MADMAN - John R. Suler, Ph.D. - copyright 1995
Chapter 1 - Up
I shifted the old Nova into second gear, splashed it through a muddy puddle, and started up the hill. Weary from many years of loyal service, and abuse, the rusty hand-me down gasped for more fuel to grapple with the climb. My prayers that it would not stall - a recent symptom of its senile rebellion - would be answered today. The road curved gracefully around the hill as might any scenic route through the mountains, but this path bore a more serious and practical intent: To guide the faithful to the Medical Center at the top. Midway up I caught a glimpse of the distant city through a brief clearing in the late autumn trees. Snuggled into the valley that stretched to the edge of the horizon, the city glowed unnaturally in the oblique rays of the early morning sun, singled out from the wooded landscape by a stream of light descending through a small, temporary break in the overcast sky. Despite the scenic beauty, that familiar tiny depression seeped into the back of my head - an almost imperceptible affect nagging for attention. I searched for its source and settled on an explanation: the long day ahead of me.
Internship. Doesn't "intern" mean "to imprison?" We're expected to work our butts off, all in the name of Training. It seemed more like a grueling rite of passage than anything else - the establishment's last chance to test the limits of the student's psyche before welcoming him to the club. I thought of Dr. Hapling, my psychopathology professor at graduate school, with his tenured feet perched atop his desk and a smile of retrospective content spread across his face. He offered his rationale, "I went through it too; we all did."
Do unto others as was done unto you.
Even graduate school was easier than this internship, and those four years at the university were no picnic. Blockbuster courses that terrorized and infantilized us; comprehensive exams that roused suicidal panic; slave labor as research assistants to tenure-hungry faculty; and, of course, the interminable dissertation, the final hurdle, the last of the Herculean tests of one's determination to overcome all the eccentricities of the academic system and its faculty. Not to mention the frustrations of dealing with professors who had complete power over the student's destiny, who with a casual comment in faculty meetings could inflate or pop a student's reputation. Then, of course, there were the nightmarish stories of the doltish professors who purposefully undermined students who were smarter than they were, or the narcissistic, fame-crazed superstars who sucked students dry and then tossed them aside, or the sleeze-buckets who subtly hinted that you had to sleep with them to graduate. The real horror show occurred when you put several of them together on your dissertation committee. Meetings became a game of "can you top this" where the most important objective was not the candidate's work - and the need to graduate - but rather proving who was smarter than whom. Select the wrong mixture of professors for your committee and the group dynamics grind you to bits.
Graduate school was a real education.
I looked at myself in the rearview mirror. "Oh, aren't we the cheerful spirit today, Tom? Are we the runner-up for the Norman Vincent Peale Award?"
After all, there WAS a positive side to graduate school. Some of the professors actually were Teachers in the truest sense; they cared about your intellectual and professional development. And we students did secretly find satisfaction in the bohemian student lifestyle of impromptu partying and discussing psychology over bottomless cups of coffee at the all-night diner. Despite all the work, there was some freedom to be unconventional and slightly irresponsible - wearing thread-bare jeans to every social event, using a fruit crate as a coffee table, catching a matinee movie. We guys could let our hair and beards grow without anyone blinking an eye. Come to think of it, almost everyone grew a beard at one time or another. It was an unconscious homage to Freud, maybe even an unconscious requirement to receive your Ph.D.
Of course, there were positive aspects to this internship too - new people and new ideas, the excitement of working in the Real World of Medicine, a steady supply of tongue depressors.
I love my work, I hate my work. There it is - that Old Ambivalence, the never ending toss-up between contradictory feelings, the weighing of the positives and the negatives, the to-be-or-not-to-be's that trouble us all. Life could be so much more enjoyable, so much more simple, without the crippling "but." Exceptions and qualifications. Are animals so indecisive? Is a frog ever conflicted about diving into a pond? Do geese draw up a mental list comparing the pro's and con's of flying south for the winter? Only humans seem to be tormented by the powers of reason and self-awareness that knot our will, that make us waver between this and that. There is no escaping ambivalence. Freud said that opposites lie close to each other in the unconscious: love and hate, pleasure and pain, desire and fear. The more healthy of us are aware of our contradictory feelings, can accept and verbalize our conflicts. We try to smooth over the internal brawl and heave our will in the chosen direction. Often, we're only partially successful. The only solution may be to force the conflict out of our mind, leaving conscious the tolerable half, burying the other. But buried ideas and feelings don't lie dormant. They creep and crawl in darkness, they go bump in the night. They seek out the cracks in our armor and make our lives miserable in disguised ways. For some poor souls, the conflict tears open the psychological gut - and out spills madness.
