K-PAX

by Gene Brewer

  ALTHOUGH we would not receive the official report from the State Board of Health for several months, the representative did point out two or three minor deficiencies that needed to be corrected, and I brought these up at the regular Monday morning staff meeting. Among the other items discussed at that meeting was the news that the search committee had narrowed down their list of possible candidates for permanent director to four-three from outside the hospital, and myself. The chair of that committee was Dr. Klaus Villers.

  Villers is the kind of psychiatrist usually portrayed in films: sixtyish, pale, trim gray goatee, heavy German accent, and a strict Freudian. It was clear that he had selected the other three names personally. I was familiar with their work and each, on paper, was a reasonable facsimile of Villers himself. But all had outstanding credentials, and I was looking forward to meeting them. My own candidacy was not unexpected, but I had mixed feelings about the directorship-it would have meant permanently giving up most of my patients, among other things.

  When that business was taken care of I summarized for my colleagues what I had learned so far about prot. Villers and some of the others agreed that it would be a waste of time to proceed with ordinary psychoanalysis, but thought my attempt to "humanize" him would also prove fruitless, suggesting instead some of the newer experimental drugs. Others argued that this approach was premature and, in any case, without the consent of the patient's family, the legal ramifications could become complicated. Thus, it was generally agreed that a greater effort should be made, by the police as well as myself, to determine his true identity. I thought of Meyerbeer's opera L'Africaine, in which Inez awaits the return of her long-departed lover, Vasco da Gama, and I wondered: Was there a family somewhere in this wide world fervently hoping and praying for a missing husband and father, brother or son to reappear?

  Session Three

  THE testing took all morning and half the afternoon of May twenty-third. I had other pressing duties much of that time, not the least of which was an emergency facilities committee meeting to approve the purchase of a new linen dryer for the laundry room following the irreversible breakdown of one of the two old ones. Betty McAllister served very well in my place, however.

  At the time, Betty had been with us for eleven years, the last two in the capacity of head nurse. She was the only person I had ever met who had read all of Taylor Caldwell's novels, and as long as I had known her had been trying to get pregnant. Although she had resorted to almost every known scientific and folk remedy, she eschewed the so-called fertility pills because, as she put it, "I only want the one, not a whole menagerie." None of this affected her work, however, and she consistently performed her duties cheerfully and well.

  According to Betty's report, prot was extremely cooperative throughout the examination period. Indeed, the eagerness with which he attacked the tests and questionnaires supported my earlier speculation of an academic background. How far he had progressed with his education was still a matter of conjecture, but it seemed quite likely, based on his confident demeanor and articulateness, that he had at least attended college and possibly even a graduate or professional school.

  It took a few days to process the data, and I must confess that my curiosity was such that I let lapse some things I had planned to do at home in order to come in on Saturday to finish what Betty had not completed by Friday afternoon. The final results, though generally unremarkable (as I had expected), were nonetheless interesting. They are summarized as follows:

  IQ 154 (well above average, though not in genius category)

  Psychological tests (left/right, mazes, mirror tests, etc.-addnl. to std. admission exam) normal

  Neurological tests normal

  EEG (performed by Dr Chakraborty) normal

  Short-term memory excellent

  Reading skill very good

  Artistic ability/eidetic imagery variable

  Musical ability below average

  General knowledge (history, geography, languages, the arts) broad and impressive

  Math and science (particularly physics and astronomy) outstanding

  Knowledge of sports minimal

  General physical strength above average

  Hearing, taste, smell, tactile acuities highly sensitive

  "Special senses" (ability to 'feel' colors, sense the presence of other people, etc.) questionable

  Vision

  1. Sensitivity to white light marked!

  2. Range can detect light at 300-400 A (UV)!

  Aptitude could do almost anything; particular affinity for natural history and physical sciences

  As can be seen, the only unusual finding was the patient's ability to see light at wavelengths well into the ultraviolet range. His apparent sensitivity to visible light could have been due to a genetic defect; in any case there was no obvious retinal damage (nevertheless, I made a note to call Dr. Rappaport, our ophthalmologist, first thing on Tuesday, Monday being Memorial Day). Otherwise there was no suggestion of any special alien talents.

  The patient's knowledge of languages, incidentally, was not as broad as he pretended. Although he spoke and read a little of most of the common ones, his understanding was limited to everyday phrases and idioms, the types found in books for travelers. Another thing that caught my eye was some information the patient volunteered about the stars in the constellation Lyra-their distances from Earth, types, etc.-nothing that required space travel to obtain, certainly, but I decided to check this out as well.

  Driving home that afternoon to the accompaniment of Gounod's Faust, I marveled once again, as I bellowed along, at what the human mind can do. There are well documented cases of superhuman strength arising from a desperate need or fit of madness, of astounding performances far beyond the normal capabilities of athletes or rescue workers, of people who can go into trancelike states or "hibernation," of extraordinary endurance exhibited by victims of natural or man-made disasters, accounts of paralyzed people who get up and walk, of cancer patients who almost seem to cure themselves or, by force of will alone, manage to hang on until a birthday or favorite holiday. No less striking, perhaps, is the case of the unattractive woman who comes across as beautiful merely because she thinks she is. An individual with little talent who becomes a Broadway star on the basis of self confidence and energy alone. I have personally encountered many patients who have done amazing things they could not do before they became ill. And here we have a man who believes he comes from a planet where people are a little more light sensitive than we are, and by God he is. At times like these one wonders what the limits of the human mind really are.

