TALES FROM THE ASYLUM (working title) is a memoir about my nervous breakdown two years ago at the age of forty-two—from mania to depression, to electroconvulsive therapy, and finally to a late autism diagnosis—and my non-therapeutic experience in the number one psychiatric hospital in the country. But it isn’t a woe-is-me kind of memoir. It is about the trauma I experienced, but more importantly it’s a story about how I healed. I hope it serves as a beacon of light for people who wonder if they’ll ever be okay again. And the answer, I am certain, is unequivocally yes.

Tales From the Asylum

by Meaghan O’Keeffe

This excerpt is about the depression I fell into in May 2023, about six weeks after my first ever manic episode. I have a very compelling argument as to why my psychiatric medication management directly played a role in that depression, but I don’t get into that here. It was around this same time that I began to develop some serious side effects from the antipsychotic I was taking, including a condition called tardive dyskinesia, which causes severe motor dysfunction largely in the oral-facial region. The condition can be permanent.

It's Mother’s Day. Elise is very excited to be making me breakfast with Andy. They make pancakes and bacon, coffee. I come to the kitchen counter and try to eat. I try to emote how special it is and how much I love it. I try to talk to my mom on the phone as normally as I can. I don’t know if I’m successful or not. But Elise seems to remember it fondly, so I guess I did okay.

The tongue thrusting is worse. I’m so agitated in the morning that when I get up I just pace quickly from one end of the house to the other. I get upset about how many glasses we have and how little room in the cabinets. It feels overwhelming and I can’t manage it. Everyone tells me to calm down, it isn’t a big deal.

Any chance I get, I go to our room to lie down. Andy firmly insists that I get up. I do. But the next opportunity I have, when he’s doing something else, I go back. I can’t help it. Everything else is physically painful.

I message my psychiatrist and we make a virtual appointment. She’s concerned and wants me to wean off the antipsychotic. She says the tongue thrusting is tardive dyskinesia, a side effective that can occur from anti-psychotics. She suspects the agitation is part of that too. But discontinuing the medication has to be done extremely slowly to minimize side effects, like insomnia.

During the last two months, I’ve asked her twice if I can go back on my stimulant medication. She doesn’t want me to and begins to suspect me of drug seeking. I try to explain that I just want to be able to function. I don’t know why I never think to ask to restart my serotonin-norepinephrine re-uptake inhibitor (SSNRI). But the real question is, why hasn’t she?

By the third week of May I ask if I can start Prozac. She agrees and prescribes it for me. I take it for a week or so and feel no difference. Yes, typically it can take at least two weeks for a noticeable change. But that has never been the case for me. When I started my first anti-anxiety medication (an SSRI that can be used for anxiety in addition to depression) in 2007, I had my first ever panic attack after my first dose. I spoke to a nurse at my primary care office and she suggested we try a different medication, as it can take some trial and error to find the right fit. I ask if instead, I could try splitting the tablet into quarters, which is essentially a non-therapeutic dose. But my thinking is, it may help my body acclimate. She’s never been asked that, she says, but she doesn’t see why not. So that’s what I do. I take half of the starting dose for a week or two and then increase to the typical starting dose. I feel different within forty-eight hours of the low dose. I increase to the typical starting dose after a week or so and tolerate it well.

When I started the SSNRI in 2018, I noticed a difference within two days or so also.

The point is, me feeling nothing concerns me.

I’m so agitated one day that I call to talk with her. She calls me back and suggests I go back to the hospital. I don’t want that. I can’t even fathom it. But I’m in so much discomfort that I can’t hide it anymore. My sister comes for the weekend to help out. We don’t normally get vulnerable with one another. We love each other and care about each other but we’re Irish Catholic for God sakes. We keep our feelings deep down where they belong. But I can’t even try to pretend I’m okay. I tell her I didn’t know anyone could feel like this. She takes care of the kids and prepares meals which on one level is a relief. But I don’t feel relief exactly, because I don’t feel anything except agitation and the desire to lie down.

Andy calls my parents and they plan to come up a few days later. They arrive in the late afternoon on a Thursday. I feel trapped in my room again. Completely claustrophobic. I don’t want to pace in front of them, I can hardly manage a simple conversation. I can hardly tolerate my physical state. The agitation is excruciating.

I tell Andy I need to go to the hospital. I tell my parents. I tell the kids I need to go to get better for good. I don’t cry. I’m emotionless.

