Dr. Michaels: Thank you for coming tonight and giving me this opportunity to speak to you about the Northern Mental Health Center. We are an important part of your community, but not enough people know about us. Because of all the shame and stigma that accompanies "mental health," we don't have testimonials or pictures on milk cartons. In a way it's too bad we have to maintain a kind of secrecy about our work, because secrecy, I'm afraid, plays into stereotyping. For instance, a lot of people believe in stereotypes about mental illness, such as (checking notes) That people with schizophrenia are dangerous. That people with depression (looking up) lack character and seek pity. That parents whose children are out of control are themselves to blame. That depression is inevitable when we get old. That -- (checking notes) -- that mental illness, emotional disturbance --No,no, I skipped one. It's --

(Silence, as Dr. Michaels turns the note paper over, searching for maybe ten full seconds of silence and then one of the seated actors speak.)

Jerome: I have all these boxes. I don't know how many. A lot of boxes. A lot of very important boxes because in them are these projects for my future In the boxes, I mean.

(Dr. Michaels looks back at the speaker)

Jerome: The room is getting completely overwhelming it's so crowded with the boxes.

Dr. Michaels: (to Jerome) Just a minute, Jerome, all right?

Jerome: All right.

Dr. M (he turns back to the audience, having found the note he wanted) As I was saying, it's a conventional misconception that mental illness, emotional disturbance, problems in living...whatever you want to call it, happens in a vacuum and has nothing to do with trauma, deprivation, discrimination, or the society and culture in which we live.

Jerome: We got to do something about the boxes. I've got to move, you know.

Dr. M: Well, you certainly know Jerome how much I support you doing something about the boxes. I thought we'd even decided what you should do.

Jerome: I've made some progress.

Dr. M: Good

Jerome: You're just saying that. Don't say something like that if you don't mean it.

Dr. M: I do mean it

Jerome: I don't think you do.

Dr.M: No, no.

Jerome: I know I drive you to distraction.

Dr.M: You don't drive me to distraction.

Jerome: Yes I do. I drive everyone to distraction. I drive myself to distraction.

Dr.M: Well, that's a little different matter, isn't it. I can only speak for myself. As for you...I mean, what do you do, how do you drive yourself to distraction.

J: Why are you asking?

Dr.M: I thought you wanted to say something about it.

Jerome: Well, I don't.

Dr.M: You don't.

Jerome: No. But I do drive myself to distraction. Just take my word for it.

Dr.M: All right. For the moment. (turning back out) Jerome is thirty years old, and lives with his mother and step-father; and though possessed of an above-average intelligence, he's only marginally employed. He's been a patient of mine off and on for about eight years. Anyway..(glancing back at Jerome, then turns out again) as I was saying or was about to say, our organization, in one form or another, has operated in this general area since the 1950's. Not long ago, several previously independent agencies merged in an effort to become more efficient financially. It's worked to some extent, but out administrative costs keep skyrocketing chiefly because of the difficulty we face in collecting anything from our patients' insurance companies. Some years we break even, others we don't, but we never have enough money to do the preventative work we'd really like to do. Preventative. Imagine that.

Jane: Whenever I think of him, I get this terrible headache. I mean, not with every thought of him, but it feels like it. It feels hard and dangerous to think of him and so I don't want to do it, but of course I do want to think about him. Because he was my son, and I knew he was in trouble off and on, but he was twenty-four, you know. I mean, a grown up and he'd been a troublemaker, but nothing serious. He had a few arrests but only as a juvenile and all for little things. Minor things, and he'd been in reform school when he was fifteen. Sometimes he didn't live with me, even, but stayed with friends. But at this point, on this night, he was living with me. But I had no idea what was really going on. I still don't. I mean, it didn't seem like big trouble but then one night he came home late and it was about midnight. Just a little past midnight and I got out of bed when I heard him and went out in my pajamas, because I was already in bed. I had to get up to go to work at six in the morning and I asked him...he was reading a motorcycle magazine, sitting on the couch with a beer and a magazine and reading some article. I could see the photographs of the engine part of this big black motorcycle, and I asked him if he needed anything and he said, "no." He seemed his regular self, as far as I could tell, but I stood looking at him for a few seconds, watching him turn the page, and then he looked up at me and he...he looked right at me and he said...

Jimmy: I'm fine, Mom. You go back to bed. You look tired.

Jane: Okay.

Jimmy: 'night, Mom.

Jane: Goodnight, Jimmy.( pause) So I went back to bed and he got up at some point and went into his bedroom and shot himself in the head while I was sleeping. In the room right next door.

Jimmy:I was fine, as far as I knew. I was drunk, a little, and you know some shit had happened. But when doesn't it. There's always shit of one kind of another. I don't think I was thinking about anything special or unusual, but just going to bed until I saw the shotgun in the corner. It stopped me in my tracks is the way I would put it. It was like it spoke almost, called out from the corner, "Hey, I'm over here; don't forget about me."

Jane: I learned later that he'd been drinking quite a bit, and that at the local hangout earlier in the evening he'd run into his ex-wife, Susie, and that when he went up to her and tried to talk Susie had gone out of her way to be really snotty to him. That's what I was told, anyway. That's the report I got. "Susie was really snotty to him." And I heard, also, that he'd run into his father who was in some other bar and drunk. So Jimmy had left the bar that had his snooty ex-wife in it and had gone to a different bar in the hopes of...I don't know what...fun at least, or a rest at least, and who does he run into there but his idiot father who was totally stupefied. I say "stupefied" because an eyewitness to their encounter told me that Marty, my ex-goddamn-husband was so drunk he didn't even recognize Jimmy at first. He didn't even understand that this nice young man who had come up to him and was talking Ð it was his own son, who had come up to say hello. And then when it was pointed out to him who Jimmy was do you know what his father did? He asked him for some money. So as far as bars were concerned that was two for two in the bad luck department for Jimmy. I guess he came home not long after that. But I didn't know any of this stuff that had happened at the time. When he looked up and told me he was fine and said "goodnight" and I went to bed, none of any of that was known to me

Jimmy: So I'm undressing; the beer empty, the gun in the corner talking. But I'm going to get some sleep, and dream maybe about the motorcycle engine I'd been reading about. The thing about a motorcycle — which I love to ride them — is the speed and the wind in your face and the way it just blows your thoughts right out of your head, the noise of it in your ears, or even magnified bigger and bigger by the ear holes in the helmet if you're wearing a helmet, and it's like this wind going into your brain and through your brain just taking your thoughts out and carrying them away. I only got about halfway undressed and I was sitting on the bed and I was tired, and the shotgun was there. My idiot father Ð what a joke, and I was trying to laugh, the way his eyes had looked at me, these big blank circles that couldn't quite get a fix on me, or were focused like I was some very far away distant object, and he didn't know what I was, exactly , let alone who. I was like some vague TV face he'd seen on some show somewhere. Then this fat guy cam up and ridiculed my idiot dad about how he didn't even know his own son. '"What?" he says. So the guy slobbers all over us both telling us one more time, who we are and good ole idiot dad comes around to face me and you can see the channel changer somewhere in behind his eyes go click-click and like now I'm maybe in color and he says, "gimmee twenty dollars, Jimmy" I give him ten. And Susie, when I think about her, when I come up to her, she's gotta be nasty. What for? She's gotta be a sly little bitch to me. For what? What's it going to get her? Can anybody tell me? I don't get it. Why do people have to be that way? Anyways, I'm in the room. My shotgun's there. My big ole twelve gauge. It's talking. I'm not talking. Nobody else is talking. I'd picked it up a hundred times. I picked it up again. By then I knew, of course, or had some idea — because I'd written the note — I put the barrel to my head...that wasn't hard...seemed sort of ordinary, totally ordinary, I mean, it didn't hurt or anything and I pointed it right here to that spot in between your eyes. Like if there's some third eye like people joke about, then that's my target. I'm thinking, if I've picked this damn thing up once, I've picked it up a thousand times. It was little or nothing, picking it up. I'd picked it up lots of times and shot things all my life. So I picked it up one more time and shot myself.

