The past nine years, on the whole, have been happy ones for Ray—a liberation beyond any possible expectation. After twenty years of being confined by Tourette’s, and compelled to this and that by its crude physiology, he enjoys a spaciousness and freedom he would never have thought possible (or, at most, during our analysis, only theoretically possible). His marriage is tender and stable—and he is now a father as well; he has many good friends, who love and value him as a person—and not simply as an accomplished Tourettic clown; he plays an important part in his local community; and he holds a responsible position at work. Yet problems remain: problems perhaps inseparable from having Tourette’s—and Haldol.
During his working hours, and working week, Ray remains ‘sober, solid, square’ on Haldol—this is how he describes his ‘Haldol self.’ He is slow and deliberate in his movements and judgments, with none of the impatience, the impetuosity, he showed before Haldol, but equally, none of the wild improvisations and inspirations. Even his dreams are different in quality: ‘straight wish-fulfilment,’ he says, ‘with none of the elaborations, the extravaganzas, of Tourette’s’. He is less sharp, less quick in repartee, no longer bubbling with witty tics or ticcy wit. He no longer enjoys or excels at ping-pong or other games; he no longer feels ‘that urgent killer instinct, the instinct to win, to beat the other man’; he is less competitive, then, and also less playful; and he has lost the impulse, or the knack, of sudden ‘frivolous’ moves which take everyone by surprise. He has lost his obscenities, his coarse chutzpah, his spunk. He has come to feel, increasingly, that something is missing.
Most important, and disabling, because this was vital for him— as a means of both support and self-expression—he found that on Haldol he was musically ‘dull’, average, competent, but lacking energy, enthusiasm, extravagance and joy. He no longer had tics or compulsive hitting of the drums—but he no longer had wild and creative surges.
As this pattern became clear to him, and after discussing it with me, Ray made a momentous decision: he would take Haldol ‘dutifully’ throughout the working week, but would take himself off it, and ‘let fly’, at weekends. This he has done for the past three years. So now there are two Rays—on and off Haldol. There is the sober citizen, the calm deliberator, from Monday to Friday; and there is ‘witty ticcy Ray’, frivolous, frenetic, inspired, at weekends. It is a strange situation, as Ray is the first to admit:
Having Tourette’s is wild, like being drunk all the while. Being on Haldol is dull, makes one square and sober, and neither state is really free . . . You ‘normals’, who have the right transmitters in the right places at the right times in your brains, have all feelings, all styles, available all the time—gravity, levity, whatever is appropriate. We Touretters don’t: we are forced into levity by our Tourette’s and forced into gravity when we take Haldol. You are free, you have a natural balance: we must make the best of an artificial balance.
Ray does make the best of it, and has a full life, despite Tourette’s, despite Haldol, despite the ‘unfreedom’ and the ‘artifice’, despite being deprived of that birthright of natural freedom which most of us enjoy. But he has been taught by his sickness and, in a way, he has transcended it. He would say, with Nietzsche: ‘I have traversed many kinds of health, and keep traversing them . . . And as for sickness: are we not almost tempted to ask whether we could get along without it? Only great pain is the ultimate liberator of the spirit.’ Paradoxically, Ray—deprived of natural, animal physiological health—has found a new health, a new freedom, through the vicissitudes he is subject to. He has achieved what Nietzsche liked to call ‘The Great Health’—rare humour, valour, and resilience of spirit: despite being, or because he is, afflicted with Tourette’s.
11. Cupid’s Disease
A bright woman of ninety, Natasha K., recently came to our clinic. Soon after her eighty-eighth birthday, she said, she noticed ‘a change’. What sort of change? we queried.
‘Delightful!’ she exclaimed. ‘I thoroughly enjoyed it. I felt more energetic, more alive—I felt young once again. I took an interest in the young men. I started to feel, you might say, “frisky”—yes, frisky.’
‘This was a problem?’
‘No, not at first. I felt well, extremely well—why should I think anything was the matter?’
‘And then?’
‘My friends started to worry. First they said, “You look radiant— a new lease on life!”, but then they started to think it was not quite—appropriate. “You were always so shy,” they said, “and now you’re a flirt. You giggle, you tell jokes—at your age, is that right?”’
‘And how did you feel?’
‘I was taken aback. I’d been carried along, and it didn’t occur to me to question what was happening. But then I did. I said to myself, “You’re 89, Natasha, this has been going on for a year. You were always so temperate in feeling—and now this extravagance! You are an old woman, nearing the end. What could justify such a sudden euphoria?” And as soon as I thought of euphoria, things took on a new complexion . . . You’re sick, my dear,” I said to myself. “You’re feeling too well, you have to be ill!”’
‘Ill? Emotionally? Mentally ill?’
‘No, not emotionally—physically ill. It was something in my body, my brain, that was making me high. And then I thought— goddam it, it’s Cupid’s Disease!’
‘Cupid’s Disease?’ I echoed, blankly. I had never heard of the term before.
‘Yes, Cupid’s Disease—syphilis, you know. I was in a brothel in Salonika, nearly seventy years ago. I caught syphilis—lots of the girls had it—we called it Cupid’s Disease. My husband saved me, took me out, had it treated. That was years before penicillin, of course. Could it have caught up with me after all these years?’
There may be an immense latent period between the primary infection and the advent of neurosyphilis, especially if the primary infection has been suppressed, not eradicated. I had one patient, treated with Salvarsan by Ehrlich himself, who developed tabes dorsalis—one form of neurosyphilis—more than fifty years later.
But I had never heard of an interval of seventy years—nor of a self-diagnosis of cerebral syphilis mooted so calmly and clearly.
‘That’s an amazing suggestion,’ I replied after some thought. ‘It would never have occurred to me—but perhaps you are right.’
She was right; the spinal fluid was positive, she did have neurosyphilis, it was indeed the spirochetes stimulating her ancient cerebral cortex. Now the question of treatment arose. But here another dilemma presented itself, propounded, with typical acuity, by Mrs K. herself. ‘I don’t know that I want it treated,’ she said. ‘I know it’s an illness, but it’s made me feel well. I’ve enjoyed it, I still enjoy it, I won’t deny it. It’s made me feel livelier, friskier, than I have in twenty years. It’s been fun. But I know when a good thing goes too far, and stops being good. I’ve had thoughts, I’ve had impulses, I won’t tell you, which are—well, embarrassing and silly. It was like being a little tiddly, a little tipsy, at first, but if it goes any further . . .’ She mimed a drooling, spastic dement. ‘I guessed I had Cupid’s, that’s why I came to you. I don’t want it to get worse, that would be awful; but I don’t want it cured—that would be just as bad. I wasn’t fully alive until the wrigglies got me. Do you think you could keep it just as it is?’