Lights On, Rats Out

by Cree LeFavour

  CHAPTER 31

  Afoot Again

  I’ve been here too long even though I can’t decide if it feels like a year or a day since I was escorted from Admitting down the hall to B-1. The fantasy of Dr. Kohl is blurring. I want him back. Visitors are a distraction and a guilty burden—my grandmother, my friend Karen and her husband, an uncle. Now I’m on “No Visitors” and “No Calls” status. These goodies I take to my room, savoring the isolation as I would baker’s chocolate. I’ve just been given permission to stuff the competing parts of my psyche away, shutting them up for a bit. They’ll be back. For now, I am relieved to have everyone on the outside firmly there, far from me.

  The sticker price of this deliverance from the world outside? I take to my bed. S. Weir Mitchell, M.D., the great father of women’s “hysteria,” wrote in 1875 in Rest in Nervous Disease: Its Use and Abuse:

  As to women, for some reason they take more kindly to rest than do men, and will stay there, once in bed, as long as you wish, and longer sometimes. Indeed, he who says to a woman “You are ill, remain in bed for a month”—takes on himself a grave duty, and may not have the luck to get her afoot again, which is a thing to be thought of when trying some of these perilous therapeutics on your future patients.

  Mitchell couldn’t be more right. Six, seven, eight weeks in, part of me doesn’t want to get “afoot” again. Dr. Simons has begun to have a certain dangerous appeal; what was once loathing has turned into a minor crush on his executive confidence and self-contained demeanor. When he told me to “Knock it off” during morning rounds a few weeks ago I thought: Is that how you talk to your patients? “Heartbreaking” he then added, as if to the air. The arm? Me? The two together? “Knock it off” is a redacted letter I can see through if I hold it up to the light. I read he sees me in full, his gaze mixing with mine to encompass the condition I’m in and then past it to my capacity to stop burning, hiding razors, holding myself apart.

  Though I swore off all group activities at the start I’ve submitted to art therapy: painting tiles, glazing and firing them. I’m calmer and more cooperative. I’ve discovered a nurse I like. We’re not pals but I almost trust her. She doesn’t condescend.

  Even my in-house shrink, Dr. Weiss, has improved. Her efforts to comprehend my wish to return to Burlington as soon as possible have divulged my erotic transference problem. I tell her I’m fixated on Dr. Kohl. I am what Freud, among others, calls “the woman scorned.” If my “transference love” for Dr. Kohl is an act of resistance to treatment, if it is specific to the analytic situation and fueled by Dr. Kohl’s rejection, I’m not ready to see it that way. I’m not even close to renouncing the principle of my pleasure when it comes to Dr. Kohl. But confessing the dirty secret liberates a tiny corner of the shame I feel, dislodging it without setting it afloat. I’ve never told anyone how I feel about him other than to say, “He’s very good” when my father pays yet another bill. I’ve been probing my relationship to Dr. Kohl as I sit through my therapy with Dr. Weiss. We get just far enough. My reluctant attachment to the inertia of Sheppard Pratt starts to take hold; this tells me it’s time.

  I’ve long since ceased being a person seeing a shrink because I’m lonely, depressed, shy, insecure, confused, bulimic, compulsive, isolated, angry, self-indulgent, and scared. I’ve entered a new category: I am a person who has been committed (voluntarily) to a psychiatric hospital. In the future I can’t politely call this phase a “nervous breakdown.” Unfortunately, the antique phrase is suspect, long since supplanted by a phalanx of clinical terms—schizophrenia, paranoia, psychosis, bipolar disorder, obsessive-compulsive disorder, eating disorders, various grades of depression from major to minor to morbid, and personality disorders of all kinds. None of the diagnoses so elegantly communicate the dissolution of the mental faculties “nervous breakdown” encompasses, describing as it does the fractured, split, and dislocated entity that’s theoretically supposed to be a relatively integrated “self.”

