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Addiction
By G.H. Ephron St. Martin's Press
Copyright © 2001 G. H. Ephron
All rights reserved.
ISBN: 978-1-4299-7353-3
CHAPTER 1
MATTHEW FARRELL stumped onto the stage of the Medical School amphitheater, folded his six-foot-plus frame, and sat on the chair opposite me. He clutched a near-empty Evian bottle in both hands. His Save the Whales sweatshirt gaped around his thin neck as he glanced quickly at the screen behind us on the raised stage. The electric blue of the slide background reflected off his face, turning the pimples on his forehead purple. He didn't seem to read the canary-yellow words. Asperger's Syndrome.
He stared down at the bottle, squeezing it and releasing it in a slow, steady rhythm. He avoided eye contact with me or the second-year students who filled the hall, all squeaky clean in their shirts and ties, sweaters and ponytails.
"Dr. Zak," my colleague, Dr. Kwan Liu, stage-whispered to me from the side of the stage, pointing to his Rolex. I checked my Timex. We'd finished with the lecture portion of our presentation, and it was time to get on with the clinical interview. We had only about fifteen minutes before our audience would summarily abandon us to their various obligations.
I cleared my throat and waited for the whispering in the hall to subside. I introduced Matthew to the audience and thanked him for agreeing to come and help our medical students better understand Asperger's syndrome. The plastic bottle went pok as he released it. "I'd like to ask you a few questions," I said.
I could feel the audience of second-year medical students strain forward into the silence.
"You like to ask questions," Matthew said, staring at the bottle. The words were delivered in an automaton voice, each syllable taking up as much space as the next.
There was uneasy laughter in the hall. "Yes, I guess I do like to ask questions. I thought I'd ask you if you are having any problems." "That's what you thought," he said, and waited patiently, presumably for me to tell him more about my thought processes.
"Are you having any problems in school?" This time, I'd phrased the question so it was harder to misinterpret.
"Yes, I'm having problems." I could understand how teachers who encountered Matthew Farrell found themselves barking "Look at me when I talk to you!"
"What kind of problems are you having?"
"Kind of problems ... hard problems."
"Do you have trouble with your schoolwork?"
"I do okay," Matthew said, still addressing the water bottle.
"Do you like hanging out with other students?"
He shrugged. "They laugh, and I don't know why. Maybe they are laughing at me." Matthew concentrated on the bottle as if it were a crystal ball. I waited. Finally he added, "Makes me do things I should not do."
Things-he-should-not-do included throwing a chair through the window of his high school English class. That's why he was spending a few weeks with us in the Neuropsychiatric Unit at the Pearce Psychiatric Institute, getting evaluated and having his medication adjusted. It was fortunate for the students attending the lecture — a live patient makes a much stronger impression than just a psychiatrist and a psychologist lecturing at you.
"Matthew, I'm going to show you some pictures." I clicked the remote control and a photograph of a smiling man was projected onto the screen behind us. "Please, look at his face and tell me what this man is feeling." Matthew stared at the screen, tilted his head to one side, and stared some more.
"How does this man feel?" I repeated.
"His glasses are crooked," Matthew said at last.
The second photograph was of another man, his face twisted with rage.
"And how does this man feel?"
"He needs a shave," Matthew offered.
And so it went, through a half-dozen pictures. No matter what the facial expression — from surprise to sadness to disgust — Matthew commented on some physical detail.
"Matthew, now I want you to repeat this: People who live in glass houses shouldn't throw stones."
There was a pause. Matthew repeated the phrase.
"Good. Now tell me, what does that mean?"
"What that means ... Throw a stone and you'll break the glass house."
"Anything else?"
"People will get angry at you. Say you should not do that."
After some more questions, I thanked Matthew and the aide escorted him from the lecture hall. We still had a few minutes before the hour was up.
I called on a young Asian woman with a close-cropped cap of glossy black hair, her hand raised tentatively. "His speech sounds almost like deaf speech. Is he deaf?"
It was a good question. "The simple answer is no," I responded. "But he takes what he hears literally. He's deaf to nuance, to inflection, to the emotional content of speech. And forget about humor, sarcasm, even anger — goes right by him. And in a sense, he is deaf to emotion. As you saw from his responses to the photographs, he can't interpret emotions in the faces of others. He can't express emotions either. The monotone voice, the flat demeanor — they don't give us a clue about his inner state."
A young man who could have doubled for Tom Cruise asked, "He seems withdrawn, depressed. Would you treat him for depression?"
"You're raising a very important point. It might appear that Matthew has an emotional disorder. But Matthew's problem isn't primarily psychiatric. It's likely caused by a brain dysfunction involving the right hemisphere. In his case, it's developmental, though you can get similar symptoms in stroke patients."
