Falling Into the Fire: A Psychiatrist's Encounters with the Mind in Crisis (26 page)

One day as we are walking down the path, our daughter, newly in kindergarten, turns and asks me to carry her. She is exhausted, and she is sweet, and I love that she still has these moments when closeness is her only desire. I lift her to me with a mock groan, to which she says, “Don’t say I’m too heavy, Mama. I never want to be too heavy for you to carry me.”

“Someday you will be,” I say. “When you are as big as me, you will be too heavy for me to lift! Maybe then you will lift
me.
” She laughs at this unimaginable thought, then quiets.

“How old will you be then, Mama?” she asks.

“When you are as big as I am?”

“When I am as old as you are now.” I do some quick math in my head.

“When you are thirty-eight years old, I’ll be seventy,” I say.

She takes this in. She lays her head on my shoulder. “Do you think you will live to be a hundred, Mama?” she asks me.

“I hope so,” I say, and squeeze her little body against me. It is the first time I am aware that she understands, if only a little, that I will someday die.

“I hope you live to a hundred and three,” she says. She cannot see the tears welling up in my eyes. Through them the rolling bay ahead of us is foggy and shifting, even less well defined.

How do we do it? How do we bear the unbearable realities of our human lives? Someday I will die and leave Deborah, and our son, and our daughter. Or someday each of them will die and leave me. How do we reckon with this inconceivable a loss? With this cruel—and fundamental—truth? Perhaps we lift our feet off the ocean floor; we paddle frantically away from what we fear. Perhaps, for some of us, our very bodies revolt against what pains us. Our limbs convulse; our muscles suddenly weaken and fail.

I scan the beach. By what dumb luck do my lovely son and daughter have sound brains, good food, warm clothes, feather collections, wooden train tracks, two mothers who have loved them fiercely every second of their lives? Thus far we have been able to protect them from the deep and enduring traumas that scar the minds and selves of so many of the patients I see. How—
how
—can I make it always be so?

My children are off at a run, racing each other to some fast-chosen landmark. My daughter’s arms flail alongside her; my son’s little legs swing in determined, bowlegged arcs. She leads confidently, looking over her shoulder to giggle and gloat, until she snags her foot on a driftwood branch and falls to the sand. She cannot decide whether she must cry. Her brother catches up, considers running on to the invisible finish line, then reconsiders and flops on top of her. They dissolve in laughter, roll so close to the water’s edge that a wave nearly drenches them. They shriek, roll away from it, convulse with laughter, shriek some more. The sun is so bright on them it whites out the edges of their bodies. The sea retreats. My children roll out of the waves’ reach. They roll onto their backs and pant, both looking up to the sky. Overhead, a lone gull flies above them, soaring, wings outstretched.

The Brown University Department of Psychiatry and Human Behavior—and in particular my departmental chairperson, Dr. Steve Rasmussen, and the directors of my residency training program, Drs. Bob Boland and Jane Eisen—consistently helped me find ways to carve out time to devote to my writing. Dr. Louis Marino guided me toward a professional schedule that made room for both writing and practicing psychiatry. I am exceptionally appreciative of such a supportive clinical home.

The MacColl Johnson Fellowship of the Rhode Island Foundation and the Eugene & Marilyn Glick Indiana Authors Award provided generous financial support to me as a writer. Bethlem Royal Hospital was kind to give me access to their voluminous archives.

Kris Dahl has been my advocate and adviser for almost a decade now. She is not only a wonderful agent but also my friend. I’m very grateful that she connected me with the good, smart people at The Penguin Press. Janie Fleming was enthusiastic about this book as my first imaginings of it began to form. Since that time the book has benefited by focused attention from Ann Godoff, Bruce Giffords, Scott Moyers, Maureen Sugden, and especially my editor, Lindsay Whalen. Lindsay asked all the right questions of the manuscript as I was writing it, and—as a good psychotherapist would—she didn’t let me off the hook until she was sure I had found the core of what I wanted to convey.

Many of my colleagues enhanced my understanding of the illnesses and experiences I’ve written about in
Falling Into the Fire.
Ann Back Price and
Drs. Colin Harrington, Martin Furman, Diana Lidofsky, Katharine Phillips, and Patricia Recupero are foremost among them, as is my friend and role model Dr. Audrey Tyrka, who supervised my work with Anna and emboldened me to consider the case as one of anxiety rather than psychosis.

Conversations with Drs. Carey Charles and Francis Pescosolido deepened my understanding of happiness and human vulnerability in immeasurably important ways. Dr. Lawrence Price has been for me a mentor of the best sort: brilliant, encouraging, scrupulous, and irreverent. He read this manuscript through a meticulous and insightful lens. The fact that he is a member of the Michigan Wolverine faithful is icing on the cake.

I am fortunate to have good writers and good thinkers as friends, including Dr. Jay Baruch, Peter Castaldi Sr., Dr. Paul Christopher, Dr. Kathryn Fleming-Ives, Kathleen Hughes, Lizzie Hutton, Kate Lorch, Alex Ralph, Leslie Smith, Maryll Toufanian, and Dr. Alexander Westphal. Our conversations and their wisdom helped shape these pages. My poor friend Sheri Hook deserves particular mention, as she somehow always ends up reading the most outrageous and disturbing things I unearth in my research forays. I also appreciate Sarah Blaffer Hrdy’s generous willingness to correspond with a stranger.

No book takes shape without essential pragmatic support. Elliot Fleming at the Brown Bookstore salvaged lost drafts and data that I had neglected to back up. Peter Shukat chased down elusive lyrics permissions so that I might have the very epigraph I wanted. And I am truly indebted to Maria Cervantes, whose kind attention to and care of my children is a gift beyond measure.

Dr. Curt LaFrance Jr. deserves special acknowledgment for sharing with me his thoughts about abiding with patients. My conversations with him transformed the trajectories both of this book and of my own psychiatric practice.

Being married to another writer is wonderful. Being married to another writer whose strengths compensate for your deficiencies is miraculous. From this book’s first thoughts to its final line edits, it benefited from Deborah’s unwavering and rigorous gaze. Indeed, it is not a stretch to say that inasmuch as the book succeeds in having a fluid and organic structure, it is a result of the many hours she spent arranging and rearranging my written lines, paragraphs, and pages to render my thoughts more lucid and my ideas more compelling and clear. Her steadfast devotion to me as a writer, as a parent, and as a partner is the single greatest treasure of my life.

Finally, I owe sincere thanks to my patients whose struggles inspired these narratives.

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