  The so-called Three-Day Letter, a formal request for discharge I have the option to make, is my only way out. If I submit it I have a chance of leaving. The three-day process begins with a hospital committee review of the patient’s chart and then, if its members decide involuntary commitment is indicated, the hospital puts the request before a judge to contest release. If the judge signs off the patient is involuntarily committed. They could recommend commitment but I don’t think they will, nor do I think a judge would agree. In my mind the problem isn’t the committee’s or the judge’s decision; the problem is the nature of their recommendation because it determines the posthospital outcome. If the committee permits me to leave, I need a proper discharge—not a contested one. That was part of the deal I made with Dr. Kohl. He won’t see me again if I leave “Against Doctor’s Orders.”

  I can oppose my father, Dr. Weiss, and Dr. Simons. But I’m not sure I can risk never seeing Dr. Kohl again. If I do it there may be no 112 Church Street, no Henry’s Diner, no receptionist, no brown leather chair, no Daffy Duck print to admire by the door. Am I ready to be so extravagant? I fear staying at Sheppard Pratt longer as I yield to its temptations. Numbed by who I might become if I drift longer on the inside, I hang on to my purpose despite how impotent the prospect of that one vital casualty makes me feel: Dr. Kohl.

  But I’m done here, even if I haven’t really “done” anything at all unless it’s locating the strength to put to the test my strange bargain with Dr. Kohl. It has taken me two months but if I find the courage to leave—or at least try to leave—I will be choosing myself over him. It’s actually fairly remarkable.

  Time to submit The Letter. I experience a flash of plenty when I know I’ll do it. If I dally there will be no leaving, because I will have fallen in full and that, surprisingly, now seems worse than gambling on being turned away from Dr. Kohl’s door. I can feel myself getting far too used to the place. It’s now or never.

  I ask for the official form from a squeaky nurse. She pushes it to me through the sliding pill window over the smooth divot where the tiny cups and so many hands have worn down the wood. It’s probably fifty years old, this oak counter—maybe more. After checking a few boxes, scribbling the date, and signing my name, I hand the completed form to one of the many indistinguishable bodies in the nurses’ nest, each one neatly packed into its own crisp white uniform, whatever its shape. With that motion a series of irreversible legal procedures will churn into action. I’ve risked civil commitment and Dr. Kohl. If I’m honest with myself I know I wouldn’t have taken the wager if I didn’t think I could convince Dr. Kohl to have me back—“Against Doctor’s Orders” or not.

  The next day I tell Dr. Weiss I’ve submitted the Three-Day Letter. I’m ready to go. I’ve said I wanted to go many times before, but this time she really listens. And then, for a change, she tells me something worth knowing. She’s been informed of a timely mistake. Mass Mutual, my worthy insurance company with Veruca Salt-worthy $2 million coverage, is not, as it turns out, so very outstanding after all. There has been a mistake, twice repeated.

  My insurance, in fact, ran out after forty-five days. I’ve been at Sheppard Pratt for two weeks without coverage. In my file the mistake is noted: “This will be disputed with evidence from the verification obtained on admission.” Although I don’t see this as a gift, it is. I overlook the white satin ribbons and shiny bright red wrapping paper Mass Mutual has just forced on me for the shabby indignity of money trouble. The insurance gap is a boon. For once—maybe for the last time—too little money is better than too much. The hospital will have a harder time keeping me without insurance; I’m a financial risk without proper coverage. Can I or will I pay the bill?

  When The Letter I’ve submitted arrives on the desk of good Dr. Simons, he and his colleagues seem to agree they can’t in good conscience keep me here without coverage given my most excellent progress. I guess “6 months to 1 year” sounded credible when the number was $2 million. After all, with that much cash to blow I could ferment seda
tely for eight years and nine months.

  My Three-Day Letter is returned to me unprocessed the next day. It has seen neither panel nor judge. The hospital, represented by attending physician Dr. Simons, does not contest discharge. Then it all happens really fast, as I’m immediately scheduled for release in two days: Friday, November 8, 1991. Dr. Weiss, in consultation with Ms. Wilpers, whose job it is to oversee the transition to life “outside,” confirms and documents in my file that I have an appointment with Dr. Kohl on Monday 11/11/91—two months to the day since I went into the hospital on 9/11/91. How symmetrical of the universe. How good of the 11s. After a stay of two months Sheppard Pratt has been generous enough to release me with a straight discharge and a prognosis of “Fair to Good.” I’m deemed “Moderately improved.” I’ll take it.

