K-PAX

Session Ten

THERE are two probes available for penetrating the carapace of hysterical amnesia; each has its proponents, each has its place. The first is sodium pentothal, also called "truth serum." A reasonably safe treatment, it has met with some success in difficult cases, and is favored by many of our own staff, including Dr. Villers. Hypnosis, in experienced hands, offers the same possibilities, but without the potential risk of side effects. With either method events long forgotten are often recalled with amazingly vivid clarity.

When I learned hypnosis as a resident many years ago I was skeptical about its value in psychiatric evaluation and treatment. But it has begun to come into its own in recent years, and is the method of choice in the management of many psychopathologies. Of course, as with other methods, success depends not only on the skill of the practitioner but also, to a great degree, on the disposition of the patient. Thus, the hypnotizability of the subject is routinely determined before treatment is initiated.

The Stanford test is used most often for this assessment. It takes less than an hour and provides a measure of the patient's ability to concentrate, his responsiveness, imagination, and willingness to cooperate. Subjects are rated on a scale of zero to twelve, the higher numbers indicating the greatest hypnotic susceptibility. Psychiatric patients, as well as the general public, average about seven on this test. I have known a few tens. Prot obtained a score of twelve.

My purpose in using hypnosis in prot's case was to uncover the traumatic event which had led to his hysterical amnesia and delusion. When had this incident occurred? My best guess was August 17, 1985, approximately four years and eleven months earlier.

The plan was simple enough: to take prot back to his childhood and carefully bring him up to the time of the putative traumatic event. In this way I hoped not only to determine the circumstances that led to whatever catastrophe had apparently befallen him, but also to get some information on the background and character of my patient.

PROT seemed to be in good spirits when he arrived in my examining room and, while he went to work on a pomegranate, we chatted about Waldorf salads and the infinite number of possible combinations of fruit juices. When he had finished his snack I turned on the tape recorder and asked him to relax.

"I am completely relaxed," he replied.

"Good. All right. I'd like you to focus your attention on that little white spot on the wall behind me." He did this. "Just stay relaxed, breathe deeply, in and out, slowly, in and out, good. Now I'm going to count from one to five. As the numbers increase you will find yourself becoming more and more drowsy, your eyelids becoming heavier and heavier. By the time I get to five you will be in a deep sleep, but you will be able to hear everything I say. Understand?"

"Of course. My beings didn't raise no dummies."

"Okay, let's begin now. One..."

Prot was a textbook subject, one of the best I ever had. By the count of three his eyes were tightly closed. On four his breathing had slowed and his facial expression had become completely blank. On five his pulse rate was forty bpm (I was beginning to be concerned-sixty-five was normal for him though he looked okay) and he made no response when I coughed loudly.

"Can you hear me?"

"Yes."

"Raise your arms over your head." He complied with this request. "Now lower them." His hands dropped into his lap. "Good. Now I'm going to ask you to open your eyes. You will remain in a deep sleep, but you will be able to see me. Now-open your eyes!" Prot's eyes blinked open. "How do you feel?"

"Like nothing."

"Good. That's exactly how you should feel. All right. We are going back in time now; it is no longer the present. You are becoming younger. Younger and younger. You are a young man, younger still, now an adolescent, and still you are becoming younger. Now you are a child. I want you to recall the earliest experience you can remember. Think hard. What do you see?"

Without hesitation: "I see a casket. A silver casket with a blue lining."

My own heart began to beat faster. "Whose casket is it?"

"A man's."

"Who is the man?" The patient hesitated for a moment.

"Don't be afraid. You can tell me."

"It is the father of someone I know."

"A friend's father?"

"Yes." Prot's words came out rather slowly and sing songy, as though he were five or six years old.

"Is your friend a boy or girl?"

Prot squirmed around in his chair. "A boy."

"What is his name?"

No response. "How old is he?"

"Six."

"How old are you?" No response.

"What is your name?" No response.

"Do you live in the same town as the other boy?"

Prot rubbed his nose with the back of his hand. "No."

"You are visiting him?"

"Uh-huh."

"Are you a relative?"

"No."

"Where do you live?" No response.

"Do you have any brothers or sisters?"

"No."

"Does your friend have any brothers or sisters?"

"Yes."

"How many?"

"Two."

"Brothers or sisters?"

"Sisters."

"Older or younger?"

"Older."

