Keeping Faith

by Picoult, Jodi

“Was she off the drug, Doctor, for a period of several years?”

  “Yes.”

  “Aren’t there adverse effects associated with its discontinuation?”

  “Yes.”

  “Such as suicide attempts, psychosis,

  delusions, and hallucinations?”

  “Again,” Johansen cautions, “you’re talking about a minute percentage of people.”

  “But might she have had some adverse effects to discontinuation?”

  “None that she reported, Mr. Metz.”

  The lawyer turns. “Dr. Johansen,

  what’s the likelihood of someone who undergoes successful treatment of depression having a recurrence of the illness?”

  “I don’t have statistics.”

  “But it happens fairly often, doesn’t it?”

  “Yes. But usually the well-adjusted ones know to return to a psychiatric professional, at that point, for help.”

  “I see. So basically you’re telling us that someone who’s crazy once has a good shot at going crazy again.”

  “Objection!”

  “Withdrawn,” Metz says. “Nothing further,

  Doctor.”

  Joan is out of her seat before the words leave his mouth. “I’d like to redirect,” she snaps.

  “I’d like to qualify the terms “mental disorder” and “depression.” Are they one and the same?”

  “Of course not.”

  “What was Mariah’s diagnosis?”

  “Suicidal depression,” Johansen says.

  “Have you ever heard of Munchausen Syndrome by Proxy?”

  “Yes.”

  “Does it stand to reason that a person diagnosed and treated for suicidal depression would seven years later develop Munchausen Syndrome by Proxy? Is that a direct relationship?”

  Dr. Johansen bursts out laughing. “No more than saying that because you eat breakfast in the morning,

  you’re likely to be wearing underwear.”

  “Thank you, Doctor,” Joan says.

  “I’m through here.”

  What Millie decides as she sweeps up to the witness stand is that she’s held her tongue long enough. As long as Joan intends to make her a character witness for Mariah, she wants to get her two cents in. She settles in the chair and nods at the attorney, ready to begin.

  “Mrs. Epstein, how often do you see Faith?”

  “At least every other day.”

  “How often do you see Faith interacting with Mariah?”

  “Again, just as frequently.”

  “In your opinion, is Mariah a good mother?”

  Looking every inch the proud parent, Millie beams. “She’s a wonderful mother. She works twice as hard as any other parent because she’s so intent on doing the best possible job.”

  “How has Mariah dealt with the media surrounding Faith these days?”

  “How would you?” Millie says. “She’s pulled Faith out of school; she keeps her hidden from their cameras. She does whatever she can to give her a normal life.” There. That’s her obligation to Joan, the material they’ve rehearsed ad nauseam. But she continues to speak,

  causing Joan to stop in her tracks and glance up, surprised at the change in script. “You all think that Mariah’s the one who has to measure up. But whose fault is this, really?” With a trembling finger, she points to Colin. “He’s the one who did this to my daughter before. He had her committed. Well, he should be the one committed, for not being able to keep his pants zipped–“

  “Mrs. Epstein,” Joan says firmly.

  “If you could just please stick to the questions?” She clears her throat and gives Millie a very pointed look.

  “No, I think now that I’m up here, I’d like to talk. Who wouldn’t be depressed if your husband starts sleeping around behind your back?

  I don’t know why–“

  “Ma’am,” Judge Rothbottam warns,

  “I must ask you to control yourself.”

  Joan walks toward the witness stand during this digression, smiling tightly. “Cut it,” she says through clenched teeth, and turns away,

  muttering something about loose cannons. “Mrs.

  Epstein, there are a variety of reasons to legally support a change of custody. To your knowledge, has Mariah ever sexually abused Faith?”

  “God, no.”

  “Has she ever hit her daughter?”

  “She doesn’t even smack Faith on the bottom when she’s being wise.”

  “Has Mariah ever emotionally abused Faith?”

  “Absolutely not!” Millie says.

  “She’s completely supportive.”

  “Does Mariah work outside the home, or in any other way spend most of the day away from her daughter?”

