The Mask of Sanity

  THE

  MASK

  OF

  SANITY

  Jacob M.

  Appel

  Copyright © 2017 by Jacob M. Appel

  All rights reserved. No part of this publication, or parts thereof, may be reproduced in any form, except for the inclusion of brief quotes in a review, without the written permission of the publisher.

  For information, address:

  The Permanent Press

  4170 Noyac Road

  Sag Harbor, NY 11963

  www.thepermanentpress.com

  Library of Congress Cataloging-in-Publication Data

  Appel, Jacob M., author.

  The mask of sanity / Jacob M. Appe.

  Sag Harbor, NY : The Permanent Press, [2017]

  ISBN 978-1-57962-495-8

  eISBN 978-1-57962-524-5

  PS3601.P662 M37 2017

  813'.6—dc23

  2016053018

  Printed in the United States of America

  For Rosalie

  AUTHOR’S FOREWORD

  Sociopaths or psychopaths—the two terms are largely interchangeable—have long been familiar to readers of Western literature. From Shakespeare’s Iago to Camus’s Meursault, these men and women are not merely villains, but villains lacking any moral compass. Rather than being victims of derangement who cannot tell the difference between right and wrong, they are self-interested and calculating creatures who recognize the difference, but simply do not care. During my career as a psychiatrist in New York City, including time spent working in a state forensic facility, I have come to know a number of individuals who wear what the late Hervey M. Cleckley, once the world’s foremost authority on sociopathy, termed “The Mask of Sanity,” yet at their cores proved incapable of feeling empathy or compassion for their fellow human beings. What follows is an effort to capture as authentically as possible the mind-set of one such miscreant.

  Too often, literature encourages us to imagine these amoral villains as dwelling along the margins of society, clinging to the lowest rungs of the economic ladder like Dostoyevsky’s Raskolnikov. Only recently, especially as a result of the exposure of gross misdeeds in the financial services industry and of large-scale Ponzi schemes, has the public become aware that many amoral individuals lurk in the highest echelons of power, be it business, law, and even in medicine. They are all around us, smiling and perpetrating evil.

  ACT I

  CHAPTER ONE

  Killing, Balint discovered, was the easy part. Not killing required discipline and restraint. Whether his medical career had inured him to death, or his steady constitution enabled him to suppress his emotions, or merely the sheer depth of his need for his wife and his hatred for Warren Sugarman transcended all moral barriers, he grew to see the slayings as a routine matter, even a mundane nuisance, like his four weekends each year as the on-call cardiologist at the hospital. Never, not even with his hands choking the life from innocent strangers, did he experience any guilt. At worst, he suffered a nagging fear of future guilt: the apprehension that he’d one day find himself overcome with remorse and confess for no good reason—like Raskolnikov or Leopold and Loeb. Then even these worries faded, leaving behind only the fact of his crimes. All of this occurred much later, of course: after he’d committed himself irreversibly.

  His transformation from conscientious physician to calculating assassin had seemed impossible only nine months earlier, on the rain-swept Saturday afternoon when he’d accidentally run over the brindled dachshund and then watched like a stranger as his own life came untethered from its moorings. He’d been driving home from Hager Heights, following lunch with his mother and stepfather. Amanda had begged off—as she often did—claiming a toothache. Their girls were away at summer camp. Balint recalled being in particularly bright spirits that day, because his promotion to section chief had been approved only the week before, which made him—at thirty-four—the youngest head of any medical division at Laurendale-Methodist Hospital. And then, out of a forsythia hedge, bolted the hapless dog.

  On a clear day, he might have stopped in time. In a steady downpour, the brakes of the Mercedes squealed until the animal bounced off the grille.

  He was traveling east on Meadow Drive—taking the shortcut between Chestnut Street and Hamilton Boulevard—with no other vehicles in sight. To his left sprawled the country club, where a flock of Canada geese sheltered itself at the edge of the golf course. To his right, thick hedges protected a row of upscale homes; farther along the road, the shrubbery gave way to a wall of whitewashed brick. Balint sat in the vehicle for several minutes, waiting for the shock of the collision to subside. Surely, if anyone had witnessed the accident, they’d have come to offer help. Nobody did. That meant absolutely nothing prevented him from abandoning the dachshund to its fate and driving off. Escape was the rational response to the situation, he told himself. Instead, he did the right thing.

