The Guardians Page 7

  * * *

  What if Harris died not because someone opened a door for him, but because he appeared at the threshold in the form of a doctor? Or a housefly? What if he glowed with a golden light and walked right through the door? What if he’d become invisible?

  What do I wish—that I could have stopped Harris from ending his life? That I could have given him permission to end his life, permission he didn’t need? What do I regret—that in the end he didn’t need me, and now I can’t need him? When did I stop separating the pathological self-murdering part of him from the rest of him—at what point did I reassign the so-called self-murder to his actual self?

  Why is it easier for me to think Harris killed himself than to think Some unknown invasive pathology entered Harris without my knowledge and, while I wasn’t looking, murdered him?

  * * *

  I don’t want to admit that I couldn’t have saved Harris from his death, that I’m not magic, that I’m not special, that I won’t be able to save anyone. The avocados ripen on the tree and the sun dries out the garden.

  The project of life is the execution of plans during an open-ended but finite period of time. Most of us don’t know how long it will be, so we don’t know how to use our time most efficiently.

  When I look at the veil that covers the end of my life, I feel overwhelmed by the certainty that I won’t use all the time as completely as I could if I knew the date of my death. I want to give up.

  From that perspective, suicide is a rational plan.

  * * *

  After I moved to Los Angeles, I drove a car for the first time in seven years and developed a stammer. When I took the wrong exit off a freeway and trusted my untrustworthy sense of direction and got fabulously lost and called my husband for help, I could hardly speak. As I drove home from the airport, stammering into the phone, I felt the adrenaline surging into my blood.

  After I’d lived in Los Angeles for a month, someone told me that plenty of people don’t use the freeways. I didn’t know. I’d thought it was required. She said, If I had to drive every day, I’d kill myself.

  I’d been making progress with my freeway panic, but as soon as she said that, I happily believed her. I no longer needed to fear I can’t do what I must do, what everyone can do, that I’m a damaged, ruined person. I stopped fearing the freeway. The stammer is gone.

  What if someone told me I didn’t have to think about Harris anymore? You don’t have to remember him. No one else does. You never have to think about him again.

  * * *

  The last time I saw him might have been the night that a percussionist performed a piece Harris had composed for an imaginary instrument—that is, an instrument he’d imagined and then built. It was something like a theremin.

  I’d arrived late, alone, because I hadn’t wanted to sit through the entire performance. I knew it would sound meaningless to my ear. I hadn’t gone beyond calculus, and Harris lived in a place where math was erotic.

  For a few minutes I stood outside, proud of Harris but not quite knowing whether he wanted to go to bed with the pretty percussionist, or whether he’d already gone to bed with her, or whether we should all go out together or separately. I remember thinking I should go home, that my duty to my friend was done, and in the next moment, I was introduced to a man from out of town.

  The Brooklyn Inn has beautiful oriel windows and pressed metal cornices. Drinking alone one night, years ago, I saw a well-dressed man step in, order a shot, down it, place some bills on the bar, and leave without sitting down. You know it’s a good bar when it attracts alcoholics with that level of familiarity.

  The man from out of town and I took the train to the Brooklyn Inn, and we sat and drank and talked. As soon as I finished my drink, I put my arm around him and said Come here, and as soon as that happened, I knew the future, and it felt like relief. We got into a cab and went to my apartment.

  We stayed awake, then slept a little, then reawoke. I called him a car and he went to the airport and back home.

  * * *

  No, I did see Harris again. He came to the Christmas party at my next apartment, the last place I lived in New York before moving to California, and he was the last guest to leave, but that isn’t the last time I saw him, either, because my journal’s last mention of Harris is the following March, the night I brought him to a concert uptown.

  At the reception after the performance, the platter of cold cuts had no knife, so we all picked up flaps of pink meat with our hands. I remember carrying a rolled-up slice of something to the twenty-third-story balcony and looking down and then assisting a man with a bout of vertigo, but I don’t remember Harris being at the reception, and I don’t remember saying good night to him, or goodbye, but it was the last recorded time I ever saw him.

  * * *

  Many psychiatric patients assume that psychoactive drugs will be unpleasant. The official list of side effects—which impair memory, cognition, digestion, breathing, all the basic processes of the organism—sounds terrifying even to me, although I’ve taken antipsychotics every day for more than a decade and don’t plan to stop.

