Chapter Text
Carrying a heavy suitcase and a heavy mind, Tyler sits on a worn down faux leather sofa in the hallway of the acute psychiatric ward, flanked by two paramedics in white polo shirts and orange cargo trousers, waiting to get admitted to the local psychiatric hospital on a windy, wet, grey October afternoon. Nameless, faceless nurses walk past them, acting as if they expected this, as if this was just a normal afternoon, two paramedics and Tyler in the middle. Numb mind, shaking body, fingernails buried into the sofa's cushioning. Tyler tries his best to ignore the voice behind his back telling him that they know, they knew you were coming, they know. He's suspended in time, heart racing, watching his thoughts fly past the window as the trees outside shake their orange and yellow coats. Even though the sky isn't snow-threatening and the trees aren't skeletal yet, an eerie, foreshadowing sense of fear has begun to creep up Tyler's legs and make itself at home right inside his chest. The fear is clairvoyant in its clarity and just about as real to Tyler. The fear that his thoughts can melt like snow on the bare, thin branches. The fear that his insides will meet the outside, of his mind becoming grey slush on the street for people to trod on, for cars to drive by. The fear that, even though he spends a good amount of time along with his thoughts, his thoughts aren't his alone. They can be heard, slithering like snakes, whispering in threatening subdued yells inside the walls of his parents' house in the suburbs of Ohio, where he used to roam the streets with his brother Zack, feeling invincible.
Now all he fells is invisible. The voices told him not to take his antipsychotic and he complied, becoming complicit with the sick part of his mind.He was switched to a different antipsychotic during the summer, the dosage forever adjusted until the voices turned into background whisper and the delusions disappeared. His whole world was muted. He could no longer hold a conversation, let alone recognize his thoughts as his own. Everytime he took his meds the sickness disappeared, but so he did he.
Tyler tried, though. He to make peace with his medicated self, tried to tell himself that after all he's been through, after all his illness has put his family has been through, staying home for the summer and not on the psych ward was actually quite an accomplishment. Forget about going to college on a full scholarship or shooting 500 baskets after dinner. "This is the first time I've seen Tyler laugh in months", his mother whispered to Tyler's dad as they all sat together for a barbecue and Jay tried to teach Tyler throwing baskets again. "I'm really glad to be alive," Tyler wrote into his journal that night and he meant it. He was trying to forgive himself quietly. He was nurturing inside himself the belief that no matter how things are now, tomorrow things can be a little better. To keep going.
Tyler did try. He tried with all his might. Over the summer he practiced the exercises his therapist had taught him to calm down, to self-soothe. To survive. Radical acceptance. Doing deep breaths. Journaling. Using a box full of distractions eveytime he feels the urge to cut himself. Diligently, he took the new antipsychotic, the antidepressant and his antiepileptic medication, only sometimes needing support of PRN meds. He saw his psychiatrist regularly, too, a guy with silver hair, a well-fed belly and a well-meaning smile. "Actually, Tyler," he suggested during one meeting, "I once had a patient with schizophrenia who played chess with his voices. Funny bloke. I'm not trying to suggest that you start playing chess with your voices," he continued, smiling at Tyler's facial expression, "all I'm saying is that there is a way to live with this illness. There is a way. You've got to learn to live with this."
His social worker came too, weekly visits from a guy who wore Birkenstock sandals and hideous khaki cargo pants, jiggling his keys and insisting that Tyler gets out of bed, out of the house, into the chaos and clamor of Columbus. It's such a beautiful day, Tyler. Let's make the most of it.
Tyler wrote into his journal, every day, trying to make himself believe that what he wrote on the pages is real.
Your soul knows good and evil, your soul knows both sides
And it's time you pick your battle, and I promise you this is mine
It's been a summer, of sorts.
The sun will rise and we will try again
To Tyler and his parents, that summer meant everything.
But it wasn't enough.
It's never enough.
