Part 5 (2/2)

Two minutes tops and he was back.

”Norma?”

Again the finger routine, more emphatic this time. Another apology, another departure, then another approach.

And finally from me, ”f.u.c.k, Clean. I'm busy here. Can't you see?”

It made you feel bad, like you'd slapped a puppy. But it had to be done. Callousness was one of the things that happened to you along with the other effects of being inst.i.tutionalized. Callousness and, what? Xenophobia, I guess.

To wit: it is significant that while I was making that phone call to my doc, I was holding the receiver with a paper towel.

I know. You'd be justified in thinking that maybe I was getting cla.s.sically obsessive-compulsive along with the rest of them, always thinking about germs. You would think so, that is, until you remember that each year alarming numbers of people contract fatal staph infections while in the hospital.

But that is not the whole truth, or maybe not even the half of it. Not the real point.

The point is, I held the receiver with a paper towel because I did not want to touch the things that my fellow patients had touched. That is the beginning of spiritual disgust. It starts in the body, in the nose, and moves to the skin, proverbially crawling, sliding first paper, then walls between itself and the unclean, then verminous other.

And once that had happened, and you could admit it to yourself, that's when you started to understand why the nurses were as grouchy as they were, and as distant and demeaning. They'd learned, as I had, first, that setting limits was paramount, but second and more shamefully, that good intentions were the casualties of contact-the same theoretically exalted human contact that I had started out so in favor of, and had seen soiled somewhere along the way.

Life at Meriwether was lived in patterns. Patterns of marked time and lost time, and doobie-do this, and doobie-do that.

The Yenta turned to me in the dayroom one afternoon and said: ”What month is it?”

”December.”

He looked surprised.

”G.o.d, time is pa.s.sing me by. The drugs make me so out of it I can't think straight. It's like waking up from a dream.”

”So you don't know how long you've been here?”

”December what?”

”Fifth.”

He counted on his fingers.

”Then, nineteen days.”

”How did you get here?”

”From rehab.”

”How does that work?”

”I was in rehab in this really dark and dingy place, and I just felt like h.e.l.l. Really depressed. I was talking with my counselor in this gla.s.s-enclosed room and I made the mistake of telling her that I wanted to bash my head right through the gla.s.s. So they sent me over here to emergency with a bottle of antidepressants. While I was waiting to be checked in, I went into the bathroom and took the whole bottle at once. They kept me in the ICU for a couple of days, having convulsions and spasms and weird s.h.i.+t.”

”What are you on now?”

”Another antidepressant.”

”Which one?”

”Effexor.”

”Oh jeez,” I said, and gave him a speech about the horrendous withdrawal that people who stop taking that drug can undergo. I told him what the docs probably weren't telling him. After I told him, he confirmed that, yes, I was right. The docs hadn't warned him.

I'd been on Effexor at one point, and had gone off it abruptly under a doctor's care. The doctor-actually, more than one doctor-hadn't warned me that withdrawal from Effexor can, and in my case did, cause, among other joys, vivid, prolonged nightmares, fever, sweats, chills, dizziness, crying jags, and what I can only describe as brain zaps, a kind of electric shock sensation inside your skull. When I started experiencing these symptoms, I went on the Web and found out that a lot of other people had endured the same torture.

”Just so you know,” I told the Yenta.

He got his discharge a few days later, and that, presumably, was that. He would go on taking the same pills to live as he'd taken to try to die. Poison in therapeutic doses, didn't someone say? Medicating, no longer self-medicating, or something like that. Getting drugs to get you over the hump, or through the objectionable days, or to help you cope, or coast, or, as in Casey's case, to do double duty, to keep you going and to help you sleep.

Casey, like me, had been prescribed the antipsychotic Zyprexa on the outside, and for the same a.s.s-backward reason. Antidepressants had made her hypomanic, so her doc had decided on a mood stabilizer.

But not just any old mood stabilizer-the pet mood stabilizer of the day. An antipsychotic that had been approved by the FDA to treat bipolar disorder. Zyprexa: the same trendy pill that, interestingly enough, was well advertised in the Meriwether ward. ”Informational” (read: promotional) displays were posted, complete with detailed, four-color leaflets, on the bulletin board outside the dayroom. Some of the nurses even carried their papers around on Zyprexa clipboards stenciled with the same promotional information that was in the leaflets. Others carried clipboards or wrote with pens that advertised competing drugs like Abilify.