"What happened to their father?"

"He died."

"Was he sick?"

"No."

"Did he have an accident?"

"Yes."

"He was killed in an accident?"

"No."

"He was hurt and died later?"

"Yes."

"Was it a car accident?"

"No."

"Was he injured at work?"

"Yes."

"Where did he work?"

"At a place where they make meat."

"A slaughterhouse?"

"TA-huh."

"Do you know the name of the slaughterhouse?"

"No."

"Do you know the name of the town your friend lives in?"

No response.

"What happened after the funeral?"

"We went home."

"What happened after that?"

"I don't remember."

"Can you remember anything else that happened that day?"

"No, except I got knocked over by a big, shaggy dog."

"What is the next thing you remember?"Prot sat up a little straighter and stopped squirming. Otherwise there was little change in his demeanor. "It is night. We are in the house. He is playing with his butterfly collection."

"The other boy?"

"Yes."

"And what are you doing?"

"Watching him."

"Do you collect butterflies too?"

"No."

"Why are ' you watching him?"

"I want him to come outside."

"Why do you want him to come outside?"

"To look at the stars."

"Doesn't he want to go?"

"No."

"Why not?"

"It reminds him of his father. He'd rather mess with his stupid butterflies."

"But you'd rather look at the stars."

"Yes."

"Why do you want to look at the stars?"

"I live there."

"Among the stars?"

"Uh-huh." I remember my initial discouragement at hearing this answer. It seemed to mean that prot's delusion had begun extremely early in life; so early, perhaps, as to preclude a determination of its causative events. But suddenly I understood! Prot was a secondary personality, whose primary was the boy whose father had died when he was six!

"Won't you tell me your name?"

"Prot"

"Where do you come from, prot?"

"From the planet K-Pax."

"Why are you here?"

"He wanted me to come."

"Why did he want you to come?"

"He calls me when something bad happens."

"Like when his father died."

"Yes."

"Did something bad happen today?"

"Yes."

"What happened?"

"His dog was run over by a truck."

"And that's when he called you."

"Yes."

"How does he do that? How does he call your' "I don't know. I just sorta know it."

"How did you get to Earth?"

"I don't know. I just came." Prot hadn't yet "developed" light travel in his mind!

"How old is your friend now?"

"Nine."

"What year is it?"

"Nineteen-uh-sixty-six."

"Can you tell me your friend's name now?" No response.

"He has a name, doesn't he?"

Prot stared blankly at the spot on the wall behind me. I was about to go on when he said, "It's a secret. He doesn't want me to tell you-." But now I knew he was in there somewhere and prot, apparently, could consult with him.

"Why doesn't he want you to tell me?"

"If I tell you, something bad will happen."

"I promise you nothing bad will happen. Tell him I said that."

"All right." Pause. "He still doesn't want me to tell you."

"He doesn't have to tell me right now if he doesn't want to. Let's go back to the stars. Do you know where K-PAX is in the sky?"

"Up there." He pointed. "In the constellation Lyra."

"Do you know the names of all the constellations?"

"Most of them."

"Does your friend know the constellations too?"

"He used to."

"Has he forgotten them?"

"Yes."

"Is he no longer interested in them?"

"No."

"Why not?"

"His father died."

"His father taught him about the stars?"

"Yes."

"He was an amateur astronomer?"

IA-huh."

"Was his father always interested in the stars?"

"No."

"When did he become interested in them?"

"After he was hurt at work."

"Because he had nothing to do?"

"No. He couldn't sleep."

"Because of the pain?"

"Yes."

"Did he sleep during the day?"

"Only one or two hours."

"I see. And one of the constellations your friend's father told him about was Lyra?'"Yes."

"When?"

"Just before he died."

"When he was six?"

"Yes."

"Did he ever tell him there were planets around any of the stars in Lyra?"

"He said there were probably planets around a lot of the stars in the sky."

"One more thing: Why don't you go out and watch the stars by yourself?"

"I can't."

"Why not?"

"He wants me to stay with him." Prot yawned. He was beginning to sound tired and I didn't want to push him too far at this point. I brought him back to the present time.

"I think that's enough for one day. You may close your eyes. I'm going to start counting backwards now, from five to one. As I count you will become more and more alert. On the count of one you will be wide awake, refreshed, and feeling fine. Five ... four ... three ... two ... one." I snapped my fingers.

