o lonely ’twas that God himself Scarce seemed there to be.

–Samuel Taylor Coleridge,

“The Rhyme of the Ancient Mariner”

December 6, 1999 Because it is bitterly cold, the snow does not stick to the pavement. It swirls beneath the undercarriage of Mariah’s car; it lies down in her path before twisting out of reach of the wheels.

Mariah keeps her eyes on the road. She concentrates on where she is going, on when she will arrive.

“Dr. Birch,” Malcolm Metz says,

“did you interview Faith White this weekend?”

“I went to the hospital, and I did get to see her, but we didn’t speak.”

“Why was that, Doctor?”

“She couldn’t conduct a conversation. She was comatose.”

“Were you able to speak to anyone affiliated with her case?”

“Yes. I spent some time with a doctor in charge of Faith’s medical care, who outlined her symptoms and test results for me.”

“Can you tell us what you learned?”

“She was admitted for observation due to unexplained bleeding from the hands. Once hospitalized, she developed a high fever,

along with febrile convulsions, renal-system failure, and she went into cardiac arrest. This wasn’t caused by pulmonary problems, nor does it seem to be a myocardial infarction,

myocarditis, or a cardiomyopathy. In short, the doctors are treating the symptoms without necessarily knowing the cause.”

“Could any of these symptoms have been caused by her mother?”

“I suppose so, under the right circumstances,”

Birch says. “Of course, in this case, since Mrs. White has not been present at her daughter’s bedside since Friday, I’d have to say that the bleeding and the fever are the symptoms most likely produced by her hand. I would have to reserve final judgment until interviewing Faith.”

Metz pauses in front of the witness stand.

“In your expert opinion, Dr.

Birch, how would you summarize the case of Faith White?”

“Again, this is hypothetical without a chance to talk to the child herself. But if the interview corroborates my gut feelings, I’d have to say that she’s a victim of Munchausen by Proxy. The child is obviously failing, and requires immediate long-term separation from her mother to ensure her mental and physical health. Her father is the obvious alternative–he can provide a supportive, loving, and mentally healthy environment for the girl. Of course, this is all dependent on whether the physicians can patch up the damage that’s already been done. But if Faith is a victim of MSP, if she comes out of the coma and is separated from her mother and given constructive psychotherapy, I think her prognosis would be excellent.”

“Thank you, Doctor.” Metz glances at Joan. “Your witness.”

Joan braces her hands on the defense table.

She is wearing her kick-ass pink suit, as she likes to call it, and feeling confident. “Dr.

Birch, are you here at the request of Mr.

Metz?”

“Yes.”

“Has he paid you to be here?”

“Objection,” Metz says. “Asked and answered.”

“Withdrawn. How many years have you been practicing?”

“Twenty-three.”

“In those twenty-three years, how many patients have you treated?”

“Oh … five hundred? Six?”

Joan nods. “I see. Out of those five or six hundred patients, how many have you personally diagnosed with Munchausen Syndrome by Proxy?”

“Sixty-eight.”

“In each of these sixty-eight cases, did you have a psychiatric interview with the mother?”

“Yes.”

“In each of these sixty-eight cases, did you have a psychiatric interview with the child?”

“Yes.”

“Have you had a psychiatric interview with Mariah White?”

“No.”

“Have you had a psychiatric interview with Faith White?”

“No. She’s in a coma, for God’s sake.”

“So you’re basing your diagnosis of this case –of this incredibly rare disease–on newspaper articles you’ve read, and doctors’ reports,

and seven-year-old records from a psychiatric institution … oh, and on hearsay?”

“No–“

“You can’t truly diagnose this illness without interviewing Faith and Mariah, can you?”

The psychiatrist’s cheeks flag with color.

“I can make a contingent diagnosis. I’m just one step removed.”

Joan arches a brow. “I see. So, you’ve … contingently diagnosed Mariah White with Munchausen Syndrome by Proxy. Are there any other diagnoses this case might support?”

“Well, there’s always something, Ms. Standish.

But having studied this syndrome for years, I’d say it’s a likely diagnosis.”

Joan looks at a pad. “Have you ever heard of somatization disorder?”

“Of course.”

“Could you define it for us?”

“It’s when a child manifests symptoms that are psychologically induced–in other words, he’s sick, but it’s his mind that’s making him sick.

Imagine a child who breaks out in hives every time his father has visitation rights; the child is expressing some internal psychological disturbance with physical symptoms. Often it’s an unconscious means of getting attention.”

“Have you ever seen clients with somatization disorders?”

“Many times.”

“It’s far less rare than Munchausen by Proxy, then.”

“That’s correct.”

“Is it true, doctor, that often the victim of a somatization disorder looks a lot like a victim of MSP?”

“Yes. In both disorders, the presenting symptoms have no organic etiology–in MSP because they’re faked, in somatization disorder because they’re psychologically driven.”

“I see. How do you go about diagnosing somatization disorder, Doctor?”

“You’d interview the parents and the child. And you’d order many medical tests.”

“The same strategy you’d use to diagnose Munchausen Syndrome by Proxy, then.”

“Yes. However, in MSP separation from the parent results in a disappearance of ailments.

If the child suffers from somatization disorder, they’ll continue.”

Joan smiles. “May I approach the bench?” Judge Rothbottam beckons the attorneys. “Your Honor, can I have a little leeway here? I’d like to bring in a live exhibit.”

Metz frowns at her. “What the hell have you got? A chicken?”

“You’ll see in a second. Your Honor,

there’s really no other way to make my point.”

“Mr. Metz?” the judge asks.

