Michael Hören walked down the hall following a policeman to room 413. A torn sheet of paper that was taped to the wall had “DENKEN” written on it with a thick black marker. The guard rummaged on his belt for a keyring, and after scanning the numbers of each key slotted the correct one into the lock, and turned the tumblers inside. The heavy door opened silently, and light from the hallway poured into the dark room. Eric was on the bed fast asleep. The guard flicked the light on and said in a booming voice, “Wake up Mr. Denken. Your shrink is here.”
Hören did not really mind being called a shrink. He was still green enough to not have the air of pompousness and pride that sometimes comes with more experience. He did not, however, appreciate the way the guard rudely woke his patient. He shot the guard a look, and reading the agitation in Hören’s eyes, the guard turned to leave. He said, “If you need anything, I’m right outside. Just holler.”
Michael thanked him and shut the door. He turned now to his patient, who had sat upright and was rubbing the sleep out of his eyes.
“Hello Eric. I am Dr. Michael Hören. I’m your shrink.” He said “shrink” sarcastically, but the boy didn’t seem to pick up on it. He sat in the chair by the door, and scooted closer to Eric.
He asked, “So how old are you?” He already knew Eric was 16, but part of the process was getting the patient to talk about himself. Eric looked at him, his face expressionless, arms on the bed with his palms flat so that his elbows bent inwards. He stayed like this for a minute until Hören asked again, “How old are you?”
Again the boy just stared. After another minute Hören said, “Will you please talk to me? Are you scared of being here?” Eric looked offended at the question, as if Hören thought he was a nine year old who was still scared of strangers.
“Where do you go to school?” Eric repositioned himself, sat on his hands, and arched his back in a silent yawn. They both sat looking at one another for about a minute, Eric not once blinking. Hören shifted in his chair and said, “You know we’re not going to get very far if you don’t talk to me.”
Eric folded his arms across his chest and cocked his head to the side. He stared at the doctor incredulously. Hören decided to try a different tactic. He said, “Why don’t you try asking me a question or two.”
The boy nodded, and stared directly at the doctor’s forehead. Hören was starting to lose his patience. He began to write on his notepad, “possible elective mute catatonic” when Eric said, “What are you writing?” Relieved, Hören looked up and said, “Oh nothing. Maybe I’ll tell you if you talk to me a little. How’s that sound?”
Eric’s eyes lit up. He started to breath heavily and said, “You heard me.”
Michael, a little puzzled, said, “Yeah… I heard you.”
“No. You heard me. You responded to what I thought.”
“What you thought? What do you mean?”
“I asked what you were writing in my mind. I said that in my mind, and you heard it.”
Dr. Hören stopped writing. “So this is why they think he is schizophrenic. He has feelings of persecution and invasion. He is under a delusion that I can hear his thoughts. Ok. That’s a start.”
Michael stood up from his chair and began to pace the room. He thought back to all his schooling and techniques for how to deal with schizophrenics. Eric had a bad delusion, and his number one priority was to not perpetuate it. Progress could only be made if Eric did not have reason to believe people could hear his thoughts. But still, this was the only lead he had. He continued carefully, “So you have been thinking the answers to all my questions, huh?”
Eric looked intently again, but Hören did not hear anything. He was sure though, that the young boy was thinking with all his might, “Yes, I have. And you heard me.”
After a few silent minutes, Hören said, “Please, just talk to me. You need to talk to me. I won’t work with a person who only thinks at me.” This was probably not the right way to deal with Eric, but it worked. Eric said, “Ok, I’ll speak.”
“Thank you. So how old are you?
“Where do you go to school?”
“I dropped out.”
“Why’d you do that?”
“I couldn’t deal with what kids thought about me. I waited until I could drop out, and I did.”
“Were you bullied?”
“No, not directly. There were rumors though. People talking behind my back, saying things about me.”
“What were they saying?”
“They said I’m a freak. They said I’m some sort of psycho who would probably be the one to shoot up the school one day.”
Hören made a note about this in his book. “Do you think that was true?”
Eric looked down at his feet. He shifted a little and said, “Yeah maybe. I would never do it but sometimes I thought about those kids being dead. I thought about how easy my life would be if I didn’t have to deal with those preppy douchebags.”
