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Introspections   |    
Skating as Fast as We Can
William Houghton, M.D.
Am J Psychiatry 2002;159:1295-1297. doi:10.1176/appi.ajp.159.8.1295
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"You can learn more from one patient than a whole book," a teacher once told me.

I first met Mary Jarycki (name changed, of course) at a college student health clinic in 1972 when she was a 28-year-old graduate student in computer science. She sat across the desk from me, smirking, wearing a wide-brimmed, flying saucer black hat. She complained of depression and anxiety, and her extreme thinness suggested an eating disorder, but her replies to whatever comment I made were filled with sarcastic omniscience. She had the primness of a convent schoolgirl, but the principles had been thrown out the window. She came from a backwoods crossroads burg "up north." Redneck teenybopper, thought I. In the 30 years I knew her, we were seldom on the same page.

I saw her from time to time at "med checks" during the next 8 years, but mostly I heard how impossible she was from a string of psychologists who had attempted therapy.

One of them gave me a poem that Mary had published in a local paper, which shows her whimsical side:

Lichen

Can be likened

To a fungus,

I suppose,

Shredded green

Patches upward

On an oak tree

From where the grass grows

To about as high

As I am.

Lichen, I suppose,

Doesn’t know

What I know—

It just grows.

I began to realize how little I knew about her.

I was out of the area during the first half of the 1980s and didn’t see her again until she came to see me in 1988, looking far more depressed. Now 44, she had been working at a large financial corporation. She told a tangled tale of conflict with a critical female supervisor and her tortuous efforts to comply. She was always a hard worker but couldn’t (or wouldn’t) suppress her determination to do better than everyone else or to make an irreverent crack, often slightly beyond the pale. When the tricyclic antidepressants, the antipsychotics, and the mood levelers of the day fell short, she was hospitalized (during which she cast a jaundiced eye on the milieu therapy). As soon as she was discharged and returned to work, the corporation fired her. She brought a suit for discrimination and was one of the first to win a large settlement. In spite of determined efforts, however, she never returned to regular work after that.

She pursued a round of hobbies with passion and intelligence: visiting art museums, cooking, gardening, orchid-growing, bicycling (with a duster), and figure skating. I am told she wore a tutu and cut good figure 8s at a local indoor rink—and once at Rockefeller Center—but it was the après-skate glasses of chardonnay that ultimately sidelined her.

In 1989, I hospitalized her at a private facility after a clear bout of full-blown mania (the convent would not have been pleased). She hated the experience, hated the other patients, and hated group discussion (which she mocked). After she had left and insisted on reading her chart, she presented me with a discharge summary on a certain "Dr. William Houghton." In a pitch-perfect pompous medical tone, the summary reported how Dr. Houghton was "dragged kicking and screaming to the hospital after running over a little child with his car. He obviously had both schizophrenia and bipolar disorder, behaved disgustingly, and could barely be drugged enough on 1800 mg of Thorazine and 2400 mg of lithium to be set loose." I disputed the diagnosis but could see the point—it feels rude to be labeled.

At the same time, she made an effort to be constructive and wrote a guide to lithium for a patient advocacy group that was well-researched and useful, as well as an expose of psychiatric wards that is probably every patient’s secret opinion.

Her more personal efforts to understand the world continued in poems she published in local papers:

How to Eat

Tip the tongue

Toward the new taste,

Let the juices roll. Chew.

Feel the smooth, the fibrous;

Savor the blends as they blend again:

Lime and pear,

Veal and artichoke,

Salmon and herring,

Shark and liver soufflé.

Clear the palate.

Wine sorbet

Or glacé?

Taste the second, the third, the penultimate

Course:

Eating equals exquisite eternity.

Dab the mouth with the linen napkin.

Summon the bill, and say:

"I asked for the bill,

Not the national budget."

Charge it and leave.

(This from a lady who dreaded an ounce of fat.)

The 1990s were not kind to Mary, and she was not kind to them. For several years she chased after bad men and tried whatever thrills they offered. Her hospitalizations became involuntary commitments. The sheriff dragged her off to the public mental health center, but she came back to see me as an outpatient. (When she was "away" for months, elaborate cards arrived for Christmas and Valentine’s Day.)

In 1993, she was in a coma for 2 weeks after a cocktail of alcohol and drugs, and I realized that her condition was one she might well not survive.

After that, she developed seizures, and I wondered about ongoing neurological damage—which the neurologist said he could not find. She swore off fast men and booze but entered a phase of mutism—or was it her minimalist period? All permutations of SSRIs, enhancers, and levelers did little good. She insisted on regular monthly appointments, paid upfront, and sat there in her broad-brimmed black hat, like Dame Edith Sitwell or Eleanor Wylie, slowly tapping the third finger to thumb on both hands. She cited Princess Di as her soul mate, although she thought the publicity was ridiculous. I patiently asked questions and speculated on her wishes for support. Often, after several months of this, I recommended terminating therapy, but she begged to continue. I wondered whether this was satire—a dumb show of her experience of abuse, with me being drafted into the role of perp. I had hunches but little to go on. She offered no exegesis.

During her last few years, she joined a psychotherapy group I was conducting. She held court regally, baked cookies, showed photographs, talked of the poetry classes she attended, and published a book of her poems (Pink Flamingo Sunday). In May 2001, she visited the Chicago Art Institute and was found dead in her suite at the Palmer House of a heart attack (toxicology clean).

A large and varied crowd attended her wake, and her sisters warmly recalled what a happy spontaneous girl she had been before the change in her teenage years. The memorial card contained this description of her condition:

Death Is Not Madness

There is a repose

In the manic episode:

One meets the unadulterated other;

Unspoken truths just spill over.

Death is the huntress.

An eye for an eye

Is not the game:

The stakes are too high.

Before I met you, I was mad.

I showered you with kisses.

Either I did something for you

Or vice versa. We changed.

Hardest thing in the world to learn,

Harder than balancing on a bicycle

Or on skates skimming over ice

That melts from the friction

Of your own silver blades.

She was always aiming to skate on the edge, drawing no fine line between thoughts and deeds. She had the kinesthetic knack, despite her falls. She played crack-the-whip with me on the tail, arms windmilling. Solon, the Athenian statesman, said it is impossible to tell if a man is happy until he is dead, all the results in. From that perspective, I see that Mary J. was no Olympic goddess, just a Polish girl from up north, trying to put a life together. She was honest, reckless, and took the trouble to say what counts. She did a pretty good job, if you go by the people who miss her, including me.

Address reprint requests to Dr. Houghton, 2437 N. Terrace Ave., Milwaukee, WI 53211; puck1595@worldnet.att.net (e-mail).

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