How We Know What We Know - Part II
I started a series a couple of weeks ago that will take readers through key aspects of my experience growing up and doing life with mentally ill parents. Ultimately, I’ll share how this has impacted the way I understand and approach our contentious and increasingly bewildering political landscape. In case you missed Part I, you can catch up here (it’s very short).
II.
From Steady State to Transient State
There’s a Simpsons episode in which Mr. Burns, the owner of the local nuclear power plant, goes to the Mayo Clinic for a battery of tests. When he returns for the results, the doctor says to him, “Mr. Burns, I’m afraid you are the sickest man in the United States. You have everything.”
Mr. Burns: You mean I have pneumonia?
Doctor: Yes
Mr. Burns: Juvenile diabetes?
Doctor: Yes
Mr. Burns: Hysterical pregnancy?
Doctor: A little bit, yes. You also have several diseases that have just been discovered. In you.
Mr. Burns: I see. You sure you haven’t just made thousands of mistakes?
Doctor: Ah no, no, I’m afraid not.
Mr. Burns: This sounds like bad news.
Doctor: You’d think so, but all of your diseases are in perfect balance. If you have a moment, I can explain. Here’s the door to your body. [Places a miniature model of a door on the table.] You see? And these are oversized novelty germs. [Gestures to a collection of round figurines of various colors on the table.] That’s influenza, that’s bronchitis, and this cute little cuddle bug is pancreatic cancer. Now, here’s what happens when they all try to get through the door at once… [All the figurines get stuck in the doorway and none get through.] We call it Three Stooges syndrome.
Mr. Burns: So what you are saying is I am indestructible.
Doctor: No, no, in fact even a slight breeze could…
Mr. Burns: [walks out with sly smile] In-de-STRUC-tible.
The comedy of this scene lies in its absurdity, which is probably why I’m irresistibly drawn to it as a metaphor for what my family-of-origin system was like for thirty years. Week after week, year after year, the key pathologies in the system stayed the same—in some perfect, grotesque balance that was resistant to major life changes like my brother and me growing up and moving out, graduating from college, becoming independent, getting married, moving out of state (or out of the country), having children, and changing careers.
But on June 30, 2014, this stable system experienced its first truly catalytic event. My mother fell critically ill. The system’s equilibrium collapsed, and the possibility of a new order emerged. In our situation, unfortunately, the possibility could only present itself in the form of severe turmoil.
About five weeks into this tumultuous period, despite playing Hillsong’s “Oceans (Where Feet May Fail)”1 a thousand times and reciting Psalm 23 over and over, I became convinced I was living in some kind of hell. It was so intensely miserable, and I was so overcome by the desire for relief, that I said to my husband, “The only way I can imagine the situation improving is if everyone dies.” It was dark, but he didn’t judge. He just said, “I get it.” I asked—begged—God to expand my imagination. Dear God, please create a path forward that’s more imaginative than simultaneous fiery car accidents, a nuclear attack, and murder-suicide.
It’s a mystery to me the way God answers prayer. Sometimes it’s quiet, as if nothing is happening except a whole lot of waiting. I don’t receive the answer as much as uncover it some time later. Like when I’m looking for one thing and I come across a completely different thing—one I was looking for months ago but forgot about and now hallelujah! here it is. Other times it comes in the form of a subtle but noticeable internal shift in thought, attitude, or attention. Soon, major things are happening that I couldn’t have planned for. Well, the answer to my desperate plea above was definitely more like the latter. Amid our collective certifiable insanity, a moment of clarity about what needed to be done broke through. My brother and I agreed to divide up care duties. He and his wife, alternating with sitters from the home health agency, would take turns keeping vigil at our mother’s bedside at the hospital, and I would bring Dad back home with me to Atlanta to tend to his mental health care needs. His and her parents. This is how my dad came to live with my husband, my mother-in-law, my daughter, and me for 3-1/2 months.
Transition State
One of the first things I did after we made this decision was make an appointment with a Houston-based psychiatrist. I figured I’d have Dad evaluated before we boarded the plane for Atlanta. A dear friend recommended someone to us. She described him as “old-school, patient, in his 70s,” and someone who “likes narrative not just pharmacology.” The doctor had an opening in two days.
While I waited for the appointment day to arrive, I started thumbing through the stack of books I had ordered for my brother just two weeks prior: Surviving Schizophrenia: A Family Manual (Torrey), When Someone You Love Has a Mental Illness (Woolis), The Complete Family Guide to Schizophrenia (Mueser, Gingerich), Schizophrenia: A Blueprint for Recovery (Greek), Soteria: Through Madness to Deliverance (Mosher, Hendrix, Fort), Rethinking Madness: Towards a Paradigm Shift in Our Understanding and Treatment of Psychosis (Williams), Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia (Read, Mosher, Bentall, eds).
