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And illness, like language, is about connection. Lauren Slater, a Boston psychologist whose award-winning nonfiction, assembled for the first time in Welcome to My Country, moves in and out of both her patients' fantastic constructs and her own, balancing confession and concession. And in doing so, she reveals the interweaving of the threads of her work, her writing, and her patients' inability (or mal-ability) to communicate.
"The schizophrenic speaks a mumbo-jumbo language psychologists call a 'word salad,' nouns and verbs, fragments from the past, snippets of dreams all tossed into the lush wet mess. [But I] feel the pulse of my voice pass from axon to dendrite and finally emerge from my mouth in blessed sentences. . . . I press a series of separate keys on this computer and up through the gas plasma screen drifts a story for you. And for me. In this way we join. The ability to use words, to tell a story, is so central to having human relationships that I find myself wondering how someone with schizophrenic illness survives the loss. When the men I work with weep or scream or clench their hands, I think they are mourning their muteness."
Slater tugs at a whole series of clinical and personal tensions: Is schizophrenia disease or disorder--that is, has it physiological or psychic roots? Does it respond to analytic therapy or behavior modification--or, if both, in which order? But it is at the intersection of metaphor and meaning that she seems to find the soul of her patients: Oscar, a grotesquely obese victim of childhood sexual abuse who alternately fantasizes prolific sexual escapes and retreats into catatonic paralysis; Moxi, a Vietnamese refugee who has mutilated himself, excising three fingers and a testicle; Joseph, the first one of the D'Agostino restaurant family to go to prep school and be accepted to Princeton, but who now obsessively scribbles reams of nonsense on scraps of paper. These and other patients drive Slater to reassess not only their eccentric logic but hers.
"Now that the stories are written," Slater says, "and I've looked at them on the page and looked at the actual patients, I realized I've mythologized them to some degree. But the stories are also static, while the patients continue to evolve.
"It's so hard to capture the complexity, especially of the schizophrenics, to render what makes them so vital. Oscar is so dead and yet so vital, and that contradiction is so hard to capture. Every day he continues to astound me. Moxi, too when he suddenly erupts with that kind of effervescence. It's impossible to render. That's the problem with art," she says, laughing, "it always ends up being artifice."
Slater's book will undoubtedly attract readers of Oliver Sacks, whose witty and restrained essays on "The Man Who Mistook His Wife for a Hat" and other extraordinary patients even inspired the movie Awakenings. But Sacks, even when he develops friendships with his subjects, remains a narrative observer; and Joann Greenberg, author of the groundbreaking memoir I Never Promised You a Rose Garden, is a survivor, though an unusually articulate one.
Slater has the benefit--some might say burden--of being both healer and patient. Although she now holds a master's degree from Harvard and a doctorate from Boston University in psychology, Slater spent great chunks of her life between the ages of 14 and 24 in Mount Vernon Hospital, diagnosed as having borderline personality disorder--a fact that she has not yet disclosed to her professional colleagues (and which revelation gives her some unease).
This ambivalence gives her writing extraordinary power: In writing this book, she not only reveals her long struggle with anorexia and self-mutilation, but admits the possibility of its recurrence:
"I can do it so no one notices, can do it while I teach a class if I need to, or lead a seminar on psychodiagnosis. I can do it while I talk to you in the evenest of tones. "Shhhh," I whisper to the hurting part, hidden here. You can call her borderline--call me borderline--or multiple, or heaped with posttraumatic stress--but strip away the language and you find something simple. You find me, part healthy as a horse and part still suffering, as are we all. What sets me apart from Kayla or Linda or my other patien--is simply a learned ability to manage the blades of deep pain with a little bit of dexterity. . . . I have not healed so much as learned to sit still and wait while pain does its dancing work, trying not to panic or twist in ways that make the blades tear deeper, finally infecting the wounds."
That passage is from the final essay, called "Three Spheres," a reference to the questions of orientation (do you know who you are? do you know where you are? do you know what day this is?) traditionally posed in evaluating new patients. Slater now lives simultaneously in three other kinds of spheres: her past illness, her professional present, and her patients' worlds. And in publishing that piece, opening her "case history" to her colleagues for the first time, she is herself accepting all three for the first time.
"I had been trying to write about the period of my life for a long time; I had many false starts over the years. But that last essay just kind of soared out of me. It was really the first time that I was able to write about it with any sort of coherency; and [reading it in print], it occurred to me that it was really real, that it actually happened. There is such a discrepancy between the girl that I was and the woman that I am that it was hard to reconcile. It's a part of me that I've had to learn to integrate."
That mutuality, that exchange of trust and remembrance of pain, might be frightening to some, but Slater calls it "an extra gift--in fact, the experience is so dynamic I'm almost surprised I get paid for it.
"My patients' pain bringing me back to my pain is empathy, when you strip it down that simply: an empathy I practice every day, and that's the highest calling a person can have."
Eve Zibart is an author and staff writer for The Washington Post.
©1996, ProMotion, inc.