I smiled at him. His eyes grew wide, and I was suddenly back in time to our sessions at Somers. Sessions I had to terminate because of the boundaries he would not respect. And the boundaries I had foolishly allowed to be crossed in my efforts to help him.
“Glenn, I should have come sooner. I know that. I was informed that you stopped seeing Dr. Westcott. I ran into him at the prison last week, and he told me things didn’t go well once you got out. Do you want to tell me what happened?” All of that was true. Once boundaries have been breached, they cannot be rebuilt. They are not walls made of plaster or brick. They exist in the mind, like words that cannot be unsaid. I had asked that Glenn be reassigned to another volunteer therapist, Dr. Daniel Westcott, and upon Glenn’s release, Westcott had agreed to continue his therapy. It was more supervision than treatment, making sure he was not allowing himself to become too obsessed with someone. Making sure he didn’t lose control again.
Glenn looked at the floor and shrugged. It wasn’t the same.
“What do you mean? He’s an excellent doctor. And his practice is right here, in Cranston.”
You know the answer, Alan.
I felt a shudder travel down my spine; my hair stood on edge. In the months that followed the transfer of Glenn’s treatment from me to Dr. Westcott, I began receiving letters from Glenn at my home. I do not know how he obtained my address or knew the names of my wife and children. I informed Dr. Westcott and the prison officials. Glenn was made to stop, and I believed that perhaps I had dodged a bullet.
Patients with borderline personality disorder are far more likely to form unhealthy attachments to their therapists than other patients. There are numbers for the increased likelihood as high as 40 percent. The numbers don’t matter so much as the certainty that it is true. Part of our training is to maintain strict boundaries. But as I have already confessed, my training proved inadequate when I first encountered Glenn Shelby. Boundaries were crossed, an obsessive attachment was formed, and a period of stalking followed—one that was, mercifully, snuffed out by the fear of solitary confinement and possibly new charges that would have kept Glenn in prison.
As an aside, this is a perfect case study to disprove the notion that no patient with an Axis II disorder can be effectively treated. The milder forms are in fact treatable, using the very basic techniques of carrots and sticks. These patients can and do curb their behavior to get rewards and avoid punishment.
They can be treated. But they cannot be cured. Once the carrots and sticks are removed, their behavior invariably returns. I never received another letter from Glenn, even after he was released from prison. But I had come to learn that the letters were not the end of his efforts to feel close to me. I came to see him this day to make it stop.
Our conversation continued for about an hour. Then I left and went home.
One week later, Glenn was found hanging from his ceiling.
When I heard the news, I would remember the things in his apartment I saw that day—things that caught my eye for one reason or another but did not give rise to any concern. They were entirely benign. The jump rope in the corner of the room, coiled up like a snake. The step stool in the kitchen. And the metal pull-up bar that had been installed into the ceiling near the bathroom door. The ceilings were quite high—eight feet, perhaps. I can close my eyes even now and picture him swinging from it, the white stool lying on its side just past the reach of his toes. The rope tied nice and short so his feet would not reach the floor. Naked except for a pair of blue briefs. I do not like to dwell on this. Perhaps I do because it was not just an average failure, the way that most people experience failure in their professions. My failure, this failure, ended with the horrific image I have just placed into your head, the same image I live with every day. It is always there, reminding me that even I cannot cure every patient.
I left Glenn alive, shaking but otherwise functional. I drove back to the office, saw another patient, then went home to my family.
The next day I got a call from Detective Parsons. It was a call I had been expecting. Remember, I was functioning at my very best again, clearheaded, precise. I could see the future. I could see it because I was controlling it. My puppets on their strings. The sticks in my hand.
You were right, Alan. About the alibi. It’s all fucking crap!
“I’m sorry. I really am.” I was not.
How did you know? Are you gonna tell me? What else are you hiding?
“I can’t tell you. I’ve explained about—”
Yeah, your sacred patient confidentiality. Honest to God, Alan. Sometimes I think you’re screwing with my head.
“It’s quite normal to want to shoot the messenger. I’m not offended. Nor did I create that assault record from Florida or lie about an alibi. All of this is real. I had no part in its making.”