Gary Small & Gigi Vorgan Read online

  The Naked Lady Who Stood on Her Head

  A Psychiatrist’s Stories of His Most Bizarre Cases

  Gary Small, M.D., and Gigi Vorgan

  This book is dedicated to all the people who have suffered from

  mental illness and found the strength to get help

  Those modern analysts! They charge so much! In my day, for five marks Freud himself would treat you. For ten marks, he would treat you and press your pants. For fifteen marks, Freud would let you treat him—that included a choice of any two vegetables.

  WOODY ALLEN

  Contents

  Epigraph

  Preface

  1: Sexy Stare

  2: The Naked Lady Who Stood on Her Head

  3: Take My Hand, Please

  4: Fainting Schoolgirls

  5: Baby Love

  6: Silent Treatment

  7: The Shrinking Penis

  8: Worried Sick

  9: Eyes Wide Shut

  10: Brain Fog

  11: Dream Wedding

  12: Gaslight

  13: Shop Till You Drop

  14: Mountain Heir

  15: Sigmund Fraud

  Afterword

  Notes

  Acknowledgments

  About the Authors

  Other Books by Gary Small with Gigi Vorgan

  Credits

  Copyright

  About the Publisher

  PREFACE

  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 I’ve 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 order—from my early training throughout the next thirty years—as 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 approaches—what has been described as an eclectic psychiatric style—drawing 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 Alzheimer’s 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 adults—nearly sixty million people—in the United States suffer from a mental disorder. Despite the public’s 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.

  GARY SMALL, M.D.

  LOS ANGELES, CALIFORNIA

  CHAPTER ONE

  Sexy Stare

  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, Boston’s 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 ambience—a 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 couldn’t believe I was going to Harvard—although 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 de
aling 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 hadn’t gotten window shades for my apartment yet. My girlfriend, Susan, was still sleeping, so I cuddled up to her for warmth—the narrow beam of sun didn’t 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 it’s such a fluke that it’s 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.

  Sometimes on the weekends I felt a little homesick. Rather than hunker down and start studying for the day, I decided to run out to get a cappuccino and a croissant at my local coffee joint, where I might bump into Mike Pierce.

  After completing his residency the previous year, Mike had started a part-time private practice while remaining half-time at the hospital as an attending physician supervising the residents. He was only three years ahead of me, but seemed to have a decade more experience and knowledge. His edgy humor reminded me of George Carlin, and he used it to teach us and help us deal with the tension that was constantly palpable. Mike was already married and had two young kids. Although he was an attending, we got to be good friends. He usually had Saturday-morning patients at his practice in the Back Bay, so sometimes we met early to get coffee and have a few laughs.

  I saw Mike in line reading the Boston Globe sports page, so I cut in. “Skipping out on the twins on Saturday morning? I bet Janey is delighted.”

  Mike laughed. “I’m just giving them some special mommy time to bond.”

  “How’s the practice going?” I asked.

  “Great. Ever since I hung out my shingle, it’s been a magnet for every desperate psychopath on the East Coast. Another couple of months and I’ll be an inpatient at Lindemann,” referring to the nearby psychiatric hospital. We took our coffees and croissants over to a small table by the windows.

  “So what’s up for you today?” Mike asked.

  “I’ve got tons to read. Lochton assigned me every psychotherapy manual ever written.”

  “Ouch, you got the Loch Ness Monster as a supervisor? Have you picked out your plot at Forest Hills?”

  Dr. Herman Lochton was my first assigned psychotherapy supervisor. He was well known in Harvard psychiatry circles and had edited several popular textbooks. He was also the team psychiatrist for the Boston Celtics, and treated senators and other VIPs who flew their private planes in from the Bahamas for therapy sessions. He had created a reputation for himself as a skilled diagnostician and therapist. When he wasn’t busy telling people about his great accomplishments, he saw patients in his private practice. He volunteered one morning a week to supervise psychiatry residents in order to keep his title as a Harvard clinical professor.

  “Okay,” I said. “He is a bit of a tyrant, and he does have a touch of narcissism.”

  Mike laughed. “A touch of narcissism? The man thinks that he’s personally responsible for the Celtics beating the Suns for the championship in ’76.”

  “Yeah, I know, the guy’s a little nuts. But I am learning from him.”

  “Just be careful,” Mike said. “He knows a lot, but I don’t think he’s necessarily the greatest psychotherapy supervisor in the world.” He took a sip of coffee and asked, “So what else is happening? How are you doing?”

  “You know, Mike, it’s weird. I’ve had some interesting cases, and I’m getting better at listening and talking with patients, but I still haven’t worked with a psychotherapy patient in long-term treatment yet, and I’m not sure I’ll know what to do.”

  “What do you mean?” Mike asked.

  “I keep flashing back to med school,” I said. “Those first experiences as a real doctor—whether I was doing a physical or taking out a gallbladder—I felt like I was acting, you know, playing the role of what I imagined a doctor to be. And I’m worried that doing psychotherapy is going to feel the same way.”

