MADMAN - John R. Suler, Ph.D. - copyright 1995
Chapter 19 - Scissors
I fall back onto the couch and stare up into the darkness. "Get a hold of yourself, cowboy!" I say. Coughs erupt from my chest. My head is stuffy, aching. I feel hot. It's a fever that encases me in a cocoon of glowing warmth. Funny, it feels safe, secure - like being in the womb. As I start to drift off, I hear a scratching at the bottom of the door. It doesn't startle me - though I imagine it should. The door opens and in walks a dog. With one leg retracted, he's limping. Was he hit by a car?
I recognize him. It's Mo - our dog when I was a child. My father loved Mo, and he loved my father. A week after Dad died Mo disappeared. We never saw him again.
"I'm not feeling well, Mo."
"I know," he says.
Walking through darkness. The sound of footsteps echo off concrete. There are walls nearby, but I can't see them. I reach my arms outward, but can't feel them. Am I in a tunnel? An alley? The darkness is vibrant, charged, alive with energy and hidden forms. Afraid that I might walk into something, I reach my arms out in front of me, trying to feel my way.
There's a light ahead. As I approach, I see someone sitting in the road under a street lamp. I can't see his face. "Hello?" I say cautiously.
He looks up. It's Doe.
"What a minute. This is a dream," I say.
"What if it is?"
I think for a minute. "They say that if you dream about your patient, you're having countertransference."
"Such big words for something so simple," Doe replies.
"Well then, you tell me. What are you doing in my dream?"
"Looking for something."
"For what?"
"Never mind."
"Listen, I really need my sleep and I don't want a replay of our intake interview to wake me up. So tell me why the hell are you mucking around in my psyche?"
"You tell me, its your dream."
"I bet you're here to make me miserable."
"You're already miserable."
"Thanks to you and my other patients and this whole damn profession - yeah, I'm miserable!"
"Externalize, externalize," Doe says with a smile.
"Yeah, now who's using the technical terms?"
"You're right. Internal, external - it's all the same place, now, isn't it? When it comes right down to it, there is nothing on the inside, and, likewise, nothing on the outside that you can grasp."
"I've had enough of you. I need my sleep." I walk away, back down the alley. The light fades behind me as I feel my way through the darkness. Eventually, I see a light at the other end. Again there's someone sitting in the street. It's Doe! It's the same place! I'm right back where I was!
"Like I said," Doe remarks, "here, there - it's all the same."
"Who the hell are you, anyway!"
"No one in particular."
"I don't know why this should bug me. It's just a dream, just a stupid dream. It doesn't matter."
"That's not very psychoanalytic, now is it? Think of it this way: A man falls asleep and dreams of being a butterfly - or is the dream the reality, and it's the butterfly that falls asleep and dreams of being a man?"
I refuse to react to his tricks. It's just a dream, I tell myself. Then it hits me. It's a LUCID dream - a dream in which you know that you're dreaming. It's the first step in being able to control and direct it. Imagine that. In your dream you can live out any fantasy. Shamans and medicine men of ancient cultures refined it to an art. They used the lucid dream to tap cosmic wisdom, to predict the future.
"Look over there," Doe says pointing back into the darkness. "Does that look lucid to you? I think we're getting a bit grandiose, don't you?"
"Maybe, maybe not," I say with renewed confidence. "But it's an empirical question, now isn't it? Maybe all I have to do is snap my fingers and you'll disappear. Or maybe I'll turn you into a frog, or a tree stump, or a can of tomato soup."
"How about the wind. I've always loved the wind."
"Your wish is my command," I say as I raise my hand and melodramatically poise my fingers.
"Are you ready?" I ask.
"Ready," Doe replies.
I snap my fingers.
Nothing.
I snap them again.
Still nothing. Doe lets out a long, slow whistle - and smiles. "Well, it was a nice try anyhow. But then again, maybe you really don't want me to go at all."
"Listen, it's my dream - and if I want to end it, I will. All I have to do is wake myself up and all this whole thing will evaporate - including you!"
"Wake yourself up, huh? That's a bit paradoxical, isn't it? Like pulling yourself up by your bootstraps. And it's a cop-out too. It's the ego's last resort - to ESCAPE at all costs, including the negating of its own creation. Your unconscious is getting a bit too close for comfort, isn't it? Even when you do wake up, I'll still be right here, right inside your head."
"Boy, don't YOU sound like the goddamn psychologist now!"
"Right here, how could I be anything else?"
"That's where I've got you," I reply. "You aren't real. You're just an image, a representation - a ghost in my mental machine. You're only what I think you are, what I make you to be - and nothing else. I've got the flu and you're the byproduct of my feeling sick. A mild delusion created by my fever. Nothing more than an epiphenomenon."
"Sounds good to me. Maybe a bit of undigested beef and the Ghost of Christmas Future - all wrapped up in one.... Or maybe I'm just a symbol."
