What role did the car crash and the damage to his frontal lobes play in his decline?

The Catastrophe

Spalding Gray’s brain injury.

BY 


In July of 2003, my neurological colleague Orrin Devinsky and I were consulted by Spalding Gray, the actor and writer who was famous for his brilliant autobiographical monologues, an art form he had virtually invented. He and his wife, Kathie Russo, had contacted us in regard to a complex situation that had developed after Spalding suffered a head injury, two summers earlier.
In June of 2001, they had been vacationing in Ireland to celebrate Spalding’s sixtieth birthday. One night, while they were driving on a country road, their car was hit head on by a veterinarian’s van. Kathie was at the wheel; Spalding was in the back seat, with another passenger. He was not wearing a seat belt, and his head crashed against the back of Kathie’s head. Both were knocked unconscious. (Kathie suffered some burns and bruises but no permanent harm.) When Spalding recovered consciousness, he was lying on the ground beside their wrecked car, in great pain from a broken right hip. He was taken to the local rural hospital and then, several days later, to a larger hospital, where his hip was pinned.

His face was bruised and swollen, but the doctors focussed on his hip fracture. It was not until another week went by and the swelling subsided that Kathie noticed a “dent” just above Spalding’s right eye. At this point, X-rays showed a compound fracture of the eye socket and the skull, and surgery was recommended.
Spalding and Kathie returned to New York for the surgery, and MRIs showed bone fragments pressed against his right frontal lobe, though his surgeons did not see any gross damage to this area. They removed the fragments, replaced part of his skull with titanium plates, and inserted a shunt to drain away excess fluid.
He was still in some pain from his hip fracture, and could no longer walk normally, even with a braced foot (his sciatic nerve had been injured in the accident). Yet, strangely enough, during these terrible months of surgery, immobility, and pain, Spalding seemed in surprisingly good spirits—indeed, his wife thought he was “incredibly well” and upbeat.
Over Labor Day weekend of 2001, five weeks after his brain surgery, and still on crutches, Spalding gave two performances to huge audiences in Seattle. He was in excellent form.
Then, a week later, there was a sudden, profound change in his mental state, and Spalding fell into a deep, even psychotic, depression.
Now, two years after the accident, on his first visit to us, Spalding entered the consulting room slowly, carefully lifting his braced right foot. Once he was seated, I was struck by his lack of spontaneous movement or speech, his immobility and lack of facial expression. He did not initiate any conversation, and responded to my questions with very brief, often single-word, answers. My first thought, and Orrin’s, was that this was not simply depression, or even a reaction to the stress and the surgeries of the past two years—to my eye, it clearly looked as if Spalding had neurological problems as well.
When I encouraged him to tell me his story in his own way, he began—rather strangely, I thought—by telling me how, a few months before the accident, he had had a sudden “compulsion” to sell his house in Sag Harbor, which he loved and in which he and his family had lived for five years. He and Kathie agreed that the family needed more room, so they bought a house nearby, with more bedrooms and a bigger yard. Nonetheless, Spalding had resisted selling the old house, and they were still living in it when they left for Ireland.
It was while he was in the hospital in Ireland following his hip surgery, he told me, that he finalized a deal to sell the old house. He later came to feel that he was “not himself” at the time, that “witches, ghosts, and voodoo” had “commanded” him to do it.
Even so, despite the accident and the surgeries, Spalding remained in high spirits during the summer of 2001. He felt full of new ideas for his work—the accident, even the surgeries, would be wonderful material—and he could present them in a new performance piece, entitled “Life Interrupted.”
I was struck, and perhaps disquieted a little, by the readiness with which Spalding was prepared to turn the horrifying events of the summer to creative use. Yet I could also understand it, because I had not hesitated, in the past, to use some of my own crises as material in my books.
Indeed, using one’s own life (and sometimes others’ lives) as material is common among artists—and Spalding was a very special sort of artist. Although he acted in television and films from time to time, his true originality was expressed in the dozen or so highly acclaimed monologues that he performed onstage. (A number of these, such as “Swimming to Cambodia” and “Monster in a Box,” were filmed.) His stagecraft was stark and simple: alone on a stage, with nothing but a desk, a glass of water, a notebook, and a microphone, he would establish an immediate rapport with the audience, spinning webs of largely autobiographical stories. In these performances, the comedies and mishaps of his life—the often absurd situations he found himself in—were raised to an extraordinary dramatic and narrative intensity. When I inquired about this, Spalding told me that he was a “born” actor—that, in a sense, his whole life was “acting.” He wondered sometimes if he did not create crises just for material—an ambiguity that worried him. Had he sold his house as “material”?


