At the end of the book, Mr. Ayers had progressed enough to be willing to stay, at least most of the time, in housing with supportive services as the “artist in residence”. He had come back partially from being a most promising musician in school at Julliard, who had then ended playing a broken violin for years on the streets, vowing never again to get traditional psychiatric treatment. However, it is apparent that he is still prone to paranoid psychotic episodes. I was left wondering if he will ever agree to try medication again, especially the newer antipsychotics, which would have much less potential for the neuromuscular side effects that could impair his musicianship. This is crucial, because it is his musicianship and love of music that gives his life it’s most meaning.
What is clear is that Mr. Lopez has been much enriched by this experience, even if at times his life also seemed at more risk. He even tries to learn to play the violin and comes to enjoy classical music. For those of us who love Beethoven and classical music, there is the bonus of the most creative descriptions by Mr. Ayers. For instance, Itzhak Perlman’s violin playing is described as “molten lava.”
Coincidentally or not, as I finished The Soloist, I received another book from a psychiatrist, also from the Los Angeles area, Robert Paul Liberman, titled Recovery From Disability: Manual of Psychiatric Rehabilitation. It was also written in 2008, and tries to provide the current, scientific state of the art for professional caregivers. Enough is known to need 561 pages to put Mr. Ayers and Mr. Helfgott into a psychiatric context. The bridge from these soloists to modern science seems to be the human relationship that builds an alliance, whether that is provided by a clinician, administrator, family, friends, or even a most caring reporter. In psychoanalytic terms, it is the creation of a “holding environment” where the person feels safe enough to address chronic problems.
So, what has happened to Mr. Ayers since 2008, you must want to know? I certainly did. However, like with most homeless mentally ill, and indeed with many of our patients who drop out of treatment, it is often hard to get updates. I do know that he played his violin at the 2009 NAMI convention. As of a year ago, the “consulting” psychiatrist told me that Mr. Ayers was still in a supportive apartment and less aggressive, but still very psychotic and unwilling to consider medication.
Certainly, we can’t expect that the stories of Mr. Ayers and Mr. Helfgott will be commonplace. Finding someone so devoted to them combined with having such high musical talent is rare, and may be one of the reasons medication remained in the background. And, of course, the stories may have many inaccuracies. But they are inspiring stories and offer an anecdote of sorts to someone like Jared Loughner, who killed and injured many in the recent Tucson tragedies, falling through the cracks of any road to the bridge of recovery for his mental illness. I am left with a bittersweet sense of just how terribly complicated it is to do all we can for the recovery of the most seriously mentally ill, especially in this day and age of limited formal resources and limited coercion. It’s time for me, too, as I often do after a hard day’s work, to be soothed by some of my favorite music.