Finding a Way Back from Suicide

I’d written about my mother, a memoir of our lives together. She was a terrible alcoholic. The manuscript felt like a betrayal. It was April, 2006. I was sick with suicide. I let myself hang from the fire escape, and almost fell from the roof of my building. My girlfriend, Regan, was exhausted from the months of my decline. I’d only got worse and worse, until, finally, my doctor told me that I would die if I stayed out of the hospital. I’d already had one trip, after the day on the roof, to a hospital in Brooklyn, but I had talked my way out, and now five weeks had passed. I was taking the sedative Klonopin, but no antidepressant. I didn’t want to die. My friend Anne was a psychiatrist at Columbia Presbyterian, way uptown; she worked in the psych emergency room, and she insisted that I come there, that they would take care of me. One day in early May, I called a car and rode uptown. I didn’t take much with me. It was a sunny, clear day, and I could see the George Washington Bridge in the distance. The car stopped in front of the E.R., and I got out and stumbled in.

In the waiting room, I sat bowed over, my head in my hands and my elbows on my knees. Eventually, a nurse came and led me to a wooden door that had a police officer standing beside it. This was the entrance to the psychiatric emergency room. The police officer knocked on the door, and a second police officer, waiting inside, opened it.

The psych E.R. wasn’t a big space. There was a reception desk, an area with five or six cots, and a few private rooms. One was mine. It had a small, hard bed. Anne was on duty. She told me that she was glad I was there, but that it might take a few days to get me a room on the ward. Then Regan arrived. She sat with me while I signed the papers granting the hospital the right to hold me, even against my wishes, should it prove necessary for my safety or for the safety of others. Then it was time for her to go. I curled up on the bed.

There was always a police officer nearby. I wore a hospital gown. I ate the food, swallowed the pills, slept, and waited for a bed on the ward.

That first night, people came. It was the middle of the night. I was deep asleep. Hands and arms lifted my body from the bed. Then I was going somewhere, moving through hallways. Was I in a wheelchair? Sometimes my eyes were open. I heard voices and machine noises. Someone said, “He can go back now.” I learned in the morning that I’d had a CT scan.

Monday morning, after three nights in the E.R., Anne told me that a room had come free, and a while later a man arrived with a wheelchair and pushed me through the hospital. We went up in an elevator, and then across a skywalk to another building, and from that building across another skywalk to the New York State Psychiatric Institute, a place I’d never heard of. We went into an elevator, and got off on the fifth floor. At the end of the hallway was a door. The door was made of steel and had a small window. A nurse inside unlocked the door, and the man rolled me onto the ward. He held out papers for the head nurse, whom I would come to know as Nurse D.

I stood up, and Nurse D. showed me around. She showed me the nurses’ station; the medication dispensary; the activity rooms; the dining room; a little gym with a stationary bike; the telephones; a quiet room, which was empty except for a mattress on the floor, where patients could cry or rest undisturbed; the medical-examination room; and the patients’ common room—everything except the bedrooms, which were down a hallway that was locked in the morning and kept locked until after dinner. We were not allowed to linger in our beds. The common room was furnished with sofas and chairs, and a television that blared, and a computer for patients’ use. I spent many days lying on a sofa there. I had a black canvas bag, and every day I used it to carry personal items—a sweater for when the air-conditioning got too cold, a toothbrush and toothpaste for when my mouth got dry. I also used the bag as my pillow. I took off my glasses and put them on a table, and then stretched out on a sofa and tried to sleep. Every twenty minutes, throughout the day and night, a nurse counted us, all the patients, noting our locations, checking on us. Were we safe?

There were several wards at the institute, one dedicated to schizophrenia and other strong psychotic illnesses, another for residents of the surrounding neighborhood, another for children and adolescents. The ward that I was on was called the General Clinical Research Unit, or G.C.R.U. Many of the patients there had volunteered for clinical trials of new treatments. I was not on a research protocol. I was a clinical patient, admitted because I was in need. There were a handful of us with clinical status, and we became a circle within the larger group, wishing one another well, consoling, hoping for happy outcomes, saying good luck when it was time for one of us to be discharged, good luck, good luck out in the world.

I recall a woman in her twenties called Sarah. (I have changed the names of the patients mentioned here.) She seemed listless and enervated, and often sat without moving. She spoke in a monotone whisper. She confided that she had survived suicide several times, and had been in and out of hospitals since her parents had divorced, when she was twelve. I don’t recall anyone visiting her except her father, who sat and played board games with her, hunched over the table.

And there was Kathy, who was my age and single and lived on disability assistance. She, too, had few visitors. She and I often sat together. Her conversation was limited to illness and its consequences. She frightened me; they all did, with their stories of past admissions, drug loads, and side effects, their perilous lives. Would I become one of them? Did I belong among them?

