by Josh Greenfield

There are chemically induced medical conditions that require more than a good sponsor and strict attention to The Steps, many in fact. There is an entire pharmacological industry that treats mental illness and it is improving all the time.  There is a lot of money in it.  The over whelming majority of these illnesses do not require hospitalization.  The patient consults with a psychiatrist, goes up to the pharmacy counter, fills his or her prescription and takes it home and takes it, with some misgivings at first, no doubt.  Still that’s how it works.  It is only on the rare occasion that those medications must be given inside a hospital, a psychiatric hospital, not to sound melodramatic or anything.  That has happened to me on two occasions.  The first time it was actually because I screwed up taking the medications on the outside. That was the story of a neurotic misbehaving during his psychiatrist’s vacation.  The second hospitalization is the one I want to address, a stay in the Westchester Psychiatric Hospital, which had everything to do with the psychotic.  It was there that for the first time I was put on Zyprexa, the latest generation of anti-psychotic medication.  I’d like to say there was a lot of Love as well.  Maybe there was a little of each.

For some days, I had been gradually descending into madness. There’s an outdated term, “madness,” sounds positively Nineteenth Century.  These days everything has a precise clinical description.  I think the doctors would say I was moving into an “episode,” a psychotic episode.  Strange things had been happening, with increasing intensity, for a few days, as I fell more and more “into character,” as I began to believe I was actually a character I had written about and portrayed in a stand-up act.  Gradually, I went from writing about this shmuck, to believing I was him. 

He, and by that I mean P.W., is a harmless guy.  He’s a comic figure really, bashful around women, unable to hold a job for more than a few weeks because of his intense shyness. In my writing, P.W. is prone to say wise and interesting things, but no one takes him too seriously.  I had even played him on the stage of amateur nights at a comedy clubs.  There he fit right in.  This is the character I thought I had become.  All my writing had autobiographical roots so P.W. was in some ways an exaggerated form of myself, but I still was taking on a different persona.  Along the way I came to believe in other things that were far removed from reality.  I looked out at the red light on top of a large building visible from my bedroom window and endowed it with supernatural meaning. I began seeing the everyday occurrences of daily life in terms of the grand issues of Good and Evil.  The talk radio hosts on the local sports radio station were somehow allied with Good.  Go figure that one.  I began cleaning my apartment in the middle of the night, making repeated visits to the garbage chute in the hall.

I’d been battling severe obsessive-compulsive disorder for a good twenty years.  I just had never had a psychotic episode before.  I didn’t even have anything in the bathroom cabinet that could have helped.  These changes don’t take place instantaneously.  During the early stages, certainly, there is ample opportunity to note them, to discover a new dimension growing inside from your healthy self, and to take appropriate remedial steps. On this occasion, I lacked that perspective.

On that August day in 2002, I walked out of my apartment building and along the sidewalk of the thoroughfare that runs out front with only one shoe on, the other being dragged by its laces.  I was thirsty.  I now know that dehydration makes the psychosis worse.  I did not know this at the time either.  I made my way along Warren Avenue past the adjoining set of six story brick buildings in the summer heat.  I passed the bus stop where people were waiting for the bus, people who may have known me on better days.  I made the choice to veer to the right into the tree lined residential area of one family homes, but the trees provided little relief.  I was going under.

Having arrived at the gate of the Rolling Hills Botanical gardens, I acted in a manner that may have been consistent with the character of P.W. but was in no way something Josh Greenfield would have done, not even on a hot summer’s afternoon.  I rang the buzzer by the side delivery entrance and asked for a glass of water.  You laugh?  I hope so.  Otherwise the rest of this is going to sound pretty strange.  I don’t know exactly how this went over in the administrative offices.  I suspect it may have been the first-time alarm bells were sounded.  But consistent with the service oriented nature of the non-profit institution the, director arrived at the gate a water bottle in her hand. She saw a man, around forty, in a loose fitting white t-shirt with a washed out print on the front wearing only one sneaker.  His jeans were worn through in the right knee.  His hair was copious and un-brushed.  We did not converse.

