“You’ll see,” she said. “She’s going to stand you up.”
“She’ll stand me up no matter what I say or don’t say,” I replied.
“Still, I’ll hate to have to say I told you so.”
Somehow I doubted that. Just then embarking on what would be a yearlong relationship with Caitlin, I already felt not only completely dismissive of her skills but also utterly defeated. None of this would be good for any of the parties involved and, as I knew in my gut on that first day, least of all for the patient who’d unwittingly landed in the midst of us.
CHAPTER THREE
IF DR. YOUNG WAS TECHNICALLY MY SUPERVISOR AT FORENSICS, it soon became clear that this was only technical. She waved each morning when she walked past me and into her office, and sometimes if we rode the elevator together, she would turn to me and ask an oddly timed personal question, like did I want children. (I did; she did not.) I had long ago, if with some regret, abandoned my notion that psychologists would necessarily have good interpersonal skills, and I found Dr. Young more likable than some. She was quite cheerful and had given me that good advice about what to do if I got stopped by the police, which, the more time I spent around the hapless defendants, the easier it was to imagine as a likely eventuality. Dr. Wolfe was often around to provide thoughtful answers to my recurring questions about the defendants we saw, and so rather than request the face-to-face time with Dr. Young that I was only half sure I was supposed to be having anyway, I took to following the master’s students around like a lamb. Another day, another 7:30.
One morning and then another, and how quickly they became so similar. Dr. Matthew Laytner, Dr. Pine, Jim Danziger, and I began with Robert Woodhale, who knew who he was but could not quite say where he was. “At Rikers?” he asked, which was not a bad guess given the bars confining us to the courthouse’s basement holding cell. “At Bellevue?” he tried again, another good guess because of course he’d been confined there before.
From what I’d seen, Mr. Woodhale was the epitome of competency assessment referrals: twenty-seven years old, a string of arrests that made a neat pairing with his string of psychiatric hospitalizations. He was African American, soft-spoken, dressed in a hospital gown and dirty sweatpants, sneakers without laces, handcuffs. When asked for his Social Security number, he recited what must have been his zip code.
Dr. Laytner—a young, good-looking psychiatrist who was as new to the forensic team as I—explained that though he was a psychiatrist, this talk was not confidential, that rather it was an assessment for the court. “Do you know why?” asked Dr. Laytner, whose careful grooming was cast in especially high relief against this backdrop.
“To avoid me staying in an institution?” Mr. Woodhale asked.
“You were arrested,” interjected Jim Danziger, looking up from his highlighter and his magazine. He also had Mr. Woodhale’s file in front of him. “Do you know what you were arrested for?” Mr. Woodhale shook his head. “You hit a guy at your group home in the face with a chair,” Jim told him. It was not a courtroom thriller.
Dr. Pine listened and took her own notes for the brief report that she or I would need to write later. I had not yet asked to conduct an interview—as the master’s students often did—but I had jumped wholeheartedly into writing them up afterward, in three pages or fewer. Dr. Laytner tried to get a coherent social history from Mr. Woodhale. He failed. Mr. Woodhale could not say how he had spent the last year; he was preoccupied with getting his disability check. Then he remembered: “Schizophrenic, I’m schizophrenic. I have a mental illness.”
“Do you know what medications you take?” asked Dr. Laytner.
“Geodon,” said Mr. Woodhale.
“Do you know what it’s for?”
“Schizophrenia.”
“Do you hear voices?” asked Dr. Laytner.
“I hear your voice,” replied Mr. Woodhale.
“Can you explain to me what your legal situation is now?” asked Dr. Laytner, continuing with the evaluation.
“You tell me that,” said Mr. Woodhale. “Explain to me please.”
“I need you to try to explain it to me,” said Dr. Laytner patiently.
“Hmm, let’s see, what’s facing me. I’m just waiting until I get out. Two years. Three years. It was hot out. They’re homosexuals. They know my name. They’re after my money.”