  ON Memorial Day my oldest daughter and her husband and their two little boys drove up from Princeton for a cookout. Abigail is the reverse of the unattractive woman I mentioned above-she was always a very pretty girl who never realized it. I don't think she has ever used makeup, doesn't do anything with her hair, pays no attention to what she wears. From the beginning she has had a mind of her own. When I think of Abby I see a kid of eight or nine marching with a bunch of others two or three times her age, all with long hair and flared pants, flashing her peace sign and yelling her slogans, serious as a kiss. Now, as a nonpracticing lawyer, she's active in any. number of women's/gay/environmental/civil/animal rights groups. How did she turn out this way? Who knows? All of our children are as different from each other as the colors of the rainbow.

  Fred, for instance, is the most sensitive of the four. As a boy he always had his nose in a book, and an ear for music as well. In fact, he still has an enormous collection of recordings of Broadway shows. We always thought he would become an artist of some kind, and were quite amazed when he ended up in aeronautics.

  Jennifer is very different still. Slim, beautiful, not as serious as Abigail or as quiet as Fred, she is the only one of the four who has showed any interest in following her old man's footsteps. As a girl she loved biology (and slumber parties and chocolate-chip cookies), and she is now a third year medical student at Stanford.


  Will (Chip) is the youngest, eight years younger than Jenny. Probably the brightest of the bunch, he is a star athlete in school, active, popular. Like Abby before him, and unlike Fred and Jenny, he is hardly ever home, preferring instead to spend his time with his friends rather than with his grizzled parents. He hasn't the foggiest idea what he wants to do with his life.

  All of which leads to the question: Is the shape of the individual personality due primarily to genetic or to environmental factors? After a great deal of experimentation and debate on this critical issue, the answer is far from clear. All I know is that, despite similar backgrounds and genetic makeup, my four kids are as different from each other as is night from day, winter from summer.

  Abby's husband Steve is a professor of astronomy, and while the steaks were sizzling on the grill I mentioned to him that there was a patient at the hospital who seemed to know something about his field. I showed him prot's figures on the constellation Lyra and the double star system Agape and Satori, around which traveled a putative planet the patient called "K-PAX." Steve studied the information, scratched his reddish beard, and grunted, as he often does when he is thinking. Suddenly he looked up with a_ ferocious grin and drawled, "Charlie put you up to this, didn't he?"

  I assured him that he hadn't, that I didn't even know who "Charlie" was.

  He said, "Terrific joke. Ah love it." My grandson Rain was banging him with a Frisbee now, trying to get him to play, after failing to coax Shasta Daisy, our neurotic Dalmatian, out from under the porch.

  I swore it was no joke and asked him why he thought so. I don't recall his exact words, but they went something like: "This is somethin' Charlie Flynn and his students have been workin' on for quite a while. It involves a double star in the constellation Lyra. This double shows certain perturbations in its rotation pattern that indicate the possibility of a large dark body, prob'ly a planet, as part of the system. Like your alleged patient said, this planet appears to travel around them in an unusual pattern-Charlie thinks it's a figure eight. Do you see what Ah'm sayin'? This is unpublished work! Except for one or two colleagues, Charlie hasn't told anybody about this yet; he was planmn' to report it at the Astrophysics meeting next month. Where does this 'patient' of yours come from? How long has he been at the hospital? His name id'n 'Charlie,' is it?" He stuffed his mouth with a handful of potato chips.

  We drank beer and chatted about astronomy and psychiatry most of the afternoon, Abby and her mother nagging us not to talk shop and to pay some attention to our sons/grandsons, who kept throwing food at Shasta and each other. One thing I wanted to know was his opinion on the possibility of light travel. "It's not," he stated flatly, still not convinced, I think, that I wasn't pulling his leg. But when I asked if he would be willing to help me prove to my new patient that "K-PAX" was a figment of his imagination, he said, "Shore." Before they left I gave him a list of questions to ask Dr. Flynn about the double star system-the types of stars they were, their actual sizes and brightnesses, their rotation period, the duration of a "year" on the putative planet, even something about what the night sky would look like from such a world. He promised to call me with whatever information he could dig up.

  Session Four

  THE Manhattan Psychiatric Institute is located on Amsterdam Avenue at 112th Street in New York City. It is a private teaching and research hospital affiliated with the nearby Columbia University College of Physicians and Surgeons. MPI is distinct from the Psychiatric Institute at Columbia, which is a general treatment center that deals with far more patients. We refer to it as "the big institute," and ours, in turn, is known as "the little institute." Our concept is unique: We take in only a limited number of adult patients (one hundred to one hundred twenty in all), either cases of unusual interest or those that have proven unresponsive to standard somatic (drug), electroconvulsive, surgical, or psychotherapies.

