My patient should not have gone blind. His glaucoma was treatable. When drops stopped working in one eye, a shunt was placed to relieve the pressure. When the shunt failed, the patient suspected sabotage; his ophthalmologist wanted him to go blind. It was a variant on the voodoo that had been cast on him for years and that had caused multiple hospitalizations since adolescence.
His monosyllables became lucid, animated monologues. We learned that he had read voraciously through his childhood and into the beginning of his psychiatric illness.
His ophthalmologist wished nothing but sight for him, of course. He was offered other ophthalmologists, other clinics. But he resisted. There would be no further shunts or any other eye treatment. His decision was absolute. He preferred to lose his vision; that much was under his control. Large doses of the many antipsychotic medications he had taken for years could not persuade him otherwise.
His medical guardian was horrified. We all were. His decision was based on delusion; the consequences would be irreversible. Surely treatment could be forced. Many conversations were held, many consultations were sought. In the end, though, no surgeon would bind him to a table against his will and operate.
We watched as he gradually lost the sight that was savable. It was like the opposite of time-lapse photography—in slow motion, his view disappeared. He still visited our mental health clinic once a month for his psychiatry appointment, listing along the hall, bumping into doors. The staff in his group home tried to teach him to master a collapsible cane and enrolled him in a day program for the blind. Budget cuts promptly closed the program, but he would not have stayed, anyway; he knew the place was full of rapists.
In the clinic, he had presented himself as a quiet, stunted man with no interests: no friends, no hobbies, no habits. Given his circumstances, this attitude was sensible. Anyone hounded by hallucinations would find it hard to maintain a lively interest in the outer world. He was monosyllabic in meetings, and we assumed his private life was as vacant as his public one.
But we were wrong. When he could no longer see outside of himself, he began looking inward. Caution is necessary here—the vision metaphor is cheap—but he seemed to be looking back toward himself.
After he went blind, for the first time we heard him talk, not about voodoo and witchcraft, but about books. His monosyllables became lucid, animated monologues. We learned that he had read voraciously through his childhood and into the beginning of his psychiatric illness. Books had raised him. Holding his collapsed cane, he sat in the office and recalled his literary life. He wanted us to know it.
His reading had been precocious and furious, political and full of feeling, biographical and muscular. It was a nutritious life. But the words he had consumed had been clothed in flame: Manchild in the Promised Land, The Autobiography of Malcolm X, Soul on Ice, The Fire Next Time, Native Son. He had chosen the books deliberately, as if he had known he would have no time for dainty, pretty, peace-loving words. He had read the books raw; their passion and rage for life reflected his own.
When schizophrenia had taken hold, he had closed the book on his books and become preoccupied with inner violences. Then, when he lost his vision, he seemed to reopen the books. Of course we offered him an entire library on tape, lessons in Braille, any possible window into a future. He pleasantly assured us that he might consider our suggestions. Months have passed, and he is still pleasantly considering.
All his life, no one had known it, but he had been on fire.
Elissa Ely ’88 is a psychiatrist at the Massachusetts Mental Health Center.