As summer began to turn into autumn, as the leaves changed from a lush green to bright, honey tones of yellow and orange, Tyler could feel himself gravitating towards the dark, scary, bleak place locked deep inside himself again. A place that isn't a place but a feeling. A feeling that isn't a feeling but a nameless shadow that's forcing Tyler to wear noise-cancelling headphones all day again and even then, he can hear them, the whispers that send him into dark corners, on his knees, rocking back and forth, praying to a cloud-scattered sky to make it all go away. His thoughts answered, hanging low in tree branches, rustling, cackling in the wind.
The seemingly unshakeable security of knowing what was real and what wasn't started to become fragile again. The leaves crunched under his feet, murmuring leave, leave, leave. The rustling of the trees like the whispering of the gods above, indifferent, yet all-knowing. Everything became a sign, an omen. The leaves outside. Static on the radio. A traffic light turning from yellow to red. Reality, as Tyler knew it, began to fissure. It became more and more fragmented until Tyler toppled over and fell right through the cracks, crashing through layers and layers of frozen ground deep inside himself.
A place like a feeling like a nothing locked deep inside Tyler. His prayers go unheard. All that is left is a voice like an echo shivering up and down his spine.
I won't be afraid
He is strong
And I'll live another day
I'll live another day
You're a worthless piece of shit
You're crazy
Look at you, you're losing it again
You are schizophrenic
You're still just nothing
Every October, Tyler prays to trees becoming skeletons and every October, his mind whispers back, sending him to the place of the big, vast nothingness, like a compass whose needle is broken.
Every October, a place opens up inside of him, pulsing like an old wound, and Tyler reponds accordingly, scratching and cutting and burning until all he can see, smell, and hear is his blood pumping through his body like tar.
Every October, reality comes apart at the seams.
"Tyler? We're ready to admit you."
Tyler looks up. Holding a file and a pen, the psychiatrist on call opens the door of the nurses' station, looking at him with a blank face. Tyler can't read her, can't place her facial expression into a meaningful context at all. She looks young, though, like she's fresh out of med school. Her eyes blink rapidly behind thick-rimmed glasses and she clicks the pen twice, signaling him to get up. Tyler stares at the beige linoleum under his feet, trying to control his racing heart. His experience with psychiatrists on the acute psychiatric ward hasn't been the best and he can already feel the doctor's eyes all over his body. Memories move underneath his skin, memories hardened, transmogrified into trauma over the years, memories that left scars like footprints on Tyler's body and mind. A med student laughing sneeringly at Tyler's disorganized speech during rounds the last time he was here. A nurse flat-out refusing to do a blood test when she saw Tyler's arms. A psychiatrist who ordered for Tyler to be put on Lorazepam long-term to "stabilize" him. Lorazepam, of all things. The drug left Tyler numb, drooling and so out of it he walked into walls and fell asleep in the visitor's lounge when his parents came to visit.
"Tyler?"
Tyler flinches. The parademic on his right places his hand on his elbow for support. Swaying slightly, he gets up. All on their own, his fingers had found the bit of gauze wrapped around his arm. He had started scratching again, removing layer and layer of skin, pain, memory until the blood had seeped through both the gauze and his long-sleeved shirt. Not meeting the eyes of the paramedics or the psychiatrist, he takes one step after another, wiping his shaky fingers on his jeans. He doesn't remember getting an injection with emergency meds. He doesn't remember having a suitcase packed ready for yet another hospital admission. He doesn't remember coming here at all. All he recalls is the terrified look on Zack's face when he found him in the bathroom. Blood smeared on the white tiles as Tyler's insides met the outside world. The screaming, the fighting. His legs that carried him away, instantly, but not far enough. His mind carries him further away, always.
The blue lights, the pinch in his arm, the silence that followed. Everything came to a crashing halt, his racing thoguhts, pumping heart, screaming mind. And now he was back here, back on the psych ward, only a few months after he got released.
For the last year and the year before that (and before that, too), Tyler has spent more time in hospitals than home. He's spent birthdays here. He spent holidays here. He spent Christmas here, Easter and New Years eve, the unforgiving fluorescent light forever oblivious to the turn of time, the unfolding of a human life, the unraveling of a human mind.
"Come on, Tyler."
