The Inheritance of Shame

by Peter Gajdics

  Alfonzo laughed. “I’m a Latino. Latinos are temperamentally different than Anglo-Saxons. Sometimes these cultural differences confuse my patients, but I would never scream at them. I know such behavior would never be acceptable. And my meals? Sorry to laugh, but I have a very restrictive diet. My wife cooks all my meals.”

  Alfonzo’s “restrictive diet” was hardly something I could forget, considering all the lists of spices and foods we were to use and avoid that he provided us with, and assumed his “wife,” Yvette, was cooking for him now only that we were gone.

  “Do you keep your beliefs to yourself? Facts about your life?”

  “Naturally,” he said, still smiling. “Why would I tell my patients about my life? My patients are all mentally ill. Most are delusional.” He glanced over at me. “No offence to them, or to Mr. Gajdics here, but if I wanted to talk to someone I wouldn’t talk to a patient. I’d talk to my wife.”

  I wanted to laugh, too. Or maybe just raise my hand and remind the good doctors and publicly appointed civil servants sitting around the shiny, lacquered boardroom table that Alfonzo had met his wife, Yvette, more than fifteen years ago when she, a “mentally ill patient,” was referred to him for treatment, and that she’d continued as his patient, in addition to becoming his common-law wife.

  “Dr. Alfonzo, have any of your current or past patients ever witnessed your own therapy, with or without the aid of ketamine?”

  “I haven’t done active therapy work since the nineteen eighties.”

  “You haven’t.”

  “No.”

  “Why then would Mr. Gajdics have said this occurred, that he had witnessed your own therapy, if it had not?”

  “Sadly, Mr. Gajdics’s ability to blend fact and fiction is characteristic of his kind of personality disorder. For a patient to witness his therapist’s own treatment would not be therapeutic. It would break all the rules. It would be traumatic for the patient, not to mention unethical and a violation of trust. I would never do that. I’m shocked that he would say such a thing. Shocked.”

  Alfonzo’s comments were puzzling. If, as he said, it truly was “traumatic,” “unethical,” and a “violation of trust” for patients to witness their therapist’s own treatment, did Alfonzo himself understand that his behavior was, indeed, unethical and a violation and now was lying just to save his profession? Or was he only telling the committee what he knew they wanted to hear even though he did not, in truth, believe it himself?

  Either way, listening to the entire conversation was like watching skilled professionals in a game of chess: The committee asked Alfonzo what they knew they needed to ask, and Alfonzo told them what he knew they needed to hear. Truth was the last thing this conduct review was about.

  “Dr. Alfonzo, when was the last time you consulted another psychiatrist or the psychiatric community?”

  “The psychiatric community?”

  “Yes.”

  “Um…I’m not sure what you mean.”

  “When was the last time you had a conversation with another psychiatrist?”

  “I used to attend some meetings.”

  “When was that?”

  “Ten…eleven years ago. In Quebec.”

  “You have not discussed your theories with another psychiatrist in ten or eleven years? Are you conducting research on your patients on the use of ketamine and nurturing in psychotherapy?”

  “Yes.”

  “Well who gives you feedback on your research?”

  “Feedback?”

  “Who do you talk to about your patients?”

  “My patients.”

  “Excuse me?”

  “My patients complete questionnaires, and we discuss their progress together.”

  “Dr. Alfonzo, are you telling this committee that you discuss your research on your patients with your patients?”

  “Yes.”

  “You have no peer review.”

  “I’ve found that the patient is the best person to discuss their progress with. Besides, research in psychiatry is not the same as in other branches of medical science.”

  “Dr. Alfonzo, this committee is not in agreement with the opinion that a psychiatrist’s treatment model should be tailored to the requirements of what the patients think they need. Especially when those patients are undergoing regression, are under the influence of extremely powerful psychotropics, and would naturally want to do or say anything to please their therapist.”

  I was struck by Alfonzo’s comment, about turning to his patients for feedback, not only because it had been true for us but because it was similar to what I’d read in cult-expert Margaret Thaler Singer’s book Crazy Therapies, in which she referred to the many “crazy” therapists, many of whom practiced a type of “feeling” therapy similar to Alfonzo’s, whose support came mainly from patient feedback, which was analyzed and evaluated by the therapists themselves.

