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What Psych Units and Astronauts Can Teach Us About American Health Care After COVID-19

The first thing you learn in a psychiatric unit is how to lie.

Here’s a little “trick” for you. When you arrive and check-in, they take your phone away from you and seal it in the security room, but if you ask for access to look up a number to use on the floor payphone, they’ll hand yours back to you for a few minutes. I did this a few times just to access the outside world. I’d look at headlines. Browse Instagram. Mostly I’d read and reread the last thing my close friends said to me, each word a foot in the ground, an anchor. Then, I’d scribble down some number I didn’t really need.

You pick these things up quickly. On my first day, two veteran patients took me aside and told me that I needed to learn to be dishonest. The first thing you learn is how to lie.

When I wrote those words, I was sitting in a hospital in Westchester, NY, where they transferred me from Manhattan after I checked myself in disoriented and feeling unsafe. Eight days later, I would discharge to a world forever changed and begin isolation in my Brooklyn apartment at the epicenter of the coronavirus (COVID-19), the new-to humans virus that causes respiratory infection and can lead to serious or fatal health complications. At the time, though, I was just focused on getting better. This particular unit is designed for people who are depressed and suicidal. We all went there because we were a danger to ourselves. We met with our treatment team every morning to find medications that could help, we took part in group therapy and classes, and we got 20 minutes a day to walk around outside.

Everything in that place is designed so you can’t attempt suicide. The showers are set to a timer. You forfeit any electronics that might distract or trigger you. A nurse checks in on you every 15 minutes to make sure you’re safe, even while you sleep.

I made the most of it. I read and wrote. I did pushups in my room. I did an hour of exposure therapy for my obsessive-compulsive disorder (OCD) on my own every day, all the while waiting for the medications to stabilize me, hoping they’d work so I could avoid the electroconvulsive therapy (ECT) coming my way if they didn’t.

While there, I read the newspaper every morning, watching the field of Democratic presidential candidates shrink to two and the number of COVID-19 cases grows to dozens in Westchester alone. Only Joe Biden and Bernie Sanders remained. Two distinct choices, in policy and in values. On the morning after Super Tuesday, I couldn’t help but think about how this primary would affect the people walking those halls with me in that unit, a fundamental decision about what kind of health care system we want in this country. We know now that Bernie won’t be our nominee, but we still have a choice over what kind of health care system we create for ourselves, and what moves me most is how that choice will affect the people who couldn’t afford to be in that hospital in the first place.

Here’s something worth sitting with: I believe the most compelling mental health stories are the ones that don’t appear in essays like this. Being diagnosed gives you validation and credibility, but many people in America go undiagnosed because they don’t have the money to see a doctor. Staying at a hospital like this gives you a story, a dramatic arc to your life. It tells people you’ve been through something. But so has my anxious friend who’s between jobs and doesn’t have insurance to cover an inpatient stay. So has my depressed friend working part-time on one of the ACA’s care plans, which prevents her from even considering the treatment I received.

We have a tendency to romanticize people who go through lengthy hospital stays and come out on the other side healthier, and rightfully so. They’ve confronted their illness and bettered themselves. They’ve done an immense, difficult thing. That’s worth celebrating. But in America, any story about a long-term hospital stay involves a great deal of privilege, no matter how inspiring it is.

So let’s also tell stories about the people working multiple jobs who still can’t afford to see a therapist. The people traumatized by sexual assault who were never offered the space to process their pain or treat their post-traumatic stress disorder (PTSD). The people who have to choose between putting food on the table and paying for the medication they need. In the midst of COVID-19, let’s tell stories about the people who are symptomatic but can’t seek care because they are uninsured, the people who went to work sick for weeks in the service and retail industries and then lost their jobs, and the people struggling to manage mental illnesses at home as they’re forced to isolate themselves.

There are close to 30 million uninsured people in the U.S. today and another 44 million underinsured, which means their premiums, deductibles, and copayments are too high for them to access meaningful care, even during a pandemic, so there are plenty of these stories to tell.

These stories don’t have the trappings of ones you see in magazines or in movies, though. They’re not cinematic because things don’t change. There’s no inspiring arc. People just survive. Day by day. Like Sisyphus, they push their boulder up the hill and watch it roll back down again. They do their work and take care of their family and pay their bills however they can, and then they wake up and do it again.

I think of this visually sometimes. People pushing actual boulders onto buses, on to elevators, dragging them through the restaurant to get to the next table, behind the bar to close down. Across prison yards and factory floors. Fear, rage, worry, pain, sadness, dread. Everything we carry with us.

What would it mean for a country to lighten that load? For a health care system to eliminate money as a consideration for care in America. What could we do with our energy, our enthusiasm, our time, if we got the treatment we needed and didn’t have to worry about how much it cost?

