by Rachel Lucas
I took a deep breath as I realized just how far removed this doctor was from Lisbeth as a person and what was best for her.
“Yes, but she’ll spend the rest of her life in an institution like this one. Don’t you understand? Lisbeth doesn’t want to plead insanity. She says she’s innocent of her mother’s death. She says that she didn’t-“
“Regardless,” he interrupted, leaning over the desk towards me, eyes squinting as he drove his point, “whether she’s guilty or innocent she needs to be in a place like this one for the rest of her life. You saw during your other visit here, she is violent. She has some very harmful personas within her. And if she is resistant to medication, it’s not safe for Elizabeth or those around her, to be in anything but a controlled institutional environment.”
“But that’s not what Lisbeth wants. She’s lived outside of an institution before. I’m sure that she could-“
“And look how well that turned out.” He tilted his head to the side with a look of confidence on his lined face, like a lawyer who had just won an important case.
I had to admit, he had me there. She hadn’t been living a very good life. From what I could tell, she’d never been able to keep a job more than a month or two. She wasn’t doing very well at supporting herself. She would stay at one place until a landlord evicted her then she would move on to another hole-in-the-wall place. Maybe she was better off here, in a clean controlled environment, safe and watched over, three square meals a day. It could be worse.
But wasn’t it just exchanging one kind of prison for another? Trading iron bars for padded walls? Did her guilt or innocence really matter?
“Let me tell you the reason I invited you here.” He slid his keyboard aside and gave me his full attention, certain he had me on his side now. “Through all of our various observations of Elizabeth, she has seemed to comply easily with our therapy sessions. She’s been very careful not to show any sign of the other personalities being present. That has changed during both of your visits. There is something about your presence that draws out the different entities. It gives us the opportunity to observe and document each of them. There’s so much we can learn from her.”
He was finally starting to talk about her like she was a person. Maybe he was only saying it that way to soften me. It was hard to tell.
“I would like to ask you to come for regular visits with her.” He went back to his computer again and pulled up a daily organizer. “Twice a week would be wonderful, but even once a week would be appreciated. Say Tuesdays and Fridays, sometime in the afternoon?” Before I could reply, he reached into a desk drawer and withdrew a few papers, pulling a pen from his shirt pocket, and sliding both across the desk towards me. “I took the liberty of drawing up a waiver for you to sign. We will be filming and documenting your sessions with her for possible publication and perhaps even a documentary. Feel free to read the full document before signing.”
“What if I choose not to sign it?” My temper was simmering to the surface as it dawned on me what he was doing.
“Then I may decide that your visits aren’t conducive to the well-being of my patient. I may have to take you off the list of approved visitors.”
I looked down at the folded hands clutched tightly in my lap. Basically, he was tying those hands. If I wanted to come back and visit Lisbeth again, wanted to find out more to see if she was innocent or not, I would have to agree to his conditions.
Standing up to my full height, I brushed down my black skirt, wrapped my jacket more closely around me and put the strap of my purse on my right shoulder.
“I’ll think about it and let you know.” The look I gave him must have been pretty intense, because he didn’t say another word as I left his office and walked down the hall, head held high. I didn’t’ slow or notice anything else around me until I was outside the building and breathing in the cool autumn air.
Chapter Twenty
“Now, who can tell me some of the signs to look for that may point to a child being a victim of physical or sexual abuse?”
I sat in Professor Craig’s psychology class a week after my visit with Dr. Ross. I hadn’t decided what to do about my visits with Lisbeth yet. I knew the clock was ticking towards the time for the trial, but I was afraid at this point I might do her case more harm than good. Dr. Ross had left messages on my voice mail a few times, inviting me back for a visit with Lisbeth, but I knew what he really wanted. He wanted me to bring the family out, to help him with his case study. Somehow, I couldn’t bring myself to reply.
Professor Craig was one of my more enjoyable professors. Instead of standing at the front of the large room and lecturing or giving out mountains of reading assignments, he drew us into discussions that really mattered. Discussions that actually made you think and get involved.
“Signs in them as a child or as an adult?” A tall girl asked from the back of the room.
“Let’s start with things you would look for in a child. Say, a toddler through pre-teen years.”
Various students started calling out answers. Bruising. Broken bones. Numerous trips to the doctor or emergency room. Unexplained injuries. Bed-wetting.
“Ok, you’ve listed physical signs. What about the emotional and psychological signs?”
Again the hands popped up. Withdrawal from family and friends. Shyness. Lack of trust towards adults. Depression. A tendency to gravitate towards substance abuse and early sexual exploration. Sometimes the opposite, staying away from sex entirely. Knowledge of sexual activity that isn’t age appropriate.
I sat in my chair towards the back of class, involved in the discussion. As much as I enjoyed this course, it still felt a bit odd going back to school and being older than most of the other college students. I was still working through some self-esteem issues and wasn’t always sure my comments were worth voicing.
