The Quiet Room: A Journey Out of the Torment of Madness

This chapter is composed of an assortment of Lori’s journal entries.

In the entry for June 3, 1988, Lori states that she ran away, and that not stabbing herself in the stomach four times was a mistake. She writes that she will kill herself the next time she runs.

In the entry for June 8, 1988, she writes that she alternately feels like she wants to kill Dr. Fischer, or to tell her that she loves her.

In the entry for June 9, 1988, she writes that, despite her pleas to leave the hospital, she truly does want to improve her condition.

Lori feels that she is caught in a cycle of boomeranging between extremes. On one side are her doctors and hospital staff, and on the other are the Voices and her intense, uncontrollable emotions. Sometimes, however, she feels determined to overcome the Voices. She also notes that reaching out to people precipitates an avalanche: when she expresses herself, her feelings come out in an intense, uncontrolled outpouring.

She also notes the continuing role of her parents in her treatment. When they come to visit her, they always bring her the specific things that they know make her happy. And when they bring food, they bring enough for the whole unit. While she has a deep love and appreciation for her parents, she also feels that she has to perform for them. Their presence creates a storm of emotions inside of her, which she must struggle to master until they leave. Their conversation topics, too—their activities at the country club, the lives of her brothers—also feel very remote and alien to Lori, whose entire life has become determined by the hospital and her treatment.

Sometimes, Lori cannot control herself and she explodes in rage at her parents during their visits. She screams that she hates them and commands them to leave. Shaken, they leave. After they are gone, Lori finds herself drowning in guilt and self-recriminations. While she does have graphic fantasies about murdering them, she also fears that her fantasies will jump into reality, and that they will be accidentally killed because of her raging, sick, and irrational fantasies. Lori often goes to The Quiet Room after her parents visit. She notes, though, that these stints in the room feel very different than how they previously did, because the staff who attend to her while she is in there are more like friends with whom she can simply talk, rather than jailers.

These flare-ups of rage are very familiar for Lori, as she has been dealing with them for years. However, she finds new allies in the hospital staff at 3 South. In addition to Dr. Doller and Dr. Fischer, she knows other staff members by name and develops a very specific rapport with each one. They each work to “reinforce the doctors’ message: that [Lori] is not helpless before the onslaught of [her] Voices” (211). They each assure Lori that, while they cannot eliminate the Voices entirely, they can teach her ways to deal with them, and to prepare for their explosions.

Lori begins to feel a romantic attraction to Dr. Fischer. She confides in Dr. Doller about these feelings, who assures her that it is normal for some patients to develop such feelings for their therapists. Lori also notes that the Voices are reacting particularly strongly and violently to Dr. Doller because they know that she represents a real threat to their reign. No matter how extreme and grotesque Lori’s urges and murderous fantasies become, Dr. Doller remains non-judgmental and supportive. She reminds Lori to stay realistic about the fact that while she is getting tools to help her cope with her condition, she will have to learn to survive with the Voices. Too, though, when Lori is hitting a stride and feeling good, Dr. Doller reminds her to remember and to hold onto those times, so that when the dark times fall, Lori can remind herself that there is light at the end of the tunnel.

With the dawn of the new year, Lori holds onto hope for recovery. She also begins to internalize and believe what doctors have been telling her for years: that the Voices are truly not real. With the help of her doctors, she begins to identify the psychological motivations behind the Voices. For example, when she tells Dr. Fischer that the Voices are telling Lori to strangle her, Dr. Fischer gently asks her if it’s possible that she is angry at her. With this kind of guidance, Lori becomes more and more able to name her anger and to articulate it in words before it comes raging out of her in a crisis. She also becomes more able and willing not only to explain her feelings to herself, but to others.

The role of The Quiet Room, too, undergoes a transformation. She voluntarily goes there in order to gather herself, and it is no longer a place of pure punishment and containment.

However, her visual hallucinations also impinge on her mental health, as she sees familiar and seemingly random faces from her past on the bodies of others. One night, she hears a baby crying outside. Hospital staff members cannot hear it, and assure her that it is a hallucination. She begs to be let outside to try to find the baby, but as it 10 degrees outside, and dark, she is not permitted to do so. Lori goes so far as to call the police to ask them to investigate, as she cannot be convinced that the crying is not real. However, the police ask to speak to a nurse, who explains that Lori is hallucinating.

Lori is also very upset by her weight. She is heavier than she ever has been, and feels like a failure in the eyes of both her family and society at-large.

