Smoking Cigarettes, Eating Glass: A Psychologist's Memoir

By Annita Perez Sawyer

"A fiercely honest and beautifully written book." —Paul Austin, author, Beautiful Eyes and Something for the PainA cautionary tale of careless psychiatric diagnosis, treatment, and resilienceSawyer's memoir is a harrowing, heroic, and redeeming story of her battle with mental illness, and her triumph in overcoming it. In 1960, as a suicidal teenager, Sawyer was institutionalized, misdiagnosed, and suffered through 89 electroshock treatments before being transferred, labeled as "unimproved." The damage done has haunted her life. Discharged in 1966, after finally receiving proper psychiatric care, Sawyer kept her past secret and moved on to graduate from Yale University, raise two children, and become a respected psychotherapist. That is, until 2001, when she reviewed her hospital records and began to remember a broken childhood and the even more broken mental health system of the 1950s and 1960s.

• Language: English
• Publisher: Santa Fe Writer's Project
• Release date: Jun 1, 2015
• ISBN: 9781939650276

Book preview

Stafford

PROLOGUE

Pay Attention

April 2004

Ha nds on the large round wall clock hesitated, then lurched forward, ticking each minute away. The meeting had started late; it was time for me to speak. I gathered my stack of notes in front of me, patting the edges smooth. I straightened my shoulders and moved a wisp of hair away from my eyes. Two-dozen mental health professionals stared at me where I sat in their midst at a square oak table in the crowded conference room. A small woman across from me, a world-famous psychoanalyst, smiled in a reassuring, grandmotherly way. The director nodded, Go.

My message of transcendence is myself, I began, working to keep my voice full. Me. Alive. Here. I speak as a seasoned psychologist, and I speak as a woman who was a patient in this institution for several years when I was young.

I glanced up. The analyst smiled again. For a moment, I sparkled.

I’d arrived early, making my way from the parking lot with the help of a map scribbled on the back of an envelope by the psychiatrist who had invited me to attend. Walking in, I’d scrutinized the faded carpets on the old wooden floors, the juxtaposition of windows and walls, the ceiling’s odd angles, wondering if I’d ever been in this particular building before, one of many in this well-known mental hospital complex known informally as Bloomingdale’s. I was struggling to remember when I’d been a teenager locked in here decades earlier—beyond all the shock treatments that erased most of my memory, beyond the doctors who gave up on me before I was twenty.

I’d worked on my presentation for weeks, writing and rewriting what I wanted to say. I’d practiced in front of mirrors. I’d recorded myself with a video camera and critiqued the tape on my TV. I might never have an opportunity like this again—I had to set them on fire.

I glanced at the men and women seated at the table and lining the edges of the room. Large and small, stylish and frumpy, young clinicians and interns sprinkled among renowned analysts and researchers. I was a thin, ordinary-looking, late-middle-aged woman with trifocal glasses and short hair. Outwardly, I appeared no different from them. Might there be others like me hidden here? I wondered.

Beside me sat the white-haired man, a few years older than myself, who had arranged for me to come. We had first met almost forty years earlier in another hospital when he was a young psychiatrist in training. I had been an inpatient on his unit. Are they expecting a doctor or a patient? A speck of anger gleamed like dust on a sunbeam. For a moment I was seventeen again, shivering, naked, rough wet sheets wrapped tight against my skin, lying on a gurney in the hall with the smell of sour sweat hovering in a cloud around my head.

My face burned. I ran a hand through my hair, forcing myself back into the present.

I was dressed in a gray Brooks Brothers suit I had found at the outlet, my favorite velvet scarf draped around my neck. A freshly polished leather briefcase my husband had given to me when I’d earned my PhD over twenty years earlier kept my feet company, resting beneath the chair. It held pages and pages of what I wanted to say, probably enough for twenty presentations.

I rubbed my thumb across a tiny silver basket pinned to my lapel, then over the silver ring on my little finger. My children had made them, with their father’s help, when they were young. Could I have imagined this scene back then? I raised my head and straightened my spine.

