Mental Hygiene

by Roberta A. Isleib, Ph.D.

If only Dr. Rebecca Butterman had been in session when the detective beeped her, she could have avoided witnessing Lawrence Merriweather's mutilated remains. The other events of the day-a tricky Rorschach inkblot interpretation, Mr. Oliver revealing his infidelity to his wife for the first time during their joint therapy hour, and then the scornful invectives of a sullen teenager-all this felt painless in comparison to Merriweather's corpse. The greasy remnants of the grilled cheese sandwich she'd wolfed down for lunch began a slow rise from stomach to throat.

"Sorry about that, Rebecca." Detective Caroline Rumson laughed softly and guided her past the technicians who buzzed around the body. "I forget that you shrinks only have strong stomachs for mental carnage. I need you to get on this ASAP. There's going to be a lot of pressure to close the dental clinic if we can't make an arrest right away. I think we can wrap it up quickly-apparently Dr. DeNardia has a history of mental instability. They even sent him to have psychological testing done last year."

Dr. Butterman took a series of deep, centering yoga breaths, a technique she often recommended to nervous patients. She was beginning to see first-hand just how little the breathing touched a case of serious stomach-wrenching anxiety.

"What the hell was sticking out of that man's throat?"

"Betty Ann, the receptionist, she called it a zerfing chisel. They use it for scaling plaque off teeth. Like I told you on the phone, the victim is Lawrence Merriweather-he's one of Dr. DeNardia's patients. Maybe you know him-he researches, well best say he used to research, some kind of brain biochemistry." Rumson cocked her head in curiosity.

"This hospital has a staff of five hundred, plus god-knows-how-many adjunct faculty. It's the second largest facility in New Jersey. I don't know every egghead in the place, for crying out loud." Dr. Butterman sometimes suspected that the detective resented relying on a psychological consultant-unconsciously, of course. But as a result, she enjoyed getting the upper hand in their relationship-by whatever subtle means it took to get there. "What do you need me for?"

"First, locate DeNardia's records in the psychology clinic and give me a summary of what you people found. Maybe he should have been banned from seeing patients at all."

There it was again-you people, as though psychologists in their generic entirety were responsible for the ill-fated attack by zerfing chisel. Sooner or later, she and Caroline were going to have to have it out.

"Did he sign a release?"

The detective nodded.

"What else?"

"I'd like you to sit in on the interviews this afternoon. Can you clear your calendar?"

The first interview was with Frank DeNardia himself. Dr. Butterman had located his testing file in the clinic. Last year's psychological evaluation had been scheduled after a complaint was lodged by one of his patients. He'd undergone a thorough battery of testing-interview, intelligence test, complete personality profile. When the results came back, the dentist was remanded for weekly psychotherapy and assigned to the clinical director. Now Dr. Butterman started to understand the urgency of her involvement in this case. It would look particularly bad if the head of the Clinical Psychology training program had one of his clients arrested for a brutal murder.

"You were evaluated at the psychology clinic last summer." Detective Rumson addressed the dentist in her brusque, television cop voice. "Why?"

"I was having thoughts about wanting to harm my patients," said Dr. DeNardia simply. "I mentioned it to several of them. My receptionist told me later I shouldn't say such things in front of other people. So I suppose one of them complained." The dentist leaned forward and placed his elbows on his knees. "But I didn't hurt Mr. Merriweather. He'd done a good job with his cleaning the last six months. And I've been going to my counseling sessions every week. Just ask my therapist." Then he smiled, revealing a set of perfectly straight, eggshell-white teeth.

Dr. Butterman was certain she could locate the appropriate descriptive code for his mental state in the Diagnostic and Statistical Manual of Mental Disorders. But let's face it, this guy was a fruitcake. Speaking as though one's dental hygiene would naturally be related to whether one should be a murder victim. But did the dentist commit the murder? She was not convinced.

"Why do you suppose you had feelings of wanting to hurt your own patients?" she asked.

He shrugged. "My doctor and I have been working on understanding that." He tugged on his earlobe. "They do make me mad, just lying there like beached whales and whining about how what I'm doing hurts them. But I don't have the whole answer yet."

