The Psychiatrist’s Visiting Interns
William Myrl Smitherman was awarded Second Place in Essay in the 2017 Prison Writing Contest. Smitherman is currently incarcerated at the Augusta Correctional Center in Virginia.
Every year, hundreds of imprisoned people from around the country submit poetry, fiction, nonfiction, and dramatic works to PEN America’s Prison Writing Contest, one of the few outlets of free expression for the country’s incarcerated population. On November 28, PEN America will celebrate the winners of this year’s contest with a live reading, Breakout: Voices from the Inside. Participants including 2016 PEN/Bellwether Award-winner Lisa Ko and 2010 National Book Award-winner Terrance Hayes will read from the prize-winning manuscripts.
The Psychiatrist’s Visiting Interns
Three new faces greet me, and there is that moth-wing tickle of recognition which foreshadows the meeting of familiar strangers. The psychiatrist, a fourth face, types into an invisible screen. He finalizes the details of another patient before pulling my record. A physical file lies upon the desk, green paper where he jots notes about our visit. This is when he introduces me as Mr. Smitherman. A pause follows. The students won’t speak until he has given them leave to do so, and I wonder if the pause is deliberate. Have they been instructed to observe the patients in the spare moments of silence before an interview? What do they learn about me from the way I sit, or smile? They are third year medical students from a nearby university. It is their place to ask questions and observe, appearing for a day before vanishing back into the labyrinths of the real world. My psychiatrist has a disclaimer: You don’t have to talk to them if you don’t want to. They can be asked to leave, and sometimes are, though not by me. He has many patients, and there is of necessity a formulaic quality to these meetings. There are things I’ve shared in that office that I’d never spoken aloud, but there is always much left unsaid, or said imperfectly, and it is some of those overlooked thoughts I will endeavor to communicate here.
They give their names, or he introduces us, and I try to put them to memory. It is a game I play with myself, pretending to be cleverer than I am. The last eight or so appointments and their concomitant names are in my head, though I’m certain to be mispronouncing a few. Their names and where they sat in relationship to me I could tell you without difficulty, but I might not recognize them if I saw them again. That is the fickle nature of the machine.
These appointments come about once a month, and the students are different, I am different, each time. The meetings follow an analogous structure, however, and my personal aversion to repetition wars with the practicalities of introducing myself and answering similar questions again and again. The students are black boxes, interrogatory golems, instructed not to share any further keyword information about them. Innocuous tidbits do slip through, though. One reads fan fiction, another enjoys the poetry of Robert Frost or has played Dungeons and Dragons. They are young, engaging, and the course of their questions can follow a circuitous route, with the psychiatrist giving a nudge whenever a given rill dries.
Basic information: They get a summary of my family situation, my crimes, and how long I have been in prison. I designate myself as bipolar, a malapropism. Manic depressive is the term I prefer. Some people resent their classification; I found that mine came as a relief. The award of a mental illness goes a long way toward easing the cognitive dissonance I feel when contemplating the arc of my existence.
The meaning of “bipolar” is a wide discussion. Popular media has made strides in the acceptance of mental illness by the general public, and also influenced the public’s perception of what it means to be mentally ill. A police consultant drama with a schizophrenic protagonist depicts him experiencing aural and visual hallucinations, working as a professor of mathematics, and solving crimes in his spare hours. His illness, far from being portrayed as a disability, is the dramatic anchor of the show, the deus ex machina when all answers are out of reach. His waking dreams solve real world problems. In Fight Club and Mr. Robot, characters afflicted with alternate personalities manage to spark revolutions without realizing they’ve done so. This is what people, even the afflicted, think of when they think of mental illness, as if every conversation about cars started with the one they drove in The Jetsons.
