Circe

by Jessica Penot

  Dr. Allen's report described Mr. Guiles as a 60-year-old white male who presented with poor grooming and a series of stereotyped behaviors. He had a flat affect and he was disoriented to person, place, and time. He suffered from a number of delusions, which lacked theme and cohesion. He was from Bayou Le Batre, Alabama and had been a resident at C.R.C. off and on for almost 32 years. His condition had worsened with time. He had no family and lacked the ability to groom himself or use the facilities by himself. Dr. Allen had diagnosed him with schizophrenia, disorganized type and given him a global assessment of functioning around 10 out of a possible 100.

  Ms. Gardner took the lead with the interview. "So, Mr. Guiles, do you know why we are meeting here today?"

  Mr. Guiles shrugged and shifted in his chair again, looking at me. "Who’s dat?" He asked.

  "This is Dr. Black and he's going to be your psychologist," Dr. Allen said.

  "What you do?" he asked me.

  "I try to find ways to help you," I responded.

  Guiles stuck his tongue in and out slowly and looked at me. "You know I lived in Africa for fifty years," he said.

  "Really," I responded. I took the opening as an opportunity to begin going through the questions of the mental status exam with him. "Do you know where you are now, Mr. Guiles?"

  "I'm in the hospital,” he said. Everyone at the table took notes.

  Ms. Gardner leaned over, “Do you know why you are at the hospital?"

  "I'm sick."

  "How?" she asked.

  "I reckon 'cause of the war."

  "Which war is that?" Nurse Brown asked.

  "One of those African wars. You know, in Negaria. I'm one of those albino Africans, you know."

  No one could have possibly been whiter than Mr. Guiles. The only African he had in him came from the imported coffee beans they served at the cafeteria.

  "Do you know how old you are?" Ms. Gardner asked.

  "Twenty-one or 22."

  "Do you know who the president is?"

  Mr. Guiles flicked his tongue again and looked at me. "I'm thirsty. They never give me any water. Why won't they give me any water?"

  I had read Mr. Guiles' file. I knew his history and his diagnosis, but everyone else assumed that I had not. Nurse Brown looked at me and answered his question without even making eye contact with him. "Mr. Guiles has had to be sent to the hospital three times now due to electrolyte imbalance. He sneaks water and drinks so much that his heart can no longer pump. He gets eight glasses a day, but he wants to drink eight gallons."

  "They steal my money, too. I got 200 million dollars from those diamond mines."

  Dr. Yoshi laughed and leaned over. "Really, can I have some?" His English was almost indecipherable.

  "Oh, when they stop stealing it."

  "Who do you think is stealing your money?" I asked.

  "Them."

  "Do you know what year it is?" Gardner asked.

  Guiles leaned over and stared at the wall behind her as if searching for some answer to the question there. He stuck his tongue out again and laughed. He put his old, freckled hand on mine. "I want to go home," he said.

  "We'd like to see you go home," I responded. "Where is home?"

  "Alaska," he said, and grimaced horribly.

  "Do you know what this is?" I asked holding up a pencil.

  "You know what that is," he responded.

  Gardner looked at his file before she asked, "Have you been going to your morning therapy groups?"

  "Yes," he said.

  "It says here that they haven't seen you in over a month."

  "Oh, yeah. Maybe I haven't been going."

  "You also haven't been going to vocational groups or afternoon group."

  He looked confused and stuck his tongue out again.

  "Do you remember what we talked about the last time we met?"

  He shook his head.

  "You have to go to your groups before we can even talk about you leaving."

  "Do you think you can remember to go to your groups this week?" Nurse Brown asked.

  "They never tell me about them."

  "Yes. They announce every group on the speaker four times before each group. They tell you about them. It says here that Katie has even been coming in to remind you before groups."

  He shrugged despondently and began to tap on the back of his neck.

  Dr. Yoshi almost moved. He asked him, "Is there anything you need from us? Do you have any questions?"

  "I'm thirsty."

