The Writing Disorder





by Henry F. Tonn

      September, 1976.
      His name is David. Six feet, two inches tall and two hundred and forty pounds. His brown hair is thinning. He walks with a ponderous tread, shoulders bent, eyes cast down. He barely communicates. During the first ten minutes of the interview he sits hunched over in the chair breathing laboriously and grimacing. It appears he wishes to speak but cannot gather his thoughts, and is frustrated by this verbal impotence.
      I lean back in my chair and put my feet on the desk. “Take your time,” I say softly. “I’ve got all day.”
      This is true. I’m not busy at all. I have just arrived in Brunswick County, a primitive, sparsely populated area on the southeast coast of North Carolina. At age thirty-three, I’m the only psychologist in the adult services unit for this new mental health center. During the first year our facility is housed in a small church located roughly in the center of the county. We have a secretary, a nurse, a child psychologist, an alcoholism counselor, and myself. It is a satellite of the main center located in Wilmington, twenty miles away, and the psychiatrist there only visits our facility once a week, on Fridays.
      The attitude of the main center has been clear from the very beginning: take care of business and don’t bother us because we have our own problems. This arrangement suits me fine. It gives me the opportunity to make decisions without some bureaucrat hanging over my shoulder second- guessing me. Consequently, the patients will receive better treatment—nearly always the case when bureaucracies can be avoided.
      The county is so primitive that a considerable proportion of the population do not have telephones. Looking up a phone number would be difficult for many of them anyway because of the high illiteracy rate. Consequently, people are prone simply to walk into the facility and announce that they wish to see the “mental man.” If asked why, they reply, “‘Cause I’m mentally.”
      Nobody seems to mind that our facility is as primitive as the county: rough wooden walls, hard floors, curtainless windows, no air conditioning. We have modern bathrooms, though I wonder how recently they have been installed since there is an outhouse in the back that appears only recently to have been abandoned. On the edge of the church is a small farm, and nearby a narrow, swamp-like river flows leisurely toward the sea, bordered by thick, moss-covered trees, and inhabited by alligators and a considerably larger number of nasty-looking water moccasins.
      I love the place.
      So we sit for a while, David and myself, and relax. Gradually I learn that he is forty-six and has been hospitalized ten times in the past twenty-four years for violent schizophrenic episodes. He first entered Dorothea Dix Hospital in Raleigh in 1954. They administered the usual treatment regimen for schizophrenics, but nothing seemed effective. Finally they decided on insulin shock therapy. Five times a week he went into a drug-induced coma, having no choice in the matter—sixty of them altogether. They also gave him medicine, everything that was available at the time—to no avail. Finally, desperate to escape this constant torture, he assured them that he was better, that he was capable of leaving and getting along just fine. They released him after sixteen months and he returned home and tried to work. Soon he was back in the hospital.
      They gave him new medicine, but this was ineffective also. They tried electroshock treatments—the latest rage. They blasted him into unconsciousness week after week, but it did not help. They tried group therapy and even individual counseling. Some of the people were nice and he remembered one psychiatrist who really took an interest in him and tried to help him. But the man was unable to make any headway and eventually gave up, considering David to be hopeless.
      Once when Oral Roberts came to town David obtained leave from the hospital and attended the revival. He went up to the podium and allowed the great man to place his hand upon his head to heal him of his illness. It was unsuccessful. Hallucinations continued.
      I find David to be an interesting man, certainly more interesting than the typical schizophrenic I have met over the years. He had graduated as salutatorian of his high school class in the late ‘40’s where he was also a basketball star, then entered the University of North Carolina at Chapel Hill with the intention of becoming a mathematics major. But already the illness was eating away at his cognitive processes, and before the first semester had elapsed he realized he was unable to concentrate on the problems at hand. He dropped out of school and went home to help his father on the farm. As the years progressed his condition deteriorated, and finally he was forced to admit himself to Dorothea Dix Hospital. Hallucinations now dominated his life.
      What makes David interesting is his awareness of his own illness and his willingness to confront it. Schizophrenics have a peculiar way of ignoring their symptoms and being resistive to treatment. However, David has been paralyzed by his disease and unable to carry out any kind of constructive activity. Voices have called him filthy names and forced him to perform humiliating acts. Nighttime has been the worst. He would sit in his swing on the back porch facing the highway and listen to the taunts. “Go out to the highway and lie down. Wait until a car comes. Go out there and lie down.”
      “No, I won’t. I’m not going to do that. I’ll get killed.”
      “Go out to the highway and lie down. Do it now. You’re better off dead. ”
