COMMUNION
AT ONE O'CLOCK
D’vorah Elias
Copyright © 2011 by D’vorah Elias
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Table of Contents
Chapter 1: Driving to Algonquin Park
Chapter
2: Dr. Joughin’s Notes
Dance
With Me
Ani
Found
Poem
Chapter
3: Beginnings and Endings
Mother
Song
Chapter 4: D’vorah’s Journal Entries
Chapter 5: Far Away In Trieste
Chapter
6: Foul Shots
Untitled
Poem (This Woman)
Chapter
9: Journal Entry: September 12, 1989
Conversion
Chapter 10: Journal Entry: October 6, 1989
Chapter 11: the Maestro’s Daughter
Chapter
12: Dr. Joughin’s Interval Note: November 1, 1989
400
Washington Street
Telephone
Calls
Chapter
13: Dr. Joughin’s Interval Note: November 7, 1989
Cherry
Blossom Time
Internalizing
Cliché
Chapter 14: Welcome to the Hotel California
Chapter 15: Dr. Joughin’s Entries
Chapter
16: But, Do You Come From A Good Family?
Even
The Rain Forest Weeps
Forbidden
Fruit
Chapter 17: Communion At One O’clock
Chapter
19: Dr. Joughin’s Entry: January 5, 1990
Sometimes
I Can Run Straight Into The Sun
Dry
Ice
Chapter
20: Dr. Joughin’s Entries
Merlin
Boston:
Saturday Night
Chapter
21: David’s Secret
He
Entertains Himself
Chapter 23: Dr. Joughin’s Entry: April 18, 1990
Chapter
24: Dr. Joughin’s Last Entry: August 3, 1990
Look
Into The Landscapes I See
Holiday
Inn By The Interstate
Chapter
25: Dr. Joughin’s Discharge Summary
Fireflies
In A Jar
Lullaby
Each
Small Death Resurrected
In
Dr. Joughin’s Office
This book is dedicated to Vic who always gave me hope;
and to
Dr. William Joughin who taught me how to give it to myself.
I don't know what prompted me to think I could write a book about such a personal journey. The fact that I kept an extensive journal while in the hospital, and that I gained unrestricted access to my clinical record two years after my discharge, gave me the encouragement that I would be able to reconstruct events as true to reality as possible.
Upon further reflection, however, I decided that the world really did not need yet another biographical account about life inside a psychiatric hospital. My woeful story would probably only hold fascination for people who know me. I decided, ultimately, that the people I had met during my stay in the hospital were far more interesting characters.
Over the twelve and a half months of my stay in the hospital, I observed enough sadness and agony to eventually come to respect the high price all these individuals (including myself) had paid for the descent into their own personal hells. Although I had, and continue to have, great admiration for the staff who treated us, I have far more respect for the patients who had the courage to “walk the way” to recovery. In the end, the patients were the ones who made the changes in their lives.
As I began to write while sitting at my kitchen table long after my family had gone to sleep, my feelings of admiration were reinforced over and over again. The people you will meet in these stories taught me a great deal about what it really means to hit bottom and to climb back up again, one rung at a time. So, I suppose this book is a testimonial to them, though not all the stories are favorable.
Some of the people I encountered didn't make it. I remember them on the new birthday I have adopted since my discharge. It is the anniversary date of my discharge – August 3rd.
Despite the fact that some of the stories about others have been fictionalized, they are all based on factual events, conversations, and observations. I have remained in contact with some of the people in these stories and have obtained their permission to use their real names. In cases where it was neither practical, nor desirable, I have changed all identifying information and names of those patient's who I felt would not wish to be identified. In those instances, fictitious personae were created to protect both the innocent and the guilty. I was able to obtain the permission of all the staff named herein, with the exception of the Unit Chief and the nursing supervisor (whose names I changed) to use their first names. My therapist's name remains unchanged.
The piece entitled “Communion At One O'clock” is based on erotic transference fantasies. The piece following it, however, is largely based on true events.
Though I have chosen to tell the stories of other patients, using my character as the protagonist, the story is really a story about myself. I have chosen to disclose painful incidents in my life in the hope that I might convey to others, both mental health care givers and consumers, that there is hope, that change does occur.
My diagnosis was Borderline Personality Disorder which, according to psychiatric literature, is an entrenched, untreatable disorder. The prognosis for anyone diagnosed as a Borderline is bleak. The current feeling within the psychiatric profession is that Borderlines are not cured but that, given enough time; they mature out of their maladaptive behavior patterns. By the time they are in their forties, the majority of Borderlines have quieted most of the demons raging inside them.
I was thirty years old when I went to the Institute of Living in Hartford, Connecticut for treatment following multiple suicide attempts. Since discharge, my life has become, in many ways, dull and unexciting. But, I have found peace within myself that I never believed existed and I have not been forced to endure the anguish that was such a large part of my existence before I received treatment. I believe that mine is a success story which is the reason I have chosen to share it. My hope is that anyone who reads this book will come away with the realization, if nothing else, that the scripts we write for our lives can be changed. The courage to take that first step and the tenacity to wade through the muck comes from within and ultimately, determines the outcome.
The names of the following people were used with their permission: Dr. Joughin, Barbara, Gary, Howard, Hugh, Jan, Sam. The following patients and/or staff members are fictitious to protect both the innocent and the guilty: Jan's husband, Tom; Dr. Gold; Anna; Peter L. (the therapist in London, Ontario); David; Andrew; Peter, the patient from another unit; Margie; Penny; Freeman; Rachel Kalman; her boyfriend, Nate; Gina and Richard Kalman; Sarah and Alex and her son, Joshua; Julie and her sister, Marian; Julie's boyfriend, Jim; Linda; Melanie; Steven.
Race the sun
it's as easy as
putting down
your foot ...... ah, the
non-believers.
