September 10, 1991
To Whom It May Concern:
This letter is to substantiate that Cree LeFavour is undergoing a severe medical emergency necessitating immediate hospitalization.
Sincerely,
Adam N. Kohl, M.D.
Dr. Kohl laid my options before me like richly patterned carpets I might wish to go home with—or not. That was the day I blew the contract I’d signed a month or so prior: my promise to stop burning. In writing, in my file, was an impossible-to-dispute paper. I’d agreed that if I did burn myself even one more time I would go to a psychiatric hospital. Or never see him again. It’s not even a close contest. My profound attachment to Dr. Kohl makes my choice simple. I’ve agreed to check myself in.
If I don’t sign the voluntary admittance papers once I arrive at the hospital in Baltimore, if I prefer not to board the plane, Bartleby style, just one glance at the mess I’ve made of the skin on my arm will be enough for Dr. Kohl to rally any two psychiatrists and a judge in either Vermont or Maryland to agree to an involuntary commitment, otherwise known as a civil commitment. This, he argued, will happen whether I decline to admit myself or sign myself out once I’m in. A stay there is the only way to return to Dr. Kohl for treatment. He won’t see me again unless I stay as long as I need to and earn honorable discharge. Then, and only then, can I come back to him at 112 Church Street to sit in my favorite chair. That was his play anyway; I’ll go if I can have him.
This mess I’m in, sitting up through the night waiting for morning, playing with fire while I still can, began with ruthless scientific clarity a bit over a year ago. That was the day of my first appointment with Dr. Kohl. I went to him because I was a bulimic, unhappy, confused twenty-four-year-old. What I wanted, though I couldn’t admit it to myself when I walked into his office for the first time, was for someone to recognize I needed help. The bulimia was just an excuse to get myself in the door; what I yearned for without expecting to find it in Dr. Kohl was an inchoate balm to soothe the lack I felt. I never once believed it was a thing that could be made, found, or bought.
For too long, as long as I can remember, I’ve been uncertain whether the effort to keep going day after day is worthwhile. Although there have been many times when I’ve felt alive and happy to be so, the older I’ve gotten the more exhausting it has become to don an acceptable disguise to present, one convincing enough to keep people from recognizing the odious, unworthy, deeply unhappy person beneath.
In going to a psychiatrist I feared seeking attention, asking for what I didn’t need or deserve. Part of me still believes there’s nothing wrong with me, or nothing self-discipline can’t fix. The cycle of self-loathing goes on and on, part of what Freud called the “compulsion to repeat,” in which the drive toward the inevitable end takes on a dark, unruly pattern. I’m more confused than ever about who I am and what I want, and yet in some form this feeling has been with me as long as I can remember. Maybe there’s something fundamentally off and unfixable about who I am that makes me want to escape. What’s worse is that some part of me likes it—a familiar masochism deep within relishes how special this shitty core makes me feel, how different I am from everyone else because of it.
My mind was less right than it ever had been when I asked for that first appointment with Dr. Kohl. My dreams were blurring the line between sleeping and waking, and the scary hallucinatory essence that followed me out of slumber was closing in on the day. Reality was slipping, nudged out by the presence of an ungainly force pressing against me.
Maybe that’s why, when Dr. Kohl asked me on that first day, “What’s your greatest fear?” the answer formed like a memorized line delivered slightly off cue, a beat too fast.
“Losing my mind.”
Taller than me—and I’m six feet—he’s trim, well proportioned, and wears what most upper-class East Coast males wear at leisure: soft earth-tone sweaters, button-down shirts in subdued blues, khaki pants, and plain leather lace-up dress shoes. My father dresses much the same way. Dr. Kohl is precisely put together and comfortable in his body, never fidgeting or shifting his penetrating gaze to escape mine. His brown eyes communicate a dangerous intelligence and sensational warmth. His plain brown straight hair is cut short. He has no scent—or maybe I’ve never gotten close enough to discern any. Being in his presence is to be recognized. From the moment he called me in from the waiting room and closed the door behind us that day I wanted what he had—a centered self.
