“Diane, we have to address these ideas. I can’t go before the judge and say, well, I don’t approve of drugs, and leave it at that. I don’t really care what Joseph feels about me—or to be more precise, why he bothers to proselytize. If you’re suggesting he feels a thwarted desire for me and that he expresses it through competition—”
“Well, as usual, you’ve put it much better than I could. That’s exactly what I think he’s about.”
“I understand. But so what? None of us can bear too close an examination of our motives. If I rejected this data out of homophobia or professional pride, I would hardly have improved matters.”
“How about rejecting it because it’s wrong?”
“I don’t know if it’s wrong. That’s why I have to study it.”
“What’s new about any of it? They’ve been making these claims—”
“What’s new to me is some proof that perceptible chemical changes occur after trauma. It still means the change is caused by emotion and conflict.”
“Then it can be changed by talking through the conflict.”
“Maybe. But maybe not if the trauma is severe enough. It doesn’t prove drugs are the answer. But—” I hesitated to say we, since I didn’t want to imply disapproval of Diane, “I really should know about it. Frankly, I’m ashamed to admit, out of my own prejudices, I ignored some of this research. In fact, some of these studies that suggest trauma can cause ongoing neurological damage were published while I was still in medical school. I’m guilty of being too close-minded.” I felt I now had to include Diane or I might seem condescending. I added, “You and I have a duty to investigate anything that might help. We’re doctors. We’re not supposed to toe a party line.”
“Look—You’re not understanding me—I don’t—This is a mistake—” Diane blurted each of these phrases rapidly, cutting them off and then resuming with an exasperated tone. The sheets and blankets whooshed. It sounded as if she had gotten out of bed. She had a wireless phone and liked to roam while talking. I was reminded of the day a year ago when she called to ask if I would entertain her while she mopped the kitchen floor. I was charmed. That was when I knew we were more than friendly colleagues. Just as, although I was irritated by her defensiveness about how Joseph treated me, I knew her protectiveness was love. Its recipe, after all, has a few ingredients that are best stirred beyond recognition.
“What’s a mistake?” I asked. We were late and needed to cut this conversation short, but I didn’t want to seem to be running from it.
“You’re too conscientious,” she said in a decisive tone. “That’s all.”
“Can a doctor really be too conscientious?”
“The world’s gonna break your heart, Rafe, if you care that much about everybody and everything. Joseph’s not a friend to you. He wants to brag to the world that he’s taught Rafael Neruda how to treat his patients.”
“Now you’re being neurotic,” I said. And immediately regretted it.
There was a heavy silence. I heard her breathing and that was heavy also, labored and dangerous.
“Sorry,” I said quickly. “I mean, Joseph isn’t like that and anyway he can’t take credit for my work. We’re not really in the same field. No one would believe him, for one thing.”
“Okay. Let’s drop it.” Her tone was irritated and irritating. “We have to get going.”
“Look, maybe Joseph’s research can help improve my treatment. Why is that something to be afraid of?”
“You’re not understanding what I’m saying. Is that deliberate? Do you really not understand?”
“I really don’t.”
“Okay.” She sighed. “Let me try to say it again. You’ve cured dozens and dozens of kids—there are plenty of people out there, like Felicia, like ‘Timmy,’ who owe their lives to you, and Joseph talks to you like you’re incompetent. And he treats me like I’m a waitress. I can’t take it. And I don’t think you should take it. I think it’s neurotic!”
“Diane, I discovered a long time ago that no blessing is unmixed. Joseph has a brilliant mind and for him to use it well he needs the illusion that his is the most brilliant mind in the world. That need is nothing to envy, because it’s doomed to be unsatisfied. I value his friendship. I know, and I know it for sure, that if I really needed Joseph, he would do everything to help me. But when we play games—and that’s what an argument is to Joseph, a game—he has to win, or at least seem to win. That’s what he needs from me.”
“So you’re enabling him?”