“Why not? I’m feeling charitable today.”

After Rothbottam agrees, Joan nods to Kenzie van der Hoven, who walks to the doors at the rear of the courtroom. She summons a bailiff, who enters with Faith in tow.

Faith is wearing a pink dress a shade lighter than Joan’s suit. Her hair is bright and silver, her smile infectious. She waves at Mariah as she approaches, and doesn’t seem to see the press snapping shut its collective jaw. With the exception of her pallor and tiny bandages at her throat and palms, there is no evidence that hours ago the girl was hovering on the edge of death.

Malcolm Metz does a double take. He turns to Colin, who is suddenly very interested in his lap. “Did you know about this? Did you?”

But before Colin can answer, Joan speaks.

“Dr. Birch, do you know this child?”

“I think … I assume … that it’s Faith White,” he says.

“When was the last time you saw her?”

“Late Saturday night. She didn’t look like she’d live through the weekend.” His eyes are wide with wonder, riveted to Faith.

“How does she look to you now?”

Birch grins, triumphant. “Absolutely fine.”

“What’s your explanation for this?”

The psychiatrist looks proudly at Malcolm Metz, then at Joan. “Clearly,

my hunch was right. Mariah White is suffering from Munchausen by Proxy. When sequestered from the mother by court order, Faith’s illness–very obviously–abated.” He gestures toward Faith, sitting primly beside the guardian ad litem. “I only hope that the court continues to keep her mother at a distance.”

Joan smiles broadly. “Doctor,” she says, “I can’t thank you enough.”

Somewhat flustered, Malcolm Metz announces that the plaintiff rests. He doesn’t trust Joan Standish as far as he can throw her, but he certainly isn’t about to question her if she wants to make his case for him. He touches his client on the shoulder after the judge orders a short recess. “Let’s go get some coffee,” he says to Colin. “It’s looking good, don’t you think?”

“Joan,” Mariah says, as soon as they are alone in a small room the size of a janitorial closet, “what are you doing?”

“Trust me,” the attorney says.

“You’re making it look like I hurt her! Why didn’t you tell Birch I saw her Sunday?”

“Well, because you’d get slapped into jail right now, for one.”

Mariah narrows her eyes. “Faith isn’t making herself sick either, you know,” she says.

Joan sighs. “Mariah, there are three branches to your defense: to prove that you’re a fit mother, to prove that Faith isn’t psychotic,

and to show the judge there might be a different disorder, other than Munchausen by Proxy,

to explain what’s going on. It’s a loophole defense–we just need to come up with an alternative to the plaintiff’s story. And if our story is better than theirs, we win. It’s that simple.” She stares directly at Mariah. “I’m not trying to place the blame on Faith instead of you. I’m just trying to arrange things so you get to keep your daughter.”

Mariah looks up. “All right,” she says,

resigned. “You do what you have to.”

Judge Rothbottam peers at Joan over his half-glasses. “Ms. Standish,” he says,

“I believe you’re entitled to make an opening statement, if you’re so inclined.”

“You know, Your Honor, I wasn’t planning on making one–“

“Ah,” the judge mutters. “Maybe God does have a hand in this case.”

“–b after all that’s been happening, I think I actually would like to say a few things.” She gets to her feet and walks in front of the defense table. “This is a confusing case,” she says flatly. “It’s confusing because it’s a custody case, but there’s a side issue going on, too. And we can’t help but notice that issue–namely, that there’s a reason this little girl has been in the news. If you listen to all the reports, well … Faith White says she’s seen God. Pretty wild, don’t you think?” Joan smiles, shakes her head.

“Mr. Metz says that all this is her mother’s fault. That somehow Mariah White is managing to get Faith to hallucinate and see God, and is physically harming her daughter to boot. And,

actually, I think that’s pretty wild, too.”

Joan turns toward the window, looking at the rapidly falling snow. “You know, I just read the other day that Eskimos have over twenty words for snow. There’s crusty snow, there’s sleety snow,

there’s powder. I might look out this window and see something beautiful. Mr. Metz might look out and think it’s going to make the commute a mess. And,

Judge, you might look out here and see a day on the slopes.

“There are many ways to look at the same thing.

You’ve seen Mr. Metz’s case. I’m going to show you the same facts, but I view them a little differently. In the first place, unlike Mr.

Metz, I don’t think this is a case about Mariah White. I think it’s about Faith. So I’m going to prove that, number one, Faith is a happy little girl. She’s not sick, she’s not psychotic, and she’s certainly not comatose.

I’m not going to prove whether or not she’s seeing God, because that’s not my job. My job is to show you that she’s psychologically happy, she’s physically okay, and she’s going to act the same way no matter which parent she is living with. The question is: Which parent should that be?”

Joan takes a deep breath. “The answer is Mariah White. And that’s the second thing I’m going to prove. Regardless of what happened seven years ago–right now, the best parent for Faith is her mother.” She trails her fingers on the edge of the defense table. “Mr. Metz has given you his interpretation of the circumstances surrounding Faith White. He’s shown you what he wants to see. Don’t rely on his eyes.”

Dr. Mary Margaret Keller seems nervous on the stand. Her eyes dart about the courtroom as if they were following a mouse no one else can see. She crosses and uncrosses her legs.

And when Joan first asks her to list her credentials, her voice shakes.

“How long have you been a child psychologist,

Dr. Keller?”

“Seven years.”

“What are your specialties, Doctor?”

“I do a lot of work with younger children who’ve suffered family trauma.”

“Why were you chosen to be Faith’s psychiatrist?”

