“You’ll be with your family!” says Sally.
The depressed girl lies in her bed in a granite silence, unignorable yet ignored.
The following afternoon we are informed that in a few days Sally too will be discharged. A social worker, Julian, is assigned to help “facilitate a smooth transition” from the psych ward to the “less supervised environment” of Bank Street. He informs me that prior to Sally’s discharge there will be a meeting with him and Dr. Mason. “It would be best if Sally’s mother could be there. And her brother.” The purpose of the meeting, he explains, is to promote an atmosphere of understanding of Sally’s “changed circumstance,” her “special needs.”
“I’ve located an outpatient program that may be just the ticket for Sally after she’s released,” he says. “I’ll have more information at our meeting.” He has the halting speech of one who has overcome a childhood stammer. Knowing that I am a writer, he bashfully tells me that he too is an artist—a cellist—social work is his backup profession, the freelance life was too stressful, the self-abnegation it required, the raw tests of endurance and nerves. “I guess I caved,” he says.
I take the sympathy that flows between us as a good omen and permit myself to worry aloud about what lies in store for Sally, fishing for tidbits of information that Julian may have overhead among the staff.
“What is it you want for her?” he asks.
The directness of the question jars me, and I hear myself wishing for the return of what has been demolished in her, if it ever really existed. “A center, I guess is what one normally calls it, where she can check on herself, even if she doesn’t pay it any heed.” I wonder if such a basic and ineffable thing can be built, like a prosthetic, or learned through a series of exercises the way one learns algebra or a second language. “If only I could give this to her,” I say.
I reach Robin at her bakery in Vermont. “I’m in the middle of making a wedding cake. It’s like building someone’s dream house. I can’t get the icing right. I’m on my fourth batch, ready to fall off my feet.”
She sounds exhilarated. Her wedding cakes are famous in Vermont. She is a gifted baker, just as she is gifted at most things she turns her hand to.
“How is she, Michael? It’s impossible to get through to her. I dial the number Nurse Phillips gave me and it just rings and rings.”
“They’re discharging her the day after tomorrow,” I say. It hits me how much I have been dreading this: Sally under our sole care. I tell Robin about the family meeting that is to take place prior to Sally’s release. “They’d like us all to be there.”
“I’ll finish the cake tonight and drive down. George will come with me. I want him to be part of this too. To show our togetherness, Michael. To Sally, but also to each other.”
“Of course.”
I hear the whir of her electric mixer. It would be nice to be able to bake, I think, “building” a cake as Robin calls it, erecting this enormous symbolic dessert that will be photographed and enshrined in a leather-bound album, and that will be eaten with music and champagne and applause.
“We didn’t have a cake at our wedding,” I remark.
“We weren’t thinking about cakes.”
True enough. We were preparing for Aaron, who would be born in less than a month. Robin’s wedding gown was a maternity dress. Our wedding was for him. Our part in it was an afterthought. We were an afterthought, even to ourselves.
In the morning I wake Aaron in his student house in Schenectady.
“I’ll be there, Pops. I’m glad she’s getting out of that place. She doesn’t belong with those people. The sooner she’s home, the better.”
We meet up with Robin and George at a coffee shop near the hospital, George in shorts, sandals, a green chamois shirt, the two of them cleaved together in their window booth, a display case of marital harmony.
“Sally’s way out there,” says George. “But hey, so are a lot of great people.” He’s a minister’s son with an enduring interest in mysticism, football, and ganja. The sticker on the tailgate of his Ford pickup says: A Good Patriot Must Defend His Country Against Its Government. It was startling to note, the first time I saw them together, how much more suited than I George was to being Robin’s husband. She seemed more sure of herself with him, less surrendering and dreamy. It became clearer than ever to me that I had thwarted her in some way, exhorting her to stick to painting, though the pressure to be an artist was obviously disturbing to her. I couldn’t accept the fact that Robin was so nonchalant about her natural talents, while I was struggling to figure out whether I possessed any at all.
Out on the street several men with pneumatic drills are tearing up the pavement—a painful racket that during her previous visit would have made Robin cower. In the company of George, however, she appears to be oblivious to the noise and immune to the cement dust that comes swirling at us as we leave the coffee shop and head to the ward. George clearly adores her, clasping her hand, deferring to her intelligence, admiring her in a way that I, for all my keenness for Robin, never did.
Pat, as always with those with whom she feels instinctively at odds, is impenetrably friendly. “You must be exhausted after your trip,” she says. “I can imagine how difficult it was for you to get away.” Her pleasantries don’t ask for a reply. It’s as if she’s watching us through a fencer’s mask.
We ride up to the ward, where Aaron is already sitting on the edge of Sally’s bed, his hands planted firmly on her shoulders, delivering what appears to be a coach’s pep talk. “You can get past this. You’re a strong girl. The strongest. The best,” he says, his eyes boring into her with an earnestness that breaks my heart. If only such exhortations could sway her. Turning to us, he says, “I was just telling Sally that when she gets home everything will fall into place. She’ll have her independence again. We’ll get your room ready, Sally. We’ll make it special. You’ll forget you were ever in this place.”
