of the next patient who walks through my door. Yes, it is true that experience makes us better at our various trades, and mine is no different. I am certainly a more capable diagnostician now than I was at the start of my career. But I have found that the diagnosis is the easy part. It’s the treatment—the careful, balanced, meticulous management of pills and therapy—that poses the most significant challenges and requires as much humility as skill. Every brain is different. And so must be every course of therapy. I never presume to know what will work. And by “work” I mean help, because that is what we aim to achieve—the helping of a human being to escape the pain inflicted by his own mind.
You may conclude me a braggart, but I have been successful in helping every one of my patients with a single exception. This has been true in both my private practice at 85 Cherry Street in Fairview as well as my more gritty work at the men’s correctional facility in Somers.
I am the only practicing psychiatrist in Fairview. The doctor who administered the medication to Jenny Kramer, Dr. Markovitz, lives in Cranston and does not provide therapy in private practice. There are far more psychologists, social workers, therapists, and the like in our town, but none of them can prescribe drugs, and none of them is trained in psychopharmacology. That is the first reason the Kramers employed my services.
The second reason is my work in Somers. Once a week, I travel upstate to volunteer a full day (eight hours that would otherwise be billable at four hundred dollars each) to treat mentally ill criminals at Connecticut’s Northern Correctional Institution. This is a level five maximum security institution. So you are not confused, the men at Somers have been convicted of crimes and sentenced to prison. Some of them also happen to be mentally ill. Criminals who are found not guilty by reason of insanity are not sent to prison. They may face their own hell confined to state mental hospitals. Sometimes they are released after rather minimal and insufficient treatment. The irony is that there does not exist a perfect correlation between the degree of a criminal’s insanity and his ability to utilize an insanity defense. An otherwise “sane” man who slays his wife’s lover in the heat of the moment may be deemed temporarily insane and have a defense under the law, while a serial killer (all of whom, I would insist, are clinically sociopathic) will wind up on death row. Yes, yes, it’s all more complicated than this. If you are a criminal attorney, you are probably jumping up and down in protest of my oversimplified rantings. But consider this: Was Charles Manson not insane for ordering his cult to murder seven people? Was Susan Smith not insane to drown her children? Even Bernie Madoff—was he not insane to continue his Ponzi scheme after he had made more money than he could ever spend?
Insanity is just a word. The men I treat are violent offenders, and they have illnesses ranging from depression to severe psychosis. I provide them with traditional “talk” therapy, though not the amount that is needed, and with medication. The prison would prefer me to focus on the drugs. In fact, the prison workers would let me medicate the entire population living within its walls if such a thing were allowed. Sedated prisoners make for easy prisoners. But, of course, it is not allowed. You can understand, though, why they are eager to send me anyone who meets their criteria. Hour after hour, they come and they go from a line outside the guarded metal door. Sometimes the line grows throughout the day and I feel the urge to cut the sessions short so I can get to all of them. I’m sure I do, and this weighs on my conscience. I see their faces on the long drive home, the ones I can’t get to that week, and also the ones I sent away in haste with a few pills.
The bean counters come each quarter to scrutinize the spending on the prescriptions, but they can’t argue with my rate. As unpleasant as it is to pass a day with violent offenders, I believe I am serving a vital role. Our prisons are overflowing with the mentally ill. Whether the illness led them to commit their crimes, or the prison environment created their illness, is not always easily determined. And for my purposes, largely irrelevant. In any case, I understand the criminal mind.
The third reason I was chosen to become involved with Jenny Kramer has to do with a young man named Sean Logan. I will get to that shortly.
After slicing her wrists open, Jenny awoke in the middle of the night. Her father was in the room and had fallen asleep in a chair. From her description of this moment, there was never any doubt in my mind that she had fully intended to end her life.
My eyes were suddenly open and I was seeing the curtain again. It’s light blue and it hangs on metal rings from this bar that goes around the room in the ICU. They put me in the same room where I was the night they gave me the treatment. The night I was raped. I hate saying that. They tell me I should say it—and think it—because it will help me accept it and I guess get better. But it hasn’t, right?
Jenny lifted her bandaged wrists in the air.
Whatever they gave me to sleep was still sort of there, so I felt pretty good. Like I was high.
“Like when you take the pills from your friends’ houses?” I asked her.
Yeah. Then all these thoughts came at once, like a stream of bullets. I’m dead. I’m alive. This whole year never happened—it’s still the night of the rape. I felt relief that this year had been a bad dream. But then I felt horrible that I would have to live it all again. And that made me come back to the most obvious thing, which was that I had cut myself. And then more thoughts fired out at me. It was like this shock that I had done that, and even relief that it hadn’t worked, because I must have been crazy to want to do it. But then all the reasons that had made me do it rushed in, and I was like, oh yeah, I wasn’t crazy. I had reasons, really good reasons, and they’re all still here. The bad stuff that I feel every day, all the time, was still there. It was like swimming up from the bottom of the pool and popping out of the water to find yourself exactly where you started before you dove in. You know what I mean? I was exactly where I was before. I tried to move my arms onto my stomach because that’s what I do when I think about it, about the bad stuff I feel, but my arms were tied to the bed rails. Then I just thought how angry I was that it hadn’t worked.
Jenny cried then. It wasn’t the first time. But these were angry tears.
It wasn’t easy, you know. I was so scared. I sat in that bathroom and I was crying and crying. I thought about Lucas mostly, and about my dad and what this would do to them. And my mom, too, though she’s stronger than they are. I imagined she would be really mad at me. I almost stopped but then I told myself, just do it and get it over with! The blade was really sharp and it hurt way more than I thought. It wasn’t the cutting that hurt, but the air when it went into my veins. It was like this horrible stinging and burning. I did both of them. Do you know how hard that was? With the pain of the first one, knowing how bad it would hurt again? They say you shouldn’t look at the blood because it will make you try to save yourself out of instinct, but it was too hard not to look. And they were right. My heart started to pound like wild and “Stop it! Stop it!” was screaming in my head. I started looking around for ways to bandage myself, but I had removed everything before I started because of the instructions I read. I knew that would happen, that I would try to stop. I had to fight it so hard. You have no idea how hard it was. I had to close my eyes and lie down on the floor and focus on the dizzy feeling, which actually was kind of good. Like I was just letting go of everything. So I did. I just closed my eyes and ignored the voices that kept screaming at me and the burning pain. And I just let everything go. I did all of that. I went through all of that and it still didn’t work.
“Are you angry?” I asked her.
She nodded, the tears flooding her eyes and running down her face.
“With whom?”
She took a while to answer. And when she did, she avoided saying the name but rather alluded to the target of her rage. What was she doing there? Of all the places she could have been. The pool wasn’t even open
