A young woman sits in the waiting room of a psychiatrist’s office. She flips through old magazines full of celebrity diets and recipes for lavish desserts, uninterested.
“OK, Sandra, you can go in now.”
Into the throne room. The palace of no return. Or something like that. Since her bipolar diagnosis (and why is everyone suddenly bipolar? Wasn’t it multiple personality disorder a few years ago?), everything has been turned upside-down.
She is on five different medications, two of them to deal with side effects from the other three. These are (supposedly) working in tandem at relatively low levels which are (supposedly) easier on body and brain. Or at least that’s the theory, until the next one comes along.
“Sandra.”
“Dr. Turnstile.” (She has never quite gotten used to that name, which made her guffaw the first time she heard it.)
“So how are we doing these days.”
Not a question, but a statement, always in the plural.
“Oh, we’re. . . just fine. But to tell you the truth, doctor, it could be better.”
“Feeling a touch of depression lately?” (He picks up his clipboard and begins to make notes.
“A touch. It’s been. . .I don’t know. Remember I told you about my brother?”
”The one who got married last year.”
“No, the other one. I mean. . .”
“Refresh my memory.”
“The one I’ve been talking about for the past five sessions.”
“I detect a note of irritability.” He makes another note.
“Yes, a note. He’s in jail now. Embezzlement. The guy is just too clever for his own good. He’s appealing, of course. I don’t mean that kind of appealing.”
“Explain.”
“Never mind, it’s just a lame joke.”
“So apart from your brother going to jail. . . “
“Oh, everything’s just hunky-dory.”
“I detect a note of sarcasm.”
“That’s because I’m lying. Everything isn’t hunky-dory. You remember my boy friend, Robert –“
“The accountant."
“Lawyer. We broke up. It was. . . I don’t know, pretty bad.”
“Are you taking your medication?
She blinks. “I wouldn’t dream of going off it.”
“Would you like me to raise the doseage on the Seroquel?”
"No.”
“The Lamotrigine?”
“No.”
“The lithium?”
“No.”
“Then let’s discuss non-medication-oriented strategies for managing the mild depression you seem to be experiencing right now.”
“Strategies.”
“Yes. You remember what I told you in our previous sessions. The principles of cognitive therapy indicate that feelings arise from thoughts. If thoughts are excessively negative, emotions will soon follow suit.”
“I always had a problem with that one.”
“Yes, I realize there has been some resistance to treatment. This must be overcome if you are to become truly well.”
“Can I be truly well if I’m bipolar?”
“Not in the usual sense. But in a relative sense, as opposed to experiencing severe episodes, then it’s possible for someone with bipolar disorder to live an almost normal life."
“Almost normal. I see. So nut cases can only get so much better before they hit a wall.”
"Sandra, that is a completely irresponsible statement.”
“But I’m just sayin’. There’s only so far a bipolar can go. The chain is pretty short.”
“That’s why it is so imperative for you to adhere strictly to the principles of cognitive therapy.”
“You see, there’s where I can’t follow you. I find it hard to believe that every emotion is just an offshoot of a thought, and that every thought can be controlled.”
“Maybe not every thought. But people have more control than they think.”
“Do they now. Then I wonder why we even need medication.”
“Sandra, you know why. You have inherited a chemical imbalance of the brain which tends to trigger extreme mood swings, which in turn skews your thoughts toward the negative.”
“But the
thoughts lead to the
mood swings, don't they? I'm confused."
“There is no need to twist my words around."
“OK then, cognitive therapy. That means I’m supposed to reframe negative events – “
"Now you’re on the right track.”
“. . . Reframe negative events so that they become positive. Let’s see. So breaking up with Robert was really a good thing.”
“Yes, yes – continue – “
“No matter how much I loved him, I – I don’t know. I can’t think of anything.”
“How about this for an alternate hypothesis. There is a possibility that this breakup will free you to explore other possibilities. You’re young. There are other fish in the sea.”
“Other fish.”
“Maybe even better fish. Have you thought of that? And how about your brother? Can we shed a more positive light on his situation, which is, after all, self-created?"
“Oh, maybe he’ll turn his life around in jail. Have a religious conversion, write a book, marry some woman on the outside who’s willing to wait fifteen years until he gets out.”
“Again, the note of sarcasm.”
“Yeah, but I just can’t
do this. This cognitive therapy, it implies we can control just about every thought, and thus every feeling that we have. We can just
decide.”
“Yes, more than most people realize.”
“Isn’t this creating your own reality? Isn’t that what crazy people do?”
“Sandra, you are deliberately poking holes in the therapeutic process.”
“Poking holes. Doctor, I wish it were as simple as deciding how to feel.”
“But to a large extent, Sandra, it is. Cognitive therapy is, after all, the primary mode of treatment in modern therapeutic practice.”
"Then why have they stopped saying that about being gay?”
He looks disconcerted, puts down his clipboard.
“You know. They used to say being gay was something you could change if you just decided to. You know, made up your mind.”
“That was many years ago.” He shifts in his chair.
“In other words: yes, you might be attracted to men, but that’s a choice. You can choose something else, a girl in other words, any time you want to.”
“That’s very simplistic.” He is turning a shade of pink.
“But according to the principles of cognitive therapy, it should work. You should be able to change your feelings of attraction to men just by changing your thoughts. Am I right?”
”The DSM specifically states – “
“Forget the DSM. Say you’re gay. You want to be straight, or your mother wants you to be straight. Hell, let’s face it, even with the progress we’ve made, it’s still easier to be straight than gay. You don’t have to explain yourself all the time. So, just change your thoughts about the subject and you won’t have those feelings any more! Think about girls instead. Finito. Problem solved.”
“We aren’t discussing sexual orientation now, Sandra.”
“Yes we are. Haven’t you been listening?”
Dr. Turnstile has the look of a fish sliding down a chute and landing helplessly in the ocean. It is imperative that they change the subject before he loses any more ground.
Sandra fixes him with her incandescent blue eyes.
“It just comes down to a decision. Am I right? But the thing is, doctor – you haven’t made that decision yet. Have you?”
A young woman sits in the waiting room of a psychiatrist’s office. She flips through an old magazine with screaming headlines about Lindsay Lohan’s latest arrest on the cover, bored.
“OK, Sandra, you can go in now.”
She tosses the magazine on the table, gets up from her chair and walks into Dr. Turnstile’s office.
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