  “She’s with her every minute.” Millie looks sourly toward the judge. “When she’s allowed to be.”

  “Thanks,” Joan says, and then sits down before Millie has a chance to say anything else.

  Metz eyes Millie Epstein with calculation. He knows damn well why Joan wrapped up so quickly–the old bat’s loopy.

  Like Joan, he plans to steer clear of questions involving reincarnation and second leases on life, questions that would only make him the butt of jokes in the legal community. He smiles,

  catching Millie off guard. From what Joan’s told her, he’s sure that he’s been built up as a piranha. “Mrs. Epstein, you really love Mariah, don’t you?”

  Millie’s face softens. “Oh, yes.”

  “She grew up very close to you, I bet.”

  “Yes.”

  Metz leans against the witness stand. “You watched her graduate from high school?”

  “Class valedictorian,” Millie says proudly.

  “And college? Magna cum laude?”

  “Summa.”

  “That’s amazing. I barely made it through Freshman English,” Metz jokes.

  “And you, of course, were there when she got married.”

  Millie’s mouth turns down at the corners.

  “Yes.”

  “I bet you taught her everything she knows about being a good mother.”

  “Well,” Millie says, flushing modestly, “you never know.”

  “I bet you taught her how to help Faith through these difficult times. Am I right?”

  Millie’s chin comes up. “I told her over and over: When you’re a mother, you stick up for your child. And that’s that.”

  “Is that what Mariah’s been doing all along for Faith?”

  “Yes!”

  Metz pins her with his gaze. “And is that what you’re doing now for Mariah?”

  Millie glances at the judge. “So? Is that it?”

  Judge Rothbottam taps his fingers on the desk. “You know, Mrs. Epstein, actually I have a couple of questions.” He glances at each of the attorneys in turn. “Apparently our esteemed counsel is running a bit shy.”

  Millie preens under his regard. “Go right ahead, Your Honor.”

  “I’ve, um, read in some of the papers that you were … resurrected?”

  “Oh, yes. In fact,” Millie rummages in her large purse, “I’ve got my death certificate somewhere in here.”

  “I don’t need to see it.” He smiles at her. “Can you tell me about it, though?”

  “The death certificate?”

  “Well, no. The resurrection. For example, how long were you clinically dead?”

  Millie shrugs. “About an hour. Signed,

  sealed, and delivered.”

  “What happened?”

  “I got into a shouting match with Ian Fletcher. The next thing I know, I’m lying on the floor and I can’t breathe. After that, I don’t remember.” Pausing dramatically, she leans toward the bench. “Then I’m all of a sudden in a hospital room with Faith leaning over me.”

  The judge shakes his head, amazed. “Any medical explanations for what happened?”

  “As far as I know, Judge, the doctors can’t explain it.”

  “Mrs. Epstein, what do you think happened?
”

  She looks at him seriously. “I think my granddaughter brought me back to life.”

  “What do you make of Faith’s visions?”

  “I believe her. Goodness, if I didn’t believe her now, I’d be an idiot, wouldn’t I?” She smiles. “Or worse–I’d be dead.”

  “Thank you, Mrs. Epstein. Mr. Metz,

  do you have any more questions?” The attorney shakes his head. “Well,” Rothbottam says. “I think I need a recess.”

  Mariah watches her daughter leave the courtroom with Kenzie. She’s still not allowed to go near Faith, and to her surprise it’s harder to keep her distance now, knowing that Faith is no longer ill. She cranes her neck, watching Faith disappear into the hallway.

  She hopes Kenzie is taking care of her.

  From the corner of her eye she sees Ian.

  Immediately she turns away.

  “Mariah.” Joan draws her attention.

  “You’re on after Dr. Fitzgerald.”

  “That soon?”

  “Yeah. Are you going to be all right?”

  She presses a fist to her stomach. “I don’t know. It’s not you I’m worried about; it’s Metz.”

  “Listen to me,” Joan answers. “When you’re up there, no matter what he says to you, you look right here.” She points behind her, to the row where Faith has been sitting. “She’s going to get you through this.”

