Transcript

52:

Edge of Sanity
Transcript

Originally aired 01.31.1997

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Full audio: http://tal.fm/52

Prologue.

Ira Glass

Dara met him in a mental hospital. They were both patients. They had group therapy together. So she knew all his secrets, even before they started seeing each other.

Dara

And they told us not to get involved and that just made it even more fun to get involved. He was very funny. He was so funny. He just made me laugh all the time. And he was really fun to be with.

Ira Glass

Things continued, even after they got out of the hospital. He was officially diagnosed as manic depressive. But he was manic a lot. She was depressive.

Dara

I guess we complemented each other in a way. But he was-- whoa. He was whacked, man. He'd be in my apartment. He'd be walking like a chicken and stuff. And I don't know. He did anything to make me laugh.

We were kind of on and off and then we decided to live together. He's a little different. I mean, I liked the crazy part of him. I liked that funny, wacky. But then, it's weird. It's different when you're living with it. It's like you have the stand up comedian with you 24 hours. It gets to be a little like snap out of it, can't you act normal? Can't you just act mellow? And no. No, that wasn't happening.

Ira Glass

It wasn't happening because he was after all, mentally ill.

Dara

He was just driving me crazy. Because also, we would be in the grocery store and it would take him so long to buy one item. He'd be looking at it, and then comparing it to another one. And then to another one. And then he was smart, so he'd be figuring everything out mathematically. And then by grams and stuff. And I would be like no way. I can't handle this anymore. I just couldn't do it.

For some reason he also thought-- he also treated me like I was the crazy one. I always thought he was crazy, I guess. So I don't think that worked.

Ira Glass

Although there are plenty of people with severe and debilitating mental illness just as often the line between crazy and not crazy is blurry. So many different kinds of behavior fall into both categories. And I think what captures our attention and our hearts when we talk with someone who's mentally ill, is not how they're different from us, but how they're the same.

Well, from WBEZ in Chicago and Public Radio International, it's This American Life. I'm Ira Glass. Today on our program we bring you stories of the sanity that is part of mental illness. People who stand on the borderline between sanity and sickness. Act One, Girl, Interrupted. A movie has been made out of Susanna Kaysen's memoir, Girl, Interrupted, about a mental hospital. If you've never read the book, it is one of the most remarkable pieces of nonfiction writing of the last few years. We have an excerpt.

Act Two, Guided By Voices. We also have this tape made by people who actually hear voices in their heads. And the tape is designed to simulate what it is that they hear. Act Three, Plague of Tics. David Sedaris explains the voices that he hears in his head. Act Four, You Don't Have to Be Crazy to Work Here, But It Helps. What it's like if you hold the keys to the asylum, but your grip on them is not too steady. Stay with us.

Act One. Girl, Interrupted.

Ira Glass

Act One, at the age of 18, after a brief appointment with a psychiatrist who she had never met before, Susanna Kaysen entered McLean Psychiatric Hospital. Her book, Girl, Interrupted, describes her stay on the ward for teenage girls, where she spent most of two years. It's partly an account of what it's like to have certain mental illnesses and partly an account of everyday life on the ward. The nurses the girls liked and didn't like, the doctors, and the way the young women on the ward interacted with each other.

Susanna Kaysen

One day a second Lisa arrived. We called her buy her full name, Lisa Cody, to distinguish her from the real Lisa, who remained named simply, Lisa, like a queen.

The Lisas became friends. One of their favorite activities was having phone conversations. The three phone booths near the double locked double doors were our only privacy. We could go in one and shut the door. Even the craziest person could sit in a phone booth and have a private conversation, though only with herself. The nurses had lists of permitted numbers for each of us. When we picked up the phone, a nurse would answer.

Hello, we'd say. This is Georgina, or Cynthia, or Polly. I want to call 555-4270.

That's not on your list the nurse would say. Then the line would go dead. But there was still the quiet dusty phone booth and the old fashioned black receiver with its sharp, dorsal ridge.

The Lisas had phone conversations. Each one got in a booth, folded the door shut and yelled into her receiver. When the nurse answered, Lisa yelled, "Off the line!" Then the Lisas got on with their conversation. Sometimes they yelled insults. Sometimes they yelled about their plans for the day.

"Want to go over to the cafeteria for dinner?" Lisa Cody would yell.

But Lisa was restricted to the ward, so she'd have to yell back something like, "Why do you want to eat that slop with all those psychotics?"

To which Lisa Cody would yell, "What do you think you are?"

"Sociopath!" Lisa would yell proudly.

Lisa Cody didn't have a diagnosis yet.

Cynthia was depressive. Polly and Georgina were schizophrenic. I had a character disorder. Sometimes they called it a personality disorder.

When I got my diagnosis, it didn't sound serious. But after a while, it sounded more ominous than other people's. I imagine my character as a plate or shirt that had been manufactured incorrectly and was therefore useless. When she had been with us a month or so, Lisa Cody got a diagnosis. She was a sociopath too. She was happy because she wanted to be like Lisa in all things.

