CHAPTER TWENTY-NINE

Lennon sat down in an auditorium chair near the back, her eyes focusing on the older man at the front of the room. Dr. Sweeton was facing the whiteboard. His name had already been spelled out above what he was currently writing. He finished the last letter with a flourish and turned toward the audience. Lennon’s gaze went to the word behind his back: Trauma. “What is trauma?” he asked. “And what part of the individual does it affect?”

A young woman in the front row raised her hand, and he pointed at her. “Trauma is an emotional response to a terrible event that the person perceives as inescapable.”

“Mostly correct,” Dr. Sweeton said. “However, trauma is not simply an emotional response. Trauma affects the body, the mind, and the brain in profound and lasting ways.” He joined his hands in front of him. “Posttraumatic stress syndrome is the body continuing to fight back against a threat that’s already over. We see this in war veterans and others who’ve survived a harrowing and highly distressing experience, such as a mugging, being raped, or an automobile accident.” He paused as he glanced around. “What happens in our body when we’re confronted with trauma?”

A different young woman raised her hand. “The sympathetic nervous system activates, priming your heart and your lungs and your muscles to either fight or flee.”

“And if both are impossibilities? If there’s no way to escape the threat? No hope in fighting it? What does the body do if the brain ascertains that the person must accept the inevitable incoming horror?” Dr. Sweeton asked. No one answered, and so he went on. “The body experiences a dorsal vagal shutdown. Our metabolism slows so that heart rate plunges very suddenly, our blood pressure drops, our gut and kidney function decrease, as does our immune response. The body ‘saves’ us”—he lifted his hands and made air quotes—“by dissociating, collapsing, or freezing.”

He cocked his head and looked around for a moment. “But what about the child who grew up in a household where they experienced frequent, ongoing trauma? A constant influx of cortisol and adrenaline? What happens to our natural alarm system when it’s constantly activated against a threat the individual has no hope of countering? What does the human mind do when its exposure to rage and terror is almost never ending? How does that child cope? What does the body do to save the mind?”

Lennon looked down at the sea of heads below her. Finally a lone hand went up, and Dr. Sweeton nodded to the young man. “Ah, do you mean, like, a child who experiences sex abuse by a family member from the time they’re very young?”

“Yes. That scenario is more common than we like to acknowledge. One in five children in this country is sexually molested, according to the CDC. And that number is likely even higher, considering many such instances go unreported and therefore untreated in any manner.”

“Damn,” she heard a girl in the row in front of her murmur. Indeed. Lennon crossed her arms, drawing her shoulders up momentarily. It was a difficult thought to consider, even briefly, that right that minute, untold numbers of children were suffering, their brains twisting as their little systems tried their best to protect them. The very same thought she’d cried over after watching all those videos. Another reminder. As if she needed one. Were those kids all fated to wander the streets someday, in filth and misery? To sell their own bodies? The ones they’d been taught were worthless and did not really belong to them anyway?

“What if someone intervenes and they get help early?” someone asked.

“If early intervention occurs with a mental health professional who understands the intricacies of trauma, especially as it affects the brain, then there is always hope that that individual can heal. Specifically, there are windows where the brain is experiencing rapid periods of growth, such as during the teen years, when such treatments are even more effective. However, often, traumatized individuals are too on guard to submit to normal human relationships where it’s necessary to become at least somewhat vulnerable, and this includes a relationship with a clinician. The body doesn’t allow this. Even mothers who’ve experienced extended trauma cannot dial down their natural vigilance long enough to nurture their children. Their mind and body are in a constant state of arousal. Either that or they are too numb to bond with other human beings. They are stuck in fight or flight, or they are permanently shut down. Their circuits need rewiring. Their internal alarm system is very simply broken.”

“Are you saying that people who’ve experienced chronic trauma are brain damaged?” a man in the middle of the theater asked.

“Yes, I am saying that. Individuals who have experienced chronic trauma, especially as children, are brain damaged. The first step in healing must target the brain itself.”

A low murmur went up. Lennon agreed that that was a bold statement. But did she disagree? She wasn’t sure.

