The Thanatos Syndrome

wouldn’t be putting out that poison where the chirren can get holt of it.” Now most physicians would not even listen or, if they did, would not be curious and would leave with a pleasantry to humor old what’s-her-name. But a good physician or a lucky physician might prick up his ears. There was something about that inguinal node—“Poison? Poison for what? Rats?” “I mean rats.” “You got rats?” “I mean. Look here.” There in the garbage can, sure enough, a very dead rat with a drop of blood hanging like a ruby from its nose. The physician went his way, musing. Something nagged at the back of his head. Halfway down St. Charles, click, a connection was made. He parked, went to a pay phone, called the patient’s father. “Did you put out rat poison in your house?” No, he had not. Is Anne okay? “She’ll be fine but get her to Touro for a test.” At the hospital he aspirated the suspicious inguinal node. Most doctors would have diagnosed mononucleosis, made jokes with the young lady about the kissing disease—So you’re just back from Ole Miss, what do you expect, ha ha. He took the specimen to the lab and told the technician to make a smear and stain with carbol-fuchsin. He took one look. There they were, sure enough, the little bipolar dumbbells of Pasteurella pestis. The plague does in fact turn up from time to time in New Orleans, the nation’s largest port. It’s no big deal nowadays, caught in time. A massive shot of antibiotic and Anne went home.
    This is not to suggest that I have stumbled onto another black plague. But if I am right, I have stumbled onto something. It is both a good deal more mysterious and perhaps even more ominous. The trouble is, unfortunately for us psychiatrists, that diagnoses in psychiatry are often more difficult—and less treatable. There is seldom a single cause, a little dumbbell bacillus one can point to, or a single magic bullet one can aim at the tiny villain. Believe it or not, psychiatrists still do not know the cause of the commonest of all human diseases, schizophrenia. They still argue about whether the genes are bad, the chemistry is bad, the psychology is bad, whether it’s in the mind or the brain. In fact, they’re still arguing about whether there is such a thing as the mind.
    It began with little things. The other day, for example, I was seeing a patient I hadn’t seen for two years. I’ve been away, but that’s another story. She had a certain mannerism, as do we all, which was as uniquely hers as her fingerprints. If she said something in her usual bantering way and I had the good luck to get behind it, make a stab in the same bantering tone and get it right, she had a way of ducking her head and touching the nape of her neck the way women used to do years ago to check hairpins in a bun and, as a slight color rose in her cheek, cut her eyes toward me under lowered lids almost flirtatiously, then nod ironically. “Uh huh,” she’d say with a smile. She monitored her eyes carefully. A look from her was never a casual thing.
    An analyst who sees a patient several times a week for two years and who has his eyes and ears open—especially that third ear Reik talks about which hears what is not said—comes to know her, his patient, in some ways better than her husband, who probably hasn’t taken a good look at her for years.
    But last week, when I saw her in the hospital, her mannerism was gone. Her eyes were no longer monitored. A curious business. I’d have noticed it even if I were seeing her for the first time. Women are generally careful of their eyes. She simply gazed at me, not boldly, but with a mild, unfocused gaze. She responded readily enough, but in monosyllables and short phrases, and now and then gave a little start as if she had in some sense or other come to herself. Then she’d drift off again.
    To summarize her history in a word or two: She was a New Englander, a Bennington graduate, a shy but assured person who married a high-born, freewheeling Louisiana Creole whom she met at Amherst, a high-roller later in oil leases and real estate. So here she found herself, set down in this spanking new Sunbelt exurb, in a new “plantation-style” house, in a new country club, next to number-six fairway. All at once she became afraid. She was afraid of people, places, things, dogs, the car; afraid to go out of