What a Jail Cell Taught Me About Mental Health Care

Source: Brett Sayles Pexels

The segregation cell, the jail's antiseptic name for solitary confinement, was about four feet by four feet. Beige brick, a red steel door, a six-inch window of scratched plexiglass that looked out on nothing. No horizon. No depth. For a man in the full grip of mania, it was close to unbearable. The air felt thin. My mind ricocheted off the walls.

On the first night, the claustrophobia rose toward panic, and I could not breathe. I tilted my head back toward the ceiling and caught it—a faint, cool draft from a vent above me: a thin current of moving air.

I turned my face up to it the way you turn toward a hand laid on your shoulder in the dark. And without warning, it brought me, my father. He had died a few months earlier, his body slowly stilled by Parkinson's, and as the draft moved over my skin I felt improbably close to him: two men worn to their most basic suffering, meeting in the plain fact of breath.

It was barely anything. It was everything.

That accidental breath of air was the first stillness I had known in weeks. It was not transcendence. It was just air. And it was enough to keep me from disappearing into the noise of my own mind.

I want to tell you how I got to that cell, because the smallness of that mercy is the whole point.

How I Ended Up in a Cell Instead of a Hospital

Days earlier, a clinician I will call M had declined to sign an emergency detention, the order that might have sent me to a hospital. I was floridly manic. I had sent my brothers messages I can still barely stand to describe. By any honest reading, I was a person who needed care.

But the question the system asks is not whether you are suffering; it is whether you are dangerous. On the metric of provable danger, I did not clear the bar, so there was no hospital bed—only booking, a uniform, a body scan, a holding cell.

I was booked in the grip of a manic psychotic episode, and the jail's own social worker saw it plainly. She asked about my history and named what she found: probable bipolar disorder, probable PTSD. She did not accuse. She recognized. The nurse who screened me confirmed I was breathing, confirmed I was a person, and she wrote it down.

None of it changed how I was handled. Moved to a dormitory, I asked deputy after deputy for food that never came. Mania turns hunger into injustice, and by midnight I was protesting too loudly to be ignored. For that, for the very symptom the social worker had just documented, I was escorted to solitary. My illness was recorded in one room and punished as non-compliance in the next.

To answer a disintegrating mind with isolation is to prescribe the one thing most likely to finish it off. In A General Theory of Love, the psychiatrists Thomas Lewis, Fari Amini, and Richard Lannon argue that because human beings regulate one another's physiology, expulsion from the company of others is the cruelest punishment we can devise. The jail's response to a man losing himself was to strip away the last thing that might have held him: Other people.

No medication came.

I was placed on suicide precautions and fitted with a padded green anti-suicide smock, a turtle suit in the inmates' slang. I said aloud that I was losing myself. And the only mercy that reached me came from none of the people paid to keep me alive. It came from the building's ventilation.

Source: Мансур Тляков/Pixabay

Containment Is Not Care

The draft did not heal me. It did not treat my bipolar disorder or shorten my episode by an hour. It was a mechanical accident in a room built to contain a body and wait.

But it did the one thing nothing else in that building did. It reached me. In a place built to keep a body still and leave a mind to burn, one small current refused to stay put. It moved. Because it moved, I could feel it. Because I could feel it, I was, for a few minutes, somewhere. Present. Here.

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That is the distinction I keep returning to: What I received was contact, not comfort. It offered nothing that resembled care. It simply touched me, reminding a self I had nearly lost that a world still existed beyond my own mind. Psychiatrist and psychoanalyst Elio Frattaroli writes that we discover who we are in our awareness of feeling, not thinking. In that cell, thinking had become the disease. The air gave me something to feel, a thin thread back to the world, and it held.

This was the exact measure of what the system offered me. Not care. Not treatment. Containment, and a small mercy it did not intend. In the New England Journal of Medicine, the psychiatrists Caleb Gardner and Arthur Kleinman named the pattern without flinching: modern psychiatry, they wrote, is marked by the "abandonment and incarceration of people with chronic, severe mental illness." I did not meet that sentence as a patient reading a journal. I lived it as an inmate. The jail was where the abandonment became a room.

Jails, as I wrote last time, have quietly become the country's largest psychiatric institutions. The journalist Alisa Roth calls this America's criminal treatment of mental illness, and I have no better words for it. This is how that abstraction feels from inside a cell: like being sick enough to be locked up and not sick enough to be helped. Like telling someone you are disappearing and being left alone to find out whether you will.

And it feels, on the first night, like tilting your face toward a vent and being kept in the world, for a few minutes, by moving air.

I got well, eventually. Not there, and not because of anything that place did. But I have never forgotten the smallest mercy, or how much it exposed by being the only one on offer. A person in psychiatric crisis should not have to be kept alive by the ductwork. That so many of us are—that our emergency care can amount to a locked door, a padded smock, and whatever grace the building's machinery happens to leak into the dark—tells us everything about the distance between confining a person and caring for one.