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Real-life case studies - Jim, Eddie and Jack
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Real-life case studies - Jim, Eddie and Jack

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Posted by Jan den Breejen on August 31, 2000 at 03:43:16:

Real-life case studies - Jim, Eddie and Jack

Case text:

This case study text is extracted from the autobiographical book
'Quitting the Nairobi Trio'(2000), by Jim Knipfel.

Living in an un-normal world.

There's a song Gene Wilder sings in Willy Wonka and the Chocolate Factory that goes, in part, "If you want to view paradise, simply look around and view it." Wilder, who plays the role of the candy magnate Wonka goes on to sing, "There is no life I know to compare with PURE IMAGINATION. Living there, you'll be free. if you truly wish to be.'. Wonka suggests that children CREATE AND INHABIT THEIR OWN HAPPY WORLDS instead of being satisfied with the UGLY REALITY (the E4 theme of 'ugly plastic world'; jdb) of the world presented to them. I never took his advice. Not intentionally, anyway. I preferred the ugly world. Fact of the matter is, it wasn't until I was in my twenties, and saw the movie for the eighth or ninth time, that it struck me that Willy Wonka was actually condoning and encouraging SCHIZOPHRENIA as a viable lifestyle option. Most people tend to get creepy and nervous when I offhandedly mention that I've spent a goodly amount of time in the bughouse. I can understand that and can also understand that it's not their fault. Life in the bughouse is a topic most normals don't care to face - especially since most everything they know about mental
institutions comes from movies, television, and the occasiona1 book about the subject. One thing these documents rarely admit though, is that there are a few folks who (maybe just because they're insane) honestly enjoy being where they are, and would never want to leave. I have run into more than a few such individuals, actually, through my own travels in and out of these places. I, for one, enjoyed my time on the locked ward. I was in the intensive care unit of what I'll call the Minneapolis General Medical Center, strapped to a bed in a small room whose walls were formed by stiff gray curtains. There were clatterings, beepings, mixed voices, the rolling of metal wheels on tile floor.

At least the guttural Gennan that had woken me had faded. IT HAD TAKEN ME A FEW MINUTES TO REALIZE THAT IT WAS MY OWN VOICE I'D BEEN HEARING, YELLING in a language I hadn't spoken in two years. '..In jener Gegend reist man jetzt nicht gut!" had erupted out of my mouth, as my surroundings finally bled into cohesion, earlier that day. "Und hast du Geist, sei doppelt auf der Hut!" I was screaming Nietzsche, I soon realized. Worse still, I was screaming Nietzsche in rhyme. "War ich krank? Bin ich gewesen? Und wer ist mein Arzt gewesen? Wie vergass ich alle das!" I could feel needles in both arms. I also felt as if something long and narrow and sharp had been inserted into the end of my penis. Something was wrapped around my wrists and ankles. I'm in a hospital. I'm screaming in German. I'm in a hospital, and I'm strapped down and I'm screaming in German, by God - I must've finally gone completely insane. That quick epiphany filled me with a strange sense of relief and near-delight. If I'd gone insane I'd be able to spend the rest of my days in an institution. As long as I continued to say funny things I'd be fed. I'd have a place to sleep. I'd have the freedom to spend my time doing whatever I pleased, saying whatever I pleased to anybody, so long as it made no sense. I had it made. Not only would I
finally be rid of the USELESS, REPETITIVE DAILY OBLIGATIONS THAT COME WITH LIVING IN NORMAL SOCIETY that come with living in normnal society, I'd join the ranks of the great VISIONARIES whO died in madhouses, like Artaud and the Marquis de Sade.

Unfortunately everything caught up with me then, and I realized that being able to think such a thing meant that I wasn't insane at all. I'd only tried to kill myself again. Mishimna I was not, however.

