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  Though it was customary for intern applicants to interview for internships with the director of training, Scott Brent had not yet taken over the job when I’d first set foot on the grounds of the hospital the previous December, early in the interview process. Kings County had actually been my first interview, and after waking up at 3:00 a.m. in a panic and not falling back to sleep (internship is a necessary precursor to finishing the degree, and that year, nationally, there were only spots available for 75 percent of applicants), I became one of the first interviewees of the season to arrive there. My timing meant that I interviewed with Sylvia Goldberg, the longtime, beloved director of training, known by that time to be retiring. She and I had clicked instantly. “What’s your biggest weakness as a therapist?” she’d asked.

  “I’m in a hurry for my patients to get better, and I go too fast,” I’d told her.

  “Are you working on that?” she replied, looking intensely into my eyes.

  “Yes,” I assured her, inspired by her earnestness and her gravity of tone.

  Dr. Goldberg invited me to come back the following month to meet Dr. Brent, who would after all be the person I reported to directly were I to match at Kings County. “It’s your choice,” she said. “It won’t impact your chances here either way.” I did not go back. The trip seemed too far. I didn’t think it mattered who the director of training was. Kings County’s internship had a good reputation around my graduate program, and that was enough for me. When Scott sent an e-mail in late May to invite me out to the hospital to meet him before my start date, I was more reluctant to say no, not wanting to offend him. But I was fact-checking at a magazine in Times Square in the weeks leading up to internship, and the hour-plus commute would have meant a good three hours away from the office, a hundred dollars out of my paycheck. About to embark on a year of low wages—Kings County called what it paid us a “stipend,” not even a salary—I pushed aside my sense that the trip might be a worthwhile investment.

  Scott asked for silence in the room, and the psychologists who lingered stopped their conversations so our director could say a few words. “On behalf of the staff of the Behavioral Health department, I want to welcome our new group of trainees to Kings County Hospital,” he said, raising his orange juice glass. “We are delighted to have you here. We know that while the year may be a challenging one, we also trust that its rewards will outweigh its difficulties.

  “We convened the staff here today because these are the people who will supervise and support you as the year goes on. I can almost guarantee that there is nothing you will experience on the job that someone in this room has not gone through, and they are available to you to lean on, if you should want that along the way. So, thank you all for coming this morning. Behavioral Health, please join me in welcoming this excellent group.” The people in the room raised their cups toward us in a friendly gesture, and a few people clapped. We smiled and nodded in response.

  When breakfast ended, Scott and Dr. Reemer, the child-track director of training, sat the ten of us down to tell us how our first two weeks would go. We would fill out the tall stack of paperwork required by the hospital, we would meet with the head of each department in Behavioral Health to decide for certain which two elective rotations we wanted to choose (two were elective, and two—inpatient and psych ER—were mandatory), and we would attend a five-day hospital orientation, which Scott described as an incredible waste of a week but one that he had been unable to get us out of. Our training proper, it seemed, would not get under way for a full fourteen days, counting weekends and the Fourth of July. Once it did, our schedules would be packed, he told us, with more than we would be able to keep up with. Rotations in the mornings, and seminars, supervisions, and outpatients in the afternoons. We’d each see two outpatients and run at least one outpatient group, with forty-five minutes of supervision for every forty-five minutes of therapy. Seminars—on topics ranging from psychopharmacology to brief psychotherapy—would each last around ten weeks, with the exception of the neuropsychology and multicultural courses, which would run all year.

  “I also want to say a few words about the lawsuit,” Scott added. “You probably all saw the headlines in the spring. In response to the suit, the Justice Department will be arriving midwinter to do an investigation, and there will be some changes being made around here in preparation for that visit. None of that will have anything to do with you. Your training will not be impacted, and you shouldn’t give any of it a second thought.”