Lisa was not so happy because she had been the only sociopath among us. We are very rare, she told me once. And mostly, we are men.

After Lisa Cody got her diagnosis, the Lisas started making more trouble. Acting out, the nurses said. We knew what it was. The real Lisa was proving that Lisa Cody wasn't a sociopath.

Lisa tongued her sleeping meds for a week, took them all at once and stayed zonked for a day and a night. Lisa Cody managed to save only four of hers. And when she took them, she puked.

Lisa put a cigarette out on her arm at 6:30 in the morning while the nurses were changing shifts. That afternoon, Lisa Cody burned a tiny welt on her wrist and spent the next 20 minutes running cold water on it.

Then they had a life history battle. Lisa wormed out of Lisa Cody that she'd grown up in Greenwich, Connecticut. "Greenwich, Connecticut," she sneered. "No sociopath could emerge from there. Were you a debutante too?"

Speed, black beauties, coke, heroine, Lisa had done it all. Lisa Cody said she'd been a junkie too. She rolled her sleeve back to show her tracks. Faint scratches along the vein as if once, years before, she had tangled with a rose bush.

"A suburban junkie," said Lisa. "You were playing that's what."

"Hey, man. Junk's junk," Lisa Cody protested.

Lisa pushed her sleeve up to her elbow and shoved her arm under Lisa Cody's nose. Her arm was studded with pale brown lumps, gnarled and authentic. "These," said Lisa, "are tracks, man. Later for your tracks."

Lisa Cody was beaten, but she didn't have the sense to give up. She still sat beside Lisa at breakfast and hall meeting. She still waited in the phone booth for the call that didn't come.

"I gotta get rid of her," said Lisa.

"You're mean," Polly said.

"[BLEEP] bitch," said Lisa.

"Who?" asked Cynthia, Polly's protector. But Lisa didn't bother to clarify.

One evening when the nurses walked the halls at dusk to turn on the lights that made our ward as bright and jarring as a penny arcade, they found every light bulb gone. Not broken, vanished. We knew who'd done it. The question was, where had she put them? It was hard to search in the darkness. Even the light bulbs in our rooms were gone.

"Lisa has the true artistic temperament," said Georgina.

"Just hunt," said the head nurse. "Everybody hunt."

Lisa sat out the hunt in the TV room. It was Lisa Cody who found them as she was meant to. She was probably planning to sit out the hunt as well, in the place that held memories of better days. She must've felt some resistance when she tried to fold the door back. There were dozens of light bulbs inside. But she persevered, just as she had persevered with Lisa.

The crunch and clatter brought us also scampering down to the phone booths. "Broken," said Lisa Cody. Everyone asked Lisa how she'd done it. But all she would say was, I've got a long, skinny arm.

Lisa Cody disappeared two days later. Somewhere between our ward and the cafeteria she slipped away. Nobody ever found her, though the search went on for more than a week.

"She couldn't take this place," said Lisa. And though we listened for a trace of jealousy in her voice, we didn't hear one.

Some months later, Lisa ran off again while she was being taken to a gynecology consult at the Mass General. Two days she managed this time.

When she got back she looked especially pleased with herself.

"I saw Lisa Cody," she said.

"Ooh," said Georgina.

Polly shook her head.

"She's a real junkie now," said Lisa, smiling.

One girl among us had set herself on fire. She used gasoline. She was too young to drive at the time. I wondered how she had gotten hold of it. Had she walked to her neighborhood garage and told them her father's car had run out of gas? I couldn't look at her without thinking about it.

I think the gasoline had settled in her collarbones, forming pools there beside her shoulders. Because her neck and cheeks were scarred the most. The scars were thick ridges, alternating bright pink and white in stripes up from her neck. They were so tough and wide that she couldn't turn her head, but had to swivel her entire upper torso if she wanted to see a person standing next to her.

Scar tissue has no character. It's not like skin. It doesn't show age or illness, or pallor or tan. It has no pores, no hair, no wrinkles. It's like a slip cover. It shields and disguises what's beneath. That's why we grow it. We have something to hide.

Her name was Polly. This name must have seemed ridiculous to her in the days or months when she was planning to set herself on fire, but it suited her well in her slip-covered survivor life. She was never unhappy. She was kind and comforting to those who were unhappy. She never complained. She always had time to listen to other people's complaints. She was faultless in her impermeable, tight, pink and white casing.

Whatever had driven her, whispered "die" in her once perfect-- now scarred-- ear, she had emulated it.

Why did she do it? Nobody knew. Nobody dared to ask. Because what courage. Who had the courage to burn herself? 20 aspirin, a little slit alongside the veins of the arm, maybe even a bad half hour standing on a roof. We've all had those. And somewhat more dangerous things, like putting a gun in your mouth. But you put it there, you taste it, it's cold and greasy. Your finger is on the trigger and you find that a whole world lies between this moment and the moment you've been planning when you'll pull the trigger.

That world defeats you. You put the gun back in the drawer. You'll have to find another way.

What was that moment like for her, the moment she lit the match? Had she already tried roofs and guns and aspirin? Or was it just an inspiration?

