At a time of growing authoritarianism, when Donald Trump threatens to herd homeless people into locked psychiatric hospitals and Robert F Kennedy Jr. wants to send those grappling with drug addiction to labor camps he calls “wellness farms,” “The Factory of Maladies” could not be more timely. A memoir by artist and writer Deborah Hartung’s account of her short but terrifying lock-up in a psychiatric ward in San Francisco, it serves as a bellwether of sorts.

Indeed, the memoir reads like a gripping mystery novel, in part because a dubious relative of Hartung   – under the spell of one of California’s many phony gurus – has somehow managed to get medical power of attorney over the author, her niece. The aunt uses this power to put Hartung in a locked ward after her suicide attempt and seems determined to keep her locked up indefinitely. 

The aunt’s motivation is never resolved, however, perhaps because this is a true story, with names of people and the institution changed to protect the innocent (or guilty). Still, it is a good reminder for people with a mental illness to choose a trusted loved one for medical power of attorney, lest someone misguided or with less-than-pristine motives step forward.

Hartung’s harrowing and well-written memoir of life on the ward  – her fear and terror, the mind-numbing boredom, the smell of mildew and moldy towels, the forced daily drugging that leaves her and most of her colleagues apathetic and barely functioning – is especially troubling since this is a private and supposedly “better” version of a mental institution. It is also an urgent reminder that the Trump administration’s plans  to bring back the institutionalization of mental patients and homeless people could dismantle decades of progress. 

One wishes that Hartung could have experienced the approach to mental illness that has been practiced for the past 45 years in Trieste, Italy – one in which people suffering from mental disorders could partake of treatment with dignity, camaraderie and fellowship in an open institution where they could come and go freely and no one was forcibly drugged. That model never took hold in the U.S., and this memoir is an urgent reminder about the risks of coercive models that force people into institutions and require them to take medications that often leave them drugged and listless.

In the book’s foreword, Duncan Macleod, author of “5150: A Transfer,” which draws on his own frightening story of institutionalization, applauds Hartung for her courage. Noting his own feeling of stigma and humiliation after being released from a psych ward, he describes “The Factory of Maladies” as a healing tool – one that can also help mental health professionals view patients not as ‘cases’ to be managed, but fellow human beings who are struggling and need their support.

“While any reader will enjoy this well-crafted recounting of a surreal situation,” Macleod writes, “it will be particularly helpful to families, friends, and medical staff of the people who are going through such difficult times…Well-meaning people who care deeply for a beloved friend or family member have an obligation to learn what the other person is going through so they can be a part of the healing process and not further exacerbate the crisis. This eloquent story, told in the first-person, teaches how to help someone to heal.”

“Nowhere To Go”: An Excerpt from A Factory of Maladies

– Come on, Jerome, it’s time to go.

Dr. Mueller’s voice was firm, but Jerome continued to ignore him; he talked and mumbled to himself, while simultaneously shoveling food into his mouth with an air of determination.

– Now, Jerome. Let’s go.

– BUT, I GOT NOWHERE TA GO, MAN! Jerome screamed while crumbs flew from his mouth.

Dr. Mueller seemed unfazed and stood his ground.

Clearly, he had heard this before and did not particularly care; Dr. Mueller was overworked and overtired. The dark circles under his eyes and bloated face seemed to confirm this.

Jerome stood up abruptly and nervously shifted his weight from his left to right leg; I realized his gargantuan size and height – he towered over the doctor. I also noticed that he was wearing street clothes – a dirty, hooded sweat‐ shirt that once read ‘Adidas’ and baggy jeans – while the rest of us were in purple scrubs. Dr. Mueller quickly led him away; no one else at the dining room table seemed to notice.