  The lawsuit, instigated by New York State’s Mental Hygiene Legal Service, had been in the local tabloids for a couple months. I’d first heard about it from my classmate Adrienne. She had done an externship at Kings County during our second year of school, and the most telling thing she had to say about it was that she’d noted, as her time there wore on, that she began to take markedly less and less care with her appearance. In May she’d e-mailed me a link to a New York Post article titled “B’klyn Psych Ward a Horror Show”:

  The psychiatric ward at Kings County Hospital is a Dickensian nightmare where patients sleep on urine-covered floors, are beaten, and are forcibly injected with mind-altering drugs, according to a shocking lawsuit.

  The suit, filed in Brooklyn federal court this week, describes horrifying conditions in the emergency and inpatient psych center, known as Building G, where patients are beaten with metal batons, bugs crawl over sleeping bodies, and the bathrooms are rarely cleaned.…

  Patients in Building G often wait for days in a cramped, dirty room for initial evaluations, the suit alleges. At night, they fight for beds, the losers often sleeping on a floor that may “be stained with blood or urine.”

  Patients tread a “treacherously thin line” between demanding basic care and being viewed as “difficult,” which could earn “severe and harrowing” consequences, the suit claims.

  “Raising one’s voice or complaining about the unbearable conditions can result in an injection or being strapped to a gurney,” the suit claims.

  Consistent with the Post’s style, the article’s hyperbole made it hard to take seriously. But Scott’s outright dismissal of the whole thing felt just as off. I hadn’t finished my degree yet, but I was already much too far along not to think about the suit’s allegations like a psychologist. My training had taught me there was a grain of metaphorical truth in even the most psychotic of fantasies. I also knew that no one in any given system—be that a family, a corporation, or a hospital—remains untouched by the problems of the larger group. With his emphatic need to preempt any concerns we might have had, it seemed to me that Scott was communicating something else altogether: if our experiences there were to go awry, well, certainly he didn’t want to know about it.

  Later, over lunch at a pizza place, we interns reassured one another—after all, we’d toured the wards when we interviewed—that things couldn’t be as bad as the tabloids alleged. A couple of the interns introduced the concern that the investigation might cost the hospital’s training program its accreditation, but soon enough we moved on to matters of greater importance to us, such as which electives we were going to choose, and also a general getting to know one another. For the next week, our group dragged ourselves around Kings County’s campus to hear about the rotations we could choose from. The week after that, we sat wordlessly together through a thirty-five-hour hospital orientation that covered topics like hazardous waste disposal and how to avoid sexually harassing anyone. (“I’m a heavy-chested woman,” our orientation leader informed the hundred new employees in the room through her microphone. “If someone mentions that, it’s sexual harassment!”)

  During those first two weeks my intern group would share the frustrations of people eagerly waiting to get started with something. My irritation grew each night when I came home to George’s stories about his days, quickly filling up with gratifying learning experiences—outpatient therapy with grad students, supervision with big-name psychologists not otherwise employed by the hospital who volun
teered their time for the auspicious privilege of affiliation with Columbia-Presbyterian. George had been provided a desk, a computer, and a phone in a proper office he shared with just one of his fellow interns, who also had her own desk, computer, and phone. In this office, he told me offhandedly, there was a private bathroom. (With this pronouncement—he knew all seven Kings County adult-track interns shared one room, you could barely call it an office—I gave him a look, and he proceeded to inform me that, also, the toilet was gold plated.) As he and I went back and forth over whose turn it was to walk the dog, I wondered silently whether Kings County Hospital had been the best second choice.

  In the end, Scott Brent and I would agree on only a few things: there was a lot of paperwork to do in those first days, the internship would indeed become demanding, and hospital orientation—other than being a study in the endemic absurdity of bureaucracy—was a complete waste of time. On other matters, it would be harder to see eye to eye.

