Kaysen believes that mental illness can be divided into two types: fast and slow. The slow type brings everything in a patient’s mind to a crawl. Time seems to creep by, powers of observation and insight are blunted, and even the body’s heart rate and immune system become weak. The fast sorts of illnesses greatly increase a patient’s velocity. Thinking speeds up immensely, torturing patients with a never-ending series of internal arguments, questions, and investigations. Kaysen delineates the thought process of a person suffering from a “fast” illness. Images and memories accompany the smallest observation, and the patient is overwhelmed by a tidal wave of perception. Yet Kaysen believes that fast and slow illnesses can appear the same to the casual onlooker, because both freeze up a patient’s ability to act, one by inaction, the other by presenting too many options upon which to make a decision. Also, patients are aware that even one small negative feeling can signal the beginning of a thought process that will culminate in overwhelming depression and self-loathing. Eventually, however, the repetition of these episodes dulls their impact. Kaysen suffers from both kinds of illness. She is never sure which is about to emerge.
Lisa makes a scene, demanding fresh air. She harasses the nurses, banging on their door and threatening to call her lawyer. Valerie, the head nurse, agrees to open Lisa’s window, but Lisa is dissatisfied. She taunts Valerie, imagining out loud what the head nurse’s experience as a patient would be like. Just as quickly as she began her tantrum, Lisa relents. Valerie is calm and able to deflate Lisa’s angry moods. The nurse goes about the difficult task of unlocking and forcing open Lisa’s heavy, barred window. She realizes that Lisa doesn’t intend to sit by the window but was merely creating a scene to entertain herself. “Hey man,” says Lisa, “it passes the time.” Valerie agrees that it does, indeed, pass the time.
Kaysen describes Valerie, the head nurse. Valerie is young, with attractive, waist-length hair that intrigues the girls. She is firm but earns the girls’ trust because she stands up to both them and the doctors. The patients meet with a doctor, a medical resident, and a therapist each day. Kaysen and the others are distrustful of the doctors and their psychiatric language, which Valerie doesn’t use. The doctors are all men except for Dr. Wick. Dr. Wick is an old-fashioned character with a colonial British background and is quite unfamiliar with the culture that produced Kaysen and her fellow patients. Dr. Wick is particularly uncomfortable with foul language and sexual allusions. Kaysen describes her relationship with her high school English teacher to Dr. Wick, including in her story a crude, invented account of how she became sexually involved with her teacher. This embarrasses Dr. Wick. The student-doctors, or residents, change often and have little familiarity with their patients’ daily lives. Therapists, the girls’ third daily medical appointment, are primarily responsible for prescribing medication. The girls dread the evening hours between the point at which Valerie and the day staff have left and the time at which the night staff comes on. During this time, Mrs. McWeeney supervises the ward. Mrs. McWeeney is a nurse of the old school, with a traditional nurse’s uniform and the personality of “an undisguised prison matron.” Although the girls detest Mrs. McWeeney, they feel protective of her in a way, because she seems as crazy as they are. Student nurses also appear regularly on the ward. The nurses remind the girls of the lives they might be living beyond the walls of the hospital. The girls pretend not to be ill and dispense advice to the student nurses, who learn very little about psychiatric care as a result.
The world is in turmoil. Kaysen and the other patients witness on television the unrest outside McLean Hospital. The war in Vietnam rages on, as do civil rights movements and anti-war struggles. The assassinations of Dr. Martin Luther King and Robert F. Kennedy shock the girls as much as they do the rest of the nation, which is mired in university protests and civil disorder. The girls identify with the protestors on the outside because they see their own anger acted out by others. The nurses relax as their patients’ behavior seems to be calmed by the actions they see on television. The girls slowly realize that the world might not actually be changing for them, or indeed for many of those fighting the battles in the streets. They watch as Bobby Seale, leader of the Black Panthers, is wheeled into a courtroom bound and gagged. His plight is not the same as theirs, the girls think, because his cause is great and righteous and theirs is small and shameful.
Kaysen attempts to explain the nature of mental illness as she understands it with two simple analogies: viscosity and velocity. A viscous substance, like syrup, moves slowly and with great deliberateness. Velocity is defined in physics as the ratio of speed to time, and is a measure of movement. Kaysen distinguishes between “slow” and “fast” types of illness, but the effect of each is the same: immobility. “Viscosity causes the stillness of disinclination,” she says, and “velocity causes the stillness of fascination.” This “stillness” is a result of either a profound inability to make decisions or an overabundance of options that makes decision impossible.
When Lisa throws a tantrum, demanding that Valerie open her window, she offers a glimpse of what the monotony of confinement can inspire people to do. Lisa’s outburst arrives without warning, but the scene is a familiar one. The girls are obliged to create whatever excitement they can. Lisa’s favorite form of expression is to cause a scene that invites the attention of the nursing staff. A telling moment arrives at the end of the chapter, when Valerie realizes that Lisa’s antics have been pointless: she never cared whether the window was open or shut. Lisa offers a succinct explanation for her behavior that everyone on the ward can understand: “Hey man,” she says. “It passes the time.” Time is the girls’ greatest resource and most oppressive captor. The best the girls can hope for is a diversion that passes the time.
The girls respond most positively to Valerie, the head nurse, because she neither condescends to them nor treats them harshly. Valerie’s presence is reassuring. Most of the girls shun the authority figures around them, from parents to doctors to other nursing staff, because they feel misunderstood. Valerie treats the girls with an evenhandedness that contrasts sharply with the excessive intrusiveness and panic they perceive in others. Dr. Wick is an example of the cultural divide that exists between the patients and the authority figures they typically confront. Dr. Wick doesn’t understand the culture that informs the girls’ opinions and behavior. Dr. Wick is older, from another country, and bothered by frank discussions of sexuality. Without any cultural reference point from which to understand her patients, Dr. Wick’s efforts are largely useless. Mrs. McWeeney’s dated nursing uniform is an outward manifestation of her value system, one that doesn’t correspond with her patients’. The biggest reminder of their confinement to the girls is the presence of the nurses-in-training. Because the trainees are the same age as the patients, they remind the girls of the lives they could be leading. The “parallel universe” Kaysen discusses in the first chapter finds expression here, as the girls watch their mirror images live their young lives in freedom.
The cultural upheaval of 1968 initially encourages the girls. They see riot and revolution on television and live vicariously through the actions of others. However, as the reality of their confinement sets in, the girls come to realize that living through others is sad and ultimately unfulfilling. Their participation in the greatest cultural shift in decades is limited to a TV screen on a mental ward. Kaysen gains some perspective on her plight when she begins to comprehend the scope of the struggles going on outside the walls of the hospital.