I went back to my room; the cold seeped into my bones and my already aching joints. I crawled into bed and watched the rain pour down and silently splatter against the window. A part of me still harbored the belief that this was a dream – a simple mistake that could end instantaneously if only I could will my eyes to open. I shivered and stared at the beige walls; an overall sense of terror seemed to be creeping up on me. It settled on me like a heavy Afghan blanket, and then, all at once, I was encased by it; fear gripped ahold of me, and I was completely smothered.

MY EYES BURNED in the fluorescent light of the hallway, which was such a stark contrast to the dim lighting of my room. I wandered around aimlessly, disassociated. I found myself at the nurses’ station – a ragged fingernail with overgrown cuticles pointed to a sign: Do Not Loiter Around The Nurses’ Station. As I turned away, I heard Connie’s voice.

– Is it time now? She asked excitedly, hands clapping. A stern voice boomed in response.

– NO! You just had your Nicorette. You don’t get another piece for a few hours. I thought I heard Connie whimper as I shuffled down the hallway.

I found myself back at the nurses’ station; for the first time, I saw a huge clock on the wall to the left of the counter. It read 2:15. I watched the hands on the clock move in slow motion, and then, suddenly, I heard a loud buzzing noise followed by the heavy slam of an iron gate.

The nurse on duty was glued to a monitor on her desk, and when her eyes finally looked up from the screen, they peered, hawk-like, at a small figure walking through a swinging door.

My aunt hugged me stiffly; I felt limp in her forced embrace. My heart beat wildly with a sense of apprehension. She was tall and sporty – naturally muscular and wiry – the type of thin person who was disgusted by fat people. She wore a faded t-shirt with a Ganesha on it, a North Face jacket, and khaki cargo pants. Prayer beads and a clear quartz crystal dangled from her neck.

– You’ve lost weight. She stepped back and scanned me with her small, blue eyes.

– Have you lost weight? I didn’t answer her question; I just stared at her vacantly.

– Look at your outfit! At least it’s a color you like.

– You’ve cut off all your hair – at least it’s not pink like it usually is. I was too embarrassed to admit that I had pulled out most of my hair.

I wanted to feel a sense of comfort from my aunt’s presence, but it only seemed to confuse me. Seeing her instilled the concept that this wasn’t a hallucination or a bad dream; the feeling of floating between worlds, touching down for a brief instant, was real. This ever-present, morbid, trance-like state was no illusion; it was reality.

---

– I’m sorry I couldn’t visit you yesterday. I really had to ground myself, so I went to Muir Woods to be with the redwood trees. You know, this city is very dense.

As Aurelia prattled on about the healing vibration of trees, I realized that her absence yesterday went completely unnoticed by me, and if anything, it came as a relief. Now that I was back in her presence, sitting in the empty and dimly lit dining room, I felt waves of anxiety crash over me as my heart went thud, thud, thud in my ever-tightening chest, and my lungs struggled for sufficient air. Although panic was rising in my system, I felt something strange happen in my mind: it became clear and focused for the first time in almost a year.

– I’m sure you know this already, but most mental illnesses are caused by energetic attachments. I really think you should be bathing at least once a day to clear any extra attachments from yourself.

Aurelia looked directly at me after stating her case, clearly expecting me to meekly agree with her. Instead, I sat there in silent defiance, and I felt a chill run down my arms as I studied her eyes: they were a very pale, sky blue with flecks of gold around her irises; although pretty in color, they were small for her face and were encased by deep wrinkles on all sides. I almost gasped aloud as I gazed into them and saw the truth for myself: they gleamed with malice.

– Showers really do clear energy and connect you to your divine state of cleanliness. I really think you need to work on this…you’ll feel better once you’re clean. Plus, who wants any of the attachments from this place? Have you seen the guy pacing the halls? Everyone here is looney!

