All Is Not Forgotten(33)

I remember quite clearly the moment I learned that the blue Civic had resurfaced in Fairview and that an arrest had been made. I had spent the entire day in Somers and was driving home. I don’t enjoy music while I drive. I find it provokes emotional responses that then distract me from my thoughts, and driving is an excellent time to think deeply about things we often shortchange. Sporting events, fast-moving ones in particular—basketball, hockey—on the other hand, stimulate these thoughts. The action and chaos float in and out of my brain, mostly providing background noise that helps me focus.

I was thinking about a patient I had seen that day. He was serving his second year in a term of three to five years for a home invasion over in Lyme. The patient came to see me for anxiety and depression. In my practice at Somers, this is, invariably, an attempt to get meds. I sometimes prescribe them out of compassion. It is a miserable experience to be in prison. I give these drugs to patients in Fairview who are going through divorce, a job change, mourning the loss of a parent—life events that can be upsetting. Certainly, by that standard, a person spending ten years in prison should warrant the same degree of compassion. But in that practice, I have to be extremely prudent with my compassion. Patients have sold their meds—pretending to swallow them upon their administration, sometimes even regurgitating them. They dry them out and sell them one at a time. Other patients—well, it’s better to just let them adjust to their new lives. They can’t stay on these meds for ten years. The prison won’t allow it, for one thing. They are also addictive over time. We don’t need to be creating drug addicts in the prison system.

I did not face this dilemma with the patient I saw the day I learned about Cruz Demarco. There was no doubt he intended to sell the pills and that I was, therefore, going to refuse to prescribe them. As the session carried on, and as he began to sense my hesitation, he started to toy with me. This is extremely common, and as much as it disproves any claims of chemical disorders like depression, bipolar disorder, schizophrenia (we call these Axis I disorders), it actually serves to confirm my diagnosis of the other types—the Axis II disorders. (Axis I disorders are, simplistically, malfunctions in the brain’s chemistry. Axis II disorders are personality disorders. They are caused by the absence of, or malformation of, normal human personality traits such as empathy and the ability to form healthy attachments. They fall along a spectrum that starts with borderline personality disorder and ends with sociopaths. The definitions, in my opinion, are somewhat amorphous. Many of them are immune to treatment.) This patient was a sociopath.

My stories from Somers would fill several volumes of textbooks. And I must humbly confess that I was not always this proficient at detecting the truly gifted Axis II patients. They do not walk in off the street in places like Fairview. In fact, they rarely seek treatment to get well. They do not believe they are ill, but they do come to realize that others perceive them as different. They can be very cunning in hiding their behavior in order to blend in and, more important, to get what they desperately need. It is only in the correctional facilities, prisons and psychiatric units, that a doctor can find them in sufficient volume to hone the necessary skills to both identify and treat them.

When I first started my work in Somers, I was not up to the task. It is difficult to accept the mistakes that I made over the first year. Perhaps longer. My worst transgression was with a patient named Glenn Shelby. I had treated him for about six months, ending the fall before Jenny’s rape. Glenn had been serving a short sentence for robbery. He suffered from two primary mental conditions, neither of which would ever be apparent to you. Coming upon him in the normal course of life, he would present as warm and curious. He would show a deep interest in you and anything you chose to share with him. On more than one occasion, even I found myself further down the path than I had intended to wander with Glenn. He would ask questions like a teenage girl gossiping with her friends, detailed questions that would lead you to disclose more than what was reasonable under the circumstances of your meeting. He would pursue you as a friend, and although it would feel uncomfortable at times, as though he were desperate to grow close to you, he would also sense this before you cut him off. He would then adjust his behavior just enough to keep you on the hook. Eventually, your discomfort would outpace his ability to make the adjustments because his need for intimacy with you, as a friend or lover, was driven by his borderline personality. That was the first condition.

Glenn also had a form of autism. I say “form” because he was never assessed by a trained professional before his borderline symptoms began to surface. Autism is also a spectrum. I detected the characteristics from his mannerisms. He was a brilliant man, very adept at mimicking normal behavior. But I was, thankfully, skilled enough to make this diagnosis. Intelligence, by the way, is often seen in patients having either of his conditions.

His parents had an abusive, explosive relationship. He was beaten himself, and subjected to witnessing the beatings of both parents by one another. His mother was tall and strong, as was Glenn. They had neither the time nor the inclination to notice the ways he was different from other children. His aberrant behavior was the trigger for much of the punishment his parents inflicted.

Before landing in prison, Glenn had been self-medicating the overstimulation caused by his autism with a variety of street drugs. When he ran out of money, he used a toy gun on a cashier at a bodega in Watertown. Glenn could not hold down a job for long. His intelligence was appealing at first, but he made people uncomfortable and was typically fired within a few months.