Wednesday, January 18, 2006



I apologise in advance for this post.

Just before lunchtime at SMACHEAD, and a gap in the patient roster. My twelve oclock patient hasn't turned up, and I've just seen one of the more alarming people I've seen at SMACHEAD.

I called Mr Jarusnich in from the crowed waiting room, where he sat surrounded by empty seats. Even by SMACHEAD standards he caught the eye. Tall, balding, hugely muscled, tattos on his arms and hands and throat and face, flags and shields and intricate banners, in what looked like the Cyrillic alphabet. He wore a long-sleeved shirt and trousers in the thirty nine degree weather, and when I called his name he rose from his chair and waddled into the surgery.

When I see clients for the first time I try to spend some time just chatting. He was keen to chat, unusually so, in fact, and I spent twenty minutes or so listening to his views on women, his health, the situation in Serbia, the medical profession, and issues relevant to bodybuilding.

Then I escorted him out, wished him well, and got on the phone to the psychiatrist.

Body Dysmorphic Disorder is something I'd read about, but hadn't really seen. Like a lot of mental illnesses, the people who almost fit into the classification vastly outnumber the people who do - I've met many more schizoid personalities than people with schizophrenia, I've seen plenty more people who skirt around the edges of clinical depression than people who are clinically depressed. And I've seen a fair few males with unusual ideas about themselves and their appearence, but I've never met anyone in as deep trouble as Mr Jarusnich.

Simply put, he has made his body into a fortress, and while it protects him from his (largely imaginary) enemies, it also cuts him off from any communication with anyone who could save him.

First, the fortress. The buzz-cut hair. The legs like towers, the thick walls of muscle, the pectorals like bulwarks, the arms like cannons, the incomprehensible heraldry and slogans - expressing sentiments popular in the Serbo-Croatian conflict of a decade ago, slogans, he said, that would get him killed were he to return to Serbia.

And the isolation. He is perhaps the most isolated man I have seen. He lives at home with his parents, but it is a relationship described by his (ex)-psychiatrist as one of 'hostile dependency' - when Mr Jarusnich spoke to me today, it was with some difficulty, because his father had kicked him in the jaw and broke it.

He has no friends. There was a close circle of friends at the gym which he previously attended, but he cannot see them any more. In fact he has spent the last three months "hiding" in his house lest they should see him - for reasons which we shall get to in a moment.

And women? A fine figure of a man such as himself, a figure of literally Herculean proportions? Is there nobody?

This is where the poison came out. Why would a woman want him? he asked. Look at him. Look at those arms - he's got nineteen inch upper arms*. What woman wants a man with nineteen inch upper arms?

I shrugged, in that "go on" kind of way.

Exactly, he continued. They all want the men with the twenty inch upper arms. Big men, real men, men they can be seen with. What woman in her right mind wants a man with little arms like this?

He hates his arms, they are so weak. If he could he'd cut them off. He can't bear anyone seeing him like this.

Like this? I said.

The shrunken chest. The skinny legs. The polio arms. His voice, as he describes his flaws, becomes almost venomous with loathing, and he scratches at his massively muscled forearm, as if to claw it away. No woman would want to be near this.

No women? I said.

No normal women he said. The girls who hang around the gym - the twelve out of ten girls. The real women, women you can be proud of, women who you won't be ashamed to be with.

I don't remember if I was able to say anything to that, but he continued on, gaining speed.

"And I deserve a twelve out of ten woman" he continued. "I've done the work, I've put in the hard yards. But I'm fucked now. It's all come apart, it's all breaking down. All the gear I took, the heavy weights - it's screwed me up. My back's fucked. My knees are rooted. I'm having to lose weight - my knees are gone, my back's gone, three discs - I'm one hundred and twenty kilos - only one hundred and twenty kilos - and I have to lose weight! I'm having to strip down sixteen kilos over the next eight weeks, get down to a hundred. But I want to do it the right way, get really vascular, really ripped, really freaky."

"How are your kidneys?" I said, envisaging a man who had lived on protein for the last ten years cutting back on water and going into acute renal failure.

He waved his hand dismissively. "I've done it before, no worries. But I'm having to go to another gym, which is hard - its expensive, and it's down near Mordor, good hour and a half drive. But I gotta go because what if someone I know sees me like this?"

