Saturday, July 10, 2010

A Psychiatrist's Banquet

Down the Rabbit Hole

I suppose I ought to be scared, but usually I'm not, when a psychotic (or otherwise) patient loses control or goes ballistic. For one thing, it doesn't happen as often nowadays as it used to because we've gotten better about anticipating melt-downs and taking steps to prevent them. They're not good for patients, they disrupt the unit, people can get hurt, and I've been one of them. You'd think if anything would scare a person, besides simply the idea of being on a psychiatric unit, it would be the possibility of patient violence.

Actually, it came as a relief when I found these situations didn't generally unnerve me. For one thing, you want to be useful when stuff hits the fan and if you can't think on your feet, you're more hindrance than help. For another, frankly, it felt good knowing my first inclination was not to immediately withdraw from the face of danger. I don't think it's a "guy" thing, either, because I've known women who felt similarly and men who didn't. It really seems to revolve around discovering that you can be capable in extreme conditions and this brings with it a sense of confidence in your ability to address the rest of life.

So, what does scare me? Besides asking a woman to dance, you mean (see 3/28/10)? What scares me are the people you wouldn't expect to. The ones who appear mild-mannered and calm, whose pleasant demeanor hides Hell Boy under the surface. Now, it's true, everyone wanders too close to the dark side of the Force for their own good, at least once in a while. But I'm talking about those whose behavior subtly and genuinely reveals a tenuous hold on reality.

The image I have is one of a fenestrated capillary. These are tiny little blood vessels with pores along the vessel wall facilitating the exchange of fluid and electrolytes with the tissues that surround them. People who are like fenestrated capillaries slip in and out of the pores without even realizing it. One second they're with you and the next they've fallen down the rabbit hole. Circumstances you'd consider ordinary trigger paranoia for them. A misspoken word and they're on guard; look closely, you can see it in their eyes.

You might be tempted to consider them a psychiatrist's banquet, a virtual cornucopia of diagnostic possibilities falling under the mystical rubric of Axis II personality disorders. That, however, like the passage of particles through capillary pores, is too easy, particularly when someone doesn't possess enough criteria for a specific diagnosis. No, for the most part, these individuals look and act normal -- until they are stressed. And what rocks their world may be absolutely nothing to you or me, but for them, it's all they need. It's their unpredictable unpredictability that makes me nervous. Mt. St. Helen's and the Richter Scale shows no activity. That's what scares me.


(Creative Commons image of Alice about to enter the rabbit hole by Valkyrieh116 via Flickr)


(Note: credit for the title as well as the inspiration for this piece is due to a loyal reader who prefers to remain anonymous. My sincere thanks for her creative turn of the phrase.)
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