The Sociopath Next Door (11 page)

From the lawn, Jackie Rubenstein looks up and notices Doreen in the office window. She waves. Doreen smiles girlishly and waves back.

At this moment, Ivy buzzes Doreen for her first patient of the day, a stunningly handsome, broad-shouldered, but very frightened-looking young man named Dennis. In hospital lingo, Dennis is a VIP (very important patient), because he is the nephew of a famous national politician. In this major teaching hospital, there are a number of such VIPs, celebrities, the wealthy, family members of people whose names are household words. Dennis is not one of Doreen's psychotherapy patients. Rather, Doreen is his administrator, which means that she meets with him twice a week to inquire how his treatment is going, to make sure the paperwork is done, and to approve his discharge from the hospital when the time comes. Doreen has already heard from the staff that today Dennis will want to discuss his release. He thinks he has gotten better enough to go home.

To separate the administrative tasks from the psychotherapeutic ones is hospital policy. Each patient has both an administrator and a therapist. Dennis's therapist, whom he worships, is the talented Dr. Jackie Rubenstein. Yesterday, Jackie told Doreen that her patient Dennis was tremendously improved, and that she plans to take him on as an outpatient when he leaves the hospital.

Now Dennis sits in one of the low chairs in Doreen Littlefield's office and tries to make eye contact, as he knows he should if he is going to appear well enough to go home from the hospital. But he has a hard time and keeps looking away. Something about her gray suit scares him, and something about her eyes. Still, he likes her, he thinks. She has always been extremely nice to him, and other people have told him that of all the doctors, Dr. Littlefield is the one who is most interested in the patients. Anyway, she is the expert.

Doreen, seated behind her desk, looks at Dennis and marvels again at the perfect lines of his face and his muscular twenty-six-year-old body. She wonders how much money he will end up inheriting. But then she remembers her mission, and tries to lock in his nervous gaze with a maternal smile.

“I hear you've been feeling much better this week, Dennis.”

“That's right, Dr. Littlefield. I've been feeling much better this week. Really, a whole lot better. My ideas are much better. They're not bothering me all the time like they were when I came in.”

“Why do you think that is, Dennis? Why do you think they're not bothering you anymore?”

“Oh, well, I've really been working hard on the cognitive therapy techniques Dr. Rubenstein taught me, you know? They're okay. I mean, they help. And . . . Well, the thing is, I think I'm ready to go home now. Or soon maybe? Dr. Rubenstein said she could keep seeing me as an outpatient.”

Dennis's “ideas,” the ones that are not bothering him so much at present, are the paranoid delusions that completely take over his life from time to time. Once a vibrant teenager who made stellar grades and was the champion of his high school lacrosse team, Dennis suffered a psychotic breakdown during his freshman year in college and was hospitalized. In the seven years since then, he has been in and out of psychiatric facilities as his delusions waxed and waned but never really left him. When these terrifying “ideas” have him in their grip, he believes that people are trying to kill him and lying about their intentions, that the streetlights are monitoring his thoughts for the CIA, that every passing car contains an agent who has been sent to abduct and question him for crimes that he cannot remember. His sense of reality is fragile in the extreme, and the torment of his suspiciousness, which is present even when the concrete delusions are in remission, makes it increasingly difficult for him to be around other people, even therapists. Jackie Rubenstein has done an almost miraculous job of forging a therapeutic relationship with this lonely young man who trusts no one.

“You say Dr. Rubenstein said you could be discharged, and that she'd see you as an outpatient?”

“Yes. Yes, that was what she suggested. I mean, she agreed that I was almost ready to go home.”

“Really?” Doreen looks at Dennis with a puzzled expression on her face, as if expecting some clarification. “That's not what she told me.”

There is a long pause, during which Dennis shudders visibly. Finally, he asks, “What do you mean?”

Doreen emits a stage sigh, full of compassion, and comes out from behind her desk to sit in the chair beside Dennis's. She tries to put her hand on his shoulder, but he pulls his body away from her, as if she were about to strike him. Staring out the window as far into the distance as he can, he repeats his question, “What do you mean that's not what she told you?”