“Do you think you would harm anybody?” Hören repeated his question because of Eric’s unclear answer. Part of the process was determining whether or not a patient is a danger to other people. Eric responded with a sigh and a “No, I wouldn’t.”
Hören marked this in his book as well. He was more direct with his next question. “Have you ever wanted to hurt yourself, or thought about suicide?”
“Have you ever made any attempts or plans?”
“Would you feel comfortable telling me about them?”
Eric shook his head, and retreated into his dome of silence once again. Hören realized that his patient wasn’t comfortable talking to him yet, so he decided he should back off of this particular subject. Today was about building trust, and even though they would only be together for three days, this first day was crucial. Hören then moved on to try and make Eric more comfortable, and got out a notecard. He wrote his cell phone number on the card and handed it to Eric. “This is my personal cell phone number. If you ever feel like you need to just talk to someone, and you don’t want to talk to your mother, please call me. Even if you don’t call me, please promise me you will talk to someone. Eric took the card and began to mangle it between his fidgeting fingers.
The rest of the appointment was an uncomfortable two and a half hours of silence punctuated by small bits of information about Eric’s life. He said he didn’t really remember his father because he would come home each night and immediately shut himself up in his room with a novel he was writing. His mother was never really around, and went out a lot to try and meet new men. Eric was well aware that his mother and father did not really care for each other, and the only reason they stayed together was because the divorce would have been too messy, and his parents wanted to avoid an expensive custody battle. When his dad went missing, she didn’t change her lifestyle. She would leave the eleven year old boy at home, often for whole weekends. Eric quickly learned how to take care of himself in terms of getting food, and managing small chores around the house. Hören noted that his independence was one of Eric’s strong points, but the compliment did little to cheer him up.
When the session was over, Hören stood up, thanked Eric for talking with him, and turned to leave. Eric said, “So what’s wrong with me?”
Hören stood with his hand on the doorknob, and turned to look at Eric out of the corner of his eye. He said, “I am not sure yet, but you will be the first to know once I figure it out. I’m here to help you, and my correspondent Dr. Phillips is here to help you too. We’ll work this out.”
Eric turned, swung his leg back up onto the bed, laid back on his pillow and stared at the ceiling. He sighed the same way he did when the doctor didn’t have an answer for him the first time.
The same guard as the day before walked Dr. Hören down the same hall to the same room with the same piece of paper that read “DENKEN” on the wall. This time, Hören asked if he could be the first to go in, as he remembered Eric’s rude awakening yesterday. The guard obliged, and Hören walked in and closed the door. It turned out though that Eric was already awake, and was standing by his window looking out over the courtyard where some of the other patients mulled about.
“Good morning Eric.”
Eric said nothing. He continued to stare out the window and did not even turn to greet his doctor. Hören sat himself down in the chair, and removed his coat allowing it to slump on the backrest. He repeated, a little louder this time, “Good morning Eric.”
Again, no reply. This time however, Eric turned to look at the doctor, the same look as the day before, as if he was trying to drill a hole in Hören’s forehead with nothing but his eyes. Hören realized he was back to where he started yesterday, and would need to find a way to coax more words from his patient. This time he played dumb, as if he had no idea about his delusion, and said, “What’s that look for? You trying to tell me something?”
Eric nodded. He squinted his eyes even harder and leaned in a little bit towards the doctor, as if his thoughts only had a certain effective range. Hören saw that it was useless to try and ignore the problem. He said, “Look, I know you think I can hear your thoughts. But I can’t. You have to believe me. I would not lie to you.” He chose his words very carefully. It is not enough to tell a schizophrenic (which is what Hören pretty confidently believed Eric was) that they are suffering a delusion, because no matter how one puts it, the delusion is real to them. The only way to deal with delusions is with coping skills. When people feel persecuted, they need a person to talk to.
Eric screwed up his face into a frustrated grimace and said, “You’re lying to me. No one tells me the truth. No one ever will. You’re lying!” Eric was very animated in his speech, and violently turned to the window again. Hören marked on his page, “Trust issues. Must first gain Eric’s trust before further progress is made.” This was a setback, because it meant that all the ground he covered the day prior had to be regained. But he began the process anew.
