A Little Bit of Me

Jottings and Writing, miscellanous misgivings

A Little Mixed Up

He had always been different. I remembered him from primary school. A ‘weedy little chap’ was how I heard the teacher confiding to her trainee. ‘Problems at home’ and they nodded wisely, in unison and said no more. I thought his home life was fantastic. We would go there after school and with the innocence of youth I failed to recognise the peeling walls, the broken floors, the weed-choked lawns. His father was always there, sitting in an old chair in front of the empty fireplace and I never questioned why he was not at work like my Dad. Or why he was so old. Art was different in so much as he sucked his thumb, wet his pants, was always in trouble. But he also was a marvel at making things, at marbles, great at sports, and he was a fighter. No-one would pick a fight with Art because he would fight with a determination and with such endurance that you would literally have to kill him to win. Then his mother disappeared. She, who had provided us with so much amusement, just went from our after school games. Everyone said that she was a loony. At the time I was told that Arts mother had an ‘accident’, and that Art was going to live with his much older brother and his new wife. Art seemed happy enough with the arrangement. Years later the story unfolded in a form that I could understand. The family was dirt poor. But when you are young you don’t recognise these things. Arts father had not worked for years and they lived on a measly benefit that could not possibly provided for the family. To make matters worse, Arts father was a drunk and a gambler. What little money did come in disappeared down his throat or into the hand of Ray the barber who was also a bookie. Ray took money off all the watersiders and unfortunates who thought they could end their miserable existence with a win on the ponies. Arts father was also a wife and child beater, but that was only to emerge many years later when Arts tragic life was made semi-public.  Anyway to get back to Art and his story. The family had been struggling more than was usual for them. The beatings had multiplied and Arts mother had reached the end of her tether. There was no food to go on the table. Desperate, and at the end of her tether, she set the table and cut photographs of food from old magazines. After placing the photographs on the plates, she sat the children down and sobbed hysterically while they looked at her, wondering what they should do. She suddenly shrieked and rose up from the table and ran outside. They remained behind contemplating what it was that was bothering mother, and what to do with the photo’s in front of them. She, meanwhile, single-mindedly made her way down to the wharf and without hesitation, jumped in. No-one saw her go, and her body was only discovered later that evening when the father finally alerted the police to his wife’s failure to return and provide him with supper.

I lost touch with Art after we left primary school. He followed his brothers and started work on the wharves. I made my way up the academic and professional ladder and ended up, first, in medicine, and then psychiatry. And that is where Arts story was played out. I was at a case presentation at a conference and a psychiatrist from my old home town was making much of a unique diagnosis that he had attached to one of his long term patients. The more I heard, the more I knew it must be Art.

Art had not worked for long. He seemed to gravitate toward drugs and drink, much like his now long-dead father. He left the wharves and worked or roamed overseas for several years before ending back in our hometown, and with the older brother. The older brother recognised that there was something terribly wrong with Art when he tried to set himself on fire. He had poured a can of petrol over himself as he sat in the very same chair that his father had spent so much time in. He then calmly lit a cigarette and if it wasn’t for the brothers hasty intervention the burning to his face and body would have been much worse. His brother said that Art had become so depressed that he literally couldn’t move. He had been amazed that he had managed to purchase the petrol and make the effort to kill himself. Art was hospitalised for the first of many times. Once in hospital he made significant progress so that he was back out in the ‘world’ again within a month. Then started the familiar routine (to a psychiatrist) of acute admissions followed by lengthy stays and then discharge to a series of placements that rapidly got worse and worse. During his second long hospitalisation, at the age of 25, while he was taking antipsychotic medication, he made his first serious suicide attempt. He had obtained a pass to attend the wedding of a woman whom he had always wanted to date, and several days after the ceremony he took an overdose of Paracetemol and drank a quart of brandy. Art later told his therapist that he was neither depressed nor manic at that time and that he had been taking his medicine while in the hospital.

He made a reasonable recovery and his elder brother, now divorced and living with his defacto partner agreed to take Art in. The defacto partner turned out to be a mixed blessing. Although she was kind to Art, he developed an obsessive attraction to her. He was getting very little sleep, feeling “oppressed” by the intense heat, and started complaining that there was “no privacy” in his brother home. This apparently started after the defacto walked unexpectedly into his room and discovered him masturbating to a picture of her. This triggered a response from the brother to the effect that Art’s time in his house would be curtailed unless he ‘pulled himself together’. Art responded to this by walking into the kitchen and picking up a very sharp knife that the object of his affections had been using to cut tomatoes. He took the knife into the bathroom, and, in his words, “I looked into the mirror and prayed for God to forgive me.” He proceeded to inflict a number of wounds on himself, beginning with his right arm. He reported that the first cut severed his hand. A second slash, to his mid-forearm, was reportedly deep enough to leave the distal end of his arm hanging. A third cut to his upper right shoulder was more superficial. He made a fourth wound by stabbing himself in the bladder, then superficially lacerated his genitals and gouged his right leg. Art reported later that he did not recall feeling any pain while inflicting these wounds.

