Projections, page 17
“Wait,” Winnie objected. “Why are these explanations always so technological, always beamed information like that?” She had to get to a resolution, and knew she was running out of time again. “You know, why satellites? Doesn’t that mean this really isn’t a disease? It’s more of a recent development, right? A reaction to technology.”
“Well,” he said, “this feeling of external control and long-range projection of information, of forces acting at a distance, was always a symptom as far as we know, long before satellites, or radios, or any kind of energy wave was known to exist.” He started to drift down toward the next room along the hall, in the pattern she knew well now, edging toward continuing his rounds. “I have to keep going now, but I think I can show you how we know this tomorrow.”
The next day, as she waited for morning rounds, Winnie wondered if among all the failure modes of the human mind, schizophrenia might be the least understood. She herself had heard nothing explanatory, and felt so ignorant about it, with many gaps and maybe misconceptions. Disorders like depression and anxiety seemed so much easier to map onto regular human experience.
Still, altered reality could also be universal in some sense. In college she had learned that while falling asleep most people can experience brief, bizarre states of confusion and hallucination; she knew that state herself, and that it was frightening enough for the instant it lasts—yet what would life be like if that state came one night and never went away? If that altered reality, once experienced, became fixed? Entrenched and unshakable for days, or for years. The idea was horrifying, and so she stopped thinking about it.
The fragmentation of the self as a concept intrigued her, and was more pleasing somehow to consider—the idea that one part of her could fail to know what another part was doing. The idea made her wonder how integration of the self is ever achieved in the first place. She had always taken this kind of thing, her wholeness, for granted, but apparently it was not so certain. Again thinking about sleep helped her understand, since on awakening, she had always felt an unraveled moment with no reality or self at first, but then experienced a gradual reconstruction, a reweaving. Short local threads—of place, purpose, people, things that matter, schedule, current attributes—came to interlock with long-range threads of identity, trajectory, self. Where is the information coming from, and where is it going, that reweaves the self in those minutes? If that process is interrupted, the result would be an incompletely formed self—and one’s own actions would seem unconnected and alien.
As Winnie thought about that disconnected state, a disturbing thought occurred. What if that underlying formlessness—needs unraveled from self, action estranged from plan—is what is real? What looks like confusion and disorganization in those psychotic states, she thought, might be simply the reality that our borders are arbitrary, and our sense of unique self actually artificial—serving some purpose, but not real in any sense. The unitary self is the illusion.
And then, what about that voice, almost imperceptible now? The doctor had implied she was thinking disconnect, and not recognizing it as her own thought—but he was missing the deeper point. Even if the disconnect thought was “hers” in some sense, who told her to think it? Did she decide, at a moment in time: I plan to think “disconnect”? No, not for that or any other thought. The thought comes. For all people, all thoughts just come.
Only people with psychosis are rightly perturbed by this, Winnie realized, since only they see the situation for what it is. Only they are sufficiently awake to perceive the underlying truth—the reality that all of our actions, feelings, and thoughts come without conscious volition. We all lie on the hard hospital bed prepared for us by evolution, but only they have kicked off the thin blanket, the comforter provided by our cortex—the idea that we do what we want to do, or think what we want to think. The rest of humanity proceeds through life in dumb slumber, serving and preserving the practical fiction of agency.
The next morning, by the time Dr. D. got to her on his rounds, Winnie felt convinced that hers was a state of insight rather than illness. She was not shielded but rather had emerged, and could sense the field, the charge surrounding everything. But before she could tell him, it turned out he had brought something for her, a picture he had printed out—first drawn, he said, by a nineteenth-century Englishman named James Tilly Matthews, in the heat of the Industrial Revolution, in the grip of what they then called “madness.” Matthews had imagined something he called an “Air Loom,” and drew pictures of himself as a helpless, cowering figure controlled by strings projecting through space from a giant and menacing industrial weaving device. Controlled from afar, by long-range threads.
Winnie was fascinated. So unexplained symptoms and feelings in schizophrenia were just imputed by patients to their time’s most powerful known phenomenon for action at a distance—whatever it happened to be that might serve as an explanation—satellite, loom, angel, demon.
Winnie had much to say after that, and she found herself more interested in exploring these ideas than in pressing for discharge from the hospital. Even if she had schizophrenia or something similar, it seemed clear to her that this was not truly a disease, but a representation of something essential—a spark of insight and creativity, an engine driving the progress of humanity.
So the next day, she asked Dr. D. to admit that this could be true, that tolerance of the unlikely and bizarre could be useful—in the context of the human brain and human hand. Only in this way could unlikely things—semi-magical possibilities, concepts unrelated to anything that had ever existed—become real. Such a setup would only be of value to humanity; there would be no value for a mouse or a porpoise in magical thinking, admitting to unlikely possibilities, believing for no good reason that something strange might be true, that a different world might be possible—with no big brain to plan it, or nimble hand to make it.