I ended up being particularly drawn to Paris Williams’s Rethinking Madness (2012) because it offered a vastly different way of thinking about psychosis. I had always taken the clinical brain disease model for granted, but now I was reading statements like:
“While it may be true that the individual’s affect and belief system are inappropriate relative to what is occurring in consensus reality, it is likely that they are very appropriate to what is going on within the person’s inner world.” (p.106)
“[Rollo May] suggested that all psychogenetic psychopathology ultimately arises from intrapsychic conflicts stemming from the unsuccessful resolution of finding both a healthy sense of individuality and a healthy sense of community and relationship… if these conflicts and the associated anxiety became too great for the individual to tolerate ‘and are insoluble on any other level,’ then psychosis is likely to ensue.” (Williams, 2012, p.128)
“In order to fight against the apparent worthlessness and disposability of our physical body, we must ‘desperately justify [ourselves] as an object of primary value in the universe; [we] must stand out, be a hero, make the biggest possible contribution to the world life, show that [we count] more than anything or anyone else.”
“As we have seen, the recovery research strongly suggests that, when supported in a compassionate and empathetic environment, psychosis often (and perhaps even ordinarily) resolves automatically.” (Williams, 2012, p.65)
“A number of scholars and clinicians have suggested that the reason we see these kinds of results is that psychosis may actually be the manifestation of a natural attempt of a psyche to survive and/or heal from an untenable situation or way of being.” (Williams, 2012, p. 65).
I had never heard psychosis discussed this way before. It made me a lot more curious about my dad’s life story. As a result, I was in a different head space on the night before the scheduled psychiatry appointment, when Dad and I were sitting on the living-room sofa debriefing the events of the day. I can’t remember the details of the conversation that led up to this moment, but suddenly he leaned back, interlocked his fingers behind his head, closed his eyes, and said, “I deeply regret immigrating to America. I regret it so much. It’s been nonstop heartache and hardship since I stepped foot in this country. I lost everything. Everything.” This confession took me by surprise, but only in its unfiltered honesty. It’s like he finally felt the freedom to say what he had been saying in a million other ways for as long as I had known him. When I was growing up, my parents had always emphasized how lucky they were to have had the opportunity to come to the U.S. Sure, there had been overwhelming challenges, they’d say, but they had conquered them and achieved the American dream. They were proud of their accomplishments. Yet here he was, his countenance wracked with pain, ready to tell a very different side of the story.
“Dad, would you be willing to tell me about your life and let me write it down?”
“What do you want to know?”
“Whatever you want to share. You can start from the beginning.”
“Sure.”
My dad was good at recalling specific dates, places, and events. Your mom and I met at a railroad restaurant in the Chiayi train station on July 20, 1969, the same day Neil Armstrong took the first human steps on the moon. And when he recalled things, especially painful things, emotions readily bubbled to the surface as if he were experiencing them all over again—grief, fear, powerlessness, neglect, anger over an injustice, culture shock, work stress, social anxiety. I let him talk, interrupting him only to ask questions for clarification. I typed everything into a Microsoft Word document. We stopped and went to bed when it got late, but he finished telling me everything he wanted to tell me the next morning.
Everything is starting to make sense, I thought. He isn’t crazy for no reason. I printed out a rough copy to bring with us to the psychiatry appointment.
In the car on the way there, my dad expressed his doubts about the need to see a psychiatrist. “My problem isn’t psychological. It’s political. These groups of people are all fighting over access to my two engineering projects. If I don’t choose the right one to give my work to, it’s going to go very badly for us. What if they kill me or your mother? I doubt a psychiatrist would know how to help me solve this problem.”
“Who are the people fighting over access to your work?”
“The Blacks, the Indians, and the Whites. Maybe more.”
“I see. Well, let’s just see what the doctor says.”
The doctor
The doctor was very nice. After introductions, I handed him the narrative that I had printed out for him, explaining that it contained details of Dad’s life that he might find relevant to his assessment. He took it, glanced through the pages politely, and then set it down. He asked my dad various questions about his life in a conversational manner. Dad sounded perfectly appropriate and sane for the entire fifteen-minute chat. Then the doctor asked him, “Tell me why you’re here today. Or why you think you’re here. How can I help you?”
“I don’t know,” Dad answered. “I don’t think I need to be here. I don’t have a psychological problem. But my daughter thinks I need to be here.” Dad laughed. The doctor laughed. I laughed too because it was kind of funny.
“Dad, it’s ok. You can tell him about your engineering projects,” I said.
It was like flipping a switch. The swirl of words came—words about various battles between races of people clamoring for his work or stealing it off his computer somehow and claiming credit for it, managing to get rich off his labor while he got nothing; words about their willingness to do him harm to gain access to it; words describing their promises to make him hugely successful if only he would leave his wife and dedicate himself to it.