Jane: The suicide note which he left was really more of a half-baked last will and testament...I mean, more than a note. What it consisted of was instructions about what should happen to a few of his things. I read it and then I read it again and I kept reading it over, looking for some little touch of feeling, of love or unhappiness or regret. Or maybe a reason. But it was just this list. There was nothing more there no matter how often I read it except these instructions about things. He wanted his brother to have his motorcycle and he had this collection of baseball cards he wanted to give to a neighbor kid. And he wanted his brother to have the shotgun. The very Remmington shotgun he used. What was he thinking? I put my foot down. I threw it in the lake. At a point where I knew it was deep. I can't imagine what Jimmy was thinking to want to do that. I mean, Dr. Michaels, I would have sat up all night with him if I had the slightest idea. I would have done anything. But I didn't know anything was needed. I was irritated, too. Tired of his troubles, tired of his coming and going any time of the day or night. Tired of his not getting his life in order but just aimless, being aimless and troubled while I held down two jobs. So I went to bed. I just went to bed. While he went into his room and...the room is just this blank thing when I think of it. I can't see him in it. And I'm just a wall away. The width of a wall and wall paper. These little birch trees. But I don't understand why. Why didn't he say something? I'm asking, because if I knew a little bit more about any of it, some of it, I think I could live with it better. Not accept it. But live with it. You must have some idea why. Tell me if you have any idea. Any idea at all would be better than what I have now. (Dr. Michaels has listened closely to this, moving up to where the mother and son have been seated. Now he turns out)

Dr.M: "Why?" she wants to know. She wants me to tell her "why". Not that I could ever really know Ð I mean, exactly know. But I don't even want to tell her what I think. I mean, my educated guess about the answer. I don't want to tell her because it feels pointless and cruel. But in my opinion, she and her son were victims of chance as much as anything else. A lottery of sorts. Chance. A little bad luck. Because I think if you take any sample of impulsive, alcoholic youth, whose lives are going nowhere, if you get them drunk, expose them to rejection, frustrate them, rub their nose in a little humiliation, then leave them alone in a room with a gun, guess what? Some of them will shoot themselves. Which ones take their lives on any given night is just the law of averages. Jane, Jimmy's mother, was my patient for a number of months. It was the suicide that brought her to me. I never met Jimmy. Like most survivors of suicide she blamed herself, and was depressed, her headaches in some way a mimicking of her son's injury, I think. The bullet to the brain. A psychosomatic symptom, a sharing, an ongoing intimacy. Anti depressant medications didn't help. All I could do was listen while she grieved. Eventually her headaches became less frequent and she began to have a little more energy to put into her life. (pause) We have a program set up exclusively for suicidal teens, and every year we get 60 to 70 referrals from the schools, about kids who have told a friend that they're thinking of killing themselves; or they've written an essay that makes a teacher worried; or the parents have become concerned enough to call or talk to the school counselor. Depression among children and teens is hard to recognize; sometimes it is the sad lonely misfit stereotype that we think of. But often it's a very popular, successful girl who's starving herself because she's obsessed with her weight; or it's a boy who's a chronic behavior problem. Are they depressed? They sure are; and they've been depressed, in all likelihood, for years, but no one recognized it, because the only way they found to ask for help was to get into trouble. And they still can't admit it or show it. Some among us drop everything to see these kids, to make sure they're safe and that their families are taking the situation seriously, or to get them to a hospital if we have to. Because in situations like this, it is of the utmost importance to...

Jerome: Dr. Michaels.(Dr. Michaelas stops and looks back) I was wondering...

Dr.M: (stopping, looking back) Oh. Yes, Jerome.

Jerome: I was waiting.

Dr.M: Well, I mean, Jerome, there's all these people and I have to...they've come and they're here to...

Jerome: I see.

Dr.M: You understand.

Jerome: So you're making me wait.

Dr.M: Well, yes. It seems that...I suppose that makes you feel a little...I don't know, I suppose you'd rather I made them wait.

Jerome: No, no, I'm not a rude person. I don't want to be rude.

Dr.M: It wouldn't be rude of you to...

Jerome: I just wanted you to know that I was waiting, but I don't care what you do.

Dr.M: You don't care.

Jerome: No. Why don't you just go ahead with what you were doing.

Dr.M: (checking his notes) You said something about progress. What was that? (moving back toward Jerome)

Jerome: Never mind.

Dr.M: No, no, what kind of progress. Just be a little more specific if you can.

Jerome: With the boxes of magazines with all the articles I plan to read some day but haven't had time yet, well, I organized them according to categories. One's a Current Events category and another is a Literary and there's Sports.

Dr.M: So are you ready to move into the apartment?

Jerome: Oh, no, not yet

Dr.M: Why not? I thought the primary obstacle was getting the boxes organized.

Jerome: I said I'd made progress, I didn't say I completed everything. Because there are all these other boxes, which are more or less untouched and more or less completely unorganized.

Mrs. Garland: What they are is a mess.

Dr.M: Hello, Mrs. Garland.

Mrs.G: I hope he's not telling you he's ready to move out.

Jerome: No. I'm telling him that I'm getting closer.

Dr.M: He's made some progress. A large number of the boxes which were unorganized are now organized

Jerome: But these others...all these others aren't yet.

Dr.M: He's organized some, but not others.

Mrs.G: And these are what category — the unorganized ones? Which are they?

Jerome: I don't know, Mom. I have no idea.

Mrs.G: Then how can you organize them by category? See, these are the kinds of plans he makes!

Jerome: That's what I'm saying, Mom. I have to go through them and identify them before I can even begin to categorize them and then organize them.

Mrs.G: And how long — if you have any idea — is it going to take before you manage to do that, which I'll call the first step, before you can begin the second step?

Jerome: Whata you care, Mom?

Mrs.G: Because I think you're stalling.

Jerome: Right. You wish. I can't wait to get out of the house and into the apartment.

Mrs.G: Stop picking at your skin like that. Keep that up for one more second and your arm is going to be bleeding right in front of us.

Jerome: I didn't even know I was doing it.

Mrs.G: Well, you are.

Jerome: It just happens.

Mrs.G: (to Dr. Michaels) can't you make him stop picking at his skin like that? Look at him picking at his skin. It's very unattractive.

Jerome:I don't mean anything by it.

Mrs.G:(to Dr. Michaels) look at him. He's just doing it to annoy me. He keeps threatening to move all the time. (back to Jerome) Why don't you just do it?

Jerome: Don't push me, all right.

Dr.M: I thought you were eager to move, Jerome. I was my impression...

Jerome: There are other categories of boxes to straighten out and then, believe me...

Mrs.G: What's in them?

Jerome: What?

Mrs.G: What's in them?

Jerome: Well, there's mainly things that I find particularly interesting, in as far as aI think they will come in handy.

Mrs.G: For what?

Jerome: Whata you mean?

Mrs.G: Handy for what? For what will these things you're filling your room with be handy.

Jerome: I don't even know what they are, half of them.

Mrs.G: Well, how in god's name are you ever going to organize them then?

Jerome: Oh, you don't understand anything.

Mrs.G: What they are, if you ask me, is the category of trash.

Dr.M: But Jerome...Jerome...listen to me.

Jerome: (to his mother) Well, sure, Mom, -- I mean, if they pertain to me that would be your opinion.

Dr.M: Jerome!

Jerome: What?

Dr.M: Just last week, you were...or I thought you were fully prepared and determined that the time had come. You'd decided to handle the boxes in stages. Move them in stages. You're not moving that far. It's only into the basement after all.

Jerome: It's not the basement.

Mrs.G: It's a basement apartment.

Jerome: And I hadn't in fact really fully decided. I'd almost decided.

Dr.M: I thought you had decided

Jerome: Not completely.

Mrs.G: He never decides anything completely.

Jerome: But I was right on the edge, right on the verge.

Mrs.G: So what stopped you?

Jerome: Jesus, mom, you had a car crash, didn't you?

Mrs.G: What's that got to do with it?

Jerome: She hit a tree.

Dr.M: You had a car crash, Mrs. Garland?

Mrs.G: There was black ice, but I didn't see it. That's the trouble with black ice.

Jerome: And then part of the tree that she hit — some of the big branches — one in particular of these big branches fell down on top of the roof of the car.

Mrs.G: Scared me to death.

Dr.M: And so...is that what you're saying, Jerome? Because your mother had an auto accident, you couldn't move even though you were ready.

Jerome: I had to help her.

Mrs.G: I was pretty banged up.

Dr.M: Of course. Of course you did. How are you feeling now, Mrs. Garland?

Mrs.G: All right.

Dr.M: Good

Mrs.G: I had to wear one of those collars which are for whiplash. I just took it off this morning.

Dr.M: I see. Well. Good.

Mrs.G: I'm feeling a lot better.

Dr.M: Good. So, Jerome, I'm trying to remember — how long is it now that this has been going on — that you've been trying to move into the basement? Do you recall?

Jerome: It's not the basement.

Mrs.G: You keep saying that. It's a basement apartment.

Jerome: It's a very nice apartment. It's just in the basement. But it's nice.

Dr.M: Of course. I'm sure it is. But it's only downstairs, after all. And you've been trying to move down two floors from where you're living for what seems like a long time.

Jerome: I don't know how long it's been.

Mrs.G: It hasn't been all that long, I don't think, has it, Jerome?

Jerome: It's been three years.

Mrs.G: That's not right. No, no, no.

Jerome: Yes it is. Almost. No actually it's over three years.

Dr.M: But something always stops you. Is that what happens?

Jerome: I guess.

Dr.M: Something gets in the way.

Jerome: What?

Dr.M: That's what I'm asking you, Jerome? Is that what happens? Does something always get in the way and stop you?

Jerome: Like what?