Forty years ago, I was a patient here, I continued. I endured years of terrifying treatment for the wrong diagnosis, treatment that made me worse. In the end, I was transferred out for lack of improvement. A surge of energy—rage? fear? joy?—swept through me, catching me off guard. Under the table, I clasped my hands together as tightly as I could, so as not to fly apart into pieces. I began to tell them my story.

I described shrinking in high school—my handwriting becoming so tiny it was illegible; my voice increasingly inaudible; my body, like my spirit, withdrawing from the world and closing in on itself. I told them about my diary heaped with guilt and self-loathing. About my suicide plans. I quoted the doctors’ assessments directly from hospital notes—patronizing and degrading descriptions of myself.

Then I described my shock treatment and the fear that the electricity inducing the seizures would kill me. I explained that when I’d failed to improve, my doctors had prescribed even more. At this, the elderly hospital director winced. His sad eyes shrank into faraway, dark points as creases in his face deepened around them. I felt myself lift out of my body—for a moment I didn’t know who or where I was.

Should I stop? I asked him.

No, no. Please continue, he said, his voice gentle, as if he recognized my distress.

"After three years at the first hospital, I was transferred. My diagnosis: Dementia Praecox (schizophrenia); my condition: Unimproved. Another year passed before I was assigned to a psychiatrist who could see me as an individual—as a person, not a syndrome. When I made stupid puns, he laughed. When I told him that evil garbage stank and should be eliminated, he told me he knew someone who found treasures in garbage. One person’s stink is another’s perfume," he’d said, astonishing me. No longer utterly alone in the universe, I grew curious about myself and how I worked. My interest in the outside world expanded. I began to heal.

But, as we all know, I added, healing can be a long and uneven process, no matter how talented the therapist or how promising the relationship. I went on to describe living without memory of my first twenty years, pretending to belong in a world I no longer recognized, hiding my mental-patient past; often, it had seemed like leading a double life.

I told them about secrets uncovered forty years later when I read the hospital records. An experienced clinician by then, I could easily recognize what had eluded my own doctors so long before. The ensuing memories had somersaulted me deep into the turbulent sea of those childhood times. I’d feared I would drown.

I looked again at the people sitting around me. Tears shone on pale cheeks. A square-set man across the table stared at me from a stern, red face. A few people lowered their eyes or looked away. Icy tendrils spread throughout my chest. Have I hurt them? Do they feel betrayed? No one present had worked at this hospital back then.

Yet what could I expect, when I had been describing misguided mental hospital treatment through the eyes of a suicidal adolescent girl? I was telling them what had happened to me so that they would listen, because doctors still made the same mistakes. Oh, yes, I’d heard many times, the speaker ruefully shaking his head, in the fifties and sixties they diagnosed schizophrenia in almost every patient and gave them shock treatment, as if this were an antique behavior no longer practiced.

But I knew differently. Fads in diagnosis and treatment persist. We mental health professionals are often pressured to label patients quickly, to recommend the newest therapies and drugs, to dismiss disruptions caused by side effects. I wanted these clinicians to acknowledge the significance of their power and its consequences. I was telling them my story so they would pay meticulous attention to every patient they encountered.

The clock urged me to hurry. A tall, slender man not far from me shifted in his seat and began to fidget with his watch, probably worried that he’d have to stop me before I finished. I knew I couldn’t possibly deliver all the information I’d worked so hard to prepare. I talked faster. I skipped my last section, even though I knew it was the most direct. I closed by repeating my plea: pay attention.

Silence. No one moved. It felt as if a numbing gas had been added to the air. Maybe this had been a mistake.

Then, slowly, people began to ask questions—thoughtful, intelligent questions, carefully phrased.

What do you think had the most profound influence on your recovery?

How do you see the role of the shock treatment in your difficulties?

They sounded kind and respectful; I hoped it wasn’t because they thought I was fragile or sick. I struggled to hold onto their questions and comments, but my vague answers meandered. Promising ideas vanished before I could turn them into whole sentences. Years later I would understand that dissociation had wrapped its foggy curtain about my thoughts, feelings, and everything I could see.

I had to leave. A new set of people were arriving; the next meeting should have already begun.

That’s it? I wondered, making my way out of the room. I had expected exultation. I was going to redeem my life. Instead of a flood of sunshine and joyful colors, I felt immersed in gray. Disappointment. Rain.

