Take Two Prozac and Don't Call Me in the Morning
Shem, Samuel
TAKE TWO PROZAC AND DON'T CALL ME IN THE MORNING When it comes to treating people's mental health, one fad does not fit all BY SAMUEL SHEM EMERSON'S HIGH WALLS AND LOCKED doors seemed...
...SO what else is new...
...I shook his hand...
...If you can be kind, like Dr...
...He’s been here forty years...
...There are no ‘psychosocial’ factors in mental illness...
...Sickened, I said, “Thank God they don’t do those anymore...
...Psychiatrists specialize in ‘And Ike specialized in suicide...
...Why’d he kill himself...
...Yeah, well, don’t hold your breath, but borderlines don’t exist...
...Now a six-year old, the boy was severely disabled...
...Testa di catzo...
...We had a wonderful talk...
...Deal,” I said, relieved...
...Nobody alive knows a suicide at all...
...This is not what I expected...
...I went into a slow burn, wanting to respond, but stopping myself...
...In psychiatry, diagnosis comes last...
...Lloyal’s his therapist...
...Here, sit,” Malik said...
...That was the face of terror, right...
...Malik asked...
...Being lied to about Ike’s death has got ’em bullshit...
...So Malik got her to tell a story, so what...
...We may need to add my other experimental drug, Zephyrill...
...I followed him outside...
...No doctors were in sight...
...Her head landed in his lap...
...he asked...
...I’ll get her informed consent...
...Emerson Two...
...I stared at him...
...Everybody loved her...
...She’d told no one but her mother, who demanded that she give the baby up for adoption...
...K’s trust fund will keep him in Misery till he dies...
...Meanwhile he terrorizes these patients-which makes ’em act like BPOs...
...They were rocking in their chairs as we entered the room...
...Let’s go...
...He started to cry...
...He was, he said, the last survivor of an old Yankee family...
...I said, ‘Yes it ’tis.’ ‘Well . . . I’m your baby boy...
...Malik said...
...Scareda me...
...You tell me if and when, okay...
...A cloud darkened the quiet porch...
...Let me read my poem or I’ll cut myself...
...This is for the benefit of the new residents,” Errol said, glancing at me and Win...
...So Blair Heiler keeps trying to fit people into BPO, but they won’t fit...
...White...
...He finds that BPOs fit the factors...
...BPO with C-Catatonia...
...Move...
...They talk finance...
...She sniffled...
...Heiler had an empty bed...
...At the nursing station I told Malik about it...
...I asked, “‘You must’ve known Ike really well...
...Hey, patients...
...My other...
...K. In silence, he was weeping...
...Luclaly, they botched his lobotomy...
...In the tense silence the crunch seemed enormous...
...like boys eyeing an electric train set...
...Save her a lot of grief-give her Placedon...
...K. seemed about ready for discharge...
...As they were coming home from vacation, the family’s luggage had blown off the roof and her six-year old’s new parka had flown away and reappeared crucified on the front grill of a trailing tenwheeler...
...Just to name it helps a lot.’’ “It’s so sad...
...Yes...
...The younger, thin man-the manic one-was reading a tabloid and eating a carrot...
...Me...
...You seem so sad,” I said, touched by all this recent misfortune...
...carrot a day keeps colon cancer away...
...What am I supposed to do with him...
...Try to help ’em and play sports...
...Yeah, well, he’s extremely paranoid and dangerous and-’’ He listened for quite a while and then said, “HOWca n we prove it...
...Enough electro-shock to light up Iowa, the most toxic drugs ever concocted, two first-rate psychoanalysesone for each hemisphere, for the left, Freudian, for the right, Jungian-and a prefrontal lobotomy...
...hd,” said Win Winthrop, “bulimic...
...Nope...
...That day the patient was Mary Megan Scorato, admitted several weeks before to Emerson 1. For those weeks, Ike had been her therapist...
...Ike had given me a lecture on borderlines, patients who were on the border between normals-or neurotics-and craziesor psychotics...
...Some of the Krotkey Factors were: impulsivity (BPOs were dramatically impulsive about sex, shopping, gambling, substance abuse, reckless driving, binge eating, etc...
