The Center Cannot Hold: My Journey Through Madness (36 page)

"No," I said. "And yes. No to the medicine, yes to the drive home."

"You're not going to jump out of the car, are you?" he asked.

"No. I'm not. Off we go, into the wild, blue yonder."

Throughout the ride from school to Westwood, Ed kept talking. "I
don't understand," he said. "Your career, your writing—it all works
when you take your medicine, doesn't it? So isn't it obvious? I mean,
that you have to take it?"

I shook my head. "No," I said. "That is not clear. Clear, fear, near,
dear. Deer in the headlights. I can't fail."

Once we got into my apartment, Ed called Donna to let her know
where he was, and how I was. "What do you want me to do, tackle her
to the ground?" he hissed into the phone. He didn't sound happy. I
wasn't, either.

I called Kaplan. "I want off the stuff!" I moaned.

"I know you do," he said. "But what you're doing is going to land
you right in the hospital instead. You need to accept that you have an
illness and need to take medicine to control it. It's not fair, it's not fun,
but that's the way it is."

No, no. I can't take the meds and I can't be in the hospital!
The
room was full of swirling, taunting demons, forces coming through the
walls and ceiling. Ed couldn't see them, but I knew they were there.

Any minute now, something terrifying would happen to us both.

"I'm being interfered with," I cried to Kaplan. "I'm so scared. Help
me, please!"

"Do you have your medications there?" he asked.

"Yes," I said.

"Then it's time to take them. Thirty-six milligrams—eighteen of
your pills. Do that now."

I looked up. Ed was staring at me. Steve would be calling soon, as
he'd done every day, to tell me it was time to take my pills. Marder was
telling Kaplan to put me in the hospital. Kaplan was telling me that
without meds, the hospital was my next stop. "OK," I muttered into
the phone. "OK."

I'd failed.

I took the whole dose at once. In minutes, I was limp and sleepy.
Ed left, I went to bed, and except for my appointments with Kaplan, I
stayed at home for the next several days.

I could no longer deny the truth and I could not change it. The wall
that kept Elyn and Professor Saks separated from the Lady of the
Charts was smashed and lay in ruins around my feet. The Lady of the

Charts was real.
That
was the truth.

For days afterward, I felt like the survivor of an automobile
accident: sore and spent, as if the slightest breeze would knock me to
the ground. I tried my best to avoid the mirror in the bathroom, but
there she was again, the wild-eyed woman I'd first seen in the mirror
at the Warneford: hair matted and dirty; skeletal face, body mostly
bones. Anyone guessing my age might have added twenty years to the
real number.
Failed, failed.
Hope was dead, and I was in mourning. I
wanted to rage, to storm through the apartment, but I was too tired to
do much more than pick up the toothbrush and, eventually, the
hairbrush.

Psychosis sucks up energy like a black hole in the universe, and I'd
really outdone myself this time. When I walked, haltingly, down the
sidewalk—one careful foot at a time, testing the pavement as though
any minute I'd fall through and be swallowed whole—all I could think
of was old ladies who walked like this, and how I'd pitied them. The
idea of shopping—making lists, getting into the car, actually going
someplace and accomplishing something as simple as butter, eggs,
bread, and coffee—was overwhelming. Thank God for good friends.

After a loss, people naturally gravitate toward the familiar for
comfort. Like a wounded animal, I burrowed into my cave and
surrounded myself with familiar objects and voices. I talked on the
phone with Steve for hours, replaying every decision I'd made, picking
through the mess, second-guessing what I'd done, how I'd done it,
and trying to get the ending to come out different each time. I had
sessions with Kaplan, where "I told you so" hung in the air but was
never spoken. I spent time with my friends who had seen me sick,
hadn't been repelled, and oddly seemed to still care about me.

And, eventually, I went back to my office at the law school, where I
tried to work on an article and prepare for my fall classes. But mostly,
I listened to classical music and took long naps on my couch. After all,
the couch was still mine; the walls were mine, the books and papers
were mine, and the office door had my name on it. When you're
worried about falling, you grab hold of whatever you can.

