Intensive Therapy Part 16

"What do you want to know?"

"I don't think about s.e.x like I used to. So with Jennie, it's not like when you and she were younger, right?"

"No, s.e.x is better. We're in a different place than years ago."

"I wish I had that," Victoria said. "Does she work outside the home?"

"My, you certainly are curious."

"You want to kid around, that's fine," Victoria snapped. "I can use some levity in my life. But no patronizing bulls.h.i.+t. Agreed?"

"I was trying to be lighthearted. I didn't mean to offend you."

"You hit a nerve," she said. "Let's leave it at that."

"Fine. Just don't expect me to read your mind. Suppose you take a moment to reflect out loud on how you're different from twenty years ago. It'll save us time."

"I have a whole work persona now," Victoria said. "I'm good at what I do. I go to court, and I fight. I claw like a tigress. I don't give up. Plaintiff or defense, makes no difference; I'm with you for the duration. I just started a trial today that could explode at any minute."

"That's good, Victoria. I always hoped you'd end up someplace where you could use your natural instincts."

"It's the wifing and mothering I'm insecure about. Except for Gregory. That's why I asked about your wife. I need to know how other people do it."

"Jennie used to work for Sotheby's, shepherding high rollers around Europe and preparing them for the auctions. You want to see raw instinct, watch an auction. It's war. After we adopted our children, Jenny developed an antique home-furnis.h.i.+ng business. It keeps her hand in the art world but lets her set her own schedule. Everyone loves her, especially her customers."

Victoria said, "She mixes her work life and her home life. I wish I could. You remember how much my parents hated me? Now, I have this creature in my house who despises me. Three nights ago, I tried reasoning with her about going to bed earlier. She got totally out of control and threw a gla.s.s figurine at me. She could have killed someone."

"How old is she?"

"Almost fifteen. Her birthday is one month after Thanksgiving."

"How long has she been this way?"

"It's been really bad the past four months, but it's been coming on since she turned twelve."

"When did she start menstruating?"

"Around the same time."

"And before that?"

"Melinda was always high-strung, hard to settle down. Always begging for one more story, or one more song at bedtime. And if Martin or I said no, she'd be upset for hours, thras.h.i.+ng around like a maniac. When we tried letting her cry herself to sleep, she wailed so loudly, you'd think she'd been dismembered. It would go on for hours."

"Did anything calm her down?"

"Not really. Sometimes I'd find her curled up in bed with all the covers and pillows piled around her like a womb."

"Did Melinda like cuddling?"

"More with Martin than with me. After Gregory was born, Melinda used to rock him. At first, it looked cute, but then she kept doing it even when he didn't want it, and she'd get angry at him for being upset."

"She was trying to comfort herself."

"Ever since, I'm afraid to leave her alone with him. Meanwhile, she's brilliant. She took the SATs in seventh grade to get into the Johns Hopkins program for the gifted and talented. You wouldn't believe her scores."

"Did you ever consider that Melinda could be bipolar?"

"You can't open any newspaper or magazine without reading about Bipolar Disorder in children. Do you think that's it?"

"You know it runs in families?"

"I knew you were going to say that. Lorraine has it. Me, too, I suppose."

"That's exactly what I think. You probably had it way back when. Bipolar Disorder went unrecognized and undiagnosed for years. It wouldn't surprise me if you had it all along."

"As for it running in families, nothing could compare to Lorraine's ups, but when she got down on me, she was merciless. Melinda tears me to shreds, too. Only now, I can't get away from it. I'm reliving the same nightmare all over. I rarely have ups; mostly I'm agitated."

"I should have asked: Did you get depressed after your children were born?"

"You mean postpartum depression. I didn't call it that; I called it 'worried.' After Melinda was born, I worried for months, thinking I'd done something wrong during the pregnancy. I barely slept during her infancy. Lorraine did better with her than I did."

"How so?"

"It didn't bother her if Melinda had trouble going to sleep. She'd stay up half the night rocking her, but of course, Lorraine didn't have to go to work like I did."

"Did you get any treatment?" Jonas said.

"Not really. My ob-gyn gave me samples of Zoloft. The first pill drove me through the ceiling. My head felt like it was exploding. The doctor said I'd get used to the medicine, so I tried for a few more days. But I couldn't take it."

"Why didn't you call?"

"Because I felt like a failure. You had never prescribed medication. I a.s.sumed you'd be upset with me."

"We've learned so much since then. Sensitive people like you often react violently to medication. Besides, medications like Zoloft can make bipolar patients worse. Much worse. We'll take care of you, but Melinda has to be seen right away."

"How about after Thanksgiving?"

"That's too long. Whatever we're dealing with, I want it addressed right away."

"You're scaring me," Victoria said.

