-[TODO psych ward—
- * The thing about being institutionalized, is that it wouldn't be such an ordeal if it happened when you were well. Getting kidnapped by strangers, having to spend three days in a bad hotel and do some kindergarten-like activities, would be a mere inconvenience while well. But _while having a psychotic break_ is the _worst time_ to be kidnapped. I often have a sense of "where I am" geographically (not just my immediate surroundings, but also knowing how my surroundings relate to the world, what city I'm in; what freeways connect to that city; doesn't exist when kidnapped)
- * Even things that are for your benefit during the check-in process are hard to appreciate as such—I remember them counting my money in front of me, and feeling like it was an Orwellian exericse to undermine my connection to reality; maybe, I didn't trust that _she_ knew how to count?
- * trying to complain to the staff—got told to speak to patient's rights; I didn't even bother, because I didn't think that was real; a later SSC claims that patient's rights is supposed to be adversarial, but that wasn't clear from the inside; I'm reminded of that AmRen article [article by a public defender](https://archive.is/HUkzY); I empathize with the defendant https://slatestarcodex.com/2018/03/22/navigating-and-or-avoiding-the-inpatient-mental-health-system/ "Usually the doctors hate them, which I take as a pretty good sign that they are actually independent and do their job"
- * First facility—separate rooms with beds for men and women; me tapping at the walls trying to teach; pacing, thinking I was one of the most important people in the world
- * Taken to a separate facility; _very_ lucky to get my own room
- * paper claims that I "self presented due to your suicidal thoughts"; this isn't true; getting stopped by the cops while trying to
- * "Now memories are blurred, and their faces are obscured"
- * racist/sexist intuitions: avoid the gaze of males; males physically smaller than me are OK
- * a moment of solidarity with a black male smaller than me?
- * beliefs about evolutionary psychology (make friends, avoid enemies) very salient
- * fragmented memory: Joy intentionally hurt herself while I was trying to help her, football coach-like orderly said he was only trying to help; Joy says, this never happened
- * black woman named "Tone" asked what we had for breakfast
- * black man saying something about his mother, I explained that his mother probably did love him, he got angry, and I hid behind my door
- * doing better than in 2013 precisely because I was modeling the place as a prison
- * wanted to avoid taking medication, put on a magician-like "show" to nurse to try to trick her, it didn't work
- * I ended up with a booklet that claims I have the right to refuse medication, but this isn't actually true in practice
- * asking Anna on the phone whether I was a political prisoner "Really?" "Really really?" followups (if I were a political prisoner; she might not be able to say so)
- * mother visited, mother was cranky, Michael Vassar visited; Michael said that rape doesn't really happen in this kind of facility, and I believed him; I handed him papers (which I thought was necessary to escape the powers that be)
- * vision of needing to pull the fire alarm?
- * other males pacing the way I pace
- * my reports were not reliable; I thought Vassar pretended to be a doctor; I thought one of the other inmates had a security code
- * trope-awareness of being a psych patient; distrustful of other psych patient; thought I could subtly leave clues that I was a Jesus-analogue (as a Jewish male with long hair) to discourage people from murdering me (because the Christianity meme says you're not supposed to do that); I told people that my father was coming to pick me up at the end of my 72-hour (== 3 days) evaluation period, but that it wasn't fair that I couldn't rescue everyone. (I'm proud of this one.)
- * my father actually did pick me up three days later!
+The thing about being psychiatrically institutionalized, is that it wouldn't be such an ordeal if it happened while you were sane. Getting kidnapped by strangers and having to spend three days in a bad hotel doing kindergarten-like activities would definitely be an inconvenience, but it wouldn't be traumatizing, if you were psychologically stable and knew that this was just a thing your Society did to people sometimes—worse than jury duty, but not _qualitatively_ worse than jury duty.
+
+The problem is that _while having a psychotic break_ is _the worst possible time_ to be kidnapped by strangers.
+
+The authorities will claim that psychiatric hospitals are for the benefit of the patients. I'll concede that this is possible in some cases: maybe some people have such dysfunctional home lives, or would otherwise be living on the streets, such that the psych ward is actually a better place for them.
