Chapter One: The Asylum

An asylum, Alba believes, is where you are sent when you want to die—a sanctuary for the prevention of suicide.

Alba's asylum, Abenaki Hospital, sits, elegant as a hotel, atop one hundred acres of land—devoted to farming in the days when inmates worked for their stay—now grown over with fields of wildflowers and the occasional wooded grove, blue-gray mountains skulking in the distance. To get there you must cross the Manasis River, giving your name to the security guard in the hut that waits before the covered bridge. The nearest town is almost twenty miles down Rural Route 3—a sleepy Maine village where the residents have the hospital's phone number on speed dial, for when they spot a suspicious character on Pleasant Street. Though most of the inmates these days are self-committed, leaving Abenaki is made so inconvenient that, once inside, the majority of patients, out of lethargy or comfort or discouragement, do not think of escaping. Except of course for the drug addicts, for whom special precautions are taken.

Abenaki is an Algonquin word meaning "People of the Dawnland." In the eighteenth century, the land had been occupied by a small tribe of Abenaki Indians, who had managed to save a scrap of their homeland by maintaining a neutral position between warring French and English colonists, and making themselves useful to both. There was a tradition—no one knew quite how it started—of sending white women off to live with these natives: wives, mothers and spinster daughters who had displayed behavior that could not be explained or cured by local doctors. Women who wept too copiously and often; women who walked or screamed in their sleep; women who attacked their husbands with sharp instruments, or defecated in their own kitchens; women who tried to take their own lives. The Abenaki were thought to be especially tolerant of the old, the sick and the insane; some believed they had secret, potent drugs that could cure things white medicine couldn't even diagnose. But mostly the women were sent there because they could be; the Indians took them in and saved the white families from shame and inconvenience. There were stories of husbands who, wracked with guilt, went riding out to see their wives and found them leather-skinned and toothless, dressed in native clothing, speaking a barbaric language, with no memory of their former lives or no desire to return to them. But generally, people did not visit the Abenaki; they were sent there to disappear.

Ultimately, most of the Abenaki men, lured by the promise of better land, became Revolutionary soldiers and were killed in the war. The women, both Indian and adopted white, died in a massacre in the winter of 1777, the details of which remain a mystery. In the aftermath of the war, the land was bought, despite the rumors of spells left behind by grudge-hungry Indians, by a doctor who had controversial theories about the origins and treatment of insanity.

A mental asylum, retreat, center or hospital—depending on the politically correct terminology of the day—has existed on the Abenaki land ever since. The name has been changed a number of times. At the beginning of the twentieth century, when it was run by the Catholic Church, it was called Saint Dymphna's Asylum, after the Irish patroness of nervous illness, and resembled a convent, with halls full of stealthy nuns. Nowadays it is one of the most renowned and expensive hospitals in New England, and includes adult and adolescent wards, as well as a drug rehab program with a highly publicized success rate. Famous people come here, and praise the staff in interviews in People magazine; movies have been filmed among the half-dozen Georgian buildings, where only a close-up lens reveals heavy gridiron lining the glass windows. Behind the main buildings are a few log cabins, left over from when the hospital housed both staff and patients in a pavilion plan. Though they should be torn down, there are some who feel the outbuildings give the place a sense of history—as if those native women are still there, tending pots over a fire. Of course, the cabins were built long after the Native Americans were gone, but this is conveniently forgotten. The movie directors love them.

No one disputes that the hospital has saved lives, though it has also lost a few—in bathrooms, the river, on tree limbs in the woods, and, once, in one of the historical shacks—but these episodes are rare, not to mention hushed up. In 1983, the name of the hospital was changed back to Abenaki, partly because of the inspiring translation—the doctors think dawn is a hopeful word—but mostly because it validated a new plaque endowed with the words Established, 1789.

When Alba Elliot was still in high school, she traveled with her father to San Francisco. They took a boat tour to Alcatraz, and when Alba stood in the concrete prison yard and saw the city's skyline across the water—looking like life held captive and miniaturized in a confetti-filled dome—she thought immediately of Abenaki. She'd already been a guest there twice, and remembered that, late at night, through certain hospital windows, she could see the faint glow of real life beyond the borders of that unused cushion of land. Prison, she thought, would be similar to a mental asylum. Not as comfortable, but operating under the same dichotomy of rehabilitation and punishment. A place where you watched your life tick by. Alcatraz became her nickname for the hospital, and she always says it with a biting, almost furious humor, which her father refuses to find amusing.

