you know, because she was laughing,
so I knew I was supposed to smile.”
“It wasn’t a genuine smile?”
Jennifer shakes her head. “It’s more like, my eyes observed
Megan smiling and laughing,
and the observation traveled to my brain,
and my brain said, Jennifer,
your friend is smiling, so you should smile, too.
So I used my face muscles to form a smile.
Like molding clay.”
Dr. Prakash nods. “You said you tried to explain it?”
“Yeah. So Megan’s laughing, and she’s happy
and having fun, and she said to me,
See, Jennifer? This is fun. Stop being depressed.
You should just do more things like this. Lighten up.
Like if I just went out and played tennis more,
everything would be better.
But it didn’t make anything better, and it doesn’t.
I told her, If I could feel better just by playing tennis,
don’t you think I would play tennis all the time?
It’s like she thought I wanted to be depressed.
That I was choosing it.”
Dr. Prakash nods. “So this friend of yours, this Megan,
she knew you were experiencing depression?”
“Yeah,” Jennifer says. “She knew
I had cut my wrists a few times,
and that I wanted to die.”
“And what did Megan say about that?”
Jennifer shrugs. “She tried to cheer me up,
like that time. But after a while, she quit.”
“She quit being friends with you?”
“No, no. She quit trying to make me feel better.
She said she couldn’t do anything but wait
until one of my attempts was successful.
Suicide attempts, I mean.”
Dr. Prakash raises her eyebrows. “Let me get this straight.
Your friend said that the only thing she could do for you
was wait until one of your suicide attempts was successful?”
“Yup,” Jennifer says.
“How did that make you feel?” Dr. Prakash asks.
Jennifer says, “It didn’t make me feel good,
but I can understand it.”
“Understand it! My goodness. I cannot understand it.”
“She was tired of my depression.”
Jennifer goes quiet, thinking.
Dr. Prakash waits.
“I just keep wondering if I could have explained it better.
To make people understand.” Jennifer sighs.
“It’s like…it’s like Megan and my other friends, they think
happiness is a bouquet of helium balloons.
Picture everyone in the world,
each holding a bunch of balloons on strings.
Most people’s balloons are plump and bouncy,
and they float really well.
Some people’s balloons might be droopy
because they’re sad, or sick, or something.
So my friends think my balloons are saggy,
and they try to help. They say, Here, have some helium.
Let’s get your balloons all floaty again.”
“Because plump balloons would indicate
that you are happy,” Dr. Prakash says.
“Right,” says Jennifer. “But the problem is,
I’m not holding droopy balloons.
I’m not holding any balloons at all.
I’m standing there with strings that lead to nothing.
So even if my friends gave me helium—
tanks and tanks of helium—
there’s nothing to put it in.
My balloons are just completely missing.”
Jennifer wipes her nose. “I don’t know.
Does that make sense?”
Dr. Prakash nods, slowly. “Not only is the depressed patient
sad and hopeless, she also experiences anhedonia.
Do you know what that means?”
Jennifer shakes her head.
“It comes from the Greek: an means not, or unable.
hedone, the root of the word hedonism, means pleasure.
Thus, anhedonia is an inability to feel pleasure.
Some patients experience anhedonia as
an inability to feel any emotion whatsoever.
So, yes, Jennifer. Not only does
your balloon metaphor make sense,
it is perhaps the best description of clinical depression
I have ever heard.”
“Really?” Jennifer is pleased.
But, as usual, her pleasure is fleeting.
It floats away, like helium gas released into the air.
“May I use your description
with other patients?” Dr. Prakash asks.
“I think it would
help them understand depression in a new light.”
“Sure,” Jennifer says.
“Thank you,” Dr. Prakash says. And then she waits,
as though she’s giving Jennifer more time to think.
After a while, Dr. Prakash picks up her blue plastic lighter
and lights another cigarette. She inhales deeply.
“Tell me, Jennifer, how are you feeling right now?”
“Sad,” Jennifer says. “Except, more tired and empty than sad.
Like I’m standing all alone, watching everyone else
play with their balloons.”
Dr. Prakash balances her cigarette in the heavy glass ashtray
and looks through Jennifer’s file.
She picks up a pen and says,
“I am writing an order for a blood panel.
We will look at whether you have a chemical imbalance causing depression.”
“A blood panel?” Jennifer asks, more curious than worried.
Dr. Prakash finishes writing. “A blood test. It might help us
zero in on a potentially helpful medication for you.”
