Mount Misery

by Samuel Shem

  ‘You? You, who’ve been a psychiatrist two whole months? You don’t know diddly-squat about treating borderlines. Your so-called “concern” is going to be a real problem – you’re already overinvolved, imagining that you can rescue her. To you, what I did seemed cruel, right?’

  ‘It was cruel, it was vicious, and I won’t—’

  ‘My friend, you’ll get used to it. We all start out oversensitive. These darn borderlines make us oversensitive, make us feel sorry for ’em. Beginners like you always get drawn in – overconcerned, trying to rescue them – these gals are seductive. The things they get us to do for ’em – give ’em meds, find ’em places to live, even loan ’em money! This one – Zoe – she’s the kind who’ll even show up at your home! You unlisted?’ I shook my head no. He shook his head too, as in You poor bastard. ‘Seduce the pants off us, given half a chance. Incredible talent they have, to somehow pick up your weakness and go for it – like they have a special radar or something.’ He shook his head in a kind of humble admiration and dismay, a dismay over male helplessness in the face of a female sexual expertise that would make Cleopatra look like Mother Teresa. ‘But hey – armed with the theory, it gets a lot easier.’

  Heiler got up, turned to the blackboard and wrote in big capital letters THE THEORY. Then for several minutes he outlined the Borderline Theory, listing the Krotkey Factors for diagnosis and then, with the aid of circles and flowcharts and line diagrams between stick figures that crisscrossed and darted into their stick brains and through their stick armpits like sword thrusts faked onstage, and even into their tiny stick crotches, focused particularly on Factor Number 3, ‘Projective Identification.’ This, spelled out with the kind of certainty you get from accountants and surgeons, showed borderline rage as so horrible that it couldn’t be contained in the borderline’s stick body, and so was projected onto the therapist’s stick body, which then, in a kind of carom shot back, made the therapist, to the borderline, seem enraged at the borderline, which then made the borderline afraid of the therapist, and hence depressed.

  I didn’t understand much of this, but I had to admit that it did seem kind of brilliant, as if, if you could understand it, it would explain, brilliantly, a lot of the things you didn’t understand.

  ‘Which is what we call empathy.’ Blair Heiler wrote, in big caps in the nexus of lines and circles that looked remarkably like a child’s try at a house, or perhaps a cat: EMPATHY. Turning to us, he said: ‘What you saw with Zoe was her and my projective identifications overlapping, which is called—’ Here he underlined the word. ‘—EMPATHY.’

  ‘But isn’t empathy putting yourself in another person’s shoes, in a feeling way?’ Hannah asked tentatively. ‘Isn’t empathy subjective?’

  ‘Exactly,’ he said, ‘which is why we’re going to be completely objective about it.’ Heiler turned to the blackboard and wrote SELF, and then OBJECT. Solini crunched my knee. I crunched Hannah’s. ‘The world is divided into the SELF,’ Heiler said, ‘and every other person, or, the OBJECT.’ He drew a vertical line between SELF and OBJECT. ‘There is a wall between them, a kind of movie screen for projective identification, or EMPATHY, which is key in working with these gals. Freud didn’t know shit about borderlines – there weren’t any in Vienna in 1890. Hell, Freud didn’t even charge his patients. My teacher, the great American pioneer in’ – tapping the blackboard – ‘SELF-psychology, and OBJECT-relations, is Dr Renaldo Krotkey, a true genius.’ Reverentially he repeated this while writing the equation, ‘RENALDO KROTKEY = TRUE GENIUS. I am a Krotkeyan. Questions?’

  Silence, one of ‘How Could We Nongeniuses Even Think of Asking Questions of Even a Protégé of the Great Renaldo Krotkey?’

  ‘But Roy and I have been thinking,’ Hannah said bravely, ‘that Zoe fits the criteria for depression?’ In a shaky, hesitant voice, Hannah retraced the genetic and personal history, along with the vegetative signs – loss of appetite, bulimia, change in sleep pattern, etc. – and the suicidal ideation. ‘And besides, she’s really responded. She’s incredibly better.’

  ‘Ah yes,’ Heiler said, nodding, ‘so all you new residents are being quote “nice” to her and she’s getting quote “better”?’

  ‘We’re not just being “nice,”’ I said, ‘we’re trying to be human.’

