K-PAX

Session Six

MY next session with prot took place the following afternoon. Smiling profusely when he came into my examining room, he handed me what he called a "calendar." It was in the form of a scroll, and so complicated that I could make little sense of it. But I thanked him and motioned to the basket of fruit on the side table by his chair.

I waited to see if he would bring up the subject of Howie and the bluebird, but he never mentioned it. When I finally asked him about it he bit into a cantaloupe and shrugged. "It had been there all the time, but nobody had looked for it." I didn't mention the larger issue of his assigning "tasks" to the patients. As long as the results were positive, I decided to allow it for the time being.

After he had finished the last kiwi, fuzz and all, I turned on the tape recorder. "I'd like to follow up on something you told me earlier."

"Why not?"

"I believe you said there is no government on K-PAX, and no one works. Is that right?"

"Quoit roit, guvnuh."

"I must be dense. I still don't understand how things get done. Who builds the libraries and makes all the equipment for them and installs it and runs it? Who makes all the holographic software, if that's the proper terminology? Who makes your eating utensils and your clothes? Who plants the grains? What about all the other things that you surely need and use on K-PAX?"

Prot smacked his forehead with the palm of his hand and muttered, "Mama mia. " Then, "All right. Let me see if I can make it complicated enough for you to understand." He leaned forward in his chair and fixed me with his penetrating black gaze, as he did whenever he wanted to make sure I was paying attention. "In the first place, we hardly ever wear any clothing on K-PAX. Except once each cycle-

every twenty-one of your years-when we have some cold weather. And nobody plants the grains. You leave them alone and they plant themselves. As for the libraries, if something needs to be done, someone does it, capisci? This goes for everything you would call 'goods and services.' Now do you get it?"

"Surely there are jobs no one wants to do. Hard labor, for example, or cleaning public toilets. That's only human nature."

"There are no humans on K-PAX."

I glared back at him. "Oh yes, I forgot."

"Besides, there is nothing that needs to be done that is really unpleasant. Look. You defecate, don't you?"

"Not as often as I'd like."

"Do you find it unpleasant?"

"Somewhat."

"Do you get someone to do it for you?"

"I would if I could."

"But you don't, and you don't think twice about it. You just do it. And it does have its rewards, right?"

The tape indicates that I chuckled here. "Okay. There are no undesirable jobs. But what about the other side of the coin? What about the specialty jobs that take a lot of training? Like medicine. Or law. Who does those?"

"We have no laws, therefore no lawyers. As for the former, everyone practices medicine, so;, in general, there is no need for doctors, either. Of course there are some who are more interested in such matters than are others, and they are available whenever anybody needs them. For surgery, Primarily-"

"Tell me more about medicine on your planet."

"I knew you'd get around to that sooner or later." He settled back into his familiar pose. "As I suggested a moment ago, there isn't much need for it on K-PAX. Since we eat only plants, we have almost no circulatory problems. And since there's no pollution of our air or our food, and no tobacco, there isn't much cancer, either. There's little stress, ergo no GI problems. Also there are few serious accidents, no suicide, no crime-voila! Not much need for doctors! But of course there are occasional outbreaks of disease. Most of these run their course without permanent damage, but there are a few nasty afflictions. For these we again have the plants. There is an herb or two for every ailment. You just have to look it up in the library. "

"You have an herb for everything?"

"So do you. For aids, for all the different kinds of cancer, for Parkinson's and alzheimer's, for blocked arteries. Herbs for selective anesthesia. They're all there, in your tropical forests. All you have to do is look for them."

"Selective anesthesia?"

"If you want to do abdominal surgery, there is something to anesthetize that part of the body. You can watch someone take out your appendix. Or do it yourself, if you wish. And so on. Your chinese have the right idea with their acupuncture."

"Are there hospitals?"

"More like small clinics. One for each village."

"What about psychiatry? I suppose you're going to tell me there's no need for it on K-PAX."

"Why should there be? We don't have religious or sexual or financial problems to tear us apart."

"All right. But aren't there those who become mentally ill for organic reasons? What do you do with them?"

"Again, these are rare on our PLANET. But such beings are usually not dangerous and are not locked up for the convenience of others. On the contrary, they are well taken care of by everyone else."

"You mean your mental patients aren't treated with any drugs-herbs-to make them well?"

"Mental illness is often in the eye of the beholder. Too often on this PLANET it refers to those who think and act differently from the majority."

"But surely there are those who are obviously unable to cope with reality..."

"Reality is what you make it."

"So no K-PAXians are ever treated for mental problems?"

"Only if they are unhappy, or request it themselves."

"And how do you know whether they are happy or not?"

"If you don't know that, dr. b, you can't be much of a psychiatrist."

"All right. You said there are no countries and no governments on K-PAX. I deduce from this that there are no armies or military weapons anywhere on your world-is that right?"

"Heaven forbid."

"Tell me-what happens if K-PAX is attacked by inhabitants of another planet?"

"A contradiction in terms. Any beings who would destroy another WORLD always destroy themselves first."

"Then what about your internal affairs? Who keeps order?"

