Virtual Paradox
Dr. Steve Kamarsky reclined uncomfortably on the metal folding chair. He tried to project an aura of relaxed control, with one ankle resting on his other knee. His arms dangled freely on either side, as did the flaps of his sports jacket.
Facing him was a semi-circle of seated, fidgeting children ranging in age from ten to thirteen years. None of them looked happy. One of them looked particularly angry.
“Morgan,” Dr. Kamarsky said, “can you tell me what Sissy just said, in your own words?”
Twelve-year-old Morgan, his jeans falling off of him, his sweat shirt stained and torn, gripped the edges of his brown metal chair and slid half off the seat and back on again repeatedly. His face twisted into a snarl and his eyes glinted.
“Morgan, I’ve asked you to try and cooperate with the group….”
“You told me to shut up so I am!” Morgan shouted.
The girls on either side of Morgan, Sissy and Kendra, each leaned away from him in opposite directions. Sissy in particular became pale and began tapping one foot on the floor.
“Morgan, I told you to stop interrupting the other kids when they are speaking. Now, I’m asking you to contribute, and it’s your turn to answer.”
Dr. Kamarsky extended the remote control and pressed “pause.” The grainy image of himself talking to Morgan froze on the television monitor that sat at the head of the table. He gestured with the remote in his right hand, “There you see one of the many tricks used by the anti-social personality. A form of manipulation.”
Dr. Shawn Gilbert, psychiatrist and medical supervisor of Parkview Heights Hospital, sat opposite, drumming his fingers on the black Formica table. “I’m sure everyone present knows this,” he said.
Also sitting at the table, attending this medical staff meeting late in the afternoon, were pediatrician Dr. Marlene Bowen, charge nurse Anne Sowards, pediatric psychologist Cheryl Doheny and counselor Ivan Fierenza.
Dr. Kamarsky continued, “Exactly, we know too well the tricks and ploys of the ASP patient in group therapy. Once we accept that Morgan, a boy of twelve years, can be treated as having ASP and not conduct disorder, we can list the symptoms and observe his behavior; the lying, stealing, truancy, the refusal to accept responsibility and tendency to blame others for his troubles. The torture and killing of helpless animals. He demonstrates a complete lack of a conscience, full-blown narcissism, and the need to immediately gratify any desire, or remove any source of frustration. He has the potential for the deadly use of force. Anti-socials of any age have an air-tight inner world that is impervious to outsiders. They are highly resistant to external influence and therefore therapeutic intervention.”
“Dr. Kamarsky,” Marlene Bowen interrupted, “I was under the impression that we couldn’t diagnose a child under the age of eighteen years with any of the personality disorders….”
“There is some difference of opinion about that, and we here at Parkview Heights, in our juvenile residential and forensic juvenile detention programs, have begun to discuss our options,” Dr. Gilbert answered quickly.
“We watch these kids — abused or not themselves — become abusers. They grow up in therapy and are admitted to psych hospitals or outpatient programs over and over again, and they still move on to perpetrate greater crimes. We have tried every kind of treatment, and combination of treatments. Nothing works. We are dealing with weary and suffering families, Dr. Bowen….” Kamarsky paused.
No one spoke. This conference room on the sixth floor seemed quiet and comfortable, with the setting sun flickering through the mini-blinds, painting the yellow walls with lines of shadow and light. The smell of pungent coffee was pleasant, and the plates of doughnuts, cupcakes, and apple fritters placed at intervals down the center of the table gave this meeting a festive air.
Dr. Kamarsky raised the remote control once more, fast-forwarded the DVD. “What I’m about to show you is experimental. I designed this treatment modality using my skills in computer programming and software development, as well as my experience as a child psychiatrist. We met the legal requirements and have obtained the permissions needed.” He pushed the “play” button.
All heads turned to watch.
It was a compact and simple room with a Formica desk complex in the center. The whole was a bit smaller than adult size, to accommodate a preteen. A large computer screen dominated the middle desk section, but different kinds of gadgets and equipment lay beneath it where a keyboard would usually be.
