Dr. Neruda's Cure for Evil (38 page)

W
ITHIN MINUTES OF MY FIRST INTERVIEW WITH
G
ENE
K
ENNY,
I
KNEW
I didn’t like him. I was twenty-five. I had received my medical degree from Johns Hopkins, done my residency at Bellevue, and was completing my training under the supervision of Dr. Susan Bracken at her clinic in Greenwich Village. I had no hint that treating Gene would profoundly alter the course of my life, I had no inkling of the tragedy that would engulf him, but I knew I didn’t want him for a patient.

Gene wasn’t my first patient, not by a long shot. He was, however, among the very first I worked with under Susan’s guidance. She had opened a community mental health clinic in a brownstone on Tenth Street, off Sixth Avenue. Uncle and Susan both considered me to be overqualified for this low-rent venue, but I wanted to learn from her and I liked the fact that the free or moderately priced therapy offered would attract a different class of patient. The well-heeled, articulate, attractive, mild neurotic that is typified in the public mind by Woody Allen movies, it seemed to me, had plenty of talent at their disposal.

In 1977, the year Gene Kenny began treatment, the clinic saw a wide variety of distress. Alcohol and drug addiction, wife and child abuse (and one case of husband abuse), a constellation of sexual disorders, crippling anxiety and chronic depression—all were plentiful, displayed by the diverse population of New York City, ranging from artists to Lower East Side gang members. What our patients had in common, with one exception, was lack of money. (The exception, an elderly woman, featured miserliness among her many anal-retentive attributes.) Of course schizophrenics also showed up, and a few people with problems I discovered were purely physical, but whose symptoms were first apparent in behavior—brain tumors, thyroid problems, certain kinds of migraines and one man with a collapsed lung. (He assumed his agonizing pain was psychosomatic. Not surprisingly, later on he did become my patient.) We referred those cases to Bellevue Emergency, as well as the schizophrenics, although we did see a few of the latter as outpatients.

Gene was fifteen. He had a full head of thick black hair, pale unhealthy skin, pouting lips, a strong chin, dark eyes, and a long skinny nose set slightly off center, like one of those Picasso Cubist faces. He looked European, although I must confess I don’t know what that means when, as a technical matter, everyone who isn’t black or Asian looks European. I guess what I mean is that his features were clearly not mixed. He seemed to be the child of generations of breeding from a specific region—Eastern Europe to my eyes. I was surprised when he opened his mouth and spoke in a thoroughly American way.

“They told me I was supposed to sit here,” he said from his slouched position in a chair. It was placed by the right wing of the desk. We were in one of two basement rooms for private sessions.

I had come from a group therapy session upstairs. It was eight o’clock, my last appointment of a twelve-hour day. I sat in the desk chair. “Hello, I’m Dr. Neruda.”

“Yeah,” he said. He averted his eyes with child-like shyness, a boy of eight, rather than the sullenness of an adolescent. “You’re Gene?”

He nodded. He rolled his full lips inward, between his teeth, and pushed them out, over and over, eyes intent on the surface of my desk. He appeared to be very nervous.

I had already read the preliminary interview, done by a New York University psychology graduate student interning for Susan. These were the facts: Gene was fifteen, an only child, in the ninth grade at the One Room School, a progressive private school in the Village, living with his parents on Lower Broadway. His father’s occupation was listed as photographer, and his mother’s as a copy editor working for a school textbook publisher. Since they qualified for free treatment, their income, at least on tax returns from the previous two years, was modest. (The private school was paid by his father’s mother. This could mean their income didn’t reflect their actual wealth; but Susan’s policy was first to decide if the patient deserved treatment and worry about payment later. If we took on Gene and discovered his grandmother was a millionaire, we would hope to be paid eventually. Anyway, this was less of an issue for me than for the other two staff therapists. I didn’t need a supplement to what Susan paid me.) At the bottom of the interview a paragraph stated he complained of sleeplessness, palpitations, loss of appetite, difficulty concentrating in school and that his mother had brought him in. She reported that Gene’s school had suggested they seek help; the school’s psychologist, a friend of Susan’s, had recommended us as a low-cost option. To relax him, I began with questions we both knew the answers to.