A steady hand directs him to the nurses' station. The sudden onslaught of noise - the humming of the cold fluorescent lights, footsteps squeaking over linoleum floor, distant shouting, the jingling of keys on keychains, the high beeping of electronic doors getting opened and lockened again - caughts him off guard. The realization trickles through his mind. He's getting admitted, again. Cacophony of noise. Panic rises in the chest. The white walls start to whisper, start to claw their way right across his mind. A spinning, sickening sense of claustrophobia begins to set in.
Hospital. So much more than a word, always.
An avalanche of fear.
Before Tyler can act on the instinct, the paramedic tightens his grip around his arm while his colleague lifts the suitcase and positions himself strategically right behind Tyler. Tyer is lead through the bright blue curtain separating the actual space of the nurses - a sofa, a coffee maker, a desk for taking notes, an ancient computer humming loudly, files of patients stacked up upon another, small, empty plastic cups waiting for evening meds, and two monitors connected to cameras in a patient's room - from the space where new patients are admitted. Two chairs, heavy and unthrowable. A desk. A gourney without a blanket. A doctor with big, blinking, worried eyes, a piece of paper right in front of her and the bulk of the paperwork that comes with a hospital admission, even an unforeseen one. Even though the sky outside is grey and subdued, a few October sunbeams still find their way into the room, illuminating the words the doctor had jutted down, gathering information from the paramedics and the emergency doctor.
Tyler Robert Joseph, male, 1 December 1988. F 20.0
F 20.0 A cryptic combination of numbers and a letter that narrow down his life to the pathological, the sickness, the loneliness.
A cryptic combination that may mean nothing to the bystander who stares at a scrawny, skinny young man in a black hoodie, eyes wild and wide with fear, not daring to leave his parent's car in front of the supermarket because it's not safe outside, it's not, it's not--
To his mother it means hiding her face inside her hands the first time Tyler came here, to the psychiatric ward, screaming and kicking. To his father, it means hiding his tears but not the despair.
To his siblings it remains being left home alone everytime their parents drive to the hospital to check up on their older brother, telling them they can come and visit Tyler soon, soon, but not now, Tyler is doing poorly.
To them it means living a house that hardly qualifies as home. Too big, too silent, too empty everytime their oldest brother is hospitalized.
To Tyler, it mainly means one thing: He has schizophrenia.
Tyler doesn't dare to sit down but crouches instead, half-sitting on the chair, not daring to touch it. The paramedic stands right beside him, his colleague still blocks the door. He doesn't stand a chance.
The doctor clicks her pen again, three times this time.
"Can you describe your mood to me, Tyler?"
I am hounded by a mind that’s gone to the dogs, how do you think I'm feeling
Tyler still stares at his feet, not daring to touch his arm this time. He feels like his brain is cocooned in invisible bubble wrap. The numbing sense of the meds cloud everything, his ability to speak, listen, comprehend. He doesn't know what he's been given, probably Lorazepam or, judging by the sense of numbness spreading inside his brain like an oil spill, Haldol. He can feel the bit of gauze coming off, can feel the fresh cuts, the ones that had healed so well, the ones he had teared open as he tried to erase himself. He doesn't trust any of them them, not the paramedics, not the doctor and not himself. The fear is still alive inside but but subdued, lurching, lurking, lingering but he doesn't act on it. Forced calm keeps Tyler rooted to his spot. A sense of calm like trees covered in frost at the beginning of a foggy autumn morning when the whole world is either asleep or dead, depending on your perspective.
The minutes wear on.
Language is far away.
The doctor waits, reading his file from his last hospitalization, looking from Tyler in the flesh to Tyler as medical lingo describes him.