Lori begins to feel the looming threat of the state hospital. She knows that she cannot stay in New York Hospital forever. But she knows that she will kill herself if the state hospital becomes her only option. She therefore asks to be become a trial patient for a new psychiatric drug named clozapine. Although no medication has ever really worked for her, and each medication she has tried has caused a host of horrifying side effects, she clings to hope that clozapine will help her recover and avoid the state hospital.

Here, Dr. Doller intimates the depth of care and compassion that she has for Lori. When Lori comes to her in fear that her father’s plane will crash—due to Lori’s sometimes-murderous feelings toward him—en route from Chicago on a snowy night, Dr. Doller sees Lori’s fear as rooted in her worry for her father, and her anger that he has not arrived to visit her. She even articulates this to Lori, who insists that she is not angry, reminds her that her thoughts alone cannot hurt anyone, and that Lori has the option to direct her thoughts elsewhere, and away from the prospect of a plane crash.

Dr. Doller reveals that she and other hospital staffers have deep investment in Lori’s healing and recovery. They also see the dramatic improvements that Lori has achieved through her own drive to get well and her persistence in employing every suggestion and technique that they have offered her. It is these things that make Dr. Doller hesitant to put Lori on clozapine. While clozapine has had some success overseas, it is seen as a last resort. The staff on 3 South also do not believe that medication is the key to recovery. They instead focus on identifying the root psychological causes for disorders within each patient. They feel that, by understanding the intricacies of each patient’s disorder and its causes, they can bring the patient into a greater understanding of themselves. Dr. Doller sees symptoms—including Lori’s out-of-control behavior—“as an understandable—if troublesome—response to her scary inner world,” and not anything that should be punished or pushed away (235).

Too, while examining Lori’s history of hospitalizations, crises, and relapses, the diagnosis of schizophrenia (and none of the less-serious conditions that had been proposed in the past) becomes salient. Dr. Doller asserts her view that people with schizophrenia are fundamentally filled with a longing: to find an explanation for their condition, and to restore their connection to the real world.

When Lori confesses that the Voices often tell her to kill Dr. Doller, Dr. Doller grows afraid. She is not afraid that Lori will kill her. Rather, she is afraid that she cannot give Lori the help that she feels Lori is asking for: for a complete silencing of the Voices. Dr. Doller knows that her only true recourse is to give Lori the tools to deal with the Voices.

However, with the arrival of clozapine, Dr. Doller sees a dim possibility of giving Lori what she truly desires: complete removal of the Voices. While clozapine’s last-resort reputation, and its high risk (1 in 100 patients could expect to die as a result of being on it)serve as deterrents, Dr. Doller also sees dramatically good results for Lori.

The drug trials are operating under the auspices of providing Sandoz, the manufacturer of clozapine, with data to present to the FDA in order to apply to sell the drug in the US. The staff is fully informed about the risks and side effects of the drug, as well as the preliminary detox from all other drugs that other patients have had to go through—which is often extremely difficult—prior to beginning treatment with clozapine. The staff hesitates, unsure of who to offer the medicine to, but ultimately determine to give it to Lori. The only thing they must do is convince her parents to go along with it.

The longer Lori stays in the hospital, the more difficult it is for Nancy to visit her. Sometimes, Lori seems well and almost totally lucid, and she and Marvin leave thinking that perhaps Lori is right, and she truly does not belong in the hospital. During those times, when Lori tells them of her destructive and self-destructive crises, they yell at her and ask her how she could hurt herself. Other days, they find Lori clearly unwell and hallucinating. Then, they feel great grief and guilt for berating her for her crises.

Nancy begins to truly wonder what will happen to Lori. Although Nancy knows that the hospital staff adore her and are rooting for her—and that they see a unique strength, intelligence, and fight in Lori—she also knows that Lori cannot remain in the unit forever. Too, although the hospital staff say that Lori is improving, Nancy doubts them, because they did not know Lori when she was well, and therefore have a skewed perception of what “well” means for Lori, as well as the brilliance that she is capable of. She writes: “[Lori] weighed 170 pounds. She was enormous. She was unkempt. He expression was flat and her eyes were glazed. She bore no resemblance at all to the real Lori” (242).

Nancy begins to think of her cousin, Sylvia, and cannot bear the thought of Lori ending up on a park bench feeding pigeons.

When hospital staff introduce the idea of clozapine to Nancy and Marvin, they tell them both the good and the bad. While the drug could kill her, it has also helped some of the sickest patients, including those that have been catatonic.

Nancy reveals that, although she always assures Lori that there is hope for her, she has secretly given up that hope. She agrees to put Lori on clozapine because, after all the long years of struggle with the illness, she and Marvin have both reached the conclusion that Lori would be better off dead if she cannot overcome the Voices.

