He says, I know I look older than 48. Its because I havent been sleeping. Ive tried Ambien and the other one, the green moth one, but they only make me feel groggy.
When I ask how long hes been suffering from insomnia, he needs no time to think it over.
Ten months.
I ask him if its the insomnia that brought him to me. He smiles up at the ceiling. Most patients choose the chair, at least on their first visitone woman told me that lying on the couch would make her feel like a joke neurotic in a New Yorker cartoonbut N. has gone directly to the couch. He lies there with his hands laced tightly together on his chest.
I think we both know better than that, Dr. Bonsaint, he says.
I ask him what he means.
If I only wanted to get rid of the bags under my eyes, Id either see a plastic surgeon or go to my family doctorwho recommended you, by the way, he says youre very goodand ask for something stronger than Ambien or the green moth pills. There must be stronger stuff, right?
I say nothing to this.
As I understand it, insomnias always a symptom of something else.
I tell him that isnt always so, but in most cases it is. And, I add, if there is another problem, insomnia is rarely the only symptom.
Oh, I have others, he says. Tons. For instance, look at my shoes.
I look at his shoes. They are lace-up brogans. The left one is tied at the top, but the right has been tied at the bottom. I tell him thats very interesting.
Yes, he says. When I was in high school, it was the fashion of girls to tie their sneakers at the bottom if they were going steady. Or if there was a boy they liked and they wanted to go steady.
I ask him if hes going steady, thinking this may break the tension I see in his posturethe knuckles of his laced-together hands are white, as if he fears they might fly away unless he exerts a certain amount of pressure to keep them where they arebut he doesnt laugh. He doesnt even smile.
Im a little past the going-steady stage of life, he says, but there is something I want.
He considers.
I tried tying both of my shoes at the bottom. It didnt help. But one up and one downthat actually seems to do some good. He frees his right hand from the deathgrip his left has on it and holds it up with the thumb and forefinger almost touching. About this much.
I ask him what he wants.
For my mind to be right again. But trying to cure ones mind by tying ones shoelaces according to some high school code of communication slightly adjusted to fit the current situation thats crazy, wouldnt you say? And crazy people should seek help. If they have any sanity left at allwhich I flatter myself I dothey know that. So here I am.
He slides his hands together again and looks at me with defiance and fright. Also, I think, with some relief. Hes lain awake trying to imagine what it will be like to tell a psychiatrist that he fears for his sanity, and when he did it, I neither ran shrieking from the room nor called for the men in the white coats. Some patients imagine I have a posse of such white-coated men in the very next room, equipped with butterfly nets and straitjackets.
I ask him to give me some instances of his current mental wrongness, and he shrugs.
The usual OCD shit. Youve heard it all a hundred times before. Its the underlying cause I came here to deal with. What happened in August of last year. I thought maybe you could hypnotize me and make me forget it. He looks at me hopefully.
I tell him that, while nothing is impossible, hypnotism works better when its employed as an aid to memory rather than as a block.
Ah, he says. I didnt know that. Shit. He looks up at the ceiling again. The muscles in the side of his face are working, and I think he has something more to say. It could be dangerous, you know. He stops, but this is only a pause; the muscles along his jaw are still flexing and relaxing. Whats wrong with me could be very dangerous. Another pause. To me. Another pause. Possibly to others.
Every therapy session is a series of choices; branching roads with no signposts. Here I could ask him what it isthe dangerous thingbut I elect not to. Instead I ask him what sort of OCD shit hes talking about. Other than the one-up, one-down tying thing, which is a pretty damn good example. (I do not say this.)
You know it all, he says, and gives me a sly look that makes me a bit uncomfortable. I dont show it; he isnt the first patient who has made me uncomfortable. Psychiatrists are spelunkers, really, and any spelunker will tell you that caves are full of bats and bugs. Not nice, but most are essentially harmless.
I ask him to humor me. And to remember that we are still just getting to know each other.
Not going steady just yet, eh?
No, I tell him, not quite yet.
Well, we better be soon, he says, because Im at Condition Orange here, Dr. Bonsaint. Edging into Condition Red.
I ask him if he counts things.
Of course I do, he says. The number of clues in the New York Times crossword puzzles and on Sundays I count twice, because those puzzles are bigger and double-checking seems in order. Necessary, in fact. My own footsteps. Number of telephone rings when I call someone. I eat at the Colonial Diner on most workdays, its three blocks from the office, and on my way there Ill count black shoes. On my way back, Ill count brown ones. I tried red once, but that was ridiculous. Only women wear red shoes, and not many, at that. Not in the daytime. I only counted three pair, so I went back to the Colonial and started again, only the second time I counted brown shoes.
I ask him if he has to count a certain number of shoes in order to achieve satisfaction.
Thirtys good, he says. Fifteen pair. Most days, thats no problem.
And why is it necessary to reach a certain number?
He considers, then looks at me. If I say you know, will you just ask me to explain what it is youre supposed to know? I mean, youve dealt with OCD before and Ive researched itexhaustivelyboth in my own head and on the Internet, so cant we just cut to the chase?
I say that most counters feel that reaching a certain total, known as the goal number, is necessary to maintain order. To keep the world spinning on its axis, so to speak.
He nods, satisfied, and the floodgates break.
One day, when I was counting my way back to the office, I passed a man with one leg cut off at the knee. He was on crutches, with a sock on his stump. If hed been wearing a black shoe, it would have been no problem. Because I was on my way back, you see. But it was brown. That threw me off for the whole day, and that night I couldnt sleep at all. Because odd numbers are bad. He taps the side of his head. At least up here they are. Theres a rational part of my mind that knows its all bullshit, but theres another part that knows it absolutely isnt, and that part rules. Youd think that when nothing bad happenedin fact something good happened that day, an IRS audit we were worried about was canceled for absolutely no reasonthe spell would break, but it didnt. Id counted thirty-seven brown shoes instead of thirty-eight, and when the world didnt end, that irrational part of my mind said it was because I not only got above thirty, I got well above thirty.
When I load the dishwasher, I count plates. If theres an even number above ten in there, all is well. If not, I add the correct number of clean ones to make it right. Same with forks and spoons. There has to be at least twelve pieces in the little plastic caddy at the front of the dishwasher. Which, since I live alone now, usually means adding clean ones.
What about knives, I ask, and he shakes his head at once.
Never knives. Not in the dishwasher.
When I ask why not, he says he doesnt know. Then, after a pause, he gives me a guilty sideways look. I always wash the knives by hand, in the sink.
Knives in the silverware caddy would disturb the order of the world, I suggest.