holiday. No less striking, perhaps, is the case of the unattractive woman who comes across as beautiful merely because she thinks she is. An individual with little talent who becomes a Broadway star on the basis of self confidence and energy alone. I have personally encountered many patients who have done amazing things they could not do before they became ill. And here we have a man who believes he comes from a planet where people are a little more light sensitive than we are, and by God he is. At times like these one wonders what the limits of the human mind really are.
ON Memorial Day my oldest daughter and her husband and their two little boys drove up from Princeton for a cookout. Abigail is the reverse of the unattractive woman I mentioned above-she was always a very pretty girl who never realized it. I don't think she has ever used makeup, doesn't do anything with her hair, pays no attention to what she wears. From the beginning she has had a mind of her own. When I think of Abby I see a kid of eight or nine marching with a bunch of others two or three times her age, all with long hair and flared pants, flashing her peace sign and yelling her slogans, serious as a kiss. Now, as a nonpracticing lawyer, she's active in any. number of women's/gay/environmental/civil/animal rights groups. How did she turn out this way? Who knows? All of our children are as different from each other as the colors of the rainbow.
Fred, for instance, is the most sensitive of the four. As a boy he always had his nose in a book, and an ear for music as well. In fact, he still has an enormous collection of recordings of Broadway shows. We always thought he would become an artist of some kind, and were quite amazed when he ended up in aeronautics.
Jennifer is very different still. Slim, beautiful, not as serious as Abigail or as quiet as Fred, she is the only one of the four who has showed any interest in following her old man's footsteps. As a girl she loved biology (and slumber parties and chocolate-chip cookies), and she is now a third year medical student at Stanford.
Will (Chip) is the youngest, eight years younger than Jenny. Probably the brightest of the bunch, he is a star athlete in school, active, popular. Like Abby before him, and unlike Fred and Jenny, he is hardly ever home, preferring instead to spend his time with his friends rather than with his grizzled parents. He hasn't the foggiest idea what he wants to do with his life.
All of which leads to the question: Is the shape of the individual personality due primarily to genetic or to environmental factors? After a great deal of experimentation and debate on this critical issue, the answer is far from clear. All I know is that, despite similar backgrounds and genetic makeup, my four kids are as different from each other as is night from day, winter from summer.
Abby's husband Steve is a professor of astronomy, and while the steaks were sizzling on the grill I mentioned to him that there was a patient at the hospital who seemed to know something about his field. I showed him prot's figures on the constellation Lyra and the double star system Agape and Satori, around which traveled a putative planet the patient called 'K-PAX.' Steve studied the information, scratched his reddish beard, and grunted, as he often does when he is thinking. Suddenly he looked up with a_ ferocious grin and drawled, 'Charlie put you up to this, didn't he?'
I assured him that he hadn't, that I didn't even know who 'Charlie' was.
He said, 'Terrific joke. Ah love it.' My grandson Rain was banging him with a Frisbee now, trying to get him to play, after failing to coax Shasta Daisy, our neurotic Dalmatian, out from under the porch.
I swore it was no joke and asked him why he thought so. I don't recall his exact words, but they went something like: 'This is somethin' Charlie Flynn and his students have been workin' on for quite a while. It involves a double star in the constellation Lyra. This double shows certain perturbations in its rotation pattern that indicate the possibility of a large dark body, prob'ly a planet, as part of the system. Like your alleged patient said, this planet appears to travel around them in an unusual pattern-Charlie thinks it's a figure eight. Do you see what Ah'm sayin'? This is unpublished work! Except for one or two colleagues, Charlie hasn't told anybody about this yet; he was planmn' to report it at the Astrophysics meeting next month. Where does this 'patient' of yours come from? How long has he been at the hospital? His name id'n 'Charlie,' is it?' He stuffed his mouth with a handful of potato chips.
