Nonimportant's story written by David. His outline is here.
It was the fifth time Friedrich Howard checked that gate. He wanted to make sure it was completely locked, as he did not want Igor to be able to escape and threaten his life. Dr. Howard knew how dangerous Igor could be. He was declared insane, though Howard suspected that maybe it was done to avoid him being thrown in jail when he was found guilty of a murder. Igor was a rich person and it could have been that he had bribed the court to ameliorate the punishment. He was sent to the Laplanche Von Kali Asylum, ruled by Friedrich Howard. Howard was one of the founding members and also the Psychiatry Chief since the former had gone insane. The psychiatrist before him had became mentally ill too, schizophrenic. That was a difficult job and some people could not stand it, the doctor thought.
Doctor Howard was checking Igor's file. He had been treated by the two former Psychiatry Chiefs, the ones who were now insane. There was something very unusual to this individual. Strangely, everybody around him had gone insane. It could be just a coincidence, but something inside Howard told him that it was not. Anyway, Howard did not trust his intuition. He believed in testable hypothesis, not just feelings about something. Howard had been trained in the scientific method and he applied it to everything he could. He came back to his private office, after leaving the files’ room. He locked it again only to remember that he had to call his assistant, Anselmo Guiverra, who was from Portuguese or Brazilian origin, he could not remember. Howard and everybody preferred to call him just Acey. The doctor picked up the phone, slowly.
"Hello?" said Acey on the phone, almost instantaneously. He always picked up the phone at the first tone, sometimes it seemed that he did it even before.
"Hello. Acey, could you come here right now, please?. I need to tell you something..." asked Dr. Howard.
"OK. I will go immediately" answered Acey.
Acey was Howard’s assistant. The doctor had hired him three months ago, but he could not be very fond of him yet. Howard was not very fond of anyone, though. There was something about that guy he could not explain, something mysterious or mystical. He had the feeling of being studied deeply while Acey was present. It was another of his “intuitions” but it was a very strong feeling. Maybe, it was some kind of arrogance Acey was trying to hide or some superiority he indeed had or thought he had. The doctor was not sure at all. He had checked his file several times only to find the same: A normal existence and a completely clean record. The worst thing is that no one knew very much about him. He came out of nowhere with his excellent Curriculum Vitae on his hand. Howard hired him because of his long time as a psychiatrist and medical assistant.
Acey did not apparently have any family and, the strangest thing, he had no girlfriend. It was not THAT strange, Howard thought, but he knew very few alone people. Anyway, Howard was sure he could never find out anything about Acey without his permission. Friedrich had tried to talk and even to analyze him but Acey always refused. He would not open his mind or his feelings to anyone. He put a block, mental block if that could exist, between him and the rest of humanity. Maybe that was the reason why he had no girlfriend. Perhaps he did not want anyone to intimate with him on any way. Howard associated him to a spy from a thriller story or something like that. But maybe he was just a little paranoid and that was all to it. The doctor considered that, as Acey had no family, maybe he had lost them on an accident or something like that, and the trauma caused by their deaths were the cause of his depression and paranoia. Obviously Acey would never confess such a thing. When the doctor was thinking about that matter, Acey knocked the door with the agreed code: 3 hard knocks, rest, 1 knock, rest then 2 soft ones, very much like the first tones of The Fifth Symphony of Beethoven. Howard loved Beethoven’s music.
"I am here, doctor" he said behind the door.
"OK" the doctor answered and stood up to open the door.
As soon as the doctor opened it he felt a headache. It was very common in him those days, he just stood up and felt that horrible pain. Then he heard a buzz and after a few seconds the pain was gone.
"Do you need me?" Acey asked, like in a hurry. Acey was always running and his mind too. He thought too fast and was nearly maniac, according to Howard. He had diagnosed him a maniac-depression disorder or ‘‘bipolar disorder’’, as current psychology called it. But everything was still conjectures.
"Yes. I want to talk about this patient, er, I mean... what's his name, oh, yes, it is I..."
"Igor" Acey completed, in a breeze.
