Mad Poet’s Society: McLean Hospital, Robert Lowell, Sylvia Plath, and Anne Sexton

In suburban Massachusetts, on 240 acres of peaceful grounds, is a literary legend—of sorts. McLean Hospital, with its long history of treating the blue bloods of Boston, has become an unlikely poetry landmark after providing both recuperation and inspiration to Robert Lowell, Sylvia Plath, and Anne Sexton.

Plath was the first of the three to stay at McLean. In 1953, during a summer at home before her senior year in college, Plath swallowed a bottle of pills and crawled beneath her house. Her failed suicide attempt led to months of treatment at McLean and began her long relationship with the psychiatrist Ruth Tiffany Barnhouse. While there, Plath received insulin-shock therapy, anti-psychotic drugs, and ultimately electroshock therapy. The experience surfaced years later in her poem, “The Hanging Man,” which begins, “By the roots of my hair some god got hold of me / I sizzled in his blue volts like a desert prophet.”

Lowell was admitted to McLean in 1958, though his infamous manic outbursts had already resulted in numerous stays at other mental institutions. Over eight years, he stayed there four times, correspondeding frequently from his hospital address, and sending letters to Theodore Roethke, Ezra Pound, and even Jackie Kennedy. Written about his first stay at McLean, his poem “Waking in the Blue” mentions Bowditch Hall and was pasted on the wall of the nurse’s station there for years.

Highly competitive with Plath, Sexton tried for years to be admitted to McLean, but her therapist, aware of the high cost, refused to admit her. Sexton first entered McLean as a teacher. In 1968, she was invited to lead a weekly poetry seminar in the hospital, providing Sexton with her first teaching experience, after which she became a professor at Boston University. In 1973, a year before her death by suicide, Sexton achieved her wish and was admitted to McLean for a five-day examination.

Plath and Sexton both attended a poetry seminar taught by Lowell at Boston University in 1959. They were each inspired by his confessional poetry and the appreciation for madness that he cultivated. In “Elegy in the Classroom,” Sexton wrote about Lowell: “I must admire your skill. / You are so gracefully insane.” Through his encouragement, they began to turn their personal experiences into verse—a quality that would mark their later work.

Plath discovered she could mine her McLean experiences for literary inspiration. She wrote in her journal, “There is an increasing market for mental-hospital stuff. I am a fool if I don’t relive, recreate it.” Thus she began her famous novel, The Bell Jar. Years later, in his introduction to Plath’s posthumous poetry collection Ariel, Lowell said, “Everything in these poems is personal, confessional, felt, but the manner of feeling is controlled hallucination, the autobiography of fever.”

Source: poets.org

Knocking Round the Zoo – by James Taylor

This is an autobiographical song describing Taylor’s stay at McLean, a psychiatric hospital near Boston where he stayed while finishing high school. Taylor was attending a strict boarding school called Milton Academy when he suffered a bout of depression that led his family to pull him from the school and send him to McLean, where he took classes at their affiliated school.

In this song, he explains how it felt like a zoo, with bars on the windows and people coming to look at you – his sister Kate broke down in tears during one visit.

While Taylor was at McLean, he spotted Ray Charles, who was sent there for his heroin addiction. Taylor’s siblings Livingston and Kate also ended up spending time there. Over the next 15 years or so, James ended up in various other rehab centers and hospitals to treat his addictions.

Just knocking around the zoo
On a Thursday afternoon,
There’s bars on all the windows
And they’re counting up the spoons, yeah.
And if I’m feeling edgy,
There’s a chick who’s paid
To be my slave, yeah, watch out James.
But she’ll hit me with a needle
If she thinks I’m trying to misbehave.

Now the keeper’s trying to cool me
Says I’m bound to be all right,
But I know that he can’t fool me
‘Cause I’m putting him uptight, yeah.
And I can feel him getting edgy
Every time I make a sudden move,
Whoa, yes it’s true.
And I can hear them celebrating
Every time I up and leave the room.

Now my friends all come to see me,
They just point at me and stare.
Said, he’s just like the rest of us
So what’s he doing there?
They hide in their movie theaters
Drinking juice, keeping tight,
Watch that bright light.
‘Cause they’re certain about one thing, babe,
That zoo’s no place to spend the night, no.

Just knocking around the zoo
On a Thursday afternoon,
There’s bars on all the windows
And they’re counting up the spoons, yeah.
And if I’m feeling edgy,
There’s a chick who’s paid to be my slave,
Watch out Kootch.
But she’ll hit me with a needle
If she thinks I’m trying to misbehave.