I shook my head. He continued. "Thing is, it's everyone. All the guys from the gym a few years back. Fucked knees, fucked back. Cancer, heart attacks. Testicular cancer. Some guys, nuts like raisins. Me, I'm on vitamins, supplements: vitamin A 3 000 units a day..." and he counted off a list of eight tablets on his broad, meaty fingers.

The conversation - less a conversation than a lancing of a boil - went on like this for close on half an hour. The constant fluctuating: the lacerating of himself for his weakness, the resolving to train harder, stronger, longer, the detailing of how his efforts to get stronger had made him weak, the increasingly extreme compensations which furthered the cycle...

This is a man who all day twists and turns and peers and preens in front of a broken mirror.

Anyway, I spoke to the psych reg at Florey. He said that there was therapy that worked in people with this kind of disorder, cognitive behavioural therapy or CBT. He didn't know about CBT in people with co-morbid body dysmorphic disorder (once called Adonis syndrome, or male anorexia) and drug dependence, but he told me where to start looking. And I've got a list of suggestions for the next time I see him, phone numbers and counselling appointments and psychiatrists who speicalise in this sort of thing... and I suspect I know exactly how likely it is that he will be interested.

Maybe I could tell him that CBT is actually some kind of illegal supplement, and the psychiatrist is a supplier.

Sigh. When I was working in psych, I discovered a new psychiatric disorder. Designed to nestle somewhere between Major Depressive Disorder and Multiple Personality Disorder, the newly minted Multiple Disorder Disorder classification would cover all those people who had symptoms of more than five other mental illnesses.

People who were depressed, anxious, schizoid, manipulative, dependent, passive-aggressive... all those words I used to throw around with such confidence, calm in my knowledge that they referred to other sick people, not healthy folks like us.

People whose Global Assessment of Function (aka GAF, the psychiatric measure of how well they were able to function in their daily life, coarsely referred to amongst medical students as the Global Asessment of Fuckedness) meant that they would not be amongst life's "doers", only amongst the "done to".

Well, this guy fitted the criteria.


Major disgusting alert follows. I mean it. If you are delicate of stomach, or posessed of even the most rudimentary spinal reflexes, look away now.

And as if the Little Big Man was not weird enough, guess who is on the list for next week? The Vampire of Morbing Vyle**. He is being seen here for issues relating to unsafe injecting practices. This man, without a word of a lie, is here because he injects himself with other people's blood. I am not making this up. And it's not as if it is carefully cross-matched blood either, it's anyone who he can find who will consent to this. He came to us in crisis because the alleged donor had reneged on the agreement to regularly provide him with "sustenance", and he was undergoing withdrawal.

Christ knows what I can do about this, except refrain from eating garlic before I see him. Probably needs referral to haematologist specialising in folkloric creatures.

That probably comes a third on the roster of disturbing bodily fluid things I have seen in the last four years. As stated earlier, look away now...

It does not quite measure up to the woman with both psychiatric and respiratory complaints who kept all her phlegm in labelled jars, preserved in vinegar ("Does it look normal?" she asked me, as I stood in her otherwise normal looking house, pictures of border collies and paintings from the kids on the walls. "I mean, the look of it?" "I don't know" I said. "I've never seen phlegm in vinegar before.").

And neither does it come close to the extremely devout man, who took his Old Testament injunction against the spilling of seed upon the ground*** very seriously, and kept it, again labelled, in an orderly series of jam jars stored about the house.

Sorry for that. A trouble shared is a trouble doubled, or whatever it is they say.
My apologies for this probably unpostable post.


*In circumference, I should point out.

** Last seen way back in May 2005, true believer! Look, continuity, just like a seventies superhero comic.

Having said that, I don't know if it's the same vampire. Maybe it's a different one. Maybe this is just the beginning of a whole coterie of vampires who will be booking in to see me throughout my professional life. This place is starting to look like Transylvania.

*** Genesis 38, I believe. Apparently Dorothy Parker had a canary she called Onan, and when asked why, replied that he spilt his seed upon the ground.


Blogger Champurrado said...


How strange and otherworldly your view of life must be. All the same, I appreciate you exposing us to the experiences without filters. Why can't I look away?

12:51 AM  
Blogger Chade said...

And BJ wonders why I love reading this blog. Crazy.

8:54 AM  
Blogger Foilwoman said...

Tell that little guy I would never get together with a guy with 20" arms. 22" or nothing, that's what I say.

My god, delusions . . . where do people start with these things? Obviously he felt weak, wanted to make himself stronger, and will never be strong enough. Maybe he should start blogging.

3:55 AM  

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