The Center Cannot Hold: My Journey Through Madness (34 page)

I called Steve and left a message, then headed for Kaplan's office.
With laserlike speed, he went directly to the heart of the matter.
"You're afraid you'll end up like your uncle Norm who committed
suicide, aren't you?" he asked. "If you don't get tenure, you'll have to
kill yourself. Or at best end up a chronic mental patient in a back ward
of a hospital for the rest of your life."

Steve was equally direct, in a different way. "What the hell's the
matter with you, Elyn?" he said, clearly short on patience that day.
"You've still got fifteen or twenty places to hear from. It's a great
article, it's going to get published in an excellent law journal. You've
convinced yourself you're going to fail, you simply need to
stop
this!"
Rather than wilting me, his words picked me up. If he thought so,
maybe it was true.

Nevertheless, I was stuck in mild psychosis for the next week or so,
during which time I increased my medication. Ed, who'd gotten a
good offer right away on his first article, understood exactly what I
was going through (although he wasn't aware of the demons swirling
around my head). He could have been competitive, even gloating, but
instead he was, and has always been, kind and supportive; I saw that
he genuinely cared. "It'll happen, Elyn, anytime now. Just wait, the
call's coming any day."

About ten days after I fell apart, I received an offer from the
North
Carolina Law Review
, a well-respected law journal. Publishing there
would count in my favor for tenure. I'd done it. The paper had been
accepted. I'd been accepted. I could breathe easy; I wasn't going to be
Uncle Norm, at least not now.

By second semester that next year, I'd accomplished one more small
seminar and was a little more relaxed in the criminal law lecture
course. I could actually hear the students; I could actually respond to
them. The MPD article was coming along. In March I presented it at a
faculty workshop. The response was encouraging; people liked my
work.

And then another colleague—one who hadn't had a particularly
easy tenure time—quietly took me aside and suggested that maybe I
needed another year to work on the paper.

"But I don't understand," I said. "Everybody else says the paper's
ready to go."

"They may be saying that to your face, but you can't always believe
them."

I was stunned; had I misread the other responses? Did they have
some kind of weird agenda, encouraging me to submit substandard
work? And speaking of agendas, why would a senior person drop this
nasty little bomb on an obviously struggling junior person? The more
I thought about it, the more transparent it became.
Trust your gut,
Elyn,
I told myself.
It's good work. Your friends told you so.

I began working on what would become my third article, another
on the conditions under which people were incompetent to refuse
antipsychotic medication, especially people whose difficulty came
about as a result of noncognitive impairments, that is, impairment
from something other than disordered thoughts. It was my argument
that many people (more than we might think) should be allowed to
refuse medication. As someone who benefits from medication, I know
that the question of when one should be allowed to refuse is a
complicated one. But I also believe that individual autonomy is vitally
important, even precious—after all, it's central to who we are as
humans on the planet, with free will and self-ownership.

As the work progressed and the time went by, my faculty
friendships came to mean a great deal to me. The lunches, the dinners,
the casual greetings in the hallway—I was grateful for all of it. I felt
less lonely; I felt more competent. Maybe the time was coming when I
could even tell my friends the truth about myself.

And then there was Kaplan. Just as I'd always done, I was
tinkering with the med levels, lowering them whenever I could, and
feeling the effects, to his increasing and obvious annoyance. One
evening, late in the summer, I called Kaplan to tell him that the earth
was caving in and he needed to take cover. He sighed. "Elyn, take
more medication." That seemed to be his answer whenever I became
psychotic.

Later that year, Kaplan was preparing to take a long vacation
trip—to China, as I somehow knew. Suddenly, I began slipping.
Demons were everywhere, and evil began oozing from the walls. I
couldn't focus my thoughts, I couldn't write. Within days, I was
huddling on the couch in my office, muttering senselessly into the
telephone to Steve, who could tell I was in trouble and tracked Kaplan
down—not the kind of thing he'd ever been enthusiastic about doing
or felt comfortable with. But he thought, in this instance, it was called
for.

