It was getting more and more difficult to move my face. My mouth had hardened. My eyes had been locked.
“He told you that?”
“Yes.”
“When?” Katherine said. “When did he say that?”
“After he did it, when we were kids. A million years ago, a million billion—”
“He told you that he killed Fiona?” The word told was like a sheet of glass shattering all over my face.
“He put his hands around my throat.” This was an exaggeration. He had said he would kill me. He had never said he killed Fiona.
“When you were boys?”
“Yes, then.”
“Pilot,” Katherine said, “are you hearing any voices right now?”
“No.”
“Do you think anyone is putting these thoughts into your head?”
“No.” But there was rushing sound coming from somewhere behind her. There was rippling in the Caribbean water.
“Do things seem real to you lately?”
“Real?” I asked. I wasn’t even sure what she meant.
“I mean, are you having any trouble understanding what’s going on around you, Pilot? You seem distant.”
“The medication,” I said. “I’m taking more of it. Dr. Lennox—” and my voice stopped without my consent.
“Okay,” Katherine said. “Okay.” The little blades of her voice cut into the blue air all around me, swirling into the water of the mural. I looked down to see my own hand on the armrest of this chair, the blackened shoelace twisted around my middle finger. I saw Katherine’s hands on her lap, each of her little fingertips scabbed over, nails bitten to oblivion.
From her office, she dialed Dr. Lennox’s extension. “Greg,” she said. “It’s me.”
“Kate.” Dr. Lennox’s voice was good-natured today. “What can I do for you?”
“I’m sorry to bother you about this again,” she said. “It’s just that I’m having, I’m having difficulties with Pilot Airie.”
He cleared his throat. “What kind of difficulties?”
“Let me start by asking you something,” Katherine said. “Is it possible to be left with only one symptom of schizophrenia? I mean, after the medication has taken effect?”
“One symptom?” he said. “I don’t understand.”
“He’s paranoid.”
“Pilot Airie—”
“—is paranoid,” Katherine repeated. “He thinks his brother is out to kill him, and he believes Eric was responsible in some way for his sister’s abduction.” She touched the simulated wood grain on her desk. With her index finger, she traced the fake whorl of a knot.
“Well,” Dr. Lennox said, “that sounds odd. All of his other symptoms are gone? Are you sure about that?”
She said, “I’m not positive, of course, but he seems fairly rational right now, otherwise. He’s not hearing voices. He’s not hallucinating. At least he says he’s not. The increased dosage is making him sluggish, I think. But overall—”
“Paranoia is not just a symptom of schizophrenia,” Dr. Lennox reminded her. “Schizophrenia may be only one of Pilot’s problems.”
“True,” Katherine acknowledged.
The doctor cleared his throat again. “Perhaps he’s ready for some cognitive therapy,” he said. “Help him to reorganize his thinking.”
Katherine allowed a few seconds to pass. She could hear the doctor’s insincere smile through the intercom. She’d been hoping for more information, something concrete.
“Is there anything else, Kate?”
“No, Greg—but thanks.”
“I’ll talk to him.”
“Bye.” Katherine put down the phone gently. She had wanted to tell him about the relationship she was having with Eric, to clear things, but for some reason she hadn’t.
For some reason, she had allowed it to become a secret.
An omission.
But since I knew, she told herself, and since she had offered to stop seeing Eric, to get me another therapist—wasn’t that enough?
So why did she continue to feel like a criminal?
On the yellow pad of paper near the phone she kept a list of numbers. It included the contact names for her clients. My mother’s was at the bottom. Katherine dialed that number now. It rang several times, and just as she was about to hang up, someone answered.
“Airie residence, Hannah speaking.”
“Mrs. Airie,” Katherine said, “this is Katherine DeQuincey-Joy.”
“Katherine DeQuincey-Joy,” Hannah said absently, as if she had never heard the name before.
“I wanted to tell you that I spoke with your son this afternoon, with Pilot, and that he seems to be doing fine. His symptoms are actually diminishing quite a bit.”
“I’m very glad to hear that,” Hannah said. Did her voice brighten at all? Was she pleased?
“I thought you would be. Pilot is responding well to the medication. He said he’s no longer hearing voices or believes the woods are going to swallow him. He has relaxed a bit about your optical condition, although I think some of his concern is appropriate. I mean, you are his mother and he obviously cares for you.”
“Thank you,” Hannah said. “Do you think Dr. Lennox will release him soon?”
“I don’t see why not,” Katherine said. “And I want you to know that I won’t be an impediment to that in any way. But—”
“But what?”
“But I did have one question.”
At the other end of the line, Hannah twirled the telephone cord around her wrist. “Go on,” she said.
Down the corridor, I sat in front of the Caribbean mural and twirled the shoelace around my own finger, tightening and tightening.
“Pilot seems to be exhibiting one last symptom,” Katherine said, “and it is Dr. Lennox’s opinion that it is more likely to be a symptom of something else.”
“Of something else?”
“A thought he’s having.” She paused. “He’s paranoid, Mrs. Airie. As I told you the last time we spoke, he believes your other son, he believes that Eric, is out to, well, that he wants to kill him.”
