MADMAN - John R. Suler, Ph.D. - copyright 1995
Chapter 24 - More Tests
Shout your name.
My finger hurts. I should go to the emergency room.
Shout your name.
My knock sounded tentative, sapless.
There was no answer - but I could see a light under the door. I knocked again, this time with more persistence. A chair squeaked, feet scuffled - then silence again.
"Who's there?" a voice crackled.
"Uh, excuse me for bothering you, Dr. Williams," I said to the door. "My name is Thomas Holden. I'm a psychology intern on the psychiatric inpatient unit. I'd like to talk to you about something, if you have a few minutes."
"I don't do lectures anymore."
"That's not what I wanted to ask you. It's about one of my patients. I'd like your advice."
"I don't do supervision anymore either."
"I'd really appreciate your help. I'm sort of, uh, desperate."
The door opened a notch, just wide enough so he could peer out the crack. He looked me up and down. "You look terrible," he said.
"I know." I waited, hoping he would let me in, but he still seemed wary of me.
"I doubt that I can be of any help to you," he said.
"I really would appreciate any thoughts you might have on the case. I'm feeling very... alone on this one, Dr. Williams."
For a moment, the suspicion melted from his face. "Very well," he answered, "but I can't guarantee anything."
As I entered his office, I felt nervous and awkward. So did he. I was an intruder into his space, a possibly untrustworthy interloper who had managed to invade his sanctuary. Neither of us knew what to expect. Once he sat down behind his desk, he relaxed a bit. The tall, chaotic piles of books and papers formed a safe bulwark around him. I had no such advantage. Among the countless stacks of journals, books, and papers scattered across his otherwise empty office, I felt lost, anomalous. There also was no chair for me to sit in.
"So what do you want from me," he said as he bit on his already bitten-down nails.
"Well, this patient of mine - he doesn't know who he is. He can't remember his name or his past or anything about himself. It seems like total amnesia, even though many of his mental functions are intact and there aren't any other obvious symptoms. He just doesn't fit the typical dissociative diagnoses. It's like his identity has been wiped clean away. Either that - or he's just faking, even though there doesn't seem to be any reason why he should be malingering. So, how can I tell whether he is or isn't?"
"Whether he's faking or not doesn't matter. In either case there is a secret, a secret he keeps from others, or from himself, or both. It's the secret that is the kernel of his identity, that forms his self boundary. It's the secret that marks the distinction between inside and outside, knower and unknown. This patient is all patients distilled down to the one essential common denominator."
"Uh, I'm not sure that I understand."
"Tell me this," he continued, now with more confidence, "why is it so important for you to know who he is?"
"I have to know who he is in order to treat him, don't I? Or, I mean, the goal of the treatment is to know who he is."
"Why - why is it important to know that, or anything else for that matter?"
His remark surprised me. Was he going to play games too? I was hoping that Lloyd Williams, of all people, would understand, but now I was beginning to think I had make a mistake. "I still don't know what you mean," I said as politely as I could.
He picked up a book from his desk. "What is this?" he asked.
"A book."
"But is that what it really is? Is it simply a book?"
I looked at its title. "Well, it's a book on epistemology."
"But is that all that it is?"
"I don't understand."
"Is that really what this thing is trying to tell you that it is?"
"I don't get it. It isn't trying to tell me anything."
"Exactly. It isn't trying to tell you that it's a book. YOU are trying to tell it that its a book, or I am."
He seemed pleased with himself. I, on the other hand, was not pleased at all. "I don't understand - I'm lost," I replied with obvious irritation. But he seemed completely unaffected by my tone of voice.
"I know, that's the problem."
"You don't seem to understand what I'm trying to say," I said.
"I understand that you really need to understand, but you don't understand that there is nothing that you can understand - and all my understanding won't help."
My irritation bubbled up into outright anger. "Will you please stop talking in riddles! I came here for help and all you're doing is playing games with words. I need help with this patient!"
"There is nothing I can say or do that will help you. I'm sorry."
"You've got to help me. I'm at my wits end. I'm trapped. I can't move ahead and I can't run away - it's like I damned if I do and damned if I don't!"
Sadness settled onto his face. "I know," he answered solemnly, "Believe me, I really do... But I'm sorry. There's nothing I can do."
The sound of the door closing behind me echoed down the dead-ended hallway. I felt stunned. There's nothing he can do? All his goddamn papers and books and awards and there's nothing he can tell me about Doe! He should have been given the Nobel Prize for Ineptitude.
That book in his hand.
Why is it so important for me to know?
Shout my name.
I knock.
No answer.
Shout my name.
I knock again.
Still no answer. Henry isn't in.
