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I'll Take the Dog
This is a true story about right and wrong, understanding and misunderstanding,
and a man who slipped through his life as quietly as a knife slips through
butter.
I'll call him Elvin, because he was. Short, slim, with a long beard. He was a
vegetarian for one reason: he couldn't stand the thought of hurting any sentient
creature. He never said or did a dishonest thing in his life. He was shy. But he
was generous to a fault, ready to do anything for you, give you anything you
needed.
What really struck me about Elvin was his wisdom. He could detect attempts to
manipulate a mile away. He spotted lies the way a bat spots the wall of a dark
cave. And he demanded the same kind of honesty from others as he demanded in
himself: the perfect kind.
He never needed to say much. He could cut through ten pounds of BS and get right
to the core of an issue with two or three words. But what little he did say
taught me much more than all the millions of words I've heard from the greatest
of experts and teachers.
As Elvin grew older, he started to feel tense. He suspected that he might
benefit from psychotropic meds, but he didn't have the money to buy them. When
he heard that meds and outpatient therapy were available for free at the local
psychiatric hospital, he decided to visit it.
Remember that Elvin was shy — painfully shy. Imagine the courage it took for
him to walk, all alone, into that psychiatric hospital. The psychiatrist,
sensing Elvin's internal anxiety and pain, urged him to take up residence there.
Elvin cooperated, hoping for gentle, effective treatment.
He was given over to the care of another psychiatrist, who put him on lithium, a
medication that causes severe nausea if it's not taken with substantial meals.
Elvin was not only a vegetarian but a light eater. He was wise enough to know
that Americans tend to think that they need much more food than they actually
need. So Elvin was overtaken by relentless, debilitating, nausea.
Somebody on the hospital staff probably noticed this and advised Elvin to eat
more, but he was alone and terrified. He didn't trust anybody in that strange
place. When he vomited, nobody comforted him. He was treated like a
"man"; that is, his misery was, for the most part, ignored.
Elvin's life became a terrifying hell of whirling sights and sounds and
well-meaning aides urging him to try the Arts and Crafts class to "get your
mind off how you feel." Elvin lacked the social skills to formulate an
assertive complaint. As a result, he never got the reduction of his lithium dose
that would have relieved his misery.
Psychiatrists seem to understand that small, slim, women need lower-than-normal
doses of psychotropic drugs. But I guess that small, slim men are a such a
rarity that Elvin's psychiatrist never caught on to why he was so reluctant to
take his meds. He or she saw Elvin as just another rebellious patient and forced
him to take as high a dose of lithium as a man twice his weight would take.
Meek, retiring Elvin was powerless to resist, or even to protest, the torture he
was being subjected to.
Night after night, alone in the dark, Elvin cried himself to sleep. Each morning
when he woke up, he resumed his struggle to find a way out of his lonely hell.
He knew about psychiatric disorders. He knew that he probably had one, and that
the right meds could conceivably cure him. But his body was sending him a much
more urgent message: "This drug is hurting you." It repeatedly vomited
the lithium out of his body. Such a message isn’t easy to ignore.
Elvin had asked for help, not torture. He'd never hurt, and never would hurt, a
soul. What had he done to deserve days and days of severe nausea, trapped in
what he now, of course, perceived as a cold, uncaring prison?
There was only so much pain that he could take. Finally, he caved. He called his
big brother, a successful businessman, for help.
Elvin's brother, Andy, was a rebellious, anti-establishment, person, suspicious
of all bureaucracies and authority figures. Andy, with a second brother, Norm,
visited the psychiatric hospital. They entered the building, not to obtain
information, not to make sure that their brother was allowed to take his meds
with his biggest meal or five minutes before bedtime, but to spring Elvin from
his perceived prison.
Andy and Norm were ushered into a small conference room, where Elvin slumped in
a chair, glassy-eyed, the lithium-sickness draining his will from him. A team of
psychiatric professionals entered the room. One of the professionals brought
with her a pitch-black, sleek-coated, Rottweiler. The dog was perfectly trained
and never made a sound or an unexpected move. Andy could see that the beautiful
dog wasn't going to hurt a soul.