Alba knows Abenaki's history not because she has been there so many times that the nurses remember her birthday, but because she read about it in a book she found while organizing the hospital's new library. She initially volunteered for this job out of nervous energy, and kept it because it relieved her boredom and the persistent fear that she is of no use in the world. The hospital hasn't had a library since after World War II, when the books were crated and stored away to make room for its first male ward, occupied primarily by traumatized soldiers. Now there is a new building—donated by a former patient whose memoir about overcoming obsessive-compulsive disorder spent 154 weeks on the New York Times bestseller list—with walls of floor-to-ceiling oak bookcases, sliding ladders, and masculine, green leather armchairs. Just-born books have been delivered by the truckload, but Alba prefers salvaging the old ones. She thinks of these musty volumes as having been buried alive; she digs them up, slaps off the dust, and returns them to the shelves of the living. One book she found, History of a Mental Reservation, was not a properly published book, but something released privately, most likely by the author. It was written in 1943 by Nathan Stockwell, chief of staff at the time, and has chapters praising shock therapy and cold-water submersion tanks. She read it all one night in her room during a stretch of insomnia. After the nurses caught her with her light on and gave her a sedative, she fell asleep and dreamed she was dressed in animal pelts, wearing war paint instead of scars, dancing to the beat of a manic drum, on the same lawn where she has spent her mornings—almost every summer for the last ten years—smoking, watching the river change, and trying to stir up some enthusiasm for rejoining the world.

This morning she watches a new patient arrive. This is not normally something she would witness, as the admissions building is a separate cottage hidden behind the main ward, which most patients see only once, unless they are readmitted. But the thin road that leads in from the countryside winds between the widest, most benign section of the river and the sloping front lawn, and Alba has a balcony view of the baby-blue Mercedes as it glides slowly by. The passenger door opens and, while the car is still in motion, a man tries to step out, but ends up tumbling, clown fashion, onto the tarmac. By the time the car stops, and the driver gets out, holding his hands up in a plea, the escapee has already gained his feet and, weaving considerably, begun walking back the way they've come. The driver, his tie flying up in his face, has to jog a few steps to catch up. He tries to put his hand on the man's shoulder, but is shrugged off. Alba hears the rustle and buzz of walkie-talkies behind her, and soon two staff members are making their way down the hill. One is a nurse with a syringe, Alba knows, hidden in the pocket of his starched white jacket. The other is a rehab counselor, which means that the thin, messily dressed man changing his mind by the banks of the river is a drug addict.

The syringe proves unnecessary. In a few minutes the man is sitting on a log by the water, his forehead pressed against his shaking knees. The counselor squats next to him, murmuring encouragement and patting his shoulder. The driver stands back awkwardly, checking around to see if anyone is watching. Seeing that every patient on the lawn is riveted, he turns back to face the water. After a while the counselor poses a question and the addict looks up, wipes his nose with his shirtsleeve, and nods. The four of them get into the car, the counselor in back with her new patient, the nurse, just in case, up front with the driver. The car makes its way around the hill and out of sight, and people begin milling around the lawn again, their conversations resume; the next drama is already brewing.

Alba knows what comes next; she can picture the man sitting long-legged and wide-eyed in a mauve armchair, clipboard and pen in his lap. For the next few hours he will be interviewed by staff and students who all look suspiciously alike, and made to fill out so many forms that, by the time he is done, he won't care where he is as long as he can lie down. Alba has a theory about entrance paperwork—the forms are like bedtime stories, uninspiring and ritualistic, intended to lull you to sleep, so that it is morning before you realize that you've signed yourself away to an insane asylum.

The first time Alba was admitted to Abenaki she was a minor, so her father was given the paperwork. He filled out forms about her medical history and psychological symptoms while Alba rocked back and forth in the armchair. The hospital had been recommended by the emergency room after Alba, who hadn't slept in twenty-six days, set a lighter to her bedroom curtains. By the time her father woke up, wrestled her outside (she had fought him, saying she needed to keep an eye on the flames), and called 911, most of the upstairs of their house had been damaged by smoke or burned. All of Alba's eyebrows and most of her formerly long, dark hair had been singed off, so, in the admissions office of the mental hospital, she would have looked comical if it wasn't for the jumpy, determined glare of her eyes.