Examination (Intern's Notes: handwritten, unsigned) 22 w.m. brought in by MPD after beingfound by apt. manager WANDERING IN THE HALLS IN CONFUSION. Problem: SUICIDE ATTEMPT. 10/85 wrist slashing. But claims other suicide attempts also. Confused on many details not substantiated. UNSURE OF CITY HE IS IN -"Is this still Minneapolis?" Thought that people were walking through walls "like GHOSTS" in the ER. He claims he's always had DISJOINTED THOUGHTS. Tonight he is CONFUSED AS TO WHAT HAPPENED, but claims he drank one beer; took 4 No-Doz and some aspirin, denies other drugs or attempted suicide. However; he claims he "feels suicidal every day" and besides the cut wrists has also tried "hanging," "drinking chemicals," "throwing myself down stairs." The patient is a university student working on a Ph.D. under stress lately. 4 weeks of the quarter left, 3 seminar papers due, also working on a paper on schizophrenia and grading tests.

- Clinical Summary: The patient is to be transferred to MMC Psychiatric Service. Mental status examination revealed that he did very well in memory, serial 7's, calculations and current events, with a wide vocabulary and appropriate interpretations of proverbs. His attention span was brief, and he did seem NERVOUS, and at times seemed to be PICKING AT THINGS AND SEEING THINGS THAT WERE NOT THERE...

In a very short time on the ward I fell into a regular daily pattern. Up at 7, shower, dress, and make the bed. Move out to the day room about 7:30, read untill, when the breakfast cart showed up. Eat, decide what I wanted for lunch, fill out the card, and turn it in. Read some more, maybe even talk to someone until lunch showed up at 12:30. Then do the same until dinner. Then do the same. moving back to my room at about 9 to go to bed. It was that kind of self -enforced strict, Germanic structure that made the days pass as painlessly as possible. I found it comforting, even relaxing, if a little dull. (I saw a doctor once a week, on Saturday momings, for 10 minutes. The doctor was gauging my progress. Back to sanity.) Before I ended up here, when I was still living in the modern world, every day had been filled with potentially disastrous MISCHIEF - DRINKING, STEALING, FIGHTING, grading student papers. And while there was certainly a romantic appeal in choosing to live that way, it was nice to take a break from it now, catch my breath a minute, before stepping back out into it again.

I just had to enjoy my time and wait until my doctor realized he was wrong about me. Much of every day-much of everyone's day on the ward, in fact-was given over to waiting. Waiting for meds. Waiting for smokes. Waiting for breakfast, or lunch, or dinner. Waiting to see the doctor. Waiting to go to sleep. Waiting for the screaming to stop. We were a roomful of Estragons and Vladimirs. I became fascinated, even obsessed, with the process of waiting while I was first STUDYING PHILOSOPHY - existentialism and phenomenology mostly. As an undergraduate at the University Of Wisconsin I'd DONE A LOT OF THINKING about waiting (schizotypical persons can get focussed on a detail-subject of study and endlessly pondering on how to solve the logical puzzle; jdb). Usually while waiting. I'd sometimes intentionally arrive at appointments half an hour early just so I could wait. Instead of letting it be the tedious and frustrating ordeal it seemed to be for most, I'd turned it into an exercise. In the NOTEBOOK I ALLWAYS CARRIED WITH ME back then, I'd chart the ebb and flow of anticipation-trying to guess when the person I was waiting for was going to arrive, or noting the exact moment at which I realized they weren't going to show at all. Most of the time they didn't. The conclusion I eventually came to was that waiting, however frustrating it could be at times, was essentially an optimistic act. If you're waiting for something, you're harboring the hope and the belief that something is going to happen. If you didn't believe that, you wouldn't bother waiting-you'd just go home and make yourself a sandwich. Here, now, behind the locked doors, if there were nothing else to keep me occupied, I could make a game out of waiting. Well, a game of sorts. I would focus all my attention-as subtly as possible, so as not to raise any undue suspicion -on a single patient (VOYEURISM; being characterisitic of some E5 characters; jdb). REGISTER EVERY MOMENT, every sound, everyword and
gesture. It was my own, quiet way of getting to know everyone. None of it meant anything, and it rarely revealed anything remarkable, but it was a way to pass the time. I was sitting at a table, occasionally looking up from my book to watch the slow and steady line for cigarettes and meds, often both. This was a line I was hoping I would never have to stand in. I considered it a couple of times - walking over and waiting in line with the rest, just as a change of pace, just for yuks, but I allways talked myself out of it. What the hell I would I do when my turn came? l'd just look foolish, and end up with another notation in my file: Patient waited in line lor no apparent reason. I counted eight in the current procession.