  Some time after Harris began taking his first antipsychotic, he told me he’d been feeling an unpleasant sensation for a solid week. I recognized it as akathisia.

  He’d expected the pills to be poisonous, so he didn’t question the side effects, didn’t ask the doctor for something else, another pill, another dose, another combination. Given the known suffering of a daily pill versus the erratic but less frequent suffering of his disease, any reasonable person would choose the latter, as he did.

  His sister told me he said to her, during the next-to-last year of his life, the year he tried to visit all of his faraway friends, I don’t think I’m going to live very long.

  * * *

  I was told that Harris was nauseated and dehydrated when he was committed for the last time. He might have been given prochlorperazine, the antiemetic that gave me akathisia when I took it.

  Now I think I know something of what he was thinking and feeling in those ten hours he was alone at the end of his life.

  Delusional and frightened, he might reasonably have accused the doctors of drugging him with an antipsychotic, not the antiemetic they claimed it was and that carried with it the same possible torment. He might reasonably have thought that as long as he stayed in lockdown, nothing would ever stop that sensation of wild, writhing movement.

  He might have left the hospital in order to be safe from the lying, malevolent doctors. He might have decided to walk off the akathisia, to wait outside the hospital in relative safety until the poisonous torment faded, but walking for ten hours might not have helped enough.

  Since he was far from anyone who could give him any medicine that would counteract the akathisia, the torment and the terrible fear and the psychosis and the dehydration and the cold rain might all have readied him to listen, finally, to the voice in his head that told him, Jump.

  * * *

  If I’d figured this out two years ago, and if I’d found a way to communicate with Harris after he was committed, and if he were in fact given a medicine that induced akathisia, and if I’d reminded him that it was just a side effect of the wrong medicine, he might not have died.

  I think I might know, now, exactly what I’m guilty of.

  * * *

  It’s tempting to try to claim I’ve learned something very important from the experience of Harris’s death, that its instruction will serve me as I continue living, that everything happens for a reason decided upon by an omniscient, omnipotent, beneficent reasoning force, which Jews are not asked to believe in, which I don’t believe in, and which cannot possibly exist in the physical universe.

  What I’ve learned from Harris’s death is that I’m capable of outliving him—and that I might live a long time, now that he’s so violently reduced the statistical likelihood of my own self-dispatch.

  * * *

  One more day at the beach, just the five of us from
Chambers Street. Harris drives us in his parents’ car. Loud music plays. He sings to every song. He turns up the volume. Heat mirrors the road.

  At the beach the sand reflects the sun. We burn ourselves on both sides and swim in the ocean. One of the others tells me to stop smiling so hard, to try to contain myself, but I can’t. It looks insincere, he says. I’m smiling now, remembering. Still smiling.

  Harris is just a shimmer, a null set. He reflects my grief, and it’s so bright I can’t see much behind it, but behind the brightness is a human shape.

  I look at him, then look away. I was so lucky.

  NOTES

  The Thursday edition of the Riverdale Press: See Megan James, “Man Struck by Train Is Identified.”

  “I’m not sure that anyone”: Emily L. Senecal, e-mail exchange with the author, 2010.

  The dictionary defines psychosis: See Merriam-Webster’s Collegiate Dictionary.

  The clinical definition narrows: Ibid.

  The dimensional approach to defining psychosis: See H. J. Eysenck, “Classification and the Problems of Diagnosis.”

  torment, restlessness, pulling or drawing: See R. E. Drake and J. Ehrlich, “Suicide Attempts Associated with Akathisia.” “Some of the best definitions of akathisia come from the medical literature on the use of reserpine as an antihypertensive in the mid-1950s.” See David Healy, Andrew Herxheimer, and David B. Menkes, “Antidepressants and Violence: Problems at the Interface of Medicine and Law.” “Akathisia has two components: subjective (psychological) and objective (motor).” See E. Szabadi, “Akathisia—or Not Sitting.”

  “the patient could not remain sitting down”: From Ladislav Haškovec, “L’akathisie.”

  one of the chamberlains of Napoleon III: From G. E. Berrios, “Lad Haškovec and Akathisia: An Introduction.”

  Akathisia became clinically relevant in the 1950s: See Martin Brüne, “Ladislav Haškovec and 100 years of Akathisia.”