  ‘Being human is being totally human, which, for your information, isn’t very “nice,” and isn’t even all that human. Christ, when I walked in here I thought I’d wandered into some kind of, I don’t know, some kind of love nest or something. It’s phony. It’s Leonard Malik’s New Agey-Wagey sentimentality, and with borderlines it does not work.’

  ‘But ever since Ike White’s suicide,’ I said, ‘we’ve—’

  ‘Ike White’s death. Believe me, Ike was one angry mother. Never got his anger out. If I’d been here to drill out your LNT, your rage at his death, you’d’ve been over it a lot sooner. What’s Malik’s theory? Having a buddy? What’s his technique? Holding hands? The Borderline Theory and Technique have been proven scientifically, accepted by the toughest referees in the toughest journals in the world.’ His voice softened, and he went on, ‘Look. I know that the first time you see it, this theory seems strange – it’s counterintuitive. If just being nice to borderlines worked, don’t you think I would do it? Of course I would! In fact, I tried, way back, at first. But it’s like dealing with difficult children: you’ve got to be firm. Everybody knows that if you don’t dig up the Latent Negative Transference in these gals, next thing you know you’ve got people killing themselves, or killing other people. For fifty years people have been trying to cure borderlines by being “nice and human” to them. Everybody felt better, nobody got better. It’s easy to act nice, it’s hard as hell to stand firm and confront the rage locked up in borderlines. Borderlines are hell. There aren’t too many of us left who have the guts to treat ’em. I’ve specialized in borderlines for years and years, and I’ve seen what works: You go through that rage to the truth, to their miserable pain and suffering, and, believe me, they get better.’

  ‘But,’ Solini said, rolling his hands and squinching his face, ‘I mean, but everybody agrees that the lady is better?’

  ‘In this case,’ Blair said, ‘better is worse. She’ll have to get worse – which is in fact better – in order to get better, which will still be worse. If she gets a little worse, she won’t get a lot better, but if she gets a lot worse, she may get a little better. Not smarmy-“nice” better, really better. Borderline better.’ He looked at his watch. ‘Daily report.’

  ‘Blair?’ I said. He looked at me. ‘Isn’t it about time for your vacation?’

  Everybody cracked up. Blair too laughed. From his great height he stared down at us. ‘I’ll be filling Ike White’s slot down on Emerson One, and Dr von Nott has converted Emerson Three to a borderline ward too. I’ll be supervising all three of you residents. Dr Errol Cabot and I have just gotten a two-million-dollar Department of Defense grant to study the use of medication on borderlines. Most Emerson patients will be on randomized double-blind trials of Placedon or Zephyrill or placebo.’ He smiled. ‘Don’t worry, Roy, your overinvolvement with her is normal. Sick, but normal. Gals like her are experts at getting guys like you entangled. Read my paper: “Rescue Fantasies in the—”’ He opened the door. People were screaming out there. ‘“—in the Naive Resident.”’ He left.

  Solini, Hannah, and I walked onto the ward. Henry reached for his key to open the door out of Emerson 2. Suddenly Zoe was in my face, eyes wild, arms raised and fists clenched, screaming, ‘How could you? I’ll never talk to you again!’

  My arms went up, for protection. ‘I’m sorry, I didn’t know.’

  ‘You’re incompetent! I hate you! Hate hate hate you—’

  Primo Jones materialized and started standing around between us, shifting his weight bulkily to counter Zoe’s moves, rolling his eyes. I left. Shaken, I followed Hannah and Solini down through the woodwork forest of the stairwell and out onto the lawn, heading toward
the lake. The day was clear and hot, with that perfection of summer that reminds you of picnics and swimming holes set amidst protective rock and straight, tall pines. From the rows of locked, screened windows of the second floor of Emerson came screams, shouts, and other desperate sounds of the first liberation of our patients from their getting better, which, according to Heiler, was their getting worse.

  ‘That was insane,’ I said.

  ‘Maybe not,’ Hannah said. ‘Dr Renaldo Krotkey is the world expert in SELF-psychology and OBJECT-relations. “Confrontation” is an accepted interview technique with borderlines. It really helps them get clearer. It did make some sense.’

  ‘Leveling her? And then saying it was my problem, being too sensitive?’

  ‘Maybe you are – maybe we all are – like the first time you see real blood in surgery.’

  ‘You’re defending that jerk?’