  CHAPTER TWO

  I CHOSE FORENSIC PSYCHOLOGY AS MY FIRST ROTATION, though I had absolutely no idea, and by that I mean none whatsoever, just what it might entail—my imaginings about it culled from all the movies I had ever seen (many) and all the television shows I had ever watched (more) that featured cops and criminals. I’d also found myself wanting to work with Dr. Sheldon Wolfe, Kings County forensic psychologist, since I’d interviewed for the internship with him the previous winter. Dr. Wolfe was in his mid-sixties and salty, short and trim and bald. He was a study in contradictions: an Orthodox Jew with a Ph.D. but the demeanor of an Irish policeman. He half reminded me of my father—the first in his family to go to college—his similar gruff mannerisms and too frequent use of the double negative preempting his education like a disclaimer. During our half hour together, Dr. Wolfe and I had talked about detective novels and police procedurals. Ours was the first interview of many I sat through that winter, and the ones that followed were predictable letdowns. Tell-me-about-your-dissertation-research. Why-did-you-decide-to-become-a-psychologist. If the rest of the forensics staff were like Dr. Wolfe, I figured I’d enjoy learning to do whatever it was they did.

  As it turned out, forensic psychology encompassed all sorts of things, most of them having to do with evaluation rather than treatment. Who knew? The forensic psychologists at Kings County spent the bulk of their time doing fitness-to-stand-trial evaluations, working not out of the hospital but in a small office on the thirteenth floor of the criminal courthouse in downtown Brooklyn. They called it the court clinic.

  Fitness to stand trial concerns a defendant’s state of mind leading up to his day in court. Anyone who cannot participate in his own defense in a meaningful way is not fit to be tried. The evaluations work like this: If a defendant seems markedly bizarre—as around 60,000 arrestees annually do—it is the mandate of his attorney, or that of the judge, to refer him for a psychological evaluation. This evaluation is conducted by some combination of two psychologists or psychiatrists and is also called a competency assessment, or a 7:30. The meaningful participation required of the accused may or may not be impaired by any number of psychological problems. After a detailed interview, the investigators write brief reports that end with recommendations to the judge as to the defendant’s fitness. Ninety percent of the time, the judge goes along with the clinicians’ recommendations. If found unfit, a defendant is treated at a state hospital with medication until he becomes able to understand and make decisions about his charges. If a defendant never becomes fit and the crime is egregious enough, the state can petition to have him committed to an institution in lieu of trying him. For misdemeanors, a defendant may simply be released for time served after his hospitalization has run its course.

  The logistics of the forensic rotation would be different from all the others, Scott explained. I would spend two full days a week at the court clinic, while the other interns would be at their various stations Monday through Friday and only in the mornings. It wasn’t clear to me how I was supposed to fill the other three mornings, and Scott would only vaguely say that I’d eventually have plenty to do.

  On the first day of my forensic rotation, I met Dr. Katherine Young, director of the Brooklyn court clinic and my rotation supervisor, not at the courthouse, but instead at Bellevue Hospital in Manhattan. Kings County and Bellevue were both city hospitals managed by the Health and Hospitals Corporation. Of the two, from what I understood, Kings County was considered the ugly stepchild and held in much lower esteem. In a largely Manhattan-centric city, it had the misfortune to be located at the outskirts of an outer borough, in a neighborhood beset by violent crime. (Army reservists training to be battlefield medics spent time in Kings County’s ER and ICU to become accustomed to the trauma wounds—from gunshots and stabbings—they would see once deployed.) Because Kings County no longer housed a forensic ward, prisoners charged with or convicted of crimes in Brooklyn who needed psychiatric hospitalization were sent to Bellevue, but the fitness-to-stand-trial evaluations of the Brooklyn accused were still conducted by the Kings County staff, and so we were in Manhattan on that July Thursday.