Lori documents her clozapine experience. When she was first put on it, she felt stoned. Also, due to the fact that a male patient who was detoxed from all of his medications spent two weeks in excruciating crises, Lori is allowed to taper off of her previous medication, Prolixin, at the same time as beginning clozapine. The two drugs, together, leave Lori very disoriented.

Too, “something about [her] depression, [her] anticipation, [her] anxiety, [her] hope, [her anguished fears] for the future combined to overload all the restraints that Dr. Doller, Dr. Fischer and [Lori] had so painstakingly built over the years” (246). Lori therefore begins to act out in wild and unpredictable ways.

Ultimately, though, Lori feels a new and deep sense of calm. She begins to actually sleep well, after years of troubled sleep. She feels as though her brain is successfully filtering out the illness, and the Voices grow steadily softer. When they threaten to erupt, it is like they meet with an invisible and strong shield. She feels as if she is being emancipated, and her journal entries become full of her declaration of a desire to live. Her increasing wellness is reflected in the way her face begins to take on normal, human expressions, and her gait transforms from that of a zombie to that of a human being.

However, the biggest change is that she begins to actually feel connected to other people. For as long as she can remember, it was the Voices that felt more real than the people around her. Now, though, it is vice versa. She therefore begins to forge real connections to her fellow patients, even pulling a fellow patient back into the unit when she, like Lori had done many times in the past, tries to flee.

Lori also begins to be able to feel a myriad of nuanced emotions, instead of merely swinging between extremes. She begins to be able to hold many complex emotions toward Dr. Fischer at once, and senses great possibility for what they can accomplish together. However, Dr. Fischer announces that she is leaving. Lori is initially devastated. However, Dr. Fischer agrees that they can correspond via letters for as long as Lori wants.

When Lori hatches a plan to commit suicide in order to get Dr. Fischer to remember her, Dr. Fischer looks at Lori “with a half smile on her face, her head tilted in her quizzical, listening pose,” and tells Lori, “No one could ever forget you—just the way you are” (251). For the first time, Lori actually lets those words be heard, and she also feels proud. She has a tearful last session with Dr. Fischer, and shares a bear hug with her that is surprisingly normal—“warm, kindly, enveloping” (252). Later, when she breaks down into tears with Dr. Doller while explaining the huge hole that Dr. Fischer left behind, she looks up to see tears in Dr. Doller’s eyes as well, and she therefore knows that while she lost a friend in Dr. Fischer, she still has one in Dr. Doller. Dr. Doller eventually agrees to step in and become Lori’s therapist.

Lori also observes that her life in the hospital has changed. Her room has furniture in it again, because it hasn’t been taken away to reduce her sensory stimulation. There are no longer guards outside her door. She no longer has to eat meals completely alone. Also, there is no more discussion of early discharge: she does not want to prematurely leave and endanger her progress.

While she has no idea how the clozapine is working, she knows that it is helping her feel like “a real human being again, a human being who [exists] in the world with other human beings” (253). She no longer needs to act out, and instead writes lists of stressful things in her journal. Also, while she occasionally fights against the slow pace of her discharge, she appreciates it as well. Because she finds the prospect of being released and expected to act normal daunting, and is afraid of a resultant relapse, she is happy to have the extra time to ease herself into leaving the hospital.

Lori gets into a halfway house called Search for Change. This time, she wholeheartedly and unhesitatingly accepts the halfway house as a gateway for her recovery. She also begins to venture further and further away from the hospital with her passes. She walks to the dentist. She goes out with another patient to eat Chinese food. While the trips do cause her anxiety, she can take medication to ease the anxiety, and her time in the outside world becomes gradually easier. She is also coming to stay with her parents regularly.

She reflects that, in the hospital, the sound of keys now signal freedom and control. She remarks that the best key of all is the 9925 key. It is the master key that all the doctors use to unlock all the doors in the unit—including The Quiet Room. It is the key that stands between Lori and freedom.

To Lori, freedom entails a kind of loss, as she has become accustomed to the security that the hospital provides, and has also learned the ins and outs of how to function within it. She also knows that she is going to miss many of the staff members, and briefly wonders how she will achieve recovery without them cheering her on. However, she quickly rallies, determined to make all of them proud of her, and to prove that she can make it.

Lori spends her last day in a circumspect state. She quietly says goodbye to each staff member, presenting them each with a small present. They present her with a gift as well: the 9925 key. Lori closes with, “On November 6, 1989, I opened the door to the outside world all by myself, and left the hospital forever” (255).