My finger was still throbbing. My head and throat ached. My congested sinuses ached. I fumbled through my knapsack for some Tylenol, and while I was in there I grabbed some more decongestants. There was a water fountain down the next hallway, but I didn't bother to walk the extra distance. I just swallowed the pills dry - all of them in one gulp. They stuck in my throat. I couldn't breathe, I was choking. I coughed them up into my mouth, wiped the tears from my eyes, and swallowed them again. This time, thanks to the extra saliva, they went down.
Why is it so important for me to know?
I knock.
No answer.
I knock again.
No answer. Marion isn't in either. No one is in.
"I'm still here," My Biographer said.
"A lot of good you do me. You types always wait until we're dead to say anything helpful."
"Well, who is left besides me? You have no alternatives."
"There are always alternatives."
"Sssssssure," interjected the elevator doors.
My dog Rags, he loves to play.
Why is it so important?
The guy behind the desk wore glasses as thick as the textbook he was reading. He didn't hear me walk in. I shot the words at his ear. "Is this radiology?" He nearly jumped out of his seat.
"Yes - that's what the sign says on the door, doesn't it?"
We both turned to look. There was no sign on the door, just a rectangular patch of clean paint where a sign used to be. "Uh, oh yeah, I forgot," he said, "we're getting a new one. Is there something I can help you with?"
"Yeah, can you tell me where the woman is who works here?"
"What woman?"
"The one who works here, in radiology."
"There is no woman who works here."
"Yes there is," I answered with persistence, "I saw her in the cafeteria. I have her exposure plate right here." I tossed my knapsack onto his desk and began rummaging through it - but I couldn't find the plate. "Damn!" I blurted.
"Uh oh!" My Biographer said, "Don't lose your head now too."
"Believe me, sir, there's no woman here."
"I know there is! There's got to be!"
"Listen, maybe I should call security and they can help you."
"Never mind! Just forget it," I muttered, and stumbled out of the room.
"Maybe you should have gotten your finger x-rayed while you were there."
"Please, shut up!"
I kick the wall - and stubbed my toe.
"Two digits down, eight to go."
"Dr. Holden!"
Now who's calling me? I looked up from the cracks in the floor tiles. It was Dr. Stein coming straight at me. I pretended not to hear. I willed him to disappear - but he didn't.
"Dr. Holden," he says as he passes by, "you made some good points during grand rounds today. Keep up the good work."
That didn't just happen. Ignore it.
Shout your name.
There's nothing he can do to help. I'll just have to do it myself. Is everyone on the unit looking at me, or is it just my imagination?
"Carol, I want to take Doe off the unit for a while."
Her eyes nearly pop out her head. "You can't take a patient in Isolation off the unit!"
"I'm taking him off the unit, just for a half hour or so. It'll be good for him."
"We have to speak to Fred about this."
"I did. I'll be with Doe the whole time. I'll take full responsibility."
"You spoke to Fred?"
"We'll be back in half an hour."
"But -"
"We'll be back in half an hour."
One isolation room closed, lights on - one room open, lights off. I should have done this a long time ago.
"How would you like to go for a little walk," I said to Doe. He was still sitting cross-legged against the wall, right where I left him.
"If that's what you want," he replied. He's not surprised. Nothing surprises him. Together we strolled off the unit and down the hallway. Almost like a couple. He seemed to know where I was taking him. He made some of the turns before I did. Who is leading whom?
"Psychophysiological laboratory," Doe read off the door plate. "Now that's a mouthful!"
"Yes, Descartes would have been proud," I replied as I unlocked the door. "Come on in. Are you in the mood for a few tests?"
Doe calmly passed his eyes over the multi-thousand dollar array of computers and polygraphs. "You mean, am I in the mood for a duel?"
"Well, let's not think of it that way. Come on into this chamber. You know, once the door is closed, it's completely soundproof in here. A very nice place to relax. You can sit down in that chair over there. I'm just going to run a few tests on you," I said as I started to paste up the electrodes, "you know, get some data on heartbeat, respiration, blood pressure - stuff like that."
When I looked up, I saw Doe playing with the video camera. He had slipped it off the mounting on the chamber wall and was staring intently right into the lens. "Hello in there," he said, "Is that you?"
"What are you doing?" I asked.
"Running my own tests, but there's a better one... Come with me." He carried the camera out of the chamber, snaking the long cord behind him, and pointed the camera into the video monitor seated next to a polygraph. The image on the TV monitor was striking. An infinite regression of TV screens, like a series of picture frames one inside the other, spiraled off into a bright white light that glowed eerily in the distance.
"Visions within visions within visions," Doe said, "Now THIS is what you should be testing."