Mrs.G: The boxes get in the way. I'll tell you that. I reach the point where I'd like to pull my hair out to get him down there where I don't have to see him and his damn boxes.

Jerome: I can't just throw them out.

Mrs.G: Why can't you throw them out? There isn't one good reason in this whole wide world that I can think of.

Jerome: Because there are projects of value in them and I want a chance to finish them.

Mrs.G: You'll never finish them.

Jerome: That's what you think.

Mrs.G: Just like you'll never move.

Jerome: (to Dr. Michaels) I will, too, move. You tell her I will, Dr. Michaels. You tell her I will too move.

Dr.M: Unless, Jerome...unless something gets in the way.

Jerome: What?

Dr.M: I don't know.

(Jerome looks at Dr. Michaels, who contemplates them, then turns and faces out.)

Dr.M: Jerome lives in one of the more remote communities we serve. Sometimes I see him at our main office and other times I meet him halfway in a small private office we keep in an old storefront along route 44. altogether the center employs thirtyfive to forty counselors trained in psychiatry, psychology, social work, family therapy, substance abuse treatment, whatever it takes. In addition there's a support staff of almost fifty people. All of them dedicated and very well trained. the area we try to cover is large -- twenty-some towns. Our clients range from wealthy weekend homeowners to dairy farmers to mill workers, Yankees, blacks, Hispanics. There's a lot of poverty here, but most of it goes unnoticed. Judged on the basis of the percentage of households in poverty, we have three of the twenty poorest communities in the state. Looking around, there's a tendency to see only white churches and antique shops; you don't see the single mother living up a dirt road in the back woods with 2 little kids and a car that doesn't work anymore; or the guy who used to work in the ball bearing plant and make a nice living, who's now trying to stay afloat by working 3 part time jobs with no benefits. Something as simple and basic as transportation can be a real problem here. If you have 2 kids in school and a sick one at home, and you need to see your doctor or your drug abuse counselor or a specialist in a town fifty miles away, and your car has 150,000 miles and break down twice a month, you're in trouble, because it's hard to better yourself, when you have to put so much time and energy into scraping by that you have nothing left.

(Frannie sits up in the chair. She is a child played by a teenaged girl.)

Frannie: Hi. I'm Frannie and I'm six. One two three four five six. That's because I was born one two three four five six years ago Ð whatever years are. What are years? I know what ears are and beers and tears and whears are. Like when you say, "Whear's my rabbit?" If you can't find a rabbit. If you have a rabbit. Sometimes I have storms. Big big storms inside me. It's thunder and lightning inside me. And it's lots of rain and wind and black skies and no moon inside me. And they just go on and on and on. Sometimes. And sometimes after a while, when the storm is scarier than a big mean bear got me in his mouth, I just get a tooth pick, or a paper clip and I stick it into my arm. Or a nail if I can find one and I stick my skin open and I keep sticking and cutting and sometimes the blood coming out of me makes the storms go awayÉ

Foster Mother: I can't comfort her. I try but it's like she doesn't even see me or hear me. I have to fight her to make her stop.

Frannie: When the storm stops, I stop.

Foster Mother: It's exhausting. Really, I'm just Ð I'm at my wits end. I don't want to be, but if I'm honest, I am.

DM: (looking to Mrs. Ryder) She needs one of us.

Mrs. R: You go ahead.

DM: I hope you're not reconsidering your plans to adopt Frannie, Mrs. Meyer, but if you are --

Foster Mother: I think I have to. I mean, I don't want to, but these fits, these tantrums --

DM: They're frightening, I know.

Frannie: Anybody with a storm inside them would do the same thing and don't think they wouldn't. Because you would. Just try having a storm inside you.

Foster Mother: She's only six, but she seemsÉdangerous.

DM: Yes, well, the behavior is violent. And so Ð

Foster Mother: It's savage and it Ð

Frannie: It's what storms do.

DM: Do you have any idea what brings them on? I mean, is there a pattern to them of any kind?

Foster Mother: I don't know. What do you think?

DM: I was hoping the new medication might have more of an effect, but apparently --

Foster Mother: You know there are times when I think there's a kind of improvement I can count on, and then something happens and she's -- I'm just not -- ( she stops for a beat) It's the visits with her birth parents and she comes back crazy. You asked if there was a pattern and that's what it is. That's the pattern.

DM: I see.

Foster Mother: I feel bad thinking that, but I can't deny it because it is what's happening. She goes for a visit and comes back -- when she comes back, she's wild.

DM: I've been talking to Protective Services as you know, and --

Foster Mother: Half the time I can't follow what they're saying --

DM: No, no, this situation is not as simple as we all thought --

Foster Mother: The messages I get from Protective Services about Frannie's future are all so confusing -- I don't even know if it's possible -- from their point of view -- that I can adopt her.

DM: Given the fact that the state terminated parental rights on Frannie's older brother on these same kinds of ground -- I mean, on the basis of parental neglect, and evidence of sexual abuse -- I mean, this situation appeared to be an open and shut case, but in these matters, nothing --

Foster Mother: At least the visits should stop.

DM: Of course. You're right. I'll talk to them.

Foster Mother: They've got to get it done. I mean, I think if we had some stability -- I don't know what happens when she's over there with them -- I'm worried something awful happens. The other day -- at school -- she tried to get this other child involved in something -- it was sexual -- some kind of sexual game, and then she beat up another child, a different child. A little girl. Frannie needs -- I need -- we both need some kind of stability if this is going to have a prayer of ever working. You've got to find some way to get the visits to stop. They have to.

Frannie: Actually, between the day I was born and the day I was four years old, do you know what happened to me? Well, I'll tell you, because i was taken up out of my parent's house and I was put in a foster home and then taken up out of the foster home and brought back to my parent's and taken out from them again and put in a different foster home and brought back and taken out and brought and taken one two three four five six times. Six again. Three times going one way and three times the other way. And this is a true things I'm telling you, a real thing, not some silly cardboard cut-out gingerbread story with rhymes about witches and woods and bread crumbs, or trolls with secret names but my very very very real life. Not that I exactly remember it, because I don't. There's all these bouncy sort of pictures and big noises and spooky colors and the sky getting dark and darker and darker and black. Which I don't think anybody, least of all me, could say is a memeory which I am remembering. I'm not saying that. I'm not saying I remember it. Becuase I don't. But the storm does. The storm remembers. The storm remembers every little second.

(Both the Foster Mother and Dr. Michaels are looking at Frannie)

Foster Mother: I never know what she's thinking. Sometimes she's so bright and dear. She's incredibly intelligent.

DM: I'll push Protective Services to move on this -- at least on the matter of visitation.

Foster Mother: They're both drug addicts, the pair of them, both the mother and the father. It's common knowledge.

DM: They came for counseling, but then they stopped.

Foster Mother: Of course. I'm sure. What else could anybody expect? I mean, that's what they'd stop. The counseling. Not the drugs. It's obvious what they love.

Secretary: Bob, have you got a minute?

DM: (glancing over) Well, not really. ( then back to the foster Mom and Frannie) But the thing is, Sally, you've got to just hang in. Stay tough. Keep the faith.

Foster Mother: I know.

DM: I mean, Protective Services is pressing Frannie to decide where she wants to live -- with her birth mother or to stay with you, and once she does --

Foster Mother: That's so crazy that she has to decide. The poor little thing, how can she decide to leave her real mother and --

DM: It's not that she has to decide --

Foster Mother: It's eighteen months since the adoption process started and it's just dragging on and on. It's not a procress. Why do they call it a process? I don't know what it is. And now she has to decide. Why cna't they decide? We should decide.

DM: She just has to say what she wants.

Secretary: Bob, please, you really have to give me a minute. I don't need long.

DM: Why can't it wait?

S: Well, I'm sorry, I don't mean to interrupt, but the session is over. Your session has been over for ten minutes, Mrs. Meyers.

Foster Mother: Oh. I'm sorry.

DM: No, no. It's all right. But I'll see you next time. I'll be in touch.

(He moves away to the secretary)

S: I apologize, but I really think you need to be brought up to date on the cost/loss aspects of this case. I have it all right here. You know that Colossal Care Inc. is currently in the role of benefits manager for Frannie's case.

DM: Yes.

S: And I just want you to be aware of the before and after statistics, because before they assumed the role of Benefits manager, Frannie was seen by us 29 times over a ten month period and the agency was reimbursed thirty-five dollars and seventy-five cents per session which, at our cost of one hundred dollars per session, is a loss of sixty-four dollars per session. so that's a total of eighteen hundred and fifty-six dollars.

DM: That's before. What about after?

S: Right. Before. And after -- the story on after is that after CCI took over, Frannie was seen 40 times in a nine month period and the agency was reimbursed fifty-five dollars a session, but in that period there were also ten sessions that were not approved for payement. With our cost of --

DM: Why weren't they approved?

S: Well, I mean, there were various reasons, but it's hard to make sense out of them.