  "We've already talked about that," Gardner said. "You drink too much water."

  His tapping became more intense and more rapid. "Is there anything else that we can help you with?" I asked.

  He just began to tap harder and looked at the wall.

  "I think Mr. Guiles is done," Nurse Brown said, and with that the mental health worker ushered him out of the room.

  "I'm recommending another three months before review. In that time, he must attend reality therapy at least twice a week and see the hygienist at least three times a week. He must also make marked improvement in his ability to care for himself before a group home will be recommended," Ms. Gardner said.

  "Current course of medication will be maintained," Dr. Yoshi said.

  "I agree," Nurse Brown said.

  "Why three months?"

  "That’s the longest period we can recommend between reviews. It is also mandatory that we go to court at least every six months to ensure that his institutionalization is legal. We'll have to deal with that in three months. Only doctors can go to court. Psychologists or psychiatrists."

  "According to Dr. Allen's report, she indicates that he has been more responsive to working with Katie and her behavioral modeling program than with the reality therapy group. She recommends a change of group and a review in one month." I looked at Dr. Allen's report as I read, purposefully trying to avoid eye contact with Ms. Gardner.

  "Mr. Guiles is purposefully resistant to any treatment and we shouldn’t change his treatment until he is at least minimally compliant," Ms. Gardner said.

  "Prior testing shows that Mr. Guiles has a borderline IQ and virtually no contact with reality, I think it’s projection to think that he’s purposefully resisting any kind of treatment. Dr. Allen's testing indicates that he’s going to need to be spoon-fed a more basic treatment. His history shows that he has been doing reality therapy for 20 years now and we can see where that has gone."

  Dr. Yoshi moved to make eye contact with me, "You have to remember how poor Mr. Guile's prognosis has always been. We don’t expect him to improve. He's been on every antipsychotic we have.” Dr. Yoshi was almost impossible to understand.

  "Drugs alone can't be the answer," I responded.

  Dr. Yoshi shrugged. "Why not try your way?" he said.

  Ms. Gardner turned beet red. "You get to do the paperwork then, Dr. Black," She threw the enormous binder that contained his file at me. "Do you know what you’re doing?"

  "I'll figure it out."

  For every treatment planning meeting there is a mountain of forms to fill in, and every member of the treatment team has to sign every page. The patient and their family also have to sign every page of the treatment plan. I was to find out later that the better portion of my day would be spent doing paperwork such as this. Mr. Guiles was brought back in and we carefully explained to him about the behavioral modeling program he would be working on with Katie, a Psych Tech. We requested his approval and he grimaced and snorted and put a shaky X on every form we asked him to sign.

  This is how my mornings went. We could see three or four patients in a morning. Ms. Gardner and I split up the paperwork. I ate lunch alone, working as I ate. Dr. Allen's office felt oppressive. Its dark walls closed in on me and the flickering neon lights gave me a chronic headache.

  Reality therapy seemed like a joke to me. Katie led me through the steps. Apparently, every morning and afternoon she went to all the patients’ rooms and recorded information on how they
were keeping up with their hygiene, whether or not they were keeping up with their rooms, whether or not they were waking up, etc. New laws had made it impossible to force the patients to do anything they did not want to do, but everything they did was watched and recorded and noted for later.

  Katie told me a story that exemplified this. Legally, every patient had to have access to a phone at all times and allowed to call 911. One patient had a number of paranoid delusions that centered on the persecutory nature of the hospital staff. So, he began calling 911 seven or eight times a day. The operators called and complained. The police called and complained, but the hospital was helpless to prevent him from dialing. Most of the time, he would call and tell them that Ms. Gardner was trying to plant microscopic bugs in his brain that forced him to steal from other patients, but the story varied and became more eclectic over the years. The phone was a payphone, so the patient could only call toll free numbers and when 911 stopped being interesting, he started calling all of the toll free lawyers he saw on TV. This problem went on until the patient was discharged to a group home, where, as rumor has it, he still calls 911 on a regular basis.

