Susanna describes the layout of the psychiatric ward. At the entrance, there are two locked security doors. Just beyond them are three phone booths, a series of single rooms, the living room and the kitchen. This section of the ward is meant to “ensure a good first impression for visitors.” Past the living room, however, “things change.” There is a very long hallway with about eight double rooms on one side and the nursing station, conference room, hydrotherapy room, and bathrooms to the right. Susanna notes that this layout means that the staff has complete oversight over their patients’ “most private acts.”
The layout of the ward is designed not with the patients’ comfort in mind, but instead with the impression it will leave on visitors. The physical atmosphere of the ward reflects the emotional one—it is a place where patients’ needs are rarely recognized and almost never met, and where the people housed within it are routinely denied integrity and emotional safety. Isolation and privacy are not the same thing, and the ward is designed to maximize isolation but minimize privacy.
Across from the nursing station, the twenty or so names of the patients on the ward are written on a chalkboard—this is how patients sign in and out of the ward when they visit their therapists or take a day trip. The names of the discharged and the dead remain on the list for a time “in silent memoriam” of those who have left. At the very end of the hall there is a TV room. While the living room belongs to the staff, the TV room belongs to the “lunatics.”
The hospital is divided into realms, whose ownership either lies with the patient or the staff. The delineation between these two worlds is an even further reduction of the world the patients inhabit, which is already considered a “parallel” world which branches off from—but pales in comparison to—the “real” world.
After the TV room there is another turn in the hall—down this stretch lies the seclusion room. The seclusion room has no windows, and the only thing in it is a bare mattress. Though the seclusion room is supposed to be soundproof, it is not. Often patients will “pop into” the room to scream, since screaming in the common areas is considered “acting out,” but screaming in the seclusion room is acceptable. Patients can also request time in the seclusion room, though not many do, as once you request to be locked in you must also request to get out. If a patient had simply stepped into the room to let off the steam, anyone could join her—a nurse or a fellow patient—but if one requested the room, they were made to remain there in isolation. “Freedom,” Kaysen writes, “was the price of privacy.”
The seclusion room is representative of the difficult bargains that Susanna and her fellow patients must make within the psychiatric ward. Privacy, a rare commodity which is erased at every turn, is available in the seclusion room—but only at the price of agency and autonomy. To obtain privacy, the girls must relinquish themselves to the whims of the staff members, who look at them and judge what is going on inside of them without understanding.
Though as a group the patients maintain a certain level of “noisiness and misery,” anyone who acts out for more than a few hours at a time is placed in seclusion. Though seclusion is an undesirable punishment, Susanna writes that it works—it either calms one down or indicates that they need to be moved to maximum security—a section of the hospital which is, effectively, “another world.” ..
Though it can be voluntarily entered, the seclusion room’s primary function is to determine which patients need to be sent off to maximum security—yet another splintered-off section of the parallel universe the patients inhabit.