Forty-five years ago, while in my psychiatric residency, I moonlighted at DC General Hospital’s emergency room. I never knew ever knew who would come in the doors down there at the General. The “White House cases” were a staple, a motley collection of characters pulled off the fence surrounding the presidential residence. One evening is etched in my mind. I received the usual call at about midnight from the nurse, who told me they had a “doozy.” The on-call room was quite a distance from the ER, and when I turned a corner, I could vaguely see a bit of a hubbub at the end of the long corridor.

After everything finally settled down, he was more than eager to spill out the inner details of the day’s adventures. It didn’t take me long to recognize the madcap mental world into which he had been thrust. The character I am about to describe could be compared to the protagonist of T. S. Eliot’s poem “The Love Song of J. Alfred Prufrock” because it portrays an average man who is anxiously adjusted to a rather narrow modern life.

Early that morning, this usually nondescript gentleman woke up and, I’m here to tell you, he felt G*R*E*A*T! Most of all he felt an enormous amount of energy, which, as William Blake famously said, is “eternal delight.” He leaped out of bed and his mind was racing from one thing to the next. His belly was full of laughter and fun. He had a large audience somehow watching him with rapt approval, loving his “performance,” anticipating with collective bated breath what in the world he would do next. He thought to himself, “Wait till they see my next move! They’ll be rolling in the aisles! They’ll love it— but first I need some cash.” He hurried to the bank and struck up conversations with several bemused passersby while waiting for the bank to open. “I need a new car and I want to pay cash for it today,” he told the banker, who I’m sure was captivated by the utter confidence of his ebullient mood.

Next, he drew a crowd at the Cadillac showroom as he theatrically insisted that he buy the model off the showroom floor. He was in a big hurry, wanting to get going with whatever wonderful thing that he was going to do next (which shifted with every passing moment). As he got behind the wheel, he suddenly thought, “It’s a beautiful day. A great day to go out to the beach, and who knows what great, fun things might happen?” But then, perhaps out of the corner of his eye, he saw a costume shop, and not being able to resist the riotous possibilities it might hold for him and his imagined horde of fans, he did a U-turn and went in.

When I first reached the ER, this fulminantly expository figure was surrounded by three or four of DC’s finest. He had been picked up for “disorderly conduct.” Before me was a fifty-plus-year-old balding man in a rumpled blue Superman costume, the cape twisted around to the front like a large red bib. The pièce de résistance was that he was wearing a necklace comprised of small plastic breasts.

This person was in the grip of an acute manic episode.

Superman with necklace of breasts

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