“HELLO, ALICIA,” I said.

Only a few days had passed since her medication had been lowered, but the difference in Alicia was already apparent. She seemed more fluid in her movements. Her eyes were clearer. The foggy gaze had gone. She seemed like a different person.

She stood at the door with Yuri and hesitated. She stared at me, as if seeing me clearly for the first time, taking me in, sizing me up. I wondered what she was concluding. Evidently she judged it safe to proceed and walked inside. Without being asked, she sat down.

I nodded at Yuri to go. He deliberated for a second, then shut the door behind him.

I sat opposite Alicia. There was silence for a moment. Just the restless sound of the rain outside, raindrops drumming against the window. Eventually I spoke.

“How are you feeling?”

No response. Alicia stared at me. Eyes like lamps, unblinking.

I opened my mouth and closed it again. I was determined to resist the urge to fill the void by talking. Instead, by remaining silent and just sitting there, I hoped to communicate something else, something nonverbal: that it was okay for us to sit together like this, that I wouldn’t hurt her, that she could trust me. To have any success at getting Alicia to talk, I needed to win her trust. And this would take time—nothing would be accomplished overnight. It would move slowly, like a glacier, but it would move.

As we sat there in silence, my head started to throb at the temples. The beginnings of a headache. A telltale symptom. I thought of Ruth, who used to say, “In order to be a good therapist, you must be receptive to your

patients’ feelings—but you must not hold on to them—they are not yours— they do not belong to you.” In other words, this thump, thump, thumping in my head wasn’t my pain; it belonged to Alicia. And this sudden wave of sadness—this desire to die, die, die—did not belong to me either. It was hers, all hers. I sat there, feeling it for her, my head pounding, my stomach churning, for what seemed like hours. Eventually, the fifty minutes were up.

I looked at my watch. “We have to finish now.”

Alicia lowered her head and stared at her lap. I hesitated. I lost control of my reserve. I lowered my voice and spoke from the heart.

“I want to help you, Alicia. I need you to believe that. The truth is, I want to help you to see clearly.”

At this, Alicia looked up. She stared at me—right through me.

You can’t help me, her eyes shouted. Look at you, you can barely help yourself. You pretend to know so much and be so wise, but you should be sitting here instead of me. Freak. Fraud. Liar. Liar—

As she stared at me, I became aware of what had been troubling me the whole session. It’s hard to put into words, but a psychotherapist quickly becomes attuned to recognizing mental distress, from physical behavior and speech and a glint in the eyes—something haunted, afraid, mad. And that’s what bothered me: despite the years of medication, despite everything she had done, and endured, Alicia’s blue eyes remained as clear and cloudless as a summer’s day. She wasn’t mad. So what was she? What was the expression in her eyes? What was the right word? It was—

Before I could finish the thought, Alicia leaped from the chair. She threw herself toward me, hands outstretched like claws. I had no time to move or get out the way. She landed on top of me, knocking me off-balance. We fell to the floor.

The back of my head hit the wall with a thud. She bashed my head against the wall again and again, and started scratching, slapping, clawing

—it took all my strength to throw her off.

I scrambled along the floor and reached up to the table. I groped for the attack alarm. Just as my fingers grasped it, Alicia jumped on me and knocked the alarm from my hand.

“Alicia—”

Her fingers were tight around my neck, gripping, choking—I groped for the alarm but couldn’t reach it. Her hands dug deeper—I couldn’t breathe. I made another lunge—this time I managed to grab hold of the alarm. I pressed it.

A wailing scream instantly filled my ears, deafening me. I could hear the distant sound of a door opening and Yuri calling for backup. Alicia was dragged off me, releasing her choke hold—and I gasped for breath.

It took four nurses to hold Alicia down. She writhed and kicked and fought like a creature possessed. She didn’t seem human, more like a wild animal; something monstrous. Christian appeared and sedated her. She lost consciousness.

At last, there was silence.