Being Locked-In May Not Be So Bad For Everybody

I Am A Doctor, But I Don’t Play One On TV

Personality-wise, the cranky and inconsiderate title character of the hit TV series House, MD are mirror opposites.  I actually LIKE people – especially people who need help (patients).

Obviously many people enjoy this series, since it is one of the highest rated. But for me, the challenge is to out-diagnose him.

In case you’ve never watched, the formula for each episode is a seemingly straight-forward illness, which (of course) is the wrong diagnosis.  The rest of the show is slapping another diagnosis on the patient, and testing the patient, which makes the patient worse. 

At a predictable spot in each episode (timed to be a cliff-hanger right before commercial break) the patient goes into cardiac or respiratory arrest – or at least major convulsions – and is snatched back from the jaws of death.

By the end of the episode, a dozen diagnoses have been treated and found to be wrong – but eventually, the correct diagnosis is realized and treated and there is usually a happy ending.

And – I’m sure – an astronomical hotel bill for all the procedures tried.

I highly recommend it – if you are into the medical thrillers and cranky old doctors.

The Marvel And Tragedy Of Asperger’s

Someone raised the question of whether the socially-avoidant Dr. Gregory House had Asperger’s syndrome — but I do not think so.  

This is a high-functioning form of autism in which someone is basically asocial–has no understanding of social interactions and skills and keeps doing things in a “wrong” or not socially acceptable way.  

People who have this can be intellectually brilliant in a field.  When I am trying to narrow in on the diagnosis, I often tell people to check out a movie called “Shine,” about a musical genius whose mom toured with him and who had a decent career as a concert pianist, even though he was often criticized for the lack of emotional expression in his playing.

Or another movie called “The Luzhin Defence” about a chess master who seems to have had Asperger’s, too.

I’m sure your favorite video rental service has both of these great movies available.

Asperger’s is the condition they used to call “Idiot Savant” — a term lost in a world where neither of its two constituent terms is particularly viewed as socially acceptable. However, I believe that both my father and brother of blessed memories had some aspects of this syndrome.  Neither one seems to have ever really understood their social context, and got some difficult feelings from such situations.

Dr. Gregory House does not have Asperger’s syndrome.  We do not see him crying in a corner, wondering what is going on to make people react to him the way they do.  We see him more as a provocateur, someone who seems to almost perversely enjoy the social havoc that he seems able to create.  

In psychiatric terms, this is a “personality disorder,” although the good Dr. Cuddy prefers to describe him as a “jerk.”  (Also an accurate diagnosis in this case).

I believe there are some moments when he is on his motorcycle speeding out of sight that he is actually happy.

The Importance Of Functioning Socially

The reason I thought of Dr. Gregory House at all is that he said on an early episode of the show, where he kept begging for the blood-stained carpet in his office to be reinstated, that his idea of happiness was to be free of social obligations.

So I thought immediately that while everyone I know in psychiatry including me at least raises the question about social function being an integral part — yea, a necessity — for mental health, maybe it isn’t.

I remember a recent study showing that most people who had serious and persistent mental illness would rather have their own rooms than be in a communal setting.  

Maybe we need to face the fact that social interaction can be a serious double edged sword. That it can make people miserable at least as easily as it can be comforting.

I remember vividly the time that my father of blessed memory, bedridden in a nursing home where he would live out his days (in a private room) told me that was the best part of his life. I had been demanding as daughters go, always needing something. There had always been stress in the family, with everyone needing something, and he said that had always been tough. Now, as he lay flat on his bed (even getting bedsores because he did not much want to be turned) people waited on him hand and foot, and the cook made him special dishes and fed him, and everyone loved and respected him.

Now he did have at least some Asperger’s traits but he was speaking truth.

The Cruelest Medical Prison

So I’m not surprised that some recent research says that a fair amount of people with locked in syndrome are happy. The first time I saw this syndrome it was a result of stroke, and there was a young woman lying in a neurology ward in an out-of-the-way hospital in France.  

She would go to a rehabilitation facility, this woman who was in her 40’s with some kind of wild and crazy blood pressure that had caused her to bleed into her brainstem.  She was sentient and heard and understood what happened by her bed, but she could only respond by blinking her eyes to signal “YES” or “NO.”

Me, I went home and cried that night — something I do not think grownup doctors are supposed to do, but I thought it the cruelest (medical) prison I had ever seen. I knew prognosis was limited. Maybe someday she would be able to do more, maybe someday talk a little.

Is It Possible To Be Happy In Such Condition?

Now I read this piece of research and I feel as if an old, sad ghost, has suddenly awoken and smiled at me. Now, I think, if she can be happy she certainly deserves it. But what does this mean?

First, I think that it means that a certain amount of happiness can be achieved by simply unhitching from the social “obligations” and “responsibilities” that people take for granted. My father of blessed memory was sincere in his professions of happiness in his final days.

I can barely imagine how many family and work pressures can be escaped from with the wordless assertion “sorry, all I can do is lie here.” It is an easier assertion than family or work related confrontation. It is as simple as a child getting a sick day from school.

I am not talking any high-falutin’ concepts such as morally right or wrong. I am talking instant relief — the joy of playing hookey from obligations that I know damned well persists into adulthood, but without the faint scent of guilt that persists in such circumstances.

It has often been suggested that one of the greatest human powers is the ability to disconnect from the opinions of others. My husband certainly reinforces me in this regard – especially in some of my entrepreneurial enterprises.

We all have our heroes — one of mine is Richard Feynman, the 1965 Nobel Prize-winning renegade physicist who explained the most abstract concepts in the most accessible ways. One of the books about this “curious character” is appropriately titled “What do you care what other people think?”  

This is a status to which the truly original mind must aspire. Me, I’m still working on it, with help from my husband. If I am getting there, telling you the “truth” and the “light,” then my husband’s support is working.

I am wondering now, for the first time, if the virtually-complete social disconnect of “locked in syndrome” is not a way to get rid of all sense of social obligation in favor of a free-flying of the soul, which can bring happiness.