Dr. Vogel said, “Why don’t I just explain my conclusions a little bit, then afterward I’ll answer your questions if you have any, okay? I know it’s very, very hard to hear difficult news about Jacob, but brace yourselves for just a few minutes, okay? Just listen, then we can talk.”
We nodded.
Jonathan said, “For the record, none of this is discoverable by the prosecution. You don’t have to worry. Everything we discuss here and everything Dr. Vogel tells you now is privileged. This conversation is absolutely confidential. It never leaves this room. So you can speak frankly, as can the doctor, okay?”
More nodding.
“I don’t understand why we have to do this,” I said. “Jonathan, why do we even have to get into this if our defense is that Jacob didn’t do it at all?”
Jonathan made a V of his hand and stroked his short white beard. “I hope you’re right. I hope the case goes well and we never have to raise this issue.”
“Then why do this?”
Jonathan turned away slightly, dismissing me.
“Why do this, Jonathan?”
“Because Jacob looks guilty.”
Laurie gasped.
“I don’t mean that he is guilty, only that there is a lot of evidence against him. The Commonwealth has not put up their strongest witnesses yet. This is going to get harder for us. A lot harder. And when it does, I want to be prepared. Andy, you of all people should understand that.”
“All right,” the doctor said, wading in. “I’ve just given Jonathan my report. Really, it’s an opinion letter, a summary of my conclusions, what I would say if I was ever called to testify and what I think you could expect if this issue ever came up at trial. Now, I wanted to speak with you two alone first, without Jacob. I have not shared my conclusions with Jacob. When this case is over, depending on how it goes, we can have a more meaningful conversation about how to deal with some of these issues in a clinical setting. But for now our concern is not therapy, it is the trial. I was engaged for a specific purpose, as an expert for the defense. So that’s why Jacob is not in the room now. He will have a lot more work to do when the trial is over. But for now we need to speak candidly about him, which may be easier if he’s out of the room.
“There are two disorders that Jacob exhibits pretty clearly, narcissistic personality disorder and reactive attachment disorder. There is some suggestion of an antisocial personality disorder as well, which is a not uncommon comorbidity, but because I’m not as certain of the diagnosis, I haven’t included it in my report.
“It is important to realize that not all the behaviors I’m going to describe are necessarily pathological, even in combination. To some extent every teenager is a narcissist, every adolescent is dealing with attachment issues. It is a matter of degree. We are not talking about a monster here. We’re talking about an ordinary kid-only more so. So I don’t want you to hear this as a condemnation. I want you to use the things I’m telling you, not be overwhelmed by them. I want to give you the tools, the vocabulary, to help your son. The point is to understand Jacob better, okay? Laurie? Andy?”
We agreed, obediently, dishonestly.
“Good. Okay, narcissistic personality disorder. This is the one you probably know something about. Its primary characteristics are grandiosity and lack of empathy. In Jacob’s case, the grandiosity does not come across as dramatic or boastful, arrogant, haughty, which is what people commonly associate with it. Jacob’s grandiosity is quieter. It shows up as an inflated sense of self-importance, a conviction he is special, exceptional. Rules that might apply to others do not apply to him. He feels he is not understood by his peers, especially the other kids at school, with a few select exceptions whom Jacob identifies as special like him, usually based on their intelligence.
“The other key aspect of NPD, especially in the context of a criminal case, is lack of empathy. Jacob exhibits an unusual coldness toward others, even-and this surprised me, given the context-even for Ben Rifkin and his family. When I asked Jacob about it in one of our sessions, his response was that people die every day by the millions; that car crashes are statistically more significant than murder; that soldiers kill thousands more and get medals for it-so why should we worry about one murdered boy? Even when I tried to lead him back to the Rifkins and prodded him to express some sort of feeling for them or for Ben, he couldn’t or wouldn’t do it. All of which fits a pattern of incidents you have described throughout Jacob’s childhood in which other children have been injured around him, children flying off jungle gyms and being knocked off bicycles and so forth.
“He seems to regard other people not just as less significant than himself, but as less human. He cannot see himself mirrored in others in any way. He cannot seem to imagine that others have the same universal human feelings that he does-pain, sadness, loneliness-which is a sensitivity that ordinary adolescents have no trouble understanding at this age. I won’t belabor the point. The relevance of these feelings in a forensic context is obvious. Without empathy, anything is permitted. Morality becomes very subjective and flexible.
“The good news is that NPD is not a chemical imbalance. And it is not genetic. It is a complex of behaviors, a deeply ingrained habit. Which means it can be unlearned, over time.”
The doctor went on with barely a pause.
“The other disorder is actually the more disturbing one. Reactive attachment disorder is a relatively new diagnosis. And because it is new, we don’t know much about it. There hasn’t been much study done. It is uncommon, it is difficult to diagnose, and it is difficult to treat.
“The critical aspect of RAD is that it stems from a disruption of ordinary childhood emotional attachments in infancy. The theory is that ordinarily infants attach to a single, reliable caregiver, and from that secure base they explore the world. They know that their basic emotional and physical needs will be met by that one person. Where that reliable caregiver is not present or where the caregiver changes too often, children may relate to others in inappropriate ways, sometimes grossly inappropriate ways: aggression, rage, lying, defiance, lack of remorse, cruelty; or overfamiliarity, hyperactivity, self-endangerment.
“The definition of this disorder requires some sort of disruption in early caregiving-‘pathogenic care,’ usually mistreatment or neglect by the parent or caregiver. But there is some controversy about exactly what that means. I am not suggesting either of you were deficient in any way. This is not about your parenting. But recent research suggests the disorder can arise even without deficient caregiving. Some children just seem temperamentally vulnerable to attachment disorders, so that even minor disruptions-day care, for example, or being passed from one caregiver to the next too often-can be enough to trigger an attachment disorder.”
“Day care?” Laurie.
“Only in exceptional cases.”
“Jacob was in day care from the time he was three months old. We both worked. I stopped teaching when he was four.”
“Laurie, we don’t know enough to presume a cause and effect. You have to resist the urge to blame yourself. There is no reason to think neglect is the cause here. Jacob may just have been one of these vulnerable, hypersensitive children. This is all a very new area. We researchers are struggling to understand it ourselves.”
Dr. Vogel gave Laurie a reassuring look, but there was a hint in her voice of protesting too much, and I could see Laurie was not mollified.
Unable to help, Dr. Vogel simply plowed on. She seemed to think that the best way to get across all this devastating information was to do it quickly and get it over with.
“In Jacob’s case, whatever the trigger, there is evidence of atypical attachment as an infant. You’ve reported that as a child he seemed guarded and hypervigilant at times, or erratic and prone to excessive anger and lashing out at other times.”
Me: “But all kids are ‘erratic’ and ‘prone to excessive anger.’ Lots of kids go to day care and don’t-”
“It would be very unusual to see RAD”-she pronounced it as a rhyme for bad — “in the absence of some sort of neglect, but we simply don’t know.”
“Enough!” Laurie raised both hands in a stop sign. “Just stop it!” She stood and pushed her chair away, retreated to the far corner of the room. “You think he did it.”
“I didn’t say that,” Dr. Vogel demurred.
“You didn’t have to say it.”
“No, Laurie, really, I don’t have any way to know whether he did it. That’s not my job. It’s not what I set out to determine.”
Me: “Laurie, this is psychobabble. She said herself, you could say these things about any kid-narcissistic,
