The Center Cannot Hold: My Journey Through Madness (39 page)

Janet's some years older than I; she's bright and funny, married
(with children and grandchildren) to a man who has his own private
practice, too. She specializes in addiction and eating disorders, and it
was easy, early on, for me to talk to her about my own illness. I was
amazed to learn that she'd been in analysis with someone who actually
knew my Mrs. Jones; I like small-world coincidences like that.

For much of my life, I'd thought of myself as a shy, ungainly
person, turned in on myself by my illness and with my books. I knew
that time and circumstance had changed my outer life, but I wasn't
truly aware that my inner life had changed as well—that instant
friendships were not only possible for me, but could become precious
and lifelong. Alicia brought that lesson home, and right beside her in
that same class was Janet. As many gifts as LAPSI has given me in the
past few years, these two women were the most unexpected and
ultimately the most precious.

Our group met on Wednesday mornings, for two classes, two
hours apiece. The building, attractive and ivy-covered, has four
seminar rooms in a row; in an interesting exercise in "concreteness,"
you move up the row for each year you complete—first room for first
year, second for second year, etc. On the very first day, I suggested we
have lunch together after class, and thereafter we always did, at a
casual Japanese restaurant right across the street. We all quickly
became close enough that we often saw one another on weekends for
dinner or a movie as well.

Our classes ranged from historical to theoretical to clinical; there
was an "early Freud" class, one on "object relations," some on
technique, and presentations of continuing cases. All the
psychoanalytic schools were represented—classical, self-
psychological, Kleinian. As in all teaching/learning situations, some of
the teachers were terrific; others couldn't have gotten the lesson
across if their very lives had depended on it. Since I'd incurred more
than a few bruises discovering how hard it is to teach, I withheld
judgment; it's not as though there was ever a shortage of knowledge in
the place.

Because these classes were small and often quite intense due to the
subject matter, it was conventional wisdom that inevitable conflicts
might arise among classmates. One evening at a dinner, the dean
made some comment to this effect.

"Our group's never had to go through that," I said. "It's amazing
how well we all get along!"

"I know," said the dean drolly, "and we're all very suspicious about
that!"

After I was far enough into my training to actually begin treating
people—in the late part of my first year of classes—I saw patients for
several years while under close supervision. I found the work
challenging yet rewarding. It is hard to understand analysis fully
without the experience of being on the "other side of the couch." I do
not intend to continue with clinical work, since analysts are supposed
to be "anonymous" to their patients and this book will complicate that.

The longer I was working with everyone at the Institute, the more
I came to believe that it was important (to all of us) that I tell them
about my illness; I eventually went to Jean, the head of the Institute's
"progression committee" (which monitors your progress and allows
you to pass from grade to grade and case to case) and started to give
her the details.

"Wait, wait," she said, and my heart sank for a split second.
I'm
out, I'm out.
But that wasn't it at all. "Do you mind if I take notes?" she
asked. "Because this is surprising!" She became my advisor that day,
and both she and the committee have remained supportive and
positive about my work. Although my clinical work may have to stay in
abeyance for now, I've already made significant progress on my Ph.D.
dissertation—the subject is "informed consent to psychoanalysis."
LAPSI recently merged with the Southern California Psychoanalytic
Institute, and we're now called the New Center for Psychoanalysis.

Kaplan, of course, followed my progress very closely; obviously, it
provided much grist for our psychoanalytic mill. Psychoanalytic
candidates usually have plenty of beefs with their institutes, he told
me, "but you seem like a happy camper there."

"That's exactly what I am," I said. "A very happy camper."

It's worth noting that Steve and I did far more than talk about my
crises in our frequent phone calls; we often worked, and very hard.
He'd been an adept, creative, and endlessly patient coach on my
restraints article, and also collaborated with me on
Jekyll on Trial:
Multiple Personality Disorder and Criminal Law
, published by New
York University Press in 1997 to positive reviews.

From Michigan, Steve had moved on to Harvard, where he took a
position as chief psychologist at the day hospital unit of the
Massachusetts Mental Health Center, working with patients much like
those who'd lived at the halfway house in New Haven. Increasingly,
his primary interest had turned to ethics, and he was named a faculty
fellow at Harvard's Center for Ethics and the Professions. He also took
a position at Harvard Medical School, in the Division of Medical
Ethics, and would eventually become the Director of Ethics at the
American Psychological Association, in Washington, D.C. In spite of
being on different coasts, our friendship had only grown stronger. We
talked often, wrote papers together, saw each other at professional
meetings or whenever I traveled east to visit my family.

It is interesting that (and in spite of his collaboration) Steve
disagreed with the key tenet of my MPD book—that someone with
multiple personality disorder whose alter commits a crime should be
found not guilty by reason of insanity because innocent alter
personalities should not be punished. ("Better to let ten guilty people
go free...") Steve believed that the "total person" should not be
absolved of responsibility. He asked if I minded if he wrote an article
in which he'd essentially debate my argument. Laughing, I said, "Go
ahead!" Once his paper was published, we appeared on
Dateline NBC
together to argue our opposing legal positions.

Steve's friendship, support, and intellectual companionship have
taken me on some interesting journeys over the years, but this was a
first. It was high-intensity, somewhat stressful, and on some level a
little surreal. They interviewed us for four or five hours, but ultimately
used about three minutes.
Crossfire
it wasn't. We were credibly
professional, reasonably lucid, and didn't exchange personal barbs,
although at a couple of points, Steve did say, "There you go again." I
guess I could have commented on his need for a haircut, but then he
might have teased me for buying a new blue suit for the occasion. It's a
tricky business, debating an old friend who knows you as well as Steve
knows me—and in fact, it belatedly occurs to me now that Steve was
entirely capable of arguing
both
sides of the question, and I could have
comfortably stayed home with Will.

