A Miracle

The sales manager of the Hyatt Regency was preparing to address a convention when her head turned to the right and stuck.

I had no idea what to do. Her head seemed immovable. She was in perfect health. Hysterical conversion was a possibility, but I was too polite to mention it.

The consultation took place in an alcove off the hotel’s main ballroom. I could hear the crowd murmur. Inside gathered half a dozen worried employees including the general manager who had phoned another hotel to get my name. Failure in this situation would be distressing. The sales manager vehemently denied feeling upset, and I had no reason to doubt her.

“Did you do anything recently you don’t ordinarily do?” I asked, grasping at straws.

She considered then admitted she had felt queasy an hour earlier and taken a pill a colleague had offered. It was Compazine, a common nausea treatment.

That meant nothing. Then it did. I could barely contain my exhilaration. Phenothiazine drugs - Compazine, Thorazine - occasionally cause a weird dystonic muscle spasm. It’s so rare most doctors never see one, but I remember a case that arrived when I was hanging out at the Bellevue emergency room as a first year medical student in 1969. In that incident, the patient’s tongue stuck out, and he insisted he couldn’t retract it. The residents on duty confidently diagnosed hysteria, and it took a while before they changed their minds. Treatment is the familiar antihistamine, Benadryl.

I carry Benadryl. Within minutes of the injection, her head came unstuck. Everyone was delighted.                                                                                                  

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.