All Is Not Forgotten(17)
Jenny did survive. And that is where I come in.
Chapter Seven
My name is Dr. Alan Forrester. I am a psychiatrist. In case you are unaware of the various credentials that exist among mental health professionals, I am the kind that went to medical school. I am a medical doctor, an M.D., graduated from Johns Hopkins University summa cum laude. I completed my residency at the New York–Presbyterian University Hospital of Columbia and Cornell. In my twenty-two years of practice, I have received numerous awards and distinctions, but I find no sanctuary in paper certificates, the kind you have undoubtedly seen hanging on the walls of your own doctors’ offices. Cream stock, Latin words written in calligraphy. Fine wooden frames. They remind me of the trophies my son used to collect after each sports season. Cheap and reflective of nothing more than the need to secure future enrollments. Nothing attracts customers like the promise of an award. They are advertisements, and those who display them publicly are nothing more than human billboards.
Mine is a profession of constant challenges. Whatever has been achieved is, by definition, in the past, and it will likely have no bearing on the successful treatment of the next patient who walks through my door. Yes, it is true that experience makes us better at our various trades, and mine is no different. I am certainly a more capable diagnostician now than I was at the start of my career. But I have found that the diagnosis is the easy part. It’s the treatment—the careful, balanced, meticulous management of pills and therapy—that poses the most significant challenges and requires as much humility as skill. Every brain is different. And so must be every course of therapy. I never presume to know what will work. And by “work” I mean help, because that is what we aim to achieve—the helping of a human being to escape the pain inflicted by his own mind.
You may conclude me a braggart, but I have been successful in helping every one of my patients with a single exception. This has been true in both my private practice at 85 Cherry Street in Fairview as well as my more gritty work at the men’s correctional facility in Somers.
I am the only practicing psychiatrist in Fairview. The doctor who administered the medication to Jenny Kramer, Dr. Markovitz, lives in Cranston and does not provide therapy in private practice. There are far more psychologists, social workers, therapists, and the like in our town, but none of them can prescribe drugs, and none of them is trained in psychopharmacology. That is the first reason the Kramers employed my services.
The second reason is my work in Somers. Once a week, I travel upstate to volunteer a full day (eight hours that would otherwise be billable at four hundred dollars each) to treat mentally ill criminals at Connecticut’s Northern Correctional Institution. This is a level five maximum security institution. So you are not confused, the men at Somers have been convicted of crimes and sentenced to prison. Some of them also happen to be mentally ill. Criminals who are found not guilty by reason of insanity are not sent to prison. They may face their own hell confined to state mental hospitals. Sometimes they are released after rather minimal and insufficient treatment. The irony is that there does not exist a perfect correlation between the degree of a criminal’s insanity and his ability to utilize an insanity defense. An otherwise “sane” man who slays his wife’s lover in the heat of the moment may be deemed temporarily insane and have a defense under the law, while a serial killer (all of whom, I would insist, are clinically sociopathic) will wind up on death row. Yes, yes, it’s all more complicated than this. If you are a criminal attorney, you are probably jumping up and down in protest of my oversimplified rantings. But consider this: Was Charles Manson not insane for ordering his cult to murder seven people? Was Susan Smith not insane to drown her children? Even Bernie Madoff—was he not insane to continue his Ponzi scheme after he had made more money than he could ever spend?
Insanity is just a word. The men I treat are violent offenders, and they have illnesses ranging from depression to severe psychosis. I provide them with traditional “talk” therapy, though not the amount that is needed, and with medication. The prison would prefer me to focus on the drugs. In fact, the prison workers would let me medicate the entire population living within its walls if such a thing were allowed. Sedated prisoners make for easy prisoners. But, of course, it is not allowed. You can understand, though, why they are eager to send me anyone who meets their criteria. Hour after hour, they come and they go from a line outside the guarded metal door. Sometimes the line grows throughout the day and I feel the urge to cut the sessions short so I can get to all of them. I’m sure I do, and this weighs on my conscience. I see their faces on the long drive home, the ones I can’t get to that week, and also the ones I sent away in haste with a few pills.
The bean counters come each quarter to scrutinize the spending on the prescriptions, but they can’t argue with my rate. As unpleasant as it is to pass a day with violent offenders, I believe I am serving a vital role. Our prisons are overflowing with the mentally ill. Whether the illness led them to commit their crimes, or the prison environment created their illness, is not always easily determined. And for my purposes, largely irrelevant. In any case, I understand the criminal mind.
The third reason I was chosen to become involved with Jenny Kramer has to do with a young man named Sean Logan. I will get to that shortly.
After slicing her wrists open, Jenny awoke in the middle of the night. Her father was in the room and had fallen asleep in a chair. From her description of this moment, there was never any doubt in my mind that she had fully intended to end her life.