His corner office occupies the ground floor of a two-story white-painted brick building in downtown Burlington. Three other psychiatrists share the building with him. The efficient receptionist answers the phone and writes out names, times, and dates on the doll-size appointment cards she hands to patients. She is master of the blocks of minutes that are transmuted into sessions she types out as billable hours on a humming dusty-blue Smith-Corona. The receptionist’s handling of the grubby business of dispensing bills and collecting checks made out to Dr. Kohl confirms Freud’s observation that “money matters are treated by civilized people in the same way as sexual matters—with the same inconsistency, prudishness, and hypocrisy.”
Where we sat that first day and in the year and two months since, the space I’ll find tomorrow before I leave for the airport, is tasteful and understated with a worn couch upholstered in Bing cherry velvet positioned under a wide horizontal window. I sit on the leather swivel chair facing him. His broad desk angles away from the wall, its position blocking any view of the framed photographs there. A side table with a clock and a box of tissues separates the couch and my beloved chair—the one I’ve collapsed into session upon session right from the beginning.
After the first time, I remember sliding the magic token of an appointment card into my back pocket with only one of the six lines completed: 7/19/90, just like the one I have now marked for tomorrow—9/10/91. Dr. Kohl’s name is printed on top, immediately beneath the line for my name, M __________________ HAS AN APPOINTMENT WITH, and then DR. ADAM N. KOHL. Six blank lines skip down the length of the card with space for the date punctuated by AT followed by a smaller blank for the time.
As I drifted down the sidewalk in the garish light reflecting off Lake Champlain that first day, I imagined a completed card, even a full deck, the ink expanding accordion-like down linked rectangles representing future time in his presence.
CHAPTER 3
IPE
Initial Psychiatric Evaluation (IPE)—Date of Evaluation: 6/26/90; Referred by: Self; Patient’s Name: Cree LeFavour; Sex: ; Age: 24; Birth Date: 9/20/65.
1. PRESENTING PROBLEMS:
“I’d like to pinpoint why I’m unhappy. (Though I’ve felt a lot worse.) I’ve been really depressed.”
Rxs [symptoms] of her depression:
1. “I hide completely, shut self off, don’t speak, isolation is really key. Need. I find a lot of freedom in that.”
2. “Feel a need to escape and not contact anyone.”
3. “Abstain from everything, including food.”
4. “Sleep as reaction to depression.”
Relationship: 1. “‘I feel like Matthew’s mother.’ This has brought something out in her. ‘I used to be more independent, more myself.’”
As a psychiatrist with an M.D. from Johns Hopkins might do, he probed my mind during the first appointment as if he meant to take a scalpel to it, his purposeful manner failing to suppress the attar of sympathy that memorably bathed every one of my senses. Emboldened by my instinct that it was my only chance to show him everything—“What you say here is confidential”—I told the truth, blushing when he asked me how often I had sex and if I had orgasms. His directness and interest in the minutiae of my biography tempted my starving narcissist to deliver monologues I didn’t know I’d been waiting to perform.
The IPE proceeds:
2. RECENT STRESSORS: He checks Pregnancy and notes “abortion” in the column EXPLANATIONS. He also checks Marriage, Divorce, Separation, Argument, adding, “Relationship wit
h Matthew Agnew.” He checks Change in Residence but not Sexual Difficulties. I miss out on Sudden Increase in Wealth, Extended Vacation. If only.
3. PAST PSYCHIATRIC HISTORY: All questions beginning with When last felt well on through Prior psychiatric treatment with __________ and Drug, Individual and Group Therapy, ECT, Hospitalizations, Longest period without psychiatric care, Diagnosis, Successful medications, Medication problems are blank or show a 0.
4. PAST PSYCHOLOGICAL HISTORY—CHILDHOOD: He checks Yes for Math difficulty, Falls or accidents, Left handed, Nightmares, Fear of dark, Death or separation in family, and Frequent moves. I’ve happily escaped a check in the Yes column for Cruelty to Animals, Fire Setting, and the ominous Promiscuity, deviation, incest.