“Eric. Please come sit on the bed. Why don’t you trust me?”
“Because you won’t answer my question.”
“I asked you if you can hear my thoughts, and you said no.” Hören could not remember Eric asking directly whether or not he could hear his thoughts, but he went with it. “Isn’t no an answer?”
“No it’s not. It’s not a true answer anyway. You are lying to me.”
“Eric, I can only answer you based on what I know and experience. I cannot hear what you are thinking. I only hear what comes out of your mouth. Please, you have to believe me. What would be the point of me coming here and lying to you for three hours? I’m not doing this for my health you know. I am here because I want to help you. I’m here because you need me to be here.”
“How many people have you helped before?
Hören began to say, “Well… I…” The question had caught him off guard. This was one of his first cases. Apart from his sit-ins when he was training to be an LCPC, he hadn’t really worked with any patients. Even here at St. Peters, his other two patients worked with their social worker rather than with him. Eric was the only person he had one on one time with so far. He couldn’t tell him that though, it would discredit him. But if he told Eric a lie, he would be in violation of what little trust the two had. His silence was enough of an answer for Eric though. “That’s what I thought. Let me guess. I’m your first patient. You have no idea what to do with me. You were hoping you would just have a simple case of depression that you could diagnose in thirty minutes. You were hoping you could just put me on some Prozac or some shit and the problem would work itself out. Until you admit that my problem is real, you can’t help me.”
Hören was silent. He was just berated by a patient, and now all hopes of building trust were shattered, dashed against the rocks and left to float out to sea. Eric was not going to be receptive of treatment until Hören confirmed his delusion. If Hören was to confirm these suspicions however, it could be detrimental to Eric’s mental state. He had to find another way to reach Eric. “Well is there anything you want to talk about? You said yesterday that you had suicidal ideations. Are those thoughts scary?”
Eric continued to look out the window. He stayed like that until Hören repeated the question a few minutes later. “Is suicide scary to you?”
Hören perked up. Eric did not turn from the window, and his face was only partially shown in profile, but Hören could see a tear welling up in his eye. His voice remained steady and flat though. There was no shaking in his “No” and his body stood resolute.
“Why aren’t you scared that you want to kill yourself?”
“Because it would mean certainty. It would mean I would not have to worry, or deal with other people judging me. I wouldn’t have to worry about what is and is not private. I would not have anyone try to get close to me. People hurt you when they are close to you. When I’m dead, all I have to worry about is rotting in the ground.”
Hören was silent. Eric was almost certainly depressed, and he finally had something that could be treated. He marked this in his book. He asked, “Have you tried to kill yourself before?” He knew the answer to this, but it was a way for Eric to start the conversation, rather than Hören.
Eric stood still for a minute, but eventually tilted his head down to look at his feet and nodded slowly. He closed his eyes and a tear poured down his cheek. He stood like that until Hören offered him a tissue from his travel pack. Eric took the tissue and wiped his cheeks with it. Hören went back to his seat but Eric remained at the window. Hören asked, “Will you tell me about it? How many times have you tried?”
“Will you tell me about them?”
Eric breathed deeply, and then began to describe attempt number one. “I was in ninth grade. I did not want to continue with school, but my mom made me go. I don’t know why she cared so much. It’s not like she was ever around to help me with homework, or pick me up from the bus stop. But she threatened to kick me out if I stopped going. I went to the drug store one night and picked up a bottle of Tylenol. I took it to school and went straight to the bathroom stall. I popped open the bottle, and slowly began to swallow pill after pill. I did this for about 5 minutes and worked my way through half of the bottle. I was taking them with Sprite, and after a while I began to feel gassy. I tried to continue, but eventually I puked up most of the half digested pills into the toilet, and fainted. A janitor found me and ran to get help. My mom was called, and picked me up that afternoon because she was ‘at work,’ but I knew better. She was out with her boyfriend d’jour, and I smelled cheap beer on her breath. I told her that it was probably the chicken I had the night before, and she believed it. I felt so dejected after that first attempt that I did not want to try again.”
Hören wrote this description down in his book and began thinking of ways to help deal with these dangerous thoughts. “You said you made two attempts, right? Can you describe the second attempt?”