“I was referred to Mrs. White by her own psychiatrist, Dr. Johansen. He called me up and asked me, as a favor, to take this case.”

“How many times did you see Faith?”

Dr. Keller folds her hands in her lap.

“Fourteen,” she says.

“What sorts of things did you do?”

“Basically, I watched her play. It’s an excellent way to pick up on disturbing behaviors.”

“What were some of the behaviors you noticed?”

“Well, there was a very strong defense mechanism she’d developed–an imaginary friend who could keep her safe. Faith referred to her by a certain name–her guard, I thought she was saying. It made wonderful psychological sense: A little girl who’s been dealt several difficult blows found someone to protect her. I thought it was very healthy.”

“Then what happened?”

“Mrs. White became concerned because Faith began to exhibit behaviors not consistent with her upbringing. She was quoting Bible verses, although she’d never seen a Bible in her life. And there were a couple of instances where Faith came in contact with an ill person, and managed to make them better.”

“What did that lead you to believe, Doctor?”

Dr. Keller smiles ruefully. “I didn’t jump to any conclusions at first. But I started to wonder if instead of calling her imaginary friend her “guard,” Faith was actually saying “God.”" She removes her glasses and wipes them on the hem of her skirt. “Seeing God is usually a sign of psychosis,” she explains. “It didn’t sit well with me, because Faith was able to function normally in every aspect of her life, with the exception of these hallucinations.

But I recommended to Mrs. White that Faith go on a trial run of Risperdal.”

“What happened when she was taking the medicine?”

“She became groggy and tired, but the visions didn’t abate. We tried a different antipsychotic medicine, and she still exhibited this behavior.”

“Finally, Dr. Keller, what did you decide to do?”

“I called in a colleague, a specialist in childhood psychosis. He observed Faith and agreed that she didn’t seem psychotic. I felt validated. There are a great deal of things I don’t understand in this world, but I do know what a psychotic child looks like, and Faith isn’t it.”

Metz stands up for his cross-examination and walks toward the psychologist. “Dr.

Keller,” he says, “do you know what you’re suggesting here?”

She blushes. “Yes.”

“Isn’t it true you went to parochial school for twelve years?”

“Yes.”

“And didn’t you have a very strong Catholic upbringing?”

“Yes, I did.”

“At a symposium, Doctor, didn’t you go so far as to admit that once you personally felt God beside you when you were praying?”

Dr. Keller looks into her lap. “I was only a child, but I’ve never forgotten it.”

“Don’t you think that you might be predisposed to believing Faith is also seeing God?”

At that, the psychiatrist glances up with a cool, professional demeanor. “Regardless of my personal beliefs, Mr. Metz, I conducted a variety of clinical tests–“

“Yes or no, Dr. Keller?”

“No,” she says militantly.

Metz rolls his eyes. “Aw, come on,

Doctor. Don’t you believe in God?”

“Yes.”

“Don’t you go to Mass every week?”

“I do.”

“And the conclusion you’ve drawn is that Faith’s seeing God. Do you think your conclusion might be different from someone who’s … say … an atheist?” Metz turns around, his eyes skimming over Ian, sitting in the gallery.

“If I was an atheist,” she says, “I’d still be a very thorough psychiatrist. And I’d still say this child is not psychotic.”

Metz narrows his eyes. This is not going the way he planned. The little wren of a woman should have folded five questions ago. “Dr. Keller,

didn’t you present Faith’s case at a psychiatric symposium?”

“Yes, I did.”

Metz advances on her. “Isn’t it true that you brought up the case at the symposium because you wanted to make yourself look good, Doctor?”

“No. In fact, I was putting my reputation on the line.” She smiles sadly. “How many psychiatrists honestly want to go on record as saying that a child is seeing God?”

“But you did get attention for yourself, at the expense of the client’s confidentiality,” he repeats. “Isn’t that somewhat unethical?”

Surprising him yet again, Dr. Keller withdraws a piece of paper from the notebook on her lap. “I have a signed release right here from Mariah White, authorizing me to take her daughter’s case to the symposium as long as Faith’s name was not mentioned.”

“Really!” Metz says. “So we have evidence of Mrs. White trying to prostitute her daughter to gain an audience.”

“Mrs. White and I discussed this in depth,”

Dr. Keller says. “It was our hope that we could involve a specialist with more experience than I have, who might help us get to the root of Faith’s visions. As you know, twenty degrees working together on a case is considerably better than just one. We weren’t looking for an audience,

Mr. Metz. We were looking for a cure.”

“Did you ever interview Mrs. White in the role of a therapist?” Metz asks.

“No, I was her daughter’s psychiatrist.”

“Then can you say with absolute certainty that somewhere in this mother’s twisted mind she wasn’t trying to make you put her daughter on display?”

Dr. Keller looks at Mariah, then at Faith sitting several rows behind her.

“No,” she says, her word soft as it falls into Metz’s outstretched hand.

“She was brought into the emergency room, bleeding from both palms,” Dr. Blumberg says in response to Joan’s question. “Traditional emergency-medical procedures failed to stop the bleeding, and I was called in for a consultation.”

“What did you do, Doctor?”

He leans back in the chair. “I x-rayed her hands.”

“What did you find?”

“No sign of trauma. Literally, a hole went straight through. No tearing of tissue, no mangled bones, nothing to indicate that this was a puncture wound of any kind, in spite of the slow and steady flow of blood.”

“Had you ever seen anything like this before, Dr.

Blumberg?”