“An antidepressant, you mean?” Jennifer asks hopefully.
Dr. Prakash picks up her cigarette, takes a drag.
“Most likely an antidepressant.
Have you been on any sort of psychiatric medication before?”
“No.”
“How would you feel about it?”
Jennifer hugs her arms tight around herself.
“I used to think it would be bad, like it would be cheating.
Or it would change me.
But now I don’t care.
I’ll try anything, if it could help.”
“Yes. Maybe it would help you get your balloons back.”
“That would be good.”
“Indeed,” Dr. Prakash says. “Jennifer,
I would like to tell you that I admire your openness.
We have covered a lot of ground today.
There are a few more questions I have for you.
Are you feeling brave enough to continue?”
Jennifer nods, hugs herself tighter.
“I would like to go back to alcohol for a moment and ask,
have you ever tried to cut back on your drinking?”
“Sure,” Jennifer says. “Sometimes I think
it would be better if I didn’t drink as much,
or as often. The calories, for one thing.
And sometimes I get myself into situations
that aren’t so great.”
“What do you mean, ‘situations that are not so great’?”
“I mean, getting drunk
&
nbsp; isn’t always the best idea,” Jennifer says.
“Have you ever been in danger? Or taken advantage of?”
“I don’t know,” Jennifer says softly. “Maybe a little.”
“Can you please tell me about this?”
Jennifer takes a deep breath. “Well, there are times
I’m the only girl around—
because I have a lot of guy friends—
and the boys…” Jennifer trails off.
She figures it’s pretty self-explanatory, what the boys do.
“Tell me, please,” says Dr. Prakash. “The boys…”
Jennifer can’t say it unless she just gets it all out in a rush:
“Once, when I was completely wasted,
boys took pictures of me.
I can’t really remember.
I was pretty blacked out.”
Dr. Prakash says, “If you were blacked out, as you say,
how do you know about these pictures?”
“Because I saw some of them. Polaroids.
The boys were passing them around at school,
you know, joking around about it. It looked like…
it looked like I was taking off my shirt.
You could see my tummy and my bra.
I don’t know if there are other pictures,
or if I took off more clothes,
or if they did anything else.”
Jennifer is crying again. “I do remember that
at some point, I was on a bed
and a boy was on top of me, kissing me.
But I don’t think anything else happened.”
“I see,” Dr. Prakash says.
“Jennifer, I need to ask you,
did you have any bruises the next morning?
Or soreness? Please, think carefully.”
Jennifer tries to remember. “No.
I was extremely hungover,
like alcohol poisoning hungover,
barfing and shaking like crazy.
But no bruises. Just the pictures.”
“And was this the only time
something like this happened to you?
The only time you have been taken advantage of?”
Taken advantage of.
It sounds really bad when she says it like that.
“Um, it’s not like
anything terrible has happened,” Jennifer says.
“One time I had sex when I was really drunk,
but I kind of wanted to. And another time,
I was at my friend’s house, a guy friend,
and all the boys said I should take a shower
to sober up, so I did, naked,
and they didn’t let me close the shower curtain,
because they said I would be safer that way, and…
they, you know, took turns
coming into the bathroom to watch.
But they were my friends, so it wasn’t that bad.”
Dr. Prakash closes her eyes for a long time,
like she is angry, or annoyed, and trying to calm down.
She opens her eyes. “Jennifer,
have you ever heard the expression
‘With friends like this, who needs enemies?’?”
Jennifer says, “I think so, but it’s not—”
“Do you have any friends who look out for you?
Who protect you from being taken advantage of?”
“Kelly, probably,” Jennifer says. “But she doesn’t really drink,
so she doesn’t always go to the same parties.”
“I see. This is something that we will come back to.”
She writes in Jennifer’s file.
“I would like to continue my questions,
if that is okay with you.”
“Okay,” Jennifer says, even though she’s surprised
to be talking so much about alcohol.
She’s here for an eating disorder, not a drinking disorder.
Dr. Prakash says, “Have you ever felt annoyed
by someone telling you that you drink too much?”
Jennifer nods. “Kelly says I put myself in bad situations.”
“This Kelly sounds like she is a good friend.”
“She is. But it still annoyed me.”
“Very well.” Dr. Prakash makes another note.
“Have you ever felt guilty about drinking alcohol?”
“Well, yeah. Every time I drink.
Because I’m lying to my parents when I come home drunk,
and they don’t know I’ve been drinking,
except for that one time when I barfed all over everything.
But I’ve been drunk in front of them tons.
