Spring 2021

One Flew Over Gimmel Ward

The closed ward at Geha hospital, one of Israel's most renowned psychiatric hospitals, is a microcosm of Israeli society.

Yaron sat in the shade of the concrete courtyard, a pale 40-year-old man, stooped over, beside his mother. She picked lint off his stained pajama top, smoothed down his sweaty, thin blond hair and kissed the top of his head. She was his best friend, he told me. This was many years ago, actually, but I remember it. She was his best and only friend, in fact, was what he said.

He had friends once, but he drove them all away, he recounted, his eyes darting back and forth behind thick glasses. It was because of the phone calls. He would ring twice, four times, ten times, twenty times a day. He would call his friends at home. At work. At their in-laws. Early in the morning, in the middle of the night and on weekends.

When they started hanging up on him, he went to their homes and rang the intercom buzzers. When they called his mother to complain, she paid for the phone company to disconnect their land lines and give them new numbers. When they summoned the police, he was hauled into detention. When they complained again, the court sent him here—to the closed Gimmel ward at Geha Hospital, home to a handful of Israel’s severely mentally ill citizens.

But why did you call them so often? What did you want to tell them exactly? I asked Yaron, who soon was diagnosed with Asperger’s, a highly functioning form of autism, and OCD, obsessive-compulsive disorder.

“I was jealous of them,” he replied. “And I wanted to tell them I was a failure.” His voice was monotonic. “Sometimes I just made animal voices into the phone receiver,” he added. A grin spread slowly across his face, and stuck there. “You know, cats, dogs. Maybe a cow.”

Why are you smiling, I asked, after a pause. “I don’t know,” was what he replied.

**

I met Yaron about 13 years ago, in March, sometime around my birthday.

Looking back at an old calendar, I see that 2008 was a busy year, filled with adventures and much movement. It started with a reporting trip to Myanmar, moved along to a canoe trip in Papua New Guinea—where I was, supposedly, searching for cannibals—and ended on an embed with US troops in beautiful Nuristan, Afghanistan. In between, I camped out in my brother’s dorm room at Cambridge University, cheering him up, post his first serious break-up; I placed third in the Tiberias triathlon for my age group; I rented a rooftop apartment near Rabin Square in central Tel Aviv; and I fell in love. It was a busy year, and a good one.

Somewhere in there, I also spent a few weeks doing research for an article on Geha, one of Israel’s best known psychiatric hospitals. A close friend of mine, Orna Arad, was doing her residency there; she connected me to Dr. Tsvi Fischel, the long-time director of her ward, an understated man with an easy sense of humor and an unhurried manner. Asking only that I not identify the patients by their real names, Fischel agreed to help me with permissions and access. I didn’t have an exact agenda or plan, I admitted. I was just curious to see what went on inside such a place—and I figured that others might be curious too, and, as such, that there would be a story to tell.
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And so it happened that I found myself going on rounds with Fischel and his team. I sat in on their staff meetings and joined their staff breakfasts. I was given a magnetic key to buzz myself in and out of the many locked doors within the ward and wandered the hallways. I chatted with the social workers and nurses, asked questions of the psychologists and drug addiction specialists, and watched the occupational therapists try to get grown-ups with blank eyes excited about finger painting. Basically, I observed the staff as they observed and diagnosed the patients: fine-tuning medications in an effort to minimize the confusions, highs, lows, rages, depressions, and abnormal behaviors that come part and of parcel with extreme psychiatric afflictions.

In my notes from those visits, in the margins, I see scribbled the word “claustrophobic” more than once. I can conjure up the feeling, too. I imagined being stuck behind locked doors day in and day out, and I felt ill at ease. My chest felt even more constrained when I imagined being stuck inside my own head: doing battle with uninvited voices in there, unable to escape and re-join the “normal” world right outside.

