“We’re not tying your brother to a chair like he was some kind of animal! Not like they do in those places. We’re his family, and it’s an honor for you to mind him. Some day you’ll understand that, I pray when it’s not too late.”
Mama cries as she and Paul help Fish back up into his chair, and Paul says he’s sorry, and everybody’s sad. Except for Fish, and Mama’s new boyfriend, standing in the door.
Fish jerks his head around, and remembers, laughing loud because they live in such a nice place, with sunshine and linoleum and good smells and no Trench outside waiting for them to make a mistake.
And then Fish looks at Mama’s new boyfriend again: the smoke in his face, the blue fire in his eyes, and remembers, and remembers there are things in the pond that swim even lower than Fish.
MERRY-GO-ROUND
The elevator is the dullest of the conveyances humankind has devised. Each year I tell the young doctors, the ones who come here eager to learn the art of psychiatry, that we should model this device after the merry-go-round. The elevator takes you from a spot on one floor, to the same relative spot on the next. The distance left and right to the end of the corridors is the same from floor to floor. The machine provides no stimulation. Moving vertically, it provides only a minimal illusion of progress.
But a similar device based on the merry-go-round: there, at least, would be a kind of stimulation. There would be different spatial relationships to experience at each floor, and the return trip back up to your room would be different from the descending trip. The overall experience would be a small, but therapeutic, one. I would think that in a top-ranked psychiatric hospital, such as this one, that would be an important consideration.
Each year the brighter ones in the new class of doctors feel obliged to answer my proposal. Their counters are always the same. Their knowledge of economics and spatial relationships, after an afternoon spent formulating the answer, will lead them to the conclusion: “That kind of arrangement would take up far more of a building’s space than the standard vertical elevator. It would require an entire vertical slice of the building, at a depth equal to that of the elevator. And you would have to build a second elevator opening for every floor with the exception of the top and bottom floors. And that space could have been used for more rooms, offices, so you’d lose all that rental income as well.”
Their knowledge of physics, after an afternoon spent drawing diagrams, will lead them to the conclusion: “A device like that would require much more time to travel from floor to floor than the standard vertical elevator. The passenger booth would be traveling along the circumference of a large circle in order to reach various vertical debarkation points. So of course they’d be traveling a much longer distance than they would using an ordinary vertical conveyance. And the speed would probably have to be somewhat slower, to compensate for the physical effects brought about because of centrifugal force.”
Good, well-thought-out answers. And each year I reply, “So? So who cares if it is slower, and less economical?” And thereby teach the doctors a lesson in humanity, if they care to let one in.
Each morning we have patient care conferences: the young doctors, Dr. James Zachary—head of the program—and me. The young doctors periodically question Dr. Zachary about why he allows a patient to come along on these confidential conferences. And that, of course, is another part of the education, and why this is one of the greatest teaching hospitals of psychiatric medicine in the world.
The conferences are informal; they normally take place out in front of the hospital, on the sidewalk, as we visit the various bakeries, drug stores, news stands, and coffee shops that share the neighborhood. The establishment on the corner always has fifteen scalding cups of coffee waiting for us at precisely eight-fifteen.
The conferences, as Dr. Zachary conducts them, are always more theoretical and Socratic than specific-case oriented. He makes the new doctors think, stretch themselves, and question their preconceived notions about psychiatric diagnosis.
“The Newman girl. Fifteen years old. If you’ll remember, she has a history of difficulties with her parents, problems relating to peers, serious altercations with authority figures of all stripes: teachers, social workers, the police.”
“She’s schizophrenic.” There is always one very eager student the first week.
The young man begins to elaborate but I interrupt. I’m impassioned on the subject, perhaps too much so for my own good. I realize I risk a little more every day I stay here. “No, she’s not. That’s nonsense.” I turn to face the young man, who holds his coffee cup unsteadily, still not used to this sanctioned interruption by a patient. “Any talented psychiatrist can make a claim of schizophrenia in any person you care to name, and prove it adequately to his colleagues. Remember the meaning of the word, doctor: ‘as if split.’ You must not forget the ‘as if’ part. It is too easy; schizophrenia is a natural state of the mind. Pull something else out of your textbook, doctor.”
The young doctors quietly shift their attention to Dr. Zachary for the final word on the subject. He smiles that famous smile of his—a slight tensing of the lips that might be construed as illness in another man—and says, “Mr. Lippmann has a point, as usual. I suggest you think about what he has said.” And, again this year, the new doctors subtly change their attitudes toward me, because the great Dr. Zachary has certified my thoughts as worthy of contemplation.
We have this same interchange concerning the diagnosis of schizophrenia sometime during the first week every year. There is always a patient on the ward to use as an example, schizophrenic symptoms always being in good supply. I know that Dr. Zachary agrees with me on the subject, although he will never admit to it outright. That isn’t his strategy.
I originally came to the hospital because of another patient of Dr. Zachary’s. Forty years ago, Dr. Zachary was just beginning his rise to fame. His patient, Roger Ellison, was a friend of a friend. I seem to recall that my friend was distantly related to Roger in some way, but my memory of that bit of conversation may be an imagined one, although I would never use that word “imagined” in describing it to Dr. Zachary.
The three of us lived in a small hotel down by the waterfront. My friend and I were roommates. Roger lived on an upper floor. He would drop down and visit us occasionally, but I never knew him well. He was mainly interested in talking to my roommate, my friend.
Roger was a very sick individual; I would no doubt agree with any diagnosis the young doctors cared to make concerning him. The specific symptoms are irrelevant; as human beings, most of us have some knowledge as to what it truly means when a human mind is in serious trouble, regardless of the jargon brought to bear by those who are trained and paid to do so. Roger possessed a superior talent for making himself unhappy. That unhappiness took many forms, but it was remarkably stubborn in its ability to circumvent the most careful safeguards. Nothing brought joy or even satisfaction to his existence.
The night Roger poisoned himself my friend was away for the weekend. He pulled himself through my doorway—I’d left it open because of the heat—and called to me from the living room floor. I’d been in the kitchen preparing iced tea. By the time I got to him, his limbs were nearly paralyzed. He had an envelope in his hand—a will, I later discovered. He insisted I “take care of things.” He made me promise I wouldn’t turn the envelope over to the police. I’d never seen anyone die before. It was powerful, irresistible. This person whom I’d met, talked to briefly, yet scarcely known, had died on my living room floor. I could not refuse whatever he asked.