They Watched Me for Fourteen Months, Then Someone Saw Me

Source: Quang Nguyen Vinh/Pexels

The very same day I was discharged from the state psychiatric hospital where I spent nearly a year as a patient, I walked directly into my new therapist's office. The State, with a genius for bureaucratic timing, delayed my release by a day and fused two monumental events into one. I arrived wearing a GPS ankle monitor affixed to my left leg, the latest link in an unbroken chain of institutional surveillance.

What I discovered was a space constructed by someone who believed the unconscious deserved a home worthy of it. Every surface was adorned. In the wake of 14 months of cinderblock and flat institutional light, it was less overwhelming than dislocating, as if I had walked into a heated house after an arduous trek in a snowstorm. I found a seat on an immaculate white couch and caught the comforting gaze of the woman across from me.

Susan was in her seventies, and she wore clothing that announced a protest of the mundane. Colorful and overgrown, in the way a garden can be when someone has loved it past the point of tidiness and embraced the wildness as a more honest expression of truth.

From the first session, Susan lent me what psychoanalyst Theodor Reik dubbed the third ear; the way of listening to another that is attuned not only to the content of speech but to the hidden messages beneath the words.

I had long been silencing those hidden frequencies. The grief around my father's death that I buried. The shame of my failure as an intellectual. The relational world of family and friends that bipolar disorder had systematically dismantled. In the place of social connection, mania gave me the certainty that I was a sufficient world unto myself. Depression joined with substance abuse to cut me off from the possibility of love. Whether up or down, the illness performed the same brutal act: it severed me from the world.

But in that ornately decorated room, Susan made me feel seen. She asked me about my gym sessions, about my mother, and about my values. A few months in, she asked to read the psychiatric reports from the state hospital, and she returned visibly moved by the gap between the manic man she read about in the bureaucratic lexicon of danger and threat and the man now sitting across from her. When she asked about my father's death from Parkinson's, about how I was absent from his life when he died, she let the gap between my words fill the room. She shared her intimate connection to mental illness: what it meant to watch a brother consumed by schizoaffective illness in a psychiatric hospital where he eventually died. That experience had clearly weighed on her, but she shared it in the spirit of empathy rather than seeking credit.

She also opened her door to my mother—something the state hospital never had a mechanism for. Recognition, Susan understood, must not be private. It should be communal.

Source: Matthew Henry/StockSnap

Surveillance and Witnessing

I have reflected before about a hospital that kept me safe but never knew me, and about a psychiatrist whose fifteen-minute med checks could manage my lithium level without ever asking me a personal question. Susan provided a counterbalance to both.

Michel Foucault wrote that the genius of the modern institution is not its overt cruelty but its totalizing gaze: the person being watched internalizes the watching and becomes his own overseer. I had spent 14 months molding myself to that gaze, assimilated not only by cameras and medication logs but by the very knowledge of their presence. Make no mistake: all of it had been, in its administrative way, conscientious and diligent. But few institutional observers were interested in my subjective personhood—what it feels like to be a prisoner or a patient.

On the surface, surveillance and witnessing have similarities. Both direct attention your way. But the difference is found in their operating rationale: while surveillance seeks to classify, predict, and warn, witnessing seeks to know another human being.

In A General Theory of Love, psychiatrists Thomas Lewis, Fari Amini, and Richard Lannon provided me with a vocabulary for the difference in care. When Susan witnessed me, she provided me with limbic resonance: a neurobiological process by which two nervous systems become attuned to each other's interior states.

During my decade of illness, I lived in the absence of sustained resonance. The manic mind is unusually resistant to attunement, operating with the conviction that its certainty is a world sufficient to itself. In contrast, Susan offered, in session after session, the gifts of attunement and witnessing, necessary corrections after a long interpersonal exile. Lewis, Amini, and Lannon observe that the goal of therapy is to listen as a means of being present for another, to recognize their humanity. And Susan listened with her body as much as her mind. After years of professional observation, her office was the first place where the recognition itself felt like medicine.

What Medication Cannot Reach

As much as attunement matters, it would be misleading to suggest that connection alone heals mental illness. The lithium I take is effective; the diagnosis and the pharmacological calibration are crucial. But they are not sufficient. Dean Ornish, reviewing decades of medical evidence, concluded that if a pharmaceutical drug had the same positive outcomes as love and social connection, every doctor in the country would prescribe it. No one does, because there is no patent on presence. Only the experience of being seen, known, and recognized can rebuild what illness dismantles: not the neural circuitry, which medication addresses, but the self's sense of its own belonging in the human world.

Personal Perspectives Essential Reads

A Tale of Two Hobbies

What an Earthquake Taught Me About Identity

Jerome Frank's and Kay Redfield Jamison's work confirms that the theoretical orientation of therapy—whether CBT or psychodynamic—is of far less importance than the quality of the patient-therapist bond, the therapeutic alliance.

After months of being surveilled, what I needed was not a method. I needed Susan's third ear. And somewhere in the patient listening—in the limbic resonance of two people sitting together long enough for the signal to find its frequency—the part of me that had been speaking into silence for years began, gradually, to hear itself answered.

In the hospital, I had been observed. In Susan's office, I was recognized. That distinction is the whole of the medicine that medication cannot reach.