Martha White

Before there was Rosa Parks there was Martha White, who was thrown off a public bus in Baton Rouge, Louisiana for sitting in the “whites only” section. This was in 1953, 2½ years before Rosa Parks was arrested for the same “crime”. White’s defenestration didn’t move the country the way that Parks’s did, but she was brave nonetheless. White died on Saturday at 99.

Above a picture of her and her friends.

Grounding

What is grounding?

Grounding is a set of simple strategies to detach from emotional pain (for example, drug cravings, self-harm Impulses, anger, sadness). Distraction works by focusing outward on the external world– rather than Inward toward the self. You can also think of it as “distraction,” “centering,” “a safe place,” “looking outward,” or “healthy detachment.”

Why do grounding?

When you are overwhelmed with emotional pain, you need a way to detach so that you can gain control over your feelings and stay safe. As long as you are grounding, you cannot possibly use substances or hurt yourself! Grounding “anchors” you to the present and to reality.

Many people with ptsd and substance abuse struggle with either feeling too much (overwhelming emotions and memories) or too little (numbing and dissociation). In grounding, you attain balance between the two– conscious of reality and able to tolerate it.

Guidelines

  • grounding can be done any time, any place, anywhere and no one has to know.
  • use grounding when you are: faced with a trigger, having a flashback, dissociating, having a substance craving, or when your emotional pain goes above 6 (on a 0-10 scale). Grounding puts healthy distance between you and these negative feelings.
  • keep your eyes open, scan the room, and turn the light on to stay in touch with the present.
  • rate your mood before and after to test whether it worked.before grounding, rate your level of emotional pain (0-10, where means “extreme pain”). Then re-rate it afterwards. Has it gone down?
  • no talking about negative feelings or journal writing. You want to distract away from negative feelings, not get in touch with them.
  • stay neutral– no judgments of “good” and “bad”. For example, “the walls are blue; i dislike blue because it reminds me of depression.” Simply say “the walls are blue” and move on.
  • focus on the present, not the past or future.
  • note that grounding is not the same as relaxation training.grounding is much more active, focuses on distraction strategies, and is intended to help extreme negative feelings. It is believed to be more effective for Ptsd than relaxation training.

Mental grounding

  • Describe your environment in detail using all your senses. For example, “the walls are white, there are five pink chairs, there is a wooden bookshelf against the wall…” Describe objects, sounds, textures, colors, smells, shapes, numbers, and temperature. You can do this anywhere. For example, on the subway: “i’m on the subway. I’ll see the river soon. Those are the windows. This is the bench. The metal bar is silver. The subway map has four colors…”
  • play a “categories” game with yourself. Try to think of “types of dogs”, “jazz musicians”, “states that begin with ‘a’”, “cars”, “tv shows”, “writers”, “sports”, “songs”, “european cities.”
  • do an age progression. If you have regressed to a younger age (e.g., 8 years old), you can slowly work your way back up (e.g., “i’m now 9”; “i’m now 10”; “i’m now 11”…) until you are back to your current age.
  • describe an everyday activity in great detail. For example, describe a meal that you cook (e.g., “first i peel the potatoes and cut them into quarters, then i boil the water, i make an herb marinade of oregano, basil, garlic, and olive oil…”).
  • imagine. Use an image: glide along on skates away from your pain; change the tv channel to get to a better show; think of a wall as a buffer between you and your pain.
  • say a safety statement. “my name is ____; i am safe right now. I am in the present, not the past. I am located in _____; the date is _____.”
  • read something, saying each word to yourself. Or read each letter backwards so that you focus on the letters and not on the meaning of words.
  • use humor. Think of something funny to jolt yourself out of your mood.
  • count to 10 or say the alphabet, very s..l..o..w..l..y.
  • repeat a favorite saying to yourself over and over (e.g., the serenity prayer).

Physical grounding

  • run cool or warm water over your hands.
  • grab tightly onto your chair as hard as you can.
  • touch various objects around you: a pen, keys, your clothing, the table, the walls. Notice textures, colors, materials, weight, temperature. Compare objects you touch: is one colder? Lighter?
  • dig your heels into the floor– literally “grounding” them! Notice the tension centered in your heels as you do this. Remind yourself that you are connected to the ground.
  • carry a grounding object in your pocket– a small object (a small rock, clay, ring, piece of cloth or yarn) that you can touch whenever you feel triggered.
  • jump up and down.
  • notice your body: the weight of your body in the chair; wiggling your toes in your socks; the feel of your back against the chair. You are connected to the world.
  • stretch. Extend your fingers, arms or legs as far as you can; roll your head around.
  • walk slowly, noticing each footstep, saying “left”,”right” with each step.
  • eat something, describing the flavors in detail to yourself.
  • focus on your breathing, noticing each inhale and exhale. Repeat a pleasant word to yourself on each inhale (for example, a favorite color or a soothing word such as “safe,” or “easy”).