"Yes, that man. I suppose I am getting old. I have checked the man's file and I have found some bizarre coincidences".
"What have you found about him?" asked Acey.
"Five people have treated him. The first two of them reached a point of no return. They did not want to know anything else about psychiatry, in spite of having dedicated many years to work on the profession. The third doctor who treated him simply fled the country without telling anyone. Some people say that he had stolen some money or that he had a lot of debts".
"Did you know that?" the doctor asked.
"No. I am just saying that I understand" Acey answered.
"OK. You could not know it, anyway, as I am the only one who has Igor's file. And the other two were declared insane. After that, I took the case. And I am starting to feel these headaches..."
"It does not have anything to do with Igor, it would be absurd” Acey said, disrespectfully. “Headaches are normal when people work more than they should, as you do. I think that the main problem is Igor himself. He makes people very angry due to his vulgarity and aggressiveness. I would have hit him several times, with pleasure, if I was allowed to do that, I confess. That patient is the worst I have ever known and I have worked on this my whole life".
"Yes, I know. I think you have seen more patients than me and I have worked for 30 years".
"Not that much. But he is completely annoying. I sometimes wonder if it would not have been better if he had gone to jail for his crimes. I think it is a little unfair for the victims..."
"We are not judges, we are scientists” Howard said. “I am not sure. But if I could cure him, that would be a great achievement for us and for him. The point is... It sounds strange on a man like me, but I do not know what to do now. I have tried several treatments with him: psychoanalysis, cognitive approach, Gestalt and behaviorism. I have even tried electric shocks on him, besides it is not usual to use them these days. And he has not responded to any of those treatments. I am not sure what I should do. I am thinking to transfer him to another asylum. Maybe more experienced people or younger doctors could help. I am tired of him. It is beyond science, it is just my feelings, by that is my decision. He may be incurable, as a killer is".
"He is a killer” Acey said, in a bad mood. “He killed two people. Merciless. Nevertheless, you are right, I think. I am tired of him, too. We cannot keep him for long time here. The people who sued him would expect to see results, I don’t know about that, but maybe they would reopen the case."
“You are right, my friend” the doctor said. “Besides the coincidences and how dangerous he can be, I am also worried by his disease. He has been diagnosed of psychopathy, you know, a chronic immoral and antisocial behavior. As such, that disorder has been the most studied to date. But it does not mean we can cure him, easily. On history, people believed that psychopaths were possessed by demons or had a pact with him. We know now those are superstitious theories, but people may still believe it into his minds. Some scholars have indicated that this kind of patients tends to be rational, I mean, they are conscious of their irrational deeds but that is no reason at all to change them”.
“Just like Igor acts” Acey added. “That is a complete description of his personality”.
“Almost” Howard said, with caution. “As psychologists have discovered, these patients do not respond to treatments like correction in jails or standard psychological treatment. They can anticipate their own failure and can predict the punishment they will receive, and they do not fear it. They also suffer from avolition, that is, they are defective in affect. They do not disconnect from reality as psychotics do. They are two different diseases. You must be thinking why I am saying this to you. The point I am trying to make is that I am organizing my thoughts about him. And I want to find a way to treat him properly”.
“I understand it” Acey answered. “Please continue”.
“Fine” the doctor said. I have reviewed the diagnosis criteria for psychopaths and I have found that he fulfills Factor1: Aggressive narcissism, and Factor2: Socially deviant lifestyle. On the first factor, he has the lack of remorse, being cunning, being a pathological liar and a big sense of self-worth, among others. On the second factor, he has parasitic life style (before entering this asylum), irresponsibility, impulsivity, delinquency among others too”.
“Yes, I think the same” Acey said. “He fills both factors completely”.
“Yes. The bad part about that is that most psychologists consider this disease has no treatment at all; it is incurable on most cases. If they are criminals as our patient, in other countries they just go to jail like everyone else. They are also dangerous, because as they are smart they lie and betray anyone in order to achieve their goals. They are expert manipulators of people.”
“As he is” Acey completed.