“It happened recently. It’s the reason I’m here. I tried to hang myself.”
Eric was silent then. Hören did not want to push his patient if he didn’t want to talk, but this was more progress than they made yesterday, and the momentum of his confessions was too good to let fade. He asked, “Why?”
“A girl I was in love with left me. Her name is Gabrielle. We had been friends for only a little bit, and I honestly think she came to me because I was the lowest hanging fruit. I was easy. She was on a rung of the social ladder even below me. Ever since ninth grade she was labelled the class whore. She slept with half of the varsity football team, but once the rest of the school found out, she suddenly became damaged goods. She sat with me at lunch on the first day of school this year, and I knew full well why she did. It was because no one else would have her at their table. But then she started to talk to me. It was only polite chit-chat at first, but after awhile she started to confide in me. She told me about her father, and how he had molested her. She held nothing back, because she knew I had no one to tell. She started to talk about her thoughts on her sexual habits. She said she wanted to exert her power over a man, and sex was her way of doing that. If she could control men through sex, she had power, something her father wielded against her as a child. I didn’t ask for any of this; I was just a receptacle. I was just a shoulder to cry on, a diary page. But I’d be lying if I said I wasn’t attracted to her. There was always the thought in the back of my mind, the niggling little fear that she would try to take advantage of me, but part of me wanted her to. Soon I began to tell her things about me. I told her about how my dad went missing five years ago, and about my mom who doesn’t want me around. It was nothing compared to the shit she talked to me about, but it was all I wanted to tell her. This went on for about a month, until I turned sixteen a few weeks ago. The day I did was when I dropped out of school. No holds barred, effective immediately, gone. I was no longer a student. I only regretted not seeing Gabrielle again. I decided to try and meet with her at lunch. Last week I waited outside the cafeteria and waited for her to take her usual spot. She looked so alone without me there, so sad. I felt like she really missed me. Then I started to think about how she looked, how she was dressed. She was a doughier girl, but she was still quite attractive. She was wearing tight jeans with sneakers, and a powder blue blouse. Her hair was in an offset ponytail, and a little bow rested itself near her left temple. I’ve never wanted anyone the way I wanted her at that moment. I started thinking about how badly I wanted to have sex with her. I envied the guys on the football team who had their turn with her. I thought all these despicable things about her and me. But I then thought of something I am ashamed of now.” He was silent after this.
Hören, who had been writing furiously, looked up from his book and analyzed his patient’s body language. Eric was slumped, hands clenched in fists on the windowsill. It wasn’t until now that Hören realized just how very tall his patient was. Even slouched the way he was, Eric had about a head and a half on Hören, putting Eric at about six foot three. He was also quite well built, but in his pathetic position he looked so weak and helpless. His pajama pants could not hide his shaking knees; it looked as if he were about to collapse. Hören asked, “What did you think of?”
Eric stood up straight. “I thought about how lucky her father was.” He made a motion as if he was going to punch the windowsill, but stopped his fist just before it hit, and instead punched it lightly. He started to cry audibly now, and his other fist found its way to his mouth and he began to bite his knuckles. Hören was unsure what to do. Touching patients is strictly off limits, so Hören had to stifle the urge to go pat Eric’s back. He instead waited for the sobbing fit to subside. He asked, “And that’s why you want to kill yourself? Because you’re ashamed of your sexual urges?”
“No. It’s what she did after I thought that.”
“What did she do?”
“She… She stood up… turned to m-… me… and shouted… ‘You fucking freak! Get the fuck away from me you fucking freak!’ The whole cafeteria fell silent, and everyone’s attention turned to the back of the room; to the door where I stood looking in, and the girl who had cussed me out. I hadn’t said a word, yet she knew I was there, and what’s more knew what I was thinking. She knew what I was thinking!” Eric returned his knuckles to his teeth.
Hören did not know where to go from there. He wrote in his book, “Delusion is cause of suicidal ideations. Believed Gabrielle could hear his thoughts, and this is why she left him. Validity of the statement is questionable due to Eric’s emotional state. Must get to the cause of delusion.” But this was enough. It didn’t matter if Hören believed Eric’s story or not, what mattered was he had a diagnosis. Eric was a paranoid schizophrenic, suffering from severe depression because of his delusions. The next step was up to Dr. Phillips. Still, Hören decided to press on. He asked, “So she heard your thoughts?”