Last hospitalization 12/2020-05/2021. Tyler appears agitated. Memory and attention span greatly reduced. He's refusing to stick to the treatment plan and remains non-compliant with taking his antipsychotic and antidepressant medication, convinced it's "poison." Medication continues to be injected which is met with great resistance from Tyler. Positive psychotic symptoms persist. Thought broadcasting. Tyler is preoccupied with the delusional belief that his thoughts can be seen and heard outside, "they turn into snow on the roof," "they are in my parent's house, threatening me, speaking to me through the walls." Paranoia. Tyler displays distrustful and hostile behavior towards staff members. "Everyone is laughing at me, judging me. They're out to get me." Command auditory and visual hallucinations, "shadows whispering in the dark." Negative symptoms. Flat affect. Paucity of speech. Lack of social skills. Tyler seems withdrawn and refuses to leave his bed. Tyler engages in self-injurious, impulsive behavior in the form of cutting and burning of the skin. Caveat: suicidal ideation.
"Trr..ed."
His tongue struggles to wrap itself around the syllables and his speech comes out all slurred, messed up by meds. The doctor clicks her pen, again.
"Come again?"
"Tred...tr..tired."
"Tired? Like you haven't been sleeping enough?"
"Tired like I don't want to live anymore."
The thought slips out of Tyler's mouth. Instantly he regrets it, seeing the look of concern slightly changen as the doctor starts to scribble something on the sheet of paper.
"And scared."
"Can you tell me what you are scared of?"
"It's all in the file," Tyler retorts. Non-compliance hangs in the room like a question unanswered. The doctor clears her throat and looks him straight in the face. She's annoyed, the lines hardening around her mouth give that much away, but behind her eyes lingers earnest, honest concern. She closes his file with a thud.
"I want to hear it from you, Tyler."
He doesn't dare to look her in the face. Instead, he looks out of the window. The nurse's station looks out on to the parking lot and a small park. From here, he can see a large sycamore tree, half-skeleton already. It's like the tree was planted for him, for this moment specifically and Tyler quickly looks away, for fear of his own mind. He can feel the weight of his thoughts press against the window, like thick fog, an, insurmountable presence that makes its weight felt against the skull, against the bones, against the mind.
Listen Tyler, listen
Don't tell her anything
We can hear you
They can hear you
"It's not safe here."
His thoughts leak from the mind to the mouth and out into this world.
"Why isn't it safe?" The doctor continues, not taking her eyes off Tyler.
Tyler stares on the ground. The fear has taken over, again, and he can't move, can't speak.
He doesn't tell her that for the past couple of weeks he avoided everyone including his family. Socializing has never been his strong suit and everytime he slips into psychosis, he's finding it more and more difficult to be with people. When all your energy goes into withstanding the voices, there's simply nothing left for socializing. At the first sight of his siblings or parents having friends over for a visit, at the first sound of laughter, warmth and joy Tyler disappeared inside his room, inside himself. He hid himself away, under covers, shivering. His mind, a wild, freakish thing, ashamed of its ways.
He doesn't tell her that sometimes, he can hear his mother crying at night.
He doesn't tell her that after he's been made aware of warning signs for psychosis coming back. After rounds and rounds of psychoeducation and therapy Tyler knows his triggers, knows what to look for. And yet, he couldn't stop it from happening. He feels caught inside himself as if his thoughts were a violent maelstrom dragging him down. At night, the shadow laughs failure failure failure into his ear.
He doesn't tell her what it feels like you can't trust the world around you and neither can you trust yourself.
"Voices. They're speaking to me."
"And what are the voices saying?"
That's exactly what his therapist asked him the last time she saw him. The therapist who wears stripey dresses and matching socks, her Harry Potter glasses balanced on her nose as she looked at him, concerned.
"Can you write down what the voices are saying?"
And Tyler handled her a sheet of paper all colored in black.
He doesn't tell her that as the voices took over he could her them clearly as if they were standing right next to him. No longer a mere background whisper, they're laughing and commenting on every step he took.
He doesn't tell her what it's like to sit in your room day after day, watching the world go from black to grey to white to black again, caught up in your own horror show.
Day after day.
He doesn't tell her the paralyzing fear psychosis brings, of seeing signs everywhere, of seeing your thoughts smeared against the night sky. A fear that makes you fumble for cameras, for bugs because you know, just know, that they're there, that your parents started to bug you again.