“This is our virtual reality room,” Dr. Kamarsky said. He fast-forwarded a bit — the DVD resumed normal play. “And here is our observation room,” he explained.
They were now looking through a large glass window at the same desk and oversized LCD monitor they had been viewing directly a moment earlier. It was somewhat disorienting.
“It’s a one-way mirror, of course. We watch the boy, Morgan, from here,” Kamarsky said.
There was a flutter in the picture and abruptly they were looking through the hidden-camera again, and the small chamber was alight. Morgan was sitting at the desk. He had a vinyl head-piece on — something that looked like a cross between a gas-mask and a baseball cap with wires extending to three boxes on the desktop to the boy’s right. Immediately before him, lying almost flat, was a rectangular plastic surface that looked like an old Etch-a-Sketch toy, only much larger. Morgan was using a combination of hand motions and a pen-like object in his right hand, to stroke and wipe and push at the plastic. It was hard to see the LCD monitor, but clearly there were figures and shapes dancing around within it.
“We’ve been observing Morgan for one week now. He has a set schedule, and has had to control his behavior on the floor in order to earn time in this room. But for two hours in the morning and two hours after dinner, before bedtime, if the techs and the shift nurses agree Morgan has behaved in an acceptable manner, he has complete access to the VPI system. He has privacy as well. He is unaware, as far as we know, that we are watching him.”
Dr. Marlene Bowen shifted in her chair. She was breathing forcefully. “I’m waiting to be impressed,” she said.
Kamarsky glanced at her, displayed a smile that was almost a smirk, and said, “VPI is Virtual Paradoxical Intervention. It’s my invention, based on the work of Perls and his ‘paradoxical theory of change,’ and Viktor Frankl’s paradoxical intention technique. Dr. Perls believed that psychological change does not take place through coercion, or an attempt by one individual to impose their standards on another. Change occurs when a person tries to become ‘what he is,’ and not ‘what he is not.’ What good are the tools of the therapist — persuasion, helping the patient gain insight, reinterpretation and summation — in treating a patient with anti-social personality disorder?” He pushed something on the remote control once more.
The forty-inch HD television before them was suddenly filled with brilliant, rich colors and stark, dynamic representations of animals, objects, and people. The images were intense, and seemed to pulsate off the screen and bounce off the hard surfaces in the room.
“You see before you what Morgan sees, or one of the tableaux that he has available to him. This is a suburban neighborhood, replete with parked cars, kids playing, pets, trees, and the like.” Dr. Kamarsky pressed “play,” and abruptly the scene came alive. “And this is the beginning of one of Morgan’s action sequences from last Wednesday, two days after he started using the system.”
Kamarsky watched his colleagues, as they watched the screen. Reflections from the writhing and swirling presentation tinted their astonished, then increasingly appalled-looking faces. He glanced up just in time to see the torture, dismemberment and beheading of one of the little virtual girls that had been jumping an animated rope. He straightened in his seat, pushed the stop button. “And I’ve spared you the music, too. Morgan likes to choose his own musical score — he makes his own mix tapes. You would be amazed at how he can turn the most innocent songs into screams of sadomasochistic terror.”
Dr. Bowden stared at the frozen picture, her hands on either side of her face, her mouth agape. “You have got to be kidding me….”
“Viktor Frankl believed there was some therapeutic value in paradoxical intention — that is, the therapist encourages and promotes the patient to indulge in their symptoms, to act them out with even greater intensity,” Kamarsky said, looking across the table at her and smiling thinly. “And with a young anti-social like Morgan, what better way for him to act out his worst symptoms than with virtual reality?”
Ivan Fierenza shook his head. “I don’t know, Steve,” he said. “Hasn’t recent research shown the negative impact of violent video games on children? I believe it was proved that these games desensitize children to violence, and make them more aggressive, less able to handle real-life social situations.”
