She was only three feet away through the wall, but an interoffice communicator, like a diploma on the wall, inspires confidence in the patient, as well as in the doctor. And it is not seemly for a psychiatrist to open the door and shout, “Next!”
“No, Doctor, that’s Mr. Greene tomorrow at ten. This is the referral from Dr. Waiters at the University Medical School, a VTT case. “
“Drug abuse. Right. Got the file here. O. K., send him in when he comes. “
Even as he spoke he could hear the elevator whine up and stop, the doors gasp open; then footsteps, hesitation, the outer door opening. He could also, now he was listening, hear doors, typewriters, voices, toilets flushing, in offices all up and down the hall and above him and underneath him, The real trick was to learn how not to hear them. The only solid partitions left were inside the head.
Now Penny was going through the first-visit routine with the patient, and while waiting Dr. Haber gazed again at the mural and wondered when such a photograph had been taken. Blue sky, snow from foothills to peak. Years ago, in the sixties or seventies, no doubt. The Greenhouse Effect had been quite gradual, and Haber, born in 1962, could clearly remember the blue skies of his childhood. Nowadays the eternal snows were gone from all the world’s mountains, even Everest, even Erebus, fiery-throated on the waste Antarctic shore. But of course they might have colored a modern photograph, faked the blue sky and white peak; no telling.
“Good afternoon, Mr. Orr!” he said, rising, smiling, but not extending his hands, for many patients these days had a strong dread of physical contact.
The patient uncertainly withdrew his almost-proffered hand, fingered his necklace nervously, and said, “How do you do.” The necklace was the usual long chain of silvered steel. Clothing ordinary, office-worker standard; haircut conservative shoulder-length, beard short. Light hair and eyes, a short, slight, fair man, slightly undernourished, good health, 28 to 32. Unaggressive, placid, milquetoast, repressed, conventional. The most valuable period of relationship with a patient, Haber often said, is the first ten seconds.
“Sit down, Mr. Orr. Right! Do you smoke? The brown filters are tranks, the white are denicks.” Dorr did not smoke. “Now, let’s see if we’re together on your situation. HEW Control wants to know why you’ve been borrowing your friends’ Pharmacy Cards to get more than your allotment of pep pills and sleeping pills from the autodrug. Right? So they sent you up to the boys on the hill, and they recommended Voluntary Therapeutic Treatment and sent you over to me for the therapy. All correct?”
He heard his own genial, easy tone, well calculated to put the other person at his ease; but this one was still far from easy. He blinked often, his sitting posture was tense, the position of his hands was overformaclass="underline" a classic picture of suppressed anxiety. He nodded as if he was gulping at the same moment.
“O. K., fine, nothing out of the way there. If you’d been stockpiling your pills, to sell to addicts or commit a murder with, then you’d be in hot water. But as you simply used ‘em, your punishment’s no worse than a few sessions with me! Now of course what I want to know is why you used ‘em, so that together we can work out some better life pattern for you, that’ll keep you within the dosage limits of your own Pharm Card for one thing, and perhaps for another set you free of any drug dependency at all. Now your routine,” his eyes went for a moment to the folder sent down from the Med School, “was to take barbiturates for a couple of weeks, then switch for a few nights to dextroamphetamine, then back to the barbiturates. How did that get started? Insomnia?”
“I sleep well.”
“But you have bad dreams.”
The man looked up, frightened: a flash of open terror. He was going to be a simple case. He had no defenses.
“Sort of,” he said huskily.
“It was an easy guess for me, Mr. Orr. They generally send me the dreamers.” He grinned at the little man. “I’m a dream specialist. Literally. An oneirologist. Sleep and dreaming are my field. O.K., now I can proceed to the next educated guess, which is that you used the phenobarb to suppress dreaming but found that with habituation the drug has less and less dream-suppressive effect, until it has none at all. Similarly with the Dexedrine. So you alternated them. Right?”
The patient nodded stiffly.
“Why was your stretch on the Dexedrine always shorter?”
“It made me jumpy.”
“I’ll bet it did. And that last combination dose you took was a lulu. But not, in itself, dangerous. All the same, Mr. Orr, you were doing something dangerous.” He paused for effect. “You were depriving yourself of dreams.”
Again the patient nodded.
“Do you try to deprive yourself of food and water, Mr. Orr? Have you tried doing without air lately?”
He kept his tone jovial, and the patient managed a brief unhappy smile.
“You know that you need sleep. Just as you need food, water, and air. But did you realize that sleep’s not enough, that your body insists just as strongly upon having its allotment of dreaming sleep? If deprived systematically of dreams, your brain will do some very odd things to you. It will make you irritable, hungry, unable to concentrate— does this sound familiar? It wasn’t just the Dexedrine!— liable to daydreams, uneven as to reaction times, forgetful, irresponsible, and prone to paranoid fantasies. And finally it will force you to dream—no matter what. No drug we have will keep you from dreaming, unless it kills you. For instance, extreme alcoholism can lead to a condition called central pontine myelinolysis, which is fatal; its cause is a lesion in the lower brain resulting from lack of dreaming. Not from lack of sleep! From lack of the very specific state that occurs during sleep, the dreaming state, REM sleep, the d-state. Now you’re no alcoholic, and not dead, and so I know that whatever you’ve taken to suppress your dreams, it’s worked only partially. Therefore, (a) you’re in poor shape physically from partial dream deprivation, and (b) you’ve been trying to go up a blind alley. Now. What started you up the blind alley? A fear of dreams, of bad dreams, I take it, or what you consider to be bad dreams. Can you tell me anything about these dreams?”
Orr hesitated.
Haber opened his mouth and shut it again. So often he knew what his patients were going to say, and could say it for them better than they could say it for themselves. But it was their taking the step that counted. He could not take it for them. And after all, this talking was a mere preliminary, a vestigial rite from the palmy days of analysis; its only function was to help him decide how he should help the patient, whether positive or negative conditioning was indicated, what he should do.
“I don’t have nightmares more than most people, I think,” Orr was saying, looking down at his hands. “Nothing special. I’m... afraid of dreaming.”
“Of dreaming bad dreams.”
“Any dreams.”
“I see. Have you any notion how that fear got started? Or what it is you’re afraid of, wish to avoid?”
As Orr did not reply at once, but sat looking down at his hands, square, reddish hands lying too still on his knee, Haber prompted just a little. “Is it the irrationality, the lawlessness, sometimes the immorality of dreams, is it something like that that makes you uncomfortable?”
“Yes, in a way. But for a specific reason. You see, here … here I ...”
Here’s the crux, the lock, though Haber, also watching those tense hands. Poor bastard. He has wet dreams, and a guilt complex about ‘em. Boyhood enuresis, compulsive mother—
“Here’s where you stop believing me.” The little fellow was sicker than he looked. “A man who deals with dreams both awake and sleeping isn’t too concerned with belief and disbelief, Mr. Orr. They’re not categories I use much. They don’t apply. So ignore that, and go on. I’m interested.” Did that sound patronizing? He looked at Orr to see if the statement had been taken amiss, and met, for one instant, the man’s eyes. Extraordinarily beautiful eyes, Haber thought, and was surprised by the word, for beauty was not a category he used much either. The irises were blue or gray, very clear, as if transparent. For a moment Haber forgot himself and stared back at those clear, elusive eyes; but only for a moment, so that the strangeness of the experience scarcely registered on his conscious mind.