An outsized Swede in a Stetson comes over, introduces himself as Soren, tips his hat to reveal reddish-brown hair — “You see?” — but is greeted only with mild curiosity. He looks marvellously out of place. Quite a feat in Vegas: no one belongs here, so everyone fits in. Says he was transferred to this country just over a year ago. How are you liking it? It is never home, ja? A stranger in a strange land, and each week the people grow stranger, ha-ha. Voice a little loud; Munin can tell he’s been drinking. There are other signs — there in the eyes, in the complexion — not hard for Munin to imagine those long Swedish nights, Soren shit-faced and singing along Sveavägen on the long walk home. Here he drinks because it’s too quiet, the light is different somehow, it keeps him awake; restive as myoclonus at 3:00 a.m., he imagines product positionings and repositionings as he tosses and turns in bed.
“At last the famous Dr. Munin. I have wanted so much to meet with you. And Dr. Hughes — you are in your element. This bedlam,” he adds, meaning Vegas. Until recently the psychiatry association had boycotted the city for its conventions.
“Coals to Newcastle,” says Hughes, and is greeted by blank expressions. Soren blanker than most — a bit too slangy for the Swede.
Judith feeds Soren the translation. “The association was concerned that a meeting here would be seen as endorsing gambling.” Vegas is the Mecca of madness: the Strip is a slow march of the multiply addicted, Hughes’s speciality; or of the obsessional, Munin’s bread and butter. The association’s past president, a specialist in seasonal affective disorder, pushed for a return to Seattle or San Francisco — rain was good business — but he was outvoted.
Judith tells them that the registration this year is reported to be a record. Vegas is a draw: bigger even than Miami last year before the hurricane hit, Soren hosting a rooftop soirée in South Beach when the rains came, driving his guests indoors to cold canapés and warmish white wine until power was restored, the host himself remaining alone in a poolside cabana drenched in Gulf stink and saltwater rain like tears.
Yes, far from home in a foreign land, feeling a little at loose ends in his Middle American middle manager’s office, his view of a parking lot with not a Saab in sight, feeling off balance when Judith made her pitch for this year’s satellite symposium. Vegas? Western theme? Thirty-eight-litre hats? It sounded terribly foreign to him, fetishistic even. In the Tunnelbane he has seen them, those slim boys with white-blond hair sporting bandanas and leather chaps, tall as the actor Randolph Scott and with that same expression, faces frozen in a rigor that was almost neurologic in origin.
Judith tried to get her client back on track. “We’re not talking tunnels here, Soren, just wide-open spaces. The meeting will be the key pre-launch event, the last promo hit before the new indication.” The plan was to corral the key opinion leaders — those cagey KOLs — and get them to present case examples of patients: obsessive-compulsive disorder, generalized anxiety, gambling addiction. Let people hear the success stories. Learn who has responded favourably to the drug. But just a soft push, the marketing had to be low-key until the product was actually approved for OCD.
Soren: “We’ll need an opening talk. Neurobiology. How the drug works. Bioavailability, pharmacokinet —”
“Who cares?” said Judith, quick to nix it. “I’m sorry, Sor, but you’re competing with the most entertaining city in the world. Leave the details to the reps in the field. The important thing is to have your key doctors do their thing. Each case is a product endorsement,” said Judith, moving in for the close, laying her hand earnestly on his sleeve. “The touch of Lady Luck.”
No luck for Soren lately; he’s got issues back at head office and he’s pissed away his per diem rolling them bones. Apologizes for being late to the dinner, says he was at a competitor’s session. “I forgot my watch,” winking now, “and you know there are no clocks in a casino.”
“They want you to lose track of time,” says Judith.
“Is that what you think?” Munin asks. More offhand comment than confrontational, but it still gets a rise out of Judith, eyes narrowing, nostrils widening, all textbook. But she’s a supplier, so she’s quick to retreat (“That’s what they say ...”), Munin giving her the impression she’d better have her facts straight before she ventures another opinion.
“I’m just curious,” Munin says. “We hear it all the time — no clocks in a casino. There are no clocks in a supermarket. No one thinks that’s some kind of conspiracy.”
“It’s probably healthy to be a little paranoid,” says Hughes, healthier than most. “What was the topic at the session, Soren?”
“Sex addiction.”
“It’s one of the better addictions to have,” Hughes says.
For no particular reason they find themselves looking at Judith. An awkward silence until Soren gestures to a waiter dressed as Pancho Villa to bring them another round of drinks. “Now, Doctors — your cases? You are satisfied with them?”
Hughes reflexively touches his neck; he has his slides saved on a flash drive hanging around his neck, a sort of a string-tie look. “It’s pretty well done, but I was thinking of adding a few things.”
He’s had a few thoughts on video poker and dissociation, those legions of slots players in a Zen state bordering on psychopathology. It was an illness, video poker linked to dissociative experiences; the phenomenon has been well documented by several groups. Inserting the coins, transfixed by the images on screen ... it’s a form of flight, the flash of cards appearing and disappearing on screen was the beat of wings struggling in air. It’s a fugue state: you abandon job and home to cross the country, and each step isn’t distance, it’s time. One of the cardinal symptoms is amnesia — and why not? With so much space between here and home, why wouldn’t you leave behind the past? Forgetting is a survival skill in America. You need it to loosen the ties of family and friends — the job strangling you, the bondage that’s your life. Time to flee and forget. Cut the anchor. Let yourself drift, a dromomane beyond the known and imagined, in greater and greater orbits until you hit the apogee ...
“Of course, leaving familiar ground and familiar faces isn’t enough,” says Hughes. “The problem isn’t the people around you. Identity itself is ballast, you see. If you want to escape, you must jettison identity itself.”
Hughes has studied them, there at the banks of video machines — uncarded college kids, housewives, middle-aged men with no ID — hypnotized, dizzy with the spin, a whole legion of people who have forgotten who they are. With dissociative fugue that was diagnostic:
Do you ever find yourself in places and you have no idea how you got there?
Do you set out on a journey but find you end up somewhere else?
Do you lose time?
“All those poor beggars at the video slots,” says Hughes. “They’re gone. Completely lost.”
“No wonder they bankrupt themselves,” Judith says.
“That’s just it — there’s nothing to bankrupt. There’s nobody home.”
“Fascinating,” Judith says in an unfascinated way before getting back to business. “Dr. Hughes, would it be too much trouble to give me what you’ve got so far?” She’s on the clock and wants to nail down some of the details from the docs. “You can always add more slides later. Of course, you’ll still have to keep to the twenty minutes we’ve allotted you.”
“If you insist,” says Hughes, surrendering his string tie. He’s a little reluctant to hand it over; it’s what Winnicott would have called a transitional object.
Judith smiles at her client — “Got it!” — but Soren just nods politely. Hughes’s talk is a nice-to-have; it will be years before the drug is approved for gambling addiction, if ever. Soren will be in a new job by then, leaving product management like a tapered