Why are we humans so afflicted and unhappy? It's sort of pathetic. What did we do wrong to deserve this? Is it the accumulation of bad karma? Is it payback for having picked the sacred apple, or for knocking off the Neanderthals?
The Nova started to gasp and shudder as the incline became more steep. It needed more power. I realized I was going uphill in fourth gear. Duh! As I tried to downshift, and momentarily took my eyes off the road, something suddenly swept passed the front of the car. I slammed on the brakes while swerving towards the inside of the hill. Did I hit it? Was that a thud? The car stopped short and I banged my head on the steering wheel. I looked around, but didn't see anything. My hands shaking, I reached for the door handle and quickly got out of the car. There was nothing there - uphill or downhill. A bluebird sitting on a nearby tree branch stared at me curiously, "What's the problem, human?"
Dare I look under the car? Scared about what I might find, I got down onto my hands and knees and peered below.... Nothing. Rubbing my bumped and now puzzled noodle, I stood back up. I could have sworn I saw something in the road, and would have pondered this mystery a bit longer, if not for the fact that something was pulling steadily at the back of my pants. I turned around, half expecting to catch some practical joking person or animal in the midst of giving me a wedgie - but I was greeted by something a bit more alarming. My belt loop was caught in the door handle of the Nova which had now begun to roll backwards down the hill. As the car began to pick up speed, with me being half dragged and half running backwards alongside it, the insight suddenly struck me that this could be a serious situation. What if the car rolled right off the side of the hill, yanking me with it down onto the rocky terrain below? The bluebird, still staring at me from its perch, quizzically cocked its head.
You would think I would have panicked and screamed like a lunatic, or been catapulted into one of those superhuman adrenaline highs in which I could have lifted the car right off it's wheels. But I just laughed. It's called dissociation, old boy. "This is ridiculous," I said to the bird while trying to control my backwards stumbling prance. "I'm going to be wedgied to death."
Suddenly, the car came to an abrupt halt, sending me into a reverse somersault onto the grassy shoulder. Green and cloudy blue chased each other round and round for a moment or two, until I finally tumbled to rest into a seated position at the rear bumper of the car. The Nova was only a few feet from the edge of the hill, and from my precipitous fate, but there was nothing else there - no tree or rock or guard rail that could have stopped the car's rolling. "What the hell...?" I stood up and looked around. Just me and the car standing there in the middle of a patch of grass alongside the road. "I guess there really must be a God," I said jokingly to the bird - but my little cohort was gone.
When I got back into the car I just sat there for a minute. Did that really happen? After taking a quick inventory of my body, I realized I was uninjured and unmarred - not even a grass stain on my clothes. But on second examination, I did discover one sequela. The belt loop on the back of my pants was torn. "Well, we're off to a good start today, aren't we?" I said as I gave the broken loop a quick tug, put the car into gear, and started back up the hill.
Finally, despite fate's warning to the contrary, I reached the top. Slowing down at the gate, I noticed Jon sitting in his booth, his nose pressed into a paperback book, probably some sci-fi novel like "The Attack of the Cabbage People." He consumed these stories like the rest of us drink water. Technically, he might be labeled as a schizotypal personality - eccentric, superstitious, preoccupied with peculiar topics, interpersonally odd. In plain English - a Space Cadet. Tall, thin, with stooped shoulders and a slightly too large head, he perfectly fit Sheldon's body type of the "ectomorph." The Hospital Rules of Convention, as he called them, forced him to wear a uniform - white shirt and dark pants - but with those pink hightop sneakers and a green paisley tie pulled to a mutated 45 degree angle from his midline, you knew from a mile away that it was Jon.
He was totally oblivious to my car idling no more than four feet away, so I tapped the horn. He nearly fell off his stool. Some security guard.
"My word! A rude awakening! How are you faring this fine day, Dr. Holden?"
If you didn't know Jon, you would swear that he was being cynical, or mocking you with such formal expressions - which would be consistent with his history as a left-over Berkeley philosophy student, 1960's radical, and perpetual intellectual prankster (he once stole the department chairman's favorite book - Aristotle's Metaphysics - replaced the entire text with blank pages, and returned it to the professor's shelf).
But he was sincere, even when he was joking.
"Well, actually, coming up the hill I almost hit a ghost... and a miracle saved me from being dragged over a cliff by my car."