“What I’m saying is not as controversial as it might sound,” the doctor went on. “We have scans that record what happens in different sections of the brain when a person is traumatized. It’s quite clear. Moreover, traumatized individuals are well aware something is very wrong and suffer because of it. They vacillate between agitation and numbness. They’re often suicidal and have extremely low self-worth. They experience chronic mental and emotional pain.”

A woman raised her hand. “Thank you, Doctor. Are there medications that can help these people?”

“Mostly no, at least not without getting to the heart of the problem. Diagnoses are thrown at those who suffer with PTSD. Attention deficit disorder. Oppositional defiant disorder. Borderline personality disorder. Intermittent explosive disorder. Reactive attachment disorder. Substance use disorder. And none of these diagnoses are completely off the mark. But none of them address the root of the problem. You can throw all the labels and all the pharmaceuticals in the world at them, and you won’t make a dent in the underlying issue. The most these substances will do is temporarily control them. In some instances, a history might be taken and a PTSD diagnosis tossed into the mix. But again, until we have ways of treating these individuals that don’t force them to deal with side effects that are worse than the diagnosis, it matters little to the person suffering.”

Lennon pulled in a breath and let it out slowly. She was familiar with the list of diagnoses the doctor had just listed. How many times had she arrived at a call for family trouble and met a child who’d been diagnosed with all those things and more? A child. In most cases, and in her gut, she believed there was something far deeper going on with a kid who acted out to that degree. And even now, sometimes she saw one of them wandering the streets of San Francisco, still high on something—only now it was of the illegal variety.

“So you believe many of the diagnoses are bullshit?” a man near the back asked.

“To put it bluntly, yes.”

The young man let out a short laugh but appeared mildly uncomfortable. “Lots of professionals would disagree with you, Dr. Sweeton.”

“Indeed, and they have. But show me one who’s helped a previously homeless drug addict with ten mental diagnoses live a full, rich life. Or one who’s assisted an incest survivor experience satisfying sexual relationships absent fear or rage. If you can, I will wholeheartedly consider that person’s professional opinion and enthusiastically inquire as to their treatment methods.”

Shifting and murmurs all around. Was the doctor saying that complete mental health for people like the ones he was describing was an impossibility? If so, why was he in this business?

A woman raised her hand, and the doctor tipped his chin in her direction. “You mentioned mental issues pertaining to a history of trauma. But if the body itself seeks to protect the individual, are there vestiges of that later in life?”

“Absolutely. Victims of prolonged trauma experience many similar physical phenomena. I have seen patients who are numb in many areas of their bodies, specifically where trauma occurred. Some can’t see themselves in mirrors. They are far more vulnerable to experiencing long-term health problems. Chronic muscle tension creates migraines, severe back pain, fibromyalgia, rheumatoid arthritis, and other pain conditions. They cannot concentrate and often lash out violently at the simplest of provocations. Speak to any victim of chronic and prolonged trauma, and they will list their physical ailments. But these ailments are only symptoms of their underlying torment. And once again, the drugs they’re prescribed may help temporarily, but are ultimately bound to fail, leaving them that much more desperate.”

The entire audience seemed to be as rapt by the doctor’s passion as Lennon. He looked pained himself, as though the torment of these traumatized patients and the lack of treatment they experienced was a deep personal wound. Maybe it was. Maybe he’d been a victim once too. Or loved someone who was.

“These people are statistics to most professionals. They overwhelm our welfare system, they fill up our prisons, and they flood our medical clinics. What can we do? We must do something. Not only for them, but for the children they will produce—the ones who will almost certainly experience trauma as well, after being raised by emotionally deficient parents who, more often than not, expose their children to the same types of trauma they themselves suffered.”

“Other than the traditional protocols, what can be done for people like that?” a girl asked after raising her hand. “People who almost literally need their brains rewired?”

“As of now? We have some promising treatments,” Dr. Sweeton answered. “EMDR is one, though it’s controversial within the field. I, however, believe it’s a worthy area of study and have used it in my practice. It stands for eye movement desensitization and reprocessing .” All around Lennon, students were jotting in their notebooks. “It’s a psychotherapy treatment that involves moving your eyes in a specific way while processing traumatic memories. Holotropic breathwork is similar—though, as the name suggests, it involves breathing techniques to influence your mental and emotional states.”

“And those things help?”

