I saw him masturbating through the eight-inch square, reinforced window in the door to his room while doing 15 minute patient checks. He was in seclusion because, despite the tempering effect of antipsychotic medication, he wasn't convinced we weren't phantoms. Sweet sixteen and muscular, when he was admitted days earlier, he was four-point restraints, tied as securely, we hoped, as a calf in a rodeo roping event. Now off restraints, he was still unpredictable and a swing of the fist was one way to find out if we were real or not.
He'd been at a rave party and someone gave him a hit of ecstasy -- MDMA or 3,4-Methylenedioxy-N-Methylamphetamine (one of those fifty dollar words we pretend to memorize in medical school). It's not uncommon for ecstasy to contain a mixture of chemicals and someone theorized his included ketamine, an anesthetic agent that may cause severe hallucinations. All we knew was, we had a psychotic kid with an uncertain prognosis on our hands.
His repetitive masturbation had become an expression of his mental state. Perseveration is the tendency to focus on a thought, word, or behavior, and repeat it over and over, almost like an obsession. In this case, most of the time he seemed scarcely conscious of what he was doing, though on one occasion, when I cracked his door open to verify he was okay, he came off his bed quickly, angrily demanding his privacy. I gladly gave it to him.
When his friends came to visit, he seemed almost normal and that was about the only time. I'd like to tell you his story had a happy ending, that he responded well to the medications, eventually was able to talk about his experience and express hope for the future. The truth is, after six weeks, he was transferred to a long-term care facility and I never heard from him again.
This is one of those situations you hear about but have to see to believe. Sixteen, popular, athletic -- he had a beautiful girlfriend -- his entire life was ahead of him. Whether the drug triggered an underlying schizophrenia or did irreparable brain damage, no one could say. He'd gotten better but he hadn't gotten well, and it wasn't clear he ever would. There should be a sign on the door of every psychiatrist, "Miracles are not performed here."
Even though we'd like them to be.
(Creative Common Image via Wikipedia)
Maybe xtcy causes masturbation in adolescents. About as sound a theory as your "irreparable brain damage" one.
ReplyDeleteThanks for the laugh.
John: Thanks for your comment. Reading back over my post, I can see how the sentance, "Masturbation had become, etc." read differently than I had intended. I've altered it to read, "His repetitive..." which is more to the point. As far as what ecstasy does or does not do, in terms of its biochemical effects, is not the issue here. What is at issue is the fact that this young man's life was altered and, as far as I know, altered permanently by his experience. And that is not humorous, it's tragic, and that is definitely my point. Thanks, once again, for taking the time to comment, I appreciate it!
ReplyDeleteThanks for your considered explanation. Appreciated.
ReplyDeleteAs one who has "used" a few of the diabolical "you gonna go mad" life's sweeteners, I stumbled upon your post a few hours ago and couldn't resist a comment.
But then again, might have been caused by listening to the Sox in the background ......
Best,
pj
I hear you, John, and living in New England, I understand how the Sox can do that, now and then. :-)
ReplyDeleteSeriously, though, your input is appreciated -- thanks!