Gary Small - The Naked Lady Who Stood on Her Head: A Psychiatrists Stories of His Most Bizarre Cases

HOW COULD SOMEONE GET SO ANGRY that he suddenly becomes mute? Yank at his hair nervously until he goes bald? Or pass out just because he sees someone else pass out? Questions like these have always fascinated me. So when I was in medical school, it came as no surprise to anyone that I picked psychiatry as my specialty, and Ive never regretted that choice. Now, after three decades of practicing psychiatry, I have seen patients whose bizarre behavior was too intriguing to forget. The mind sometimes pushes people to the extreme, and I was taught that a good psychiatrist can help bring them back.

In this book, I will tell all about my most unusual patients and how I was able to help many of them return from the brink of insanity. I will share my feelings, thoughts, and reactions to these bizarre cases, because it should be understood that being a psychiatrist and neuroscientist is not only a professional journey but a personal one as well. As I illustrate the challenges I faced with each case, I want you to join me in unraveling the puzzles underlying my patients mental issues and to observe how solving these cases and gaining experience made me a better doctor.

I relate these cases in chronological orderfrom my early training throughout the next thirty yearsas they shaped the way I have matured as a psychiatrist. Throughout these accounts, I explore several dynamics, particularly how the mind can make the body sick, as well as how the body can imbalance the mind. In working with my patients, I used a variety of approacheswhat has been described as an eclectic psychiatric styledrawing upon both physical and mental explanations for psychological problems and treating problems with talk therapy, medication, or both.

In more recent years, I have also focused my career on understanding and preventing memory loss and Alzheimers disease. While I helped my patients preserve their memories, it struck me that many of them had memories they wished to forget, driven by unresolved psychological issues, conflicted relationships, and insurmountable challenges that sometimes made them flee reality. Helping memory-challenged individuals overcome their mental struggles can be as essential to their well-being as preserving their memories.

It surprises me that many people, even those with crippling mental disorders, still fear psychiatry and never get treatment. Often what seems to keep people away is the lingering stigma of seeing a shrink and admitting one has a problem. Thanks in part to the media, there exists an unwarranted pessimism about psychiatry that dissuades many from getting the help they need. Psychiatrists are sometimes viewed as probing mental detectives who take control of their patients minds rather than heal them. With this book, I hope to debunk such misconceptions and demystify the treatment of mental illness.

In any given year, an estimated one in four adultsnearly sixty million peoplein the United States suffer from a mental disorder. Despite the publics misconceptions, psychiatric interventions have been shown to diminish and often eradicate the symptoms of psychosis, depression, and anxiety; yet many people do not have access to care, and often those who could improve with treatment never seek out a specialist.

I have described the events in this book as I experienced them, in the first person. My co-author and wife, Gigi Vorgan, has been essential to the writing of this book, helping me shape the narrative so that readers can better grasp the events and the science behind them.

The people and situations portrayed in this book are based on real patients and their emotional struggles. The details are derived from my case histories and vivid memories; however, many of the particulars have been altered to protect the confidentiality of my colleagues, patients, and their families The cases have been re-created as accurately as possible to give readers a true sense of my experiences as they occurred. Some dialogue, locations, and situations have been altered or fictionalized, as well as traits of some patients embedded onto others, to further protect the privacy of those involved. Any similarities to real people are unintended.

It is my hope that this book will both entertain and help those who fear psychiatry to overcome their fears and get help if they need it.

G ARY S MALL , M.D.
L OS A NGELES , C ALIFORNIA

Winter 1979

I BOBBED AND WEAVED MY WAY through the crowded waiting area of what we called the APES, short for the Acute Psychiatric Service, Bostons busiest walk-in psychiatric clinic. It was just down the hallway from the emergency room of Massachusetts General, the major teaching hospital at Harvard Medical School. Our group of young psychiatric trainees nicknamed it the APES because of its jungle-like ambiencea perpetual array of troubled souls found their way here, either by their own free will or thanks to the assistance of the local police or emergency technicians.

I was twenty-seven and had finished medical school and a year of internal-medicine internship before leaving my hometown of Los Angeles for Boston. Only six months earlier, I had sold my car and everything else I owned and shown up at my empty one-bedroom Cambridge apartment with three boxes and a duffel bag. I had been anxious about moving and starting a new training program but excited to begin my career in psychiatry. Even though I was Phi Beta Kappa and summa cum laude, I still couldnt believe I was going to Harvardalthough part of me thought, if they were letting me in, how good a school could it really be?

As I inched through the cramped waiting room, I almost bumped into a woman with bloodstained white gauze wrapped around her wrists, being escorted by two emergency technicians. I finally made it to the coffee room, where some of the other psych residents were taking a break between patients. There was something about being thrown into this intense environment that created an immediate bond between us. Humor was our favorite coping mechanism, and we constantly tried to one-up one another with jokes and patient horror stories to both shock and impress.

The first year of psychiatry residency combined rotations in emergency settings and inpatient units. In addition to these medically oriented training experiences, we were expected to begin taking on at least three long-term outpatient psychotherapy cases. I felt like I was finally jumping out of the textbook into a whirlwind of clinical experience. At the same time, I was dealing with a plethora of real people and their very real suffering. I found it overwhelming, frightening, and often exhilarating. Although I was energized by the intensity of the work, I was usually exhausted and always relieved when my shift ended.

The next morning was Saturday and I could have slept in, but the sunlight on my face woke me up early. I hadnt gotten window shades for my apartment yet. My girlfriend, Susan, was still sleeping, so I cuddled up to her for warmththe narrow beam of sun didnt do much to heat the room. January was not my favorite month in Boston. Had Susan not been there, I would have already been huddled by my space heater reading Jung and Freud, looking like the Michelin Man in my three-pound parka and wool cap. Instead I threw the blankets over my head and imagined myself back in Los Angeles, where everybody always pretends its such a fluke that its eighty-five degrees in January. I knew that calling the landlord to turn on the steam heat for more than five minutes twice a day was fruitless, so I stayed where I was until Susan, an ICU nurse at Cambridge Hospital, stirred and mumbled that she had a shift that morning and had to go.