Dr. Sweeton paused for a moment. “They can, depending on the depth of trauma.” He looked around again. “I realize I have presented a problem that seems to have a lack of solutions. What I would encourage you to do, future doctors, is to think outside the box. An unprecedented problem requires an unprecedented solution, not only for the institutions I mentioned but for the human beings affected by trauma. Push forward with new advances as they arise, and if mental health is the specialty you choose, be dogged in your pursuit of treatments that make a real difference. Don’t fall into the trap of medical complacency. And until the problem can be addressed in a meaningful therapeutic way, never stop asking ‘What can we do?’ We must do something.” He looked around the room, almost beseeching. “I leave you with that.”

The audience applauded, and Dr. Sweeton gave a small, humble wave before leaving the room. The students began to gather their things, and the chatter grew louder. Lennon scooted out of her seat and made her way down the center aisle, and then through the door where the doctor had gone.

She caught up with him in the lobby near the front door. “Dr. Sweeton?”

He turned, giving her a mild smile. “Yes?”

“Hi. I’m Lennon Gray, and I’m an inspector with the San Francisco Police Department. Do you have a minute?”

“Oh. Yes, of course.” He stepped off to the side, and she followed. A stream of students who’d been in the presentation started filing out.

“Thank you.” She removed her phone and pulled up the photo of the pills from the crime scene with the “BB” logo and held it up to him. “Have you ever seen this medication?”

He leaned closer, studying it. “‘BB’? No. It looks more like a homemade medication than a pharmaceutical-grade product.”

“It is. It’s related to a crime, and we’re trying to trace its origins.”

“Ah. I’m sorry to hear that. And sorry I can’t be of more help.”

She nodded. “I listened to your talk. It was ... depressing.”

He gave her a fleeting smile as the last of the students walked by, the door right in front of them closing, quiet descending in the open two-story entryway where they were standing. “It can be, yes. But there are breakthroughs happening every day in the study of mental health. And human beings can be extremely resilient if given the right tools.”

“As a former beat cop, I related to a lot of what you said. I’ve driven plenty of eight-year-olds to the mental ward who have all the diagnoses you mentioned listed on their forms.”

The doctor sighed. “Children. Yes. It’s the hardest part, isn’t it? Trauma is one thing, but treatment becomes that much more challenging when the child hasn’t formed an attachment to their mother, or another caregiver. An understanding of self is formed through such a relationship.”

“The mirror thing?”

“Yes. To themselves, they do not exist.”

“That’s awful.”

“It is awful.”

“So it’s your belief that everyone who is diagnosed with a mental or psychological disorder is really suffering from trauma?”

“Don’t be naive, Inspector. There’s never an everyone in either of our fields. If there was, it’d make our jobs much easier.”

He wasn’t wrong, but she still wasn’t sure how she felt about this man. Now that she was looking directly in his eyes, she felt that he was hiding something. But what or why, she had no clue. “You talked about the lack of options and misdiagnoses of people suffering that way and mentioned the eye movement thing and the breathwork. But what about hallucinogens?”

The doctor paused, the expression on his face enigmatic. “Are you referring to ketamine therapy?”

“I don’t know. I’m not familiar with any of these treatments. I do know that ketamine is highly addictive and sold on the streets under the name Special K, or Vitamin K.” She’d heard others too ... Kit Kat, Cat Valium ... but the ones she’d mentioned were the most common.

“Yes. Ketamine is a dissociative anesthetic medication that is sometimes used off label to treat depression and anxiety disorders. It’s not currently approved by the FDA. But perhaps more importantly, patient results are often unsustained—especially without multiple sessions, which become challenging when dealing with certain populations.”

“I see. What about other hallucinogens?”

Again, he paused. “As they pertain to therapy? There is evidence that hallucinogens may stimulate nerve cell regrowth in sections of the brain that are responsible for emotion and memory. There are only animal studies thus far, but supporters of psychedelic drugs as a treatment for PTSD believe they can and should be used to decrease anxiety and fear pathways in the brain. Patients become highly suggestible when under the influence of these drugs, which can be used for good.”

“Or bad.”

“Potentially, in the wrong hands, yes. But that can be true of any drug, Inspector Gray, as I imagine you must know well.”