5. PRESENT PSYCHOSOCIAL AND NEUROPSYCHOLOGICAL HISTORY: He checks Yes for Phobias, Obsessions, Rituals, and Excessive Eating, Vomiting (“None for 3 months; used to do it more”), Speeding (“Likes to go 85 mph”), High Fever (“When younger”), and Dizziness (“Fainted once”). He adds and underlines, “Severe Nightmares.” Even if bulimia was my ticket in the door, my up-front reason for going, it was a symptom that paled next to my scary obsessions. I wasn’t going to go into this private madness straight off; I just said yes when he asked if I had “obsessions.”
6. MEDICAL HISTORY: He notes, “Broke limbs falling off horses” and circles the words Alcohol, Cigarettes, and Street Drugs. I tell him I’ve smoked, swallowed, or chewed “marijuana, cocaine, hallucinogenic mushrooms, ecstasy (MDMA), and speed.” But I don’t do any drugs now nor have I done any for at least three years. I drink very little these days—a beer now and again.
7. FAMILY HISTORY: “Father (56) and mother (52) divorced in 1981. Father is a chef and lives in St. Helena, California. Throughout her childhood he owned restaurants in Aspen, Idaho, and California. Mother lives with her partner in Eureka, CA. Sister, Nicole, good health, close, lives in Idaho.” He then asks me for maternal and paternal history of various mental disorders. He marks Yes for a history of Depression; Mental Illness, Alcohol, and Drug Use; Eccentricity, Creativity; Aggression, Mood Swings, and Financial Problems. As a whole we LeFavours managed to escape Yes to Attempted/Committed Suicide along with various physical disorders like Cancer, Stroke, and Color Blindness. We seem to have the remainder covered.
8. MARITAL AND SEXUAL HISTORY: Under If Female in the column Most of Life he checks Difficulty Getting Excited, Disinterest in Sex, and Masturbation, noting after the last, “Don’t now, in this relationship.” All but one of the remaining questions have checks under Never, including H/O Fetishes, Cross-Dressing; Reaching Orgasm Too Quickly; and Sexuality with Females. Contraception: “Diaphragm.” Frequency of Intercourse: “3 x/week.” Under the remaining Different Sexual Habits he writes “???”
9. EDUCATION: “Middlebury, B.A. 1988”
10. WORK AND FINANCIAL HISTORY: “Chittenden Community Action. Helps people with welfare problems.” He notes to himself, “Emotionally really dangerous.”
11. HOBBIES, SPORTS HISTORY: “Read a lot—no favorite. Used to compete x country skiing (high school). Now I don’t exercise.”
12. RELIGIOUS AND SOCIAL HISTORY: “Parents both atheists, me too.”
13. MILITARY HISTORY: 0.
The final part of the form has a separate title: MENTAL STATUS EXAMINATION (IPE). He skips all but two of the unnumbered sections, including categories for BEHAVIOR, BEHAVIORAL EXPRESSION OF AFFECT, and DISORDERS OF SPEECH. Under COGNITIVE FUNCTIONING he completes only Estimated Intelligence: “Above average.” He then skips all but the last part of the longest category, APPERCEPTUAL FUNCTIONING, including Hallucinations, Thought Disorder, and Delusions, to focus on Proverbs and Similarities: Stitch in Time, Bird in Hand, and Glass Houses. I pass, completing the phrases with the correct proverbs and explaining the meaning of each. It was a fairly simple, not particularly accurate test of abstract reasoning—proverbs are, after all, culturally specific. I came up cold on Burnt Child. (The answer is, “A burned child dreads the fire,” meaning we learn to avoid harm through painful experience. At the time, having never burned myself with a cigarette, I didn’t recognize the uncanny significance of my failure to complete the phrase.) My reply to the final partial proverb, Tongue Is Enemy, was apparently worth note: “Talk too much get head cut off.” What an odd proverb to include on a questionnaire to launch a course of psychotherapy. Similarities are: Orange—Apple: “Fruit,” Airplane—Bird: “Fly,” and Man—Squirrel: “animals.”