  “Dr. Alfonzo, could you explain to this committee your use of ketamine hydrochloride and the general use of anesthesia in your psychotherapy?”

  “I use only very small doses of ketamine to avoid the hallucinogenic effects. No more than a quarter to a half cc. I’ve found that by using the drug, I am able to eliminate the patient’s observing ego, thereby allowing direct contact with the patient’s child self during the nurturing sessions with the surrogate parent.”

  He reached below the table and started shuffling through his boxes, heaved one up onto the table and began flipping through the six-inch-thick tabbed binders. “I’ve brought a research paper that was written thirty or so years ago, in Russia, where ketamine was used to enhance psychotherapeutic processes. If you’ll just…just give me a minute…one…second…”

  I knew the paper he was referencing. Since leaving the house I’d done my own research. The paper was about ketamine-assisted psychotherapy for detoxified heroin addicts—not exactly correlative to my own history.

  One of his boxes tumbled back onto the floor and some of its content scattered beneath the table. Before Mrs. Humphries had had a chance to stop him, he was down on his knees, like a schoolboy, crawling under the table, gathering the loose papers and clipping them back into their respective binders.

  “If you’ll just give me a minute,” he said, popping his head up from beneath the table. “I’m sure it’s here, somewhere…I’m sure I can find it…”

  Some of the committee members hid their faces in their hands. Alfonzo’s pasty-faced lawyer ducked beneath the table and whispered for him to sit back up in his chair.

  “Dr. Alfonzo…Dr. Alfonzo,” Mrs. Humphries called out from across the room, “please stand up. This committee is not interested in Russian research papers written thirty years ago.”

  Alfonzo finished clipping his papers back in the binders and returned to his seat, looking more frazzled than when he entered the room.

  “Dr. Alfonzo, can you please tell this committee why you would not have used benzodiazepines, rather than the ketamine?”

  “I don’t want to sedate my patients. I want to stay away from dampening their feeling. It’s important that my patients retain the ability to communicate their progress with me.”

  Considering that I had been taking Rivotril, a benzodiazepine, for most of our years together, and that I had been beyond “sedated” and close to catatonic due to the elevated levels of all the medications combined, Alfonzo’s comment left me dumbstruck.

  Mrs. Humphries flipped through another voluminous file.

  “Dr. Alfonzo, we understand that at one point Mr. Gajdics had been prescribed up to…five hundred fifty milligrams of Elavil every day, on top of the other medications.”

  “That sounds about right.”

  But taking 600, I wanted to say.

  “Five hundred fifty milligrams,” Mrs. Humphries repeated, flatly.

  “Yes.”

  “Dr. Alfonzo. Are you aware that five hundred fifty milligrams of Elavil would normally be restricted to the most severely ill patients in hospitals or ins
titutions?”

  “Normally, yes.”

  “You are aware of that.”

  “Yes.”

  “And that the medication’s side effects alone would have caused Mr. Gajdics extreme suffering, not to mention a complete inability to communicate any progress he may or may not have been making in his treatment.”

  We all waited for Alfonzo’s response. He had none. Elavil, especially at the doses he prescribed, had a long and worrisome list of possible side effects, almost all of which I’d experienced, including anxiety, blurred vision, diarrhea, disorientation, dizziness, drowsiness, fatigue, hallucinations, insomnia, decreased sex drive, excessive perspiration, irregular heartbeat, lack of coordination, loss of appetite, nightmares, numbness, rashes, swelling of the testicles, and weight gain. Tricyclic antidepressant overdose, as I had also read, was a significant cause of fatal drug poisoning.

  “Can you please explain to this committee your rationale for prescribing such high doses to Mr. Gajdics?”

  “I admit, few outpatients require such high dosages. They were needed for Mr. Gajdics because he was quite mentally ill.”

  There was a suspended moment when I looked around the table at each committee member, and each of them looked back at me. I had worn my best suit, was freshly shaven, and my eyes, I knew, had the clarity and sparkle of a sane human being.

