Life inside the psychiatric ward

"A kind of laziness brings me back to normal life. I am like a prisoner who is enjoying an imaginary freedom while asleep; as he begins to suspect that he is asleep, he dreads being woke up, and goes along with the pleasant illusion as long as he can."

– Renee Descartes,Meditations on First Philosophy

In the mornings, Creedmoor Psychiatric Center's Ward 3B resonates with a brand of white noise unique to a psychiatric hospital. It is loud with tinkling and crashing pumped in from television speakers: the metallic rush of the Price is Right wheel pulled by the show's spinning, smiling winners. Loud with the snores of still, slumped bodies in sticky vinyl chairs, with the shuffling of the 40 slippered and sneakered feet that pace between the two dayrooms, that wander around the nurses' station. Loud with the rollicking cackles of Caribbean therapy aides. With occasional outbursts over thefts real or perceived — "I wanna see her fit in a size 18! Let me see her breasts fit in my size 18 shirt. I wanna fucking see that right now, hippo!" Fights flame up and flicker out, undulating with moods, obscuring but never quite eclipsing the television and the miniature people who live so noisily inside it. The floor echoes with the game show announcer introducing his grand prize, a state-of-the-art home entertainment system. "If you're anything like us," he booms, "you watch a lot of TV!"

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Alice Trovato watches a lot of TV. Sitting here, she looks like any other 52-year-old Queens housewife idling the occasional lazy morning in her living room to the soundtrack of soap operas and sitcoms. But Alice, clad in a navy institution-issued sweatsuit that stretches at the belly and tennis shoes that squeak across the linoleum, can be found here every morning dispensing wisdom to fellow inpatients, her surrogate daughters, from a chair she calls her "therapist couch."

Though Alice's skin is pallid and her cheeks sunken, her brown eyes are comparatively lucid in a room filled with women alternately sedated or enraged. She comforts Shania, who believes a bulldozer is parked inside her forehead, and Sabrina, who thinks an ex-boyfriend has taken custody of their nonexistent septuplet babies, whose names she cannot always remember but each of whom is called a different diminutive form of "Angel." She chides the woman called simply Rodriguez — who scratches and spits during fights and has an unnamed communicable disease the ward psychologist says "you don't want" — for disrupting therapy groups, and counsels Cynthia, an obese 20-something who hears voices, against her meal of Snickers bars — a meat patty, pastries, and Pepsi — even as chunks of cream cheese dangle from the girl's lips and bits of bagel fall to the floor.

The dayroom is not a living room and these women are not Alice's family — her own grown son and daughter live, as does Alice's husband, on their own on the outside. Alice's "daughters" — the three or four young women who call her Mama, waist-deep in depressions and psychoses similar to those Alice herself has battled, for a comparably shorter period, over the last five years — stroke Alice's scalp, tie her hair up for her in a tight bun, and unleash to her their problems, actual and imagined, comprehensibly or unintelligibly. She is the ward's elected president, a self-described advocate for those here contending with disorders she believes are more incapacitating than hers. Most days, she's feeling better.

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Sometimes, though, angry voices and strange images emerge from the tightly folded recesses of her mind. Remnants of an abusive childhood, embedded in her memory the way accustomed-to house mice are in the walls of her old apartment, their presence, though once infuriating, forgotten until one scurries out from a hiding place, irrepressible, and she is forced to admit: "You're here for your own self, too."

Alice arrived at Creedmoor Psychiatric Center in September 2010 after spending eight months in Elmhurst Hospital Center following her latest suicide attempt. By the time she arrived on Creedmoor's 3B, a ward historically known within the hospital as "one of the wildest" wards for its "out of control female patients," she had been living full-time in psychiatric wards for over a year, had tried to kill herself in five separate, violent suicide attempts, and had been admitted to 14 different hospitals. For Alice, Creedmoor is both the latest stop and the last resort on a five-year-long involuntary journey into the depths of her illness.

Creedmoor Psychiatric Center sits on 200 acres in Queens Village, a residential neighborhood spliced by the Grand Central Parkway and Union Turnpike, and bordered by the leafy wetlands of Alley Pond Park in eastern Queens. The land it sits on remains largely unchanged from its depiction in "Creedmoor — Bird's Eye View of the Crowds," a painting reproduced in an 1877 issue of Harper's Weekly: sprawling blond grass, clusters of trees, and flattened acres stretch across a landscape then, as now, as vast and bare as muslin pulled taut over a loom.

