“There!” said Dr. Rosanoff, triumphant. “Flycatcher’s tongue. Not a good sign. An early indication of tardive dyskinesia. The facial tics, the involuntary spasms, the way he moves back and forth. That’s not the illness you’re seeing. That’s the drugs. We got to him just in time.” Dr. Rosanoff rolled himself back, made a note of it in the logbook. “First thing we do is pull him off his meds.”
“But—if he crashes?”
“He crashes. The shock might do him some good. Might shake things up a bit.” He swivelled around to look at Thomas. “I’ve reviewed your transcripts. The idea was good, but it’s not working. The entire process seems to have stalled. They aren’t confronting each other or their delusions. Why do you think that is?”
“Well, they did confront each other at the start,” Thomas said. “But as the sessions went on, they seemed to have focused on me instead. They sort of ganged up on me. I was becoming worried that they might have been reinforcing each other’s delusions.”
“You’re right to be concerned. It’s a common problem with group therapy, patients banding together to form a ‘solidarity of madness.’ Understandable, I suppose. Harsh truths are often unpalatable. Fantasies are so much more alluring. Our role is to act as envoys, Tommy. Envoys from the real world. Here, have a seat.”
Thomas rolled a chair up to the monitors. He found it distracting seeing his three Christs boxed in like a life-sized game of Clue. (Mr. Green, in the conservatory, with a dagger.)
“They’ve each adopted a different strategy,” said Dr. Rosanoff. “Have you noticed that?”
“I have. They’re using denial, withdrawal, and avoidance. Eli denies there are any contradictions in what he believes. Sebastian won’t engage. And the magician sidesteps the conflict, turns it back on itself.”
“The magician? Why don’t you use his real name?”
“He won’t tell me his real name.”
“No identification?”
“None on him.”
“That’s peculiar. Even the most down-and-out hobos in Tent City have some sort of ID on them, even if it’s an expired out-of-state driver’s license.”
“I’ve asked. He won’t tell me, he says, ‘You know my name.’ ”
“He’s playing games. If he won’t give you a name, assign him one. You’ve referred to him as John Doe in the transcripts. Call him that to his face. For someone with such an inflated sense of self, having a boilerplate name slapped onto him will get under his skin. Call him John Doe till he gives up his real name. Referring to him as ‘the magician’ only elevates his status at the expense of your authority. Having a secret name gives a person power; naming them diminishes that power. It undercuts any phony mystique they may try to claim.” Dr. Rosanoff tapped the TV screen that displayed the magician. “Our friend here. What exactly are we dealing with?”
“Um, not entirely sure. I mean, I have an idea. Probably a schizophrenic delusional disorder—we have active-phase symptoms—but overall, his behaviour is fairly coherent.”
Dr. Rosanoff swivelled his attention onto Thomas. “Living in an alley, sleeping in your own filth, eating out of a garbage can. That’s coherent, is it?”
“Well, no, but . . . We found traces of naloxone in his blood.”
“Is that so?” A smile twitched on his father’s lips. “The thread begins to unravel. Do you know what ‘schizophrenic’ means, Thomas? From a purely medical point of view? It means ‘Fucked if I know. Give ’em a pill.’ ” He looked back at the monitor where the magician remained, not moving, staring up at them. “Do you want to know what I think? I think he’s trying to play us. I don’t think he’s delusional, I think he’s manipulative. My preliminary diagnosis, based on your notes and my observations? Possible antisocial personality disorder.”
“Really? That seems a bit . . . extreme. I mean, we haven’t seen any evidence of a lack of empathy toward others. Quite the opposite.”
“Extreme? Or decisive? And anyway, I said possible. We’ll see if his apparent displays of empathy are real. As for Sebastian, I’d say we’re dealing with a dependent personality disorder: passive, reactive, unable to care for himself. With Eli, we have a classic case of persecution complex accompanied by paranoid delusions. But those are only the outer trappings of what’s going on below the surface. Ask yourself, What is their cardinal trait? Their defining characteristic?”
“Faith?”