"O.K., I'll buy that. But if you're a symbol - a dream symbol - what do you symbolize?"
"You tell me. It's your dream."
"But the formulation doesn't make sense. There's something wrong here. Since when do symbols in a dream tell you they're a symbol? It defies Freud. It defies the concept of dream censorship. It defeats the whole purpose."
"There are more things in heaven and earth, Dr. Holden. Consider it a game of hide-and-seek."
I feel tired. But how could I feel tired? I'm already asleep. Nevertheless, I feel like I can lie down right here in this road and take a nap. Would I dream - a dream within a dream? If I did, I have a feeling I would end up right here where I am right now, with Doe, getting sleepy and falling asleep again, ad infinitum - an endless string of dreams within dreams that I could only escape by an infinite regression of awakenings.
"This all has been very interesting, Doe, but I really must leave now.... I'm sick. I want out."
"I know," he says sympathetically. "But before you go, I have something for you." As he turns towards me I notice grass and dirt stains on the knees of his trousers. Funny, I didn't notice them before.
He holds out his hand. In his palm is a key. I take it from him, but it's no longer a key. It turns into a mirror. I hold it up to my face and look in. There's nothing there, just darkness....
I'm lying on a stone tablet atop a grassy hill. It overlooks a vibrant blue ocean. A figure wearing a long, flowing robe is standing above me, talking to me. He is unnaturally white, bony white - he's made of marble.
"You must wake up!" the figure says.
Oddly, despite his bleached complexion, he has bushy black eyebrows and a bushy moustache.
"You must wake up!" he repeats while shaking me.
"Why?"
"It's time for morning report!"
The grassy knoll and blue ocean evaporate. Vaguely, I realize where I am. I open my eyes. It's Sheikh, standing above me, looking very concerned. I'm in the resident's lounge.
"It's time for morning report!"
"O.K., O.K.," I mumble, "Go on ahead, I'll be right there."
"You must hurry," he says as he leaves.
I swing my legs off the stone tablet and onto the floor. At my feet, neatly folded, are my jeans, sneakers, and vinyl rain jacket. I slip them on, walk to the corner of the room, and pull out the lawn-mower.
"Be careful, it's still running," my father says.
I feel confused. Shaking my head, I try to remember why I am bringing a lawn-mower to morning report.
"Tom, You gotta wake up," my father says in his middle eastern accent. His bushy black eyebrows are twitching.
"I'm up! I'm up!"
"No you're not. It's a false awakening," the man in the flowing robes says.
My mind turns over. I open my eyes.
"Come on, Tom. You have to wake up."
It was Sheikh standing over me. I was still on the couch.
"O.K., O.K. Go on ahead. I'll be right there."
I swing my legs off the sofa and rub my face. Am I really awake this time? I look around the room. Nothing unusual. It takes me a second to realize that I feel like shit. "Morning report," I mutter to myself, "Gotta get going."
I had forgotten to bring a change of clothes. There's nothing quite like spending a whole day in your clothes, then sleeping in them, then getting up and spending another day in them. The difference between you and the fabric becomes moot. A splash of water on my face - that will have to do. The bright hallways intimidated me, made me feel tiny and insecure. In the Men's Room I stared into the mirror, not quite recognizing the guy looking back at me.
"You look like shit," the guy said.
"Thanks for the feedback," I replied.
The water on my face felt cool, refreshing. It conjured up the sensation of ocean waves washing over me. Got to clear out those braindikes. I rummaged through my knapsack, found two decongestant tablets, downed them with a handful of water. Now the urinal, quick. Jesus saves. She blinded me with science. Look up, look down - the joke is in your hand.
"Morning report, morning report," I continued mumbling all the way to the unit, hoping the mantra would focus my concentration.
The coffee pot ran out as the precious juice reached the halfway mark in my cup. Half empty or half full? I shoveled in several spoonfuls of powered cream substitute. It floated precariously on top of the coffee. "There, that'll do it," I said undauntedly.
One more stop. At the nursing station I yanked my intake reports out of Doe's and Mobin's charts. I could barely read them, especially the report on Doe. It didn't even look like my handwriting. Too late now. I stuffed them into my knapsack.
"Good morning," someone said. It was Carol, the head nurse.
"What's so good about it?"
"From the way you look, not much. Are you sick?"
"Just a cold."
"Better take care of yourself," she answered with concern."Before you go into morning report, I'd appreciate it if you would do something about your patient."
"Who?"
"John Doe. See him over there, in Center Circle?"
There he was in the very middle of the unit, standing with his legs wide apart, bent forward, his head dangling between his knees. Some patients were standing around him and staring quizzically. Rachel Finski was attempting to imitate his posture.
"Jesus, what the hell is he doing?"
"Got me," Carol replied. "He's been that way for fifteen minutes. I spoke to him a few times already, tried to convince him to straighten up and go eat breakfast, but he said he was waiting for you."