“Absolutely not. It stumped me. I called in experts and colleagues, pediatric and surgical and orthopedic specialists, and we ruled out the medical possibilities one by one.

Eventually I just treated the symptoms and sent the girl home, then went back to my office and started reading medical journals.”

“What did you discover?”

“That, as many people know, this had happened in the past.

And I mean in the way, way past. I was wary of believing it myself, but apparently several Catholic saints have exhibited stigmata, or spontaneous bleeding from the palms, side, and/or feet that is medically inexplicable, but also medically verifiable. And there is no physical cause for it.”

“When was the last documented case?” Joan asks.

“Objection–Dr. Blumberg hasn’t been ordained.”

“I’ll allow it,” the judge says.

“Doctor?”

“There was a man named Padre Pio, who died in 1968. But the most famous stigmatic would probably be Saint Francis of Assisi,

who lived in the twelfth century. According to the reports I read, the wounds are quite real, quite painful.”

“What are the main characteristics you found in journals about stigmata?”

“They can’t be cured by ordinary remedies used to control bleeding or induce clotting. They last for months or years at a time, but unlike long-term natural wounds,

don’t fester.”

“How does that correspond to Faith’s wounds?”

“Very closely,” the doctor says.

“Did you officially diagnose Faith with stigmata?”

Blumberg grimaces. “No. I was too skeptical. On her record I wrote that after weighing all medical possibilities, the conclusion I’d reached was that it was possible that Faith suffered from stigmata. But frankly,

I’m still not comfortable with that diagnosis.”

“This past weekend, what was Faith’s medical status?”

“She was critically ill. She had been put on dialysis and had gone into cardiac arrest twice, her hands and side were bleeding again, and she’d slipped into a comatose state. My professional opinion was that she wasn’t going to recover.”

“What is Faith’s medical status now?”

Blumberg grins. “Shockingly healthy.

Kids tend to bounce back quickly, but this is truly remarkable. Nearly all her bodily systems are functioning at a hundred percent,

or are well on the way to doing so.”

“In your opinion, Doctor, was Faith’s heart and kidney failure intentionally caused by someone?”

“No. There are too many medical personnel around in an ICU for that to happen. Not to mention that traces of medicine which might, for example,

cause the heart to arrest were not found in Faith’s bloodwork.”

“Were her hand and side wounds caused by someone?”

He shakes his head. “As I’ve said, there was no indicative trauma. Just a tiny tunnel … right through the skin and muscle and bone and sinew.” He holds up his palm. “There are more bones in the hand than anywhere else in the body,

Ms. Standish. It’s virtually impossible to puncture it without causing some trauma. Yet that’s what I saw. Faith was just … bleeding.”

“Doctor, are you required by law to file reports of possible child abuse?”

“Yes, any physician must.”

“Did you file this report after seeing Faith White a month and a half ago?”

“No, I did not.”

“Did you file this report after admitting Faith White on Thursday night?”

“No.”

“Was there any reason for you to file that report?”

“Absolutely none.”

“Thank you,” Joan says. “Nothing further.”

“Dr. Blumberg,” Metz asks, “how many cases of stigmata have you treated?”

The doctor smiles. “Just this one.”

“But you feel qualified to give us an expert opinion here? Isn’t it true that because you couldn’t diagnose Faith’s wounds, you made an educated guess?”

“First let me tell you what I ruled out,

Mr. Metz. I considered both direct and indirect trauma to the appendage. I examined the possibility of skin secretions, or nerves adjacent to the skin producing some substance, but the emissions were laboratory-tested, and they were indeed blood. Stigmata was the only diagnosis I could find that even came close to matching the clinical observations I made.”

“Can you say without a doubt that this is stigmata?”

“Of course not, it wouldn’t be my job. It’s the pope’s, I guess. All I can tell you is, Faith White was bleeding. And there was no medical explanation for it.”

“Is there a psychological explanation for it?”

Blumberg shrugs. “In journals I read,

there were attempts to replicate stigmata in patients under hypnosis. In a couple of very rare cases, psychiatrists managed to induce a kind of colored sweat … but no blood.

There’s no scientific proof that the imagination can produce stigmata apart from a religious idea.”

“Could the wounds have been produced during a sleepwalking episode?”

“I doubt it. As I said, they looked nothing like puncture wounds.”

“Can you say conclusively that Faith’s injuries were not caused by Faith herself,

or by another person?”

“It wasn’t apparent,” Blumberg says carefully. “I certainly couldn’t come down with an absolute, but this clearly was not a case of child abuse. Mrs. White refused to leave her daughter’s side, was extremely concerned about Faith’s prognosis, and became very agitated when I hypothetically suggested a diagnosis of stigmata.”

“Have you ever seen cases of child abuse, Dr.

Blumberg?”

“Unfortunately, yes.”

“In any of those cases did the parent harm the child in front of you?”

“No.”

“In any of those cases did the parent seem concerned about the child’s prognosis?”

“Yes,” the doctor admits.

“In any of those cases did the abusive parent herself bring the child in to be treated?”

Blumberg clears his throat. “Yes.”

Metz turns on his heel. “Nothing further.”

Faith leans to the right. “Kenzie,” she whispers, “I’ve got to pee.”

“Now?” the guardian ad litem asks.

“Yeah. Like right now.”

Kenzie grabs the girl’s hand and makes their excuses down the row of seated people. Outside the courtroom, she turns left toward the ladies’

room. She waits for Faith to finish in a stall and come out and wash her hands. Then she smooths the girl’s hair. “How you doing?”

“It’s boring in there,” Faith whines. “Can we get a Coke?”

