had settled into the prescribed ward routines and had made a few friends/acquaintances. With only a few days remaining until my release, I was thinking that I might escape this place without accruing any additional scars.

And then my roommate lost his shit one night.

He took offense to something that was said by a visiting nurse, cursed her out, and then spat at her face from a supine position on his bed. One of the officers on duty rushed to the aid of the nurse who’d just been assaulted. I was thankful that the roommate seemed to calm as the dreadlocked and bulky cop firmly established himself at the nurse’s right flank. As I watched the situation quickly unfold, I felt as if I’d experienced whiplash. What would possess a usually docile and gentle man to assault someone in a manner that was vile, and in a place where immediate repercussions would be meted out?

The incident with my roommate, the loss of my job and girlfriend, and other things weighed on my mind when I went before the clinical team/parole board to discuss my progress as a patient. My fellow Igbo man had been given a seat at table. His inclusion in that group would have made me clam up a few days ago. I became a puddle a tears and snot on that day, though, oblivious to the judgments and affirmations of the people who watched me in that room.

•••

It wasn’t until I was given access to my clothes and phone again that I became truly secure in the fact that I was finally leaving the hospital that had been my home for the past month. I found Geoffrey in his room so that I could say goodbye. When I reached up to shake his hand, he said, “I don’t ever want to hear that you have come back to this place.”

I responded firmly. “I promise that I won’t.”

•••

Thirteen years have passed since I left the hospital. I remain a healthy, contributing member of society, who seems to have discovered the perfect formula for managing a chronic precondition—lower doses of psychotropic medicines are an important part of this formula. I’ve secured a master’s degree in health administration, and I’m up for a promotion with the employer with whom I have enjoyed my longest tenure. Those dark days from thirteen years ago have faded to the rearview of my life’s journey, but I still think about Geoffrey every single day.

I hope that he has been able to carve out a life for himself, though I am not optimistic that he has. He and I may have been two mentally ill individuals who’d gotten to know each other for two weeks in the same psychiatric ward, but I was blessed with certain advantages that would make it easier for me to regain the life that I’d nearly lost. Education, a loving family, and the absence of a criminal record all worked in my favor. Geoffrey would have to make his way in the world absent of the advantages that I had. And given the fact that he was a black man, which is a state of being that diminishes one’s prospects for success in society even when you are educated and healthy, his situation is very precarious.

I wish that there were some way to find out that he is all right.

•••

EZE IHENETU is a hospital worker and freelance writer living in Denver, Colorado. Once a teacher and an actor, Eze is confident that writing will be the last stop on his long professional journey. He is currently working on a memoir about his time as an elementary school teacher. You can reach him on twitter at @Eihenetu.

Lexapro: A Mother-Daughter Love Story

Image courtesy of Steve Rosenfield's What I Be Project — Image courtesy of Steve Rosenfield’s What I Be Project

By Judy Bolton-Fasman

The panic attacks almost always happened deep in the night, their after-effects rippling through my life like the aftershocks of an earthquake. The first happened the summer before my junior year of college. I was sure that my heart would explode. But my heart didn’t blow up. Instead, its rapid, loud, insistent beat filled my head, and I rocked back and forth in bed until the sun came up.

Panicking, I quickly learned, was exhausting. Anticipating the next attack was grueling.

Panic afflicted my gaunt sepia ancestors; it has walked with us hand-in-hand for generations. We are a people who open doors to empty rooms, expecting to see our worst fears incarnated. It’s difficult to articulate what exactly those fears are. Some of them can be as nebulous as the panic and depression that have smothered the Latina and Jewish women in my family.

No one in my family talked about the forced cold showers, the electroshock therapy involved in keeping my paternal grandmother’s anxiety in check. No one said a word about my other grandmother’s body odor, greasy hair, and catatonic states. When I was a child, no one acknowledged that my mother masked her phobias, her phases of panic with bullying, narcissism, and half-hearted suicide attempts.

I suspect that the ghosts of panic that frightened my grandmothers and drove my mother to the brink of insanity have haunted me since the moment I was conceived. And when panic first happened to me, the machinations it planted in my mind threw me into a future I imagined so catastrophic that I saw myself completely incapacitated. What if, What if, What if, went around and around in my brain like ticker tape.

•••

Dread and wonder coursed through my body the day I found out I was pregnant with my daughter. How could I be a mother, let alone a decent one? When the panic strangled me in my sleep, I was terrified it would cut off oxygen to my baby. My heart revved up until its beating migrated to my head. I had never taken medication for panic. And now that I was pregnant, I wouldn’t even take a Tylenol.

Throughout my pregnancy I struggled to decipher arguments about nature versus nurture, biology versus psychology. I intuited that between these polarities lay a multitude of explanations for how behaviors developed and persisted not only within a single individual, but also across generations. Would my baby imbibe anxiety and depression through my milk? Would I model it to her? Would she inevitably flinch at my shaky touch?

The baby was beautiful and terrifying. What if, what if, what if? I filled in the hot white blanks with pure disaster. What if I stopped functioning and couldn’t care for the baby? What if I panicked with her in the supermarket? And most chilling of all—what if I had passed down my chipped, inferior genes to her?

“Stop torturing yourself,” said my gentle husband who, at the time, was working on the Human Genome Project. How I prayed that the genes that triggered my anxiety and depression would combine with my husband’s pristine genes, losing their power to hurt my daughter. I fantasized about him hard at work hunting down the gene for what ailed my ancestors, what ailed me. My husband was clearly on the side of nurture and promised me that our daughter would grow up secure and loved.

