I knew a man who became paraplegic after voices commanded him to jump from the top of a building. He did, twice. His voices disappeared—their work was finished—but delusions persisted. In the state hospital, he believed he was being raped continually by nursing staff, who entered his room each night and hypnotized him into quiescence. Sometimes he felt that they assaulted him during the day, even in the very moments he was talking to others. He would grip his wheelchair and shake in the middle of a conversation. He would turn red and blue, like something twisted out of balloons.
There were medical consequences. He caused himself to vomit, which led to malnutrition. He did not allow his catheters to be changed, refused treatment for constant low-grade infections, and wouldn’t let nurses near the pressure ulcers on his buttocks that needed debriding. The ulcers were recurrent, the psychosis was treatment-resistant, his behaviors were demanding, and his presence—though it had its reasons—unendurable. Even the most pleasant and demented patient refused to share a room with him. He spent years alone in a room at the end of the hallway.
My patient had a small, beaten-down mother who sent cards to staff on holidays. She visited him faithfully and ferociously, through all variants of psychosis and all variants of psychiatrists. She came to the Team, bringing notes she had taken—books of them after all the years—in order to ask respectful questions about symptoms and medication side effects. She would never have dreamed of telling us our business, even though she was forced to rely on us—the randomly chosen us—to ensure her son’s existence. We could hear him at the end of the hall sometimes, screaming at her.
We decided to enlist him into the Team as a formal member. It was an unoriginal strategy, culled from textbooks, meant to be preemptive. Every Monday afternoon at 2 p.m., we would bring him in for a consultation. We explained that we wanted to hear all the details of his experience, but only in as much detail as fifteen minutes would allow. Fifteen minutes was the therapeutic box. In that short time, experiences that overcame him could not overcome us—and we hoped, eventually, somehow, he might not feel so overcome, either.
The news he brought at first was unrelentingly grim: nightly rapes, hypnosis performed upon him by nursing assistants, malignant forces causing him to behave in terrible ways. There was no mercy.
Similar descriptions went on for months, accompanied by demonstrations of chair-gripping and -shaking to assure us of their ferocity. We came to dread our good idea. Then one morning he wheeled himself into Team, pulled up and braked beside the social worker, and leaned over, eyelash to eyelash. His voice was filled with authority. It seemed to be coming from someone else.
“I’m going to Abilene with ten thousand head of cattle,” he said, in what I later realized (though I honestly think he did not) was a middling imitation of John Wayne. “Are ya coming with me or not?”
We had heard many shocking requests in Team, but never this. We asked him to repeat it.
“Are ya coming with me or not?” he said.
The social worker, who is an unfazed saint, answered immediately. “I’m coming with you,” she said.
He nodded brusquely, and wheeled himself over to the physical therapist.
“I’m going to Abilene. I’ve got ten thousand head of cattle. Ya with me or not?”
“With ya,” the therapist said.
He asked the head nurse. He asked the internist (who was willing to go to Abilene if everyone else was going). He asked the dietician. He asked me. He polled everyone in the room. It was unanimous. He was taking us to Abilene, ten thousand plus.
“That’s all I wanted to know,” he said, and wheeled himself out.
Slowly, very slowly after that, his delusions began to shift. What caused them to change was a mystery. It was not our preemptive strategy but something deeper and more humane. They were still delusions, but instead of being torturous and self-preoccupied, they blossomed, and became benevolent and grand. He had a task. A large herd of steer and, as it turned out, all mankind were under his care now.
Over the following weeks, he updated us on evolving projects, as they grew increasingly heroic. He needed to divert an asteroid heading toward North America from destroying the country. It was a physically exhausting task but necessary for the safety of the continent. He also arranged for the donation to child welfare charities of millions of dollars earned from writing Hollywood screenplays, as well as after-tax profits of several sports teams he owned (only winning teams). These last obligations were not as taxing as the asteroid diversion. All they took from him, he explained, was money.
There were medical benefits to his altruism. He started shaving, stopped vomiting, and allowed his catheter to be changed. His nutrition improved. Eventually, the wound clinic discharged him. One Tuesday at 2 p.m., he rolled into Team. The consultations had come to feel like meetings he chaired in the board room of his private plane. He looked around at us and said, “I know you think I’m nuts.”
Here it was: the green flash, what every psychiatrist dreams of and few have ever seen—schizophrenia overcome, psychosis suspended. He had been shocked into reality. It was a miracle.
His hands were relaxed on the arms of the wheelchair. His face glowed. “You think I’m nuts,” he said. “But here’s the thing: there are ten of me in the world—the politician, screenwriter, superhero. I can’t wait until they come together in one man.”
The head nurse wiped her eyes. It was a miracle that had nothing to do with sanity. He was no less schizophrenic. But his psychosis had been transformed into something blessed, full of hope.
A few months after the herd had left for Abilene, his mother came with him to Team. She did not look well at all. She had a tremor, and her ankles were swollen. At the end of the meeting, she tried to rise from her chair, swayed, and fell back again. Something was certainly wrong.
She wiped her eyes. “Why are you crying?” my patient asked, embarrassed, hoisting her up by an elbow. “I am getting weaker,” his mother said. “Oh mother,” he said, rolling his eyes. Parents can be so dramatic. But she persisted.
“I am getting weaker,” she said to us, then nodded toward him. “But he—is getting stronger.” The balance had finally changed. All these years she had been holding on, waiting to grow weak while he grew strong. When the right generation is rising and the right one falling (as they are meant to do), what happens next is just the natural order. She wasn’t weeping. She was rejoicing.
If a man is ready to leave for Abilene, you must gather whatever pots and pans and horses and tack and supplies you can lay hands on at a moment’s notice and saddle up. The weak have grown strong; there is miracle in the midst of sickness. Sometimes, we are led by our patients. Humbly, we follow.