CASE1

I just know it was a terrible mistake to come here. For the third time, Aileen Parmeter got out of her chair and walked to the window. A wiry 5 feet 2
inches, this former Marine master sergeant (she had supervised a steno pool) weighed a scant 100 pounds. Through the slats of the Venetian blinds, she
peered longingly at freedom in the parking lot below. I just dont know whatever made me come. You came because I asked you to, her clinician
explained. Your nephew called and said you were getting depressed again. Its just like last time. No, I dont think so. I was just upset, she explained
patiently. I had a little cold for a few days and couldnt play my tennis. Ill be fine if I just get back to my little apartment. Have you been hearing voices
or seeing things this time? Well, of course not. She seemed rather offended. You might as well ask if Ive been drinking. After her last hospitalization,
Aileen had been well for about 10 months. Although she had taken her medicine for only a few weeks, she had remained active until 3 weeks ago. Then
she stopped seeing her friends and wouldnt play tennis because she just didnt enjoy it. She worried constantly about her health and had been unable to
sleep. Although she didnt complain of decreased appetite, she had lost about 10 pounds. Well, who wouldnt have trouble? Ive just been too tired to get
my regular exercise. She tried to smile, but it came off crooked and forced. Miss Parmeter, what about the suicidal thoughts? I dont know what you
mean.I mean, each time youve been herelast year, and 2 years before thatyou were admitted because you tried to kill yourself. Im going to be
fine now. Just let me go home.But her therapist, whose memory was long, had ordered Aileen held for her own protection in a private room where she
could be observed one-on-one.Sleepless still at 3 A.M., Aileen got up, smiled wanly at the attendant, and went in to use the bathroom. Looping a strip she
had torn from her sweatsuit over the top of the door, she tried to hang herself. As the silence lengthened, the attendant called out softly, then tapped on the
door, then opened it and sounded the alarm. The code team responded with no time to spare.The following morning, the therapist was back at her bedside.
Why did you try to do that, Miss Parmeter?I didnt try to do anything. I must have been confused. She gingerly touched the purple bruises that ringed
her neck. This sure hurts. I know Id feel better if youd just let me go home. Aileen remained hospitalized for 10 days. Once her sore neck would allow,
she began to take her antidepressant medication again. Soon she was sleeping and eating normally, and she made a perfect score on the MMSE. She was
released to go home to her apartment and her tennis, still uncertain why everyone had made such a fuss about her.

CASE2

Elisabeth Jacks ran a catering service with her second husband, Donald, who was the main informant. At age 38, Elisabeth already had two grown children,
so Donald could understand why this pregnancy might have upset her. Even so, she had seemed unnaturally sad. From about her fourth month, she spent
much of each day in bed, not arising until afternoon, when she began to feel a little less tired. Her appetite, voracious during her first trimester, fell off, so
that by the time of delivery she was several pounds lighter than usual for a full-term pregnancy. She had to give up keeping the household and business
accounts, because she couldnt focus her attention long enough to add a column of figures. Still, the only time Donald became really alarmed was one
evening at the beginning of Elisabeths ninth month, when she told him that she had been thinking for days that she wouldnt survive childbirth and he
would have to rear the baby without her. Youll both be better off without me, anyway, she had said. After their son was born, Elisabeths mood
brightened almost at once. The crying spells and the hours of rumination disappeared; briefly, she seemed almost her normal self. Late one Friday night,
however, when the baby was 3 weeks old, Donald returned from catering a banquet to find Elisabeth wearing only bra and panties and icing a cake. Two
other just-iced cakes were lined up on the counter, and the kitchen was littered with dirty pots and pans. She said shed made one for each of us, and she
wanted to party, Donald told the clinician. I started to change the babyhe was howling in his basketbut she wanted to drag me off to the bedroom.
She said Please, sweetie, its been a long time. I mean, even if I hadnt been dead tired, who could concentrate with the baby crying like that? All the
next day, Elisabeth was out with girlfriends, leaving Donald home with the baby. On Sunday she spent nearly $300 for Christmas presents at an April

garage sale. She seemed to have boundless energy, sleeping only 2 or 3 hours a night before arising, rested and ready to go. On Monday she decided to
open a bakery; by telephone, she tried to charge over $1,600 worth of kitchen supplies to their Visa card. Shed have done the same the next day, but she
talked so fast that the person she called couldnt understand her. In frustration, she slammed the phone down. Elisabeths behavior became so erratic that
for the next two evenings Donald stayed off work to care for the baby, but his presence only seemed to provoke her sexual demands. Then there was the
marijuana. Before Elisabeth became pregnant, she would have an occasional toke (she called it her herbs). During the past week, not all the smells in the
house had been fresh-baked cake, so Donald thought she might be at it again. Yesterday Elisabeth had shaken him awake at 5 A.M. and announced, I am
becoming God. That was when he had made the appointment to bring her for an evaluation. Elisabeth herself could hardly sit still during the interview. In
a burst of speech, she described her renewed energy and plans for the bakery. She volunteered that she had never felt better in her life. In rapid succession
she then described her mood (ecstatic), how it made her feel when she put on her best silk dress (sexy), where she had purchased the dress, how old she
had been when she bought it, and to whom she was married at the time.