One of the special features of Spalding’s monologues was that, onstage at least, he rarely repeated himself; the stories always came out in slightly different ways, with different emphases. He was a gifted inventor of the truth, of whatever seemed true to him at the moment.
The family was due to move out of the old house on September 11, 2001. By then, Spalding was already consumed with regret over selling it, a decision he regarded as “catastrophic.” When Kathie told him about the attack on the World Trade Center that morning, he barely registered it.
Ever since, Kathie told me, Spalding had been sunk in depressive, obsessive, angry, guilty rumination about selling the house. Nothing could distract him from it. Scenes and conversations about the house replayed incessantly in his mind. All other matters seemed to him peripheral and insignificant. Previously a voracious reader and a prolific writer, he now felt unable to read or write.
Spalding had had occasional depressions, he said, for more than twenty years, and some of his physicians thought that he had a bipolar disorder. But these depressions, though severe, had yielded to talk therapy, or, sometimes, to treatment with lithium. His current state, he felt, was different. It had unprecedented depth and tenacity. He had to make a supreme effort of will to do things like ride his bicycle, which he had previously done spontaneously and with pleasure. He tried to converse with others, especially his children, but found it difficult. His ten-year-old son and his sixteen-year-old stepdaughter were distressed, feeling that their father had been “transformed” and was “no longer himself.”
In June of 2002, Spalding sought help at Silver Hill, a psychiatric hospital in Connecticut, where he was put on Depakote, a drug sometimes used for bipolar disorder, but there was little improvement in his condition, and he became more and more convinced that some sort of irresistible, evil Fate had drawn him in and commanded him to sell the house.
In September of 2002, Spalding jumped off his sailboat into the harbor, planning to drown himself (he lost his nerve and clung to the boat). A few days later, he was found pacing on the Sag Harbor bridge, eying the water, until the police intervened and Kathie took him home.
Soon after this, Spalding was admitted to the Payne Whitney Psychiatric Clinic, on the Upper East Side. He spent four months there, and was given more than twenty shock treatments and drugs of all kinds. He responded to none of them, and, indeed, seemed to be getting worse by the day. When he emerged from Payne Whitney, his friends felt that something terrible and perhaps irreversible had happened. Kathie thought that he was “a broken man.”
In July, when Spalding first came to see Orrin and me, I asked him if there were any other themes besides the sale of his house that he ruminated about. He said yes: he often thought about his mother and the first twenty-six years of his life. It was when he was twenty-six that his mother, who had been intermittently psychotic since he was ten, fell into a self-torturing, remorseful state, focussed on the selling of her family house. Unable to endure her torment, she had committed suicide.In June of 2003, hoping to clarify the nature of his deterioration, Spalding and Kathie went to U.C.L.A.’s Resnick Hospital for neuropsychiatric testing. He did badly on various tests, which showed “attentional and executive deficits typical of right frontal lobe damage.” The doctors there told him that he might deteriorate further, because of cerebral scarring where the frontal lobe had borne the impact of the crash and the imploded bone fragments. They told him that he might never be capable of original work again. According to Kathie, Spalding was “morally devastated” by their words.
In an uncanny way, he said, he felt that he was recapitulating what had happened with his mother. He felt the attraction of suicide and thought of it constantly. He said he regretted not having committed suicide at the U.C.L.A. hospital. Why there? I inquired. Because one day, he replied, someone had left a large plastic bag in his room—and it would have been “easy.” But he was pulled back by the thought of his wife and his children. Nevertheless, he said, the idea of suicide rose “like a black sun” every day. He said the past two years had been “gruesome,” and added, “I haven’t smiled since that day.”

