Praying for Sleep

occasionally damp as the leaves of a plantain lily.
    But gradually she improved. She took Prozac for a time, which made her jaw quiver and fingers tremble and infused her dreams with spectacular effects. It also aggravated the insomnia. She switched to Pamelor, which was gentler.
    And then, one day, she simply stopped taking the pills and hung up her housecoat.
    “I can’t tell you what happened. Or when exactly. But I suddenly just knew it was time to get on with my life. And I did.”
     
    “I’d had some clues that Michael’s delusion involves American history,” Kohler told her. “Particularly the Civil War . . . ‘Sic semper tyrannis’ —that’s what Booth shouted after he shot Lincoln.”
    “ ‘Thus ever to tyrants.’ ” Lis the schoolteacher added, “It’s also the state motto of Virginia.”
    “And the April 14 reference. The assassination.”
    “What does Lincoln have to do with anything?”
    Kohler shook his head. “Michael’s been very reluctant to talk to me about his delusions. Only hints, cryptic phrases. He didn’t trust me.”
    “Even you, his doctor?”
    “ Especially me, his doctor. That’s the nature of his illness. He’s paranoid. He’s always accusing me of trying to get information out of him for the FBI or Secret Service. He has a core delusion but I can’t get to the bottom of it. I suppose it centers on the Civil War, Lincoln’s death, conspirators. Or some event he associates with the assassination. I don’t know.”
    “Why’s his delusion so important?”
    “Because it’s central to his illness. It explains to him why every day is so unbearably hard. A schizophrenic’s life,” Kohler lectured, “is a search for meaning.”
    And whose isn’t? Lis wondered.
    “It’s a very controversial matter right now,” the doctor said, adding that he himself was considered a bit of a renegade. She thought he was a little too smug with this characterization of himself. “Schizophrenia is a physical illness. Just like cancer or appendicitis. You have to treat it with drugs. No one disputes that. But I differ from most of my colleagues in thinking that you can also treat schizophrenic patients very effectively with psychotherapy.”
    “I can’t really imagine Hrubek lying on a couch talking about his childhood.”
    “Neither could Freud. He said schizophrenic patients shouldn’t be treated with psychoanalysis. Most psychiatrists agree. The current treatment is to get them on brain candy—that’s how the cynics among us refer to their medication—and force them to accept reality, teach them to order in restaurants and do their own laundry, then turn them loose. And it’s true—extended analysis, with the patient on the couch, that’s wrong for people like Michael. But certain types of psycho therapy work very well. Seriously ill patients can learn to function at a very high level.
    “Most psychiatrists think that schizophrenic patients ramble incoherently, that their delusions are meaningless. I think that almost everything they say is meaning- full . The more we try to translate their words into our way of thinking, yes, the more pointless those words are. But if we try to grasp their metaphoric meaning, then doors open up. Take a Napoleon, okay? That’s the popular image of a schizophrenic. I won’t try to convince a patient that he isn’t Napoleon. And I wouldn’t just pat him on the head and say, “Bonjour,” when I pass him in the hall. I’d try to find out why he thinks he’s the emperor of France. Nine times out of ten there’s a reason. And once I know that, I can start to unlock doors. I’ve had remarkable results with patients—and some of them are a lot sicker than Michael.” He added bitterly, “I was just getting inside him, I was almost there . . . When this happened.”
    “You make him sound innocent.”
    “He is innocent. That’s the perfect word for him.”
    She thought angrily, Oh, isn’t the good doctor used to people buying his bill of goods? The malleable patients who nod their damaged heads and shuffle off to obey. The sorrowful families pecking through his pompous words for comfort like birds for seed. Young, terrified interns and nurses. “How on earth,” she asked, “can you romanticize him? He’s just a set of muscles free to do whatever he wants. He’s a machine run amok.”
    “Not at all. Michael’s tormented by the inability to achieve what he thinks he can become. That conflict shows itself as what we