+
+For most people of my social class, I don't think this is plausible; if the welfare of the crazy person were the primary criterion, almost everyone would be better off with their friends or family, in a familiar environment with people you know.
+
+Rather, psych wards make sense as being for the welfare of friends or family who are _sick of putting up with living with a crazy person_. It's a form of responsibility laundering: if there's a designated institution for taking care of crazy people, you can dump your loved ones there to be _someone else's problem_ (at least for a few days), with a clean conscience, because anything bad that happens inside of an officially sanctioned institution, isn't anyone fault.
+
+It's important not to be misled by the name, psychiatric "hospital". The word _hospital_ gives the impression of a place where medical procedures are performed, like how real hospitals do surgeries and set broken bones. We don't really have _procedures_ to treat mental illness—not ones that are held in high regard these days, anyway.
+
+It's a jail—a place where you lock up undesirable people where they can't impose costs on anyone who isn't being paid to deal with them. And precisely _because_ I was modeling it as a jail, my social performance was a lot better this time around than in 2013.
+
+I unironically suspect it would be kinder and less confusing if the authorities would just explicitly label it a jail: to just say, Society or your loved ones are _sick of your antics_, so we're going to lock you up in this place and drug you until you obey us and act "normal". An honest punishment of force applied to change behavior is so much less cruel than the psychological abuse of a punishment that coerces its recipients into affirming it as "care".
+
+
+[TODO psych ward scenes—
+
+A nice thing about being a free citizen that you don't notice until you've lost it by being kidnapped and thrown in jail, is having a sense of where you are in the world. When visiting an unfamiliar place, I at least know _how_ I got there, how this place _connects_ to everything else in my model of the world: I may not be familiar with this building or these streets, but I know the train or highway that I took to get here from places that I do know—at worst, if I brought my phone, I can pull up Google Maps to see where I am.
+
+In psych jail, this sense of connection is suddenly absent. You don't know what route the ambulance took. You're locked in a building with strangers. There is no Google Maps. You could be anywhere.
+
+...
+
+
+Even things that are more-or-less genuinely intended to be for your benefit, are harder to recognize as such when you're _insane from sleep deprivation_ and rattled from just having been _kidnapped by armed men_.
+
+When being checked in, they confiscate any belongings you have on you. I remember one of the psych ward employees counting the money from my wallet in front of me.
+
+In retrospect, I can appreciate this practice as the system trying to offer evidence of its trustworthiness: they don't just steal your stuff; they _document_ the items they're confiscating, and give it back to you afterwards. (I have in my possession a yellow carbon copy of my "Patient Valuables Record", form A7026, which lists what they took.)
+
+At the time and in context, I wasn't prepared to appreciate it; the employee counting my bills in front of me seemed like an Orwellian ["There are five lights"](/2018/Aug/interlude-xii/) dominance display, intended to undermine my connection to reality—and maybe, I didn't trust that _she_ knew how to count.
+
+...
+
+
+When I tried to complain about the injustice of my confinement to staff, I was once told that I could call "patient's rights". I didn't bother. If the staff weren't going to listen, what was the designated complaint line going to do?
+
+About a year later, Scott Alexander published a _Slate Star Codex_ post, ["Navigating And/Or Avoiding The Inpatient Mental Health System"](https://slatestarcodex.com/2018/03/22/navigating-and-or-avoiding-the-inpatient-mental-health-system/), which claimed that patient rights advocates _do_ advocate for patients in opposition to the rest of the system. ("Usually the doctors hate them, which I take as a pretty good sign that they are actually independent and do their job.")
+
+This was _not at all_ obvious from the inside. I'm reminded of an article I once read in the racist[^racist-magazine] magazine _American Renaissance_, [by a public defender complaining about the behavior of his predominantly black clients](https://archive.is/HUkzY):
+
+[^racist]: I think they would prefer that I say _racialist_? But I also think that, when pressed, they would concede that _you know what I mean_.
+
+> If you tell a black man that the evidence is very harmful to his case, he will blame _you_. "You ain't workin' fo' me." "It like you workin' with da State." Every public defender hears this. The more you try to explain the evidence to a black man, the angrier he gets.