The land where Creedmoor's campus now scatters, some of its 50-plus buildings long abandoned, was first a plot of farmland owned by the Creed family before its conversion into a National Rifle Association shooting range and National Guard barracks. A psychiatric hospital opened in 1912 with 32 patients; by 1933, its maximum capacity had exploded to 3,319. In September of 1958, when Alice was born, Creedmoor was in the midst of its busiest and most overcrowded period, serving between 6,000 and 7,000 patients, who paced the sprawling grounds and performed in choral groups, an orchestra, and minstrel shows.

Beginning in the 1960s, however, newly developed antipsychotic drugs and changing social policy led to the rapid deinstitutionalization of psychiatric patients here and throughout the country, shifting the burden of their care as much as legally and medically possible from the shoulders of the state to the backs of their communities. By the end of 1985, Creedmoor's population was down to 1,258. Ten years later, it had dropped to 924, and by 2005, when Alice began having "breakdowns," the population had shrunk to 449. The year she checked in, 2010, Creedmoor's average daily population had dwindled to 393, with 386 admissions and 390 discharges accounted for that year — a statistical success, in the view of the New York State Office of Mental Health, whose goal, according to one staff member and echoed by others, is to "get them in, so we can get them out."

Creedmoor continues to serve its designated district, the 2.3 million-person, 112 square-mile borough of Queens, with 16 wards and 395 beds for longer-term inpatients, in addition to outpatient services, the predominant treatment for the mentally ill in the years following deinstitutionalization. The majority of the patients here are on Medicaid; as a state hospital, Creedmoor cannot turn anyone away, including illegal immigrants and the uninsured. Many suffer from chronic schizophrenia's fixed delusions ("They wouldn't know to come in from the cold," explains Kevin Lynch, the hospital's director of quality management and a licensed social worker), from schizoaffective disorder, or from other thought disorders. Before arriving here, they believe "'this life's not working out for me,'" says Lynch. "Everybody's here because things weren't going well out there."

For employees and visitors, there are a few ways to get here: Exits 23 off the Grand Central or 28A off the Cross Island Parkway, or a combination of subway routes and a handful of buses. Creedmoor evokes for longtime Queens drivers a peculiar curiosity: Framed by the pristine, lonely edges of Alley Pond Park, the two-winged main building cuts a silhouette evocative of the Lincoln Memorial's statue of the seated president, but bereft of any elegance, its color that of sun-blanched sandstone. Dropped, seemingly, into the only remaining area of Queens uncluttered enough to hold both its campus and the expansive grassy radius that seems to protect it, Creedmoor could not be mistaken for anything other than a hospital or a housing project; it remains an unsettling, 17-story question looming high above the low-slung homes that hedge it and that look as though they want to keep their distance.

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To come to Creedmoor as an inpatient is to travel a very different route. The institution accepts only adults who are classified as "severely ill" and at high risk of hurting themselves or, less frequently, those around them. Patients must be referred by another hospital; there are no walk-ins accepted. Sometimes they are transferred voluntarily; other times, with only the consent of their caretakers. While policy may have made the route more labyrinthine, Creedmoor remains for those who find their way here — for Alice and others chronically suicidal like her — the only remaining defense against themselves.

Alice arrived on the admissions ward in September 2010, referred by Elmhurst Hospital Center, a public hospital in Queens. Upon admission, she was, as all new patients here are, analyzed according to Creedmoor's Psychiatric Assessment, a standard 11-page questionnaire that details every aspect of her medical and personal background: Illness onset (early 2005); symptoms and diagnoses (auditory/visual hallucinations, severe depression, suicide attempts; a bipolar disorder misdiagnosis that was recently changed to schizoaffective disorder); marital status (married to her childhood sweetheart, "the only man I ever had," Alice calls him); medication regimen (18 pills, administered throughout the day); hobbies (crochet, reading). Less quantifiable aspects are recorded as well. Question 10 asks, "Does the patient seem motivated for education/treatment?" Alice, says social worker Jacquelyn Smith, a young woman with an eyebrow ring and mousy ponytail, is very motivated.

In October 2010, Alice was transferred to ward 3B, an all-female inpatient unit on the third floor of the main building known for dialectical behavior therapy, a Zen-based cognitive therapy instituted here in 1995 that has since proven effective for reducing suicide attempts and other forms of self-harm. The windows of the activity room on 3B frame a skeletal bustle of leafless trees that separates the parkway from the houses beyond, which are invisible from this vantage point. Muted cars speed across the asphalt in the distance. Before her admission, Alice drove down that parkway often. "I used to live on Long Island," she says. "Whenever my husband and I would drive by Creedmoor, I'd say, 'I wonder what it's like in there?'" Today, in her fourth month living at Creedmoor, she says, "Well… I know."

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