Turtles All the Way Down(20)

“How are you?” she asked as I sat down. The walls in Dr. Singh’s office were bare except for this one small picture of a fisherman standing on a beach with a net slung over his shoulder. It looked like stock photography, like the picture that came free with the frame. She didn’t even have any diplomas up on the wall.

“I feel like I might not be driving the bus of my consciousness,” I said.

“Not in control,” she said.

“I guess.”

Her legs were crossed, and her left foot was tapping the ground like it was trying to send a Morse code SOS. Dr. Karen Singh was in constant motion, like a badly drawn cartoon, but she had the single greatest resting poker face I’d ever seen. She never betrayed disgust or surprise. I remember when I told her that I sometimes imagine ripping my middle finger off and stomping on it, she said, “Because your pain has a locus there,” and I said, “Maybe,” and she shrugged and said, “That’s not uncommon.”

“Has there been an uptick in your rumination or intrusive thoughts?”

“I don’t know. They continue to intrude.”

“When did you put that Band-Aid on?”

“I don’t know,” I lied. She stared at me, unblinking. “After lunch.”

“And with your fear of C. diff?”

“I don’t know. Sometimes it happens.”

“Do you feel that you’re able to resist the—”

“No,” I said. “I mean, I’m still crazy, if that’s what you’re asking. There has been no change on the being crazy front.”

“I’ve noticed you use that word a lot, crazy. And you sound angry when you say it, almost like you’re calling yourself a name.”

“Well, everyone’s crazy these days, Dr. Singh. Adolescent sanity is so twentieth century.”

“It sounds to me like you’re being cruel to yourself.”

After a moment, I said, “How can you be anything to your self? I mean, if you can be something to your self, then your self isn’t, like, singular.”

“You’re deflecting.” I just stared at her. “You’re right that self isn’t simple, Aza. Maybe it’s not even singular. Self is a plurality, but pluralities can also be integrated, right? Think of a rainbow. It’s one arc of light, but also seven differently colored arcs of light.”

“Okay, well, I feel more like seven things than one thing.”

“Do you feel like your thought patterns are impeding your daily life?”

“Uh, yeah,” I said.

“Can you give me an example?”

“I don’t know, like, I’ll be at the cafeteria and I’ll start thinking about how, like, there are all these things living inside of me that eat my food for me, and how I sort of am them, in a way—like, I’m not a human person so much as this disgusting, teeming blob of bacteria, and there’s not really any getting myself clean, you know, because the dirtiness goes all the way through me. Like, I can’t find the deep down part of me that’s pure or unsullied or whatever, the part of me where my soul is supposed to be. Which means that I have maybe, like, no more of a soul than the bacteria do.”

“That’s not uncommon,” she said. Her catchphrase. Dr. Singh then asked if I was willing to try exposure response therapy again, which I’d done back when I first started seeing her. Basically I had to do stuff like touch my callused finger against a dirty surface and then not clean it or put a Band-Aid on. It had sort of worked for a while, but now all I could remember was how scared it had made me, and I couldn’t bear the thought of being that scared again, so I just shook my head no at the mention of it. “Are you taking your Lexapro?” she asked.

“Yeah,” I said. She just stared at me. “It freaks me out some to take it, so not every day.”

“Freaks you out?”

“I don’t know.” She kept watching me, her foot tapping. The air felt dead in the room. “If taking a pill makes you different, like, if it changes the way-down you . . . that’s just a screwed-up idea, you know? Who’s deciding what me means—me or the employees of the factory that makes Lexapro? It’s like I have this demon inside of me, and I want it gone, but the idea of removing it via pill is . . . I don’t know . . . weird. But a lot of days I get over that, because I do really hate the demon.”

“You often try to understand your experience through metaphor, Aza: It’s like a demon inside of you; you’ll call your consciousness a bus, or a prison cell, or a spiral, or a whirlpool, or a loop, or a—I think you once called it a scribbled circle, which I found interesting.”

“Yeah,” I said.

“One of the challenges with pain—physical or psychic—is that we can really only approach it through metaphor. It can’t be represented the way a table or a body can. In some ways, pain is the opposite of language.”

She turned to her computer, shook her mouse to wake it up, and then clicked an image on her desktop. “I want to share something Virginia Woolf wrote: ‘English, which can express the thoughts of Hamlet and the tragedy of Lear, has no words for the shiver and the headache. . . . The merest schoolgirl, when she falls in love, has Shakespeare or Keats to speak her mind for her; but let a sufferer try to describe a pain in his head to a doctor and language at once runs dry.’ And we’re such language-based creatures that to some extent we cannot know what we cannot name. And so we assume it isn’t real. We refer to it with catch-all terms, like crazy or chronic pain, terms that both ostracize and minimize. The term chronic pain captures nothing of the grinding, constant, ceaseless, inescapable hurt. And the term crazy arrives at us with none of the terror and worry you live with. Nor do either of those terms connote the courage people in such pains exemplify, which is why I’d ask you to frame your mental health around a word other than crazy.”