"Hmm... I'd say that kismet is on your side." He seemed only mildly surprised, as if these sorts of things happened in his world all the time. "Which reminds me..." He paused and cautiously looked from left to right, as if someone might overhear our conversation out here in the middle of the road! Tilting precariously on his stool, he leaned towards my window until his back curved into the shape of a question mark. His eyelids drooped slightly, covering half his pupils, giving him that quasi-conscious, burnt-out look so typical of those sensation-seekers who dropped a few too many hits of acid during their college days.
"Officially, it is quite impossible to get a staff sticker for the A lot up here at the top of the hill. But I have some underground connections. I might be able to get you a visiting clinician sticker. As long as you don't park up here every day, they probably won't notice."
"That'd be great, Jon. But if you're gonna get into trouble doing it, please, don't take the risk."
For a moment his eyes opened wide. "Risk? I am thoroughly enamored of risks, especially when it involves stratagems to thwart administration. It's my most preferred avocation."
"Just be careful, Jon. Someday they're going to catch you and they'll force you to reveal all your escapades - and all your secrets."
His body straightened up to military attention."Not even if they locked me into a room and forced me to listen to Don Ho!"
"O.K. Just trying to look out for you. After all, if you were fired from this job, when would you find time to read?"
Jon laughed. He leaned towards me again and spoke in a whisper, "If I lost this position, I might have to become a psychologist, read their science fiction, and trick my patients instead."
I never could outwit him. He was the master of passive-aggressive joking and oneupmanship. It was his sense of humor, as well as his offbeat mind, that I enjoyed most about him.
"Very funny, Jon. See you later."
"Before you go, Dr. Holden, I have a riddle for you. What happens when you mix a dyslexic, an agnostic, and an insomniac?
I reflected on this for a moment, but nothing came up, except a brief thought of what it would be like flying through the air while shackled to my car. "I give up."
"You get someone who stays up all night worrying, 'Is there a DOG?'"
I laughed. "Your mind is not normal, Jon."
"Thank you," he replied, pleased with himself.
As I drove away he called out to me, "Dr. Holden, bid my fond greetings to Barb!"
"Will do," I shouted back.
I parked near a black Jaguar, which probably belonged to some surgeon, in hopes that it would catch the security patrolman's eye and divert his attention from my decrepit Nova. A very long shot, but I was willing to try anything. I couldn't afford any more tickets. Parking in P-lot at the bottom of the hill and taking the shuttle bus up - the only alternative - was extremely inconvenient. Even chief residents were forced to ride the shuttle from P, or "Peon" lot as we affectionately called it. Being allocated a sticker to the upper lots required payment with your testicles or your first born child. Only one other privilege was considered more precious by the hospital staff, a privilege for which some would lie, cheat, and steal: an office with a window.
I leaned forward, reached behind me, and felt the broken belt loop. My heart started racing. Ah, ha! There's the anxiety, set to delayed response! I can't afford that right now. Can't dwell on it. Got to get going. Three deep breathes - and onward.
As I walked towards the medical center I forced my mind to focus on its architecture. Constructed of steel and mirror-glass that distorted the nearby trees, its two front surfaces swept away from the main entrance in graceful curves suggesting a large circular structure. Yet the impression of size and circularity was deceptive, for just beyond the edges of the building, out of view from the front entrance, the walls turned sharply inward and ended abruptly. An illusion of grandeur. No doubt this location also was chosen to magnify the building's import. Perched on top of a hill amidst rural surroundings, it seemed to herald the power of medical knowledge rising above the untamed wilderness. If only they could keep the mindless geese from shitting on the sidewalks, it would all be so perfect.
I leaned against the rails of the escalator that sympathetically carried me up to the third floor. At the end of the hall stood the gray metal doors with wire-mesh windows that marked the entrance to the inpatient unit. In such a modern and esthetically designed building these institutional looking doors were an anomaly. Why not wood, or even a pleasing coat of paint on the metal? The patients were rarely violent, so there was no need for wire mesh to guard against projectiles. The doors, in fact, were never locked. Nevertheless, this ominous entrance stirred the almost palpable sensation that something dangerous lurked just beyond: The nightmare of insanity, the bedlam of the present-day possessed, the horror of souls gone awry. I suddenly remembered my old high school friends and our favorite joke as we drove by the antiquated mental institution near our hometown. It was a huge gothic building with smoke bellowing from tall brick stacks. "How many do you think they're burning today?" I laughed off my medieval thoughts, but as I approached the entrance to the unit, I noticed again the slight tension in my throat and accelerated heart-rate that betrayed anxiety. Summoning up a half-hearted confidence I pushed through the double-doors and strode onto the unit.