“How can you be sure? Are you sure you maybe had not told her you felt strongly attracted to her beforehand, and when she saw you she reacted poorly? Maybe she did not know how to take it when you first told her.”
“Where is this first time telling her coming from, Doctor? When did I say that? That was the first time I thought about her that way. Don’t put words in my mouth.” Then he straightened up, turned from the window, and raised his voice to a yell. “I get it now. You think I’m lying. You think I’m lying because you don’t believe other people can hear my thoughts, don’t you? You think I’m delusional. You think there is no way she could have heard my thoughts, so she was just reacting to something I told her before that day. Fuck you! I know what happened. I know what fucking happened!” At this the guard came in and walked towards Eric.
“Don’t you fucking touch me! Don’t come near me! Get him out of here!” At this he pointed at Dr. Hören. The guard came over and grabbed Eric by the shoulders. A nurse rushed in the room with restraints. The guard was trying to get Eric on the bed, but Eric was fighting with him, all the time shouting, “You fucking liar! Gabrielle heard what I thought that day, and you know what else? You heard what I thought today! I thought everything I said to you, you fucker! And you said you couldn’t hear my thoughts. You fucking liar!”
Soon the shouts turned to sobs, and Hören was ushered out of the room. He walked with another guard to his office, and met with Dr. Phillips there.
“So what was all that about?”
“Oh nothing. That was just my patient. He got a little upset when he thought I was trying to put words in his mouth. He thinks people can hear his thoughts.”
“Oh yeah, the schizophrenic. You did confirm that’s what’s wrong with him right?”
“Yes, as well as severe depression resulting from his delusion. I don’t know how you would go about treating that.”
“Well, we’ll first start him on some Zoloft. We’ll let his outpatient Doc worry about the schizophrenia. We’re only treating him one more day. You got the diagnosis; your part is over.”
“True.” Hören looked down at the tiles, and folded his hands.
“What’s wrong? He was your first patient. He was a little more crazy than you might have bargained for, but look at it this way. The next one should be cake compared to that. We get a bunch of people each week who just feel a little mopey. Quick, easy diagnosis, and out they go. Here’s a three month supply of happy pills, and you’re done. You get more of those than you do ‘Erics’.” With this, he turned back to his computer.
Hören, looked at the back of Dr. Phillips’ head with disgust. “Is that what St. Peter’s is?” he thought. “We’re just a holding pattern? We take these broken people, write them some prescription, and send them off without following up with them?” He got up and decided to go walk the hall.
He passed the doors with different names on the plates. DECKER, MALKE, JONES, PETULANTE. All just names to Dr. Phillips; all problems that can be sent away with his ledger. He reached the end of the hall where Eric’s room was, and the guard and nurse had just finished subduing him. She said he was tied down securely, and a sedative was going to work on him, but it was still not a good idea to go in the room. He could watch through the window however. The two left the doctor alone, and walked down the hall.
Hören approached the window, and looked in at his first patient. Four simple looking knots tied his arms and legs to the bed, and he was slowly rolling his head back and forth on his pillow. It was such a pitiful sight. This young man had his whole life in front of him, and now any sense of normalcy had slipped away. He will be in and out of hospitals most likely, if the rest were anything like St. Peters, and he’ll be on pills for his schizophrenia forever. He looked down at his shoes, and shuffled his feet as he thought about the wreck on the other side of the glass. Then, seemingly from nowhere, he heard a voice. He turned up and looked down the hall to see if the guard had called him, but the guard had just turned the corner and out of sight. Again, he heard the voice. It was a familiar voice; in fact it was Eric’s voice. It said, “Why are you still here?” Hören slowly turned his head to the window, and his eyes met with Eric’s. Eric sat up as far as he could, his eyes widened, and he began to scream.
Alex Sanna is an English Education major at Towson University. He can often be found sitting on a bench with a cup of coffee, a good book, or sometimes just sitting with his thoughts in place of the book. A lover of philosophy and literature, he enjoys thought for the mental exercise, great ability to kill time, and cheap cost.