Brooklyn Zoo (9 page)

In school I had learned that the emotional pull toward the grossest distortion of external reality—psychosis—takes root or doesn’t in the first year of life, from some combination of
nature and nurture. If what’s going on in a baby’s environment is too dreadful to accept, or if innate characteristics result in said baby experiencing his world in that way, he may never lay to rest the most frightening concerns of early life, which psychologists think of as engulfment and annihilation. Extremes of environment or biology or some combination of either can impede an infant’s ability to accomplish two of the basic emotional tasks of the first year: realizing that he exists as a separate being, and establishing a rudimentary trust in those around him. If there is a relationship in which a baby receives sufficient soothing, and if his brain allows it, these tasks become faits accomplis. If not, a person will go through life vulnerable to the fears that luckier people master early, in times of stress becoming psychotic or dependent upon the primary defenses used by infants to hold himself together.

Psychologists label the earliest defenses “primitive” and mean that in the most literal (read: non-pejorative) sense: developmentally early. The primitive defenses, in contrast to “higher order” ones, reflect qualities associated with a child’s preverbal phase of development—lack of understanding of reality, and lack of appreciation of the separateness and constancy of others. The primitive defenses include colloquially familiar ones like denial and projection—when feelings that originate inside the self are misunderstood as coming from others. They also include less familiar ones like introjection, when what is threatening and outside is experienced as if coming from within, and omnipotent control—the fantasy that one controls the external environment with one’s mind. The use of each can result in psychotic symptoms. Some of these symptoms, like stilted turns of thought, are subtle enough to escape casual notice. Others are more florid: hallucinations, delusions, acute paranoia, and the like. It was these that were
almost always on display at forensics, and seeing them up close for the first time felt valuable, even if I wasn’t getting to do any treatment.

Illogical thinking is one artifact of psychosis, and the defendants we saw often had interesting ideas about how they’d become ill. Mr. Ruiz, with his salt-and-pepper hair and the same date of birth as my mother, attributed his confusion to a watermelon seed. “I swallowed it, and I felt it go up into my head,” he told us. “It’s causing trouble. I feel it there now, and I can no longer think very well. When I was young, my mind was okay, but not now.” His crime was trespassing, though by his account his trespass was only into his former home, an abandoned building where he’d squatted for three years before the absent owners insisted he leave. “They turned on me,” he said glumly. He’d been homeless much of his life. He wore a sweatshirt tied around his neck like a cape. He would not agree to either take a plea or go to trial, and he kept insisting, “I can’t pay these people,” meaning his lawyer, though it was repeatedly explained to him that someone else would cover the expense. Mr. Ruiz was not fit to stand trial.

I climbed back upstairs to wait for the next round of interviews and was sitting in the clinic’s reception area when Dr. Ruben tore into the office in worked-up excitement. He had done an evaluation of a highly distractible defendant. Accused of robbing people on the subway, a crime the man claimed not to remember, he seemed unable even to follow his evaluators’ conversation. Furthermore, he could not understand why he could not simultaneously claim lack of memory of the event
and
that he hadn’t been carrying a gun. Dr. Ruben wanted to argue the defendant unfit on the basis of attention deficit disorder. He was an older psychiatrist, educated before attentional disorders were a point of focus, but he’d recently been
reading about them in the
New York Times
. He was asking the clinic secretary if she could order the paper-and-pencil tests used to diagnose it when I interjected to tell him that the hospital already likely had them, and also offered to do the testing myself. I knew that ADD on its own did not cause the level of inattention Dr. Ruben described, but I thought it could be an interesting assignment and was ready to do something more active than sitting in on evaluations, which were never boring but were starting to feel repetitive nonetheless.

Dr. Young overheard my offer and popped her head out of her office to endorse it. She agreed that even if our guy had ADD, it was likely to be the least of his problems given, naturally, his very long history of psychiatric hospitalizations and arrests. Still, the testing would help fulfill one of my training requirements (five or six full testing batteries), and it would satisfy Dr. Ruben’s nascent curiosity. It was a win-win. And so the sporadically homeless, often incarcerated, and chronically mentally ill Grant Carson, as the defendant was named, became the unlikely subject of an extensive psychological screening.