Mr. Woodhale was escorted out of the holding cell. Later, Dr. Pine and Dr. Laytner would have no trouble agreeing that this defendant—unclear as he was on whether he had even been arrested—was not fit to stand trial.
The corrections officer returned with our second evaluation of the morning, a Mr. Ramone. “Call me Paulie,” said the big-gutted, blustery Italian man in his fifties. His hair was bleached blond with dark roots. He had one black eye. He was wearing a plaid bathrobe and carrying a Bible. Paulie’s presence was like a shot of hard liquor, and the mood in the room lightened. Immediately, we all knew he was manic, or using manic defenses—primarily denial and acting out—in order to escape distress and avoid feelings of loss. Most everyone uses manic defenses once in a while, and they can be fairly benign. I was familiar with them firsthand, having spent more than a few afternoons in furies of cleaning and errands when I was fighting a black mood. But on the more pathological end of the spectrum, mania can dislodge rational thought and completely disrupt a life.
Dr. Laytner introduced us all, our smiles now broad, and asked Paulie if he knew why he was there. “To see if I’m sane,” Paulie replied, smirking. “You can’t build appliances for twenty-nine years and be insane, sir.”
“When did you do that to your hair?” asked Dr. Laytner, responding to the jovial mood in the room while also asking an important question about the inmate’s history—that is, how long had he been sick enough to make himself look so odd.
“After my wife left,” Paulie said proudly. “The girls love it. I get more winks and smiles than I ever did with the gray. You can see why, right, sweetheart?” he asked, turning to me. I smiled wider and nodded.
“What happened to your eye?” Dr. Laytner inquired.
“I’m not a violent person,” said Paulie. “I love people. I’m a lover. I was a hippie, sir.”
“It says here that you got into a fight with your cell mate,” said Jim, reading from the file.
“Without the Klonopin, everything bothers me,” explained Paulie. “It seems like everyone wants to fight with me. Once I’m out, the only medication I’ll need is my Harley.”
Dr. Laytner explained why we were gathered there and made Paulie aware that our talk was not confidential. He gave him a consent form to sign. “No problem. I’ve got nothing to hide,” he said.
“Do you know what you’re accused of?”
He sighed. “I’m getting divorced. I drove my Cadillac through the garage door. But it wasn’t my fault. It was an accident.”
“Anything else?”
“No. Well, okay, barricading myself in my house. My wife had an order of protection against me. There was a warrant out for my arrest because they said I’d been driving by the house, which was a lie. I was upstate. My cousin will swear to that.”
“Why did you barricade yourself in the house?”
“I didn’t! I went over there to watch the Giants game. I didn’t even know she’d come home and called the police. I went to sleep and woke up to helicopters and SWAT teams. They stormed into my bedroom to get me. My wife will do anything to put me in jail.”
“Why does she want to do that?”
“I’m not in her mind, sir. You’ll have to ask her that question.”
“Well, what is your best guess?”
“She’s mentally ill. This is all part of her evil plan.”
“Evil plan?”
“I go to the loony bin for the rest of my life, and she gets everything.”
“Do you think that plan makes any sense?”
“Any spouse can lock up any other spouse. It’s the law. You should know the law before you co
me to see me, sir.”
“How do you plan on handling your conflict with her?”
“See this Bible? God is with me. I’ll make sure the newspapers get my side of the story. I’m going to sell my house and move to Barbados. I’ll raise German shepherds. I may still love her, but I’ll divorce her. It’ll make headlines. She’ll regret all this then.”
Mania in and of itself does not necessarily make a defendant incompetent. But as Dr. Laytner went on with the interview, it would become clear that Paulie’s use of denial was behind his refusal to craft a reasonable plan for dealing with the charges against him. “They’re going to be dropped,” he kept insisting. “You can’t be put in jail for breaking into your own house.” Dr. Pine and Dr. Laytner would once again agree: not currently fit to stand trial.