There was a greasy and UNPLEASANT PARANOID LITTLE CREEP l'll call Eddie near the front. Behind him was a fellow l'll call Jack, whom l'd begun to like. He didn't bother anybody, and I was finding I could talk to him, at least until the Haldol kicked in. The problem with trying to have a simple conversation with the other patients, about the weather or the food, or their lives, was that most of them simply wouldn't talk to me. They would stare at the ground, or the table, or their hands, and remain perfectly silent. At most they'd make uncomfortable, quiet meeping noises. Others would only deign to speak to a single chosen pa- tient. Those few who would talk to me often never knew when, or how, to shut the hell up. Eddie the Paranoid, as I called him, had come over to me the previous afternoon, my fourth day on the ward, to strike up a conversation. I thought at first it was a friendly gesture on his part. None of the other patients except Jack had said so much as hello to me. I hadn't spoken to anyone, really, apart from various humorless doctors, nurses, and social workers, since l'd arrived. The "conversation" with Eddie quickly began to spiral out of control. Once his CLIPPED, RAPID-FIRE DELIVERY (spit out between quick drags on bis unlit cigarette) sped past the fact that he was the one who had shot Kennedy, the continued influence to this very day of the Trilateral Commission, the POISONS THAT WERE SLIPPING INTO OUR FOOD, the fact that the nurses and orderlies were ALIEN OPERATIVES, and how a transmitter had been implanted in his brain by the CIA, he started talking about clothes. The Trilateral Commission and aliens I handled fine, even enjoyed. I'd long been intrigued by CONSPIRACY THEORIES, especially the particularly outlandish ones.

But I'd never known anyone worth the time of day who'd ever had the patience to tolerate hour-long monologues about clothing. Such people may very well exist, but if they do I don't care to hear about them. "Most people overlook socks," EDDIE MACHINE-GUNNED. "Most people don't understand socks, y'know? Cover your feet and that's all, they think, y'know? But the material means everything, see? The material." He continued sucking frantically on the cold butt as he spoke, pretending to tap the ashes off the end every few minutes. IT WAS A TORTURE. "Look, Eddie," I said finally, "I'm gonna read now, okay? We'll talk sometime later." "I'm not finished yet," he said, annoyed by the interruption. Then he continued. He went on from socks to the importance of pockets, back to the CIA, until the dinner truck showed up, nearly three hours after we'd begun our little chat. I was left nearly too numb and too exhausted to eat. I learned later that Eddie was only talking to me because nobody else in the room would let him sit down anywhere near them. No Eddie today. He stood there in line in front of Jack, HIS EYES SCANNING THE ROOM. His eyes would pause on me with each sweep, and narrow. But he stayed in line. It had been an easy day so far. Then I heard the first hoots and saw the first body slam hard against the Plexiglas window of the television room. I looked over to see what was happening, and found that everyone in the room was jumping up and down on the chairs and couches, flailing their arms, screaming with a strange mixture of glee and outrage.