I glanced at Kwan. He picked up without missing a beat, "If we only pay attention to the psychiatric presentation, we might prescribe Prozac or another SSRI." When it worked, Kwan and I were like a team of relay runners, passing the baton back and forth, our narrative flowing like a single stream of consciousness. "But in this case, an antidepressant is contraindicated. It could end up making him more distant from his own emotional states, feeling more out of control, possibly suicidal."
"What's the prognosis?" The question was called out from the back corner, an area usually occupied by faculty who drop in when one of our weekly lectures piques their interest. "Are there treatments, drugs? How do they do out in the real world?"
Surprise turned to pleasure as I recognized the voice, saw the face. It was Channing Temple. She still wore her straight blond hair pulled back from her face. She'd never been exactly pretty, but she had the kind of looks that made an impression, made you listen when she spoke. We'd been friends for years. Back in college, I'd been in love with her.
She delivered her question standing up, canted forward with a finger raised. It was a stance she'd used to good effect when I'd first laid eyes on her. She was twenty years old, grilling the university provost about institutional investments in tobacco stocks. Today, her tone had none of the in-your-face brashness that irritated the provost to the point where he found himself, much to the students' delight, red-faced and screaming back at her.
There was a hesitancy to her voice that made me pause before answering, take a few extra seconds to edit the usual blunt way I allow myself to talk to doctors about mental illness. Asperger's syndrome is a difficult diagnosis, and I wondered if her question was personal.
Before I could phrase a response, Kwan answered. He always likes to get in the first word — and the last. "There is no cure, per se." The unvarnished words made me cringe. "There are medications to help control the anger that arises out of their frustration with the world." At least that sounded a bit more encouraging.
I added, "In terms of treatment, we might try cognitive behavioral therapy to help the individual use his intellect to adapt. We can work with them, teach them to notice what they don't notice — facial expression, for example — and get them to take a step back and ask questions whenever they're perplexed. The good news is, there's potential for living a satisfying life."
Channing mouthed, "Thanks, Peter," and sat.
I nodded back. I tried to remember the last time Channing and I had gotten together socially. It might have been a catered dinner at her and Drew's Back Bay town house — could that be right, two years ago? It might even have been the last party I went to before my wife, Kate, was killed.
Since Kate's death, I'd avoided parties — and old friends, too, for that matter. I was working long hours, keeping busy, and generally keeping to myself. I'd seen Channing from a distance, run into her at meetings. She'd left a message on my voice mail some weeks earlier, but it had been business — she'd called to recommend a resident for a rotation on my unit. Fortunately or not, the Pearce Psychiatric Institute is so big that it's easy to avoid anyone you don't work with directly.
If I'd been my own therapist, I'd have explained that grief has to be felt in order to be worked through. You can dull the ache for only so long with busyness. Remove the anesthetic, and the pain returns double. But I was lousy at taking my own advice.
Kwan thanked the students for coming and reminded them of the agenda for next week's lecture. Channing stood at her seat. She waved at me, pointed out to the lobby, and held up one finger. Even from a distance, her face seemed strained with anxiety. I nodded and smiled back.
I waded into the lobby and poured myself a cup of coffee from a large metal urn. Kwan was already there, helping himself to a cookie. He glanced up at me and tsk-tsked. "How many cups is that for you today?"
I took a sip and grimaced. The coffee tasted boiled. "One too many."
Channing emerged into the lobby. When she saw me, her expression morphed from pleasure to hesitancy. No, I wanted to whisper, it's not your fault that we've become strangers.
She came over. We did a little awkward dance where she went left and I went right, and we ended up air-kissing nose to nose instead of cheek to cheek. She laughed. "Peter, it's so good to see you." She put her arms around me and hugged hard. She still smelled of citrus. "We've missed you."
I held up an empty coffee cup.
"No thanks. They never have any tea at these things," she said, "and when they do, the water's usually tepid."
"Ah, another tea aficionado," Kwan said. "So few of these Philistines understand."
I knew it was killing him to know what kind of relationship I had with Channing Temple. Friends, just friends, I would have told him. But he'd have guessed we were once much more.
"Hi there, Kwan," Channing said. "Long time no see." They executed a flawless, cheek-brushing-without-colliding air kiss. She let her hand linger on his arm. "Mmm, nice fabric. Nice suit. Armani?"
"No, but close. Some of us try," he said, eyeing the Harris tweed jacket I'd bought in England a decade ago.
"At least mine still fits."
