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  First, Do No Harm

She wanted help. Instead, she got a prescription and an addiction.

by "Tory"

Editor's Note: The following is a first-person account of depression, addiction and treatment written under a pseudonym by a local social worker, "Tory." All names of people in the story have been changed, as have a few descriptions of vehicles. Other than that, Tory's story is reported as she experienced it. It is not intended as a comprehensive study of local mental health treatment or professionals, but as one individual's experience with them. We are publishing it because it is a compelling narrative told from a perspective that is not often aired, and we hope it will provide some insight into the complexities of dealing with mental illness and addiction, both for patients and practitioners.

Hello, my name is Tory and I am an addict. This story is dedicated to my psychiatrist and to all the doctors and psychiatrists in Knoxville who dole out pain pills and benzodiazipines (better known as valium and xanax) like candy to recovering addicts—or to anyone, for that matter. I don't have to tell you who you are. You already know.

After having been a crack addict in New York City many years ago I had been clean and living a semi-normal, middle-class life for 15 years. I have a modest house in a lower middle-class Knoxville neighborhood with hanging plants and a green, antique rocking chair on the porch. Inside my house there are many books, an upright piano, vases of flowers, a floral couch from the 1920s, and a lot of ragged antiques and dresser scarves I picked up at Menagerie, my favorite antique store on Central. I live in elegant squalor.

I have a respectable job working with mentally ill patients who cut on their arms and imagine they are being watched by extraterrestrials. My favorite patient thinks he is God when he is in his manic phase: "If I'm not Jesus Christ, may God strike me dead right here and now," he says, as he hikes his pants way up above his waist.

Up until a few months ago I enjoyed my life. Having lived in the center of a volcano in New York for many years, I was content to stay home with my cats, read books, and write a few bad poems from time to time. I no longer craved excitement or danger and stopped being attracted to men in handcuffs. I attended Mass each Sunday, though I was not Catholic, and attended AA meetings regularly. It was enough.

In February I began seeing my dead friends again, those who had died within six months of each other in the past year. I was sure I saw my friend, Fred, who died of lung cancer, driving his Ford down Broadway. Or I'd see my scrappy little friend Tony with the orange hair, who died of an allergic reaction to the drugs they gave him at a local treatment center, sitting on the steps of the mission waving merrily at me. Lisa, who died of Chrohn's disease after months of merciless, unending pain, I didn't so much see but feel next to me on the piano bench as I played the one Bach toccata that I know over and over. She often warned me of danger or urged me on to some happy event that I might have foregone without her advice. Of course, I knew these sightings of my dead friends were not real, but then again, you can never be so sure.

In February I became a patient myself. I began to go for days without sleep, suffered deep depression and wrenching anxiety. In vain, I called my old psychiatrist, who refused to see me because I had missed two appointments. Nor would he refer me to another doctor. (In my experience, psychiatrists are not known for compassion, and for all the time they spend with you, you might as well go through a drive-through window, get your latest diagnosis and prescriptions, and hurry on your way.) I called a few other psychiatrists listed in my insurance handbook. They could see me in June. Well, if I could go for four months without a psychiatrist then I probably didn't need one.

I asked if I could be put on a waiting list in case someone canceled or died.

"We don't do that," the secretary said. "Call Mobile Crisis if you are feeling suicidal."

Though I was getting stranger and stranger, and more and more depressed, I was still looking pretty good on the outside. I dressed meticulously, I kept my car clean and shining, arrived at work on time and left late. My mentally disturbed clients began to seem more and more normal to me. Maybe extraterrestrials really were watching us. To tell you the truth, I have often wondered the same thing myself.

I became obsessed to the point of madness with death and the seeming meaninglessness of life. I was confirmed in the Catholic church and began going to mass every day, as much for the beauty and art of the service as for any spiritual solace I found there.