His brother only visited once in his subsequent hospitalisation, but during that visit Mr. A told him that all he wanted to do was go to sleep and never wake up. His brother looked down at him and replied, “But we were so kind to you and you go and repay us by your filthy behaviour”. Art lost his right arm and walked with a pronounced limp from that day. The medical staff had no explanation for the limp, as he had not damaged any organs that would cause this.

Art deteriorated further. He basically was now living on the streets. After a hospitalisation he would be discharged to a halfway house but he would abscond within a week and he became a feature about the city. He was often found sweeping the streets, directing neighbourhood traffic, attempting to organise a rock concert on the sidewalk, or donating his meagre belongings to passerbys. Often the police would be called out because Art was walking around nude and quoting scripture. It was during one of these episodes that Art made his second sacrifice to what he had started calling ‘His Saviour’. The tragedy for Art was that he performed this amputation in a very public place, so public, that the local authorities called for an investigation of psychiatric outpatient services in the city. Art had wandered down to the wharves, which were undergoing a transformation since the tourist industry had daily cruise ships from al around the globe calling in. Disgustingly wealthy patrons alighted from their berths in the morning and spent huge amounts of money looking around each port and then, returned to the ship and trundled to another port for the next day and a repeat of the same routine. I don’t doubt that there was some significance in choosing the wharf to carry out this deed but Art was so far gone that it could have been pure coincidence. He sat on the edge of the wharf and removed the shoe from his right leg. Before any of the onlooking elite of the planet could stop him he produced a small tomahawk from his coat pocket and with one amazingly anatomically aware blow severed his foot from his leg. He then slumped forward and pitched headlong into the oily waters between the ship and the dock. Unlike his mother he was fished out immediately, the bleeding stemmed, and again hospitalised. This hospitalisation was all the more dramatic as his face and deed appeared in the local press for the duration of the enquiry which, of course, concluded that this was an atypical incident and in no way representative of the excellent services provided by the local health authority.

After the furore died down Art was not much seen in public for a number of years. The presenting psychiatrist described a more sober and discrete lifestyle. Art would occasionally be seen being wheeled into the outpatient department of the psychiatric unit but his behaviour was under much better control.  The next time Art did come to the attention of the therapist was when he presented with profuse bleeding from an eye socket in May1997. He had seen an attractive woman in the street and felt guilty about his “lustful thoughts” about her. He had stuck a thumbtack in his right eyelid more than 50 times, completely annihilating the eyeball. When he was asked about this incident, Art replied, “The Bible says that if the eye offends you, then you must pluck it out.”

I approached my colleague after he had summed up the case as an example of predicting self-mutilative behaviour by a combination of behavioural sign and medication compliance. I enquired as to the whereabouts of Art.

“We are having fantastic success with this patient since the case notes I described concluded”, he replied, neither confirming or denying that his patient was Art. “Since his last self mutilation episode he has become very compliant. At the moment we are working through his request to be castrated.” I must have telegraphed my incredulity at this remark more obviously than I thought.

“I am completely comfortable with it. The patients wish for castration is authentic, long-standing, and nonpsychotic in nature. Although the request was thought to be unrelated to delusional beliefs, his overvalued ideas regarding the relationship between sexuality and spirituality seemed unusual, rigid, and intractable. No symptoms of a current, full psychiatric syndrome are present. In explaining his wishes, the patient referred to two scripture passages: ‘If your right hand offends you, cut it off” and “there be eunuchs, which have made themselves eunuchs for the Kingdom of Heaven’s sake. He that is able to receive it, let him receive it.’ The patient has shown mutulative behaviour in his past, but I consider this to be a genuine desire to move out of the trap that he has been in for most of his life. He wishes to become completely asexual and feels that castration will remove temptation from his life. If you recall from my talk, temptation has played a large part in his self mutilations.”

I asked if the doctor was actually going to go through with the castration.

“Oh no! We are working through the issues but it would be ethically and morally impossible for me to actually let the patient be castrated. “

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