The doctor nodded and said, “I’m going to give you some medication to help you with this. I’ll be right back.” He stepped out of the room and returned a minute later with two handfuls of individually sealed packets. He handed them to us. “Try this out. It’s a starter pack, all labeled. People tolerate it very well, so you don’t have to worry about side effects. Take 1 mg twice a day on day one, then 2 mg twice a day on day two, then 4 mg twice a day on day three, and then stay at 6 mg twice a day. These samples should last about three weeks. If it works well, let us know and we’ll call in a full prescription.” He scribbled a diagnosis in my dad’s chart. Delusional disorder.
“So, it’s not schizophrenia?” I asked quietly. He shook his head and answered with a wink, “He’s too organized.” As he moved toward the door, I asked, “Do we follow up?” Without slowing down, he said, “As needed,” and then he was gone. Holy pharmaceuticals, Batman! What exactly would indicate that the medication is working well?
When we got back to my parents’ house, I looked up the side effect profile of the medication. It was two pages long. Listed under “very common” and “common” were things like dizziness, somnolence, fatigue, rash, aggression, delusion, tachycardia, hypotension, dry mouth, nausea, muscle spasm, stiffness, akathisia, dyskinesia, dystonia, extrapyramidal disorder, lethargy, tremor, heart palpitations, asthma, sinus congestion, urinary incontinence, and more. I sighed.
I carried the medication samples into my bedroom. I dropped them onto the bed and stared at them. I felt conflicted and unable to make a decision about whether or not to give Dad the medication. The limited and ultimately unsatisfactory interaction with the doctor hadn’t inspired much confidence. It certainly hadn’t resulted in the clarity I had hoped it would. Since we were going to be flying back to my house in Atlanta soon, I decided I would wait until we were settled there before starting anything new. I gathered the medication packs into a gallon-sized Ziplock bag and slid them into a zippered compartment of my suitcase.
Sitting down on the edge of the bed, I read through Dad’s narrative again. A lifetime’s worth of pain, confusion, unresolved tension, and grief emanated from the pages. Most of it is stuff I will never share publicly. But I want to share this part. It’s long and contains pretty technical terms, but the details and my dad’s relationship to them are indispensable to understanding the rest of the story.
In 1989, I was working on a high-density polyethylene (HDPE) project run by Chevron and based in Orange, Texas. When I reviewed the designs for the Phillips HDPE plant in Pasadena, I found a design element around the settlement tank that I believed was flawed and could pose an explosion risk. I felt the sizes of the discharge and settlement pipes carrying the highly flammable vapors were too large—3 inches and 10 inches—which meant there was no room for operator error. I told my supervisor, and he dismissed it. But because my conscience couldn’t let it go, I went over his head and talked to his boss about it. Unfortunately, he also dismissed it. After that, everyone, even your mom, was mad at me for being impolitic. I’ve never been good at reading people or social situations. Anyway, in October of that very year, there was a series of massive explosions at that plant, the Cedar Bayou plant. It killed 23 people.2 The cause was traced to the valve of that settlement tank. I feel like if they had listened to me, those lives and that plant could have been saved. Even after it happened, though, no one ever acknowledged that I had tried to point out the possibility. No one listened to me when I tried to point out the flaws in the flash tank portion of the HDPE plant that I was working on for Chevron either. I told them I could redesign the flash tank and make it much better. But the client insisted, “Just work with what’s there.” So, I did. And of course, the outcome was less than ideal, just as I predicted. But they made it sound like I failed because I was incompetent, not because they made it impossible for me to succeed.
The same kind of thing happened the next year when I was working on a large project that consisted of two major portions: a pre-poly vacuum drying project and a polyol reactor project by Arco. The lead engineers of both arms of the project instructed me to use conventional approaches to revamp the polyol reactor. But when I did this, it achieved only a 6% increase in the annual production rate, which was far below the 25% increase that the client wanted. I think my superiors must have overpromised the client those results and then let me take all the blame for their failure to achieve them. The client’s project manager said to me, “Is this all you can do?!” and then stormed out. It was humiliating!
I was actually very successful on every other project during my time with the engineering firm, but after those two projects went badly, they demoted me twice. And in 1993, they laid me off on Christmas eve, right before the company Christmas party. I couldn’t believe it. All my life I worked so hard to make people happy, but everywhere I went I was pumped dry and then kicked out. Those two projects have haunted me ever since, day and night for 24 years.”
In Part III, I’ll share what happened during the 3-1/2 months that my dad lived with me.
I never want to hear this song again!
For details on the Phillips plant disaster of 1989, see https://ncsp.tamu.edu/reports/phillips/first%20part.pdf and also the following news report video: