7/12/00 2:40 p.m.
Talking Crazy
The author turns the interview on a team of psychiatrists.

By Michael Long, director of the White House Writers Group

egalomaniacs, delusionals and hothouse-flower schizoids occupy — fortify — Washington as if it were an asylum under the direction of its inmates.

Which, perhaps, it is.

This fact made it all the more surprising to find relative sanity in a psychiatric waiting room in downtown D.C. I stumbled out of the elevator and onto the 9th floor of the George Washington University Medical Center's Ambulatory Care Center to find a fairly unexcited, calm-eyed-but-not-medicated-looking pile of people spread across a dozen chairs. We were there as guinea pigs for up-and-coming psychiatrists, to be interview subjects for board-certification exams. For the modest compensation of $15 per session, each of us had agreed to sit for two half-hour psychiatric interviews with a licensed physician whose job it would be to divine our mental condition while impressing upon a pair of examiners his professional acumen and ability.

"If you want to be a psychiatrist, you gotta be able to talk to people," said a shrink friend of mine — the guy who signed me up for this in the first place. "Hell, you could probably get board certified yourself," he told me.

While I've never been accused of being a gentle conversationalist, I understood his point.

"That's all the test is about?"

"Yeah. Interview skills."

"Do I have to tell them the truth?"

"Nah. Tell 'em anything you want."

"How about I see dead people?"

"Whatever. That's their problem, to figure it out."

Armed with dispensation to be a jackass — many would assert this is as necessary for me as granting Bill Clinton permission to be a tad randy — I accepted the challenge to earn thirty samoliens in the easiest way possible: by talking about myself.

I was greeted on the 9th floor by Wendy, a blonde woman with an I'm-staff attitude who immediately offered her hand and asked my name, which she then repeated very loudly, as if presenting a sorta-sober convert to a twelve-step brigade. I grabbed the next-to-last open seat and started taking notes. Then I realized that scribbling notes in a cramped hand on a tiny pad in a psychiatric waiting room looked a bit … psychiatric.

But what the heck. Who am I trying to impress? They're here, too, aren't they?  No one here looks crazy, I thought. Then again, I guess I don't look crazy, either. The rest of the people in the room might not have agreed. I had a fresh, bad haircut: vintage Private Pyle in Full Metal Jacket. If I had grinned wide and rolled my eyes, I could have cleared the place. If the others weren't too nuts to run. Which, of course, they might have been.

Here's who was there, around the room, counter-clockwise: a brown-haired college girl with a blank stare. A black woman under a great knockoff of Ted Danson's hairpiece. A rugged, relaxed white woman with kinky black and gray hair. A man in black jeans with a haircut straight out of my own 1981 Southern Redneck High School yearbook. A bald black woman. A tense, cramped-up blonde all in black. An old man. A middle-aged man. Another college girl, this one pimply. And the resurrected, rotting corpse of Dr. Carl Sagan.

Lo, what psychotropic drugs course these veins? What Jungian platitudes have translated to wrinkles on their cortexes? What destructive passions have fallen to the subjugation of true understanding and integration with personality?

The hospital had provided for our afternoon-snack needs, or at least attempted to. In the middle of a coffee table was a tray of Honey-I-Shrunk-the-bagels in sesame and poppy.  At the center of the tray was a pint of roiled, damp cream cheese whose very consistency suggested by visual inspection alone that the stuff was too warm to be safely consumed.  On an abandoned desk across the room were the remains of the beverage cart: three bottles of Coke and four paper carafes (a new invention, at least to me) of black coffee in various faux-Starbucks flavors. Most of this stuff was gone, but no one was eating.

This room used to be part of Urology, and I'd rather not recall for you the walk-gently-if-at-all-and-whatever-you-do-don't-bounce-'em experience in which I found that out, years ago. Along the wall were leftover pamphlets in a yellowing plastic rack, a bunch of patients' rights flyers and one red tract about incontinence. I just read that Jon Benet might have been killed because she wet her bed! Is this significant?

I note that no one has a tic.

"What's Wrong With You?"
After I've been sitting for twenty-five minutes, a graduate student comes in to inform Wendy that it is "four minutes to the interviews." Not five minutes, not a couple of minutes, not when the examiners get back from the bathroom. The precision in her choice of words suggests — insists — that we will be waiting four minutes exactly. Four minutes, Miss Graduate Student? Tell my examiner that I diagnose you with obsessive tendencies.

Thirty seconds later, Wendy divides us into two groups and leads us down steep, fire-escape-pitch steps to the examining rooms on the floor below.

I'm first. Wendy points me into a drab little twelve-by-twelve office. The few colors and patterns present are mismatched, and so is the furniture: one upholstered chair, one desk chair, a short couch and an angular, wooden, straight-back torture seat that looks as if it escaped under its own power from a rural Havana yard sale. Complementing all this is a weedy aural garden: the window is open and it's loud outside with construction and cars. And, as a bonus, I get what I did not know existed in all of Washington: a view of Rosslyn that somehow manages to make the otherwise green place look positively gritty.

This office is the momentarily-abandoned base of a staff psychiatrist for the hospital. A dozen years of medical training and this is where you end up. Sheesh. I note his diploma from 1990 and unhappily calculate that the doctor who belongs to this sheepskin was in grammar school while I was working on my college degree. And he works on people's heads. For money. I feel old, like when I see skateboarders or force my kids to listen to Styx on long car trips.

Then through the open door come a pair of examiners and their charge, a young Indian man with a lazy right eye whose name to my ears seems to be Dr. Panda. Examiner Number One asks me to surrender my soft spot on the couch for the square little orphan chair across the room; ostensibly, this is so I can be closer to the interviewer, but as he gleefully bounces down onto the big comfy cushions of the only decent seat in the room, I sense that his motives are less charitable.

Dr. Panda — no slouch — cuts to the chase.

"What's wrong with you?" he asks.

"Isn't that what you're supposed to figure out?"

The examiners smile. It won't be the last time.

He leads me through questions about my medical history, about my past, about my work, my education, my family. He asks about my emotional state and I lead him through a thorough explanation of the roles in my life of my parents and religion — an explanation that may or may not be true, but which will certainly give him something to chew on when he later pronounces his conclusions to the honchos who are watching. A few minutes later, he is drilling for details.

"So, let's go back to the conflict with your father."

"No. I didn't say I had problems with my father. Let's be precise here," I say. Isn't it always about hating your father? Or having sex with your mother? What are they teaching these people, anyway?

Panda, cowed by the half-hour time limit, demurs, and moves to the canned, psychiatric-triage questions.

"Have you heard voices that others cannot hear?"

I pause. "Well, there's times when people are … whispering."

"And do others hear this … whispering?"

"I'm kidding." The examiners laugh out loud. Panda doesn't seem to get it.

"Have you seen things that other people cannot see?"

"Metaphorically," I say, staring him down with my best Hannibal Lecter. Fearing another joke, Panda takes a couple of notes and this time keeps his reaction to himself.

"Now, I'm going to say three words to you and I want you to repeat them back. Red. Cat. Broadway."

"Red.  Cat.  Broadway."  I wonder what made him choose those particular words.  Sympathy for communism?  Appetite for mice?  Suppressed desire to be a fey stage actor? But he is moving along before I can ask.

"And what is the capital of Tennessee?"

"Um … Nashville."

Panda makes a note.

"How did you know?" I ask.

"I didn't," said Panda. "I just assumed you did, since you said you had lived there. I'm from New York, we don't know anything about any other state." He smiled to indicate that he meant this as a joke, but it just came out sounding … New-York-y. Like something the first lady would memorize to whip out as a casual retort in a scripted TV interview. My confidence in Panda's certification slips further, and I recall that he and the other doctors being tested are already allowed to practice.

"This is a test of excellence, not competence," said my shrink friend.

"They're supposed to be past competence."

I imagine for a moment a tour of Panda's patient files. I find every one noted with the same diagnosis. Conflict with father. Hears whispering. Remembers red and cat; suppresses Broadway.

"Now I want you to count backwards from one hundred by sevens." I do this rapidly. He tries to write down the numbers I'm saying. He can't keep up. He cuts me off at 58.

"Um, has anyone ever asked you to do that before?" he says.

"No."

"Well, I guess with your mathematics background, that's something you could do pretty well."

"That's not mathematics so much as arithmetic, but I understand your point."

Checking In
Back in the waiting room.  The bald black woman now has a hat on, a purple Utah Jazz hat. Utah?

The woman dressed in black seems not to have moved, though now, after the first interview, her lips are pursed even tighter.

A Republican In Washington, D.C.
For the second interview, I am led into the office next to the one I was just in. This one is a little larger, a little grungier, and is interrupted by a four-foot-by-one-foot projection of air duct or hallway closet or something, and it extends to the middle of the floor. Against the narrow side of the block is the same proletariat power seat that had been in the other room — my chair, I just know it. But, ever the optimist, I plant myself on the end of the couch farthest away from it and take in my new temporary digs.

The books here are somewhat thematic, and the first volume I see is the Textbook of Sexual Medicine. Sex Medicine? You mean there's something else besides Viagra?  Cool! But before I can squirrel the book away into my computer bag, my next interrogator and another mostly-mute Greek chorus arrive.

This time I am to be interviewed by a woman — another Indian, establishing a curious trend for a treatment whose success depends to a large extent on cultural commonality. And the name on her nametag is an angry gang of hard consonants attacking an Alamo of O's.  I nod at the introduction, shake her hand, and note with some relief that this time no one is chasing me out of the only good seat in the room.

Her interview is a replay of Panda's, only cut and re-assembled in coherent order. She asks about my past, about my childhood in rural Missouri, about growing up in an evangelical church. English is obviously her second language. I strain not only to hear her very soft voice, but to figure out the words. I wonder if she is getting the meaning of what I say, too, and catching the nuances. I wonder if the cultural differences are simply too great between a country boy and a country girl — from a country half a world away.