“Did your mother bring you?”

He nodded. “She’s waiting.”

“How old are you?”

“Fifteen.”

I went through a few more. Then, “So, what’s going on, Gene? Why are you here?”

“Mommy brought me,” he said.

I noted that he used a child’s term for her. “You don’t want to be here?”

He shrugged. His eyes roved the desk.

“Many people prefer to talk while lying on the couch. Would you like to lie on the couch?”

He frowned. His eyebrows were thick and jet black against the pallor of his skin. They were expressive and let me know he certainly did not want to. They crossed together in a frown, reared up in surprise, and then scanned the couch with an unmistakable look of fear and disgust.

I was about to tell him he could stay in the chair, when he said in a mumble, “Okay.” He hurried to the couch, never looking in my direction. He sat on the edge, head hanging, and waited, as if ready to be punished.

This was the moment when I experienced a strong feeling of dislike for Gene. It shocked me. I had never felt anything like it as a doctor. Both at the hospital and at the clinic, I had hostile, repulsive, sometimes physically deformed patients; patients who were trying and upsetting because of both their behavior and their appearance; patients who were virtually autistic or psychotic. I treated one schizophrenic who moved his bowels while I took his blood pressure. Certainly I hadn’t enjoyed many of those encounters but I never felt dislike, a complete lack of sympathy.

“You can take off your shoes,” I said, following a routine.

He pushed off each of his Keds sneakers without untying them and flopped back. Only his torso, however. His legs draped over the side, feet skimming the parquet floor—another indication that he wasn’t happy about lying down.

“Do you want to be on the couch?”

He shrugged. I saw, but pretended not to. “What did you say?”

“It’s okay,” he said, almost inaudibly.

“I’m glad we’re doing what you want,” I said and immediately regretted it. What in God’s name did I mean by this taunting comment?

“What?” he mumbled.

“Nothing,” I said, compounding my mistake. A therapist should be the last person on earth to maintain that something said casually has no meaning. Besides, he had probably heard me. His “What?” was a reaction to the oddness of my remark. My cover-up just made things worse. For a moment I considered ending the session and fetching someone else to see him. Unfortunately, Susan was the only other staff present at that hour and she was busy.

“You can put your feet up,” I said.

He winced. His reaction was unmistakable: my suggestion caused him pain. Yet he promptly raised his feet to the couch. He submitted, but did not relax: keeping his knees bent, arms rigid, palms pressed onto the cushions, as if prepared to leap up.

I left my seat to move to the wing chair placed a little behind and to the side of the patient’s head on the couch. That would keep me out of sight unless he twisted his head and gave me an angle to view his expressions. Although it may strike the reader as silly, this seating arrangement was a deliberate reform of the tradition, which is a chair placed directly behind the couch, to prevent both therapist and patient from any chance of seeing each other’s face.

Gene heard my movement. Our floor had buckled from water damage over the winter and groaned at the slightest pressure. His head snapped to the side, his feet arched, and his right arm reached out as if to ward off an attack, like a newborn’s startle reflex.

“I’m going to sit in this chair,” I explained. Gene twisted to watch me. “If I stay behind my desk you’ll have to shout.”

He nodded. I settled into the wing chair. Gene remained in his pose. It was an uncomfortable position he couldn’t maintain for long.

I decided to unveil the mystery of my suggesting the couch. That was one of Susan’s lessons—don’t build unnecessary walls between patient and doctor. “I prefer it when people are willing to lie on the couch,” I said. “That way I can listen to you without having to think about my own face—whether I should smile or frown or look blank. That takes away from the time I should be spending listening to you. And you’re free to let your thoughts wander. It frees both of us to concentrate on you and not on our manners. But if you don’t feel comfortable we can work with you sitting up. I see several people who hate the idea of the couch and we’ve done fine.”

For a moment he remained frozen in that awkward twist. Then he allowed his head to fall back and his arm returned to his side. His knees straightened a little.

“So you’re staying on the couch?” I asked.

