by Anna Burke
“I suppose not all the work has to be done here?”
“No, and you don’t have to wait until all the work is done to get that surgery. That could happen soon, in fact. What you do here, and in outpatient treatment, will help you get through the surgery and whatever comes after surgery. In the meantime, let’s talk about how we can get and keep the important people in your life where they are for now. No more hiding or dumping people before you even give them a chance to see you as you are. Agreed?”
“Agreed, but it might take me a few more days before I can come clean to Giovanni. It’s a lot to talk about on the phone.”
“You don’t have to do it all at once, Alexis.”
“He knows I’ve had issues with pills and with alcohol, so that won’t be new to him. Who hasn’t? Maybe I’ll start there. Going to rehab isn’t more onerous these days than visiting a fat farm. Less even. Rehab gets used as a cover for nips and tucks—28 days in rehab and you come back with a new face. I’ll call Giovanni when it’s a decent hour there.” Alexis let out a long, deep breath. A breath it felt like she had been holding for months.
“Good, that’s a step forward. We can process that call, if you want to, when we talk tomorrow. Or if you need to talk before that, find me. I don’t mind needy, Alexis—that’s why I’m here.”
“Thanks, Angela.” They spent another half hour together, most of it reviewing inventories and social history forms Alexis had completed on her first day. From all that background they began to form a few treatment goals, giving focus to her therapy. That background included information about Alexis’ drug use. In the beginning, alcohol and drugs had fueled bubbly; her social butterfly routine an affectation of teenaged rebellion. That had been such a long time ago. So much time had passed.
All that talk about her past caused Alexis to take a look in the mirror when she accompanied Angela to the door. Age was taking a toll on the one thing she had always felt good about, her beauty. She still looked good, for her age. Gone was the luster of youth even with hormone replacement and skin and hair treatments. The alcohol and drugs had added to the destruction wrought by sixty years of gravity, ultraviolet radiation, and oxidative stress. Alexis could lecture on the subject of aging. She just couldn’t do anything to stop it.
What good was it to be rich and loved and beautiful if it was all going to end in dust anyway? The harder she fought to keep the harbingers of age at bay, the more she yearned for oblivion. The more she sought oblivion, the more she hastened the destructiveness of nature. It was a vicious cycle, made worse by the new battle she faced with cancer. Bette Davis had said it all: Growing old isn’t for sissies! Surgery, chemo what was the point? Where were the compensations to those who aged—wisdom, self-acceptance, and peace?
How many pills did she have stuffed into the lining of her overnight bag? She had brought them along as insurance, in case they were lying about being able to control her withdrawals. The long nights without sleep were the worst. How on earth did I end up here? Alexis wondered as she looked out to the horizon. A favorite line by Ralph Waldo Emerson popped into her head: The years teach much which the days never knew.
“Let it be true,” Alexis whispered as she turned from the door to look at the schedule for the rest of the day. Next to that schedule was a gift from Bernadette. “She’s no sissy, that’s for sure,” Alexis said, as she picked up the sparkling crystal rosary. Could she find the courage that Bernadette had displayed in her own life? Tackle the mess she was in, yes, and find some way to be more available as a mother to Jessica. Perhaps by focusing less on her fear of being needy, and more on being needed. She didn't know what her daughter needed, but she would try to find out.
19 Degrees of Separation
“The line between bad therapy and out-and-out fraud is thin, Jessica. Too many therapists do things that make me wonder about my chosen profession. They’re not all social workers. There’s plenty of bad practice by psychologists and psychiatrists too. Some of it’s a lack of professionalism, like not keeping up to date on what works and doesn’t work. There are those who stretch the ethical boundaries. They manipulate insurance to get more treatment sessions, switching from one client to another in a family to extend treatment or use it all up! Psychotherapists will tell you they’re trying to make the most of meager mental health coverage to get work done with clients, and often that’s true. Some let their do-gooder tendencies foster dependency. My colleagues who practice brief term, problem-focused work somehow figure out how to get a lot done in six to ten sessions. It's a tough job, Jessica, so I shouldn't be so judgmental.”