"You're not leaving here until there's a plan for Melinda. I have someone in mind. Rob Milroy. We worked with teenagers years ago in Philadelphia, and we stay in touch. I don't know if I can reach him tonight. How do I get you tomorrow? If I can get him to see Melinda on short notice, I'll need to get you the information right away. Do you know how to text message?"

"Between Martin and Gregory, I can manage."

"Good. I don't want us playing telephone tag tomorrow."

Jonas didn't finish with Victoria until close to nine o'clock. He prescribed tiny doses of medication to calm her, nothing that would dull her or make her more agitated. They agreed to meet in a week and have a phone session after Dr. Milroy evaluated Melinda.

"How much do I owe you?" Victoria asked.

"How's this? Pay me the same rate you get per hour. I'll keep track of the times and phone calls and bill you every month. Agreed?"

"Very fair. That was easy. Do sessions still last forty-five minutes?"

"Sessions last as long as they need," Jonas said for emphasis. "The forty-five minute hour was more about the doctor than the patient. For me, combining medication and therapy is as much art as it is science. I generally schedule patients an hour apart, unless it's someone new or a more complicated family session, then I block off more time. It all depends."

"What about those doctors who see six patients an hour for medication and send them to social workers for therapy?"

"I don't know how they do it," Jonas said. "It's impossible to evaluate someone's mood and response to treatment based on a howdy-do and a self-report questionnaire. I tried it for a few months and I hated it. I can't do my job with a meter running. It would be like telling someone having a heart attack he has forty-five minutes to get better because the doctor has another patient."

"I'm glad you operate that way."

"What can I tell you, Victoria? I'm an a.n.a.lyst. It's what I do. It's who I am."

The next train to Philadelphia left at ten o'clock. Jonas walked Victoria to the hospital entrance where she could get a cab. On the way, she said, "It was very kind of you to see me on such short notice. I'm still worried about Melinda, but at least there's a plan. I feel less alone."

"Bring Martin along next time," Jonas said as they approached a line of taxis. "It would be good if he's in the loop."

"That's not necessary. I'll fill him in myself," Victoria said, which made Jonas wonder what she was and wasn't telling Martin and what, if anything, it had to do with him.

31.

Dr. Milroy had juggled his schedule to arrange the consultation the next afternoon, but Melinda wouldn't leave her room. He told Martin and Victoria to come anyway, to provide her history and decide what to do. Leaving Gail Heath, her paralegal, to keep an eye on Melinda's door, Victoria brought Gregory with them to the doctor's office, where he sat quietly doing math puzzles.

Like Jonas, Dr. Milroy also had a couch that looked more like a decoration. What is it with these guys? Victoria wondered. They show off their couches like Purple Hearts.

Dr. Milroy had a jovial, round face, a full beard, and a carefully trimmed mustache. His eyebrows rose and fell rhythmically with his "ah-hahs," "um-hmms," and "I sees." After hearing about Melinda's behavior, his expression turned serious.

Victoria said, "She's stopped changing her clothes. Her room is filthy, littered with dirty dishes and half-drunk gla.s.ses of chocolate milk and cans of Red Bull. No one can get her out of her room, not for school, not for dinner, not even to shower. When I spoke to her about her bedtime and going for counseling, she had a s.h.i.+t fit and threw one of her skating trophies at me. Then, she blamed me for upsetting her. She thinks I'm following her; that we're trying to get rid of her."

Dr. Milroy's eyebrows furrowed. "Melinda's not going to make it easy for us," he said somberly. "I've met lots of adolescents like her. Unfortunately, they become so consumed by their distorted views, that they misinterpret the intentions of people who really care for them."

Victoria said, "She's constantly feeling misunderstood and unappreciated, criticized for expressing her thoughts, some of which, frankly, are rather out there. She's incredibly bright-you should hear her vocabulary, and her SATs were off the charts-but she can't see how her behavior affects other people."

"Don't be misled by her fancy language," Dr. Milroy said. "I've seen many youngsters flaunt their grandiosity with big words, but underneath it all, they're insecure about themselves and seek affirmation in self-defeating ways that leave them even more isolated."

"I've told ... no, we've told her she can go to boarding school wherever she wants-Andover, Choate, Exeter-where she can be with people like herself. It's such a paradox. How can someone so bright not get it that you can't treat people like garbage and still expect them to tell you how smart you are?" Victoria winced, remembering how she used to devalue people, especially girls, the way Melinda did.

"She'll never agree to boarding school," Dr. Milroy said. "Not now. That's because of her dread that she'll be found ordinary and untalented."

"It sounds like you've met her already."

"Believe me, I've known more than my share, so bright and full of rich ideas, yet locked in their own world. Their minds race a mile a minute. That's why they barricade themselves in their rooms, to regulate sensory inputs on their already overstimulated brains. Music can block out intrusive images. Every moment is a struggle to control their bad thoughts.