  “Dr. Alfonzo,” Mrs. Humphries responded, her inflection rising dramatically, “are you trying to tell us that this young man sitting before us here today, that this man is a very, very, very, very damaged human being who required five hundred fifty milligrams of medication every day just to function? Is this what you are trying to tell us?”

  Every person in the room—Alfonzo, his lawyer, Mrs. Humphries, the committee members, even Tommy—had turned and looked at me, and I looked, one by one, at each of them. Several moments, it seemed, were happening in slow motion: Mrs. Humphries’s question, everyone’s glances at me, all of us waiting for Alfonzo’s response. Then Alfonzo turned to me as I did to him, and we all turned back to Mrs. Humphries as he responded to her.

  “Yes,” he replied.

  Some of the members shook their heads in what appeared to be bewilderment. I caught the eye of one committee member. She winked at me.

  “He looks great today,” Alfonzo added like a hiccup. “Obviously my therapy worked.”

  “Dr. Alfonzo, do you deny all of the allegations laid our in Mr. Gajdics’s complaint letter?”

  “Yes,” he said.

  I looked around the room. The members’ heads were all faced down at their yellow legal-sized pads of paper.

  “Dr. Alfonzo, tell me, please, what could possibly motivate a person, any person, to invent and then spend years of their life pursuing a complaint of such magnitude, unless at least some part of it were true?”

  “I now have sixty-five patients. None of them are complaining. Besides, most of my referrals are self-referrals that have come to me from other patients.”

  “Dr. Alfonzo, complainants come to the College without thought of gain but out of concern for the physician’s behavior. Even one complaint is cause for concern.” Mrs. Humphries inhaled deeply before continuing. “Dr. Alfonzo, your treatment plan is a highly unorthodox form of therapy. The committee is aware that it has never been properly investigated and that it leaves much to be desired at the scientific level. The fact that an experimental program of this type of therapy was run almost thirty years ago is not sufficient. Scientific knowledge must be continuously evaluated and reevaluated in order for advances to be made. Moreover, the committee is concerned that you are isolated from the psychiatric community. We are concerned about your future group work with patients, your individual therapy, and your use of ketamine.”

  One committee member, a man, spoke up for the first time. “Dr. Alfonzo, I have to say that I am not at all comfortable with your style of practice. Personally, I find it extremely distressing. Tell me: When do you plan to retire?”

  “Oh, not for a while. Ten years or so.”

  For several minutes no one said a word. Mrs. Humphries wrote notes and exchanged a hushed conversation with a colleague. Others looked at me and smiled, blinked in acknowledgment. I did not look at Alfonzo, but I could hear him whispering with his lawyer. Tommy had not said a word to me the whole time we’d been seated.

  “Dr. Alfonzo,” Mrs. Humphries said, turning back toward the room, “the College will arrange to have your practice reviewed. We will be in touch. Mr. Gajdics, would you like to say anything before we adjourn for the day?”

  “Nothing, thank you. I think my complaint letter said it all. But thanks to everyone for their time. I appreciate it.”

  “Then we’re finished. Thank you to all for your time and energy.”

  I looked at my watch. Despite being told that reviews rarely lasted longer than thirty minutes, mine had lasted more than two hours.

  Out on the street, Tommy and I walked to his car in the pouring rain.

  “Don’t you want to get under?” he motioned, opening his umbrella.

  I nodded, turned my face up toward the sky. Rain was what I needed.

  “They believed you, Peter, not him,” he said as we climbed in his car. “He looked like the mad professor, down on his knees, picking up binders, mumbling something about ketamine being used in Russia. I think their only hope now is that he retires one day soon.”

  “Maybe. Maybe not. I don’t know.”

  This had been the first time that I’d seen Alfonzo in nearly three years. The last time I’d seen him, he had been like a father to me, a demigod; now he was more like a phantom from someone else’s nightmare. I didn’t know which disturbed me more: his current behavior or the fact that I’d submitted to him for as long as I had, fearing that if I didn’t, somehow I’d be punished.