“A new day,” says George.
“Amen,” says Robin.
Hugs all around, as Sally looks on, restless and glazed.
Her roommate lies under our radar, bundled in her mummy sheets exactly as she was the last time I was here. I notice the eyes of the others drift over to her, taking in the weight of her presence.
Julian pokes his head in. It’s time for our meeting. He leads us through the hall and into a small locked conference room or lounge.
On the table is a copy of the New York Times.
A pipe bomb spiked with nails and screws shattered the Summer Olympic Games today in Atlanta, transforming an international event of sport and fellowship into a symbol of the dark side of modern life.
The six of us sit down like people assembled in a courtroom waiting for the judge to emerge from her chambers and take her place on the bench.
Sally supplies the soundtrack, her left leg in a continuous shudder, her foot tapping the floor at lightning speed.
“Do you have children?” she asks Julian.
“As a matter of fact, I do, Sally. I have a daughter. She’s almost two.”
“The age of genius.”
Dr. Mason comes through the door, greeting us as a single entity with a sweeping nod. “Good. You’re all here. How do you feel?” she asks Sally.
“Like I’m packed in foam rubber.”
“That’s not surprising. You’re still getting used to the medication.” To us she says: “I like Sally’s answer. It shows she’s thinking outside of herself. She’s shifting away from the literal-mindedness of psychosis where a person is not like God, he is God. Mind you, I’m not saying Sally ever thought she was God. I’m just giving the most obvious example. Do you have any thoughts about what I just said, Sally?”
“Have you decided whether I’m crazy?” she asks.
“‘Crazy’ is a word we prefer not to use,” says Mason.
Sally’s foot tapping continues, like the ticking of a rapidly turning wheel.
“This will pass when the haloperid
ol is adjusted,” says Mason.
“When will that be?” I ask.
“That’s a matter for Sally’s outside doctor to deal with.”
I worry aloud about the extent to which the medication will change Sally over time. “It seems to be killing more than her psychosis.”
“Well, yes, Mr. Greenberg, the medication is changing her. That’s what it’s supposed to do. There will be side effects, of course—sluggishness, some blobbing perhaps.”
Beneath her supremely authoritative surface, I sense the resignation that settles on many clinical psychiatrists after a while, like a dull professional coating: the tacit, almost visible shrug that says, This is all I can do for you, which is the psychiatrist’s cross to bear. It’s easy to imagine how dispiriting it must be to administer a series of unrewarding treatments that have not progressed much since Lady Macbeth’s doctor observed: “This disease is beyond my practice…More needs she the divine than the physician.”
Aaron wants to know if the average person on the street will be able to tell that Sally is on medication.
“She won’t be doing the Thorazine shuffle, if that’s what you mean. But will she be the most normal-looking person on the A train? Probably not.”
“How about on the 1 train?” asks Pat.
We laugh, Sally the loudest.
“At fifteen one’s personality has not yet crystallized,” says Mason. “Adolescents go through phases that feel…transformative. There are so many possibilities, so many roads not taken that may still present themselves to Sally. We don’t yet know her baseline, so I can’t tell how close to it she is now.”
Sally’s baseline: one’s median behavior on the mood chart. (Who created this chart? And how can its accuracy be gauged?) The word has a strange power. If a runner strays from the baseline he is automatically ruled out. Is the return of Sally’s baseline what I’ve been waiting for all these weeks? Or is Mason referring to a new normal that I haven’t encountered yet, but will recognize when it makes itself known?
I look at Sally sitting across the table between Robin and Aaron, depressed or elated or in a mixed state that includes all moods at once. How would I know? She has been wrenched from the severest form of psychosis—exorcism by drugs, just enough for her to go home. But what else has been achieved?
“When she gets home don’t put pressure on her,” advises Mason. “Give her time.” And turning to Julian, she says: “Do you remember the girl whose parents said, ‘When you come home you can do this and this,’ and they listed a whole calendar of activities they had set up for her, and she said, ‘Yeah, all the things that put me here in the first place’? That was just perfect.”
I feel as if she’s just punched me in the face. With a look, I appeal to Julian who strikes a neutral, slightly embarrassed pose, not wishing to endorse Mason’s comment, but wary of antagonizing her. Until now it has been a matter of tacit medical agreement that Sally’s illness is purely a case of neurotransmitters that have gone haywire. However, Mason, in an unguarded aside that seems to represent her true belief, has blamed us for Sally’s condition. The humiliating assumption is that when we take Sally home she will be returning, in the parlance of mental hygiene workers, to “a situation that is not working.” As the architects of this “situation,” we are promoters of psychosis. We are guilty on both counts, it seems, nature and nurture.
By now, my hopelessness about a medical solution is complete.
Finally, Mason delivers Sally’s diagnosis. Ostensibly, this is the purpose of our meeting, but she treats it as if it is an item on an uncompleted form that must be filled in and filed. She pronounces Sally “bipolar 1,” not because she places great store in this diagnosis, I think, but because Sally has to have a label, an identity card to carry her through the mental health system, and bipolar 1 will do.