From there I headed straight downhill toward the Hudson River, one of the landmarks of the community.  It seems I had a destination in mind.  I walked down the pot holed scared pavement of 254th street on a weekday afternoon.  There was no one else about.  At the foot of the hill was the Riverdale Train Station, one stop on the Metro North railway headed up toward Poughkeepsie.  I walked up the stairs to the overpass that passed above the train tracks, still with just one shoe on.  On the far side was terrain with which I was intimately familiar.  From the southbound platform, I jumped down to the dirt borderline of the river itself.  Thick undergrowth grew by the rocks that abutted the water.  I made my way south through an opening in the weeds and onto what passed for a beach in the northwest Bronx.  Then I did something I have never been fully able to explain.  I slipped out of my clothes and into the water.  I fully submerged myself.  Dr. Rubin with his encyclopedic knowledge of the many religious traditions called it a rite of baptism.

The water may have temporarily cooled me, but it did little to improve my state of mind.  I put my clothes back on, this time lacing both sneakers and began to make my way north along the water’s edge.  I paused to sit on one of the rocks with water of the Hudson sloshing around below my feet.  To my right was a flock of geese.  But on that August afternoon they assumed an aura of mythic proportions to me, like messengers from some avian land, far away or far above.  Lodged in the rocks, but within arm’s reach, was a small plastic bottle, half filled with river water.  This too I assumed had been left for me by a divine power, and I drank it to assuage my thirst.  I was a hot day.

I continued along the eastern bank of the Hudson River.  On the opposite shore were the Palisades cliffs, geologically significant rock formations running vertically from the line of green trees above to the water below.  They appeared remote through the haze and humidity.  I approached the next outpost on the Metro North rail line, the Ludlow station.  Here again, I did something to draw attention to myself as a man have a breakdown, a psychotic episode, a descent into madness, call it what you will.  Under the overhang of the otherwise deserted southbound station I saw a metallic pipe protruding from the side wall.  Beneath the pipe on the right-hand side was a metal chain.  I pulled on the chain and water came running out of the pipe.  This was just what I needed, cold water that had not been contaminated by the many impurities of the Hudson River and the remains of someone’s three-week old Gatorade.  I lay down on the ground, pulled the chain and let the cool water run over my face and head.

As I lay there on my back I became aware that a man was observing me from the over pass.  He looked down on me through the plate glass and moved on.  I wasn’t interested in taking a train.  Instead I began to walk south back along the train tracks to the Riverdale Station.  It was then I first noticed the three police men who were to set the future course of events in motion.  They were walking quietly towards me, two men and a woman.  I approached them as well.

Their greeting was friendly, “How are you doing?” one of the police men asked.

I was aware that things had taken a serious turn.  The “men in blue” were on the scene.  I did not answer the policeman’s greeting, but kept walking along the dirt that divided the southbound track from an abandoned track no longer in use.  The three policemen fell in line and began walking beside me.

At this point P.W. did exactly what P.W. was inclined to do.  Without directly acknowledging the presence of the officers he, that would be me, began proclaiming his credentials to the hillside at healthy decibel levels.

“Stanley Greenfield, my father, Harvard Business School, Class of 1949….Phillips Andover Academy, Class of 1980… Cornell University Class of 1984”

The policemen walked affably by my side.  I was moving in the direction they wanted, toward the Riverdale Station and the help that awaited.  We arrived at a patch of shade beside a particularly large bush.  Here I was inclined to stop. The policemen did not immediately force the matter.

“What’s your name?” One of the men asked.

“P.W.” I answered without reservation.

“I’m J.T.” the woman, a young svelte African American answered.

“I’m A.J.” The man who had asked the original question answered as well.

“I’m G.S.” The third police man completed the introductions.

Remembering these events all these years later, still brings a tear to my eye.  Do they teach that in police officer school, or were these guys just really good?

The fact remained that they had business to attend to.  They had an ambulance waiting.