My doctor was Dr. A. He was in his mid-thirties. He wore a tie and a white coat and was always harried. He told me that a whole team would take up my care—doctors, nurses, psychiatry residents, and social workers. He promised that they would get me better, that they wouldn’t give up, and that I would be safe. I sat in the common room and gazed out at the Hudson. The sun was setting over New Jersey, and the river shone in the light. It was evening. Regan had come for visiting hours. She’d brought toiletries and clothes—pants and shirts, underwear and socks. Nurse D. separated the things that I could keep in my room from the things that I couldn’t. What I couldn’t keep—like my razor—she locked away.

I wouldn’t have used it, I might have told her, not for suicide, not in those first days. I felt relief once I had finally arrived on the ward, and even anticipation. I was out of immediate danger, out of harm’s way, as we put it—my own harm to myself. I could not relax my muscles, or walk a straight path down the hall. I believed that my life was ruined and that I would be locked away for a long time, but I nonetheless could not easily die in the hospital.

Maybe you’ve spent some time trying every day not to die, out on your own somewhere. Maybe that effort has become your work in life. Perhaps there is help from family and friends, all the people who don’t quite understand that, when you tell them they will be better off with you dead, you are speaking a truth. Maybe you’re alone in a room, lying on a bed, and your chest is tight and your breathing shallow; you feel afraid to move; you sleep two or three hours each night, and then wake up in fear. Maybe you pace. Maybe you keep pills in a jar or a drawer, or hidden behind a box in the closet. Maybe you’re afraid of the hospital. Who isn’t scared of the hospital? We know, or think we know, its histories of lobotomy, shock therapy, and mind-control experiments.

Shortly after I was admitted to the institute, after my team had looked, listened, consoled, questioned, and taken notes on me, I began an eight-week drug trial. The drug was nortriptyline, an older-generation medication that affects norepinephrine and serotonin levels, though not as effectively as the newer SSRIs and SNRIs—Prozac and Effexor, for instance—which I couldn’t take.

Nortriptyline didn’t work. Eight weeks is a long time to sit getting worse in a hospital. Three times each week, I had psychotherapy with Dr. A. I begged him to promise that I would ride my bike again, or write another story, or survive the loss of my mother. At the end of each session, he asked me to draw a house. My houses were plain; I can’t draw, but so what if the walls were crooked and the windows oblong? No one was ever in those houses, no stick-figure family, no mom, no dad. My feeling that I would die, or that I would at least never live outside an institution, grew stronger, and I became convinced that I was in the wrong hospital, that I was sick in my body, not in my head.

“I feel sick all over,” I told Regan.

Some days I wept in the quiet room; on other days, I wept to friends on the pay phone, or talked to the nurses, or looked at the computer. I wrote short notes to my friends—terrors and updates. I stretched out on a sofa and waited for the meds to calm me enough that I could watch the news or read a book from the patient library, a room right outside the locked doors of the ward. The library featured works on psychiatry as well as paperback novels, memoirs, and biographies left by previous patients.

I couldn’t read much, though. Moving my eyes, even to gaze around the ward, was fatiguing and painful. I took Ativan, a sedative, and Seroquel, an antipsychotic, when the anxiety was excruciating. The anxiety by now had become less a matter of shaking and trembling and more a kind of buzzing in my chest. Seroquel made me sleepy, but it didn’t put me to sleep. I lay still, but I wasn’t still—I was vibrating. I was clumsy. I might reach for a cup and knock it over with my hand. I might walk down the middle of the hall and find my shoulder brushing against the wall. Sometimes I lay like a corpse, my arms folded over my chest, just as I had in the months before I was admitted to the hospital, when I was preparing in earnest for death. I asked the nurses if I would be all right. Would I make it? I made the effort to move my jaw, my mouth and tongue. Did the others on the ward feel as scared as I did? Were they afraid that they’d never be well?

Visitors came after dinner, mothers and fathers, brothers and sisters, couples and single friends. The nurse let people in, locked the door, and then called our names or came looking for us. All guests stopped at the nurses’ station, where a nurse looked inside bags and backpacks. Some families didn’t talk but instead sat gathered around tables, playing board games. The hospital had a closetful of games. Other patients were alone during visiting hours.

My friends and I might hug when they arrived, but only for an instant. We sat in the common room. I asked about the world, and my friends talked about their lives. I tried to describe my state to Dave and Geneve, to Kathy and Jon, to Paul, to Jane, to Jenny, to Nicky, to Janice, to Sasha and Vlada. But I didn’t have many words. And how were they to understand my feeling that I was dying, that I was leaving them? I felt as if my friends were far away. I think of that remove as not a distance but a disconnect. The disconnect seemed, for want of a better way of putting it, dimensional—a disturbance in the cosmos. I have heard this sensation described as a glass wall. My friends and I occupied, it seemed, different times and places. We were sitting together, but we weren’t together. They lived in historical time, not in eternal dying; they had yesterdays, and a today, and a tomorrow. The world from which they’d come, and to which they would return, was lost to me.