We drank beer and chatted about astronomy and psychiatry most of the afternoon, Abby and her mother nagging us not to talk shop and to pay some attention to our sons/grandsons, who kept throwing food at Shasta and each other. One thing I wanted to know was his opinion on the possibility of light travel. 'It's not,' he stated flatly, still not convinced, I think, that I wasn't pulling his leg. But when I asked if he would be willing to help me prove to my new patient that 'K-PAX' was a figment of his imagination, he said, 'Shore.' Before they left I gave him a list of questions to ask Dr. Flynn about the double star system-the types of stars they were, their actual sizes and brightnesses, their rotation period, the duration of a 'year' on the putative planet, even something about what the night sky would look like from such a world. He promised to call me with whatever information he could dig up.
Session Four
THE Manhattan Psychiatric Institute is located on Amsterdam Avenue at 112th Street in New York City. It is a private teaching and research hospital affiliated with the nearby Columbia University College of Physicians and Surgeons. MPI is distinct from the Psychiatric Institute at Columbia, which is a general treatment center that deals with far more patients. We refer to it as 'the big institute,' and ours, in turn, is known as 'the little institute.' Our concept is unique: We take in only a limited number of adult patients (one hundred to one hundred twenty in all), either cases of unusual interest or those that have proven unresponsive to standard somatic (drug), electroconvulsive, surgical, or psychotherapies.
MPI was constructed in 1907 at a cost of just over a million dollars. Today the physical facility alone is worth one hundred fifty million. The grounds, though small, are well kept, with a grassy lawn to the side and back, and shrubs and flower gardens along the walls and fences. There is also a fountain, 'Adonis in the Garden of Eden,' situated in the, center of what we call 'the back forty.' I love to stroll those pastoral grounds, listen to the bubbly fountain, contemplate the old stone walls. Entire adult lives have been lived here, both patient and staff. To some, this is the only world they will ever know.
There are five floors at MPI, numbered essentially in order of increasing severity of patient illness. Ward One (ground floor) is for those who suffer only acute neuroses or mild paranoia, and those who have responded to therapy and are nearly ready to be discharged. The other patients know this and often try very hard to be 'promoted' to Ward One. Ward Two is occupied by those more severely afflicted: delusionals such as Russell and prot, manic and deep depressives, obdurate misanthropes, and others unable to function in society. Ward Three is divided into 3A, which houses a variety of seriously psychotic individuals, and 3B, the autistic/catatonic section. Finally, Ward Four is reserved for psychopathic patients who might cause harm to the staff and their fellow inmates. This includes certain autists who regularly erupt into uncontrollable rages, as well as otherwise normal individuals who sometimes become violent without warning. The fourth floor also houses the clinic and laboratory, a small research library, and a surgical theater.
Wards One and Two are not restricted in most cases, and the patients are free to mingle. In practice, this takes place primarily in the exercise/recreation and dining rooms (Wards Three and Four maintain separate facilities). Within each ward, of course, there are segregated sleeping and bathing areas for men and women. The staff, incidentally, maintains offices and examining rooms on the fifth floor; it is a common joke among the patients that we are the craziest inmates of all. Finally, the kitchens are spread over several floors, the laundry, heating, air-conditioning, and maintenance facilities are located in the basement, and there is an amphitheater on (and between) the first and second floors, for classes and seminars.
Before becoming acting director of the hospital I usually spent an hour or two each week in the wards just talking with my patients, on an informal basis, to get a sense of their rate of progress, if any. Unfortunately, the press of administrative duties put an end to that custom, but I still try to have lunch with them occasionally and hang around until my first interview or committee meeting or afternoon lecture. On the day after the Memorial Day weekend I decided to eat in Ward Three before looking over my notes for my three o'clock class.
Besides the autists and catatonics, this ward is populated by patients with certain disorders which would make it difficult for them to interact with those in Wards One and Two. For example, there are several compulsive eaters, who will devour anything they can get their hands on-rocks, paper, weeds, silverware; a coprophagic whose only desire is to consume his own, and sometimes others', feces; and a number of patients with severe sexual
