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Tuesday, February 28, 2012

“My Chemical Imbalance”




Whilst out in Los Angeles I met some wonderful people. One such person was Ernest Pith Garnell, a real work of fiction, a nom de plume if you will.

Ernest Pith Garnell, like many who live in Los Angeles, is a struggling writer who had wrote a short screenplay. He was hoping that he could find the right people to star in his short skit or, better still, to have his skit aired on national TV... Hollywood rejected him.

On first reading it I had one of them Nescafe of the monitor moments...and then I realised the message Ernest was trying to portray.

Here's that skit.




“My Chemical Imbalance”


By Ernest Pith Garnell 
Storyline: A lunatic psychiatrist sees a patient who questions his prescribing authority and convinces him he is a fraud.

Cast of Characters:
Psychiatrist: Dr. Wolfgang von Wissensquell

Assistant: Helga

Psizer Rep: Brad Hardsell

First Patient: Darleen Le Blanc

Second Patient: Sidney Smiley

Third Patient: Gertrude Guilderstern


Voiceover: “Today psychiatry has advanced by great leaps and bounds thanks to the devotion of scientists who create the hypotheses that illuminate our understanding of the disorders of the human mind; disorders that just yesterday remained a mystery; disorders that just yesterday didn’t even exist.  This is the story of one such pioneer in the burgeoning science of psychopharmacology, Dr Wolfgang von Wissensquell.”

(In the Doctor’s office)
Wolfgang: (Reading the American Journal of Psychiatry and intermittently swatting at imaginary flies with his pen)  “Idiots!  What do they know of science?  Helga, are there any patients today?”

Helga: “Yes Doctor von Wissensmell, but not until 11:00 o’clock. The Psizer Rep is here now.  He has been waiting to see you. ”

Wolfgang: “That’s von Wissensquell!  How many times do I have to tell you?  von Wissensquell.  von Wissensquell! von Wissensquell!  And what does Psizer rep want with me again?  Pills, pills, pills.”

Helga: “Sorry, Doctor.  He said he has a gift for you.”

Wolfgang: “Thinks he can bribe me with another trip to Hawaii for Zoldoff scripts, eh?  Alright, alright, alright. Show him in.”

Helga: “Yes, Doctor.”

Enter Brad Hardsell


Wolfgang: “Yes, yes, yes. Come in. Come in. Come in”

Brad: “Doctor von Dissensdell, how good to see you again.  I bring good news from the latest research developments in Psizer labs—it’s the serotonometer.”

Wolfgang: “von Weissensquell! von Weissensquell! von Wissensquell!”

Brad: “Sorry”

Brad produces a box with something that looks like a big thermometer and hands it to Wolfgang.

Wolfgang: (Opening the box and inspecting the serotonometer) “What this thing, serotonometer? What, what, what?”

Brad: “It’s the most accurate measuring device for the diagnosis of psychiatric disorders--depression, social anxiety disorder, obsessive compulsive disorder, intermittent explosive disorder, schizophrenia-- you name it, the serotonometer does the trick.  And it’s absolutely free—a gift to you from the good people of Psizer pharmaceuticals.” (Trumpet sound.)

Wolfgang: “Do you mean to say that we now have way of measuring chemical imbalance?  How does it work?  How? How? How?

Brad: “Yes, we found out that all that talk about measuring the metabolite of serotonin in the cerebrospinal fluid was non-sense.”

Wolfgang: “Non-sense?”

Brad: “Non-sense. Now we know better.”

Wolfgang: “Better?”

Brad: “Better. You see Doctor, our researchers have discovered that saliva contains serotonin, so all you have to do is insert the serotonometer into the patient’s mouth to get an accurate reading of the serotonin.  Look here at the meter.  (Pointing at the meter in the Doctor’s hand).  On the bottom, ‘low,’ ‘too low,’ and ‘really too low’–not enough serotonin.”  That means depression, social anxiety disorder, you know, things like that.

Wolfgang: “Singing Da Blues?”

Brad: “That’s right, it’s time for Zoldoff.”  And on the top, ‘high,’ ‘too high,’ and ‘really too high’--too much serotonin.” That means mania or schizophrenia.  Now when the meter reaches this point, it is time for Zoldoff too.”

Wolfgang: Dementia praecox?

Brad: “Yes exactly, certifiably barking mad.  Like howling at the moon-- totally bonkers.”

Wolfgang: “Ah ha, just want I need.”

Brad: “Oh, I almost forgot. (Handing the doctor the journal) I have also brought for you the latest issue of the Journal of Clinical Psychiatry, with an article by the top opinion leaders in the field that proves the efficacy of our serotonometer, ‘Accurate measurements of 5HT (5-hydroxytryptamine) detected in saliva by Psizer serotonometer,’ by Dr. Charles Semerov, et al.”

