Tales from the New Asylum: Slow Poison

Psychiatric TimesPsychiatric Times Vol 28 No 11
Volume 28
Issue 11

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

Life presents immeasurable challenges as we stroll down its enigmatic walkways. Hopefully, the challenges do not become too difficult until we are sufficiently introduced to reality and the resources we will need to understand, adjust, and accept. By challenges, I refer to the more serious variety-loss, illness, trauma, and the like. Let us begin with an analogy, which Freud noted “decide[s] nothing, but . . . can make one feel more at home.”

Take the practically folkloric tale of the baby left on the doorstep. Now here is a precarious way to be welcomed onto the planet. Does such a thing actually happen in this day and age? I submit to you that it does.2 But let’s look at this from the point of view of the newly embodied consciousness. First, there is the prob-lem of immediate survival-will some benevolent soul open his or her door in time, before the small, fragile flame is extinguished? Next, yet another hardship awaits; one is likely to be whisked away by Child Protective Services and spend critical developmental years in a series of foster homes.

Forgoing the odds of encountering “good enough” nurturance in a state-run foster home, let’s assume our doorstep protagonist encountered a bit of good fortune. His stars temporarily aligned, and he was raised in a decent, middle-class home by a married couple. In fact, they raised him well enough that he excelled in academics and obtained an advanced degree. He exceeds everyone’s ex-pectations and is rewarded with a job in a government think tank, where his knowledge of economics and philosophy is valued and relied on. Despite overcoming slanted odds, he nevertheless finds himself apart from others. He finds it hard to relate to them outside of work, and they, in turn, find him difficult to “warm up to.”

His source of self-esteem-his vital energy-derived from his impressive intellect, as well as his ability to work long hours with little need for “leisure” time. This stabilizing energy was abruptly cut off when our protagonist, Mr E, developed a severe, progressive disease that set about shutting down his kidneys. Without work to sustain him, he found himself with an excess of time to spend around his now elderly mother.

It takes a certain intellectual courage for a man to frankly recognize that he’s nothing more than a human tatter, an abortion that survived, a madman not mad enough to be committed; and once he recognizes this, it takes even more moral courage to devise a way of adapting to his destiny, to accept without protest and without resignation, without any gesture or hint of a gesture, the organic curse imposed on him by Nature.

-Fernando Pessoa1

Perhaps it was she who had originally fostered his interest in philosophical debate, for they both began to engage in an unrelenting, bitter exchange of sentiments. There was to be no true resolution to their debate, as Mr E ended it decisively one evening with a point his mother could not rebut. He then placed her body, not on a doorstep, but in an alley in a plastic trash bin. Focusing primarily on the manner in which Mr E chose to deposit his mother, the court sentenced him to life in prison.

When I encountered Mr E, his end-stage renal disease was well advanced. He required regular, 3-days-per-week dialysis-a medical intervention he concluded was an indignity and a torture. The fact that nursing staff had so far managed to convince him to make the routine trips to an outside hospital should qualify them for the highest honors in nursing. I began seeing Mr E for his chronic treatment refusals, depression, and talent for alienating himself from peers and staff. But what seemed to upset medical staff the most was his refusal to adhere to his renal diet. Since the term “nonadherent” is really not a fair description, I shall be blunt. Mr E used his renal diet “do not eat list” as his main menu. Blocks of cheese rich in calcium. Chips chock-full of sodium. Sausage stuffed with . . . well, you get the idea.

Years of subjecting himself to routine dialysis treatments had taken a toll on Mr E.3,4 He had grown weary of the tedious, never-ending purification of his blood. Yet what seemed to displease him most were the austere limitations placed on his diet-eating being one of his last enjoyable refuges. Labs reflecting failing renal function held no sway in Mr E’s court. He was openly blamed for worsening his own condition.

There were even some who were not the least bit upset by his dialysis refusals. Their view: why even give him the option of having dialysis? But alas, in no area of medicine do we refuse treatment for those suffering the consequences of their own bad judgment.5 If this were the case, a very generous proportion of us would forfeit all future health care. Let him who is without any physical vices cast the first “double down.”6

One of the main reasons I enjoyed listening to Mr E was his ability to argue points on an intellectual level that kept one’s mind in constant vacillation. It was not uncommon to find one’s head nodding in semi-agreement. He was, after all, a philosopher’s philosopher. Not only that, but he had a life sentence-and was doing everything he could to shorten it. This alone made him fascinating, as he carried about him a blatant aura of indifference to life itself. He knew he was not long for this world, yet he had the attitude of an annoyed patron waiting for the valet to hurry up and bring his car around . . .

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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