By Dr David Laing Dawson
In 1968 the police brought a very tall man to the emergency department of a large urban hospital. I quickly learned the man had two PhD’s, one in literature and one in Library Sciences and he was employed as the chief librarian of an important Canadian Library. He was also manic. He could not sit still; he could not stop talking. What spewed from his mouth was a fascinating, pressured, endless run-on sentence of literary quotations, interpretations, criticisms, philosophical observations, and trivia.
The emergency department was designed as an oval, so it was possible to walk the corridor in a continuous circle of approximately 200 feet. This we did. I kept pace as he strode, talked, ranted, and raved, around and around that oval. I carried with me a glass of water and a pocket of tablets in my little white intern’s jacket. Every second or third circuit when he paused briefly to catch his breath I offered him a tablet and a sip of water. He accepted this, swallowed the tablet and continued his journey. I tried to remember some of what he said. I wish I had had a tape recorder handy. His observations roamed over much of English Literature and the history of western thought, in fragments, non sequiturs, creative associations and rhyming couplets.
The tablets in my pocket each contained 100 mg of Chlorpromazine. At four hundred milligrams he slowed at little. By the time I had given him 600 mg he was able to pause. And finally, at perhaps 800 mg and the passage of the better part of an hour, he could sit. The pressure in his speech diminished. He could now absorb his environment. I could now speak a little and he could now hear me.
In 1970 a dishevelled, tall bearded man was brought to a hospital by his family. They had found him, after months of searching, standing outside the Vancouver library in the rain. He had been sleeping rough; he was malnourished; he was not speaking. He was also a lawyer who had disappeared from his office practice, and his family, after announcing he was running for parliament, emptying his bank account, and then being briefly arrested for causing a disturbance. Now he was homeless, depressed, not communicating.
With clean clothes, a soft bed, good food, friendly nurses, and my anti-depressant medication, he was soon talking, more animated. But then he swung into a manic state: over-talking, grandiose, agitated, irritable, demanding. He wouldn’t sit in my office. He stood, paced, demanded I let him leave, ranted invective at my profession, my interpretations of reality, refused my pills. He stood and paced. I sat and listened. He didn’t leave, though the doors were never locked. His family let him know he needed to stay and accept treatment. The law society told him they would not reinstate him without treatment and a doctor’s note. Eventually he sat. Eventually we talked. He accepted my pills, my mood stabilizing medication, lithium. Eventually he was reunited with his family. Eventually he got his licence back. He became an outpatient. He re-established his practice, stayed on his medication, and asked me if I would like to play squash with him.
In 1978 parents brought a young man to see me. He was mute. He had stopped talking altogether. I had a white board in my office, and pads and pencils. The young man was willing to sit and respond to questions by writing out his answers. I found he dare not speak because if he did some tragic event would occur in the world. People would die. He knew this because it had happened. He had become angry, and had taken the Lord’s name in vain, and an earthquake had killed hundreds of people in the Middle East. He agreed to return to live with his parents, to eat and shower and sleep, and to swallow before bed each night the small tablet of Perphenazine I prescribed, and come to see me weekly. He came each week, and each week for an hour he wrote his answers on my white board, and when he tired of that, on the pad of paper I gave him. On his ninth visit I handed him the pad of paper. He put it aside and said, “We don’t need that anymore.”
On a lovely Sunday morning in June of 2008 my wife and I went for a walk. On the journey back I pondered ways to spend a leisurely afternoon. But then we found a frantic woman waiting for us in our parking lot. “John is psychotic again,” she said. John is her brother. An hour later I was in their father’s house. John was on the back porch smoking and pacing. I joined him there. He was agitated, mumbling half sentences in a semi-coherent fashion, some to himself, some to me. Changeable moods swept across him. His eyes would light up and he would tell himself and me that he was Jesus, and he had a mission to save the world, and that I would be forgiven, and then his mood would quickly darken, and he was evil, perhaps the devil himself, and that he should be punished, that he should destroy himself, and then just as quickly back to Jesus. I offered him a wafer of Zydis, a rapidly dissolving form of Olanzapine. He ignored this. His moods and thoughts continued to shift from Jesus to the devil, from good to evil, from a mission to save the world, to the need to destroy himself. I offered the wafer again, and this time he took it and let it dissolve in his mouth. A half hour later he was able to come into the house, and sit, and to sit quietly, and sip tea, and then to speak more rationally. Over the next few hours he became more coherent, better able to focus on the reality at hand. He would stay this night at his father’s, take another Zydis before bed, and they would come and see me in the morning.
It is now 2015. I am astonished to learn that there are people today, even some mental health professionals, who do not believe in the existence of mental illness, nor of the efficacy of psychiatric medications. I suspect that the closest brush they have had with insanity and pharmaceuticals is reading Jack Kerouac and William Burroughs in college, and the only knowledge they have of mental illness, and of the fate of the mentally ill before these medications were developed, has come from Hollywood, or the episode of Murdoch Mysteries I watched last night.