In fact, it is the diagnosis I have been hoping for, because its social weight is lighter than the other diagnosis, the doomed diagnosis, schizophrenia. Manic depression (as bipolar 1 used to be called) is the affliction of Byron, Robert Schumann, Virginia Woolf—the disease of exuberance, of volatility and magnetism and invention. If only I believed this.
“I would call Sally’s case classic,” Mason says, “except for the fact that she is a tad young to be presenting in such an…adult fashion. The initial manic episode doesn’t usually occur until the patient is in her twenties. The prognosis for adolescent onset can be less optimistic, but there are no rules…”
Her tone of voice suggests that she has already left the room, which she promptly gets up to do, the legs of her chair scraping against the floor as she rises. “You’re going to be fine. Things will work out. Trust your doctor. You just need to follow the program.”
There is a momentary vacuum after Mason leaves.
“Quite a piece of work,” says George.
Robin sighs, as if to indicate a collective release of tension.
Encouraging and nervous, Julian says: “I’ve received a green light from the outpatient program, so when you leave us, Sally, you won’t be stepping into a void.”
He announces that we must draw up a “Wellness Contract,” a set of guidelines to follow when Sally returns home. “It’s a contract between Sally and you, her caregivers,” he explains, removing a yellow legal pad from his briefcase and setting it on the table. “You’ll find it helpful to have these things spelled out in black and white. It’ll give Sally something to work toward, a feeling of progress. A goal.”
On the pad Julian scratches out a twelve-step style list of declarations.
Manic depression is a biological illness. I cannot make it go away because I want it to go away. But I can manage it and keep it under control. How can I do this? Take my medication and take responsibility for my treatment. No drugs or alcohol. Ever. What will happen if I follow these rules? Little by little I’ll gain more and more of the independence I want and deserve.
We negotiate what this “independence” will entail, hashing out the details, a series of punishments and rewards modeled on the five levels of privilege on the psych ward’s erasable board. Except that from this point forward the “ward” will be our apartment on Bank Street. Sally’s demands are desultory and unclear, as if the idea of leaving the hospital is unreal to her. The immediate future doesn’t exist, only the fantasy future of perpetual childhood and genius—Sally’s ultraviolet utopia. “Okay, okay, I’m sick!” she says, and with an abrupt, almost cheerful flourish she signs the contract and slides it across the table in my direction. I sign it too, as do Pat, Robin, and George.
Aaron abstains, in order to maintain his status as Sally’s “peer and confidant.”
We shake hands like diplomats. Sally will be discharged at 10:00 A.M. tomorrow. The Wellness Contract, with its grade school wording, is what we have to guide us.
1) Visits at home of fifteen minutes with one friend at a time.
2) Trips outside of fifteen minutes in the neighborhood on my own.
3) Longer visits with a friend at home.
4) Longer trips in the neighborhood on my own.
5) An overnight visit with a friend at my home.
If I am trustworthy and continue to recover, I will be able to move to the next step, one step at a time. If I am not trustworthy, I will move backward.
“Attach it to your refrigerator door,” says Julian. “Try to be patient. You’re doing everything right. Do you want to go home, Sally?” he asks.
Sally nods abstractedly. Then she laughs, a clipped staccato eruption, her eyes magnified and shiny, yet narrowed in their new menacing way.
We head back to Sally’s room at the far end of the ward.
“I don’t like Julian,” says Robin. “He gives me a creepy feeling.” George takes her arm. We pass a long row of half-open doors. “Now I understand why we couldn’t handle Sally when she lived with us in Vermont,” she says.
When we reach her room, Sally announces that she wants to be alone with Aaron.
The rest of
us wait in the hall, George and I smiling helplessly at each other, Pat silent, Robin teary and warm. She’s thinking of buying their neighbor’s horse, she tells us. “She’s a chestnut, a Morgan, just like Pepsi,” she says, naming the horse that her parents kept on their Vermont property when I first met her.
“I’ll have to build a stall for it,” says George.
Aaron emerges from the room with Sally, his arm draped around her.
“I love my brother,” she says. “My big brother. He still has a chance.”
“I sure as hell hope so,” says Aaron.
Sally goes back into her room. “Leave now. I want to be alone.”
We say our good-byes. George will have to return to Vermont tonight, but Robin offers to remain in New York for a few days.
“I’ll stay with my aunt and uncle at Westbeth, if you think it will help,” she says. “It’s only a few blocks away from you.”
“That will be great,” I say, surprised and moved.
Pat concurs, softening.
“It’s not all on your shoulders, Pops,” says Aaron. “You won’t have to deal with this alone. You have all of us.”
Robin nods with feeling, and she and George depart on a wave of good cheer.
Fabulosa, wandering along the hall, spots Aaron and, with a wild cunning, swoons dramatically to demonstrate her infatuation with him. She lifts her shirt, showing snatches of a raw and violent nakedness.
Aaron plays along, instinctively kind, even though he seems jittery and baffled.
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