Betsy Stark sat at the table in the morning room as she had often done since the early 90s when Bernadette had brought her home. She wasn’t eating like a starved creature as she had been when Jessica first caught sight of her years ago. Jessica had walked in on the enormous teenager eating slice after slice of Bernadette’s French toast. Betsy’s jet black hair had been long and curly, out of control, even pulled back with a scrunchie. She had worn baggy sweat pants and a loose t-shirt in a gray color.
How does any girl that big find clothes that baggy? her snide younger self had wondered.
Jessica had said nothing snooty out loud, at least. When Bernadette introduced them, Jessica sat down across from Betsy, with her own plate of French toast. They had eyed each other with wariness as Bernadette bustled around them. Bernadette sat down and attempted to engage them in conversation, but Jessica and Betsy had been monosyllabic in response that day.
What a little snot I was, Jessica thought as the two of them sat across from each other, now, two decades later. Jessica had been a wimpy little thing, full of fear about anything new or different. It wasn’t just Betsy’s hair, her size, or the way she attacked that plate of food that had seemed so fierce. There was a tension in the way Betsy sat—like a rattler, coiled, and ready to strike.
More likely on springs and ready to bolt, Jessica figured, thinking about it now. From the snippets of background she had wrung out of Bernadette, Betsy Stark’s life was a hellish one. She had much more reason than Jessica to be a scared rabbit. True, at ten, Jessica’s parents’ marriage had begun to crumble around her. Still, Jessica had a home, parents who loved her, and Bernadette, too. Betsy had nothing. Worse than nothing, because the people in her life were more like blood-sucking vampires than caregivers. As far as she could tell, Betsy Stark had been raised by wolves.
What Jessica remembered most was the awe she had felt as the teen rose from the table. Betsy stood and stood and stood... It seemed like it took several minutes for her to rise to her full height. She was close to six feet tall, at 15 or 16-years-old.
The woman who sat there today appeared transformed. Even taller, she was big, too. A solid build without an ounce of fat anywhere. She wore an inexpensive suit, in a dark blue pinstripe, with a pale blue cotton blouse—business attire on a budget. Pumps, with a low heel, and dark stockings completed the outfit, creating a no-nonsense, professional air.
Betsy’s hair was not the least bit unkempt. Dark as coal, it was pulled back into a tight bun at the nape of her neck. Not a strand out of place. She wore a hint of makeup on her broad oval face, with its high cheek bones and arched brows. Her dark eyes sparkled with intelligence, confidence, and good humor. None of those were words she would have applied to Betsy Stark during the years she had shown up several times a week to help out around the house. The adult Betsy Stark was an attractive, albeit unconventional, woman with a daunting presence.
“Some of them step way over the line, in my book, ‘advocating’ for clients, which includes signing off on what I suspect are false claims for disability. Often referred by members of your profession who aren’t any more ethical, I might add. Over-prescribing medication is one of my biggest gripes. Too many of the clients that end up at my office have a problem with drugs prescribed by a doctor or psychiatrist. A few, like Dr. Carr, cross the line by having romantic or sexual encounters with clients. There are more subtle flags that
ought to set off warnings about wounded healers that haven’t tended to their own wounds. We’re not so great, yet, about policing our ranks or getting the word out about unscrupulous or impaired professionals. A lot of clients have little choice about treatment providers and don't know their rights as clients.” Betsy took a breath and slugged down coffee. “Sorry, you’ve hit a sore point and triggered a rant.”
“I get it. As you mentioned, we have similar problems among practitioners of the law. So how does any of this relate to false allegations, False Memory Syndrome, or whatever it’s called?”