  CHAPTER 32

  The Ceiling of the Profile

  Ms. Wilpers insists we review the standard handout: “TIPS FOR STAYING OUTSIDE THE HOSPITAL.” While she talks I amuse myself with visions of perching on the steep gables, lurking beneath windows, climbing the stately trees …

  A few highlights from Ms. Wilpers’s twenty tips:

  • Don’t look back to the hospital or how it used to be.

  • Strongly consider a structured living situation for at least 3–6 months after discharge.

  • Have set appointment with outpatient treaters before leaving the hospital.

  She asks me to write three lists before I leave. Fine. I like lists enough, paper and words acting as magical vehicles of clarity and insight. First up, “Things I’m dreading” (my words, not hers):

  1. Explaining where I’ve been.

  2. Make place [apartment] cozy—now a mess.

  3. Isolation—being without staff and support they provide.

  4. Newness/familiarity of apartment.

  5. Structuring time.

  6. Food/eating. New routine.

  7. Dealing with/reassuring family.

  8. Establishing new level of honesty/relationship with friends and family.

  9. Boyfriend/old relationships. Establish new pattern.

  10. Finding a job.

  11. Saying good-bye to old job/coworkers.

  Second, my Supports at home, “outside” the hospital.

  1. Doctor.

  2. Sister/father.

  3.–6. A handful of friends, Matt, and my cat, Billbob.

  7. Exercise.

  8. Computer.

  9. Books.

  Finally, I’m to draw up a list of Warning Signs that signal a worsening mental state:

  1. More isolation/not answering phone.

  2. Not really sharing anything.

  3. Problems with food/bulimia.

  4. Desire to burn.

  5. Biting nails off.

  6. Sleeplessness.

  7. Extreme agitation/restlessness.

  8. Withdrawal from activities.

  9. Not exercising.

  10. Over-dependence on …

  I cross this last one out. I’m thinking of Dr. Kohl, of course, but I’m not going to admit that to her.

  The official discharge papers read as follows:

  Discharge Diagnosis—DSM-III-R

  Axis I: Bulimia

  Axis II: Borderline personality with Narcissistic Features (principal diagnosis)

  Axis III: Healing second-degree burns—right arm, foot, cheek

  Axis IV: #4, severe—enduring circumstance (parental neglect)

  Axis V: GAF: Current: 60 Past year: 75

  Although bulimia is my Axis I, or what they call a “principal diagnosis,” this is just a quirk of the DSM that 301.83 is Axis I while other, seemingly more important diagnoses are considered secondary. My Axis II is the ever slippery Borderline Personality Disorder (BPD). It’s not a pretty diagnosis and the prognosis isn’t very good. The criteria, according to the DSM-II-R standard, are as follows:

  1. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of over idealization and devaluation.

  I idealize Dr. Kohl. And my father. I’ll give them this one.

  2. Impulsiveness in at least two areas that are potentially self-damaging, for example, spending, sex, substance use, shoplifting, reckless driving, binge eating (do not include suicidal or self-mutilating behavior covered in No. 5).

  Yes, I did binge and purge. And I spend more money than I have—always.

  3. Affective instability: marked shifts from baseline mood to depression, irritability, or anxiety, usually lasting a few hours and only rarely more than a few days.

  Yes, but I bet lots of people could say the same of themselves.

  4. Inappropriate, intense anger or lack of control of anger, for example, frequent displays of temper, constant anger, recurrent physical fights.

  Finally, a definite no. I do not fight, scream, or display my temper. I might be better off if I did.

  5. Recurrent suicidal threats, gestures, or behavior, or self-mutilating behavior.

  Okay, yes. This one isn’t too hard.

  6. Marked and persistent identity disturbance manifested by uncertainty about at least two of the following: self-image, sexual orientation, long-term goals or career choice, type of friends desired, preferred values.