Doreen understands enough about paranoid schizophrenia to know that Dennis already suspects this is going to be news of treachery on the part of Dr. Rubenstein, the person he thought was his only real friend in the world.

“What Dr. Rubenstein told me was that she was sure you were much sicker now than when you came in. And as for outpatient therapy, she made it very clear that she'd never agree to see you outside of the hospital. She said you were much too dangerous.”

Even to Doreen, it is apparent that something in Dennis's heart is flying out of the window and away, not to return to him anytime soon. She says, “Dennis? Dennis, are you okay?”

Dennis does not move or speak.

She tries again. “I'm so sorry I had to be the one to tell you this. Dennis? I'm sure it was just a misunderstanding. You know Dr. Rubenstein would never lie to you.”

But Dennis is silent. He has to cope with the fear of betrayal every minute of his life, but this huge new wave of it, coming from his wonderful Dr. Rubenstein, has blindsided him and made him stone-still, like a statue.

When Doreen realizes that he really is not going to respond at all, she goes to the phone and calls for assistance. In no time, two burly mental health workers appear at her office door. They are big, but she is the authority, and they will obey her orders without question. Thinking this gives her a little shiver of pleasure, but wearing her gravest expression, she signs the order to board Dennis. “Boarding”—a euphemism that makes it sound like the hospital is putting someone up at an inn—means that a patient is transferred from an unlocked ward, such as the one Dennis has been in, to a locked unit with greater security. Patients are boarded if they become violent, or when, like Dennis, they have had a serious relapse. If necessary, they are restrained and remedicated.

Doreen is fairly certain that Dennis will not tell anyone about what she has just said to him. Dennis does not tell his secrets. He is too paranoid. But even if he does tell someone, he will not be believed. No one ever believes the patients over the doctors. And from what she just saw, he will be out of it for quite a long time, and not really talking about anything. With a rush of satisfaction, she realizes that Jackie Rubenstein has just lost herself one truly delectable VIP patient. He will be wildly paranoid about Jackie now, and the best part is that Jackie will blame herself, will think she missed something important in her therapy with him, or said something harmful. Jackie is such a loser about things like that. She will actually take the rap, and then she will hand the patient off to another therapist. So much for all the talk around the hospital about Dr. Rubenstein being a miracle worker.

Blue Smoke and Mirrors

Doreen Littlefield is what personality theorist Theodore Millon would call a “covetous psychopath,” where “psychopath” refers to sociopathy, or the absence of conscience, and “covetous” has its usual referent: an inordinate desire for the possessions of others. Sociopaths do not always have a covetous nature—some are very differently motivated—but when lack of conscience and covetousness occur together in the same individual, a fascinating and frightening picture emerges. Since it is simply not possible to steal and have for oneself the most valuable “possessions” of another person—beauty, intelligence, success, a strong character—the covetous sociopath settles for besmirching or damaging enviable qualities in others so that they will not have them, either, or at least not be able to enjoy them so much. As Millon says, “Here, the pleasure lies in taking rather than in having.”

The covetous sociopath thinks that life has cheated her somehow, has not given her nearly the same bounty as other people, and so she must even the existential score by robbing people, by secretly causing destruction in other lives. She believes she has been slighted by nature, circumstances, and destiny, and that diminishing other people is her only means of being powerful. Retribution, usually against people who have no idea that they have been targeted, is the most important activity in the covetous sociopath's life, her highest priority.

Since this clandestine power game is priority number one, all of the covetous sociopath's deceitfulness and tolerance for risk are devoted to it. For the sake of the game, she may devise schemes and perform acts that most of us would consider outrageous and potentially self-destructive, in addition to cruel. And yet when such a person is around us in our lives, even on a daily basis, we are often oblivious to her activities. We do not expect to see a person direct a dangerous, vicious vendetta against someone who in most cases has done nothing to hurt or offend her. We do not expect it, and so we do not see it, even when it happens to someone we know—or to us personally. The actions taken by the covetous sociopath are often so outlandish, and so gratuitously mean, that we refuse to believe they were intentional, or even that they happened at all. In this way, her true nature is usually invisible to the group. She can easily hide in plain sight, as Doreen has done among genuinely intelligent, professional people at the hospital for nearly a decade.

