I got a letter from a Doctor Davey the other day, from
Doctor Davey is the only methadone prescriber for two hundred kilometers – he says the town is full of “surfers and travellers and lost children.” He sounded tense and a little worn down. He was asking what I knew about Anushka Sharapova.
I wasn’t able to tell him much. We hadn’t had her for long, only a couple of months. She’d come down from
But it hadn’t been her, and she'd gone, and there was very little I could tell him about her.
The reasons for this are complex. I had not admitted her to our programme, that had been Dr Grizzle, and before I saw Anushka I glanced at Dr Grizzle's write-up - a complete nutritional history, a few questions about body image, symptoms and signs of hyperthyroidism, a gentle but thorough discussion of licit and illicit amphetamines.
And I looked at the BMI, the starting point for discussions about issues of weight and size, and swore, and I went out into the waiting room and called her in.
Anushka was thin, frighteningly thin, the angular frame and stretched-parchment features you only normally see on an thyrotoxic, an ascetic or a cachectic, someone consumed from within by thyroid hormones or God or cancer. She sat, baggy-jumpered, flared jeans, on the chair opposite me and stared with large, dull eyes, and answered the questions about drug use history in a flat, soft voice, monotones, uncommittal, and the only time any kind of energy came into her voice and her face was when explained how she wanted to help people.
“Kids on drugs,” she said, speaking slowly. “I want to talk to them. Be a counselor or something.”
I had a vague idea, spoke almost on impulse. "Is that something you want to give your life to?" I asked.
She nodded, earnestly.
After she left - I had done pretty much the same as Dr Grizzle had done, asked the same questions, come up against the same thick stone walls - yes, she tried to gain weight, no, she didn't think she was overweight or fat, yes, she knew about bone density and tooth decay and constipation and headaches and death. She didn't want to see anyone else, she didn't think that she was depressed, she was a happy kind of person. And the food was just like for everyone else, there were no forbidden foods, no rituals, she ate pretty much everything, she loved eating and cooking food for other people.
I glanced up when she said the bit about "cooking food for other people", but that in itself is not a symptom of a mental illness, otherwise the backs of ambulances would be full of celebrity chefs. I remembered speaking to a woman with bulimia in Florey - she was hungry every hour of every day, always hungry. In the end I prescribed daily multivitamins along with her methadone and wrote her a short script so that she had to come and see me in a month.
I drove home with this vague disquiet, and strange thoughts breeding in my mind. There was a strong sense that I had done the wrong thing, that bad things were going to happen to Anushka soon, but I had no real idea - then or now - what else I could have done, how I could have made things better.
And most of all, I think I did so little because I had and have a profound sense that I had not understood Anushka Sharapova, that the chances were I had mistaken and misheard and maybe even mis-seen her, and that lack of comprehension was what paralysed me and Dr Grizzle and every other unexceptional doctor she had seen.
See, this is how my thought would go. Anushka was starving, I would think. What did she get out of starving, what did she get out of being starved? To be "successful" in suicide, one of my lecturers once said, one has to want to kill, to want to be killed and to want to be dead. It was rare for all three drives to intersect in the same person, when that happened, the person died. I used to think about that, walking the corridor down to the emergency department, rooms full of people who wanted to be dead or who wanted to be killed, but few who wanted to kill.
Anushka, I thought, wanted to starve, to punish, to deny. It's not far from that to want to kill.
And anyway - that whole "three things" thing - maybe it was just a slogan. You can argue that we are all suicides - Most people who die, die from self-inflicted wounds. We eat too much, we still smoke, we don't wear a condom, we go back to dangerous men. When you graduate from medical school, unless you are exceptional, your idea of medicine doesn’t deal well with this kind of slow, partial suicide, these kind of people, yet they are among our most common presentations. At best we see people who don't look after themselves as frustrating, at best, at worst, as morally compromised, taking up valuable resources that we could otherwise use to save people who really deserved it, really needed our help.
I don't know. Those who punish the body are not new to us. St Maria Maddalena de Pazzi lay naked on thorns. Saint Catherine of
It is of interest that as we fatten and age as a culture we focus more of our vision on the anorexic, the ascetic. S/he is a strange figure, someone who stands at the heart of our culture, someone whom we cannot face yet from whom we cannot look away. Like many of the other mental disorders, it is at least partially defined by income - Anushka and those like her must be cured, Gisele and Saint Catherine must be emulated.
I think realizing that I thought like that was why I felt considerable trepidation* in treating Anushka. I had no feeling at all that I saw "her", instead I knew I was seeing what I thought, superimposed on her, an idea that's stuck in my head. What next - prescribing sanctolytics or sanctoplegics, some prayer uptake inhibitors, a short course of diabolic steroids? When you see your own ideas, your own prejudices, your own beliefs and mystifications instead of the patient, you can't do anything for anyone. You don't see other people, obviously, you see something inside yourself, a category, a symbol, a cliché. You can't cure an eidolon, an idea.
But then what do you do?
I wonder if that was part of what was worrying Doctor Davey. I wonder, in fact, if that is part of what makes us struggle in the psych wards against the dying of these young, superficially placid and obedient women, part of what was behind the confusion, the frustration, the fear and opposition that those around Ss Catherine, St Therese di Lisieux and St Gemma Galgani felt.
Anyway, this hasn't come out right. I will try and write more coherently next time.
Thanks for listening,
John *Current leader, clumsiest phrase or sentence in a work of fiction.
*Current leader, clumsiest phrase or sentence in a work of fiction.