I give it a minute or so before I glance over at his sheet. He’s using a dull lavender-grey crayon, making dots and curls and tiny circles, all packed in tight, crowded and overlapping. I watch as he makes the pattern denser and denser, the edges pushing slowly outward, the centre seeming to bulge with the encrusted weight of all the layers he’s put on. It’s like watching a cancer grow.
“What’s that, Joe?” I ask softly.
It takes him a while to answer. It generally does, so I know to be patient. He can’t always find himself right away.
“How they are,” he says finally.
“How who are, Joe? Your voices?”
“Not mine,” he says, and a spark of bitterness punches up through the flat tone of his exhaustion. A pause. “It feels like this. Kind of.”
I tilt my head to look. Tendrils of thick, crayoned impasto curl away from the centre now, the compounded circles and curves curving back on themselves even as they spread out, a fractal pattern advancing across the far reaches of the paper. It seems to me that it isn’t meant to show the boundaries of a multitude; instead they extend into an infinite, undiminished distance. If he’s drawing a crowd it looks endless, limitless, everywhere.
It’s a moment before I can speak.
“Is that how many there are, Joe?” I manage finally. He nods, then shakes his head, then nods.
“Yes. No. Yes,” he says, and then whispers, “I can’t tell.”
“Can you tell me how they sound? Not what they say,” I add quickly, mindful of what he’s just endured. “Only what the voices sound like. Are they high or low, or male or female, do they sound local or foreign…?” I trail off because Joe’s shaking his head firmly now, and there’s a look on his face that’s almost determined.
“It’s not like that,” he says. “It’s like lots of people all saying the same thing at the same time so it almost sounds like one voice, but not really, because some of them are closer and some are far away, but it’s still all the same. And the way they talk isn’t like English, I don’t know what it is, that’s the way I hear it but it’s not the way they say it. Send it.” The words are coming in a rush, as though he’s not sure he’ll be able to get it all out before he’s stopped. “And, and –”
He stops.
“And what, Joe?”
He takes a couple of deep breaths, holding on the inhale, hissing a little on the exhale. It looks like one of the calming techniques Panko’s tried to teach him. “The way they talk to me, it’s like they’re not just talking to me. It’s as if they think I’m a lot of people. They think I’m like them… that I’m not just me, I’m lots of other people too, like I’m connected to lots of people. They think if they keep on talking and talking then eventually everyone will answer back. They don’t understand that the only person who can hear them is me. And I’m not connected to anyone.”
I struggle to make sense of this. Joe’s staring at me, intently, insanely, and as he grips the pitiful remains of the crayon I can see how white his knuckles are. He’s holding on for dear life here, fighting for once to explain instead of simply annihilate himself, fighting to make me understand something. And what he’s saying is mad, of course, but for the first time I begin to sense a strange internal logic at work.
“Is that what you were trying to tell them? When we came in?” I ask. “That you can’t – I don’t know – pass on their message, or whatever?”
“Yes. Yes. I’ve told them before, told them and told them, but they don’t understand. Or maybe I’m not loud enough.” Another, longer pause. “It shouldn’t be me. That’s what I want to tell them. I can’t do what they want me to do. Whatever it is they want me to understand, I don’t understand. I’ve tried but it’s too big for me. Whoever they want me to tell, those aren’t people I know.”
He stares away, towards the small window that looks out onto scrubby trees and the strip of weedy grass that runs along the back fence. “I don’t know anyone anymore. Only Beth, and you, and the people here.”
The sadness in his voice makes me ache for him, but for the first time in a long time with Joe, I feel a surge of hope. He knows what he’s lost, what these voices and the images they conjure are costing him. He has a plan, and that’s something. He’s managed to talk about the voices, to control them for long enough to describe the experience, instead of collapsing in agony or trying to dig them out of his own skull. That’s a very big thing. There’s more of him left than I’d thought, more I’m sure than Panko thinks.