+
+After my psych ward experiences, I deeply empathize with the clients here. In the defense attorney's worldview, he's working to protect his clients' interests, and is frustrated that they don't appreciate that. What the defense attorney doesn't see is that his work only benefits the clients from _within_ the terms set by a system of power that looks arbitrary and unjust to those on the other end of it. From the perspective of a client who doesn't think he did anything particularly wrong (whether or not the law agrees), the defense attorney is _part of the system_.
+
+So I think my intuition was correct to dismiss patient's rights as useless. I'm sure _they_ believe that they're working to protect patients' interests within the system, and would have been frustrated that I didn't appreciate that. But what I wanted was not redress of any particular mistreatment that the system recognized as mistreatment, but to be _let out of psych jail_—and on that count, I'm sure patient's rights would have told me that the evidence was harmful to my case. They weren't working for me.
+
+...
+
+After I was released and got my belongings back, I couldn't find my Driver License. For a few days, I assumed that one of the psych ward employees had stolen it out of my wallet. I was wrong: actually, there was a separate license-holder compartment inside the wallet. I had forgotten.
+
+...
+
+This was a theme in my thoughts at the time: I was scared that the world was a much less orderly place than I knew. I used to believe the world was "made out of words": that the things people said were mostly true, that the world protrayed in books and maps mostly _was_ the real world. Suddenly, I had been granted a different view of reality, a world of animals in which _words don't matter_.
+
+In retrospect, my psychotic vision of a languageless world turned out to be false. Most people really _do_ know how to read.
+
+I fear that some readers will take this as an admission that the authorities were right, that conventional social reality is right—that I was _just_ crazy, and everything I thought while I was crazy can be costlessly discarded.
+
+I don't think that's right. I _was_ crazy, but _that doesn't mean ordinary social reality is sane_—and it doesn't mean that some of the things I thought I saw from my altered perspective weren't _directionally_ correct, as I can evaluate them from a more standard frame of mind now.
+
+Sometimes, the words written down in official documents really are just lies. I have in my possession an "Involuntary Patient Advisement" form, which claims that I "self presented due to [my] suicidal thoughts". This isn't true. Getting accosted by cops while trying to go into the train station to get back to my apartment is not the same thing as "self presenting"![^telephone-game]
+
+[^telephone-game]: Reading the doctor's notes six years later, it seems likely that this false description was copied from the beginning of a note ("WHO WAS SELF PRESENTED TO CCRMC PES VOLUNTARILY DUE TO SUICIDAL THOUGHTS") that _also_ contains a more accurate description of events later in the same note, except for the substitution of Oakland for Walnut Creek ("PT SEEN EARLIER TODAY IN THE KAISER OAKLAND ED BUT WAS RELEASED WITH THE CONTRACT MOTHER WOULD TAKE HIM HOME AND MONITOR HIM. AFTER THEY GOT HOME PT LEFT WITHOUT TELLING ANYONE. MOTHER REPORTED HIM A DTS"—danger to self—"AND POLICE EVENTUALLY FOUND HIM AT THE BART STATION").
+
+I ended up with a "Rights for Individuals in Mental Health Facilities" handbook, which claims that:
+
+> You have the right to refuse medical treatment or treatment with medications (except in an emergency) unless a capacity hearing is held and a hearing officer or a judge finds that you do not have the capacity to consent to or refuse treatment. The advocate or public defender can assist you with this matter.
+
+Naïvely, one might expect that having the right to refuse medication means that when someone tries to give you medication, you can just say that you don't want to take it, and they'll respect that. This did not seem to be true: I was reluctant to take medication, but the behavior of the staff made it clear that they weren't going to take no for an answer, and I folded, _because they were holding me prisoner_.
+
+I remember trying to deceive a staff member, putting on a "show" with magician-like hand flourishes (to which she dutifully pretended to be impressed, as one would to a toddler) before taking the pill—hoping to palm it before swallowing it without her noticing. It didn't work. I swallowed.
+
+Maybe if I had had the presence of mind at the time to read the rights handbook, and point to the specific line where it says, "You have the right to refuse [...] treatment with medications", they would have accepted that? But it seems likely that that would have been punished by a longer stay. A "right" that you get punished for exercising is ... not much of a right?
