Brooklyn Zoo Page 5

  After that we interviewed two more like her. Both men heard voices, wore shoes rendered laceless to preclude suicide, and could not make logical decisions about how to proceed with their charges. Unfit, unfit. We returned upstairs, and I settled back in the waiting area. The master’s students flirted and made boozy weekend plans. By four o’clock the staff was packing up. The defendants had to be taken back to Rikers around three, and once the psychologists’ paperwork had been finished, there wasn’t anything left to do. I went home to take the dog for a walk along the promenade and wait for George, who had been getting home much later than I. It was our fourth week of internship, and while I was eagerly awaiting the assignment of outpatient cases and supervisors and seminars to fill my days, he was already swamped with work and with classes—five outpatients and five outpatient supervisors, a rotation in a drug and alcohol treatment center, seminars with heady titles. The discrepancy had me antsy, worried that I wasn’t going to get enough.

  When George got home, I told him about my day: Dr. Wolfe’s lecture, treatment court, the basement holding cell. “So all you’re supposed to do is watch these interviews for three and a half months?” he asked.

  “I guess so,” I said, feeling protective of the experience. “But they’re interesting. The defendants are basically psychiatric patients, just in a different setting.”

  “Well, I’m sure that will be good,” he said, only almost trying to keep the skepticism out of his voice. It irked me, not least because I quickly made it my own.

  George told me about his day. He’d been assigned some interesting cases and was excited about the analytically trained supervisors he’d met so far. At least one of his seminars seemed as if it was going to be thought provoking, as good as any of the best classes we’d shared in the last four years. Columbia-Presbyterian was clearly more like grad school than Kings County. I missed school intensely then—my supervisors, my classes, my patients there. One of the latter had wanted to continue our work together after my course work ended, to come see me at the hospital’s outpatient clinic, but in an e-mail exchange over the summer Scott had declined to approve that, suggesting that the very request was indicative of my own pathology—a difficulty coping with separation and loss. (Having your personality critiqued was an expectable part of being a doctoral student in clinical psychology, so it wasn’t a particularly surprising rejoinder.) “What about the fact that long-term cases are valuable to your training?” Dr. Aronoff had asked, with feeling, in the last session we had before internship began—logistics would make it impossible for us to meet during the coming year. In her voice I heard the chagrin that might have been my own had I not leaped so quickly to feeling shamed. I tended to take all criticism to heart. It seemed the one true thing.

  George’s training director had allowed him to transfer one of his grad school patients to the outpatient clinic at the Pres (as he and his fellow male interns were calling it, in tones of jaunty Ivy rowers). He had been seeing this old patient since week one of internship, Tuesdays and Thursdays. This was another point in favor of his fancy private hospital—the opportunity to do twice-weekly outpatient treatment. I sighed at my own predictability. Was I bound to spend the whole of the year comparing my experience with George’s and always to find my own wanting?

  One of my graduate school supervisors once made the offhand remark that a lot of people walk around a little psychotic a lot of the time. I was in my fourth year, and in my inexperience this took me by surprise, though I had by then read enough that it might not have. On forensics what I saw was that, also, a lot of people walk around a lot psychotic a lot of the time. With Dr. Wolfe’s lecture on the ambiguity inherent in the fitness standards in mind, I’d looked forward to animated debates about whether this one could make rational choices about his options, or that one could maintain emotional stability throughout a trial. But each of the men and women who sat down across from us in the basement holding cell was simply batshit. It didn’t leave much to discuss.

  Dedon Willis wore several dirty T-shirts and baggy jeans. At first he was very upset, too agitated to listen to the doctors’ questions or take in the charges presented him by his lawyer, Jim Danziger. “I want this case to be dropped,” he insisted over and over, raising his arms and popping off the bench a couple inches, then finally settling down. “I don’t know what they said I did.”

  “Disturbing the peace. Screaming at people on the subway. Spitting on a police car. Cursing out a cop.” Jim ran down the list.

  “It’s not true! This case is garbage. I want to get out of here,” he said. He had a black eye after three fights at Rikers. He was homeless with a long history of psych hospitalizations. He was twenty-seven and had been arrested eighteen times.