"K-PAX is already orderly."

"But you also said there are no laws on your planet. Correct?"

"Kee-reck."

"Without laws, how does one know what is right and what is wrong?"

"The same way human beings do. Your children don't study law, do they? When they make mistakes, these are pointed out to them."

"Who decides what a 'mistake' is?"

"Everyone knows."

"How? Who created the original behavior codes?"

"No one. They just became obvious over a period of time."

"Would you say there is some moral basis for these codes?"

"Depends on your definition of 'moral.' I presume you are thinking about religion."

"Yes."

"As I said before, we have no religions on K-PAX, thank god."

"God?"

"That was a joke." Prot entered something into his notebook. "Have you no sense of humor on this PLANET?"

"Then you don't believe in God?"

"The idea was kicked around for a few hundred cycles, but it was soon rejected."

"Why?"

"Why kid ourselves?"

"But if it gives comfort..."

"A false hope gives only false comfort."

"Do all K-PAXians share this view?"

"I imagine. It's not something that's discussed very much."

"Why not?"

"How often do you discuss dragons and unicorns?"

"What sorts of things are discussed on your planet?"

"Information. Ideas."

"What sorts of ideas?"

"Can one travel forward in time? Is there a fourth spatial dimension? Are there other UNIVERSES? Stuff like that."

"One more thing before we move on to something else. What happens-I know this is rare-but what happens when someone breaks one of your behavior codes? Refuses to conform?"

"Nothing."

"Nothing?"

"We reason with him or her."

"That's all?"

"Yes."

"What if he kills someone?"

Somewhat agitated: "Why would any being do a thing like that?"

"But what if someone did?"

"We would try to avoid him or her."

"But is there no compassion for the person he has killed? Or for his next victim?"

Prot was staring at me, disgustedly it appeared, or perhaps in disbelief. "You're making a mountain out of a molehill. Beings don't kill other beings on K-PAX. Crime is less popular than sex, even. There's simply no need for it."

I had a hunch I was on to something here. "But if someone did commit a crime, shouldn't such a person-uh, being-be locked up for the good of everyone else?"

Prot was clearly becoming irate. "Let me tell you something, doc," he almost snarled. "Most humans subscribe to the policy of 'an eye for an eye, a life for a life.' Many of your religions are famous for this formula, which is well known throughout the UNIVERSE for its stupidity. Your christ and your buddha had a different vision, but nobody paid any attention to them, not even the christians and buddhists. On K-PAX there is no crime, you dig? And if there were, there would be no punishment. Apparently this is impossible for EARTH beings to understand, but it's the secret of life, believe me!" By now prot's eyes were bugging and his breathing was hard. I sensed it was time to end the day's session, if somewhat prematurely.

"I admit you have a point there. And by the way, I'm afraid I'm going to have to cut our session a little short today. I hope you don't mind. I have an important meeting which couldn't be rescheduled. Would it be all right with you if we continue with this next week?"

Calmer now, but not much: "Perfectly." Without another word he got up and stalked out.

I sat in my examining room for a few minutes after he had gone, thinking. Until that moment I had seen no evidence of anger, and rarely even a frown, in this patient. Now it appeared that just below the surface lay a seething cauldron, a volcano that could erupt at any time. Had it erupted in the past? Hysterical amnesia sometimes results from a violent and irreversible act. Had prot, in fact, killed someone, possibly on August 17, 1985? As a precaution, should I have him transferred to Ward Four?

I decided against the latter move, which might have driven him deeper into his seemingly impenetrable shell. Besides, all this was pure speculation at this point. And even if correct, he was unlikely to become violent unless we made substantial progress toward unraveling his past actions, the precipitants of his amnesia, a development I welcomed. Nevertheless, I would notify the staff and security office of the potential problem, have him watched more closely, and conduct subsequent interviews with greater caution. I decided also to notify the police department about a possible violent altercation some five years earlier, hoping it would help them to track him down, something our previous clues had failed to do.

But August seventeenth was fast approaching. I was frustrated and tired. Perhaps, I thought, I was getting too old for clinical work. Maybe I wasn't good enough any more. Maybe I never was.

I never wanted to be a psychiatrist. I wanted to be a singer.

As a pre-med student in college my only real interest was the annual "Follies Brassiere," a talent show for students and faculty, in which I shamelessly belted out Broadway tunes and opera arias, to loud and addictive applause. By the time I graduated, however, I was already married and it made no sense to pursue such a frivolous dream. I was no Don Quixote.

Thus, it wasn't until I got into medical school itself that I began to have serious doubts about my choice of profession. But just as I was about to confess to my new wife that I might rather try something else, Mother was diagnosed with liver cancer. Although the doctors decided to operate, it turned out to be far too late.

Mother was a courageous woman, though, and she put up a good front until the end. As she was being wheeled into surgery she talked about all the places she wanted to visit and all the things she wanted to take up: watercolors, French, the piano. But she must have known the truth. Her last words to me were, "Be a good doctor, son." She passed away on the operating table, never to see her first grandchild, who was born three months later.