I wanted to scream, I’M ONE OF THEM, TOO! as loudly as I could. I was no better or worse than Alex or anyone else on the unit; although our symptoms manifested in different ways, we suffered from the same illness invisible to the naked eye: unbalanced brain chemistry. Furthermore, we were being held in a psychiatric unit against our free will and receiving the bare minimum of care without therapy or proper medical intervention. I had seen enough in my tenure on the psych ward to glean that most patients were given medication as a stabilizer, and then after they were fed for a day or two, they were released back into the world without any true resources, only to reappear in a few days, weeks or a month later with the same – or worse – mental health issues. We were largely misunderstood and judged by society. I wanted to scold Aurelia for being so awful and hypocritical, but instead, I selfishly used the moment for my own potential escape.

– If it’s so terrible here and everyone is crazy, then why can’t I go somewhere else? Somewhere private? I will pay… all I need is for you to agree and sign the papers. I continued to plead my case before Aurelia, who refused to make eye contact with me and stared straight ahead at the blank wall as if she was only half listening to me. My stomach dropped, as I could tell that she was only biding her time before another torrent of New Age babble spurted forth from her pursed and heavily lined lips.

– If you would have followed Bodhi’s* teachings, none of this would have happened. I’ve seen you fail to follow through on other spiritual lessons before, and I’ve held my tongue, but this time, you’ve really created a mess for yourself.

Aurelia swiveled her neck to look at me after making her proclamation; I thought she was finished, but she had one final blow to deliver.

– You will stay exactly where you are and reap what you’ve sown.

Her tone was icy and firm, and as she sat next to me, squinting her eyes to emphasize her point, I felt my blood run cold. Reap what you’ve sown. Reap what you’ve sown. I knew this was a common phrase, but I also knew that Bodhi used it repeatedly, with bizarre karmic implications thrown in for dramatic effect. It illustrated the firm grasp he had over my aunt; I shrugged my shoulders up, almost to my ears, and shivered. A part of me knew that it was a fruitless endeavor, but I knew I had to speak up for myself, even if Aurelia was deaf to my warning cries about her spiritual teacher, who became more sinister with each passing moment.

– If I had followed his ‘teachings,’ I would be dead right now.

I said it: the truth. It was supposedly going to set me free (metaphorically speaking), but physically, I still found myself trapped in a psych ward, and although I felt a tiny bit of relief after revealing this revelatory information to my aunt, not much else changed in my psyche. It took an incredible amount of willpower to speak the words that now resounded in my head and hung heavily in the air, but my retort was met with a dubious expression from Aurelia and stony silence. She petulantly wrapped her lower lip around her top lip, which I knew was her form of pouting; the wrinkles on her lips were now smooth, and she sat there with her arms wrapped around herself like a toddler, slowly rocking back and forth.

Are you ok? Although I was the one in the hospital, I felt a momentary concern for Aurelia, for she looked, and was acting, incredibly strange. 

– I’m fine. I’m just doing what I need to do to protect myself. 

She snapped and turned to look at me with hatred burning in her eyes. It was clear that she meant to say, I’m fine. I’m just doing what I need to do to protect myself FROM YOU! 

I nervously laughed out loud; of course, it was all my fault, and Bodhi was immediately absolved of his guilt and role in my attempted suicide. Why had I bothered confiding in her? She was obviously too brainwashed by Bodhi to listen to reason; if my suspicions were right, he was probably ‘guiding’ her through channeling sessions and tarot readings about my treatment and hospitalization; he was always there, in the background, pulling the strings of her person – and her wallet. 

As I slowly made my way back to my room, completely drained from my interaction with Aurelia, I passed Tiffany’s room and felt terrified: the door was open, and she was pacing up and down the narrow room like an angry tiger in an enclosure at the zoo, ranting and raving about her chihuahua and Adderall, while her poor roommate sat on her bed, completely frozen and staring at the blank wall. Her eyes refused to blink, and I could tell that she was still trapped in the terror of her own psyche. 

Then, out of the corner of my eye, I noticed a billboard nailed to the wall halfway between Tiffany’s room and mine. It contained an elaborate table, with Today’s Date is April 11th! Written on the top in bright green marker was a list of all the patients and their corresponding room numbers, doctors, and psychiatric nurses. Had this been here all along? Something about the date jarred me to my core: it was not that it verifed my suspicion that I had been on the unit for four days, but something else. 