**

It is estimated that one in four adults in Israel—a statistic that is similar to numbers around the world – has experienced some form of psychiatric illness in their life, if taking into account bouts of depression and anxiety. The vast majority of these people—with time, proper home care, maybe an appointment or two with a private doctor, or a visit to outpatient ward, and perhaps medication—manage to keep their illnesses under control.

However, a very small percentage of those with mental health issues, about two percent, find themselves completely unable to function in regular society. Their behavior abnormalities become troubling, or burdensome; in the worst-case scenarios, a risk to themselves or others. Some of these severely mentally ill, whether due to negligence or misdiagnosis, don’t get the proper treatment they need. But many end up at a place like Geha’s Gimmel ward, or at any one of the dozen or so other closed psychiatric wards in Israel.

And there, locked in, removed from society, these people remain, on and off, for weeks, months, even years. Over eighty percent of the patients who check out of one of Geha’s two closed wards find themselves returning. It’s usually just a matter of time. For most, the mental institute becomes a way of life.

Geha, situated in Petach Tikva, just east of Tel Aviv, is responsible for the mentally ill who live in its extended geographical zone—from northern Tel Aviv, Ramat Gan, Givatayim, and Bnei Brak to Rosh Ha’ayin, Yehud, and Kfar Kassem. Amongst the 40 or so patients hospitalized at any given time in Gimmel ward, there will typically be a mix of Yemenites, Ashkenazim, and Sephardim. There will be Russian immigrants, Ultra-Orthodox Jews, Christian and Muslim Arabs, Ethiopians, and a smattering of almost everything else. Severe mental illness strikes across the board. It does not differentiate, obviously, between high-school dropouts and professors, army officers and longtime drug addicts, women and men, gays and straights.

In a way, Geha is a typical microcosm of Israeli society. If only, in Israel’s larger society, people from such different religious, cultural and socioeconomic backgrounds mixed as much, or had so much in common.

But that’s not usually how the people in Geha are perceived.

“Typically, we think: ‘these crazies are not like us.’ We don’t hear about these people because we don’t want to hear. Because no one likes to look at these patients,” Fischel told me, when I first sat in his unadorned office and took out my notepad. “There is no sex appeal here.”

While almost every ward in the nearby Beillinson and Schneider hospitals have donations pouring in—which go to beautify the hallways, open up playrooms or libraries, bring in extra staff and purchase new, needed equipment—Geha gets practically no private funding. Precious few donors, it turns out, are interested in a plaque with their name on it in a locked ward for the mentally ill.

“The words ‘mental illness’ or ‘psychotic disease’ fill us with fear. People don’t know how to behave,” Fischel continued. “You don’t know how to evaluate bizarre behavior. Is it dangerous? Is it okay? You would rather not engage.”

**

The day-to-day routine for the patients locked in Gimmel ward, I soon found, was simple, repetitive, and boring. A few were there by choice, but the vast majority were either placed in the closed ward by the courts or by the district psychiatrist. In either case, in order to be released, given a home visit, or accompanied leave, patients had to convince an external committee of mental health experts that they would not do themselves or others harm if allowed out.

They wait for the committee to see them, wait for their meds, wait for mealtimes, wait for their doctor’s visits and wait, mainly, to feel better. They meander the unadorned hallways in department pajamas, or, if they had gained some privileges, in their own familiar clothes. They go up and down the stairs to the cigarette littered inner courtyard, or sit in the row of chairs in the front room, staring out into space, chatting, or pestering the nurses.

Every time I visited there was a group loitering around the ward’s public phone, hoping someone might call them. Others would be shuffling in and out of arts and crafts classes or down to the exercise bike in the basement gym. Some read the papers. Some napped. Some smoked. Some fought. And, in the early evening, just as I rushed out, back to Tel Aviv and whatever plans I had, they would retire into their shared rooms, where they might toss, turn, snore, sometimes cry, sometimes yell, and hopefully sleep—until it began over again the next day.

