Shrink

by Kjell Rosenberg

I had a patient once who called himself Jesus. For a minute of your time, he would absolve you of your sins. We met often, and when we did:

“Your sins are forgiven.”

“How’s that?” I said at our first meeting.

“Your sins are forgiven,” he said. Then he smiled, tipped his old brown Stetson, and sat on the leather couch. I can’t remember a time when I ever saw him without that worn hat.

“Thanks,” I said, “and how are you?”

“Fine thanks, but the weather does wear hard. How goes it with you?”

“Good. I’m a little stiff, but good. The wife and I played racquetball last night and I think I pulled a deltoid.”

“Racquetball was it? Always preferred tennis myself. Of course the weather makes it hard to play tennis nowadays.”

The weather was a favorite topic, so we discussed it often. The weather did wear hard. Terribly hard. Mother Nature had been brutal this summer, sending one of the most powerful hurricanes of the century straight through Mobile. In many cases, the damage she had done was irreversible.

“There’s a hurricane coming,” he said.

“How do you know?” I said.

“My father told me,” he said, “to warn my sheep.”

“About the storm? Will it be bad?”

His eyes narrowed at the apparent lack of concern for a serious subject. He leaned forward, and braced himself against my desk with his hands said, “People will die.”

“Who will die?”

“My sheep, if I don’t warn them.”

“Warn them,” I said, “how will you do that”

The muscles in his face tightened, his mind trying hard to focus. He leaned back and slumped into the couch. I looked at his diagnosis on my desk. Axis I: no pathological causal factors. Axis IV: traumatic stressor, hurricane, death of relatives, destruction of residence. Rigid upbringing with possible confusion of reality. Genetic predisposition likely.

“Jesus” was once a local minister, Pastor John Frieburger. Now he is an inpatient at St. Jude’s Psychiatric Hospital in downtown Mobile. When he remembers the life he had before, he talks about the art museum which he used to frequent. Sometimes I take him there as recognition therapy. I don’t really know much about art, so I bring my wife, Kate. The two of them can discuss the value of line in a Picasso for an hour.

Kate is always trying to get me to take an art class at the community college. “Get some culture,” she says. She wants me to buy some prints to decorate my living space. When it comes to hanging things on walls, it is my opinion that less is more.

I have one painting in my office. It’s an oil that I picked up at a yard sale while I was in college. It’s a picture of a forest with a huge gnarled pine tree in the center. I hung the painting over my desk until I graduated from medical school and then hung it in my office. The tree fascinated me. How did it grow like that, all gnarled? Was it something in the soil? The trees around it had grown straight and smooth. Perhaps the tree’s growth had been compromised by its genes? Still, the pines must have grown from similar seed.

Kate says it’s morbid. Her vote goes for a print of Renoir or any other French impressionist. I told her that if my book gets published, I’ll buy her a Renoir original.

The addition of John Frieburger to my caseload gave me the study I needed to write the chapter on Delusional Disorders. He would be, literally, a textbook example of Delusions of Grandeur.

“I am the bread of life,” said John. “He that believes in me shall neither hunger nor thirst, but will have eternal life.”

“What is eternal life?”

“To know me and my father.”

“Who are you?”

“Who do you say I am?”

“John Frieburger.”

“I am the light and the life of the world,” he said. His face showed marked irritation.

“John Frieburger is the light and life of the world?” Finally, I was achieving some inner conflict.

“Before Abraham was, I am.” He hovered over my desk. I pursed my lips and leaned back in my chair. I made a note to write him a prescription for Xanax, a mild tranquilizer. I hesitated to put him on an anti-psychotic. Sometimes patients on anti-psuchotic drugs become catatonic, and I couldn’t risk losing my best case study right now.

“I am the door, I am the way the truth and the life.”

“You are a Pastor, John.”

“I am the Good Shepherd: the Good Shepherd giveth his life for his sheep.”

“Who are your sheep?”

“I know them, and they know me.”

“What are their names? Are they your family? Are they your wife Emily? Your son James? Tell me their names.” Tell me something I can use. I stretched my shoulder. No more racquetball for a while.

“Whosoever believeth in me shall not perish.”

“What about your family?”

“They are not dead, but sleepeth.”

“Will you wake them?”

He nodded.

“You’ll bring them back? What will people say?” John looked down and tapped his feet on the floor. “I think what we should do is keep your identity to ourselves. When you come in to see me, we can talk about your divine mission. Other than that we should keep it between us.” Until I publish it, anyway.

“A city that is set on a hill cannot be hid.”

“You will scare people. They will mistreat you.”

“A prophet is without honor in his own country and among his own kin.”

“Why is that?”

“He is too familiar, I suppose.”

“Is that why the Jews rejected their Messiah?” I hoped to establish an identiy difference between John and his delusion, but the best prognosis for delusion is usually that the patient is no longer dangerous, even if the delusion persists.

John’s delusion were not particularly harmful to anyone else, but when some of his concerned parishioners brought him in, he was nearly starving to death. John was determined to begin his ministry with a forty-day fast that nearly ended his life and did end his freedom.

I rubbed my shoulder and made a mental note to pick up some Ben Gay on the way home.