I stood in the hallway and stared at the date again, willing the information floating in my brain to avail itself to me and begging my neurotransmitters to “read.” I tightly closed my eyes and repeated the date out loud over and over; at this point, I doubted any of the staff would bat an eyelash if I suddenly began having conversations with myself. Suddenly, a tangible source of energy ran through my entire being as the mystery was instantly solved: Krishna returned home from India on April 14th – only three days from now! They had to release me once he was home; I knew he would be my advocate and do everything he could to transfer me to a private facility or simply take me back to our apartment, which was what I needed the most. I felt stable – aside from the stress of being in the hospital – after being on my meds for just four days, and I silently vowed to take them for the rest of my life. 

I spun on my heels and made my way across the hallway to the Nurses’ Station, determined to share this news with Dr. Mueller, for even he could not argue that I would be ready to leave soon and no longer was a danger to myself. Surely, someone else was in desperate need of my bed. I walked as quickly as I could to the Nurses’ Station, and without even observing the nurse seated before me, I began gushing about Krishna and his imminent return and the fact that he would take care of me. I emphasized that there must be another person in dire need of my bed and that I was stable, so there was no need to keep me in the hospital any longer. When I finally finished my tirade, I looked up to find Cranky Nurse staring at her computer screen, as per usual. 

– Well? I pleaded. 

– Well, what? she retorted. 

– Can I talk to Dr. Mueller about my discharge? 

Now I was beginning to worry, as it was clear Cranky Nurse had not heard a word of my passionate speech, or if she had, she did not care in the slightest about helping me. 

– I’ll see what I can do. Dr. Mueller is very busy today, and he will be off the entire weekend. 

With that, she returned to her screen and ignored me while I hovered around her and fidgeted with my hands out of nervous habit. I was just about to give up when she finally looked up at me; I was filled with immense amounts of hope, and I waited with bated breath for her to speak. 

– By the way, you have a phone call. That was it. She did not make eye contact with me and seemed to be very annoyed by my presence. Before she could inform me that she was transferring my call, I was already in front of the hideous yellowish, green rotary phone.

 – Debster? A man’s gentle voice, calling me by my childhood nickname. I was shocked: it was my Dad on the line.

 – Dad? Is that you? 

Although I knew it was him, I was a bit doubtful. Maybe this was another illusion, or I had suffered a final break from reality. He was the last person I expected to call me, as I had been so distant towards my parents over the last year. It began, of course, with Bodhi blaming my parents for ‘a traumatic event’ that occurred when I was an infant (conveniently, I was too young to remember this), but then Aurelia became involved and said she witnessed my mistreatment firsthand, for she was always eager to pit me against my parents and drag me deeper into her New Age ‘soul family.’ None of that mattered now, and I felt the lies and illusions of the last year wash away as I was comforted by my Dad’s concern. 

– I’m here. So is Mom. …

I burst into tears and apologized for the last year again. I said I was sorry for being so isolated and removed and that I never meant to hurt them; as guilt began to rise in my consciousness and internally, I felt the torrent of paranoia and brain fog instantly return. 

– It’s ok, Debster. We know you were off your medication. You must promise to take it from now on, ok? 

I silently nodded my head in agreement and vowed again to take Cymbalta each and every day of my life. 

– Are they…treating you alright? 

My Mom’s voice was wavering, and I knew this was a sign of intense worry and anxiety on her part. 

– Yeah, I’m ok…I just…really want to get out of here. 

This time, I was hysterically crying, and my parents tried to be soothing, although this was difficult over the telephone. 

– Aurelia just called us this morning and explained what happened. We would have called sooner, but we had no idea where you were. I don’t know why she didn’t call us when you were in the emergency room; we’re your parents, for god’s sake! 