I had an inspiration once. I woke up one morning and I knew that today I had to swallow 50 aspirin. It was my task, my job for the day.

I lined them up on my desk and took them one by one, counting. But it's not the same as what she did. I could have stopped at 10 or 30. And I could have done what I did do, which was go onto the street and faint. 50 aspirin is a lot of aspirin. But going onto the street and fainting is like putting the gun back in the drawer. She lit the match.

Where? In the garage at home where she wouldn't set anything else on fire? Out in a field? In a high school gym? In an empty swimming pool? Somebody found her, but not for a while.

Who would kiss a person like that, a person with no skin? She was 18 before this thought occurred to her. She'd spent a year with us.

Other people stormed and screamed and cringed and cried. Polly watched and smiled. She sat by people who were frightened and her presence calmed them. Her smile wasn't mean, it was understanding. Life was hellish, she knew that. But her smile hinted she'd burned all that out of her. Her smile with a little bit superior. We wouldn't have the courage to burn it out of ourselves, but she understood that too. Everyone was different, people just did what they could.

One morning somebody was crying. But mornings were often noisy. Fights about getting up on time and complaints about nightmares. Polly was so quiet, so unobtrusive a presence that we didn't notice she wasn't at breakfast.

After breakfast we could still hear crying. Who's crying? Nobody knew.

And at lunch, there was still crying.

"It's Polly," said Lisa, who knew everything.

Why? But even Lisa didn't know why.

At dusk, the crying changed to screaming. Dusk is a dangerous time. At first she screamed, aah and ee! Then she started to scream words. My face, my face, my face!

We could hear other voices shushing her, murmuring comfort. But she continued to scream her two words long into the night.

Lisa said, "Well, I've been expecting this for a while."

And then I think we all realized what fools we'd been. We might get out some time, but she was locked up forever in that body.

Ira Glass

Susanna Kaysen. Her book is called Girl, Interrupted.

[MUSIC- "YOU NEED AN ANALYST" BY ALLAN SHERMAN]

Act Two. Guided By Voices.

Ira Glass

Act Two, Guided by Voices.

Pat Deegan heard voices and she was a psychologist. When she was a girl the voices were friendly. She thought everybody heard voices. She didn't know that other people didn't.

But when she turned 17, the voices changed. They became vicious, critical, unbearable. She was diagnosed as a schizophrenic.

Years later, as a psychologist herself, she thought the only way mental health workers can really understand what their patients go through is if they hear the voices too. So she and some other people who hear voices got together to make a tape. They talked about the kinds of things the voices normally say to them and put together a script and had it recorded. And then they set up these training sessions where mental health workers would listen to this tape on a Walkman.

Dr. Patricia Deegan

And while they are listening to the voices, we also have them go through a mock psychiatric emergency services situation where they receive a mental status exam. They go to a mock psychological testing center where they do a reading comprehension test. They go to a mock day treatment program where they do some cognitive puzzles. And we also send them out into the community to have some kind of interaction. Get four quarters for a dollar, for instance, where they have to have some kind of social exchange with the public while experiencing these voices.

Ira Glass

And the actual voices that we're hearing on the tape, are these people who actually experience voices or they--

Dr. Patricia Deegan

Yeah

Ira Glass

--actors? They are?

Dr. Patricia Deegan

These aren't actors, no. All of us were voice-hearers.

Ira Glass

And are people simply reciting the voices that they themselves hear in their head sometimes?

Dr. Patricia Deegan

No, interestingly, we decided as a group that that's, for voice-hearers, much too dangerous a thing to do. People can actually internally get into enormous conflict and go into enormous crisis by revealing the content of what it is their voices are saying. Voices, very frequently, don't want to be broadcast all over the place. And so we had to take great care around that as voice-hearers ourselves.

Ira Glass

And so, for example, I think there's a man on there who says, you disgust me. That isn't his own-- that isn't what he, himself, hears, that's what somebody else might hear?

Dr. Patricia Deegan

That's right.

Man 1

That's right. That's right. Look at them. Their eyes are filled with disgust. They know how disgusting you are. Stop it now. Stop, stop, stop, stop. I see you. I see you. They see you. Everyone sees you. They hear you. They know you. They know how foul you are. Ugh. You are foul. Don't touch it. Don't touch it. Don't touch it. Don't touch it. Don't touch it.

Ira Glass

The layering of voices on the tape, is that the way people actually experience this? That they'll hear several voices at once?

Dr. Patricia Deegan

Again, there's enormous individual variation with this. But it's not at all unusual for people to have more than one voice and to have more than one voice activated or talking at the same time.

Ira Glass

Are the voices generally negative? Are they saying negative things?

Dr. Patricia Deegan

That seems to be a characteristic of people who are showing up for help with the voice-hearing experience, is that there aren't a predominance of helpful or good voices as we would call them.

Man 2

Filth, swine, disgusting garbage eater. I said you. Yeah, that's right. You stink. You stink. Filth, dirt, smirk, laughing, huh? You're not funny. You're pathetic. [LAUGHTER] You stink. Stinky, stinky, stink, stink. Stink. The only thing that's funny around here is you. That's right.