Kwan sniffed. "Oh, so now I know why you never wear a hat — can't find one big enough to cover that swelled head of yours."
Before I could come up with a snappy retort, he tugged at his vest, gathered his dignity, and turned to talk to a group of medical students.
"What brings you to a lecture about Asperger's syndrome?" I asked Channing.
"Actually, you were on my mind," Channing said. Her hair was wound around and anchored to the back of her head with ivory chopsticks. It was a severe look that emphasized her strong chin and prominent cheekbones. There were lines now, etched around her eyes and along the upper edge of her thin lips. "The other day, Drew brought me a beautiful spray of orchids, and I was putting them in a vase, the one that Olivia made with Kate." She put her hand on my arm. "You know how terrible we feel about what happened."
I nodded and blinked. Sympathy still threw me. I hate being out of control.
"That vase, it's really quite lovely," Channing went on.
"Kate thought Olivia had talent," I told her. I remembered the night of Channing's party, Kate had offered to teach potting to her quiet, gawky preteen daughter, who seemed to evaporate into the corners of the home. Kate had enjoyed the "lesson," and she'd been looking forward to another one.
"Then it seems like the very next day," Channing went on, "I see your name on a bulletin board in the cafeteria announcing this lecture. Asperger's syndrome. I've been seeing articles about it in the popular press."
"It's actually an old syndrome with a new diagnosis — wasn't in DSM-III," I said.
"Something like dyslexia for interpersonal nuance," Channing said.
"Exactly."
Channing lowered her voice and took a step closer. "Peter, I had an aha in there, listening to you." For a plain, severe-looking woman, she could become quite beautiful when she turned on, lit from within. "Know how you can be an expert in something, but when it's someone you love, someone in your own family, you turn stone-blind? Well, as you were talking, I realized — that's Olivia. She's been seeing a therapist, tried antidepressants."
I led Channing over to the window, away from the crowd. "Are you concerned about anything in particular?" I asked, the clinician kicking in.
"It's everything in particular. You wouldn't recognize her. You could say that she's using her appearance to make a statement. And her behavior — she's turned moody and dark. She comes home, goes upstairs. Wham, shuts herself into her room. Spends hours alone."
At sixteen, how I'd longed to have a room to close myself in and the world out. But in a one-bedroom apartment — my brother and I slept in the bedroom; my parents slept on a foldout sofa in the living room — there's only so long you can lock yourself in the bathroom before someone threatens to kill you.
"I know what you're thinking," Channing said. "What do I expect from a seventeen-year old? You don't have to tell me this is normal. And God knows, it would probably help if I'd experienced good mothering when I was her age."
I remembered. Channing's mother had killed herself when Channing was still in grammar school. Shot herself in the head. But there was no bitterness or self-pity in Channing's voice. It was just a fact, something she'd learned to live with. Once we'd stayed up most of the night, looking through Channing's family photo albums and comparing childhoods. I'd been struck by the change she'd undergone, before and after her mother's suicide. As an eight-year-old, she'd flirted with the camera, sturdy and buoyant, her blond hair short and soft around chubby cheeks and mischievous eyes. A year later, she looked away, morose and brooding. Her hair had grown long, stringy bangs creating a veil over her eyes.
"But Livvy's turning more and more inward," Channing went on. "Blows hot and cold like that." Channing snapped her fingers. "She says nothing she does is good enough for me — but the truth is, she's the one who's so ashamed of her own work that sometimes she refuses to even try. When she has to do something that seems hard, she has an anxiety attack.
"When she's in her room, she's on her computer. Hard to believe she's my daughter." Channing gave a wry laugh. "It's all I can do to answer my email. What do they do in chat rooms, anyway?"
"You probably don't want to know," I said.
"Probably not. What I do know is that she's in another world, all the time, one I don't understand at all" — her voice broke — "one I can't reach into."
I squeezed her arm. "She has friends?" I asked.
"I really don't know," Channing said wearily. "She doesn't bring kids home. But she goes out. I think she's got computer friends. If you can call that friendship. Who knows who they are. I worry. She's so young and inexperienced."
Channing was the one person who'd always had everything under control. Figures — it would take a teenage daughter to throw her off-center.
"Peter, I'll bet if you spent even fifteen minutes with her, you'd be able to give us a better sense of what's going on."
I knew what was coming. I should have stopped her right there, invoked the unwritten rule: Thou shalt not treat friends or their relatives. That's if she'd been a casual friend or a colleague. But Channing was much more than that.
"Please. See her informally," she begged.
(Continues...)
Excerpted from Addiction by G.H. Ephron. Copyright © 2001 G. H. Ephron. Excerpted by permission of St. Martin's Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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