Up on the television screen - which I glimpsed only briefly between the flying bodies - two men in garish tights were throwing each other around a ring. I glanced over at the nurse's station. Nobody seemed to be paying attention. Jack swallowed his pills, got another cigarette, and returned to his regular table in the middle of the room. Jack was an older, heavyset guy, his thinning white hair neatly combed straight back from his wide forehead. To first look at him, even talk to him, most people would probably say JACK was perfectly normal. More than that, even. Jack seemed like one of those people -a rough character maybe, a tough guy, but one who could flow through life like water. Jack had been an ELECTRICAL ENGINEER, I'd discovered, until he started HEARING THE VOICES. One day the electricity itself started whispering to him as it coursed through the wires, telling him how to do his job. He was a nice fellow, even now, but the medication slowed him down a lot. Mostly he just smoked and waited for the next meal to roll around, like everyone else. He'd get out one day, sure, but he didn't seem to much care, one way or another, when or if that ever happened. Jack seemed pretty satisfied to be wherehe was now. He was glad not to be hearing voices anymore, that's for damn sure. "Hey, Jack," I said, and pulled up a chair next to him. He was keeping an eye on the TV room too. "Hey there, Jim." "Hey, so, what's going on in there?" I nodded toward the miniriot. "Wrestling. Drives 'em crazy every time." "Jesus, huh?" I figured it was best, especially after he'd taken his pills, to keep the conversation simple. "Yeah, you said it'. JACK NEVER LOOKED AT ANYONE HE WAS TALKING TOO. We both sat there a minute and watched as a sofa cushion bounced against the window, then fell back to the floor.

"Why do they let'em watch it if it does this to them?" Jack thought about this for a long while. "Oh, guess it don't hurt 'em at all. Lets off steam. Better than going after the nurses, huh?" He made a grunting sound that I think was supposed to be a chuckle. "Yeah, I suppose," I said, a little doubtful. "Besides," he went on, slowly, working his latest cigarette, trying to make it last, "they always keep it in there, and they always pick up afterward. Quiet for a week afterward."And nobody's been killed yet?" "Naaahh..." He dragged it out. "They got too much in 'em to hurt each other too much." I presumed he meant medication. He was silent again for a moment. "I still wouldn't go in there if I was you." "Oh, don't worry about tbat." I was quickly finding that Jack was a good person to talk to. "Well then, thanks," I said, standing back up, not wanting to bother him too much. "I was just curious." "Yeah, fine," be said. I went and took my own now-regular seat again, moving it around so that I could get a clear view through the window of the TV room. It was impossible to tell how many people were in there, exactly, given the dim light and tbe commotion, but there were at least five or six of them. From the glimpses of tbe screen I was able to snatch between the flopping bodies, it appeared tbe patients in the room weren't just jumping up and down, cheering their favorite wrestlers and damning the villains; they were literally acting out everything they saw on the screen. More slowly, of course, as a result, I guessed, of the drugs. I saw
evidence of most every headlock, and bumbling approximations of every body slam.

I bet that's why the walls are carpeted, I surmised. An hour later, after the show bad ended, the TV room was quiet again. The only motion now came from the patients -as Jack had predicted- picking up sofa cushions and moving chairs back into place. I couldn't wait to see what happened wben Ice Capades or Wild Kingdom came on.

+++ Jan's analysis

I've allways thought of Alice in Wonderland being a kinda virtual experience of an Idiosyncratic/schizotypical style character: Alice. Now I can see that there are more of these movie themes: Willy Wonka, Heavenly Creatures, Truman Show, Alice in Wonderland, Sixth Sense. All of these movies show persons who live in a un-normal fantasy world which they often prefer above the ugly plastic real world; for which they seem to sensitive and because of their introversion they can't grapple this 'real'world very well; hurting themselves emotionally and physically.

Let's take a look of the characters in the case.

Odd and aloof behavior, depersonalization, spiritless look (photo), prefers privacy and isolation, thoughts of life's emptyness and meaninglessness (causing suicidal inclinations), bodily illusions, magic thinking. Diagnosis: Idiosyncratic Style.

Suspicious, conspiracy theories, vigilantly scanning, alert, quick to take personal offense and react angrily (when Jim wants to end the conversation), far fetched assumptions (aliens), unyielding convictions. Diagnosis: Vigilant/paranoid Style (disorder.)

Hearing voices, apathetic, joyless, self-absorbed, no eye contact. Diagnosis: Idiosyncratic/Schizotypical Style.

Comments anyone?


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