North and eastward —
into twilight.
No
money,
little gas in the tank.
Who says man can't fly?
Just drive, only drive.
Look at the map
and
just drive
myself crazy.
It's terrible to feel so
alone
when all you want to do
is crawl inside another person's
skin.
Trees fuller than most people's memories.
Pine needles
crunch... …snap, crackle...
pop into reality now and
then.
Telephoning coordinates —
s.o.s. calls.
The wire
snaps.
Camera shutter
captures —
a face
a famous
picture...
A little girl running
beside a ditch flowing with
human wreckage,
her skin dripping
from her bones.
Names
carved into history on picnic tables
like weather-worn
faces.
People long gone
who
probably left no mark
in the
world but here.
I add my own initials.
This body is
one
large
empty place,
always burning.
Where's a forest ranger
when
you need one?
Running
and no matter where you go
there you
are.
There, there
you are.
I see you
hiding in dark
places
where you think
no one can see you.
Where you
think
no one can
find you.
Under the bed
under the covers
under the anger.
Running so
god-damned fast
but never
fast enough.
and,
so there you
are
always
just where you started.
Racing the sun
flying
with wings
carved from granite
but
with striations
like
feathers.
It's no wonder
you crash so hard.
Chapter 1
DRIVING TO ALGONQUIN PARK
“This is the Bell long-distance operator. I have a collect call from D'vorah. Will you accept the charges?”
“Yes.”
“Howard? Jesus, Howard, you have to help me!”
“Where are you?” he asked.
“I can't tell you.”
“Then how can I help you?” Click... click...
“I don't know...”
“Where are you?”
“I was going to kill him!”I shrieked
“Who?”
“Peter.”
“Peter, who?”
Howard said.
“You know … the shrink.”
“Oh – God. You have to tell me where you are.”
“No, I'm not going to the hospital again. I'll never get out. I'm going crazy!”
“Just calm down..... You're not going crazy. I got the things you left me. I can't do anything with that stuff, you know. It's not a proper will. You have to come back. Can you do that?”
Silence.
“Are you still there, D'vorah?”
“Yes.”
“Can you come back here? Do you need someone to come and get you?”
“If someone is going to come to get me, then I have to tell you where I am.” I said.
“Yes. Tell me where you are and I'll come and get you.”
“No. I'm going to hang up now.”
“Don't hang up.”
“I have to. I have to think. I can't think straight.”
“Don't hang up the phone.”
“I'm going to hang up. I'll call back later.”
Back in the car. Safety. Driving again. What am I going to do? My God, what have I done? Stop it. You haven't done anything. You weren't really going to do it. Oh, yes, I was! No, you weren't. Have to get gas. No money. Now what? No credit cards. I'm going to run out of gas. Where the hell am I? Two hundred miles from nowhere and going nowhere fast. Algonquin Park. They say it's such a pretty place. It's almost Canada Day weekend. There will be a lot of people. Have to pick a very out-of-the-way spot.
Tired. I'm so tired. Maybe I should go home. Home. Where is home? Back to London? Back to what? Seeing him all the time. I'm going crazy! You've been crazy for a long time now, or didn't anyone tell you that? Why won't someone help me?
It's really not his fault. He tried his best. No one can help me. If anything, I should feel sorry for him. Poor guy. I don't think anyone can help me anymore. This is my destiny. To kill myself. I have to kill myself now. I don't trust myself anymore. Not when I've been thinking the way I have for such a long time. Couldn't even tell anyone. No one would listen. Or maybe I was afraid they would listen. What am I going to do?
Driving for hours. Through one dinky town after another. Maybe they've called the police. Just what I need. Just what I need. Look at the map. Have to take Highway 4 north to get to Algonquin Park. Big place. Thousands of square miles. No one will ever find me.
When did everything start to go wrong? He was gone. On vacation. My husband was away. Took all those pills and ended up in the hospital again. Still alive. Wish someone would kill me and put me out of my misery. What kind of way is this to live? Never happy. Never satisfied with anything life dishes out. Always causing trouble for people. They'll be better off when I'm dead. No one will even miss me, I'm sure.
All I wanted was for him to love me. Too much to ask. That's not his job. His job is to help me cope. Get better. But how can I get better? He left me. Just like everyone else has. I ask for too much. Demand too much. Don't appreciate what I've got. Never satisfied.
Left all those silly instructions with the rabbi. Want to be cremated. Right. No way will they cremate me. They'll say I was crazy. Didn't know what I was asking for. Bury me. Put me in the ground. Worms. No. It doesn't matter, though. I'll be dead. Won't feel it. Won't have to feel anything anymore.
“Hello.”
“Howard?”
“I'm here.”
“...Scared. I don't know what to do.” Click.... click....
“Come home. Vic is worried sick about you.”
“Can't come home. Can't face it anymore.”
“Where are you?” Howard asked again.
“I'm very far away. No one will ever find me.”
“There are a lot of people who wish you would come home. I'll come and get you if you don't think you can manage the drive back.”
“No. It's almost Shabbat. You'd never make it home in time. Too far away.”
“I don't care about that right now. Saving a life is more important than Shabbat. You know that. Tell me where you are and I'll leave right now.”
“No. Almost dark. Time is running out. I have to hang up now.”
“Please tell me where you are.”
“I'm such a failure. My life has been such misery. I don't want to go on anymore. Can't. Can't face the pain anymore. No one can help me. I can't stand it anymore.”
“There is someone who can help you. We just haven't found that person yet. But if you hang on, we'll find them.”
“No. Can't hang on anymore. Been hanging on by my fingernails for too long now as it is.” Click.... click..... clickkkkkkkk
“Howard?”
“Yes.”
“Do you think I'm a terrible person?”