  “Where do you want to go to eat?” I said to Tommy, my face still dripping from the rain. “I need a drink.”

  22

  IN AUGUST 1999, FIVE months after the conduct review, I received an envelope in the mail with no return address; inside was a poorly photocopied, four-page document that took me several minutes to decipher. It was a copy of the review of Alfonzo’s practice, as conducted by “two independent psychiatrists,” both hired by the College of Physicians and Surgeons.

  The review had taken place in Alfonzo’s office, the document read, on a single day over a period of four hours. The two psychiatrists commended Alfonzo for his availability and cooperation in pulling charts from recent patients. They asked him questions about how he conducted his practice; Alfonzo, in turn, told them of his therapeutic houses, which he stated no longer existed. He explained that his therapy consisted of “about fifty percent cognitive behavioral and about fifty percent feeling therapy,” and that its purpose was to “allow retrogression and to link the past with the present.” The “about fifty percent cognitive behavioral” comment left me perplexed. If Alfonzo had changed his practice since my days in the Styx, this was news to me. Maybe we had been his guinea pigs.

  The doctors discussed Alfonzo’s nurturing sessions. Alfonzo affirmed that the powerful emotions that emerged during these sessions connected past events to the present. The doctors discussed the potential problems with regression, their concern about a patient’s ability to return to normal functioning. Alfonzo said that his patients emerged fully able to live in the present.

  The document concluded with the following summary:

  Strengths:

  1.Dr. Alfonzo is trying his best with a difficult patient mix.

  2.He is well-intentioned and approaches his work with diligence.

  3.The notion of support and nurturing as a treatment process for personality disorders is not without foundation.

  Weaknesses:

  1.Occasional involvement in nurturing sessions himself. We are clear that this is not a sexual violation but is most likely a boundary violation.

  2.Giving gifts to patients would be considered a boundary violation.

&n
bsp; 3.Use of Ketamine, which is an anesthetic drug that produces disinhibiting and hallucinatory experiences. This is not a standard, accepted psychiatric practice.

  4.Potential problems with regression (retrogression) and return to normal function in a short period of time with individuals who are vulnerable in this experience.

  |||||||||||

  Natie and I had not seen each other in almost ten months when she visited me in my apartment. Since undergoing a colostomy for stage 3 cancer, she told me, her life had revolved around her now “nonexistent asshole,” and the fact that she would have to “shit out of a bag” for the remainder of her life.

  For the time being, she was unable to sit for long periods of time, and even when she did, had to use a doughnut-shaped pillow to soften the feeling of sitting on a pinecone. She also went through a six-month course of chemotherapy, which caused the usual symptoms of nausea, vomiting, diarrhea, fatigue, hair loss, skin rash, and mouth sores.

  Her recent three-month follow-up test, she explained, came back negative, although her doctor was quick to remind her that these types of tests were not at all sensitive; he could neither confirm nor deny that she had cancer. At times, her feelings of grief, exhaustion, and sadness were almost too much to bear. But she was aware that soon she would have to put this demon in the cage she had built for it in her mind and carry on with life, knowing full well that the demon that was cancer could emerge and consume her once again, this time for good.

  Natie and I had always shared a brutal honesty. After lying regressed on a mattress for years, confessing the shame of our childhood sexual abuse and the ways in which we’d sought the love of our parents through hundreds if not thousands of sexual partners, there was little else to hide. Little else embarrassed. Physical nakedness paled in comparison. So I asked about her cancer, about whether she thought there was a correlation between the fact that her childhood abuser had anally raped her and that her body developed colon cancer some thirty-five years later.

  “Of course I’ve made the connection,” she said. “I don’t have an asshole anymore. The hole my abuser entered me through has been sewn shut. I’d be a fool not to think of that. On one hand, I know that I’ve survived this crippling disease we call cancer. But the experience of having cancer has meant so much more to me; it’s gone far beyond a bunch of microorganisms in my body. It’s illness as metaphor. The cancer was a message. It forced me to stop and reexamine how I was living my life, how I should live my life, how I want to live my life. Like you and the therapy. I think in a lot of ways it’s easier to have cancer than to go through what you did with the therapy.”