Major and Minor Tranquilizers

Guests often ask for something to calm them, and I try to comply by stocking Valium.

Tranquilizers relieve anxiety but not the pain of a terrible event such as a family death. Unhappy victims regularly ask for something to “put me to sleep,” but only general anesthesia does that. Even sleeping pills merely produce drowsiness; if you’re miserable, sleep comes hard.

I give a Valium injection if asked, but I have a low opinion of its tranquilizing properties. Valium pills work better because the more you take, the drowsier you get. The effect of the maximum Valium injection does not impress me. I prefer Thorazine.

Valium and its relatives are minor tranquilizers; the Thorazine family belongs to the major tranquilizers. “Major” and “minor” have nothing to do with strength; they refer to the seriousness of problem they treat. Thorazine helps schizophrenia, a major mental illness. The first of a numerous class of drugs called phenothiazines, its US approval in 1954 marked a huge advance because it calmed schizophrenics enough so most could leave mental hospitals and live on the street, thus saving tax money.

People who deny that schizophrenia is a brain disease claim Thorazine works because it makes patients somnolent. In fact, many newer phenothiazines aren’t sedating but work as well. Thorazine and its family turn off the positive symptoms of schizophrenia:  hallucinations, delusions, bizarre behavior. Movie schizophrenics seem to enjoy themselves, but hearing a voice inside your head frightens most people even if it’s God.

Despite their dramatic effects, phenothiazines don’t cure schizophrenia because they don’t eliminate the negative symptoms such as apathy, social withdrawal, and self-neglect. Being around a well-behaved schizophrenic remains an uncomfortable experience. Something is missing.

Unable to Check Out of the Hotel

“There’s an emergency with my eye. Can you come right away?”

Hotel doctors don’t like to walk in on emergencies, so I asked him to elaborate.

“I’ve been to the Mayo Clinic where, it’s sad to say because they’re wonderful doctors, they performed the wrong MRI, so the eye is now looking to the right, but it’s not right because I’m a right-thinking citizen who looks both ways before crossing the street….

If a schizophrenic checks into a hotel, I hear about it.  

In its dictionary derivation, schizophrenia comes from the Greek meaning “splitting of the mind.” Hollywood, as usual, gets it wrong in movies featuring entertaining characters with multiple personalities. In fact, split personalities are so rare, some psychiatrists believe they don’t exist. The “split” in schizophrenia doesn’t involve personality but reality. Schizophrenics don’t know what’s real and what isn’t. They find this confusing, but it’s surprisingly uninteresting to observers. Holding a conversation is frustrating.

Like any disease, symptoms wax and wane. Victims with enough connection to reality to check into a hotel may deteriorate and become unable to check out, so employees ask my help. Everyone (the movies again…!) think an injection will fix things. Antipsychotics eliminate delusions, hallucinations, and disordered thinking but do nothing to restore a sense of reality. In any case they may take weeks to work. 

Anxious to relieve themselves of a demented guest, hotels often offer to pay my fee. I once spent an hour in a room with a naked, incoherent man, and since then I try to solve these problems over the phone. Hotel employees may believe they can’t call the police unless there’s a danger, but I assure them that if someone is too helpless to care for himself, the police will take him to the appropriate social agency. It’s OK to call the police for crazy people.