"Lucky me."
"You got to admit, he's pretty well stretched for an old dude."
"Yeah, just like his brain. I'll see ya later."
Hoping not to draw any more attention, I nonchalantly walked over to Doe and kneeled down beside him. "What are you doing, may I ask?"
"Trying to see things your way," Doe said with an inverted smile.
"Please, do me a favor and stand up. This kind of behavior isn't appropriate around here."
"If you say so," he replied and with ease swung himself into an upright position.
"You know, you're going to confuse the other patients when you do stuff like this," I said, "and you also make life difficult for me. What makes you do this sort of thing?"
"Maybe it's just a bit of undigested beef."
His words opened up a box inside my head. I vaguely remembered a dream - something about a tunnel, and a mirror. Was it a dream? The image started to fizzle out before I could bring it into focus.
"Uh, let's talk some more later. I have a meeting to go to now. O.K.?" I said.
"I'm ready when you are," Doe answered.
Nearly all the staff were seated and ready for morning report. I prayed that they weren't waiting for me. Fortunately, my prayers were answered. Dr. Stein strolled in just seconds after me. He drove in each day from the city, two hours away. He refused to live anywhere except the city. He also had a thriving private practice in the wealthy section of town. He seemed content with his commute - as he used the time to dictate his books - but he had a terrible habit of speeding in his Porsche and refusing, in his inimical narcissistic style, to pay his tickets. Finally, his license was revoked. So he hired a chauffeur.
Fred cleared his throat to signal the beginning of the ritual. "First order of business for the day - who is the acrobatic patient out there?"
"He's my patient," I said, "He was admitted last night."
"Would you like to give us the intake report," Fred said as he perched his wristwatch atop his coffee cup.
"No."
Everyone looked at me. Even Stein looked up from his nail file. "What?" Fred said. I too wasn't sure I heard myself right. I almost looked behind me, expecting to find the real perpetrator.
"Uh, Doe... he's a John Doe. Hold on a second," I said as I rummaged through my knapsack for the intake report. Suddenly it struck me that the knapsack seemed unusually light. Something was missing. Panic shot through me! It was my journal! It was gone!
"Something wrong?" Fred asked impatiently.
"Uh.... no." Stay calm. It's probably in the resident's lounge. Just go ahead with the report. My voice sounded tinny, hollow, disconnected from my body and consciousness - as if I were watching it take a walk around the room by itself.
"John Doe is a... uh... approximately a 60 year old male. Last night the police found him wandering along the highway and brought him here. He either can't remember or won't tell us his name... or... uh... where he lives... or for that matter, anything about his history. For the most part he resisted the mental status exam, but my impression is that he is oriented to place and person and that his judgment, abstract thinking, and concentration are poor... uh, that's it."
"That's it?" Fred echoed.
"That's all I got right now."
Fred looked nervously at Stein. He didn't have to say anything to The Boss. I could read the disclaimer on his face: "It's not my fault. He's not one of us - he's the psychology intern."
"Were there other symptoms of dissociation?" Stein said blandly to Fred.
"Were there other signs of dissociation?" Fred said to me.
"Other than the possible disturbance in his memory, I didn't detect any derealization, depersonalization, or disturbances in his identity." I threw in some technical terms as a desperate attempt to redeem myself.
Fred was not particularly impressed. "We have to get more information on this guy - try to locate his family or friends. If necessary, speak to the police again in case they have any clues. We have to find out who this guy is."
"Perhaps he's in a fugue state," Ron Peri interjected. "He may have repressed his previous identity from where he used to live - perhaps due to some trauma. The police may have picked him up while he was in flight to another town or city. That would explain why they found him on the highway. Typically, in a fugue state the person adopts a new identity after they relocate to another area. Because he didn't yet arrive at a new destination, his identity may still be unformulated, in transition - on the road, so to speak."
"I don't think so, Ron," I answered. "He wasn't going anywhere in particular when the police found him. He just wanders along the road picking up - uh, he just wanders along the road."
"What does he pick up?" Fred never missed anything.
"Uh, dead animals."
"Dead animals? What does he do with them?"
"He buries them."
"Buries them! Well, the guy either loves funerals or is clearly psychotic. I'll bet on the latter."
Ron couldn't contain himself. "Perhaps the dead animals symbolize his past identity which he wants dead and buried." Actually, his remark surprised me. Since when was Ron interested in symbols?
Fred gave Ron his "Please Can It" look and then focused his eyes back on me. "Hold off on meds for this guy. We need MORE information. We can't even process him though the system until we have a name for him. Find out who he is. Otherwise, if he's not suicidal or homicidal - and I'm assuming he's not since you didn't say anything about it - we can't keep him here against his will....Right. Let's move on to the next item on the agenda."
