Quiet Room - Lori Schiller [109]
That's why Diane Fischer's relationship with Lori was so stormy. As Lori's therapist, it was Diane's job to get into the deepest recesses of her mind—which was a place Lori was afraid for her to go. Lori knew that Diane was trying to get inside her head, to probe her darkest, most secret feelings. That terrified her. She was constantly running away from Diane, or firing her, leaving messages in her box that she didn't want her to be her therapist anymore. Behind her flight were her own fears that Diane would reject her first.
My relationship with Lori, on the other hand, could be far more relaxed. I handled her medications, her passes, her statuses. Our interactions could be much more casual and informal. I was always available to chat.
What I did with Lori wasn't therapy. The therapist's job wasn't to say, “Oh, everyone feels that way.” The therapist's job was to say: “What does this mean to you? What do you feel about it?” But by saying to Lori, “Don't worry about it, we're going to make everything all right,” I was also building a therapeutic relationship.
Because her relationship with me was so concrete, we could break through her reluctance to let anyone know what was going on in her mind. She could say to me, “I'm afraid to tell you, I'm afraid to tell you,” and I would say, “Oh Lori, how bad could it be?” Each time she broke through the reluctance it got a little easier, and a sense of trust began to grow.
Eventually, she began to show me some of her journal entries. When it came to the one about the voices wanting to kill me, I was worried. I wasn't worried because I was afraid Lori was actually going to kill me. I was worried because I could tell from her voices’ comments that Lori herself was really beginning to believe in me. She thought I was powerful enough to get rid of the voices, and she was using the voices to let me know that.
I was worried because I was afraid I was going to let her down. I knew I could help her, but I knew that relief and control were all that my help could offer her—not an end to the voices. I could teach her to live with the voices, but I couldn't make them go away. I didn't think there was anything that could do that. That needed stronger medicine than I was able to offer. I didn't think there was a medicine in the universe that could do that.
And then came clozapine.
By early 1989, clozapine had become a big deal on our unit. Clozapine was the first entirely new antipsychotic drug to be introduced since Thorazine in the 1950s. We knew that the drug helped people who hadn't been helped before by medications. We just didn't know which people it would help, or why.
What we did know was that clozapine was a dangerous drug. While it had been used in Europe and experimentally in the United States for years, it hadn't yet been approved for general use here. We had just gotten access to clozapine under a compassionate-use protocol. It wasn't as rigorous as a research program, but the drug's use had to be carefully monitored. Sandoz, the manufacturer of the drug, was collecting data to present to the Food and Drug Administration as part of its application to market the drug in the United States.
The protocol we were to use in dispensing the drug on an experimental basis was complex and a little bit scary. That's because a number of patients in Europe had died from complications caused by the drug. In some cases, clozapine caused a condition called agranulocytosis, a suppression of the white blood cells that was potentially fatal. Before we picked the patients to start on clozapine, we all went to seminars to discuss the drug, the paperwork that would have to be done, the consent forms and who would have to sign them, the rigorous