“The guard’s trying to get my kidney,” said Charisa, the round-headed waif. The first thing she said to me.
“Why does he want your kidney?”
“They all do,” she whispered. “They want to sell it.”
“Others are in on it?”
She glanced back at where the guard might be and stepped in my room.
“Yea, they’re all in on it: the guard; the doctors, they want to give me pills so they can do the operation; the hospital makes a lot of money off body parts; they pay off the police; my mother…”
“Yea, she took my other one,” she said flatly. “She cut it out of me and gave it to my brother.”
The waif must have encountered many people who hadn’t believed her, for she added, “It’s a true story,” undid her hospital gown, turned, and showed me her back.
“You see the scar?”
There were scars, but they were old welts healed over. They were horizontal, the result of whippings. They were not cuts from surgery.
She had constructed an alternate story: a story more acceptable to her, as bizarre as it was, to account for the scars on her back.
I said, “Oh.”
What I did at that point is what I often do with delusional patients when there’s nothing left to do. I went to my cupboard chocked full of therapeutic techniques and opened up a can labeled reflection of feelings.
“That must be awful, feeling like you’re hunted down for your kidney.”
Yea, it sounds canned. It is canned. But starving people don’t mind canned food if that’s all they can get.
“It’s a true story,” she repeated, driving home the very point I had the most difficulty with.
“I believe in the truth of the story.”
I hid a subtle point in that declaration’s awkward construction. Every story, I believe, has some truth buried in it, no matter how outlandish it first appears.
There are some who say that I shouldn’t encourage psychotic patients this way, by giving them the impression I believe their fantasies. It only makes the delusions stronger, they say; it keeps them in denial, it keeps them stuck, it impairs their ability to reality test.
I say floridly psychotic people are isolated enough as it is, what they really need is someone to try to understand them, not argue with them. When you dispute their beliefs, you only alienate them more.
“Yea, no one believes me.”
“I believe you’re lonely and hurt. People must tell you you’re crazy.”
“Yea, I get that all the time.”
“The worse you feel, the more crazy you must sound to them. Then, when people think you’re crazy, you feel even more lonely and hurt.”
She was silent. The way people get when you hit it right on the head.
Then she said, her face void of expression, “My kidney’s no good anyway. I’ve been damaging it so they can’t use it. I haven’t been peeing. That hurts the kidneys.”
“You haven’t taken a piss in, how long?”
“Oh, I don’t know, a few weeks.”
“I didn’t know that was possible.”
“It leaks out sometimes.”
Being psychotic doesn’t mean you can’t be determined and disciplined. You can make some sense, even though it’s your own kind of sense. It doesn’t mean you can’t have the Kegel muscles of Charles Atlas.
“Hey, do they know?” I nodded towards the camera.
She turned and noticed the camera for the first time. She turned away, as a child may shrink from a vengeful parent.
“You gotta tell ‘em. Then they won’t hunt you anymore.”
She turned back, her eyes wide. “You think I’ll get in trouble?”