Fred glanced down at his list, and frowned. "One of our patients - Elizabeth Baso - who was discharged last week died yesterday." He threw me a look out of the side of his head. "Looks like you're up at bat again, Dr. Holden. Can you tell us what happened."
"She was hit by a mail truck. The police think it was an accident, but they're not completely sure. While she was here she responded well to medication and psychotherapy. When she was discharged I didn't see any evidence of suicidal ideation - so my guess it was purely an accident."
Again Stein looked up and spoke to Fred. "Who was the attending physician on this case?," he asked Fred. I knew what he meant by that question. He didn't want to hear from me. The bastard didn't trust my judgment! I spent hours and hours with my patients, and Stein prefers the judgment of the attending who spends two minutes a week with them.
"Uh, I was." Fred replied. Tiny beads of sweat were forming on his upper lip. Now it wasn't just me - Fred was feeling the heat too. "I also didn't see any signs of suicidal ideation at the time of discharge.... Um, her death must have been a freak accident."
"Has there been any word of a legal suit against us?" Stein added. I could see anxiety spread across Fred's face. He looked at me.
"Not that I know of," I said.
Stein went back to his nail file. Case closed, for now. Fred looked relieved.
"I agree that her death was an accident," Marion injected. "I also think we should bring this up in the Community Meeting. Many of the patients and staff liked Elizabeth. Her death will have an effect on everyone."
"Right. I'll do that.... Let's move on to the next item. Richard Mobin was admitted yesterday..." He looked around the room to find a presenter.
"He was mine too," I called out, attempting to sound confident. The room became very quiet. I could see, in their eyes, that the staff was starting to feel sorry for me. Morning report was turning into the Crucifixion of Dr. Holden. But I actually felt a little optimistic. This was another chance to redeem myself.
"Richard Mobin is an 18 year old male who lives with his mother. Over the past few months he has shown a drastic decrease in his functioning at school and in his health and hygiene. He isolates himself in his room and stares at his fish tank in what appears to be a catatonic-like state. He hears voices and has delusions of being hunted by strange men. There is some history of psychiatric disorder in his extended family. His mother also suffered a postpartum depression when Richard was born. He was generally resistant to the mental status exam and showed poor performance on orientation, judgment, short and long term memory, and abstract thinking. Some of his associations to the questions were idiosyncratic. My diagnosis is paranoid schizophrenia. The patient left the unit last night AMA."
Success! I pulled it off without a hitch. As long as they don't question the AMA, I'm home free.
"He's back," Fred said.
I was stunned. "He is?"
"His mother brought him in this morning."
"How did he get home?"
"He called a cab - and he stopped off for a hamburger on the way home. Apparently, he's not as disoriented as one might think. I heard that there was an incident with him during the intake. Is he violent?"
Holy shit! Now I'm really going downhill.
"There was an outburst of anger, but he calmed down quickly once I terminated the intake. He experienced the questions as intrusive and he's not exactly happy about being here. Otherwise,there is no history of violence." An image of drowning baby birds flittered through my thoughts.
"Nevertheless, this guy could be a real live wire," Fred said. "Put him on a 15 minute check. If he shows any signs of violence put him in Center Circle. If he escalates - and he may - we'll have to put him in Seclusion. Unfortunately, the beds at Widner State are full right now so we have nowhere to send him if he gets unmanageable. Did you ask the resident on your team to evaluate him for meds?"
"Uh, no."
"Who is the resident backing you up on this case?"
"Uh..."
"I am," Sheikh interjected. "I saw Richard this morning and started him on stellazine."
"Good," Fred said. "Does anyone have any other comments on this patient." He seemed to be looking at The Boss.
Stein looked up from his nail file. He was going to speak for a third time! A new world record! "Keep an eye on this patient," he said. "And make sure the resident keeps on top of this case."
I felt defeated, humiliated. At that moment I realized how much I hate to be criticized, how much I loathe being found wrong. It punctures a hole in my fragile sense of omnipotence and exposes all the insecurities and feelings of helplessness hiding inside. I started to worry. I fucked up my cases. Everyone has lost their respect for me. I wouldn't be surprised if they asked me to leave my internship. Maybe I should quit this profession before I'm drummed out of it in a state of disgrace and mortification. And I don't even know where my journal is. It may be lost forever, leaving me with no fail-safe. I'll probably end up walking the streets as a bag-person, picking through garbage for half-eaten candy bars and discarded shoes, and looking for my journal... My life is over!
My God, look at me! I'm catastrophizing like there's no tomorrow. Where is Aaron Beck when you need him?
I felt light-headed, dizzy. The decongestants were kicking in. In fact, I felt rather weird. My thoughts, sensations, and body movements were not quite in synchrony. As a child I once made my own puzzle by cutting up a magazine picture of a man riding a horse. Sometimes I randomly slid the pieces left and right so that the bodies of the man and the horse were chaotically disjointed. That's how I felt right now. Out of kilter.