...While these names were enticing, as if, if you did these drugs you’d be partalung in an encounter with two of Babar’s lost children, I was appalled at this, a diagnosis and treatment totally at odds with her obvious and what seemed to be normal grief...
...Walk me out...
...Roy, you’re gonna think this is crazy...
...Oh, it wasn’t that bad,” Mr...
...You had an ‘anniversary reaction’-it’s totally normal...
...I turned back to Mr...
...Finally Mary agreed, on one condition: that the Clarissan nuns taking the baby let her see it just once...
...I was too...
...Malik made a stabbing motion up through his own eye socket, and then a slashing wiggle...
...Wlora...
...Mary read her poem, ending with: “We all imagined his hesitant, stammering manner Merely concealed his heart...
...My daddy’s rich, made a fortune burnin’ trash down Cancer Alley...
...Thirty-one years ago, when she was seventeen, she’d been forced into sex with a neighbor and gotten pregnant...
...Yeah,” Malik shot back, “for assholes like you...
...Malik made shooingaway motions, saying, “GO, go...
...Thank you...
...chair-seemed like so many wounded, shell-shocked refugees, waiting for a war to end so they could move...
...The treatment of choice,” he said, “is my experimental drug amyoxetine-brand name Placedon...
...And he didn’t ask, like you did...
...Image is a hller, and self-image is a killer killer...
...About 20 other patients were sitting around the living room, staring at me...
...Malik asked, talkmg into the phone...
...Good...
...The one with the carrot...
...He walked away and sat down...
...All this fatal-disease bullshit is so they don’t have to admit they killed him...
...Wrote the classic papers, yop...
...But this, you, what you’re saying, it’s nothing like my month with Ike...
...I picked it up...
...K. listening, Malik told me that when Mr...
...Dunno...
...Proverbs can help find out which is which...
...His dark red hair was cut back like the helmet of Winged Victory, and he wore a long, white lab coat...
...Fame, money, climbing the greasy pole of academia...
...Now we gotta protect him...
...I was surprised you told them about Ike White...
...I thought you were a patient...
...I couldn’t even eat...
...K. “Gonna ask you two proverbs,” Malik said...
...He removed his glasses, squinted like a mole in the light, and wiped away the tears with the back of his hand...
...Big-time...
...He was speaking: “Like I said, Ike White killed himself...
...Check out Archives of General Psychiatry, June ’ninety-one...
...Like pissing in the ocean...
...Placedon makes Prozac look like popcorn...
...I remembered that she was the “acutely suicidal patient” Ike had needed to see the day before as I’d left his office...
...Her thin cheeks made her eyes seem huge...
...Mary Megan baked cookies for us all, listened to other depressed patients’ problems, cleaned countertops, and did laundry...
...Woo-wheeee...
...K, what do people mean when they say, ‘A rolling stone gathers no moss?’ ” “They mean that I have never been happier...
...He gets drug money to study the Krotkey Factors to diagnose BPO...
...No joke...
...K., whom I recognized as the kindly old gentleman who’d been playing tennis with Malik...
...Know anything about it...
...What meds are you on, sweetheart...
...He turned on his Walkman...
...Quite a ioincidence, eh...
...He started dialing a phone...
...Yop...
...I’m thinking of writing one called horexia Digest...
...Left half a frontal lobe...
...But you are a shrink...
...That would be fine...
...She’s gotten him exactly right...
...That’s quite funny actually,” Mr...
...I saw the two tennis players...
...Maybe we’ll find out more, with time, and the more you find out about a person, the more sense they make, never less...
...You play any sports?’’ “Tennis, basketball, and golf...
...Stillness...
...He glanced at my suit...
...Red-faced, Errol rose and said, “Know what your “Maybe that I think you’re a neo-Nazi...
...Maybe even next week...
...They could change in an instant, for no clear reason...
...Yeah...
...They’re almost impossible to treat...
...Wait...
...Thorny was glowering at me...
...he said, disgusted, getting up...