I’m admitted to the ER and brought to a room that looks like a prison hospital cell. The back wall is a metal corrugated door, like a garage door.The room is stark, the walls are dingy. There’s a glass door and a window that looks out into a hall-like area where several people are lined up in stretchers waiting for either an ER bed or to be admitted to the hospital. Andy leaves to go home to the kids but he feels terrible about leaving me here. A psych nurse practitioner comes to assess me while he’s gone. She suggests I go to an inpatient psych hospital. I really don’t want to and I text Andy. He says he’s on his way back and I tell her my husband wants to talk to her first. She seems to balk at this, probably because she anticipates a difficult conflict ahead. But when they talk she quickly relaxes because he isn’t confrontational, he just has questions. She has a compassionate demeanor as they discuss. He ultimately agrees that I should go, so I do too. There’s an open bed, she says. This is good because during my first hospital stay I heard from some people that they had to wait up to two days in the ER for a bed to open. Then she says where it is, and it happens to be the same facility where I stayed last time. I tell her I’m extremely anxious and she prescribes me Xanax. As she leaves the room I ask her if she thinks I can get better. She says she does and I desperately want to believe her but I can’t imagine it. I can’t imagine anything. My mind is blank, no visual thoughts, no cognitive thoughts, no thoughts at all. The EMTs who will transport me on my second eight-hundred-dollar ambulance ride to the hospital arrive. It’s the only way you can be transported. They drive me to the facility and I’m admitted. I’m brought to my room. I shit you not, it’s the same room I stayed in on my first admission. Except this time I’m on the door side instead of the window side.

I’m in my bed as much as possible. This is an issue for my roommate though she isn’t mean about it. I can understand it being difficult for someone to always be there, having to feel like you need to tiptoe and whisper because they’re sleeping. I let her know that I don’t need her to worry about that. I don’t have the words to explain why, but it’s because when I’m lying down I can completely dissociate. It doesn’t matter what’s happening around me. It’s like I’m not even there. It’s the only comfort I have besides sleeping.

When I’m awake I’m so agitated that I can barely stand it. I rock constantly because it’s the only thing that helps, and even that doesn’t help very much. When I’m summoned in the morning to meet with my psychiatrist and social worker, I often say I don’t think I can do it. Yes you can, the social worker says with certainty. So I do.

When I see myself in the mirror there’s a feral look in my eye that disturbs me. My facial muscles are tense. I don’t look like me. They start me on a few medications. The psychiatrist tells me that my psychiatrist told her about my asking for Adderall. She insinuates this is drug seeking behavior. I’m not able to find the words to defend myself.

Several times a day I’m asked the same questions that everybody else is asked. What is my depression level? Anxiety? Thoughts of self-harm or harming others? Ideation? Plan? My answers are always the same. 8 to 9 out of 10. 8 to 9 out of 10. No. No. And No. And then they say: Is there anything I can do? No but thank you.

One of the charge nurses tells me that when she gets back after the weekend, I’ll start to feel better.

When she comes in on Monday, she asks how I’m doing. I shake my head. Really? she asks with surprise. Her reaction isn’t exactly comforting.

My mom sends me a text once or twice a day. All I can do is an emoji response. I can’t come up with words. Every few days or so I text Soph and Tommy that I love them and miss them. I feel so guilty that so much time passes in between. I feel so guilty that I can’t say anything more than that. I don’t cry. I don’t have emotions.

They force me to go to these “classes” that are supposed to be the key to my getting better. The classes are led by a tall man with white-ish hair and glasses. His arms are long and he moves them as if they’re a little rubbery, as if he doesn’t completely control them. He reminds me of Gumby. He’s an unbelievable idiot. One of the guys in my group asks him what he should tell his eight-year-old. It’s been a couple of days since he was admitted and they told the kid that he’s on a camping trip. But should he explain more? And how much?

Nah, the guy says. Kids that age don’t know what’s going on.

I can’t talk but I also cannot believe he said such bullshit. I rock constantly in class and try to play with a stress ball but I often have to leave after twenty minutes or so. He turns the shitty AC off in the room because he claims it’s hard for him to talk over it. If we get too warm, we can ask to turn it back on. It’s already too warm with the AC on. In one class I ask to turn it back on and everyone gives me a grateful look or seconds that they too are hot. I have to listen to him go through Erikson’s stages of development. A topic that was drilled into me in nursing school. His explanations are bizarre and his examples are absurd.

Andy comes to see me as often as he can. After ten minutes I can hardly bear it anymore. The agitation is excruciating, and I’m not able to talk. I tell him he should go, not because I want him to but because I can’t stand being upright. I need to lie down or—I don’t know what else. I just have pure adrenaline coursing through me. He gently tells me he’s going to stay a little longer. He holds my hands and tells me why things are going to get better, why everything is okay. He tells me little things about each of our kids, small happy stories to let me know that they’re not struggling. They’re leaning on each other and that’s because of me, he says. It’s because of my mothering. It has nothing to do with my mothering as far as I’m concerned. I don’t even have a sense of what the concept might mean. I don’t know what he’s talking about. He continues to visit, driving almost an hour each way. Tell me why everything is going to be okay, I start to ask him. Tell me why things are getting better. I hang onto those words with everything I have. I don’t believe them because I can’t imagine ever feeling any other way. My world is black and white and gray, but with a sickening yellowish tint. Sallow. Like an old photograph. Like a mental hospital.