  So, when we did reality therapy, our primary goal was to sucker the patients into showing up and staying any way we could. It was also our goal to convince the patients that it was in their best interest to try to learn things like how to bathe, to eat with silverware, and to ignore the voices in their heads.

  Katie showed me the files for the patients who were supposed to attend reality therapy before group began. There were 45 files in all.

  "Is this one for real?" I asked her as I looked through them.

  "Afraid so," Katie answered.

  "Mr. Craig Fat?"

  "His father was Chinese or something," Katie answered. Katie was a pixie of a creature who couldn’t have been more than 23. She had a Bachelor's degree in Psychology and did most of the grunt work for the first floor chronic ward Psych team. "His name will seem even funnier when you meet him," she said.

  The group members trickled into the therapy room slowly. They sat down in the farthest corners, away from each other, that they could find. When Katie finally closed the door, there were no more than six patients present.

  "Is this all?" I asked.

  "This isn't the acute ward," Katie answered. "Most of the patients here have been here for years and there is no reason for them to care."

  "Can't we give them some incentive to come? Six out of 43 patients are coming to group? That isn't even funny," I said.

  "We try things all the time. The patients can't get grounds privileges unless they come. They won't leave unless they come. They don't care. They only have to come twice a week and we have it twice a day. A lot will put in the mandatory two, but many won't even do that."

  Katie stood up suddenly and closed the door to the group room. She slowly approached the group.

  "Alright," she said. "Who remembers how we are supposed to sit in group?"

  Mr. Fat raised his hand eagerly. "We’re all supposed to sit in a circle."

  The other patients tried to ignore the suggestion. "Get up and move into a circle facing forward," Katie said in an almost military tone.

  The patients obeyed her order with a series of noncommittal shuffles and half-assed attempts at moving chairs. In the end they weren't quite in a circle, but at least they weren't facing the corners.

  "Okay," Katie began. "I'd like you all to meet Dr. Black. He's going to be watching the group for a few days and eventually he's going to take over, so let’s all show him how much we can get done. Who wants to start today?"

  Mr. Fat's name was too appropriate. He was a caricature out of some Flannery O'Connor short story. I almost snickered when I realized who he was. Mr. Fat was morbidly obese on a level that is rarely seen in day-to-day life. His legs were so fat that cellulite puckers dripped off of his ankles, and even the bony parts of his skull bulged with excess weight. He smiled lazily at me across the room and pushed his glasses back onto his nose. Surprisingly, he was one of the most well-spoken patients in the chronic ward. His pathology wasn’t so easily seen as everyone else's.

  "Well," Mr. Fat began slowly, with a drawl you could almost see dragging across the floor. "I've been good since I've been here. I've been following the rules and I think I should be able to go home now." Every syllable he uttered was slow and laden with the heaviness of his presence.

  "Hmmmm," Katie responded thoughtfully. "What brought you here?" she asked.

  "They said I was too fat."

  "Is that the only reason you’re here?"

  "I eat too much." He whined like a little girl when he talked.

  "What does your treatment plan say?"

  "It says I'm fat."

  "I think it says more than that. You haven't noticed any other behaviors that you think need to be changed?"

  "No."

  "They wouldn't have put you in here for just being fat."

  "They did."

  "Let's ask the group. Maybe they can help. What does everyone else think? Is being fat the only reason that Mr. Fat is here?"

  An emaciated man in a red leather jacket virtually leapt out of his chair and very rapidly said, "He's one crazy motherfucker."

  "What does that mean, Mr. Nicca?" Katie asked.

  "He's crazy fucked, man. Y’all seen him. He be nasty. He gets his food and eats until he barfs and then he keeps on eating. Nasty piece of shit."

  "Fuck you," Mr. Fat said. His speech became less slow in his anger.

  "So you’re saying that he eats his food, vomits on it, and continues eating?" I asked.

  "And that ain't all that nasty fucker does. He be nasty."