He shrugged. Shrugging while lying down is difficult but he could move his skinny shoulders as expressively as his eyebrows. I was trying to elicit something positive or negative from him, a clear statement of personal preference. His passive behavior and suppressed anger at his own obedience is a common pattern; I hoped to learn whether that was typical of all his relationships or a defense mounted for this situation.

“So, Gene, do you want to stay on the couch?”

“I guess.” That was a barely audible murmur.

“Do you want to be here at all? Or is it entirely your mother’s idea?”

Another silence. His fear of answering was palpable. “I don’t know,” he said at last. He seemed relieved to have come up with this temporizing response.

“Guess,” I said.

“Guess?” he asked, his adolescent huskiness breaking up into a child’s trill.

“Yeah. Take a guess. Do you want to be here?”

“I had to,” he complained. “One Room told my Mom I had to.”

“So it’s not your mother’s idea?”

He shrugged.

“And you don’t want to be here?”

“I don’t know.”

I waited.

He waited. Then he complained, “How can I know until afterwards?”

“You can’t know whether you want to be here until after you’ve come and gone?”

Again, Gene tried to twist to see me. He could only accomplish that by raising himself but he didn’t feel that rebellious. He gave up, letting his head lie sideways, mouth in a pout.

“What do you mean?” he said, back to a mumble.

“You said you can’t know whether you want to be here until afterwards.” I paused. I was about to push this beyond my formal training. Susan wouldn’t mind, but, strange as it might seem after her success with me, I wasn’t comfortable with her bolder methods. “I don’t believe you,” I said mildly.

“It’s true,” he said sadly. “I don’t know if I like something until …” He trailed off, sighed, and then added, “Sometimes for a long time.”

I had my answer, in a way. He was passive about everything. Well, I thought, brushing aside my transitory dislike, this is an easy case. Well identify his feelings and with that recognition a gradual confidence in expressing them and insisting on their acknowledgment will relieve his depression and anxiety.

“I think you’re confusing two things,” I said. “Not wanting to be here is a feeling; knowing whether you’re right not to want to be here is a judgment.”

Gene shut his eyes. He drew up his legs. Turned sideways on the couch, that put him in a fetal position. His left hand drew close to his chest. I peered at it and discovered what I expected to: his thumb was hidden inside his fist. He was fighting an urge to suck it.

“I want to know what you feel, Gene. I’m not worried about whether you’re right or wrong to feel it. That’s something you can decide, or maybe the world can decide. Personally, I don’t think there is any right or wrong when it comes to feelings. Actions, yes. Not feelings. Our job is to help you know what you feel.”

Gene opened his eyes. He brought the fist with the hidden thumb up to his chin. “I didn’t want to come,” he said, his voice trembling. He paused, hardly breathing. What did he expect from me? Shouting? Violence?

“So you don’t want to be here?”

He nodded. His fist covered his mouth now, the entombed thumb centered on the lips. Was he pushing them in and out as before? That was a sucking motion. Freud would have his diagnosis by now. He’d grab a helmet and flashlight and move resolutely back into the cave of time to illuminate the story of Gene’s breast-feeding—and, I knew uneasily, he might be right to go on that quest.

“Do you want to be on the couch?”

He shook his head, moaning a little. He had regressed dramatically and it happened again: I didn’t like him. Why was he so undefended? I felt an urge to shout at him to sit up and act like a man. Fight me, I thought, staring at the ball he had made himself into.

“Then why are you lying on it?”

He shook his head and moaned again.

“Gene, I don’t know what that sound you’re making means.”

He moaned some more, head still shaking no.

I lost it again. “If you don’t talk to me, I’ll have to end the session.” There was sweat at my temples. I was literally hot from emotion. I was shamed by all these blunders, but I couldn’t seem to stop making them.

His moaning ceased at my scolding, of course. He dropped his fist to his stomach and covered it with the other hand. His face looked sweet and innocent. “Sorry,” he said in a low, contrite voice. Thanks to my mistake I had lost ground.

I should end the session, I thought. “If you—” I sighed, tried to settle down. “If you didn’t want to get on the couch, why did you?”

“I thought you wouldn’t like me,” he answered clearly.

“Why do you care if I like you?”