A highly articulate, intelligent and a very handsome young man, Y was committed to the hospital after threatening his mother, “the parturient,” that he would make sure she burned in thousands of hells. Like Nietzsche’s portrayal of himself in his letter of insanity (1889), Y too was at root every name in history or every historical personage, but on file he was just another “male schizophrenic patient with first rank symptoms and cannabis abuse,” or F20.0 (paranoid schizophrenia) and F12 (mental and behavioral disorders due to use of cannabinoids), according to the ICD-10, the World Health Organization’s manual that classifies and categorizes diseases. And like other F20’s he was prescribed antipsychotic
medications. Since Y was not willing to comply with the pharmacotherapy he was offered, he was forced by law to receive it by injection; and because of severe side effects known as extra-pyramidal symptoms (EPS), mostly akathisia (continual restlessness), but also agitation and grand mal seizures, he also received a “cocktail” of five to seven other drugs a few times a day. Y felt these medications were killing him, and most of his treatment was characterized by his struggles with the staff, which, in his experience, wanted to reduce him entirely to a body to be medicated. Smart and eloquent, Y studied the psychiatric discourse of his time and communicated with his doctors and nurses using mainly psychopharmacological language. He would say: “I want more Lustral; I need only a therapeutic dosage of liquid THC; give me Valium, it always worked. I need antidepressants, not antipsychotics,” and so forth. His communications sounded uncannily more and more like discussions during our daily morning staff meetings. One of the oldest nurses in the ward used to say in Yiddish that our concerns for the patients had been reduced to essen, pissen, kaken und trinken (“eating, pissing, shitting and drinking”). And, indeed, staff meetings more often included a dry report of patients’ behavior and follow-up recommendations for adjustment of their medications.