Prot looked at me and smiled brightly. "When do we begin?" he said.

"It's already over."

"Ah. The old 'fastest gun in the west' routine."

"I know that feeling!"

He had his notebook out; he wanted me to tell him how hypnosis worked. I spent the rest of the hour trying to explain something I didn't fully understand myself. He seemed a little disappointed.

After Jensen and Kowalski had escorted him back to the wards I listened to the tape of the session we had just completed and, with mounting excitement, jotted down my conclusions. It seemed clear to me that prot was a dominant secondary personality who had come into being as a result of the perhaps unexpected death of his alter ego's father, a trauma which was obviously too much for the primary personality to bear. It seemed evident also why he (prot) had chosen an alien existence: his (their) father had instigated in him an interest in the stars and in the possibility of extraterrestrial life occurring among them, and this revelation had come immediately prior to his father's demise.

But this did not account for the extraordinary dominance of prot over the primary personality. It is the secondary identity who ordinarily remains in the background, watching, waiting to take over when the host personality runs into difficulty. My guess was that some far more traumatic event must have drawn the primary-let's call him Pete into a thick, protective shell, from which he rarely, if ever, ventured. And I was more certain than ever that this terrible incident, whatever it was, occurred on August 17, 1985, the date of prot's most recent "arrival" on Earth. Or perhaps a day or two earlier, if it had taken a while for Pete to "call" prot, or for him to respond.

Why did I not suspect that prot was a secondary personality earlier on? MPD is not an easy diagnosis under the best of circumstances, and prot never showed any of the symptoms usually associated with this disorder: headaches, mood changes, frequent memory lapses, depression. Except, possibly, for his outbursts of anger in sessions six and eight, and the episode of panic on the Fourth of July, the host personality (Pete) had never made his presence felt. Finally, I was completely thrown off by his other aberrant traits-a dominant secondary personality who is himself delusional, and a savant as well-the odds against such a phenomenon must be astronomical!

But who was Pete, the primary personality? Apparently he was in there somewhere, living the life of a recluse in his own body, refusing to divulge his name or much of his background, except that he was born in 1957, apparently, to a slaughterhouse worker who died in 1963, perhaps somewhere in the northwestern part of the United States, and he had a mother and two older sisters. Not much to go on, but it might help the police trace his origin. Strictly speaking, it was Pete's identity, rather than prot's, that we needed to ascertain. Any information we could get about him, any knowledge of things familiar to him, might facilitate my persuading him to come out.

All this put prot's "departure date" into an entirely new light. It is one thing for a patient to announce an end to a delusion, but quite another for a dominant alter to disappear, leaving behind a hysteric, or maybe worse. If prot were to leave before I could get to Pete, it might well preclude my ever being able to help him at all.

I wondered whether the unhypnotized prot knew anything about Pete. If not, the plan would remain as before: to bring prot/Pete slowly and carefully, under hypnosis, up to the time of the traumatic event(s) which precipitated Pete's dramatic withdrawal from conscious existence. Even if he did know about Pete, however, hypnosis might still be necessary, both to facilitate prot's recollection and to make possible direct contact with the host personality.

But there was a dilemma associated with this approach. On the one hand, I needed to talk to Pete as soon as possible. On the other, forcing him to relive that terrible moment prematurely could be devastating, and cause him to withdraw even further into his protective shell.

GisELLE seemed a little less cheerful than usual the following Monday morning. "My friend down at the Sixth Precinct couldn't find any report of a missing person who disappeared from the upper West in August of 1985," she said, consulting a little red notebook much like the one prot was fond of. "Somebody killed a man and then himself in a little town in Montana on the sixteenth of that month, and in Boise on the eighteenth another guy ran off with his secretary and a hundred fifty thousand dollars of his company's funds. But your guy isn't dead, and the one who ran off with his secretary is still in the Idaho State Penitentiary. My friend is expanding the search to cover January through July of 1985, and then all of the United States and Canada. It will be a while before he gets the results."I also know someone in the Research Library at New York Public; during her breaks she's doing some searches for me for the week of August seventeenth. You know newspaper reports of anything unusual that might have happened during that period in Montana, Idaho, Washington, and Oregon. Nothing there so far, either." She closed the little book. "Of course," she added, "he might have been raised in the Northwest and then moved somewhere else...."