“No, I think you're unhappy and confused. But I don't think you're a terrible person. Why do you ask?”
“I told you why.”
“Tell me again.”
“I was going to kill him.”
“Yes, you told me you were going to kill him. But you didn't. He's still alive. I spoke to him.”
“When?”
“I called him.”
“You called him!”
“Yes, I called him after I talked to you.”
“How could you do that?” Click..... clickkkkk...... click, click
“I wanted to make sure he was okay and I wanted to know if he'd spoken to you. He said you hadn't called him. He's alive. He's okay. You didn't hurt him. You can come back.”
“They'll put me in jail.”
“No one will put you in jail,” he reassured.
“Yes, they will. I was conspiring to kill him. They'll put me in jail.”
“I promise you that no one will put you in jail.”
“They'll put me in the hospital.”
“Maybe you need to be in the hospital right now to sort things out. Maybe it would help.”
“It never helped me before. Why do you think it would help me now?”
“I'm worried that you're not safe.”
“I'll never be safe.” Click...click, click...
“What's that noise on the phone, Howard?”
“I don't know.”
“You're lying to me.”
“You know I don't tell lies.”
“Well, I think you're lying to me right now.”
“Please tell me where you are.”
“No.”
“Why did you call, then?”
“Because I'm scared. I'm going to die and I need to talk to someone. Do you want to hang up?”
“No.”
“I want you to grant me forgiveness. I've been such a bad mother, bad wife, bad person. Can you do that for me?”
“You know we don't do things that way.”
“Well, can you send a priest?”
“I can, if you'll tell me where you are.” Click, click, click, click
“There it is again. Are you sure you don't know what it is?”
“I'm sure. You were going to tell me where you were, remember?”
“Oh...., that. Right, I was, wasn't I? I'm up north.”
“Where north?”
“I'm not sure. But, it's far away from London. I know that. I've been driving all day long.”
“Are you near Toronto?”
“I don't think so. I'm going to hang up now. You won't send a priest. I was a bad Catholic too, you know. Just a bad person, all my life. Hang up the phone, Howard.”
“I'm not going to hang up the phone. You have to hang up.”
“Don't make me hang up the phone on the rabbi!”
“Then don't hang up. I can sit here all night long and talk if you want to. But I'm not going to hang up the telephone. You're actually doing me a favor, did you know that?”
“How?”
“I got out of a Board of Governor's meeting tonight. Thanks.”
“Well, maybe I'm not a total wash-out, then.”
Sun setting. Getting cold. Driving. Into the Park. Ranger asks me if I'm going all the way through or planning to camp. What should I say? No, I'm going to kill myself. Do I need a special permit for that? Inside the park. So green. Beautiful, really. Seems a shame to defile such beauty with death. Look for a side road. Need a map of the park. Should have bought one. Too late now. Can't go back and ask for one, he'll get suspicious. Can't find any side roads.
“Hello?”
“Howard. God, you are such a good friend. I'm here. Going to do it. Will you do something for me?”
“What's that?”
“Will you tell Vic and the kids that I'm sorry?”
“Sorry for what? For being human? For being sick? No, I won't tell them that.”
“Why NOT?”
“You tell them yourself. If you kill yourself, I'm going to be plenty angry at you and won't feel like doing you any favors at all. Understand? I'm not even sure I'll give a eulogy at your funeral. Think about that.”
“Oh...”
“Well? Committing suicide is the coward's way out. I always thought you had more courage and strength than that.”
“I don't.” Click, click..... click
“I think you do. I think you have more courage than you ever give yourself credit for. Come home. The kids are terrified. Vic is a wreck. I'm scared shitless.”
“I can't. I told you already.”
“Why? Because you're afraid people will laugh at you? No one's laughing at you. Everyone is worried about you.”
“I'm too tired to drive home now. Tired. Sick and tired.”
“Then tell me where you are. I'll come get you.”
“Maybe I'll just go to a motel and sleep for a while. Then I'll come back tomorrow. Okay?”
“Do you have money?”
“No.”
“Then how are you going to stay in a motel?”
“I didn't think about that.”
“I'll tell you what. You go to a motel and have them call me and I'll put the charge on my VISA.” Silence. “D'vorah? Are you still there?”
“Yes.”
“Can you do that?”
“No.”
“Why not?”
“I'm not sure I want to go to a motel.” Click, click..... “I'll tell you where I am....
“Where?”
“I'm in Algonquin Park.”
“God, how did you get to Algonquin Park?”
“I drove the car.”
“What are you doing there?”
“I told you. I'm going to kill myself.”
“How?”
“I have all the stuff. A hose, some rags to pack the tailpipe. I'm going to gas myself in the car as soon as it's really dark.”
“And then I'm supposed to execute the will, right?”
“Yes.”
“Why don't you come home and we'll work something out? Have you thought about what this will do to your kids?”
“Doing what? My kids? I don't know. No. They'll be okay. Vic's a good father.”
“They'll never recover, you know”
“Yes, they will. They'll be fine. I'm a terrible mother. They'd be better off not having a mother like me.” Click, click.
“And Vic. Have you thought about what it will do to him?”
“Yes. He will be sad.”
“Do you think that's all?”
“I don't know. I don't want to talk about this anymore.”
“When are you coming home?”
“I can't. Stop asking me that!”
“Well, what do you want to talk about then? The weather?”
“NO!”
“Have you seen any moose in the park? Any bears?” Silence. “D'vorah?”
“What?”
“Why did you call me? Are you angry at me, too? Do you want to punish me, too? Because if you do, it's working.”
“Punish you? For what?”
“For making the referral to Peter in the first place. I'm sorry it didn't work out. It's no one's fault. I thought he'd help you.”
“Well, you were wrong, for once. He didn't help. He made things worse.”
“I'm sorry for that.”