"Try not to be upset by what I'm about to propose," Dr. Milroy said. "Pennsylvania Hospital has an excellent inpatient adolescent psychiatry unit. I wish there was another way, but I'm afraid she won't go for help unless she's dragged in kicking and screaming. But, because she's under sixteen, you can admit her. She should be admitted as soon as possible-waiting will only prolong everyone's misery and protract Melinda's brain dysregulation, which will only get worse."

"Are you sure hospitalization is necessary?" Martin asked.

Dr. Milroy looked at Martin and Victoria without wavering. "Yes."

Victoria pictured Melinda shot full of tranquilizers, writhing and howling, carted off by linebacker-sized orderlies in white coats. "What's going to happen there?"

"She'll get medicine that will slow her mind and quiet her irritability."

"How do you know she'll go along with the program?"

"Although we can never be totally sure, there's something comforting about being with one's peers. She'll meet teenagers with similar issues. They'll confirm that medication and therapy help. The mood-stabilizing medications we use promote sleep and clear thinking, and we teach mindfulness and breathing exercises, and other techniques that help regulate thoughts and feelings. Think how empowered Melinda will feel, knowing she can control what's rattling around inside her head."

"What about the stigma of being psychiatrically hospitalized?" Victoria said. "Won't she hold that against us?"

"Not in the long run. You'll see; she'll come around. I genuinely like teenagers, especially bright ones like Melinda. I can usually find a way to speak their language and hop aboard their metaphors. I like figuring them out. After that, it's about getting them to see what's special about themselves while accepting their limitations. I share stories about myself, my family, and my friends when we were young. Kids eat them up. I also run outpatient groups for mood-disordered teenagers. I try to introduce prospective members while they're still in the hospital. It gives them hope they'll get better. I'm sure the other kids will welcome her. She'll feel at home in no time."

Dr. Milroy continued, "There are several groups, one for the more withdrawn schizoid types-that's not Melinda. There's one for depressed teenagers without mood swings, and one for the grandiose genius-wannabes. I mix and match the kids carefully, depending on their needs. No bullying. We're there for support, not to knock anyone down. I also see every patient individually, so I can regulate his or her medication and discuss where they're at. I'll have to convince Melinda that mania is no way to influence people.

"You know who pioneered this approach, don't you? Dr. Jonas Speller, the man who referred you to me. I finished training two years behind him. By then, he had developed many innovative strategies, all in the era before today's mood stabilizers."

Victoria liked Dr. Milroy's a.s.sociation to Jonas. Reluctantly, she and Martin agreed that waiting would only delay the inevitable.

Dr. Milroy said, "Because psychiatric hospitals employ skeleton crews for holiday weekends, and only minimal therapy is available, I think it makes the most sense to intervene after Thanksgiving. If we admitted Melinda tomorrow, it wouldn't be until Monday that she'd get the full attention that will ease her into the milieu. I wouldn't want her isolated in her room for five days. That could make her even harder to reach. We can always admit Melinda between now and Monday if she threatens to hurt herself or someone else, but that's unlikely unless she's provoked."

"Should we take her with us for Thanksgiving dinner?"

"That's a very good question." Dr. Milroy paused thoughtfully. "I wouldn't want her to feel excluded. Give her the option and see what she makes of it. Follow her lead. If she decides against going, someone should stay home with her." After discussing the logistics of getting Melinda to the hospital, he produced his card and cell phone number. "I'm reachable any time. Don't hesitate to call. As it stands now, I'll see you on Monday morning."

Victoria had a phone session with Jonas the day before Thanksgiving. Although it had been less than two days since they last spoke, it felt like a month.

"Your vocal cords sound tighter than my violin's E string," Jonas said after hearing her first words.

Victoria tried to re-create the feeling of being in Jonas's presence. She said, "You have no idea what's been going through my mind. I have awful thoughts about Melinda, of tussling with her to the point that someone gets b.l.o.o.d.y, and I can see her stabbing herself or someone else. There are times I get so angry at her, I imagine garroting her, like in the G.o.dfather movies. Imagine having thoughts like that about your own child! They're so sickening they make me nauseous-that same feeling I had in your office way back on the first day we met."

"Well, the good news is that you're aware of your anger. Back then you were totally dissociated."

"I'm not sure this is any better."

"Well, we better up your medication. We'll find the right level. It's going to be a day-by-day, sometimes minute-to-minute battle to keep your mind calm. Keep doing the deep breathing and yoga. Think of those techniques as medicines without side effects. Try to get to the gym, too, where you can burn off some steam. Can you focus on work?"

"It's a struggle. I'm always feeling guilty, like there's something more I should be doing for Melinda. Meanwhile, this trial has me amped up like I'm on speed."

"Tell me about Dr. Milroy."