Brooklyn Zoo (10 page)

After Grant and I had spent two days and many hours engaged in the Rorschach, the Thematic Apperception Test, the Delis-Kaplan Executive Function System, and the Test of Memory Malingering, among others, on yet another morning Dr. Wolfe came down with me to meet Grant and to administer
the Multidimensional Inventory of Dissociation (MID), to determine once and for all if our guy had multiple personalities. Grant spoke a little differently of the white man named Ken this time around, and it was hard to say whether he was a hallucination or an alter. The MID wasn’t a huge help because while Grant agreed that yes, he had trancelike episodes where he stared off into space and lost awareness of what was going on around him, felt uncertain about who he really was, and relived traumatic events so vividly that he totally lost contact with his surroundings, he didn’t always seem to completely comprehend the statements he was endorsing. Dr. Wolfe was not convinced, and I didn’t know what to think. With so much trauma in his history and so many symptoms in his present, it was difficult to parse the whole thing out. This was almost always the case with our defendants, though Grant was an extreme example. Dr. Wolfe and I settled on a diagnosis of chronic post-traumatic stress disorder, among others.

Every testing report ends with recommendations, and beyond suggesting that Grant be found unfit to stand trial, ours came down to this: get this guy some serious psychological help. I had never before so vehemently hoped that my recommendations would be implemented, but given that Grant still stood accused of holding up honorable citizens at gunpoint on the subway, and that the justice system had limited resources when it came to mental health care, I doubted he would ever get the therapy he’d need to have any relief. Grant Carson was probably the first person I’d ever met who made me question whether significant relief was always even a possibility. Maybe a person could only take so much. Maybe there was a point of psychological no return.

As one month passed at forensics and then another, I began to be acutely discomfited by the fact that I had yet to actually conduct a fitness-to-stand-trial evaluation. The students were allowed, if never outright encouraged, to do this—to go through the standard interview protocol with a defendant while the doctors looked on. Given that these evaluations were more or less all that went down in the court clinic, I felt conspicuous about my reluctance, my self-appointed status as the wallflower at the orgy. I’d grown up with a critical father. I’d gone on to choose first one and then another career where I could make others the explicit focus of attention—perhaps no one need notice me—but now there was this live audience. At forensics I’d looked on as the master’s students led the assessments, and I knew I couldn’t do much worse. One particularly shiny-haired girl had giggled most of the way through, to the point where I cringed mightily for the defendant, whose business there was not a laughing matter. In the laid-back court clinic, where responsibility for teaching was after all so diffuse, no one was going to suggest that I do anything. It was all up to me, which made my reticence feel all the more like a personal failure.

Dr. Wolfe walked back to collect a couple students. I had stopped waiting a beat to volunteer to go downstairs to watch, and so I stood up right away. The mood that day was jovial. Dr. Wolfe and Dr. Laytner were excited about this case, a young man who had tried to kill his family with a samurai sword. It had dramatic overtones and a potentially compelling narrative, at least relative to the heavy rotation of disturbers of the peace who so often filled our days.

It was actually starting to feel monotonous, all that craziness I was not there to learn to treat, and so I had decided—with Scott’s approval—that I would leave the court clinic for
good that week, a month early. All the commuting back and forth midday had proven a disappointing way to spend my time, and also I guessed, having gotten a feel for what profound mental illness looked like, I’d learned as much as I was going to there. One rotation or another had to be cut short by a compulsory month in the psychiatric emergency room anyway. Beginning the next week I would be at the hospital full-time.

From the other interns’ experiences—shared in fitful bursts before our seminars and during our weekly intern support group—I understood this would be a mixed bag. My sense that psychologists might be dismissed by the psychiatrists who ruled the G Building had been correct, to the extent that the M.D. in charge of the inpatient unit that Jen, Leora, Zeke, and Alisa had been assigned to had refused to give them patients at all. Instead, this psychiatrist distributed therapy duties among the third-year medical students, who, while they had passed gross anatomy, had likely never as much as taken Psych 101. Scott had tried to intervene to no avail, and our director finally settled on moving the interns to a different unit altogether, but not before we’d all learned a pointed lesson about the dismissive arrogance of psychiatry. Until then it had been for us mostly a myth.