...The patients-teen to senior citiZen, dressed from high fashion to rags, many with bandages around their wrists or heads or legs, one in a neck brace riveted into her skull, one in a wheelSAMUEL SHEM is the pseudonym of Stephen Bergman, M.D...
...Oh, but they do...
...She had had her share of suffering: married at 40, she gave birth to a baby with Down syndrome...
...All three floors of Emerson are rumblin’, ready to blow...
...TAKE TWO PROZAC AND DON'T CALL ME IN THE MORNING When it comes to treating people's mental health, one fad does not fit all BY SAMUEL SHEM EMERSON'S HIGH WALLS AND LOCKED doors seemed sinister...
...Borderlines were emotionally labile, sometimes seeming completely normal, sometimes really crazy...
...Errol Cabot, the world expert of the day, his world expertise being the drug treatment of mental illness...
...Don’t read, do...
...What’s the other...
...It’s easier than being human with that kind of suffering...
...What meds worked best in the past, gal...
...Sometimes people don’t know that on anniversaries they crash...
...The head nurse and social worker listened in...
...Ha...
...Thanks...
...Errol and Win kept rocking in their chairs, but said nothing...
...For a while I stared at a duck carving lines on the still lake...
...Never...
...The DSM described borderlines as suffering from a pervasive instability in interpersonal relationships, self-image, and feelings...
...I was to find that Errol-and Win too-had two traits that would prove remarkably useful as they threw drugs into people: unawareness of self, and unawareness of others...
...But check out the diagnoses: BPO with A-Anorexia...
...He’d come to Misery a month ago for a rest...
...His wiry athlete’s body seemed too small a container for his energy...
...I found him on the sun porch, finishing The Wall Sh-eet Journal...
...He turned to me...
...BPO with D-Depression...
...You ain’t gonna pay for another day of Mr...
...You sound pretty cynical...
...He and Win then discussed the “case,” fitting it brilliantly to Borderline Theory, concluding that the diagnosis was BPO with A and B-Anorexia and Bulimia-even though Mary had explicitly denied bulimic vomiting...
...Be human,” Malik said...
...This morning I wrote a little poem for this conference,” she said...
...I never even told poor Dr...
...Though fat, he was energetic and optimistic, with the keen intelligence I had always associated with people with his fiery red hair and freckled, alabaster skin...
...After she’s on it, we’ll get some of her blood,” Errol said...
...both had their red hair cut like Prince Valiant and both were bulky under long white lab coats...
...He waited...
...We coulda got any diagnosis we wanted outta Mary Megan, depending on which diagnosis the world expert we called in was world expert in...
...But we gotta face reality...
...These were the dread “borderlines...
...He gets Lloyal to give him a ward for BPO...
...Lloyal means he was biologically depressed, but depression never has to be fatal...
...Waiting in the conference room was Dr...
...Which is one of the two reasons they specialize in drugs...
...This new doc is pit...
...People said, mistakenly, that she “loo ked good I’ Two weeks before she completely snapped...
...Heiler had left the ward full...
...Looking away, he chomped his carrot mournfully, giving out several forlorn crunches...
...Thanks for sharing, Errol,” Malik said, “and now go fuck yourself.“ “So:) Errol went on, as if Malik hadn’t said what he had said, ‘To get these experimental medications, she has to be in our new research study...
...Heiler set it up before he went on vacation...
...Other than drugs, the only way to make a living as a shrink is to write some bullshit self-help book...
...Time that had flown by...
...The normal, older man, in a crisp summer suit, was reading The Wall Street Journal...
...He trotted off...
...You have a kind face...
...You think this is a science...
...Boy, you got it bad...
...K. was six, driving with his mother, a car hit them and she was decapitated...
...Humiliated, I decided to interview another new patient of mine named Mr...
...Dr...
...I’m the new resident...
...Most borderlines were women...
...What’s with the carrot...
...An athlete’s hand...
...Malik explained that we would talk...
...Hall meeting’s just about over...
...Malik handed her a box...
...No one, not even Ike White, had been able to find out...
...Everything this fanatic was telling me was the opposite of what I’d been taught about psychiatry before...
