Jonathan Kellerman - Silent Partner

Yet that was exactly what this study sounded like.

My eye dropped to the last line on the page:

And deep thanks to Alex, who even in his absence, continues to inspire me.

I turned the page so hard it nearly tore. Began reading the document that had earned Sharon the right to call herself doctor.

The first chapter was very slow going- an excruciatingly complete review of the literature on identity development and the psychology of twins, flooded with footnotes, references, and the jargon Maura Bannon had mentioned. My guess was that the student reporter hadn’t gotten past it.

Chapter Two described the psychotherapy of a patient Sharon called J., a young woman whom she’d treated for seven years and whose “unique pathology and ideative processes possess structural and functional, as well as interactive, characteristics that traverse numerous diagnostic boundaries heretofore believed to be orthogonal, and manifest significant heuristic and pedagogic value for the study of identity development, the blurring of ego boundaries, and the use of hypnotic and hypnagogic regressive techniques in the treatment of idiopathic personality disorders.”

In other words, J.’s problems were so unusual, they could teach therapists about the way the mind worked.

J. was described as a young woman in her late twenties, from an upper-class background. Educated and intelligent, she’d come to California to pursue a career in an unspecified profession, and presented herself to Sharon for treatment because of low self-esteem, depression, insomnia, and feelings of “hollowness.”

But most disturbing of all were what J. called her “lost hours.” For some time, she’d awakened, as if from a long sleep, to find herself alone in strange places- wandering the streets, pulled to the side of a road in her car, lying in bed in a cheap hotel room, or sitting at the counter of a dingy coffee shop.

Ticket stubs and auto rental receipts in her purse suggested she’d flown or driven to these places, but she had no memory of doing so. No memory of what she’d done for periods that calendar checks revealed to be three or four days. It was as if entire chunks had been stolen out of her life.

Sharon diagnosed these time warps correctly as “fugue states.” Like amnesia and hysteria, fugue is a dissociative reaction, a literal splitting-off of the psyche from anxiety and conflict. A dissociative patient, confronted with a stressful world, self-ejects from that world and flies off into any number of escapes.

In hysteria, the conflict is transferred to a physical symptom- pseudoparalysis, blindness- and the patient often exhibits a belle indifférence : apathy about the disability, as if it were happening to someone else. In amnesia and fugue, actual flight and memory loss take place. But in fugue the erasure is short-term; the patient remembers who he or she was before the escape, is fully in touch when he comes out of it. It’s what happens in between that remains the mystery.

Abused and neglected children learn early to cut themselves off from horror and, when they grow up, are susceptible to dissociative symptoms. The same is true of patients with fragmented or blurred identities. Narcissists. Borderlines.

By the time J. showed up in Sharon’s office, her fugues had become so frequent- nearly one a month- that she was developing a fear of leaving her house, was using barbiturates to calm her nerves.

Sharon took a detailed history, probing for early trauma. But J. insisted she’d had a storybook childhood- all the creature comforts, worldly, attractive parents who’d cherished and adored her up until the day they died in an automobile crash.

Everything had been wonderful, she insisted; there was no rational reason for her to be having these problems. Therapy would be brief- just a tune-up and she’d be in perfect running order.

Sharon noted that this type of extreme denial was consistent with a dissociative pattern. She thought it unwise to confront J., suggested a six-month trial period of psychotherapy and, when J. refused to commit herself for that long, agreed to three months.

J. missed her first appointment, and the next. Sharon tried to call her but the phone number she’d been given was disconnected. For the next three months she didn’t hear from J., assumed the young woman had changed her mind. Then one evening, after Sharon had seen her last patient, J. burst into the office, weeping and numbed by tranquilizers, begging to be seen.

It took a while for Sharon to calm her down and hear her story: Convinced that a change of scenery was all she really needed (“a willful flight,” commented Sharon), she’d taken a plane to Rome, shopped on the Via Veneto, dined at fine restaurants, had a wonderful time until she woke up, several days later, on a filthy Venice side street, clothing torn, half-naked, bruised and sore, her face and body caked with dried semen. She assumed she’d been raped, but had no memory of the attack. After showering and dressing, she booked the next flight back to the States, drove from the airport to Sharon’s office.

She realized now that she’d been wrong, that she seriously needed help. And she was willing to do whatever it took.

Despite that flash of insight, treatment didn’t proceed smoothly. J. was ambivalent about psychotherapy and alternated between worshipping Sharon and verbally abusing her. Over the next two years it became clear that J.’s ambivalence represented a “core element of her personality, something fundamental to her makeup.” She presented two distinct faces: the needy, vulnerable orphan begging for support, endowing Sharon with godlike qualities, flooding her with flattery and gifts; and the rage-swollen, foul-mouthed brat who claimed, “You don’t give a shit about me. You’re only into this in order to lay some giant fucking power trip on me.”

Good patient, bad patient. J. grew more facile at switching between the two, and by the end of the second year of therapy, shifts were occurring several times during a single session.

Sharon questioned her initial diagnosis and considered another:

Multiple personality syndrome, that rarest of disorders, the ultimate dissociation. Though J. hadn’t exhibited two distinct personalities, her shifts had the feel of “a latent multiple syndrome,” and the complaints that had brought her into therapy were markedly similar to those exhibited by multiples unaware of their condition.

Sharon checked with her supervisor- the esteemed Professor Kruse- and he suggested using hypnosis as a diagnostic tool. But J. refused to be hypnotized, shied away from the loss of control. Besides, she insisted, she was feeling great, was sure she was almost completely cured. And she did look much better; the fugues had lessened, the last “escape” taking place three months earlier. She was free of barbiturates, had higher self-esteem. Sharon congratulated her but confided her doubts to Kruse. He advised waiting and seeing.

Two weeks later J. terminated therapy. Five weeks after that she returned to Sharon’s office, ten pounds lighter, back on drugs, having experienced a seven-day fugue that left her stranded in the Mojave Desert, naked, her car out of gas, her purse missing, an empty pill vial in her hand. Every bit of progress seemed to have been wiped out. Sharon had been vindicated but expressed “profound sadness at J.’s regression.”

Once again, hypnosis was suggested. J. reacted with anger, accusing Sharon of “lusting for mind control… You’re just jealous because I’m so sexy and beautiful and you’re a dried-up spinster bitch. You haven’t done me a fucking bit of good, so where do you come off telling me to hand you my mind?”

J. stomped out of the office, proclaiming she was through with “this bullshit- going to find myself another shrink.” Three days later she was back, stoned on barbiturates, scabbed and sunburned, tearing at her skin and weeping that she’d “really fucked up this time,” and was willing to do anything to stop the inner pain.