“It’s important that we stay inside. It won’t be too much longer.”

“Just a Coke? Five minutes?”

Kenzie stretches out the kink in her back.

“All right. Five minutes.” She leads Faith to the machines just inside the main lobby of the courthouse. People mill about: sequestered witnesses awaiting their limelight, attorneys on cell phones, uniformed men laying new mud mats on the floor. Kenzie deposits seventy-five cents and lets Faith push the buttons so that the can hurtles out of the chute.

“Mmm. That’s good,” Faith says after taking a sip. She pirouettes, testing out her legs after sitting so long, and stops abruptly when she looks through the glass doors of the courthouse. On the steps, on the snow-covered lawn, are hundreds of people. Some of them hold up placards with Faith’s face posted; some of them wave rosaries in the air. Their shout of support swells like a tsunami as they catch a glimpse of her.

She had not seen them coming in; Kenzie had taken her through a rear entrance simply so that she would avoid this. “Hold my drink, please,”

Faith says, handing Kenzie the Coke can.

“Faith, don’t–” she calls, but she’s too late. Faith has already pushed open the doors to stand on the stone steps that lead into the courthouse. After a rousing cheer from her supporters, she raises her hands, and they cry out even louder. Stupefied, Kenzie finds herself unable to move. “Hello,” Faith says,

waving. She smiles as their prayers fall over her, accepting her due like a queen.

“I’ve been treating Mariah White for seven years,” Dr. Johansen says. “Ever since she left Greenhaven.”

“What was your opinion about her institutionalization?”

“It never should have happened in the first place,” the doctor says. “There were a variety of other treatments for depression that would have been just as effective.”

“Was there any way Mariah could have prevented herself from being hospitalized?”

“No. Her husband believed it was the best option. Her mother was in Arizona at the time,

unaware of the proceedings. Mariah was heavily medicated, and so removed from reality that she couldn’t stick up for herself.”

“What was your opinion of Mariah White’s mental state upon release from Greenhaven?”

Dr. Johansen frowns. “I found her to be emotionally fragile, but receptive to learning coping skills. And, of course, she was very preoccupied with her pregnancy.”

“Did she exhibit signs of psychosis at that time?”

“No.”

“No delusions, no hallucinations?”

“Never. Even when Mariah was hospitalized,

it was for depression.”

“Dr. Johansen, what is your opinion of Mariah’s mental state today?”

The psychiatrist stares at his client as if divining her thoughts. “I think she’s getting stronger and stronger,” he says solemnly. “As evidence of that, you need only consider that she’s waived doctorstpatient confidentiality here in court, in an effort to retain custody. And look back to August: When presented with virtually the same trigger situation that once made her suicidal, she reacted this time in a much healthier manner. She pulled herself together, took care of her daughter, and went on with her life.”

“Doctor, in your mind is there any possibility that this woman would harm her daughter?”

“No.”

“In your therapy over the past seven years,

has there ever been an admission, inclination, or thought of Mariah harming her daughter?”

“Absolutely not.”

“Has Mariah spoken to you about the current circumstances surrounding Faith?”

“You mean the visions and the media? Yes.”

“Does Mariah believe that her daughter is,

indeed, a visionary?”

Dr. Johansen is silent for so long that Joan starts to repeat the question. “Mariah believes her daughter is telling the truth,” he says. “For whatever that’s worth.”

“How do you go about getting someone committed to a mental institution?” Metz begins.

“It’s a court process,” Johansen says. “A psychiatrist evaluates the person, and the judge reviews the files.”

“So several people are involved in the decision.”

“Yes.”

“Does the system work?”

“Most of the time,” the psychiatrist says.

“In the cases where you can’t trust a person’s own judgment on the matter.” He stares pointedly at Metz. “However, in this particular case the system didn’t work. Mariah White was severely depressed and overmedicated, and her own wishes were not respected.”

“If the judge had believed that Mrs. White didn’t need institutionalization, would the court order have been passed?”

“No.”

“If the psychiatrist had believed that Mrs.

White didn’t need institutionalization, would the court order have been passed?”

“No.”

“If the next of kin, Colin White, had believed that Mrs. White didn’t need institutionalization, would the court order have been passed?”

“No.”

“I see. So you’re suggesting that these various people should have set aside their observations and taken the opinion of a woman who cut open her wrists a week earlier?”

“That’s not–“

“Yes or no, Doctor?”

The psychiatrist nods firmly. “Yes, that is what I’m saying.”

“Let’s move on. What did you prescribe for Mariah White when she first left Greenhaven?”

Dr. Johansen looks down at his notes.

“Prozac.”

“Was this a continuous prescription?”

“For a while. But after a year she went off it,

and she functioned beautifully.”

“You considered her emotionally stable?”

“No question in my mind,” Johansen answers.

“Has Mariah White asked for a refill of that prescription?”

“Yes.”

“When?”

“Three months ago,” the psychiatrist says. “August.”

“Right after her husband left? Then she wasn’t as stable as you thought–right, Doctor?”

Dr. Johansen straightens. “The same exact thing that threw her for a loop seven years ago happened again, Mr. Metz. This time, instead of attempting suicide, she called me up and said, “I need help.” Any psychiatrist in the country is going to view that as a mark of mental stability.”

“Are there side effects to Prozac?”

“Occasionally.”

“Such as?”

“Sometimes fluoxetine may cause headaches,

chills, nervousness, insomnia, drowsiness,

anxiety, dizziness. Also hypertension, rashes,

nausea, diarrhea, weight loss, chest pain,

and tinnitus.”