  I’m not always sure who I am, I don’t kiss girls, I might want to be a doctor but I think I’ll end up as an academic. I have always wanted to be a writer but I’m unwilling to admit that audacious ambition so I pretend I haven’t. I am a bit shaky on friends and values.

  7. Chronic feeling of emptiness or boredom.

  Yes to emptiness, no to boredom.

  8. Frantic efforts to avoid real or imagined abandonment (do not include suicidal or self-mutilating behavior covered in No. 5).

  I admire the way the manual’s compilers anticipated including self-mutilating behavior under frantic efforts to avoid real or imagined abandonment. I would have listed it here. Since I can’t do that, I’ll admit I get frantic when Dr. Kohl leaves town or threatens to leave me.

  I solidly qualify for BPD by this standard—it’s difficult to deny seven out of eight when only five are needed to confirm a diagnosis. But it seems that Dr. Adam Shearer, who wrote the report after psychological testing, wasn’t so certain. Despite the discharge diagnosis of BPD (301.83), his report states, “Although some dimensions of her projective assessment, interview presentation and history would suggest borderline personality disorder, it is noteworthy that there is no appreciable elevation of the scale on the MCMI-II that taps the DSM-III-R defined features of borderline personality disorder.”

  The report, produced after several hours of psychological testing only ten days before I signed my Three-Day Letter, notes my response to the Dissociative Experiences Scale (DES) “produces an overall average score (20) which is on the low end of a wide range of scores generally suggesting significant PTSD or dissociative symptomology.” Hooray! If there’s anything to celebrate it’s safe to say I’ve narrowly escaped the dread MPD. Then there’s the Rorschach—those crazy inky blots that surely look like genitalia to all but the most pristine nuns. Beyond frequent sightings of penises and Georgia O’Keeffe-esque vaginas the report states:

  Ms. LeFavour produces a rather lengthy protocol … It’s worth noting that her thought processes seem distinctly disjointed during the administration of the Rorschach … Although the resulting protocol was difficult to score, it is noteworthy that she displays quite meager capacity to produce “good form” and uncontaminated responses, suggesting that her capacity for effective reality testing is easily compromised.

  He concludes that this indicates “considerable cognitive slippage to an extent ordinarily associated with a thought disorder.” He then ominously adds, “Indeed, the index related to schizophrenia is significantly elevated…. It is also worth noting that there is an appreciable elevation of an index related to the risk of future suicidal behavior, though this elevation is just short of the level that has been empirically demonstrated to b
e predictive.” None of this seems to be particularly good news.

  Dr. Shearer writes in the Discharge Summary, “The most significant aspect” of my Millon Clinical Multiaxial Inventory-II (MCMI-II) is in the “scale related to aggressive/sadistic personality features.” It’s not just high. It’s “elevated to the ceiling of the profile.” He notes that “such personality features only underscore her difficulties in reconciling the cruelty of others as well as her own cruel and aggressive impulses.”

  Additional data in the report come from notes ferreted in my file by the spying white-suited Mus musculus, who noted that my “narcissistic personality traits” may have contributed to “my considerable difficulty accommodating to treatment,” as evidenced by my objection to “petty” hall rules and “my inclination toward seeking special treatment.” I might argue that failing to accommodate to “milieu therapy” demonstrates an unduly healthy response to the conditions on the unit rather than a sign of pathology. They backhandedly compliment my “fairly well-controlled angry responses.”

  In summary, the Report of Psychological Consultation states that my MCMI-II profile “does not suggest any indication of prominent Axis I psychopathology at this time … although she may have met the criteria for a major depressive episode in the recent past.” In addition, these features, as tested by the 175 true-or-false questions in the MCMI-II, allow Dr. Shearer to conclude that the “most prominent dimension coming out of the test seems to be that of severe personality disturbance, including avoidant, narcissistic and passive-aggressive features.” It’s that fucking “characterologic” word again, this time laid out in more detail. He adds, “PTSD and/or dissociative disturbance certainly deserve continuing consideration in terms of longitudinal assessment.” La-di-da.