Back upstairs the students milled about the small, tidy forensics office. I stood in Dr. Wolfe’s vacant cubicle, looking to see how far he’d gotten in the Times crossword puzzle and hoping he’d come back from his morning interviews to chat. What I wanted to talk about I had to keep to myself: how frustrated I was feeling in the G Building, by Scott and Caitlin and what little else was going on there as of yet. I needed someone with some authority to validate my discontent and offer me condolence. To tell me I was right. If I could only get it surreptitiously by talking about the crossword puzzle, I would settle for that, but when Dr. Wolfe arrived, I became self-conscious and blushed. He looked at me funny. “Is it hot in here?” he asked.
“I get flushed easily,” I explained. It was true, but maybe I also had a schoolgirl crush on him. It was hard, sometimes, to differentiate between all the kinds of longing.
Dr. Wolfe sat down at his desk, and I settled across from him. Apropos of nothing obvious, he began to tell me a story about a job interview he had once sat in on. The male psychologist doing the interview had taken it upon himself to confront the female interviewee with what he supposed was the “fact” that she wanted to sleep with him. The story was tangentially related to earlier discussions Dr. Wolfe and I had had about my theoretical orientation, about the flouting of social convention that he viewed as a point of pride among psychoanalytically oriented clinicians. But why had he associated to that particular story in that particular moment? As happened more and more the longer I was in school, I couldn’t stop myself from thinking like a therapist. My training had taught me to pay attention to associations: each new idea is linked to the one that came before it. I imagined Dr. Wolfe believed my blushing a sign that like the interviewee in his story, I was harboring prurient thoughts. Given our age difference, I hoped he would only be flattered, but in moments like those I often felt I’d rather not be privy to the ways of knowing of my field. I was certainly not a mind reader, as strangers I met at parties sometimes seemed to fear, but like a telepath I did have clues to bits of others’ private thoughts that a non-psychologist was spared. I guessed that I could never go back to being that, and my chest filled with regret.
When a defendant had the money to make bail, he could walk into the courthouse like a free man and meet with us up on the thirteenth floor. Because people with such abundant resources rarely needed our services, I saw this happen only once. The man was kempt and handsome, in suspenders and a navy blazer with a yellow tie. Despite this sartorial care, there were strings hanging from the bottom of his pants, as if he were waiting to unravel. His name was John Douglass. He’d been arrested for having a loaded gun but no permit. The police found him sitting in his car with it contemplating suicide.
“My wife saw me leave the house and called them because she knew my state of mind,” he explained. “I had it for target shooting. I just hadn’t ever bothered to renew the license.” He referred to his arrest as “the incident.”
“I haven’t worked since the incident,” he told us. He’d been a newspaperman for more than twenty years. He regretted the changes wrought by technology. “I lived for pasteup—the careful cutting, the precision. Now everything’s computerized, and it’s just a job.”
He’d never been hospitalized, but he’d had problems with cocaine for a long time, giving it up only a couple years before with the help of Narcotics Anonymous. “But then I got addicted to painkillers,” he said as he began to cry. “I’ve put my wife through so much. It’s been the usual craziness that comes with abuse. Lying. Money problems. I drank four or five quarts of beer and took nine Percocets, and I went out to end my life.”
Dr. Wolfe asked if he’d ever thought about suicide before.
“No, just in this past year. I couldn’t believe I was capable of this moral and physical decay.”
He was sleeping okay. Eating, too. He was planning on returning to work. He was not confused or unable to communicate with his lawyer, but there was concern that the pressures of a trial would drive this still emotionally fragile man back down to a place that was dangerously bleak. It had only been two weeks since the incident.
For the time being, the doctors agreed he was unfit.
