TRANSCRIPTION OF OCTOBER 25, 2012 THERAPY SESSION BETWEEN PATIENT MICHAEL MANSFORD AND DOCTOR JOHN LINDGATE. SESSION BEGINNING AT 1:30 PM, EASTERN STANDARD TIME.
Lindgate: Welcome back, Michael.
Michael: Doc. How are you?
L: Actually, that’s something I need to talk to you about.
M: Oh, will I be getting paid this time?
L: Very funny. Maybe I’ll just cancel the fee on that book you’re never going to bring back.
M: Oh. Shit. Yeah, I guess that’s fair. So what’s on your mind, Doc?
L: I’m afraid this is going to be our last session. I’m taking a sort of early retirement.
M: Really? You’re what, 50? How’d you swing that one?
L: Pretty easily. Didn’t even have to plan for it, in fact. (Pause) The whole story includes me getting diagnosed with pancreatic cancer last Friday.
(Nearly a minute of silence)
M: Shit. (Pause) I’m so sorry.
L: Thank you.
M: Is it serious? I mean, cancer, people have cancer all the time. They’ve got chemo down to a in-out, hour-long procedure, right? You can beat this.
L: Maybe. But it’s stage four, and it’s in my pancreas. So it’s not a simple skin-cancer removal, or the ‘in-out,’ get some radiation and come back next month type of cancer.
M: You think you’re gonna die?
L: They gave me five to seven months.
M: God, do they really say it like that? ‘We’re giving you five months?’
L: Not so straightforward, but it was like that, yes.
M: ‘We’re giving you five months.’ And you, rich ol’ therapist and all can’t even pay them for an extra month. Can’t slip them a tip and ask for an even half-year. Can’t do anything. You just sit there and say ‘Thank you ever so much for those five months.’ Shit, Doc. That’s rough.
L: If it makes you feel any better, I believe I swore instead of thanking the doctors.
M: That does help. Thank you.
L: You’re very welcome. Well then, first on today’s agenda is settling on a new therapist for you.
M: Or we could keep talking about your problems. How’s your wife, Deborah is it? How’s Deborah taking the news?
L: Sharon, and you can ask her on your own time. Have you heard of Dr. Patrick Morrow? His office is in Brooklyn, so it’s a bit of a trip, but I think he could be a really good fit for you. He’s written some interesting articles on depression. Impressive theorist. I read some of his work while researching for my book.
L: ‘Eh?’ What is ‘eh?’
M: It’s ‘eh.’ It’s not the sound of thrill.
L: What’s wrong with him?
M: Eh. Probably nothing. He’s probably a perfectly nice guy.
L: You don’t sound sold.
M: I don’t know. I’ve been thinking, maybe it’s time I ‘graduate’ therapy or whatever. Maybe your ‘retirement’ is a sign my time on the couch is over, you know? The universe is telling me to move on.
L: You can’t just quit, Michael.
M: Why not? God, I mean, talking about all this shit every three days isn’t making me a better member of society. Talking about my feelings isn’t improving my impact on the U.S. economy. What’s the point?
L: ‘The point’ is therapy was part of your agreement. Your parents signed you out of Steadbrook on the condition you attend therapy twice a week. You know this.
M: Steadbrook. What a bullshit name. I thought there’d at least be a brook at the place. Even a fountain would’ve been nice.
L: Well at least you’re not there anymore, right?
L: You don’t have to settle on Dr. Morrow right now. What about the therapist you saw before going to Steadbrook, Dr. Roy? Did you like him?
M: He was (Pause) nice.
L: Yes? Would you want to do your therapy with him again?
L: May I ask why not?
M: I couldn’t get anywhere with him.
L: What do you mean? This was before the first suicide attempt, correct? Do you think Dr. Roy didn’t do enough to help you feel like life was worth living?
M: I didn’t say that.
L: He just couldn’t help you get better?
M: You wanna know why I couldn’t get better? It wasn’t Dr. Roy’s fault, exactly. He just had this finger growing off his thumb. Like another tiny thumb stuck right on the knuckle. I can’t believe he hasn’t cut it off already. He’s a fucking doctor, he could afford it. God, it was just hanging there, unable to move unless it got flicked around by another finger, or he hits it on the table or something.
L: And his finger kept you from talking about your depression?
M: Kinda, yeah. I spent the entire session trying not to stare at this weird little finger. I was trying to look at the guy in the eyes instead of staring at his hands, but then if I stared in his eyes too long, I felt like he was gonna know I was consciously trying not to look at his hands. Plus, the whole time I’m looking this guy in the eyes, I’m still thinking about the stupid little finger. It’s like when someone tells you not to think about zebras, zebras are the only fucking thing you can think about for the next ten minutes. And while I’m trying to distract myself from staring at his finger, the guy’s still asking me questions, and fucking folding his hands so the thumb is front and center. Of course I can’t hear any of his questions because I have to concentrate, so I had to keep asking him to repeat himself after, like, every sentence, and the poor guy just had to know I was distracted and had to think it was because of his finger.