I’d wept deeply before my time in the hospital, and have since, though never for as long during a day, or over as many days, as I did in the quiet room. I went into the room, lay down on the mattress, and sobbed over my betrayal of my mother, over old loves, over my decision, when younger, to write, over the houses that we’d lived in when I was growing up, the friends that I’d made and then said goodbye to whenever we moved. I cried over our cats, Zelda, F. Scott, Justine, Pippin, the litters of kittens on blankets in boxes—so many cats. I’d held them, and slept in bed with them, and cradled them in my lap.

The nurses urged me off the mattress. They suggested groups for game-playing sessions, and leisure-activity workshops. They suggested that I keep a journal. Writing would promote neuronal growth and emotional insight, but I refused. It was awful to see my misshapen letters and unreadable words. I’d worked most of my life at writing; I’d been a professional, and now I couldn’t bear it. I recall an afternoon in the common room. Maybe I had been in the hospital for a month or so. The TV was on, and patients sat watching. I was lying on my back on the sofa. My head rested on the canvas bag, and my arms were crossed over my chest. It was late in the day, and, looking out the windows, I could see blue sky. I got up and walked across the room. I could sense the hairs on my arms, as if blown by some faint breeze. It was a burning feeling.

Around that time, sometime in late June, I noticed that my feet and shins tingled and ached, and often looked blue. My nails hardened, thickened, developed ridges, and became opaque. I couldn’t bite through them. I wasn’t shaving, and my beard grew stiff and wiry. I complained to Regan. Was I suffering from a vascular disease? A rheumatologic disease? Why was I being held on a psychiatric ward? I knew the doctors’ position on these questions. They understood, or knew, or simply believed that I was not making sense.

“I’m not delusional,” I said, over and over again, to Dr. A. I told him I knew that I was sick, but not in the way that he believed, and that I needed a different kind of medicine. In order to calm me, he made an appointment with the internist on call, who crossed the skywalk from Columbia Presbyterian, read my lab reports, checked my neurological functioning, listened to my heart and my breathing, and told me that I was medically fit. I was relieved, though only for three or four minutes. I thanked the internist for his patience. I left the exam room. My chest tightened, and my arms and legs again felt leaden.

In early July, my memoir about my mother came out. I’d been on the ward for two months. There had been no time for the publishers to delay the publication. Someone brought me a copy, but I didn’t want to hold it. The memoir came out around the same time that I developed eczema on my forehead, a patch of itchy, reddish skin above the bridge of my nose, between my eyes, exactly where the mystical “third eye” appears in religious iconography and artistic imagery, and directly over the area of the brain known as the medial prefrontal cortex, which is associated with empathy, anxiety, temporal and spatial awareness, autonomic-nervous-system functioning, memory retention and sequencing, stability of mood, and executive functioning. The medial prefrontal cortex is crucial to proprioception, bonding with others, and our sense of safety in the world.

Touching was not permitted on the ward. The hospital is meant to halt and reverse the effects of trauma, but is governed by protocols that enforce patients’ separateness from one another—a new isolation. For many of us who had survived alone, the hospital was the first time in a long while that we had been part of a group. Some of us had been sexually or otherwise violently abused—hit, bullied, intimidated. Some of us had been left by loved ones. Some didn’t know what had happened; the disease had seemed simply to appear, maybe during childhood, in college, or, as with me and many men, in middle age. Physical contact between patients was potentially traumatizing. Touch came only from nurses drawing blood, or light hugs with visitors, who, when saying goodbye, seemed eager to go—and with whom I longed to leave, if only to have dinner together over on Broadway, a few blocks east.

I would not have made it to Broadway. Had I tried to stumble down the hall, beltless, in my socks or unlaced shoes, I wouldn’t have got far. I could not have read a menu and chosen what to eat, or picked up a glass without spilling, or held a knife and fork without trembling. I could not easily swallow; my jaw hurt, and my mouth was dry from medications. I could not have joined the conversation. I would only have made people nervous. Dining out, driving a car, making coffee—these things were not possible. They were unsafe. Everything outside the ward was unsafe. My apartment was unsafe. The subway was unsafe. The street was unsafe.

We used to call hospitals asylums. An asylum is a refuge, a place away from harm. In another, perhaps fuller sense, asylum is a provision. Asylum can be legislated and granted. Refugees, political prisoners, those who are persecuted for their race or their way of life may find asylum in a church, a new country, an international airport, or any hidden place. Children bullied at school may find asylum at home, but for children abused in the home there is no asylum. Grave psychotic illness has one refuge.