Still bound in fog, almost out of reach, I waited my turn in line in the hall outside the bathroom, hoping that in time I’d stand with both feet firmly set on solid ground. Two women stopped to thank me for my presentation. Generous…valuable…inspiring, they might have said. Others approached and used similar words. I stared hard at the speakers, wanting to penetrate each heart and measure the depth of its sincerity. Should I believe them?

Maybe I’ll be okay, I mused as I wandered out of the building and headed toward my car. No one had criticized me. No one had sneered. I hadn’t acted crazy.

By the time I reached the parking lot, I no longer felt suspended in space or entirely incredulous. I was beginning to comprehend that I had just revealed my most personal secrets in public. For the first time, after close to forty years leading a double life, I wasn’t hiding half of who I was. Perhaps feeling stunned made sense.

Releasing the scarf tightly clutched in my hand, I unlocked the car door and paused. I stretched out my arms, filling myself head to toe with a deep breath of fresh, spring air. I still couldn’t remember having been on this part of the grounds before, but I could picture the desperate adolescent whose fear colored every moment she had spent here. She’d never have dreamed of being in my role that day.

I stretched again and surveyed the scene, taking comfort in the orderly world around me. Clumps of crimson tulips and bright yellow daffodils bloomed along the well-tended walk that bordered the parking area. Beyond the fence, pine trees glistened in the sun. Rows of high white clouds marched across the sky. A cool breeze blew strands of hair into my face. I brushed them away.

I did it, I said to myself as I slid onto the seat. I actually did it.

Part One

Locked Up

CHAPTER ONE

Swept Away

May 1960

Water on a rising tide splashed and fizzed around rocks on the beach by a tiny cottage where we’d spent the night. The sky was bright, the air brisk and salty. From outside the screen door, Sara urged me to hurry; everyone wanted to go swimming, and I wasn’t close to ready. Go ahead, I said. I’ll catch up with you, don’t worry.

She frowned. I hated it when Sara was annoyed with me, but I just couldn’t get myself moving. She gave me a long stare, as if she were thinking about what to do. All right, she said. Then she moved on to join the others. Just don’t dilly-dally, she added over her shoulder.

I’d come to Montauk Point with friends from high school to spend Memorial Day weekend. It was a holiday we had planned for months—or rather, they had. Although we were all juniors, I felt more like a whisper that echoed everyone else’s ideas than a true teenager in my own right. When my friends spoke, I heard a funny sound in my head, a sort of ringing or high buzz, and they seemed far away, like toys I could move around.

I intended to kill myself that weekend. When my friends were off together, I was going to take some heavy chunks of rock and wade into the ocean, past where the water came over my head, and hold onto them until I drowned. I hadn’t figured out the exact timing.

Maybe because I didn’t really like to swim, and because I was mulling over the details of my plan, I took a long time changing into my bathing suit. Sara, Fran, and the others were gone when I opened the screen door and stepped into the sun.

Tightly gripping my towel, I watched my feet press into the warm sand, making deep troughs that filled in once I’d passed. I looked up to see a commotion where we’d parked the cars. A group of people had gathered near a tan Chevy that hadn’t been there before. It resembled my parents’ car. Uh-oh, I thought.

I quickened my pace. The shlishing sand and fizzing waves merged with the buzz in my head, which felt light, as if it were a balloon lifting me through the air, as if I were flying. I shook my head to clear it. My feet hurried faster. I soon found myself by the cars, next to Sara. She stood facing my mother and father. Uh-oh.

I really don’t see that you have anything to worry about, Sara was saying to them. She was defending me—she truly was my best friend—but she looked more worried than her words implied. What had they told her?

Sara turned to me. Your parents think you aren’t safe here, she said in an apologetic voice. They want you to leave. Now. Fran looked down at her feet. Emily and Steffi decided to return to the water. Sara stepped back, leaving no one between my parents and me. The wanted criminal, having been tracked down, was about to be taken into custody—I felt as good as handcuffed, right in front of my friends.

And yet, there was a strangeness about the scene that made me think I might be dreaming.