And yeah, that makes me feel guilty.
Because they trust me.”
“I see,” Dr. Prakash says.
“And have you ever had an eye-opener?”
“An eye-opener?”
“Have you ever needed or wanted to
drink alcohol first thing in the morning?”
“Gross,” Jennifer makes a face. “No way.
Why would I do that?”
Dr. Prakash shrugs. “Some alcoholics do this
to stave off withdrawal symptoms.”
“I’m not an alcoholic.”
Dr. Prakash raises her eyebrows.
She doesn’t say anything.
“I don’t…I’m not…,” Jennifer says.
“I don’t drink every day.”
Dr. Prakash says, “Jennifer. These questions
I have been asking.
They are known as the CAGE Questionnaire.
They are a screening tool for alcoholism.”
Jennifer shakes her head. “Alcoholism?
I mean…no. What are you talking about?”
“Do you feel tricked?” Dr. Prakash asks.
“I am sorry if you do.
But I could not very well tell you ahead of time
what I was asking, could I?
And so I am telling you now.
I would always like to be honest with you, Jennifer.”
“I don’t…” Jennifer’s fingers are tingly.
Her heart is flickering. “I don’t understand.”
“CAGE is an acronym.
It stands for Cut back, Annoyed, Guilty, and Eye-opener.
It is a very simple but surprisingly effective screening tool.
Anyone who answers yes to two or more of the questions
has a 90 percent chance of being a problem drinker.
An alcoholic, Jennifer.
The last question, about an eye-opener,
is especially important
because it indicates withdrawal.”
“But I said no to that one.”
Dr. Prakash nods. “And you said yes to the other three.”
Jennifer can’t think of anything to say.
“We must deal with the fact that
you drink excessively, Jennifer.
You abuse alcohol. You are an alcoholic.”
Jennifer swallows. She picks at a loose thread
on her sweatshirt wrist,
pulls both sleeves over her hands.
“Tell me, Jennifer. How does that make you feel?”
“Not good,” Jennifer whispers.
“Not good, yes. What else.”
“Scared.” Jennifer grabs a tissue.
“Embarrassed. Like slime.”
“Like slime? Why is this?”
“It’s shameful. Alcoholics are bums.
My grandfather was an alcoholic
and my dad was terrified of him.”
“Having a problem is not shameful if
you get help for it,” Dr. Prakash says.
“Do you agree with my assessment?
That you are an alcoholic?”
Jennifer takes a deep breath. Slowly she nods.
“I guess. I’m not a homeless wino, but…
It’s probably a problem.”
Jennifer’s chapped lips puff at the p sounds:
Probably. Problem.
“I think you will need to begin
attending Chemical Dependency group.”
Dr. Prakash says. “It meets on the Adolescent Unit.”
“The Adolescent Unit?” Jennifer squeaks.
Everyone says the kids on Adolescent are
scary goths and major drug addicts.
Adolescent is even more like a prison than the EDU.
It has insanely strict rules: no phone, no TV, no talking.
Dr. Prakash is nodding, writing in the file.
“And you will need to tell your family.”
“Um. Can’t you tell them?”
“No, Jennifer. It must be you who tells them.
But I want you to wait until a family therapy session.”
“Oh,” Jennifer says. Now that it’s out there,
Jennifer doesn’t think she can wait.
She needs to get it over with.
“When will that be?” she asks.
Dr. Prakash glances at a calendar.
“Next weekend, most likely.
Perhaps your parents can take you out on a pass afterwards.”
Oh, sure. Great.
Confess to your parents that you’re an alcoholic
and then just smile and go to the movies
like a normal, happy family.
But…wait. Dr. Prakash thinks she can have a pass?
“A pass? But I’m not medically cleared.
I’m not on stage two.”
Dr. Prakash smiles. “I have noticed
you like to point out ways in which you do not feel
qualified for things. Do you notice that?”
Jennifer shakes her head. She hadn’t noticed.
Dr. Prakash leans forward.
“Jennifer, you do not have to be medically cleared
to reach stage two.
I recommend that you request
a two-hour pass at treatment planning.
Or better yet, two two-hour passes,
one for Saturday, one for Sunday.
Fresh air would do you good.
If your parents can manage a visit.”
“Really?” Jennifer says, a wide grin on her face.
“Does that mean I’m in stage two now?”
Dr. Prakash leans back in her chair,
crosses her arms over her chest.
“Jennifer, our stages are a continuum.
Believarexic Page 13