But Andy was an expert at defusing tense situations with humor, and the dog was
a fair target. He leaned over and whispered into Norm's ear, "You take the
psychologist; I'll take the dog."
The psychiatric professionals were reluctant to release Elvin for exactly the
same reason that he believed he needed to leave: his low weight. They saw it as
a symptom of illness rather than what was causing his unbearable agony.
"Look at Norm and me," Andy, an eloquent speaker, said. "All
the men in this family are skinny. I'll take care of him. I've got the means to
support him. And he's not a danger to anybody, including himself. You have no
right to keep him here against his will."
Andy's point was cogent and irrefutable. The hospital gave Elvin over to Andy's
care; it was the right thing to do under the circumstances. It was the
circumstances that were wrong. Elvin should not have been made so ill in the
first place. He should have had no reason to try to get out of the hospital.
Once Elvin left the hospital, he never touched a lithium capsule, or any
psychotropic medication, again. He substituted the tender, understanding, care
of his brother for the treatment that would have alleviated his symptoms and
made him independent enough not to need to be cared for.
Yet I'm sure that Elvin didn't suffer noticeably more than the average consumer
suffers. If you have never felt happiness, you don't miss it. If you haven't
slept through the night since you were a child, and you have nowhere you feel
you must rush off to when you wake up, you don't yearn to sleep through the
night. If your needs are few, and your big brother is happy to fill those needs
as soon as they arise, you don't long for a paying job. When there has been a
little too much change or excitement in your life, and the unconscious anxiety
overflows and becomes conscious tension, you go into your quiet, safe, room and
sit on your bed and rock gently back and forth, back and forth. And pretty soon,
you rock the tension away.
I know. I've been there. It's not bad. It's not good. It's just life, your life.
And, if you're an untreated bipolar, your life is your whole universe.
Elvin and his too-short existence taught me that life contains many more
questions than answers. Is my life, rushing around fighting all my self-created
battles, any healthier or happier than Elvin's? But, on the other hand, how many
people could Elvin have helped if he had conquered his disorder and become able
to share his wisdom?
What would it have taken to get Elvin to take the meds that would have worked
for him?
I know what did not work. Forcing him to take so much lithium, its side effects
unmitigated by food or sleep, that he associated psychiatric treatment with
interminable and intolerable nausea did not work.
Was the hospital so understaffed that not one aide, not one caseworker, could
have befriended Elvin and earned his trust, then worked out a treatment plan
that would have made the hospital seem to him like a haven rather than a house
of torture? Wasn't his psychiatrist able to figure out that Elvin's low weight
warranted a lower-than-normal dose of meds? Couldn't Elvin's caseworker and
psychiatrist have gotten together with him and worked out a way to reduce the
hideous nausea?
"Cut the pills in half," he could have said, "and if the side effects are still
unbearable, cut them in half again. Either eat a huge meal with them or, if huge
meals make you almost as uncomfortable as the nausea does, eat a meal, take the
meds, then go to bed — in rapid succession."
Some people take the meds and recover, because they are not forced to take them on a nurse's
schedule. Instead, they are allowed to take them on a schedule that reduced their negative
effects. Why wasn't Elvin treated with that respect?
You can make a psychiatric hospital as pretty and open and comfortable as the
nicest home, but any resident looking at that hospital through the woozy,
whirling, eyes of nausea will see it as the ugliest, most hateful place in the
world.
We will never get a second chance with Elvin; it's too late. But there are
Elvins being admitted to psychiatric hospitals every day. Each new patient is a
real person with unique needs. Why not make it up to Elvin by meeting other new
patients' needs?
I've heard that having a dog can go a long way toward relaxing you and helping
you cope with life's problems. And if I ever have to choose between (1)
treatment by whoever that psychiatrist was who expected Elvin to endure days and
days of debilitating nausea, and (2) a dog …
I'll take the dog.
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