Gene Brewer - K-PAX

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 This is unpublished work!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.

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 problems.

One of the latter,- dubbed "Whacky" by a comedic student some time ago, is a young man who diddles with himself almost constantly. Virtually anything sets him off: arms, legs, beds, bathrooms-you name it.

Whacky, is the son of a prominent New York attorney and his ex-wife, a well-known television soap opera actress. As far as we know he enjoyed a fairly normal childhood, i.e., he wasn't sexually repressed or abused in any way, he owned a Lionel train and Lincoln logs, played baseball and basketball, liked to read, he had friends. In high school he was shy around girls, but in college he became engaged to a beautiful coed. Although convivial and outgoing, she was nevertheless extremely coquettish, leading him on and on but never quite going "all the way." Crazed with desire, Whacky remained as virginal as Russell for two agonizing years-he was saving himself for the woman he loved.

But on their wedding day she ran off with an old boyfriend, recently released from the state prison, leaving Whacky literally standing at the altar (and bursting at the seams). When he received the news that his fiancee had jilted him, he took down his pants and began to masturbate right there in the church, and he has been at it ever since.

Prostitution therapy was completely ineffective in Whacky's case. However, drug treatments have proven marginally successful, and he can usually come to the table and get back to his room without causing a disturbance.

When he is not caught up in his compulsion, Whacky is a very pleasant guy. Now in his mid-forties, he is still youthfully handsome, with closely cropped brown hair, a strong cleft chin, and a terrible melancholy that shows in his sad blue eyes. He enjoys watching televised sporting events and talks about the baseball or football standings whenever I see him. On this particular occasion, however, he did not discuss the Mets, his favorite team. Instead, he brought up the subject of prot.