It was mischief. He didn’t see what I saw.
Pathology.
Disorder.
“You think a lot of children do things like this?” I asked.
“Kids do a lot of weird stuff, I guess.”
“Other children do mischievous things. But not to this degree, Luke.”
“You’re being honest again, right?” Luke said.
I said nothing, again using silence to move the therapy deeper.
“You’re right, though,” he replied. “I know I was different as a kid, Dr. Reese.”
Luke fell silent. Gradually, he became restless, shifting his arms and legs. Eventually, he exhaled noisily, the way one does when feeling burdened.
“What are you thinking about?” I asked, sensing he was conflicted.
“I don’t how to say it because I’m already a fucking freak in your eyes.”
“Remember, this is not about judgment. It’s about understanding.”
“I was eleven. Sixth grade. I—I took a cat and drowned it.”
“Whose cat?” I asked.
“My mother’s. Penny”
Hearing him say this, I felt my eyes widen and my mouth drop open. Luke was on the couch, and I was grateful he didn’t see my reaction.
“Okay. Tell me what happened.”
“She loved this cat. Treated it better than me. Better than anyone, really. I took it out one night and shoved it under the pool cover.”
I leaned back in my chair, speechless and stunned.
“My mother couldn’t find it, but she never stopped looking. When the pool opened in May, there it was floating in the water.”
“She must’ve been devastated.”
“It was gross. Never saw anything so disgusting. And after a while, I felt bad. I remember crying for days about it.”
Hearing this narrative upset me more than listening to Luke describe what he did to Gallin. Within seconds, I realized this session highlighted something more troubling—a pattern of violent behavior. Killing was not a one-time occurrence. It happened before, and if it had happened at age eleven and at age twenty-five, it could happen again. There was also a sixteen-year gap to account for between Penny and Donald Gallin.
Are there more killings to discover?
My stomach pitched, and I felt lightheaded. But I had to press on.
“Sounds like you were upset you killed Penny, just like you felt regret about Gallin.”
“Yeah.”
“I think you take your own feelings of rage and deadness and make others suffer.”
“How do I make sure it doesn’t happen again?” he asked.
“By telling me if there’s any more secrets.”
It was almost imperceptible, but the barrel of Luke’s chest lifted up ever so slightly and then back down in a shudder. He began to cry. I saw a tear make its way along the side of his face. His body shook silently, and then without warning, he pounded his fists into the couch cushions.
“I have these attacks because...because...I can’t control my emotions... and...I’m afraid I’ll lose control again.”
Again. I heard him say again.
I regarded him closely, studying his posture on the couch.
“Have you lost control other times?”
“No, no more surprises,” he insisted. Luke grabbed a tissue, wiping his eyes and nose.
“Is that the truth?” I pressed again, leaning forward in my chair. “Is that really the truth?”
Luke bolted up from his resting position and swung his legs to the side. I shrank back as he looked at me long and hard.
“Just can't talk anymore today,” he said. “I'm gonna have another panic attack if I do.”
Before I could respond, he handed me his tissue and rushed from the room.
“Luke,” I shouted as I got up from my seat.
I tried to catch up to him, but the door slammed. By the time I got to the waiting room, he was already out the office suite. I moved into the building’s hallway and ran toward the stairs just as the door clicked shut. I hauled it open and took the stairs, jumping onto the concrete landing.
“Luke, wait,” I yelled.
My voice echoed around the walls, as did the trailing noise of his footsteps.
Seconds later, the only sound I heard was my own breathlessness.
As I walked back into the office, I heard my words again and again in my head
Is that the truth?
Is that really the truth, Luke?
My hands began to tremble, and my knees weakened.
I fell to the floor as a wave a terror took hold of me.
Notes
Luke reveals he killed the family cat at age 11.
Long-standing history of significant aggression as a child.
He’s 27 now. What’s happened in between these years?
Passive-aggressive stealing, hiding and infringing on others without regret. Lack of empathy and escalation of fury and rage.
Battles panic as he tells me about this. Anxiety level so high, he flees the office before the appointment is done.
Luke is intense and unpredictable.
Transference: Still positive. High regard for me.
Counter-transference: Again, feeling terrified at times in the session. Growing fearful and suspicious. Feel the need to check on his story about the cat to maintain hopeful, positive connection. But how?
Relevant issues: Paper again. First session, the bathroom cup, he works for a paper. Now he gives me his used tissue. Is he giving me his garbage?
Another theme: Dirt. Puts dirt in mother’s food, urine in her drinks. So primitive. Talked about being covered in dirt when he killed Gallin.
Significant history of fooling. Even says it feels satisfying. Is he fooling me? Could all this be untrue?
Diagnosis: Panic Disorder. Psychopathy. Antisocial Personality final consideration.
Prognosis: Guarded.