Butterman waited until the detective had ushered the dentist from the room, then pulled out the psychological testing file a second time. She located the Rorschach Miniature Ink Blots in Color scoring sheet. The page, which contained a mini-replica of each of the ten Rorschach cards, was covered with scribbled notes and arrows. Dr. DeNardia had described aggressive action scenes when presented with most of the stimulus cards, especially those in color. The test administrator made the obvious interpretation that the dentist had hostile and angry impulses that he found difficult to control. No surprise-he'd admitted as much in the interview. The test report also noted that he had an arsenal of potential coping resources that worked well when he could muster them. But how much progress had been made in shoring up those resources? She'd have to speak to the clinical director later.

Detective Rumson stalked back into the office, a small gray-haired woman in tow. Dr. Butterman shuffled the test results back into their manila folder. "This is Betty Ann Romano," said Rumson. "She's the receptionist for Dr. DeNardia and two other dentists in the clinic."

"The others had the morning off," squeaked Betty Ann. "Oh my lordy, lord. I can't believe this is happening."
"Who else was in the office this morning?"

Betty Ann gripped her short curls with both fists and furrowed the skin above her eyebrows into Shar-pei folds. "There was Mr. Roden. He comes in almost every month demanding whitening gel syringes. I'd suggest you take a long, hard look at that man. He's crazy."

"Excuse me," said Dr. Butterman. "What are whitening gel syringes?"

"The stuff they use to bleach teeth," explained Betty Ann. "Usually it only takes two of the syringes to do the job, then maybe a touch-up every six months or so. We recommend it to almost all of our patients." She ventured a small, but very white smile. "But Mr. Roden can't get enough. Susan slipped him some extras, but Dr. DeNardia finally put his foot down this morning and said "No more!" That man was so angry when he left."

"But why kill Lawrence Merriweather?" asked the detective.

Betty Ann shrugged and began to cry. "It couldn't have been Dr. DeNardia. He's talked about hurting patients, but I can't believe he'd ever do it. I've answered his phone calls and scheduled his appointments for twenty years."

"Who else was around the office this morning?" asked Rumson.

"Just me and Susan."

"Susan?"

"The dental hygienist. She's worked with us for fifteen years. She was helping me with the filing this morning. We were talking about gardening. I prefer wildflowers but she goes for the more formal, English style. The roses are pretty and all, but the chemicals she has to use to keep them pretty." She began to weep again. "I don't know…people walk up and down this hallway all day long. The security in this hospital is dreadful. Someone could have slipped in from outside and stabbed Mr. Merriweather and we'd never have known it."

The detective led the sodden Betty Ann out of the room and returned with Susan Olmsted, the hygienist. As they took their seats, Rumson's cell phone shrilled. "Dammit," she said. "I have to take this. Go ahead and start-I'll be back shortly."

Susan settled into the chair across from Dr. Butterman and gazed around the room. Finally her eyes rested on Frank DeNardia's test file. Just the edge of the ink blot score sheet poked out from the folder.

"Oh how pretty!" she exclaimed. Before the psychologist could protest, Susan eased the Miniature Ink Blot scoring sheet out from the file and held it close to her face. "I don't care for the black ones, but these colors are beautiful-up against that white, white background. You could frame this-it's just that pretty."

"Tell me what you noticed at the clinic this morning," Dr. Butterman prompted, reaching to retrieve the score sheet. It was extremely irregular to have an employee looking at her boss's psychological test materials.

"It was a busy day, and in between patients, I helped Betty Ann with the filing." She frowned and made a clucking noise. "She tends to get behind and then you can never find a chart when you need it. With the way insurance companies operate these days, you have to stay on top of things."

"How did Dr. DeNardia seem to you today?"

Susan thought this over carefully. "He was a little on edge when he came in. I don't think he's been sleeping well. He forgets things. He puts instruments back in the wrong place. It's not at all like him."

"Were you aware that he had been having thoughts about harming his patients?" asked Dr. Butterman as the detective reentered the room.

"Oh that," said Susan with a dismissive wave. "He'd never follow through. You know how upset you can get if things aren't going right. Sometimes he just says things he doesn't mean."

"Tell us about Lawrence Merriweather," the detective demanded.

"He does a good job taking care of his teeth between visits." Then she hesitated.

"What else?"

"That's all I can think of. Very little plaque, no receding gums, he almost never bleeds during a cleaning."

"What's he like?"

"He seems like a nice enough man-a little boring. He always wants to talk history and biography." She scrunched her face with distaste. "Me? I love mysteries."