They did ask a few questions of Alba herself, privately, after they'd gleaned all they could from her frightened but poised father. They brought her to a separate room where four psychiatrists, two counselors, and five medical students were lined up at a table that could have been set for dinner. Alba sat alone, set back from the table and exposed, wondering what to do with her knees. One of them—a woman—asked her why she had set the fire.

Because I was tired, she said.

Tired of what?

Tired of trying to remember all of the things I would have to save if the house caught on fire.

I see, the woman said, but Alba didn't think she really did.

The students scribbled furiously on their clipboards long after she refused to answer any more questions. At one point she yelled—What the fuck are you writing, I haven't said anything—and that was the end of the interview.

Her first diagnosis—Bipolar Disorder—stuck, though she has collected additional variant disorders since then. She seems to develop new symptoms soon after she has the last ones under control. In her massive chart are labels like Agoraphobia, Anorexia, PTSD, SAD and, the latest one, Panic Disorder. Now, at twenty-five, Alba has been in that admitting cottage ten times. For years her father believed—despite all contrary medical opinion and a genetic predisposition—that she was merely going through a "bad stage," and would grow out of it. Sometimes, she seemed to. Months would accumulate where her days were not measured by levels of mania or depression, but simply lived. She would appear, even to her father, like a normal young woman. Medication, once life-saving, would seem genuinely unnecessary, until she ended up back at Abenaki. When she was eighteen, in her first year of college, and she slit her wrist to the bone during spring break, her father stopped believing in his bad-stage theory. Alba never believed it anyway; she knew who she was, knew even before the symptoms started that there was something elementally wrong with her. More wrong than other children—disturbed in their own ways—from single-parent homes in the privileged Cambridge she grew up in. What Alba often forgot were the details of her illness, and how quickly they took control. When she abandoned her medication, she did so under the delusion that the next time she fell apart, she would be able to handle it. Stop it before she lost herself.

When she sees that drug addict, as she watches his resigned shoulders ducking back into the car, she envies him. She would like to be here for the first time. The first time is when you believe that all you need is a rest from the world, a transition before your life kicks into gear. Something that will turn into anecdotal material in later years—when your life is organized by details and ambition rather than symptoms and a plastic days-of-the-week pill case—when it becomes "that time I went away for a while." Before you start to suspect, after three or four returns, that it is you—not the world—that is deranged.

This time, she has a plan. She hasn't always had one; on most visits she is so drained she decides to merely surrender, live out her life as an inmate. She is almost always here in the spring or summer, the seasons that feed her mania, or in November, when daylight savings nose-dives her into depression. Her latest abandonment of medication led to the inspiration to drive across the country. Her father had to bail her out of jail in a small town in Iowa, after she refused to pull over for speeding and led the young local sheriff in his first real car chase. She came back to Abenaki and, once the Lithium got the mania under control, she began having panic attacks, which require additional medication. Her father has accused her of playing Russian roulette with her pills, and her doctor, though not inclined to use such suggestive terms, thinks the same. Alba has recently calculated that she has lost a third of her life to illness and hospitalization. Another third has gone to starting over.

Her plan is this: she will take her medication every day for the rest of her life; she will live mentally muzzled and stop wishing for something more exciting. Excitement, her father insists, lasts for about six weeks, in that hypomanic stage, where she is brilliant and creative—alive—and anything seems possible. It is always, without fail, followed by chaos, and then darkness.

Of course, none of this is what she really wants. What she hopes for is a miracle—mental health without the dependence on drugs that snuff out her soul. The drugs buffer so many sensations, flatten all but the most benign feelings, that she wonders if death would be all that different. No one, not her doctor or her boyfriends or, when she's sick, even Alba herself, believes that it is possible for her to live without drugs.

And though she keeps thinking about that drug addict for the next few days, though she'll be sorting books in the library and suddenly remember his face—blotched, desperate and defiant—she believes he is merely a symbol, a reminder that she is face to face with her final chance. She doesn't realize that it is the man himself, and not what he represents, that will change her; doesn't know that he will throw an unexpected twist into a journey she seems fated to repeat, over and over, with little hope of ever getting it right.

The foregoing is excerpted from Love in the Asylum by Lisa Carey. All rights reserved. No part of this book may be used or reproduced without written permission from HarperCollins Publishers, 10 East 53rd Street, New York, NY 10022