“What about hallucinations?”

“Yes,” Dr. Johansen admits. “But quite rarely.”

“And suicidal ideation?”

“On occasion. However, you must remember that I’ve seen this particular patient on this particular drug at a dosage of twenty milligrams P.o. for over a year. I know how her body reacts to it. were this a new prescription, Mr. Metz, you might be right.

But not in the case of Mrs. White.”

“Was she off the drug, Doctor, for a period of several years?”

“Yes.”

“Aren’t there adverse effects associated with its discontinuation?”

“Yes.”

“Such as suicide attempts, psychosis,

delusions, and hallucinations?”

“Again,” Johansen cautions, “you’re talking about a minute percentage of people.”

“But might she have had some adverse effects to discontinuation?”

“None that she reported, Mr. Metz.”

The lawyer turns. “Dr. Johansen,

what’s the likelihood of someone who undergoes successful treatment of depression having a recurrence of the illness?”

“I don’t have statistics.”

“But it happens fairly often, doesn’t it?”

“Yes. But usually the well-adjusted ones know to return to a psychiatric professional, at that point, for help.”

“I see. So basically you’re telling us that someone who’s crazy once has a good shot at going crazy again.”

“Objection!”

“Withdrawn,” Metz says. “Nothing further,

Doctor.”

Joan is out of her seat before the words leave his mouth. “I’d like to redirect,” she snaps.

“I’d like to qualify the terms “mental disorder” and “depression.” Are they one and the same?”

“Of course not.”

“What was Mariah’s diagnosis?”

“Suicidal depression,” Johansen says.

“Have you ever heard of Munchausen Syndrome by Proxy?”

“Yes.”

“Does it stand to reason that a person diagnosed and treated for suicidal depression would seven years later develop Munchausen Syndrome by Proxy? Is that a direct relationship?”

Dr. Johansen bursts out laughing. “No more than saying that because you eat breakfast in the morning,

you’re likely to be wearing underwear.”

“Thank you, Doctor,” Joan says.

“I’m through here.”

What Millie decides as she sweeps up to the witness stand is that she’s held her tongue long enough. As long as Joan intends to make her a character witness for Mariah, she wants to get her two cents in. She settles in the chair and nods at the attorney, ready to begin.

“Mrs. Epstein, how often do you see Faith?”

“At least every other day.”

“How often do you see Faith interacting with Mariah?”

“Again, just as frequently.”

“In your opinion, is Mariah a good mother?”

Looking every inch the proud parent, Millie beams. “She’s a wonderful mother. She works twice as hard as any other parent because she’s so intent on doing the best possible job.”

“How has Mariah dealt with the media surrounding Faith these days?”

“How would you?” Millie says. “She’s pulled Faith out of school; she keeps her hidden from their cameras. She does whatever she can to give her a normal life.” There. That’s her obligation to Joan, the material they’ve rehearsed ad nauseam. But she continues to speak,

causing Joan to stop in her tracks and glance up, surprised at the change in script. “You all think that Mariah’s the one who has to measure up. But whose fault is this, really?” With a trembling finger, she points to Colin. “He’s the one who did this to my daughter before. He had her committed. Well, he should be the one committed, for not being able to keep his pants zipped–“

“Mrs. Epstein,” Joan says firmly.

“If you could just please stick to the questions?” She clears her throat and gives Millie a very pointed look.

“No, I think now that I’m up here, I’d like to talk. Who wouldn’t be depressed if your husband starts sleeping around behind your back?

I don’t know why–“

“Ma’am,” Judge Rothbottam warns,

“I must ask you to control yourself.”

Joan walks toward the witness stand during this digression, smiling tightly. “Cut it,” she says through clenched teeth, and turns away,

muttering something about loose cannons. “Mrs.

Epstein, there are a variety of reasons to legally support a change of custody. To your knowledge, has Mariah ever sexually abused Faith?”

“God, no.”

“Has she ever hit her daughter?”

“She doesn’t even smack Faith on the bottom when she’s being wise.”

“Has Mariah ever emotionally abused Faith?”

“Absolutely not!” Millie says.

“She’s completely supportive.”

“Does Mariah work outside the home, or in any other way spend most of the day away from her daughter?”

“She’s with her every minute.” Millie looks sourly toward the judge. “When she’s allowed to be.”

“Thanks,” Joan says, and then sits down before Millie has a chance to say anything else.

Metz eyes Millie Epstein with calculation. He knows damn well why Joan wrapped up so quickly–the old bat’s loopy.

Like Joan, he plans to steer clear of questions involving reincarnation and second leases on life, questions that would only make him the butt of jokes in the legal community. He smiles,

catching Millie off guard. From what Joan’s told her, he’s sure that he’s been built up as a piranha. “Mrs. Epstein, you really love Mariah, don’t you?”

Millie’s face softens. “Oh, yes.”

“She grew up very close to you, I bet.”

“Yes.”

Metz leans against the witness stand. “You watched her graduate from high school?”

“Class valedictorian,” Millie says proudly.

“And college? Magna cum laude?”

“Summa.”

“That’s amazing. I barely made it through Freshman English,” Metz jokes.

“And you, of course, were there when she got married.”

Millie’s mouth turns down at the corners.

“Yes.”

“I bet you taught her everything she knows about being a good mother.”

“Well,” Millie says, flushing modestly, “you never know.”

“I bet you taught her how to help Faith through these difficult times. Am I right?”

Millie’s chin comes up. “I told her over and over: When you’re a mother, you stick up for your child. And that’s that.”