Ira Glass

It's interesting because over the last few days, as a been thinking about this and listening to the tape and looking at your book, I've tried to be aware of whether in some low level way, I hear voices in my head. And I feel like I hear songs run through my head a lot more than I hear actual voices. And I was wondering if you view what voice-hearers experience as being just on a continuum from what everybody experiences in their everyday life?

Dr. Patricia Deegan

I think that the idea of a continuum is a nice one, but I'm afraid in this way I don't think it's accurate to talk about voice-hearing as being a continuum. The big, big, big difference between hearing the song in your head and having experience of hearing distressing voices is that first of all, in the truest sense of hearing, you don't hear it in the way that you hear my voice right now. The voice-hearing experience is first and foremost and most primordially, a profoundly auditory experience. To the point where you can actually startle if a voice starts up suddenly and you turn around and you're wondering where it all started, and if someone is actually in the room.

Ira Glass

I feel silly that I didn't understand that up until this point. Somehow I had thought that what we were talking about were just simply-- I didn't realize that it was an auditory experience that one might confuse with actually hearing a sound in the room.

Dr. Patricia Deegan

Oh, absolutely. You absolutely hear it.

Man 3

Hey, turn around and listen to me. Hey. Hey. Yeah, that's you I'm talking to. You're nothing. You know it's the truth too. You know it.

Oh. Ah. Ah, I can't stand it anymore. You are disgusting.

Slow down. Slow down. Slow down. Slow down. Slow down. Slow down. Get in the house. Go where you belong. Hide away. Hide away. You know what? You can't hide. You can't hide. They know where you are. They're going to find you no matter what you do. They know. You know. I know. We know. They all know. Stop it. Stop it.

Ira Glass

Among the materials that you've put out, there's a pamphlet called, "Coping with Voices: Self-help Strategies for People Who Hear Voices That Are Distressing." You have advice for people who are hearing voices, the simple things that they can do. And one of them that you suggest is-- just to take a typical one here. One of them is using ear plugs. You say that some people have found that putting an ear plug in an ear can greatly reduce or eliminate distressing voices?

Dr. Patricia Deegan

Yes, this is an interesting finding. And empirically what they've found is that putting the wax in both ears does not work. You have to try through trial and error, work with you right ear, then your left ear.

For some people, for instance, putting it in the right ear, leaving it there for 15 minutes, will interrupt the voices. And in some cases, make them go away.

For other people you leave it in the right ear for 15 minutes and it's only when you take the plug out that the voices are interrupted and/or stop.

Ira Glass

Do you have any thoughts about why it might work?

Dr. Patricia Deegan

No, I really don't.

Ira Glass

Is it just as simple as, well, let's just change the situation and just any change, like any physical change might help?

Dr. Patricia Deegan

I think, frankly, after my studies and also through a lot of personal trial and error and learning experiences myself that there really is enormous truth that anything that promotes a sense of personal efficacy and power. That seems to be the key that these voices, which present themselves as the all-knowing, all-powerful, we know everything, we see everything you do, and on and on and on, to find that I can interrupt that powerful a force, really creates a space for me to have some power.

And of course, this flies in the face of what much of modern psychiatry is saying. That people who are experiencing major mental illness are having broken brains and can't possibly take a stand towards what's ailing them, except to take medications. I feel we're doing an enormous disservice in the United States in particular, by saying that medications are the only answer.

Ira Glass

Pat, do you talk about your own experiences of voice hear? I don't want to intrude in something that's private that you don't talk about publicly and ask you questions on this thing if you don't.

Dr. Patricia Deegan

No, I do talk about it in some generality. Yes.

Ira Glass

In your own experience, have you successfully made voices go away completely? Do they come back sometimes for you?

Dr. Patricia Deegan

I live with distressing voices on almost a daily basis. Not 24 hours a day, but usually in the course of the day my voices do come. So, for instance, just before coming into this recording studio, I was sitting out in the waiting area. In the BUR offices. And there's a lot of what I would call white noise out there. White noise coming from a fan and a ventilation system in the room. And for me, that was very prominent. And for me and many other voice-heareres, a white noise situation is a set up for the emergence of distressing voices. So as that began to happen, I could say to myself, OK, it's going to be all right. I know I've got 10 minutes before the interview starts. And I pulled out an ear plug and I put it in my left ear, which is the ear that works for me. And I reassured myself that once I got out of the white noise situation that I would be doing better.

Ira Glass

How do you conceive of the voices that you hear? Do you conceive of them as being separate from yourself? Or do you conceive of them as being a part of yourself that you can recognize?

Dr. Patricia Deegan

I think that for me it's a goal to eventually be able to say these voices are a part of me. And that's actually one of the self-help coping strategies that I do use sometimes.

So, for instance, if I have a particularly derogatory, awful voice that I might say as a coping strategy, today I am feeling like I am no good. Today I am feeling like I'm a worthless person. These are my thoughts. These are my feelings.

Ira Glass

Is that because when the voice is saying that, literally you are not having the feeling, oh, I'm feeling bad today?

