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Home » Blogs » Knoll

Psychiatric Times. Vol. 28 No. 11
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TALES FROM THE NEW ASYLUM 

Tales from the New Asylum: Slow Poison

By James L. Knoll IV, MD | November 8, 2011

The prison Christmas party was greatly anticipated by inmates. For a few hours, they were allowed to gather in the gym, sit at folding tables, talk, listen to music, and best of all—eat. But harbor neither outrage nor envy—it was not quality food, but a matter of quantity. And Mr E, every year, had a Christmas ritual. He would thrill his peers by eating ice cream non-stop until the inevitable, and would then emerge from the men’s room with a triumphant look on his face. Not only had he bested his last record for most bowls of ice cream eaten, but every spoonful was strictly prohibited by his renal diet.

Most had given up on encouraging Mr E to be mindful of his kidneys. Indeed, most seeking to do so were made to feel like ignorant dupes in need of remedial tutoring.7 Having become rather comfortable in the role of ignorant dupe, I did not deny nursing’s request that I speak to Mr E about his leisurely, deliberate, self-annihilation. To the best of my unwitting, dupish memory, our session went something like this:

Me: It seems to me that you are slowly poisoning yourself on purpose.

Mr E: Let me cut to the chase, doctor. You will tell me I don’t have to be this way. I will then tell you that I want to! You will then counter: ‘But you don’t have to.’ Then I shall reply: ‘But I will!’ . . . and so on, ad infinitum . . .

Me: So you are resolute . . . in your decision to slowly kill yourself?

Mr E: Doctor, we have discussed this before, and you should know me by now. I’ve read Freud as you know. I am quite beyond the fantasy we feed our children, which we desperately hope applies to us—that some benevolent, well-meaning, caring presence is out there to guide us into the landing strip after our journey.

Me: Okay. So by your actions in life—what are you trying to tell us?

Mr E: What should be obvious. Life is hard. It can be quite unpleasant if we let it.

Me: And why do you need to say this?

Mr E: Much like Caligula, doctor, I have the means to do so.

Me: Well . . . there must be more to it than that . . .

Mr E: Let me put it like this. One doesn’t suddenly wake up in a strange neighborhood, and then simply carry on as though nothing’s amiss. Preposterous! One’s first bit of business is to find out where you are. That is called finding ones’ place in the universe—discovering that one is on a planet that orbits a sun, and so forth. One’s next bit of business is to find out how you got where you are in the first place! That is called discovering evolution.

Me: Okay. I follow . . .

Mr E: So once you have an inkling of where you are, and how you got there, the next big question is ‘why?’

Me: All right. But that is a question for all of us. Don’t you think we each have to search for the answer on our own?

Mr E: There can be no relativism here, doctor. Either there is reason, or there is none.

Me: I think we are engaged in a very fine intellectual discussion, but one that does no work toward getting to why you feel angry and disposable.

Mr E: In the end, doctor, we are all disposable. Perhaps you missed that day of medical school?

Mr E was done with me, and he returned to his Christmas “festivities,” which included perusing a sampling of cold cuts that would soon tax his glomeruli. Mr E had done well in terms of making me feel ignorant, and his reference to Caligula had left me at a loss. Heretofore, all I knew of Caligula was that he had been a debauched Roman Emperor and that some 2000 years later, a very naughty film was made about him.

After a search, I learned that Caligula had also been a play written by the philosopher Camus. On reading the play, a tragedy involving bringing about one’s own suicide, I came upon the following lines:

Helicon: And what is this truth you’ve discovered?

Caligula: People die. And they are not happy.

Helicon: That’s a truth we manage to live with, Caligula. It doesn’t prevent most Romans from enjoying their lunch.

Caligula: That’s because everyone around me is living a lie, and I want people to live with the truth. Remember, Helicon, I have the means of forcing them to live with the truth.

A week or so later, I happened upon Mr E as he sat by himself eating several bags of heavily salted chips. I told him that my interpretation of his Caligula reference involved him searching for meaning in his life. I added that I wondered about how he felt about his “mothers.”

He promptly launched off on a dialectic that likened humans to viruses that have managed to proliferate on a habitable and temporarily accommodating host organism in the “Goldilocks zone” of the solar system. Trying to stay with the affect, I suggested that he was angry over what must seem to him a lack of meaning. Sensing that I may not have the chance again, I added that I had to wonder about the sadness underneath his anger. I was, not surprisingly, treated to a barrage of condescending comments about my therapeutic skills.