DM: Give me one. Let me -- No, no, I mean who's handling this with CCI. Are you?

S: Getting them on the phone is a full time job and then once I do manage to get them, a simple answer to a simple question does not seem to be covered by their guidelines.

DM: Get them on the phone for me. Could you do that?

S: I'll try. But to finish up. With a reimbursement of fifty-five dollars per session for thirty sessions and nothing for ten sessions and our hundred dollar cost per session, that's a loss of forty-five dollars for thirty session and a hundred for ten sessions for a negative total of two thousand three hundred and fifty.

DM: Get them on the phone.

S: Like I said, I'll try.

(She strides off, leaving Dr. Michaels, who starts scribbling some notes.)

Alex: When I was first thinking about possibly going to the center, I thought it might be best if I wore a disguise. I went so far as to actually create one and try it on, but in the mirror, I just looked like me with a fake mustache and unattractive clothes. So I thought, "I can't go like this. I can't even go out of the house looking like this" I changed back to what I like to wear, and sat in front of the television watching Jerry Springer and thinking, I won't go. Or if I do go, I won't tell them anything -- which made no sense -- so I thought, Well, at least I won't tell them I'm gay, which made no sense. What would I tell them? And then, watching Jerry Springer, I thought, "These people are crazy. They're much crazier than I am." So the next day i called to make an appointment and got one, and a couple days later, I drove over -- stopping and turning around a half dozen times, and then reversing it all again. I got there just in time and I had my first session, or initial whatever with Dr. Michaels, and it started out okay but after a while -- I don't know what it was -- but he made me uncomfortable. I wasn't sure that he liked me. Not that he could or should like me -- after all, I'd just walked in off the street and sat down and there I was, you know, talking about myself. I refused to entertain him -- I wasn't there to entertain him -- I wasn't going to even try -- but he looked bored, or suspicious, or unhappy, or something, and the next thing I knew, I just stopped talking and he didn't say anything for the longest time, and I got very tired, I got very very tired and just kind of this hopeless feeling came over me, and this really painful heaviness in my chest and stomach, and before I knew I was even going to speak, I said to him, in this little voice, this very soft little voice, "Could I maybe see a woman counsellor? Would that be possible or is it impossible?" His expression remained totally unchanged and indecipherable, but, after what in my experience anyways seemed maybe a week, or a week and a half, said, "Of course, Alex. Do you think you'd like that?" And I said, "Maybe". And he looked out the window, so I looked out the window, so we were both looking out the window when he said, "I think you and Mrs. Ryder might work out."

Mrs.Ryder: I found Alex to be an extremely appealing man, though very shy and withdrawn. He's an only child; both of his parents are deceased. They passed away in the same year -- the year he was a freshman in college. He'd lived at home until then, but after that, as soon as he could, he got a single room at school where he could live by himself and he continued to live that way through junior and senior year, -- alone -- as he has lived every since graduation. He identified himself as gay, though he said he'd had very little sexual experience. What he likes to do is to go to gay bars, where he sooner or later finds someone who becomes his imaginary lover. These affairs in Alex's mind last for months. He interprets every look and gesture made by his imaginary lover in the bar as a secret signal to him.

Alex: (to Mrs. Ryder) He's a little paunchy, and my guess is he's a weekender -- a kind of distinguished, executive type, but it was uncanny -- the wave length we shared -- the vibe. He would touch the glass -- he was drinking gin and tonic and then he would slide the glass along the bar -- ease it along the surface of the bar -- not able to look at me -- and when the glass had moved about a foot or maybe more -- maybe foot and a half to his right, he would bring it back and cradle it in both palms, raising it ever so slowly to his mouth to drink. And I thought, "Oh, god, so this is it, so this is what love is like, this is what it feels like not to be alone." Do you remember when I first came to you, Mrs. Ryder, how I was so lonely and I was so depressed, I couldn't talk about anything except the envy I felt for people who had someone in their lives. Anybody who had somebody to be close to. Well, all the boring sadness, that woebegone tedium is totally past tense, because I've had this wonderful man in my life for almost a month now, and after that first weekend, it's only gotten deeper and deeper, even though on the second weekend he was a little shy, but then on the third, when I would stare at him -- I mean, you know, not rudely, but discretely, covertly, he started to loosen his tie and tighten his tie, and loosen it, and then he turned finally, his finger still toying with the know and he looked at me. And his eyes were -- I couldn't stand it. I got up and walked away -- out the door, out to my car. That was just three days ago. I don't think I can stand waiting till next Saturday. I don't know how I'll survive until he's there again, because he will be, I know and something -- I don't know what, but -- something will happen. More will happen.

MR: Of course nothing more happened, except that sooner or later the whole sad little fantasy crashed -- the man didn't show up the next weekend where Alex was certain they had agreed to meet, or the man turned away, or lit his cigarette as a sign of his sudden weariness with Alex, sudden dislike. Or he raised his drink to a height that declared his absolute and final rejection.

Alex: I don't understand it. I don't understand why I did, or why he had to act that way. I was so careful, so thoughtful with him.

MR: It's difficult, I know.

A: It's unbearable, really. I'm feeling just awful, you know.

MF: I can see that, Alex.

Alex: I'm feeling just so crushed.

MF: Perhaps -- I'm wondering if we might consider prescribing some kind of medication to get you through this.

A: Like what? Valium?

MR: Acutally, I was thinking more along the lines of something else. Of Prozac.

A: Prozac? For me? For what>

MR: It might help you level out and --

A: I was thinking Valium, you know.

MR: I'm coming at this from another angle.

A: Hey. Whatever. Fine. Sure. The way I feel, I'll try anything. Prozac schmozac. Gimme the whole cornucopia.

DM: Sometimes it's like teaching a child how to ride a bicycle. You can explain how to steer and how the pedals work, but you can't explain balance and momentum. You have to hold the bicycle up while the child learns these things. A good psychotherapy is in essence a creation, a change in the patient's way of being, crafted by the pateint and the therapist ina mutual process. For many patients it may be their first creative effort since kindergarten. (checking notes) Let me see-- I've covered, what have I covered? (pause) We have numerous programs and among them two devoted to senior citizens in the community. I should mention that seniors who --

Foster Mother: Dr. Michaels, we have to come over.

DM: What? Now?

Foster Mother: We have to, Dr. Michaels, right now. Please. She's getting worse. I dont' know if I can take it. The other night, in the middle of the night, I don't know what woke me, but something did, or I just woke and thought to check on her and when I walked into her room, she was there and she was digging into her arm with a bent paper clip, it was bent open and she was stabbing her arm with it like with a pin. I stopped her and she was bleeding all over the sheets. And the next night I heard this crash and I ran into her room, and when I ran in she'd broken a lam and she was going to use the pieces to cut her arms.

DM: Frannie.

Frannie: What?

DM: What happened?

Frannie: Where?

DM: You must have been very upset?

Frannie: When?

DM: when you did those things to yourself -- when you broke that lamp and then started to --

Frannie: I didn't break it. It broke itself.

DM: What?

Foster Mother: She doesn't remember.

Frannie: I didn't do it.

Foster Mother: See. When I came into the room andI managed to calm her down, she said she didn't know what happened.

Frannie: I remember not breaking it is what I remember. It broke itself, I think.

DM: Why would it do that?

Frannie: I don't know. Ask it.

DM: Ask the lamp?

Frannie: Yes. See what it says.

DM: But it's a lamp. It can't talk, can it?

Frannie: Maybe.

DM: Maybe it can talk?

Frannie: Maybe.

DM: What would it say if it could talk?

Frannie: It would say maybe it broke itself and I was sleeping.

Foster Mother: And the other night, she threw a chair through the window.

Frannie: Did not.

Foster Mother: Well, it didn't jump.

Frannie: It could have.

Foster Mother: She doesn't remember. Ever since she told Protective Services that she wanted to stay with me and not go back to her birth mother, all this has started happening, and it's because she's still seeing her birth mother, or something. It's something like that.

DM: (rotation in his clip board) If I remember correctly, it's nine months since the court-appointed psychiatrist recommended that parental rights be terminated. Is that right? Has it been --

Foster Mother: Yes, it's been that long--

DM: I dont' understand why this is taking so long.

Foster Mother: Please don't ask me. I hope you're not asking me, Protective Services hasn't terminated the visitation rights and in this one area those awful people are determined to go by the letter of the law, and so she's still visiting, and I don't know what's happening to her there, but something is.

DM: When is her next session? Is it scheduled?

Foster Mother: I don't want to leave. I'm afraid to be alone with her.

DM: Well, I don't think Ð I mean, you understand that's not Ð

Foster Mother: I'm exaggerating. I know. Of course. It's just how I feel.