Soothing grounding

  • say kind statements, as if you were talking to a small child. E.g., “you are a good person going through a hard time. You’ll get through this.”
  • think of favorites. Think of your favorite color, animal, season, food, time of day, tv show.
  • picture people you care about (e.g., your children; and look at photographs of them).
  • remember the words to an inspiring song, quotation, or poem that makes you feel better (e.g., the serenity prayer).
  • remember a safe place. Describe a place that you find very soothing (perhaps the beach or mountains, or a favorite room); focus on everything about that place– the sounds, colors, shapes, objects, textures.
  • say a coping statement. “i can handle this”, “this feeling will pass.”
  • plan out a safe treat for yourself, such as a piece of candy, a nice dinner, or a warm bath.
  • think of things you are looking forward to in the next week, perhaps time with a friend or going to a movie.

What if grounding does not work?

  • practice as often as possible, even when you don’t “need” it, so that you’ll know it by heart.
  • practice faster. Speeding up the pace gets you focused on the outside world quickly.
  • try grounding for a looooooonnnnngggg time (20-30 minutes).and, repeat, repeat, repeat.
  • try to notice whether you do better with “physical” or “mental” grounding.
  • create your own methods of grounding. Any method you make up may be worth much more than those you read here because it is yours.
  • start grounding early in a negative mood cycle. Start when the substance craving just starts or when you have just started having a flashback.

One need not be a chamber to be haunted – Emily Dickinson

One need not be a chamber to be haunted,
One need not be a house;
The brain has corridors surpassing
Material place.

Far safer, of a midnight meeting
External ghost,
Than an interior confronting
That whiter host.

Far safer through an Abbey gallop,
The stones achase,
Than, moonless, one’s own self encounter
In lonesome place.

Ourself, behind ourself concealed,
Should startle most;
Assassin, hid in our apartment,
Be horror’s least.

The prudent carries a revolver,
He bolts the door,
O’erlooking a superior spectre
More near.

~ Emily Dickinson

Waking in the Blue – By Robert Lowell

The night attendant, a B.U. sophomore,
rouses from the mare’s-nest of his drowsy head
propped on The Meaning of Meaning.
He catwalks down our corridor.
Azure day
makes my agonized blue window bleaker.
Crows maunder on the petrified fairway.
Absence! My hearts grows tense
as though a harpoon were sparring for the kill.
(This is the house for the “mentally ill.”)

What use is my sense of humour?
I grin at Stanley, now sunk in his sixties,
once a Harvard all-American fullback,
(if such were possible!)
still hoarding the build of a boy in his twenties,
as he soaks, a ramrod
with a muscle of a seal
in his long tub,
vaguely urinous from the Victorian plumbing.

A kingly granite profile in a crimson gold-cap,
worn all day, all night,
he thinks only of his figure,
of slimming on sherbert and ginger ale–
more cut off from words than a seal.
This is the way day breaks in Bowditch Hall at McLean’s;
the hooded night lights bring out “Bobbie,”
Porcellian ’29,
a replica of Louis XVI
without the wig–
redolent and roly-poly as a sperm whale,
as he swashbuckles about in his birthday suit
and horses at chairs.

These victorious figures of bravado ossified young. 

In between the limits of day, 
hours and hours go by under the crew haircuts 
and slightly too little nonsensical bachelor twinkle 
of the Roman Catholic attendants. 
(There are no Mayflower 
screwballs in the Catholic Church.) 

After a hearty New England breakfast,
I weigh two hundred pounds
this morning. Cock of the walk,
I strut in my turtle-necked French sailor’s jersey
before the metal shaving mirrors,
and see the shaky future grow familiar
in the pinched, indigenous faces
of these thoroughbred mental cases,
twice my age and half my weight.
We are all old-timers,
each of us holds a locked razor.

~ Robert Lowell, from Life Studies, 1959

Benzodiazepines Addiction and Abuse

Benzodiazepines are a class of drugs that are commonly prescribed as a short-term treatment for anxiety disorders, panic attacks, and insomnia.

Although safe and effective when taken as prescribed, benzodiazepine drugs like Xanax or Ativan can be misused for their effects.

Over time, benzodiazepine abuse can lead to severe physical dependendence, addiction, withdrawal symptoms, and other negative health consequences without treatment.