Now, with his partly paralyzed foot and the brace, which irritated him if used for any length of time, he was also denied physical outlets. “Hiking, skiing, and dancing had been a huge factor in my mental stability,” he told me, and he felt, too, that he had been disfigured by the injury and by the surgery to his face.
There was a brief, dramatic break in Spalding’s rumination just a week before he came to see us, when he had to have surgery because one of the titanium plates in his skull had shifted. The operation took four hours, under general anesthesia. Coming to from the anesthesia and for about twelve hours afterward, Spalding was his old self, talkative and full of ideas. His rumination and hopelessness had vanished—or, rather, he now saw how he could use the events of the past two years creatively in one of his monologues. But by the next day this brief excitement or release had passed.

As Orrin and I talked over Spalding’s story and observed his peculiar immobility and lack of initiative, we wondered whether an organic component, caused by the damage to his frontal lobes, had played a part in his strange “normalization” after anesthesia. It seemed as if his compromised frontal lobes no longer allowed him any middle ground, either paralyzing him in an iron neurological restraint or suddenly, briefly, releasing him into an opposite state. Had some sort of buffer—a protective, inhibiting frontal-lobe function—been breached by his accident, allowing an uncontrollable rush of previously suppressed or repressed thoughts and fantasies into his consciousness?
The frontal lobes are among the most complex and recently evolved parts of the brain—they have vastly enlarged over the past two million years. Our power to think spaciously and reflectively, to bring to mind and hold many ideas and facts, to attend to and maintain a steady focus, to make plans and put them into motion—these are all made possible by the frontal lobes.
But the frontal lobes also exert an inhibiting or constraining influence on what Pavlov called “the blind force of the subcortex”—the urges and passions that might overwhelm us if left unchecked. (Apes and monkeys, like children, though clearly intelligent and capable of forethought and planning, are relatively lacking in frontal lobes, and tend to do the first thing that occurs to them, rather than pausing to reflect. Such impulsivity can be striking in patients with frontal-lobe damage.) There is normally a beautiful balance, a delicate mutuality, between the frontal lobes and the subcortical parts of the brain that mediate perception and feeling, and this allows a consciousness that is free-ranging, playful, and creative. The loss of this balance through frontal-lobe damage can “release” impulsive behaviors, obsessive ideas, and overwhelming feelings and compulsions. Were Spalding’s symptoms a result of frontal-lobe damage or severe depression, or a malignant coupling of the two?
Frontal-lobe damage can lead to difficulties with attention and problem-solving, and impoverishment of creativity and intellectual activity. Although Spalding felt that he had not had any intellectual deterioration since the accident, Kathie wondered whether his unceasing rumination might not, in part, be a “cover” or “disguise” for an intellectual loss that he did not want to admit. Whatever the case, Spalding felt that he could no longer achieve the high creative level, the playfulness and mastery, of his pre-accident performances—and others felt this, too.
I saw Spalding again in September, 2003, two months after our initial consultation. He had been living at home, feeling very grim, unable to work. When I asked whether he felt any different, he said, “No difference.” When I remarked that he appeared more animated and less agitated, he said, “People say so. I don’t feel it.” And then (as if to disabuse me of any notion that he might be better) he told me that he had staged a suicide “rehearsal” during the previous weekend. Kathie was away at a business conference in California, and, fearing for his safety in the country, she had arranged for him to spend the weekend in their Manhattan apartment. Nevertheless, he told me, he had set out for an excursion on Saturday with an eye to casing the Brooklyn Bridge and the Staten Island Ferry as suitable venues for a dramatic suicide, but he was “just too afraid” to act—particularly when he thought of his wife and children.