His demeanor had been one of bothered disdain, which is why I was surprised to find that he had sent me a poem via prison mail several days later. (Word spreads quickly in a prison, and the word was out that I valued inmates’ poetry.) His poem was attached to a newspaper clipping proclaiming: “Baby Born to Brain-Dead Woman Dies.”8 Mr E’s poem was titled “Life Support,” and read:

Life is like

A baby dying,

Born to a brain-dead mother,

Premature, and unprepared

For the bacterial onslaught.

Might we be the infection

That infiltrates

A planet, born premature

To a universe

Devoid of reason?

Over the next several months, I simply listened to Mr E’s explanations of this poem, his views of the universe, and his take on its meaning. I no longer questioned or challenged him. I simply listened with sincere interest. Nothing monumental hap-pened. He continued to intermittently skip dialysis and follow a diet of reckless abandon. But he did seem to enjoy “educating” me. He became slightly less condescending. He showed some moderate decorum and courtesy on telling the nurses not to wake him for transportation to dialysis. I would like to imagine that he lived these last months a bit lighter for having showed me his version of “living with the truth.”

There is a picture, hanging on the wall of one of my Correctional Officer friends. It is a Polaroid picture of Mr E in the final days of his life. The two of them are flexing their biceps for the camera. Mr E has a broad smile on his face as he appears to be mocking my friend’s genuinely large bicep with his own arm—comparable in size only because it is enormously swollen from many weeks of refusing dialysis. On seeing the picture, it seemed to me that Mr E had become comfortable with his decision, having told his “truth,” and in his own way, found meaning in it.

“I’m so cold, so weary in my abandonment. Go and find my Mother, O Wind. Take me to the house I never knew.”1

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by Henry Altenberg | February 02, 2012 4:00 PM EST

The Sufis say "A pessimist is an optimist with more information."I am an incurable optimist. I agree the pessimist has more informaion, or sees "the truth" more cleary than the optimist. Perhaps the optimist is in denial or simply doesn't obtain "the truth." Nonetheless, optimists have been studied in contrast to pessimists, and the optimists live longer. I also enjoy Samuel Beckett's seeming pessimism when he says, witth an Irish twinkle in his eye, "We are on earth; thee is no cure for that." Beckedtt as a young man suffered from some depression but he eventually overcame it, with some help from a competent therapist and lived to 84, and won the Nobel Prize for Lliterature.
Every so often an Avatar apppears among the human race, such Buddha and Jesus. They each seem to be in touch with Truth. "In as much as you do it for the least one, you do it for me (or for yourself?)."
Whoi is to declare him/herself as the true judge of what is fair or just, or "valuable." I didn't see the movie, Dead Man Walking" but I have read about the nun who counseled condemned prisoners. Perhaps a good model for all of us.

by William Goodman | December 14, 2011 6:31 AM EST

HI James;
I lost your email address in my move to NYC last February. Maybe you'll see this post and give me a buzz at bg14830@aol.com. I've been working at Riker's for a private managed care co. as a private contractor. Interesting contrasts with the state. And I find there are some differences between Corning, NY and the BIg Apple.

DId you happen to see James Woods' piece on the New Essayists in this week's New Yorker? Not that I read it.

Best wishes,
Bill

by Ronald Pies | November 19, 2011 12:52 AM EST

I found Dr. Knoll's piece to be both poignant and brave. And, I, too, am puzzled by the remark about a "waste of resources."Certainly, trying to work therapeutically with individuals like Mr. E. must be taxing and challenging--but is time spent doing so a "waste" of human resources? It seems to me that no effort aimed at listening with sincere interest to a suffering human being is "wasted". There is a saying in the Talmud that comes to mind:

"Do not despise any person...for there is no person who does not have his hour and no thing that does not have its place." [Avot 4.3]

Ron Pies

by James Knoll | November 18, 2011 9:42 PM EST

A fair and relevant comment. Yet how many of us could be considered a waste of resources? Where to draw the line on the continuum of waste - to - parsimony? And is this how human life should be decided? If so, who will make such decisions?

Of course, I could well have misunderstood, and the comment may be referring to the resources used to write and publish this article. If this is the case, I still respect the comment.... ;)

by Carl M. Adler | November 08, 2011 5:05 PM EST

what a waste of resources





Image from the album Slow Poison by The Bravery


 
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