My brain sifted through all the sounds in the room - the voices, ruffling papers, coughs, shuffling feet, the whirs of the soda machine. My brain was looking for something. Eventually, all the sounds flatten out to a thin line - none of them any more important than the others. My mind was searching for their common denominator, something underlying all those sounds, feeding them, sustaining them - something much more basic. Finally, I found it. Outside the window, the branch of a tree tapped gently against the glass pane. It was a message from the wind. I listened - waiting for the code to come clear.
"Earth to Dr. Holden, do you read me?"
I came back - from wherever I was - to discover Fred standing over me. People were leaving. Morning report had ended. "So what's going on?" he said in his clipped voice.
"Uh, nothing."
"It sure doesn't look like nothing. You're sick, aren't you?" His voice changed to a soft, even sensitive tone. "You've got a difficult case load, so if you need any help today, let me know."
It surprised me. I was expecting the third-degree, or at the very least a disappointing head shake and a word of paternal advice. I appreciated his kindness, but on a deeper level I found it a bit unsettling. It wasn't like the usual Fred.
I followed him out of the room and hustled to the nurse's station. My notebook was nowhere in sight and no one had seen it. I was tempted to run to the resident's lounge to look for it there, but an obstacle presented itself - Richard Mobin was approaching the nurse's station. He was holding a bedpan and poking his finger into it.
"A worm in there," he said angrily.
I looked into the bedpan. It was filled with feces and urine. Not feeling up to par in the first place, I now felt like retching for sure. Fortunately, Carol overheard Mobin and stepped in to take charge of the situation. "Let me look," she said and peered in. "I don't see any worm."
"There!" he snapped back as he poked his finger into the mushy contents. My stomach tightened. He growled, "Worms're inside me!"
"It's not a worm," Carol replied calmly. "It looks like a piece of string. Don't worry about it." Mobin plopped the bedpan down on the counter in front of me and stormed off.
"I can't take this anymore," I said as I put my hand to my stomach.
"Just try to think about it clinically," Carol answered as she moved the bedpan away. "He's a paranoid schizophrenic and he's terrified of anyone getting too close to him - especially you, his therapist. So he'll try anything to drive you off, even waving in your face the most disgusting aspects of his being. It's really quite symbolic, don't you see? He's showing you the shit in his soul."
"It's easy for you to be so psychologically analytic when you have a stomach of steel. But I don't. Excuse me." I ran as fast as I could to the nearest restroom and puked into the toilet. It was a rather unpleasant history lesson on my diet for the past 24 hours. Most notable was the pasta from yesterday's lunch.
"Hello Spaghetti Man," I muttered between heaves. "Fancy meeting you here."
"You're not looking too well," he replied.
"You don't look so great yourself."
For a few minutes I just sat there on the floor, feeling the cool porcelain against my cheek. Maybe I should go home. I'm too sick to work. But something in me refused - the masochistic part of me, the martyr. But a martyr for what cause? I felt that I had to finish out this day, that something in this place was holding onto me for a reason.
When I staggered back onto the unit the staff were arranging chairs in the Center Circle. I was momentarily puzzled, then it hit me - today was Community Meeting. It was a relatively small area at the center of the unit, so the circle of chairs were packed in tight. Some of the patients voluntarily took their seats while the staff tried to round up the others. Kathy Mummon playfully was chasing a young male patient with her wheelchair. Mrs. Watts, sitting with her purse in her lap, kept packing and unpacking its contents. A few of the patients sat down, became distracted by something, then got up and walked away. Other patients must have thought there was some logic behind this, so they got up and wandered around too. Eventually the staff caught up with all of them and steered them back to their chairs.
As more patients and staff settled into their seats, the circle began to stabilize. Out of chaos comes order. Yet my patients - with the exception of Kathy - had not yet arrived. I almost wished that they wouldn't because I feared, even fatalistically expected, that they would say or do something that would embarrass me. All the staff secretly worried about that - but today seemed especially jinxed for me. Finally, Mr. Tennostein, looking as organically confused and puzzled as ever, shuffled towards the circle at his breakneck speed of one meter per hour. As I helped him into his seat, Richard Mobin lumbered into view, stuffed himself into a chair, and began rocking himself into his agitated, autistic stupor.
We were all there, except Doe. Where the hell was he? I scanned the circle of faces. The staff were supposed to intersperse themselves among the patients - but all of them, with the exception of me, were sitting in twos. It felt safer that way. Pairing is a basic unconscious defense against anxiety in groups. But anyhow, with everyone dressed in street clothes, who could tell the patients from the staff?
Doe was nowhere in sight. I began to worry. Had he sneaked out of the unit without telling anyone? Just as I was about to get up and look for him, I suddenly noticed someone sitting in a chair to my far left, exactly opposite from Mobin on my right. It was Doe, looking completely placid, almost expressionless. How the hell does he appear out of nowhere? He wasn't there a second ago, I was sure of it. Or maybe he was. The Chameleon Man. In any event, the circle was now complete. We were ready to begin.