He was not as excited as she thought he might be. “People have thought about this,” he said. “Not to say that’s not an interesting idea, or that it doesn’t have a certain appeal. It might even be right in some sense. But schizophrenia is much more, and much worse, than a little bit of magical thinking. There are also the negative symptoms of schizophrenia, which prevent patients from even accessing the basic and useful parts of their mental world anymore. There’s an apathy, a loss of motivation, a lack of social interest.
“And then there is a symptom called thought disorder, in which your whole internal process can become disrupted in a very harmful way,” he said. “Think about thinking for a bit, which you have been, but now about the flow of thought. We do plan to think a thing—not always, but sometimes, or at least we can if we wish. We set out to reason through things, we choose to build a series of thoughts: imagining paths radiating from a decision point, planning to go through each of them systematically, and stepping through that sequence. This is a beautiful thing about the human mind, but this beauty can be corrupted. Patients lose the memory of their positioning along each planned path of thought, and even lose the ability to chart the path at all. Words and ideas get jumbled up together, getting inserted or deleted too. Eventually thinking itself is shut down completely. We call that thought blocking—when patients crash out of conversations midsentence, midword. Thoughts come unwanted, but also don’t come when wanted…and can’t be summoned.”
Winnie knew she had exhibited long silences in the ER—but she had been thinking about AJ dying. She reminded the doctor about AJ, saying, “I don’t think my silences that first day were thought blocking, Dr. D. It was just a strong feeling, from a personal memory that mattered—my brother’s death everyone was asking me about, nothing else.”
“Okay, yes, that may not have been thought blocking,” he said. “It looked that way—but the good news is it’s happening a lot less for you on the antipsychotic medication. And thank you for letting me know. We try to visualize what is going on inside our patients’ minds—but thought disorder is not something most people can vividly imagine, and so we could get it wrong. It’s maybe even the most debilitating symptom in schizophrenia, but extremely hard to explain.”
Maybe because this is the most human symptom, she thought, a deficit in the most advanced brain system, with no analogy in any other animal or being. But more importantly, control over one’s own thinking is just an illusion anyway—it’s the fantasy of control that is uniquely human. Thoughts are only ordered after our guts decide what we want, and fictional thought sequences are built up and installed retroactively. This perception of order in our thinking is as unreal as agency over our actions. Both are rationalizations—just neural backfill.
* * *
•
The day before discharge, he came to update her on the final reading of her MRI. There was nothing in her brain that they could see—no AVM like the one that had killed her brother, no tumor, no inflammation. “What this means,” he said, “is that your episode of psychosis might well be a sign of schizophrenia. We don’t know for certain yet, but that is the working diagnosis. But there’s one more test we need to do. We need to check your cerebrospinal fluid for signs of something that might be treatable—cells that shouldn’t be there, or infectious agents, or proteins like antibodies. This means we have to do a lumbar puncture—a spinal tap.”
Winnie felt herself flinch slightly, remembering the terrifying length of the chemo needle. “I know, sorry,” he said. “You’ve had these done before—yes, it’s invasive, but almost painless, and we know from the brain imaging that you don’t have any worrying pressures in there that would make it unsafe.” Her experience as a teenager fully surfaced itself, uninvited, as he prepared the consent form. Winnie remembered how she had been positioned on a bed facing the wall, in a fetal curl to present her lower back—but it was true, she remembered no pain, just a deep and achy pressure.
“It is pretty unusual to do on this unit, so we’ll have to take you to the open floor,” he said. “No needles are allowed on the locked unit, except in emergencies.” Winnie signed the consent, they had her change into a hospital gown, and then she walked with Dr. D. and the nurse to the locked exit door. The ward clerk buzzed them through, and she was out in the legal open for the first time since her admission nearly a week ago.
As they set her up in a procedure room, she considered the irony of what was about to happen: after her frenzy of concern about long-range access to her brain, here she was willingly allowing them direct entry, right into her central nervous system. And they would withdraw material—her own liquid from deep within her—and keep it, and test it, and enter the results into databases that would never go away.
But she had somehow consented, and it was all happening. Dr. D. positioned Winnie on her side with a gentle curl, and with her hospital gown pulled away to expose her lower back. First came the surface anesthetic: a small stick, from a tiny needle. The big one would come once he had the location exactly mapped with his hands. He talked her through it—“I’m finding the boundaries…framing the top and bottom lumbar vertebrae, these define the space, the fourth, the fifth—there it is.” After a breathless pause, she felt that familiar deep ache. The needle was in her spinal column.
It would be a clear liquid, she recalled as she fixated on the wall in front of her—cerebrospinal fluid, unlike any other in the body. They would test it for cells, sugar, and ions. CSF, bathing the brain and spinal cord, cushioning the neurons of thought and love and fear and need, with just the right salt concentrations of our fish ancestors, along with a touch of glucose—a little bit of the ancient ocean we carry with us, sweetened, always.
