Cracked: Putting Broken Lives Together Again - Drew Pinsky, Todd Gold (2004)
WHEN I GET off the airplane I feel half dead, and wonder how I’m going to get up for work the next day. But come sunrise I’m back in the routine, starting out the morning at my private practice. I have one message from a woman asking if she can substitute generic hypertension pills for those I originally prescribed, and another saying that Beverly Norton called, wanting me to know that her husband, Richard, had a pretty good day yesterday. The last message is from Tina Markow, an eighty-one-year-old woman recovering from shingles but suffering from the depression that commonly follows. She wants me to call.
I dial the number and get her daughter. All of a sudden it’s good-bye jet lag, hello everyone else’s problems. After reminding me that she’s an occupational therapist, the daughter complains that her mother doesn’t have any energy. Listening to her dire description of her mother’s various problems, I get a good idea of what is really going on. I ask a number of questions just to make sure.
By the end of the session, I’m pretty confident about what’s really happening here: The daughter is having a difficult time dealing with her mother’s failing health. No surprise: It is hard, mentally, physically, and emotionally, to watch your parents in decline. The demands are enormous. The responsibility is huge. And when the relationship between parent and child is close, as I gather theirs is, things only get more difficult.
I try to help her understand the real reasons for her mother’s lack of energy: She’s past eighty, has congestive heart failure, and was nearly done in by a painful, debilitating bout of shingles. She’s recovered nicely. But she’s old and frail, and she will never be the same. That’s reality.
Absorbing that kind of reality is something many find hard to do. As a culture, we’re woefully disconnected from the biological reality of our lives. We are born, and then, at some point we can’t predict, we die. Like Dr. Finley always reminds me, “There’s never a perfect time to be born, to die, or to have a child.” We are biological organisms that operate for a finite amount of time. Those are the facts of the human condition, and we don’t have any control over them. The one thing we can do is exert some control over what we do with our lives between birth and death.
That’s the enormous lesson I try to communicate to patients. A person who’s addicted to drugs or alcohol needs to know that all is not lost. They aren’t helpless, but they are powerless over their disease.
I’m called to Linsey’s room soon after I arrive at the unit.
Alexi is already in her room, hovering nearby. Linsey is curled up in a fetal position on the bed, her knees pulled tightly to her chest, her torso twisted; she claws at the sheets so feverishly I’m surprised they aren’t ripped into shreds. Alexi and I get on either side of the bed and try to get her attention, but Linsey is out of control, and she doesn’t respond to our efforts. She’s facedown, crying into the pillow. I shake her, trying to snap her out of the dissociative state she seems to be in.
She turns over.
“Breathe!” I tell her.
I see panic in her eyes.
“I—I—I don’t know what’s happening to me,” she gasps between sobs.
Linsey appears to be depersonalizing, a strange scary feeling where people feel as though they have ceased to exist. They sometimes describe feeling as though the world is unreal, or as if they’re watching it on a movie screen. Dr. Finley arrives, surveys the situation, and confirms my impression. Leaving Linsey in Alexi’s capable hands, we step into the hall, where he shares a little additional information about her from an interview he did the other day, as well as notes from the counselors that led her groups.
“She has a borderline history, with a lot of trauma and PTSD, either one of which is like a ticking time bomb when a patient is going through detox,” he says.
“Of course,” I say. The biological effects of withdrawal tend to amplify this sort of patient’s tendency to shift rapidly between intense emotional states. What’s happened is that Linsey has frozen in the midst of overwhelming feelings. That is typical. Sometimes that involves dissociation, a biological response that’s an evolutionary remnant of the risky strategy of feigning death. That sounds like Linsey.
We go back into her room, where Alexi is trying to soothe the patient, without much success.
“I want to wake up,” Linsey cries. “Why can’t I wake up?”
Occasionally patients are bad enough that we might transfer them to the hospital’s acute psychiatric wing, but we can handle Linsey’s condition on our unit. She’s not dangerous to herself or others. What she requires is patience and special handling, which Alexi does with textbook calm.
“You’re in a safe place,” Alexi says, rubbing Linsey’s back.
Finley and I debate whether to give her any medication. He says no; he’s concerned that she needs to learn how to handle her anxiety. I wonder if she might be too overwhelmed to handle anything right now. I suggest giving her medication to suppress the symptoms contributed by withdrawal. “None of the pharmacotherapy I suggest is meant to gratify,” I emphasize.
Linsey eventually goes to sleep. Later, she can’t remember anything specific about the episode, though she does complain of feeling spaced out and scared.
“I feel so small,” she says in a soft, weepy voice. “I don’t know if I can stand any more of this.”
“Come to the staff when you feel like that. You’ve got to trust us. Let them in. Learn to connect with them.”
I don’t know how much she can comprehend. Not a lot, I’m sure. Nonetheless, I explain that her fragile internal self had been overcome by runaway biology and stress. She’s curious about why it happened. I can’t say. But I notice a copy of Hemingway’s For Whom the Bell Tolls on her nightstand, and that may be a clue: provocative, emotional material, of the kind found in a good, challenging novel, can precipitate such episodes.
“You might have felt as if you passed through a dream,” I say.
“A nightmare is more like it,” she says. “I felt myself slipping away into…into like what I said before, nothingness.”
Her description is a good one. It makes sense. Growing up, she never received the emotional nourishment needed to build a competent self. To her, “normal” meant feeling helpless, empty, and powerless. On even her best days, she wasn’t present in her own life. At her worst, as she had just experienced, she ceased to exist. She was dead, but conscious of it. How frightening is that?
“Scary stuff,” I say.
“I want my mom,” she sniffles.
“But earlier you told me you didn’t want her involved in your treatment. You said she makes things worse.”
“I never really even had her,” says Linsey.
I encourage her to stay with that realization. If I’m correct, Linsey feels terribly alone, even as she’s aching for a relationship she never had. She wants connections, and she will have to work at developing them. We are going to help her. Though weak and confused, she nods at my explanation. I can’t tell what she means, if she even understands. She probably doesn’t. But at least it’s a start.