WILLIES by MAYA KAATHRYN BOHNHOFF
You never know what may have practical applications.... 
The plate was empty. Two minutes ago it had contained a grilled croissant slathered with Nutella. Sprinkled with sugared coconut. The now-empty plate was supposed to have contained a chicken breast sandwich with bib lettuce and cucumber, held together with low-fat cream cheese.
Victoria Spoon stared at the plate. Moments earlier, it had looked like a long-lost friend. Only now, when it was too late, did she see its true form--that of an implacable enemy. Tears welled up in her eyes. How many hours of exercise had she just wiped out? How many cucumber sandwiches had she just zeroed? Tears sliding down her face, she took out her cell phone and tapped out a number she knew better than she knew her own mother's. It was Sunday morning, but she prayed her call would be answered.
It was, on only the second ring.
"Doctor Geller, I'm so sorry. I--I--I..." Victoria hiccupped. "It was a croissant ... with Nutella ... and coconut. Please help me!"
Doctor Geller was a saint. No hemming, no hawing, just: "Come right over, Vic. I'll meet you at my office."
She hung up, her eyes going against her will to the half-empty glass next to the empty plate--the glass that was supposed to contain a double low-fat latte, but which actually held hazelnut mochachino with whipped cream. Real whipped cream.
Still hiccupping through her tears, Victoria Spoon picked up the glass and drained it.
* * * *
"Annette, it's Sunday."
"I know." Dr. Annette Geller rolled from beneath her husband's arm and out of bed.
"We were going to sleep in."
Annette grinned at him over one bare shoulder. "Is that what we were doing?"
"We were going caving today."
"We can still go ... after."
"Annette, it's Sunday."
"I believe we've established that." She paused in the act of rooting underwear from her bedside dresser and turned to look at him. "Tell me, Dr. Hamlin, if this was one of your patients, would you just tell them to cool their jets until Monday?"
"I don't have patients. I have test subjects."
"Elliott..."
He sighed and flung his forearm over his eyes. "Oh, all right, yes. If it were my patient, of course, I'd see them. Who is it?"
"Victoria Spoon," Annette answered from the bathroom.
"The binge eater?"
Annette's head popped out through the bathroom doorway. "How'd you know that?"
"You consulted with me about eating disorder studies, remember? When you first started treating her."
"Oh, right."
"Alas, Ms. Spoon's ailment is beyond current science."
"And technology. Her last therapist recommended she get her jaw wired shut. She drank malteds from a sipper cup. I don't suppose you have any applicable studies in the pipeline now?"
He shook his head. "My team's working on reflexive aversion right now. And Doctor Pandit is prepping for a sleep disorder study. Hey, if she eats in her sleep--" The end of his sentence was lost in the sound of shower spray.
For Elliott Hamlin, Victoria Spoon's cry for help was literally a wakeup call. Calculated by the Deity, he figured, to remind him why he was no longer in clinical practice. Whenever he would begin to feel inadequate as a psychologist because he wasn't considered "hands on" by his private practice peers, whenever he found himself missing the peculiar satisfaction of dealing in depth with the problems of individuals, something would happen that reaffirmed his commitment to neurological research.
It wasn't always a Sunday or late night call or having an intimate moment interrupted by a patient's needs. Those were trivial things--things therapists laughed about over lunch. Sometimes it was having a patient attempt suicide--or worse, succeed at it. Sometimes it was unsympathetic family members who thought the patient should just "get over it," or insensitive bosses who suspected an employee with a mood disorder of everything from drug abuse to being a potential mass murderer.
It was a sometime bone of contention between him and Annette. Despite the fact that she'd witnessed the efficacy of drug and gene therapy on maladies as seemingly diverse as diabetes and bipolar disorder, she still retained her bias toward talk therapy. Elliott, for his part, argued that when Annette had a breakthrough, it provided a solution for one patient. When he had one, it provided a solution for an entire class of patients. At least, that's what he told himself every time he was tempted to return to private practice.
* * * *
"Chewing ice, cracking knuckles, wadding paper."
Elliott glanced up from his keyboard to where his colleague, Dr. Richard Kelsey, pored over survey forms. "Gender and age?"