“Why won’t they take me to the right hospital? There’s nothing wrong with my brain. I need to be in a regular hospital! They’re going to kill me!” I cried to Regan, and begged her to tell the doctors that they were making a mistake. “They won’t listen to me! They think I’m crazy!” I shouted into the phone, over and over again.

“You’re not crazy,” Regan might say, and eventually she did phone my doctor. She talked to him more than once.

But we were also fighting.

Regan, and my friends who visited the ward and then returned to the outside, the people I depended on and who depended on me, would no longer want or need me; I was certain of this. I would never write again—that was over. “I ruin everything,” I told everyone, my friends in New York, and the ones who came from out of town. Some came often; others were scared to visit but came anyway. They sat across from me. They were uncomfortable, exasperated, wanting to leave, not knowing what to do with their hands, smiling too much, forcing calm expressions, making sympathetic faces, posing. My hands shook. My skin was itchy, and my hair was growing out. My beard grew down my neck.

“You haven’t ruined anything! Don’t say that!”

“I’ve ruined myself.”

“Donald.”

“I have.”

“Donald.”

“Look at me! Can’t you see what I am?”

Every night at nine, after the visitors were gone, the nurses unlocked the dormitory. This was when I took my night meds. The meds nurse was older, and kind. He had good words for us. “Here you go,” he’d say gently. After swallowing the meds, I might sit in the common room and talk to Kathy about her medication, or about what it was like to live on disability. Nighttime was when I felt best. In bed, I waited. These were my only moments, the twenty or thirty minutes before sleep, as the medications began to work, my only times of anything like peace.

At the beginning of my stay, I had a roommate. He was in his early thirties. His face was scarred, as if it had been slashed with a knife. We had our beds and dressers, and a bathroom with a shower. My face in the bathroom mirror looked gray. I could see the dark circles under my eyes. An outside curtain covered a strip of unbreakable glass in the bedroom door. Every twenty minutes throughout the night, a nurse would pull the curtain aside to peek in at us. Were we breathing? Had we found a way to die? Doorknobs were narrow and thin; there was nowhere to hang a knotted sheet. No nails showed in the furniture. My roommate was nervous, aggressive; he moved in bursts. I was uneasy around him, though I never felt in danger. Maybe he needed a friend. We didn’t talk, and I never learned his history, though it seemed to me that he’d suffered some great and lasting violence. That was what I felt—I felt his past, you could say, and my own. Later, I was moved to a single room at the end of the hall.

At night, I slept two, three hours, and then woke. Sometimes I got up and stumbled down the hall to the nurses’ station, where I asked for more Seroquel. Then back to bed for a few more hours before waking again, early in the morning, when the medical residents and the daytime staff arrived. I could hear their footsteps and their voices. Patients lined up for blood-pressure and weight checks. Sometimes a nurse or a resident took me into the medical-examination office and drew blood. I clenched my fist. The nurse searched for a vein—tap, tap, tap, on my arm. It usually took a minute. The nurse cleaned the skin with a cotton pad. I could smell the rubbing alcohol—the smell of going to the doctor. “Just a little pinch.” It usually took one poke, and then another and another, before the vial started filling. I watched blood seep into the vial, and then looked away. The nurse popped one cartridge out of the hypodermic chamber and inserted the next. I felt the needle moving beneath my skin. When would it end? I was sweaty and breathing quickly. The nurse taped a cotton ball over my skin.

“All done.”

Couldn’t the doctors see, in my blood work, signs of my real disease? There was nothing wrong with my thinking. I had a vascular disease. Why else would my extremities tingle and ache? Or I had a muscular disorder, some sort of dystrophy. Why else was I so clumsy and stiff? Did I have a rare illness that affected the bones of my face? Why else would I see my misshapen skull in the bathroom mirror? It was fleeting, a moment of death imagined. I stood before the mirror and saw my hair, ears, and beard, my chin and mouth, my cloudy eyes. But my jaw looked warped and disfigured. My cheekbones jutted out, and I thought I saw, for a moment, my eye sockets instead of my eyes.

I ran from my room, down the hall, careering, furious, scared. Was it morning? Was it nighttime? And when was it that I stormed the nurses’ station? It was a day near the end of my medication trial, a day in July. Why hadn’t I already been taken by ambulance to the right hospital? Why was I being held against my will? Why would no one listen to me? Why would no one help me? I was pleading. I was begging. I don’t remember if I was shouting.

Dr. A. was standing behind the desk. He stepped back. Immediately, the area filled with personnel. Nurses and residents and social workers appeared and formed a kind of semicircle. They were ready to tackle and restrain me. “Stop right there,” my doctor said to me, and I stopped. Were the other patients watching? Would I be put in a straitjacket? Dr. A. held his hands out, palms facing me, as if he were pushing something away. Then he turned his hands palms down. “Take it easy,” he said. No one moved. The doctor gently lowered, and then raised, and then lowered his hands. I stepped back. I looked down at the floor. Had he really thought that I would become violent? He dropped his hands, and I went into the common room and lay on the sofa. I felt misunderstood, and I was ashamed.