He had resumed cycling a little, and often rode past his former home, though he could hardly bear to see it repainted, in the possession of others. He had offered to buy it back, thinking that this might release him from the “evil spell” cast on him, but its new owners were not interested.
Yet, Kathie pointed out, despite being deeply depressed and obsessed, Spalding had pushed himself during the past two years to travel and to give several performances in other cities. But these shows, in which he recounted the accident, were far from his best. At one theatre, he knocked on the stage door before the performance, and the director, who knew him well, took him at first to be a homeless man—he looked dishevelled and unkempt—and Spalding seemed distracted while he was onstage, and alienated the audience.
As we concluded our appointment, Kathie added that Spalding was due to go into the hospital the next day for an attempt to free his right sciatic nerve from the scar tissue that embedded it. His surgeon hoped the procedure might permit some regeneration of the nerve and allow him to move his foot properly. He would be having general anesthesia, and, remembering how anesthesia had affected him so dramatically a couple of months earlier, I arranged to visit him in the hospital a few hours after the operation.
When I arrived, I found Spalding remarkably animated and sociable, with a spontaneity I had not previously seen in him—a picture very unlike that of the almost mute, unresponsive man who had come to my office the day before. He started a conversation, offered me a cup of tea, inquired where I had travelled from, and asked what I was writing. He said that his obsessive rumination had totally ceased for two or three hours after the anesthesia wore off, and was still much reduced.
I visited again the next day—it was September 11, 2003, two years since he had fallen into his “evil” depression. He continued to be animated and conversational. Orrin, on a separate visit, was also able to have “a normal conversation” with Spalding. We were both amazed at this almost instantaneous reversal.

Orrin and I again speculated as to what might have allowed this temporary “normalization.” Orrin felt that, for nearly forty-eight hours, the anesthesia had damped down or inhibited the rumination and the negative feelings that Spalding’s frontal-lobe damage had released; the anesthesia, in effect, provided the protective barrier that intact frontal lobes would normally provide.






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On a third visit, early on the morning of September 12th, I again found Spalding in a good mood. He said that he had very little post-operative pain, and he got out of bed with alacrity to show how well he could walk without either crutches or a splint (though there was no neurological recovery as yet, and he had to lift the impaired foot high as he walked). As I was leaving, he asked me where I was going—the kind of friendly question he had scarcely asked in his self-involved state. When I said I was going swimming, he said that he, too, had a passion for swimming, especially in a lake near his house, and that he hoped to swim there when he got out of the hospital.
I was happy to observe a notebook on his table. (He had told me that he kept a journal while in the hospital in Ireland.) I said I thought that two years of torment was enough. “You have paid your dues to the powers of darkness.” Spalding half smiled and said, “I think so, too.”
I felt guardedly optimistic at this point. Perhaps he was emerging, finally, from both his depression and his frontal-lobe injury. I told Spalding that I had seen many patients with more severe head injuries who, with time and the brain’s ability to compensate for injury, had regained most of their intellectual powers.
I had planned to visit Spalding again the next day, but I was diverted by a phone message from Kathie saying that he had left the hospital without checking out, and without any money or identification.
The next morning, I found another message, telling me that Spalding had made his way to the Staten Island Ferry and then left a phone message saying that he was contemplating suicide. Kathie called the police, who finally picked him up around 10 P.M.—he had been riding back and forth on the ferry. He was admitted as an involuntary patient to a hospital on Staten Island, and then transferred to a special brain-rehab unit at the Kessler Institute, in New Jersey, where Orrin and I saw him a few days later.