Like every medication, Navane (which I'd been taking for a dozen
years) has side effects. Some are dangerous, such as neuroleptic
malignant syndrome, a potentially lethal condition in which the
medication literally becomes toxic to your system; others are
extremely unsightly and uncomfortable, such as TD. And then there's
the sedative effect, the grogginess, which I combated with ample vats
of black coffee.

In women, one common side effect of Navane is an elevated level

of prolactin, the hormone that induces milk production for newborns.
Thirteen is a normal prolactin level. Most women on antipsychotic
medication go up to 30 or 40. I was consistently running 130 to 140.
There's reason to believe (although the research is not without
controversy) that breast cancer is associated with an elevated level of
prolactin. My gynecologist agreed that elevated prolactin was a risk
factor for me, at which point I told Kaplan I wanted to consider other
medications.

He suggested Zyprexa, one of a new class of antipsychotic
medications that showed great promise and had come on the market
only recently. Despite the good things I'd heard, I was wary of new
drugs and would have liked to wait awhile, to see whether Zyprexa and
its cousins would continue to be safe and effective. But a prolactin
level of 130-140 convinced me that now was the time to make the
change, and I began to take Zyprexa in place of Navane.

The change was fast and dramatic. First, the side effects were
much less than with Navane. Instead of being groggy or feeling tired, I
felt alert and rested, energetic in a way I hadn't felt in a long time—so
long, in fact, that I'd almost forgotten what those good feelings were
like. On the other hand, I quickly gained a lot of weight—thirty
pounds. However, in recent years I'd been quite thin, so aside from
the dismay I felt at suddenly tight waistbands, I just decided I'd have
to find a way to exercise more and get that number down a little.

The clinical result was, not to overstate it, like daylight dawning
after a long night—I could see the world in a way I'd never seen it
before. While Navane had helped keep my psychosis "tamed," I'd
always had to remain vigilant. The psychotic thoughts were always
present, and I often experienced "breakthrough symptoms"—fleeting
psychotic thoughts—many times each day. With Zyprexa, though, I
shut that door and, for the first time in years, it stayed shut. I could
take a break, go off duty, relax a little. I couldn't deceive myself—the
illness was still there—but it wasn't pushing me around as much as it
once did. Finally, I could focus on the task at hand, unencumbered by
the threat of lurking demons.

The most profound effect of the new drug was to convince me,
once and for all, that I actually had a real illness. For twenty years, I'd
struggled with that acceptance, coming right up to it on some days,
backing away from it on most others. The clarity that Zyprexa gave me
knocked down my last remaining argument.

In spite of my intelligence and education, in spite of all the doctors
and the psychotic breaks and the hospitalizations and the lessons so
searingly learned, I'd nevertheless managed to hold on to the belief
that basically, there was nothing unusual about my thoughts.
Everyone's mind contained the chaos that mine did, it's just that
others were all much better at managing it than I was. All people
believed there were malevolent forces controlling them, putting
thoughts into their heads, taking thoughts out, and using their brains
to kill whole populations—it's just that other people didn't
say
so. My
problem, I thought, had less to do with my mind than it had to do with
my lack of social graces. I wasn't mentally ill. I was socially maladroit.

Of course, that wasn't true. Most other people did not have
thoughts like mine. They weren't more disciplined about hushing their
demons, they simply didn't have any (or at least none that might lead
to a diagnosis of psychosis). Thanks to the new chemicals coursing
through my body, I experienced long periods of time in which I lived
as other people did—with no psychotic thinking at all. The Zyprexa
did that.

There's no way to overstate what a thunderclap this revelation was
to me. And with it, my final and most profound resistance to the idea I
was mentally ill began to give way. Ironically, the more I accepted I
had a mental illness, the less the illness defined me—at which point
the riptide set me free.

Happily, I'd discovered that writing on subjects I knew well and that
genuinely interested me—mental illness in various legal
contexts—interested other people, too, including publishers and
journal editors.
Refusing Care: Forced Treatment and the Rights of
the Mentally III
was published in 2002 by the University of Chicago
Press. The topics were ones close to my heart: civil commitment, right
to refuse medication, restraints and seclusion. The book was well
received, getting a good review in the
Times Literary Supplement
and
an especially good one in the
New England Journal of Medicine.

While I still found teaching stressful, I was well liked by students
and had become particularly close to some, especially those who did
research for me. While not "out" about my illness to my classes, the
students knew I had a special empathy for the mentally ill. Not
surprisingly, some students taking mental health law have personal
issues of their own; one young woman brought me a note in the
middle of class one day which read, "I'm suicidal," and I quickly got
her to the student counseling sendee. Another student, an
undergraduate, revealed to me that she had been incorrectly
diagnosed, heavily medicated (with narcotics, not just the usual
psychiatric medications), and hospitalized, at which point her
therapist had seduced her. She believed that she'd been somehow
programmed to commit suicide by a certain date. Being in my class,
and being able to talk to me about her terrible experiences, she felt,
had kept her from that.

I was able to refer her to another, ethical therapist who'd had a
great deal of experience working with patients with her sorts of issues.
The student instituted a case for disciplinary action against her earlier
therapist. These days, I talk to her from time to time, and watch her
progress with great pride. She has recently passed the bar exam. In
her refusal to be dismissed or defeated, I can see a little of
myself—and I like that.

chapter twenty-three

I WAS NEARLY
forty years old, and for the very first time in my life,
I was in love.

Even looking at that sentence now gives me a feeling of such
astonishment and joy. I knew I cared for Will; I knew he cared for me.
But it wasn't until we had a huge fight and made up afterward that I
actually said the words. "You're the first person I've ever been in love
with," I told him.