A few days later, Dr. A. brought me into the dining room. It was midday. The tables had been pushed to the walls. My team of doctors and nurses and psychiatric residents sat in a row, like a jury. There were the social workers, the ones who’d encouraged me to join in activities that I rejected. I didn’t want to play games with patients who got excited and noisy, or eat the doughnuts that the nurses brought. I didn’t want to sit in the leisure-activity workshop and hear about pleasures that I would never feel—of relaxing on porches or going on vacations or having picnics. I couldn’t bear the weekly cooking class that was held in the little kitchen down the hall from the dining room. Must I fumble with pans? I couldn’t safely boil water. I’d once been a good home cook. I had cooked with girlfriends, and read literature, and gone to movies, and acted in plays, and graduated from schools, and run errands, and sat with my mother while she shook from delirium tremens, and driven with my grandfather, her father, through the North Carolina mountains, to which he and my grandmother retired.

In 1983, a friend whose mother had died of suicide referred me to my first therapist. D. had come to New York from the Midwest, where he’d been a Congregationalist minister. D. told me that he’d become a therapist because he had felt unable to help his parishioners; all he’d had to offer were homilies and consolations. His office was in a brownstone, three blocks up from my apartment, on the second floor in the back. D. said that if I drank I would become an alcoholic, like my parents. I went to Al-Anon. I read and reread the Twelve Steps of A.A. At night, I called my mother, and we talked about the program.

D. left the city in 1985, and three years later I began therapy again, with R., who had come from England to study at the William Alanson White Institute, on the Upper West Side. He and I met twice a week in an attic room. I rode the Eighty-sixth Street bus across Central Park. Sometimes, when coming into the room, I might say hello and ask R. how he’d been, and he might then ask me what it would mean to me to know. We tangled over whether I needed to talk about my father. The William Alanson White Institute looks at interpersonal relations, examining the family and society—the patient’s story of growing up and living in the world—in relation to trauma, broken bonds, and compromised lives.

After leaving therapy with R., in 1991, I began with M. I moved to Brooklyn, to the apartment where, years later, I tried to die. M. had grown up on Staten Island. Her office was in an Art Deco apartment building on York Avenue, in Manhattan, near the East River. I commuted from Brooklyn to see her, sometimes once a week, sometimes twice. Our therapy lasted fifteen years. M. followed Heinz Kohut, an Austrian immigrant who practiced what he called self psychology, which emphasizes the integrity and wholeness of the self, whatever that is.

I had survived, or thought that I’d survived, my parents’ drinking and shouting, our constant moving, the losses of places and friends, annihilation after annihilation. I’d played in the yard, and smashed tennis balls against walls for hours, and built model airplanes, and listened to my records at night in my room. I’d slept with cats for company, and ridden my bike, and struggled in school, and, later in life, gone to bars, and then quit going to bars, and smoked cigarettes and pot, and fallen in love, and argued and made up, and refused to speak to my father, and suffered my mother. None of this had stopped my dying. Writing had not stopped my dying. The Twelve Steps had not stopped my dying. Therapy hadn’t stopped it, and my old friends couldn’t stop it; nor could Regan. No one could.

Dr. A. waited in the patients’ dining room. Nurse D. was there. My doctors, my team, sat in a row, holding notebooks and pens. At the center of the dining room was a chair for me. One person in the room I did not recognize—a woman wearing a Chanel suit. Her hair was cut short. She spoke directly and deliberately, and immediately I was terrified of her.

“You are sick,” she said. “You are psychotic.”

I sobbed, “No, no.”

“We can get you better.”

Tears ran down my face, onto my clothes.

“We can get you well,” she said.

Dr. P. was an ECT specialist at the institute. Electroconvulsive therapy, once known as shock therapy, sends an electric current to the brain, which produces convulsions that affect the patient’s levels of dopamine and other neurotransmitters. During the procedure, the patient is anesthetized, and paralytic drugs are administered to quiet convulsions in the body. Without paralytics, the patient will twitch and flail on the operating table. ECT is a powerful measure against suicide, and yet it has traditionally been used as a treatment of last resort. Early images of patients undergoing shock therapy inform our fears. I was terrified of ECT. I imagined the electric chair, and I knew, or thought I knew, what shock would do to me. It would destroy my ability to write, or even to think clearly. It would take away my memories and my personality. I would be unable to function, would live confined to hospital wards.

“We want to perform ECT. It is an excellent treatment. There is nothing to be afraid of. ECT will not harm you. It will help you. We need you to agree. We need your consent,” Dr. P. said.