...They use drugs to stay away from being with people...
...Is there some dirt, some secret...
...Haha...
...Win’s father was a Boston Brahmin, a well-known lawyer at Hale and Dorr, and he had been disappointed in Win’s choice of psychiatry, for he had been hoping against hope for the only honorable medical specialty, surgery...
...If this wasn’t a borderline, who was...
...I asked the ward secretary where I could find Dr...
...I’m sorry, Mr...
...The ones who needed to stay, he’d go to bat for...
...I felt moved, awed even, by Malik‘s way: so simple, so there with her...
...Basch, go talk to Thorny...
...But how did you know, I mean about the other son...
...Heiler’s in a catfight with his rivals at McLean to corner the market on BPO...
...He said, “managed care, I love it...
...Eleven months of the year Heiler terrorizes these patients, so nobody else wants to deal with the mess in August when he’s on vacation in Stockholm...
...Hey, borderlines...
...To be a shrink you still got a lot to unlearn, like all us kids who went to med school...
...Thanks for stopping by.’’ “Don’t worry, we’ll get her to sign.,’ “She won’t talk to you, guaranteed...
...They can’t touch you,” Malik said...
...Malik hung up...
...BPO with M-Mushrooms I’ “Mushrooms...
...They don’t like me teaching you new guys, ’specially not here on Blair Heiler’s ward...
...You don’t treat brain tumors with psychotherapy...
...Catch ya later...
...Human being...
...All this...
...Empty beds mean stalled careers...
...Mary Megan Scorato came in...
...Big article proving that lobotomy is the treatment of choice for refractory obsessive compulsives...
...Herbert Whoever...
...And when I’m gone in a month, protect him from Blair Heiler and you...
...In psychiatry, diagnosis comes last...
...My heart seemed to tear loose inside me...
...Cause they mistake having no feelings for being smart...
...Borderlines are the worst patients in all of psychiatry...
...It goes against hundreds of years of medical science...
...I asked...
...Malik left, but I couldn’t yet...
...More sickened, I said, “But we had a great talk, Mr...
...Think these people are fragile...
...Anything else before I show you what’s what...
...I’d just been called a dickhead in Italian...
...I felt a kind of “click...
...Dickhead, tell me about yourself...
...I laughed, thinking he was joking...
...Mary handed the piece of glass to Malik...
...Drug-therapy guys like Errol see six patients an hour, at seventy dollars a pop: four hundred and twenty dollars an hour...
...Mary Megan was a hefty woman, but she had lost her appetite, begun eating very little, and lost a great deal of weight...
...His wife was drinlung again, and his daughter had run off with a drug dealer...
...He wore jeans, suspenders, a blue work shirt, and bow tie...
...Oh, God...
...A woman from a poor Irish family, she’d worked her way through secretarial school and had become an assistant director of admissions at Harvard, over an hour’s commute away...
...he said happily...
...Got here a month ago from New Orleans...
...They make your life as a psychiatrist miserable...
...The Mother Superior agreed...
...You don’t know what you’re talkmg ab - ” “Kid, you’re gonna go for Heiler like America goes for stars...
...He seemed too . . . vulnerable...
...We’ll get husband Joey to sign...
...Jesus...
...Nobody knows why...
...Good...
...That seems pretty bitter-” I started to say, but then stopped, for Malik had tears in his eyes, ambertinted wetness...
...He gets more patients, with more BPO...
...You feel okay about telling us...
...I did okay till I was eighteen, ’n’ got sent north to Princeton...
...This was a surprise...
...He had jet-black hair, parted carefully and slicked up and over in front...
...Tell me, Mr...
...Errol’s jaw dropped, as if this were incredible, for a doctor to actually talk with a patient...
...I use it, if it’s right to use...
...I didn’t know what to say...
...I was, but I wasn’t going to let him know it...
...I came here to read my poem for Doctor - ” “What about anticonvulsants, honey...
...Later I couldn’t recall how it came about, but after just a few minutes of their talking, talking as if they were old friends meeting after a long time, tallung about her Down syndrome son and the parka crucified on the truck, Malik asked her something that seemed completely bizarre: “Tell me about your other son...