"Please, come back into the chamber. This won't take long." I steered him inside and sat him down onto the reclining chair. After repositioning the video camera on its mount, I attached all of the electrodes to him - EEG, EKG, GSR, arm and forehead EMG - as well as the automatic blood pressure and respiration cuffs. It's not often that you use all the psychophysiology measures at the same time, but I didn't want to leave any stone unturned. I stepped back to marvel at my masterpiece. With electrodes and wires radiating out from his head, arms, hands, and legs - he looked like the Bionic Patient - a modern age Frankenstein's monster.
"Mourning becomes electric," Doe said, unruffled.
"None of this is going to hurt," I said. "These wires will just be measuring some basic physiological processes - like heart rate, brain waves, and muscle tension. All you have to do is sit here and relax for a while, and in few minutes I'll give you some instructions over the intercom."
I didn't tell him that I intended to use the psychophysiological measures as an objective, quantifiable means of probing his thoughts and emotions - that I intended to bring to bear all the tools of modern technology to enter his internal subjective world.
"Remember," Doe said as I closed the chamber door, "there is nothing on the inside and, likewise, nothing on the outside that you can grasp."
"Ssssssure," I whispered to myself, and locked the door.
I turned on the polygraph, calibrated it, and powered up the computer interface. There's an odd sense of security in pushing buttons, pulling levers, and turning dials. It all seems so definite.
"All you have to do for the next few minutes is sit back and relax so I can get a baseline," I said into the intercom. On the video monitor, Doe appeared calm, even peaceful. Some people panic in there.
No activity registered on the polygraph or the computer screen. Just flat lines. Did I forget to turn something on? I checked the equipment - everything was as it should be. What the hell? Is something broken? I banged my fist on the top of the computer.
Nothing. Damn!
"Are you O.K. in there," I said into the intercom. "Are you asleep?"
"Perhaps you are?" Doe's voice replied through the speaker.
"How do you feel?"
"Usually with my hands, but often with all my skin."
"Listen, I'm not getting any recordings out here - did something come unplugged in there?"
I looked at the video monitor. Staring quietly up at the ceiling, Doe had settled back into a reclining position. Suddenly, all the polygraph needles sprang to life and the computer screen spat out its series of digital values. Funny. Must have been a loose connection.
"O.K. I've got it," I said. "What I'm going to do now is play a series of tones over the loudspeaker in there. You don't have to do anything. Just sit there and listen to them."
I started up the tone generator and watched his physiological responses. In response to each tone, his galvanic skin response jumped and his heart rate decelerated then accelerated - the typical orienting reactions to a new, moderately loud sound. At least I knew his nervous system acted like that of normal people. Over time, his responses would diminish in volume as he became used to the tones. "Habituation," I mumbled to myself. "Habituation."
But he didn't. Tone after tone, he showed the exact same magnitude of response. I waited - ten, twenty, thirty trials - and still no change! The polygraph curves looked like exact copies of each other. It was like he reacted to each tone as if he were hearing it for the first time. His EEG showed slow wave delta patterns indicating deep sleep, and the respiration recording fell to a nearly flat line. It didn't make sense.
"Enough of this bullshit," I said to myself. "Time for the real stuff." I pressed down the intercom button. "O.K., let's try something different. I'm going to ask you some questions, and you just answer yes or no. How does that sound?"
"Like you have many questions," Doe replied.
"I do."
And I was determined to get some answers - even if it meant resorting to lie detection technique. Better start off with easy, non-threatening inquiries. "Here's the first question: Do you live in this state?"
"No."
There was little if no physiological reaction, indicating no noteworthy emotional response. People feel anxious, guilty when they lie. They get aroused... He must be telling the truth.
"Did you come here from the north or south."
"No."
No physical reaction. Good, I'm narrowing down the possibilities.
"From the west?"
"No."
"Then you must come from east of here, correct?"
"No."
Still no physiological reaction! He hasn't lied yet? How could he not come from any direction? Something is wrong here! Try something else.
"Does your last name start with any letter between A and M?"
"No."
No reaction.
I was almost afraid to ask the next question. "Does it start with any letter from N to Z?"
"No."
Again no reaction! How can this be! This just isn't working. All this equipment and technology is garbage! I closed my eyes and wracked my brain for another question to ask. Nothing came to me, just images and voices and people's faces. My concentration drifted in and out. I felt dizzy. Blackness billowed up below my feet. Where am I?... Shout my name... By the power of fear and sheer determination, I yanked myself out. "Who are you!" I implored through the intercom.
No answer. The polygraph recordings were flat lines. The computer screen was blank. I looked up at the video monitor. The seat in the soundproof chamber was empty....EMPTY! Where was Doe! I jumped up, unlocked the chamber door. He wasn't there - just the wires and electrodes placed neatly across the armrest.