A fear that made Tyler take countless photographs, of his room, of the walls, trying desperately to prove to himself what was real and wasn't, that he wasn't going crazy again just like the cackling, malicious voice back told him. But even on the photos the shadows appeared and he could almost her the voices through the walls on the screen of his phone, too, and it was getting too much, voices inside the walls and the phone so he hid his phone and dared not to touch the radio or the tv. He could feel the dark screens crinkle with static and the inside of his own head.
Psychosis. Reality fractured by the static of intrusive thoughts.
"Okay." The doctor exhales, bringing half of Tyler back into this world. "I suggest we continue this chat some other time. Gentlemen, thank you for your time," she gestures to the paramedics, "I'm sure Josh will be here shortly, I told him we got a new patient--"
Right on cue, the blue curtain opens and a psychiatric nurse enters the room, someone Tyler has never seen before. Pink hair, dark jeans, a black Death Cab for Cutie t-shirt. He doesn't look like a nurse at all, rather like someone Tyler could meet at a concert. At a different time, in a different life. The only things that give him away is the rainbow badge around his neck. Tyler can barely make out the name. Joshua Dun.
"Hey there, sorry, I got delayed. I'm Josh," he turns to Tyler, completely unfazed that there are two paramedics in the room, "I'll show you to your room and explain what happens next."
Slowly, Tyler follows him, moving as through a dream. He can see doors, figures. He doesn't know if they exist or not, can't match a face to the voices he can hear, can't match the voices with memories he has of this place. Josh shows him to his room. There's a single bed there, a metal frame with a mattress, in there and not much else. No furniture, nothing you can use to hurt yourself. Nothing but a bed and a camera in the far corner. Tyler is drawn to the camera like a moth to the flame.
Images, hallucinations, memories all move through him, blurred and blotched, as if drawn in smudged ink. Tyler turns on the spot, not daring to sit down, move, speak. He doesn't know if any of this is real or not. He feels like he's caught inbetween worlds, as if he's supposed to wake up but can't.
Psychosis. A somnambulistic state of mind.
"No, none of that. Come, sit on the bed with me."
Josh's arms pry him away from the window, just as Tyler was about to slam his head against the glass.
I just wanted to make sure I'm safe. My thoughts are outside, wanting to get in. I'm not safe here, not like that. I'm not safe --
The bed smells faintly of bleach and starched hospital bedding. It creaks everytime Tyler moves, a sound he can feel inside his entire body.
"Look what I got for you. This is your therapy schedule for the week."
Josh keeps talking as if this is just right within the ordinary, Tyler sitting on the bed, rocking, scared out of his mind the window will burst and Josh, a calming presence, talking to him as if he was a person still. He is still a person, somewhere deep inside he knows that and yet, he can't feel it at all. He's all sickness, all thoughts gone wrong, his entire world turned upside down.
Josh keeps talking. Therapy schedule. Psychotherapy. Occupational therapy. Group therapy. Art therapy. Music therapy. Meal times. Vitals. Meds. Slowly, Tyler's body loses its rigidity and eases into a more comfortable position. He doesn't dare to let go, doesn't dare to fully lie down and relax. He can't trust his body, his mind but he can sit, right here, legs turned into a knot. Breathing. In through the nose, out through the mouth. Riding the storm, however dark it may appear. Stay in the moment. Focus. Focus.
Footsteps disappear and appear. A plastic cup of tea is placed on the nightstand, together with sweetener. "I hope black tea is okay, Tyler."
Tyler wants to say "okay" and "thank you" but language is far away, again. Slowly, he turns on the side, pulls the duvet over his head and rolls into a ball, letting himself get carried away by the distant murmur of Josh's voice, the humming of the lights overhead, and the ebb and flow of thoughts coming in and going. Of the feeling that's lingering behind the sadness, the brokenness, the loneliness of it all. That this isn't the end. It's simply time needed to readjust. To still inside yourself the belief that there's a tomorrow, after all.
Black tea
That's okay,
Thank you
Thank you
Outside, wild geese cry. They're flying south, dreaming of a land far away. The October leaves rustle in the wind, quietly.