...And just where is it you put the carrot...
...He took out a lavender form and got up...
...Which is another Krotkey Factor: BPO with SS-Successful Suicide...
...He walked away...
...Human...
...It was as boneless as Ike White’s had been the night before...
...Tillinger, he just told me that unless you let him stay he’s gonna come right down there to your office with a gun and- That’s right, a gua, and in his words, ‘blast them insurance fuckers to smithereens.’ Now, where exactly are you located, dear...
...Now that it’s out, we can help you to heal the wound I’ She wept again, quietly...
...Lobotomy’s making a comeback...
...The drug doctor was so restless and hyper he always struck me as being on drugs...
...They killed him...
...Institutions like Harvard always have a warm-hearted type on the front lines, protecting the hard-hearted higher-ups, and Mary Megan was it in Admissions...
...Thank you for your time...
...Covering the receiver, Malik shook with laughter...
...Doctor, I’ve got some advice for you: Always keep a low center of gravity sometimes...
...But all the studies of compliance show that patients don’t take their drugs fifty percent of the time, and that the only reason they do is if they have a good relationship with their doctor...
...Not only that, but by sheer coincidence he was also the world expert in the drug to treat it...
...Sucking Nobel Prize butt...
...He stretched his quads, pulling a bent leg up behind his back so that, with those amber lenses straddling his beak nose, he looked like a wise, hip stork...
...X year and a month ago,” she said now, “on his thirtieth birthday, the phone rang...
...You residents shouldn’t waste your time learning how to do this mumbo-jumbo, ’cause there’s no ‘it’ to do...
...We got ourselves a real loser in this Roy G. Dickhead Basch...
...Isn’t diagnosis important...
...K. said, shaking his head in amazement...
...The woman is going through a normal grief reaction,” Malik said...
...I blew it...
...Malik picked up Mary Megan’s chart and reading aloud as he wrote, “Patient is mentally competent...
...Mary Megan left, shutting the door quietly behind her...
...I nodded...
...C’monl’ In the nursing station, as he changed into shorts for his morning run, Malik said, “Don’t get me wrong, I’m not against using medication...
...Lasted but three months...
...After only a month Win, like a dog with its master, had become much like Errol: both were hyper and manic with eyes wide...
...Ike’s suicide for her, for all of us, is a big ‘Fuck you!“ He signed...
...Thorny said frantically...
...Good...
...Specially us hot-shit high- achiever Jews...
...I turned, and then realized once again who it was...
...That’s bullshit...
...They say he died of a fatal disease and-” “Oh, pleeeeeze...
...K.,” I said...
...he cried...
...Why’m I preaching to you...
...I hesitated...
...I told no one, no one knows this, no one a’tall, not even my dear husband Joey...
...And wouldn’t you know it but BPO with A and B was a particular diagnosis Errol just happened to be world expert in...
...She refuses all drugs,” Mahk said, rising...
...One tear, escaping from under his glasses, ran down his cheek, translucent, losing form as it ran, leaving a trace behind, like a snail’s...
...I felt a sharp pain in my palm...
...Malik said that most of the patients would be better off out of Misery and that we would discharge as many as possible...
...And BPOs don’t even exist...
...The lecture was based on the DSM-the Diagnostic and Statistical Manual-the bible of psychiatric diagnosis published by the prestigious American Psychiatric Association...
...Read,” Malik said...
...Her clothes, usually neat and clean and perky in the way that an old-fashioned, good mother’s lutchen clothes are perky, were rumpled and too big for her thinning body...
...When her level’s in the therapeutic window, she will be competent, and then she can decide rationally about going off Placedon no problem thanks...
...We’ll discharge you soon...
...He ’n’ von Nott agreed Mr...
...He publishes, they perish...
...Mary Megan stared at him and then took a green piece of glass out of her sleeve and held it to her wrist...
...I was clutching my key ring so hard the keys were biting into the flesh...
...Think of Mary Megan, her face when she took out that piece of glass...