DM: Come in tomorrow. We'll make sure you get Ð

Secretary: Bob, I've got CCI on line six, can you take it. It's about this Ð it's about Frannie and what you were about to Ð

DM: (to foster Mom) Excuse me. I'll make certain you get in tomorrow. (into phone) Listen, this has to get straightened out. Although it's true that our net income per session from CCI is slightly higher than our previous situation, it has come at the cost of extremely time-consuming redundant paper work, telephone time on hold, telephone tag, requests for authorization, "lost in the mail" excuses, verbal authorizations that are given but not backed up in writing, along with authorizations for treatment that are rejected on the most petty grounds. So that the entire endeavor is beginning to seem Ð

CCI REP.: (with a phone) I'm sorry, but could you clarify what you mean by that.

DM: By what?

CCI: "Petty." You said Ð

DM: (on phone) Could I clarify it? The word you mean.

CCI: (on phone) I know what the word means, but I'd like you to clarify your precise use of it in regards to us.

DM: (on phone) I think I could do that.

CCI: (on phone) Well, I'm certain I would find that helpful, if it wouldn't be too much trouble.

DM: (on phone) No, no, not at all. By "petty" I mean, in as much as Ð to cite one example, we have a very troubled little girl who we are trying to help and she is in a foster home and if the foster Mother, who is dealing with a very difficult situation needs to come in for a conference after one of our counselors has had a session with the little girl, well, I those circumstances we have to wait until the next day to have that session, because your office won't allow two treatment sessions on the same day. And so the Mother, who is already at the center with us because she brought the child in, has to drive home and whatever the emergence Ð it has to wait until she drives all the way back the next day, because, as I said CCI won't allow two treatment sessions on the same day. Does that help you with what I mean by "petty"?

CCI: (on phone) Actually it doesn't, because our guidelines have very sounds reasons behind them. They're not arbitrary, or lacking a basis in statistical fact or experience. They may be inconvenient at times, but they are solidly grounded in our long term expertise in these matters. F: Mommy, gimme something, you got to gimme something.

Foster Mother: What?

Frannie: I want some dying. Where is it?

Foster Mother: Frannie, what?

Frannie: I want some dying. Where is it? I want some dying.

Foster Mother: I don't know what you mean.

Frannie: Where is my dying. I want some dying for me. Some deadness. Gimme some deadness.

Foster Mother: Frannie stop this. Just stop it.

Frannie: There's big knives in the kitchen go get one so I can give myself some dying. I want some dying and deadness and that's all. Where is it?

Foster Mother: (on a phone) Dr. Michaels, I don't think I can handle this.

DM (on phone) Is she with you now.

Foster Mother: (on phone) Of course she is; I can't let her out of my sight. It's out of control.

(They hang up the phones and he strides to her.)

Foster Mother: She hasn't slept for four days, and I hate to say this but she's urinating in her room and shitting too. In the corner of the room, she's both defecating and peeing and the bathroom is right outside the door. The first time I thought it was an accident, or you know, just something that wouldn't happen again. But it's almost constant now.

DM: And she's not sleeping, you said.

Foster Mother: It's been four days.

DM: What about the change in medication, would you say it's helped at all?

Foster Mother: I can't tell. I don't think so. This is the worst it's ever been.

DM: So it's four days that you've been wihtout sleep, too -- is that right?

Foster Mother: I just sleep sometimes, I just fall asleep whether I want to or not, but -- and it's only two weeks until the final hearing on terminating those lunatic's parental rights, but I don't think I can stand what's going on 'til then.

DM: You shouldn't have to. There's something we can do. Look, just get over here as fast as you can.

Foster Mother: I want to stand it, I want to, I just don't know if I can.

DM: There's a way to get help. I've spoken to Protective Services and if you agree, I would recommend and Protective Services supports this idea, we all feel that a period of psychiatric hospitalization for Frannie is appropriate. Would you agree to that?

Foster Mother: Yes. I think so. Yes.

Frannie: Do they know about storms there?

DM: What Frannie?

Frannie: In this hospital is it a storm hospital? Do they know about storms, because the storms will come with me.

Foster Mother: How much will it cost? I can't pay. DM: No, no. I'll speak to CCI. That's their responsibility. FM: How much will it cost? It would cost a lot right.

DM: That's not your concern. (rising, starting to move)

Frannie: Tell them I'm bringing lots and lots of storms.

DM: All right, Frannie. I will. (putting his phone to his ear)

Frannie: They better be ready.

CCI: (on a phone) No, no, no. We've given a thorough reassessment of all the reports on this little girl and it's our determination that psychiatric hospitalization is not medically necessary at this point.

DM: You read my most recent report.

CCI: Of course.

DM: And that's your determination?

CCI: That's our firm determination.

DM: Because I disagree totally. I disagree as forcefully as Ð

CCI: I think I said, it's our "firm" determination.

DM: I understand that but this child is suicidal. At six years old. And a hospital stay Ð

CCI: I told you, Dr. Michaels, I read the report.

DM: But with a hospital stay she could learn that when she can't control herself, there are safe places for her to go to. Her medications could be changed and stabilized in a "clean" environment where her reaction might be assessed more carefully. The foster mother would be able to see that there's help when things go out of control. And they could rest. Because they both need some rest.

CCI: Here's what we're recommending. We're recommending that you table the hospital idea and substitute an increase in the frequency of session.

DM: That's what your recommending when the child is in a state of Ð

CCI: Needing rest simply does not meet the criteria of Medical Necessity required for hospitalization.

DM: To how many? Increase the frequency of sessions to how many?

CCI: As many as you see fit.

DM: It would be at my discretion

CCI: Well, you're the on-site care-giver.

DM: Will you put that in writing?

CCI: What?

DM: What you just said. What you just told me.

CCI: And what was that?

DM: What was what?

CCI: What did I say?

DM: You're asking me to tell you what you said?

CCI: I'm asking, What do you think I said? What do you think I said?

DM: What you said, and what I want you to put into writing is that you are authorizing me to determine the frequency of sessions necessary in this case.

CCI: I don't understand.

DM: What? What don't you understand?

CCI: I can't possibly do what you're asking Ð give you 'carte blanche' on the frequency of sessions.

DM: So you're saying that's not what you said?

CCI: I would have to Ð there would have to be a complete reevaluation of the case before such a radical authorization could even be considered.

DM: I can all but guarantee you Ð I'm absolutely certain those were not the words you used a few minutes ago.

CCI: Probably not, because in those circumstances, As I understood them, what I was doing Ð or trying to do, is not what I'm doing now.

DM: What are you doing now?

CCI: What am I donÕt? Well, I'm Ð I mean, what I'm doing doesn't matter, because the guidelines on this question are detailed and unequivocal and as firm as possible.

DM: So you're not authorizing what I thought.

CCI: Not if you thought that.

DM: Then what are you authorizing?

CCI: Well, that you see the patient as often as you deem necessary, using your best judgment, and being as scrupulous as possible and responsible to all our interests, taking everything into consideration, and then just submit requests to us for reimbursement.

DM: Which you may or may not accept.

CCI: Right. It will depend on whether or not they qualify according to the guidelines.

DM: I see. Well, there's no need to put that in writing.

CCI: No, that's already in writing. Which is why we have the guidelines. To eliminate this kind of confusion.

DM: I see.

CCI: Good. Call us if you have any questions. (Dr. Michaels hangs up and turns out.)

DM: Our last authorization from CCI pre dates the time when Frannie's behavior escalated out of control. There has been no response to our continued resubmitting of our subsequent request, which means we may not be reimbursed for any sessions after that date. It seemed that it must have been obvious to anyone that a child in such a drastic state would require continued treatment until she found a permanent home. Instead, we were allowed four individual and two family sessions over the next two months. We expect not to be paid for the extra session we provided, while interestingly enough, it has come to my attention that, during that same year, the stockholders in CCI were so happy with the company's performance that they rewarded their C.E.O. with a Fifty Million Dollar one-time bonus. On our ledger, the upside is that the foster mother hung in and is still working towards adoption. We treat Frannie with medication, play therapy, and provide counseling for the foster mom.

Foster Mother: Frannie?

Frannie: Hmmmmmm?

Foster Mother: How do you feel?

Frannie: I don't know.

Foster Mother: Not even a little bit?

Frannie: My foot hurts.

Foster Mother: What happened to it?

Frannie: I don't know. (pause)

Foster Mother: Frannie, I'm wondering, you look so thoughtful.

Frannie: Uh uhhh.

Foster Mother: To me you do. Would you try and tell me just a little bit -- one little corner of what you're thinking right now.

Frannie: No. It's getting dark.

Foster Mother: What do you mean? The sun is bright.

Frannie: There's clouds.

Foster Mother: Are you teasing, honey? I don't see them. It's a beautiful day.

Frannie: They're over behind the trees. Because they're hiding behind the trees on the bottom side of the world. (gesturing off)

Foster Mother: (looking) I don't see them.

Frannie: I can't see them.

Foster Mother: (looking) Over there? I don't see them.

Frannie: It's too dark, Mom. It's too really dark.

Foster Mother: Am I your Mom, Frannie?

Frannie: Yes.