  Dr. Alvin Fitzgerald has no sooner taken the stand than Metz stands up.

  “Approach!” The attorneys walk up to the bench. “I want to know if this guy interviewed Faith.”

  Joan barely spares him a glance. “No,

  because I knew you’d complain if he did. If there needs to be an interview at a later date,

  both of our experts can have a chance. However, I can show what I need to show without Dr. Fitzgerald interviewing Faith.”

  At this, some of the wind goes out of Metz’s sails. “All right,” he says tightly.

  “Dr. Fitzgerald,” Joan begins, “can you state your credentials for the record?”

  “I graduated from the University of Chicago’s medical school, did a residency and fellowship in child psychology at UCSF, and I was the principal investigator on a large grant studying CFS and somatoform disorders.”

  “We’ve heard an awful lot about Munchausen Syndrome by Proxy. Can you tell us if this particular case fits the criteria for that disorder?”

  The psychiatrist shrugs. “Well, there’s a lot that matches the basic DSM-FOUR criteria.”

  Joan watches Metz’s mouth drop open in surprise as the psychiatrist repeats the highlights of Dr. Birch’s testimony. Then she asks, “Are there elements in this case that don’t seem to fit MSP?”

  “Yes. For one, Faith’s symptoms are real, and bizarre. It’s a lot easier to fake nausea than to fake stigmata. As for the hallucinations, I disagree with Dr. Birch. Just because Mariah White was at an institution with psychotics doesn’t mean she could make Faith convincingly fake a hallucination–that’s like saying that riding on the Bulls’ team bus will make you play like Michael Jordan.” He grins.

  “Another discrepancy is that Munchausen by Proxy is chronic. These parents go from emergency room to emergency room so that doctors don’t pick up on what they’re doing. Yet Mrs. White has taken Faith to the same health-care provider, Dr. Blumberg,

  repeatedly. She’s gone so far as to request him to examine Faith numerous times.”

  “Is that all, Doctor?”

  “Oh, I’m just getting warmed up. The perpetrators of Munchausen by Proxy traditionally have an emotionally distant childhood,

  which Mariah White did not have. But the biggest problem I have with a diagnosis of MSP is simply that there are alternative diagnoses that explain this case equally as well.”

  Joan acts surprised. “Really? Like what?”

  “Somatoform disorder, for one. Basically,

  it’s when a patient experiences emotional distress in a physical way. Imagine a child who develops severe stomach cramps every time she has to take a test, because she’s so anxious about school. She’s truly hurting, but she can’t articulate why. Remember Freud’s hysterical patients? They were the great-grandmas of today’s somatoform-disorder patients.”

  He holds up his hands, demonstrating a sort of scale. “It’s helpful to consider these disorders by imagining a range,” the psychiatrist says. “On one end is malingering, which we’ve all done: You pretend you have the flu to get out of jury duty, for example–symptoms are intentionally faked to achieve an intended goal.

  On the other end is somatoform disorder, where a patient unintentionally produces a symptom that looks and feels like the real thing–and doesn’t know that she’s doing it, much less why. Somewhere in between these is Munchausen Syndrome by Proxy, where symptoms can be intentionally feigned … but for unintentional reasons.”

  “So the difference, Doctor, is in the intent.”

  “Exactly. Otherwise, these two disorders look similar. Just as in Munchausen by Proxy,

  a doctor will examine a child with somatoform disorder and not be able to find any organic etiology for the symptom. She may undergo CT scans and MRI’S and dozens of tests, to no avail, because the presenting problem doesn’t fit with the physiology. However, in a somatoform disorder,

  the symptom is set off by stress. In MSP,

  the symptom is set off by Mom. In somatoform disorders, the symptom is real. In MSP,

  it’s faked. Often deciding which is which comes down to a judgment call requiring the knowledge of the context of the illness, the players involved, and what gains have been made by them.”

  “Then part of the diagnosis involves who’s trying to get attention–the mother or the child.”

  “Exactly.”

