What If You Can’t Believe Your Senses Anymore
A story about perception in a world that no longer makes sense
It was on a Tuesday morning twice a month that Dr Lionel Salisbury made his rounds at the Livermore Psychiatric Hospital in Boise Idaho. It was not a large facility with only 72 patients, with most patients suffering from drug and alcohol dependency. There was one patient with severe schizophrenia, Douglas Sizemore who had been a professor of neurobiology at the University of Idaho.
On March 15, 2001, when Dr Salisbury arrived at the facility, he was surprised to discover that Douglas Sizemore was sitting in a chair that had been put on top of a table in the main visiting room. Dr Salisbury’s colleagues were simply standing and watching Douglas sitting atop the table.
“How long has this been going on?” he asked his colleague Frances Bastille, who was standing 3 feet away from the table.
“It’s going on two hours now,” she responded. “He’s not created a disturbance. He hasn’t demonstrated any aggressive behaviour. He just took a chair, climbed up on the table and has been sitting there.”
“Has anyone bothered to ask him what he wants?” Dr Salisbury asked her.
“He says he’s been waiting to talk to you, Doctor.”
“I can see this is going to be an interesting day.”
Dr Salisbury set down his bag on the floor near a small sofa and moved closer to the table. He could see that Douglas had bowed his head and his eyes were closed.
“They tell me that you want to talk to me,” Dr Salisbury spoke slowly and firmly. “You don’t have to get my attention like this, you could have written me a note.”
“I had to do this,” Douglas, opening his eyes, spoke slowly and deliberately.
“Have you been taking your medication?” Dr Salisberry asked. “Did you take it this morning?”
“He took his medication,” Greta, one of the nurses responded. “I gave it to him just this morning.”
“Is something wrong, Douglas? Have you been hallucinating again? You know I can tell when you’ve been hallucinating.”
“I don’t think you can,” Douglas responded. “You’re bluffing me.”
“Did anything unusual happen?” Dr Salisbury turned to the others and everyone shook their heads.
“Alright, we’ll talk.” Then, to everyone’s surprise, Dr Salisbury took another chair, put it atop a nearby table, then climbed on the table and sat down beside Douglas. Everyone was stunned at what Dr Salisbury had done and several of the staff began to gather around them as both of them sat atop their tables.
“There is a method in my madness,” Dr Salisbury attempted to reassure his colleagues.
“Okay, Douglas, I am listening. What did your friend tell you today?”
“I don’t want you to call him my friend,” Douglas responded.
Dr Salisbury, in a more serious tone, began to speak, “Did he tell you something today?”
“He told me to put a chair on the table and sit down on it.”
“Why would he do that? To make a fool out of you? How could that be friendly?”
“He said that he likes you and he thinks that you are a good man.”
“Do you think I am a good man, Douglas? Whatever this person is telling you, it’s you telling you.”
“It is not me. He knows things that I would not know. He says things that I could never see.”
“How old is this person?”
“He is a boy, 11 or 12 years old.”
“What were you like when you were 11 or 12?”
“I was a strong-willed child,” Douglas responded. “Kind of rough on the edges, I was nothing like this boy.”
“You must know that he is a projection of your subconscious. You are having a dopamine rush and your subconscious is creating him.”
“He knows things that I could not know.”
“Give me an example.”
Dr Salisberry could see that Mitchell Pavelchek, the hospital director, had stepped out of his office and was watching the entire encounter from the southwest corner of the activity room.
“He said your sister died in a boating accident when you were 12 years old. You became a psychiatrist because your mother suffered a breakdown after your sister died.”
“You’ve seen the photograph of my sister in my office numerous times. I never told you she was my sister. But the photograph is there. There is also a photograph of my mother.”
“Your mother’s name was Minerva.”
“Yes. There is no secret in this hospital about who my mother was. She volunteered here until three days before her death six years ago. Again you could have overheard her name here. People here remember her and occasionally speak about her. All of this is coming from inside you.”
“He says I’m going to join him soon in his great journey. He needs me because I can speak for him.”
“He speaks to you and then you speak for him. Do you see how problematic what you’re saying is? He paused. “What else does it tell you?”
“He says one day you will also be helping him.”
This seemed the most ridiculous of Douglas’ claims. Dr Salisbury began to chuckle.