Jessica regarded Betsy with the respect she afforded professionals she consulted, from time to time, in her work as a lawyer. It was more than that though. Betsy was a marvel, a walking miracle, given all she had lived through. The woman had spent time in ‘the slabs’ as a child, Jessica recalled. Slab City takes its name from the concrete slabs left behind when Camp Dunlap was shut down. Not far from Salton Sea, the area had become an ad hoc off the grid community. Temporary and permanent residents included homeless in makeshift campsites, snowbirds, retirees living in RVs and an assortment of others in unconventional abodes. The most famous dwelling, dubbed Salvation Mountain, marked the entrance into the slabs.
When Betsy turned up again in Rancho Mirage in August, Jessica had registered surprise. Bernadette did not. She and Betsy had remained in contact even after Betsy went away to college. While Jessica was off pursuing her own education, marriage and law career, Betsy returned to the Coachella Valley. Back in the community where she had grown up, Betsy had visited her old friend and mentor often.
In August, Betsy and Jessica spoke briefly, exchanging polite greetings. That’s when Jessica discovered that Betsy’s career had involved case management with severely mentally ill adults. Smart, hard-working, and with that master’s degree in social work, Betsy had moved up the ranks and into administration. She was now in an administrative role at one of the local disability offices.
Even before the incident at the top of the tram, it had dawned on Jessica that Betsy might be a resource to help her better understand the chaos and confusion surrounding Libby Van Der Woert’s life. Nora and Nick Van Der Woert had been more than willing to give Jessica permission to consult the woman about Libby.
“I’m dubious about the notion that there’s a False Memory Syndrome, per se. Syndrome is too structured a way of characterizing false claims of molestation or rape based on recovered memory. There are many ways in which false allegations occur, in or out of the therapeutic context. You must have encountered that in your profession.”
“True. My knee-jerk response has always been to take women at face value when they make claims against their spouses, fathers or other men in their lives. We learned that rape and abuse are scary and humiliating, and that it's under reported. My limited experience with pro bono work in community agencies and clinics says that’s true. I saw several situations in which women were unwilling, out of fear or shame, to report or file charges after an assault. Still, there are endless stories about couples making false allegations in the course of a bad divorce or a custody dispute. In those situations the lawyers are pretty convinced the charges are trumped up out of spite, not delusion or mental illness.”
“Yes, Jessica, spite's one reason why people ‘bear false witness against thy neighbor’. Anger, greed, revenge, too, can be reasons a sane person might cook up a story aimed at taking down a partner or family member. Even a perfect stranger for that matter. That’s what keeps libel and slander attorneys in business, right?”
“True,” Jessica replied. It was amazing how quickly Betsy was getting to the heart of the matter.
“Okay so it’s not just divorce proceedings in which false allegations are made.”
“Yes, threats to spread nasty stories unless money is paid out, is old-school extortion. In Libby’s case, money is involved, so extortion is on the list of charges that might be brought against her. That presumes she’s well enough to be taken to court.”
“That doesn’t sound the least bit crazy. Morally corrupt, but not anything that would get a clinical diagnosis. Well, I take that back—it could get you a personality disorder label. In this case, without talking to the woman, it’s hard to know.”
“At some point, she’s had just about every diagnosis in the book. Until recently they had settled on bipolar disorder. Nora, her mother, thought Libby was prescribed a mood stabilizer and an antipsychotic medication, but she wouldn’t always take them. Libby was agitated most of the time while we were at the top of the tram—pacing and talking a mile a minute. Not all of it made sense, so I thought maybe it was a manic episode.”
“There could be a delusional component to the allegations. Delusions can be expressed during both the manic and depressive episodes of bipolar disorder. It sounds like Libby’s had problems being truthful for a long time.”
“Yes, she’s a practiced liar, according to her mother. This isn't the first time Libby’s come up with strange claims about the people in her life, often directed at her mother. Nora’s never known, for sure, if her daughter was just being histrionic, trying to get her goat, or if she believed the things she said. Was Libby wondering aloud about the scary, chaotic thoughts stewing in her troubled mind; or continuing to play the part of a teen well into her twenties by being nasty; or flat out accusing her mother of infidelity or possessing witchlike powers because she actually believed it?”
