Patients’ Nicotine Dependence

Patients’ Nicotine Dependence stands out in the memoir as one of the psychiatric hospital’s most visible routines: an intense, consuming practice that the institution forbids neither in its young patients nor in its ordinary grounds. The narrator sees smoking not as a casual accompaniment to life but as an act that commands attention, organizes bodies, and marks the ward for patients with Bipolar Disorder. Its force becomes clearest in the contrast between the hospital’s strict prohibition of alcohol and its ready supply of cigarettes, and in the image of a young woman whose physical impairment does not diminish her attachment to smoking.

A concentrated ritual

The patients smoke with an exclusiveness that the narrator distinguishes from his father’s habit of keeping a cigarette in his mouth while reading a crime novel, driving, or even shaving electrically. Hospital smoking allows no such division of attention. The act begins with drawing a cigarette from its packet and continues through holding it, bringing it to the mouth, and inhaling. Patients sit on benches or lean against walls; some turn away to be left alone. Their inward-directed gaze and deep inhalations make them seem absorbed or absent, while their tightly closed lips convey, to the narrator, the urgency of desire.

This absorbed manner is unlike the relaxed gestures the narrator associates with film stars: these smokers do not have casually bent wrists or graceful movements. Instead, their attention seems bound to the next cigarette, as if they were secretly waiting for it. The contrast gives dependence a distinctive physical vocabulary. A small, familiar object commands the whole sequence of gesture, while the smokers’ concentration sets them apart from the everyday world around them.

Permission, provision, and dependence

Many of the smokers are strikingly young, but their age attracts no apparent intervention. Alcohol, by contrast, is strictly prohibited throughout the hospital grounds, and the narrator never sees a patient with a can of beer. Nicotine appears to have been permitted from the highest level and without an age restriction. The discrepancy is enacted not only in policy but in daily practice: nurses, attendants, doctors, psychologists, and therapists all smoke, and staff distribute cigarettes generously to patients who beg for them.

The patients spend the small amounts they earn on cigarettes. The detail makes smoking more than a background habit: it is also a regular claim on their limited personal resources, sustained by a supply that staff themselves help maintain. The institution’s rules therefore draw a sharp boundary around alcohol while allowing nicotine to circulate through the hospital’s shared life. The memoir presents this inconsistency plainly, without describing a formal rationale for it; its significance lies in the contrast between prohibition and routine, and between the patients’ dependence and the adults’ participation in making cigarettes available.

The ward’s landscape and collective rhythm

Smoking is most obsessive among the patients with Bipolar Disorder. They smoke each cigarette down to their soot-yellow fingertips, and the narrator describes them as taking the smoke into themselves as though it were their rescue. The route to the ward’s main entrance is strewn with cigarette ends. On either side, near the benches, discarded filters and stubs have accumulated in small mounds, roughly the size of molehills. The grounds preserve the repetition of the habit in material form: each cigarette is brief, but the leftovers gather into a persistent landscape.

The building itself bears a longer record. Cigarettes have been pressed against one of its walls over a period of years, leaving thousands of ash marks. When the narrator lets his eyes go slightly out of focus, the dark specks resemble tiny bullet holes or entrances to a gigantic termite mound. The comparisons turn ordinary traces of smoking into a dense, unsettling pattern. They register how repetition has marked the building, while keeping the image rooted in what the narrator actually sees: accumulated ash, soot, filters, and stubs.

The patients’ smoking can also become synchronized. The narrator recalls around thirty depressed patients drawing on their cigarettes together, inhaling together, exhaling together, then lowering their cigarettes for barely longer than a second. Speech is scarce. The women, he observes, smoke with even greater obsession than the men; he remembers women and girls clinging to their cigarettes as if suspended by a thin thread of smoke above a dark abyss. Their faces seem to him to share a puzzling resemblance. He reads the visible compulsion as evidence of an inward kinship, a particular kind of fellowship in despair. The scene does not make smoking a cure; rather, its shared rhythm offers the narrator an image of connection among people whose suffering he cannot otherwise explain.

Dependence and bodily vulnerability

Another remembered scene, outside a different ward, concentrates the account in one person. A young woman’s spasmodic movements prevent her from holding a cigarette herself. Loops attached to the armrests of her wheelchair hold her hands in place so that she can control them. Her attachment to cigarettes remains unmistakable, and a nurse steadies her head and feeds her smoke.

The scene brings together physical limitation, assistance, and dependence without making them interchangeable. The woman cannot perform the act unaided, yet the cigarette remains something she wants; the nurse’s intervention makes the act possible. In the broader portrait, cigarettes are passed out by hospital staff, bought with patients’ small earnings, consumed in intense solitude, and smoked in unison. This individual image returns the reader from the ward’s collective spectacle to the particular bodily circumstances through which dependence is lived. The cigarette is at once a personal attachment and a routine sustained within the institution.