Wolfgang: “You know I have heard rumor that these things are ghostwritten by the manufacturers themselves.”

Brad: “Yes, Doctor, just a rumor, a scandalous rumor circulated by anti-drug fanatics and Scientologists.  Have a look for yourself.  (Opens the journal before the Doctor’s face.) Can you doubt the things you read in the top medical journals? (Snaps it shut.) ”

Wolfgang: “Well, you must be right.  After all what would we doctors do for accurate information without pharmaceutical reps?”  (Angelic Choir.)

Brad:  (Shakes the hand of Wolfgang) “You are too kind, Doctor.”

Wolfgang: “Helga, please show Mr. Hardsell out.”

Helga: “Yes, Doctor and your 11:00 o’clock appointment is here, Mr. Sidney Smiley.”

Wolfgang: (Mutters to himself) “Sidney not-so-Smiley.  Another low-grade miserable”…and says to Helga: “Yes, yes, yes. Very good.”

Helga: “The Doctor will see you now. (Showing Sidney into Wolfgang’s office.)

Wolfgang: “How is that Prozac I prescribed for you last time, Mr. Smiley?”

Sidney: (In a depressed monotone voice.) “Not too good, I am still as depressed as ever, can’t get any sleep, my mojo is kaput and, quite frankly, well, it made my hair turn white. (Pointing to his completely white hair.)  Sometimes I think I would be better off with nothing at all.”

Wolfgang:  “Non-sense good man. We just need to do little test here.  Helga, bring in serotonometer.”

Helga: “Yes, Doctor von….”

(Helga enters with a box containing the serotonometer, and hands it to Wolfgang.)

Wolfgang: “Now if you would just open your mouth.”  (Inserting the serotonometer like a thermometer into Sidney’s mouth opened wide.)  Consulting his watch he says: “One Mississippi, Two Mississippi, Three Mississippi…(Wolfgang waits, removes the serotonometer and inspects it for a result.)  “Ah ha!  Just as I suspected.  You have chemical imbalance.  Serotonometer says ‘too low,’ not enough serotonin.”

Sidney: (Still in depressed but questioning monotone.)  “Not enough serotonin? What does this mean?”

Wolfgang: “Don’t you worry.  Medical science is advancing every day, you know.  Now we have measuring device for accurate diagnosis, and miracle pharmaceuticals for correcting chemical imbalance.   You see right here, Sidney, (pointing to a chart “How Paxil Works.”)  In depression too little serotonin is available to be released and received by nerve cell in the brain.  This interferes with message sent and results in symptoms of depression.  Now our miracle drugs target messengers and re-supply brain with right amount of chemical.”

Sidney: (Seemingly hopeful) “My goodness.  That is amazing.”

Wolfgang: (Consulting his Medical Reference Cards for Psychiatry.)   “Let’s add some Zoldoff 100 mg to that Prozac, Halcion for insomnia, Viagra for zat other little problem, and Grecian Formula 700.”  (Writing out a script for Zoldoff, etc, tearing it off the pad and handing it to Sidney) "Here you go."

Sidney: “How can I thank you, Doctor?”

Wolfgang: “Visa, American Express, will be fine.  Helga.  Ready for next patient.”
(Putting serotonometer back into the box and returning it to Helga.)

Helga:  “This is Ms. Darleen Le Blanc, a new patient referred to you from Camarillo State Hospital.”

Wolfgang:  “Hello Ms. Le Blanc.  Good to meet you.  Now, just exactly what is problem?”

Darleen: “People keep staring at me and I am hearing voices. You see, you see, why do you keep staring at me like that? (Staring straight at Wolfgang and shaking her head from side to side in the direction of the imaginary voices.)  What did you say?  What did you say?”

Wolfgang: “Now, now, now, may I call you Darleen?  It’s just me, your Doctor here now.”

Darleen: “How do you know?” (Shaking her head from side to side in the direction of the imaginary voices.)

Wolfgang: “Let’s just consult your history for your medications.  (Looking at Darleen’s chart.)  I see you have been on Zyprexa, Ambilify, Paxil, Prozac, Triazolam, Clonazepram, Risperdal, … “ (interrupted by Darleen)…

Darleen: “You think I’m crazy?  You just wait. And you too.  (Looking in the direction of another imaginary voice.)

Wolfgang:  “No, no, no, my dear, you just need little modification and everything will be right….  Helga, Serotonometer again.  ( Helga complies.)  Here open your mouth so that we can find out.”