Pretty much all the patients I spoke to wanted me to know — and jot down in my notes, that they really needed and wanted to get out of the ward: That they had changed, and were ready to go home or that they were never supposed to have been in this “place for crazies” in the first place. In many cases, there lurked an ambivalence beneath this stated desire to leave, the staff told me, but still, this was the mantra repeated over and again to anyone who would listen.

“No one pays attention to me here!” screamed a disheveled drug addict, eating yogurt and mumbling his words as he turned to a social worker. “I am an adult—not a little boy! I’m not a thief! Why am I not free?” He began to cry. “My grandson has a Brit today. Who will take me there?”

Another woman, who confused “she” and “I”, told a nurse she was knitting baby boots for her son— — who was 25 years old. “Let me die. She is suffering!” wailed the woman. “I need to go home and help mother. She said we need to go get facials together. She said I have beautiful skin.” In reality, the woman’s mother had rejected her and did not want her home for Seder, even though she had been given permission for leave.

Shaul was a different story. A large, loud man with a shaved head and deep scars across his neck, who spat uncontrollably when he spoke and admitted freely that he “scared people,” didn’t want to go anywhere. “I love this place,” he said simply “…Where else do I have to go?”

Shaul had been diagnosed with a schizoaffective disorder, a disease that caused him to have hallucinations, suffer from paranoid and bizarre delusions, and experience intense maniacal highs. He hobbled slightly, thanks to a shattered ankle from a suicide attempt. His wrists showed signs of razor marks and his chest had been burned by acid. He had tried to kill himself, he calculated, “more than a hundred times.” He was, then, 33 years old.

He needed to suffer, he explained to me. There was a reason for it: “I help prevent tragedies,” he said. “Instead of a terrorist attack that would kill tens of people, I cut myself a little—I take the hit—and that is how I protect the people. We don’t need the Shin Bet or the police. I take care of it. I am the protector of Israel.” The Torah, he continued, “…says everything about this. It makes it clear who I am and what I am doing.”

The first time he was sent to Geha was after he stripped down naked outside Radio 103 FM in Givatayim. The day had started with him writing God’s name across his chest with a thick red magic marker, and demanding to speak to the radio personality who hosted the weekly Kabbala program. “I wanted him to explain to me who I am and why I am. Of course he thought I was crazy so he didn’t come,” Shaul shrugged.

Disappointed, what Shaul did next was to take his pants off and race around yelling: “the King is naked. Don’t you get it?” That’s how the police found him when they showed up. They handcuffed him and brought him to Geha for an assessment. “When I first arrived, I wreaked havoc on the place,” he recalled. “I threw benches and tables and smashed things. They had to tie me up.” He had been in and out of the ward over 30 times since.

I see a quote from Fischel underlined, twice, in my notes: “The truth is that in order to work with these people, typically you need to love them,” the doctor told me. “Loving them means that despite how sick they are, and despite the many frustrations, you need to see the human, warm side to them.”

**

My plan, if I remember correctly, was to open my article with the story of Rabab, a 37-year-old Arab mother of seven from Kfar Kassem, and an interesting case. Six years previous, taking a walk with her one-year-old baby in her arms, she fell in a ditch and went into a dissociative state—remaining low-level conscious but completely unable to function. Her baby grew up and went to first grade, and then second and third. Her other children stopped asking her for help with homework or to make them a snack. Her sister-in-law moved into the home to help with the housework. Throughout, Rabab sat staring at the walls.

Brought into the day wards at Geha, Rabab was given one medication after the next, but nothing helped. Finally, when her condition worsened, she found herself in Gimmel ward, where a new experimental course of drugs was tried. Something clicked, and, over the course of a winter, she slowly came back to life. But then, frustrated by all the years she had lost, and unable to remember anything about them, Rabab became terrified of sinking into a semi-conscious state again, and projected symptoms of a post-traumatic stress disorder.