      And they would throw him off the swing on to the floor and bang his head against the boards, smashing his head over and over again until the pain was finally too great. He would relent and rise and make his way to the highway in the darkness and lie down on the cool asphalt and wait for a car to come, a car that could smash his body into a lifeless hulk. And no matter how late it was, a car eventually appeared, and a terrible fear would rise up in him because he did not want to die, but also felt he could not leave the road because of the terrible condemnation by the demons, because he was a vile and evil person unworthy of living. And so the car would draw nearer and nearer, the headlights growing brighter and brighter, and a trembling would take over his body as he wondered if this was indeed his last minute on earth. Paralyzed, limbs frozen in place, afraid of dying, desperately wanting to live, he was unable to move because of the guilt and condemnation that would occur. So he would wait until the car was almost upon him when, the fear of death finally surpassing the fear of demons, he would begin to crawl to the side of the road toward the bushes which bordered the edge. But it would be too late. And the car would almost be upon him when he finally rose up and threw himself across the road to the shoulder just in time as the car sped by, the driver perhaps unaware of what had just taken place before him.
      Was that a deer in the darkness?
      And he would remain huddled in the bushes shaking and perspiring, animal sounds emanating from his throat. And the voices would return and order him, “Go into the highway. Take off your clothes and go into the highway and lie down. Do it now.”
      “Take your clothes off and go naked into the highway. Go now. You’re going to die naked as you came into the world. Take off your clothes and go into the highway.”
      “No, I won’t.”
      And they would smash his face into the dirt, forcing him down violently, filling his mouth and nostrils and cutting off his breath. He would moan and struggle but find himself helpless to resist. Finally, unable to bear the pressure any longer, he would rise and shake himself from head to foot, gasping for air, and then remove his clothing, slowly, piece by piece, and walk into the highway, tears streaming down his face, and lie once again on the dark asphalt and wait for the next car, wait for the same scenario to repeat itself, over and over again, because there was no other choice, because the demons would have their way.
      However, I believe I can help this man where others have failed. I have studied schizophrenia for years and understand the disease. I know it is biochemical but also suspect that there are psychological components that can be addressed to ease the symptoms overall. Give the patient tools to fight the terrible hallucinations and all the havoc they render and this in itself will improve the situation. And medication, the proper medication needs to be determined. This is mandatory. I know there is always a best medication combination−the mix that reduces the symptoms by the maximum amount with the least side effects.
      I have been searching for a patient like David for a long time to test my theories. He possesses three qualities I consider invaluable: 1. Intelligence 2. Awareness that his hallucinations are, indeed, hallucinations and not real people talking to him 3. A willingness to fight.
      “Why don’t you come in and see me on a regular basis for a while?” I suggest after two hours. “I think I can help you.”
      He regards me skeptically. “How old are you?” he asks.
      “You look younger.”
      “I got a master’s degree at twenty-two. I’ve been a psychologist for eleven years.”
      “You don’t look that old.”
      “Good genes. But I think I can help you.”
      “You’re not going to experiment on me, are you?”
      I shake my head. “Not a chance.”
      He shrugs his massive shoulders. “Okay. How often should I come?”
      “Let’s start off at three times a week. Let’s really hit this thing hard. I’ve got the time. Can you come in that often?”
      “Sure. What else have I got to do?”
      “Come in this Friday first and see the psychiatrist and we’ll get your medications straight. Then we’ll go from there.”
      He visits the psychiatrist on Friday, and we fiddle with his medication over the next three months until we fall on the right combination. That in itself helps. He starts coming to the center in the early afternoons on Mondays, Wednesdays, and Fridays for therapy. My plan is to start slowly and drift into the core of his illness. I have a library of reference books at home and can consult them whenever needed. I feel all these preparations are more than adequate for the task at hand, and have little doubt I can handle whatever comes up.
      I am wrong.
      His illness explodes on me like a titanic bomb. Fifteen minutes into the first session he throws himself to the floor and begins screaming. His head twists to the side as though being wrenched by some macabre spirit, and his eyes roll up out of sight. “Get off me! Get off me!” he hollers, and writhes with what seems like an epileptic seizure. He wails and covers his head with his hands. He rises on all fours and shakes himself violently, like a dog trying to expel flames from its fur, all the while making strange guttural sounds. Then he returns to the floor and curls into a fetal position, moaning quietly, apparently exhausted by his exertions.
      I am speechless and I contemplate what to do. The books don’t say anything about this kind of behavior when you are treating someone on an outpatient basis. How many books on schizophrenia have I read? A dozen? Fifty? A hundred? What have I missed? How many experts have I consulted? How many seminars have I attended? Eleven years I’ve spent preparing myself and now I sit here completely impotent, confused, and even frightened. I’m like a graduate student seeing his first patient. I’m clueless.
      Eventually David recovers, and slowly picks himself up from the floor and sits back in his seat. He is obviously shaken by the experience, and gives the appearance of a trauma victim. He lets out a deep sigh and stares down at his hands.
      “Tell me what happened,” I say.
      His eyes are twin pools of pain. “The demons rule me,” he replies.
      And so we begin.

Henry F. Tonn is a semi-retired psychologist whose fiction, nonfiction, poetry, literary and book reviews have appeared in such print journals as the Gettysburg Review, Fifth Wednesday Journal, and Connecticut Review, and online journals such as the Summerset Review, Front Porch Journal, and Eclectica. He writes monthly reviews for "Demons" is an excerpt from his recently completed memoir, I NEVER MET A PARANOID SCHIZOPHRENIC I DIDN'T LIKE, which covers the first twenty years of his career as a psychologist in various mental health settings.

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