How could I consent? Who could save me? I wandered around the ward, crying. I asked one of the residents if she would have ECT herself, and she told me that, if she were as sick as I was, she would.

Later that day, or maybe it was the next day, the patients’ phone rang. It was for me. It was the writer David Foster Wallace. I’d met David, but didn’t know him well. I’d read his writing—his frantically paced stories about manic, destructive characters, his funny and digressive intimate nonfiction pieces, and the novel “Infinite Jest.” Suicide features in much of Wallace’s work. He told me, on the phone, that our mutual friend Jon had shared the news about my situation. Did I mind hearing from him?

“No, I don’t mind,” I said, and he asked how I was feeling.

“Not so good.”

“How long have you been there?”

“Two months.”

He said, “I’m calling to tell you that if your doctors recommend ECT then I want you to do it.”

David told me that he’d had ECT in the Midwest, twenty years before. He said that it could save my life, that it was a safe treatment, that the doctors knew what they were doing, and that I should not be afraid of losing my memory or my competency; I was in good hands. “I want you to try ECT,” he told me. He said it again and again, because he knew that I was ruminating, and that I would not be able to believe him for more than a few minutes.

“Tell me one more time?” I asked. I didn’t want him to go. He stayed on the phone with me for a long time.

Afterward, I went looking for my doctor, and a day or two later, early in the morning, a nurse came to my door. She had my medical charts. She gave me a hospital gown. I put on my socks, pants, and the gown, and we walked through the ward. The nurse unlocked the main door, and we went to a room down the hall.

This is how it goes: You lie on the table in your gown and your socks. You’re looking up at the white ceiling. The ECT nurse sticks electrodes to your head, chest, arms, and legs. Wires run from the electrodes, across your body. You nod to the anesthesiologist, who is usually pretty friendly and who sticks you with a needle, to set up the I.V. Maybe you speak to the administering physician, the team leader. This doctor stands behind your head, programming the shock. You look up at the doctor’s face. The ECT nurse fits a pulse oximeter over your index finger, and then binds your ankle with a blood-pressure cuff. The cuff will remain inflated throughout the procedure. It blocks the muscle relaxant, succinylcholine, from entering your foot. This allows your toes to twitch, visible evidence of convulsion. Vital-signs monitors beep. You are having right unilateral ECT. The convulsion should last half a minute. If other patients are doing ECT, your buddies on the ward, you may glimpse them asleep on gurneys in the recovery area. You feel something like fellowship, as if you were all at war together, or had survived the same dreadful accident. You ask the ECT nurse to hold your hand, and you squeeze hard. The anesthesiologist says, “Atropine.” Atropine keeps the heart beating. You are crying. You’ve been in tears the whole time. You tell the doctors that you want to get better. You’ve only ever wanted to get better. There is a bite block on the metal table beside the anesthesiologist. The nurse fits the oxygen mask over your face. The anesthesiologist inserts a syringe into the pipette connected to the needle in your arm. The anesthetic trickles down the tube. You can smell it. It has a sweet smell. You count backward, a hundred, ninety-nine, ninety-eight, and then the anesthetic reaches your blood, and a second passes, and you feel that you are falling—and then blackness. The succinylcholine goes in, and you no longer breathe on your own; you are on life support, and your body will not shudder or shake. And now you are awake—did anything happen? Is it about to begin? A voice asks you where you are, and you reply that you are in the General Clinical Research Unit, on the fifth floor of the New York State Psychiatric Institute, at 1051 Riverside Drive, in Manhattan. You are behind a curtain, recovering in bed. You have had general anesthesia. Your mouth is dry. Your friends in treatment have already woken and been returned to the ward, and, in fact, you are done; it is over.

“How are you feeling?”

It was the nurse who had brought me to the ECT room. She held my arm, steadied me while I stood, and we walked back to the ward, where there was breakfast. I sat alone in the dining room. I ate oatmeal, and drank milk and coffee. It was midmorning. Then the nurse helped me down the hall. ECT patients could go to their rooms after treatment. I lay in bed and wondered if I felt better. Had anything changed? Maybe I slept. I looked forward to feeling well. I couldn’t recall feeling well, or imagine what that might be like.

Shock treatment for suicide wasn’t induced electrically until the early nineteen-forties. Electroshock therapy proceeded from a line of hormonal and chemical treatments that sometimes showed positive results but caused anxiety and discomfort, both for patients and for their administering doctors, who worried that the therapy might kill (which, though rarely, it did). Insulin shock, which was developed and promoted by Manfred Sakel, an Austrian, came into use in the early nineteen-thirties. The patient was given increasing doses of insulin, which reduced blood sugar and produced coma and seizures. Old film reels show insulin-shock patients trembling and quivering. Many treatments were required, and Sakel’s patients underwent them daily, which must have been gruelling. Sakel proclaimed insulin-shock therapy a cure for schizophrenia and other historically intractable psychotic illnesses, even drug addictions. The treatment was used in Europe and America until the fifties, when it gave way to electroshock therapy, a safer and more effective procedure.

