Lilith

by J. R. Salamanca

  After the reading of this report—which was much more detailed than the brief summary I have given here—there was a discussion period, in which Dr. Lavrier commented freely, interpreted events and behavior of the history in psychiatric terms, and directed us as to the most useful and effective means of dealing with the patient.

  “I think the best general course to follow,” he said, “is a kind of liberal realism. I wouldn’t tolerate her fantasies—even at the cost of losing companionship or contact with her—and certainly would never indulge them; but there’s no need to be aggressive about it. I think it’s best to make a consistent, calm distinction between fantasy and reality, without being argumentative about it, or getting her worked up. I wouldn’t insist on activities for her, but continue to offer them daily, with a little mild persuasion. I’d like particularly to get her to one of the tea dances, although I understand she won’t go near them. I hope you’ll keep working on that.”

  He seemed to regard her case as a classical one—and therefore a particularly instructive one for us—in that it offered a “fairly simple pattern of withdrawal from reality.” By this he meant, as he explained, that her delusions of persecution by the Church were a fairly straightforward dramatization and exaggeration of the feelings of guilt and the fear of punishment created by her expulsion from the convent school where she had studied; and the rejection of her parents an equally apparent reaction to the shame and outrage with which they had received the news of her behavior and the vindictive manner in which they had subsequently treated her. The delusional system of this patient, Dr. Lavrier explained, is so closely related to its cause that it is unusually easy to study the process of evasion by which she has escaped from an intolerable reality—the delusion being, in her case, simply an extension and hyperbole of the reality: “The Church punished me once, so it is determined to punish me still, even more severely; my parents virtually disowned me, so I will acknowledge being disowned by them; I will not recognize them.” There is a simplicity about this, a kind of insanely innocent logic, which I find oddly appealing and which increases my sympathy for these people greatly.

  Bea introduced me to Dr. Lavrier after the discussion, and he asked me—it had apparently been prearranged between them—to stay for a few minutes. Our conversation, although it was conducted in a very informal way, was in fact, I suspect, an interview and part of a regular Lodge procedure to insure that their employees are of an acceptable standard of character and intelligence.

  “Bea tells me you’ve made a good start,” he said.

  “I hope so. I haven’t really had a chance to make many mistakes yet. I guess I’ll make my share of them when I do.”

  “Well, we all do,” Dr. Lavrier said. “But you feel reasonably confident about the work?”

  “Yes. And very excited about it.”

  “Good. I don’t know if Bea told you, but I’m a sort of counselor for the O. T. staff. Any problem you have of relationships with patients that seems to require a medical interpretation—something you can’t work out with Bea—I’ll be happy to help you with. And of course anything else that comes up that you might want to talk about—your own orientation, project ideas, anything at all. Perhaps you’d like to do some reading in the field.”

  “Yes, I would very much,” I said. “I was going to ask Bea for some titles.”

  “Well, she can give you a better list than I can, on O. T. itself. For general background in psychiatry and mental illness, here are a couple of good standard surveys.” He wrote the titles on his desk pad while he spoke. “And of course you can’t do better than to read the masters: Freud, Jung, Adler. You may find this pretty steep going, but you can dip around in them until it takes a firm hold somewhere.”

  “Thank you very much.”

  “We don’t have a strictly scholastic attitude here, although most of the doctors have been educated and analyzed in the Freudian tradition. But I think it’s a good thing—particularly for a novice—to be aware of all the influences and attitudes that have gone into modern psychiatry. We have lectures once a week—besides case histories—which you’ll find useful, too. A different staff doctor speaks every Monday morning from nine till ten. You ought to try and attend those pretty regularly.”

  “Yes, I will. I’m looking forward to them.”

  Our conversation came to a sudden halt—not an end, as I understood, for it was obvious that he had more to say—during which, while he studied frowningly and with unnecessary attention the list of titles he had written, corrected a perhaps imaginary error in his spelling and restored with elaborate care his fountain pen to his breast pocket, I sensed that he was suffering from the embarrassment of being required, by the responsibilities of his position, to make a succinct official estimate of my character; and being a man of natural diffidence and delicacy, he found it distasteful, I was aware, to do so under the pretense of a private relationship. I could not help wondering if this kind of fastidiousness was not a liability to a man whose very profession was the investigation of personality by means of expertly stimulated and sustained conversation; but then, I suppose that the interviewing of applicants represents a very incidental part of his duties and that the relationships of employer to employee and of analyst to patient are not, at any rate, comparable, the latter being so much more profound that a man might, by the very nature of the superior sensibility which makes him an artist at it, find himself handicapped at the former.