“Yeah, so am I! Okay. It doesn't matter..... Howard?”
“Yes.”
“When I was a little girl I used to always wonder about why my mother left me. Did I ever tell you that? I used to have all these different fantasies about it, like that she was young and poor and couldn't keep me, even though she desperately wanted to. Or that she died. Or that she was a prostitute. Sometimes I hoped that she had eight other children...I always wanted to be part of a big family. Maybe that's why I had so many children myself, huh? Anyway, she had eight other children and I was just one too many extra. I wanted Peter to mother me, too. But he abandoned me. I hate him.”
“Peter isn't your mother, though. You know that. It was transference.”
“I know that! Don't start talking headshrinker lingo with me!” Click, click, click....
“Hold on just a minute, okay? Can you hold on?” Muffled sounds. He is talking to someone in the room. “Okay, I'm back.”
“Who were you talking to?”
“My wife.”
“She must be powerful mad at me.”
“Why would she be mad at you? She's worried.”
“I'm talking up a lot of your time.”
“No, she's not mad at you. No one is mad at you”
“I'm going to hang up now. You go eat your dinner. It must be getting cold. I'm tired of talking.”
“I don't want to hang up.”
“Yes, but I'm tired. I've been standing here in this phone booth and my legs are tired and they hurt. I want to sit down. I have to go to the bathroom. I want to go to sleep.”
“I thought you were going to kill yourself.” Silence...
“Howard? Are you there?”
“I'm here.”
“I don't really want to kill myself, you know. I just don't want to feel like this anymore. I can't stand it anymore. I'd do anything to escape the pain. What should I do?”
“My wife says that you're not far from the Jewish summer camp. It's about ten miles away. I want you to go there for the night. I'll call them. And then Vic and I will come tomorrow to get you.”
“Oh, you think I'm just going to show up at some camp in the middle of the night...”
“It's not the middle of the night...”
“...and just say, 'Hi, I'm the crazy person the rabbi called do you about. You don't mind if I just bunk down here for the night, do you?' No. I'm not going there. And how did she know where I was? You told her, didn't you? Who else did you tell? I'm hanging up!” Click...click...click......
“You can't stay overnight in your car. You have to go somewhere you'll be safe.”
“I told you, I'll never be safe.”
“When you come home, why don't we see if we can set up a meeting between you and Peter to sort through the things that went wrong. Don't you have another doctor? Maybe he...”
“She.”
“...maybe she can help us do that.”
“She doesn't help me at all. You know why?”
“No, why.”
“Because I won't let her. I won't let anyone help me. That's why I'm not ever going to get any better. That's why I have to kill myself. Because if I'm going to be like this for the rest of my life, then I'd rather be dead. But, you wouldn't understand that, would you?”
“I understand more than you might realize.”
“Why is God doing this to me? Making me suffer like this? You're a rabbi, you must know the reason.”
“I think there is a reason for it, yes. You just don't know what it is yet.”
“Oh, shit. I knew you'd say that. You clergy are all alike. God's infinite wisdom, right? The hell with God! He's given up on me, why should I believe in Him?”
“I think you're the one who's given up on God, not the other way around.”
Clickkkkkkkkk.......
“There! You must've heard that!”
“Heard what?”
“Don't tell me I'm hearing things. I'm not hearing things, too!”
“I never said I thought you were psychotic.”
“Did you hear that clicking noise on the line?”
“No.”
“I'm hanging up. I'm tired.”
“Did I tell you about what happened when I went to the Rabbinical Convention?”
“No, and I don't care.”
“It was really quite funny. We were all sitting in this room eating lunch and then...”
“Howard?”
“What.”
“You don't have to do this?”
“Do what? I'm trying to tell you a funny story and you don't appreciate my humor.”
“I want to hang up.”
“So hang up.”
“I want you to hang up first.”
“No. Anyway, we were all sitting in this room eating lunch and this rabbi from California gets up to do his speech...”
“Howard?”
“Yes?”
“You have been such a good friend to me. Do you know that?”
“I care about you. You've been a good friend to me, too. I would miss you if you were gone.”
“I knew you wouldn't fail the test.”
“What test? I never knew there was any test.”
“I knew that if I asked you to help, you would.” Silence. “And do you know what else?”
“What's that?”
“I appreciate all the help you've given me over the past couple of years. You've kept me going a lot of time. I'm sorry for all the… trouble I've caused you.”
“It's never been any trouble.”
“I'm going to hang up now. Thanks.”
“Don't hang up the phone. I'll really be angry if you hang up the phone.”
“Then I'll just lay it down here and walk away.”
“No. Don't do that, either. I'll be angry if you do that, too.”
“There's a car coming down the road. Shit! Did you call the police?”
“Yes.”
“Why? Why did you do that?”
“You didn't give us any choice. What did you think I was going to do? Just sit by and let you harm yourself? No, I'm sorry, D'vorah. Friends don't sit and do nothing when someone they care about is going to self-destruct. I want you to get some help.”
“I don't need anybody's help.” Car coming down the road. “I have to hang up now.”
“Don't hang up the phone, I'm telling you. Where are you going to go, anyway?”
“Someone's coming. I have to hang up now!”
“D'vorah! Listen to me. Don't hang up the phone.”
Car pulling into the lane way. Men getting out. Slamming the door shut to the phone booth. Dropping the telephone.
“Mrs. Elias! Mrs. Elias, please open the door
“Go away!”
“We're here to help you. Please open the door and come out.”
“NO! Go away!”
“We're not going to go away. We want you to open the door and come out. Now. Please.”
“Go away!”
“We've been searching for you all day. We're not going to go away. We want you to come with us to Huntsville. There's a doctor who wants to talk to you.”
“I don't want to talk to any damned doctors!”
“Please open the door and come out.”