  “The first case you had was serious,” said Jim.

  “We don’t need to go there,” said Mr. Willis.

  “Attempted murder,” Jim told us. “He did four years upstate.”

  “Why did you scream at those people?” asked Dr. Ruben, one of the two psychiatrists on the forensic staff.

  “I woke up on the subway, and I didn’t know where I was at,” he told us angrily.

  “Why did you spit on the police car?”

  “The cop was bothering me. He was telling people my business. I told him not to talk about me in public.”

  Jim cut in. “Better than his last arrest. Last time he tried to punch an officer who bumped into him.”

  “They’re always trying to get under my skin!”

  Dr. Pine asked what medication he was on. “Haldol. But I don’t take it every day. I don’t use drugs. That’s why I don’t take my medication. It’s a drug.”

  “How do you want to resolve these charges?”

  “I want to get out,” he said.

  “You can either go to trial or take a plea,” explained Dr. Ruben.

  “Is it a felony or a misdemeanor?” he asked. The latter. “I’m not stupid. Why should I go to trial on a misdemeanor?” Then in the same breath, “I want to go to trial. It’s my word against the cop.”

  The doctors and Jim looked at each other. “It has to be one or the other,” said Jim. “My job is to help you decide.”

  “I’m not talking to you, man.” Mr. Willis spit toward Jim’s foot. “I’m not stupid. I’m not stupid.”

  The Brooklyn courthouse was a ten-minute walk from my apartment. I had never before worked so close to home. Had anyone? It was luxurious. I took to buying coffee from the breakfast cart on the corner halfway between home and the office. Soon the guy who ran it knew my order. Milk no sugar.

  In the basement holding cell Dr. Wolfe, Dr. Pine, Jim Danziger, a master’s student, and I sat waiting. We were a big crowd. On the outside it was still very hot, but the basement might have doubled as a meat locker, and I always brought a sweater. Our first defendant walked in handcuffed and escorted by a guard. He removed her restraints, and she sat down across from us. Her name was Beth. She was white with stringy hair. She was thirty and woozy. Jim announced her charges: assault in the second and third degree. She told us she was living at Rikers and listed the antipsychotic medications she was taking. I was learning the names of drugs that none of my graduate school patients had been on: Risperdal, Seroquel, Abilify, Depakote. They signified serious problems, as if in the holding cell these were ever remotely in question. Beth knew what month it was and the year—she was “oriented to time”—but she told us she had memory problems.

  “What kinds of things do you forget?” asked Dr. Wolfe.

  “Sometimes my name,” she said.

  She remembered that she’d been hospitalized for the first time at thirteen.

  “How come?” asked Dr. Wolfe.

  “I tried to kill myself,” she said.

  “What was going on?”

  “My parents died. Something like that.”

  Jim sat with his New Yorker, highlighting passages in slippery green.

  Beth told us she’d been born in the United States but grown up
in Haiti, where her parents were missionaries. After they died, she returned to New York, where her aunts and uncles had declined to take her in and she was put into foster care. At nineteen she returned to Haiti, where she met a woman named Joanna who she believed was her sister. Dr. Pine flipped through Beth’s chart. “It says here she’s obsessed with Joanna,” Dr. Pine whispered to Dr. Wolfe, but loud enough for everyone to hear.

  “After I met Joanna, other people in my family started dying,” Beth told us. “And now sometimes I hear her voice, telling me to do things to people. She told me to attack those women.”

  “She’s delusional,” Jim announced, putting down his magazine.

  “In the U.S. you call them delusions, but that’s not what we call them in Haiti. In Haiti we call it voodoo, and there are laws against it. I want to see a Haitian doctor who can help me with the voodoo and my visions.”

  “So how about the insanity defense?” Dr. Pine asked our lawyer friend in the same half whisper she’d used before.

  “That was my original plan, but she’ll get more time in the hospital with that than she will in jail for what she did, so it doesn’t make any sense.”

  “Do you understand what will happen if you go to trial?” asked Dr. Wolfe.