L: I’ll cross Dr. Roy off the list.
M: I mean, why hasn’t this guy gotten that finger removed yet? It’s not like it’s fused to his spine and he’ll die if the doctor screws up. The guy’s married, too. God, you think he strokes his wife’s hair with that finger?
L: Ready to move on?
M: Yeah. I’ve been storing that shit up for years. Thanks.
L: That’s what I’m here for. There’s another therapist you might like, Dr. Roan Tiesen.
M: Isn’t that the guy that soap star did an ad for? Sandie Rose?
L: I believe so. He’s very good.
M: Not if he can’t convince Sandie Rose her name is stupid. Next.
L: I have down Dr. Lindsay Sanders. She’s young, just out of school, maybe a year or two older than you.
M: Aw, Doc, you know that would never work. I’d fall in love with her, unless she’s a total drag to look at, in which case, chances are she’d fall in love with me. You should know I have a very strong effect on women. Especially the ugly ones.
L: How noble of you to look out for her. Listen, Michael, are you going to consider any of my suggestions?
M: Honest? Probably not.
M: I don’t need therapy.
L: Your family thinks otherwise.
M: My family doesn’t even know me. You know me better than they do—do you think I need this?
L: You’ve had episodes of depression since the age of 12. Attempted suicide twice in a threemonth period. Been hospitalized for almost a year. I’d say you’re a good candidate for it.
M: But do you think I need this?
L: I like to think you’ve made some progress in our sessions.
M: You’d like to think so, or you know I have?
L: Plead the fifth.
M: Exactly. I’m sure therapy is great for adults with repressed emotions or daddy-issues or people who can’t seem to figure out what’s going on inside their own heads unless they say every thought out loud. But I’m not those people. I’m the chronically depressed.
L: My specialty.
M: Your best friends. You wrote a book on us so you think you know us like characters in some novel you created. Like you’re my author, inside my head, free to change the clothes I’m wearing from a red t-shirt to a grey hoodie as my personality shifts throughout the story.
L: My book is based on research and case studies. It’s not a piece of fiction.
M: What’s the difference?
L: Between fiction and nonfiction?
M: You’re watching these people, then guessing what’s going on inside their heads. Sounds made-up to me.
L: Except I’ve conducted studies. Scientific findings.
M: Yeah? What am I thinking about right now?
M: (Breathy laugh). You can research the hell out of me, videotape me for a week straight, dissect my stool samples and study my earwax, but you’ll never really know what it’s like to be depressed.
L: I know.
M: That’s what I like about you, Doc. You know.
L: What do you mean?
M: A lot of therapists out there bullshit patients like me and make their money by selling empathy. They’ll say shit like ‘we all feel depressed at times, it’s natural.’ They think I’m some 14-year-old girl on the rag, letting my feelings get out of control. They talk about depression like it’s a hole you can climb out of, like it’s a place you can get away from. Buy a ticket and take the bus out of Depressionville. I swear to God, I had a therapist tell me once that my depression was like being in the deep end of a pool and if I wasn’t strong enough to pull myself out just using the wall, I could think of therapy as the stairs and handlebars along the side. I could get out whenever I was ready, he said.
L: I thought it was a good metaphor. I wish I’d used that during my grief-therapy sessions.
M: But not during your sessions with the depressed?
M: That’s where other therapists make their mistake. They treat depression like a stage of grief, not like—
L: Depression is one of the stages of grief.
M: Yeah. It’s a normal emotion most people get over in two to five weeks. But then there are those of us that don’t just get over it, mostly because there’s nothing to get over. We aren’t depressed about something. We’re simply depressed. No cause. No rhyme, no reason. They think of depression as an extended sadness, cause-and-effect. It’s not the effect of anything, except our fucked-up brains.
L: Your brain is not fucked-up, Michael.
M: God, I’m sorry. Here I am talking about stages of grief right in front of you. Sorry.
L: Not necessary. If it makes you feel any better, I believe I’m still in the anger stage.
M: Really? At who?
L: (Sighs) Doctors, I guess. In my mind I know it’s irrational, but they’re the only ones I can even irrationally project my anger onto.
M: The mind of a psychologist, folks.
L: Thank you, thank you. I’ll be here another five to seven months.
M: Oh God.
L: No, it’s just—I went in to urgent care for stomach pains last month. The doctor, he was just a kid really, barely felt my abdomen before telling me it was simply trouble with bowel movements. I keep thinking, if that boy had just taken a x-ray, would he have seen the tumor earlier? Would it have gotten to stage four? Would I still die this year?
M: Jesus. How did they find out.
L: You don’t want to hear about it.
M: No. Please.
L: I starting vomiting and couldn’t stop. My stomach was cramping because it was running out of anything to send up. My wife and I took three different cabs to the hospital because the drivers kept kicking us out. I had bags to catch the vomit and all, but the cabbies could only stand the retching so long.