“Esteem. Elevated, inflated, unearned, unwarranted, pathological levels of self-esteem. We aren’t dealing with a physical illness here. We’re dealing with false beliefs, and it’s our job to hammer these beliefs down by any means necessary, to confront these delusions head-on. They need to work their way back to reality. It’s our responsibility to make sure they don’t falter or fall.”
“But if we push them too hard . . .”
“They’ll leave? I don’t think so. We won’t let them.”
“I don’t think we’d have much choice in the matter,” said Thomas. “The magician is free to go anytime he likes, and Eli and Sebastian can always request a return to San Hendrin if they find the therapy too stressful.”
“True, true. The regulations regarding nonvoluntary commitment are stringent. We can’t hold them indefinitely. Unless . . .” Dr. Rosanoff smiled, a satisfied turn of the lips. “Unless they might be considered a danger to themselves or to others. If that were the case, I could arrange emergency medical custody, renewable on review, of course. Consider our friend Eli: destructive tendencies, a history of violence, tried to remove his own eye, for God’s sake. And Sebastian? A pattern of self-harm, several attempts at suicide—none successfully. Poor bastard, he’s even a failure at that. And as for our last fellow, the magician? Delusions of grandeur, highly manipulative, oppositional. As I said, he may have an antisocial personality disorder. Run him through Hare’s Psychopathy Checklist. You may be surprised at what you find: glibness, superficial charm, a grandiose sense of self-worth, pathological dishonesty.”
“But—”
“On Axis V of the SDM, where would you place him?”
“The magician?” asked Thomas. “Zero: not enough data for an assessment.”
“No. We place him at a one.”
“One? On a scale of one hundred?” Thomas was taken aback. He knew what that diagnosis meant. It meant the patient was an imminent danger to himself and others.
“A score of one hundred would be optimum,” said Dr. Rosanoff. “You and I would score in that range. Fifty is iffy. But if we place him at a one, it gives us a certain . . . leeway.”
“But an assessment like that, it’s committable.”
“Exactly. Remember, what we’re doing here is for their own good. We’re trying to help them. Don’t ever forget that. If someone were drowning, wouldn’t you do anything to save them, even if they were flailing about, even if they were scratching and clawing and pushing you away?”
“I—I suppose.”
Dr. Rosanoff rose to his full Easter Island height. “Come with me, Tommy. I want to show you something.”
Leaving the confines of the control room, they returned to the expansive views and warm leather of Dr. Rosanoff’s study. Professor Plum, in the library, with a crucifix. Dr. Rosanoff opened his laptop, brought up Thomas’s file on the third Jesus, aka “John Doe,” aka “the magician.”
“Let’s say we add a notation of SPD to his file: ‘Severe Personality Disorder.’ Seems reasonable enough, yes? But after that, all it takes is a single letter, one stroke of the keyboard, a ‘D’ in front of it and suddenly we have a classification of DSPD: ‘Dangerous and Severe Personality Disorder.’ That’s all it takes. That single letter gives us the authority—and, I daresay, the duty—to take whatever measures are necessary to treat him. This can include a recommendation for indefinite confinement.”
“But he isn’t dangerous.”
“A manipulative patient with psychopathic tendencies and oppositional beliefs? That’s not dangerous? Danger comes in many flavours,
Thomas. It only takes one letter. . . .” His hand hovered over the keyboard, above the D. “But let’s hold off on that for now, shall we?”
He smiled and stepped back: from the brink, from the keyboard, from his son. He smiled, but the threat was implicit.
“Our guests are waiting,” he said. “Shall we?”
CHAPTER FORTY-ONE
IDENTITY THERAPY: SESSION ONE. The following is a transcript of a group session conducted at the Kingsley Hall medical facility by DR. THOMAS ROSANOFF on test subjects ELI WASSER (57), SEBASTIAN LAMIELL (28) & JOHN DOE (age uncertain), with Thomas Rosanoff observing. Test subjects are seated around a large table. Water has been provided. John Doe is holding a copy of Dr. Rosanoff’s book Be OK, Do OK!
(Not noted in the transcript? The fact that Dr. Rosanoff’s two burly orderlies stood next to him, on either side, arms crossed, unsmiling.)
DR. ROSANOFF: Let me start by saying: I don’t care.
The three Jesuses shift in their seats, not sure how to respond.