  The condition seemed to result more frequently at higher doses: “Neurology textbooks of the pre-antipsychotic era described akathisia in Parkinsonian patients, and the importance of the term has further increased after the introduction of antipsychotics in the 1950s.” From Pavel Mohr and Jan Volavka, “Ladislav Haškovec and Akathisia: 100th Anniversary.”

  Some studies now show upwards of 75 percent: “Akathisia is common in general medical settings, especially when patients are taking antiemetics. In cancer patients undergoing chemotherapy, 50 percent of patients met the diagnostic threshold of akathisia, yet 75 percent stated they would not have reported the symptoms of akathisia.” See Hiroko Akagi and T. Manoj Kumar, “Akathisia: Overlooked at a Cost.”

  Extraordinary suffering: Akathisia has been well documented as a common and distressing side effect of antipsychotic drugs and an important cause of poor drug compliance. See Akagi and Kumar, “Akathisia.” See Thomas R. E. Barnes, “A Rating Scale for Drug-Induced Akathisia.” See Healy, Herxheimer, and Menkes, “Antidepressants and Violence.” “Failure to identify and treat this disorder can result in extraordinary suffering for the patient, which can in turn lead to preoccupation with the idea of suicide, specifically by jumping.” See M. Sabaawi, T. F. Holmes, and M. R. Fragala, “Drug-Induced Akathisia: Subjective Experience and Objective Findings.”

  when symptoms develop gradually: From Emily L. Senecal.

  without adequate clinical supervision: “Used ineptly or without adequate clinical supervision, [antipsychotic drugs] can cause akathisia, an extremely uncomfortable state of agitation, muscle discomfort, and a difficulty in sitting still (often described by patients as feeling as if they are ‘jumping out of their skin’).” See Kay Redfield Jamison, Night Falls Fast.

  mania: See Barnes, “A Rating Scale for Drug-Induced Akathisia.”

  anger: See Drake and Ehrlich, “Suicide Attempts Associated with Akathisia.”

  overwhelmingly identified as homicide and suicide: See Drake and Ehrlich, “Suicide Attempts Associated with Akathisia.” See Healy, Herxheimer, and Menkes, “Antidepressants and Violence.” See J. R. Schulte, “Homicide and Suicide Associated with Akathisia and Haloperidol.”

  specifically by jumping: “Failure to identify and treat this disorder can result in extraordinary suffering for the patient, which can in turn lead to preoccupation with the idea of suicide, specifically by jumping.” See Sabaawi, Holmes, and Fragala, “Drug-Induced Akathisia.”

  I can hear the music all around me: Dudley Moore, last words as reported by Rena Fruchter in her book Dudley Moore: An Intimate Portrait.

  When a male child is born: See Esther Hecht, Official site of the Maltese Jewish Community.

  One of us would ask: Woody Allen, Annie Hall.

  Statistics show that suicides: Centers for Disease Control and Prevention, National Vital Statistics System, Mortality Tables.

  In one of them, she wrote: From “Three Songs” (part III): See Rachel Wetzsteon, lines from “Three Songs.”

  Clinicians write that akathisia: See Healy, Herxheimer, and Menkes, “Antidepressants and Violence”; Sabaawi, Holmes, and Fragala, “Drug-Induced Akathisia”; and Schulte, “Homicide and Suicide.”

  Case 1: A man with chronic schizophrenia: See Drake and Ehrlich, “Suicide Attempts Associated with Akathisia.”

  Case 2: The admission note: See Schulte, “Homicide and Suicide.”

  Case 3: A man received two 25 mg doses: See Schulte, “Homicide and Suicide.”

  BIBLIOGRAPHY

  Akagi, Hiroko, and T. Manoj Kumar. “Akathisia: Overlooked at a Cost.” British Medical Journal 324:7352 (22 June 2002): 1506–07.

  Allen, Woody. Annie Hall. Film, 93 minutes. MGM/UA, 1977.

  Barnes, Thomas R. E. “A Rating Scale for Drug-Induced Akathisia.” British Journal of Psychiatry 154 (1989): 672–76.

  Berrios, G. E. “Lad Haškovec and Akathisia: An Introduction.” History of Psychiatry 6 (June 1995): 243–51.