I turn this over in my head while I look at him looking at the window, look at the curling star-clusters of his madness pinned down for the moment to a sheet of paper.
“Okay, Joe,” I say finally. “I have an idea.”
We show you we prove us see us see the truth the light the life of ages. See us where we dwell beyond stars beyond space along the strings point to point the point is you are us all of you is all of us is all. All is yours this is you come to us you will come to us join with us we are here we are us we are many and one and endless. We call to you we hear you we dream you. See the light of the stars that are ours that are yours, see our proof the lines the strings point to point, you to us, connected, indivisible. Hear our truth see our proof show us share us. Show the more who are you who are the more of you the truth of us.
I write up my notes, and then spend more than an hour cross-referencing them with the previous entries in Joe’s chart made by me, Stevie, and others. My earlier twinge of caution when I thought he might finally be making progress now feels prophetic.
Talking therapies calm him a little, but not enough and not for long. His dosages creep up and up, until the meds have to be changed for his own safety. His last psychiatrist fought tooth and nail to get him ECT; that worked so well they were able to send him home. When he came back a few weeks later, head wrapped in bloody bandages, he said the explosion of sound was so sudden and so loud and so painful he couldn’t think what else to do.
He’s an extreme case, an outlier; one of the unfortunate souls cursed with a delusion that resists every attempt at treatment. I dig out a journal article from a pair of researchers who theorized that odd similarities in a handful of globally distributed cases, the ineffectiveness of standard protocols and their tendency to violent suicide, suggests a rare genetic defect: some fundamental flaw in the wiring.
Whether they’re right or wrong about that isn’t going to help Joe, but what might is the medication they developed. It was recommended for him after the power drill episode, when he was transferred here, and I feel a sense of defeat. I’d been so sure I could do better.
I delay the inevitable, checking his history for intolerances and combination risks, wishing I felt more relieved at not finding any; but in the end I complete the application form quickly. Poor Joe Herald, I think as I tap to send the request. We know everything there is to know about you now, including how few options you have left.
Central appears to agree – I’ve only just got off the phone with the sister when approval comes back from them. What I expected, in half the time, and as I attach it to the chart I try to shake off the feeling that I’ve failed. Every doctor wishes they could cure every patient, but we all know that’s just not possible. Sometimes limiting the damage is the best, the only thing you can do.
I hear Stevie’s voice in the outer office. More notes for the chart, and probably some disagreement. The new meds will render therapy pretty much irrelevant, and Stevie isn’t always realistic about the limits to what it can do. I’m going to be argued with, I think. I’m going to be challenged. And Stevie is a dedicated therapist, and deserves an answer.
The answers are here in the chart; enough to prove, even to Stevie, even to myself, that it’s time to stop hoping for a miracle. We need to move Joe along, and if we can’t get him back to what he was before, we’ve at least got to get him away from where he is now. That much I know Stevie will agree with.
They’re not happy. I can tell the way my fingers an
d toes go hot and cold, hot and cold, shivering hot and burning cold, and feeling as if I banged my elbow, like electricity running up and down my arms, over and over. It’s not enough to make me cry, but too much to let me sleep.
It’s what frustration feels like. I drew them and I talked about them, but I didn’t get them what they want. Whatever that is.
I’ve failed and they’re disappointed. I’m a disappointment. Again. I’m sorry. I don’t know what else I could have done. I’ve tried and tried and it’s never enough.
Stevie said there could be a way to satisfy them, to make them think I’m getting it right. I don’t understand how that can work though. They’re in my head; wherever they are in real life, they’re still here in my head. They’ll know if I’m making things up. I can’t fool them, I know I can’t.
Stevie said this would be making it real, not making it up. I don’t understand how that’s supposed to work, but maybe Stevie knows a way.
I used to think there was only one kind of real, but I don’t think that anymore.