In school I had learned that the emotional pull toward the grossest distortion of external reality—psychosis—takes root or doesn’t in the first year of life, from some combination of nature and nurture. If what’s going on in a baby’s environment is too dreadful to accept, or if innate characteristics result in said baby experiencing his world in that way, he may never lay to rest the most frightening concerns of early life, which psychologists think of as engulfment and annihilation. Extremes of environment or biology or some combination of either can impede an infant’s ability to accomplish two of the basic emotional tasks of the first year: realizing that he exists as a separate being, and establishing a rudimentary trust in those around him. If there is a relationship in which a baby receives sufficient soothing, and if his brain allows it, these tasks become faits accomplis. If not, a person will go through life vulnerable to the fears that luckier people master early, in times of stress becoming psychotic or dependent upon the primary defenses used by infants to hold himself together.
Psychologists label the earliest defenses “primitive” and mean that in the most literal (read: non-pejorative) sense: developmentally early. The primitive defenses, in contrast to “higher order” ones, reflect qualities associated with a child’s preverbal phase of development—lack of understanding of reality, and lack of appreciation of the separateness and constancy of others. The primitive defenses include colloquially familiar ones like denial and projection—when feelings that originate inside the self are misunderstood as coming from others. They also include less familiar ones like introjection, when what is threatening and outside is experienced as if coming from within, and omnipotent control—the fantasy that one controls the external environment with one’s mind. The use of each can result in psychotic symptoms. Some of these symptoms, like stilted turns of thought, are subtle enough to escape casual notice. Others are more florid: hallucinations, delusions, acute paranoia, and the like. It was these that were almost always on display at forensics, and seeing them up close for the first time felt valuable, even if I wasn’t getting to do any treatment.
Illogical thinking is one artifact of psychosis, and the defendants we saw often had interesting ideas about how they’d become ill. Mr. Ruiz, with his salt-and-pepper hair and the same date of birth as my mother, attributed his confusion to a watermelon seed. “I swallowed it, and I felt it go up into my head,” he told us. “It’s causing trouble. I feel it there now, and I can no longer think very well. When I was young, my mind was okay, but not now.” His crime was trespassing, though by his account his trespass was only into his former home, an abandoned building where he’d squatted for three years before the absent owners insisted he leave. “They turned on me,” he said glumly. He’d been homeless much of his life. He wore a sweatshirt tied around his neck like a cape. He would not agree to either take a plea or go to trial, and he kept insisting, “I can’t pay these people,” meaning his lawyer, though it was repeatedly explained to him that someone else would cover the expense. M
r. Ruiz was not fit to stand trial.
I climbed back upstairs to wait for the next round of interviews and was sitting in the clinic’s reception area when Dr. Ruben tore into the office in worked-up excitement. He had done an evaluation of a highly distractible defendant. Accused of robbing people on the subway, a crime the man claimed not to remember, he seemed unable even to follow his evaluators’ conversation. Furthermore, he could not understand why he could not simultaneously claim lack of memory of the event and that he hadn’t been carrying a gun. Dr. Ruben wanted to argue the defendant unfit on the basis of attention deficit disorder. He was an older psychiatrist, educated before attentional disorders were a point of focus, but he’d recently been reading about them in the New York Times. He was asking the clinic secretary if she could order the paper-and-pencil tests used to diagnose it when I interjected to tell him that the hospital already likely had them, and also offered to do the testing myself. I knew that ADD on its own did not cause the level of inattention Dr. Ruben described, but I thought it could be an interesting assignment and was ready to do something more active than sitting in on evaluations, which were never boring but were starting to feel repetitive nonetheless.
Dr. Young overheard my offer and popped her head out of her office to endorse it. She agreed that even if our guy had ADD, it was likely to be the least of his problems given, naturally, his very long history of psychiatric hospitalizations and arrests. Still, the testing would help fulfill one of my training requirements (five or six full testing batteries), and it would satisfy Dr. Ruben’s nascent curiosity. It was a win-win. And so the sporadically homeless, often incarcerated, and chronically mentally ill Grant Carson, as the defendant was named, became the unlikely subject of an extensive psychological screening.
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