Generally, psychologists do two kinds of testing, cognitive and personality, and I’d done a fair amount of both in graduate school. Cognitive tests measure IQ and educational achievement. They’re used to diagnose learning disabilities, including ADHD, and to quantify other intellectual abilities, most often when they seem on the decline, say after a head injury, or if some kind of dementia is settling in. Personality tests look at different aspects of a person’s cognitive, emotional, and interpersonal functioning. Some of them involve self-reports, where the participant answers a series of questions about himself. Others are projective, which means the subject is presented with an ambiguous stimulus like an ink blot and asked
to make meaning of it, offering clues to his emotional preoccupations. Cognitive and personality tests are ideally given in conjunction, as the two areas are inextricably intertwined, our intellect shaped or constrained by our character.

The first time I met with Grant Carson, it was not to administer any test but simply to hear about his life. I went into the basement on my own for the first time, down the very long staircase, and found him sitting, lanky limbed and bent, on the metal bench that lined the back wall of the holding cell. He was staring at the gray cement floor beneath his laceless boots. He did not look up when I introduced myself and explained why I was there, though he did stick out his cuffed hands meekly to shake mine. His long neck craned downward, his eyes hidden in shame, he was the most pitiful being I’d ever seen, like a woodland creature awaiting transformation in a fairy tale. Though he was almost fifty, he looked like a little boy, something in his face and the way he was folded. I sat down at the table in front of him and put down my notebook and pen. “How are you doing today?”

“I’m tired,” he said, still looking at the floor. His tone and prosody did nothing to lend credence to the idea that he was a grown man. “I don’t sleep much at Rikers.”

“How come?” I asked.

“My mother comes to see me in the middle of the night. She sits next to me and we talk. She died of cancer a few years ago, so the only time I get to see her is when she shows up real late.”

I nodded and thought. “What do you talk about?”

“About when I was a child. I tell her if she’d loved me, she wouldn’t have let my stepfather rape me. She tells me I’m worthless and that I should shut up.”

“What’s that like for you?”

“She’s a real comfort,” he said, nodding his head and rocking back and forth.

“How long has she been coming to see you like that?”

“She started when I was in Attica.”

Grant Carson went on to describe his life, more than a third of it spent in one type of prison or another. His longest stint had been ten years at Attica Correctional Facility in upstate New York, not too long before our meeting. The charges had always been similar: robberies he could not recall, criminal possession of weapons, drugs. He told me he started using marijuana at age seven, the year after his stepfather began sodomizing him in his closet on an almost daily basis. When he wasn’t being raped himself, he could hear the man in the next room with his sister. “I used to see her crying in her room, and I knew.”

His stepfather threatened to kill the children’s mother if they told, and Grant kept quiet. He began responding to a voice that no one else could hear around age nine, was disruptive in class, and got suspended or expelled multiple times. His family doctor labeled him hyperactive. His stepfather died when Grant was fifteen, but the man continued to haunt him in his dreams, where his appearance was enough to make Grant get up and run in his sleep. He began drinking at eleven and using crack at sixteen and angel dust at twenty. He got what passed for help—that is, antipsychotic medication—for the first time in jail at age twenty-five. He’d never had any kind of talk therapy. During his time away from jail, he’d fathered a child every few years—none of the five now wanted much to do with him. His acting out was like Russian roulette: he’d tried to hang himself dozens of times while at Attica, where the guards would always arrive in time to save him, in time but also much too late.

“Your stepfather never comes to visit like your mother?” I asked.

“No, just in my dreams,” he said, shaking his head. “But sometimes Ken comes.”

“Ken?”

“He’s this white guy.” Grant was black. “He’s been coming around since I was a kid.”

“Do other people know Ken?”