...Only recently had things gone awry...
...Patient refuses all drugs...
...He waited...
...When are you gonna study drug compliance...
...Hahaa...
...Don’t read any bullshit articles...
...She was picked up by the state police on the side of the interstate, weeping hysterically, threatening to throw herself into the traffic...
...If it’s mental illness, it’s biochemical, and vice versa...
...K.’s chart...
...When I stopped, no one said anything...
...Feel...
...Cmon-” “Wait...
...I do...
...If and when I act like a shrink, yeah...
...Your job is to resist brain-washing as long as possible and just try to help these poor people...
...Hard to take...
...I’m here...
...It’s a memorial to the harm done by shrinks trying to fix people...
...She deserves a trial of Placedon...
...Someone giggled...
...White...
...No I am not...
...Mary Megan sat up in shock, her eyes wide...
...Yes...
...He blinked, looked around in puzzlement...
...That’s the first real thing you said...
...I knew at once...
...Studies have proved it...
...Know what they don’t do?,, I asked what...
...You stopped yourself...
...We shook hands...
...Weird, ain’t it,” he said, “to be so scareda just sitting down and talking to somebody...
...But he’s so pissed off, suppose I say the wrong thing...
...Malik shouted...
...Any effect is placebo effect...
...Problems with relationships, self-image, feelings, impulsivity...
...Thumbs up...
...Sports...
...Sort of,” I said, sensing him sensing my discomfort wearing a suit...
...And, ‘People who live in glass houses shouldn’t throw stones’?’’ Abruptly he stopped sobbing, began laughing hard, and said, “It’s a big cry, a big big cry!“ ‘And who’s the president of the United States...
...Every year, every single year on his birthday, she would think of that baby boy and wonder where he was, and what his life had become...
...They hurried out...
...She’s not competent to give permission...
...We all got that...
...I laughed...
...C‘mon, we got Case Conference...
...I knew Win from medical school...
...What can I tell you...
...Your problem is you’re nuts and you should be on medication...
...Errol asked...
...Calls himself the Burn King of the Bayous...
...Laughmg, he gave me a thumbs down and a high five...
...His golden retriever, Duke, had died...
...I asked, stunned...
...Blair Heiler, local borderline expert, was a follower of Krotkey...
...I‘ll try,” Malik said...
...Given the fact that insurance companies were now dedicated to not paying out insurance, this wouldn’t be difficult...
...His son had come out as gay...
...He died of death...
...I‘ve been trying to figure out what von Nott meant by a fatal disease...
...Psychiatrists specialize in their defects...
...Just checking...
...Lloya1 was crushing him...
...From then on, because he’s rich, he was assaulted by whatever treatment was at the leading edge of American psychiatry: insulin shock, cold water dousings, being strapped into the Benjamin Rush restraining chair and given emetics and whirled around ‘til he puked his guts out, enemas and high colonic irrigations to get it out from the "What can I tell you...
...The more I see, the more I think that if all shrinks in the world were to die of heart attacks at once, all the world would be a helluva lot better ofE‘ “Including you...
...Ever hear of a mental status exam...
...You know what I mean, doncha...
...Aerosmith...
...I felt really bad...
...So now you see all the bullshitology around ‘diagnosis...
...If the other shrinks are lying about him killing himself and you’re telling the truth, aren’t you gonna get into trouble...
...I said that Mr...
...Just try ’n’ change ’em...
...Surely this is backward-I was supposed to be asking about him...
...Thorny said...
...fear of abandonment, unstable relationships, suicidal or self-mutilating acts, mood swings, feelings of emptiness, and a fierce, withering rage...
...K. needed a trial of BPO with HFL-Half a Frontal Lobe...
...He fixed me with his eyes...
...He started to plug the earphones in...
...Why does Heiler try to fit people into diagnoses...
...Can I ask you a few questions...
...But something didn’t make sense...
...Malik...
...From what...
...The edges of her lips turned down, as if she were on the verge of tears...
...Errol asked...
...When she talked about that parka, crucified, I picked up somethin’, like ‘lost son.’ So I took a shot, got lucky...