Benzodiazepines are what’s known as central nervous system depressants (CNS). When taken, they depress central nervous system activity, which can affect breathing and physical movement.

Benzodiazepines are known to enhance the effects of the brain chemical GABA. When taken, this can cause calmness, sedation, and reduce anxiety.

Benzodiazepines, also known as “benzos,” can be abused in several ways. What benzo abuse looks like can vary from person to person, and some signs may be less obvious than others.

What benzodiazepine abuse might look like:

  • taking higher doses than prescribed
  • taking doses more often
  • crushing and snorting benzodiazepines
  • injecting benzodiazepines
  • drinking alcohol to enhance drug effects
  • mixing benzos with other drugs to get high
  • taking someone else’s prescription

Chronic benzodiazepine abuse, characterized as a pattern of frequent benzodiazepine misuse, can be dangerous and may harm both physical and mental health.

Misusing benzodiazepines can be dangerous. Both acute and long-term dangers can occur by taking this type of drug in any way other than prescribed by a doctor.

Primary dangers of benzo abuse include:

  • severe dependency
  • drug addiction
  • drug overdose
  • increased risk of polysubstance abuse
  • worsened mental health conditions
  • potential brain damage

Benzodiazepines are rarely dangerous when taken as prescribed. But misusing benzodiazepines carries a risk of serious dangers, including drug overdose.

Benzodiazepine overdose can occur by taking excessively high doses of a benzodiazepine, or by combining the use of benzodiazepines with other drugs, such as opioids, alcohol, or heroin.

People who overdose on benzodiazepines may experience difficulty breathing, breathe very slowly, become unresponsive, or collapse. If this happens, call 911 right away.

Mixing benzodiazepines with other substances such as cocaine, heroin, methadone and alcohol can have serious effects on both short-term and long-term health, with the potential to affect vital organ function and increase the risk of drug overdose.

Common short-acting benzodiazepines include:

  • alprazolam (Xanax)
  • lorazepam (Ativan)
  • triazolam (Halcion)
  • midazolam (Versed)
  • temazepam (Restoril)
  • oxazepam (Serax)

Common long-acting benzodiazepines include:

  • Klonopin (clonazepam)
  • Valium (diazepam)
  • Librium (chlordiazepoxide)
  • flurazepam
  • clorazepate (Tranxene)

Paliperidone (Oral Route)

Brand names:

  • Invega
    • Extended-release tablet: 1.5 mg, 3 mg, 6 mg, 9 mg
  • Invega Sustenna
    • Extended-release injectable suspension: 39 mg, 78 mg, 117 mg, 156 mg, 234 mg

Generic name: paliperidone (pal ee PER i done)

Paliperidone is a medication that works in the brain to treat schizophrenia and schizoaffective disorder. It is also known as a second-generation antipsychotic (SGA) or atypical antipsychotic. Paliperidone rebalances dopamine and serotonin to improve thinking, mood, and behavior.

What Should I Discuss With My Healthcare Provider Before Taking Paliperidone?
  • Symptoms of your condition that bother you the most
  • If you have thoughts of suicide or harming yourself
  • Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects
  • If you ever had muscle stiffness, shaking, tardive dyskinesia, neuroleptic malignant syndrome, or weight gain caused by a medication
  • If you experience side effects from your medications, discuss them with your provider. Some side effects may pass with time, but others may require changes in the medication.
  • Any psychiatric or medical problems you have, such as heart rhythm problems, long QT syndrome, heart attacks, diabetes, high cholesterol, or seizures
  • If you have a family history of diabetes or heart disease
  • All other medications you are currently taking (including over the counter products, herbal and nutritional supplements) and any medication allergies you have
  • Other non-medication treatment you are receiving, such as talk therapy or substance abuse treatment. Your provider can explain how these different treatments work with the medication.
  • If you are pregnant, plan to become pregnant, or are breast-feeding
  • If you smoke, drink alcohol, or use illegal drugs

Paliperidone tablets are usually taken 1 time per day with or without food.

Typically patients begin at a low dose of medicine and the dose is increased slowly over several weeks.

The dose of the tablets usually ranges from 3 mg to 12 mg. The dose of the Sustenna brand of long-acting paliperidone injection formulation usually ranges from 78 mg to 234 mg every month. The dose of the Trinza brand long-acting paliperidone injection formulation ranges from 273mg to 819mg every 3 months. Only your healthcare provider can determine the correct dose for you.

The tablets should be swallowed whole. They should not be chewed, crushed, or broken.

What Are Possible Side Effects Of Paliperidone?