My father drove during the long ride back from the far end of Long Island, my mother glum beside him. Neither spoke. Occasionally cellophane on a cigarette pack crackled as one or the other pulled out a fresh Chesterfield and reached for the lighter. Each exhale that followed filled the car with a terrible, heartfelt sigh.

I sat silent, folded into the back seat. If only you’d acted more quickly, you’d be gone by now, I lamented. Concentrating all my energy, I tried to redo reality, to force another chance. I pictured myself heading earlier in the day into the ocean, drowning myself sooner, listening to reports of my death. All to no effect.

Unable to accept that my plan had failed, I moved into a separate plane of existence. The scene inside the car as well as outside of it grew small, as if my life had become a play I watched from seats in the farthest balcony. Colors dissolved into gray. Time lost its moorings.

Admissions, my father mumbled through his cigarette to a man inside a small gatehouse set at the base of an impressive formal driveway. I cringed at that word, admissions. I cringed, too, seeing my usually dapper father’s shrunken gray face and dangling Chesterfield, hearing him sound like a gangster heading to jail. What had I done?

I watched as the car traveled in what felt like slow motion uphill to the center of an imposing psychiatric facility—several buildings spread across a sizable estate. I’d often seen them from a distance, since it was located near the center of my town. A tall iron fence surrounded the whole area, keeping ordinary people out. I didn’t belong inside.

I promise I wasn’t serious, I said, pleading with my parents beside me. But they focused on the doctor facing us, enthroned behind his vast, polished desk. He was discussing my admission to the hospital. Please don’t leave me here! I was slipping off the edge of the universe and my parents were my only tether to earth. If they left, I’d be gone.

All three stared at me, unmoved.

Please, please, please, I beg you, take me home now. I spoke to my mother, palms open, beseeching.

Her face looked hard, her lips pursed tight to keep any contradicting voice from spilling out. Ordinarily my mother’s dark, pleading eyes convinced me not to go against my parents’—really my father’s—wishes. Her sagging shoulders, sighs, and desperate looks reminded me that if I disobeyed, I’d hurt her worst of all. Ever since I was a little child I’d worried I might damage, even kill her, if I caused too much distress. Now her eyes seemed dull, as if she had already died. Her voice was flat.

The doctor wants you here, she said, turning her head away from me. We have to do what’s right. I stopped entreating and watched.

My slender, boyish-looking father puffed on his cigarettes nonstop. He spoke softly—not his usual style. Instead of taking over, he was deferring to the doctor determining my fate. His gentle voice and fluttery hands told me that he, too, was afraid.

Daddy, please, I didn’t mean it, I tried one last time. He looked at his hands. No one would protect me. Panic roared through my chest up into my throat.

The doctor, a lanky, imperious man with wavy reddish brown hair and a long oval face, leaned forward to make his point. He warned my parents I might kill myself, that I shouldn’t go home, that only the doctors in their hospital knew what to do with me. My parents seemed paralyzed, unable to object.

I saw the evidence against me: I’d written in my diary the plan to drown myself, and my mother had read it. Now the doctor sat there holding my secrets in his large, bony hands. He opened the book and looked at some of its pages, running his fingers across the ink. He stopped to read aloud words here and there—dangerous…bad…loathsome—defiling what had been mine but now was his. Then he turned to the last page and read the part about my death. My ears were ringing so loudly I couldn’t hear what he said.

This is a serious misunderstanding, I heard my voice explain. There’s nothing wrong with me. I don’t need to be in a mental hospital.

No one listened. My parents signed the necessary papers and left.

New York Hospital, Westchester Division

Admission Note

May 30, 1960:

Miss Perez was admitted to the hospital today from her home in White Plains accompanied by her parents. In the admitting room, she appeared cooperative but extremely shy and fearful. She expressed doubt that she needed to be hospitalized but was cooperative to her admission and quietly accompanied the supervisor to the admission hall.

—Dr. Ryan

In a dormitory style room, I lay in bed, trembling. A terrible mistake was being made. I was not mentally ill. I needed to die, because I was bad, but that was a distinctly separate issue. I couldn’t explain how I knew these things, but I was sure that I knew them.