...I had no idea what he meant...
...Case Conference was designed to try to get a fresh look at a problem patient by bringing in a world expert to talk things over...
...She gave birth to a boy...
...Oh shit,” I said...
...One of these days he’ll admit an adolescent with BPO with Z-Zits...
...Not a good start...
...So he keeps adding letters...
...Dickheads Slam Doors!“ The same sandy-haired young man as before...
...Her freckled milky complexion was marred by dark bags under her eyes and slack skin around her mouth...
...BPO with B-Bulimia...
...Her auburn hair was unwashed and halfheartedly in a bun, ends escaping out and hanging despondently down, ends she didn’t brush out of her eyes...
...How could you not...
...Why are all these experts denying their feelings about Ike...
...The drug cowboys are takmg over...
...Renaldo Krotkey...
...A man’s voice asked, ‘Is this Mary Megan O’Toole...
...It blows me away...
...I was excited at this, my first good interview of a borderline...
...First, diagnosis...
...How do you get insurance to pay for them to stay...
...He was wearing a shortsleeve white shirt and a slender red tie, khaki trousers, and well-worn Nike running shoes...
...Finally Malik said, “YOU okay, Mary...
...It’s the borderline ward,” I said...
...He took another bite out of his carrot, closed his eyes and chewed carefully, savoring it...
...Okay!“ Errol said as we sat down, before Mary Megan was brought in...
...But he was just transferred over here to Borderline yesterday...
...Becomes world expert in BPO...
...So listen up, if you need me, call...
...She nodded to Errol, Win, Malik, and me and sat down...
...Ike had painted me a dire picture, and now I quoted Ike to Malik, “Borderlines are hell...
...He took a bite...
...SO if you know what I mean, you don’t ask what I mean...
...We’ll listen...
...he said, his laugh crackling and highpitched, like a child finding a favorite toy, say a stuffed zebra...
...Now let’s do some real work...
...their defects...
...At ten he was institutionalized...
...The official diagnosis of Borderline Personality Organization, or BPO, was defined by 13 Krotkey Factors, created by the borderline world expert Dr...
...Since then she’d been actively suicidal...
...If we can keep her off drugs, she’ll pull together just fine...
...I stood and watched...
...Are you sad, hearing all that...
...He led me back to Mr...
...So, Dr...
...But do sports...
...Yet she herself remained hidden...
...The nuns never let her see it...
...he said, and started to sob uncontrollably, on and on, in horrific pain...
...Listen up: all you gotta do to learn is keep your eyes open, your fly zipped, your feelings up front, and ask for help...
...Win and I have read the chart, so we all know the case...
...What’s that...
...I was okay for a year, but then, this year, without him, when that day came ’round . . . I could not go on...
...That would be grand...
...He was large for his size and, though tight with tendons, gentle...
...Sure is sad Ike White killed himse’f ain’t it...
...What do you mean...
...Anniversaries are killers,” Malik said...
...This...
...Talk-therapy guys see one an hour, at a hundred bucks...
...Listen up...
...No joke...
...Tis cause for weeping, yes...
...That is crazy,” I said...
...Finally I said, “I don’t know, Malik...
...It shut with a tremendous “wham...
...I felt confused and overwhelmed...
...Brought it back from Bangkok-in my backpack...
...You...
...Lotta suicides on the ward...
...He squeezed my arm and walked off, stopping to pick up a piece of litter...
...And why didn’t you tell Dr...
...Fifteenminute sessions, a hundred twenty bucks a shot...
...White was so kind and good, I wrote a poem...
...You wanna talk suicide, I’ll talk suicide...
...Money...
...she said, and began to weep softly, and on her tears rode a story none of us had ever heard from her...
...I saw you playing tennis yesterday...
...Thorny,”Malik said, “meet the new resident, Roy G. Baschl’ I looked into the eyes of the tall, sandy-haired, baby-faced man...
...he said he wanted to meet just the once, no more...
...There’s never once been a controlled experiment that showed that talking to patients does any good at all...
...You look kinda tentative, Doc...
...Let’s go...