  The dog lay unconscious, but breathing. Blood had colored its left eye crimson and a bone protruded through the fur below its left front knee. The luckless animal’s body shivered, either from cold or pain. Balint wrapped the creature inside his sport jacket. Rain matted his shirt to his chest—and it struck him, too late, that the water might cause his hospital pager to malfunction. His initial intention had been to carry the beast back to his car and to drive it to the emergency room. Yet as Balint lifted the heavy, sopping body, he suddenly recalled that Sugarman, the transplant surgeon, lived hardly a block away. In an instant, he made the decision that would lead to so many others, and he carried the bleeding animal around the corner toward Sugarman’s house.

  Sugarman’s son and his own older daughter attended the same grade at Laurendale Prep. Amanda and the boy’s mother played tennis together. Over the past several years, a friendship had arisen between Balint and his colleague—not an intimate friendship, but a convivial relationship built around common circumstances and shared worldviews and overlapping social circles. Both men had graduated from Columbia within three years of each other and from its medical school in the same class; both attended the same synagogue on High Holidays. When Balint ran into Sugarman on the ward service, he enjoyed his coworker’s easygoing good cheer. In all likelihood, if Balint’s daughters married someday, Sugarman would attend the weddings, although the surgeon’s recent, bitter divorce threatened to complicate the seating chart. At the same time, if Sugarman vanished suddenly—accepted a job in a different state or even burst an aneurysm—Balint couldn’t say that he’d have suffered any genuine sense of loss. What mattered at the moment was that Sugarman lived nearby, and that he might be capable of stabilizing an injured dog.

  Later Balint reflected on how many unfortunate contingencies led to what transpired next. After all, had the asphalt been dry, or had he left his mother’s place only seconds earlier, he might have avoided the smashup entirely. Or he might not have recollected that Sugarman lived on Meadow Court. Or he might have decided that a transplant surgeon could offer little service to an injured canine. An infinite number of other possibilities might have happened; what actually did happen was that he approached Sugarman’s driveway, his forearms straining under the weight of his cargo, and he spotted a familiar silver Saab sedan parked beneath the basketball hoop. Again he had an opportunity to avoid calamity—to return to the main road and go in search of help. Instead he stole around the side of the building.

  Sugarman’s backyard looked almost indistinguishable from his own: a slate patio equipped with a kettle barbecue, a swing set, a vegetable patch ringed with chicken wire. All that differentiated the surgeon’s property was the absence of a swimming pool. Despite the pelting rain, Sugarman’s sprinklers ran at full tilt—likely on a timer.

  Balint climbed the woo
den steps onto the deck. He peered into the nearest window and was rewarded with a view of an empty kitchen. The second window belonged to a dimly lit bathroom. Beyond the third window—at the far corner of the patio—stood a spacious den, furnished much like Balint’s own family room, with two love seats and a sofa focused upon a large-screen television.

  The transplant surgeon relaxed on the sofa. He sipped from a brandy snifter. Amanda’s head nestled in Sugarman’s lap, her bare feet resting on the far arm of the couch. His fingers toyed with her chestnut hair. While Balint’s mind struggled to place an innocent spin on what could not plausibly have been an innocent encounter, his colleague set down the snifter and allowed his free hand—that same hand trained to shear human flesh—to trace Amanda’s cheek, her neckline, the curve of her breast. And then, without warning, the surgeon leaned forward and rubbed his nose against hers, a gesture as intimate as it was sensual.

  Balint watched, paralyzed, still clutching the injured dachshund to his chest. And then the weight on his forearms felt heavier, almost imperceptibly, but just enough to tell him the poor creature had expired. That was too much for him. He retreated down the patio stairs and dropped the dachshund’s remains into the flowerbeds. Not his problem.