In life, a mental illness often has a much subtler effect on a person’s well-being. I knew a young woman who cried before she went to sleep. She was my friend, and managed most of her affairs as well as anyone, keeping a job, going to school, and crying into the late hours. The people she interacted with on a daily basis didn’t know she suffered from depression. At the time, with the hubris of youth, I believed her problem was something that could be solved holistically. She didn’t start receiving treatment until her early 20s, when she felt sufficiently debilitated to break away from the default assumption that she should be able to handle her issues on her own. People can come to think of the symptoms of their illness as a legitimate part of themselves. This is a dangerous misconception that delays treatment until those symptoms become impossible to ignore.
“We cling to metaphors because we don’t have anything better to explain what we feel, and it isn’t helpful to say nothing at all.”
Emotion is incommunicable, and because of its incommunicability, written descriptions of mania and depression can sometimes stretch credulity. What does it feel like to walk among the stars, or to be bound at the bottom of an abyss? It’s nothing like a mood disorder, and yet these are the sorts of phrases people use to trap the disease in language. We cling to metaphors because we don’t have anything better to explain what we feel, and it isn’t helpful to say nothing at all.
Once, I told the students a story.
“There was a fisherman that lived on a bluff by the sea. Every day, he went out onto the waves, casting his nets, and every day they returned empty from the water, until he caught a mermaid. She was sick, and he brought her back to his home intending to make her well. He could not help her, and when she died he was so weak and starved himself that he ate her. Afterward, his luck changed. The fish leapt into nets, and he became a rich man. He hired other men and boats, and ate fine foods, and wore fine clothes, and built a new house in town. The fisherman married into a good family, and his wife loved him. Still, he went out onto the waves, for his clothing chafed, and food was not satisfying, and the woman who loved him and whom he should have loved inspired no matching ardor in his heart. Every day, he went out onto the waves, casting his nets, and every day they returned empty. All he wanted was the mermaid, and all he wanted was gone.”
I told the students then, “That is what depression means to me,” and they nodded all at once, as if they understood. But they couldn’t understand, because that had been a story, and not the thing itself.
A student asked me whether I had had a mermaid. It was a reasonable question that missed the point of the exercise. Mermaids don’t exist. The thing you are missing can never be found. Depression can be a feeling of emptiness, an absence or incompleteness, a psychic wound that excises a part of the soul.
“There is a hole in my heart
as wide as the grain
of pollen that floats
on the near evening stain
as wide as the mote
that flicks on the wave
as wide as the space
between drops of rain
There is a hole in my heart
as wide as the hand
that once held my own
and equally grand
as castles becoming
mere shapes in the sand
as wide as the breach
between present and past
as hot as the stars
as likely to last
There is a hole in my heart
a hole in my heart”
This is a dark lens through which to view the world, but there is also a bright. A truer term than bipolar might be binocular. People who suffer from depression are often unable to find enjoyment in everyday activities. Mania can result in the opposite, an enhanced sensorium that can give even the mediocre sense of majesty, that can infuse meaning into the mundane. Music is different. It enters and instills, rather than being merely heard.
In hindsight, it is difficult to identify specific actions or thoughts as being manic; only that certain actions and thoughts are more likely in a manic state. I know that it has sometimes felt as if other people were not seeing the same beauty that I saw, or listening to the same song. For them it was a simple, pleasant thing, while to me it seemed the key to everything. If depression is emptiness, then mania means to be too full. It confers confidence, charm, and arrogance. It transforms an obstacle into a challenge, and bestows a heroic rime to a sadly unheroic world. The opinions of others fade into the background and your own swell in significance.
One of the hallmarks of mania is an increase in goal-oriented behavior. While skipping school, I decided to teach myself how to play piano, starting with the “Mephisto Waltz.” In the same morning I was sending an email to members of the school board describing our education system as a beast that swallowed children and shat out hopeless adults. Neither activity came to much.
“I was sending an email to members of the school board describing our education system as a beast that swallowed children and shat out hopeless adults. Neither activity came to much.”