Friday Night
I
was told early on in my psychoanalytic training I had the temperament to work with intense cases.
I also possessed a natural curiosity to seek out the origin of pathology instead of sitting in judgment of it.
Growing up as a Coda deeply influenced the way I approached life. Having to live in-between the spaces of two worlds made me patient, compassionate, and open-minded. I was never an all-or-nothing person, a black-and-white thinker. I preferred to see the gray of it all.
And that made me a good clinician.
But no case challenged me more than Luke.
I pulled out the Miami Press article. It was a copy, not an original, though the layout, typeface, and newspaper logo looked real. With all that went on in this session, I had to verify the article. I needed it for my own grounding.
Ryan had been a professor at Long Island University, and I was always on campus using the library. I decided to access the newspaper on microfilm. There’d be no trace that way.
The campus was a short drive from my office, and within minutes, I was at the West gate entrance and parked right next to the B. Davis Schwartz Building. I trotted down to the lower level where the periodicals were housed, and after talking to Sharon, a college student who worked the night desk, I figured out how to get things done.
“So I need The Miami Free Press for the year 2015.”
“I’ll bring it right out to you, Dr. Reese,” Sharon replied, happy to have something to do.
After about ten minutes, she emerged with the films. “Want me to help you load it into microfilm reader?”
“I got it,” I said, wanting to be alone.
I worked the directional buttons on the film tray and found Luke’s article. I pulled out the copy of the one he gave in the session and compared it.
They were identical.
“Shit. It’s real,” I said under my breath.
I moved to the following days and weeks after Gallin’s murder an
d read all the articles written. No leads. I also researched the months that followed. Only two articles were written saying the trail had gone cold.
“Luke told the truth,” I said to myself.
I considered making copies of all the articles but doing so required a credit card.
Could be traced back to the library here.
Emailing them to myself—or anyone else I knew—was out of the question too. Could be traced.
Instead, I exited out of the reader and brought the film back to Sharon behind the desk.
I drove home relieved.
He’s not fooling me.
Session Seven
Monday, June 19th
“
Sorry I left early last session.”
“Not your fault. I pushed too hard.”
Luke was silent for a while.
“I was pissed you didn't believe me,” he finally said.
“You're right to be upset. I was shocked to hear about Penny. And I pressed the issue more than I should have.”
Luke stilled himself and listened.
“I was insensitive. And I apologize,” I continued.
“I don’t get a lot of I’m sorry’s.” Luke ran his hands over his face, rubbing his eyes. “It’s—it’s a nice thing to hear.”
“Why’s that?”
“Because you’re owning your shit. You care I got upset.”
“I do care.”
“Well, I realize I can’t get better if I’m not honest about things. But I gotta know I can tell you anything. And that you’ll trust me.”
“You got my trust, Luke.”
“So, do you believe me when I say, no more surprises?” he asked.
“I do.”
Luke nodded, and a silence fell in the room, strangely fixed and static.
“I wish I could go back and change things. Gallin, Penny. All the stupid shit I did as a kid. When I think of it all, I feel sick.”
“Disgust is a good thing. That you hate what you’ve done is really important.”
“Why?”
“Because it means you’re conflicted. And wherever there’s conflict, there’s possibility for change.”
“How do we make that happen?”
“We start linking the pieces of your rage and your actions.”
“All right.”
“When was the last time you felt out of control?”
“Well, about a year. When I was at Club Camber?”
“And since then?”
“Nothing I couldn’t handle.”
“Any panic attacks since you talked about Donald Gallin?”
“No.”
“Why do you think your emotional control is better?”
“Coming clean about what I’ve done.”
“And what else?”
Luke brought his hand to his face and stroked his chin with his fingers. I heard the friction of his whiskers against the tips of his nails. Soft sandpaper sounds.
“My mother isn't around to torture me anymore.”
“Yes. And since your mother died, how’s your anger been?”
“Definitely less.”
“It’d be good for us to have a plan if things worsen. I’m hoping that won’t happen, but if it does, we can feel confident we have a what-if set up.”
“Like what?”
“What if you do have an urge again? What if you find yourself in a rage and can’t control it? What if you can’t get in touch with me right away, what should you do? Something where if you feel any impulses to hurt someone, or even yourself, gets you the help you need.”
“What will happen if I call you?”
“Well, we’d talk about exactly what you’re feeling and try to contain it. We can schedule an emergency session or work over the phone.”
“Okay, sounds good,” Luke said.
“If we can’t get a handle on your urges, we’d get you to a hospital.”
“Calling you or coming here isn’t a problem. But if I have to go to the hospital, what would you tell them?”
“I’d explain that you’re having violent impulses and that you’re worried you might harm someone.”
“What if they ask if I’ve been like this before?”
“Well, we’d tell them, yes, you’ve felt this before—”
“We’d tell them that? We’d tell them I’ve killed before? Are you fucking kidding me?”