Dr. Patricia Deegan

That's right.

Ira Glass

Wow.

Dr. Patricia Deegan. Her organization, The National Empowerment Center, can be reached at 1-800-POWER2YOU. That's 1-800, then the word "power", then the number "2", then the letter "U".

[MUSIC- "SEETHER" BY VERUCA SALT]

Coming up, David Sedaris rocks, but not the way we usually mean when we say that. And other stories in a minute from Public Radio International when our program continues.

Act Three. Plague Of Tics.

Ira Glass

It's This American Life, I'm Ira Glass. Each week on our program of course we choose a theme and invite a variety of writers, documentary producers, and performers to do stories on that theme. Today's program, on the edge of mental health. Stories of people who stand right at the border of sanity and sickness. We have arrived at Act Three of our program, Plague of Tics.

Well, regular listeners to our show are familiar, very familiar, stunningly familiar, with David Sedaris. In the past, he's come onto the show to tell stories about getting the drama bug in high school, of his sister and mother deciding that they're going to solve crimes, of his first attempt, himself, at visiting a nudist colony. Today's story begins in grade school.

David Sedaris

When the teacher asked if she might visit with my mother, I touched my nose eight times to the surface of my desk.

"May I take that as a yes?" she asked. According to her calculations, I had left my chair 28 times that day.

"You're up and down like a flea. I turn my back for two minutes and there you are with your tongue pressed against that light switch. Maybe they do that where you come from, but here in my classroom we don't leave our seat and lick things whenever we please. That is Ms. Chestnut's light switch and she likes to keep it dry.

Would you like for me to come over to your house and put my tongue on your light switches? Well, would you?"

I tried to picture her in action, but my shoe was calling.

"Take me off," it whispered. "Tap my heel against your forehead three times. Do it now. Quick. No one will notice."

"Well?" Ms. Chestnut raised her faint penciled eyebrows. "I'm asking you a question. Would you or would you not want me licking the light switches in your house?"

I slipped off my shoe, pretending to examine the imprint on the heel.

"You're going to hit yourself over the head with that shoe aren't you?"

It wasn't hitting, it was tapping. But still, how would she known what I was about to do?

"Heel marks all over your forehead," she said, answering my silent question.

It was a short distance from the school to our rented house. No more than 637 steps. And on a good day, I could make the trip in an hour, pausing every few feet to tongue a mailbox or touch whichever single leaf or blade of grass demanded my attention.

If I were to lose count of my steps, I'd have to return to the school and begin again. I might touch the telephone pole at step 314 and then 15 paces later, worry that I hadn't touched it in exactly the right spot. It needed to be touched again.

This was a long and complicated process. It demanded an oppressive attention to detail. Bypass that mailbox and my brain would never for one moment let me forget it.

I might be sitting at the dinner table, daring myself not to think about it and the thought would revisit my mind. Don't think about it. But it was already too late and I knew then exactly what I had to do.

Excusing myself to go to the bathroom, I'd walk out the front door and return to that mailbox. Not just touching, but jabbing. Practically pounding on the thing because I thought I hated it so much.

What I really hated, of course, was my mind. There must've been an off switch somewhere, but I was damned if I could find it.

I didn't remember things being this way back north. Our family had been transferred from Endicott, New York, to Raleigh, North Carolina. That was a word used by the people at IBM, "transferred."

A new home was under construction, but until it was finished we were confined to a rental property built to resemble a plantation house. The building sat in the treeless, balding yard. Its white columns promising a majesty the interior failed to deliver.

The front door opened onto a dark, narrow hallway lined with bedrooms not much larger than the mattresses which furnished them.

Once home I would touch the front door seven times with each elbow, a task made much more difficult if there was anyone else around.

"Why don't you try the knob?" my sister Lisa would say. "That's what the rest of us do and it seems to work for us."

Inside the house there were switches and door stops to be acknowledged. After kissing the 4th, 8th, and 12th carpeted stair, I wiped the cat hair from my lips and proceeded to the kitchen, where I was commanded to stroke the burners of the stove, press my nose against the refrigerator door, and arrange the percolator, toaster, and blender into a straight row.

After making my rounds of the living room, it was time to kneel beside the banister and blindly jab a butter knife in the direction of my preferred electrical socket. There were bulbs to lick and bathroom faucets to test before finally I was free to enter my bedroom, where I would carefully align the objects on my dresser, lick the corners of my metal desk, and lie on my bed, rocking back and forth and thinking of what an odd woman she was, my third grade teacher, Ms. Chestnut.

Why come here and lick my light switches when she never used the one she had? Maybe she was drunk.

On the afternoon that Ms. Chestnut arrived for her visit, I was in my bedroom rocking. Unlike the obsessive counting and touching, rocking was not a mandatory duty, but a voluntary and highly pleasurable exercise. It was my hobby and there was nothing else I would rather do.

The point was not to rock oneself to sleep. This was not a step towards some greater goal, it was the goal itself. The perpetual movement freed my mind, allowing me to mull things over and construct elaborately detailed fantasies. Toss in a radio and I was content to rock until 3 or 4 o'clock in the morning, listening to the hit parade and discovering that each and every song was about me.