Like Mother T and others, Casey had gained a lot of weight on Zyprexa. This, along with a propensity to cause diabetes, is a common side effect of the drug, and one that its manufacturer, Eli Lilly, knew about all along but failed to disclose to the public. The truth came to light in early 2007, when the New York Times New York Times reported in a series of articles that Eli Lilly had agreed to pay hundreds of millions of dollars to settle thousands of law-suits brought by people who had taken the drug. reported in a series of articles that Eli Lilly had agreed to pay hundreds of millions of dollars to settle thousands of law-suits brought by people who had taken the drug.

Wisely, Casey had gone off Zyprexa on her own. But at Meriwether they were tossing her Seroquel instead.

Thankfully, Casey was only in for three days before her therapist either came to her senses or responded to pressure from Casey's family and friends. She showed up at Meriwether and corrected her mistake.

Casey left Meriwether as bitter, angry, and frightened as I had been my first time around in the bin, and she had learned the same lesson. No matter how bad you feel, never go to the bin. In fact, never confess enough to your therapist to give her even the slightest inclination to commit you to the bin, unless you know her well enough and trust her enough to know she'd never do such a thing.

Don't a.s.sume she'll be able to tell the difference between contained, nonspecific suicidal thoughts and real, imminent danger to self or others, because the truth is, more often than not, she'll probably commit you either way, just to cover her a.s.s in case you do end up trying something.

Discernment can be hard to come by in psychiatrists. This has been my experience, anyway, and, obviously, it was Casey's as well. The human touch is not very often their strong suit. Nor is true empathy. Attend the annual American Psychiatric a.s.sociation conference, as I did, and you'll see that the emphasis is far and away on the science, not the emotional intelligence.

As noted psychoa.n.a.lyst Adam Phillips wrote in the New York Times New York Times (”A Mind Is a Terrible Thing to Measure,” February 26, 2006), ”Psychotherapists of various orientations find themselves under pressure to prove to themselves and to society that they are doing a hard-core science. . . . Given the prestige and trust the modern world gives to scientific standards, psychotherapists, who always have to measure themselves against the medical profession, are going to want to demonstrate that they, too, deal in the predictable; that they, too, can provide evidence for the value of what they do.” (”A Mind Is a Terrible Thing to Measure,” February 26, 2006), ”Psychotherapists of various orientations find themselves under pressure to prove to themselves and to society that they are doing a hard-core science. . . . Given the prestige and trust the modern world gives to scientific standards, psychotherapists, who always have to measure themselves against the medical profession, are going to want to demonstrate that they, too, deal in the predictable; that they, too, can provide evidence for the value of what they do.”

These people are thinking in categories, not only because that is how they are trained but because anything else is too vague, too absurdly metaphysical, to advance the cause of their credibility in medicine.

And yet, given what it is capable of doing, the brain is like no other organ, and does not submit, at least in the lived experience of the patient, to anatomy and chemistry alone. How can we treat it the way we treat, for example, a kidney? There is the brain, whose business is thought and feeling and judgment and even mystical experience. And then there is the kidney, whose business is p.i.s.s.

I can heal your kidney, or your heart, or your bowel without empathy, though bedside manner never hurts. But can I heal your mind without empathy?

So much of psychiatry is perception, not just bodily function. And so, to be effective, mustn't a psychiatrist feel? Mustn't he, too, have experience? And by experience, I don't mean how many patients he has diagnosed, or how long he has been diagnosing them. I mean personal experience. How much he actually knows, or at least can vividly imagine, about what it's like to be mentally ill, or what it's like, day-to-day, to take drugs that alter your consciousness, or, finally, what it's like to be locked in a ward.

It might do wonders for the profession if all psych residents were required to spend ten days incognito as a patient in a locked ward. Or to be given antipsychotic medications to sleep. Or to have their intelligence insulted by someone who doesn't know what neurotransmitter that drug happens to work on. Then, at least, they would know a bit more whereof they committed, prescribed, and consulted, and they'd think twice before suggesting hospitalization as a means of putting the Caseys of the world to rights.

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