DR. ROSANOFF: Your uncle fingered you behind the woodshed when you were four? Your parents never bought you that toy fire engine you wanted when you were five? You were toilet-trained too soon? Or too late? Your mother breastfed you too long, or not long enough? She was cold and aloof, or she smothered you with love? Your father was violent? Your father was passive? Whatever it was: I. Don’t. Care. I accept no alibis, no excuses. We must not blame others. Everything we do in life is a choice, and you have chosen madness. We need to be clear on this from the start: You do not hear voices, you choose to hear voices.
The three Jesuses say nothing.
DR. ROSANOFF: So. Here are the ground rules. There are really only two: First, we must accept responsibility for our actions and the consequences of our behaviour, and—just as importantly—we must understand that retreating into silence will not be tolerated. Choosing not to speak is a sign of weakness, a sign of avoidance. If you three gentlemen truly are God incarnate, you are not weak. Agreed?
He waits for a response.
DR. ROSANOFF: Agreed?
Mumbled replies of assent from the three men.
DR. ROSANOFF: Thank you. (turning his gaze to Sebastian) Mr. Lamiell, you have put your family through utter hell. You have caused untold pain and suffering through your actions, and you have tormented them with your madness. Your father and sister are in anguish—because of you. How do you respond? No comment? Nothing to say for yourself? Empathy isn’t in your emotional repertoire, is it, Sebastian? Self-pity, yes. Self-centred delusions, clearly. But empathy, for your family, your loved ones?
No response. Dr. Rosanoff next turns his gaze on Eli.
DR. ROSANOFF: And you, Mr. Wasser? No thundering invective? No lightning bolts from Heaven? You say you’re God, but you can’t even strike me blind or cause a few locusts to fall from the sky. I say you are a fraud. Prove me wrong. If you can.
Nothing happens. The doctor now turns his attention to the magician.
DR. ROSANOFF: As for you, Mr. Doe, you seem awfully quiet. Nothing to add to this?
Unlike the other two, John Doe (aka the magician) meets Dr. Rosanoff’s gaze headlong. When he speaks, his voice does not waver.
JOHN DOE: Get thee behind me, Satan.
DR. ROSANOFF: Ah. You see me as an antagonist. That’s understandable. I’m not here to coddle you. I’m here to challenge your beliefs. In this room, we do not ask why. We ask what. We ask what you’re doing that’s self-defeating, and what you can do to change this. (addressing all three patients) Gentlemen, I’ve seen the tests that young Thomas ran on you, the brain scans and medical assessments. (He flips through the report Thomas has prepared.) Galvanic skin responses, muscle contractions above 2.0 volts, all within standard range. Sebastian here was on the higher end of the anxiety scale, Mr. Doe on the lower, but all three results were normal. EEG readings, same thing. MRIs as well. Your temporal lobes and auditory cortices are in proper working order. No signs of congenital defects, no damage to the impulse control regions, no thinning of the brain’s cerebral cortex, no history or evidence of epilepsy or injury. No aneurisms, no structural abnormalities. Everything looks perfectly fine, which is to be expected. Brain trauma causing behavioural changes is exceedingly rare. So let’s be clear. You are not sick, gentlemen. You are crazy. And there is a difference between the two. Sickness is physical. Crazy is how you act. Crazy is within your control. Eli, you look distressed! You shouldn’t be. This is good news! This is very good news. A brain trauma or a tumour can be almost insurmountable, can take years to overcome. But crazy is a matter of choice. Stop acting crazy and you will stop being crazy.
SEBASTIAN: (softly) Judge not, lest ye be judged.
DR. ROSANOFF: What was that?
Sebastian repeats his comment.
DR. ROSANOFF: An excellent point, and I commend you for contributing to this discussion. But I must respectfully disagree. To become healthy we must change, and to change we must be willing to judge—and be judged. That’s how reality works. (He pushes his chair back.) We have become a nation of enablers. Adopting the mantle of victim is now actively encouraged. It’s become a coveted role. There was a time when being a victim was something to overcome. Now it’s something to aspire to, something to revel in. Gentlemen, when I look around this table I see three strong individuals. Individuals who are more than capable of becoming healthy members of society, individuals who can change the way they look at the world, who can stop wallowing in madness and self-pity. I see three individuals who might yet become whole again.