“No!”
“There isn't any place for you to go. We can stay here all night if you want to stay inside the phone booth.”
“Am I under arrest?”
“No, you're in our protective custody.”
Protective custody? Who is this guy kidding? I don't feel like I'm being protected. They sent FIVE big guys to arrest me? Must've thought I'd put a pretty good fight.
“Howard? Why did you call the police?”
“I told you why. They're not police anyway. They're park rangers.”
“Smoky the bear types?”
“Well, I guess so. Why don't you go with them? I think you need to get some sleep, if nothing else.”
“Oh, Christ.”
“You told me you don't really want to kill yourself. Don't box yourself into a corner any more than you already have. Let them help you. That's what they're there for. When you get home, we'll find someone who can really help, okay?”
Opening the door. Surrender. Can't even kill myself right. Fail every time.
“Hello, Rabbi? We're here. She's safe. We'll be taking her to the Huntsville Hospital now. Thanks for your help. I think she needs some sleep... okay.... bye.”
A jeep. I'm in Smoky the Bear's jeep. An Emergency room. People everywhere, asking questions. Leave me alone! Why won't they just leave me alone!! A tranquilizer? I don't need a tranquilizer! I'll go to sleep. You don't have to make me go to sleep. Well, maybe if I go to sleep, I won't ever have to wake up again.
Chapter 2
DR. JOUGHIN'S ENTRY: ADMISSION NOTE:
JULY 19, 1989
Psychiatric History:
Informant: The informant is the patient who is reliable.
Chief Complaint: "I'm here because I keep trying to kill myself."
Present Illness:
The patient on June 28 wrote an 18 page summary of her discontentment with a former therapist, Dr. L., that was to be sent to the physician’s disciplinary committee of the Province of Ontario. This made her so angry that she consciously chose to be suicidal rather than homicidal towards Dr. L., and on the weekend of July 1 she drove some 400 miles to Algonquin Provincial Park with the intent to kill herself with carbon monoxide. She had obtained a hose, wadding to pack the hose in the tail pipe, and tape to seal the windows.
Her flight had been noticed because she left a note with explicit directions as to how her body should be disposed of and when she called the rabbi from her synagogue in her home town, his phone had been tapped after he had gone to the police with the information she had left him. The police discovered her and brought her to a general hospital where she stayed overnight before being flown back via air ambulance to the London (Ontario) Psychiatric Hospital where she stayed for five days before being sent home. That night she and her husband got into conflict with each and she stayed with a friend. She took, at that time, eleven 1 mg. Ativan, saw her psychiatrist Dr. M., and was admitted to St. Joseph's Hospital in London for four or five days and stayed with the same friend for a day or two before arrangements could be worked out for her treatment at the Institute of Living at which time she was transferred here.
Past History:
Mrs. Elias began her psychiatric history at age 15 when she overdosed on 150 aspirin in the context of a boyfriend pressuring her for sex, failing her math course, and being estranged suddenly by her friends who felt she had become "too egotistical". She spent two weeks on a psychiatric ward and then was in outpatient treatment for six months. She received no medication at that time. She next was involved in marital counseling at age 21 for about six months because of marital problems and she again was on no medication.
In January of 1987, after the birth of her youngest child, she took 180 aspirin and was given activated charcoal in the emergency room. She claims she only stayed in the emergency room overnight, but was in treatment for ten weeks afterwards and received Elavil. She is equivocal as to whether the medication helped. She next saw Dr. S. from April through October of 1987 and was seen both individually and in couples therapy with her husband.
In October of 1987, she began treatment with Dr. L. with whom, according to her and as suggested by her history, she developed a very significant transferential relationship. During this treatment period she was on Desipramine, 200 mgs. a day, and in March, 1988, she took 86 50 mg. pills of Desipramine. She was in intensive care for three days and then transferred to London Psychiatric Hospital. The treatment relationship with Dr. L. was terminated by telephone and in the patient's mind was misconducted and this became the basis of her letter of complaint to the authorities and the source of her immense fury.
She began treatment after termination from Dr. L. with a psychologist but since he was not a physician, there was no insurance coverage and so she began then to see a psychiatrist, Dr. M. who saw her until her transfer here. She remembers being tried on two different neuroleptics but only took them each for two days.
Family History:
Mrs. Elias does not know any of her genetic history. She was born in Korea and adopted at 11 months of age by her American parents–an American Caucasian woman and an Hawaiian father of Japanese descent. She believes that she was placed for adoption at about five months of age, that she was to be adopted at age 7 to 8 months but then subsequently contracted the measles and was, therefore, adopted later. She knows her mother was Korean and her father was most likely American. She was told that she was picked from several photos of children to be adopted because she looked the cutest.
She has a 20 year old brother, also adopted, who is full-blooded Chinese and who was born in her home town where her parents still reside.
Personal History:
The patient was raised in Cincinnati and lived there until she was about age 18. She attended elementary and junior high Catholic schools and then attended a local public high school. She took a college preparatory curriculum but did not go to university because she feared she could not do the work. She never took her SATs. She had musical interests and sang.
She moved to Washington, D.C. in 1977 and met her husband there when she was 19. He was a post-doctoral student in physics and they were married in July of 1978. She has four children, three boys and a girl.
Her January 1987 overdose took place shortly after the birth of the last child. She wanted to have a tubal ligation and the husband resisted because of his Orthodox Jewish views. They fought, she had the tubal ligation and one week later she overdosed.
Her husband's name is Victor and their conflicts center on money, their sexual relationship, disciplining the children and religion. The patient was raised Catholic and converted to Judaism before their marriage. She describes her husband as being a "born again Jew" and says "I didn't marry a rabbi, but I ended up with one." She has had a close relationship with a rabbi named Hoffman. She describes herself in her family of origin and in her current family as "never feeling like she belonged anywhere" and "detached from people like an observer."