I noticed five other girls asleep sprawled out in beds around me. I didn’t intend to sleep. My only hope was that the entire experience might be a dream. I had to stay awake in case it wasn’t a dream, because by sleeping I would make the dream come true. As if everything in the world had been switched backwards, and I held the key. I couldn’t let down my guard for an instant.

Daddy had seemed near tears when he said good-bye. My mother couldn’t speak at all. I was appalled to be causing my parents so much grief. Yet the harder I tried to figure out how to undo the harm, the harder it became to think clearly. Like a ship trapped in Arctic ice, I was beset, my mind frozen. Cold dread swelled in my chest and spilled into my stomach. I had caused some unspeakable damage; only death made sense to me.

A few weeks later, I’d turned into a robot running on low batteries. Medication, plus the sense that nothing was real, left me feeling like a powerless machine in a human form.

At least I’d learned the hospital routine. I knew the names of most of the nurses and patients. I knew what staff meant when they referred to OT (Occupational Therapy) and CO (Constant Observation), PT (time at the gym), meds (drugs handed out at certain times of day—morning, noon, or evening), and EST (Electric Shock Treatment). But I would never agree that I should be in a mental hospital.

Although I kept to myself, I was polite and did what I was told. It was useless to argue with Mrs. Adams, the head nurse, who put the rules first: no talking after lights out, no staying in your room if she thought you needed more social interaction. Miss Thompson, her younger assistant, was more sympathetic and more fun. She liked to play Monopoly and Parcheesi and tell stories about her adventures with her boyfriends and her three cats. I wasn’t a game player. If a game was planned, and a nurse or another patient asked me to join, I’d say, Yes, and pretend to go along, but I’d dawdle while looking for a sweater in my room, or I’d take a long time going to the bathroom and let myself get distracted on the way back. With luck, by the time I returned they’d have started without me.

On this floor most people shared rooms with two or three others. I was still fairly new, so I slept in the larger admissions dorm, which had space for six patients. Patterned bed skirts of pink and red peonies with large leaves fringed the beds, topped by bedspreads that matched. Starchy white curtains decorated large windows that didn’t open. We each had a dresser and a small nightstand. Flowered wallpaper gave the rooms a homey feel, until you remembered that you were here against your will.

From the beginning, the shock treatment and accompanying dread dominated my life. Every Monday, Wednesday, and Friday a nurse woke me early for a shot to sedate me. I wasn’t allowed to eat breakfast. Afternoons I sat dazed, holding still so as not to worsen the headache and upset stomach that always followed. This meant I rarely participated in activities—occasionally gym on a non-shock day, and sometimes OT, where yes, I made pot holders, the same sort I probably had made in second grade, the same multicolored loops I had interwoven and hooked across square metal frames in Girl Scouts to earn a handcraft badge.

Shock treatment felt like facing death again and again. Not only because the doctor caused a seizure by shooting electricity through my brain, which meant I risked dying if he miscalculated, but because it also interfered with my memory. I’d wake up terrified, not knowing who I was, the world a meaningless blank. It was as if each seizure carved me into a new jigsaw puzzle, and I had to start from the beginning to figure out how the pieces fit together. There was no guarantee they would.

Because I forgot much of what happened day to day, I had trouble getting to know other patients. I lost touch with my friends at school. I told myself that if I didn’t see them, I shouldn’t miss having friends. I tried not to care, but I was lonely. I felt an ache in my heart that never went away.

Soon I’d had so many shock treatments, I barely remembered anything about my life before the hospital.

Oh, shock therapy does interfere somewhat with short-term memory, my psychiatrist, Dr. Ryan, once explained when I complained, but your longterm memory shouldn’t be affected. To make his point, he showed me a paragraph about it in one of his fat medical textbooks. See?"

If you’re old enough to write a text book or pull the switch, maybe you think five or ten years is short-term, I thought. For a teenager like me, short-term encompassed my whole life.

At night, nursing staff went from room to room, creaking the doors open and shining flashlights on us in our beds, checking to see who was asleep and who was not. I’d slept badly all my life. When I did sleep, I had nightmares. Still, I felt ashamed to be identified as having stayed awake, accused of misbehavior when I was dedicated to being good. Nightmares made me scream. I knew because I woke myself up, or a roommate complained. This, too, might lead to a reprimand by a nurse, although, to be fair, at the time I couldn’t tell a straightforward question or a sympathetic observation from a reprimand.

