Little Islands, Dead Sea
‘In this unserious yet oddly exaggerated moral context, building up a self or having it destroyed becomes something of a shameless game… In hospital, the inmate can learn that the self is not a fortress, but rather a small open city.’ [1]
I am sitting on a patch of astroturf in the ‘outdoor’ area of the RPA Psychiatric Ward — a locked transparent box that overlooks the streets of Camperdown in Sydney. If I stand in one corner of the box and hold onto the railing, I have a full view of the university attended by most of my friends, and the cemetery we’d sit in as teenagers to drink cask wine after school. On the opposite side is the shortcut I’d walk through with my boyfriend to get home after a night out (kicking through the rotting camellias that carpeted the pavement), and the place we first separated when I was too unwell to concentrate (my fists pressed against the grass, the dew collecting underneath my fingernails).
Public hospital policy denies psychiatric patients access to phones, laptops or the internet, and I haven’t yet been granted any leave. I know nothing about whether my friends are drinking cask wine after university, or whether they feel the same way about their institution as I feel about mine. I only know that I am here and they are there. Inside the ward, a group of patients are sitting on stained armchairs, watching Big Brother on the one working TV in the building. A new patient, Ivan, has taken to hiding the remote down the front of his pyjama pants, giving him the power to control the television at all times. He’ll often sit in the adjoining dining room after eating a meal, unable to even see the TV, and start pressing buttons for a laugh. We do not want to touch the remote anymore, so we do not protest this.
When I first started my career as a psychiatric patient, I became convinced that the nightly line-up of TV shows was being produced by the hospital’s doctors. Judge Judy, Dr Phil, A Current Affair, The Bachelor, The Biggest Loser. This was why they were too busy to bother seeing any of us — they were in a studio somewhere, producing reels of film that gleefully objectified fat, poor or crazy people, which would be beamed into the ward to teach us all a lesson. It was only later that I realised these themes just happened to be de rigueur in the world of modern commercial television.
These days, as I navigate the unreality of the psychiatric system, it often feels as if the experience could be pitched as its very own reality show. Each morning, as patients are silently whisked away to other facilities or discharged home, new characters stumble in and regulars resurface. There are no psychologists on public wards to administer therapy, so we stride about with Mills and Boon paperbacks and bowls of lumpy soup, looking for signs of life, or waiting for the elusive psychiatrist to arrive and double our lithium. Each patient is granted one initial interview to summarise their identity and emotional history for the hospital record, before this document is reinterpreted or recast without warning. It is an added challenge to communicate your history when you happen to be exiled, physically and mentally, from the world in which the majority of your story occurs.
The nurses are asked to observe patient interactions to ensure we’re not getting ‘too friendly’, or organising a coup, or discussing the gory details of our disorders. The looming presence of CCTV cameras only heightens the knowledge that you’re being held in a confined space with specific rules and objectives, while also being barred from knowing anything significant about your fellow inmates. Of course, there is an occasional rush of competition and intrigue. Rivals on an arcane island, fighting over the state government’s meagre resources, struggling to curry favour with their captors! I peer into the lounge room and wonder which of us, if any, will claw ourselves back to real life.
As soon as Big Brother finishes, Joe heads outside for his nightly ‘cigarette’, joining me on the wooden bench inside the locked transparent box. Smoking is another activity that is disallowed in the public system. If a patient is granted a short amount of supervised leave by their psychiatrist, their bags are searched each time they re-enter the facility, and any contraband is confiscated and recorded by the nursing staff. Sometimes a nurse will slap a Nicorette patch on the patient’s arm if they’re complaining.