“I know,” my mother said resignedly.
“More importantly, he believes Eric had something to do with your daughter’s—”
“Fiona?”
“Yes, with her disappearance.”
“Like what?”
“He thinks Eric… killed her.”
“Oh.” It was a small sound.
Katherine imagined my mother in an elegant house, with beige carpets and tan velvet furniture, with white flowers in glass vases on rattan tables. “Mrs. Airie,” Katherine said, “the reason I ask is not to bring up unpleasant memories. In fact, I really hate to do that. It’s just that I think whatever is causing these thoughts or feelings in Pilot may be what triggered this episode.”
“Sounds plausible,” my mother said.
“It’s clear, however, that Pilot is no longer a threat and that the medication has greatly helped. I mean, it is making him a bit sluggish, but that should go away over time. And, even though I can’t speak for Dr. Lennox, I don’t see why Pilot won’t be released in the next day or two. But we’d like to recommend continuing therapy, insight therapy. I believe it would greatly improve his—”
“I’m a physical therapist,” Hannah said. “You don’t have to convince me of the benefits of therapy, Miss DeQuincey-Joy.”
“I’m sorry. I just—”
“It’s all right,” my mother said brusquely. “You would handle this counseling yourself?”
“I would like to. If you’d rather, I’m sure Dr. Lennox can recommend another qualified—”
“No, no,” Hannah said. “I’d like you to do it.”
“Oh,” Katherine said.
“Would you come out to my home for the sessions?”
“I could,” Katherine said. “But if we don’t do it at the clinic it would have to be a separate financial arrangement. I’d be happy to oblige, however, and I’d c
harge as little as—”
“I’m sure Pilot would rather do it here,” my mother said. “Have you discussed this with Eric?”
“No,” Katherine said. “I haven’t spoken to him about it.”
“I understand you and he are friendly.”
“I find Eric very, very nice, Mrs. Airie. I’m new here, and he’s been, well, he’s been nice to me.”
“Yes.”
“You have two fine sons, Mrs. Airie.” Katherine waited for a response. She pictured our mother looking around her perfect house for anything that was out of place. She imagined Hannah picking up a fine glass figurine, examining it for particles of dust.
The truth was, Hannah was standing in her dirty yellow nightgown, her fingers tracing a line along the edge of a pile of ancient National Geographics. “I’d like to speak to Eric about the therapy,” was all she said. “And to Pilot, too, of course.”
Katherine looked at her cluttered office, the papers strewn everywhere, the ugly furniture. “Of course,” she said. “Absolutely.”
With the smallest turn of his head, Dr. Lennox indicated the hideous brown three-person couch, the same kind Katherine had in her office, opposite his equally ugly brown chair. I sat down, hands gripping the edge. “How’s it going, Pilot?” he said almost absently. “Are you feeling better?” His eyes seemed fixed on a point somewhere behind me. I turned and looked, but there was only a wall back there, a display of diplomas and certificates, faded pictures of his children, an overweight woman I assumed was his wife.
I said this as clearly and as brightly as I could: “I’m feeling much better, Dr. Lennox. Thank you.”
Behind him was his desk, its surface clean and open, the window overlooking the parking lot, the highway in the distance, a mass of trees forming at the edge of it. The leaves were changing now, I noticed, turning from green to yellow to gold. The pyrotechnics of death.
“I spoke to Kate and she said you aren’t experiencing anything unusual anymore. Is that true?”
“No more unusual than usual,” I said good-naturedly.
“Good.” Dr. Lennox laughed. “No more voices?”
“No.”
“No irrational fears?” He was smiling.
“No.”
“No feelings you can’t explain?”
I shook my head.
“No visual hallucinations?”
“Not unless I’m hallucinating you.”
This was insane-asylum comedy. This was institutional burlesque.
“And I’m glad to see your sense of humor is intact.” Dr. Lennox chuckled. “Always a good sign.”
“I’m feeling much better,” I said. “Really.”
He leaned forward now, hands on his thighs, saying, “Kate has one concern that she wanted me to address.”
I knew what was coming. I anticipated it like a blow to my face.
“She’s says you’re afraid,” the doctor went on, “afraid that your brother, that Dr. Airie—”
I literally winced.
“—is trying to hurt you.”
Dr. Airie. I’m Pilot, I thought, Pilot the schizo boy, and Eric is Dr. Airie. “Are you telling me I’m paranoid?”
“What makes you think he would try to harm you?”
I couldn’t help it. I felt compelled to inform him. “When we were children,” I said, “our sister was—they said she was abducted from our house during a party our parents had on a Labor Day weekend.”
“I know.”
“She wasn’t.”
“No?”
“Eric killed her.”
Dr. Lennox leaned back in his chair, an aura of incredulity settling over him. “Okay.” He smiled. “And you confronted him with this?”
“In a manner of speaking.”
“How did he respond?”
“I ended up in the hospital with the symptoms of schizophrenia.”
Dr. Lennox closed his eyes and nodded very slowly. “Yes, you did.”
“Do you see what I mean, Dr. Lennox—Greg?”