I started stealing flowers out of rich people's yards and delivering them in beautiful, old vases in the middle of the night to my friends. When I got home I dug out my own garden, shovelful by shovelful, so that, from a distance, it looked like a large mass grave. It is, in fact, a garden planted in memory of my dead friends and is full of zinnias, sunflowers, lavender, and all manner of herbs. The last thing Fred said to me was, "When I get out of this hospital I'm going to get a little house, plant a garden, and maybe run a little hot-dog stand." He never got out of the hospital.

I knew I was in trouble when I began picking up cigarette butts off the street and from out of the ashtrays in front of Kroger's and Walgreen's. (Wal-Mart on Clinton Highway has the best butts. They are almost like new.) After picking up cigarette butts from the Wal-Mart, I'd stop along the interstate and pick armloads of red poppies planted in memory of the veterans. These I kept for myself, and there were red poppies all over my house, along with lit candles of all sizes and shapes, statues of the Virgin Mary and Archangel Michael. A little more detail and it could have been a Catholic shrine.

I began going out to visit clients in the middle of the night, in the projects, in Lonsdale. I held their hands and listened to their delusions. I listened to their friends' delusions. Suddenly, I myself, like my favorite patient, was God.

After days and nights of picking and delivering flowers, smoking other people's cigarette butts, and knocking on other people's doors in the middle of the night whether I knew them or not, and nights of no sleep, I ended up in a local hospital emergency room. After about six hours a social worker interviewed me. I have little respect for most social workers, particularly those connected with the mental health corporation in Knoxville that seems to own everything connected to mental health in this city, but this one was astute and asked all the right questions. As I answered and watched her scribbling and nodding, I diagnosed myself: "You think I'm bi-polar, don't you?"

"I do," she answered, and referred me to a local hospital program, which is actually quite good as far as those things go. Ever the social worker, by the time I was there 10 minutes I knew what everyone's diagnosis was, what meds they were on, who their doctor was, and was arranging for them all to go back to college and get their degrees.

Almost every patient except for myself had tried to kill themselves at least once, and most had cuts on their arms from self-mutilation. About 75 percent of them had been diagnosed as having multiple personality disorder, now called dissociative identity disorder. Since this is supposed to be a rare disorder, I figured that must be the fashionable diagnosis of the day, like attention deficit disorder is for kids. One man, who spoke very slowly and deliberately, told me that we were very lucky because "they used to lock people like us up." A woman with red hair and a pale face was so over-medicated she couldn't move her head to either side, and I wondered why no one else could see this but me. It should have been a red flag. It turned out that her doctor was also my doctor.

Finally I got to meet the psychiatrist. He had white hair, glasses, and a bored expression and looked better suited to being an accountant or an insurance salesman than someone who listened to the anguished tales of others. He looked at his watch as soon as I entered the room.

"In a hurry?" I asked him.

"It's OK," he said, and then asked me a few perfunctory questions and diagnosed me again as bi-polar, Type I. He did not look at me once and did not spend more than five minutes with me. He wrote out my prescriptions: depacote, celexa, and 60 xanax, with two refills. I had already told him clearly that I was a recovering addict and I reminded him again, as xanax is one of the most addictive drugs on the market, and many people have to be hospitalized to get off of it. I'd never had much experience with downs, as I was strictly a speed girl—cocaine, amphetamines, crystal meth.

Giving an addict access to 180 xanax and telling her to take it as prescribed is like setting a three-year-old out by the side of the road and telling him to have fun but not to get in front of any cars.

I will admit that it was great to sleep again, and I did pretty good for awhile. Half a pill at breakfast, half at lunch, and a whole one at bedtime. The doctor had excused me from work for one month, with pay, and for several days life was good. Very good. I felt safe with a bottle of little green pills in my purse. Whatever happened, I could handle it.

I continued planting my garden, stopped writing bad checks, took my xanax as prescribed and was as peaceful as a new moon above a country road. Xanax was pretty cool. I could handle it. My anxiety had vanished, and so had my dead friends. I didn't bother to take the depacote or celexa after awhile. Xanax was the wonder drug of the world and I was a happy, anxiety-free person. I was in control and all was well.