"Female. Thirty-eight." Kelsey turned the survey form over and raised a pale eyebrow at Elliott, watching him enter the information into the project database. "You still think this is evolutionary?"
"I think there's a high probability that it is. Any response that automatic is likely to be an evolutionary adaptation."
"Ah. From the time our ancestors were menaced by huge roaming wads of crumpled twenty-pound bond? Or ice-chewing velociraptors?"
"Velociraptors and humans didn't inhabit the planet at the same time, Rich."
"Okay. Ice-chewing woolly mammoths, then."
"I think those sounds may be similar to sounds that triggered our ancestors' flight-or-fight response."
"It's simple frequency saturation," said Kelsey.
"It's evolution." The declaration came from the lab doorway in the heavily accented voice of Dr. Avram Shevelov, recently of Taras Shevchenko University in Kiev.
This was an argument almost as old as the one psychiatrists and neurologists had about the cause of mood disorders. "Why can't it be both?" asked Elliott, as he usually did at this point in the debate.
"How does frequency saturation account for the emotional component?" Avram asked. "Consider your own aversion to the innocent ravioli, Elliott. Can saturation--at any frequency--explain that?"
"Ravioli look like bloated jellyfish," Elliott said, trying not to visualize them.
"Ah! Evolution! Jellyfish are dangerous to small primates, yes?"
"Nonsense," said Richard Kelsey. "These are completely different responses."
"Not experientially," Elliott pointed out. "The cause is different, but the neurological effect is the same--"
Avram was nodding his shaggy head. "Adrenaline, vasoconstriction, piloerection. In a word, 'heebie-jeebies.'"
"That's two words," protested Richard.
"Willies," said Elliott, experiencing piloerection at the sudden and unwelcome thought of a plate full of stuffed pasta. "That's one word."
"Yes, but it's the wrong word," said Richard. "Goosebumps--that's the word. Willies are a fear response--not an aversion."
Avram snorted. "In practical experience, there is little difference."
Elliott let out an exaggerated sigh. "Gentlemen, sheath your daggers. We have data to compile."
Avram grunted and crossed to his cluttered workbench.
Richard glanced at the next form on his stack. "Fingernails on a chalkboard," he said. "Male. Twenty-two."
Elliott dutifully returned his fingers to the keyboard and began to type.
"I'm so sorry about Sunday, Dr. Geller. I hated to bother you at home. I felt so guilty." Victoria Spoon's huge brown eyes recalled those of a Newfoundland that had been Annette's childhood pet. Her thick, lustrous black hair with its natural wave and heavy bangs enhanced the likeness. And then there was the fact of her size. Victoria was a tall young woman, whose weight hovered uneasily between plump and obese. But she hated how she looked much less than she hated how she felt.
"I don't walk, I stomp," she'd complained at their first session. "In high school I was a gazelle, now I'm a T-Rex. I used to love to hike and climb and snowshoe. Now it takes too much effort to walk to the office coffee machine. I loved dancing. Now everything jiggles so much it hurts. And I get bra burn just thinking about jogging. The only thing I can do is aqua-aerobics. Even a hippo is graceful in the water."
At first, Annette had leapt on the point of change: what had happened after high school? Looking for trauma, she uncovered only teenaged lightheartedness trammeled by adult stress.
"No guilt," Annette said now. "There's no need. I'm a therapist because I want to help. You needed help. If it weren't for you, I couldn't fulfill my purpose in life. Besides, you know what happens when you get into guilt."
Victoria grimaced. "Yeah. Same thing that happens when I get into anything. I eat ... big."
A lot of people ate when they were in the grip of strong negative emotions--anger, sadness, guilt, stress, frustration. Victoria Spoon--who lamented her unfortunate last name and joked about changing it--ate when in the grip of any emotion. She ate when she was sad; she ate when she was happy; she ate when she was stressed or excited; she ate when she was bored or had the blahs.
"I wish there was a pill I could take," she said.
Doesn't everyone? Annette noted the comment on her palm pad. If Elliott had his way, there'd be a pill for everything. No, that wasn't fair. Like her, Elliott only wanted to help.
