Richard Powers - The Echo Maker

You have to help me. I’m begging you. I’ll do anything you want. I have to find this person.

But why, Mark? What can he give you that I…?

This guy knows . Knows why I’m still alive. Something I’d like to learn.

Karin wrote Gerald Weber.He’d told her to write if Mark’s status changed. She didn’t mention seeing him on television. She said nothing about buying his new book or finding it cold and tired, filled with recycled pronouncements about the human brain and empty of the human soul. She wrote: “Mark is clearly getting worse.”

She described the new symptoms: Mark’s obsessive theories about the note. His doubling places now, along with people. His rejecting the house, the subdivision, maybe even the whole town. His drifting into territory so weird it left her shaky. She asked Dr. Weber if the accident could have given Mark false memories. Could something have happened to his inner, generalizing map? Every small change was making Mark split each now into a unique world.

She mentioned a case in Weber’s first book, an elderly woman called Adele who’d assured Dr. Weber that she wasn’t lying in a hospital in Stony Brook but was in fact in her cozy saltbox home in Old Field. When Dr. Weber pointed out all the expensive medical devices in the room, Adele had laughed. “Oh, those are just props, to make me feel better. I could never afford the real things.”

Reduplicative paramnesia . She copied the words from his book into her e-mail. Could Mark actually be suffering from that? Could he be seeing details he’d never seen before? Did brain damage ever help memory? She cited Dr. Weber’s second book, page 287: the man he referred to as Nathan. Damage to the man’s frontal lobes somehow destroyed his internal censor and freed up long-suppressed recollections. Nathan, at fifty-six, suddenly realized that at nineteen he had killed another man. Could Mark be remembering old things about himself — or even about her — that he could not accept?

She knew her theories were crazy, even as she suggested them. But no crazier than Capgras. Weber’s own books claimed that the human brain was not only wilder than thought, but wilder than thought could think. She quoted from The Country of Surprise : “Even baseline normality has about it something hallucinatory.” Nothing in Dr. Weber’s examination of Mark had anticipated these new symptoms. Either Mark needed a whole new diagnosis, or she was hallucinating.

She got back a cheerful reply from Weber’s secretary. Dr. Weber’s new book required him to travel to seventeen cities in four countries over the next three months. He’d be largely out of e-mail contact, except for emergencies, until the fall. The secretary promised to alert Dr. Weber to Karin’s note at the earliest opportunity. And she encouraged Karin to be in touch if things with her brother became more serious.

The response enraged Karin. “The man’s ducking me,” she told Daniel. “He’s taken what he wants, and now he’s blowing us off.”

Daniel tried to hide his embarrassment. “I doubt he even has time to duck you. Things must be nuts for him right now. Television, radio, and newspapers every day.”

“I knew, all the time he was out here. He thinks I’m a problem patient. A problem relative. He read my e-mail and told his staff to cover for him. Maybe it wasn’t even his secretary. Maybe it was him, just pretending…”

“Karin? K.?” Daniel had grown older than the neuroscientist. “We don’t know…”

“Don’t patronize me! I don’t care about what we know or don’t.”

“Shh. It’s okay. You’re angry. You should be. With all the professionals. At this whole business. Maybe even angry with Mark.”

“Are you analyzing me?”

“I’m not analyzing. I just see that…”

“Who the fuck…?” Do you think you are?

The words, even stifled, knocked them both silent. Her hands started shaking and she sat down, numb.

“My God, Daniel. What’s happening? Listen to me. I’m him. Worse than him.”

He crossed to her and rubbed the life back into her upper arm. “Anger is natural,” he said. “Everything gets angry.”

Everything except the saint she lived with.

She made an appointment to see Dr. Hayes. Pulling into the garage at Good Samaritan for the appointment, she reverted to the night of the accident. She had to sit in the parked vehicle for ten minutes before her legs would support her weight.

She greeted Dr. Hayes professionally. The appointment meter was ticking. She listed Mark’s new symptoms, which the neurologist copied into Mark’s chart.

“Why don’t you bring him in? I’d better have another look at him.”

“He won’t come,” Karin said. “He won’t listen to me, now that he’s back living by himself.”

“Have you considered taking steps to assume legal guardianship?”

“How…what does that involve? Would I have to declare him mentally unfit?”

Hayes gave her a contact. Karin jotted it down, the ugly hope washing over her. Use the law against your brother. Protect him against himself.

“How sure is your brother that his home is a fake?” Hayes asked, fascinated.

“Out of ten? I’d say he’s a seven.”

“How does he explain the switch?”

“He thinks he’s been under observation since the accident.”

“Well, he’s right, isn’t he? It’s too bad our author isn’t here to see this. This one could have come straight out of his cases.”

“But it didn’t,” she said, brittle.

“No. I’m sorry. It didn’t.” He set down his pen and fingered a thick, green-bound medical text on the shelf behind him. But he didn’t remove it. “Studies show a high incidence of overlap for the various misidentification syndromes. In fact, they may not be entirely distinct disorders. A quarter or more of Capgras patients go on to develop other delusional symptoms. When you consider the different causes of Capgras…”

“You’re saying he could get worse? He might start thinking anything? Why didn’t anyone tell me this before?”

He shot her a maddeningly composed look. “It hadn’t happened before.”

Dr. Hayes wanted more observation. Mark was scheduled for his first outpatient CBT session in a week. The therapist, Dr. Jill Tower, had already gone over the file. Dr. Hayes would do his own follow-up assessment. Meanwhile, neither the diagnosis nor the indicated treatment would change.

They’d reached minute seventeen; she was already overdrawn. “I also wanted to get your opinion,” she started. “I understand that Dr. Weber is an acknowledged expert. But I’ve been reading about this kind of therapy. It just sounds to me like, I don’t know. Like glorified conditioning. They try to weaken the delusion just by training and…modification. Do you think that such therapy is appropriate in Mark’s situation? The scan shows damage. What good is mental habit-changing going to do against a physical injury?”

She hit a sore spot: clear by the way the neurologist started hedging. “We need to explore a variety of approaches. Cognitive behavioral therapy will certainly not hurt your brother as he learns to adjust to his new self. Confusion, anger, anxiety…”

She grimaced. “Does it have any chance of helping his Capgras?”

He swung back around to his shelf of books, but again removed none. “A small body of literature shows some melioration of misidentification delusions in psychiatric disorders. Whether CBT can do anything for Capgras caused by closed-head trauma, we’ll have to wait and see.”

“We’re the guinea pigs?”

“Medicine often involves some degree of experimentation.”

“Every time I show Mark how crazy he’s being, he comes up with another more elaborate theory to explain himself. How can a therapist reason him out of this?”