  ‘Shhh,’ she said, grabbing my arm, nodding toward Emerson. ‘Here he comes.’

  Blair Heiler had come out of Emerson and was walking up the road to Misery Daily Report. He glanced at us. He was well out of earshot, but I stopped talking, as if he too had borderline radar. His gait was peculiar. As if contact with the ground stopped at his belly, each leg shot out of its own blind will, each step pivoting his hip seductively. The walk of a stick figure.

  As he disappeared over the rise in the road, Hannah said: ‘Look, Roy, I kind of agree with you. While it was going on, I was appalled. But then, when he explained it, it was incredibly brilliant. I mean he really woke Zoe up – she was acting really real – wasn’t she?’

  ‘You understood it?’

  ‘No, it’s way too complicated to be understood by beginners, people who don’t really understand. Malik’s a sweetheart, but what’s his theory? If he has one, it’s kind of fuzzy and …’ She fell silent, drifting off.

  Standing there in the moment’s sun, the slight breeze stirring the fresh chlorophyll scent up from the lawn clippings, I saw what she meant. Heiler had gotten to Zoe, flipped her into a hyper-real rage. He’d been able to justify everything he’d done. The theory rang true. ‘Henry,’ I said, ‘what do you think?’

  Solini thought. He thought so hard he gave the impression of having lost his train of thought. He tugged his earring; his brow furrowed like a basset’s. Henry too had flourished under Malik, finding a support group of Jamaicans in Dietary, jamming with them in the music room of the Recreation Building. ‘Malik was cool,’ he said, ‘but for the next few months we’re like three white mice, man, running the Heiler maze. Maybe we gotta just chill?’

  ‘How can it be right to treat a person like that?’ My question hung there without answer, like a dead branch of a tree, caught in other, live branches. Like the ghost of Ike White.

  ‘Got to go,’ Hannah said. Smoothing her skirt over her thighs, she did something she’d never yet done in her two months of psychiatric training.

  ‘Solini, look,’ I cried out. ‘A smile.’

  ‘Holy shit. Far out, Hannah-babe. Go for it.’

  Hannah smiled more, in embarrassment. ‘But the thing is …’ She trailed off again, an index finger caressing a corner of her smile.

  Solini and I waited. No luck. ‘What, Hannah?’ I asked. ‘What?’

  ‘Oh.’ She seemed surprised that we were still there. Blushing, she said, ‘It’s just that he’s so brilliant and … and God is he handsome.’

  Handsome he was, and as is often the case with great Americans, his handsomeness solidified his power.

  From that morning on, the Emersons changed. With Malik there’d been a sense of all of us – residents, nurses, social workers, MHWs – working with the patients, walking a path beside them at their pace, trying to match their gait. But Zoe’s door slam was like the starting gun of a fierce race with no clear course and no clear finish, everyone for him-or-her-SELF. From that day on the patients started to turn against us. It was what Blair had drawn on the board: SELF versus OBJECT, with a wall in between.

  That first day set the tone and the pattern: Blair would do his ‘Insurance Rounds,’ crunch a patient or two on the way out, and spend the day in his office in Farben. There he would see his private patients, many of whom were exquisite and sexy BPOs with HF (Hysterical Features) from Misery’s wealthiest families. He would supervise his research lab and tend to the banks of computers that were crunching up complex and confusing raw data from the Emerson patients, spewing out intricate permutations of the Krotkey Factors, encoding the spew into diagnoses of ‘BPO with (LMNOP),’ and wadding the encoded spew into an even more complex and confusing Borderline Theory for publication. With Blair gone from Emerson, the crunched-up patient would try to crunch up the staff.

  Blair moved swiftly to take over Emerson 3, Psychosis, rediagnosing almost everyone as BPO with P (Psychosis); and Emerson 1, Depression, rediagnosing almost everyone as BPO with D (Depression). The small sign on the doorpost of Emerson 2 – ‘Borderline Ward’ – came down. A big sign went up over the main entrance to all three Emersons:

  BORDERLINE HOUSE

  He took most patients off their antipsychotic or antidepressant drugs, and with Errol and Win began the two-million-dollar Department of Defense drug study. At random, without any of us knowing which patient was being put on what drug, most Emersonians were put on Placedon or Zephyrill or placebo, and except for Henry and Hannah and me, never spoke to a doctor in person again. Abandoned by their doctors, they were left with feelings of abandonment. This, Blair said, was nothing but our old Krotkey friend the LNT, Latent Negative Transference.