+
+As it happens, I _now_ think that taking the medication was a good idea. The reason I think this is because when I sought psychiatric help for insomnia in early 2021—intending very dearly not to go insane from sleep deprivation again, very much not wanting to be institutionalized again—the doctor told me that my records from my 2017 institutionalization said they had me on Zyprexa 5mg and Trazadone 50mg. Trazadone!—that was on [Scott Alexander's insomnia page](https://lorienpsych.com/2021/01/02/insomnia/).
+
+I worry, again, that some readers will take this as vindication that the authorities were right: they forced me to take drugs, and now that I'm sane and have a little more information, I agree that the drugs were a good idea. Why, the contemptuous normie reader asks, does this not demonstrate that they were right to force me, when I was crazy and therefore couldn't make decisions for myself?
+
+Because submission to authority isn't the same thing as sanity. In the psych ward in February 2017, I _knew_ that I needed sleep. If someone I trusted to have my best interests at heart had _told me_, "This is 50mg Trazadone; I strongly recommend you take it, because it will help you sleep; I also have this Trazadone fact sheet you can read if you want more information," I would have taken it.
+
+But a system that actually had my best interests at heart would not have _kidnapped me and locked me in a building with strangers_, which is _not a good environment for getting rest_. Serious antipsychotic medication is scary stuff. When I was institutionalized in 2013, I got tardive dyskensia—an involuntary lip-smacking compulsion—from the Haldol that they gave me. Tardive dyskensia can be permanent in some cases. Given that experience, and given the information I had at the time in 2017, I do not think I had good reason not to just trust the system!
+
+...
+
+I remember pacing the tiled halls of a the first facility where they took me—probably [Contra Costa Regional Medical Center](https://cchealth.org/medicalcenter/psychiatric.php) in Martínez.[^ccrmc] I was exhausted, but also feeling a sort of manic euphoria, pacing around, tapping demonstratively at the signs on the walls, thinking it was my duty to teach the other inmates how to read. Ziz's report of Vassar's comment about "Zack Davis _vs._ the world" stuck with me; I had of vision of myself as one of the seven most important people in the world in the lead-up to the intelligence explosion, as reckoned by future historians. Being a world–historically important genius wouldn't have _felt like_ being a genius at the time, most of the time. It must have felt like being pretty smart, and the rest of the world seeming dumb and crazy. (A young Albert Einstein working in the Swiss patent office wouldn't have had the mononymic aura of "Einstein" _to his contemporaries_.) Notwithstanding that I was having psychotic delusions of grandeur at the time, I do think it was legitimate for me to feel that I was pretty smart, and that the rest of the world was dumb and crazy.
+
+[^ccrmc]: I only know this because, when consulting the doctor's notes available to me while writing this up more than six years after the fact, one of the notes mentions "CCRMC PES". "PES" is probably "Psychiatric Emergency Services".
+
+There were two rooms with beds, in that first facility: one for women, and one for men. I didn't end up sleeping there that I recall. Before long, I was taken to a separate facility, [Fremont Hospital](https://fremonthospital.com/), which had individual rooms. (Or was I incredibly lucky to not have been assigned a roommate? Having to sleep by someone else at night would have been very bad for me, given my fear of the other inmates and my desperate need for sleep.)
+
+...
+
+My memories of life in psych prison aren't very clear, partially because of how out-of-it I was, and partially because it's been more than six years since then, and memories decay if you don't _write them down_ (within hours, days, weeks—not _six years_). I wrote a [little](/2017/Mar/fresh-princess/) [bit](/2017/Jun/memoirs-of-my-recent-madness-part-i-the-unanswerable-words/) about my experiences in 2017. I think I would have written more if I had remembered that the consequence of not confronting [the challenge of](/2017/Nov/the-blockhead/) recording painful memories is that you lose them. I retain some access to my psychotic [sense of life](http://aynrandlexicon.com/lexicon/sense_of_life.html), but only episodic fragments of specific events. ("Now memories are blurred, and their faces are obscured, but I still know the words to this song" ...)