Later, Steve recited the call to me verbatim: "Dr. Kaplan, I'm very
concerned about Elyn. She seems more psychotic than she's been in a
very long time, I thought you needed to know. For instance, she told
me that she was going to China in advance of your trip, to clear it out
of all the bad persons."

"How very considerate of her!" Kaplan dryly responded. And then
he suggested that I increase my medication.

There were, in Kaplan's way of thinking, three different lenses through
which I viewed myself—three "me's," as he put it, although without
any implication that these were actual selves or personalities or
people or anything of that sort—it was purely a heuristic device. One
me was Elyn, one me was Professor Saks, and the third me was "the
Lady of the Charts"—the person who was a mental patient. I couldn't
argue with the metaphor, since it pretty much summed up the way my
life worked: I was Elyn with my family and friends, Professor Saks
when I was teaching or writing articles, and the Lady of the Charts
when I was ill. Kaplan believed that it was Elyn who was the most
neglected of the three.

There were many days when I believed I was nothing more than
the Lady of the Charts—a crazy woman who'd faked her way into a
teaching job and would soon be discovered for what she really was
and put where she really belonged—in a mental hospital. Other times,
I denied that the Lady of the Charts even existed, because my illness
wasn't real. If I could just successfully get off medication, the Lady of
the Charts would disappear. Because how could I reconcile the Lady of
the Charts coexisting alongside Elyn and Professor Saks? Either I was
mentally ill or I could have a full and satisfying personal and
professional life, but both things could not be equally true; they were
mutually exclusive states of being. To admit one was to deny the other.
I simply couldn't have it both ways. Didn't anyone understand this?

During the spring of our second year together, the relationship
with Kaplan really got rocky. As I'd always been somehow able to do, I
saved most of my psychotic thinking for my sessions. On the couch, I
could lie down and relax; there, I felt safe. If the closet door that kept
my demons in check burst all the way open, and they all came
exploding out—well, that was OK. I was in analysis, where that sort of
thing was supposed to happen. Say what's on your mind—or so Mrs.
Jones and Dr. White had taught me.

But Kaplan had decided that my way of using analysis had itself
become a problem; it was my way of not dealing with more pressing
issues. The Lady of the Charts was taking up all his time, and Elyn was
getting nowhere. I was filling my hours on the couch with psychotic
gibbering. I hadn't had a date in years, and certainly had no
foreseeable prospects for a relationship or marriage, something I now
insisted that I wanted badly. Kaplan thought the analysis had become
too unstructured, and he let me know it.

Then, for some reason, he had to be away; during his absence, I
saw another psychiatrist, Kaplan's backup, whom I'd come to know
and like. When Kaplan returned a couple of weeks later, he told me
the backup doc had reported that he'd noticed what appeared to be
trembling movements around my lips, a possible first sign of tardive
dyskinesia—TD—the movement disorder caused by antipsychotic
medications. Perhaps you've seen it among street people with mental
illness: lip smacking, tongue lolling out, limbs shaking uncontrollably.
TD's an unmistakable sign that something's wrong; it might as well be
a placard stuck to your shirt: "crazy person here." Even worse, there's
ample evidence that it's progressive and irreversible.

Quickly, Kaplan referred me to an expert, Dr. Stephen Marder, an
internationally known schizophrenia researcher. He did indeed
diagnose me with a mild case of TD. On what's called the AIMs test
(Abnormal Involuntary Movement), my lips were involuntarily
moving; my eyes were blinking too hard and too often. Although the
movements were subtle, there was no assurance they would stay so.
Friends at the law school had noticed something, too, they told me
later. But out of kindness (and not knowing what the cause was), they
hadn't said anything.

In spite of Marder's diagnosis, Kaplan insisted he'd never seen the
movements. "I'm not convinced you have TD," he said firmly. Marder
was the TD expert; nevertheless, Kaplan refused to confirm the
diagnosis, which felt dismissive of my very serious concerns that had
been raised by the expert Kaplan himself had sent me to. Thanks to
my doctors, whom I'd trusted, it seemed that I'd been taking
medication the side effects of which would now remove any doubt to
the outside world of who I really was: the very shaky, mentally ill Lady
of the Charts.

