The Diagnosis (chapter 5)

Wednesday, August 11th  2010

For the first few days we have no diagnosis for Scott. The morning after he was transferred to the Haven he was seen by his medical team. I don’t recall exactly who was on the team, but I know there was at least his doctor, his social worker, a nurse and probably some other mental health workers. 

Perhaps that’s another reason one pays a premium at the Haven – just the concept of having a ‘medical team’ is somewhat reassuring. Contrast this with what happened in the Men's Ward where we had to fight to get just 10 minute's of the doctor's time. Scott’s doctor, whom we will refer to merely as Dr. S., was a lifesaver and real blessing. My husband Chuck and I were still completely overwhelmed and terrified by the situation, but we were moving towards firmer ground and Dr. S. helped to get us there. He spoke with us daily, in a manner that was straightforward and open. He didn’t sugar-coat anything, but his directness, calm demeanor and matter-of-fact presentation helped to make things a little less scary. 

He explained how Scott was still in a paranoid delusional state and still believed that the cars parked outside the hospital were there to watch him. He further explained that in this state, he couldn’t just tell Scott that he was having a psychotic break because it would all just get folded into his paranoid view of the world. Instead he said that he would wait and as the medication started to provide some scaffolding for Scott’s jumbled mental condition, it would eventually crack the door open just enough for Dr. S. to get his foot in.

Far from making a snap decision like the incompetent and unthinking doctor at the ER, the  team at the Haven are monitoring Scott and his reaction to the medications he is being given.

Scott was immediately placed on very high doses of Lithium and Zyprexa. Still he remained very manic and volatile, and so he was also given Thorazine to help calm him at times when the bull started to rage. This usually happened at night, when sleep evaded him and he would get agitated. I recall Dr. S. telling us that if any of us were taking the medication that Scott was on, we would lay down and sleep for a week. But Scott was like a run-away freight train at that point all the lassos that Dr. S. threw up around him were unable to slow him down.

When Scott is manic he gets fixated on sports, usually football. At the Haven, he only wanted to wear athletic clothes with sneakers, and he liked to set the treadmill at an angle of 15 and run on it. In the middle of a conversation or sometimes during a meal, he would drop to the floor and start doing push-ups. This thing with push-ups he had been doing for some time. 

We were so naïve we missed all the warning signs. If we had known anything at all about mania, we would have been tipped off when during a July 4^th weekend party at a friend’s house, he got up at 6 a.m. after only a few hours sleep and decided to jump in the pool and swim laps at great speed. He tried waking all of his friends but they were hung over and told him to go away; saying he must be crazy. He told us all this upon his return from the weekend away, in his ebullient verbose way of that summer, but we merely shrugged and marveled at his high energy.

Yet his high energy eventually degraded to erratic behavior. When the psychosis came, it seemed to us that it came quickly, but in reality he had been able to ‘cover’ it for some time. It was only after he was hospitalized that we started to discover some of the things he had been doing. For example, we discovered in his wastebasket a check for $200 that he had thrown out, but fortunately had not ripped up as he had most of the other things he was getting rid of. We found a hardcover book that he had attempted to burn in the outdoor fire pit (not sure what his thinking process was but the book was the Diary of Anne Frank). He had been practicing self-defense with golf clubs and garden tools, knocking the head off a hoe as he smashed it against a rock. It eventually came out that he thought his father and I were with the CIA and were plotting to have him killed. Therefore he had to cut his ties with his past and be prepared for the attack when it came. My heart hurt to think of him in this dark place. 

And so we waited for a diagnosis. Dr. S. seemed to feel that Scott’s symptoms pointed to a mood disorder, especially once he found out that Chuck’s father suffers from Bipolar Type II, but it seemed that he was still reluctant to rule out schizophrenia. Bipolar has a strong family tie, and if one member of the family has it, it is much more likely that others will too. It is also more common in males.

Dr. S. would eventually settle on a diagnosis of Bipolar Type 1, the more severe of the multiple types. These days they talk about a schizo-affective spectrum and don't rush to label an illness with a tidy label. But the waiting to know what he had and therefore what we could expect as a prognosis was hard, and it was hard to have Scott be so different from his usual self … so ‘crazy’.

Most of us have an inherent fear of madness. This fear stems from our old lizard brains, and is often irrational. We fear snakes and things that move in the dark, or the spider that drops from the ceiling into our hair. We fear people who, in less enlightened times, were labeled ‘lunatics’. We fear the institutions where they were housed. The term ‘lunatic asylum’ conjures up Hollywood-conveyed images of terrifying spaces overflowing with people who have left the boundaries of what we understand to be our fellow humans. We are all tainted by these images. When a person you love abruptly becomes somebody else, somebody unrecognizable, unpredictable and irrational – and you know that the things you say and do are now being interpreted by him through some distorted lens, it is as if the ground beneath your feet has cracked and you have been swallowed into a dark chasm. We lose our foundation and we lose our way. Our minds were gripped by fear,  our thoughts darting about like insects trapped in jar. Chuck and I feared this madness that had claimed our sweet son. We feared it deep down inside our old brains, where a knot of terror sat like a malignant tumor.

Yet we had an unspoken pact to never expose these feelings inside the walls of the hospital. When we pressed that buzzer to request entrance to the Haven, whatever turmoil or anguish we had been engulfed in up to that second, we covered up with a smile and an outwardly calm demeanor. Scott was so volatile, that our primary goal in those long days at the hospital was to keep him calm and to distract him if he looked like he was headed towards an agitated state. Because he had so much energy, it was hard to be indoors with him, but it would be many days before he was cleared to spend an hour or two outside in the courtyard under the supervision of mental health workers. Fortunately they have a ping-pong table at the Haven, and we spent hours and hours playing ping-pong. Both Scott and his father are quite good, and Scott’s greatest glee was to challenge his father to a game in hopes of beating him. Sometimes he would win, but not always.

As the days passed slowly by, Scott started to forge bonds with the other patients. While we had been motivated to move him to the Haven so that he would be with other people his age, it turned out that the patients who had the greatest influence on him were adults. There were two people in particular who played an important role in his path to healing. One was a recovering alcoholic whom I gather had been on a bender and checked himself into the Haven. He was in his mid-forties and I believe he was a successful businessman who may have been involved in commodities. Group sessions took place in the morning before visiting hours, and we came to find that Scott was wholly impressed with what this gentleman had to say, and respected his input. The other patient was a doctor. I do not know why she was in the Haven but she read a lot and was doing research on her condition. When Scott went into crisis in his second week at the Haven, these two would play a pivotal role in helping him at a time when neither his doctor nor his family could reach him.

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