from my book, ‘PLAY’

Therapy? Psycho-therapy, of course, is out of the question. The Holy Grail is “monotherapy” – a once or twice a day dose of a single medication that will adequately “treat” your “condition” without having to resort to an increasingly lethal combination of psychotropic substances that may boost the effectiveness of the first, or counter some of its more insidious side-effects, only to add even more serious ones to the mix.

In most “cases” it never gets that far, as it almost always takes at least a few months to figure out a proper “regimen” – meaning the awful effects of the drugs are somewhat less awful than the symptoms they attempt to suppress – and usually you only get to stay a couple of weeks in the Hotel Bassett. So it’s a stab in the dark, a best guess – say, Lamictal or Depakote, or Lithium – and you’re out on your own, and supposed to work out the rest with professional Help, preferably from your local licensed “nurse practitioner.” If you’re a repeat offender, then they’ll put you on a second or even third “trial” of monotherapy. Three strikes, however, and you’re considered more or less “chronic” (i.e. hopeless) and from then on, the door simply revolves.

At least that is what I’ve learned from talking to fellow inmates, as my own personal experience is somewhat limited, my sentences (unlike these) being short and infrequent, my symptoms relatively benign (e.g. hypo-mania) and given my hypersensitivity to drugs of any kind, which makes any regimen impractical, though whether this fact is in fact a fact remains a bone of contention between myself and the medical establishment.

Likewise my “diagnosis” – Bipolar NOS (Not Otherwise Specified) being the most recent, with possible “schizo-affective tendencies” thrown in for good measure, but what any of this is based on I have no idea, as no one ever paid the slightest attention to what was going on inside my head – all that mattered was whether I was behaving myself. Perhaps it didn’t matter to them to be any more specific, though it seems I’m unfit for any of the three or four standard categories listed in the DSM (the Diagnostic and Statistical Manual, the official psychiatric Bible).

But no doubt about it, I am definitely somewhere in the ballpark. Perhaps camping out in left field, pretending to play the game, but really just hoping to pass for “normal,” blending in with everyone else in the bleachers.

In less enlightened cultures (Haiti, for example), they see it all very differently – your “symptoms” are signs of a need for spiritual mediation – so instead of the nuthouse, it’s off to the local Vodou temple, the Hounfour, where you can let it all go for a few hours, entering a trance state with all the other supplicants, under supervision of the head priest (a Houngan or Mambo, depending on gender), offering yourself up to the gods of the Underworld, so you can be taken over and danced back into a state of balance with the cosmos. This is considered perfectly normal, a part of everyday life. Without ritual contact with the spirit world, you’d just be a lost soul.

The rest of the therapeutic regime in the American System (aka “the medical model”) – besides the pills, which are designed to ensure you never have any contact with anything remotely resembling a god – consists mainly of routine instruction in a variety of “coping skills.” As, for example, The Short Term Goal, on this card:

Handed out daily, to be filled out prior to group therapy, where you go round the room and are “encouraged” to share what you’ve written down when your turn in the spotlight arrives.

9 out of 10 an honest response would be something along the lines of “Get out of jail FREE.” But if you write something like that, then of course you won’t. So you write something more… practical: “Write letter to mom. 1: Find paper/pen; 2: Find time; 3) Find something to say.” And if you’ve failed to “obtain your goal” today, ponder what you can do “differently” to achieve it tomorrow. Never give up. Try harder. “Think more about mom.”

What have I got against goals? Haven’t I set myself a goal of writing at least 500 words of this book each and every day. Guess what? I’m already at 739 – so see ya tomorrow. Just kidding.

But seriously, look at it from the other side. Why does one need a goal in order to live? Do you need one to eat, or sleep, or visit the bathroom, or sit quietly for a few minutes and think of… nothing at all? Well, yes, if you’re clinically depressed, any one of those might present a challenge. But the main reason behind the logic seems to be a matter of achieving basic satisfaction, achievable, by definition, only through the conscious application of effort and willpower. Put your mind on X and once you’ve done it, you’ll have some sense of… “agency” – “the capacity of an entity to act independently” in a given environment.

In more enlightened cultures (ancient China, for example), the notion of acting as an independent entity was frowned upon. If there was a goal, it was not to have one. Wu-wei (NON-action) was the ideal – to act only in accord with the Tao (the Way). Try to get the Tao to accord with your goals and you are just getting in the way and asking for trouble.

The ancient Greeks didn’t frown quite so much on independent action, as long as it was for the public good, but purely private goals, merely to further your own ends, were another matter. Then you were behaving oddly, like an idiot – idiotes is Greek for a private person, as in idiosyncrasy.

And even today, in Buddhist cultures (Tibet, for example, now (alas) the Tibet Autonomous Region of China), it’s very difficult to be goal-oriented. You are a part of the community. You have your place. You don’t need a goal to get through the day. Just do whatever is necessary. Instead of self-reliance, you take refuge in the Buddha (the model of a real human being in the world), the Dharma (how to be one), and the Sangha (your fellow practitioners, practicing together, to be one, right now). If you have a problem, you rely on them.

Not that you aren’t a separate person. Except that none of us started out intending to be a person. We all just turned into one, and are still at it, everyone and everything “arising co-dependently,” all of us adrift together, each on our own private continent. If our world is ill, so are we. If I am here, it’s only because you are there, reading this (are you?). No light without shade, or life without death, nor strength without weakness.

My real beef with the setting of daily goals: if we are always here, but wanting to be somewhere else, there is this continual sense of dis-satisfaction with whatever is happening now. Not enough just to be here, we must always be doing something to be better, or better off, at some point in the future, when we will have reached our……………………………………………………………………………………………………………………………………………………..goal.

Give up your fixation on a goal, and chances are your problem will go away too, or solve itself. But of course, far easier said. At least, you’ll know what you’re missing. Like my teacher always used to say, “The best nostalgia is nostalgia for the present moment.”

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Irene: My diagnosis? I’m Angry.
Me: That’s not in the DSM.
Irene: Not yet. But I’m working on it.

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I’m working on it too. The constant dry mouth, the constipation. From the meds and the anxiety. The hairs of my mustache always getting in my food, because they won’t let me trim it. Or let you have anything sharp. After a week, the ear wax doesn’t get any thicker, but forget about Q-tips. The food gets stuck in your teeth, and of course there are no toothpicks. If you have a broken nail, you just have to chew it off.

And the food… You fill out a menu card the day before for your meals, from a list of what’s available. But half the time, you get something else, or something is missing, but complain, and they’ll tell you you’re on a restricted diet, because your blood pressure is too high. Guess why it’s too high? (But sir, if you want, we can give you a pill to lower it.) After a week I developed a gum abscess and just tried to ignore it. Ask for a doctor to look at it and by the time anyone shows up…

And though there’s a Rule about NO LOUD MUSIC, for some reason that never gets enforced, and the radio in the day room is always blasting. The same cheesy pop tunes about Love & Betrayal, played over and over, written according to the same deadly formula.

And then there’s the boredom, endless and mind-numbing. You look at the clock. How much timebeforedinner? Time for your… meds? Time to leave? If you weren’t crazy when you came in here, you will be by then.

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                                [to be continued]