Auto-Ethnography

“He’s trying to figure out if he’s high or just psychotic,” I explain. I’m listening as a doctor a few feet down the hallway tells a middle aged man, “We’re worried that you’re hearing and seeing things that aren’t there, so you’re going to need to stay for a little bit.” I’m with a friend who studies homelessness, an ethnographer’s ethnographer whose work I often find myself jealously comparing to my own. But now we’re in my domain—mental health care—and I’m happy to feel like the hundreds of interviews and observations I’ve conducted in the last two years makes me something of an expert. “If it’s drugs, they’ll let him come off it here and release him—otherwise, it’ll be a hospitalization,” I muse, “But it’ll be tough to keep him if he’s not dangerous.”

The doctor walks towards us. In my fieldwork, I love these moments, where I have a chance to ask my subjects about the reasoning and years of experience that go into the snap decisions I observe. But the doctor isn’t chatty and he isn’t answering questions. “What’s going on?” he asks me, with none of the warmth of the nurse who triaged me two hours prior, who told me, “Don’t worry, you’re in the right place.” Instead I feel like an imposter. He interrupts me after a few seconds of blubbering about my PhD. “What’d you do to your arms?” I’m crying too much to answer. “You didn’t actually break the skin anywhere, did you?” I don’t know what the standard is—they sure seemed like cuts to me—but I shake my head dejectedly. Apparently I am a failure even at self-harm.

I’ve been struggling to get access to a psychiatric ER since I returned from France. It’d be the crown jewel of my dissertation: comparing how apparently similar legal standards like “imminent danger to self or others” are applied by psychiatrists on opposite sides of the Atlantic. As it turns out, there’s an easy way in that doesn’t involve waiting months for a response from an Institutional Review Board or cajoling MDs into taking a chance on research they neither understand nor see much value in. All you have to do is write “suicidal ideation” on an intake form.

In the social sciences, most researchers wind up studying themselves, in one way or another, and I am no exception. But in my mind, there’s always been a divide between the world of high-functioning worried-well in talk therapy and on anti-depressants—the one I inhabit—and the world of repeated hospitalizations, disability payments, and heavy medication loads—the one I dart in and out of for my research.

Even as I hit peak melt-down—when my therapist, my parents, and my friends all converged on convincing me I needed to go the ER—I still felt like, intellectually, I had a handle on the situation. “They’ll give me an Ativan, an outpatient follow-up appointment, and a $6,000 bill,” I joke. I’ve had too many conversations about the declining number of inpatient beds in the U.S. and the revolving door of “Treat and Release” ER visits for me to believe they’ll keep me. “Maybe in France I’d be hospitalized for a few nights, but not in California”, I tell my friend.

The news doesn’t even come from a doctor. I’m chatting with a medical technician about his upcoming MCAT and our ear gauges when he tells me, sheepishly: “You’re actually on a 5150 hold so I need to go through your belongings, and you have to change into these.” He cuts me a break and gives me privacy while I put on my hospital pajamas, but for the rest of the night, I will not be the one making observations, but become the object of one-to-one surveillance.

Goffman talks about the entrance to a mental hospital as a progressive stripping away of roles, rights, and identities beyond those of a “patient.” At the moment, it felt more absurd than that. Someone whose face is obscured in my memory by a cloud of anxiety meds—by then in full swing—arrives to tell me that, having been 5150’ed, I can no longer buy a gun for the next five years. I try to make a joke that, in Trump’s America, it might be good to give everyone a preventative 5150; they don’t laugh. I realize I’m just a crazy person saying crazy shit.

I sign off on a list of “valuables” I will no longer have access to, including “duct tape wallet” and “Cult of Elk identification card.” I wonder if that puts me in the same category as the person actively hallucinating at my normal subway stop, his possessions a pile of rags next to me. Then there’s the lady who wants my insurance information. I’ve only seen a doctor for three minute, but in the end, my private insurance has a much greater influence on which hospital I wind up in.

Had anyone in the ER asked me if I wanted to go to the hospital, I probably would have said yes. But I am so ashamed to have sunk, so quickly, to the point where it wasn’t even worth posing the question to me anymore.

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