I told her about prot's (Pete's) father and the slaughterhouse. "Ha!" she replied. "I wonder how many of those things there are in the United, States?"

"I don't know."

"I'll find out," she said with a wave.

"Wait a minute," I called after her. "He was born in 1957."

"How did you find this stuff out?" she demanded to know.

"Ve haff arrrr vays, mein Madchen."

She ran back and kissed me on the mouth (almost) before dashing out. I felt about thirteen years old again.

KAREN and I were inseparable after my father's funeral. If we could've lived together, we would have. I especially loved her fat, pink cheeks, which became red and shiny, like little apples, in the wintertime. But it took me another year to get up the nerve to kiss her.

I studied the way they did it in the movies, practiced for months on the back of my hand. The problem was, I wasn't sure she wanted me to. Not that she turned away whenever our faces were close together, but she never indicated in any clear way that she was interested. Finally I decided to do it. With all those movies it seemed abnormal not to.

We were sitting on the sofa at her house reading Donald Duck comics, and I had been thinking about it all morning. I knew you were supposed to kiss sort of sideways so your noses wouldn't bang together, and when she turned toward me to show me Donald's nephews carrying picket signs reading: "Unca Donald is stewped," I made my move. I missed, of course, as first kisses often do, as Giselle's did before she ran out.

THAT afternoon I found Giselle in the exercise room talking animatedly with prot. La Belle was asleep in his lap. Both were jotting things down in their respective notebooks, and prot seemed quite comfortable with her. I didn't have time to join them, but she told me later some of the things they had discussed. For instance, they had been comparing the Earth with K-PAX, and one of the questions she had asked him, in a brash attempt to track down my patient's origins, was where he would like to live if he could live anywhere on Earth. She was hoping he would say "Olympia, Washington," or some such town in the upper West. Instead, he answered, "sweden. "

"Why Sweden?" she wanted to know."Because it's the country most like K-PAX."

The subject then turned to those human beings who seemed most like K-PAXians to him. Here is what he said: Henry Thoreau, Mohandas Gandhi, Albert Schweitzer, John Lennon, and Jane Goodall.

"Can you imagine a world full of Schweitzers?" she hooted.

I said, "John Lennon??"

"Have you ever heard 'Imagine'?"

I told her I would look it up.

Then she said something I had been wondering myself: "You know what else? I think he can talk to animals!" I said I wasn't surprised.

I had no time for them that afternoon because I was on my way to Ward Four, where Russell was trying to get in. Apparently distraught with the loss of his followers to prot's counsel and advice, and his failure to wake up the catatonic patients, he had decided to convert some of the psychopaths. When I arrived I found the nurses attempting to get him to go back to his own ward. He was up on his toes shouting through the little barred window high in the steel door: "Take heed that no man deceiveth you! For many shall cometh in my name, saying, I am the Christ; and shall deceiveth many!" Apparently his words were not falling on deaf ears, as I could hear laughter coming from inside. But he kept on yelling, even after I pleaded with him to go back to Ward Two. I ordered a shot of Thorazine and had him taken back to his room.

That same day two other things happened that I should have paid more attention to. First, I got a report that Howie had asked one of the residents how to perform a tracheotomy. Dr. Chakraborty finally told him, thinking Howie was going to show Ernie how easily he could be saved even if he were to get choked on something, despite the unfortunate example of his mother's demise.

The other event concerned Maria. One of her alters, a sultry female called Chiquita, somehow got into Ward Three and, before anyone discovered her presence there, offered herself to Whacky. But the results were the same as with the prostitute prescribed earlier. Facing this unexpected rejection, Chiquita quickly exited and Maria appeared. Though finding herself with a naked man engaged in self manipulation she didn't become hysterical, as you might expect. Rather, she immediately began to pray for Whacky, whose despair she seemed to understand completely!

On the lighter side, Chuck presented prot with a drawing summarizing his assessment of the human race, one of many attempts, I discovered, to impress prot so that he would take Chuck to K-PAX with him. It is reproduced here:

Purely by coincidence this diagram described almost perfectly our second applicant for the position of permanent director. He obviously had not bathed in weeks or even months. A blizzard of dandruff snowed from his head anddrifted onto his shoulders. His teeth seemed to be covered with lichen. And, like the previous candidate, Dr. Choate, who checked his fly every few minutes, the man came with excellent references.