The Moon and the Mind

THE MOON AND THE MIND

  They say the crevasses of the mind expand with a full moon.  Tiny fissures that snake through the cerebral cortex in all of us widen and grow with the pull of the tides. For many, this just creates a widened arena for the boundless joy and wonder they feel when gazing into the bright night sky. But for some, these growing, empty spaces in the brain are ripe for contamination by the world’s tilted, irrelevant logic or just provide fertile ground for the seed of disarrayed thoughts planted through childhood trauma or genetics. For a host of tortured souls, the passage into psychosis or depression is finally complete when the moon swells into its fullest, luminous grandeur.  

  I see this transformation every month. Those unfamiliar with the mental health field often scoff at the notion that more disturbed and off-balanced people walk in or are brought to hospital emergency rooms during a full moon. But those of us directly connected to the repercussions of mental illness know full well that the gravitational pull of the moon dictates the direction of the psyche as well as how busy we will be on that particular night.

  So, I was prepared to be swamped when I began my shift that evening. I tried to push down my own problems so I could focus on the needs of others. I refused to think about David and the affair I suspected he was having. I was determined to ignore my panic at the thought of being left alone to raise our hyperactive son. I didn’t want to dwell on our dwindling bank account and the looming credit card bill. I needed to be in tune with the suffering of those around me and not myself. 

  My job was to provide assessment for those arriving in our town’s emergency room suspected of being mentally ill.  The criteria for my assessment of the need for hospitalization were simple really. A person had to be a danger to themselves or others or be unable to care for themselves due to a mental illness. If they were capable of acknowledging that they needed treatment and agreed to be admitted, they could come into the psych unit voluntarily. But if they refused needed treatment and met the above criteria, they would forfeit their rights and be involuntarily hospitalized until further assessment and a court hearing. 

  On paper, the job looks relatively easy. Cut and dry. Black and white, as they say. But what they don’t tell you in grad school or the training the community mental health system provides is that people’s minds and lives are complicated.  Very complicated. And the job gets even more difficult with a full moon. All those fissures are expanding in the brains of both the assessed and the assessor, just like the tides.  I could almost feel my own cerebral gaps exploding as the police brought in my first patient. 

  Mr. H., forty-five years old, was picked up by police as he was trying to climb over the rail of a bridge. It might seem coincidental that officers just happened to be patrolling in the area just as Mr. H. had made up his mind to jump. But, when the moon is full, I don’t believe there are any coincidences. It’s like the whole universe expands, including the symmetry and purpose of our actions. Mr. H. was in tears when I met with him.  His girlfriend had left him, he had recently had a serious accident in the company truck, causing him to lose both his job and his commercial driver’s license, and he was being evicted from his apartment. Ending his life was the only way he saw to get through this tragic phase of his life. 

  As I tried to reassure Mr. H. that his life had the potential to improve, the words caught in my throat, and I had to step aside and take several deep breaths. A thought had arisen and lingered briefly inside my brain and gut—that I didn’t know if I possessed the strength to face my own problems head on. A sickening feeling of gloom came over me. I was wavering with indecision for both Mr. H. and myself. Mr. H. had every reason to feel desperate, but he saw no hope in any kind of treatment. I wondered if being involuntarily sucked into the inpatient system would destroy any remaining sense of autonomy and damage him further.  I tried to detach myself, as I usually did, so that I did not get pulled into the spiraling tragedies of others. But gravitational forces are always stronger for everyone at this time of the month.

  Ms. W. was a thirty-three-year-old homeless woman whom I had seen many times. Her family had kicked her out of the temporary housing they had previously provided for her because she kept neighbors up all night with her rantings about the devil. She was convinced that Satan had taken up residence into her intestines and was causing her to vacillate between constipation and diarrhea. She walked into the emergency room that night, like she had so many other times, requesting medical intervention to remove Satan for his lodging in her bowels. “Just stick that camera you guys have down my throat or up my ass and you’re bound to see him,” she screamed. “Then you can scrape him out.” Reassurance by the doctors that there was nothing medically wrong with her did no good. As ridiculous as Ms. W. sounded, I grimaced at the thought that I too would love a magical fix that would remove my cheating husband from my life and then I could return to normal after a short convalescence to heal from the incision.  Technically, Ms. W. was not a danger to herself or others and was actually trying, in a very disturbed way, to care for herself. She would get to walk out of the hospital door that night, just like I would at the end of my shift, with nothing in our lives altered and the devil still in pursuit.