Joe is a gentle man in his mid-sixties, with a receding hairline and a grey ponytail. It’s worth noting that the nurses refer to him as Joe, but he is introduced to me by the other patients as ‘Grandpa’. He is known for sleeping on top of his bare mattress with a single cotton blanket, the rest of his sheets piled in a heap beside his hospital bed. He is also known for sneakily placing biscuits on other people’s pillows for them to find before they go to bed, as if he were a maid at a budget psychiatric hotel. In his five-week stay, he has managed to smuggle in a lighter and rolling papers in his running shoes, but hasn’t had any luck with tobacco. ‘Maybe tomorrow,’ he mouths to us, each time he is escorted back through the door.
Despite this, his smoke break is a meticulously scheduled ritual. He knows that if he goes outside and starts rolling around eight pm, just as the nurses are busy preparing our nightly medication, he’ll be finished by the time they call for us. He grins, reaches into his pocket and produces a selection of tea bags stolen from the group room. I respectfully decline. Joe splits open the tea bags and rolls four Twinings English Breakfast cigarettes, and one Bushell’s Decaffeinated. One for now, three for some of the patients inside, and hopefully one for later. To avoid the smoke alarms and security cameras, Joe squats in one corner of the transparent box and exhales carefully, threading a narrow ribbon of smoke through the gap between the concrete and the perspex. As he smokes, we quietly discuss our shared psychiatrist, a dead-eyed young man who doesn’t wear socks with his business shoes. I am on lookout duty — one eye fixed on the nurses, the other on the world outside.
I’m regularly amazed by the moments of ingenuity and humour that can arise from the institutional experience. Sociologist Erving Goffman writes that each psychiatric institution is ‘a kind of dead sea in which little islands of vivid, encapturing activity appear’[2], as patients attempt to simulate normality through the formation of daily rituals, familial interactions, social groups and casual disobedience. Each moment of levity or rebellion seems to represent a victory, a rare opportunity to take control and carve out a world from whatever you’ve been left with. Through this lens, Ivan’s remote-in-pants trick almost makes me feel like I’m sitting in the living room with my real dysfunctional family.
But my pride at having learned to make do, as if each institutional failing is a new challenge to transform, often eclipses the truth — that it shouldn’t have to be this way. At my fierce insistence, only three people have ever seen me during any of my hospital stays — my mum, my dad, and my first boyfriend. When I return to the real world, I might mention some of these stories to my friends, or write about them the way I am doing now. I do so as if I am a glib anthropologist, sent to hospital to capture these absurdities rather than to participate in maintaining the illusion of personhood amid a world of pain.
I perpetuate these half-truths to protect myself, the people in my life outside the hospital, and the institutional system I have been braided to for much of my adolescence and adulthood. To continue receiving treatment, I must maintain the belief that I can simultaneously exist within these spaces and preserve a whole identity. If a semblance of a full life can be accessed within psychiatric institutions, I don’t need to mourn the world I am missing out on outside the perspex box. Within the public psychiatric system, it is the task of the individual to unearth the strength and agility to maintain this illusion, and not question why state social policy is forcing us to build ‘little islands’ in the first place.
Before I leave, the doctor asks to keep
My fat heart — his new panic button
My hot mouth — a neat paperweight
And snuffs the incense in my tomb
Is this what happens? I ring the bell,
And they return me to my teenage bedroom
Where I sift through litter and old love notes
Like a nurse inspecting a stranger’s wound —
(This won’t hurt —
You’ll barely feel — )
Note: Little Islands, Dead Sea is an excerpt taken from a longer project that combines elements of memoir, poetry and academic theory to explore Australian psychiatric institutions and their patients.
Ruby Hillsmith is a poet and nonfiction writer. Her work has been published in Cordite Poetry Review, Sick Leave Journal, Honi Soit and Young Writers Showcase. At the moment she feels compelled to write poetry about her housemate’s delinquent pet bunnies, and essays about the Australian psychiatric system.
[1] Goffman, E. (1959). The Moral Career of the Mental Patient. Psychiatry, 22(2), pp.123–142.
[2] Goffman, E. (2017). Asylums. Abingdon: Taylor and Francis, p.69.