...K. didn’t we...
...Steven Tyler is my God...
...Uh-oh...
...She’s a borderline...
...He’s a protCg6 of Lloyal von Nott, world expert in money...
...Wait,” I said...
...As a shrink, Roy, you got to be able to tell when something’s organicmedically treatable-as opposed to mental...
...I felt for her...
...I felt a kind of rush, a “click”he was the first person since I’d been there who had talked to my fear...
...An ice pick, stuck in his brain...
...Places like this kill guys like him right and left, and a lot of the dead don’t even know when they’re dead ’cause their souls die first...
...Money and fame...
...I had a strange sense of being seen into...
...Read Mr...
...Two glints of tears were running sadly down his old man’s old damaged man’s cheeks...
...And see everything in Misery in terms of Ike’s suicide...
...Nobody knew Ike well...
...I walked over to Thorny, thinking about how to be human...
...The one you lost...
...Sometimes your patients are better than you...
...He sDread his arms...
...Listen up...
...Not without her permission...
...K. said, chuckling normally...
...Mary Megan got more and more subdued...
...In psychiatry, first comes treatment, then comes diagnosis...
...Errol was a chunky 35-year-old man with a square-jawed flat face and eyes that seemed to bulge out of a sea of thyroid...
...a psychiatrist at Harvard, and a playwright and novelist...
...Yes, you did...
...White...
...They gotta pay or else I’m dead...
...Calming down, she went on, “We met a few days later, and...
...This is a BPO ward...
...I asked, squinting at him in the bright sun...
...It went on like that, Errol talking drugs and Mary Megan tallung poetry...
...Every year, for thirty years, on that day, she’s wondering where he is...
...Malik walked over to us...
...He talked with her for a while, and then the strangest thing happened...
...See...
...Game’s over for him, but not for us...
...Mary Megan was one of those “salt of the earth” people whom everyone loves, a kindhearted woman of Irish descent married to an Italian who, in her weeks on Depression, had taken to “mothering” all of us, patients and doctors alike...
...A row of fresh sutures, like a tiny barbed-wire fence on his forehead, overlay other old scars...
...With him was his protkgk, a new first-year resident named Win Winthrop...
...With Mr...
...problem is, Malik...
...Talk therapy is dying...
...It’s absolutely clear this gal is a BPO with Ano-” “First,” Malik said, “we talk with her...
...Dickheads Save Planet...
...Mary Megan had said nothing about another son...
...K. said, putting his thumbs down, smiling sweetly...
...I sat on the lush, close-cropped grass, staring at Malik‘s tank top, on which two lambs were holding hands over their heads in triumph, and the acronym L.A.M.B.S...
...strong core, But he had his misoy, his hesitant stammering mannq And nothing more...
...Terrorizes...
...Won’t help...
...You do okay in psychiatry as long as you keep playing sports and use what you know from sports...
...Why should luggage falling off a car and a parka on the front of a truck plunge a fine, by-all-accounts cheerful woman with lots of friends at work and home into suicidal despair...
...I asked...
...SO y’think there’s a big difference between doctors and patients...
...Thorne’s stay here in the hospital...
...I wanted to ask what he meant but stopped myself...
...In his long tan face, his hawk’s nose was bridged by black-framed glasses whose lenses were tinted amber...
...Well, Ms...
...Errol asked...
...I felt a strange fear...
...K. chided...
...He gulped down sobs, his Adam’s apple shuttling up and down his thin neck...
...They all looked at him...
...They’re just people, right...
...You gotta know it to let go of it...
...She wept frantically, searching for tissues...
...And guys like Errol are terrible at relationships...
...Okay good great,” Errol said loudly...
...What comes first?’’ He put a hand on my shoulder...
...I waited...
...Beautiful,” Malik said, “and true...
...But hey, I know you’re scared...
...HIS eyes locked in again...
...Noting the "Split Risk” sign, I opened the door to my new ward, Emerson 2, Borderlines, with caution, shielded the opening with my body, back-flipped in fast and threw the door closed...
Vol. 29 • March 1997 • No. 3