  “I’m not going to trial,” she said.

  “So what is your plan?” he followed up.

  “I don’t have a plan,” she said.

  She refused to speak anymore, and the doctors summoned the guard, who cuffed her and escorted her out. Unfit, the doctors agreed.

  “Is anyone ever fit?” I asked Dr. Wolfe quietly. I didn’t want to embarrass myself with a stupid question. Maybe people were found fit all the time, and I just hadn’t seen it yet.

  “Sometimes,” he said, without lowering his voice. He was as unself-conscious as I was reticent, which was partly why I enjoyed him so much. “But think about who refers them for evaluation—lawyers and judges. Unless it’s a lawyer grasping at straws to get his client out of something, they’re usually just sending us people who are pretty obviously disturbed. Also, the mentally ill wind up arrested a lot. Twenty-five percent of inmates meet criteria for a psychotic disorder.”

  Another defendant was brought in. He was twenty-six and from the islands. He was big and looked menacing until he sat down and started to cry fat tears like a toddler’s. Dr. Pine and Dr. Wolfe could not establish whether he had a history of psych hospitalizations or had simply been in the hospital for other health problems. The defendant was too confused to be helpful. Not fit. As the guard led him out, I reluctantly got up and excused myself to go back to the hospital. Seminars were starting that week, and though the topics would shift, the timing would not. One month in and my days at forensics were from then on to be interrupted. The hospital was an hour door-to-door from the court clinic, and the seminars were that long as well, so I’d be missing three hours at my rotation to attend them, which made little sense to me, but it was the schedule I’d been handed. Our first mandatory seminar was on group therapy, and at least it was a modality close to my heart. I’d co-led a group for women with eating disorders during my last two years of school, and I’d loved it, the fast pace and the treacly intimacy.

  I arrived at the N Building, the child and family clinic, where the seminar was taking place, and I found that our teachers were two junior psychologists not long past internship themselves. In grad school, seasoned psychologists taught and supervised within specific areas of expertise; at Columbia-Presbyterian, too. I’d anticipated the same at Kings County, though I would later wonder if in this expectation I’d only been setting myself up for disappointment. “What is a group?” our teachers proposed once everyone was assembled. “Is a group one person? Is a group two people? Is a group a bunch of strangers waiting in line together at a grocery store?”

  We were seated around a large table—the adult-track interns, the child-track interns, and a handful of psychiatry residents whom we’d only seen around. We interns shot each other looks to relieve a strong mutual feeling of insult. We replied to our teachers in silence, a tool of our trade. The psychiatry residents picked up our slack.

  “A group can be anything!” exclaimed one of them, a salt-and-pepper-haired man in plastic-framed glasses.

  “Groups are everywhere!” offered another with undue enthusiasm. I imagined that there must have been few rhetorical questions in medical school. Maybe they hadn’t been allowed to speak at all.

  The teachers seemed relieved to have participants. They all went back and forth. An hour passed this way, the interns stony faced, the psychiatry resident with the glasses proudly sharing group techniques he was pioneering, like this one to deal with reticent, inpatient adolescents: “I curse to let them know that I’m cool.” We interns told him that if foul language did not come naturally to him, the kids would see right through it. Like most of us seated around the table that afternoon, he looked disheartened.

  By the time I made it back to the court clinic in the afternoon, the doctors were already well into their post-lunch interviews in the holding cells downstairs. I couldn’t go down to join them, because one could not just waltz into the basement as if arriving at a potluck supper. The conflict between forensics and didactics was obviously going to be a problem. I went to Scott to explain my predicament, suggesting that I occasionally be excused from the Tuesday or Thursday class in order to actually spend the entire day that had been promised me on my rotation. My request seemed so reasonable that it surprised me when he said “Absolutely not” and looked at me with some suspicion, as if I were a high school student trying to wriggle out of last period.