I look back in my notebook, deciphering my handwriting, and reconstructing her words from back then. “I woke up and felt like I was in the middle of a road and I did not know where to turn. I did not know where I wanted to go,” she had explained. “I am sad. Why did this happen to me? I peep out the window at the neighbors and I don’t want to be friends with them. I am angry and I am jealous. They clean and cook and I don’t know how. I forgot how to cook anything. My husband tells me I used to bake lovely cakes.” She had tears streaming down her cheeks, I had written in the margins.

“I have everything. I have a nice house and children, but I am so sad. Something is missing,” Rabab told me. “I miss my children, even though they are around. I feel they don’t love me. I see my neighbors’ children are not like mine. They hug their parents, they love them. My baby cries when the caretaker leaves. She has forgotten me.”

“And I am scared, so scared, that it will all happen again. It’s in my head all the time. I am afraid to be alone…What is happening to me?” she asked. “What is going on with my brain?”

If I didn’t lead the article with Rabab, I remember thinking, I would go with Baharu, a 50-year-old schizophrenic and father of three who immigrated to Israel from Ethiopia in 1988. Like Shaul and Yaron, he had been committed to Gimmel ward by a court order. I first talked to Baharu during an arts and craft therapy class, where he was busy with some red and yellow strings and a very blunt needle.

He didn’t want to talk about what happened, but acknowledged that he was accused of abusing his older children and trying to kidnap his baby daughter from his estranged girlfriend. “Some say that, but it was not really me,” Baharu insisted. What really happened, he claimed, was that the baby had a terrible rash and he had voices in his head telling him to help her, but anyway, she jumped on a donkey and galloped away. The thread of his logic—like that in so many of the stories I heard on the ward—was difficult to follow. After spending four months in jail, Baharu was sent to Geha for treatment.

“At first I would imagine things. I had all kinds of unwanted thoughts. But now I am okay. I was helped,” Baharu insisted, as he painstakingly sewed together pieces of fabric for a wallet. “When I am told what to do—I do it. All my bad thoughts are going away… and next week I will meet my daughter. She used to be scared of me…but not anymore,” he said. The wallet, he said, shyly, would be for her.

Visiting hours have always been unusually long at Geha—from 8am until 8pm—but there is never any rush of family or friends. Baharu claimed he had 16 siblings living in Israel. I remember him counting them out on his fingers, one by one. But when, before being committed to the ward, he had found himself homeless, none of them offered a spare bed. “Or even a couch,” he corrected himself. And then in Geha, while Baharu kept saying one of his brothers was coming to pay a visit, and often sat in the front room in the afternoons waiting, not one had shown up.

**

I never finished my article, and it was never published.

I can’t remember what went wrong. Did I abandon it so as to run off to a different project? Did the magazine that I pitched it to not want it? I vaguely remember that it was difficult to get anyone too excited about it. Whatever the case, in between the exotic cannibals in Papua, the monks in Myanmar and the US Marines in Iraq, the stories of the people locked up in Geha—those with, as Fischel might put it, no sex appeal—never went anywhere.

A few years later, in Jerusalem, I bumped into a young woman I had met doing my reporting: Keren, a religious 25-year-old Yemenite woman who grew up in an affluent family in Ramat Aviv and had been diagnosed with a bi-polar personality. She asked me about the article. I apologized for letting it slide. She said it didn’t matter, and that she didn’t blame me. “Boring!” she laughed. I remember the friend I was walking with asked me about Keren; asked if she was a doctor or a nurse and noted how beautiful she was.

Keren had always felt she was terribly ugly, she told me when I first met her, back in the ward courtyard. “Everyone would laugh at me because of my glasses and elephant teeth in school,” she said. When the class picture was handed out at the end of the year, she put a big X over her face, she felt so ugly.

By the time she reached junior high school her father, diagnosed with schizophrenia, had left home, and Keren found herself retreating even more into her own shell, watching hours of TV every day, reading books in English and imagining, she said, that she was living in Los Angeles along with the cast of Beverly Hills 90210.

