fandom_clinic | FH Clinic (5/22)

A few minutes after his appointment time, Tyler came back to the clinic and walked up to the woman, a little tentatively. "Hi, I'm trying to find Dr. Pevensie."

"You've found her. I'm Dr. Pevensie. And I assume you're Tyler?" She held out her hand to him, and then nodded toward the clinic. "Why don't we go inside?"

Tyler coolly assessed the woman before taking her hand in a shake. "If you want," he said, indicating the clinic.

"It has a little more privacy," Susan pointed out, leading him to her office. "I received your file from Bates on Saturday. Is there anything you'd like to discuss before I start the evaluation? Any concerns you have that need to be addressed?"

Tyler took a deep breath. "You tell me," he said. "I mean, I feel fine. Other than that the meds Dr. Troy gave me make me want to puke my guts out every night."

"That's not an uncommon side-effect, but I'm glad you mentioned it." Susan sat down and gestured to the couch or the chair across from her. "Sit wherever you feel comfortable. Are there any other side effects? Headache, blurred vision, lethargy especially? Are you able to actually keep food down, or is it effecting your appetite?"

Tyler closed his eyes, thinking. "I'm sleeping. Which is actually kind of a newish experience. And yeah, I keep food down as long as I eat slow. No blurred vision."

He rubbed his temple. "I did have a little headache Sunday."

"I'm hesitant to change the dosage of your psychotropics when it's only been recently prescribed; however, I can prescribe an anti-nausea medication that should relieve the worst of that, without interfering with the purpose of prescription." Susan made a note on her pad, then leaned back, studying him. "As I said, I've read your case history. Is there anything that wasn't included that you think I should know right now? Have you self-medicated in the past, to help you cope, for instance?"

"No," Tyler said, rapidly. "I mean, I drink, but not to that point."

Tyler said drinking and drugs were just another way to shut the world out, fight clubs for the weak.

He held out his hands, palms up, then bit his lip. "So do the files they sent you have everything? I'm just curious what Bates told you."

Susan tapped his file, but didn't show it to him. The terminology of psychiatry could be intimidating as well as depressing to patients with problems as severe as Tyler's. "The initial diagnosis was Disassociative Identity Disorder, with some debate among my colleagues who examined you regarding whether you have a mild form of schizophrenia which is contributing. Do you understand what those terms mean?"

Tyler had an internal debate but decided not to plead ignorance. Or ask what else it might say.

"It means you couldn't decide whether I just have an imaginary friend, or whether I'm also really crazy," he said. "That about it?"

"Oversimplified, but not inaccurate," Susan responded. "DID is primarily a psychological disorder. Your mind detaches itself from its own actions, to a certain extent. Thus, your 'imaginary' friend, who commits acts you don't remember and can't reconcile with your own character." She carefully watched him for reaction, aware that even this was not specific enough.

"It varies wildly from person to person who has it, has many causes, but one of the components is a high degree of imagination and suggestibility. Schizophrenics also often manifest a strong imagination and level of creativity. But their hold on reality is much more fragile, and there is almost certainly an underlying biological cause. Which is why we're hedging our bets with the anti-psychotics. "

Tyler touched his fingers lightly to his lips and averted his gaze. "Do you want to know what I think? Usually you guys just like to hear yourselves talk."

Susan nodded calmly. "Sometimes we do. It's a way of clarifying our thoughts. Psychotherapists are as prone as anyone else to needing that." She paused. "And sometimes we're trying to make sure our clients have no reason to be frightened or confused by what's going on inside their own heads. Especially when those processes can be made easier to live with."

"Huh," Tyler said. "So that's what the drugs are supposed to do. Numb the chaos so all of this is easier to live with."

He ran a hand through his hair. "And so I don't do anything that could hurt people again."

"I read the police reports as well," Susan said, her voice level. "Do you remember the sequence that lead up to those bombs being placed?"

Tyler stared at his shoes for a long moment. "Yeah," he said. "It kind of all came back, at the end."

"I'm not ashamed of everything we did," he said. "Everything I did. But if I knew where it would lead, I would never-" he shook his head.

"This is, unfortunately, why you need to stay on the medication. And stay in therapy," Susan said quietly. "Your ability to derail those impulses is impaired. Whether from schizophrenia or counter-productive coping mechanisms doesn't matter. As-- thrilling, perhaps? As that reality may be, it is not helping you. I'm very glad you're well enough to realize that, now."

"That reality was a reason to live," Tyler said, quietly and honestly, blue eyes fixed on Susan. "It was my best friend. My everything."

He stood. "Does it matter if I say I don't feel schizophrenic?"

"And now you have to construct a new one. One that has stronger ties to the reality everyone else lives in." Susan paused. "I believe you can do this. We just have to go slow enough, and give you the tools to differentiate better."

Susan looked up at him. "And how do you think schizophrenia feels? How do you think it is different, from how you feel now?"

"Whee," Tyler said sardonaically. "What if I still like mine better?"

"And point. I guess I just think schizophrenia sounds crazier, you know? I held a job, I lead people, I ....okay, I talked to myself, but I wasn't panhandling or claiming there was an antenna in my brain."

"Most people have their own realities, Tyler. Their internal world. And most prefer it to the exterior. The trick is to bridge the gap, and make it not so extreme."

"You're not wrong; if you have schizophrenia, it's a fairly mild case. It's too early for a complete diagnosis, to be honest. I don't want to take chances. You are missing several symptoms of classical schizophrenia. There shouldn't be a stigma attached to this-- and if it is schizophrenia, the prognosis becomes much more difficult." Susan cocked her head. "Let's give it-- two weeks, let's say? And begin to taper off your medication then. If your ability to function isn't impaired, we'll do this gradually, so as not to be a shock to your system."

Tyler nodded. "Um, last time I went off the pills, before I came here, was when Tyler came back," he said. "He almost blew us up."

"But tapering off might work better. I hope."

"Thank you for telling me that. Hopefully, with continued therapy, that part of your personality won't feel the need to either act out like that-- or you'll be able to control the impulse, and channel it into something else." Susan smiled. "I'm optimistic, truly. Shall we meet again next week? The only 'assignment' I shall give you, in the interim, is to keep a journal. That will account for any missing time, and any instances where Tyler may be taking control. All right?"

Tyler made a face and muttered something under his breath about journals being for girls and Conor Oberst. But he didn't look entirely unhappy. "Keep a journal, check in next Monday," he said. "I can do that."

"Thank you. I appreciate your commitment to this." She rose to her feet, and gave him her card. "Here is where you can contact me, should you need to. If you don't have any other questions, I'll see you next week."

Tyler fingered the card. 'No questions," he said. "See you Monday."

He left the office and headed back to the campgrounds, feeling vaguely unsettled.

FH Clinic (5/22)

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