  "Let's focus on this one thing. Do you think it is healthy to eat your own vomit?" Katie asked Mr. Fat.

  "They don't let me eat. They hate me. I'm hungry all the time."

  "Do you think it is normal to eat your own vomit?"

  "I don't know," Mr. Fat whimpered.

  "Before you were here, at the institution, did you see other people eating their own vomit?"

  "No."

  "So do you think it's normal?"

  "Probably not."

  "Do you think this is something you might need to change before you leave?"

  "Maybe."

  "So, there is more than your being fat keeping you here?"

  "Yes."

  "How are you going to change this behavior?"

  "I won't do it anymore."

  "You can ask for seconds."

  "I'll ask for seconds."

  "What else is keeping you here?" Katie asked.

  "I just wanna go home."

  "Where would you go?"

  "To my mamma's house."

  "Your mamma has already said she doesn't want you living with her. Isn't that right?"

  "I don't know why."

  "So where would you go?" Katie asked again.

  "My mamma loves me."

  "Why doesn't your mamma want you at home?"

  "I don't know."

  "Think about it."

  "She was trying to starve me. She was always with them, trying to starve me. It wasn't my fault."

  "We've been over this a hundred times. I'm not asking about what your mamma did, I'm asking what you did. Why can't you go home?"

  "I stabbed her."

  "You don't think that is something you should work out before you go home? Is it normal to stab people because they take your toast away?"

  "I reckon not."

  "So why are you here?"

  "Cause I hurt people when I get too mad."

  "Right."

  "I can't listen to 'em anymore. I just gotta say to myself they ain't real. No one is trying to steal the food."

  "Very good. Now next time you come to group I want you to be able to tell me why you’re here the first time I ask, okay?"

  "Okay."

  "You’re making good progress. You know that, right?"

  "Right."

  Katie looked at the res
t of the group. She smiled comfortably. "Who wants to go next?" No one answered this time. The group sat quietly, trying to avoid eye contact. "How about you, Mr. Nicca? You had a lot of goals last time we met. Do you remember any of them?"

  "Fuck! I ain't crazy. Shit, I don't need no goals. You not helpin' me and I told you what the problem was."

  "Stay focused....."

  "You know they still be under my bed!"

  "Who?" I asked, more out of curiosity than anything else.

  "Them demons. Always after my student loans. I don't have 'em!"

  "Try to stay focused," Katie said. "What are you supposed to do when you hear demons under your bed?"

  "None of y’all care. None of y’all. You just be puttin' me in this room with all these crazy motherfuckers! That bastard over there," he pointed to Mr. Guiles, who sat quietly with his tongue hanging out. "Pees on my bed. Why do he gotta be peeing on my bed? He can go pee on his own. And he smells and I gotta sleep in the same room as him and y’all don't care. You don't care and they want the money. I tell 'em I don't got it...."

  "Mr. Nicca," Katie almost yelled. "Stay focused. What are you supposed to do...."

  "Fuck you bitch!" Mr. Nicca stood up and pushed his chair over violently. He spit twice on the floor and ran out of the room.

  Mr. Nicca's file described him as a schizophrenic, paranoid type who was nonresponsive to medication. He had been in and out of a number of hospitals over the past five years and no treatment had lasted for long. He had been at Circe for more than two months, so they had to shuffle him over to the chronic ward, but as soon as the doctors found a medication he was even minutely responsive to he would be discharged to yet another group home.

  The rest of the group members did not say much. Many of them didn't or couldn't say anything. The group went by slowly, with Katie constantly prodding the patients with numerous questions and sometimes demonstrating the things they were supposed to be doing, such as brushing their hair or eating. The group wasn’t quite as much fun after Mr. Nicca left.

  After group, I did my interviews. This, too, proved to be an exercise in futility. I interviewed Mr. Benoit first. He was a fifty-year-old white male who had been transferred to our side two days ago. I had all of his evaluations from his old treatment team on the acute ward, but I had to write another report for our ward.