She managed to finish high school, do a stint of national service, and register for a linguistics degree at Bar Ilan University. But, lonely, she also began hanging out at the mall in Ramat Aviv, where she would start up conversations with strangers. A chance encounter with an older man led her to a group of hippies living in a commune in Jaffa. Soon, she had joined them.

Nineteen at the time, Keren started a relationship with the older man, an American from Albany who dressed in biblical garb and talked about redemption. He was, she said, “different:” the kind of guy who would organize a break-in to the Safari Park at night and smoke pot near the giraffe enclosure. She dug his American accent. He plied her with drugs. “He had a vision of revolution and I fell in love with him,” she said. “He took care of me.”

One day at the commune, she tried a new drug—she didn’t know what—and suddenly, her world flipped upside down. “Right in front of me, everything changed. I started to see fairies and midgets and also some frightening things and then I started going wild. I started yelling and lashing out. It was not nice at all. I was in a psychotic state only I didn’t know it yet. Everything became different. The grass was not grass. The buildings were not buildings. And it went on and on. Not for hours, for days. On and on. That’s when my disease broke loose. It was the trigger. I thought I was going to die.”

Eventually one of the commune members called Keren’s mother. Kicking and screaming, the young woman was taken to a private psychiatrist and put on medication—which, back home, she promptly stopped taking because it made her gain weight and feel even uglier. Her friends at the commune did not want her back; her boyfriend rejected her, called her crazy, and eventually went back to Albany for good. She spent her days watching soap operas in bed at her mother’s house, afraid to go out because she felt so unattractive.

On a sweaty afternoon, holed up inside and depressed, Keren swallowed 30 lithium pills, one after another, with lots of water. She put on her favorite black shirt and pink skirt, fixed her lipstick, wrote a short note to her mom saying she was fed up, turned off the TV, and lay down to die. It didn’t work. She started vomiting violently, and soon her mother came home, rushed her to the hospital, and had her stomach pumped. Keren was committed.

What followed were years in and out of Gimmel ward. In between were stints at the university, a love affair with an army officer, and gigs singing at Rainbow gatherings around the country. But Keren’s disease always caught up with her.

“The medications dry my face,” she said. “Am I ugly? I am not ugly, am I?” she asked, over and again. I remembered her talking to Fischel, back in the ward, one time: “It’s not only the ugliness,” she confided in him. “I don’t want to take my meds because I don’t want to be defined as mentally ill.”

Fischel looked her straight in the eyes. “But you are mentally ill,” he replied. “It’s a fact.”

***

Often times, Fischel explained to me, a mental illness will sit dormant in its carrier until awoken by a trigger—an extreme circumstance or stress that releases a disease that was always there. Or, at least, he added, that is what patients and their families often tell themselves.

“You can never know if it’s a real trigger or if the disease was rising up before, naturally. It’s hard to know,” explained Fischel. “But what is clear is that everyone, in their story, has a trigger. It’s human nature to look for a reason for everything—so we say, ‘this is because of the army,’ ‘this is because of the war,’ ‘this is because my wife left me,’ ‘this is because I was fired from work.’ In everyone’s private script, there is a trigger.”

In Shaul’s explanation of things, it was years of physical abuse by his father, and later sexual abuse by a teacher at school that begun to unhinge him; that and the break-up with a girlfriend that took him over the edge. In Rabab’s case, her fall was the obvious turning point. For Keren it was the particular drug experience.

For Baharu, it was Israel. The country he had so longed to reach had made him crazy—that’s what he believed. “If I had stayed in Ethiopia it would have been different. In Gondar I would not have been sick because there is no stress there. There is nothing there,” he explains. “Here, it is hard. Everything is crowded. Everything is stressful. It’s a small country.”

For Yaron, the trigger was the moment he realized he couldn’t hold onto a job.

“I kept trying to find work. My mother helped me and I pushed myself too. I would sit and look through the wanted ads in the newspapers and I got some jobs but they didn’t work out,” he said.