Fred cracked his knuckles and cleared his throat - the signal that he was about to deliver his prologue. I mumbled along with him. It was the same exact speech, word for word, every meeting.
"Once each week we all get together for community meeting. It's an opportunity for us to talk to each other. Feel free to say anything that's on your mind. If there's anything that you want, or need, or that worries you, please let us know. We are all here to listen, to learn, and to help. So why don't we begin."
Someone once asked Einstein what he considered the greatest achievement of modern times. Everyone expected him to say that it was space travel, atomic energy, or some such technological wonder. His reply was "plumbing." But maybe he was wrong. Just maybe the answer is modern psychiatry. After all, what could be a greater, more amazing achievement than gathering a bunch of crazy people into a circle with so-called normal people for the purpose of curing their madness. Actually, the concept is not new. As early as the 13th century, there was a therapeutic community near Antwerp - known as the Gheel Colony - that consisted of normal people living and working together with the insane. Mental health through osmosis. Maybe we keep reinventing the wheel.
"Please feel free to speak up," Fred continued. "Are there any concerns?"
"My room is too hot at night," Kathy Mummon said.
I bet it is, I mumbled to myself.
Carol interjected. "There's been a problem with the heating system. Phil is going to work on it today."
"Right. We'll have it fixed shortly." Fred sounded both reassuring and reassured. Now that was easy, wasn't it?
"Are there any other concerns?" Fred repeated.
After a brief silence, Rachel Finski spoke out, "There's something wrong with the plumbing in this place." I erupted into a laugh. People threw me a puzzled look. I bit my lip in an attempt to control myself.
"What do you mean, Rachel?" Fred answered, trying to ignore me.
"The cold faucet comes out hot and the hot faucet comes out cold. It's all reversed. When I need warm water for my braindikes - exactly 101.1 degrees - the water comes out too cool. That can be very dangerous for the neural flow. And when I need cool water to ease the heat displacement through my teeth, it comes out too hot. I might accidentally melt my teeth and the connecting channels. Something needs to be done right away."
"Has anyone else noticed any problems with the water," Fred asked. No one responded. Carol looked at him and shrugged her shoulders. "Rachel, I'll ask maintenance to check out the water, so let us know if the problem persists. But you do remember that all this talk about braindikes is inappropriate. The staff has explained that to you - and now I'm asking the rest of the group, both staff and patients, to help Rachel control this kind of talk. O.K.?"
No one responded. Rachel seemed completely unaffected by Fred's little sermon. She had about as much intention of giving up her beliefs as the Pope is willing to give up Catholicism.
"Right, are there any other concerns that people have?"
"Yeah, the food is lousy," the adolescent male said.
"And such small portions too," I called out and giggled.
Fred and Dr. Stein both jabbed me with a stare that could burn holes through steel.
"What was that, DOCTOR Holden?" Fred asked.
"Uh, never mind," I replied as apologetically as I could.What the hell was I doing? Was I on a Self-Destruct Sequence or what? Everyone was throwing me a puzzled look. Everyone except Doe. He was smiling. What the hell was he thinking? Forget it for now. I had to get serious, and quick. Think Clinical. I gently rocked back and forth in my seat as I concentrated. Let's see. The patients are complaining about the food being bad. That's symbolic. Even the seemingly trivial concerns they raise during community meeting are disguised expressions of unconscious issues. It's just a warm-up. If they're saying the food is bad, then they're saying that our feeding them is bad, which means they perceive our nurturance as toxic, or at least less than sufficient. We're not the Good-Enough Mother. A common psychotic transference. Right! Let's see if Fred supports my interpretation.
"Yeah, I don't like the food either," another patient added, "and I never get what I order."
"Sometimes people accidentally fill out their meal cards wrong," Fred replied. "If you're having trouble filling it out, ask one of the staff for help. Sometimes people forget to fill out their meal cards altogether. If you do forget, the kitchen will send up the standard meal. About the food being lousy - I know it's not the greatest cuisine in the world. There's not much we can do about that. But perhaps, when you say that the food tastes bad, maybe you also mean, in general, that you're not satisfied with what you're getting here. Perhaps some of you feel that you're not getting the treatment that you need or want."
Bingo. Great minds think alike, right Fred?
The group fell into silence - the silence of subconscious incubation. They were thinking over Fred's question, extrapolating their gripes about food into deeper worries about parental deprivation and abuse - about the nurturance, mirroring, unconditional positive regard, and loving guidance that they never knew. Any minute now, the real anxieties would rear their ugly heads. The truth would surface, clearly and honestly. But what patient would be the first to take this risky step?
Rachel broke the silence. "The vegetables are too soggy - much too much water. It destroys their solitude."