I could not remember the last time, if ever, I had been so angry
and frustrated. White and Kaplan had
betrayed
me with their
constant insistence that I take the medication. Of course I'd been
aware of the risks, but still, the word "betrayal" rang in my ears. I was
pretty good at hiding what I was thinking, but once TD set in, how was
I supposed to hide how I looked?

And then Kaplan added insult to injury. "You can't lie down in
session anymore," he said. "From now on, you have to sit up, in a
chair."

What the hell? To my mind, he'd just said that I wasn't well
enough to be in psychoanalysis. While Kaplan insisted that effective
analysis could occur on or off the couch, to my ear he was telling me I
was unanalyzable. I was the Lady of the Charts. Good-bye, Elyn.
Good-bye, Professor Saks.

"I'm seriously thinking of quitting with you," I fumed to him, and I
said as much to Steve on the phone before and after the sessions.

"There's no point to working with him anymore, Steve; he doesn't
want me there anyway, that's clear. I annoy him, I don't do what I'm
told. Besides, he's not paying any real attention to me—other people
see my lips trembling, he doesn't. Other people see my eyes jumping
and blinking, he doesn't. What's the point of him?"

"What's the point of you?" I asked Kaplan. "Not only do you think
I'm
only
the Lady of the Charts, you seem determined to expose me to
the world that way!"

My anger alternated with complete despair. My analyst, the one
who was supposed to know me the best, the one whose job it was to
help me navigate and understand my world, obviously thought I was
ultimately slated to be nothing more than a street person. Well, then,
maybe I should just move to the streets and be done with it.
I'm
destined for degradation. I belong on the streets. All else is pretense.

My fantasies of actually living as a street person grew more intense
every day; after all, it wasn't the first time the possibility had been
raised. The experts at MU10 had predicted as much when I was
hospitalized in New Haven. Maybe they'd been right about me all
along; maybe I'd been wrong.

Kaplan was immovable, but Steve was my consolation. We spent
hours on the phone every day, as he listened to me rant and rave, and
tried his best to talk me down from the ceiling. "I think there's method
in his madness," he said.

"His
madness?" I said.

"Yes. It's as though he's setting up a different construct, a different
dynamic between the two of you than you're used to. Stay in analysis,
Elyn, and sit up if you have to. Would that truly be so terrible? You've
been writing, you've been teaching, it's all been going well. Everything
you've ever wanted is in your grasp, if you can just get through this
hard phase with him. Are you going to throw everything away just
because you're angry?"

Then Kaplan delivered the coup de grace: his diagnosis.
Schizophrenia. "In the past, I've diagnosed you as 'atypical psychosis.'
But that's only allowed you to minimize your condition. Now I think I
was wrong." His delivery was chilling and abrupt, as though he were
serving his diagnosis up with a carving knife. Here's the deal, take it or
leave it. "When you're ill, you're totally indistinguishable from the
worst kind of schizophrenic. It's not going to change, it's not going to
get better, and it's not going to turn into something else. It's time for
you to stop fighting, and accept it."

"Stop fighting?" If I was angry before, now I was raging. "Stop
fighting? I thought I was supposed to be the crazy one in this room."

I'd show him; he'd left me no alternative. I'd show Kaplan and the
whole world that I was not mentally ill. I was Elyn and I was Professor
Saks, but I was
not
the Lady of the Charts; she was figment of
his
imagination, not mine. I'd show them all—I'd get off the damn meds
once and for all. And then they'd all see what was what.

chapter twenty

K
APLAN WAS ASKING
me to surrender. That's the way I heard it,
and that's the way that it felt, deep inside my core. Asking, hell—he
was
telling
me to surrender. I'd never surrendered to anything in my
life. If the doctors up to this point were right, wasn't I supposed to be
in an institution by now? Virtually every single expert, at one time or
another, had suggested that this was my destiny. If I had ever truly
believed them, if I had ever surrendered to their version of me
(instead of doggedly hanging onto
my
version of me), I'd still be
crawling around the tunnels under the Warneford, burning my arms
and legs with a lighter and waiting for devils to blow the world up by
using my neurotransmitters in some inexplicably evil way.