“Yes” the doctor said. “Another important characteristic of psychopathy is that they are not psychotic, I mean, they do not usually have any type of hallucinations or irrational thought. They do not have neurotic manifestations. Some patients have an external charm”.
“Igor does not have it” Acey commented.
“Not at all. Also they have great poverty on affective behavior, no remorse, they are big liars, complete lack of learning from errors and irresponsibility in relationships. Another factor that can be present is the symptoms of the antisocial disorder. Igor is highly antisocial, he shows no empathy and cannot understand the feeling of others”.
“You are right.” Acey said.
“And most psychopaths”, Howard continued, “…as I said, are expert liars. Lies are their instrument of work in manipulating people. They can lie while looking at a person directly to the eyes”.
“He has tricked most of the nurses on this asylum” Acey added. “Some of them even feel pity for him. And they even know that he has killed people”.
“They also have a relative sense of good and evil” Howard said. “If you ask him why he did such a bad thing, he may answer that good is relative and that no one holds the truth. Nobody can say what is normal, according to the psychopath. Moreover, they can manipulate people by finding out their irrational motives. That is why they often are good sellers. They find the hidden motives of the buyer”.
“Yes, they predate other humans for their own good” Acey commented.
“And they can be very dangerous” Howard indicated. “They never accept a responsibility. When they get frustrated or they fail to do something, they simply say “they made me fail…”, that is, they never understand their own guilt. They blame on everyone, be it their parents, the law, the country, etc. Besides, they see and treat other people as though they were stuff, things, not humans. Besides that, for a psychopath, the law is just an obstacle between him and his goals”.
“Exactly” Acey completed. “Igor sees everyone as things, moreover, as if people were his inventions or own dreams. He tried to hit a nurse because he did not like her and he wanted to get rid of her as soon as possible. Fortunately, I was there and I could stop him. He never showed any remorse for his action”.
“Yes, he is a psychopath” Howard concluded. “I think he fills the entire profile of a psychopath, as if the definition was created for him”.
“But there must be something we can do for him” Acey said. “Science must have discovered an effective treatment. What about psychoanalysis?”
“Kernberg analyzed psychopathy deeply” the doctor answered. “He says the first thing to do when treating a psychopath is to differentiate between psychopathy and antisocial personality. And to differentiate between antisocial personality and criminality. Antisocial personality can be defined by psychiatry and criminality is a legal concern. There are psychopaths who fill the three aspects depicted before, like Igor, but there are others who do not”.
“And what else does psychoanalysis say about antisocial disorders?” Acey asked.
“Kernberg says antisocial disorders have to do with narcissistic personality. There is excessive self-reference, grandiosity, exhibitionism, dependence on admiration by others, emotional lack of expression. Also, they suffer from great envy and total lack of empathy to others. And the super ego of psychopaths is affected too, because it is unable to feel depression, suffer great spirits changes. The patient fears to be caught doing bad things, they do not have an internal moral. He has also childish values. He tries to mutilate others or to self-mutilate, that is the malign narcissism. And the antisocial main part has to do with small aspects and crimes, also: pathological lying (not a crime), to steal, to falsify, to murder”.
“A criminal with mental problems” Acey said.
“Yes, something like that”.
“I would like to suggest something...” Acey said.
"What? Say it, please, that is why I called you" the doctor said.
When Acey was going to answer they both heard screams coming from the patients' rooms. They sounded like they were beating someone. Screams of pain and of brutal happiness were heard. They both were afraid. Acey checked if he still had his gun on his pocket, but the doctor did not see him, fortunately. Doctor Howard hid under his desk.
“What do we do?” asked Howard, very frightened.
“We cannot stay here for a long time” answered Acey in a low voice. “We will have to open the door and see what has happened”.
“I will call security” said Howard.
“I think security is outside. I have recognized some of the voices. Don’t worry, I will cover you”.
“And if they hit us? Maybe they are armed”
“Trust me…” said Acey.
The doctor had to trust his assistant. Howard never trusted someone who said “Trust me” but Acey inspired admiration. He did not seem to be afraid. Thirty seconds later, seconds that passed like a year to Howard, Acey started to open the door, slowly, preparing for the worst.