Quiet Room - Lori Schiller [106]
Over the two years she had been with us, I believed we had helped her. I thought over what we had accomplished. She had significantly more insight, and considerably more control over herself. I felt I had developed a relationship with her that was in itself a good thing. It was healthy and sustaining and supportive. I was proud of that, proud of what my own efforts had accomplished.
None of us on the unit wanted to give up on her. We all felt she was someone worth fighting for. When the craziness cleared, she was such an engaging and likable person, witty, thoughtful and fun. And she worked so hard on her own behalf. I had seldom seen someone work as hard as Lori did. She was driven to get well, and used her energy to put into practice every technique we all suggested for her.
But I was constantly faced with the fact that what I was doing wasn't enough. It was all well and good that Lori trusted me, but she was still having psychotic episodes and destructive impulses. She took up a lot of staff time, with meeting after meeting after meeting to discuss what we were going to do with Lori. It was also hard to ignore the fact that she was still in great pain.
A long time ago I realized that, as psychiatrists, we had to have a healthy respect for our own humanness, and our own smallness in the face of what we were dealing with. If a person got better, we could appreciate that we had done a good job, but we also needed to realize that God—or luck—was on our side. If the person got worse and had to go to a state hospital, we had to keep ourselves from feeling that we hadn't done enough. For the truth is, we were powerless in so many of these situations. We did what we could, but sometimes the illness was just bigger than we were.
The feeling at New York Hospital was that because of cloza-pine's dangers, the drug should be given only to hopeless cases. I wanted to do whatever I could to help Lori. But could I face the fact that there really was no other hope left for her?
A lot of people thought Lori was already a hopeless case back when she came to our unit two years ago. I didn't believe it, though. It wasn't that she wasn't desperately ill. She was. In fact, coming to our unit in itself was like being branded a hopeless wreck. Our unit only took the very sickest patients, the problem patients. We took only the patients everyone else had given up hope on.
And we had a fair amount of success with them. I had some former patients who were living on their own, some living in halfway houses, even a couple who were managing to hold down full-time jobs. We hadn't cured them; these were people for whom no cure seemed possible. What we had done was to help them live more comfortably and function more effectively with the illness that they were probably going to have for the rest of their lives.
That's what I hoped to do for Lori.
Her records hadn't looked promising: Several long hospitaliza-tions. Persistent out-of-control behavior. Suicide attempts. Still, her history looked quite similar to those of other patients on our unit: The normal childhood, followed by a break in her teens. The early inability of her family and of Lori herself to accept the fact that she was seriously ill. The early reluctance of doctors to brand Lori with a diagnosis of schizophrenia, preferring instead to suggest that other illnesses like manic-depression might be responsible.
Then came a middle period when her behavior became more erratic and doctors began considering the possibility that Lori might be suffering from a personality disorder. Her behavior— throwing things, breaking things, and running away—was seen as deliberate and manipulative. It was felt that strong discipline and control were the key.
And then finally, as her illness progressed, she arrived at our doorstep clearly in the grip of severe psychosis.