After a while I started chipping off tiny pieces as I drove down the interstate. If someone pulled in front of me I'd chip off a little piece. If the light didn't change soon enough, another little chip. Chip, chip, chip, chip, chip. Sometimes I'd think about death again and I'd take a whole xanax in between prescribed doses, then two. Everyone who has ever been an addict knows the old story. Once you're a junkie, you're always a junkie, recovering or not. No matter how many years or decades of clean time you have, once you get the drug in your system, you can't get enough of it.

At my next appointment I told the doctor I was getting addicted to xanax. "You'll be all right if you just take it like it's prescribed."

"I'm not," I explained. "I chip away at it all day, whenever I have a negative thought, when someone gives me a dirty look, or just because I feel like it."

"It sounds like you're doing fine." Without looking up, he blithely wrote me a script for 60 more xanax and two refills. Not surprisingly, I ran out two weeks early, and the pharmacist told me I could not get my prescription filled for two more weeks without my doctor's permission. I called him up. I was going to Europe for two weeks, I said. Could he approve my prescription early? Of course, he replied.

The next time I ran out I told him I was addicted and needed just enough to get me through until my next doctor's appointment. A different doctor, I might add. Going to a doctor to get help for depression and anxiety, I had come out a junkie again in full swing. He called in a prescription for 10 xanax, to last six days, and, surprise, surprise, within a day and a half it was gone and I was out. OUT.

If you've never been a junkie you can't imagine the panic that comes when you realize you are out of your fix and the craving sets in. The paranoia. The trembling. The hopelessness that fills your whole being, body, mind and soul. You know if you go beyond the craving, the withdrawal will pass, but at the time you think you will feel this way for all eternity and all you can think of is getting something to get rid of that feeling. It becomes your whole focus, and you will do anything to stop the craving and misery. Nothing, nothing else matters.

On Saturday morning I drove my car behind the Fifth Ave. Motel and parked in front of the mission. For those of you who lead sheltered lives, the Fifth Ave. Motel is a residence inhabited by crack addicts, heroin addicts, and alcoholics, among others. Naturally, my brand new red Honda civic drew a lot of attention, though I was dressed in ill-fitting clothes, having lost 15 pounds, and hadn't had a shower for three days.

A tall black man with his head shaved jumped out of a truck parked alongside of me, flailing his arms in the air. In his left hand was a hypodermic needle filled with a thick white liquid. "Get away from me," I screamed. In all my days, I never shot up. I don't know how I escaped it, but I did.

Actually, he was a gentleman in his own way, and apologized profusely for scaring me. "I just want a xanax," I said, like I was asking for a glass of water. I met a very nice woman named Nancy, dressed in a blue and white gingham shirt and a pink tank top, who told me she would try to find me some.

"You're not a narc?" she asked.

I told her that no, I was not a narc, just a junkie. Though she swayed dangerously as she walked, she went to considerable trouble to try and find me either some xanax or valium. "Hooty-hoo," she called up to the upper windows, and heads started popping out. No luck. Clearly this was not a place for such a yuppie drug. People ducked into dark rooms, tying up their arms to shoot up or lighting up pipes to get a hit of crack.

I hooked up with a guy named Sammy, with thick glasses and a disarming smile. He could get me xanax but first I would have to drive him to Austin Homes where he would buy crack with 10 dollars, sell it, then get my xanax. I was desperate and willing to try anything. After we got the crack with 10 dollars, I made him smoke it outside the car. I would rather be stung by a scorpion than get back into that again. Then we went back to the Fifth Ave. Motel and he disappeared into the crowd. Susan, a very clean-cut young girl with sincere-looking blue eyes, asked me what I was looking for.

"Xanax," I said.

"No problem," she said. "I know where we can get some." She asked me for my cash. Sammy took my cash.

"That was a big mistake," she said. "You'll never see it again."

"Wait for me here. I'll go get more money," I said. There's an old saying around recovery rooms that the only time an addict lies is when he opens his mouth. This is true. I went to my sister's, told her my check hadn't come yet and asked for $25. Then I went to a friend's and got another $25, telling him the same story. Surely I could get a few xanax for $50.

