Our Serotonin, Our Selves? - Page 3


Remembering Clients Lost

While Arango and I talk, I find myself thinking of Juan, one of my clients when I ran a supportive housing program for formerly homeless people with mental illness about three blocks away from where we now sit. Juan died by suicide, or probable suicide, and I imagine his brain would have been interesting to Arango. I'd like to know what she'd have found in it.

When I first met Juan, he described his previous life—the life when he used every drug he could snort, ingest, or inject, though heroin was his primary addiction—as that of a "Puerto Rican punk gangbanger," who was homeless, opportunistic, depressed (he'd had a number of suicide attempts), and mean. His former zeal for substances was such that on the last day of his brief career as a machinist, he took a bunch of pills and got very drunk, reported to his work station, took a deep breath, and jammed his finger directly into a circular saw. His finger was immediately sliced off and he was rushed to the emergency room. Ultimately, he received a $30,000 payout from the company, which wanted to avoid insurance claims and litigation. Juan used the cash to buy a host of street drugs.

By the time I met him, he'd been clean for three years, and he was anything but disreputable. Modest, well-spoken, polite, and trying to make amends, he was earnestly pursuing a difficult reconciliation with his wife and three kids (whom he visited each weekend at their rundown Bronx apartment). He was taking classes at a community college with the goal of becoming a physician's assistant, was repeatedly elected to be the client representative in his housing residence, and was the leader of the substance abuse prevention group

Juan had thick black hair, which he wore slicked back, in a ponytail. He had a broad, handsome face, and was often smiling, a few missing teeth showing. He had any number of highly idiosyncratic beliefs and behaviors. His diagnoses, other than major depression, were bizarre and vague: "intermittent explosive disorder" and "psychotic disorder NOS." What those meant, in English, was that he apparently had a rough time keeping his temper (although I never saw evidence of that: in all my experience with him, he was the embodiment of equanimity) and that, as he related to me after I got to know him well, he believed that a woman who'd stood a few feet from him in the line at a Bronx movie theater sometime in the mid-'80s cast spells over him. In some insidious way, she controlled everything, or everything bad, in his life.

I could never ascertain what it was about that person—a bystander, whom Juan never spoke to—that instilled such a deep-seated belief. He'd sort of trail off when bringing up the story of the woman in the movie line. It was clearly too painful a subject to speak about.

His morbid, brooding nature was occasionally misinterpreted by inexperienced clinicians. A novice psychiatrist once called me to say that she was hospitalizing Juan because he'd revealed in their session that he'd wanted to go back to sleep that morning after waking up. The doctor interpreted this as an indication of suicidality, and she hospitalized him against his will that same day. I knew him well enough that I felt, in this instance, he was really just saying he wanted to go back to sleep.

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