  On the journey home, his entire body shuddered violently—just like the dog’s had done—and as he crossed the highway overpass onto Roosevelt Avenue, an intense urge seized him to veer into the traffic below. Somehow he managed to resist.

  AMANDA URANSKY hadn’t been the prettiest girl Balint ever dated. In fact, they’d slept together for a brief spell in college—and then he’d cast her aside, rather unfairly, to forage in different pastures. Yet she’d taken her rejection in stride, unlike several of the other women he’d mistreated; instead of crying and pleading, she merely gave him a farewell hug and sent him a card on his birthday for each of the next four years. So when chance reunited them in the medical school library, where he was cramming for his anatomy final while she interned at the circulation desk, he found her company a warm refuge from his cold, unforgiving nights of memorizing pharmacological mechanisms and the symptoms of obscure diseases. Soon enough, he didn’t even notice the extra flesh on her hips or that her deep-set black eyes, otherwise enthralling, sat slightly too close together. Even as they planned their wedding, Balint knew he’d chosen wisely. His bride possessed all the practical skills he lacked: she could haggle with a caterer, threaten to discharge a florist. When they blew a tire on the way to the rehearsal dinner, she climbed down on her knees beside him and showed him how to install the spare.

  That had been nine years earlier. Two daughters ago. Balint tried to remember who he’d been before his marriage, but the Jeremy Balint of his bachelor days was as inaccessible to him as his months inside the womb.

  At home, he found a note from Amanda on the letter table in the foyer: “Tooth better. Gone shopping. Back at four.”

  He did not experience anger, not at first. He didn’t feel numb. What swept over him was a sense of helplessness. How would he handle life without Amanda? He had no clue how to prepare his estimated taxes for the accountant, or where the key to their safe-deposit box was hidden, or the telephone number for the pediatrician. He didn’t know in which banks they held accounts or even how much money they had. Even if he divorced Amanda and won full custody of the girls—not an impossibility with the right attorney—he had no idea how to raise children on his own. All he knew was cardiology, and that Amanda attended to everything else—and now one of those two pillars of faith appeared in jeopardy of toppling.

  He passed the afternoon scouring the bumper of the Mercedes for dachshund blood and scrubbing it from the sleeves of his shirt. The sport jacket proved unsalvageable; he dug a shallow hole behind the woodpile and buried it.

  Amanda returned at precisely four o’clock. The backseat of the Saab was loaded with grocery bags and she asked for his help carrying them into the kitchen. Now the sky had cleared; puddles still pocked the front walk.

  “They had a special on paper towels,” she said. “Eighty-nine cents a roll. So I bought twenty.”

  “I suppose we can never have too many paper towels,” replied Balint. “What made you limit yourself to only twenty?”

  What he wanted to ask was: How long has this been going on? How could you betray our daughters in this way? And what does Warren Sugarman have that I don’t? And are you going to leave me? But he didn’t dare, because he feared the answers.

  He deposited the last of the paper grocery bags on the countertop.

  “Aren’t you glad they didn’t have a special on anvils?” asked Amanda.

  She sounded so nonchalant. As though she had indeed spent the entire day searching for discounts on paper products.

  “How’s your mouth?” he asked.

  “Better. Not good, but better.”

  “I’m glad,” he said.

  Even a simple phrase like “I’m glad” now sounded strange to him. Had his inflection hinted at doubt? Would she think he was mocking her? On an ordinary afternoon, was this something he might have said?

  “Are you up for dinner on the town?” his wife asked. “Someplace romantic.”

  “I really should get paperwork done,” he lied.

  Amanda approached him from behind and wrapped her arms around his abdomen. This was not something she normally did, he thought; she was obviously overcompensating for what had occurred that morning. Balint racked his brain to recall other recent episodes of uncharacteristic behavior.

  “Come on, Jer. You can do all the paperwork you want next month when the kids get back from camp.” She rested her chin on his shoulder. “How many nights do you get to spend alone with your devoted wife?”