"Now that you've had time to think about it," she said, "what happened Sunday morning?"
Victoria shrugged. "I don't know. I felt fine."
"Well, let's think about it this way: if you could take a pill, what kind would you take?"
Victoria grimaced. "A pill that would make me hate croissants smothered in Nutella and love cucumber sandwiches."
"I thought you did love cucumber sandwiches. They were part of your nutritional strategy--eat what you love."
"I do love cucumber sandwiches. I just love croissants smothered in Nutella a lot more."
"Why?" Annette asked on a whim. It seemed an obvious question with an obvious answer, but she'd pursued every other angle she could think of. "What is it about croissants and Nutella?"
"They taste good? I mean, it's an awesome combo. And while I'm eating it, I feel great."
Okay, Annette thought, endorphin release. She shook her head. Now she was starting to think like Elliott. A pill that knocked down endorphins? She'd have to ask him if there was any such thing. "You feel good while you're eating. And after?"
"Terrible. Awful."
"And what about before?"
"Excitement. Anticipation."
More endorphins. "I'd like to recommend something to you that we haven't tried yet."
"Yes?"
She looked so hopeful, so eager, it made Annette want to hug her. "Meditation."
Vic's face fell. "Tried it."
"Yes, but not this way. I want to try something different. I want you to work on a mantra. Something that will calm you. Keep you on an even keel. The key here is balance, Vic. You eat when your emotions are engaged. Let's find some way of disengaging them so you don't get so excited around food." And meanwhile, Annette thought, I'm going to talk to a man about a pill.
* * * *
"What could the evolutionary benefits possibly be?" Richard asked.
"You joke, yes?" Avram stared at him eyes wide--a daunting picture given their sheer size.
The two researchers couldn't be more different, Elliott mused. Where Avram was tall, lanky, and thin, with a shock of curly black hair, Rich was stocky and thick-waisted. His fair hair was the only thing about him that was thin. It seemed almost cosmically right that the two men adopt opposite viewpoints on the same research--as if the universe were using them to stay in balance.
"Is flight or fight, yes?" Avram continued. "If you are hirsute primate, piloerection increases your apparent size. Bobo looks like King Kong."
"Elegant, but erroneous," said Richard. "Oh, hi, 'Nette. You're here just in time to weigh in on the nature-versus-nurture debate."
Elliott turned in his chair to see his wife waving at him from the laboratory doorway. "Lunch time already?" He checked his watch.
"No, this isn't a social call. I need a consult." She glanced at Richard and Avram. "What's the debate?"
"Willies," said Elliott. "Biological knee-jerk response or evolutionary adaptation?"
"Willies?"
"Goosebumps," said Richard. "Whim-whams, jinks, heebie-jeebies, yips."
Avram added, "Your heart races, your pupils dilate, your hair stands out." He made an appropriate gesture. "You look larger than life and amply menacing."
"The human ear," said Richard, "is exquisitely sensitive to sounds in the 2000 to 4000 hertz range. You've seen the test data. The sounds our subjects are responding to are all saturated in that range."
"So are many sounds they do not respond to."
"What sort of sounds?" Annette asked.
Elliott rolled his eyes, then sat back and cracked all ten of his knuckles resoundingly.
Annette gasped and jumped, rubbing her arms. "God, Elly! You know I hate it when you do that!"
Richard pointed at her. "You see? Frequency aversion."
"Fight or flight," said Avram.
Annette shook her head. "You're studying people's reactions to knuckle-cracking?"
"Not exactly," said Elliott. "The question is: What gives people the willies and why? As you can see, it's a contentious issue."
"So what do you think, Doctor Geller?" Avram asked. "Bio-physics or evolution?"
"What's the difference?"
"Oh, Doctor Geller!" Richard's dismay, Elliott knew, was only half-feigned. "There is a world of difference." He checked his watch, then got up from his desk and excused himself. "I have interviews to conduct. Are you coming, Dr. Evolution?"
"Pedant," muttered Avram and followed him from the room.
Annette chuckled, moving to perch on a stool next to Elliott's workbench. "When you said you were doing aversion studies, I didn't realize you were referring to your colleagues' aversion to each other."
