Tuesday, June 9, 2009

Fleetingly improvised men

Despite the benefits that I had observed in Chris from the assemblage point shift, Chris continued to present a poor clinical image at his day program. In early June 2006 at our monthly meeting, I argued the never-ending medication point once again with Dr. 'L' in the presence of Ian and Chris. I was getting that “please, dear” look from Ian, but I persisted.

Suddenly, in the midst of our discussion, Dr. 'L' did exactly as I expected he would that day. He was determined to demonstrate to us why Chris’s medication needed to be raised. He focused his gaze on a point near the window where Chris’s gaze was wandering, and asked quietly and with evident dramatic flourish, “Chris, what do you see?”

“Uh, someone over there near the window.”

“Surprise, surprise,” I thought sarcastically. Chris was seeing people in the room who weren’t us. He was hallucinating. Instead of the term “hallucination” I like the term that Daniel Paul Schreber used to describe people populating the corners of his gaze. He called them “fleetingly improvised men.” To Schreber, these were "souls, temporarily given human shape by divine miracle".

Dr. 'L' had caught Chris in the act, and waved this around as proof positive that he needed to have his medication increased. I knew Dr 'L' would pull this trick and I was prepared, sort of. Chris had warned us before our meeting that Dr. 'L' wanted to raise the medication. I would have preferred to ignore Chris’s wandering eye, but it was rather obvious. So, instead, I said, “Yes, Dr. 'L', but in the bi-weekly meetings with the other families involved in the program, it has been said that we shouldn’t pay undue attention to voices. Therefore we haven’t. Of course he hears voices and sees things. Isn’t that what schizophrenia is all about? It’s not for academic interest that we talk about voices in the bi-weekly meetings in the first place. The drugs haven’t prevented the voices, have they, so what good are they in Chris’s case?” What I would have loved to add, but did not, was that two years in Dr 'L's day program hadn't fixed the voices either.

Alas, as I also predicted, we allowed Dr. 'L' to raise one of his two medications from 200 mg to 300 mg. Chris, after all, was acting more skittish than we had usually seen him in Dr. 'L's presence. It was hard to deny it, but the medications wouldn't fix it. We were stuck in this clinical program for better or worse and it was now a question of humoring Dr. 'L' until we could execute a graceful exit strategy from the program and the stupid medications.

Daniel Paul Schreber, “Memoirs of My Nervous Illness,” New York Review Books Classics (January 31, 2000)

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