Yes, I do. “You cited studies, but do you have an opinion on the subject of hallucinogen use? Professionally or otherwise?”

“I think that there’s potential for hallucinogens as a treatment for PTSD in a medical setting under a doctor’s supervision. They can produce extremely intense experiences that are subjectively mystical and accompanied by positive change in insight, motivation, and behavior. I’m hopeful about future studies. But as of now, therapeutic use of psychedelic substances has only been legalized in Oregon and Colorado.”

“As a well-known progressive state, California can’t be far behind?”

The doctor shrugged. “I don’t make the laws.”

“And you don’t break them.”

“No, I don’t break them. Look me up. You won’t find so much as a speeding ticket on my record.” He tilted his head as he studied her. “Have you experienced trauma, Inspector? Do you have any personal experience with it?”

“Haven’t most people to some degree or another? Life is often cruel.”

He smiled. “Life. Ah, yes. Life is often cruel.” He paused, his gaze assessing. His phone began to ring, but he didn’t break eye contact. “But it’s the easier burden to bear. When humans are cruel, specifically the ones who are tasked with caring for you, it is the most unbearable cruelty of all.”

Lennon had thanked the doctor quickly so he could take his call. She had his information, and she couldn’t think of anything else to ask him. Though the talk he’d given was still swirling in her head, making her feel upset and distracted and sort of hopeless overall. What can we do? he’d asked in closing. We must do something.

What can we do?

She came in contact with the type of people the doctor was referencing all the time, and she had no answer to his question. Most mental health professionals were drowning too. And if they didn’t know, if they had no answer—then who did?

No one. No one does.

And so they all just applied Band-Aid after Band-Aid, knowing the underlying wound was growing more and more infected by the day.

She’d been walking slowly through the parking lot, lost in her own thoughts, when the sight of the doctor rushing to his car in the other direction caught her eye. He was still on his phone, talking animatedly. And then he stopped and hung up, seeming to dial again. She held back for a moment, then moved behind him as he resumed walking, the phone held to his ear.

A name caught her attention. Ambrose. Her heart sped, a zap of electricity moving down her limbs. The doctor unlocked his car, lights flashing as he stopped near the door, looking around. She ducked behind a minivan, unseen but still close enough to hear. “We can’t lay low. We’re on day five, and there’s no turning back. You know that.” Silence for a moment. “Okay. Yes. Be at the offices tonight. I’ll determine if we can move through six and seven more rapidly.”

She heard the doctor get in his car, and scooted to the other side of the minivan, moving quickly down the aisle of cars as she heard his vehicle start and then pull out of the parking spot, driving in the opposite direction.

She hurried to her car, easy to spot because of the window covered by plastic and duct tape, and answered her ringing phone as she walked. “Hello?”

“Lennon, Lieutenant Byrd. We know who he is. His name is Ambrose DeMarce.”

She stopped. “DeMarce?” So Mars was an alias, but it hadn’t been far off. “Who is he?”

“He’s a bounty hunter. Mostly a lone ranger, but he’s contracted for the FBI and the US Marshals and who knows what other agencies. He went rogue by infiltrating our investigation, and no one knows why. But they’re also blocking any further action against him. For now, anyway.”

Her mouth dropped open. “Why?”

The lieutenant sighed, and she could see him now, rubbing his left eye the way he did when he was tired and frustrated. Which, honestly, was a hell of a lot of the time—no surprise considering the job he did and where he did it. “Because he’s valuable to them and they don’t want him in jail or otherwise compromised, I guess. Anyway, it’s clear he acted on his own, and you’ve been reinstated. I’d tell you that you could come back tomorrow, but the chief needs to sign off on it, and he’s not returning until Friday.”

She huffed out a breath of frustration. Not that being stripped of her police powers had kept her from working, but still. “Promise me you’ll call if our killer strikes again or new information comes to light? I want to get right back to it on Friday.”

“Sure, Gray. I’ll let you know if there’s a new development in the case.”

She thanked the lieutenant and hung up. She felt that fire again in her gut. Ambrose DeMarce was part of this. Some bigger picture that had to do with trauma. Treatment. Hallucinogens. A miracle treatment. She needed answers. So she’d be back to work at the end of the week. But first, she knew what she had to do tonight. Because she knew where he’d be.