As the discussion continued, I couldn’t help thinking about Lisbeth. What signs had she shown that I had missed? I was her best friend. I should have seen some of the problems she was having. Maybe if I had picked up on some of those signs sooner, I could have done something. I searched for something she may have said or done that I had missed.
“These are all great answers. They are all important signs to look for in dealing with a child that may have been a victim.” Professor Craig was young for his position, hardly older than me. He was African-American, with close-cut hair and lively brown eyes behind his rimless glasses. He looked around the room at the many students, pausing for effect. “But there’s another answer I’m looking for. Perhaps I should clarify that this is something that could possibly be the result of extreme physical or sexual abuse of a child.”
More answers. The child becomes an abuser himself. The child begins a life of crime. The child becomes extremely anti-social.
My hand came up almost of its own accord. “The child suffers a psychotic break. A split.”
Professor Craig smiled and raised his hands to stop any other answers. The room quieted down immediately. A few students whispered to others to ask what I’d said. I guess my voice had been a bit quiet.
“Very good.” He approved. “Caitlyn, is it?”
I nodded, somewhat surprised he remembered my name. Some things didn’t change after all these years. I still tried to blend into the background at school.
“Caitlyn,” he spoke to me but addressed the entire class, “what is the result of a psychotic break or a split?”
“With a psychotic break the child will sometimes lose touch with reality. In some cases they become catatonic, a waking coma. In the case of a split, the child may even develop an alternate identity or personality. They will develop another person or even several people for different purposes.”
“Excellent.” Professor Craig nodded as he walked across the room. He was very good at making eye-contact with his students, mentally gauging which students were paying attention, taking notes, or distracted. Most of the time, he kept everyone’s attention. Just like now. Every stu
dent in the class had their eyes glued to him, waiting to see where he was leading the discussion.
“We’ll be discussing a few cases in the upcoming classes of well-documented patients. We will know them by fictitious names of course, but I assure you they are all real people with real psychiatric splits. The first one I want to discuss is Jon.”
He turned off the lights and projected his laptop onto a screen at the front of the class. A picture of a dark-haired man in his late-twenties appeared onto the screen. He looked completely “normal”, if a bit sad and tired. He was wearing a T-shirt and a jacket with a NFL team logo on it. He was broad, masculine and could have been a football player. There were also a few other pictures of the same man as a child. In each picture he was solemn, serious. There were no toothless, happy grins. No clowning around for the camera, no childish antics.
“Don’t worry, this isn’t the guy living in the dorm next door to you,” he joked and the class chuckled along. “Actually, Jon was treated in a hospital in Pittsburg. I won’t go into too much detail about the abuse he suffered, only to tell you it was from an aunt and uncle that took him in after his mother deserted him. He was six months old when they took custody. The aunt abused him physically and mentally, the uncle abused him sexually.”
He tapped a key on the laptop and went to the next slide. It was a simple graphic with a small picture of “Jon” at the bottom and four lines drawn up to corresponding boxes. Each box had a name in it. Matthew. Charles. David. Rikki.
“Doctors believe that sometime during the initial abuse Jon had his first split. The first split is usually someone mentally stronger. Someone to jump in and take the abuse when the ‘core’ person, Jon in this case, can’t handle it anymore. Jon’s first split, they believe, was Matthew.”
He went to the next slide. Matthew was spelled out with a detailed description. Early twenties, hard, tough, frequent use of foul language, serious attitude. Rebellious. Prone to substance abuse as Jon reached his teenage years. Matthew was the protector. He took the hardest of the abuse to protect Jon. He was created to protect but also became the fighter. Abusive towards adults, men in particular.
“Matthew is fairly typical of the personality created to do what the core personality cannot. In this case: to protect. Jon wasn’t able to withstand the abuse, but he couldn’t escape it either. So Matthew was the answer.”
Every member of the class was frantically writing notes. Professor Craig had everyone’s attention. Normally, I would be writing notes too, but my hands seemed frozen as I gazed at the screen. This was just too close to home. It was hard to stay detached from a case study when I had lived so close to the real thing.
Charles was the next slide. Insecure, shy, awkward. Charles was created to handle all the pain, fear and uncertainty from the abuse. He internalized everything. He was fragile and broken. He didn’t speak much, and when he did it was in a very child-like voice. Charles never grew up. He was an eternal child of ten.
“Once the first split occurs, it seems common for a few others to follow, as the need arises. Charles, as you can see, was the second one to evolve. While Matthew protected, Charles absorbed. It stunted his emotional growth and left him with no ability to mature or age. The next slide is of David. Intelligent, accomplished. David was the survivor. He was born out of the need to not just survive the abuse but to move on and achieve. Because of David, Jon was able to do relatively well in school and in his higher education. Often we find, in these cases, that a personality will emerge that is strong and driven. That was David.”
The next slide showed a new face, or what looked like someone new at first. It took a moment to realize that the face was “Jon” but the features were soft and effeminate. He had on eye-liner, dark lipstick and hair gelled into curls and spikes. A few snickers could be heard throughout the room.