Foster Mother: Good. I'm glad you think so.

Frannie: Thunder's coming, Mom. It's gonna rain.

(DM pauses; checks his notes.)

DM: All of our programs, both those for children and those for adults have three things in common : we try to make them practical to make them accessible, and to make them preventive. No one comes to a place like ours to pass the time of day. People who come here have urgent, difficult problems that often have caused so much stress that our customer fears he's losing his mind. We don't want to hypothesize about fear of success with a man who's desperate because he's lost his job. We want to help him find a job. Not many people realize that our average client sees us for about eight sessions, then is on his own again. "Adult Out Patient Services" is a program available to all adults in our area regardless of their income, or insurance, or severity or problem. Unfortunately, ther's not state grant for this program. Connecticut restricts its mental health funding for adults to those with chronic mental illness. So if you're fired from your job and you get depressed as a result, and you slash your wrists and get taken to the hospital, the hospital will get paid for stitching you up; but if you decide as a result of that experience that you'd better get some outpatient care before you try it again, you're going to have to pay for that the best way you can. Suppose you had cancer and required regular chemotherapy, or kidney disease and required dialysis, or pulmonary disease and needed oxygen -- what would happen if there were an annual cap on benefits for these conditions? What would happen if there were a co-pay of 50 percent on these benefits? Something would happen, I'll tell you that, but we seem to take it for granted that there should be caps and co-pays on mental health services which is our way of reinforcing the message that the victims are to blame for their own disease.

Switchboard Operator: Hello. Northwest Health Center.

Teresa: Hello, is this the Northwest Health Center?

SO: Yes it is. This is the switchboard.

T: CAn I talk to someone there?

SO: This is the switchboard. Do you need a counselor? There's several peopl --

Teresa: I'd like to talk to someone right now. My husband won't get out of bed.

Switchboard Operator: Perhaps you'd like to make an appointment.

T: No, no. Do you make house calls? My husband won't get out of bed.

SO: What do you mean, he won't get out of bed.

T: Just that. Can I talk to someone?

SO: Do you mean, you're husband won't go to work , or he's not feeling well or Ð

T: No, no, he won't get out of bed and it's been weeks. (turning to her husband) Get up goddamnit. Right now. Get up.

Barnard: I see no reason to get up.

T: Please.

B: I just can't right now. All right.

T: how long do you think I can keep doing this and taking care of everything, Barnard. I'm going nuts. (into the phone) He says he can't get up right now.

SO: Is he depressed?

T: Of course he's depressed.

B: No, I'm not.

T: You are. Of course you are.

B: No. I feel empty.

T: He says he's not depressed, he feels empty.

SO: I'm sorry, what?

T: He feels empty.

B: I feel empty.

SO: I'm going to get someone Ð I'm going to see who's available to talk to you.

T: Do you make house calls?

SO: Hold on please, Mrs. Gilchrist. And your husband's name is?

Barnard: (In an intelligent but rambling monologue, Barnard starts with everyday problems of aging, continues to tell about several previous episodes of depression in his youth and in middle age) Barnard. Barnard. I was just Ð I was just Ð the dog had vomited on the basement stairs and I was going to have to clean it up. But I wanted to drink this morning drink I take of vitamins, because I'd been feeling a lot of fatigue, lately, and so I made my drink and I was drinking it, when I had to go to the bathroom and on my way back, I had the drink in my right hand and I was walking. I don't know what I was thinking about Ð I think Ð that it was my Ð when I Ð No, no. I don't remember. That's the truth, I don't remember. I don't really remember what I was thinking about, I want to, and I want to think I do, and claim I do, but I don't. I have no idea. But I had the drink in my hand and I was walking, when my other hand, my left hand -- the drink was in my right hand and my left hand came up for no reason I can remember and hit the drink. My left hand knocked the drink and almost knocked it out of my right hand. It had some purpose -- my left hand, I remember this vagure sense of purpose -- that it was going to do something, which was not to knock the drink, but something else and it was moving to do that, ostensibly. But what it did was bump the edge of the glass, tilt it almost out of my grasp so about half of what was in the glass spilled on our beautiful Persian rug. It was splattering on the rug the color of the drink which was yellowish. I looked at it and went into the kitchen to get some rags or something, sponges to wipe it up, and as I was in thekitchen, the phone rang and I answered, hoping it was -- I don't know who, but hoping something because I picked it up with this energy, this sense of expectation, and what it was a phone company trying to get my business back. We'd been with this phone company for a while, then recently switched to a different phone company that had called soliciting us, and now the company we had abandoned wanted us back. I told them, "No," we were happy with out new phone company, but this woman on the other end insisted on running her whole spiel by me, about everything they would "Give Me," and it made me sad to hear her because I knew she was a stranger and I knew she just wanted my money. She wanted her money, her salary, and to get that she had to try and get my money for her company so they would give her her money. Well, I sat there listening, because I knew she was just some poor desperate woman doing her desperate stupid job. I told her that I had to go a couple of times, but she didn't give up, so I sat there wishing I coul be rude, trying not to be rude, and then finally it was over. She said she'd sign me upa nd I said, "No. No, don't sign me up. I have to go." I remembered the dog vomit then and I was cleaning it up when I heard my wife scream about something awful, something hideous on the rug. Which was of course the spilled drink. I said it was just the spilled drink. "What spilled drink?" she wanted to know. It was a natural enough question but it seemed unnecessary. What did it matter, "What spilled drink?" Considering everything going on in the world, "What did it matter?" I didn't answer; couldn't answer really, my tongue was so thick and numb, like this hunk of meat stuck in my mouth and rotting there, and I couldn't move it. I went and knelt down on the Persian rug and looked at all the dead Persians depicted on horses and carrying big pieces of pottery. I cleaned the spilled drink up and she helped and it didn't take long, maybe a few minutes, and then she smiled and rushed out to the car to drive away to have coffee with a friend, and I watched her go, and then I went to bed.

Mrs. Ryder: And this was two weeks ago.

B: That's what she says.

MR: And this -- is this the first time any such thing has --

B: Like this?

MR: Yes. That it's happened.

B: Oh, no,no, no.

MR: I see.

B: When I was in my mid-twenties. It happened.

MR: I see.

B: I don't know what brought it on. i mean, there were the usual things, like this girl I though I loved, and she broke up with me. She had this uncle to whom she was devoted, and uncle who had in fact raised her and he got killed in an accident in this factory where he worked in steel -- he worked in steel, this foundry, and something awful happened to him. This machine that he worked with every day -- he made a mistake or someone else did, and it fell on him, or he got caught in it -- I can't remember actually, but he was crushed. Then she just withdrew from me. It didn't make any sense why what happened would cause her to withdraw from me, but she did, she withdrw and then she said she didn't want to see me anymore, not even to be friends, and I was sad for a long time. I was sad for a whole year at least and then it was maybe two more years when one day I thought of her and the machine and the way it had turned suddenly from an implement of labor to weapon, a killing thing crushing her uncle, and that was when I went to bed. I lay down to read one night and I was reading these books like I and Thou by Martin Buber and The Tao of Physics and The Dancing Wu Lu Masters and The Cloud of Unknowing and some pure pysics books, and Meister Echart, the Essential Sermons becuase I was looking for meaning, for a meaning to life beyond what was normally taken to be enough meaning,something else, something more, and I was hoping to find it, and I kept reading but I never did find it.

MR: You didn't.

B: No. Have you?

MR: Have I? Well, no, I guess. Not really.

B: Have you looked?

B: Well, I guess -- I guess I haven't.

B: That's probably smart.

DM: The estimates are that depression is the second most costly disease in America. Over $44 billion in 1995; second only to cancer, more costly than heart disease, diabetes,lung disease, arthritis and AIDS. Now if this is the case, you may be asking yourself, "So where's the big national foundation leading the battle against depression?" Well, people with the diseas are ashamed and stay hidden away, feeling miserable and blaming themselves. Another part of the problem is the way the word has been degraded. We got to Dunkin Donuts one morning and find them out of our favorite jelly-filled, and what we say is, "I'm so depressed without my jelly-filled donut." But that's not the depression I'm speaking of. "Depression" in a medical sense is not a feeling state, it's an illness, and if you get it, you're liable not to seek treatment because you feel that you are not worth the expense. Which reminds me..

(He looks one way and then the other until he sees Jerome, who sits dozing in his chair.

DM: Jerome.

Jerome: (startled) What?

DM: Come over here. I've been thinking about you.

Jerome: Why?

DM: Come over here.

Jerome: Why? (moving over grudgingly) What do you want? What do you mean you've been thinking about me? (stalling) What have you been thinking about me?

DM: Come over here. All the way. Come on.

Jerome: Why?

DM: Sometimes we therapists can't see the forest for the trees.

Jerome: What do you mean?

DM: When you came by the other day --

Jerome: Which day?

DM: You were concerned about some of your behavior which you defined as compulsive in nature, and it got me thinking. I should have thought of this sooner.