"And Mr. Roden?"

Susan smiled, her teeth even whiter than her coworker's. "I warned him not to come in when Dr. DeNardia was here." She dropped her voice to a whisper. "Dr. D believes too much of the whitening gel can harm the enamel. I think he's too conservative, but he is the dentist..."

"Thank you for your time," said Dr. Butterman.

"Please wait outside with the others," said the detective. Susan gathered her lab coat around her shoulders and walked briskly from the room.

"Well, Doctor?" Rumson demanded. "What do you think?"

"You start," the psychologist countered.

"Murder by zerfing chisel…I would not rate that as a well-planned methodology."

Dr. Butterman laughed. "More like someone got pissed, grabbed the first instrument available and struck." She paused, her chin resting on her fist. "On the other hand, was it really a random choice? What did you say they use it for?"

"Plaque," said the detective. "Scaling scum." Both women laughed. "Let's go with random then. Next, who was pissed at Lawrence Merriweather?"

"Sounds to me like you better get some of your people gathering background data," said Dr. Butterman. "Possibly one of the dental employees knew the man in some personal context that they aren't disclosing."

"Duh. I hired you for psychological insights here, not tips on basic police procedure."

Dr. Butterman rubbed her eyes and sighed. "Try this out. We're looking for someone who may appear in control but underneath, the emotions are ready to boil over. Which is exactly what DeNardia's test profile suggested."

"It would be a matter of the right trigger," Rumson agreed.

"I have a hunch about the teeth bleaching. It's a long shot, but if I were you, I'd bring them all back in here and push a little more on the whitening system. Maybe someone's ready to crack."

"I think it may be you, dear," said the detective. Then she shrugged and went to the door. "Dr. DeNardia? Susan? Betty Ann? Could we see all of you in here please?"

Dr. Butterman stashed the psychological test folder under the blotter on the desk. "We'd like to hear more about your teeth whitening program."

All three broke into demonstrative alabaster grins.

"We offer it to all our patients," said the dentist. "Susan is an expert at talking them into trying it."

"And they look so much better when they've worn it for a few weeks," added Betty Ann. "I wouldn't be surprised if Susan was responsible for some major improvements in their lives." Susan just beamed.

"How does it work?"

Susan produced a chart from the pocket of her white lab coat and held it out toward the two women. A row of single teeth ranging in color from cigarettes-and-coffee yellow to stark white marched along the sheet. "We make an impression of the upper and lower teeth. Then we use this color chart to determine where the patient starts and how light they wish to go."

"What about Mr. Merriweather?" asked Dr. Butterman. The smiles evaporated.

"We've tried," shrugged the dentist.

"He just wasn't interested?" asked the detective.

"Oh he claimed he was interested," said Susan. "Four years ago he bought the whole system. We had the personalized dental trays made for him and everything. But then he refused to try it."

"What was the problem?" asked Dr. Butterman.

"Every visit there was a different explanation," said Betty Ann. "First he claimed he was a problem sleeper."

"This time, he had read the patient information about the possibility of heightened sensitivity during the bleaching process."

Susan spat the words out. "He insisted it would give him neuralgia."

"You'd had enough," observed Dr. Butterman.

"Have I been a good boy?" Susan sneered. "He asked that every time he came in." Her face twisted with rage. "I couldn't listen to any more excuses. He'd been a bad, bad boy."

Dr. DeNardia and Betty Ann rose slowly from their seats and backed toward the door.

"Would you two kindly wait outside?" asked the detective. "You have the right to remain silent…" she told the dental hygienist.

Detective Rumson banged her draft beer down on the sticky counter. "What finally tipped you off?"

"The inkblots," said Rebecca. "She picked up the Rorschach score sheet before I could get it away from her. I've never seen such a strong reaction to color. And her responses were not mitigated by form. Only the most histrionic patients react this way, and it's usually in the service of warding off some very ugly impulses underneath."

"So now you're diagnosing murder based on a suspect's reaction to someone else's inkblot test?" The detective's voice was incredulous.

"It worked, didn't it?" Dr. Butterman fingered the tooth color chart that lay on the bar, then held it up next to her friend's face. "You might want to consider this bleaching treatment yourself…right now I'd say you fall somewhere between numbers four and five."

Rumson batted the card to the floor and called for the check.

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