I might have to listen 200 or 300 times to the same song, but sooner or later it's private message would reveal itself.

I was coming to terms with "The Shadow of Your Smile" when Ms. Chestnut arrived. She rang the bell and I cracked open the bedroom door, watching as my mother invited her in.

"You'll have to forgive me for these boxes," my mother flicked your cigarette out the door and into the littered yard. "They're filled with crap, every last one of them. But God forbid we throw anything away. Oh no, we can't do that. My husband saved it all." She mopped at her forehead with a wadded paper towel. "Anyway, to hell with it. You look like I need a drink. Scotch all right?" Ms. Chestnut's eyes brightened.

"I really shouldn't but, oh, why not?" She followed my mother up the stairs. "Just a drop with ice. No water."

I tried rocking in bed, but the sound of laughter drew me to the top of the landing, where from my vantage point behind an oversized wardrobe box, I watched the two women discuss my behavior.

"Oh, you mean the touching," my mother said. She opened her mouth just slightly, running her tongue over her upper lip, and then she inched forward, her index finger prodding the ash tray as though it were a sleeping thing she was trying to wake.

I had never seen myself an action, but a sharp stinging sense of recognition told me that my mother's impersonation had been accurate.

"God only knows where he gets it from," my mother said. "He's probably down in his room right this minute counting his eyelashes or gnawing at the poles on his dresser. 1, 2 o'clock in the morning and he'll still be at it, rattling around the house to poke the laundry hamper or press his face against the refrigerator door. The kid's wound too tight, but he'll come out of it. So what do you say, another scotch, Catherine?"

Now she was Catherine. Another few drinks and she'd probably be joining us on our summer vacation. How easy it was for adults to bond over a second round of cocktails.

I returned to my bed, cranking up the radio so as not to be disturbed by the sound of their cackling.

Following Ms. Chestnut's visit, my father attempted to cure me with a series of threats. "You touch your nose to that windshield one more time and I'll guarantee you wish you hadn't," he said, driving home from the grocery store with a lot full of rejected, out of state coupons. It was virtually impossible for me to ride in the passenger seat of a car and not press my nose against the windshield. And now that the activity had been forbidden, I wanted it more than anything.

I tried closing my eyes, hoping that might eliminate my desire, but found myself thinking that perhaps he was the one who should close his eyes. So what if I wanted to touch my nose to the windshield? Who was it hurting? Why was it that he could repeatedly worry his change and bite his lower lip without the threat of punishment?

My mother smoked and Ms. Chestnut massaged her waist 20, 30 times a day. And here, I couldn't press my nose against the windshield of a car?

I opened my eyes, defiant. But when he caught me moving towards my target, my father slammed on the brakes.

"You like that, did you?" He handed me a golf towel to wipe the blood from my nose. "Did you like the feel of that?"

Like was too feeble a word for what I felt. I loved it. If mashed with the right amount of force, a blow to the nose can be positively narcotic.

Touching objects satisfied a mental edge, but the task involved a great deal of movement. Run upstairs, cross the room, remove a shoe. I soon found these same urges could be fulfilled within the confines of my own body. Punching myself in the nose was a good place to start. But the practice was dropped when I began rolling my eyes deep into their sockets, an exercise that provided quickly jolts of dull, intoxicating pain.

"I know exactly what you're talking about," my mother said to Ms. Shatts, my visiting fourth grade teacher. "The eyes rolling every which way. It's like talking to a slot machine. Hopefully one day it'll pay off, but until then what do you say we have ourselves another glass of wine?"

I took to violently shaking my head, startled by the feel of my brain slamming against the confines of my skull. It felt so good and took so little time, just a few quick jerks and I was satisfied for up to 45 seconds at a time.

"Have a seat and let me get you something cool to drink." My mother would leave my fifth, and then my sixth grade teacher standing in the breakfast nook while she stepped into the kitchen to crack open a tray of ice. "I'm guessing you're here about the head shaking, am I right?" she'd shout. "That's my boy, all right. No flies on him."

This was part of my mother's act. She played the ringleader, blowing the whistle and charming the crowd with her jokes and exaggerated stories. "It's a stretch, but I'm betting you're here about the tiny voices," she said, offering a glass of sherry to my visiting seventh grade teacher. "I'm thinking of either taken him to an exorcist or buying him a doll, so he can bring some money as a ventriloquist."

It had come out of nowhere, my desperate urge to summon high-pitched noises from the back of my throat. These were not words, but sounds that satisfied an urge I'd never before realized. The sounds were delivered not in my voice, but in that of a thimble-sized, temperamental diva clinging to the base of my uvula.

[MAKING NOISES]

I was host to these wailing, but lacked the ability to control them. When I cried out in class, the teachers would turn from the blackboards with increasingly troubled expressions. "Is somebody rubbing a balloon? Who's making that noise?"

I'd like to think that some of my nervous habits faded during high school, but my class pictures tell a different story. "Draw in the missing eyeballs and this one might not be so bad," my mother would say.