I picked up Susan and her boyfriend and we headed over to Walter P. Taylor projects.

"How much will they be?" I asked.

"Five dollars apiece," she said, blinking her blue eyes at me innocently, but that stupid I'm not.

"I'll give you three," I told her. "But I have to get the xanax before I give you the money." Actually, at that point I would have given her the whole 50 dollars for one, but I wasn't going to tell her that.

"That's not how it works, baby," she said. "You have to trust me." Again the blue eyes. She went over to a guy with long braids sitting on the lawn and chats briefly. "OK," she said, "You can have them for three."

She went upstairs and I waited. And waited and waited. Susan's boyfriend started to get out of the car but I told him sternly: "You're not going anywhere until she gets back." He stayed put. What did he think, that I, at 105 pounds, was going to take him out?"

At last Susan came back, minus the xanax, and also minus my $25. What a jerk, I said to myself. After 15 years I had lost all my street savvy.

"Give her the money," she said to her boyfriend. He obviously didn't know what she was talking about. It was over. I'd been had. I thought about driving them to Oliver Springs or some equally unsavory place and setting them out, but instead I took them back to the Fifth Ave. Motel, where, astonishingly, Sammy came over to the car with my $10 still in his hand. There's something I like about Sammy. He still hadn't scored me any xanax but he hadn't ripped me off either.

"Listen, girl," he said. "You don't change paddles in the middle of the stream. You just don't do that."

We traveled back to Austin Homes and back a few more times and he finally scored me five pink xanax. All in all I had spent six hours on and off with Sammy just to get five weak xanax. It's rare to find an honorable junkie, but Sammy came through for me as best he could. If I had been smart I would have rationed those xanax out for the next two days, when I could be seeing a new doctor, but addicts are not too smart when it comes to rationing. After a few minutes, when I was feeling warm and fuzzy and calm, I saw Susan, sitting on the steps next to a tall girl with shoe-polish black hair and the numbers 666 tattooed across her forehead. I asked Susan for a cigarette. She gave me one. By then I was sufficiently high to be wondrously caring and kind.

"Even though you ripped me off, " I told her, "I understand, because I know you just needed your fix."

Her blue eyes teared up. "I didn't used to be like this. It's only since DCS took my little girl away from me."

By then a small crowd had gathered on the sidewalk. Susan and I embraced and they all applauded. One man told me what a great woman I was. I was thinking pretty much the same thing myself, you know, what a great forgiving person I was. That's how you think when you're high.

Sammy took me into a room where about 15 people were either sitting around nodding, or in the kitchen getting hits of crack out of a pipe. I caught a glimpse of myself in the full-length mirror, ghostly and unreal, and was appalled. Surely this could not be me, this forty-something woman with the fading blonde hair and emaciated body.

I flashed back to a room on Charles Street in New York, where everyone was sitting around smoking ounces and ounces of cocaine, good cocaine, and drinking cases of Spanish champagne, listening to Marvin Gaye. Though we had more money, and it was another time and place, it was not that different. It was bitter winter and there was a heavy woolen quilt over the broken window and a fire lit the fireplace of the one-room apartment. I weighed 85 pounds and was near death. People rang the raucous buzzer all day and night until finally it got stuck and never stopped its buzzing...

Finally it was midnight at the Fifth Ave. and I gave up for the night. Police were everywhere and my new car stood out like a Christmas tree. I went home and lay on the bed as straight as a board, a blanket over my head, trying to keep the wires in my arms from popping out, waiting for the anxiety to subside. In a kind of epiphany, I realized that all I wanted was what I already had. My little house, my animals and books, my graveyard-like garden and peace of mind.

The next day, Father's Day, I went to cop one last time. (Though my father is very ill, I was too ashamed and wired to go home.) I walked around. An elderly woman wandered around the parking lot. I asked her how she was. "I don't know," she told me. In front of the door of one apartment a printed sign read: "Do not enter under any circumstances." On a door was a sticker from the "700 Club." "Find hope through Jesus." In a second-floor window were red and yellow plastic flowers. Beauty in the midst of despair. There's hope in that.

