Much Appreciated


Comments   |   Blog, Stress

Mr. B. believed he had made billions of dollars creating an entertainment park in Saudi Arabia.  With the money he had bought the hospital where he now resided on the inpatient psychiatric unit.  He was very distressed that we had dismantled his stem-cell research lab in the hospital cafeteria, and routinely reported to me how he could buy me an entire country if I would just unlock the doors and let his private chauffer pick him up and take him to his Cessna.

He was never violent or aggressive, although mildly irritated at our unbelievable stupidity.  Medication was not for him, as there was nothing wrong, and he had invented it anyway for the other people who needed it.  Besides, this was not really a hospital, but part of his new Hollywood project, with hidden cameras capturing his most banal moves for prosperity.  It was to be part of a ride in the Saudi Arabia Theme Park.

Lithium Citrate chemical signatureMr. B participated in the groups, kindly and sagely giving advice to the other patients how to invest their disability checks, sometimes in exchange for a “much appreciated” cigarette.  “Much Appreciated” was the catch phrase for Mr. B.  He used it as a thanks for cigarettes.  He used it to thank the attendants who opened the bathroom.  He used it when the nurse would offer him medications he would always refuse.  And when he wanted to end the session with me: “Much appreciated.”  I never knew if he was thanking me for talking with him, or for my leaving him alone.

His delusion was fully functional and intact.  He tenderly tolerated my gentle suggestion he try a medication, even asking me if I thought he was crazy.  I explained it was unlikely that he was a billionaire, to which he responded blithely how I could explain the Hollywood-like actors and actresses he had hired to play the parts of patients, or that he had just received the praise of the Sheik of Arabia who had sent him a telepathic message how much he had enjoyed the rides in the Saudi Arabia theme park built by Mr. B.

Every suggestion about starting back on his medication was met with a kind but firm dismissal.  He did not need medicine.  He was fine.  “Perhaps you need medicine, Dr. Shrand!”

One day I walked into Mr. B’s room to find him beaming and excited, almost bursting with an enjoyment I had not seen in him before.  He had taken two feathers from the Art Therapy room, the kind one would find in a pillow, small, fluffy.  One was dyed blue, the other yellow.  The yellow feather was balancing on his head, and he limited the movement of his neck and the tilt of his cranium to keep it in place throughout our conversation.   It had a curve to it, resting on his head a slightly flattened yellow arc, swaying gently back and forth.  Precarious, likely to fall off at any moment, but kept in place by the concerted effort of Mr. B.

The blue feather, a delicate piece of down, was carefully placed and stuck in the center of his forehead, like a religious marking.  It hung there, a small piece of fluff, the slight movements of his head or the surrounding air enough to nudge the insubstantial blue filaments as the ripples of flagella.  It actually was quite elegant in its simplicity.  After our customary greetings I found myself asking the obvious.

“So, what’s with the feathers?”

“Ah, Dr. Shrand.  I’m celebrating.”  He pointed to the blue feather.


“Yes. Celebrating.”  He again pointed to the blue feather, stuck somehow onto his brow.

“Celebrating what?”

“I have cracked the code.”

“The code?”

“The code.”

“What code?”

Mr. B leaned in towards me, carefully keeping his head tangential to the ground so the yellow feather stayed on his head.  His eyes did the main work, scanning around and past me to be sure no one else was spying.  This was an important and secret breakthrough.   “The Da Vinci Code”, he whispered.

“The Da Vinci code.”

“Yes.”  His body was calm and he had a facial expression seen only on those who have made a tremendous and satisfying discovery.  He carefully nodded his head slightly, to keep the feathers in place.  “I have cracked the code.  We are all connected genetically, through a secret code that only I know.  But as soon as you let me out of here, I am going to my publisher and tell the world.  We are all related.  So I’m celebrating”, and he pointed to the blue feather on his forehead.

“And the yellow feather?”

“Oh, I just like the way it looks.”


“Much appreciated, Dr. Shrand.”

Eventually I had to apply for a commitment, asking a judge to substitute his judgment for that of Mr. B.  Albeit reluctantly, Mr. B began to take his medications: Lithium, a mood stabilizer, and an antipsychotic.  His mantle of omnipotence slowly dissolved.


Mr. B was being discharged home.  His wife had come to pick him up, take the prescriptions, hear his promises that this time would be different and he would take the medicine religiously.  He admitted that he did like the feeling of going up, that hypomanic state just before he got delusional, but he didn’t need to feel it anymore.  He was done.  He shook my hand before he walked out the now opened locked door.

“Much appreciated, Dr. Shrand.”

“I’m God.”

Mr. B sat in front of me robed in a hospital Johnny, unkempt and unshaved, his hair a bramble.  It had been almost six months since he had been admitted.  This time he had been pulled over by a police car after he was seen careening off a steel barrier that separated the State Highway.  Mr. B. had been driving over 80 miles an hour with his eyes closed.

He got up to pace the floor, then would sit down and fidget, his body a mirror of the thoughts that raced in his mind.

“What happened?” I asked?  “Driving with your eyes closed at 80?  What were you thinking?”

Alternating between sitting, standing, and pacing adorned in his hospital Johnny he simply said, “I’m God.”


“I’m God.”

I knew if I challenged this delusion I would be incorporated into it somehow.  Instead, I found myself saying, “God!  That’s an enormous responsibility isn’t it?”

His voice a-breath with a sense of overwhelming appreciation Mr. B. looked at me and said, “It is!  I can’t stand it anymore. I have to go back on my Lithium!”

“Let’s do it.”  I said.  He paused.  As if relieved of an enormous burden he put out his hand to shake mine.  “Much appreciated, Dr. Shrand.”