In my case, ECT was administered three mornings a week, Monday, Wednesday, and Friday. Would it work? And, if not, what came next? The doctors added lithium to my drug load. Lithium, used long-term, can slow the metabolism. My weight increased, and my movements and speech slowed. I searched for words, even for the answers to simple questions. “Uh, uh, uh,” I would say before beginning a sentence. A week went by, and then two, and then three: one treatment, and then two treatments, and then three, four, five. I had ten rounds of ECT, or maybe eleven. The anesthesiologist told me that the doctors wouldn’t give up. “We’ll take care of you,” he said, and then he told me that he had once been averse to ECT, thinking it barbaric, but had been persuaded to come across the skywalk from neurosurgery and observe. He said that he’d watched patients improve and go home. The ECT doctor recalibrated the shock. We kept going.

Patients were discharged, and new patients arrived on the ward. John came one morning in a wheelchair. John was my age—forty-seven. He’d been transferred from another hospital. He looked sick and wretched in his gown. He wasn’t registering much. Dawn came late at night. She was on a gurney, tranquillized, breathing slowly, her stiletto heels laid on top of the sheet that covered her. During her first days, Dawn did not leave the quiet room. She wore her hospital gown, and did not speak. She was thirty, and had been an artist, had acted in experimental theatre. She’d grown up in New York, and was an only child. She described herself as manic-depressive—bipolar—and said that she’d been in a manic turn when they brought her in. I never learned what had happened. She and I sat in the common room with John, whose beard grew down his neck. He’d swallowed Klonopin tablets that he’d saved up from his monthly prescriptions. It had taken him months to save enough. I saw in his life what I feared for my own. He’d been married, but there were no children. This wasn’t his first hospitalization. There was no family—or maybe there was a sister. He was a banker, but out of work. Before he came to the hospital, on weekends he’d drive to Long Island, where he was building a house that he was unable to complete. All he could envisage was sitting in his house on Long Island Sound, by himself.

Helen came to the institute in late July. She was eighty, or older, catatonic, stooped over from the pain in her muscles and joints. She pressed her arms against her sides, and her hands were clenched. She couldn’t look up, or eat much, and she barely spoke. She moved very little, but she did not seem still. She began ECT immediately after she was admitted. Sometimes, before bedtime, Dawn and I huddled on the sofa. We sat close, though not so close that a nurse might see and then stop us. Sometimes we touched hands. The television blared. Dawn and I whispered about other patients, about our families and our childhoods, about what we did on the outside. Her parents came to visit, and I met them.

The paralysis of suicide is not apathy or stillness. You may feel encased, restrained somehow, breakable. You may stop opening mail and drop contact with people. You may stop bathing or brushing your teeth, and neither leave nor clean the house, walking around the piles of dirty dishes and dirty clothes and the week’s trash. You may feel as if you are burning, as if your cells have caught fire. You may get only a few hours of medicated sleep, or you may sleep and wake throughout the day. This is not resignation; it is sickness. You picture taking the canoe out to the middle of the lake, rowing slowly over the water, and then slipping in; or you pick up the pistol, the one in the cabinet, and hold it for a moment, and that helps, gives you the security that the bullet will be there when you need it. You are a burden to your caretakers; you know this, no matter what they say to soothe you, no matter how much they love you. If you are agitated, pacing, smoking, then you may appear to be fleeing demons, or even to be a demon yourself, crazed, possessed. Or you may turn out the lights and sit, as if waiting, telling yourself that tomorrow you will walk alone to the lake, or pull the trigger, or drop from the roof.

Why did he do it? Why did she? Why did they? What didn’t we see? Is it our fault? What more could we have done? Was it the pain? Was she unable to bear it? Did he become exhausted with life and give in to despair? Wasn’t she always unstable, oversensitive, crazy? Does it run in the family? Is suicide hereditary? Is it genetic? Was there a note?

One day in August, I took a walk with Nurse D. It was dinnertime. The sun was in the west, and the hallway to the dining room was filled with light from the windows facing the Hudson. I’d had five weeks of ECT. I felt stable on my feet, and found it easier to talk. I asked Nurse D. whether she had noticed anything—anything about me that might be different. She said that she had seen changes, they all had. She told me that the doctors and the nurses can see health before the patient feels it. She told me that I was getting well. The muscles in my neck and face had loosened and relaxed, and my breathing was smoother. I took steady breaths. My voice was deeper, and I wasn’t clumsy, only depleted from the treatment. I realized that I had not destroyed my life by writing about my mother. My life was not over. I could stand up straight when I walked down the halls, and friends who visited or phoned told me that I sounded better. People could stand to listen to me! I went to a cooking class—it was a Friday—and picked up implements, and held them, and contributed. We made hamburgers.

