Madness (15 page)

Je regrette les temps où la sève du monde,

L'eau du fleuve, le sang rose des arbres verts,

Dans les veines de Pan mettaient un univers!

( . . . in the veins of Pan, a whole universe!)

At the end of my first month back at work, there's a letter from Aaron's rooms in the mailbox. It's soggy where rain has seeped through cracks in the brick. I slide a finger under the edge of the envelope while driving to the library. It's a typed letter. A long typed letter. I pull over on the side of the road, under a streetlight. And then I take a long breath in . . . and forget to breathe out.

I've been dumped by my psychiatrist. This is not something I'd considered – Duty of Care and the Hippocratic Oath and all that. He says, in part, that I have poor insight and symptoms of psychosis. He says I'm not always compliant with his recommended treatment and I'm not always honest. His professional opinion is that my prognosis is of serious concern. He suggests I either re-connect with the Community Clinic or find another clinician. He wishes me well for the future.

I fold the letter in half and sharpen the crease and then I fold it in half again and sharpen the crease and then I fold it in half again and sharpen the crease. Once home from the library I put the fat little square of paper in the rubbish bin.

So my confusion about Psychiatry as a discipline solidifies. It was a vague mistrust in the beginning, a nebulous sense that something about the nature of the practice wasn't right.

As a medical student on psych rotations, the psychiatrists who taught us showed a modicum of respect and interest in the patients while in front of the patients (as professionalism dictates) but once we were closeted in an office, they'd discuss various symptoms as though they were disconnected from ever belonging to a human being. Sometimes they'd disbelieve a patient we'd interviewed somewhat condescendingly, or flat-out dismiss another patient's suffering. One psychiatrist said, as I was shadowing him on a public unit, ‘This place is a zoo. Get into private practice as soon as you can if you do psychiatry.'

The debilitating side effects of high dose antipsychotics like mental clouding, lethargy and sedation were glossed over. One feels (every hour of every day) the slow drowsiness of having drunk a lot of alcohol without any of the associated pleasure or relaxation or emotional warmth. I wondered (then and now) if it would make a difference if these doctors themselves just once tried a low dose of the drugs they were prescribing.

Eight months away from becoming doctors ourselves, we'd had almost no teaching about the ways mental illness cause disruption to the lives of family and friends as well as to that of the sufferer, and we had little insight into the often life-long associated disability. No one ever said, ‘Ethan over there was a highly functioning young man with a job and a lover and dreams and ambition and hope for the future. He was brought into hospital in the back of a Police van. Can you imagine the grief and confusion that must come with a diagnosis of manic-depression?'

There is always a power imbalance between a patient and physician, but I've witnessed it more acutely in psychiatry than in almost any other branch of medicine. ‘Them And Us.' And never the twain shall meet.

But Winsome chooses not to give up on me.

‘I fully understand that all is not well and that you have been in a terrible space. It is good that you are still alive,' she says at our first session since my discharge from the inpatient unit.

‘Winsome,' I say. ‘I'm sorry.'

‘Please do not apologise. You are in no way to blame.'

I look up from the floor fast, right into her eyes. My eyes. Hers. Oh, relief. I smile for the first time in weeks. ‘I was difficult and I feel bad about that. But thank you. I seem to have regained my rational mind.'

‘Wonderful,' she says. ‘For better or worse, the last eight weeks are murky and confused – until I woke up on Sunday and felt myself.'

Winsome smiles. ‘What a relief for you.'

‘I think . . . I hope . . . the blackness and the paranoia is not all of who I am.'

‘I agree.'

‘Coming here this morning I was scared you might have had enough.'

‘Of?'

‘This. Me. Us.'

Winsome waits, not staring at me, but just with her presence, creating space (in which to be honest).

‘Um, because this means a lot. This. Us. I pay you, it's professional and so on, I know that. Still.'

‘And we'll work together till you get there Kate. You will get there.'

I'm running on a beach, flat, hot, beautiful sand, water, waves, flying.

For a second.

But it's good.

‘Do you think there is such a thing as a psychiatrist who sees the whole person – I mean really sees the whole person?' I ask.

‘I don't know,' says Winsome.

‘Damn it Winsome, all the facets of the human condition exist in a person with mental illness. Right?'

‘Right.'

‘Desire, love . . . search for meaning. Connection. Pain.'

‘Yes. Absolutely.'

‘D'you know, the literal translation of psychiatry is healing of the soul.'

We sit quietly with this.

Winsome moves her consulting room to a comfortable cream Edwardian with tall roses in the front garden. The chairs are deep and soft. The courtyard has cumquat trees in pots around its edges. The cumquats are the glowing orange of just-blown-on-coals.

‘We all have a presentable face – a self that is socially acceptable and professionally acceptable,' Winsome says. ‘Yes?'

‘Yes.'

‘Here we are exploring the much deeper stuff. All the layers underneath.'

‘Yes.'

‘And some of your layers have been hidden for a long time, and there is a lot of pain.'

I nod.

no kill her

‘Can you tell me more about the pain?'

do it do it hands throat THROAT

There appear to be clouds in the room.

‘It's awfully crowded . . .' I tap my head with my index finger. Tap. Tap. Then I hunch up. There are clouds in the room.

‘Crowded,' Winsome says.

‘Foreverandeverandever,' I whisper to the rug. My boots are purple.

‘Pardon?'

‘Clouds.'

Winsome's eyes are the only light. ‘Tell me what is going on . . . in your mind . . . right now.'

Silence-and-clouds and

is-there-an-I and

are-they-going-to-let-me-live.

‘Do you think everyone has . . .?'

‘Has . . .?' says Winsome. Her voice is measured, soft.