“Is that what Mariah’s been doing all along for Faith?”

“Yes!”

Metz pins her with his gaze. “And is that what you’re doing now for Mariah?”

Millie glances at the judge. “So? Is that it?”

Judge Rothbottam taps his fingers on the desk. “You know, Mrs. Epstein, actually I have a couple of questions.” He glances at each of the attorneys in turn. “Apparently our esteemed counsel is running a bit shy.”

Millie preens under his regard. “Go right ahead, Your Honor.”

“I’ve, um, read in some of the papers that you were … resurrected?”

“Oh, yes. In fact,” Millie rummages in her large purse, “I’ve got my death certificate somewhere in here.”

“I don’t need to see it.” He smiles at her. “Can you tell me about it, though?”

“The death certificate?”

“Well, no. The resurrection. For example, how long were you clinically dead?”

Millie shrugs. “About an hour. Signed,

sealed, and delivered.”

“What happened?”

“I got into a shouting match with Ian Fletcher. The next thing I know, I’m lying on the floor and I can’t breathe. After that, I don’t remember.” Pausing dramatically, she leans toward the bench. “Then I’m all of a sudden in a hospital room with Faith leaning over me.”

The judge shakes his head, amazed. “Any medical explanations for what happened?”

“As far as I know, Judge, the doctors can’t explain it.”

“Mrs. Epstein, what do you think happened?”

She looks at him seriously. “I think my granddaughter brought me back to life.”

“What do you make of Faith’s visions?”

“I believe her. Goodness, if I didn’t believe her now, I’d be an idiot, wouldn’t I?” She smiles. “Or worse–I’d be dead.”

“Thank you, Mrs. Epstein. Mr. Metz,

do you have any more questions?” The attorney shakes his head. “Well,” Rothbottam says. “I think I need a recess.”

Mariah watches her daughter leave the courtroom with Kenzie. She’s still not allowed to go near Faith, and to her surprise it’s harder to keep her distance now, knowing that Faith is no longer ill. She cranes her neck, watching Faith disappear into the hallway.

She hopes Kenzie is taking care of her.

From the corner of her eye she sees Ian.

Immediately she turns away.

“Mariah.” Joan draws her attention.

“You’re on after Dr. Fitzgerald.”

“That soon?”

“Yeah. Are you going to be all right?”

She presses a fist to her stomach. “I don’t know. It’s not you I’m worried about; it’s Metz.”

“Listen to me,” Joan answers. “When you’re up there, no matter what he says to you, you look right here.” She points behind her, to the row where Faith has been sitting. “She’s going to get you through this.”

Dr. Alvin Fitzgerald has no sooner taken the stand than Metz stands up.

“Approach!” The attorneys walk up to the bench. “I want to know if this guy interviewed Faith.”

Joan barely spares him a glance. “No,

because I knew you’d complain if he did. If there needs to be an interview at a later date,

both of our experts can have a chance. However, I can show what I need to show without Dr. Fitzgerald interviewing Faith.”

At this, some of the wind goes out of Metz’s sails. “All right,” he says tightly.

“Dr. Fitzgerald,” Joan begins, “can you state your credentials for the record?”

“I graduated from the University of Chicago’s medical school, did a residency and fellowship in child psychology at UCSF, and I was the principal investigator on a large grant studying CFS and somatoform disorders.”

“We’ve heard an awful lot about Munchausen Syndrome by Proxy. Can you tell us if this particular case fits the criteria for that disorder?”

The psychiatrist shrugs. “Well, there’s a lot that matches the basic DSM-FOUR criteria.”

Joan watches Metz’s mouth drop open in surprise as the psychiatrist repeats the highlights of Dr. Birch’s testimony. Then she asks, “Are there elements in this case that don’t seem to fit MSP?”

“Yes. For one, Faith’s symptoms are real, and bizarre. It’s a lot easier to fake nausea than to fake stigmata. As for the hallucinations, I disagree with Dr. Birch. Just because Mariah White was at an institution with psychotics doesn’t mean she could make Faith convincingly fake a hallucination–that’s like saying that riding on the Bulls’ team bus will make you play like Michael Jordan.” He grins.

“Another discrepancy is that Munchausen by Proxy is chronic. These parents go from emergency room to emergency room so that doctors don’t pick up on what they’re doing. Yet Mrs. White has taken Faith to the same health-care provider, Dr. Blumberg,

repeatedly. She’s gone so far as to request him to examine Faith numerous times.”

“Is that all, Doctor?”

“Oh, I’m just getting warmed up. The perpetrators of Munchausen by Proxy traditionally have an emotionally distant childhood,

which Mariah White did not have. But the biggest problem I have with a diagnosis of MSP is simply that there are alternative diagnoses that explain this case equally as well.”

Joan acts surprised. “Really? Like what?”

“Somatoform disorder, for one. Basically,

it’s when a patient experiences emotional distress in a physical way. Imagine a child who develops severe stomach cramps every time she has to take a test, because she’s so anxious about school. She’s truly hurting, but she can’t articulate why. Remember Freud’s hysterical patients? They were the great-grandmas of today’s somatoform-disorder patients.”

He holds up his hands, demonstrating a sort of scale. “It’s helpful to consider these disorders by imagining a range,” the psychiatrist says. “On one end is malingering, which we’ve all done: You pretend you have the flu to get out of jury duty, for example–symptoms are intentionally faked to achieve an intended goal.

On the other end is somatoform disorder, where a patient unintentionally produces a symptom that looks and feels like the real thing–and doesn’t know that she’s doing it, much less why. Somewhere in between these is Munchausen Syndrome by Proxy, where symptoms can be intentionally feigned … but for unintentional reasons.”