  “Welcome to the club. I have my own practice, and I still feel like I’m faking it from time to time. But it does seem like the more experience I get, the less I feel that way.” Mike finished his coffee and looked at his watch. “I gotta run. I’ve got my multiple personality at eight-thirty. I never know who’s going to show up.”

  The following Tuesday, Lochton was scheduled to lecture at group supervision in the psychotherapy clinic. I was the first resident to arrive and caught him combing his hair while holding a small hand mirror. I didn’t know why he bothered because his hair was so stiff with Brylcreem that it never moved.

  I couldn’t resist and said, “You’re looking very sharp this morning, Dr. Lochton.”

  “Gary, you can never look too professional for your patients. It shows respect.”

  As I noticed his shiny black dress shoes, I pulled at my khakis in a feeble attempt to mask the scruffy hiking boots that I wore in the snow. I was thankful that I had at least remembered to wear a tie that day.

  A few other residents filed in and took seats in the conference room. Lochton checked his watch and began.

  “Today I want to talk about the perfect patient for psychotherapy; we call it the YAVIS. The term stands for young, attractive, verbal, insightful, and wealthy—the s standing for the dollar sign of course.” He picked up a piece of chalk and drew a large $ on the board. As he continued on about his ideal patient, I kept thinking he was living in a dream world, because we residents almost never saw a YAVIS. We were used to treating the sociopathic, drug-addicted dropouts who frequented our clinic. Rich, intelligent people solved their problems with experienced private practitioners, not first-year psychiatry residents at bargain-basement prices.

  At the end of his lecture, Lochton instructed us to look through the file cabinets lining the walls of the clinic. They contained brief evaluations of patients seeking psychotherapy in the resident clinic. He told us to find a teaching case so we could get started doing real therapy. As soon as he finished, we all raced from the room, practically trampling over one another to get to the file cabinets, knowing how ridiculous it was because we had all been rummaging through those files for weeks looking for a decent case.

  Searching the files was futile anyway because the typical folder contained only a patient’s basics—age, marital status, and reason for referral. It seldom had enough information to tell us if we had stumbled upon a YAVIS or not. In fact, if it really was a YAVIS, the evaluating resident would have snagged the patient for himself. The real way to find good psychotherapy patients was through personal referrals or word of mouth, not unlike landing an awesome apartment or being set up on a great blind date.

  Despite all that, I still routinely thumbed through those tired files, and after a few weeks, I thought I had found my first YAVIS. Sherry Williams was a housewife in her early thirties who lived in the suburbs. She was a college graduate and had never been arrested or hospitalized in a psych ward. She came to the clinic complaining of chronic anxiety. I knew Lochton would approve. I called her and arranged our first appointment.

  The first-year psychiatry residents had to use whatever offices were available in the clinic for the day. I scored an office with a little window, although part of the view was obstructed by a file cabinet. There was a small desk that I kept bashing my knee on and a chair and sofa for patients. It had the bare necessities of a psychotherapy practice, including a telephone with intercom and a box of tissues.

  At our first mee
ting, Sherry Williams entered my office dressed like a teenage girl, wearing tight jeans, sneakers, and braided hair. She sat on the sofa cross-legged, looked up at me, and waited. Clearly, it was my move.

  I broke the ice by asking about her drive in from the suburbs. It seemed to relax her and start her talking. “You know those Boston drivers; they think traffic laws are optional.”

  Not sure what to say next, I ventured, “So tell me about yourself, Sherry.”

  “Well, I’m married to my college sweetheart”—she flashed her big diamond ring—“who’s still gorgeous. We have a brand-new fabulous house with a step-down living room and an incredible deck.” She went silent again, waiting for me to say something. Okay, I thought, now what would a real therapist ask?

  “So what brings you to the clinic today?”

  She stared at me for a moment and finally said, “I just can’t stop feeling nervous, Doctor.”

  At the word Doctor, I almost giggled. I felt like such a phony.

  Thankfully she went on. “The feeling gets worse when my husband travels, and he travels a lot for work since he got his promotion to regional manager. I feel lonely in that big house—it’s boring. Sometimes I get so edgy that I can’t even handle the housework. The laundry piles up, and nothing gets done.”

  It sounded like her anxiety was so overwhelming that it might be paralyzing her at home. My instincts told me not to discuss her mental paralysis at our first session. Instead, I tried to be supportive and get her to talk more about her feelings. “The anxiety must be very difficult for you,” I said in my most empathic voice.

  “It is, Dr. Small. It really is.” She uncrossed her legs and sat in what seemed to be a slightly seductive pose on the sofa. “I just worry about everything…my husband’s job, the mortgage payments—which is stupid, because I don’t even know what our mortgage is. Eddie takes care of all the bills.” She sighed and looked at the file cabinet in front of the little window.