  It is really astonishing how quickly certain personalities can become attuned to one another and how swiftly a sympathy can be established between them. I found myself so sensitive to Dr. Lavrier’s position as my reluctant interlocutor and so anxious to relieve his embarrassment that I myself began casting about for topics which he might find productive and which I might introduce, with apparent innocence, for the purpose of my own improvisation upon them. On the wall behind his desk there was a group of three original oil paintings, framed in “antiqued” oak. Although I know nothing about art, these were remarkable enough to attract my unfeigned interest. They were abstractions, very vividly and boldly executed, the paint applied so thickly that it seemed to have been plastered to the canvas with a knife blade, and crusted here and there with bits of extraneous material—splinters of colored glass, wisps of straw and coarse grains of sand—which were incorporated with dazzling ingenuity into the fierce and somber improvisations in line, texture and color that the paintings appeared to represent. They gave me the feeling of bitter excitement with which I remember certain incidents of the war.

  “Those are the work of a patient,” Dr. Lavrier said, noting my attention to them, “an engineer who was here about two years ago. A remarkable man. Do you find them interesting?”

  “Yes. I don’t know why, but they remind me of a lot of modern poetry: a kind of explosive quality.”

  “Yes, they have. Schizophrenic art is fascinating. And astonishingly like what we call ‘modern art’ in many respects. Modern poetry, in particular, as you say, has many devices that resemble the aberrations of a certain type of schizophrenia which we call hypomania: the fragmentation, the same intense symbology, the neologisms, the compulsive internal rhyme and word association. It’s quite amazing.”

  “Is the significance of that as obvious as it seems?” I asked.

  Dr. Lavrier smiled and tossed his head in a gesture of pleased amusement. “That’s something I’m really not allowed to speculate on—professionally, at any rate,” he said. “I must leave that to the sociologists, or the critics. I don’t think there’s any doubt, though, that the world has been greatly influenced by the work of some extraordinary schizophrenic minds: Savonarola, Hitler, Van Gogh, Kafka—the Lord knows how many. The schizophrenic is not always easy to identify, even today. Particularly the very gifted paranoid type, with a highly organized delusional system and great intelligence and energy. They are very persuasive people, and there’s no doubt that in times past they’ve been extremely active and influential members of societ
y. They still are.”

  I asked how, if they were so effective in the world, it could be justified in calling them insane.

  “Well, insanity is a matter of degree, of course: the degree of appropriateness of the delusion. And in marginal cases it’s a very delicate thing to decide. How are we to regard Blake’s visions? Or St. Teresa’s? Or the testimony of St. John of the Cross? As madness or revelation? I suppose there are many modern psychiatrists who wouldn’t hesitate to call them hallucinations, but they’ve comforted and inspired millions of people.” He had all the while been manipulating his curious pipe, and now he tapped his teeth thoughtfully with the stem. “Mad people have a strange history,” he said. “They’ve been savagely abused in many societies and treated with reverence in others. I suppose the fact is that we’ve never been quite sure about them. We’re not yet. But we know a good deal more today than ever before; particularly in the last five or six years, the strides that have been taken are enormous. It’s a very exciting thing to be alive at a time of so many critical developments in a science.”

  “Is it really a science?” I asked.

  “I’m very pleased that you ask,” he answered, smiling. “I much prefer to think of it as an art, myself; but I’m never sure of being forgiven for the idea.”

  I think he is a very likable man, for whom I felt a strong and immediate affinity.

  This afternoon I worked with second-floor male patients, whose quarters are divided by a central partition from the female section of the floor. As Bob was away on a field trip, I accompanied Charles Mandel, who is the single member of the staff I have met so far that I do not like. He is a short, muscular, wiry-haired young man with a constant rather bitter expression on his face. His attitude to the patients seems abrupt and impatient, and to me it was unpleasantly officious. He made, for my benefit, a great show of his experience and authority, offering much gratuitous and rather condescending instruction and emphasizing his seniority by reminding me, at least three times, that he has been here for over eighteen months and was “in line” to succeed Greta as head of Recreation.

  We worked with three patients, only one of whom I had not met before. This was a boy named Howard Thurmond, who cannot be older than sixteen and seems to be in a much poorer condition than the other second-floor patients. He talks and giggles incessantly, making extravagant comic gestures with his hands and peering with a look of owlish merriment from behind his thick-lensed glasses. He had been reading a book called Zotz!, which apparently concerns a character who has the preposterous ability to kill people by pointing his forefinger at them and shouting this nonsense syllable, a faculty which so delighted Howard that he attempted to duplicate it all the while we were with him, exterminating every nurse, attendant and patient who came our way. His constant manic good spirits, which I found infectious at first, became unbearably tedious in a very short while.

