The Mind and the Moon by Daniel Bergner

Author:Daniel Bergner [Bergner, Daniel]
Language: eng
Format: epub
Published: 2022-03-19T00:00:00+00:00

Eight

I asked Goff about Caroline’s brain. We had been talking about the hippocampus and its relationship with the prefrontal cortex. He had been teaching me about the differences—some hypothetical, some tenuously substantiated—between the brains of those with psychosis and the brains of those who inhabit a more widely shared reality. Our conversation had ventured, as it often did, into questions of how our circuitry becomes our consciousness. For my lesson, he had cued up images of the hippocampus on his computer. He was going to lead me into the intricacies. This was the context of my question about Caroline. I wasn’t asking for diagnosis; I was interested in his perspective on possible physiological distinctions. I recounted some of her story, acknowledging that my summary wasn’t nearly enough information and that his response would be inherently speculative, and then asked for his impressionistic sense. “When you think about her brain, what are you seeing?”

But his reply, in his invariably quiet and compassionate voice, rerouted our conversation. “Has she been tried on clozapine?” It seemed that he hadn’t heard me. His mind had leapt to medication, to a particular antipsychotic, the first of the second-generation drugs, the one that appeared to have the best odds of diminishing psychotic symptoms but that also, beyond the side effects of weight gain and permanent disorders of movement, dangerously depleted the immune system. His mind went not to her brain; rather, it felt to me, he went straight to the attempt to purge or contain.

Has she been tried on—the phrase sounded tangled. It was telling. I felt that he was well outside Caroline’s brain and mind, that his instinct was to draw a line around them, to bound them, to subdue their aberrations, to prevent their anarchy from spreading. Admittedly, this was merely my own intuition, yet has she been tried on was certainly a striking construction, distinguishable from has she tried. She was the object, not the subject, of the sentence, the recipient, not the one deciding.

I said that although she’d taken a number of antipsychotic cocktails, she’d never taken clozapine. I said, too, that although her voices persisted, I doubted she would choose to take anything at this point.

He emphasized that the early onset of her psychosis—in childhood as opposed to late adolescence or early adulthood—meant that her case was probably especially severe. Then he returned to clozapine. His language shifted. He did make her the grammatical subject now. But he didn’t seem to fully take in what I’d said about her not being interested in resuming medication. He evinced no curiosity about that. Was she coping? How well or poorly? He didn’t pause to ask how this severe case was doing without antipsychotics. “Someone like her will not know the potential benefit of clozapine unless she tries it,” he said. “My recommendation is often to try it for three months. It does have some side effects. But only then can you really make a decision about what life might be, free of the voices and free of the paranoia.

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