07/18/2014 02:16 pm ET Updated Sep 17, 2014

The Faint Line of Sanity

Years ago, when I was doing a psychiatry rotation at Bellevue, I learned a valuable lesson. One that has stayed with me since. Sometimes, it whispers softly in my ear reminding me. Other times it shrieks desperately to me.

It is that the line between "us" and "them" is so tenuous.

One of my patients was a charming man named Paul. He spent hours telling me how the government needed him out of circulation so they purposely made him go insane so he would be stuck in Bellevue, forced to do art therapy and take pills to silence him. Paul was fascinating. He would be frenetic and loud and totally unpredictable. The things he said often made no sense. He was clearly mentally ill. He looked it. He talked it. He smelled it. I liked Paul. I think I liked Paul because the line between me and him was an electrified fenced border. There was Paul -- with his paranoid non-sequitirs. There was me -- with my organized thoughts and my history of not once thinking the CIA was following me. I was the clear winner. Everything made sense and fit in my construct of a mental institution and its inhabitants.

The line between "us" and "them" was drawn with a fat black Sharpee.

But then there were the others.

The "them" that would shuffle from their rooms to the plastic chairs in the common room for group therapy and would need a few minutes to recover from the amount of energy that task required. Getting from bed to chair was their marathon. It took colossal strength to participate in living. The mental exhaustion was etched around their eyes and the corners of their mouths. It made their shoulders slouch and their bellies stick out. They didn't care enough to suck it in and sit straight. Waking up and breathing was all they could do some days. They didn't lash out. They didn't talk at all. They listened (maybe) and stared sideways, far far away.

I could barely take the fear they instilled in me. Because I got them. They didn't fascinate me at all. I had no questions for them. I wanted them to have co-diagnoses of bipolar or schizophrenia to explain why they ended up there. I read their charts looking for some unspeakable childhood trauma that made them like this. Sometimes there was trauma. Many times, there wasn't. And that scared the blessed shit out of me.

I would talk to them when they had the energy to hold a conversation and would try desperately to make the line between us thicker. I was in graduate school, he dropped out of high school. Phew. Until there was the woman who was an OB-GYN. And the man who worked for Merril Lynch doing something important with other people's money. And the college student who tried to kill himself. Three times.

I remember riding the bus home from work one day and making a mental list of the reasons I didn't belong in an institution with "them." I needed to convince myself that my depression was different, mild, curable. I would never end up like "them."

And I never did end up institutionalized. Though I've had days where I wanted to be so I can rest and get right in my head. But what I learned from that time has stayed with me. Just because we hold down jobs, have kids, go to parent-teacher conferences, occasionally exercise, get married, have meaningful friendships, write a blog, doesn't for one minute mean that we can't end up in an uncomfortable plastic chair in the common room in Bellevue.

It means that luck, good meds and love has kept me on this side of the line today.