“Diane.” I couldn’t fight my irritation. “I’d really prefer it if we didn’t use jargon.”
“What you mean is, if I didn’t use jargon.”
“No. Jargon is jargon no matter who’s using it.”
“Look, Rafe, honey, all I’m saying is if a patient talked like you are—”
“Diane, we’ve got to get going. I’ll pick you up and we’ll finish this on the way. Okay?”
“I’m done. I’ve said what I have to say.” Her tone was clipped.
“You sound furious.”
“I’m not. I’ll be waiting downstairs.”
At first I didn’t feel my reaction. I left calmly, happy to be in my car driving on the empty Saturday morning streets. A few blocks from Diane’s apartment, however, my heart raced as I rehearsed replies, some angry, some earnest. But when I turned onto her street, I laughed. It was funny. We were having a fight, a married fight.
I stopped laughing.
We were having a fight over our identities, testing the limits of each other’s private selves. Just how deep did I want Diane to plant her flags in my life’s terrain? She didn’t know about Joseph’s rescuing me from the streets of Washington Heights. She didn’t know that he had spent his childhood in isolation, that he had no clue how to conduct a friendship. She didn’t know that Joseph himself belied his conviction that all of human character is merely a matter of how the chemistry was mixed at the instant of insemination. Joseph’s ideas were driven by the emotional need to prove his parents had no damaging effect on him. How could he blame them for anything after what they had suffered in Germany?
Diane knew none of this and, to be fair to her, how could she comprehend my behavior without the information? (I also wondered why I hadn’t told her. Did I resent that I owed Joseph anything? Did I want to maintain an illusion for Diane’s benefit that all the giving was on my side?) The most tangled knot for me was the self-consciousness of any exchange with her. I was sure Diane wouldn’t agree that, in spite of Joseph’s emotional need to believe environment had no impact on people, his ideas might still have a great deal of objective truth. Once I told Diane his history, she would probably feel affection for him and she would forever dismiss him intellectually. This weakness, a reductive view of human beings reinforced by her training, a need to feel in secret command of why people behaved as they do as a prerequisite for tolerance, was the dark side of her initial interest in psychology.
In the same vein, I believed she dismissed my fear of falling victim to what Joseph suffered from—seeing only those facts that confirm a comforting theory of life—as nothing more than a by-product of the traumas of my childhood. She knew of the passionate ideologies of my childhood and its results: my mother’s suicide, my estrangement from my father, Uncle’s alienation from everyone he loved, my nervous breakdown, my own attempt at self-murder. But those bald facts weren’t really all of it. Not even my mother’s incest (a secret from all but Susan Bracken and Diane), not even that would fully explain my attitude. The lurid events are too overpowering in themselves; in their glare, the effects on the real person cannot be seen. She would have to hear as complete an account as this to understand. And would she hear it? Or would she hear it as a psychologist? I didn’t want to be Diane’s patient.
Or did I? Did I need her as a woman or as a therapist? Did I want to be loved or understood? Were both possible? With Julie that was never a question. She was a part of my life despite her ignorance of all it
s facts. She understood without telling. She loved without questions and answers.
Of course I could push our relationship through this impasse. A single anecdote about Joseph’s mother would melt Diane’s objections to him; a recounting of how he saved me from my mother’s abandonment would silence and embarrass her. She would tolerate my investigation into his research as some sort of repayment and leave me alone. But that was a trick really, a manipulation. Did I want a relationship that I was managing?
These questions played in the background while Diane got in the car, kissed me with an open lingering mouth, settled in the seat and energetically reviewed aloud her notes from our first interview with the children we were about to see. Apparently the subject of Joseph was closed. Just as well, I thought. The mid-November day was cool, but a pale sun struggled to make us comfortable and implied that day might be our last chance to enjoy being outdoors before winter settled in. Entering the clinic, I longed to escape the office. Diane did too. She whispered, “I wish we were in Paris.”