Symptoms can fluctuate by day or by minute. There were hours spent staring at the water falling in the shower, listening to “Lux Aeterna” by Clint Mansell, or writing poems now forgotten. Grandiosity is merely believing that you are exceptional, not doing anything to prove it. High school felt impossible, an unacceptable and insulting yoke that needed to be thrown off. I made flyers that said “Rise up, drop out,” and left them in the bathrooms of my school. Keeping my mind in one place, concentrating in my classes, required a monumental exertion that I deemed them unworthy to warrant. I blamed the arbitrary nature of the lessons for my own failure to marshal sufficient attention and effort to complete them. Forgoing my diploma would have no negative consequences; on the contrary, it would be a point of pride when I was famous.
From the ages of 16 to 19, it is probable that I experienced three fully qualified manic episodes, and multiple lesser “hypomanic” states. My first dalliance with truancy would be one of the three, another came earlier that year.
It began with a bet. I had already begun to think about dropping out of high school, and a friend quite sensibly inquired what I would do for money afterward. She was a bit worried by my insistence that I could make more money in a month than our teacher did, but she accepted my wager of five dollars on the matter. My plan, if it can be so described, was to amass a number of respectable income streams using the internet. My after-school job would provide start-up money. For most of a month, I slept two to four hours a night, staying awake to watch porn and buy into pyramid schemes, assured that the next user agreement would lead to the break I needed. Funds ran thin, so I borrowed from my older brother and made free use of one of his credit cards. Soon, a note arrived from Wachovia informing my parents that I had overdrafted my account. The embarrassment helped snap the pattern of my behavior. They were duly confounded by the scams I had bought into, along with other anachronistic purchases. But canceling and replacing my debit card stopped any residual fees, and after I paid off the overdrafts the episode was mostly forgotten. Teenagers do stupid things on occasion, but you move on once the mess is dealt with.
The third manic phase came when I was 19 and left my job by texting the boss, “I quit, not enough eagles.” The vibrations in my pocket stopped after about a week, as the coworkers who had thought we were friends gave up calling. The next few months were my last as a free person, and though there were doubtless periods of normalcy, the spikes and troughs of mania and depression color my memory of the time. I concealed my unemployment, and in the final month, committed a series of robberies that resulted in my incarceration. The workless days were filled with computer games and driving aimlessly and downloading the federal budget for 2009 so that I could balance it myself; making attempts at a philosophical treatise on the impossibility of free will and making wigs out of yarn.
A mood disorder cannot hold blame, cannot be held responsible. The choices I made were the choices of the person I was in that time. Humanity tells stories about itself; people tell stories, and internal narratives help to make sense of their lives. These narratives are tinted by the dark lens and the bright. I find my own story has become clearer now that mental illness has been interpolated into it.
I once went to segregation, “the hole,” because of a minor altercation. No charge was processed, and I was to be released back into general population within a couple of weeks. Segregation consists of cell time, being escorted to three showers a week, and one hour in a dog cage outside every day. You’re alone except for the voices of other offenders in the vents and echoing in the pod. For almost a year, I refused to leave that cell except to shower, and sometimes not for that. They served me two institutional charges for “disobeying a direct order” in the first couple of months but subsequently stopped bothering. In segregation, by myself as I had not been in almost three years, I felt the knot of anxiety in my chest unravel, vanishing as if it had not been a physical part of me for months past. The seclusion lent a new focus to my writing; there were 1400 pages of fiction, innumerable letters, and one small religion I manufactured with the idea that it would one day change the world. I called it Alethianism. Focus and energy do not always take us in sensible directions, or to rational conclusions. It was during that year that I decided to seek the counsel of a mental health professional. I had been vacillating as to whether there was really something wrong with me, until a letter arrived that helped settle the issue. It was not an intentional argument. A friend sent me news that she had graduated college, including a picture of herself in cap and gown. In this, I saw the shades of my other life; the life where I hadn’t decided to quit school, where I wasn’t a criminal, or alone. This was the life I had not lived, and there had to be a reason why, because my rationalizations were insufficient.