“This is Rikki. He was created from a need to cope with his sexual identity after the abuse from his uncle. He’s a gay male, possibly trans-gender. Rikki is also very intelligent and sexually aggressive.”
Professor Craig turned off the laptop and switched on the light. He walked over to the dry erase board and wrote the word “integration” in black.
“What is integration in relationship to this disorder and why is it important?” He addressed the room.
A hand shot up from the far side of the room. A studious looking young man answered hardly before Professor Craig could acknowledge him.
“Integration is a balance of medications meant to repair the splits. It puts all the personalities back into one.”
“Very good.” He nodded. “It’s important for the patient, Jon, to have the splits repaired in order to live a functional, ‘normal’ life. In his case, the doctors found the correct medications and the integrations were considered a success. Last update, Jon was living a happy, productive life as a computer software engineer. He’s married and has two children.”
The class nodded their approval.
“But what about his children?” The same young man asked. “Isn’t there a possible genetic factor?”
“The possibility exists, granted, but in many ways this disorder tends to be impacted more from environment than genetics. In any event, he does have the advantage of knowing what to look for and to be able to watch for early signs in his own children.”
The class continued to take notes but something was nagging at me. I raised my hand.
“Yes, Caitlyn?”
“There have been cases where the patient has chosen not to be integrated, right?”
Professor Craig gave me an interested look, a little surprised at my question. He seemed to direct his answer to me.
“That’s a good point to bring up, Caitlyn. Yes, there have been noted cases where the patient has chosen not to be integrated. They’ve chosen to live with the different personalities and still been able to live a relatively productive life. I think the important difference here, besides the choice of the patient, is what type of personalities are involved. If you have only a few personalities involved and they are all fairly benign, the patient may be okay not being integrated. In upcoming classes, we’ll explore a few other documented cases where the patient has some highly dangerous personalities. The only choice in these cases is either medication and integration, or institutionalization.”
Time was up for the class and some students were starting to gather up books and backpacks. Many wanted to linger as was often the case with Professor Craig’s class. We would get so caught up in the discussion that we wanted to continue it even after the class was over. I slung my backpack over my shoulder and headed for the door when Professor Craig stopped me.
“Caitlyn, do you have a moment?” A few students looked back with curious expressions as they exited the room.
“Sure, this is my last class of the day.” I stopped a few feet from the door as he approached.
“I just wanted to check with you.” He stopped a ways down the aisle from me. “You seemed a bit disturbed during some of the discussion today. I know that we’re delving into some pretty deep subjects in this course. I try to be on alert for any of my students having problems with the subject matter.”
I hadn’t realized I’d been that transparent. My mother had always said that every emotion I had showed on my face. I guess some things never change. I tried not to seem uncomfortable with his concern.
“I understand that some of the subject matters may hit close to home.” He continued. If only he knew just how close he was to the truth. “If you have any concerns, we have a great free counseling service here on campus. I can give you the numbers of a few of our therapists who do a great job. I’d be willing to talk to you any time too. I understand how difficult it is to discuss child abuse and child sexual abuse, especially if you’ve been a victim.”
He thought I was a victim of abuse? Perhaps as an adult, in my marriage, but not as a child.
“No, Professor Craig, you don’t understand.”
“It’s nothing
to be ashamed of. I’m sure many victims of child sexual abuse gravitate towards a class like this one to help them understand what they went through.”
“Professor Craig, this isn’t about me. It’s about a friend.”
“Oh, I see. A ‘friend’.” I could tell he didn’t believe me. He seemed very sincere and I thought he was one of the best professors I had. Maybe it would help to have someone like him to confide in.
“Listen, do you have a little time before your next class?” I asked.
“My next class isn’t for two hours.” He gave me a puzzled look.
“Ok,” I sat down in the closest seat and he followed suit and took a seat a few places away. “Let me tell you about my friend, Lisbeth.”
Chapter Twenty-One
My discussion with Professor Craig, “James”, went the entire two hours and into his next class. He was fascinated by Lisbeth’s case and had endless questions. By the time his room was filling up with the next class he had thanked me for confiding in him and asked me to keep him up on any new developments. I could tell he was itching to go down with me to visit Lisbeth in the state hospital. I had left out Dr. Ross “blackmail” but told him I would keep him posted.
As I walked across the campus towards my car, I checked my cell and noticed a text from Logan. He asked how I was doing and wanted to me to give him a call after his shift tonight. I had to admit, I felt a bit conflicted and torn.
On one hand, I really appreciated his help. It was great having someone to talk to that understood the situation with Lisbeth. He seemed concerned and caring and had an insight into the law enforcement side of this that was invaluable. He was handsome and easy to talk to and didn’t seem to mind my questions and concerns.
On the other hand, I was beginning to get the feeling he was interested in more. In a way, it was flattering, especially to my bruised self-esteem. But I wasn’t so sure I was ready for another relationship quite yet. It had only been a few months since my divorce had become final. I was only just now working on getting my life back, figuring out how to be independent and self-supportive. I was still working on learning how to trust again. And I didn’t know if it was such a good idea to add another complication to an already complicated situation.