“Why don’t we head up to the station?”  The first policeman asked respectfully.

I wasn’t inclined to move.  I was appreciating the shade, and I told him so.

“Better move out of this hot sun.”  The second man said.

I still wasn’t moving.

“Bet we could find something to drink.” The woman said.

Still no go.  With a stubbornness completely out of character to Josh Greenfield, P.W. had become a problem.  He had resolved not to cooperate.  The police officers, kind as they had proven themselves, understood that action had to be taken.  Much as Josh Greenfield might shudder at the thought, these two strong police man picked P.W. up and carried him the remaining distance to the Riverdale Station, up the stairs, across the overpass and into the ambulance waiting on the other side.  P.W. did not fight.  He did not resist.  He simply remained limp.

I say I believed I was this character.  That is not completely true.  There was some part of my consciousness that was still Josh, and that part knew what was going on, and frankly, was terrified.  The ambulance attendant, some kind of E.M.T., treated me kindly as well, and with him, I was more cooperative.  I lay down in the back of the vehicle and let him secure me.  That was the last I saw of the policemen.  They had done a first-rate job.  Things had gotten a little stressful when I wouldn’t go along with them, but on balance I couldn’t have asked for a better rescue team.  I had been in deep trouble and the three policemen had taken the first step toward setting things right.  If love is “wanting to make another person happy,” as Dr. Rubin has proposed, then these three police officers performed a loving act that day.

I rode in the back of the ambulance with the attendant by my side, and no siren blaring.  Together we made the short trip to the psychiatric emergency room of the Allen Pavilion of the Columbia Presbyterian Hospital.  The Allen Pavilion is a kind of annex that serves the far northern regions of Manhattan. The ambulance pulled up to the unloading area, and I was wheeled inside.

So there I was in the receiving area of the psychiatric emergency room of the Allen Pavilion of the Columbian Presbyterian Hospital.  One of the first things I did was step into the small bathroom and throw up.  I didn’t think this one through at the time, but in hindsight I can see that it was my body rejecting the unconventional means of hydration I had employed while walking beside the river.  I had had the bizarre idea that the small plastic bottles lodged among the rocks had been placed there by some divine power for my benefit.  Actually, they had been sitting there for days, if not weeks, and were filled with river water, and rain water, and the remains of someone else’s beverage and were entirely unfit for human consumption.  I threw up the whole lot.

Then it was back onto the dolly where I was to remain until I could be transported to some more permanent facility.   Unfortunately, I am compelled to report that during my brief stay in the emergency room I again did not cooperate.  Maybe it was because I had yet to receive any Zyprexa, I really don’t know, but I did not do exactly what they wanted. The burly male attendant wanted me to lie down.  I wouldn’t, I refused.  I felt I was compelled to play some part, a part I knew was not in my own self-interest.  He pushed me down.  It wasn’t that big a deal I guess, but at the time, on top of everything else, it was quite upsetting.

I have no recollection whatsoever of speaking with the doctors at this psychiatric way station.  They must, however, have learned the names of my parents or other family members, possibly with the help of the policemen and my digressions while walking by the river, because from there on out, things were taken out of my hands.  Arrangements were made.  I was provided for.  On this occasion, everything, I believe, was done right.  The psychiatric emergency system worked.  That August afternoon, I was in no condition to take care of myself, or fend for myself, or really do much of anything for myself.  I needed help, and I got it.

I was loaded in the back of another ambulance, and taken to my more permanent accommodations in the bucolic surroundings of Westchester County.  There are reasons they locate these kinds of places in the countryside, amidst the trees and the grass.  When, years later, things got rough again, I tried to replicate the experience on my own by spending time in the Rolling Hills Gardens, not outside the gate, and in Pine Plains, a green and quiet town in the Hudson Valley.  Granted some hospitals are right in the heart of Manhattan, so I suppose it isn’t always possible, but on balance, I believe it is preferable. There is something about being in nature that is good for the mind.  It has healing qualities.  I have a distinct recollection of lying in the back of the ambulance as the vehicle drove up the long drive way that led up to the hospital, and looking out the rear window at the trees passing over head.

