PRESENTING THE SUBJECT

A creak sounded as the doctor rose from his chair and moved to the large bookcase by the window.

Had there not been a paper circulated by the Schizophrenia Research Council which had referred to delusions of being super-human in the context of bi-polar disorder? Reading his own notes from the last consultation, he was questioning now which of the characteristics were dominant, which controlling, which stimulating or informing the other.

His finger worked back along the dates. How long ago was it? Last year, or earlier? He glanced at the clock. Perhaps it would be better to look for it later; he should spend the time now composing himself for the appointment. Particularly in the first minutes of their encounter, the subject could be an awkward man to engage and would require his undistracted attention.

He had stopped opposite the mirror, and, at the very least, he needed to find a comb.

His mental struggle with the many complexities of the case had been physically expressed by his fingers fighting with his hair. He looked very wild and this would not do. He did not want Dr Funffingerberg to appear like an actor playing the barmy professor! The subject was, in one of his aspects, sceptical enough about his therapist’s competence as it was.

His mind played back to the conclusion of the last interview.

He had been probing the awareness of the past lives, asking questions to establish when the subject’s consciousness of these was strongest, when was it most significant, when was it related to the circumstances existing in the subject’s current life. Admittedly, the questions were perhaps not as well-articulated, or as logically sequenced, as he might have wished, but the subject had been merciless in demonstrating the obvious nature of the weakness.

For the following two or three days, his own mind had smarted from the subject’s cold, uninvolved dismissiveness as he stood up, with one hand on his folded coat, and posed a question of his own: “And your point is?”

The doctor sighed. Of course, he enjoyed exposure to the challenge of such an extraordinary psyche but he could not warm to the depressive aspect of the subject’s personality. The manic side was far more engaging; he would never learn as much professionally from the subject’s manic presentation, with its juvenile simplicity and transparent responses to instinct, but, on a simply human level, it would be a pleasanter afternoon.

He allowed his professional interest to establish precedence and combed his hair whilst considering the peculiarities of the subject’s bi-polar presentation. There was a normal divergence between the two aspects both in terms of body language and of willingness to respond, of garrulity in the one phase and reticence in the other. However, the unique features included the manic’s insistence on having super-human powers in a past life, the eating disorder, his impressively heightened olfactory sensitivity and an uncanny consistency in not exhibiting any experiential skills beyond the adolescent.

The heightened sense of smell was verging on the bizarre. He had set the subject various tests, including bringing into the room some twenty air-tight tins, all of which had been used for the storage of strongly scented items such as moth-balls, lavender, shoe-polish, peppermint sweets and the like. Some of these he had even prepared himself with fish-skin or the juice of onions or some other powerful smell. Before the subject’s arrival, he had distributed six plain shortbread biscuits among the twenty-three tins and replaced the lids tightly. He then placed the tins in a row, not quite touching and in a random order, on the long table by the door.

When the subject arrived, he had been fortunately presenting in the manic phase and was, therefore, more than willing to indulge him in a game. He had asked the subject to stand at the other side of the room and to tell him in which tins he could smell a biscuit but, at no time, had he disclosed that there were six biscuits to be discovered.

The subject had shown common signs of increased excitement (quick hand and body movements, mild trampling on the spot, exaggerated smiling, raised aerobic exchange and the like) and had, after sniffing at the air intently for the best part of a minute, identified six tins. The six correct tins. A positive result of 100%! If only he had had a professional witness in the room at the time!

He had yet to investigate whether the subject’s sensitivity to smell was increased only in relation to food-stuffs.

In fact, he had to take particular care to remind himself that the subject had been referred to him principally because of an eating disorder. The whole presentation of the subject was so much more complex than that and, accordingly, the eating disorder was hard to view as significant; certainly he did not find it the most interesting of the abnormalities!

Of course, it was commonplace that over-eating presented during depression (comfort-eating as the press liked to say) but, here, the over-eating never presented during the depressive phase of the cycle, only during the manic. As always with this subject, none of the usual trends applied, except perhaps in the matter of nicotine addiction: the subject did not even carry cigarettes in the manic phase, whereas, in the depressive aspect, he chain-smoked compulsively.

In addition to the obsession with food, the referral had related to the subject’s employer being uneasy about his tendency to appear on campus with a hand-gun pressed to his temple. The occupational therapist’s report stated that the subject had explained how the sensation of cold metal so close to his brain was comforting, was somehow connected to his past, to a sense of control and purpose. When asked what he had been doing when standing in the window or walking by the lake with a gun to his head, the subject had claimed that he was praying!

The OT report went on to state that several students had filed complaints alleging that the subject had referred to them in passing, not as students, but as “servants” and “underlings”.

The feedback from students was unequivocal when read beside the occupational therapist’s clinical notes: the subject had an entertaining, exuberant and manic side which connected directly to the students’ own immaturities as an ally and which then became, apparently without reason or warning, converted to a depressive aspect in which the students were treated with contempt by a teacher whose arrogance and aloofness left them disconcerted and alienated.

Dr Funffingerberg gripped his notes with vigorous hands. He was determined today to progress towards a clinical opinion which would inform a course of remedial treatment! The manic and depressive aspects were clearly derived from a single personality; the task then was not to address any abnormality in the psyche per se but to decrease the scope of its polarization.

To this end, was recall relevant? It was, in this case, singularly interesting but how far did he need to investigate the subject’s descents into past lives before determining a more cognitive approach to the prevention of polarization?

Of more importance, it seemed to him, were the causes for a change in aspect. Which triggers operated to move the subject’s state of mind from the manic to the depressive, and vice versa? It would be tantalizing to watch this occurring during the course of a consultation! Could he provoke it? Would he be able to provoke it this afternoon?

He tried to recall the answers to any questions previously aimed at this point.

The difficulty was that the manic was given to a simplistic iteration of what depressed him as a manic (usually circumstances related to the absence of sufficient food or to incarceration underground), whereas the depressive, if he answered at all, was deliberately unforthcoming and tried to prevent the line of questioning by making remarks such as, “Everything’s a useless struggle until you die” and, “ I’m not going to explain myself”.

When he had once reminded the subject, out of frustration, that the subject’s employer was paying for the doctor’s professional assistance and that the professional assistance was a non-negotiable condition for the subject keeping his job, the subject had looked him straight in the eye, removed the cigarette from his mouth and replied bleakly, “You have a brain. Use it.” He had been under the strong impression that the subject had only just stopped himself from adding the word “ass-hole”. Good grief!

The doctor’s brain span in a heated vortex of memories: intelligent, belittling, caustic phrases addressed to him during his subject’s interviews to date, interspersed with excited expressions showing unusual levels of enthusiasm and attraction to novelty in the most trivial of forms and, then, shards of disturbed recall from the subject about prayers and demons and chains and years of calling and searching, deep impressions of loss and failure, witness to murder and disaster and constant paranoia as to identity, reality, significance, loyalty, betrayal, starvation, darkness, possession, obedience, protection, desertion, scripture theft, fallibility, immortality, the heavens, gods, the universe and beyond!

The sheaf of notes slid from Dr Funffingerberg’s inattentive hands and fell into an untidy pile on the polished surface of the desk. He made an effort to steady his breathing, to impose order on his scattered thoughts. Look at the time!

The clock on the landing struck two. He heard the front door close and then the light tread of feet on the stairs.

The subject had arrived, the extraordinary, perplexing subject who saw the world sometimes with purple, cheerless eyes and, at other times, felt his ears growing longer and his stomach craving an excessive volume of food in fear of another five hundred years of famine.

There came a knock at the door, and the doctor cleared his throat and called out, “Come in!”