“Who knows for sure. It sounds like Libby's been on a lot of drugs since adolescence. That has to have damaged her ability to think straight.”
“Dr. Carr didn’t make that any better. My conversation with him at the top of the tram was a brief one. But one of the points he made, during a pompous rant, was how skilled he was at manipulating his clients. He implied that drugs helped him do that. The gentleman held me at gunpoint while he ranted, so I could have some memory problems of my own. Too bad I’m not better at that repressed memory bit. I could do with fewer memories, thank you very much.”
“I’m sure you could. But a more typical response is intrusive memories and recurring images of the traumatic event, Jessica. Documented cases of trauma-induced amnesia are few unless there’s a head injury. It’s far more common to think about the event over and over, and replay it, rather than forget it. That can be disturbing. If it’s a problem, you could see someone...”
“Thanks Betsy. I’ve got a therapist who’s been helping me. She’s focused on getting me to expand my repertoire of coping skills beyond binge shopping at Saks. I’m hoping I can manage the flashbacks until I forget the latest brouhaha. Maybe my skills at repression will get better.”
“You won't forget, but making the memories more manageable is a reasonable goal. Putting improbable events in proper perspective helps. I’m not sure how you do that when it comes to taking a tumble off a cliff. I suppose it helps to realize it won't happen again. That's a low probability event, to begin with, so what are the odds of it ever happening again?” Jessica nodded, resting her weary head in the palm of her hand, closing her eyes for a moment as she considered Betsy’s point.
“Slim, I’m sure. I spend an inordinate amount of time in the land of low probability events, however.”
“Well that’s what you get for being a member of the one percent, Jessica.”
“No! Do you think that has something to do with it?” Jessica looked up to see a smirk on Betsy’s face.
“Of course not, I’m kidding. I've spent plenty of time in that zone myself and I'm no one-percenter. Shopping won’t help any better than drowning your sorrows in alcohol or drugs, so it’s good you’re working on developing other strategies to cope with stressful events—rare or not. Getting back to your original point, though, drugs might have been useful to the doctor, adding to Libby’s confusion, making her more dependent or more easily influenced by him. He wouldn’t be the first psychiatrist to over prescribe medications to his clients. The FDA just ordered docs to lower the doses of Ambien being doled ou
t to women. That’s a zombie drug as far as I can tell.”
“That’s what I think, too, Betsy,” Bernadette said, appearing out of nowhere. “I keep reading about sleep-dramas because of that Ambien. Zombie drug problems cause serious trouble for celebrities,” she said, as she swept on by, headed out to the back patio with a covered tray.
“Carr’s manipulation of Libby is similar to the circumstances in the 1990s that set off the False Memory Syndrome backlash against recovered memories of abuse. Several techniques used by therapists came under scrutiny, including hypnosis and the use of high doses of medication. Planting a false memory using leading questions is not hard to do. Have you seen that study about manipulating memories of encounters with Disney characters—telling stories to study participants, some of them creepy and some of them fun? The ones who heard creepy stories later remembered bad experiences with characters at Disney. I’ll bet Disney is thrilled.”
“I saw that, Betsy, when I was doing background research about Libby’s parents’ situation. Libby used the recovered memory lingo when her parents first asked her where the allegations came from. She told me first that she made it all up and then began to believe it. She was all over the place about where those allegations came from. The Disney company execs must have been shocked to learn how easy it is to turn someone against Mickey with the mere hint that Mickey is a creep.”
“Yes, it’s unnerving to learn how easy it is to create memories, even in brains that aren’t already struggling with delusions or doped up.”
“Once the legal system started winning malpractice cases, I understand therapists backed off using hypnosis, asking leading questions, and relying on the idea that even if you have no memories of an event, your body can remember, or something like that.”
“You're talking about body memories. Sometimes the shrinks are more disturbed than their clients, Jessica. I had to take a case manager to task for talking to one of her clients about entities—some pseudo-religious belief she picked up from reading a book. Body memories,” Betsy muttered to herself, shaking her head.