During her marriage there have been many moves all connected with her husband's career as a theoretical physicist. He now has a tenured position at the University. She has not spoken about how these moves affected her.
Summarization of Admission Assessment:
The beginning of this patient's psychiatric history at age 15 and the context of her multiple and serious suicide attempts clearly indicate extraordinary sensitivity to rejection and abandonment with resulting rage of enormous proportions mostly directed towards herself, but capable of being directed towards others.
The patient's beginning–her being abandoned by her biological mother (parents?), being adopted after a delay with an illness, and the indignity of being picked on the basis of a picture is a potential source of pain, anger, and distrust. The way in which her own development compounded or exacerbated this potential is not clear. There is an obvious implication relative to her brother–that he is pure and also that the patient had been an only child for ten years prior to his arrival. There is the sense conveyed by the patient when she emphasized "Appalachia" that the mother came from a poor background, and equally relevant that the father's mother had been abusive to him. How these parental developmental experiences affected their personalities which in turn interacted with the patient is not clear except that she had serious problems by age 15.
The patient's transition from her family to her husband in the context of her life was more a search for a new home than for most and there is a sense that the patient felt betrayed by the husband's increased orthodoxy as she described his "being a born again Jew" and an obvious area of stress is the many moves connected with the husband's career.
The diagnosis of Borderline Personality Disorder pertains and the task will be to get the patient to stay long enough to be more fundamentally in touch with her pain and to have the experience of being able to contain both anger and love within her relative to relationships. Only if this happens, can she end the pattern of excessive positive distorted transferential idealization which reaches levels from which enormous rage develops when there is disappointment.
William Joughin, M.D.
Dictated: 7/28/89
Transcribed: 7/3l/89
There are many secrets to come. You are now parting with food that sustained you – all the secrets and secret powers – and no other nourishment has yet appeared to replace it. This is the hardest time of all, harder than even your sickness as sometimes. You will have to trust me enough to take on faith that the new food, when it comes, will far richer.
JOURNAL ENTRY: JULY 25, 1989
There are only two staff doctors here–Dr. Joughin and Dr. Gold, the Unit Chief. There are also a few assorted residents, but I don't have any contact with them–just the big guy, Dr. J., who is to be my primary therapist.
Dr. Joughin is sort of a funny looking guy. He's short, not much taller than me and has silver hair that falls over his left eye and which he is constantly pushing out of his face. He appears to be in his mid-50's. His voice is gravelly and husky, and he speaks very softly, almost in a whisper. One has to work pretty hard to hear him sometimes.
He has a strange mannerism, too, of listening to me talk with his eyes closed, as if he is asleep. I guess that goes with the territory of being in the shrink business–one often thinks of them as being eccentric and weird. Sometimes I think he is asleep, and I will stop talking. There is usually a long silence then and I end up feeling weird and uncomfortable. Then he will come out with some zinger of a retort that proves that he was not only listening to what I said, but taking in every single detail. He has this funny habit of carrying shelled peanuts in the pocket of his suit coat and then trying to sneak them into his mouth when he thinks no one is watching. Strange. He's a strange man.
I will see him three times a week for approximately an hour each time. Ugh. I'm dreading it already. When I asked Dr. Joughin about that today, he immediately shifted into headshrinker mode and asked me why I thought I wasn't seeing a resident.
I gave a few reasons: they aren't experienced enough to “handle me”; they rotate every six months and I need the stability of one person; because I have trouble trusting people I probably wouldn't trust a resident, etc. He didn't answer me for a long time but when he did he merely asked me how it felt not to have my questions answered. Ha! What a shit!
He is doing his best to provoke me and make me angry–I know it–even though he says he isn't. I think he's a liar.
It is different here, though. Much more so than I expected...
I have a primary nurse with whom I am expected to connect with every day, in some acceptable manner. Her name is Liz and she works every day from 7:00 to 3:00. Now, don't get me wrong. So far, Liz seems like an ok person. She is very soft-spoken, a real lady. She's sort of heavy and older and in a weird way, she reminds me of my mom. Liz has these funny looking glasses, old-fashioned 1950's glasses with the cat-eye shape. She has a funny of habit of peering at me over the top of her glasses and giving me, what I have no other words to describe, the "hairy eyeball". Especially when I am being bad. And, though I've been here only a few days so far, I have given them previews of coming attractions, and lots of them. So, consequently, I get lots of those looks from Liz. I like her, so far, but I'm not really sure what to make of her. She appears to have me pretty well figured out already, though. It isn't easy to pull the wool over this lady's eyes or bullshit her. She can give me a stare that would make the Mother Superior at my old Catholic grade school envious.
I only have group twice a week, so far. We have a very short meeting every morning and a unit meeting every Wednesday afternoon. There are “Team” meetings on Tuesdays and Thursdays and you have to submit a written request for an increase in status and there's no guarantee you'll get any change. You can't just ask your doctor for an increase in privileges. They apparently practice what they call “milieu therapy” here.
There is no Occupational Therapy per se, but there are activities which are used as O.T. but each activity area functions autonomously. You have to have an “activities card” to be allowed to go to any of them unescorted, otherwise, you have to wait for a staff member to take a group of people to a specific activity. It feels so infantile. I'm not sure I'll do well with this kind of arrangement. I am used to coming and going as I please, like most adults in the real world. But, I forget, this is not the real world. I don't think we're in Kansas anymore, Toto!
Smoking is really restricted here and there are scheduled “smoke breaks” which last only fifteen minutes each. That's going to be a drag. Ha, ha. I mean, a bitch.
Surprisingly enough, therapy has not been nearly as intense as I expected. Maybe this is the calm before the storm.