In the evenings, after we’d had our meds, Dawn and I sat together on the couch. I felt safe with her, safer than I’d felt at any other time at the institute. I cared so much about her and the other patients—I mean that I liked them, and felt for all of us. We say that we feel “in touch” with the world, with people, with our feelings. Was I in touch? The daylight through the common-room windows seemed clear, somehow gentle. The sky was deep blue, going orange in the west, and the trees along the Hudson looked bright with color. I no longer minded the sound of the television. My friend Jon had brought me a tiny music player—it fit in my pocket—and Nurse D. let me keep it. I walked the halls, listening to the beat, grooving, tuned in and in touch, greeting people, chatting. My weight went up and up from the medications, and I could barely get my pants on, but I didn’t care. I was alive. It was mid-August. I did not feel burning in my gut; my legs didn’t tingle or shake; and I no longer woke in terror at three in the morning. Dr. A. congratulated me on my recovery, on working hard and persevering. A day or two later, he invited me for coffee and a Danish. He unlocked the big steel door, and we left the ward. I felt uncertain at first. My doctor and I walked down the hall to the commissary. I looked out the window at the day. I felt free, not from the hospital, not from illness, just free. It felt good to be in the commissary, holding a cup.

I never wanted to die. Have you wanted to die? Do you now? At what stage of sickness do these desires come? Are they even desires? You might say that you are death-obsessed, consumed. You might refer to your obsessions as intrusive thoughts, or as ideations, as if you were having ideas about dying, when, in fact, you have certainties. When were you first aware of your own death? When did you first picture it? Can you name the day, the hour? What did you see?

For me, picturing it began in the winter, in the months before my hospitalization. I was lying in bed. Regan slept beside me. I was sweating, and the sheets smelled like cigarettes. I went to the living room and turned on a light. It was better to sit in the light than to lie in the darkness. I couldn’t bear music, and movies and television shows, even comedies, scared me. I sat shivering, waiting for the sun to rise, the time when I could take another Klonopin. Why was I thinking about knives? Why couldn’t I stop? Surely it would pass. I stayed quiet about it, though. Death is our burden and our comfort. Others can’t know. If they know, they will worry or be scared, or threaten us with the hospital. They’ll tell us that life is good, that we have only one, and that it is worth living. Try not to lose hope, they’ll say. Try to stay optimistic. Keep faith. Losing us, they say, will be the end for them.

But, to the suicide, hope is a death sentence. The suicide cannot feel or live on hope. Our hope is gone.

I went home from the institute by myself. I’d been there almost four months. Regan wanted me to go away with her after discharge, to go somewhere quiet. I think that she wanted to celebrate, if that’s the right word, my recovery. But I didn’t think that I could do it. “I’m not strong enough,” I told her. Life in the world—what would that be like? What if I couldn’t make it? Would I be a disappointment? Regan had helped me, but I was afraid to resume life as it had been before the hospital.

On my last day at the institute, the community—the patients and the doctors and the nurses—gathered in the common room to say goodbye, a hospital tradition. I was grateful for them, for the hospital, a wondrous place. I felt something that seemed brand new in my life, a sense of calm, even happiness. I wished John well with his ECT, and told Helen that I saw her improving. I promised Dawn that I would stay in touch, which I did, for a while, after she got home. I shook my doctor’s hand, and hugged Nurse D. and the other nurses, and then I packed my clothes into my black canvas bag. Nurse D. gave me my prescriptions, my phone, and my keys. She opened the door, the gate, the portal, and I went out. The door closed, and I heard the key in the lock. I walked to the elevators, rode up a floor, and crossed the skywalk to Columbia Presbyterian. There were cabs on the street. I got in one and said hello to the driver. I opened the window and felt the fresh air. We drove down Riverside Drive, and then cut over to the West Side Highway. It was about four o’clock in the afternoon. To the right was the Hudson, shining in the light, and to the left were the buildings of Harlem, and then the glass-and-steel skyscrapers of midtown. We passed Chelsea and the Village. At Canal Street, we turned left and headed east through Chinatown to the Manhattan Bridge. We crossed the bridge and drove up Flatbush Avenue, and then turned right, and then left onto my street.

The car stopped in front of my building. I’d taken myself to the hospital in the spring, and now it was almost the end of summer. I got out of the car and stood on the sidewalk. I could hear children playing. Had you seen me climbing the stoop, opening the front door, you might have thought that I was coming home from a job in the city or an errand in the neighborhood. I’d been gone so long, and it seemed only hours or a day. ♦