August 28, 2012 First Person Heal Thyself By Maureen Miller According to every epidemiological study of medical-student mental health ever published, a large percentage of us suffer from, well, something. The discussion sections of these research papers generally propose we educate one another in mental hygiene. They suggest we should practice more “mindful medicine.” And, good students, we oblige. A medical student may not come into med school knowing how to handle a “high-functioning” anxious type in clinic, but the diagnosis doesn’t require an office pamphlet. It’s visible right there in the room. At my school, we first learn to integrate this understanding of acute and chronic anxiety into clinical practice via the required six-week psychiatry clerkship. Six weeks of immersion in “ICU psychiatry,” the psychiatry faculty argues, is not enough time to master the management of anxiety disorders, but at least it is something. Third-year medical students spend six weeks on one inpatient psychiatry ward as well as several night shifts in a CPEP (Comprehensive Psychiatric Evaluation Program), the ER for the ill at ease. In these settings you learn to triage threat and fear until you know from anxiety. There you learn the difference between anxiety and agitation. Panic-attack patients stay in the ER for a while for cardiac and thyroid workups. Anxiety in the CPEP counts as psychosocial stressors, or Axis IV on the DSM-IV: losing your edge, losing your family’s support, your job your benefits, your place to live. Maybe you will have an adjustment disorder on Axis I, or existential anxiety that keeps you off your axis. Agitation is losing your cool, and sometimes losing your hospital gown if you’re especially feisty. For anxiety there is benzos and SSRIs; for agitation, benzos and antipsychotics and sometimes four point restraints. They call the agitation cocktail a 5+2, for 5 milligrams of Haldol and 2 milligrams of Ativan, though I saw one “frequent flyer” get a 10+4. Read More
August 23, 2012 First Person Finding Marie Chaix By Harry Mathews In 1970 I was living in France full-time, partly in Paris, partly in a mountain village on the fringe of the Alps. In that year I had the good fortune of becoming friends with the author Georges Perec, who had acquired a modicum of fame when his original first novel, Les Choses (Things), was awarded the Prix Renaudot, one of France’s prestigious literary prizes. Georges had read the French galleys of my own first novel shortly before it was published; he wrote me a short but enthusiastic note about it, which I gratefully answered. After an exchange of phone calls, we agreed to meet one autumn evening at the Bar du Pont Royal on Rue du Montalembert, where we drank five vodkas together, followed by a good dinner nearby. By the end of the evening we were fast friends. And he was the best of friends—smart, sensitive (at once funny and depressive), as loyal as the rising sun. At the time, Georges was uncertain about what to do next as a writer. An editorial assistant at his publisher suggested he translate my second novel. After the in-house readers of English-language manuscripts had given the book unanimously negative reports, Georges decided to accept the task anyway and did the work on spec. The publisher accepted the novel as soon as he read Georges’s French version. A few years later, for another publisher, Georges produced a brilliant translation of my third novel. He also translated the first poems I published in France. Read More
August 22, 2012 First Person Letter from India: The Permit, Part 3 By Amie Barrodale The story so far: Clancy and Amie continue to struggle to obtain the elusive permit that will allow them to find accommodation in a remote mountain area. We stayed one night in McLeod Gange. It might be called the woo-woo capital of the world. Woo-woos everywhere—frustrated, blissed out, on drugs—unwashed woo-woo land, with lots of coffee shops. In the morning, we passed a black street dog with white paws. He limped on a hind leg. Clancy said, “Hey, White Socks, how’s it going?” Read More
August 21, 2012 First Person Letter from India: The Permit, Part 2 By Amie Barrodale The story so far: Amie and Clancy find themselves stranded in a remote area, in need of a permit before they will be allowed to stay anywhere. The next day, as we were heading out to get a car, Tenzin, the proprietor of the guesthouse, stopped us and explained that it might take us two or three days to get the permit. He suggested we pack our room, offering to sell it while we stayed in Dharamsala. He said, also, that we could stay until August 6—we could stay as long as we liked. “I can shuffle rooms around,” he said once, and then later, “We have had a cancellation.” Still later he added, “You will have to change rooms, but your new room will be just as nice.” We shrugged our shoulders. So long as we had a room. In Dharamsala, we were directed to “District Commissioner” office 111. We poked our heads into a medium-size room shared by four men. Their desks were piled high with manila folders tied together with tennis-shoe laces. We said, “Protected area pass?” in a tone that suggested we might be arrested for asking the question. The administrators reacted as any American in her office might, should an Indian couple poke its head in and say three words in Hindi. Read More
August 20, 2012 First Person Letter from India: The Permit, Part 1 By Amie Barrodale We were on our way to a small Tibetan colony in Himachal Pradesh. I lived there for about a year in 2008 and wanted to show it to my traveling companion, Clancy. Also the house where I stayed is very peaceful and nice, and I thought it would be a good place for Clancy to finish the book he is working on. We had about ten days to spend there and were in agreement: no cars, no roads. I wrote to the manager of the house, which is called Old Labrang. It is a guesthouse, but you can’t really stay there unless you get the okay from the manager. In the past when I stayed there, it was during the off-season. Since my last visit, the place had undergone major renovations and is now, by any standard, a desirable place to stop. Palazzo floors, an interior garden with flowers and orange trees. It costs eight dollars a night, and as a result I had a feeling that this time there would be a problem securing a room. I didn’t want to sit down and write the request. Read More
August 14, 2012 First Person Someone to Watch Over Me By Nica Strunk When I was twelve and my parents’ marriage was falling apart, my dad explained to me that he never actually wanted to get married and have kids. The only reason he did it, he said, was because it would make him less likely to be drafted into the Vietnam War. It never occurred to him that telling me this might hurt me. He was a successful musician and an esteemed jazz scholar, but he had virtually no ability to sense another person’s feelings. If he were growing up today, his diagnosis would have been obvious: Asperger’s syndrome. I shrugged this moment off as another instance of my dad’s profound insensitivity, which was so much a part of my foundational world that it didn’t feel shocking. I knew he was clueless about the emotional bonds that connected us, but they were real to me anyway, and reacting would have been pointless. I had watched my mother pour her heart out to him, and he never once heard her. She could never make him understand how the things he did affected her—his charts analyzing how much money she spent on different categories of groceries at the Safeway, his refusal to break his routine when she needed to talk. “Make an appointment,” he told her, and the emotional response that followed didn’t even pass his notice. He didn’t get that channel. Read More