I'm more willing than I was when I first arrived to give this place a chance. Do I really have much choice anymore?
JOURNAL ENTRY: JULY 27, 1989
Today you told me that you could stand whatever it is that I have to dish out. I wonder what makes you so sure. You spoke about seeing another part of me today, the angry part. What would you say if I told you that it was only the tip of the iceberg? Do you have any concept of how tightly I sit on my anger all the time? I suspect you do. You've probably seen it all before, only the faces and the names change.
In many ways I feel as if I'm already dead inside. Maybe it's like you said–that a part of me has already committed suicide. I hurt inside all the time. I don't want to share my hurts with anyone because doing that makes me vulnerable. It means I have to trust.
I'll tell you something–whenever I've attempted suicide, I never warned anyone, except this last time. Do not think I will ever trust you enough to warn you, even if I do stay. I don't think anyone can “fix me” as my husband says.
You keep telling me just how tough you are. But has anyone, besides me, told you how tough I am? I have confounded, frustrated, irritated and exasperated many other doctors before you, my friend. What makes you so special? Is it because you specialize in “Borderlines”? Find us interesting, do you? We are, indeed a fascinating group of fucked up people.
Aside from the fact that this place is different from any other hospital I've been in up to now, I'll need more and better reasons for choosing to stay, that's for sure. Are you up to it?
Shall we dance?
You have learned your lessons well
When to cringe and turn away
and close the door behind you.
There is no method to this madness,
only up and down
and round and rounds.
We twirl in circles as we go.
So, rally round the maypole, darlings.
Race around the pond.
Ring around the rosie, babies.
I fall down.
Rock-a-bye, my honey bunch,
It’s time to go to sleep.
And he will find a rabbit skin
To wrap you snug and tight
and chase away the bugaboos
that steal your dreams at night.
Come dance with me, my little ones.
Paint a smile upon my frown.
Ring around the rosie, we all
fall
down.
DR. JOUGHIN'S ENTRY: JULY 27, 1989
Patient seen for fifty-five minutes. She was angry, withdrawn and testing in the context of believing I missed an appointment at 2:00 p.m. Wednesday which I know she was told was for 7/27/89, especially as the 2:00 p.m. Wednesday time conflicts with the community meeting time. She has signed out last night and I suspect it is related to her husband's being on a trip with the children and even farther removed from her. She clearly states that it is for her to decide what to do with her life, and if she feels nothing can change, then she can make her own decisions in that context. The patient does describe this hospitalization as different and I stressed the possibility therefore of a different outcome. She wanted to know if I was going on vacation and whether I was Jewish which she said was related to how much detail she would have to go into about her Jewish culture. And whether I was going to leave her hanging. She commented on the number of different psychiatrists she has seen over the years and this was related to all of her reasons to distrust. I asked her to sign in, she didn't but I suspect she will. The husband can't be reached until Monday about possible need for commitment hearing.
JOURNAL ENTRY: JULY 29, 1989
Were you notified last night that I had run away? Or did you just discover it this morning when you arrived? I told you that locked door had little meaning for me, didn't I? So you shouldn't have been too surprised to learn that I left. I told you that if I really wanted to go badly enough, the lock on the door would not stop me. I wanted to prove to you that I mean what I say! I don't make empty threats. Be forewarned. The next time I leave, I will not come back. And don't think I can't go if I want to.
I've had pet names for all my shrinks in the past and I have decided to dub thee “Merlin”. Merlin was also slightly “acidic” as you so aptly describe yourself. He lived his life backwards, according to legend. Did you know that? Sort of reminiscent of therapy, wouldn't you say? To my mind, Merlin was not so much a magician as he was someone who could convince others to believe in his ability to make magic. You, I think, definitely believe in your own ability to change people and things.
You told me that you regard yourself more as a cryptographer–you decipher all the codes of feelings and past hurts that your patients send out to you. I think maybe you're more of an alchemist, in my case changing shit into gold.
I can see you aren't afraid to fight with me. Everyone else has always been afraid to fight with me. My other therapist would never raise his voice to me. He just stuck me in the hospital whenever I was being ‘bad’ in order to get me off his back. But since I'm already in a hospital, I guess we've successfully eliminated Step A. He never reacted. You do. It surprises me. You really are unconventional, Dr. J., I'll give you that much.
My friend, Sharon, told me after meeting you, “I think you've finally met your match in this one, D'vorah.” Maybe she was right, huh?
I have a certain amount of grudging respect for you, your toughness. I didn't respect any of the other doctors, so you should feel privileged. But don't make the mistake of thinking that toughness is the only thing I need–or will respond to. You will need to walk a fine line between toughness and TLC and perhaps, most importantly, knowing when to be tough and when to be tender. Do you know how to be tender with your fragile patients?
I have cancer in my soul.
JOURNAL ENTRY: AUGUST 7, 1989
I asked him last week if he thought he could ‘cure’ me. No response, of course. At least, no direct response. He said that when I leave here I will probably be just “desperately unhappy” as opposed to miserable all the time. Well, golly gee whiz and thanks a lot! Then why the fuck bother?
I really HATE Dr. Joughin. I find him arrogant, rude, cocky and paternalistic. I wish I could find out if there is a way to change doctors. Even if it meant I had to change units, I'd do it just to get away from him. I don't see how he can help me if I can't stand him. I don't want to cooperate at all with someone I dislike so intensely. And I can't understand how being at odds with someone all the time is going to help me.
DR. JOUGHIN'S ENTRY: AUGUST 9, 1989
Patient was seen for fifty-five minutes. She is perturbed at the idea of a session on a Friday that could get her close to her feelings only to be abandoned by me when I go away for the weekend. She wore a Mickey Mouse shirt as, I felt, a statement of her intent, but actually she was able to talk about her knowledge that she was abandoned naked and spoke of what that might have meant about her mother's love or hatred for her. In an understandable way but unfortunately a long–nearly characteristic–duration, she talks about these moments of abandonment almost like a play script for off-Broadway.
