March 13, 2008 I write this because, as of now, I am not sure if I am privy to a terrible secret or if I myself am insane. Being a practicing psychiatrist, I realize that would obviously be bad for me both ethically and from a business standpoint. However, since I cannot believe I'm crazy, I'm posting this story because you're probably the only people who would even consider it possible. For me, this is a matter of responsibility to humanity.  Let me say before I start that I wish I could be more specific about the names and places I've mentioned here, but I do need to hold down a job and can't afford to be blacklisted in the medical and mental health fields as someone who goes around spilling the secrets of patients, no matter how special the case. So while the events I describe in this account are true, the names and places have had to be disguised so that I can keep my career safe while also trying to keep my readers safe. What few specifics I can give are these: My story took place in the early 2000s at a state psychiatric hospital in the United States. My fiancée, Jocelyn, a puckishly intelligent, ferociously conscientious, and radiantly beautiful trust-funder who moonlighted as a Shakespeare scholar, was still mired in her doctoral thesis on the women in King Lear. Because of that thesis, and because of my desire to stay as close to her as possible, I had decided to interview only at hospitals in Connecticut. On the one hand, having gone to one of the most prestigious New England medical schools and followed with an equally rigorous and esteemed residency in the same region, my mentors were particularly adamant on the subject of my next professional step. Appointments at little-known, poorly funded hospitals were for the mere mortals from Podunk State, not doctors with Lux et Veritas on their diplomas, and particularly not doctors who had done as well as I had in my studies and clinical training. I, on the other hand, could not have cared less about such professional one-upmanship. A brush with the ugly side of the mental health system in my childhood, following my mother's institutionalization for paranoid schizophrenia, had made me far more interested in fixing the broken parts of medicine than ensconcing myself in its comfortably functional upper echelons. But in order to get a job even at the worst hospital, I would need references, which meant that the faculty's prejudices would play a part in my decision- making. One particularly curmudgeonly doctor I turned to happened to know the medical director at the nearby state hospital from his own medical school days. At least, he told me, working under someone with her pedigree would prevent me from learning bad habits, and perhaps our "overactive sense of altruism" would make us a good fit for each other. I readily agreed, partially just to get the reference and partially because the hospital my professor had recommended -- a dismal little place I'll call the Connecticut State Asylum (CSA) for the sake of avoiding a lawsuit -- suited my preferences perfectly, being one of the most underfunded and ill-starred in the Connecticut health system. If I hadn't committed to the scientific mind-set that refuses to anthropomorphize natural phenomena, it would've almost seemed that the atmosphere itself  was trying to warn me during my  first trip  up to the hospital for my interview. If you've ever spent time in New England during spring, you know that the weather often turns ugly with no warning because, with apologies to Forrest Gump, the climate in New England is like a box of shit: whatever you get, it's gonna stink. But even by New England standards, that day was bad. The wind screamed in the trees and slammed against first me and then my car with the violence of a charging bull. The rain pelted my windshield. The road, kept only semi-visible by my windshield wipers, seemed more like a dark charcoal path to purgatory than a thoroughfare, demarcated only with dull yellow and the husks of cars driven by fellow travelers who were more phantoms than actual humans in the wet, gray expanse. The fog choked the air with its forbidding tendrils, some spreading across the pavement, daring the navigator to risk the loneliness of the country road. As soon as the sign for my exit loomed out of the fog, I turned off and began driving up the first of what felt like a maze of dismal lanes smothered in mist. If not for the trusty set of MapQuest directions I'd printed out, I probably would've gotten lost for hours trying to find my way up the various mountain paths that led, with a serpentine laziness that baffled and mocked the navigator, up the rolling hills to the Connecticut State Asylum. But if the drive to the place itself felt ill omened, it was nothing compared to the misgivings that struck me when I pulled into the parking lot and saw the campus of the Connecticut State Asylum sprawling before me for the first time. To say the place made a strong and unpleasant impression is the most diplomatic description I can give. The complex was surprisingly vast for a place so underfunded and radiated the peculiar decay of a once proud institution scarred by neglect. As I drove past row upon row of abandoned, boarded-up old ruins that must've once housed wards, some built of faded, crumbling red brick and others of blighted, ivy-eaten brownstone, I could scarcely imagine how anyone could have once worked, let alone lived, in those ghostly tombs that comprised