I could tell my Dad was angered by Aurelia’s actions, as was I. I assumed that my parents wanted nothing to do with me because I had avoided them for the better part of a year; this fact, compounded by the massive amounts of guilt Aurelia instilled into me, only made me feel more helpless and untethered from reality. The fact that my parents were clueless about my hospitalization was a shock; I knew Aurelia was manipulative, but this was a new low, even for her.

 – Do you need us? We’ll get on a plane today if you want. 

I sighed and felt a surge of anguish and disbelief: this was the help that I had been hoping for since my admittance into the hospital, and yet, I knew that I could not accept it. I felt my emotional body being torn into shreds, and I began to shake; I knew that my aging parents always traveled together and that the sight of me in this institution would disturb my Mom to her core. It seemed unfair of me to cause her more anxiety and sleepless nights; I felt protective of her, and I was more concerned for her emotional well-being than my own.

 – Thank you, but it’s ok… 

I fought back the tears welling up in my eyes and tried to control my quivering upper lip. 

– What about when you’re released? You will need some help then. Mom told me Krishna has to go back to work as soon as he gets home. 

– Ok, um, that sounds good. Thank you. 

I was grateful for their support, and I realized that they were right: I would need help upon my release, as I had not functioned in the world for almost a year. 

– Can you ask Dr. Mueller when I will be released? 

I pleaded and willed my parents to answer emphatically, ‘Yes!’ 

– We tried, but he won’t tell us anything because that sister of mine is your medical power of attorney. 

My mom was clearly frustrated with this news, and so was I. How had Aurelia managed to become my medical power of attorney? I had no recollection of signing any documents over to her, and I thought that because Krishna was out of the country, my parents were automatically given that role, as they were my next of kin. Again, something was very wrong with this situation. I felt bile rise up in my throat, and my whole body broke out into a cold sweat as my heart pounded away in my chest. 

My mom now tried to make light, small talk during my silence. 

– What do you do all day? Can you at least watch TV for entertainment? 

– We don’t really do anything…there is a television, but it’s permanently stuck on the Weather Channel. 

My parents laughed simultaneously, and I felt some relief as I inwardly recognized how absurd this was, and I was glad for a moment of amusement. I saw Dr. Mueller out of the corner of my eye, and I knew this was my opportunity to track him down and share the news of Krishna’s imminent return. 

– I…uh…I have to go now. 

– Ok, we will call you tomorrow. Take care, Debster. My Dad hung up his telephone, but my Mom remained on the line. 

– Talk to you tomorrow! Lots of love. My Mom hesitated before hanging up, but finally I heard the familiar sound of a pulsating dial tone in my ear. 

I was comforted by my parents’ phone call, and this seemed to be just the confidence boost I needed to confront Dr. Mueller. I used all the focus I could muster to keep my eyes on Dr. Mueller and his whereabouts; I was not going to let this opportunity go. He was standing at the Nurses’ Station and talking to Cranky Nurse; he seemed to be looking through a stack of files. I walked as quickly as possible across the hallway, and just as I was about to call his name, I heard someone calling mine. 

– Deb! Deb! 

I cringed, as I had never liked this nickname, but I recognized Lauren’s shaky voice instantly, and I knew this was her way of conveying that she liked me. I had to make an immediate choice: turn around and engage with Lauren and lose sight of Dr. Mueller and relinquish my chance to speak to him until Monday, or be a decent human being and interact with the one person who had shown me immense kindness during my time on the unit, especially when I was terrified and very confused during the first two days of my stay. When I heard Lauren’s slipper socks dragging on the floor and picking up momentum behind me, I knew that my choice had been made. I sighed deeply and turned to meet my fellow patient.

Factory of Maladies by Deborah Hartung is available online and in bookstores and Target Books.

• Bodhi is a pseudonym for the spiritual advisor to one of Hartung’s aunts, whose name has also been changed.