“So the difference, Doctor, is in the intent.”

“Exactly. Otherwise, these two disorders look similar. Just as in Munchausen by Proxy,

a doctor will examine a child with somatoform disorder and not be able to find any organic etiology for the symptom. She may undergo CT scans and MRI’S and dozens of tests, to no avail, because the presenting problem doesn’t fit with the physiology. However, in a somatoform disorder,

the symptom is set off by stress. In MSP,

the symptom is set off by Mom. In somatoform disorders, the symptom is real. In MSP,

it’s faked. Often deciding which is which comes down to a judgment call requiring the knowledge of the context of the illness, the players involved, and what gains have been made by them.”

“Then part of the diagnosis involves who’s trying to get attention–the mother or the child.”

“Exactly.”

“How do Faith’s symptoms fit a somatoform disorder, Doctor?”

“First, the presenting problem isn’t organic.

She’s bleeding from her hands, but there’s no tissue mutilation inside–kind of hard to fake a wound like that. She may be hallucinating, but she’s not psychotic. And there’s an argument to be made that the illness was brought on by stress, that she unconsciously believes that by being sick, the stressor will go away.”

“Would a divorce qualify as a stressor?”

Fitzgerald grins. “You catch on fast,

Ms. Standish. In a child’s mind is the unconscious thought, “If I get sick, my parents will stay together to take care of me.” Without even knowing she’s doing it, the child makes herself ill and draws attention to herself. Not having actually met Faith, of course, I can only hypothesize that her mind is making her body sick, in the hopes that her family will remain intact. And look–it’s working. Her parents are both here today, aren’t they?”

“If that were true, would Mrs. White be in any way involved in her daughter’s illnesses?”

“Oh, no. It’s all being done psychogenically, by Faith’s mind.”

Joan pauses. “How would you go about determining whether Faith’s illnesses were caused by her mother’s hand or by her own mind?”

“By default. I’d remove Mrs. White from her child to see if the symptoms abated.”

“What if I told you that a comatose child whose bodily systems were in acute distress was restored in a period of an hour to perfectly normal levels of functioning once she was reunited with her mother after an extended separation?”

“Well,” Dr. Fitzgerald says, “it would certainly rule out Munchausen by Proxy.”

“You’re not a hundred-percent sure, are you?”

asks Metz. “That it’s somatoform disorder plaguing Faith … or that it’s Munchausen by Proxy plaguing her mother.”

“Well–“

“Do children always develop somatoform disorders after messy divorces?”

“No,” Dr. Fitzgerald says. “A variety of maladaptive behaviors might occur.”

“Can you list them for us, Doctor?”

“Sometimes kids act out behaviorally, or sexually. Grades drop in school.

Appetites rise or wane. There’s a whole range, Mr. Metz.”

“I see. Are only a small percentage of Munchausen by Proxy cases reported?”

“Yes.”

“So, although it is a rare disorder, it may be more prevalent than one might think?”

“That’s right.”

“Is it true that most patients diagnosed with MSP are female, with a median age of thirty-three?”

“Yes.”

“How old is Mariah White, and what sex is she?”

“She’s a thirty-three-year-old female.”

“Is it true that the perpetrators of MSP are usually mothers?”

“Yes.”

“Is Mariah White Faith White’s mother?”

“Yes.”

“Have most people who suffer from MSP undergone a significantly stressful life event, such as a divorce?”

“Yes.”

“Did Mariah White just go through a divorce?”

“Yes.”

“Most of the perpetrators of MSP have some experience in the health field, as either patients or professionals, correct?”

“Yes.”

“Did Mariah White spend several months in a mental institution?”

“Yes.”

“Is it true that in MSP, the parents seem very interested in the child’s treatment?”

“Yes,” Dr. Fitzgerald says dryly.

“But most parents with a sick child–whether they have MSP or not–tend to be interested in the child’s treatment.”

Metz shrugs off the response. “Has Mariah White been very interested in her child’s treatment?”

“That’s what I hear.”

“Is it true that most symptoms presented in cases of MSP do not often respond to conventional medical treatment?”

“Yes.”

“Have Faith White’s hand wounds resisted responding to traditional clotting medicines?”

“Yes.”

“Have Faith White’s hallucinations persisted in spite of antipsychotic drugs?”

“Yes.”

“Is it true that patients with MSP are unconsciously looking for attention?”

“Yes.”

“Is there an incredible amount of attention focused on the case of Faith White?”

“Yes.” The doctor sighs.

“Is it true that the perpetrators of MSP deny what they’re doing, either because they’re pathological liars or because they’ve dissociated from the behavior?”

“Yes.”

“Has Mariah White admitted to harming Faith?”

“Not to my knowledge.”

“Does that fit the MSP profile?”

“Yes, it does.” Fitzgerald raises a brow. “Of course, it also fits the profile of a mother who hasn’t hurt her child.”

“All the same, Doctor, you’ve just given me about ten specific reasons that this case looks like Munchausen by Proxy. If it looks like a skunk and smells like a skunk and acts like a skunk … well, you can’t say honestly that this is clearly somatoform disorder, can you?”

Dr. Fitzgerald’s mouth flattens into a line. “That’s completely specious logic.”

Metz shakes his head. “Yes or no.”

“No.”

“And what does that leave us?”

The psychiatrist meets the attorney’s gaze. “If it’s not somatoform disorder,” he says, smiling slowly, “I guess it could always be a seven-year-old seeing God.”