the vast monument to rot that was the Connecticut State Asylum. Perched at the center of the campus, dwarfing its forsaken brethren, stood the one building that had managed to remain open despite the budget cuts: the main hospital building. Even in its comparatively functional form, that monstrous red-brick pile looked like it was built to do anything but dispel the shadows of the mind. Its towering shape, dominated by severe right angles, with every window a barred rectangular hole, seemed designed to magnify despair and cast more shadows. Even the massive white staircase that led to its doors -- the one concession the place made to ornament -- looked more like something that had been bleached than painted. As I stared at it, the phantom smell of sterilizing agents floated into my nose. No building I have seen since seemed to so thoroughly embody the stern, bleak lines of arbitrarily enforced sanity. Paradoxically, the interior of the building was remarkably clean and well kept, if colorless and austere. A bored-looking receptionist aimed me toward the medical director's office on the top floor. The elevator hummed softly for a few moments as you'd expect, before it suddenly and unexpectedly jerked to a halt at the second floor. I braced myself for a fellow passenger as the doors slowly slid open. But it wasn't just one fellow passenger. It was three nurses clustered around a gurney carrying a man. Even though the man was strapped down, I could tell just by looking at him that he wasn't a patient. He wore the uniform of an orderly. And he was screaming. "Let -- me -- go!" the man roared. "I wasn't done with him!" Not replying, two of the nurses pushed the gurney into the elevator, where the third -- an older woman with her dark hair done up in a ridiculously tight bun -- followed him, clucking as she, too, hit the but- ton for the third floor. "Dear, dear, Graham," she said, her voice carrying a faint lilt that I recognized as Irish, "that's the third time this month. Didn't we tell you about staying out of that room?" Witnessing this interaction, I naively thought this was a hospital that truly was desperately in need of my knowledge and care. So I wasn't surprised when I was offered the job on the spot, though I experienced a curiously rigorous grilling by Dr. G --, the medical director for the institution, during my interview. It probably won't shock you that working in a mental hospital, especially an understaffed one, is both fascinating and dreary. The majority of our patients were short-term or outpatient, and their cases ranged from substance abuse and addiction to mood disorders, particularly depression and anxiety-related issues, as well as schizophrenia and psychosis and even a small group of eating disorders. As a state facility, we have to help everyone who comes to our door, and typically they've bounced through the system quite a bit and are at their wits' end and their financial limits. Changes to the mental health system both political and economic mean that we have only a small long- term ward. Most insurance companies won't pay for sustained care, so these are private patients and wards of the state. Within the walls of those wards you encounter people with views of the world that would be darkly comical if they weren't causing so much suffering. One of my patients, for instance, tried desperately to tell me that an undergraduate club at a certain elite university was keeping some sort of giant man-eating monster with an unpronounceable name in the basement of a local restaurant, and that this same club had fed his lover to it. In truth, the man had experienced a psychotic break and killed his lover himself. Another patient, meanwhile, was sure that a cartoon character had fallen in love with him and came in for short-term care after he was arrested for stalking the artist. I learned the hard way in my first months that you don't point out reality to people who have delusions. It doesn't help, and they just get angry. Then there were the three or so elderly gentle- men, every one of whom thought he was Jesus, which made them all yell at one another anytime they were in the same room. One of them had a background in theology and was a professor at a seminary. He would shout random quotes from Saint Thomas Aquinas at the others, as if this somehow made his claim to the title of Savior more authentic. Again, it would've been funny, if their situations hadn't been so depressingly hopeless. But every hospital, even one with patients like these, has at least one inmate who's weird even for the mental ward. I'm talking about the kind of person whom even the doctors have given up on and whom everyone gives a wide berth, no matter how experienced they are. This type of patient is obviously in- sane, but nobody knows how they got that way. What you do know, however, is that it'll drive you insane trying to figure it out.   Ours was particularly bizarre. To begin with, he'd been brought into the hospital as a small child and had somehow managed to remain committed for over twenty years, despite the fact that no one had ever succeeded in diagnosing him. He had a name, but I was told that no one in the hospital remembered it, because his case was considered so intractable that no one bothered to read his file anymore. When people had to talk about him, they called him "Joe."   Excerpted from The Patient by Jasper DeWitt All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.