  Our second patient was Mr. Palakis, a middle-aged man with whom I talked briefly in the shop about Dostoevski, the first day that I was here. Today he seemed anxious and depressed, mumbled a good deal and, when I attempted to resume our discussion, shook his head wearily and murmured something about, “Noisy . . . fatuous . . . useless.” He has a habit of stopping suddenly while walking, lifting his clenched fist and staring at it sorrowfully in thought.

  “These ‘great’ books,” he said a moment later, ironically isolating the word, “make a lot of noise—oh, thundering great rhapsodies, they are—and for a while, while one is reading them, they succeed. They drown it out, you know: that terrible sound. One actually believes, for a moment, that it is possible to snare divinity in a web of rhetoric. But does it really matter that somewhere, sometime, a man has written a book? Does it change our condition? Even if one’s attitude is changed, is his condition any different? I ask you quite humbly.”

  I said I was not sure of his meaning.

  “That sound is always there,” he said, “when the other noises stop; no matter how beautiful they’ve been—fiddle strings, iambs, the feet of dancers—when they stop, one hears it still. Listen.” He lifted his hands, laying them on my and Mandel’s arms, holding his head in an attitude of attention. “Do you hear it?”

  “No.”

  “Listen.”

  I did, indeed, hear something then—perhaps the wind in the leaves, or the rummaging of a sparrow—as I confessed.

  “Do you know what it is?” he said.

  “The wind in the leaves, I think.”

  “No, it is the sound of teeth,” he said. “Teeth, crunching through bone and muscle. It never stops. In my room it is particularly bad. I think there are rats in the walls. Last night it was fearful.”

  This is apparently a chronic auditory hallucination of his—one from which it must be dreadful to suffer. We walked for about forty minutes, and in a little while he seemed to have regained his spirits somewhat, launching into a long discussion of Dostoevski’s minor characters, particularly Lise, in The Brothers Karamazov, which was very perceptive and vigorous.

  Our final patient, as yesterday, was Warren Evshevsky, who is now on Second Floor. I was surprised and disappointed to find that he had been returned there last night from Field House in a state of severe depression—not long, apparently, after our contact with him. He seemed to be suffering both humiliation and loss of confidence at this relapse, and was far less animated than yesterday. I was gratified and touched, however, to see that he greeted me with obvious if subdued pleasure, and was encouraged by his request for us to take him walking. He asked if he might go as far as the pond, but as we turned into the open stretch of road that leads across the farmland he caught sight of a group of women patients playing croquet on the green behind Field House, and he asked if he might watch them for a while instead. Mandel agreed, and we sat for perhaps half an hour in garden chairs on the flagstone terrace that overlooks the green, exchanging occasional random observations while we watched the women playing in the sunlight. With their unbound hair and light summer dresses and the mannered attitudes of the game, they had a pretty, old-fashioned look of pastoral charm, like the figures in an eighteenth-century landscape. I realized that Warren was hoping to find Miss Arthur, and although I have never seen her I was sure, from his air of disappointed melancholy, that she was not among them. He seemed content to remain, however, and sat with his elbows on the arms of his chair, his slender hands folded together with the finger tips clenched inside his palms, staring out with a brooding look of combined pleasure and affliction at the white limbs of the players, bare and bright in the sunlight, and the flashing of their hands and the soft confusion of their hair.

  “It would be nice,” he said once, “if we could have an outdoor concert sometime. I think many of the patients play.”

  Mandel objected that it would be impossible to transport a piano.

  “Yes,” Warren said. “Perhaps some chamber music, though. There are some lovely ensembles of Mozart’s; one with a flute, which I think would be particularly appropriate.”

  I supported him animatedly, somewhat indignant at seeing this faint flicker of enthusiasm crushed so arbitrarily, and feeling that Mandel’s objection was very poorly calculated to improve his state of despondency.

  “I’ll mention it to Bea this evening,” I said.

  “Will you really? I think it would make a very pleasant afternoon. Perhaps we could substitute it for one of the tea dances sometime during the summer.”

  “I don’t see why it couldn’t be managed,” I said. “If we can find enough musicians.”

  “I’d be very happy to help,” he said. “I play a violin, you know. Not well, of course, but adequately, I think.”