  Tommy S. was a fifteen-year-old high school sophomore brought in by his parents. He had been tortured by obsessive thoughts and compulsive solutions for the past year. He saw germs everywhere and had developed excessive rituals to combat their attacks. Nothing could be touched directly by his hands without adequate preparation. Doors were opened with gloves, food was eaten only after the utensils had just emerged from two cycles of the dishwasher, thorough handwashing occurred every thirty minutes, and he continued to wear a mask twenty-four hours a day even after the pandemic had subsided. Tommy also was convinced that he would perish if he did not get a full eight hours sleep each night and was hysterical whenever he could not fall asleep precisely at nine o’clock pm. Which obviously compounded the problem. He had been hospitalized voluntarily several times previously but still was persecuted by his fears. As I interviewed Tommy, my mind started to wander to my own fears. I was afraid of failing my son, concerned that I had become too dependent on having someone else help me get through life’s bumps, and, honestly, petrified that no one else would ever love me. Like Tommy, I saw no way to dispel these fears. Tommy would be given another chance at an easier life with his agreement to spend the next week or so in the adolescent psychiatric unit, but I would go home to my cheating husband with my fears following me like a shadow.

  Mr. A. was fifty-seven years old and floridly psychotic. I knew his history well, having assessed him multiple times previously. It was a sad story. At eight years old, he had witnessed his father kill his mother by stabbing. A young Mr. A. then watched from his bedroom door as his father retrieved the revolver from the nightstand, walked out into the hallway, and shot himself. As a young man, Mr. A. had started to hear voices chastising him for not saving his mother and slandering him as weak and impotent. He began to see blood splattered on the ground whenever he walked outside and then later coating his furniture and clothing. He had tried to protect himself from the enemies inside his head by making himself and his small, subsidized apartment as unappealing and repugnant as possible. He thought the enemy who watched him constantly and often commanded him to kill himself would be driven away by foul odors and filth. His landlord had requested that police pick him up for an assessment. 

  Mr. A. met involuntary hospitalization criteria pretty easily. He was not competent to make the decision to admit himself on a voluntary basis and clearly was not caring adequately for himself.  I suddenly realized I was chastising myself inside my own head for not making the decision to leave David as fluidly and effortlessly as my decision about Mr. A. I knew what David was doing. I had known it for a long time. All of the times he said he was on a business trip or had to work late. The unexplained charges on his credit card. His reluctance to make love. The distance in his eyes. The evidence was there even before I looked at his phone while he was sleeping one night. Her name was Abby. At least that’s what the contact for all of those calls said. Part of me wanted to take the path that Mr. A. had taken. To give up, let myself go, not care about anything at all anymore. Let the voices in my head have their way with me. Withdrawing into my own little shell seemed like the only way to get through this dark thing looming before me. This new direction in life that I never would have chosen to take. This frightening, unbalanced passage into a world that tilted and jolted like a wild carnival ride. 

  I needed to take a break. I wanted to go smoke one of the cigarettes that I had vowed to give up but succumbed to because I am weak. But the suffering souls kept coming in. One after another. Eyes glazed with fear. Voices screaming their pain. Muscles tense with debilitating anxiety. Minds confused and petrified by the commands of forces outside of their control but inside their brains. So many lives without a rudder. So many humans searching for a way to cope with life. And so much of life delivering nothing but obstacles meant to not only impede but to stop them from taking another step toward wellness.

  Finally, Ms. J. was my last client of the night. She was brought in by police close to the end of my shift after she was found walking down the middle of the highway.   I was tired. It had been a long night as the moon gazed down at the red brick hospital struggling to pull back from its mighty force waging havoc on the lives of so many. Ms. J. was a thirty-year-old mother of four children, ages two to twelve.  Four children, malleable and impressionable, who had been taken from her care because of Ms. J.’s inability to choose them over crack cocaine. She knew the pain she had caused them and wanted desperately to change her path, but the allure of the high and the physical craving of the body would not allow her. The drug was her passage to both ecstasy and destruction.   As I sat by Ms. J’s side and asked her about her intent to harm herself, I could see the pain in her eyes. She looked lost, without foundation or footing. Like she was missing an integral part of herself. Like the world no longer held a spark and the only way to cope was to go numb by any means possible. I sighed. Numbing sounded good right now. There was a bottle of wine waiting on my counter for me when I got home. Inviting and comforting. My son would be asleep. His father likely just hanging up from talking to his new girlfriend.   I could drift away from my sharp thoughts. Mellow and dull the hard edges of my worries that suddenly seemed as jagged as broken glass. 

  We all have our own way of coping with life’s traumatic passages. Some turn inward and retreat from the world, some maintain constant vigilance to ward off the enemy, some scream out their angst inside their bodies, and others anesthetize the pain. Some want to just pull the whole curtain down.  I don’t know if Ms. J. will be able to get her kids back after she is discharged from the rehab center I arranged for her. Both Ms. W. and Mr. A. will likely keep their distance from the realities of this world. Mr. H. may bounce back if he’s lucky. And I hope Tommy finally finds some peace from the anxious demons that torture him. He’s young, so he’s got an advantage over the others. But he has many, many more full moons to go through. So many more cycles of the push and pull of celestial forces upon the mind.  The others likely do as well.  I, too, if I’m lucky, need to prepare myself for the heaven’s impact on my world and my response to its meddling for many years to come.  The obstacle in front of me now will not go away. I don’t know which coping strategy I’ll choose, but I hope it’s one that the moon will bless.