On our trek down the long courthouse staircase, Dr. Wolfe told me Scott had asked him to supervise the women’s depression group I had recently begun co-leading in the outpatient clinic. Each of the five forensic psychologists spent one day a week at the hospital proper, so many of them supervised non-forensic goings-on. Dr. Wolfe’s news was especially welcome because with forensics coming to a sudden close, I had regretted cutting ties with him, the only psychologist I’d so
far found to look up to. It was proving hard, at this institution under siege, to locate someone willing to take on that role. If there was an every-man-for-himself ethos in Behavioral Health that year, I could hardly blame the staff, who from the junior psychologists on up seemed themselves without solid leadership. Still, I felt a lack. I had started co-leading a support group for cancer patients as they waited for their chemo, and my warm but impossibly overstretched oncology group supervisor canceled about half the time. I had signed up for a seminar on family therapy, which included taking on a family case, and my supervisor for that was equal parts helpful and scatterbrained—“I got held up at the bank” was the best he could do after forgetting to show up for what would have been our third-time-rescheduled second meeting. (“At gunpoint?” Jen asked, not altogether kidding, when I repeated his words to her later.) We’d started an interesting psychopharmacology class, but the psychiatrist teaching it only managed to make it once in a while. While Caitlin Downs never canceled a supervision, our time together was so unsatisfying I wished she would. Dr. Wolfe was available
and
knowledgeable about psychology, and after all these weeks seemed fond of me. As small a bright spot as that was in the larger picture of my training, it was sustaining.

Joseph de la Paz sat waiting in the basement holding cell. He was small, in his mid-twenties, and with the by-now-familiar history—his education cut short when his thoughts began to feel scrambled, his sporadic drinking and drug use becoming heavier as his psychotic symptoms intensified. He was obsessed with homosexuality and homicide. Mr. de la Paz traced the origin of his problems to his aunt, with whom he lived. She’d put something in his soup, something she had
gotten from a “homosexual” who also happened to be a witch doctor. He feared that people were out to destroy him. He’d purchased the sword at a mall in order to protect himself from his aunt and her gay witch doctor friend and anyone else who might be involved in conspiring against him.

“Why would they want to hurt you?” asked Dr. Laytner.

“Because now women don’t respect men,” replied Mr. de la Paz.

“But why hurt you in particular?” he followed up.

“Because in America there are a lot of homosexuals,” replied Mr. de la Paz.

“But why you?” persisted Dr. Laytner.

“Only God knows,” he concluded.

The guard led him out of the cell while we remained. During the interview he had become suspicious of the lawyer Jim Danziger, who he feared might be under the control of the witch doctor. He would not talk to Jim, and so he would be found unfit. As we waited for the next defendant, I gathered my determination and requested to lead the 7:30. Dr. Laytner and Dr. Wolfe said sure. To be polite, I thought, they changed the subject and looked away, allowing me and my nerves some time alone. But my trepidation was for nothing. The guard came in to report the defendant was refusing to see us. The morning was over, I had to go back to the hospital, and telling myself that at least I’d tried, I would not volunteer again.

On my last day at the court clinic, Dr. Young called me into her office for the first time. Because my days at forensics were ending, she needed to formally evaluate me. She had a form for this on her desk, and I could see the Likert scale on which
she was supposed to rate me, one through five—five being the best—on various dimensions. She read the first item aloud to me. “ ‘Student was able to incorporate new material effectively.’ How do you think you rate on that?” she asked.

“Uh, well, this was all new, and I think I get what these fitness evaluations are all about, so good, I guess,” I replied, looking at her questioningly. Did she want me to choose a number?

“Okay, well, let’s say we give you a four on that?” She marked it and went on. “ ‘Student applied existing knowledge to new situations.’ How about that?”

“I didn’t have existing knowledge about forensics when I got here, so I’m not sure that one applies,” I said.

“Well, there’s no ‘NA’ choice. It seems like you didn’t do that very well, I guess. I’m going to give you a two,” she said, making a sympathetic face and then checking the box with her pencil. She presented more statements and waited for my quantitative judgments. When I hesitated to give myself a ringing endorsement on any item, she made a sorry face—not apologetic, more like she regretted my incompetence—and gave me a one or a two. Around question ten, I decided to bring up the fact that maybe someone who knew me better should be filling out the form. She waved away my concerns. “It’s not important anyway,” she said.

“To you it is unimportant,” I wanted to say. “To me it is not.”

When this absurdity reached its conclusion, I walked out of Dr. Young’s office and shut the door. I realized I probably should have asked for more direct supervision from her weeks before. I would have learned something from it. Dr. Wolfe was standing nearby making copies.

“What’s wrong?” he asked. My face always gave me away, but of course it wasn’t appropriate to register my complaints about his nominal boss.

“I don’t think that internship is going to make me a better therapist” was the best I could come up with, realizing only as I said it that I was actually concerned, given the way things were going, that this was true.

“Maybe not,” he said thoughtfully. “But it will make you a better psychologist.”

I had been very good at being a graduate student. After my first semester I’d even gotten a letter—bizarre in retrospect because what could have been the point?—informing me that I’d been selected among the best in my class. But it was one thing to be a good doctoral candidate and another altogether to be a good psychologist. My friends who’d gone to law school had all eventually observed that three years in classrooms had taught them about the law but hadn’t prepared them to work as lawyers. I’d never thought about the parallel to my own education, though now it seemed so clear. My training was in long-term work with relatively high-functioning people, with the goal of achieving character change. If every patient I encountered on internship could use a really good therapist, given the acute problems they showed up with, a talking cure was never going to be the most immediate concern.