Falling Into the Fire: A Psychiatrist's Encounters with the Mind in Crisis Read Online Free Page B

are, thankfully, far more humane than those I find documented as I page through the nineteenth-century Bethlem casebooks, I am struck by the disquieting fact that Charles Harold Wrigley, with his exact symptoms and story, might as easily have been seen in one of the psychiatric wards on which I work today.
    I could likely guarantee Mr. Wrigley more dignity, more comfort, and more privacy than he received in 1890 in “Bedlam.” I could prescribe him modern medications and offer him appropriate psychotherapy. But in spite of the surefire treatments that have been found in the last three centuries for countless
other
medical conditions, I could not guarantee that my treatment would bring him relief or cure.
    So, standing in the dark of Joseph’s room, my mind returned to young Charles Wrigley, who was described as miserable and holding his hand on his forehead as if in pain. “I just want to be left alone,” Joseph had labored to tell me from his impenetrable stillness when I began to test his gag reflex. “I’m terribly depressed.”
    I sat down beside Joseph to ask him more questions, now that he’d broken his silence. “How long have you been feeling this way?” I asked. His eyes remained closed. He did not respond.
    “Joseph?” I tried again. “I’d like to hear about what you’ve been going through so that I can help.” He did not stir. I sat there beside him, the awkward silence in the wake of my voice hanging between us. I felt a palpable discomfort—my own inability to penetrate Joseph’s misery, the paralysis of his suffering. I found myself thinking of a short-lived flirtation I’d had with Buddhism in graduate school, when I’d sit and reach for the meditative stillness the practice espoused only to find my mind wandering and waylaid, my body stiff or itching. “Joseph?” I said again. “Joseph?” Eventually I stood and left the room.
    Medicine asks its practitioners to confront the messy, unsatisfying, nonconforming human mind. As psychiatrists, we see the mind while it careens and lists, and we are not always sure how—or whether—we can right it. How do we respond when a patient’s suffering breeds unbearable discomfort and unease within our own selves? What do we do when our patients’ symptoms do not relent? When their experiences cannot be accounted for—or helped by—what we know about medicine, or the brain?
What then?

( CHAPTER ONE )
    The Woman Who Needed a Zipper
    Those wounds heal ill that men do give themselves.
    —Shakespeare,
Troilus and Cressida
    L auren’s back again.” The gastroenterology fellow groaned. “Lightbulbs this time.” I was in my second year of residency training and had just started working in a major medical hospital as a psychiatric consultant for medical and surgical inpatients. I had no idea who the fellow was talking about. When I told him so, he began to laugh. “Oh, my God. You’ve never seen Lauren? Every time she comes in, the ER docs call us and we call you guys. We all give our advice on how to treat her, but you know what she really needs?” I didn’t. “A zipper,” he said. “See you in the ER.”
    I was utterly confused. Lightbulbs? A zipper? Sounded more like supplies for a child’s science project than relevant clinical information. My mind was spinning as I walked through the dingy hospital stairwell to the emergency room to meet Lauren. On the wall at the landing hung a faded hospital-benefit poster of a horse-drawn carriage in the snow and some lines from Robert Frost. When I walked by the poster, I was typically working an overnight shift, and so “miles to go before I sleep” had taken on a bleary, fluorescent-lit meaning quite detached from woods, “lovely, dark and deep.” As I swiped my badge to go into the ER, the lines were still running through my head:
Between the woods and frozen lake / The darkest evening of the year.
    Lauren was in a room across from the nurses’ station. The ER rooms had three walls; the