“You know we are going to have to moderate your medicine to inhibit these dopamine rushes that are causing these hallucinations.”
“He says that you’re not an unfeeling man, just confused.”
“It’s my job to get you back into your life again, to give you the means to cope with whatever conditions are causing these hallucinations.”
Douglas reached into his pocket and retrieved a folded piece of paper.
“He’s given me a list of questions he wants me to ask you.”
Douglas unfolded the paper and set it down on his lap. Dr Salisbury shifted a moment on the chair and the table began to wobble, scaring many of the staff members that Dr Salisbury would fall. But Dr Salisbury shifted his weight and rebalanced the chair.
“Five Questions,” Douglas acknowledged. “Number one. Are there questions Dr Salisbury that you would like the answers to? Some mystery from your past? Some questions about your mother or father? Number two. Is there something about tomorrow or next week or next month you would like to know? Number three. Would you like a glimpse into where you will be 10 years from now? Just enough to reassure you and give you confidence?”
“There are so many issues about trust and about discernment embedded in your questions,” Dr Salisbury answered, “that I don’t know if I could ever trust an answer.”
“Number four. Would you like to know if there will be a tragedy in your life?” He paused. “Number five. Would you want to know the future outcome of your life?”
“I don’t think anyone should know too much about his future. It could drive a person mad.” He passed. “Let’s suppose for the sake of argument you could offer me these things you speak about, I am not yet convinced that the knowledge won’t be more of a curse than a blessing. I am content enough to remain in ignorance. Can we get off the tables, before I lose my position and they put you on much more powerful medication?”
“There is no amount of medication that will obliterate this boy.”
“We can see about that, Dr Sizemore. Please don’t do this table thing again.”
That was stepped off the table and we turn the chair to the floor. Dr Salisbury left his chair on the table. Mitchell Pavelchek approached Dr Salisbury.
“I can’t have you reinforcing the patients’ inappropriate behaviours,” Dr Pavelchek told him. “We will have other patients following suit.”
“I’m just trying to find a way to connect to him.”
“He is schizophrenic, Doctor. I don’t know that there is a way you can effectively connect to him. Your job is managing the hallucinations and we do that with medicines. I don’t think it’s possible or constructive for us to try to decipher meaning from his hallucinations. Please come to the office so we can talk about this privately.”
Dr Salisbury followed Dr Pavelchek back into his office. When they both had entered the office, Dr Pavelchek closed and locked the door.
“Please take a seat, Doctor. This should only take a few minutes.”
Dr Salisbury sat down on a chair, while Dr Pavelchek sat down behind this desk.
“When I hired you for this position, I already knew that you and I have a fundamental difference in how we approach these illnesses. From the background information, we understood that you are more Jungian than I am. You want to look into the symbolism of mental illnesses. You see these disabilities in terms of grand metaphysical principles. I look at it more as a biochemical problem. You want to read into the statements he makes the hidden meanings and important significance of his life, his traumas, the deepest secrets of his psyche. I can appreciate that, but it’s my job to find a way to stop the hallucinations so that he can return to his life. It’s not my job to find the deep meaning in what they are expressing to him personally. As I’m sure you know, schizophrenia is very rare in someone who has as high an IQ as he has, and there is a good chance that we can return him to his prior life. That is what I hope to accomplish in whatever time we have here with him. He is not here under a court commitment, He is here voluntarily. He could leave any time he wants. I just don’t know how helpful it is to indulge in these delusions of his.” He paused. “You have read his chart. I am sure you understand his personal history. His son died in a drowning accident at 11 maybe 12 years old. It was devastating to him and his wife. Then she came down with terrible debilitating brain cancer and died as well. I could look at these incidents and find this symbolism easily into why his delusion is about a boy and about loss. I just don’t know how helpful that would be for him. They tell me before the incident that brought him here, he had collapsed in his classroom from the stress of it all. I don’t want to bring any more stress into his life.”
“Neither do I,” Dr Salibury acknowledged.
“I don’t want to tell you how to take care of your patient. We were very happy for you to come here. I just want you to consider what I’m telling you. Thank you, Doctor, I have said my peace.”
“You are a good man, Dr Pavelchek. I will seriously consider your words.”
“That’s all I ask.”
Dr Pavelchek stood up from his chair and opened the door for him to leave. He was sure this would not be the last time that he would have to talk to Dr Salisbury about this subject.