‘Other . . . I know there's the self . . .'

‘Yes.'

‘Here,' I tap my head. Tap. Tap. ‘There's a sort-of-self, a theoretical self, at least I think so, because I'm saying I . . .'

I stare at my boots. My boots are purple. Winsome thinks there are two of us in this room, but she is wrong.

kill her

Time diffracts.

‘Sometimes the thing called self disappears completely. There's an awful lot of black. Black bile, black dog, Black Death, and . . . I'm kind of governed.

Actually, I'm kind of suffocated.'

Hunched up. The rug is Turkish. My voice is over the other side of the room. The people in my head are going to kill her for this line of questioning, but Winsome is relaxed; still – in her chair, her neat feet quiet on the floor. She isn't bothered by the clouds.

‘Kate,' she says. ‘You are safe here.' She pauses. ‘You are safe enough to tell the truth.' She pauses. ‘Who is suffocating you?'

‘There's um, there's quite a lot of them,' I say.

Now the shaking. Thighs, knees. Nipples tight shut.

‘They live . . .'

Winsome's expression hasn't changed. She doesn't look like she's trying not to laugh. I open up my hands. There are little sweat-rivers in the palmar creases.

‘They live . . .' I tap my head with my index finger. Tap. Tap. ‘Here.'

The room has shrunk; the walls folding into a cylinder, pressing. Low cloud like fog . . . and where is the light? Winsome's eyes keep me from dying.

‘Years and years and years and years and years and years and years. Jesus.'

do it do it hands throat THROAT

‘Sometimes they rage,' I whisper. ‘Sometimes it's do this, do this and then they laugh.'

And then my breath runs out.

Gag.

shhhh

‘Shhhh,' I whisper. Frozen. I have given them up – a betrayal, and they are like Medusa: snaky-headed, potent gazed. Perseus severed Medusa's head from her body and not even that curtailed her power. Poisonous vipers grew from the spilt drops of her blood.

you bitch

this is the end

They are in unison. They are around my throat and my life is in my throat and air isn't moving anymore and evidently this is the end.

Winsome waits until my breathing rights itself. After a long time I look up and nod and smile and wipe the sweat from around my eyes and lips.

‘Jesus,' I say in my ordinary voice. ‘The clouds have gone.' I move forward in the seat to stand up but my knees won't straighten.

‘Take your time,' Winsome says.

‘Sorry,' I say, flushing and suddenly cold. I look up again. The room is cream and softly lit and I'm still alive. I've told someone about . . . and I'm fucking well still alive.

All night I sit in bed with cats asleep around me and think. Meaning. Illness. Ordinary life. The beauty of ordinary life and the enormousness of
their
power,
their
truth,
their
meaning. The cats stretch and sigh, air fluffing through their noses. Their eyelids flutter as they dream. On my bedroom wall is Marc Chagall's painting,
Three Candles
: a twilight world of rapt figures in which the gold candles throw yellow through blue and lovers embrace the sky in a dreamy elegance; their hands touch among fruiting lilacs. Orange angels populate the boughs with fully fleshed bodies attached to wings ethereal as cotton flowers. It is enough.

In the morning I walk to the train station with the sun low in the eastern sky. The air feels new in my mouth and lungs. The people in my head are hissing as usual and I can feel the heat of their eyes but I can also hear Winsome's voice, low and soft, ‘You are safe'. So I get on the train, stand in the corner of the carriage, headphones on, books clutched, and I get off at the right station and go to work. And all through the day and into the evening when I walk from work into the city, I wonder . . . at the possibility . . . that
their
truth may not be the truth.

I've believed them, all of them, since I was sixteen – fifteen years of bitter acumen, sarcasm, bile and vomit, fifteen years of their ability to halve and quarter me. I am naked before them and whenever they see my body their laughter is high and mirthless. They have always outwitted me.

And now. Given that I'm standing here on the steps of Flinders Street Station, oddly enough alive . . .

Oddly enough alive.

The dusk air carries with it the colours of the sunset – carmine red and cadmium scarlet and magenta – smooth as honey on my skin. I sit on the steps until the almostblack sky is above and all around. There are no stars.

A week later Winsome draws a picture of my brain.

‘We know you have a presenting self – let's put that towards the front. Then there's the . . . cacophony, made up of the voices and their judgements and criticisms and bullying. And in between is a sliver of real self.'

‘Real self? Huh.'

‘Yes indeed. And one of our goals here is to manage the cacophony and to find some space in which the real self can grow.'

Then Winsome says, ‘Who are you, Kate? What makes up your real self?'

I think about this for a while. ‘Most of the time, about twenty percent of me is alive in the external world and the rest flails about . . . mired, stammering . . . in the internal world.'

‘That must be very tiring,' says Winsome.

‘Yes. ‘

eeeeeeeee shhhh die do it doit THROAT

I close my eyes. Put my hands around my throat.

‘Take your hands away from your throat, Kate,' says Winsome. ‘Tell me what's happening.'

Her voice is safe.

I sit on my hands to keep them under control.

I take a breath.

Then I say, very quietly, ‘There were only three of them to begin with – BANG – when I was sixteen. I don't know where they came from. At first I kept looking around to see if anyone else heard them shouting, but no one ever did. And then I assumed everyone had, you know,
other
 . . . but that it was something private, like vaginitis, so I never said anything and I practiced a pleasant face. No matter what they said . . . no matter what they said, I trained myself not to react. Now when they order me to do things, I do it with a smile.'

Winsome doesn't look aghast and nor is she laughing. ‘Thank you for sharing this with me,' she says. ‘How did you train yourself not to react?'