There was only one other moment when I almost decided to chuck the whole thing. It was the afternoon I saw my first cadaver.

He was a forty-six-year-old white male, overweight, balding and unshaven. As we started to work on him his eyes popped open, and they seemed to be appealing to me for help. It wasn't that it made me feel faint or nauseated-I had been on too many hospital rounds as a boy-it was that the body looked exactly like. my father the night he died. I had to leave.

When I told Karen what had happened, that I couldn't cut into someone that looked like my own father, she said, "Don't be silly." So I went back and opened that man's arms and legs and chest and abdomen, all the time hearing my father, who considered himself something of a comedian, whispering in my ear, "Ouch, that hurts." But I was more certain than ever that I didn't want to be an internist or surgeon. Instead, I followed the example set by my friend Bill Siegel, and went into psychiatry. Not only because it seemed less sanguinary, but also because it appeared to be a great challenge-so very little seemed to be known about the subject. Unfortunately, that sad state of affairs is as true today as it was nearly thirty years ago.

THE afternoon that prot stalked out of my examining room I got a call from a freelance reporter who was planning to do a story on mental illness for a national magazine. She wanted to know whether she might be able to "set up shop" at MPI for a few weeks to gather background material and "pick our brains," as she put it. That's a phrase I've never liked much, along with "eat your heart out" and "chew someone out"-I think of vultures. However, it was hardly a basis for rejecting her proposal, and I gave her tentative approval to do the article, hoping that the notoriety might get us some additional dollars. I transferred her call to Mrs. Trexler to arrange for an appointment at a time convenient for both of us. I laughed right into the phone when she said that "now" was convenient for her.

A new patient of Dr. Goldfarb's arrived over the weekend. I'll call him "Chuck" because, although that is not his name, that is what he wanted to be called. Chuck was a sixty-three-year-old New York City doorman-or doorperson, as Abby would have it-and a chronic cynic, hopeless pessimist, and classic curmudgeon. He was brought in because he was beginning to inform everyone who walked into his building that he or she "stunk." Everyone within fifty miles of him "stunk." Indeed, his first words, when he entered the hospital, were, "This place stinks." Bald as an eightball and somewhat cross-eyed, he might have made an almost comic figure had not his presence in Ward Two brought terror to the heart of Maria-he reminded her of her father.

Maria had been at MPI for three years and, in all that time, Russell was the only male who could get near her. At first she had numerous Sunday visitors, as befit her large family, including cousins of all ages. But the visitations soon dwindled to her mother and the odd aunt or uncle every month or two for the simple reason that when they came to see Maria they often found someone else-Maria suffered from multiple personality disorder.

MPD begins to manifest itself in early childhood, as an attempt to deal with a terrible physical or mental trauma from which there appears to be no escape. Maria wasn't beaten, Natalie was; Maria wasn't molested, it was Julia; Maria can't bear these attacks but Debra is strong. Many of the victims harbor scores of distinct personalities, depending on the number and severity of the -abuses, but the average is about a dozen, each of whom is able to "take over" under certain circumstances. For reasons that are unclear, instances of a single alter ego are relatively rare.

Personality differences among the various alters are often astonishing. Some are much smarter than others, express widely discrepant talents, score uniquely on psychological tests, and even produce disparate EEG patterns! They might also visualize themselves as being very dissimilar in appearance, or even of a different sex, from that of the other identities. Whether these are true individuals is questionable, but, until integration occurs, many of the alters, including the "primary" personality, are totally unaware of what the others are doing when in control of the body.

Maria was known to harbor more than a hundred separate and distinct personalities, most of whom rarely made an appearance. Otherwise her case is typical for this disorder. She had been raped innumerable times by her father, starting when she was barely three years old. Her devoutly religious mother, who cleaned a dozen large offices at night, never knew about these violations, and her older brothers had been threatened into silence until they were old enough to demand some of the "action" for themselves. Under such circumstances life can become quite unbearable and the desire for escape overwhelming.

A pretty girl with long black hair that shines like the stars, Maria came to us after she, as Carmen, had nearly scratched a boy's eyes out when he tried to make advances. Until that incident she was thought of as "quiet" and "distant." No one has touched her since, with the possible exception of Russell, who, of course, refers to her as "Mother."

But Maria herself is seldom in evidence. Most of the time one of the others is in charge, one of her "defenders" or "protectors." Sometimes, when one of her "persecutors" takes control, we see another facet of Maria, a darker side. One of these, who calls herself Carlotta, has tried to kill Maria, and therefore herself and all the others, on at least two occasions. It is this constant struggle for control among the various identities, often accompanied by anxiety, insomnia, and ceaseless headaches, that makes for the singular horror of the multiple personality sufferer.

Chuck thought all of Maria's alters stunk. Also Russell, Mrs. Archer, Ernie and Howie, and even harmless little Bess. The entire staff, including myself, stunk to high heaven. To his credit he admitted that he, himself, smelled worse than all the rest of us put together-"like a gutwagon," as he put it. The only person in the entire hospital who did not stink, in his opinion, was prot.