"There is no psychology; there is only biography and autobiography." - Thomas Szasz

—Arkham State Penitentiary, Arkham, Massachusetts. March, 1990.—

Vincent Cavanaugh reflected, as he stood outside the half-open door of his office and flipped through the thick manila folder he held, that he really didn't deserve to have Herbert West as a patient. Although 'patient' was perhaps too strong a term; Cavanaugh was well aware that, as a psychiatrist working part-time at a prison, he was likely to be ranked below a priest on any list of expendable formalities. Nevertheless, he was still young enough to be cheerful and idealistic about the work he was able to do for the prisoners and their myriad disorders, and had even become quite accustomed to the kinds of men who cycled in and out of the environment of incarceration: those who came and went erratically and those who were trapped forever in the malformed tide pool of the penitentiary. Moreover, he felt encouraged by the way that the prisoners had been, while not overly responsive to him, not overly hostile either, which was more than he knew a great many of those who worked with prisoners received for their trouble.

West, however, was entirely dichotomous to the large, loud, poorly educated, and often repeatedly violent men he generally served who often lapsed into uncharacteristic bouts of shyness when seated face-to-face with a psychiatrist or counselor. But West was small, almost delicate, in size and stature, and fastidious in his dress and mannerisms; his movements were all very deliberate and calculating, while every expression to cross his face seemed underscored by something contemptuous that was not quite scorn but not quite pity either. For Cavanaugh, it was a disconcerting—almost thrilling—change of pace.

And yet, while West's case promised to be an interesting challenge and a desirable break in the daily tendency toward monotony, Cavanaugh found the man entirely unnerving, even slightly repulsive, in his haughtiness of presentation; simply put, he was terribly intimidated by the young doctor. Moreover, Cavanaugh was more than conscious of West's intelligence relative to his own—while he would never make an outright comparison between West and the fictional Dr. Hannibal Lecter, he imagined that their conversations would share some of the same dreadful overtones of the exchanges between Clarice Starling and the psychotic psychiatrist in that movie everyone seemed to be fawning over lately. It was a scenario he was most emphatically not looking forward to being a part of.

Therefore, in preparation for their first court-appointed meeting, Cavanaugh had done as extensive an amount of research as time and resources would allow, obtaining reports from the court psychiatrist who had declared West competent to stand trial, newspaper articles concerning the infamous Miskatonic Massacre and Arkham Tragedy, even managing to get detailed records of West's employment and education, including information from Zurich about the time he had spent in study with Dr. Hans Gruber. He'd found the earlier records to be strangely spotty in many places, as if someone had set out to destroy the less savory aspects of Herbert West's past. The psychological profile and accompanying records made and collected by the court-employed psychiatrist were even more irritating to wade through: completely uncomplimentary, repugnant in a way that was almost worthy of a tabloid, and poorly organized to boot. But what Cavanaugh found most intriguing was the shadowy presence of West's so-called scientific "partner," to whom he found numerous references in the periphery of his patient's colorful background. So, out of idle curiosity more than anything else, Cavanaugh had put in a request for any information about Daniel Cain as well, in an attempt to understand the life West had led before his incarceration.

The folders that had come back to him from his two separate requests for information had formed the basis for several nights of fascinatingly morbid reading and creative deduction. From what Cavanaugh could glean from the melding of the two sporadic histories, Cain had been a handsome, successful medical student with a serious girlfriend and a 3.8 grade point average when West had entered his life in the beginning of his third year at Miskatonic; a month later, Cain's girlfriend and her father, the dean of the medical college, were dead and both Cain and West were indicated as suspects in the incident. West had been seriously injured during the so-called "massacre" and was unable to return to classes for nearly six months following the entire messy debacle. The charges against them were eventually dropped due to a lack of evidence.

Then, for reasons Cavanaugh could not begin to imagine, West and Cain had continued to live with one another throughout the remainder of their time spent in medical school and their residencies. They had traveled to Peru together to assist as physicians during some of the less consequential skirmishes in the area during the local civil war, and had returned to Arkham after Cain had sustained an injury during a midnight ambush. They had then rented a house together and allegedly performed a kind of clandestine medical research as partners. Cavanaugh made a note to himself to ask West about what, exactly, their research had entailed. He knew from the reports that had been made during the highly publicized trial that it had a focus that was at least tangential to medicine and that human cadavers had been somehow involved, but assuming anything more was putting too much faith in a sensationalist media.