“No, no, we couldn’t tell them that,” I replied.
Luke’s agitation was intense. He looked as if he’d spring from the couch any second. He clutched his chest as it wrenched itself up and down in spastic movements. The anxiety barreled forward in seconds.
“Luke, slow your breathing down.”
Like a driver preventing a car from careening off the roadway, he steered his breathing in another direction. He took long, slow breaths in-and-out in a series of successions. Gradually, his body lost its panicked rigidity. I watched as his fluttering eyes closed and the scowl on his face melt away.
“Sorry our discussion brought that attack on,” I said.
“I’m not comfortable with this arrangement, Dr. Reese. I’m just not.”
“You interrupted me before I could finish. I wouldn’t go into specifics. I’d explain these kinds of feelings happened before, but nothing more. What’s in the past stays in the past.”
“What goes on in the hospital if I go?”
“They’ll stabilize your mental and physical functioning, maybe introduce medication. Once you’re feeling better, we’d resume sessions again.”
Luke remained quiet, thinking about what I described.
“You're angry with me now,” I said.
“No shit,” Luke shouted.
“Do you feel an urge to hurt me?”
“No, I’m just... just frustrated. I don’t wanna hurt you. I’d never hurt you, Doc. I know you’re trying to help me.”
“You know I'll keep all you’ve told me confidential. It’s important you realize what I’m saying. I’m here for you. I’ll work with you, I’ll do all that I can to help you. But if you feel you can’t work within the plan, I—”
“I can work within the plan, Dr. Reese,” he cut in.
I sighed. “That’s good to hear, Luke.”
The session’s end was but a few minutes away.
“We have to stop here, but I’ll see you Wednesday.”
Notes
Session finally confirms psychopathic tendencies.
Subtype of psychopathy is secondary psychopath - guilt-prone, poor impulse control, physical aches and pains, worries, driven to avoid and escape pain.
During session, had anxiety which escalated to a panic attack and successfully managed it.
Using insight to teach him about his defenses, like displacement, splitting. Will continue to do so.
Transference: still positive. Was able to expressed anger, frustration and disappointment with me – but not feeling overwhelmed or agitated to act on these impulses.
Counter-transference: Feeling in control now that emergency plan set up. Feeling hopeful but guarded regarding prognosis. Still have positive connection to patient.
Relevant issues: Psychopathic personality resistant to change. Research suggests prognosis poor. Will discuss further in supervision.
DSM V Diagnosis: Panic Disorder, Antisocial Personality Disorder.
Prognosis: Guarded.
Monday Night
N
ow that I had a formal diagnosis and an emergency plan, I was ready to work the case.
I knew the likelihood of change for Luke was small, but psychoanalysis could, at the very least, offer structure and safety. As long as I didn’t become an object he needed to injure or destroy, devalue or dominate, the work could be done.
As I followed the arc of my thoughts, I wondered if Luke was able to gain a sense of real control since his mother was dead.
She was gone.
Fixed forever in time.
Just as I was ready to leave for the night, the phone rang. The caller ID said it was Dr. Paula Karne.
“Hi Dr. Reese. Am I calling too late?”
“No, I’m just finishing my night, Dr. Karne.”
“So, Lucas finally made it to you.”
She called him Lucas, I thought to myself. Guess he never told her to call him Luke.
“Yes. Just started working with him.”
I walked as far as the landline cord would let me, balanced the phone on my lap, and sat down on the edge of the picture window. The sunset was just too good to miss.
“I wanted to know about your work with him,” I said.
“We used a lot of behavioral techniques to reduce anxiety. Realistic Thinking, Exposure Therapy. Even tried Virtual Reality Therapy. Minimal improvements, though.”
“That’s what he reported at the intake.”
“Interesting kid. I sensed he was withholding a lot, though. Didn’t really talk much. But he worked hard in the sessions. It just wasn’t a good fit for him.”
“Well, I appreciate the referral,” I said.
“How are things going in treatment?” she asked.
“It’s a challenging case. If there’s anything else coming to mind about your work with him, let me know.”
“I will.” Karne shifted the conversation. “Might I see you at the psychological association luncheon next month?”
“Haven’t RSVP-ed, but I think I’ll be there.”
Of course, that was unlikely, but I said it anyway. Nothing I did socially since Ryan died was ever planned. If I felt good in the moment, then I’d go. More often than not, though, I never felt like going anywhere or doing anything.
“Well, I hope you come. Would be nice to see you.”
I cradled the phone back in its place after saying goodbye and set it back on my desk. The clock was nearing eight fifteen, and I thought about getting home for the night.
I detailed my call with Dr. Karne in Luke’s file and then slid the rest of the day’s files back into their alphabetized slots. Just before I locked the cabinet closed, the phone rang.
The Ninth Session Page 9