  A couple days later, during a meeting where Scott pointed out for the third time in as many weeks that Zeke and I were the only interns he hadn’t handpicked (could that have really been such an injurious affront? I refused to believe it), there arose an actual something I wanted to get out of: an unfortunate supervisory assignment. It was for a case in the outpatient clinic. I was assigned to a patient named Carmen Thompson, and Scott announced that I would be supervised by the staff neuropsychologist, Dr. Caitlin Downs. Neuropsychology is a specialty within clinical psychology. Neuropsychologists do testing, not therapy. While Dr. Downs would’ve had a graduate school education at least marginally similar to my own, she had chosen to specialize afterward in something that had nothing to do with being a therapist and had likely not seen any patients herself since her own internship. All of my supervisors in graduate school had been not only Ph.D. therapists but also psychoanalysts, which meant that they had spent a minimum of five years in intensive postdoctoral therapy training; most of them had decades of experience as practitioners besides. I raised an obvious objection: “But she’s a neuropsychologist.”

  Scott was nonplussed. “She’s a licensed psychologist. That’s all that matters here,” he said. Jen and Leora made sympathetic faces from across the table. Remembering that two of my classmates had come back from their internship interviews with Scott talking enthusiastically about wanting to be supervised by him, I decided to take one last stab at relieving myself of the non-therapist.

  “Do you have any interest in supervising the case?” I asked him, trying to adopt his winking tone. “I’ve heard you’re pretty good.”

  Scott looked at me with a deep skepticism, his perpetually raised eyebrow, a shake of the head. I’d asked for too many adjustments already, and the asking itself had begun to offend him. I didn’t like where that left me, but there was nothing to be done about it. Scott went back to addressing the group.

  “You should call your patients to set up your first appointments immediately. The old interns told them to expect to hear from you sometime in August. You’ll also need to speak to your supervisors to set up supervision times. Do that as soon as possible, too. Preferably before you see your patients. Your supervisors all worked with the last interns on these cases, so they can give you a heads-up about who you’re seeing.”

  In the midst of all those forensic assessments
, I felt pressed to get going with my outpatient work and soon, so I walked down the poorly lit hall to Dr. Downs’s office straight after the meeting. She’d already introduced herself as Caitlin in passing, as her office, along with Scott’s, flanked the intern room. She and he were the best of friends, constantly dancing back and forth between each other’s doorways to speak in conspiratorial whispering verse.

  “Your new patient doesn’t exactly make therapy a priority,” Caitlin said to me as she invited me in. She closed her door and shook her head and made a face. She was probably forty, with blond-tinted hair and airbrushed acrylic nails that said “Queens” to me. I was not much younger, of course, and apparently a snob. “We got her to the point last year where at least she would call when she wasn’t coming,” Caitlin continued. “You need to let her know from the get-go that she has to give you at least twenty-four hours’ notice if she’s going to cancel.”

  Caitlin seemed to want me to join her in her distaste for the patient. Instead, I felt it toward her. Our supervisory relationship no more than two minutes in duration, Caitlin had already said at least three things that offended my sensibilities as a therapist and given me one explicit order that I knew I would not carry out. “If a patient doesn’t show up, we call it resistance,” I wanted to begin, the voice in my head unbearably disdainful. How quickly I disliked myself in her presence.

  “What do you think she’s communicating in not showing up?” I asked instead. This is one thing my graduate school supervisors would have thought about had they been supervising the case for the last year, but I might have worked harder to get the tone out of my voice.

  “Just make sure you let her know she needs to call you in advance,” Caitlin reiterated.

  There was nothing particularly wrong with Caitlin’s instruction, but I found it jarring: in my experience, supervision was for learning how to think, not being told what to do. And while I didn’t imagine I would have any more success than the previous therapist with getting Carmen to come regularly, the last thing I wanted was to begin my relationship with her with the shared assumption that she would miss her sessions. I told Caitlin about one of my former supervisors, who’d said that she never talked about cancellation policies with patients until after they had actually canceled on her. “If I start by talking about cancellations,” Dr. Stein had said, “I’m conveying the message that the therapy is not something worth making an effort to show up for. Instead, I start with the idealistic and unspoken notion that the work will be gratifying and that of course the patient will come every single time.” Caitlin was unimpressed.