Darleen: “You think you are going to stick that nasty thing in my mouth? No telling where that’s been.”

Wolfgang: “Now Darleen this is a sterile scientific instrument.”

Darleen: “Well if you say so…” (Opens mouth wide.)
  
Wolfgang: (Consulting his watch) “One Mississippi, Two Mississippi, Three Mississippi…” (Removing serotonometer and inspecting the result) “Ah, too much serotonin.  You have schizo—mania—psychotic disorder.”

Darleen: “Schizo-mania-psychotic disorder,” what is that?

Wolfgang: “New chemical imbalance just discovered in new edition of Psychiatric Diagnostic Manual.  You will need BIG Zoldoff pills for that one…  Helga, 2500 mg Zoldoff.”

Helga: “Coming right up.” (Helga enters with two huge Zodofft tablets.)

Darleen: “Ha, I’m thinking suicide just looking at those things.”

Wolfgang: “Now, now, now.  You see, nothing wrong with you, just little chemical imbalance corrected by medicine.”

Darleen: “Well, ok, I guess you are the Doc.” (Darleen leaves with her two huge Zoldoff tablets.)

Wolfgang:  “Now, Helga, next patient.”

Helga: (Shows Darleen out and Gertrude in.)  “Doctor, Ms. Guilderstern is here..”

Wolfgang: “Yes, yes, yes. Gertrude, good to see you again. How are we doing?”

Gertrude: “Just a bit stressed and overworked.  Maybe it is just life but I thought I needed to see you again.”

Wolfgang: “Have you been taking medicine?’

Gertrude: “No.”

Wolfgang: “Well, you know, Gertrude, this anxiety you experience is co-morbid symptom of affective disorder.  You are depressed.”

Gertrude: “Depression? No, not really. I just go for a good run or play volleyball when I feel down.”

Wolfgang: “We need scientific measurement, because many people are depressed but don’t know this.  Oh, burdens of undiagnosed depression.  Bad, bad, bad.”

Gertrude: “Really? But how do we know.”

Wolfgang: “Latest scientific advance in serotonometer.  Helga, serotonometer.”

Helga: “Yes, Doctor von…”

Wolfgang: (waving finger at Helga who is about to mispronounce his name again.) “Eh, eh, eh!”

Helga: (brings in box with serotonometer, removes serotonometer and hands it to the doctor.)

Wolfgang: “Now, please open wide.”

Gertrude: “Ahhhhhhhhh…..” (opens mouth.)

Wolfgang: (Inserts serotonometer) “One Mississippi, Two Mississippi, Three Mississippi…” (Removes serotometer and inspects it.) “Just as I thought. Too low.  Depression. You need Zoldoff.”

Gertrude: “How can you be so sure?”

Wolfgang: “Serotonometer says so.”

Gertrude: “Hey, wait a minute. Let me see that thing.  (takes serotonometer from Wolfgang’ hand.)  It’s rigged.  There are only two measurements—too high and too low.  That means everybody’s on Zoldoff and nobody is normal.”

Wolfgang: “Now, now, now.  You are patient.  I am doctor.  We all have our place, don’t we now?”

Gertrude: “Look at what happens when you peel off the Psizer sticker.  (peeling off the Psizer sticker.)  This is just a candy thermometer.  It says so right here (pointing to the place where the sticker was removed.) —‘Cooper Candy thermometer.’”

Wolfgang: “What? This is scientific instrument.  How do you question authority of science?”

Gertrude: “You better start shopping for another ass, Buster, because I’m going to sue the one you have right off your backside.”

Wolfgang: “But Psizer Rep gave it to me.  This was developed by expert scientists and confirmed in medical journal.”

Gertrude: “Why don’t you just fess up? You don’t know what the hell you are doing, do you?  All you do is put people on pills that do no good at all and you call it ‘medical science’.”

Wolfgang:  “Wait, wait, wait!  (Takes medical diploma off the wall, blows on it twice, rubs it reverently with his elbow and replaces it on the wall. Thinking for a minute with right hand cupping his chin.  Then he stands facing the audience/camera, raises his right hand and looks far off into space. Angelic Choir.) Could it be that I have blindly followed the psychiatric tradition of my time without critical examination?  Could it be that the whole premise of biological psychiatry is wrong?  That the whole idea of chemical imbalance is just bad marketing copy of an abandoned hypothesis?  Could I, Dr. Wolfgang von Wissensquell, lead the way to a new age of enlightenment?   Could I be the leader of a new skepticism of pharmaceutical manipulation of my profession?  …

Gertrude: (With serious face and shaking the serotonometer threateningly at Wolfgang.)

Wolfgang: “But what about my free trips to Hawaii?”


THE END 





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