Jerome: What?

DM: Well, you feel your eating patterns are compulsive and the way you pick at your skin, you wish you could stop, you feel it turns people off.

Jerome: I think it does, don't you.

DM: Then why don't you stop?

Jerome: I dont' even know I'm doing it most of the time. By the time I notice and stop, I've already done it.

Dr. Michaels: What I ended up thinking was that we should try Prozac for you. You don't exhibit the more standard symptoms of depression such as sleeplessness -- and you are full of energy and so that misled me, I think, but on the other hand you have trouble concentrating -- you can't decide on a job, or if you do manage to decide, you change your mind.

Jerome: Well, Doc, a job is very important.

DM: I know that, but Ð

Jerome: I want it to be perfect.

DM: But it can't be perfect.

Jerome: Of course it can.

DM: No. I don't think so.

Jerome: But why take a job that's less than perfect? Why sell myself short? I'll hold out until one comes along.

DM: No, Jerome. It can't be perfect. How can it be? What would it's traits be? Tell me, Jerome, how would you recognize this perfection if you saw it.

Jerome: But I'm not depressed. I feel pretty good a lot of the time.

DM: I think that's largely the reason I didn't come to this understanding sooner.

Jerome: I'm very lively every now and then.

DM: And yet you haven't managed to move two flights down the stairs into the basement of the very house you live in where there's an apartment you want to move into. For three years you've been trying and failing because one thing or another stops you. Your mother, or the boxes. You never get them organized.

Jerome: But I'm a lot closer.

DM: But you're not finished. Or are you? Are you finished with the boxes and ready to move, Jerome?

Jerome: No.

DM: Prozac might give you the focus you need to advance in some of this. If we consider all this compulsive behavior as a mask, and depression as a diagnosis, we can see how you do on prozac. Would you do that, Jerome? Would you give prozac a try?

Jerome: Okay. Sure. I'll give it a try.

DM: Good. (writing) I'm certain the psychiatrist will agree. I'll speak to her about a prescription.

Jerome: Fine. Sure. I'll give it a try, but it's not gonna work. (heading off) See you, Dr. Michaels.

DM: Goodbye, Jerome.

Jerome: Bye.

DM: (after watching Jerome, he turns out) Well, all right. What about me? (he looks the audience over) I recently passed my 49th birthday. No big deal, except that for years I believed that Iw ouldn't live past my 42nd. The age my father took his own life. I was obsessed with the idea that whatever drove him over that dark edge, that that same thing, would catch up with me. It is hardly a unique idea among the children of suicides, I've learned. But when it's your condition, it really doesn't matter how many other's have had to endure it. After my father died what I felt, at least as far as I knew --"conciously". as we like to say in the trade -- what I felt was anger. I blamed him for being selfish, and considered it obvious that he never really cared about me. My mother and I had a hard time, because she remarried quickly -- far too quickly fo my tast, and I was thrust into a whole new family -- step-father and step-siblings I wanted nothing to do with. Rather than let myself feel rejected by this bunch, feeling already rejected by both my Father and Mother, I developed an icy armor. At school, I was a one man brain trust and so I dove into that arena. "Grades." I thought, "books, learning. Knowledge." I had terrific grades, terrific SAT's, was editor of the yearbook. I won a scholarship to a college a thousand miles from home. I told myself, "Here I go and I'm never looking back." but when I got here, I was unprepared for the fact that there were hordes of people as smart as I was. Suddenly, everything I'd accomplished in high school was overshadowed and I didn't stand out anymore, and without that idea of myself, I got scared. I learned to drink. My grades sank. I wasted four years of college and staggered on for a few more years feeling scared and depressed, and maintaining this self-image as a misunderstood genius who was going to write the great American novel, or accomplish something else earthshaking. But I didn't write or do anything constructive. My idea of myself as a misunderstood genius was a pathetic attempt not to need anyone. I started mixing alcohol and pills, the same sleeping pills my father had used. There were nights when I didn't care if I woke up the next morning. But thena friend -- and looking back, a very good friend, told me to get some therapy -- he even recommended a therapist and I took him up on it -- for whatever reason -- something tipped the scales. It turned out to be a husband-and-wife team, practicing some of the gimmicky Transactional Analysis type stuff so popular in the 70s. They passed me back and forth between them, and had me join a group they were running. It was pretty hokey, yet very helpful. It wasn't long before I was thinking of counseling as a career. I went to graduate school and did well, but I had a problem with stage fright; which made it almost impossible for me to speak up in class. When one of my professors asked why I was so quiet, I confided in her, and she suggested that I see a colleague of hers, a psychoanalytically trained psychiatrst. I jumped at the chance. By now I had learned enough to look down on the therapy that I had once thought so helpful, because it was viewed as not scientifically respectable. With a psychiatrist, I would be moving up the pecking order of treatment expertese. But then things went very wrong. Shortly after our first appointment, my new Doctor came down with a serious illness that laid him up for several months. When he came back, he seemed weak and frail. In his office on the 23rd floor, he sat between me and the window and as I looked at him and listened, I found myself swallowed up in huge and unrelenting anxiety attack. I felt that something was drawing me out the window. It was the worst feeling I can remember ever having, and from then on, it happened every session for the next three years. After my father, my deepest fear, unknown to me at the time, was that if I let myself depend on someone again, I could lose them and it would be my fault, because my deepest truth, my father's legacy was that I was unlovable. And there he was -- my new Doctor, my future -- the future I hoped to inhabit, and he was ill and frail and tentative. I couldn't feel safe or comforted in his presence. This was despite the fact that I liked and respected him. My life on the outside went along pretty well. But every week I would be sweating bullets in his office, convinced I was doomed. I was 35 and believed time was running out for me. I can't explain why it went on so long, why he let it and I endured it, but finally, I extricated myself by getting accepted as an analytic subject at the Chicago Institue for Psychoanalysis. When I met my analyst, I was startled and disappointed that he wasn't much older than I was, but he was pretty unstuffy for an analyst, had a quirky sense of humor. I stayed with him for five years, getting through my 38th birthday. Somewhere along the line I learned to understand and forgive my father a little. My mother once said that Dad saw himself as a burden on us; removing that burden was, in his mind, a gift to us. I'm still trying to digest this point of view, and it certainly helps me feel less anger toward him; but the terrible, implicit sadness in it is something I can only take in small, small doses.

(Alex walks up to Dr. Michaels)

Alex: Dr. Michaels, how are you?

DM: Fine. Hello, Alex. Good to see you.

A: Asking you to let me go to Mrs. Ryder -- do you remember when I did that?

DM: Oh, yes. Of course.

A: It was just one of the luckiest things I ever did. She's remarkable. Just so insightful and caring and I'm on this medication, which has been so good for me. I mean, there were these things in my life -- certain things I was pouring all my energy into and they were just silly day dreams really, taking all my time. I'm considering asking for more responsibility at work.

DM: That's wonderful.

A: I might even get into a program where I could get some advanced training. anyway, my session's in a few minutes and I want to -- I have to go to the bathroom.

DM: Well, you better do that.

A: Yes, I better.

DM: (As Alex goes off, Dr. Michaels turns out.) WE're busy. Most people don't realize how busy we are. In 1998, among our four offices we have been averaging 70 new cases every month; about three new cases every working day. (glancing at notes) Anyway, as I was saying about our Senior Programs -- Or I think I was -- did I start to explain some of the programs we have for the elderly, because it really is a large part of our --

Mrs. Ryder: (striding up) Bob, do you have a minute? It'll only take a minute.

DM: Alex was just looking for you.

Mrs. Ryder: (glancing at her watch) I have a minute or two before his session.

DM: You look troubled. What is it? He seemed fine.

Mrs. Ryder: No, no, Alex is doing fine, but Mathew Tarcher. I'm jus very concerned about Mathew. He's in my group on Tuesdays in Torrington. Have you had any dealing with him?

DM: Well, I know who he is, but I've never --

Mrs. Ryder: I don't want to sound the alarm bell or anything just yet. On the other hand I think I have to be extra alert.

DM: I'm sure you can handle it.

Mrs. Ryder: He's so delicate -- I mean, the things that imperil people, you know. He has this pet Hamster. And he's so attached to him.

DM: Otto, yes.

Mrs. Ryder: He adores the Hamster, and it's in fact the strongest most satisfying relationship Mathew has -- the way he talks -- in session, it's the one subject he really warms up with -- gets happy -- little anecdotes about the way the animal looks and acts, it's little traits, and habits.

DM: I've heard him.

Mrs. Ryder: Well, the Hamster has to go into surgery. Mathew is an nervous wreck, he's having nightmares and anxiety --

DM: What's wrong with him?

Mrs. Ryder: Well, that's what I'm saying -- he's anxious and frightened and --

DM: I mean, with the Hamster. Surgery for what?

Mrs. Ryder: It's in his stomach, the intestines, some kind of blockage, and I'm just afraid that if anything should go wrong -- becuase Mathew is so vulnerable right now, that if something happened to the hamster, it would be shattering.