The last of our interviews, Albert, our abused and abusive thirteen-year-old, arrived late, just before lunch. With him, atypically, were two men. One waited outside with Al while the other came in to speak to us privately. He identified himself as a paratherapist—a term new to me that I assumed meant he was a glorified attendant. He explained Al had attacked another boy at the Yonkers shelter that morning. Al broke the boy’s arm and threatened to gouge out his eyes with a spoon he had filed down. They decided to bring him to our session anyway, although he was going to be shipped back to Metropolitan State Hospital and would lose his privilege of coming to see me for the other two scheduled sessions. I would have to see him in Met State’s adolescent lockup ward in the future. (That meant a barred room reeking of garbage from Dumpsters behind a side door.) The paratherapist, a bald man, asked if he should stay in the room for our session. Diane was upset by the news of Albert’s violence. I said she should call a cab and go home. She protested weakly; I insisted. She had confessed during our drive up in the car that Al’s brutalizing of his niece (Diane’s patient) prejudiced her against him. The news of this attack on another child would only intensify her dislike. After she left, I told the attendant I could handle Albert alone.
The bald paratherapist looked me up and down. There was something funny about being evaluated in this way. I was more than a foot taller and eighty pounds heavier than Al.
“Okay, I guess it’ll be safe. But don’t turn your back on him. All right? Technically we shouldn’t’ve brought him here, but they said you would insist and we can’t take him to Met State until three for some crazy reason.”
Al shuffled in, ignoring the chairs, and sat on the floor, his back against the wall. There was a welt above and around his right eye. His skin was a deep dusky black. Al’s face was elegant, a high forehead and strong chin, eyes dark and brilliant. He was a handsome boy with no adolescent awkwardness. I asked if he wanted something to drink. He said he’d like a Coke. I offered ice water. With Ritalin in his system he could do without adding caffeine. I noticed his mouth was slightly swollen. After I gave him the water I asked about his bruises and he said, sullenly, nodding at the door to the waiting room. “They did it.”
“Not the boy whose arm you broke?”
“He didn’t lay a fucking finger on me. They punched me. They enjoyed it too. You know, the bald guy’s a fag. He wants my sweet ass.”
For the next half hour Al told me how he would have enjoyed scooping out his victim’s eyes, or better still, cutting off the bald man’s balls. He told me he was sorry Diane wasn’t there. He liked looking at her tits; he wished he could bite off her nipples. He wondered if cutting off a nipple would cause a lot of blood to flow. Those were some of his milder remarks. In my previous interview with him he had been sluggish and quiet, the docile manner of a drugged kid, not this, the “monster” that was supposedly caused by a poor brain recipe. Was he off the Ritalin? Not according to his chart. Had he been dumping it? Supposedly his caretakers were too smart for that: the boys were watched while they drank their medication.
I listened patiently to his horrible threats for ten minutes and then commented, “I’m disappointed in these fantasies.”
“Yeah? I’m sorry. I’m real sorry.”
“What about me? Don’t you want to do something terrible to me?”
“Yeah? You want me to? You want me to fuck your ass?”
My fatigue caught up with me, amplified by despair at Albert’s situation. I had been up most of the night reading. If the kindling studies on rats (and Albert seemed very much like a rat at the moment) were applicable to people, then when his mother used him sexually and tortured him physically his brain chemistry was altered (presumably to compensate for the extraordinary stress) and that change was ongoing, serotonin or dopamine or lord knows what flooding him in excessive or insufficient quantities, fighting off rage, despair, and loss from a past that no matter how distant or well understood, continued to hurt him without a break or diminishment. But if true, why couldn’t it be measured against a so-called normal brain? And yet it might be true anyway. Could I fight its control with mere words?