The next morning, he conveyed the results: more good news. Nothing of concern, all clean; in fact, he confided, it had been a champagne tap—which meant the CSF had come out fully clear with no blood from a nicked capillary, not a single red blood cell. For residents and interns performing their first LPs, he said, this is usually occasion enough for a bottle of champagne, marking a milestone of technical skill along with a little luck. But more important for Winnie: no white blood cells, no inflammation, no proteins, no antibodies. Glucose and ions all normal.
Another minor side note: something called cytology was still pending, a detailed analysis for cancer cells, but lymphoma recurrence was not suspected by the laboratory. And so this day would become the day of her discharge, as he had promised—and they would send her home with a prescription for the new medication, the antipsychotic.
“And the discharge diagnosis?” she asked. “Will you say schizophrenia, or not?”
“We still can’t be certain, but schizophrenia is likely,” he said. “Some psychiatric diagnoses can be applied only if everything else is ruled out, only if enough time passes with no other explanations found. So for now, we’ll give our temporary diagnosis: schizophreniform disorder, which can be converted to schizophrenia at your outpatient follow-up.” An unappealing prospect—Winnie felt disinclined to let that happen.
Champagne tap—my brain feels like champagne, she thought later, back in her room, waiting for the discharge orders to go through. She had liked that phrase he used, champagne tap, and so she began to play with a more retro image of filtering—moving away from modern electronics, to more of an Industrial Revolution filtering of bubbles, more like James Tilly Matthews might have pictured as he pondered his drink. Bubbles of ideas are seeded deep, guesses to explain the world—why is that screw there?—models nucleating on the side of the mind’s champagne flute, rising quickly if able to combine with others in support to form a larger bubble, a more complete hypothesis, that can rise more powerfully past filters that can only arrest the small and weakly moving, the unlikely, the poorly justified.
The bubbles that rise the fastest and grow the biggest, encounter more support and reach the brim—the border of awareness—only then to burst into consciousness. Once that burst happens, it’s irreversible. It’s no longer a guess, it’s Truth—molecules forming part of the oxygen of the mind now. There is no re-forming of bubbles that is possible; there is no sending them back into the champagne.
And most important of all—sometimes a few little bubbles that should have been stuck instead slip through. Winnie thought: Why not send them up? The world is always changing.
She was discharged on the afternoon of her tenth day—the last dose of the pill, the antipsychotic she had been given daily from her initial admission, had been administered by her nurse the night before, and she had a prescription to fill at home, so she could keep taking it. With a tentative diagnosis—schizophreniform disorder—she was free to go.
* * *
•
Winnie never filled the prescription or followed up in the clinic, and never planned to. She felt fine. When she got home she skimmed Dr. D.’s card across the room and let it lie where it fell by the gas fireplace, a white marker thrown down where she could see it and remember—and in the meantime there was work to do.
She felt good going online, not even worrying about Erin. The hacking conspiracy was still there in her mind, but not as an overwhelming invasion anymore—more of a polite houseguest. They could leave each other alone, pass in the narrow hallways of her mind with a slight turn of the shoulders and a courteous nod.
She even felt more secure about her own body, her own borders. The Raiders hat went back into storage. As she was reorganizing the closet she came across her old copy of Benjamin Franklin’s “Letters and Papers on Electricity” from 1755 and went straight to her favorite passage, from his letter to Dr. L——, describing the discovery of what would become known as the Faraday cage, savoring again, as she read his words, Franklin’s false humility:
I electrified a silver pint can, on an electric stand, and then lowered into it a cork ball, of about an inch diameter, hanging by a silk string, till the cork touched the bottom of the can. The cork was not attracted to the inside of the can as it would have been to the outside, and though it touched the bottom, yet, when drawn out, it was not found to be electrified by that touch, as it would have been by touching the outside. The fact is singular. You require the reason, I do not know it. Perhaps you may discover it, and then you will be so good as to communicate it to me.
Winnie felt a connection again to the cork. After a brief and tumultuous emergence, where she had been buffeted by the fields of an external reality, she had now returned to the silver can, the shielded cage, the shared and common human frame.
There probably never was a miscarriage though—that idea had become uncoupled from her also, drifting off, a cinder lost, a dark mote dimming.
She ate ravenously that first week home—with a hunger like nothing she had felt before. Controlling her own food again was a revelation, a release. She cooked pasta, bought cakes. Toward the end of that first week, an odd thought appeared—she was not sure she had a mouth. Even while eating—especially while eating—she had to touch her lips to make sure they were hers, and were still there.
Between meals, the patent lawyer in her reemerged—strong and refreshed and tireless. Just as at work when tackling a new field of art, she spent many hours each day at her computer, delving into the scientific literature, seeking knowledge and precedent. She found her way to dense and intriguing papers on schizophrenia genetics: the collection of DNA sequence information from human genomes, with massive teams of scientists spelling out individual letters of genetic instructions within tens of thousands of schizophrenia patients. She wandered, fascinated, through the hundreds of genes found, associated, linked—that all seemed to play some role in schizophrenia. Each gene alone had only a tiny effect on the individual human being, with no single thread setting the pattern, none by itself defining the weave, or the fray, of the mind.