During his army service, Yaron served in the Kirya’s kitchens in the army; and afterwards as a clerk at the tax authority archives, a travel agent, an intake assistant at a Maccabi clinic, and a phone operator at Yes TV. The first time he was fired, at the tax authority, it was because he failed their IQ test. “Yes, it hurt my feelings. A little,” he admitted. “People liked me then, but there are rules about IQ, so I couldn’t stay.”

He met a young woman who had been diagnosed with schizophrenia. They went on dates in Dizengoff Center, got married in Or Yehuda, and went to Tiberias for their honeymoon. His mom had helped them with the money for the wedding and they had 80 guests. “My bride’s wedding dress was so beautiful,” he told me. “I have photos but the photos are in my wallet, in my pants, which were taken away.”

He got a job as an operator at Bezeq, back in the days when people still called 144 to ask for a phone number, and kept it for three years. Things were alright, he reflected, but then—he didn’t know why—everything started going wrong.

“It ended badly at Bezeq,” he said. “I made mistakes. I gave wrong numbers and I was not careful. So I was fired. The manager said I had misled the public because I would give wrong numbers. I was not focused. I was thinking about other things and it held me back. I did not argue.”

His lack of social skills, clumsiness and an intense preoccupation with narrow subjects—all symptoms of his disorders—made Yaron both unpopular and unable to fulfill tasks given to him.

Yaron kept trying to keep in step with normal life, even as his mind drifted. He did some telemarketing, and some phone surveys, and found a new job, in a candle factory, which he liked because he liked the smells. But he did not last anywhere for more than a month. “I kept getting fired faster and faster. And I was very frustrated. I would not come on time to work. I would forget to shave. I looked a little derelict. I did not treat the job respectfully. And then at some point, I saw I was not succeeding anywhere—that I was being fired everywhere—so I gave up.”

It was at this stage, explained Yaron, that he stopped being able to control his behavior. “I was very stressed and I started harassing my friends. I was jealous of them for having jobs,” he reflected. “I don’t know why I could not stop myself. Maybe it was frustration. Or badness. I don’t even know. But at the end they started calling the police and complaining.”

“The disease was bursting out. I could not help it. I would call several times a day. I would drive them crazy. I would tell them how unhappy I was, about how I was not doing well. And they got sick of hearing about it and would put down the phone on me. Not one or two. Everyone. It was insulting. No one wanted to be my friend. All ten friends I ever had left me. These ten had all been at my wedding, but they all deserted me. They decided that I had lost my mind, that I was a harasser. They said I was a serial harasser and they all broke off contact with me.”

A court dropped the harassment charges against Yaron, pronouncing him unfit to be prosecuted, and sent him to Geha for 180 days. His wife cried when this happened, he said. “She knows there is something wrong with me, just as I know she is unwell, too” he explained. “But this does not deter us from loving each other.” She is not angry with him, he insisted, even though she had lost all her friends too, because of him.

“I never imagined that I would end up here. It’s a nightmare for me. A real nightmare. I am used to a settled life. I want to be at work. And to see my wife who needs me. And see my mother, and eat at my mother’s house. My life is standing still now. I feel like I have failed. Like I have had such bad luck,” Yaron said.

“But,” he added, with an inappropriate grin, “despite all the suffering my actions have brought me—I still want to call and harass people. Harassing people has ruined my life. Look at me. But I still have those urges.” He leaned in conspiratorially, and revealed a secret: “yesterday, I even called and harassed someone from the public phone here!” The woman he called used to be his wife’s best friend, he said; someone he had been harassing for years, and who frequently complained to the police about him.

“I told her ‘why did you put me in this nut house? Look! Because of you I’m stuck here!’ And she said, ‘that’s where you belong. That’s where harassers like you belong.’ And I said, ‘but I’m suffering here!’ And she said, ‘you deserve to suffer. You deserve to suffer for the rest of your life. I hope you stay there forever.’”

And then what happened? I asked. “And then she hung up.”