  MPI was constructed in 1907 at a cost of just over a million dollars. Today the physical facility alone is worth one hundred fifty million. The grounds, though small, are well kept, with a grassy lawn to the side and back, and shrubs and flower gardens along the walls and fences. There is also a fountain, "Adonis in the Garden of Eden," situated in the, center of what we call "the back forty." I love to stroll those pastoral grounds, listen to the bubbly fountain, contemplate the old stone walls. Entire adult lives have been lived here, both patient and staff. To some, this is the only world they will ever know.

  There are five floors at MPI, numbered essentially in order of increasing severity of patient illness. Ward One (ground floor) is for those who suffer only acute neuroses or mild paranoia, and those who have responded to therapy and are nearly ready to be discharged. The other patients know this and often try very hard to be "promoted" to Ward One. Ward Two is occupied by those more severely afflicted: delusionals such as Russell and prot, manic and deep depressives, obdurate misanthropes, and others unable to function in society. Ward Three is divided into 3A, which houses a variety of seriously psychotic individuals, and 3B, the autistic/catatonic section. Finally, Ward Four is reserved for psychopathic patients who might cause harm to the staff and their fellow inmates. This includes certain autists who regularly erupt into uncontrollable rages, as well as otherwise normal individuals who sometimes become violent without warning. The fourth floor also houses the clinic and laboratory, a small research library, and a surgical theater.

  Wards One and Two are not restricted in most cases, and the patients are free to mingle. In practice, this takes place primarily in the exercise/recreation and dining rooms (Wards Three and Four maintain separate facilities). Within each ward, of course, there are segregated sleeping and bathing areas for men and women. The staff, incidentally, maintains offices and examining rooms on the fifth floor; it is a common joke among the patients that we are the craziest inmates of all. Finally, the kitchens are spread over several floors, the laundry, heating, air-conditioning, and maintenance facilities are located in the basement, and there is an amphitheater on (and between) the first and second floors, for classes and seminars.

  Before becoming acting director of the hospital I usually spent an hour or two each week in the wards just talking with my patients, on an informal basis, to get a sense of their rate of progress, if any. Unfortunately, the press of administrative duties put an end to that custom, but I still try to have lunch with them occasionally and hang around until my first interview or committee meeting or afternoon lecture. On the day after the Memorial Day weekend I decided to eat in Ward Three before looking over my notes for my three o'clock class.

  Besides the autists and catatonics, this ward is populated by patients with certain disorders which would make it difficult for them to interact with those in Wards One and Two. For example, there are several compulsive eaters, who will devour anything they can get their hands on-rocks, paper, weeds, silverware; a coprophagic whose only desire is to consume his own, and sometimes others', feces; and a number of patients with severe sexual problems.

  One of the latter,- dubbed "Whacky" by a comedic student some time ago, is a young man who diddles with himself almost constantly. Virtually anything sets him off: arms, legs, beds, bathrooms-you name it.

  Whacky, is the son of a prominent New York attorney and his ex-wife, a well-known television soap opera actress. As far as we know he enjoyed a fairly normal childhood, i.e., he wasn't sexually repressed or abused in any way, he owned a Lionel train and Lincoln logs, played baseball and basketball, liked to read, he had friends. In high school he was shy around girls, but in college he became engaged to a beautiful coed. Although convivial and outgoing, she was nevertheless extremely coquettish, leading him on and on but never quite going "all the way." Crazed with desire, Whacky remained as virginal as Russell for two agonizing years-he was saving himself for the woman he loved.

  But on their wedding day she ran off with an old boyfriend, recently released from the state prison, leaving Whacky literally standing at the altar (and bursting at the seams). When he
received the news that his fiancee had jilted him, he took down his pants and began to masturbate right there in the church, and he has been at it ever since.

  Prostitution therapy was completely ineffective in Whacky's case. However, drug treatments have proven marginally successful, and he can usually come to the table and get back to his room without causing a disturbance.

  When he is not caught up in his compulsion, Whacky is a very pleasant guy. Now in his mid-forties, he is still youthfully handsome, with closely cropped brown hair, a strong cleft chin, and a terrible melancholy that shows in his sad blue eyes. He enjoys watching televised sporting events and talks about the baseball or football standings whenever I see him. On this particular occasion, however, he did not discuss the Mets, his favorite team. Instead, he brought up the subject of prot.

  Whacky had never seen my new patient as far as I knew, since inhabitants of Ward Three are not permitted to visit the other floors. But somehow he had heard about a visitor in Ward Two who had come from a faraway place where life was very different from ours, and he wanted to meet him. I tried to discourage the idea by downplaying prot's imaginary travels, but his pathetic baby-blue eyes were so insistent that I told him I would give the matter some thought. "But why do you want to meet him?" I inquired.

  "Why, to see if he will take me back with him, of course!"

  The sudden silence was eerie-the place is usually one of noisy confusion and flying food. I glanced around. No one was wailing or giggling or spitting. Everyone was watching us and listening. I mumbled something about "seeing what I could do." By the time I got up to leave, the whole of Ward Three had made it clear that they wanted a chance to take their cases to my "alien" patient, and it took me nearly half an hour to calm everyone down and make my exit.