Nevertheless, I found articles that claimed phobias and panic disorder could very well be inherited. “Genetic switches,” I, practically panting, recited to my husband, “can get tripped and set off chemical changes that occur in a fetus’s DNA, thereby imprinting familial trauma on them.”

My husband shook his head. “It won’t happen to our baby,” he said.

“And why not?” I asked.

“Because we’ll know how to treat her right,” said my husband the geneticist.

“But what about bad luck—that’s always a factor that could wire our baby for anxiety and depression.” As I spoke, I thought about an observation my therapist made that there are some people who never panic under any condition. The first time I heard him say that, I pictured a flurry of Magritte’s topcoat-wearing men raining down on me. Cradling my newborn daughter, I knew that I could never share the Magritte image with her.

•••

My mother, her long black hair falling out of its bun, frequently pleaded with my father to send her away. “Please,” she begged, gulping for air, “I need to go. Now.”

Over the years, I periodically asked my therapist to commit me too. “You’re just tired,” he said.

What I most remember about therapy with him was that I refused to acknowledge panic in my world. I was twenty-seven, eight years out from my first panic attack. I lived in terror that my world would shrink to the point that I couldn’t leave my apartment. The word “phobia” scared me so much that I asked my therapist to remove a book he had on his shelf with the word on the spine. “I am not that person,” I told him all the while living in fear that I would panic in public without a way to get home.

At the height of my panics, Prozac had just come on the market, and it was touted as the miracle drug for the anxious and depressed. I read testimonials in which people swore the drug gave them their life back. They were newly confident, newly capable, and most importantly, newly happy. The words “brain chemistry” bubbled to the surface in these articles. But I was sure my brain was beyond fixing. And more to the point, taking medication was one of my phobias. Would my memory slip away? Would I feel numb? Would my future children have birth defects? And worse yet, would the pills not work and leave me forever hopeless?

That last question scared me enough to keep me just on the other side of trying Prozac. I could tough it out. My people were scared to death of taking medication. “Do you want to be in La La Land?” my mother taunted me that first summer of panic. “I have two other children to take care of,” she screamed. “”I’ll send you to the Institute for Living,” she said threatening to institutionalize me. Her face was so close to mine I could see her large pores. At the time, I didn’t have the vocabulary to express that I could feel the weight of her mental illness imprinted on my cells.

•••

I had been flirting with the idea of taking medication after I finished having children. A girl and a boy, perfect bookends, a friend said to me. Perfect bookends with an imperfect mother. But I hesitated to take medication. I wanted to be strong. I wanted to beat this thing on my own. But with whom was I waging war? Panic? Myself?

The night I wanted to commit suicide, I had been caught up in a loop of panic for weeks. My two small children slept peacefully as my husband rubbed my back. “It’s time,” he said. By that I knew he meant that I needed to call the psychiatrist I had consulted with for a prescription of Klonopin that I had not filled.

In the coming weeks I took the Klonopin with Lexapro, an anti-depressant. I didn’t feel relief exactly. Instead, I detected emotions coursing through my body, a circulatory buzzing of activity that the medication tamped down. The first side effect I experienced was how hard it was to cry. But the panic drained out of me until it was a bearable, hum of anxiety. And then one day I suddenly realized I was happy. The revelation happened in the car on one of my daily drives to and from my daughter’s school. I had settled into a routine. “You’re a caballo de circo,” my mother chided me when I was a child comforting myself with repetition. Maybe I was a circus horse driving the same route over and over. But on that day I picked up as many of my daughter’s friends as could fit in my SUV. Their chatter delighted me. Their energy soothed me.

I’d proved that anxiety was not an accurate predictor of a situation. This was what I told my daughter when she called me from camp. Just sixteen, she said the world had gone very sad on her. “It’s like there’s a curtain of gauze suffocating me,” she cried. My God, had my genes taken the best of her? As I listened to my girl on the phone, I knew that she was trapped in her thoughts. “What if I freak out in front of people? What if I die?” she said breathlessly. There it was again: What if? What if? Another generation struggling to fill in that sharp, menacing blank. But I also remembered my husband’s wise words—we’ll know how to help her.

My daughter is now twenty-one and also stable on Lexapro. She studies psychology. Her choice of major makes me believe that she wants to cure herself, even cure me. My daughter also knows that hiding is dangerous—even futile—and so she decides to tell the world about her condition with a one-word story literally written across her face. In the photograph, the word “Lexapro” starts across her forehead, goes down to the bridge of her nose, and finishes at her left cheek. “I am not my anxiety,” my girl declares. Her face, her struggle, is her contribution to the “What I Be Project” founded by a photographer who describes it as social experiment. In word and picture, a subject boldly declares that he or she is not solely defined by societal reactions to her life story.

With my daughter’s picture out in the world, I pray that the Lexapro will continue to quell her panic. I pray that the doubts, the worries, the blame will continue to diminish for both of us. I pray that the night will never again be a long tunnel of fear and hopelessness. And I pray that Magritte’s men will simply float away.

•••

JUDY BOLTON-FASMAN is an award-winning writer whose work has appeared on the New York Times opinion page, the Boston Globe, Cognoscenti, The Rumpus, Lunch Ticket, Brevity, Salon, and other venues. Judy has completed a memoir called The Ninety Day Wonder, in which she tries to get closer to her remote father through saying the Kaddish—the Mourner’s Prayer—only to uncover her father’s secret past.