Fred's chest sank. His gallant effort to plumb the collective unconscious of the group went over like a limp string bean. But Fred was not one to give up easily.
"We'll give the kitchen a call and see what we can do. But other than the food, there must be something else you feel is not up to par. Maybe you're also saying the treatment feels a little bit soggy or limp." He grinned. He was pleased with what he considered a clever interpretation. But the patients didn't. They exchanged befuddled glances. Even Mrs. Watts stopped packing and unpacking her pocketbook and pensively searched the ceiling for some clarity.
"Why do we have to have lights out at 11:00?" another patient asked. "I like to watch the late news."
"Some patients are tired and want to go to bed at 11:00," Fred answered. If we left the T.V. on, it would disturb them. I understand that this means some people have to forgo some of their usual nightly routines, and we all appreciate that. But it's important that we all follow the same schedule."
"Yeah, but we got to stay up late LAST night," the adolescent male said defiantly.
"That was because we had to cancel the movie, so we thought we'd allow people to stay up a little later than usual."
"How come we couldn't see the movie?" another patient said. "You treat us like we're kids or something."
"Yeah," several patients chimed in.
Fred looked nervously to Stein for support. But Stein, staring down at his finger nails, let him know he was still on his own. "As I mentioned last night," Fred said, "it was a mistake that the movie was shown in the first place. Although some of you may have enjoyed it, others might have found it too upsetting. I apologize for the mistake. It was our fault."
The adolescent grew more angry. "If someone didn't like the movie, they didn't have to watch it. They could have left. We're not a bunch of babies you know. Shit, you doctors are just like my goddamn parents. They never let me do anything."
Mr. Tennostein shot his shaky finger into the air, "They're trying to take away my car, and my license! They want to put me away in a home. They're trying to ruin my life!"
Several patients gasped and united in a disjointed chorus of objections: "No!" - "How dare they! - "I don't believe it!" Now they were really revving up to rattle their cages. It all came back to me. It was a familiar pattern - the same each week. They start off the meeting with seemingly trivial issues, then complain about their treatment, then work themselves up into a mini-revolution in which they demand more freedom. And Fred, playing his role in the litany, tries to assuage them with a quasi-convincing song-and-dance about our benign dictatorship. When it comes right down to it, they don't want much more freedom. Do any of us? It's too scary to have choices. Choices make us all anxious. It's much easier to be told what to do. That way you don't have to worry about doing the wrong thing and facing the possible negative outcomes. Unlimited freedom means you don't have to go to college, or graduate school, or have a job, or make money, buy a house, get married, raise a family, pay taxes - any of those expectations that society breeds so thoroughly into us that we think they're our own needs and wants. Unlimited freedom means infinite ambiguity and possibility. Who the hell wants to face that? Reminds me of my existential philosophy professor who told us we could write our term paper on anything we wanted - anything at all! He gave us absolutely no rules or guidelines. We all panicked. We begged him to give us a topic, to tell us what to do.
Holy shit, I'm drifting off again. Goddamn it, Holden, stay tuned in! Concentrate!
"... so it's important that we take every precaution we can to insure that everyone feels safe. This is our most important rule." Fred was still up at bat. He sounded convincing, authoritative. He might as well have been reading the Ten Commandments right off the stone tablets.
The group fell silence. I couldn't tell if it was quiet submission or a breather to gather strength before launching another wave of revolt. As it continued, I felt an awful mixture of drowsiness and apprehension wash over me. If I fell asleep, not only would I look like a fool, but I was sure I would have nightmares. My eyes rolled back into my head - for brief seconds I slipped into a quasi-unconscious state, but I was jolted awake by an vision of my journal floating away down a muddy river.
A tension began to build within the group. It hung over the room, almost tangible - a kind of sticky anxiety like the air on a hot muggy day - something I had never sensed before in community meeting. Something more than a simple revolution, something ugly. It made me uneasy, almost queasy. Say something Fred, will you? Don't let the silence go too long. What would happen if the patients did revolt - I mean REALLY rose up and attacked the staff in a rush of mass insanity? A quick survey told me we were outnumbered, and that I, of all the staff members, was farthest from the exit.
I tried to reassure myself. I remembered the story of the patient who always arrived exactly on time for his analysis, dutifully lay down on the couch, and said absolutely nothing - for six months. And the analyst said nothing too. For six months. Finally, when the patient did speak, he profusely thanked the analyst for allowing the silence, for not intruding on him like his mother. Throughout his childhood, she had violated his privacy in every way imaginable, including administering daily enemas. It was a major breakthrough in the analysis.