“The Jews were old bottles,” he said. “They weren’t ready for new wine.”

“The people of this city may not be ready for new wine either.”

My secretary poked her head in the door. “Doctor Seward, your three o’clock is here,” she said.

“It would appear that our time today is up, John,” I said. I stood up and walked to the door. He followed and said, “Now shall the prince of this world be cast out.”

He put his hand on my shoulder as we stood in the doorway I looked at his tired face. Shaded areas under his eyes marked the passage of time since the storm. His once tanned skin had turned pale after days and weeks inside the hospital. He had once been the man who lifted hundreds of pounds of wreckage from the hidden bodies of his wife and son, but now he was thinned to a ghostly remnant.

“Be thou whole,” he said. Then he turned and walked into the waiting area.

I watched him walk down the shiny white hallway towards the commons area of the psychiatric ward. He walked through the hall looking hard at the bare white walls with a fond remembrance, as if he were saying goodbye to an old home.

I massaged my arm, but the knot was gone. I must have worked it out, but still I felt the warmth from his hand where he had pressed it against the sleeve of my shirt. I remembered reading about the power of the mind in the healing process. One man having heard of a “miracle drug” had nearly recovered from cancer, only to die shortly after finding out that the drug was a placebo.

Kate and I went to see my mother every other Thursday. Tonight was the night. My mother lived with Lucy, the oldest daughter, who had also been widowed for some time. We spent most of the evening talking to Lucy while mother did her jigsaw puzzles. Mom had heard somewhere that doing puzzles helps you stay sane once you get to be an old lady. Lucy put the puzzles in frames and hung them around the house.

“How else am I going to have such a nice collection of Monet?” Lucy said.

“Soon you’ll have to build another wall to hang them on,” said Kate.

I said, “It’s too bad she doesn’t paint. You can sell paintings.” Not that she needed the money, but it seemed more productive to me.

“Neil said you’ve nearly finished your book,” said Lucy. Lucy loved to bring up Dr. Stein whenever she could. It was my fault, really, that they had even met. I told her not to date a shrink, especially any colleague of mine, but as little sisters do, she ignored me. Dr. Stein and I were writing a book about delusional patients. In reality, he was writing it, and I was doing the research.

“He says that you have a crazy guy who is perfect,” Lucy said. “He says it’s really lucky.”

“Lucky for who?” said Kate. I nodded. I was deliberately ambiguous. Delusional psychotics were favorite clients, and in my opinion there weren’t enough to go around.

“Thinks he’s Jesus,” said Lucy. “Maybe he thinks he can save you. That would really be crazy.”

“It would definitely be a miracle,” Kate said. She said she would sell her left eye if I ever stepped into a church.

Finally, Kate and I said our hasta luegos. When we got into the car, Kate was still thinking about John.

“So what’s your prognosis, Doctor?” she said in her most official voice. John’s treatment program was almost complete, but he hadn’t shown any signs of progress. Soon his insurance would run out and he would become a ward of the state. That meant Clozapine or some other anti-psychotic medication.

I said, “I’ll give him some good stuff; after a few days, he won’t care who he is.” That wasn’t what Kate wanted to hear. She leaned back in her seat and stared out the window at the glare from the wet asphalt streets.

The truth, however bleak it may be, is that once delusions are firmly embedded in the mind, the outlook isn’t very good. Distortion of reality to that extent usually marks the end of cognition; the patient no longer desires to live in the real world and has successfully departed from it. The inability to save his family was the final trauma for John.

We drove from the south side to North Hills in silence. Finally Kate said, “You remind me of your mother.”

“Why? Because we both have gray hair and wear a girdle?” She laughed.

“Besides that. You both love puzzles. You spend hours putting the pieces together, but once you get the thing done, you are at a loss for what to do next.”

“That’s not true,” I said; “I write books telling other people how to put the pieces together.”

“And your mother hangs them on walls.” Neither of us spoke for the rest of the trip.

When I arrived at my office the next day there was a memo on my desk telling me to call Records Department of Administration. I stuck it next to my phone and looked through the mail.

One letter was from Dr. Stein. No doubt he was reminding me about the meeting with out editor. No doubt one of the other letters was from the editor himself reminding me to have the entire manuscript with me. There was one letter with no return address. Usually such letters come from drug companies who want you to at least open the envelope before you file it in the wastebasket. I opened it.

 

Doctor,

I was hungry and you gave me food; I was thirsty and you fed me; I was a stranger and you took me in, but now I go where you cannot follow. The day has come when the bridegroom shall be taken. I will go and prepare a place for you.

 

I looked back at the note from Records, and I felt my hands start to sweat. My knees shook from the muscle spasms in my claves. Losing patients was not an uncommon thing for a doctor, but after years of practice I was still unprepared to hear about it. I called Administration.

“Records please. This is Dr. Seward.”

“Doctor Seward, John Frieburger has died of coronary heart failure; we need you to bring a copy of his file to the morgue.”

I hung up the phone and leaned back in my reclinable leather chair. Fifty percent of heart attacks were pathologically unexplainable, but I wasn’t sure if this one wasn’t a gift from above. Perhaps God had seen this man suffer enough. Then again, perhaps he was tired of the blasphemy.