Before long, I’d mastered the slow, even way of breathing that made the nurse think I was asleep when she checked. Dr. Ryan insisted that no one held me responsible for my insomnia or nightmares, but I didn’t believe him.

For years I’d worried that as a human being I was despicable. I’d tried to be a good Catholic and go to church every week. Yet, no matter how much I prayed or confessed every bad thought, no matter how hard I worked at being kind and responsible, I couldn’t shake the conviction that I was evil at the core and didn’t deserve forgiveness. My mission was to rid the world of myself.

The winter before, I’d swallowed part of a bottle of aspirin, but nothing happened. My plan to drown at the beach had been another attempt at fulfilling my goal. I knew I’d been erroneously admitted to the hospital. I wasn’t sick; I was bad. There was a difference, but Dr. Ryan seemed incapable of comprehending it.

Although I met with him several times a week, I had little to say. Thoughts rarely came, but when they did, I didn’t think he’d want to hear them.

What have you done with other patients your age? he would ask.

Nothing, I’d answer. I don’t know what to say to them.

How do you get along with your parents when you are at home? How do you get along with your brothers? What do your friends like to do for fun?

We get along fine. It’s all fine, I’d say.

I tried to answer Dr. Ryan honestly, but I couldn’t stay interested in the mundane stuff he brought up. I’d find myself looking at something like the plant on his desk and wondering how often he watered it and if he did it himself or had a maid. I often missed what he was talking about. How my friends or my brothers spent their time was trivial compared with eliminating the evil that was me. When pressed to name what I considered most important, I tried to justify those feelings, but I couldn’t find a way. I kept repeating the same explanation, which clearly annoyed him.

From the center of my being, through all of my organs, to the outer tips of the hairs on my skin, I felt filthy and vile. I couldn’t say why. I couldn’t provide concrete facts. But I knew it. I felt it. I was absolutely sure of it: I was a walking cauldron of sin.

New York Hospital, Westchester Division

Progress Notes, continued

July 31, 1960:

Throughout the month the patient has been receiving shock treatments and will have received a total of 18 by the end of the month…she remains massively self-deprecatory and continues to display the subtly and stubbornly resentful attitudes which are a characteristic of her illness…Thus she constantly reiterates the word crummy in describing herself and yet steadfastly refuses to explain why she considers herself so crummy.

…It seems probable that the patient will require a full 25 EST but it is felt that she will be definitely improved by this.

—Dr. Ryan

In the months leading up to my admission, the chasm between how I looked from the outside and my

Reviews for Smoking Cigarettes, Eating Glass

[jasonpettus · Rating: 4 out of 5 stars]

(Reprinted from the Chicago Center for Literature and Photography [cclapcenter.com]. I am the original author of this essay, as well as the owner of CCLaP; it is not being reprinted illegally.)Annita Perez Sawyer's memoir Smoking Cigarettes, Eating Glass is hugely typical of a type of book we get sent here all the time; a fascinating true story but from someone who is not usually a creative writer, most often published on a tiny press that exists specifically for these kinds of manuscripts, it's hard to deny that such books are immediately compelling simply from the spellbinding nature of the autobiographical tale they're telling, even as I'm forced to admit that the actual writing style of most of these books is only pedestrian at best. In this case Sawyer has put together a look at her youth as a misdiagnosed schizophrenic in the early 1960s, back when such conditions were typically treated with cruel and ineffective electroshock therapy and then incarceration into a "medical" facility that in the Mid-Century Modernist years was more like a prison, the hook here being that Sawyer grew up to be a respected psychotherapist herself, and was able to literally use her own medical records from her own youth to help change the way the entire profession now looks at the subject of bipolar disorder. As such, then, certainly this book is an enjoyable page-turner, and will hold a lot of interest for those who are grappling with these subjects themselves; but be warned that, typical of these kinds of memoirs, the writing itself is no great shakes, a manuscript that at least does the job of conveying the sentences Sawyer wishes to communicate, but that doesn't do much more than that. A recommendation today but a limited one, mostly to people who are already fascinated by this subject and wish to learn more.Out of 10: 8.0