I suppose I should try and say something about my state of mind during all this, this being a first-person account, but that is not easily accomplished. Rubin, my doctor at the time, asked me to write him a long hand account of what I was experiencing from the hospital, he may even have it filed away somewhere, who knows.  From my current perspective those thoughts are not easily recreated.  Nor would I want to, to be honest.  The whole thing was so dark and twisted and distorted.  I still believed I was someone I was not.  I believed I was this character, this P.W. By this point I was no longer uncooperative.  I was doing what I was told and going with the program. To be honest, I had absolutely no idea what was going on.  I was very mixed up.

They gave me my own room, and started me on the Zyprexa.  My doctor had been informed as to my whereabouts, as had my parents and my sister and brother-in-law.  My doctor knew, like the last time around, that these things happen.  He put in a lot of extra hours on the phone speaking with my family, and with me in the hospital, to make sure things proceeded as they should, but this whole thing didn’t throw him.   

The Westchester Psychiatric Hospital was entirely situated on one floor.  It was not well light, at least that is the way I remember it. I had my own room, small and rectangular with white walls. At one end of the room opposite the door was a large window that looked out on something green.  There was a single bed along one wall and a large closet.  There was also a dresser where I had the vague idea it would be necessary to hide my writing from the authorities who would search the room.  In retrospect, I do not believe any such searches took place. All the necessary functions of daily life were provided for.  I remember that breakfast cereal was provided at a central table along with orange juice and milk and plastic bowls and cups for consuming them.  There were bathrooms, but here the details remain vague.  Personally, I was still in another time and place.  Call it the Twilight Zone if you like.  I never watched the show all that many times, but it might come close.

I do have a specific recollection of the central meeting room, where at periodic intervals, once a day, or once every few days, all the patients on the floor would gather to be interviewed by one of the senior doctors, each in turn.  This doctor was a woman, and she was good.  In a few sentences, she would speak with each of us to determine how we were doing, and at the end of the session she would decide what our medication levels were to be.  I think she did a great job.  They had me on twenty milligrams of Zyprexa, which is an extremely high dose, and day by day, it did its thing.  It brought me back to this planet.  It returned a sense of reality, of what was really going on in this world, around me.  I took the medicine. I did everything I was asked to do. I would like to say, at this point that my behavior throughout my stay at the Westchester Psychiatric Hospital, unlike my behavior during the heart of the crisis, was exemplary, just as cooperative and courteous as could be. I got along fine with the doctors and the other patients and did everything as it should be done. 

The front door was locked.  I never went and tried it myself, but I’m quite certain it was and I remained aware of this fact.  There was a loss of freedom here.  Clearly, there were sufficient reasons for this.  Some of the other patients might have wanted to walk out, I don’t know. Speaking for myself, I had no desire to confront the system in any way, but others might not have been so stable.  I’m sure the precaution had to be taken.  I was constrained and despite the outdoor exercise and the amiable nurses, that was ever present.  Beyond that there isn’t a whole lot I can say.  I suppose it is a built in human defense mechanism that we are endowed with the ability to put these experiences behind us.  On a day to day basis I think about that time not at all.  A city bus I take regularly drives directly in front of the Allen Pavilion and the thought sometimes crosses my mind,

“I’d rather be out here than in there”

That’s all it amounts to.

About the Author:

Josh Greenfield is a graduate of both Phillips Andover Academy and Cornell University’s College of Arts and Sciences. He holds two master’s degrees from the City University of New York, one in History and one in English Literature. He also completed the better part of a doctorate in English at Fordham University. He is the author of two books, The Obsessive Chronicles: a novel and Homeward Bound: a novella of idle speculation, both published by Lulu. His work has been featured in The Cornell Daily Sun, The Riverdale Press, Appalachia, and Word Catalyst Magazine. www.JoshGreenfield.net