By the time classes began that fall, I was somewhat back on my
feet, able to concentrate and genuinely looking forward to greeting
students and colleagues who'd been away for the summer. The easiest
way to explain things, I guess, is that it was as though I'd had a very
bad flu; it took a while to get over, but each day, I felt a little better.
Even in sunny two-season California, September always feels

especially promising.

In spite of my ugly misadventures with medication, I'd been able
to stick to my original plan for tenure—to write and publish enough
papers that I could "stockpile" in case I had to take time off for illness.
I'd already published several law journal articles on competency to
refuse treatment, and the paper I'd written in George Mahl's Freud
class at Yale came out in a psychoanalytic journal. I'd also completed
my first paper on the criminal responsibility of individuals with
multiple personality disorder, and had begun to sketch out several
more exploring MPD and the law. For obvious reasons,
psychoanalysis and the law had become my main area of interest and
academic research.

Certain faculty members at USC's medical school had noticed my
published work, and I was gratified and flattered when I was offered
an academic appointment there. I happily accepted, but felt that I
needed to leave my MDDA support group—the med school
appointment was in the psychiatry department, and I couldn't risk my
illness being somehow exposed, certainly not before I'd achieved
tenure. I called Steve Wizner at Yale and told him that I'd risen above
my lifelong status as patient and become a colleague to an entire

medical school. "I've infiltrated the enemy!" I said. The sound of his
laughter was gratifying.

chapter twenty-one

T
HINGS WITH KAPLAN
were not going well. No matter what I did
or said,
I
tested his patience. For example,
I
'D
had a physical, during
which the physician found a thyroid nodule which needed to be
biopsied. Subsequently, an endocrinologist examined me and said I
probably had Marfan syndrome, a genetic connective-tissue disease
with a life expectancy in women of about forty-five (in recent years,
that's been revised upward, to mid-sixties). At the time, I was
thirty-seven. I was devastated, and wild with anxiety.

So I did what I always do—found articles referencing Marfan,
frantically read them all, and saw myself on every page. I certainly had
a lot of the physical characteristics: tall and thin, highly flexible in my
joints, with a fast heartbeat and a brain bleed. I was doomed, I just

knew it. My demise was imminent.

"Lincoln had Marfan," I wailed to Steve.

"But that's not what he died of, Elyn. Come on, get a grip. Just
don't go to the theater."

Kaplan wasted no time in letting me know that he thought the
whole thing was baloney, and dismissed it out of hand. "The doctor's
hearing zebras when he should be hearing horses," he said.

"He's an expert," I protested. "A full professor at UCLA. And he
said he'd be 'surprised' if I didn't have Marfan. Why aren't you taking
this more seriously?"

The results of the intensive medical workup showed that I did not,
in fact, have Marfan syndrome. That didn't stop my psychosis from
bleeding in around the edges of my life for the next several days. I had
to admit it: I was a full-fledged hypochondriac. My body had betrayed
me so many times in the past, why did Kaplan expect me to behave as
though it would never do so again?

And then one day soon after, I retreated to a familiar theme: "I've
been thinking," I said. "Maybe if I were on an antianxiety medicine, I
could get off the antipsychotic medication."

Kaplan blew a gasket. "I've repeatedly told you that you'll need to
stay on meds the rest of your life, that trying to get off them keeps you
stuck in the same place—going from well to symptomatic to well
again." He was practically shouting. "I'm just not going to put up with
this anymore! If you reduce your meds again, you cannot stay in
treatment with me. In fact, you can't even
talk
about reducing your
meds and stay in treatment with me. This stops now."

The look on his face registered as pure anger. That was it. There'd
be no more discussion of medication with Kaplan. The issue was off
the table.

Steve agreed with him. As far as he was concerned, after the last
episode, the data were in. "When you lower your meds, your judgment
is compromised," he said. "Every time, you go into the downward
spiral, one bad decision after another, none of them in your best
interests. It's...tiring. Aren't you tired of it, too?"