After leaving segregation, I spent six months in population before being transferred to a lower security institution. I met with a psychologist in a nicely cramped little office and told her about my life. We talked about suicidal thoughts, and I explained to her something I had never shared with anyone, my internal contract. In jail, I had made a bargain with myself. It may not have always been serious, but it made me feel better about who and where I was. I wasn’t allowed to die until I had written something good enough to go out on, that was the deal. It was something often in my mind.
“As it happens, the fastest way to see a psychiatrist is to leak water from your eyes in front of a psychologist.”
My fixation on suicide didn’t involve concrete plans. I never set any deadlines; it was an infatuation, no different from thinking about a pretty girl in class who I knew I would never ask on a real date. As it happens, the fastest way to see a psychiatrist is to leak water from your eyes in front of a psychologist.
Those first students are gone from my memory. I wasn’t keeping the names then. Each meeting would begin with an autobiographical sketch, but the pattern changed as I became more comfortable with the process and with the students and the doctor. Now they just ask questions, and I try to answer. Often, I think I muddy things more than I clarify them, but there is an incommensurability to emotions that can’t be circumvented. A student asked me about suicidal thoughts, and I responded with a snippet of Keats, the bit in “Ode to a Nightingale” that begins: “Darkling I listen; and, for many a time / I have been half in love with easeful Death.” Other times I quoted “Jabberwocky,” and one day when there were no students, the psychiatrist asked me how much poetry I knew.
In jail, there had been a library we weren’t allowed to visit, but books were semi-regularly brought around a small cart. When a chapbook of Keats appeared, I claimed it and imprinted it almost totally within me. Memorizing poetry was a way of collecting something that could not be taken away. My collection has dwindled since its inception, the volume of its verses fluctuates with my interest in maintaining them, but I can still recite “The Raven” by stanza, backwards, or out of order. At the end of a session, the psychiatrist will generally ask me whether I would like to share a poem or recite anything, and I do. It is the only time all the hours I have put into my collection come to any use. Poetry is not useful for delivering complex verbal concepts, but like music, it can be a more effective translator of emotion than vast quantities of more prosaic communication.
Medication is always a topic, what I’m taking and how it’s working for me. Lithium and an antidepressant have effectively exorcised my suicidal fixation, but the efficacy of psychotropics can be hard to gauge. What does normal feel like? Is mine higher or lower than yours? Is there something missing from music now, or does it possess a new quality that before went unheard? People who live with manic depression can be asymptomatic for months or years between episodes, or they can seem to be cycling constantly. As an episode fades into the past, it is easy to pretend that it betokened nothing more than adolescent pains, or a bad phase, or a down period since overcome. We rewrite our narratives to keep ourselves sane. Writing was once my medication; the drugs reduce the need for it, and not having my sense of self-worth tied directly to a writing calendar is existentially freeing. I don’t expect my emotional spectrum ever be entirely regular, but it has become manageable, and I do credit my medication with that.
Outside the office, separated by bars from the hall leading in, is a waiting area. It’s used for drug testing and institutional hearings as well as psychiatry. Depending on a number of incidental factors, there may be two offenders waiting or ten filling the benches. They will have the usual circular conversations about COs, food, changing policies, and friends in common, as well as queries about prescriptions. One absolute: The student gender ratio will be noted. If there is a girl, I hear about it hours before my appointment.
“We rewrite our narratives to keep ourselves sane.”
On more than one occasion, the doctor has asked what my question would be for me, if I were the student. It’s hard to imagine the person I would be if I had spent most of a decade in higher education instead of in prison, so I equivocate, meander, and never really answer. But as the purpose of this essay is to be more forthright and complete than I am with the students in any one meeting, I have the question now.
“Why do you want to live?”
I would give this thing a name
that dwells inside of me
that in the darkness becomes bright
and in the lightness, darkens me
I would find a path to frame
a new biography
where all that’s lost would come to right
and righted, last eternally
I would make my face the same
as him I wish to be
return to that familiar sight
of home and love, in liberty