The first thing you learn in a psychiatric unit is how to lie. But what if we didn’t have to? What if it wasn’t all a rigged game, a calculus, a mission to squeeze the most we can out of a system before the system comes after you. Before it destroys you, as our healthcare system is doing to so many during this crisis. Surely, there is another way.

Astronauts often describe something called the “overview effect” that occurs in space. After being out there for a while, their perception of the planet and everyone on it changes. Divisions of race and gender and politics blur and eventually fade, just as the borders between countries do. Interpersonal problems and arguments lose meaning. Looking at that blue marble hanging there in the pitch, astronauts report feeling a great appreciation for life and a desire to do better by it.

I’m thinking of this now because I see a similar overview effect that takes hold when you live in hospitals. We’re also disconnected from society, but instead of traveling beyond the limits of our world, we’re traveling inward, exploring the depths of our minds and bodies.

I’d argue the effect is the same though. People often discharge from that psychiatric hospital with a zeal that’s hard to fathom. They’re returning to the same life that nearly destroyed them, but those boulders don’t seem quite as heavy. It’s because they’re looking at the world the way a space traveler would. Like their stressors and responsibilities and rivalries don’t mean as much. They’re blurring, fading with the borders. But some things remain constant, clear. Your family. Your partner. Your community. Everything you fight for. It’s that same appreciation, that same desire to do better.

My colleague Ady Barkan was diagnosed with ALS in 2016 and has devoted his remaining time on Earth to improving healthcare in America. At his testimony in support of Medicare for All before Congress, Ady said he didn’t want people to waste their fleeting time on this planet on administrative health care headaches. He wanted people to spend their time with the people they love:

“Our time on this earth is the most precious resource we have. A Medicare For All system will save all of us tremendous time . . . for patients and our families, it will mean less time dealing with a broken healthcare system and more time doing the things we love together.”

Today, as this virus keeps many of us separated from our loved ones, and we question when or if we’ll ever get to see them again, it would be nice to have some of that precious time back. One more family dinner or afternoon in a darkened movie theater. One more night dancing with friends or morning waking up in a partner’s arms. Everything we forgot to miss. It would be nice to spend less time surviving in this country and more time living in it.

It makes sense to me that Ady would come to this conclusion after everything he’s been through. Because for four years, Ady’s been an astronaut, an explorer. He’s been out there, telling us all that there’s a better way, that things look different from the clarity of space. I can’t claim to have Ady’s strength or courage or wisdom. But after spending a month contemplating taking my own life, I’m coming to the same conclusion.

What I’m saying is this: maybe now, more than ever, it’s time we listen to our astronauts, to the people who’ve been closest to the other side. To everyone walking the halls of psychiatric units or receiving medication for substance use disorder or being hooked up to ventilators to breathe through this virus. To everyone with the quieter stories, lacking the resources to receive those treatments without giving up food or shelter or security. To everyone who used to push their boulders to work or to school or through disability hearings and are now pushing them through isolation or quarantine. To everyone who knows they are sick but can’t do anything about it in America.

These people know struggle, and they have vision. They have insight. They’re out there in orbit, looking at how this country functions, telling us exactly what’s wrong with it. Grassroots activists and organizers have been telling us this for years. People directly impacted have been telling us this for years. Doing the work. Moving the needle. Showing us a better way.

During my hospital stay, a test revealed I have a genetic anomaly that explains why psych meds have never worked on me in eight years of treatment, something nobody noticed until now. I lack the serotonin receptors required for most antidepressants to function. We’ve switched meds to target other receptors, and I’m showing some tentative signs of improvement. So it wasn’t strength of will or persistence that got me better, if these improvements do last. It wasn’t courage. It was access to care. It was insurance. It was a doctor treating a patient. That’s how it’s supposed to work. That’s how it could work.

We could put that vision into action right now by using a stimulus package to expand health coverage and improve care in this country or by passing emergency legislation to cover the cost of treatment for the uninsured for the remainder of this crisis. We can also rally Congress and our next president to pass long-term health care legislation that serves all of us. I hope Vice President Biden draws wisdom from what’s made Medicare for All so popular with voters, from the millions of people who drove this movement and collectively reimagined what’s possible for a healthcare system in this country. I hope he looks at the COVID-19 crisis and understands that tying health insurance to employment is antiquated and unforgivable, that it leaves people unprotected, that it leaves our most vulnerable behind. As an organizer, I hope we do our job to move him there, to make him see.

Here’s to wielding that wisdom. Here’s to listening to our astronauts. And here’s to everyone out there, dragging their boulder across the floor as a pandemic spreads and capitalism fails, protecting everything and everyone they love in this world, doing whatever it takes to survive another day in America.

Vinay Krishnan is the National Field Organizer for the Center for Popular Democracy Action (CPDA). To join CPDA’s next digital rally demanding universal health care during the COVID-19 crisis, sign up here. Follow Vinay on Twitter @vinayrkrishnan.

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Photo by The New York Public Library on Unsplash