  Brüne, Martin. “Ladislav Haškovec and 100 Years of Akathisia.” American Journal of Psychiatry 159:5 (May 2002): 727.

  Centers for Disease Control and Prevention. National Vital Statistics System, Mortality Tables. www.cdc.gov/nchs/nvss/mortality_tables.htm.

  Drake, R. E., and J. Ehrlich. “Suicide Attempts Associated with Akathisia.” American Journal of Psychiatry 142 (1985): 599–601.

  Eysenck, H. J. “Classification and the Problems of Diagnosis.” In Handbook of Abnormal Psychology, edited by H. J. Eysenck, 1–31. London: Pitman, 1960.

  Fruchter, Rena. Dudley Moore: An Intimate Portrait. London: Ebury Press, 2004.

  Giuliani, Rudolph. Press conference speech (11 September 2001).

  Godard, Jean-Luc. A bout de souffle. Film, 90 minutes. Les Productions Georges de Beauregard, 1960.

  Haškovec, Ladislav. “L’akathisie.” Revue Neurologique 9 (1901): 1107–09. Translated from the French by G. E. Berrios.

  ———. “Nouvelles remarques sur l’akathisie.” Nouvelle Iconographie de la Salpêtrière 14 (1903): 287–96.

  Healy, David, Andrew Herxheimer, and David B. Menkes. “Antidepressants and Violence: Problems at the Interface of Medicine and Law.” PLoS Medicine 3:9 (September 2006): 1478–87.

  Hecht, Esther. Official site of the Maltese Jewish Community. www.jewsofmalta.org.

  James, Megan. “Man Struck by Train Is Identified.” Riverdale Press (7 August 2008).

  Jamison, Kay Redfield. Night Falls Fast, p. 250. New York: Random House, 1999.

  Journal of the American Medical Association 43 (27 August 1904): 622.

  Merriam-Webster’s Collegiate Dictionary, Eleventh Edition. Definitions of psych- and -osis.

  ———. Definition of psychosis.

  Mohr, Pavel, and Jan Volavka. “Ladislav Haškovec and Akathisia: 100th Anniversary.” British Journal of Psychiatry 181 (2002): 537.

  Sabaawi, M., T. F. Holmes, and M. R. Fragala. “Drug-Induced Akathisia: Subjective Experience and Objective Findings.” Military Medicine 159:4 (April 1994): 286–91.

  Schulte, J.
R. “Homicide and Suicide Associated with Akathisia and Haloperidol.” American Journal of Forensic Psychiatry 6 (1985): 3–7.

  Senecal, Emily L. E-mail exchange with the author, 2010.

  Szabadi, E. “Akathisia—or Not Sitting.” British Medical Journal 202 (19 April 1986): 1034–35.

  Wetzsteon, Rachel. Lines from “Three Songs.” The Other Stars. New York: Penguin, 1994.

  ACKNOWLEDGMENTS

  The author acknowledges the American Academy of Arts and Letters, the American Academy in Rome, Adam Chapman, Maggie Nelson, Domenick Ammirati, Mitzi Angel, Chantal Clarke, Kathy Daneman, Jeremy Dauber, Matt Haber, Ben Herzog, Sheila Heti, Chelsea Hodson, Mishka Jaeger, Jennifer L. Knox, Nick Laird, Alan Lyman, Judith and Frank Manguso, PJ Mark, Jenny Moore, Ed Park, Emily Senecal, Michal Shavit, David Shields, David M. Sollors, Lorin Stein, Deb Olin Unferth, Carol and Howard Wulfson, and the editors of the Seattle Review, where a portion of this book was published in a slightly different form under the title “Class Note.”

  ALSO BY SARAH MANGUSO

  The Two Kinds of Decay

  Hard to Admit and Harder to Escape

  Siste Viator

  The Captain Lands in Paradise

  A NOTE ABOUT THE AUTHOR

  Sarah Manguso is the author of a memoir, The Two Kinds of Decay; two books of poetry, Siste Viator and The Captain Lands in Paradise; and a short-story collection, Hard to Admit and Harder to Escape. A recent Rome Prize Fellow, she lives in Brooklyn, New York.

  Farrar, Straus and Giroux

  18 West 18th Street, New York 10011

  Copyright © 2012 by Sarah Manguso