**

This year just past, 2020, has been a less busy year. An adventure, I suppose, but of a somber sort. Movement was replaced by lockdown, companionship by solitude, frenetic work and travel with a quiet punctuated by screen time.

The COVID-19 pandemic, with its attendant long months of economic hardship, isolation, and fear has stopped us in our tracks, with little control over what is coming up next. We have all been—so to speak—locked up, and overly busy inside our own heads.

Studies by Israel’s Bureau of Statistics show significant increases in reports of insomnia, anxiety, depression, substance abuse, and post-traumatic stress this past year. This, in addition to findings that COVID-19 itself is leading to neurological and mental complications, such as delirium and agitation.

Over thirty percent of those surveyed by the bureau said their mental health had deteriorated since last March. ERAN, Israel’s mental health support hotline, echoed these findings, saying they were receiving “unprecedented” numbers of suicide-related calls.

Meanwhile, for those who, even in regular times, suffer from severe mental illnesses—schizophrenia, bipolar disorder, and the like—the difficult times the world is going through offer up more, and more varied, triggers that can, and do, lead to more crises. And all this is happening as overwhelmed health systems, in Israel and around the world, are forced to disrupt regular psychiatric services.

Finally, there is general concern that worse is yet to come: that there are multitudes suffering from mental health problems silently today, unable or unready to turn for help during the lockdowns, who will eventually surface.

In this context, and for the first time in a long time, I thought back to the patients I had met at Geha all those years ago: met, but, in my own way, forgot about. I was supposed to tell their stories, but never did. I remembered them now, and felt badly. I figured that this could be a good time to finish that article. I had the time, and the inclination, and I suppose I felt that I—and readers—might have more empathy and compassion now for those whose maladies suddenly felt far less foreign or impenetrable than they might have seemed before.

So, I recovered my old notebooks, re-found some drafts of the old article in a forgotten file on my laptop, and, over a decade later, retraced my steps back to the closed ward. My friend Orna, today a mother of three with a thriving private practice, put me back in touch with Fischel. I was a little embarrassed, considering how all the time and attention he had given me had come to naught back then, but I chanced it and asked to return to pay a visit or two, anyway. Fischel, who still runs Gimmel ward, and is also, now, the president of the Israel Psychiatric Association, didn’t seem to hold any grudges at all. Sure, he said, and helped find me an early morning ride to the hospital with a new resident on the ward.

Fischel sports reading glasses now, the kind that hang around your neck and snap together, and has, maybe, a few more white hairs. His son, a tot when we first met, is halfway through high school. But much else has remained the same. I found Fischel in the very same bleak office, with the same coffee maker in the corner, and he still comes in, every single day, before 7am, sporting his same signature colorful sneakers.

Despite there having been, in the intervening years, something of a shift in attitude towards mental health, with a growing sympathy for and interest in those who suffer, there is still almost zero private funding at Geha, Fischel told me as we headed to the staff breakfast. They were serving the same avocado and eggs and tehina on white bread, only now, in the days of corona, eaten on throwaway plates and out in the courtyard, where everyone took as best care as they could to keep socially distanced.

I’m not sure what I thought I would find, going back to Gimmel ward all these years later. I recognized some nurses, social workers and counselors. Many of them had been here, like Fischel, for decades. But none of the patients that I spoke to back in March 2008 were around when I visited this time. I asked the chief psychologist Rachel Golan, who was getting ready for her retirement that very week, after 30 years on the ward, if she knew what had become of this one or that, but she didn’t or couldn’t say. Two of the nurses remembered Yaron, recalled his meowing and moo-ing, but didn’t know what had become of him. Several others, like Keren and Shaul, had, I was told, been in and out of the ward many times over the years.

There are certainly cases of patients from Gimmel ward, Golan said, who manage to control their conditions and find ways to lead stable, even productive, “normal” lives. Often, she said, these are the patients with stronger family bonds, more supportive communities, and the ability to adhere to their medication regimes—although, sometimes, too, she admitted, it was just luck. The vast majority of patients, in any case, return, over and again. Even the very lucky ones who don’t, Golan stressed, typically face a lifetime of fighting their demons.

