Сэмуэль Шэм - Mount Misery

to me.

"Great, just great," he said, pointing out that while Zoe had often called me "jerk" and "incompetent," this was my first "asshole."

"Easy for you to say. She loves you. Hates me, and loves you."

"She's splitting."

"What's 'splitting'?"

"Krotkey Factor Number Four." He went to a blackboard and did stick figures.

Splitting was so complex that I was soon lost in the childlike scribbles. In the center, with bald head and glasses, Blair wrote DR. RENALDO KROTKEY = BORDERLINE GENIUS. On either side were a tiny stick figure with diapers, labeled BORDERLINE BABY = SELF, and a large, strangely imposing stick figure with comically large breasts, who turned out to be BORDERLINE MOM = OBJECT. Blair took the eraser and split MOM vertically into two parts, which he labeled GOOD MOM and BAD MOM. I didn't understand much of this, except that it was classic KROTKEY and that BABY SELF could not contain all the rage it felt in its stick body at OBJECT MOM, and so, in order to achieve OBJECT CONSTANCY and keep MOM in one piece, it had to split MOM into two pieces-GOOD MOM and BAD MOM-and love GOOD MOM and hate BAD.

"I'm the GOOD MOM," Heiler said, "you're the BAD, you poor bastard."

"Why?" I asked, using Blair's favorite confrontational word.

"Good question. Because the MOMs of borderlines are so screwed up."

"Why are these MOMs different?" Hannah asked. "Oh God," Blair said, as if this were the dumbest question ever. "The sicker the person, the earlier in life the damage was done. The damage done you two guys-your being so 'nice'?" Solini and I looked at each other. "You got to about age three before you took the hit. Borderlines are so sick, they take the hit earlier, in the first year of life." "How do you know that?" I asked. 'They had to be damaged that early, to be so sick! Whose fault is it?" He drew a box around MOM. "MOM's fault. MOM won't let the borderline separate from her, become a SELF-sufficient SELF and treat others like OBJECTS. The borderline tries to suck MOM's tits dry."

"Which is why Zoe treats me as BAD MOM and you as GOOD MOM?"

"That, and because you're doing a terrible job with her by being 'nice.' "

"But what do I do about it?"

"Treat her worse."

"And she'll like me better?"

"Ahh, women," he said, staring at Hannah as if she were a specimen. 'Treat 'em worse, they love you better. An eternal truth. Stop trying to be a nice guy and she'll split the other way."

"I'll be GOOD MOM and you'll be BAD?"

"Guaranteed."

"That's crazy!"

"No, that's Krotkey." He sighed in admiration. "A man who never took a hit. Totally undamaged. A genius."

"But Malik says that-"

"Malik finishes training in July. Do you know where Malik will be then?"

"No, where?"

"Neither does he, and neither does anybody else. But it won't be here at Misery. Malik's a pussy." An Asian woman came in and placed a ribbon of computer sheets on Blair's desk. "Prehminary data on Placedon and Zephyrill."

"Already, man?" Solini asked.

"You've got to publish the preliminary before they beat you to it. Borderline work is dog-eat-dog. Lotta sonsabitches. You guys'11 want to join my research team, get your names on my papers, start those careers."

"But about Zoe," I said, "I don't think I can be nasty."

"Sure you can. It's in you, and it's fun. To think only of your SELF? To get out your anger at OBJECTS? It's the greatest. Mind you," he said, with a wink, "healthy narcissism can be hard for some OBJECTS to take."

"But won't my being SELF-centered get in the way of relating to others?"

"No. Relating to others will get in the way of your SELF. Get a SELF, then get yourSELF a sexy OBJECT." On the blackboard he wrote: SELF = SEX. MORE SELF = MORE SEX. He chuckled. "Yes, yes, narcissism is what made this country what it is today." His eyes shone proudly. For a second it seemed he might cry, with pride. "My dad, a major general, taught me that." Jesus, I thought, the guy has a heart after all. "Healthy narcissism, Renaldo Krotkey. The American Dream."

It was all I could do to keep from saluting.

"Now then," Blair said, snapping back from pride and glory. "Solini?"

"Sir?" Henry sat up, expecting to be reamed out as a gay-latent all over again. But Blair reached over and shook his hand. "Glad to see that Thorny your dickhead is doing worse."

"Thanks, sir. But he thinks he's doing like better?"

"Never accept a borderline's reality as real."

"But I'm worried. He's talking pretty well to OBJECTS like me and Roy."

"Maybe he is," Blair said, "to real OBJECTS. I'm talking internal OBJECTS, people inside his head. We physicians are smarter than that. The more intelligent the person, the higher the graduate degree, the less concerned with reality. Don't quote me on that, but as a rule of thumb. So don't be 'nice' to him, eh?"

Solini pledged that he would not, and we waited for Heiler to turn to Hannah and her great work down in Depression where all her patients were so terrifically worse-especially her favorite, Mary Megan Scorato, who was on five-minute checks for suicide-that we thought that rather than a handshake she'd get a small medal. To our surprise Blair totally ignored her. Her face fell.

"Because you guys are getting the hang of this," he said, "I'm going to teach you the most important and delicate matter in all of psychiatry-harder than borderlines, more intellectually challenging than research." He walked to the blackboard and drew a stick building. "Pick a city-say Boston. What are the two biggest buildings in Boston?"

"The Prudential," I said, "and the John Hancock."

"INSURANCE," he said, writing it in caps. "INSURANCE bastards. Biggest buildings, biggest profit margins on earth. The cocksuckers."

Heiler proceeded to give his most complex lecture. Stick figures represented DOCTORS, PATIENTS, and, in the stick building, stick INSURANCE executives with dollar signs ($ $) where their eyes should have been. Basically it was about how, for each patient, you had to make up multiple DSM diagnoses to dupe INSURANCE and transfer some of the dollars from the INSURANCE executives' eyes to the

DOCTORS' pockets. He concluded, "Every single day, we doctors have to make sure our patients are sick enough to stay in the hospital, but not so sick that INSURANCE says they're not improving and have to be discharged. Sick, but getting well. Getting well, but still bad. Bad, but getting better." "Which is worse," Solini said.

"Which is," I said, "in fact better." Blair laughed. That charming laugh.

"So we have to keep them acutely chronic?" Hannah asked. "No, chronically acute," Blair said coldly. "Welcome to mental health care in America, folks. It sucks, and I want you guys to start doing it." "Doing what, man?"

"INSURANCE rounds. Stop talking to patients, start talking to INSURANCE."

"You want us to not see patients?" I asked pointedly. "Not seeing them is seeing them-part of Borderline Technique. Think / don't know how infuriating it is for them to try to catch me to talk? Drives 'em nuts. They go ballistic, start acting like they're guzzling rocket fuel. Which lets 'em stay here longer, long enough to shift from BAD OBJECTS to GOOD." He flicked a blond forelock and downshifted to his Huck Finn aw-gosh mode. "Look, guys, / know that sometimes I seem uncaring. But it's because I really care for these borderlines. For them to get better, I have to confront them all the time, and to do that I have to keep them here as long as possible. It's hard to change a borderline. Most psychiatrists won't even try. They hear the word 'borderline,' they run like hell. There are only a few of us left who are fighting to take the time and energy to do it right. Think I like spending four hours a day on the phone to these high school dipshits in fucked-up places like Omaha and Toledo telling me they're gonna discharge my borderlines because they're not sick enough? I do it to give these borderlines the time they need. I do it because I care." Oh my God, I thought, underneath all this, he's nice? "/ care enough," Blair went on, "to let these darn borderlines stay here and take all the time they need to get worse."