Since Sammy was not there I went with another complete stranger to Lonsdale. Jamal, who wore a black Yankees cap backwards over his frizzy hair and baggy pants, was sure he could get xanax there. "Pull over and turn your lights off," he told me when we got there. There were a lot of cars parked in front of a forlorn-looking house on one side and an empty lot on the other. It was very dark.

An evil-looking man, who looked like he would sooner stab me in the eye with a needle than give me anything, came over and handed me a plastic bag, grabbing the bill in my hand. He walked rapidly away, and when I looked in the plastic bag it was empty. That was okay—instead of the 10 dollars he thought he was getting, I had given him a dollar. I was beginning to understand drive-by-shootings. You give them your last dime and you still don't get any relief and you really do feel like shooting someone. I didn't see Jamal so I went on home and lay awake all night praying for sleep.

The next morning I was so shaky I could not drive, but a friend brought me one xanax so I could get to my new psychiatrist's office. He is a good man, an old soul who sees through all the disguises I have acquired in order to survive in the various worlds I have inhabited. He listened to me for one hour and looked at me while I talked. He gave me a prescription for three different doses of tranxene—the withdrawal is less severe from tranxene. When I got off it, I experienced violent stomach cramps and nausea for four days. That went away. The disorientation is still there, though. Everything is distorted, and at first this distortion made me very, very afraid that I was really losing my mind.

Everything seems to be bathed in a golden light, as if transcendent. My psychiatrist calls this altered state of mind "sensory misperception." He said zyprexa would diminish the paranoia, but it did not. I have adapted myself to it, and it's not all bad, just strange. When it rains, I hear each drop of rain separately, in a cacophony of sound. When the wind blows, I feel the breeze intensely, as part of me, and it is quite beautiful. Colors are brighter, I notice every flower. I smell the wet earth and evergreen trees as though my face were pressed against them. Perhaps I am seeing things the way they are for the first time. It's a little like taking mushrooms.

It's only when I'm at work and around other people that it is distressing. I can't understand what people are saying, their voices are so far away. At night, I hear my name being called from a great distance, as though my soul were calling me back to it. I don't know if this state of mind will last. Like I said, it's not all bad, just different.

It has been five weeks since I had my last xanax. My garden no longer looks like a graveyard. Red, yellow, orange and pink zinnias are popping up everywhere. I am back at work and little changed except that now I am driving a gray 1988 Subaru that I actually like. And I have a doctor I can trust. Maybe with time we'll find a medicine that will make me feel better. Or I'll just feel better. Period.

I have anxiety again and am depressed, but perhaps that will pass. I have fleeting thoughts about how good it would feel to have a xanax, but I banish them immediately. I take my share of the responsibility for getting addicted again. I knew better. But so did my doctor. If I were to see him again, I would walk past him as if he didn't exist, but I am giving him the message now. Remember the line attributed to Hippocrates: "First, do no harm."

Every day on my way to work I pass the Fifth Ave. Motel and the residents wave at me as if we were old friends. One day Sammy ran after my car as if to get a ride. I wanted to give him one but knew I could not. I whispered a prayer instead. I said a prayer for all the addicts of the world. It takes courage to live that way. It takes courage not to.

Today as I watch the six o'clock news I hear that two people have been shot in Lonsdale in the middle of the afternoon inside their car. They were shot on McPherson St., the same street where I was buying an empty bad plastic bag one week ago with Jamal. The driver, a woman, was shot in the head, her male companion in the leg. I will hear on the 11 o'clock news that she has died. A cool breeze blows through the curtains and I wrap my arms around myself. My animals gathered around me sleeping, my Virgin Marys and my candles. I shiver, as though the Angel of Death has entered the room, and think of the words of J.P. Donleavy at the end of The Beastly Beatitudes of Balthazar B.: "It doth give one pause."

August 9, 2001 * Vol. 11, No. 32
© 2001 Metro Pulse