“I have to admit, Pilot, that I’m not sure I do. It sounds very complicated and… circular, in a way.” He rubbed his hands together. “Let me ask you something.”
I waited.
“How do you know?”
“I remember.”
“Recently? You remembered this recently?”
“All my life.”
“A lot of things we remember from our early childhood, especially things that seem traumatic, are not necessarily real memories. Do you follow me?”
“This was real,” I said. “Absolutely—”
“Pilot,” he interrupted, “it may seem like a real memory, I know it does, and that doesn’t invalidate your experience of it, but it also doesn’t necessarily mean that it actually happened the way you remember it.”
I twisted the shoelace around and around my middle finger. I said, “Okay.”
“I just want you to consider the possibility that what you’re remembering might be closer to, say, a dream, or a nightmare even, than it is to a memory of something that actually happened.”
I waited for a moment, considering whether I should argue. I wanted to get out of here, though. Desperately. “I’ll try,” I said.
Smiling, Dr. Lennox said, “What would you think about being released from the clinic?”
“I’d like that,” I said quietly. “That would be excellent.”
“You would go back to stay with your mother?”
“I’ve got nowhere else to go.”
“What about your brother?”
“I have to deal with him, too, I guess.”
The doctor looked at me, and then he said, “Okay. But I’m going to ask that you stay on the medication. Would that be all right with you?”
“No problem.”
“And I would like you to have some counseling with Kate.”
I hesitated, then said, “All right.”
He seemed concerned. “Would you rather someone else did it?”
I thought for a moment, wondering if I should tell Dr. Lennox that Katherine and Eric were fucking. But I decided against it. “No,” I said. “Katherine’s good. She’s fine with me.”
“Great.” He clapped his hands against his legs. “Why don’t we check you out tomorrow morning, then? Is that enough time to get ready?”
I tried to regain my positive attitude. “Ready when you are, Doc.”
Dr. Lennox looked at me, his eyes fixing somewhere in the middle of my body, taking me in, I supposed, objectively.
I could feel the muscles of my face moving beneath my skin. I rose from the couch.
He said, “I’ll see you later, Pilot.”
“I have one question.”
“Okay.”
“What am I?”
“What do you mean?”
“What is my diagnosis?”
He looked at that place on the wall now. “A diagnosis is just a word, Pilot,” he said. “Just a way for us to describe and categorize illnesses and conditions. It’s not an identity.”
The definition of psychotic in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition—or the DSM-IV, as it’s known in the trade—is this: “delusions or prominent hallucinations, with the hallucinations occurring in the absence of insight into their pathological nature.”
Does that sound like me?
Did I fail to see my own “pathological nature”?
Definitions of various forms of schizophrenia, according to the DSM-IV, are as follows:
Schizophrenia is a disturbance that lasts for at least 6 months and includes at least I month of active-phase symptoms (i.e., two [or more] of the following: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms). Definitions for the Schizophrenia subtypes (including Paranoid, Disorganized, Catatonic, Undifferentiated, and Residual) are also included in this section.
Schizophreniform Disorder is characterized by a symptomatic presentation th
at is equivalent to Schizophrenia except for its duration (i.e., the disturbance lasts from 1 to 6 months) and the absence of a requirement that there be a decline in functioning.
Schizoaffective Disorder is a disturbance in which a mood episode and the active-phase symptoms of Schizophrenia occur together and were preceded or are followed by at least 2 weeks of delusions or hallucinations without prominent mood symptoms.
Delusional Disorder is characterized by at least 1 month of nonbizarre delusions without other active-phase symptoms of Schizophrenia.
Brief Psychotic Disorder is a psychotic disturbance that lasts more than 1 day and remits by 1 month.
Shared Psychotic Disorder is a disturbance that develops in an individual who is influenced by someone else who has an established delusion with similar content.
In Psychotic Disorder Due to a General Medical Condition, the psychotic symptoms are judged to be a direct physiological consequence of a general medical condition.
In Substance-Induced Psychotic Disorder, the psychotic symptoms are judged to be a direct physiologicalconsequence of a drug of abuse, a medication, or toxin exposure.
Psychotic Disorder Not Otherwise Specified is included for classifying psychotic presentations that do not meet with criteria for any of the specific Psychotic Disorders defined in this section or psychotic symptomology about which there is inadequate or contradictory information.
“He really thinks you killed her,” Katherine said.
My brother sat up against the wall, pushing the sheet off his chest with one hand, rubbing his face with the other. “He really does?” His voice was pained. “How could he—” but he stopped himself.
Katherine pulled her portion of the sheet up to her chin. It was getting cold out, an early winter this year, and the heat hadn’t come on in her building yet. They were in the enclosure, on the mattress on the floor of her tiny living room, all the lights off. “He does,” she was forced to say. “It’s irrational, I know, but he really thinks—”
“Did he tell you how? Did he say how he thought I killed her, for Christ’s sake?”
Katherine sighed. “He didn’t say anything to me about that. Perhaps he said something to Dr. Lennox. I know Greg talked to him about it this afternoon. Pilot’s—well, he’s very vague.”
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