Years ago, when I was interned in a psychiatric unit, I watched as a young woman was wheeled in on a gurney. She was about my age and only semiconscious, her pallor nearly as gray as the gown issued to each of us patients. The gray blanket covering her legs and feet and the unit’s gray walls gave the whole scene, as I recall, a chilling grisaille, overlayered with apprehension. The accompanying silence was funereal. Sounds baffled, death was in the air.

Penny, as I will call her, had been resuscitated in an emergency room after an overdose of barbiturates, and then brought to the unit for treatment. After sleeping for a few days and starting on some 1980s-era pharmaceutical rescue regimen, she became lively, smart, affable, and wry. She and I formed a friendship, in a fellow-patients-in-a-hospital-unit way, got together a few times post-discharge, then lost touch. Yet decades later, the memory of that underworld scene still elicits a frisson of dread.

I’d been interned there for being depressed and lonesome, desperate to escape my family’s view of me, and dangerously self-depriving. Eleanor, down the hall, had been interned for not “responding” to antidepressants and sentenced to electroconvulsive therapy. Gene, in the room across from mine, ditto. MaryAnn had also “failed” antidepressant therapy and was there to be transitioned onto a different drug. Now Penny.

Psychiatric hospitals have often been likened to prisons, and I wouldn’t disagree. But the place was also a factory, its product the clearer-minded person, its processes regularized. I was to sleep a certain amount, consume a certain number of calories, and undergo both psychotherapy (still Freud-tinged, in those days) a couple of times a week and ancillary therapies (art, occupational, group). Penny was to take prescribed doses of the new medication that would wean her off the other medication (of which she had taken too much) and also undergo talk therapy. Eleanor and Gene had their electroshock sessions, MaryAnn her pill regimen. A process for each of us. Wake up, medication call, breakfast, therapeutic activities, medication, lunch, rest, more therapy, medication, dinner, hang out in the TV room to practice being social. We were empty vessels, waiting to be filled.

What stings in remembering these gray scenes is that our inner worlds had been remade into deserts, waiting to be colonized by the medical institution.

Why does this memory ring so loud right now? I think it’s because our universe has suddenly come undone. The Enlightenment has collapsed. The external world can’t be made sense of, not by resorting to any principles other than “He Who Has, Gets” and “Only the Strong Survive.” The inner world, the ever-roiling ocean that we call the mind or the self, is increasingly threatened with oblivion. The central fact of humanity, which is that we are all alike in that our inner worlds are all unlike, is in danger.

The threat is not that we won’t be able to think (although I suppose AI, if it doesn’t eat itself as I suspect it will, would eventually abolish even that faculty of ours). The threat is that we will not be able to think for ourselves, and to feel with others. For that, after all, is the aim of the regimes that dominate in the United States today, and in many other nations, too. To reduce us to autonomous but utterly lonesome monads, detached from our inner worlds and the emotions of the people who live alongside us.

In this era of the World Turned Upside Down, it’s urgent, and might be somehow comforting, to remember that one’s inner world is always upside down: uncertain, inconsistent, not fully knowable, fearful, and constantly shifting.

That memory of hospitalization awakens now because it has everything to do with the mind, the belief in illnesses of the mind, and the urgency with which powerful institutions try to turn the unruly self into a manageable thing. To draw from Walter Benjamin, the remembrance of past experience revivifies a uniqueness, a “now-time,” which remains crucial to appreciating the current moment. The recovery of memories may offer a script that “prophetically glosses the text” of the past for an uncertain present.

Our present is certainly uncertain.

“Illness is the night-side of life,” Susan Sontag writes, the dark “kingdom,” as she calls it, where sooner or later we all end up. Sooner or later: she means that we will all eventually be diagnosed, and in that sense, we will be diagnosed with the thing that will kill us. Fair enough. But night-side and day-side aren’t the only two realms: Most of us, much of the time, live in twilight, illuminated by relative vigor and, for the lucky, by love, but darkling with self-doubt, anxieties, the troubles of today and tomorrow. Recognizing our misgivings about our own selves, more and more of us reach for diagnosis: The number of depressed people only goes up each year, and a 2023 Gallup survey found that 29 percent of Americans—nearly a third of us—report having received a depression diagnosis at some point. We see the same trends with ADHD, anxiety, and symptoms of obsessive-compulsive disorder. Many people seek a diagnosis for the silence it provides. For the release from exploring, even reckoning with, inner turmoil. For permission to tell a prepackaged story of themselves, which is to say to adopt what today is called an identity.

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Philip Alcabes is Professor Emeritus of Public Health at Hunter College, the City University of New York. His writing on health, medicine, and illness has appeared in the * Scholar * since 2004. He is working on a book about the institution of medicine and public health.