Re-entry

I am trying to come up with a theory about night times here. Night-times here are weird.

“What, in the psychiatric ward?” you say.

But it’s true.

In the small hours of the morning a man strides along the corridors, purposive, possibly fixated, an empty watering can in hand, as he has done almost every hour of the last three days. A slump-shouldered girl and a red-head young man play pool, him almost unbelievably poorly: he is, he says apologetically, normally quite good, but the lithium makes him miss-hit. An elderly woman moves nervously along the corridor, smiles apologetically at me, but flinches if I smile back.

Last night there was someone sobbing, or someone singing – you know those sounds at the periphery of your hearing, like when you can see something but you can’t quite work out what it is – singing or sobbing just before dawn.

Like they said in Spinal Tap – Well, I'm sure I'd be more upset right now if I wasn't so heavily sedated.

There seem to be two separate populations of people, or two aspects of the same person, a nocturnal and a diurnal, like the crescent and the gibbous moon. In the daytime people here are relatively gregarious, but solitude is a nocturnal creature. The grey-headed woman with the walking frame who shuffles along so slowly at three in the morning, I am sure she is not the same woman as the one who sat chatting over her Earl Grey tea with her relatives this afternoon.

Anyway, the theory. It’s not coming that easily, and only part of that can be blamed on the olanzapine (wouldn’t have been my first choice, but, hey, I’m not getting paid to make the decisions). Last night, just meandering, I wondered if the theory would have something to do with phobons. That’s phobons, like photons and phonons, but different.

Photons, as you know, are the smallest possible lumps of light. Light doesn’t come in any smaller sizes than a photon – you break up a photon and what you’ve got left isn’t light anymore. Phonons, from what I understand, are analogous quanta of sound – when sound travels in a crystal lattice, phonons are the smallest possible chunks of sound.

(As an aside, light is made of photons. Pretty much everything else can be divided into tachyons and tardyons. Tachyons – and I cannot remember if they have actually made the leap from science fiction to science fact – travel faster than the speed of light in a vacuum, they have mindbending properties like negative mass and getting younger as time passes. Tardyons is everything else – we are made of tardyons).

Phobons – and I’m making this up as I go along – phobons, like photons and phonons, would be fundamental particles… but of fear. I’ve got this vague idea of the walls of psychiatric hospitals being saturated with phobons, all those anxious, depressed, miserable people giving off phobons year after year. And then, at night time, the lights go off and you get a phobovoltaic effect, so that stored phobons are emitted… and that’s what makes night in psych hospitals so weird.

Okay, it’s a crap theory. But that doesn’t mean it can’t be used in medicine. Crap theories have a long and distinguished pedigree in medicine. There is a strong tendency in medicine to substitute “what we understand” for “what works”, to do things that accord with what our theory says should be the case rather than things that accord with our (or, Heaven forbid, our patient’s) experience.

The problem with this is the patient’s experience is often a bloody great chunk of what makes the patient believe s/he is sick. You end up with those dialogues where the patient says “I’m still sick” and the doctor says “Well, you shouldn’t be.”

The patient gets frustrated and the doctor gets angry because the patients aren’t getting better like the theory says they should – and if the fault does not rest with the theory (which may be literally unthinkable), then it must rest with either the doctor (very unpalatable), or the patient (unfortunate, but seemingly unavoidable).

This kind of theory based thinking is what kept us bloodletting, prescribing purgatives and carminatives that made sick people vomit and poo until they were transparent, doling out medicinal arsenic and mercury… and today keeps us “curing” homosexuality and “preventing” AIDS without using condoms.

What I am trying (for some reason) to say is fundamentally medicine shouldn’t be a science, it should be a technology. How does lithium work in bipolar disorder? God knows, but if you wait for a perfect theoretical understanding before taking the tablets, you’ll be no better off than those inhabitants of asylums in the eighteenth century who were taken out on boats and exposed to the moonlight – because the theory said it should make them better.

Hence the name "lunatics", by the by.

Anyway. Off to tell the night staff my new phobon theory. I’m a bit nervous, so I’ll keep the phobons out by just putting on this tin-foil hat – there, fits perfectly.

That should get the night time dose of olanzapine back into double figures. I’ll be looking like a sperm whale come Christmas.

Thanks for listening,
John