  “How do Faith’s symptoms fit a somatoform disorder, Doctor?”

  “First, the presenting problem isn’t organic.

  She’s bleeding from her hands, but there’s no tissue mutilation inside–kind of hard to fake a wound like that. She may be hallucinating, but she’s not psychotic. And there’s an argument to be made that the illness was brought on by stress, that she unconsciously believes that by being sick, the stressor will go away.”

  “Would a divorce qualify as a stressor?”

  Fitzgerald grins. “You catch on fast,

  Ms. Standish. In a child’s mind is the unconscious thought, “If I get sick, my parents will stay together to take care of me.” Without even knowing she’s doing it, the child makes herself ill and draws attention to herself. Not having actually met Faith, of course, I can only hypothesize that her mind is making her body sick, in the hopes that her family will remain intact. And look–it’s working. Her parents are both here today, aren’t they?”

  “If that were true, would Mrs. White be in any way involved in her daughter’s illnesses?”

  “Oh, no. It’s all being done psychogenically, by Faith’s mind.”

  Joan pauses. “How would you go about determining whether Faith’s illnesses were caused by her mother’s hand or by her own mind?”

  “By default. I’d remove Mrs. White from her child to see if the symptoms abated.”

  “What if I told you that a comatose child whose bodily systems were in acute distress was restored in a period of an hour to perfectly normal levels of functioning once she was reunited with her mother after an extended separation?”

  “Well,” Dr. Fitzgerald says, “it would certainly rule out Munchausen by Proxy.”

  “You’re not a hundred-percent sure, are you?”

  asks Metz. “That it’s somatoform disorder plaguing Faith … or that it’s Munchausen by Proxy plaguing her mother.”

  “Well–“

  “Do children always develop somatoform disorders after messy divorces?”

  “No,” Dr. Fitzgerald says. “A variety of maladaptive behaviors might occur.”

  “Can you list them for us, Doctor?”

  “Sometimes kids act out behavioral
ly, or sexually. Grades drop in school.

  Appetites rise or wane. There’s a whole range, Mr. Metz.”

  “I see. Are only a small percentage of Munchausen by Proxy cases reported?”

  “Yes.”

  “So, although it is a rare disorder, it may be more prevalent than one might think?”

  “That’s right.”

  “Is it true that most patients diagnosed with MSP are female, with a median age of thirty-three?”

  “Yes.”

  “How old is Mariah White, and what sex is she?”

  “She’s a thirty-three-year-old female.”

  “Is it true that the perpetrators of MSP are usually mothers?”

  “Yes.”

  “Is Mariah White Faith White’s mother?”

  “Yes.”

  “Have most people who suffer from MSP undergone a significantly stressful life event, such as a divorce?”

  “Yes.”

  “Did Mariah White just go through a divorce?”

  “Yes.”

  “Most of the perpetrators of MSP have some experience in the health field, as either patients or professionals, correct?”

  “Yes.”

  “Did Mariah White spend several months in a mental institution?”

  “Yes.”

  “Is it true that in MSP, the parents seem very interested in the child’s treatment?”

  “Yes,” Dr. Fitzgerald says dryly.

  “But most parents with a sick child–whether they have MSP or not–tend to be interested in the child’s treatment.”

  Metz shrugs off the response. “Has Mariah White been very interested in her child’s treatment?”

  “That’s what I hear.”

  “Is it true that most symptoms presented in cases of MSP do not often respond to conventional medical treatment?”

  “Yes.”

  “Have Faith White’s hand wounds resisted responding to traditional clotting medicines?”

  “Yes.”

  “Have Faith White’s hallucinations persisted in spite of antipsychotic drugs?”

  “Yes.”

  “Is it true that patients with MSP are unconsciously looking for attention?”

  “Yes.”

  “Is there an incredible amount of attention focused on the case of Faith White?”

  “Yes.” The doctor sighs.

  “Is it true that the perpetrators of MSP deny what they’re doing, either because they’re pathological liars or because they’ve dissociated from the behavior?”