“I’m not really sure,” he told me. “When Ken comes, Grant leaves.”

I paused at the last part. I’d quickly assumed Ken was just another auditory hallucination, a voice in Grant’s head. But if he really experienced himself as leaving upon Ken’s arrival, he might be describing an alter, another personality. Dissociative identity disorder (DID), or multiple personalities, is theoretically an outgrowth of early and chronic traumatic experience, so it fit with Grant’s history, but there was debate in the field about the disorder’s actual existence. Some clinicians identify DID in a large number of their traumatized patients, while others claim it’s iatrogenic, or brought on by the treatment itself, by practitioners who want to find it working with patients who are eager to please. I’d taken an entire class on the defense called dissociation, the process that underpins DID. Like all defenses, dissociation is a normal function of the mind, widely experienced, for instance, in the benign form of daydreaming—the daydreamer “leaves” a situation mentally while remaining physically present and physiologically awake. Dissociation also offers protection from overwhelming experiences of terror, as an unbearable event is processed as if not quite happening to the self. Trauma victims commonly describe watching themselves as if from the outside as the very bad thing goes on, and therapy with this population is necessarily
focused on integrating the disturbing experiences—making them part of their conscious and continuous life story. Like other defenses, dissociation is only pathological when it becomes a person’s go-to way of dealing with even objectively minor life stressors, and this is what theoretically happens in dissociative identity disorder. DID always made sense to me: it just seemed like dissociation reaching its inevitable potential. But I’d never before been seated at a metal table across from someone who had it, and I found it perversely exciting.

“What do you mean Grant leaves?” I asked. There were specific questions designed to clarify whether someone was prone to dissociation, but damn it I couldn’t remember them just then.

“Sometimes Ken takes over,” he replied.

When I finished my interview with Grant, I went back upstairs and straight to Dr. Wolfe’s cubicle—he had been assigned to oversee the case—and he was thoughtful.

“It might explain why he can’t remember the robberies,” he said. “Or he could be malingering.”

It was hard for me to believe that the fragile man who’d sat before me could fake a toothache, let alone anything as elaborate as a white man named Ken, but I agreed the matter warranted more attention. Dr. Wolfe suggested I add a self-report measure that helped flesh out dissociative experiences to the list of tests I’d administer to Grant, and he told me he’d want to speak to Grant himself before the testing was through. We told Dr. Ruben, the psychiatrist who’d made the referral, that I suspected DID, and he expressed faux annoyance: he’d had high hopes that this one might be treated with a quick dose of Ritalin and then sent off to trial. “Multiple personalities!” he exclaimed under his breath and walked off, shaking his head.

The next week Grant was returned to the courthouse twice
to take hour upon hour of tests. Given that our mutual efforts would likely culminate in the conclusion that he, like all the others, was unfit to stand trial, it seemed like overkill, but who was I to say? First thing in the morning, he was waiting for me in the basement holding cell, his head held low. We started with the WAIS—the Wechsler Adult Intelligence Scale. David Wechsler, the American psychologist who developed the test, defined intelligence as “the global capacity of the individual to act purposefully, to think rationally, and to deal effectively with his environment.” The test measures verbal and nonverbal abilities, and it’s how you arrive at someone’s IQ. Some parts of the test involve learning a new skill, and these measure what is called fluid intelligence, while others look at fund of knowledge, or crystallized intelligence. Generally speaking, intelligence is impacted by a lot of things. Like every aspect of being, some of it has to do with innate capacity, and some of it has to do with environment. Grant had only gone as far as the ninth grade, and given all the abuse he was enduring at home, it wasn’t likely he was able to focus on what was going on in the classroom, whether or not he had ADHD. As Grant and I moved through the different parts of the test, it was obvious he wasn’t doing well. We’d been carrying on for a while when he couldn’t define one of the vocabulary words I presented to him, and he looked as if he might break down. I stopped to ask why he thought he was getting so upset.

“I want to do well because then I’ll feel happy,” he answered, and I couldn’t say which I thought was less likely.