JOURNAL ENTRY: AUGUST 22, 1989
Today is my birthday and it is the most miserable birthday I've ever spent. It has never been a happy day for me in the past anyway. It has been particularly painful for me to realize that this was probably not a day of joy for my mother, either. And this is, in all likelihood, not even my real birth date. Of that I'm almost 100% certain, so today is yet another reminder for me that I really had nothing as a child–no tenderness, no caring, no stability of love or acceptance from people who were paid to care for the children at the orphanage.
Not too much different from the way I view the staff's caring for the patients: it's their job.
It hurts to realize that my mother did not love me enough to–to what? To keep me even though my life would have been hell? I guess so. I feel such guilt over mourning her absence in my life knowing that the parents who raised me love me as much as they do.
Yes, today is a memorable birthday. No celebration. No party hats for this bad baby. No proud parent here to take pictures of her little girl in her best birthday finery that Korean money can buy. Just lots and lots of tears.
I have no memories of this woman who gave me her DNA. Sometimes I think that having even bad memories would be better than having none at all.
Will I tell Dr. Joughin that today is my birthday? I don't know. I doubt it.
It is far easier for me to fight with him, keep him at an arm's distance and constantly on his guard, than it is to admit how afraid I really am. It is easier to keep him wary than to let him see how easy it would be for him to hurt me. I do not want him to know how hurt the child inside of me always feels.
DR. JOUGHIN'S ENTRY: AUGUST 22, 1989
Patient seen for fifty-five minutes in the context of an “ultimatum” that if she didn't get the pass as she wanted and without submitting a request to the Team, she would leave. The patient admitted that her husband had told her that when she got like that, it was like ‘negotiating with Hitler’ with the obvious implications that her anger was beyond understanding and that Jews would pay: the patient's family, him and the children. After the session the patient was changed and did submit a request. Of note, but not mentioned nor appreciated by me was that today was the patient's birthday as best as that is known in the context of her abandonment. Obviously a very important issue in terms of the day and the degree of process.
I am
some woman's cast off
abandoned in a garden
on a cold, January morning
in Seoul, Korea.
I am Jung-Ran Lee
who flourished in a French orphanage,
nurtured by many mothers
who was chosen from the rest
by parents
half a world away.
I am Lee Ann Kobata
who learned her catechism without fault,
who knelt before the altar
every Sunday morning
but who could not swallow the dogma
as easily as the bread
and who felt like a cannibal
for drinking Christ's blood and
eating his flesh.
I am Lee Ann Elias
who lights six candles every Friday eve
and walks to shul on Shabbos
with four children by my side.
I am D'vorah
who wears white on Rosh Hashannah,
who shivers in the succah
who fries latkes every Chanukah,
who dreads the ritual cleansing of Pesah.
D'vorah, who never makes it through the fast
on Yom Kippur.
Ani D'vorah
who rejected the Trinity
and kowtowing before graven images
but who, ten years later,
still longs for mistletoe and holly,
glass globes that shine
on fresh pine boughs
and on soaring pagodas.
From Necessary Loses by Judith Viorst
Babies need mothers.
Our need for our mother’s presence
is absolute.
There is a time to leave her
and to be left.
Unless we are ready to
separate,
anything is better than
separation.
Mother stands
for safety.
Mother teaches us
that we are loveable.
If we are too deprived
of our mother
we sustain an
emotional injury:
doused with oil;
set on fire.
The healing
is hard
and slow.
Expecting to be abandoned,
betrayed or refused.
Disappointed,
we bring about
what we fear,
driving away
those we love most
by our needy rage.
Chapter 3
BEGINNINGS AND ENDINGS...
I had just begun to feel settled in when he hit me with another whammy. I was just beginning to feel safe, comfortable. In retrospect, that was precisely why he chose that time. He didn't want me to feel too comfortable. I was not there to feel comfortable. I was there to work All my hopes of feeling some peacefulness were broken. I was once again spending my time avoiding my life (he did not like that). I was hoping against all odds that if I only wished things away, they would go...
When you wish upon a star... a dream is a wish your heart makes... dream a little dream of me... Dr. Joughin wants to know about my first life. He calls it my first life, the life I lived in some little village in Korea, the life that I have kept in my scrapbook all these years.
"How do I tell you something I don't know?"
"Do you really think you don't know it?
"Of course, I don't know it. I was a baby. I was only about five months old when, you know...
"Know what?"
"When she ditched me."
"Ditched you?"
"Yes. Got rid of me. Ditched me. Terminated our relationship. Finito. Do you remember that song I played for you last week? The one on the cassette tape I borrowed from Sam, the music therapist?" Dr. Joughin was staring at me blankly. "You know, the one from Man of La Mancha?"
"The one that Don Quixote sings about his love, Aldonza?"
"Yes. That one. To Each His Dulcinea? She sings a very different song from the one that Don Quixote sings."
"Who? Who is singing this song? Dulcinea?"
"Aldonza. Aldonza, Dulcinea. They are the same person, only Aldonza hasn't been transformed into Dulcinea when Don Quixote sings the song. Anyway, Aldonza sings a song about being spawned in a ditch by her mother. That's what happened to me, I think. She left me. In a ditch."
"You were about five months old. She didn't just leave you. She kept you for some time. Did you ever think about what must have finally happened to force her to give you up? She must have had some reason to have kept you around for five months or so. Do you have any thoughts about why that might have been?"
"Yes, I thought about it lots. Who the hell knows? Maybe she kept me around because I was just too cute. I was just too irresistible. Maybe she thought she could sell me into a baby brothel. I don't know."