"They're just passionate about their work. And they're enjoying themselves immensely."
"If you say so. I take it you're the go-between?"
"It works. So, what's the consult?"
"My binge eater. I know you're not doing any food-related studies right now, but I wondered if you knew of any available medication that will damp endorphins."
"Sure. In fact, we're using endorphin blockers in this study."
"Really? In what way?"
In answer, Elliott swung back to his computer and loaded a video clip. It showed a man sitting in a cubicle, wired for heart rate, blood pressure, and brain waves. He wore a set of headphones.
"The subject," said Avram's voice from the computer speaker, "is a forty-three-year-old American male of Asian descent. He will be given a series of aural stimuli."
What followed still seemed comic to Elliott, despite the fact that he'd seen it too many times to count. It was also uncomfortable, for the sounds the subject heard were also audible to the observers. Footsteps in mud. A finger circling the rim of a glass. Paper rattling. A balloon being rubbed. And the inevitable fingernails on a chalkboard. The expressions on the subject's face were priceless.
Elliott watched his wife watch the test subject as the video played. She reacted to all but the rattle of paper, her mouth and nostrils twitching as she fought her own responses. When the clip was over, Elliott loaded a second one. "Here's the same subject after he's been given a small dose of naloxone to inhibit the expression of endorphins."
The sounds repeated. Annette wriggled uneasily, but the test subject barely reacted. In fact, only nails on a chalkboard--which Avram likened to primate screeches of warning--got any visible reaction.
"Wow," said Annette, rubbing her goosebumps. "Does that work with positive stimuli as well?"
"Better. They tested this at Stanford years ago, using evocative music. Naloxone suppressed reaction in low doses in three of ten subjects and in higher doses, it suppressed reaction in all subjects. Why the interest?"
Avram came back into the lab just then, humming an old Thomas Dolby tune, and Annette said, "Got a minute for a cup of coffee?"
"Sure, but I'd recommend a cup of tea, instead. Coffee's toxic this morning. I think one of the other teams is working on an aversion study of their own."
They wandered down to the break room. Elliott didn't bother to prompt Annette. Silence meant she was gauging how much she needed to tell him about her patient.
"When I interviewed Victoria this morning," she said finally, dunking a bag of Tetley's into hot water, "I was struck by the role endorphins seemed to play in her disorder. The cycle goes something like this: She gets emotionally revved up about something--positive or negative, minor or major--it doesn't seem to matter. Then she sees a food item. The thought of eating it excites her further, and while she's eating it, she feels great. But when she's all done, she feels like crap. She's disappointed herself. Again. She feels guilty, which only serves to feed a later binge--no pun intended."
"So, you're hoping an endorphin damper might break the cycle?"
Annette looked at him over the rim of her teacup. "What do you think? Is it feasible?"
"Well, yeah. I assume you're interested in an oral application."
Annette nodded. "Can you give me the minimum effective dosage?
"Sure. I'll check Avram's lab notes."
"Side effects?"
"Headache, fatigue, nausea in a few subjects."
"Worth a try?"
"Maybe. I need to warn you, though," Elliott said. "This is not a drug you're going to want to use long term. Damping the emotions for any period of time--"
"I know. Believe me, I'm reluctant to medicate at all. But, Elly, this girl is desperate. She's tried everything. How long do the effects last?"
"In our trials, an hour or two, depending on the dosage and the sensitivity of the subject."
"She'd only need to take it at meal time." Annette set down her teacup and gave him a sly look from under her lashes. "You haven't said 'I told you so' or gloated over me asking you to recommend medication for one of my patients."
Elliott shrugged, smiling. "I'm just not that kind of guy. Which, I assume, is why you married me."
"No, I married you because you're smart and sexy." She wound her arms around his waist and kissed him.
"So, what made you wonder about endorphins?" he asked when their lips parted.
"Frustration. I've hit an impasse with Vic. This morning she said, 'I wish there was a pill I could take.' I thought, 'Okay, what would Elly do? What questions would he ask?'"
He nodded. "You asked about the emotions surrounding the binging."