Kamarsky nearly stood in his place, but then settled back into his chair as he answered calmly. “None of those studies is conclusive. Most are flawed. But that is besides the point. I’m not here to promote or deny virtual reality therapy for the average child or teenager, but for those already displaying symptoms of conduct disorder or anti-social personality disorder. This could even be extended to all the personality disorders — none of which is easily treated by conventional means. What are you talking about, ‘desensitize children to violence’ — Morgan is already violent. He already has been caught torturing and killing small animals, and sexually abusing younger siblings and cousins and neighborhood children.”
Marlene Bowden spread her fingers out on the table in front of her. “Steve, just why did you ask me to attend this meeting? You have your legal permissions, and the family didn’t consult me.”
“You are the family’s doctor. We are consulting you, and Ivan the family therapist, and we would like your opinion,” he answered. “Anne, could you tell us about Morgan’s behavior on the floor for the last week?” he asked Anne Sowards, the charge nurse on the forensic juvenile detention floor.
“It’s like a miracle,” Mrs. Sowards answered. “Morgan has been compliant, and there have been no threats, threatening gestures, or explosive outbursts. We’ve had more trouble with Sissy, Jason, and Alyssa fighting, and Brandon’s anger-management, than with Morgan this week.”
“But to what end?” Dr. Bowden asked. “Where is this going? You let him use any scenario to carry out his wildest fancies? Aren’t you letting him practice for the real thing? For patients with ASP thinking and believing are the same as reality. Thought is action. Morgan already thinks he’s infallible, omnipotent, and everyone else is unimportant. Aren’t you supposed to be teaching Morgan to identify these distortions in his thinking, to accept responsibility for his actions? Are you now giving him complete approval and affirmation that his inner world is valid?”
“No,” Kamarsky said loudly. “You aren’t paying attention. Didn’t you hear Mrs. Sowards assessment of Morgan’s behavior? No pill can stop his con, his game. No therapy can give him a conscience or make him empathetic to the suffering of others. So we put him in a virtual world, where he can be who he is. Where he can be himself, and not hurt anyone. Here, let me show you….” He had been gripping the remote the entire time, and now he pushed “play” once more.
Dr. Bowden almost had to force herself to watch, as the digitalized figures in Morgan’s movie began moving to the side and backing away while a shadow approached from the viewer’s vantage point. The shadow grew larger and larger. Then there was a blur, like the back of a head moving too close to the camera. Then the blur advanced further into the picture and turned, came into focus. It was Morgan himself, several yards tall, dressed in some sort of khaki military uniform. He was facing his audience, his hands crossed over his medal-covered chest, his head slightly lowered. All the characters in his scenario were genuflecting at his feet. One simulated girl, who resembled Sissy, her clothing torn off and her breasts exposed, appeared to beg the giant Morgan not to kill her.
“I think that’s enough, Dr. Kamarsky….” Shawn Gilbert said, letting the last syllable drift away as he noted that virtual-Morgan was looking at him now.
“It’s just a game, in the computer. That’s the whole point. Morgan is channeled, he can’t really hurt anyone,” Kamarsky said. He was about to turn off the DVD player and wrap up the demonstration, when he hesitated and lowered his arm, resting the base of the remote on the table. It seemed that Morgan had raised his head a bit more, and was looking specifically at him. Kamarsky didn’t remember this from earlier reviews of the recording.
“Oh my God,” psychologist Cheryl Doheny whispered. “Is he pointing?”
Kamarsky’s expression twisted, then soured. Mainframe Morgan’s simulated left arm was raised and his extended index finger seemed to aim at a spot right between Dr. Kamarsky’s eyes. Kamarsky slammed the remote on the table and punched the “power” button simultaneously. The Morgan simulacrum folded onto itself and collapsed. The DVD player made a hissing noise. The “Sony” logo appeared on the television
“Well….” Kamarsky said nervously, awkwardly fingering his beard. He felt hot as the others stared at him. “As I said, this is nothing but an animation. Morgan created it several days ago. We record all of his action sequences. There is no doubt he has a lot of issues….”
Tom
WOW!!
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