  Dr. Young was waiting for me in the enormous airy lobby. She was slim and bespectacled, with gray hair, and in her mid-forties. Immediately chatty, she told me that she’d been a professional opera singer before earning her doctorate at Penn State, where she’d become aware of the revolving door between jails and psychiatric hospitals. She decided to commit her life to helping the mentally ill get fair treatment in the justice system. We were at Bellevue that day, she explained, to evaluate three defendants, and we would meet their public defender and another of the forensic psychologists upstairs. As we emerged from a full elevator into the hallway of the locked prison ward, a uniformed guard motioned us to the side. In front of us, a dozen or so shackled black men in orange jumpsuits were being led backward out of a freight elevator. The sight of them was shocking—their shackles and their labored, tandem shuffling. Their jumpsuits were stamped “DOC,” for Department of Corrections, in bold letters. Another guard unlocked a metal gate and watched their awkward passing as the rest of us tried to look away.

  Dr. Young and I crossed the hallway and entered a waiting room with chairs and a mounted television. She introduced me to the lawyer, Jim Danziger, and the other psychologist, Dr. Pine. The two psychologists conversed happily. Dr. Pine was just back from a long vacation, and they had a lot to catch up on. Jim recognized my Michigan twang from some time he’d spent in Ohio, and he told me about those years. He was truly friendly and we chatted with some energy. Then a guard came and escorted us through the metal gate and another locked door into a small, windowless room with four chairs and a table.

  “First we’ll see Randall Corbin,” Dr. Young told me. “He declined to speak to us once before. He’s accused of trying to kill his wife. He keeps writing letters to her, threatening.”

  “He threatened me, too,” said Jim. “Tried to grab me from behind the bars of his cell.”

  The psychologists decided that Jim should stand near the door. Dr. Young, Dr. Pine, and I would take the chairs. “Do you feel safe?” I asked them. Never having met any, I assumed prisoners were dangerous.

  They both replied no, shrugging their shoulders, but neither of them moved. In the end it didn’t matter, because Mr. Corbin refused to see us. On the basis of this decision, which they believed reflected paranoia and was not in his best interest, both psychologists would recommend that he be found unfit.

  The next defendant was Franklin Drury. He was charged with public indecency. He, too, had threatened Jim, not to kill but to sue him. In the hospital he’d been diagnosed with schizoaffective disorder. I had heard of this but barely knew what it was. The diagnosis came from the Diagnostic and Statistical Manual—the DSM, which we had not paid much mind to in graduate school, where we were distinctly not being taught to categorize patients according to collections of observable symptoms. In our outpatient clinic we didn’t have to: unable to provide the support they needed, we did
not see anyone with such debilitating problems. The DSM was only a book of lists that I might have sat down and read with some benefit. Between George and me we had two copies. But instead I’d chosen to feel ill at ease in my unfamiliarity with its principles.

  Franklin Drury had a long psych history: multiple hospitalizations as well as arrests. The guard asked us to remove some paper clips from the table, and then he brought the prisoner in. Mr. Drury had light brown skin and had twisted some of his locks into braids and knots that made his head look like an unfinished macramé project. In a soothing voice, Dr. Young explained to Mr. Drury why we were there and let him know that our talk was court ordered and therefore not confidential. “Your lawyer believes you’re unable to think clearly,” she said.

  “I’ve never seen that man,” Mr. Drury said, barely glancing at Jim before sharply turning away.

  “We’ve met a few times,” Jim corrected him.

  “How are you doing here?” asked Dr. Young.

  “No one will tell me where I am. They won’t give me the address,” he said. “I want to let my mother know I’m okay.”

  “Do you know why you’re here?”

  He shook his head. “I don’t know who, why, or how I got here. I’ve done nothing to deserve this misery.”

  “Do you know what you’ve been charged with?” asked Dr. Pine.

  “I don’t know for sure,” he said.

  “Menacing,” interjected Jim. “You exposed yourself to two adults and told them you were going to get them, and then you asked two little girls to lift up their skirts.”

  “I didn’t,” said Mr. Drury, refusing to look at Jim.

  Dr. Young asked some questions to get a sense of our client’s history. He was raised by both parents along with an older sister, did okay in school but hadn’t had many friends, had gotten through five semesters of college before “some people tried to destroy me. They put drugs in my milk.”