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Psychiatric Services, VOL. 52, No. 12

Columns | December 01, 2001

Personal Accounts: Us and Them

Larry Davidson, Ph.D.

Psychiatric Services 2001; doi: 10.1176/appi.ps.52.12.1579

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You just have to trust—that's all you have left, is trust," I said aloud to myself.

It has happened only on two occasions in my life. The first time was when I was in graduate school and was just learning how to drink. I had never had alcohol as a teenager or in college, because of what I considered at the time to be my "principles," which dictated that I not alter my natural state of consciousness artificially through chemical means, whether alcohol or other drugs, but only through more natural means such as yoga.

This changed in graduate school, when my peers made fun of my so-called principles and when I started to learn that life was more complicated than I had thought. Drinking beer with pizza in the dorm was scary enough at first; then I progressed to wine and eventually to hard liquor. But it is getting drunk for the first time—getting really drunk—that I remember so vividly now, and that I look to for some solace and comfort, for some reassurance that I will get through this too.

The evening started out with dinner at a friend's house. My best friend in graduate school and I were just beginning to date two women in our program who also were friends. They had invited us over for dinner and served wine. We finished two bottles over dinner, and from there went to a party where I continued to drink until the wee hours of the morning. I have no sense of how much I drank that night, and no memory of what happened at the party or afterward. And that's exactly the point. I woke up the following morning with a hell of a hangover—and no knowledge of how I had gotten back to my apartment, let alone into my bed. I didn't remember anything beyond arriving at the party.

I crept out of bed, went into the bathroom, and stared at myself in the mirror. I couldn't remember what had happened. When did I get home? How did I get home? Who had brought me? What had happened? And then the most worrisome, unanswerable question of all: What had I done? Whom had I talked to at the party? What had I said? How had I behaved when disinhibited by the alcohol? Who was I when I wasn't self-monitoring on a constant basis, when I wasn't living with at least the illusion of being rationally in control of my own behavior?

There was a block of time, several hours' worth, that was almost entirely unaccounted for; that terrified me. I stood at the bathroom mirror and stared at myself—just kept staring at myself, into my own eyes, trying to see who was there. I gave up after a while, and stepped back from the eye-to-eye scrutiny without having found any answers; pulling back from the mirror, I said aloud to myself, "You just have to trust—that's all you have left, is trust."

I've not had that much to drink since. And yet not long ago I found myself standing in front of the bathroom mirror again, staring into my own eyes, again looking for answers, but this time with my wife and children asleep nearby rather than my roommate. I hadn't blacked out the night before, and in fact hadn't had anything to drink at all. What brought on this new bout of self-scrutiny was my opening a pill bottle, taking out two Zoloft tablets, and washing them down with a glass of water. I caught myself in the mirror as my head snapped back into place from gulping back the pills. Then I remembered the "You just have to trust, that's all you have left."

I have been a mental health professional for almost 20 years, providing services to people with major mental illnesses, people who take medication for schizophrenia, bipolar disorder, and depression. I was in psychotherapy for nine years off and on during my training, with at least four different therapists. And in my work I have focused in particular on the fact that people with these disorders—mental patients, as they are commonly referred to—are still people like you and me, still "more fundamentally human than otherwise" (1)—despite the stigma and the stereotypes that perpetuate the dichotomy between "us" and "them" that permeates even the mental health field.

My career had been devoted to breaking down the barriers separating the "us's" and the "them's," reaffirming that people with mental illness were people first and foremost, with the same needs and desires as anyone else. I was proud that I had friends who were consumers, that I had socialized with people who had disabilities, that I took my children to the local consumer social club to sit on Santa's knee, and that my daughters had taken a hike in the woods to look for four-leaf clovers and squirrels with a young woman who had schizophrenia.

I had given a well-received talk just the week before to a large lay audience, in which I stressed that "they" were just folks like the rest of "us" who had illnesses like diabetes or hypertension—not "a schizophrenic" or "a borderline," as I had been taught in my clinical training, but people with illnesses who could take medications, get treatment and rehabilitation, and resume a normal life. And here I was, a week later, taking a psychiatric medication.

My hands shook as I opened the bottle for the first time. It was a watershed event—one of those times when you know as it is happening that things will not be the same afterward. In my life there always will be a before-Zoloft and an after-Zoloft era. There would be no turning back once I took the first pill. And take it I did, not with as great a sense of dread as I might have expected, but with a sense of adventure, nervousness, and even anticipation, as I did the first time I deboarded a plane in Europe. In this case, though, I was entering a foreign land that I should have known very well from my years of study and practice. It was as though I had been playing a computer game for years in which I had traveled in virtual space up and down Madison and Fifth Avenues in Manhattan without ever actually having been there, and all of a sudden I was plunked down in front of Macy's on Christmas Eve.

It was a real pharmacist who had silently handed me the pill bottle over the counter without her usual chipper "Do you have any questions?"—not the pharmacist in someone else's story who was being distorted by paranoia. It was real nausea in my gut for the first few days I was taking the pills, not someone else's "side effects." And it was going to be me who would have to struggle with the issues of disclosure and stigma and possible discrimination from my family, colleagues, coworkers, and employers, not the clients I had gently reassured by touting the virtues of the Americans With Disabilities Act.

All of that, though, as troublesome and worrisome as it was, was just so much hangover. It was unpleasant, but it would go away. What won't go away are the unanswerable questions. The impenetrable eyes, the need for trust. I have long known that I had taken a "leap of faith" (2) in believing that life and the world at large are good, are gifts to be appreciated. As much as having children had proved that, becoming a parent also had underscored the basic tenuousness of life, the need for faith in order to get out of bed in the morning, and even more to drop off a crying two-year-old at day care. It had made palpable to me the riskiness of the leap for all that I now had to lose should anything happen to my children. But only on these two occasions did I face the leap of faith I take each moment in believing in myself.

Schizophrenia, it has been hypothesized, involves a loss of self. The conventional question has been: How does the self get lost? Deleuze and Guattari, in their Anti-Oedipus series (3,4), turned the question around and asked instead: How could the rest of us come to believe in such a thing as a self? Where did that come from anyway? What makes us think we have one? I was and am right about the "them's"; they are "more fundamentally human than otherwise." What I was wrong about was the "us's"—or, more specifically, the me. I had that dead wrong. And what makes me think that I have it any more right now?

Dr. Davidson is associate professor of psychiatry at the Connecticut Mental Health Center, Yale University School of Medicine, 145 CMHC, 34 Park Street, New Haven, Connecticut 06519 (e-mail, larry.davidson@yale.edu).

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Larry Davidson; Personal Accounts: Us and Them. Psychiatric Services. 2001 Dec;52(12):1579-1580.

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