Spalding was very conversational and showed me fifteen pages he had just written—his first writing in many months. But he still had some strange and ominous obsessions—one had to do with what he called “creative suicide.” He regretted that, after speaking to a reporter who was working on a magazine article about him, he had not taken her on the Staten Island Ferry and demonstrated a creative suicide there and then. I was at pains to say that he could be much more creative alive than dead.
Spalding returned home, and when I saw him on October 28th I was pleased to hear that he had performed two monologues in the past couple of weeks. When I asked how he could manage this, he emphasized a sense of commitment: if he had agreed to do something, he would do it, however he felt. Perhaps, too, he hoped that these performances would reënergize him. In the old days, Kathie told me, he would remain energized after a show and entertain friends and fans backstage. Now, although he would become somewhat animated in the act of performing, he would fall back into his depression almost as soon as the show was over.
After one of these performances, he left Kathie a note saying that he was going to jump off a bridge on Long Island—and he did jump. He felt he could not go back on this “commitment.” This was a very public jump—he was observed by a number of witnesses, one of whom helped him back to shore.
Spalding wrote frequent suicide notes, which Kathie or the children would find on the kitchen table; the family would be thrown into a state of intense anxiety until he reappeared.
In November, Orrin and I went to see one of Spalding’s performances; we were impressed by his professionalism and his virtuosity onstage, but felt that he was still submerged in his memories and fantasies, not mastering and transforming them as he had once done.
Spalding and Kathie came to see me again in early December. When I went to usher them into my office, Spalding’s eyes were closed, and he seemed to be asleep—but he opened them at once when I spoke to him, and followed me into the consulting room. He had not been asleep, he indicated, but “thinking.”
“I still have enormous problems with rumination,” he said. “I feel destined to follow my mother in a sort of self-hypnosis. It’s all over, terminal. I’d be better off dead. What do I have to give?”
A week earlier, Spalding and Kathie had taken a boat trip, and she became frightened by the “purposeful” way he eyed the water—she felt she had to watch him all the time now.
When I told Spalding how impressed people were by his latest monologues, he said, “Yes, but that’s because they see the old me, the way I was, even though that’s gone. They’re just sentimental and nostalgic.”
I asked him whether transforming the events of his life, especially some of the very negative events, into a monologue enabled him to integrate them, and thus defuse them. He said no, not now. He felt that his current monologues, far from helping him as they once would have, merely aggravated his melancholic thinking. “Previously,” he added, “I was on top of the material; I had the use of irony.”

He spoke of being “a failed suicide,” and asked me, “What would you do if your only choice was between institutionalization in a mental hospital and suicide?”
He said that his mind was filled with fantasies of his mother, and of water, always water. All his suicidal fantasies, he said, related to drowning.
Why water, why drowning? I asked.
“Returning to the sea, our mother,” he said.
This reminded me of the Ibsen play “The Lady from the Sea.” I had not read it for thirty years, but now I re-read it—Spalding, a playwright himself, had surely read it—and was reminded how Ellida, who grew up in a lighthouse, the daughter of an insane mother, was herself driven to a sort of insanity by her obsession with the sea and what she felt as a “terrifying attraction” to a sailor who seemed to embody the sea. (“All the force of the sea is in this man.”)
Moving to another house, for Ellida, as for Spalding, played a part in tipping her into a near-psychotic state, in which quasi-hallucinatory images of the past and of what she felt to be her “destiny” surged up like the sea from her unconscious, almost drowning her ability to live in the present. Wangel, her physician husband, sees the power of this: “This hunger for the boundless, the infinite—the unattainable—will finally drive your mind out completely into darkness.” This was my fear now for Spalding—that he was being drawn toward death by powers that neither he nor I nor any of us could contend with.

Spalding had spent more than thirty years on “the slippery slope,” as he called it, as a high-wire performer, a funambulist, and had never fallen off. He doubted if he could continue. While I expressed hope and optimism outwardly, I now shared his doubt.
On January 10, 2004, Spalding took his children to a movie. It was Tim Burton’s “Big Fish,” in which a dying father passes his fantastical stories on to his son before returning to the river, where he dies—and perhaps is reincarnated as his true self, a fish, making one of his tall tales come true.
That evening, Spalding left home, saying he was going to meet a friend. He did not leave a suicide note, as he had so often before. When inquiries were made, one man said he had seen him board the Staten Island Ferry.
Two months later, Spalding’s body was washed up by the East River. He had always wanted his suicide to be high drama, but in the end he said nothing to anyone; he simply disappeared from sight and silently returned to the sea, his mother. ♦