Twice last week I found myself in a discussion focused on “tragedy.” Twice. Perhaps shopping to get a “better” answer? Perhaps to get any answer. I had simply made the statement, “I struggle to grasp the nature of tragedy.” This began with what any clinical observer would term a day of a Verdi marathon of sorts, in eight separate acts 1 ” ; and each act’s crescendo is a stream of “lability”; a seemingly uncontrollable swing in affect – frequently from laughter to tears and back – seemingly contrived, but in actuality, quite genuine.
Act One opened with a stunning onset of gasping, body-wrenching sobs, induced by the seemingly benign question, “What is your date of birth?” I was so rocked & confused by the reaction that for a moment, I was paralyzed; nothing in the form of an intervention came to mind. And thus began the rambling, tangential, psychotic presentation of a “bleeding out,” the other Triple A: abandonment, adoption, and abuse. “I don’t know my real date of birth.” It is exceptionally stressful, embarrassing, and even distasteful to describe the experience of witnessing the human mind ravaged by PCP, methamphetamine, and disease. The intensity of the struggling thought process is, for me, surprisingly painful, while the content, the expressed verbal “madness,” is heartbreaking. You are too young to be this sick! And if I accept the data by which we plot these morbid processes, this course is irrevocable. And now she is sobbing at the cruelty of the Dept. of Corrections for not notifying her “fans” (“And I just love each and every one of my fans”) that she had new housing: “They were outside my old window, holding signs, waving to me and calling me to come to the window. I could hear them, and I was crying; I was helpless.” Exactly 31 days separate her from her “fans,” her law & medical degrees, her singing career, and, of course, her children. Exactly 31 days before her fourth attempt to stay out of prison.
Act Two was a phenomenal window into what Dr. George Vaillant has termed, “the wisdom of the integrated adaptive central nervous system.” The Ego. Freud analogized this inexplicable “mediator” of the warring storms of the mind, the Id & the super-Ego, to Plato’s horseman attempting to “ride two horses at once.” But Valiant concludes:
I believe myself to be a “benign,” friendly presence, but approaching Act Two, she immediately stepped backward against the wall. Once my purpose was explained, she cautiously came into the office, seated herself and slowly began the forward-to-back rocking that would continue until she went home. Probably medication, probably mind, but rocking always strikes me, as an observer, a comforting, even soothing behaviour; like the rocking motion of those at the Wailing Wall, while unconscious, it nevertheless “feels” proper. And slowly unfolded what you would predict in schizophrenia: a flat, rangeless affect; minimal direct eye-contact; delayed thought processing; abrupt, concrete answers. While the ego provides the capacity to “synthesize ideas with feelings”, here, as with so many, the capacity appears absent. “I watched my mother murder my father when I was 10.” And while there are two prisons for women in SoCal, and Act Two has a long and rich history of incarceration, it appears they are deliberately separated. Raped by an uncle, and later gang-raped on the streets. My mind reels with the infliction of such trauma on a child, but she only rocks, with not an inkling of emotion, as if she had told me about today’s lunch. “The ego struggles to cope and reduce the forces that work on it”. My approximate fifth question, “Do you have children?” unleashes a flood of tears and sobbing. Now, I simply wait this out to hear, “My oldest told my youngest ‘Mama is a drunk and I won’t listen to her anymore.’ It would seem foolish – and I suspect pointless – to attempt to “quantify” the psychological impact of murder, rape, or the loss of the respect of your children. The portent of which, however, is realized in front of me. From which horse has the rider fallen?
Suffice it to say that next five acts, to little varying degree, were similar. And I say this to emphasize the impact of this day, not to suggest trite occurrence. But the day ended as far too many end, with the tragic and concluding act. Act Eight was far too young to have the history of developmental disability, psychopathology, lengthy state hospitalizations, court-ordered medication, and violent “incidents” that comprised her story. She was loud, unkempt, eating crackers with her mouth open & spilling onto her shirt as we spoke, and yawning, yawning, yawning. She had a baby exactly 32 days prior to our “visit.” She was zooted to the max on medications (Haloperidol, Risperidone, VPA, Lithium Carbonate, Diphenhydramine, & Trazodone!), required an explanation of each and every detail, and I finally ended up writing out, step-by-step, from the gate to home, what she needed to do in order to meet parole requirements, arrange post-natal care, and find a “dual-diagnosis” drug treatment program. But she is a documented pain-in-the-ass and manipulator, so they want her to “do things for herself.” Schizoaffective, Bipolar Type, with the highest level of developmental disability the CDC can determine, Polysubstance Abuse, and in 19 days will walk off a commercial bus into Compton (You know, “God bless the memory of Easy E,” Compton”) to take custody of her newborn. And before she left, she exercized the “time-honored” prison tradition of “play-you-as-a-sucker-until-proven-otherwise” by mildly asking if she could use the phone to call her mother. Without looking up from my paperwork, “Nope.” She started with the attitude, head bobbing, hands and arms in that gangsta thing. “You won’t lose those papers I gave you, right? Should I put a copy in your mailbox?” “Nah, I’m cool.” And she was gone.
I did not write this with the intention of examining the why’s, the source or inherent responsibility/liability for “outcomes.” In fact, as someone simply confronted with people set before me, the why’s are of no practical significance. My question is how to understand the wreckage, the waste, the tragedy that is before me. My pride, like a Job without righteousness, questions that this is, for now, “beyond my understanding,” and in fact, has a cosmic significance. All tragedy – be it innocent children who witness horror beyond their comprehension, or those I witness as grossly abused in every aspect of their existence – is present for a reason I cannot comprehend, but will ultimately be revealed as sensible, as part of an essential plan, later.
My pride, like Job without righteousness, is impatient. My pride, like Job without righteousness, struggles to comprehend why the opera will begin again in the morning. My pride, like Job without righteousness, seeks justification and comfort for making eye-contact with emptiness and chaos. Fr. John Breck, in the confidence of his heart and in the comforting softness of his voice, once told me that, the greater the tragedy, the more intimately drawn is the presence and hand of God. My pride, like Job without righteousness, needs to believe.
- Note that, while I describe actual patients, on an actual day in clinic, I have been careful in concealing their actual identities. ↩