+
+My beliefs about game theory and evolutionary psychology—the theory and practice of making friends and avoiding enemies as a animal—seemed much more salient and actionable than anything about the world that was made of words, or the right way to behave as a person in civilization (as contrasted to an animal).
+
+It seemed important to avoid the gaze of males, particularly males physically larger than me. (If they noticed me noticing them, they would try to threaten me.)
+
+...
+
+An Asian woman named Joy seemed to hurt herself on the hinges of the cart used to bring us meals, in a way that plausibly looked like my fault—maybe I had opened the door on the cart while her fingers were in the wrong place? A football-coach-like orderly took my side (in the manner of a grown-up intervening in a squabble amongst kindergarteners), saying that I was only trying to help. When the orderly was out of earshot, Joy looked at me and whispered, "This never happened." I was never sure what that was about. Had she only been pretending to be hurt, and was telling me to keep quiet?
+
+A young black woman named Tone asked me what we had for breakfast—as if the Orwellian dominance rituals we were forced to undergo, had her doubting her senses and her memory, and she was looking to me (a fellow inmate, not an authority) to keep her sane, to verify her connection to reality.
+
+A black man in the hallway was saying something about how his mother didn't love him. This seemed unlikely to me, so I tried to explain to him that his mother probably did love him. He got angry. I hid behind a door.
+
+I shared a moment of solidarity with a black man who was physically smaller than me, and therefore seemed safe to interact with. Society locked us up here because they don't want to deal with people like us, I said, but we need to stay strong.
+
+...
+
+I got the idea that it ought to be helpful to prove my agency to the staff. I'd say something like: I'm going to take a shower now, and then be ready for bed at this-and-such time, and then point out at the aforementioned time that I was actually ready, just like I said I would. My ability to make correct predictions about my future behavior showed that I was an approximately coherent agent, therefore sane, and therefore that I should be released.
+
+...
+
+I remember having Anna on the phone, and asking if I was a political prisoner. (The Soviet Union had declared its dissidents sick with sluggish schizophrenia as a pretext for persecuting them; how could I be sure things worked all that differently here?) She answered in the negative. "Really?" I said. (If I _was_ a political prisoner, she might not be able to say so over a telephone line controlled by the authorities.)
+
+...
+
+My mother visited. Her presence was actively anti-helpful. She was very cranky, acting like being here was my fault, my punishment. I had a vision of pulling the fire alarm, and being held back by the knowledge that it would only make my punishment worse. (I'm not confident there was actually an alarm for me to pull; I would have expected other inmates to have had the same idea.)
+
+Michael Vassar visited, overlapping with my mother. Michael was extremely helpful, including in de-escalating my mother's hostility. (I would later describe him as "pretend[ing] to be a doctor for my mom", but on reflection, I don't think that's what happened; More likely, he had mentioned MetaMed, and I misinterpreted it.) I talked to him in a side room, saying that I was scared to sleep because I was afraid that this was the part of the simulation where I would get anally raped. Michael said that that didn't really happen in this kind of facility. Crucially, _I believed him_. (I wouldn't have believed any assurances from the "hospital" authorities.) I handed him some folded papers on which I had jotted down some notes (inmates were allowed dull golf pencils), thinking that I needed to be covert to escape the attention of the authorities.
+
+...
+
+I remember seeing another male pacing the hallways, the way that I pace sometimes. I hadn't particularly thought of that as a "gendered" (sexually dimorphic) trait, but seeing another man do it (and not particularly remembering seeing a woman do it) made the hypothesis salient, that it was the spandrell of some hunter (not gatherer) behavioral program.
+
+...
+
+I was a very genre-savvy psych prisoner. I was distrustful of the other inmates, and distrustful of the authorities, but in different ways; the optimal strategy to protect myself against each was different.
+
+I feared violence from the other inmates. I thought I could subtly leave clues that (as a Jewish male with long hair), I was an incarnation of Jesus, which would discourage them from attacking me (because many of them would have already been programmed by the Christianity memeplex to believe that killing Jesus was the worst sin). I told people that my father was coming to pick me up at the end of my three-day evaluation period, but that it wasn't fair that I couldn't rescue everyone. (I'm proud of this one, even though I no longer agree with the threat model.) My father actually did pick me up in three days.
+