There were not going to be any endings to tack onto my stories here, I quickly realized. I also realized that, while there were all new faces among the patients in the ward, most of the afflictions, needs and demands rang familiar. It was as if I had stepped away for just a moment, and come back to find a different cast of characters acting out the same play, with the same staff handing them props, fiddling with the lighting and trying to direct the scenes.

“I need to get home. I’m a normal person,” a young woman in tight jeans and brown leather boots told Fischel as she was brought in for reverse-style-rounds. These “corona rounds” now involve the staff sitting—in facemasks and, at least in theory, a meter each apart—in one big room, while the patients come in to them, one-by-one and masked, to sit behind a plastic divider and give an account of how they are feeling. “You guys just like having me here because you like having someone normal in a ward filled with abnormals,” complained the young woman. “Let me go! Don’t be mean!”

“I talk to people a lot. It’s not because of a mania. It’s because I am lonely,” explained the next patient, a slight man whose big white kippa kept slipping off his head, even as his mask kept slipping off his face. “I have been in this ward five times this year, and I am suffering. The drugs you are giving me make me fuzzy. I can’t even brush my teeth. It’s a bummer. I want to have faith that you can help me,” he said and then, fed up with the mask, pulled it down and cried out: “Can you help me?”

“I want to get out to see people, even just to the mall,” a tall, elegant immigrant from Russia, who recently smashed her arm into a wall in the ward so violently that she now had it in a sling, requested, politely. “What, we are not people here in the ward?” Fischel replied, teasing her a little. “No!” she responded, “…I mean happy people. Regular ones.”

Before each patient left the room, Fischel offered them a wrapped sugar-free candy from a bowl. They were to choose one, he told them: either mint flavored or berries. Each and every patient took some time considering their choice. And each and every one said thank you: pleased, it seemed, with the token act of kindness, or perhaps just with the normalcy of the interaction.

Another thing that I found had not changed over the years was the claustrophobia that the ward induced in me. At one point, leaving the courtyard and intending to head back to Fischel’s office upstairs and around a corner, I found myself stuck, because, this time, I didn’t have a magnetic key to let me through the various locked doors. I sat down on a windowsill in a hallway, waiting for a staffer to walk by and help me out.

As I sat there, trying not to feel stressed, looking through my notes, a spritely 73-year-old grandmother, who was born in Afghanistan and had grown up in Tel Aviv’s Shapira neighborhood, came and sat beside me. She whispered that she didn’t know what she was doing on the ward. When I expressed my condolences for the loss of her husband—who I knew had recently died—she looked conspiratorially down the hallway and confided that I should be congratulating her. We chatted a little. She told me her daughter was married to the most famous dog surgeon in California and asked if I knew him, although she could not remember his name. She told me no-one from her family had ever visited her in the ward, although, she whispered, they wanted to. She had not seen her grandchildren in a long time.

I stopped taking notes. I decided, right then and there, that I needed to first do right by all those whose stories I had long left untold, before replacing them with these new faces and new narratives. Yes, in a way, these were all versions of the same story, equally good illustrations of some larger tale. But at the same time, each and every patient I had spoken to, all those years ago, had shared their very specific, very personal story. I felt there was something not quite right about leaving all those old stories stuck in the proverbial hallways at Geha forever.

I went home—to a different apartment now, in a different part of town—and sat down to think, again, about Yaron. I don’t know where he is today, or how he is doing, and I probably never will.

I wondered if he was still harassing people on the phone, and whether the fact that fewer people have land lines nowadays had affected him. Maybe he got a mobile phone. I hoped he had found a job. I wondered if he and his wife stayed together, and whether his mother was still alive and picking lint off his pajamas and whispering words of encouragement in his ear. I found myself hoping he had made a friend or two along the way.


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