Kaysen considers the suicide attempt that contributed to her stay at the hospital. She compares suicide to premeditated murder, asserting that detachment, planning, and motive are necessary to a successful outcome (in this case, death). The person must prepare by imagining the means of death, be it jumping, slashing wrists, or leaping in front of a train. Kaysen claims that her motives for dying weren’t compelling enough to make her own attempt successful. Any minor grievance would prompt an internal debate about whether to live or die—even events as trivial as missing the bus or enjoying a movie. When Kaysen eventually attempted suicide by taking fifty aspirin, she warned her boyfriend in advance. As she waited for the overdose to take effect, Kaysen regretted her decision and realized that she didn’t want to die after all. She wanted to kill only the part of her that urged her to suicide. Eventually, the police found Kaysen and rushed to her to the hospital, where doctors pumped her stomach. In the aftermath of the suicide attempt, Kaysen felt better, as though she had successfully committed the “partial suicide” she imagined would improve her life. Kaysen replaced her high school boyfriend with her English teacher, who took her to museums and impressed her with his intellect and wisdom. Looking back, however, Kaysen realizes that she was only temporarily free of the problems that had tormented her.
Kaysen wonders how a doctor with whom she had not previously consulted could have diagnosed and committed her to a hospital in only twenty minutes. The doctor told Kaysen that her stay at McLean would last a few weeks, but she feels betrayed: she stayed for two years. Kaysen imagines that the doctor’s decision was governed by the fear and confusion adults of his age felt toward young people at the time. She thinks that the doctor must have believed that he was saving her from a downward spiral of drugs and self-damaging behavior. Because she was eighteen, Kaysen had to sign herself into the hospital. While waiting to be checked in, she noticed a recurrence of a problem with patterns she had been having. Tile floors, intricately sewn rugs, and even faces did not appear to her eye as they did to others’. Despite the visual confusion, Kaysen was always fully conscious of the disorientation and understood that she was not processing patterns correctly. Most troubling to her was the question of whether everyone else was simply pretending to be normal, as she was. “Was insanity just a matter of dropping the act?” she asks. Kaysen felt great satisfaction in denying herself pleasures. Checking herself into a mental hospital was the greatest form of suffering she thought she could undertake.
The entrance to the hospital ward could easily be found in a prison. Patients walk through a locked door, wait until that door is relocked, and then enter through another locked door. The public rooms, a lounge and kitchen, are arranged near the entrance doors in order to impress visitors. Just beyond the public rooms, however, the ward begins to appear more like the place of incarceration that it is. A very long hallway divides the patient quarters from the staff sections. Kaysen notes that the bathrooms are on the staff side of the hallway. Across from the nursing station, a blackboard lists the names of all patients. When a patient leaves the hospital or dies, her name remains on the board for some time. At the end of the hall is the TV room, the girls’ favorite gathering space. Here, the patients have the freedom to socialize, smoke, and operate generally free from staff interference. The seclusion room sits at the very end of the hallway. Patients who are too rowdy or noisy are banished to the room to wear themselves out. Kaysen points out that patients can request to be put in the seclusion room. This is the only private place on the ward; patients are forced to exchange their freedom for a chance to be alone.
In dissecting the memories of her suicide attempt, Kaysen refers to the importance of detachment, a motif that appears throughout the book. In order to commit suicide successfully, she says, a person must create in her mind a “proper distance” from the act itself. This detachment simultaneously plagues and benefits Kaysen during these difficult years. A note regarding her diagnosis states that she feels disconnected from life and relationships, a symptom of a number of mental illnesses. Yet detachment also allows Kaysen and the other girls on the ward to separate themselves from the endless tedium of life in confinement. Detachment can be evidence of a psychic wound or a useful tool in battling oppressive circumstances. Kaysen speaks of the “partial suicide” she feels took place in the wake of her attempt to die. In killing the “part of [her] that wanted to kill herself,” Kaysen believes that she temporarily killed her most dangerous instincts. But eventually, she learns that mental illness needs to be confronted in its totality.
The greater theme of generational conflict, or the difficulty older people have in understanding the changing culture of the young, also appears in this scene. Kaysen believes that the doctor is simply a product of his background; he is unfortunately unable to comprehend his troubled young patients. The youth culture of 1967 was frightening to many, especially suburban, white, middle-class professionals like the doctor. Older people often confused drug use or typical teenage behavior with mental illness, having lived through their own adolescences in calmer times. Class distinctions were also heavily policed; the doctor thought he was saving the child of a peer from falling in with the dangerous elements of youth culture. Kaysen is careful not to present these factors as evidence of a mistaken diagnosis. Rather, she is establishing a context for her experiences. Kaysen leaves the issue of her mental health vague, aware that her own memories may be as imprecise as the doctor’s understanding of her mental state.
McLean Hospital is a cold place designed to reinforce authority by dehumanizing its patients. Descriptions of the entrance and cell-like rooms evoke images of prison, with nurse and patient areas strictly separated. Kaysen tells us that the girls’ central complaint is the lack of privacy the ward affords. Cruelly, the only private space is a “seclusion” room that serves primarily as a holding tank for wild patients. To be alone in the hospital is to be even more harshly confined.