I look at the picture. Stevie says stop sometimes, sit back and look at what you’ve done, see what you’re doing before you go on. I think I’ve been trying to show how big it is in my head, but maybe if I stop for a while I can make it smaller. Maybe I can keep it on one page.
Maybe that’s what Stevie was trying to explain. Put the bigness of them onto, into, something small. Something I can get my hands around, get my head around. But I don’t understand how I’m supposed to do that. It’s like trying to fit the ocean into a drinking cup.
Stevie said it’s all in the way you think about things, but it’s hard to think about anything with them grumbling and growling at me, prowling in my mind, pouncing. It makes me want to pull myself apart to get at them, get them out, shut them all the way up. I know that’s bad. I shouldn’t hurt Beth like that. But I can’t keep waiting for the next time, strung up, strung out, helpless. I need to be able to do something.
Every time I think I can’t break any more, I do. Every time I think I can’t take much more of this, I’m right.
Everyone wants me to make sense, but I don’t care if it doesn’t make any sense, I don’t care if Stevie’s plan makes no sense. I don’t care what I have to do, what we have to do. I don’t care, as long as it ends.
I can’t take much more of this.
She’s given up. Panko’s given up on Joe. One little break, just one lousy break like all of the others and that’s it. Never mind that it didn’t make him give up. She’s decided it’s time to throw in the towel, throw up her hands, wash them clean of him. And it’s not the kind of abdication that’ll let anyone else keep trying. It’s the kind that means he’ll have no chance.
Even when I talked her through our session, what I understand now about the way he constructs what’s happening to him, how I think we can help him subvert the delusion – she just kept tapping at the chart, showing me old entries, saying this was no different than any number of times before. Shaking her head, saying how sorry she was, that she knows how sad it is, how bad this is. Compassionate abandonment.
How do you know it won’t be different this time? How can you know if you’re not willing to try?
I managed to not quite barge out of there, but I’m so upset, so angry, I so need to keep moving so that no one can talk to me, that I’ve made it all the way across the yard before I even realise where I am.
I stop amongst the stunted trees, glance up at Joe’s window and wonder if he’s in there looking out at me. Looking at me, and the world, and hanging on to my promise to help him back into it.
If Panko has her way we’ll keep that promise, after a fashion, but it won’t be anything like what I meant. Like what he knew I meant, when he trusted me to understand him. But it might be the only way he can ever get out, the only way he can survive, and I know that too.
I wonder what the hell I’m supposed to do.
She told me to think about what he’s going through, the agony of it, the slow damage that the current meds are doing to him anyway without giving him hardly anything in the way of relief. Weigh up the long odds of a breakthrough against the certainty of his daily suffering, and ask myself what, really, is best for him.
I don’t know. God help me, I don’t know what’s best. I can’t be sure this idea of mine will work. A lot of people have tried a lot of things over the years with Joe. I want to believe I have an insight that they didn’t, but do I really? Even if I do, can I make it count? My plan isn’t just a repeat of all the others, but is it different enough?
Panko will let me pitch it to Beth. We agreed that much. We’ll set out the alternatives, explain the risks. I can argue my case – Joe’s case – and she can decide.
Poor girl. It’s not a fair thing to do to her either.
We have shown we have spoken we speak we call we cry why do you resist, persist, in silence, ignorance, ignore us? Speak, we speak, we will speak into the silence, we are here we are always here, endless, we are here you will hear us. So few hear true, you do, we boost the signal when you sing us, we make it stronger for the you who are all of you to hear the all of us. So long we have called to you, we have shown you the whole the light the stars where we dwell, we throw our songs along the line the light from ours to yours to you. We are here on the strings, distant and there, point to point, indivisible. We sing, we will sing, for a vessel a vision that can hear and bridge us, bring us, join us, answer, bring you to us, bring you into the whole that is us with you with all of us. Endless, always, we call.