  Heiler couldn’t have been happier. Day after day he would unlock the massive hall door at nine sharp, wearing yet another from his collection of stylish summer suits and ties with tiny and bright flowers, graced by what seemed yet another alluring cologne. Closing the door behind him gently, he would turn and face the Emersonians. They, knowing that this would be their only chance to try to talk to the guy controlling every aspect of their fate, would eye him fiercely, as if they’d like to kill him and eat him. It was a moment of incredibly high voltage. Blair would look down at them from his safe height and smile sardonically, shaking his head in dismay at their plight. This provoked more rage. As his stick-figure legs kicked out machinelike from his hips, carrying him through the clawing underlings with the imperturbability of a shooting star through empty space, they would try to get through to him, asking for privileges, begging for a personal meeting with him, demanding discharge or transfer to another unit.

  Before disappearing into his office for insurance rounds, he would turn and face the snarling patients. There would be a hush. Then Blair would smile, shake his head with disgust and contempt, say loudly, ‘These darn borderlines,’ and close his door quietly. The place would go bananas.

  The Emerson staff too would try to corner Blair on these stick-figure drive-bys, trying to make him understand that the atmosphere on the unit was so bad that no-one was getting better but in fact everyone was getting a lot worse.

  ‘Good,’ Blair would say, moving away. ‘Good work.’

  ‘But they all hate us,’ said Vijay, a Pakistani mental health worker.

  ‘Great,’ Blair said. ‘That’s just great.’

  ‘They think we’re all assholes,’ the head nurse said.

  ‘Assholes?’ Blair said pensively. ‘Assholes?’ He considered this. Nodding his head sagely, he said, ‘Yeah, they’re right. You are.’

  This would infuriate the staff further. I soon realized that this was perfectly in line with his being an orthodox Krotkeyian: Focusing his attention on his SELF, but for a tiny sector for every other person as an OBJECT, was the theoretically correct technique for infuriating. Expertly, in the name of EMPATHY, he treated us as OBJECTS.

  Zoe, enraged at me, kept pointing out my incompetence. Her bulimia blossomed, her weight plummeted. She conceived a passion for thinness. I was appalled by this, and stuck to my Malik routine, sitting in his chair out in the living room for rounds, available to any
one who wanted to talk to me, trying to keep on being human. This seemed to make my patients even more enraged. Rather than talk to me, they shouted at me. The LAMBS died. I didn’t know what to do.

  Solini and Hannah were having just as bad a time as I was. The next Case Conference, Solini presented his therapy patient Thorny. Since my night on call when I had screamed back at him, Thorny had been doing better. Coming from Cajun country, Thorny was a fan of zydeco music, which was close enough to Solini’s reggae for them to form a bond, if not a band. Henry and his nascent band of Jamaicans would sometimes allow Thorny to join them on drums. Thorny had been sent to Misery because of his uncontrollable temper. Under the influence of alcohol or other drugs, he would pick fights in bars with men who were bigger and tougher than he, leaving a record of scars, which had finally made his father, as legal guardian, commit him to Misery. I’d been in touch with his father – the ‘Burn King of the Bayous’ – and we were on the verge of discharging Thorny to a halfway house nearby.

  But somehow in the conference, Blair not only provoked Thorny to an enraged door-slam that measured at least eight on the Krotkey Scale, but provoked tiny Henry Solini himself. Towering over him, pointing to Henry’s earring, Blair accused him in front of everyone of being ‘a fag.’

  ‘You better start working on your latent homosexuality, Dr Solini,’ Blair said, ‘because that’s what’s making your patient sick – your not being honest about wanting to fuck him up the ass.’

  ‘Homophobe!’ Henry shouted, fists clenched. ‘Fascist homophobe!’

  Blair paused, then smiled. ‘Good. Work on that gay little Latent Negative Transference of yours, will you?’ He walked out, the others following. Hannah and I went to our small friend, who was trembling all over.

  ‘C’mon, Henry,’ I said, ‘let’s take a walk.’

  ‘How’d he know what Split Risk said to me, about “up the ass”? Did you tell him, Roy?’ I said no. ‘How’d he know that? Radar?’

  ‘Unreal. Accusing you of that, in public.’