In group shots I was easily identified as the blur in the back row. For a time I thought that if I accompanied my habits with an outlandish wardrobe, I might be viewed as eccentric rather than just plain retarded. I was wrong.

Only a confirmed idiot would wander the halls of my high school dressed in a floor length caftan. And as for the countless medallions that hung around my neck, I might as well have worn a cow bell. They clanged and jangled with every jerk of my head, calling attention when without them I might have passed unnoticed. My oversize glasses did nothing but provide a clearer view of my rolling, twitching eyes, and the chunky platform shoes left lumps when used to discreetly tap my forehead. I was a mess.

"College is the best thing that can ever happen to you," my father used to say. And he was right. For it was there that I discovered drugs, drinking, and smoking.

I'm unsure of the scientific aspects, but for some reason my nervous habits faded at around the same time I took up with cigarettes. Maybe it was coincidental, or perhaps the tics retreated in the face of an adversary that, despite its health risks, is much more socially acceptable than crying out in tiny voices.

It's as if I'd been born to smoke. And until I realized that my limbs were left to search for some alternative, everything's fine as long as I know there's a cigarette in my immediate future.

The people who ask me not to smoke in their cars have no idea what they're in for.

Ira Glass

David Sedaris' story, "Plague of Tics" is in his book, Naked.

[MUSIC-"PSYCHO" BY ELVIS COSTELLO]

Act Four. You Don't Have To Be Crazy To Work Here, But It Helps.

Ira Glass

Act Four, You Don't Have to Be Crazy to Work Here, But It Helps.

When he was in his 20, Joel Lovell had a job in a mental hospital helping care for patients. Usually he worked days, nights he says, were different.

Joel Lovell

We often made fun of the night staff. Said that they were as crazy as the patients. There was Joe, the monosyllabic bodybuilder, and John, the pathological liar, and Shawn, who arrived each night for his shift raw-throated and near tears from his own afternoon session of scream therapy. Between midnight and seven we'd say, it wasn't at all clear who should be carrying the keys.

The suggestion, of course, was that during the day it was clear. And that those of us who carried the keys, the shrinks from Harvard, the nurses in charge of the floor, even the lowly mental health workers like myself, were all models of sanity in the midst of so much chaos.

We had keys to everything. There was a key to the front door and a key to the nurse's station. There were keys to the therapy offices and to the linen closet and to the staff bathroom across from the quite rooms, two windowless, white isolation areas to which we also had keys. And of course, there was the restraint key, a thin pointed silver thing, more like a tiny pocketknife than a key that slipped into the buckle of the straps we used to secure a patient's limbs to the corners of a metal bed.

If a patient wanted to use the toaster, we had the key. If they wanted to use their own nail clippers, they were kept in a cabinet and we had the key.

During the day, we moved through the hall like a team of custodians, rousting patients out of bed, urging them to shower and dress and brush their teeth. To attend, in hospital parlance, to their activities of daily living. We ushered them into large group meetings and small group meetings. Meetings in which we discussed the dynamics on the hall, meetings in which we explained the effects of medication, meetings in which patients were often told news they didn't want to hear. That they would have to endure another round of electro shock therapy. That they were not well enough to attend their daughter's birthday party. That for yet another week, they would not be allowed to do almost anything unsupervised.

It was a place where much more often than not, short-term hopes were dashed, ineffably sad outcomes were commonplace. And anger over illnesses that no one knew precisely how to treat could erupt spontaneously.

We were constantly gauging the mood of the hall in the way that I imagine desperate farmers gauge the mood of the skies and reacting accordingly. There has to be more of a staff presence on the hall someone would say. Meaning that there was a palpable tension on the unit, a sense of danger in the air. And that rather than spending time back in the nurse's station blowing off steam and catching up on notes, we had to make our presence known out on the floor.

Occasionally, for extra money, I'd work nights. Everything about the place seemed different at night. It's a sentimental notion, I know. But I could never quite shake the sense when driving through the front gate for a night shift of entering a parallel universe, a place where all the day's demons were laid to rest. Where medicines worked. Where minds were calmed. Where the safe haven we tried so hard to create during the day was actually made real.

I'd drive slowly along the winding road to our unit and look out at the moon on the snow, at the lights on here and there in the red brick buildings across the hospital grounds. And I'd think that, for all the terrors a place like this connotes, it couldn't possibly look more welcoming, less coldly clinical than it did in the middle of the night. Night, of course, can have this effect anywhere. Exhaustion finally wins out over struggle. But the sense of calm that settled in at the hospital always surprised me.

The job at night, such as it was, consisted mostly of just staying awake. If you were the staff member on checks, you were responsible for knowing where each patient was. You sat in the foyer with a flashlight and every 30 minutes made a tour from one end of the unit to the other, poking your head into each darkened room and shining a quick bloom of light on the patients asleep in their beds. It was a simple, remarkable thing to see, people in so much pain sleeping peacefully.

There was Barbara, the reverend's wife, who previously had snuck in a utility razor and cut a five inch gash into the sole of her foot.