SEBASTIAN: Four.
DR. ROSANOFF: I beg your pardon?
SEBASTIAN: (avoiding Dr. Rosanoff’s gaze) You said that you saw three individuals in front of you. But there are four of us.
He is referring to Thomas.
DR. ROSANOFF: Young Thomas is not being treated. I was referring to the three of you, each claiming to be the same person.
ELI: (under his breath) Blasphemy.
DR. ROSANOFF: What did you say?
ELI: Nothin’.
DR. ROSANOFF: (turning his attention back to Mr. Doe) You’ve been holding a copy of one of my books this entire time. Is there something you would like to say?
JOHN DOE: There is, yes. Something I’d like to read to the group. May I?
DR. ROSANOFF: Certainly. That book was written for a popular audience, so it’s meant to be accessible to readers such as yourself. But the fundamentals behind it remain as strong now as they did when first published. Please. Go ahead.
John Doe (aka the magician) opens the pocketbook to a folded page and reads.
JOHN DOE: “Many accomplished and well-adjusted figures in history have entertained eccentric or even strange beliefs. Holding strange beliefs in and of itself is not an indicator of mental illness.”
Long pause.
DR. ROSANOFF: Your point being?
THOMAS: (interjecting) Um, Dr. Rosanoff? If I may—I think what Mr. Doe is suggesting is that ideas, on their own, although they might be eccentric, are not necessarily indicative of a disease. They might simply be a way of looking at the world that is—
DR. ROSANOFF: (impatiently) Of course it’s not a disease. I never said it was. There is no such thing as a mental disease, because the mind is not an organ. There is indeed brain disease. That’s physical. But there is no mind disease. As for Mr. Lamiell, Wasser, and Doe, we aren’t trying to cure a disease. We are trying to change behaviour.
John Doe raises his hand.
DR. ROSANOFF: Mr. Doe, you don’t need to raise your hand to speak.
JOHN DOE: Do you know what I think?
DR. ROSANOFF: I would be delighted if you could elucidate the issue for us.
JOHN DOE: I think society needs people like us to define what normal is. The mad serve a useful role—always have. If madness didn’t exist, we would need to invent it. (pause) Some might say we have.
DR. ROSANOFF: So you admit you’re mad?
JOHN DOE: Well, it’s either you or
me. We can’t both be right. Can we?
Loud noise.
—END OF TRANSCRIPT—
CHAPTER FORTY-TWO
“LOUD NOISE,” OF COURSE, could mean anything: a crack of thunder, a sudden burst of laughter. In this case, the transcript was referring to the sound of breaking glass.
Dr. Rosanoff told the orderlies, “Stay here with our guests. I’ll see what’s going on.”
He strode down the hallway with Thomas hurrying behind him. The Kingsley Hall staff had gathered by the front door, looking anxious.
“Security is on its way,” one of the valets assured them.
A stained glass panel framing the main door had been broken. Thomas peered through the ragged hole, saw a figure being dragged across the grounds by a pair of guards. It was Amy.
Wild and unruly, she was screaming, “I know you’re in there, Thomas! Where is he? Where’s my brother!” She fought against the guards, twisting about to no effect, voice raw. “Where is he?”
Thomas felt his knees give out. He staggered, felt the floor shift.
Remember me.
• • •
“Rest assured, I have full medical custody of Mr. Lamiell, as arranged with the seminary at Saint Mathurin’s.”
They were in Dr. Rosanoff’s office, as Thomas paced back and forth, avoiding the view from the window. He could hear Amy. She was outside the gate yelling, her voice muffled but insistent.
“You’ve met Father Patrice?” asked Dr. Rosanoff. “He has a medical background, so he’s more sympathetic to these sorts of things. He’s overseeing Sebastian’s case, and he turned his files over to me. I repeat: Amy is not the legal custodian. She has no authority. True, she can go to a judge, file a T-42, but that would have to go through the medical review board, and that could take weeks.”
Thomas stopped his pacing, looked at his father, eyes brimming. “This is not what I had in mind.”
“Oh? And what exactly did you have in mind?”