Common side effects:

Tachycardia, drowsiness, extrapyramidal symptoms, restlessness, headache, increased prolactin, cholesterol abnormalities, increased glucose, vomiting, tremor.

Rare/serious side effects:

Paliperidone may increase the blood levels of a hormone called prolactin. Side effects of increased prolactin levels include females losing their period, production of breast milk and males losing their sex drive or possibly experiencing erectile problems. Long term (months or years) of elevated prolactin can lead to osteoporosis, or increased risk of bone fractures.

Some people may develop muscle related side effects while taking paliperidone. The technical terms for these are “extrapyramidal symptoms” (EPS) and “tardive dyskinesia” (TD). Symptoms of EPS include restlessness, tremor, and stiffness. TD symptoms include slow or jerky movements that one cannot control, often starting in the mouth with tongue rolling or chewing movements.

Temperature regulation: Impaired core body temperature regulation may occur; caution with strenuous exercise, heat exposure, and dehydration.

Second generation antipsychotics (SGAs) increase the risk of weight gain, high blood sugar, and high cholesterol. This is also known as metabolic syndrome. Your healthcare provider may ask you for a blood sample to check your cholesterol, blood sugar, and hemoglobin A1c (a measure of blood sugar over time) while you take this medication.

Schizophrenia and Trauma

Trauma and psychosis can each derail a person’s daily life by causing mental and physical disturbances which significantly disrupt even basic day-to-day functioning and skills. When experienced together, they can wreak emotional and mental havoc if left untreated.

When the onset of a psychotic disorder like schizophrenia happens to occur after a traumatic event, it can be tempting to blame the development of the former on the occurrence of the latter. Causality is comforting, in a way—being able to answer the larger question of why your loved one is living with the symptoms and challenges they currently face is somehow less daunting than having no answer at all.

What causes Schizophrenia?

Scientists identify a variety of causes and risk factors for schizophrenia. Research shows the disorder is brought on by a combination of neurological, genetic and environmental factors, including life experience. Schizophrenics have an imbalance of the neurotransmitters dopamine and serotonin in their brains, which is why they are often prescribed antipsychotic drugs. There may also be a genetic component; the risk factor of one person developing schizophrenia goes up if other close blood relations have been diagnosed with it.

Other factors which play a part in the development of schizophrenia include psychoactive drugs, such as methamphetamines or LSD. These drugs can cause brain damage, psychotic episodes, or trigger a schizophrenic onset.

Childhood factors may also affect onset and development. Fetuses exposed to malnutrition or viral infections in the womb may have a higher chance of getting schizophrenia. And childhood trauma can significantly change how children’s brains and thought processes develop and affect their adult lives.

Can trauma cause Schizophrenia?

While the jury is still out on whether trauma directly causes schizophrenia, according to research conducted by the University of Liverpool, children who experienced trauma before the age of 16 were about three times more likely to become psychotic in adulthood than those who were randomly selected. The more severe the trauma, the greater the likelihood of developing illness in later life. They even found indications that the type of trauma experienced may determine what specific psychotic symptoms will manifest themselves later on.

It is also certainly true that trauma which occurs after the onset of schizophrenia can exacerbate psychotic symptoms—especially if it leads to the development of a co-occurring trauma disorder, such as PTSD. Separately, these conditions can pose serious challenges to a person’s ability to live a “normal” life—together, they can become overwhelming and debilitating without proper care and support.

Source: BrightQuest

E. Fuller Torrey On Deinstitutionalization

Deinstitutionalization:

“It is important to understand the magnitude of deinstitutionalization. In 1955, when the United States had a population of 164 million people, there were over 558,000 mentally ill individuals in public mental hospitals. In 2006, the United States had a population of almost 300 million; if in 2006 we had had the same number of individuals in public mental hospitals as we had in 1955 in proportion to the population, the number of hospitalized patients would have been just over one million. In 2006, there were in fact only approximately 40,000 individuals in public mental hospitals.

Deinstitutionalization was not a onetime experiment that might be easily reversed. Once a patient was discharged from the hospital, that bed was no longer available for that person to return to or for a new patient to use. Eventually, at least forty state mental hospitals were closed altogether. Many of the seriously mentally ill individuals…who today are homeless, incarcerated, victimized, violent, or otherwise not receiving treatment have never been hospitalized at all.”

~ E. Fuller Torrey, from The Insanity Offense: How America’s Failure to Treat the Seriously Mentally Ill Endangers Its Citizens

#MentalHealth #Deinstitutionalization #TheInsanityOffense #MySchizLife