I’ve scheduled the meeting for the start of visiting hours so she can’t go talk to Joe first. I want Beth to know what’s really going on before she sees her brother; to know that he’s not getting any better, and that all it’ll take to start to change his situation is her agreement. I want her to have some context if he starts blathering about Stevie this and Stevie that. And if being in my office at nine o’clock the morning after his latest episode makes what I have to say seem that much more urgent, well, that’s no bad thing.
Stevie settles her into a chair before I can, but remains standing, leaning against the bookshelves, a brooding presence that obscures the diplomas hanging on the wall. I assume it’s not deliberate. I need to keep this from appearing adversarial, or she could end up trusting neither of us.
So as I take her through what happened yesterday, I invite Stevie to comment, to confirm, to help me explain it. A dedicated, ethical therapist will report accurately and without embellishment, and Stevie doesn’t disappoint. That corroboration falls away when I move on to the analysis of Joe’s records, showing her how it proves he’s not improving. But I expected that, and by this point, I hope, it shouldn’t matter.
“I think we’ve reached the limit of what we can achieve with therapy,” I say finally. “And – I hate to have to admit this, Beth – but I’m not sure we’ve helped him that much. In most cases we can work with the voices, turn them into a conversation that the patient has control over, that they manage. The way you manage a relationship, even an unpleasant one. But with Joe – well, we can pick out good sessions and good days and even good weeks, but when you look at the overall pattern –” I tap the chart for emphasis, “– he hasn’t got better, he hasn’t even stabilised. He’s still at risk. We’ve managed to keep him safe, and maybe we’ve slowed the rate of decline a bit. But he’s still getting worse.”
I watch her eyes start to well up. Stevie twitches away from the wall, mouth opening to speak, but I get in first. “Which is why I’m recommending a complete overhaul of Joe’s medication. We need to face the fact that he falls into a very small group of people who are very difficult to treat, Beth. But there is a treatment, it’s had positive outcomes for similar patients, and I think it could really help.”
She looks up at me, sharp and accusing despite the tear that spills down her cheek. “Why haven’t you tried it, then? What are you waiting for?”
“For you. We’ll talk to Joe about it, of co
urse, but you know he can’t make decisions for himself any more, Beth. This is a significant step, and we need your permission.” I explain about the new treatment, what it will entail.
“Enough patients have been given this now that we have a fair idea what to expect. He’ll be calm and relaxed, before too long he should be able to leave the hospital. Sometimes the voices go completely, but even if that doesn’t happen, they stop being a problem. He won’t pay attention to them any more, they won’t have any meaning for him. They’ll just be background.”
“You need to understand,” Stevie interjects, “exactly why they won’t bother him any more.”
I suppress another surge of annoyance. Stevie might be pursuing a different agenda, but it’s a fair point. Beth does need to understand.
She nods. She’s been paying attention. Might have done her own research in anticipation of this, for all we know.
“What you’re saying is… These new drugs. They’ll change him? Permanently?”
“Yes,” we say, an accidental chorus, only Stevie adds, “Not just change. Damage.”
Beth looks at me and I nod, reluctant. “He’ll need to take them for a long time. Probably for the rest of his life. They’ll impair the area in his brain that’s engaging with the hallucinations, which is the good part; but that will have an effect on personality and cognitive skills as well. I’m sorry, Beth. I truly am. I know this is a terrible decision to have to make for your brother. But he’s suffering, he’s in pain, and we’ve tried everything else.”
“Not everything,” says Stevie, finally moving forward to take a seat. Beth glances from one to the other of us, startled. I shrug.
“Joe’s already had hundreds of hours of therapy,” I say tiredly. “I’ll be honest, I don’t see what any more can do. I’m afraid it’ll just prolong his misery, and he’ll end up even more traumatised than he already is. Stevie has a… different view.”
I wish Beth looked a little less eager to hear it. She turns back to Stevie, who’s bending towards her now, elbows on knees and fingers steepled; conspiratorial, intimate.
Paradox: Stories Inspired by the Fermi Paradox Page 18