And there was Tim, the former track star, who had gained so much weight from taking anti-psychotic meds that he'd spend hours each day with this high school yearbook in his lap, open to a page that had a photo of some graceful, muscled kid who looked vaguely like him.

There was Ann, and Mike, and there was Carol, who's sister came every Thursday afternoon. Whenever she visited, I'd watch them in the foyer. Carol's sister talking and Carol staring out from behind her thick glasses, smoking cigarette after cigarette. Her face, her hair, like a smudged version of the attractive woman sitting next to her.

My own brother, the person I loved most in the world, was a patient in a psych hospital in Saratoga, New York. It seems obvious now, though I couldn't quite articulate it to myself at the time, that I worked where I did not because, as I told myself, it would help me on my applications to medical school. But because it allowed me to be both closer to my brother and more distanced from him. To understand in some vaguely intimate way what he was suffering and to reassure myself that I was, in fact, safe from his madness. That I was so sane I carried the keys.

Whenever I visited him, I couldn't stop myself from imagining us like Carol and her sister, his Goofus to my Gallant. And the thought both comforted me and filled me with shame.

After I checked on the last patient, I'd go back to the foyer and bide my time. I'd sit and drink coffee and watch the clock, waiting for the next half hour to tick by. Or I'd find a deck of cards on one of the shelves and play solitaire. Or sometimes I'd try writing letters to my brother that I never sent. Opening them with some bad joke about how at that moment, both of us were in a hospital, but he was probably deep into sleep and I was the one up scribbling nonsense.

Sometimes late in the night, it could feel like I, too, was starting to unravel. I'd go into the nurses station and pull charts and read my notes from the day shifts. I'd focus on their authoritative tone.

Patient oriented to time, place, self. But continues to ruminate about radio messages being sent through her braces.

Patient remains highly paranoid, fears government is poisoning him through hospital food.

At the end of most of my night shifts, my notes were all the same. Patient slept. Patient slept. Patient slept.

On the last night shift I worked I fell asleep while on checks-- the one mistake a night worker was never supposed to make. I was probably out for 45 minutes, long enough theoretically for something terrible to happen. I woke to Carol standing in front of me in her night gown, a cigarette in hand. "I need a light," she said. And then she sat down next to me near the foyer and made fun of me for falling asleep.

"Go lie down," she said. "Ive got everything under control here."

She wasn't wearing her glasses and her hair was pulled back. Her disheveledness seemed normal in the middle of the night, the way any of us look when we shuffle in half sleep from our beds to the kitchen or bathroom.

I'd been having a dream in which a party was going on in a hospital, though not the one where I worked. Patients were coming out of their rooms in ball gowns and tuxes and my brother was there, looking happy and handsome.

Now the pleasantness of the dream was fading and Carol must've been able to see it on my face. She asked me what was wrong and because it was 5:00 AM and because I was exhausted and nauseous and not my appropriate daytime self, I told that I'd been dreaming of my brother and that he was in a hospital sick.

"In the body or the head?" she asked.

"The head," I said.

She nodded knowingly, took a tremendous drag on her cigarette, and blew a cloud of smoke out over the two of us.

"He'll be all right," she said, in what seemed to me to be the sanest tone I'd ever heard her speak. "We'll all be all right."

Carol finished her cigarette went back to bed. I did some jumping jacks in the foyer in order to stay awake. Eventually the sky began to lighten. The day staff came in with snow melting on their shoes.

They crowded into the nurse's station for the change of shift report. I stood there for a while watching the quick nods, the efficient division of responsibility. I considered saying something about Carol, about how lucid she'd seemed to me just a couple of hours ago. It wasn't so extraordinary, I knew. But still, I wanted the conversation on record.

On the way out I stopped to see Carol. She was awake and eating breakfast, and I wanted to thank her for our conversation.

"I appreciate what you said earlier, Carol."

She didn't look up. She was preparing for cereal and muttering to herself, something about the children's book, Johnny Tremain, that she'd been reading over and over for the past several weeks. I thanked her again and again she didn't look up.

When I left the room, she was pouring sugar in huge spoonfuls over her Apple Jacks.

Ira Glass

Joel Lovell lives in Brooklyn.

Credits.

Ira Glass

Well, our program was produced today by Alix Spiegel and myself with Peter Clowney and Nancy Updike. Additional production and editing by Susan Burton.

[ACKNOWLEDGEMENTS]

Musical help from Peter Margasak, John Connors and Sarah Vowell. To buy a cassette of this or any of our programs, call us here at WBEZ Chicago 312-832-3380. Or you can listen to most of our programs for free on the internet at our website www.thislife.org. Thanks to Elizabeth Meister who runs the site.

This American Life is distributed by Public Radio International.

[FUNDING CREDITS]

WBEZ management oversight by Torey Malatia, who has this advice for all our listeners--

David Sedaris

If mashed with the right amount of force, a blow to the nose can be positively narcotic.

Ira Glass

I'm Ira Glass, back next week with more stories of this American life.

David Sedaris

Like was too feeble a word for what I felt. I loved it.

Announcer

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