ASSESSMENT
1. Symptoms (DSM-II)
Axis I: “Bulimia”
Axis II: “Bulimia with vomiting long history
History of depression
History of severe drug abuse (alcohol, cocaine, amphetamines)”
2. Circumstances Associated with Symptoms
a. Environment: “F/H [family history] alcoholism.”
b. Physical Illness: “ handed, eyed.”
c. Drug Abuse: “Alcohol abuse in college; heavy use of amphetamines, 1987 (6 weeks); periods of regularly using cocaine but not for long (2 weeks).”
d. Other: “Severe family deprivation (left totally alone at age 13). Learned to survive alone so she equates surviving with aloneness.” I tell him, “My mom not a mom, just not mothering type.” He writes, “Aloneness is source of depression.” I report that my sister and I had lived alone since I was in 9th grade. “It’s just the way it was.” “LITTLE BUDDY = small child who was totally unattended.” That was my mother’s favorite nickname for me. Rosy Rotten Crotch was another.
PLAN:
“1. Discussed alcohol, speed, cocaine with her.” What he said was if I was doing drugs or drinking there was no point to being in therapy.
There is no number two. Time was up.
The IPE interview was not my first encounter with Dr. Kohl. I’d been to his office once before as a favor to my then boyfriend, Matt, who asked me to come along to one of his weekly appointments with Dr. Kohl. These sessions were mandatory—whether by agreement with his parents or by court order. Matt told me only that there was an incident in high school. Despite our living together for more than a year the explanation remains a void I fill with the worst possibilities: gruesome suicide attempt, child molestation, unspeakable violence. Those are the worst causes I can think of—the only answers to explain why he refuses to tell me what happened and why he is required to see Dr. Kohl once a week. I’d agreed to go along to one of Matt’s sessions to describe his lack of motivation and offer my insight into the bad choices he made. Matt thought me quite eloquent on these points.
Curious as I was about meeting a psychiatrist—would he see through me and if so what would he see?—I had no idea how significant the request would be in determining who I would become and where I’d end up. After meeting Dr. Kohl for the first time, I asked for an appointment of my own. Without that introduction I would not have had the courage or audacity to see a psychiatrist, no matter how I felt. It simply wasn’t in my WASP-atheist-hippie repertoire.
I remember the throat-tightening embarrassment of asking if he had time or would be willing to see me. In part I was ashamed because of my very secret bulimia. Even more shaming was admitting I wanted his help, imagining I might be worthy of seeing a psychiatrist. Begging for money from him would have been easier than requesting 55 minutes of his amply compensated time.
At the end of our third session he gave me a suggestion and two homework assignments.
First, Overeaters Anonymous. I scoff. As a devout atheist and someone who loathes group anything, I wasn’t going near a VFW hall or church basement. I’m not sure how rude about this I was at the time. Likely, very.
Second, write down how often and what foods I ate. A “Vomiting Diary.” The name alone was enough to make me want to stop. I agreed to comply, as sobering as it was to see the pattern of failure on paper. Showing him the diary was the rebar cementing my humiliation.
Third, read Alice Miller’s The Drama of the Gifted Child. I devoured every word. “Gif
ted” in the context of Miller’s theory refers to certain children’s heightened sensitivity to the dynamics of the adults around them. Her point is if these adults are self-involved or neglectful the hyper-attuned—“gifted”—child exhausts herself to please her parents. The price she pays is the negation of her individuality and all the needs, desires, and emotions that belong to it. It all sounded terribly familiar.
∗ ∗ ∗
Dr. Kohl and I quickly covered the facts of my past over the next several months while I fell more and more in thrall to him and the process. I was born in Aspen, Colorado. I have one sister, Nicole, sixteen months older. She is a teacher and political activist living in Boise, Idaho. Different as we are in character, body, and intellect, you’d know we’re sisters at a glance even if only from the jaw we share and the sound of our voices. On the phone nobody can tell us apart. Having shared a childhood we carry a collective knowledge nobody else is privy to. It makes a powerful bond.
My father the chef—gentle, brilliant, and emotionally withdrawn. Little as he knows—or has wanted to know—of my inner life, my father’s warmth and generosity are rich compensation for his flaws. Always financially supportive given his income from the trusts that held the family newspapers in upstate New York, he agreed to pay the roughly $40 per psychiatry session my insurance doesn’t cover. He is remarried and retired, having sold his well-regarded restaurant, Rose et LeFavour, in the Napa Valley, where he lives.
Lights On, Rats Out Page 2