  If he were going to hate Amanda, that would have been the moment. But what he actually felt was confusion. An oppressive sense of psychological bedlam. So he accompanied her to the candle-lit bistro overlooking the harbor and then for ice cream cones at the old-fashioned parlor opposite the railroad station. He made conversation—but as he spoke, mostly about the girls, but also about the family vacation to Disney World they had planned for November, he felt like an actor in a play.

  In the back of his head, he was planning how to rebuff Amanda if she sought to get frisky that evening. He would refuse—he had to draw a line somewhere. But to his relief, and also disappointment, she didn’t try.

  BALINT’S ENCOUNTER with Warren Sugarman two days later could not reasonably have been termed a coincidence. He was not the service attending that month, and he had only a handful of private patients in the hospital, so he had no reason to be wandering through the wards. Yet he somehow found excuses for multiple forays onto the acute care units. He’d spot a specialist he hadn’t seen in some time—and they’d stand at the nursing station, chatting, while the interns and residents typed away on their progress notes. Inevitably he crossed paths with his wife’s lover.

  Sugarman stepped off the elevator with a pack of house officers in aquamarine scrubs nipping at his heels. The burly surgeon sported a copper-tone business suit over a burgundy shirt and lavender bow tie; a matching handkerchief protruded from his breast pocket. He walked backward like a tour guide, declaiming to his minions as he went. When he spotted Balint, who was in the process of purchasing a soda from a vending machine, he broke off his lecture and dispatched his disciples to their tasks.

  “Balint!” he hailed. “How’s the new division?”

  “I’m still trying to figure that out.”

  Sugarman strode up to him and actually slapped him on the back. “You medicine people never cease to astound me,” he said. “I keep telling myself that I’ll relearn physiology someday, but I never get much further than one heart, two kidneys.” He glanced at his wristwatch. “I’m far better off sticking to plumbing, I know. Everybody needs a plumber.”

  “Especially on a weekend afternoon,” replied Balint.

  “Agreed,” said Sugarman—without a hint of discomfort. “Especially on a weekend aftern
oon.”

  The doors to the transport elevator opened. They stepped aside, allowing a crew of orderlies to maneuver a lunch-tray rack into the corridor.

  “Damnedest thing happened to me,” said Sugarman. “Someone killed my neighbor’s dog and tossed the carcass into my tea roses. Isn’t that the damnedest thing?”

  “When did this happen?” inquired Balint.

  Was that a reasonable question? Had he displayed too much curiosity?

  “Over the weekend,” said Sugarman. “I went outside to check on my gladiolas yesterday—I’m trying a new breed this year—and smack in the middle of my rose garden is a goddamn dog carcass. Smelled like hell too.” He waved his palm in front of his nose. “Flies everywhere.”

  “Flies,” echoed Balint. “Nothing good about flies.”

  He had hoped to run into Sugarman all morning, but now that he stood face-to-face with the man, he longed to be rid of him. What could the two of them possibly have to talk about? A certain caliber of husband, Balint recognized, would have challenged the surgeon directly: fisticuffs, pistols at dawn. And he had also heard of so-called “enlightened” spouses who might take the affair in stride, wishing their rivals the best of luck—or even comparing notes. Balint was neither brave nor liberated. He didn’t want to fight his colleague, or to tolerate him. No, what he wanted was for Sugarman to stop screwing his wife. Nothing more or less. But that wasn’t the kind of request you could make without humiliating yourself.

  “Balint? You okay?”

  Sugarman had been talking to him—probably more nonsense about the dead dog—but he hadn’t been listening. “I’m fine. Just a migraine.”

  “You’ve got to take care of yourself, Balint. None of us is getting any younger,” Sugarman said, patting his own paunch. “Want to hear my idea for a new novelty item? Of course, you don’t—but I’m going to tell you anyway.” He punctuated his remark with a chuckle. “Dementia cookies, that’s my milliondollar gag. Just like fortune cookies, only they all say the same thing inside: ‘This is a cookie.’ Half of the twenty-five-year-olds in the country would buy a box for their fathers. Now am I right or am I right?”