DM: Can't the other members help?

Mrs. Ryder: They've been very supportive. They're calling him at home and reassuring him. The group is the best support he's got, but he's still so worried.

DM: I guess we'll just have to tell everyone to keep their fingers crossed for the hamster.

Mrs. Ryder: I guess.(as she walks away)

DM: Poor Otto.

(An actress stands and plays Sarah)

Sarah: I was so scared one day. I have two pre schoolers and my husband is never around, or he's drunk when he is and there's no money, and this one day the kids were screaming, the both of them, one had broke and old light bulb I'd taken out of this lamp to change, but forgot to throw away, and they broke it, and I was cleaning up when the other baby tipped over the garbage can, and it was just two days after I'd lost the part-time job I had at Subway because I couldn't be there when they wanted because my sister was sick of baby-sitting my kids so I could work and they were screaming and I thought I was going to kill one of them. I mean, really kill them -- that's what I was thinking of, like that woman in wherever with the car and she drowned them, just to get rid of them, and I started crying and I coulnd't stop, and somehow the thought came to me to call the Center and I did and I begged them to help and do you know what happened? One of them came to my door. They came right to the door and came in and sat with me like I was the baby.

Teresa: Hello, this is Barnard Glazier's wife, Teresa, I need to speak to Mrs. Ryder. Barnard is not doing well at all. He was doing better but now, he's not. He looks like a corpse. He's not dead. But he looks half-dead.

(An actor stands and plays Timothy)

Tim: I have a daughter who -- she's a freshman in college and she came home after her first year -- I'm divorced and it's over, I mean, the whole hostile, miserable mess -- things have almost found a kind of equilibrium -- and so when she came home, my daughter, I mean, -- my ex wife was in Europe with her new husband for the summer, and my daughter was not herself. She was moody -- which is hardly novel, but there was more to it -- she just had adespondency to her, a lethargy -- I mean, her regular operational mode was to snap, or fly off the handle, not mope and sleep and just -- I had to do something after a while and it was like dragging a dog by a leash to get her to go, but I managed to get her to go by the center and talk to somebody and what came out -- after a couple of weeks of talking to someone there, what came out was that she had been raped at school. At college. Date rape. And well, then they had to talk to me, too. Becuase I wanted to, you know, find the guy and kill the guys -- but anyway -- we went, the two of us, to sessions, and we're still going and she's doing a lot better. I can see she's getting ack to her old self, almost. She says she was feeling awful shame and self-blame.(pause) Shame and self-blame. Me, too.

Barnard: Mrs. Ryder, I feel it's passed. I really do. It was just an episode, a difficult, a grueling episode, but nothing more. I'm fine now.

(another actress stand and plays Darlene)

Darlene: I'm not going to try and slide the whole load or anything, because you know, the dorp off is too down. I'm twenty four, three kids already, and pregnant once more, I got this heartstopper of a man who I cannot get out of my blood just yet who is I admit it a known drug dealer. I know it, he knows it, the people at Protective Services know it. But he does not bring drugs into my apartment when he comes to see me. I will not allow it. The problem is that livin' around me in this housing complex is a whole bunch of nasty bitches, who are not better off than me, and they know it, but if you dare piss one of them off -- half the time you don't even know what you did, but what they will do to get you back is report you to Protective Service for abuse or neglect of your kids and how the hell are they going to straighten that one out. They aren't with you twenty four hours a day. They don't know you have pissed this nasty bitch off so she is lying about you. So that's what we got here, the bunch of us ratting each other out for no good reason except somebody crossed us when they shouldn't have. I've done it. It was just a couple days ago, I ratted out this evil bitch, Maggie and I don't really regret it, even if I know I should and I know she don't abuse her kids even though seh abuses everybody else in her sad life. But I have done it because I think she called them on me, when I do not abuse my kids; I take care of them, and provide for them as good as anybody around here.

Jerome: (on the phone) I love the apartment, Dr. Michaels, I'm very happy down here and I'm thinking I might enroll in a community college. I want to increase my value in the marketplace and schooling would do that. But I don't know if right now is the best most optimum time, because I want to get straight A's and I might not have the time and energy to get straight A's. Or else, why bother? I mean, so Ð maybe now isn't Ð maybe it isn't Ð (he stops)

DM: Jerome?

Jerome: I'm thinking.

DM: About what?

Jerome: I just heard myself, and the point of school isn't straight A's, but learning stuff. I mean, I'd like to get A's, I'd like to get straight A's and if I work hard, maybe I will, but I don't have to wait until I think everything is in order to almost guarantee those A's Ð because I'll never know when that is. How could I ever determine that? So I'll just go. I'll go. I'll take the classes; I'll study hard. Bye. (hang up and gone)

(Alex rises and walks to Mrs. Ryder)

A: Mrs. Ryder.

Mrs. Ryder: Oh, Alex yes. How are you?

A: Guess

Mrs. Ryder: You want me to guess how you are?

A: I'm sure you can tell.

Mrs. Ryder: I haven't heard from you for so long.

A: I know.

Mrs. Ryder: Do you want to make an appointement?

A: No, no. I just stopped by to tell you. three nights ago, this redhead on a motorcycle came wheeling up just as I was getting out of my car. I was going in the bar for a quick drink, maybe dinner, and as my foot hit the ground, there he was, the engine booming. I froze. I didnt' want to look at him, but I couldn't stop myself. And the way he removed the key, I knew he was flirting with me and thinking about me. It was shocking, the instant feelings he had for me. It was so strong, so harsh and irresistible. He propped the bike up and walked away, begging me to follow. Desperate for me to follow.

Mrs. Ryder: Was he from around here -- I mean, does he live around here?

A: What does that matter?

Mrs. Ryder: It doesn't. It doesn't matter. I just thought that when you talked, it might have come up as a --

A: We didn't talk. Our communication isn't restricted in that way, it isn't earthbound, it isn't gross and dreary and earthbound. I mean, I talk to you. I'm talking to you and what use is it? What value does it have?

Mrs. Ryder: Alex, how's your medication? Do you need another prescription?

A: No, I do not.

Mrs. Ryder: Well, if you do --

A: I'm done with that.

MR: You're not taking your medication?

A: It wasn't good for me. It was terrible and diminishing. It was mundane. It didn't feel like myself. I didn't feel like myself at all. This is me. This is me!

(Vanessa stands with a postcard and pencil)

Vanessa: Dear. Dr. Michaels. Guess where I'm standing as I write this postcard? Stretching out in front of me is the jungle as I am looking from the very top of a Mayan pyramid. Sure, my fellow tourists are everywhere, but I bet I'm the only one who couldn't leave their room three years ago -- whose back yard terrified them because it seemed so huge and empty space. The only ex Agoraphobic looking out over the reds and greens of the wild trees below. If there's any place on earth that ought to get me quaking it's the time and space that this place bears witness to. But here I am, feeling mainly thrilled. I can't thank you enough for the help you gave that got me here. Not that it wasn't a steep scary climb up these stairs, because it was. But I got up, and I'll get down. With the deepest gratitude. Vanessa.

(Mrs. Ryder approaches Dr. Michaels)

Mrs. Ryder: Bob.

Dr. Michaels: Yes, Helen.

Mrs. Ryder: Did you hear? The Hampster survived.

Dr. Michaels:: Really?

Dr. Michaels: Oh, that's wonderful news. Good for Otto.

Mrs. Ryder: The little thing came through with flying colors.

Dr. Michaels: (as she departs he turns out) When I first came to this area, a local gentleman took me up to the attic of his two hundred year old home. In the floorboards, making a circle around the chimney, was worn a path. It was an actual pathway rubbed into the oak floor by the feet of someone confined to the attic, someone with a mental illness, who was kept away from view, left with nothing to do but walk for days, months and years. When I think of the figure, that sad phantom Ð man or woman Ð I don't know which Ð- but a human being banished, pacing with their demons, fleeing, pursuing, alone, round and round the chimney as if in supplication of a totem. So driven, so repetitive as to chaff a trail into the planks of the floor Ð it seems almost holy to me, almost a shrine or memorial to what should not be. Too late for that poor ghost, too late for my father, we try to be in time for others. Remembering always that it could have been me up there had I lived back then. Or someone dear to me. Because it could be almost anyone, when the circumstances are wrong enough, the dark push unflinching enough. The straw that breaks the camel's back is just a straw. Anything can do it Ð since all that's required is a straw whose addition is diabolically timed Ð anything Ð the death of a hamster, the loss of an imaginary lover, or the loss of a real lover. An accident, the death of a dear one, the loss of a job Ð the range is limitless when everything else has been prepared in us secretly and against our will, without our knowledge, and beyond our rule. But hopefully, our misfortune won't be to end like that poor figure who once haunted that attic and now haunts my thoughts. Prowling and pacing. Round and round. Waiting for help.