M: Man. I’m so sorry. Well, you look good. Now. You must be feeling kinda better?
L: ‘Eh.’ I’ve only been drinking fluids since then, so there’s not much left to vomit.
L: But, fun as my story is, that’s not what you’re here for. So, Michael, no more avoiding this choosing a new therapist. I have to pass on your file, sign the releases, etcetera, etcetera.
M: Or, hear me out on this, we could just pretend this whole conversation never happened. Pretend you’re not retiring; pretend you’ve got irritable bowel instead of pancreatic cancer. We’ll let my parents think I’m coming to your office every Monday and Thursday, and in return, they’ll keep sending you those fat monthly checks.
M: I know, I know. It’s against your ethics. But think about this: Doctor-patient confidentiality. Yeah?
L: I don’t exactly know where you’re going with this, but I’m thinking no.
M: I mean, there is absolutely nothing I say aloud here in the sessions, delightful as they have been, Doc, that I don’t already know. I’m not discovering new things about myself. You aren’t telling me truths about the universes and the importance of life that are changing my perspective on the world. So what good is my coming here?
L: It’ll help pay my chemo bills, at the very least.
M: Exactly! So let’s keep sucking at that rich teat of the Mansford family fortune. You get money for the hospital bills and I get some peace and quiet to live out the rest of my days.
L: It’s tempting.
M: I see a small little Doc on your shoulder telling you to do it. And what’s that? Is that a halo over his tiny Doc head? Oh my god, it is!
L: You really think you’re doing that well on the Lexapro alone?
M: Those pills got me acting like a normal, functioning member of society. I’m working in a bank, for god’s sake.
L: I believe you, but the thing is, you still talk about your depression like it’s never left. Ideally, with the pills, you’d feel free from depressive symptoms.
M: Again, it’s something you’ll never understand, Doc. Not until you’ve been clinically depressed yourself.
L: Which, ideally, is the stage I’m hoping to be in next week, and if I stay on track, out of before Thanksgiving. I am pretty good at finding the ‘pool ladders,’ as you call them.
M: Very funny, Doc, but no. You’ll never really understand. It’s not a pool. Pills and therapy and weed and alcohol aren’t stairs getting you out of the dark place. You can’t get out, because the pool’s not your depression, it’s you. You’re every fucking drop of water filling that pool. You’re what the doctor wants you to get out of. It’s not like depression is a part of your mind. It’s your whole fucking psyche. It’s like, like, the depression mates with your mind, with who you used to be, gives birth to a new hybrid you, and you can never go back. You look in the mirror, you don’t see yourself in the reflection anymore. You try to remember what you used to think about, how you used to act around your friends, what you used to be like and you got nothing.
L: Like you got bitten by a vampire? Like you can never see your own reflection again? That’s a little dramatic.
M: Oh no. There’s still a thing in the mirror. It’s just a crusty old shell, a suit the depression has taken on. And all you think about now is trying to go back to the way things used to be. And the worst part is, nothing’s caused this but you. Your cat’s still alive, your girlfriend’s hot as ever and pleasing you nightly, you’re doing fine at work, at least at first. So when the therapist asks what ‘caused’ the depression, it’s just as bad as calling it a fucking pool.
L: You still feel this way?
M: Yeah, of course. Don’t get me wrong—the pills help. It’s no candle to light up the dark, but it is comforting. Like a little dose of weed for your morning. Wake and bake and go to work and laugh to yourself about the way no one notices there’s something off about you. The pills help me act like normal, even if the depression’s still there.
L: Its sounds like you’ve accepted this.
M: I’ve tried to.
L: Maybe you’re on the wrong medicine, though. Maybe you need a stronger dosage.
M: I’ve tried enough medicine, believe me. Prozac gave me shakes. Citalopram caused the worst headaches. Luvox gave me nosebleeds, like my brain was trying to escape through my nasal cavities. Paxil was what I was on those three months when I kept trying to kill myself. Four times, actually, although my chart only lists two. Zoloft made me puke constantly and Viibryd doesn’t come in a high enough dosage to help. I love my Lexapro, Doc. Only slight insomnia.
L: So you’re resigned to thinking this is as good as it’s ever going to get?
L: And you’re okay with that?
M: Well, yeah.
L: You’re okay with feeling like the pool? That you are your depression? And you’re satisfied with taking medicine that only hides some of your symptoms?
M: I mean, ideally, I’d love to be ‘depression free’ or whatever the fuck people say. Like, ‘I beat depression,’ or some shit like that. But it doesn’t work that way.
L: How do you know? Why are you so sure you can never beat it?
M: Because I’ve fucking tried. I’ve tried four fucking times and all it’s gotten me is admission to a psych home and some bullshit, albeit enjoyable, therapy sessions with you.
Part 2 Coming Soon