K-PAX

Prologue

IN April, 1990, I received a call from Dr. William Siegel at the Long Island Psychiatric Hospital. Bill is an old friend of mine, and a distinguished colleague. On this particular occasion the call was a professional one.

Bill was treating a patient who had been at the hospital for several months. The patient, a white male in his early thirties, had been picked up by the New York City; police after being found bending over a mugging victim in the Port Authority Bus Terminal in midtown Manhattan. According to their report his answers to routine questions were "daffy" and, after they booked him, he was taken to Bellevue Hospital for evaluation.

Although he was somewhat emaciated, medical examination revealed no organic abnormality, nor was there evidence of formal thought disorder, aphasia, or auditory hallucination, and he presented a near-normal affect. However, he did harbor a rather bizarre delusion: He believed he came from another planet. After a few days' observation he was transferred to Long Island, where he remained for the next four months.

Bill was unable to do much for him. Although he remained alert and cooperative throughout the various courses of treatment, the patient was completely unresponsive to the most powerful antipsychotic drugs. At the end of it all he remained firmly convinced that he was a visitor from "K-PAX." What was worse, he was able to enlist many of his fellow patients to this fantasy. Even some of the staff were beginning to listen to him! Knowing that the phenomenology of delusion has long been an interest of mine, Bill asked me to take a crack at him.

It couldn't have come at a worse time. As acting director of the Manhattan Psychiatric Institute I was already swamped with more work than I could handle and, indeed, had been phasing out patient interaction since January of that year. However, the case sounded both interesting and unusual, and I owed Bill a couple of favors. I asked him to send me a copy of the man's file.

When it arrived I was still bogged down by administrative duties, and a few more days went by before I found it lying on my desk under a pile of personnel and budget folders. With renewed dismay over the prospect of another patient I quickly read through the chart. It summarized a puzzling history indeed. Although our "spaceman" was quite lucid and articulate, and demonstrated a strong awareness of time and place, he was unable to provide any reliable information as to his actual origin and background. In short, he was not only delusional, but a total amnesiac as well! I called Bill and asked him to make arrangements for the transfer of this nameless man, who called himself "prot" not capitalized-to my own institution.

He arrived the first week in May, and a preliminary session with him was scheduled for the ninth, a Wednesday, at the time I usually set aside to prepare for my regular "Principles of Psychiatry" lecture at Columbia University. We met at weekly intervals for several months thereafter. During that period I developed an extraordinary fondness and regard for this patient, as the following narrative, I trust, will show.

Although the results of these sessions have been reported in the scientific literature, I am writing this personal account not only because I think it might be of interest to the general public but also, to paraphrase Dr. Arieti, because of what he taught me about myself.