Gene Brewer - K-PAX

St. Martin's Paperbacks ISBN: 0312977026

When we successfully treat a patient ... we experience a burst of joy because we have helped a suffering person who is happy to have known us. But we also feel a secret joy, because we have come to know him, and in knowing him we know more of ourselves.

-SYLVANO ARIETI

IN April, 1990, I received a call from Dr. William Siegel at the Long Island Psychiatric Hospital. Bill is an old friend of mine, and a distinguished colleague. On this particular occasion the call was a professional one.

Bill was treating a patient who had been at the hospital for several months. The patient, a white male in his early thirties, had been picked up by the New York City; police after being found bending over a mugging victim in the Port Authority Bus Terminal in midtown Manhattan. According to their report his answers to routine questions were "daffy" and, after they booked him, he was taken to Bellevue Hospital for evaluation.

Although he was somewhat emaciated, medical examination revealed no organic abnormality, nor was there evidence of formal thought disorder, aphasia, or auditory hallucination, and he presented a near-normal affect. However, he did harbor a rather bizarre delusion: He believed he came from another planet. After a few days' observation he was transferred to Long Island, where he remained for the next four months.

Bill was unable to do much for him. Although he remained alert and cooperative throughout the various courses of treatment, the patient was completely unresponsive to the most powerful antipsychotic drugs. At the end of it all he remained firmly convinced that he was a visitor from "K-PAX." What was worse, he was able to enlist many of his fellow patients to this fantasy. Even some of the staff were beginning to listen to him! Knowing that the phenomenology of delusion has long been an interest of mine, Bill asked me to take a crack at him.

It couldn't have come at a worse time. As acting director of the Manhattan Psychiatric Institute I was already swamped with more work than I could handle and, indeed, had been phasing out patient interaction since January of that year. However, the case sounded both interesting and unusual, and I owed Bill a couple of favors. I asked him to send me a copy of the man's file.

When it arrived I was still bogged down by administrative duties, and a few more days went by before I found it lying on my desk under a pile of personnel and budget folders. With renewed dismay over the prospect of another patient I quickly read through the chart. It summarized a puzzling history indeed. Although our "spaceman" was quite lucid and articulate, and demonstrated a strong awareness of time and place, he was unable to provide any reliable information as to his actual origin and background. In short, he was not only delusional, but a total amnesiac as well! I called Bill and asked him to make arrangements for the transfer of this nameless man, who called himself "prot" not capitalized-to my own institution.

He arrived the first week in May, and a preliminary session with him was scheduled for the ninth, a Wednesday, at the time I usually set aside to prepare for my regular "Principles of Psychiatry" lecture at Columbia University. We met at weekly intervals for several months thereafter. During that period I developed an extraordinary fondness and regard for this patient, as the following narrative, I trust, will show.

Although the results of these sessions have been reported in the scientific literature, I am writing this personal account not only because I think it might be of interest to the general public but also, to paraphrase Dr. Arieti, because of what he taught me about myself.

MY First impression, when he was brought into my examining room, was that he was an athlete-a football player or wrestler. He was a little below average in height, stocky, dark, perhaps even swarthy. His hair was thick and coal-black. He was wearing sky-blue corduroy pants, a denim shirt, and canvas shoes. I didn't see his eyes for the first few encounters; despite the relatively soft lighting, he always wore dark glasses.

I asked him to be seated. Without a word he proceeded to the black vinyl chair and plopped down. His demeanor was calm and his step agile and well coordinated. He seemed relaxed. I dismessed the orderlies.

I opened his folder and jotted the date on a clean yellow pad. He watched me quite intently, envincing a hint of a smile. I asked him whether he was comfortable or needed anything. To my surprise he requested an apple. His voice was soft but clear, with no detectable regionale or foreign accent. I buzzed our head nurse, Betty McAllister, and asked her to see if there were any available in the hospital kitchens.

While we waited I reviewed his medical record: Temperature, pulse, blood pressure, EKG, and blood values were all within the normal range, according to our chief clinic physician, Dr. Chakraborty. No dental problems. Neurological exam (muscle strength, coordination, reflexes, tone) normal. Left/right discrimination normal. No problem with visual acuity, hearing, sensing hot or cold or a light touch, handling platonic solids, describing pictures, copying figures. No difficulty in solving complex problems and puzzles. The patient was quick-witted, observant, and logical. Except for his peculiar delusion and total amnesia, he was as healthy as a horse.

Betty came in with two large apples. She glanced at me for approval and, when I nodded, offered them to the patient. He took them from the little tray. "Red Delicious!" he exclaimed. "My favorite!" After offering us a taste, which we declined, he took a large, noisy bite. I dismissed my assistant and watched as "prot" devoured the fruit. I had never seen anyone enjoy anything more. He ate every bit of both apples, including the seeds. When he had finished, he said, "Thanks and thanks," and waited for me to begin, his hands on his knees like a little boy's.

Although psychiatric interviews are not normally recorded, we do so routinely at MPI for research and teaching purposes. What follows is a transcript of that first session, interspersed with occasional observations on my part. As usual during initial interviews I planned simply to chat with the man, get to know him, gain his trust.

"Will you tell me your name, please?"

"Yes." Evidence for a sense of humor?

"What is your name?"

"My name is prot." He pronounced it to rhyme with "goat," not "hot."

"Is that your first name or your last?"

"That is all of my name. I am prot."

"Do you know where you are, Mr. prot?"

"Just prot. Yes, of course. I am in the manhattan psychiatric institute."

I discovered in due course that prot tended to capitalize the names of planets, stars, etc., but not those of persons, institutions, even countries. For the sake of consistency, and to better depict the character of my patient, I have adopted that convention throughout this report.

"Good. Do you know who I am?"

"You look like a psychiatrist."

"That's right. I'm Doctor Brewer. What day is it?"

"Ah. You're the acting director. Wednesday."

"Uh-huh. What year?"

"1990."

"How many fingers am I holding up?"

"Very good. Now, Mr.-excuse me-prot: Do you know why you are here?"

"Of course. You think I'm crazy."

"I prefer to use the term `ill.' Do you think you are ill?"

"A little homesick, perhaps."

"And where is `home'?"

"K-PAX. "

"Kaypacks?"

"Kay-hyphen-pee-ay-ex. K-PAX."

"With a capital kay?"

"It is all capitals."

"Oh. K-PAX. Is that an island?"

He smiled at this, apparently realizing I already knew he believed himself to be from another world. But he said, simply, "K-PAX is a PLANET." Then: "But don't worry I'm not going to leap out of your chest."