"Yes. Then I asked, 'If you could take a pill, what would it do?' She said, 'Make me hate croissants.'"
"Naloxone won't give her an aversion to rich food, unless one of her side effects is nausea."
Annette, who hated nausea more than just about anything, shuddered. "Perish the thought. I--" She broke off, her face going blank in that way that told Elliott wheels were turning. "Elly, could I get you to have lunch with me and Vic? I'd like you to help me assess whether she's a candidate for medication."
"When?"
"Today, if I can arrange it."
"O-kay..."
Annette laughed. "Don't look so skeptical. I'm not a talk therapy fanatic, just a slightly biased zealot."
* * * *
They lunched that afternoon with Victoria Spoon. An unfortunate name, Elliott thought, for a woman with an eating disorder. Annette chose the restaurant--a bistro that was apparently one of Ms. Spoon's favorite places to fall off the wagon. Elliott didn't wonder at that--the eatery had a boulangerie whose gleaming glass cabinets contained a horrifying array of high-calorie, high-fat goodies. Enough, Elliott was sure, to make a nutritionist run screaming into the night.
Seated, Victoria dithered over her order, her eyes drawn irresistibly to the forbidden items mere feet away. Still, she ordered a sensible sandwich with a curried dressing obviously intended to enhance the flavor and "mouth feel" of low-cal dishes. As they ate, Annette told her patient about her endorphin theory and explained why she'd called Elliott in to consult.
"Anything," the young woman said. "I'll do anything. How long would I have to be on medication?"
"We're not sure," said Elliott. "What Annette is hoping to do is keep you on meds just long enough to break the cycle of binging. The object of the drug is to dampen your enjoyment of eating or anticipating eating so that rich food doesn't excite you quite so much."
As if on cue, Victoria's eyes strayed to the dessert cart, which was even now wending its way through the tables steered by a smiling waitress who clearly had never sampled her own wares.
Elliott glanced at his wife, who nodded. Yep, her expression said, this is a desperate case.
The dessert cart drew near; Victoria's eyes never left it. "I'm really excited," she said absently. "I hope this treatment will work."
"Me too," said Annette.
The cart stopped next to their table and the waitress cheerfully described each of five deadly dishes.
"Oooh," breathed Victoria, leaning over the flans, tortes, cheesecakes, tiramisus, and truffles.
Annette kicked Elliott under the table. He glanced up at her, startled. She laced her fingers together, pantomimed at him, and mouthed, "Crack your knuckles." When he hesitated, she kicked him again and repeated the pantomime.
Out of the corner of his eye, he could see the waitress lifting a hunk of cheesecake from the cart. He laced his fingers together under the table and flexed, cracking all ten knuckles in a perfect and percussive arpeggio.
Annette jumped.
Across from her, Victoria shuddered visibly and tore her eyes from the cheesecake that hovered above her plate. "Ew!" she said. Then to the waitress, "No, thanks. I'll pass." The expression on her pretty face as she watched the dessert return to the cart was eloquent with loathing, as if a whipped cream-covered chunk of earwax graced the dainty plate. "I'll be right back," she told Annette. "I need to get a glass of water."
Elliott stared at his wife, who was grinning from ear to ear. "You didn't bring me here to consult about naloxone. You brought me here to give Victoria the willies."
"You think?"
"You," he said, "made use of my research."
She shrugged and sipped her latte. "Think of it as a field study. Avram and Rich will be intrigued."
"Avram and Rich will be thrilled. If this works--for Victoria, for other patients with compulsive disorders--we'll be able to suggest a real-world application for our research."
"Yeah. Ain't private practice grand?"
"Young man."
The voice came from Elliott's left shoulder and drew his gaze up to a pair of pale blue eyes that glittered with icy disapproval. They belonged to a well-dressed older woman whose short silver hair was fairly bristling with indignation.
"That was incredibly rude of you--cracking your knuckles like that in a busy restaurant, of all places. You," she said accusingly, "gave me the heebie-jeebies."
She turned and walked off then, back ramrod straight, looking larger than life and amply menacing.
Copyright 2006 Maya Kaathryn Bohnhoff