I don’t want to see anyone else because I don’t want them to see my like this. Rocking like a mentally ill person. Unable to think of a single word to say.

I wake up most mornings fully drenched in sweat, in the throes of a full panic attack. Ironically, through this whole period, I have consistently good dreams. Wonderful dreams. Leaving them every morning is a devastating blow. If I’m not having a panic attack, I’m lying awake waiting for the sounds I hate the most. The door opening and closing as the day staff comes in. Keys jingling. Everyone wishing each other good morning, exchanging a light joke.

When I’m experiencing the panic attacks, I’m told to practice slow, deep breathing. Ativan is given once or twice but reticently, somewhat suspiciously. One morning I go to the nurse’s station to ask for one because I’m in so much distress. The nurse looks at me for a second and says, You can’t go home on this, you know. She gives me the Ativan, her facial expression making it clear that it’s against her better judgment. Looking back now, I find this absurd to the point of hilarity. As if I was going home anytime soon.

After two to three weeks the staff, even my doctors, start becoming exasperated by my lack of improvement. I get lectures about my refusal to use any of my “mental health tools”. I should be attending more classes—to listen to fuckface say categorically incorrect and illogical nonsense mind you. I should be journaling, I should be downloading Insight Meditations and practicing. I can’t manage the most basic phone functions, let alone downloading and navigating an app. Then YouTube, my psychiatrist says. I can’t do that either but they think this is “uncooperative” behavior. Stubbornness. They say I should be going outside. “Outside” is a small courtyard with a central island that has a birch tree and a few small bushes. It’s pleasant enough. Except it’s summer and I can’t stand the heat. And there are about five metal chairs that aren’t comfortable, and there isn’t anywhere else to sit. Most people walk the path that goes around the tree, over and over again. It takes a minute or so—and that’s being generous—to make one circuit.

In other words, it fucking sucks. No. Thanks. I don’t want to go outside.

When asked at group meetings what mental health tools I’m using, I start saying “positive thinking”, which is on the list. This seems to satisfy the staff and the nurses.

We’re all encouraged to go to a showing of a documentary about a therapeutic technique called Emotional Freedom Technique. It’s a method of tapping various pressure points on your body while saying an affirmation. “Even though I feel anxious, I deeply and completely accept myself.” A nurse is very excited for me to learn about this as yet unrevealed technique. I’m instantly annoyed. I learned about EFT from Esther in 2012 and had practiced it off and on for years. I took an adult ed class several years after that to refamiliarize myself and practice. I don’t say any of this. I don’t have the ability to communicate. The “documentary” feels much more like an infomercial and I quickly realize that I’ve seen most of the material on YouTube years ago. It features people who’ve had chronic pain, people with mental health challenges who’ve learned self-acceptance and gained self-esteem, people with PTSD. They’ve all been essentially cured of their ailments.

When the documentary is over, we file out of the room as a group. In the hallway the nurse makes a beeline for me. Well? She wants to know. Her eyes are gleaming. What did you think about that? Good, I say. She thinks this is the secret for my recovery. She thinks it’s pure magic.

We never practice EFT. It’s the first and last time it’s even mentioned.

It’s around this time that I’ve agreed to start electroconvulsive therapy. The plan is to transfer me to the main psychiatric hospital campus, where the ECT clinic is located. This is not the ECT that’s been portrayed by Hollywood, One Flew Over the Cuckoo’s Nest being the best known example. Instead, the sessions are done while under anesthesia. The actual procedure takes very little time. Getting prepped beforehand and recovering from the anesthesia afterward take most of the time. You’re in and out, from start to finish, in about an hour and a half. The sessions are done three days a week, and it takes about eight to twelve sessions for the patient to notice a difference. They say that typically others will see a change in about six sessions. Even six sessions feels like an overwhelmingly long time to continue existing like this. But what’s the alternative? The thing that stresses me out the most is the possibility of peeing during the ECT itself. The booklet I’m given recommends having a second dry pair of underwear to change into. This overwhelms me with anxiety because it involves having clean laundry and any tasks feel dreadful and impossible, especially laundry. So it isn’t the peeing that bothers me. In the end, I never have to worry about this. They always give you time to go to the bathroom right before you get hooked up to the monitor and prepped for anesthesia. I always wake up dry. I feel a constant sense of terror and doom here in this other campus. There are two times that I feel anything else. One is when I’m sleeping and I have these achingly beautiful dreams until I’m ripped away by being awoken to the nightmare that is my real life. The other is the five seconds or so before I lose consciousness in the ECT procedure room.