“No, you probably want to fill my hole,” Albert was saying. “You want to suck my cock?” Albert stood up quickly. I didn’t move: I wasn’t frightened of him. He wasn’t threatening me, anyway. He pulled off his shirt. His chest was a boy’s—flat, ribs showing. A line of four scars began above his right nipple and to the right of his navel: circular puffs of twisted bleached skin where his mother had pressed out her cigarettes. He tried to cup the dark nipple beneath the first scar, but it was too flat for the gesture to work. “You want to suck my tit?”
Of course my colleagues love to prescribe drugs for patients like Albert, I thought. Perhaps it was the right road, maybe Prozac was the leading edge of some bright future where psychiatrists can heal with the ease of GPs curing ear infections, but that wasn’t why my colleagues were so eager to abandon psychotherapy for pharmacology. It was despair at the hopelessness of human relations, of our ability to heal each other with love and understanding.
“Albert,” I said, “I want to take you off Ritalin.”
Albert let go of his breast. “Maybe you want to suck my cock.” He jerked the belt of his jeans and quickly unzipped, pulling both dungarees and underpants down to his thighs.
The reality of the damage his mother had done to his penis—it had been described in his medical file and by Albert verbally—was much more horrible to see than I had imagined. I pressed the edge of my fingernails into my palms to help control my features. It was crucial not to react with either horror or pity. I asked, “When did he see you?”
“You want to suck it?”
“When did the boy you attacked see you naked? Today? Or did it happen a while ago?”
Albert rotated his hips, gyrating like a stripper. He grabbed his wounded penis. “I could make it into a pussy. They can do that. They make a hole in you and push it in. They make a clit outta this”—he squeezed the scarred head to almost nothing—“so you still get off.”
“Did he see you in the shower? The bathroom? Where?”
“What the fuck you talking about?”
“You’ve taken off your clothes to show me what your mother did. I understand. But I need to know exactly what happened with the other boy, Albert—”
He let go of his penis and stopped gyrating. He frowned and interrupted. “Don’t call me Albert. Okay, fuck face? That’s not my fucking name.”
“What should I call you?”
“Zebra. You like that? Call me Zebra.”
“Is that what he called you?”
“He didn’t call me nothing. You ain’t so smart. You think you know everything, but you don’t know shit. You think you making us better? You think Shawna’s better?” That was the niece he had sodomized. “She’s sucking off all the boys. She’s seven and she gives better head than your wife.”
“Did she suck off the bo
y whose arm you broke?”
Albert smiled. He turned around and showed off his buttocks. The burn on his right cheek had the shape of its cause, an iron’s triangle. “Kiss my ass.” He was facing the wall. He lowered his head and rushed at it. His skull whacked hard against the plasterboard. The impact pushed him back a step or two. He paused and then repeated the action. His legs wobbled this time. He staggered. I was up from my chair now. He gathered himself, slammed into the wall again, and collapsed.
I hurried over and rolled him on his back. Blood flowed from his left eyebrow. His eyes were unfocused. He probably had at least a mild concussion. I was worried about what was in his system. One possibility was a rebound effect, that his brain was accustomed to the doses of Ritalin and now demanded more and more. His physical movements were jerky, foreshadowing the damage neuroleptics and Ritalin can create, namely tardive disorder. [Neuroleptics cause tardive dyskinesia—loss of muscular control resulting in painful disfiguring spasms—in at least twenty percent of patients who take them for longer than a year. I had seen research that showed Ritalin, not a neuroleptic, can have the same effect and much quicker on children. Hence my alarm.]
While I tried to take Albert’s pulse, the attendants pushed me aside. I hadn’t heard them enter. The bald one put his knee on Albert’s chest. The other grabbed his feet, staring at his genitals, mouth open with disgust.
“Did he hurt you?” the bald one shouted.
“He never touched me,” I said. “Get off him. You’re making it hard for him to breathe.”
Albert reached—ineffectually, like a drunk grabbing for support—for the bald man’s shoulder. In response, the paratherapist put his other knee on Albert’s stomach and slapped his face.
Dr. Neruda's Cure for Evil Page 41