I am surprised to hear her draw accurate conclusions from my statements. Maybe this one knows what she's doing. But then she stumbles, cutting me off in mid-anecdote, in mid-revelation, in mid-faux-confession. No one's face suggests objection; the examiners are emotionless and looking very bored. Maybe a day full of this kind of stuff has finally caught up with them, now that it's pushing 4:30 and there's so very much stipend left to spend before midnight.

"Do you hear voices that other people cannot hear?"

"No."

"Do you hold beliefs that others find unrealistic or foolish?"

"I'm a Republican in Washington, D.C. You tell me."

My mind begins to wander. Two additional examiners walk in, suck up a few of my intimate details, and walk out, according this already-public psychiatric examination all the privacy of a Bush-era FBI file at a Clinton-Gore campaign party. Even if it were just the two of us here — Dr. Consonants and me — could anyone really get well in this room?  It is as colorless and life-sucking as depression itself. It is cramped and cold, even with the heat on. It feels so third world, so clinical, so utterly impersonal. When they designed this sad, little space, did anyone think about how much mental illness really and truly hurts?

"You have one minute," says the examiner.  The doctor, who seemed to run out of prescient questions and comments five minutes back, now stares me down without saying a word.

"That's what you do when you don't know what to say, isn't it," I asked my shrink-friend.

"Yup," he said. "Punting."

Finally, she finds a question, obviously something surfaces, something to fill the void.

But the examiner leans in. "Time's up."

Then, suddenly, the doctor's lips pooch out, as if making a kiss. She narrows her eyes.  She has been cut off in the middle of epiphany; this is immediately clear to all of us.  Desperation finds her so fast that her shoulders literally slump.

There is near-panic in her eyes. "I forgot to ask one very important question, didn't I?" The examiners do not answer. There is an unpleasant, telling pause. "I wish I had time for just one more question. Just one more. I don't suppose I can ask one more question, can I?"  The examiners still say nothing, and everyone is half-standing.

"Just one more?"

I start to speak, think better of it.  This is their show, not mine.

The awkward instant passes and this seems to signal that the interview is officially over.  One of the examiners turns to me and, in a remarkably officious tone toward someone who has volunteered to help, tells me I can go.

But the little doctor with the big nametag is between me and the door. She reaches out to shake my hand, takes my hand, grips my hand hard, looks at the examiners.

She bears down even harder — very hard for such a slight woman, even more remarkable for such a slight hand. The desperation in her shoulders is now up in her face, and it's 110 percent I've-blown-the-boards-and-I'm-going-to-have-to-come-back-and-do-this-again-aren't-I?  She faces me full-on, draws a breath, aims, fires.

"Have you ever tried to kill yourself?"

Prognosis & Quesadillas
Back upstairs in the waiting room, we queue for our payment. It's in cash, drawn from a stack of cracker-crisp new $5 bills. The woman in black with the pursed lips — they're drawn so tight now that she looks like a mackerel — declines the money. "I feel bad taking money for helping," she says. With no checkbox on the flowchart for this surprise, the graduate students in charge try to force it on her anyway.  She declines again. I note that there is little contingency for spontaneous charity anywhere anymore, and I note too that this is one of those long-range, way-down-the-line effects deep in the culture that shows what happens when the government takes over charity and starts calling it entitlement.

I accept my own cash, and consider bagging some bagels and the last of the Cokes for the road.  After all, charity still begins at home, and I myself have no trouble with that.

The next day, I tell my buddy the shrink about the experience. My friend teaches psychiatrists, but he doesn't seem to take personally this poor performance by his rising colleagues. Maybe he remembers, as I do, that even the most emotionally clumsy psychiatrist is saved — rather, his patients are saved — to some extent by the mechanical, memorizable nature of the basic interview. The questions do get asked, even if they come out awkward and in the wrong order. And people do get relief, though maybe more often with medicine than with talk.

Or maybe he was so casual about it because these birds weren't his students.

Later, I peel off my thirty bucks for Mexican food with my wife.  "How did the interview go?" she asked.

"I don't think the people that interviewed me passed. The thing is, they're already in practice, and they don't really seem qualified."

The waiter brought us another cup of red salsa. A few minutes later, he refilled my water glass. And my iced tea. And he did it without my having to ask — in my post-interview state, I wondered if it was because he could read my mind, or if he just noticed that the glasses were empty. He asked my wife how she liked the quesadillas; he asked me if I cared for the chili. And when my wife and I left, we felt both fuller and more satisfied. 

"Even a bit saner," I said to myself in a voice that no one but me could hear. And no one asked on our way out the door — or at any point, for that matter — if we had ever tried to hang ourselves.

My wife left to pick up the twins from the mother's day out-program. Me, I was inspired.  I went home to undertake a draft of a new curriculum for America's student psychiatrists.

I think I have found the practicum they really, really need: waiting tables.