CASE3

Im a writer, said Iris McMaster. It was her first visit to the interviewers office, and she wanted to smoke. She fiddled with a cigarette but didnt seem to
know what to do with it. Its what I do for a living. I should be home doing it nowits my life. Maybe Im the finest creative writer since Dostoevsky.
But my friend Charlene said I should come in, so Ive taken time away from working on my play and my comic novel, and here I am. She finally put the
cigarette back into the pack. Why did Charlene think you should come? She thinks Im high. Of course Im high. Im always high when Im in my
creative phase. Only she thinks Im too nervous. Iris was slender and of average height; she wore a bright pink spring outfit. She looked longingly at her
pack of cigarettes. God, I need one of those. Her speech could always be interrupted, but it was salted with bon mots, neat turns of phrase, and original
similes. But Iris was also able to give a coherent history. At 45, she was married to an engineer and had a daughter who was nearly 18. And she really was a
writer, who over the last several years had sold (mainly to womens maga- zines) articles about a variety of subjects. For 3 or 4 months Iris had been in one
of her high phases, cranking out an enor- mous volume of essays on wide-ranging topics. Her wired feeling was uncomfortable in a way, but it hadnt
troubled her because she felt so productive. Whenever she was creating, she didnt need much sleep. A 2-hour nap would leave her rested and ready for
another 10 hours at her computer. At those times, her husband would fix his own meals and kid her about having a one-track mind. Iris never ate much
during her high phases, so she lost weight. But she didnt get herself into trouble: no sexual indiscretions, no excessive spending (Im always too busy to
shop). And she volunteered that she had never seen visions, heard voices, or had funny ideas about people following me around. She had never spent
time in the funny farm. As Iris paused to gather her thoughts, her fingers clutched the cigarette package. She shook her head almost imperceptibly.
Without uttering another word, she grabbed her purse, arose from the chair, and swooped out the door. It was the last the inter- viewer saw of her for a year

and a half. In November of the following year, a person announcing herself as Iris McMaster dropped into that same office chair. She seemed like an
impostor. Shed gained 30 or 40 pounds, which she had stuffed into polyester slacks and a bulky knit sweater. As I was saying, were the first words she
uttered. Just for a second, the corners of her mouth twitched up. But for the rest of the hour she soberly talked about her latest problem: writers block.
About a year ago, she had finished her play and was well into her comic novel when the muse deserted her. For months now, she had been arising around
lunchtime and spending long afternoons staring at her computer. Sometimes I dont even turn it on! she said. She couldnt focus her thinking to create
anything that seemed worth clicking on save. Most nights she tumbled into bed at 9. She felt tired and heavy, as though her legs were made of bricks.
Its cheesecake, actually, was how Iris described her weight gain. I have it delivered. For months I havent been interested enough to cook for myself.
She hadnt been suicidal, but the only time she felt much better was when Charlene took her out to lunch. Then she ate and made conversation pretty much
as she used to. Ive done that quite a lot recently, as anyone can see. Once she returned home, the depression flooded back. Finally, Iris apologized for
walking out a year and a half earlier. I didnt think I was the least bit sick, she said, and all I really wanted to do was get back to my computer and get
your character on paper!

CASE4

Im a yo-yo!Without her feathers and sequins, Honey Bare looked anything but provocative. She had begun life as Melissa Schwartz, but she loved using
her stage name. The stage in question was Hoofers, one of the bump-and-grind joints that thrived near the water- front. The billboard proclaimed that it
was Only a Heartthrob Away from the Navy recruiting station. Since shed dropped out of college 4 years earlier, Honey had been a front-liner in the
four-girl show at Hoofers. Every afternoon on her way to work she passed right by the mental health clinic, but this was her first visit inside. In our
current gig, I play the Statue of Liberty. I receive the tired, the poor, and the huddled masses. Then I take off my robes. Is that a problem? the
interviewer wanted to know. Most of the time, it wasnt. Honey liked her little corner of show biz. When the fleet was in, she played to thunderous
applause. In fact, I enjoy just about everything I do. I dont drink much, and I never do drugs, but I go to parties. I sing in our church choir, go to movies
I enjoy art films quite a bit. When she felt well, she slept little, talked a lot, started a hundred projects, and even finished some of them. Im really a
happy personwhen Im feeling up. But every couple of months, thered be a week or two when Honey didnt enjoy much of anything. Shed paste a
smile on her face and go to work, but when the curtain rang down, the smile came off with her makeup. She was never suicidal, and her sleep and appetite
didnt suffer; her energy and concentration were normal. But it was as if all the fizz had gone out of her ginger ale. She could see no obvious cause for her
mood swings, which had been going on for years. She could count on the fingers of both hands the number of weeks she had been just normal. Lately,
Honey had acquired a boyfrienda chief petty officer who wanted to marry her. He said he loved her because she was so vivacious and enthusiastic, but
he had only seen her when she was bubbly. Always before, when she was depressed, he had been out to sea. Now he had written that he was being
transferred to shore duty, and she feared it would be the end of their relationship. As she said it, two large tears trickled through the mascara and down her
cheeks. Four months and several visits later, Honey was back, wearing a smile. The lithium carbonate, she reported, seemed to be working well. The peaks
and valleys of her moods had smoothed out to rolling hills. She was still playing the Statue of Liberty down at Hoofers. My sailors been back for nearly
3 months, she said, and hes still carrying the torch for me.