The covetous sociopath is the ultimate wolf in sheep's clothing, and in Doreen's case, the disguise is especially elaborate. Doreen is a psychologist, or, at any rate, everyone at the hospital believes she is a psychologist, which for Doreen Littlefield's purposes is much the same thing. The truth, should anyone ever discover it, is that she has no psychology license, nor does she have a doctoral degree. When she was twenty-two, she did receive a bachelor's degree in psychology from her state university back home, but that is all. The rest is an extravagant charade. When they hired her as a postdoc at the hospital, they checked her references, but these were both very prominent men who had succumbed to certain embarrassing liaisons with her, though they should have known better. The hiring committee did not check the credentials she listed. Because she came so prestigiously recommended, they simply assumed she had a Ph.D. After all, who on earth would lie about a thing like that? As for her ability to behave like a psychologist well enough to fool the professionals and the patients, Doreen has always felt, and apparently she is borne out in this opinion, that a person can learn a lot by reading books.

Doreen has just seen her recovering eight o'clock patient, drop-kicked him into an acutely paranoid state as retribution against an innocent colleague, and sent him off to be medicated and confined to a locked unit. What does she do for the remainder of the day? If we were to rejoin her in her office, we would find that she calmly meets with the rest of her scheduled patients, makes phone calls, does paperwork, and goes to a staff meeting. We would probably not see anything out of the ordinary. Most of her behavior would look normal to us, or close enough to pass. Perhaps she does not do her patients very much good, but she does them no obvious harm either, except in those instances, like this morning, when manipulating a patient will serve to damage a colleague she has targeted.

Why would she direct her skills against psychiatric inpatients? They have nothing she wants. They are disenfranchised by the world, and she can feel powerful merely by sitting in a room with them. The exception might be the occasional female patient who is a little too attractive or, worse, a little too smart. Then Doreen might have to bring her down a peg or two, tweak a bit of the self-hatred that is usually already there in these patients. In her role as a psychotherapist, she finds this ridiculously easy to do. The setup is always one-on-one, and the patient never understands what hit her well enough to complain to anyone outside of the therapy room.

But when people do not provoke in Doreen a desire for something they have, or for something they
are,
then she does not target them. To the contrary, she may be especially charming and courteous when she believes that certain underlings, as she thinks of them, are useful in maintaining her sheep's-clothing disguise, a disguise that includes a presentation of herself as an extraordinarily nice, caring, responsible, and pitiably overworked person. For example, when Doreen is preparing to leave work on the day she has secretly sabotaged Jackie Rubenstein and Dennis, she makes sure to stop by Ivy's desk for an endearing little chat. She tries to do this every evening. Ivy is the secretary-receptionist for the professionals on the ward, and one never knows when such a strategically placed person may come in handy.

Doreen comes out of her office, collapses into one of the reception room chairs, and says, “Oh Ivy! I'm so grateful this day is over!”

Ivy is twenty years older than Doreen. She is overweight and wears big plastic earrings. Doreen thinks she is pathetic.

Ivy replies to her warmly, “I know. You poor thing. And that poor Dennis! I'm no doctor, but I do see the patients around, you know, and I sort of had my hopes up. . . . I guess I was wrong.”

“No, no. You're very observant. He did seem better for a while. This work breaks your heart sometimes.”

Of course, this morning the two no-nonsense attendants carrying Dennis off the ward passed right in front of a wide-eyed Ivy. She now looks at Doreen with concern.

“You know, Dr. Littlefield, I worry about you.”

As Ivy makes this confession, she notices that Doreen's eyes are pooling with tears, and she continues in a lower voice, “Oh my, today was terrible for you, wasn't it, dear? I hope you won't think I'm getting too personal, but you're so sensitive to be doing this kind of work.”