Was this going to be a turning point in community meeting? Maybe, maybe not. Maybe the tension was all in my imagination, all in me. After all, I was sick, I felt like shit. That must be it. And maybe the group also was just a little under the weather that day, a little tired, perhaps a bit constipated. Maybe we all need a good enema. But no matter how hard I tried, no matter what I said to myself, I couldn't relax. My fingers dug into my thighs as the silence persisted. It was so still in the room, so absolutely, ungodly still - like a picture frozen in time, like the calm before the storm, like still water that deep down harbors all sorts of nefarious creatures, like -
"I hate him! I hate his fuckin' guts!" Richard Mobin suddenly shouted. It was a crack of lightning ripping through darkness. Whatever it was that had pierced through his crazed mind and jolted him out of his autistic stupor, it must have been mighty powerful. His face was bright red, his eyes bloodshot, his white-knuckled fist clenched into tight balls of rage. "Who are you talking about?" Fred asked.
"Him!" Mobin shouted as he pointed his finger across the circle. "Who the hell are you?" He was pointing at Doe.
Most people would have run, cowered, or at the very least flinched in the face of such boiling anger. But not Doe. His calm expression didn't change one iota. "I'm just another drowning lunatic, like you," he replied.
I waited for the explosion, for Mobin to jump up and attack. Should I try to intercede? Could I restrain or deflect him? Psychotic rage injects people with superhuman strength. He could easily tear me apart. It would be like trying to stop a charging bull. Surely someone would help.
But to my surprise, Mobin slumped back into his chair and returned to his stupor - in fact, he seemed almost pacified.
The group again fell into silence. What had just happened? I know I wasn't sure what to make of the whole interchange, and others must have been similarly confused. Yet no one spoke. I couldn't believe that Fred, or Stein, or some staff member didn't intervene. Wasn't it important to respond to Mobin's outburst? And to Doe?
Finally, Rachel broke the silence. "I think my braindikes are starting to open."
Mrs. Watts stopped packing and unpacking her suitcase - and lifted up her head.
"I think I've been making some progress," another patient added, "and I would like to thank the people here for all the help they've given me. Everyone has been so supportive and encouraging. I'll be going home tomorrow, and I'm looking forward to it - but I will miss all of you."
No one spoke, but the group seemed pleased, even cheerful in response to her comment.
"Where is Elizabeth Baso?" Rachel asked.
My heart sank. Oh, shit! Is there no relief?
"I'm glad that you asked that, Rachel," Fred replied. "Some of you may have heard already, but we wanted to announce some tragic news. Unfortunately, Elizabeth was in a car accident yesterday - and was killed. This is very upsetting to many of us. We all liked Elizabeth and were pleased to see that she did so well here on the unit. The accident was very tragic. We all need to talk to each other about this - whatever it is that we're thinking or feeling, no matter how silly or crazy it may seem. We can do that here, or later you can talk to your therapists. But it's important that you give yourself the opportunity to talk - especially the patients who knew Elizabeth."
Again, silence.
"My braindikes hurt," Rachel said.
Mrs. Watts resumed packing and unpacking her pocketbook.
"Some of you may think you're getting better," a patient added, "but I'm getting worse. I'm not ready to go home. I don't think any of this is helping me at all."
Fred was ready with his response. "It's not unusual for people to get nervous as they get closer to the time they'll be going home. Some of their symptoms might even return at that point. We call it discharge anxiety. Often people are afraid to leave the safety and security of this place, or are afraid to confront the troubles that may await them out there in the real world. It's something that everyone has to deal with and work through... And today, when we've learned what happened to Elizabeth, people are especially afraid that something awful will happen to them if they leave. Some of you may think that going home means death. But this is an irrational belief. What happened to Elizabeth is an unfortunate and rare exception. Talk with your therapist about how you're feeling and about what you're afraid of, but remember that it's highly unlikely that you will die when you leave here."
That's easy for you to say, Fred. Sure, maybe there isn't a mail truck out there with your name on it, but there are a thousand and one ways to die - and for many of them you live right through it. I wanted someone to speak up. But no one had a chance to say anything. At that moment the door to the recreational therapy room opened and out stepped Ginny, the RT Coordinator. She looked worried. She tried not to attract too much attention as she walked over and began whispering to Fred and Dr. Stein. Everyone bent their ears trying to catch any little snippet of the what must be a very interesting conversation. Besides, we needed a distraction.
"I have another announcement to make," Fred finally said."Ginny has just reported to me that there are a pair of scissors missing from the recreational therapy room. We all know the rules - no sharp objects are allowed on the unit, and no one is allowed to use scissors unless its during recreational therapy under the supervision of one of the therapists. Now maybe someone accidentally carried them off. If you know where the scissors are, please tell us and no questions will be asked."
Everyone looked expectantly at everyone else. There is a criminal among us. It felt like a recapitulation of third grade, when someone stole the teacher's red pen. Only this could be much more serious.
"Does anyone know where the scissors might be?" Fred asked again. When no one replied, he looked to Stein. The Boss nodded once. "Very well," Fred continued, "We have no choice but to conduct a search of the unit. We'd like all of the patients to return to their rooms and wait for further instructions. All staff members please remain here."