Oh, God, yes, I was tired—tired of being alone, tired of flailing
away, tired of beating my head against the wall. For so many years, I'd
resisted the "crutch" of the meds—to use them meant I was weak of
will, weak of character. But now I began to question my own
absoluteness. For instance, if I'd had a broken leg and a crutch was
required, I'd have used it without ever thinking twice. Was my brain
not worth tending to at least as much as my leg? The fact was, I had a
condition that required medicine. If I didn't use it, I got sick; if I used
it, I got better. I don't know why I had to keep learning that the hard
way, but I did.

A friend used the riptide analogy: You get sucked in, and your first
instinct is to fight it. The harder you fight, the more energy you spend.
But the simple truth is, a riptide is stronger than you; you cannot
outmuscle it, and if you continue to try (if you exercise, as I
continually did, "maladaptive stubbornness"), you drown. The simple
lesson (as California surfers learn over and over every year) is to stop
fighting and go with it. Save your strength, stop fighting, and the
riptide itself will quickly propel you out of harm's way, into calmer
waters. At that point, if you've preserved your energy, you can make it
back to shore on your own. But first, you have to give in.

As exasperating and frightening as my years-long process of
tinkering with my meds was for my friends and physicians, I
understand now that it was hugely important for me to do it; it was a
necessary stage of development that I needed to go through to become
my full-fledged self. It was the only way I could come to terms with the
illness.

So I vowed I'd take my Navane and do no more experimenting.
What happened next was a pleasant surprise: Almost immediately, I
actually felt quite good. Once again, I'd learned that it wasn't my
stubbornness or discipline that kept the demons at bay; it was the
medicine. I knew the demons were there; every single day, they found
ways to remind me, however subtle those reminders were. But
nevetheless, they were
behind the door
, and it was firmly closed, at
least for now. And besides, I decided that there were other, better,
more interesting parts of my life worth tending.

I'd met someone, a nice someone. His name was David and he was a
microbiologist—and he seemed to like me. He asked me out on an
actual date, my first since law school. The first date went well. The
second date went OK. Soon, though, he was beginning to press me to
be sexual. I wasn't ready for that with him, or with anyone, and things
continued, but not easily. After a while, instead of being fun, being
with David was tense, and tension was the last thing I wanted.

We stopped dating, but remain good friends to this day. He is kind
and smart and funny, and someone whose friendship I cherish.
Ending the relationship was right, but it made me sad. Not because I
was no longer romantic with David, but because of a bigger question:
Was there anyone out there for me? Many of my female colleagues
had put their personal lives on hold while they pursued educations
and careers, but lately, it seemed, many of them were finding
partners, falling in love, having children—living the kind of life I could
only imagine. I watched movies in which people met and fell in love,
and sat there feeling as though I'd come from another planet.
Damn
it, I want that.
Intimacy, and love, and trust, and the touch of
someone's arm around my shoulders, someone's hand in mine. The
Lady of the Charts was quiet these days, and Professor Saks was
humming along just fine. So what were we going to do about Elyn?

The more I explored multiple personality disorder, the more intrigued
with it I became, and since the MPD article had been well received, I
thought I'd try my hand at writing a book about it. As part of the
preparation, I needed to get up to speed on the clinical presentation of
the disorder. So I went to a local hospital once a week for several
months, and there I met with people actually diagnosed with and
being treated for MPD.

The first young woman I spoke with was completely
lovely—high-spirited, charming, and committed to therapy and to
getting better. She'd recently married, she told me, but only after a
two-year engagement, during which her then-fiance, at his insistence,
proposed to and got the consent of each of her alternate personalities!

I also watched a hundred hours of videos of patients being
administered a diagnostic instrument called the
Structured Clinical
Interview for Dissociative Disorders (SCID-D).
Even though a good
case can be made that MPD is overdiagnosed—and sometimes created
by the treaters themselves—it seemed utterly clear to me from the
evidence on those tapes that MPD was a genuine phenomenon.