In the end, of course, West was arrested in conjunction with the events that had resulted in the death of a police lieutenant and several apparently innocent bystanders as well as the cave-in within the Arkham cemetery. Cain surrendered evidence and testimony against West in exchange for a grant of immunity from the district attorney's office, and West had been summarily convicted. But still, throughout the meandering account Cavanaugh was able to create for himself of their time spent together, the odd undercurrent of their unnatural and unspecific scientific treatises wove their meager personal lives into some sort of wayward marriage of a dominant and a submissive personality.

Cavanaugh felt a bit ashamed as he skimmed through West's case file there in the hallway and paused over the statement made by the court psychiatrist. He found it difficult to reconcile the facts he had about West's life with the recent report that had been issued by Matthew Pierce, who was employed by the district attorney and a man Cavanaugh had never been able to respect on a professional level.

Pierce had a tendency to fill his reports with downright insulting comments about the accused men and women he interviewed, all of whom he generally spoke to for less than two hours before releasing his definitive statement. His take on Herbert West had been, unsurprisingly, to note that there was no basis for a plea of insanity and to recommend a diagnosis of sociopathic personality disorder. In what seemed to Cavanaugh to be an entirely irrelevant observation, Pierce had also made the assertion that a repressive sexual disorder was likely. Probably thinks he's some sort of a deviant or a homosexual, Cavanaugh noted cynically; he knew that Pierce enjoyed tying all violent behavior back to some sort of psychosexual trauma or distraction. Cavanaugh himself tended to find the entire philosophy somewhat lurid and exasperating. But though he had initially rolled his eyes at Pierce's assessment, he'd found himself beginning to take it into serious consideration as more information about West and his partner in research and—apparently—high crime became available to him.

So it was that he stood outside of his office just before his first formal meeting with West, as well-educated on the subject of his patient's background as he could hope to be. But he still felt inadequate when it came to his ability to assess the man's psychological state. The glum sight of the guard stationed by the large set of steel doors at the end of the corridor was just another reminder that he wasn't going to have a session with the average depressed housewife or angst-filled teenager.

"Dr. West," Cavanaugh attempted a friendly smile and held out his hand as he entered the office and turned to face the plastic chair which was bolted to the floor, where West sat. "Good to see you today. I'm Dr. Vincent Cavanaugh."

West stared up at him placidly, but did not extend his hand in return.

Cavanaugh cleared his throat and slipped his outstretched hand into his trouser-pocket as he sidled around the desk to his chair, dropped the folder onto his blotter, flipped it open, and sat down heavily. "Well, Dr. West… I've given this some thought, and I think our first order of business should be to dispense with any presumption of bullshit, here."

West raised one curious eyebrow.

"You are here because, though the court psychiatrist ruled you competent for trial, it was recommended that you follow-up with me due to suspicions of a form of personality disorder and accompanying violent or destructive tendencies."

West interrupted with a small sniff of indignation. "A completely unfounded assumption."

"And that may very well be true," Cavanaugh replied soothingly. He plucked a pen from a crowded holder and toyed with it as he paged through the folder until he found a blank page on which to take notes. "Still, I'm afraid I can't let you off the hook based solely upon your opinion. You're a bit of an anomaly for me, you know. I'm sure you're aware of the kind of patients I normally treat."

"'Treat?'" West's face twisted into a contemptuous sneer. "And here I was under the impression that the actual treatment of mental health in this charnel pit mostly involves tossing mass-quantities of lithium down the throat of the problem until it is no longer able to howl in your ear."

Cavanaugh continued to smile blandly through the unflattering editorial statement. "Well, I myself try to avoid taking that particular approach. But I can't speak for the rest of my colleagues, as you are no doubt aware."

West didn't respond, but his gaze remained unrelenting. Cavanaugh turned back to the case file and made a show of flipping through the pages, trying to ignore the creeping sensation of horripilation at the back of his neck.

"But let's not get sidetracked." He paused, trying to recall which course of dialogue he had decided would be most effective in teasing the most information from his clearly reticent patient. His eyes lit upon the account of West's time spent abroad, and he looked up, suddenly decisive. "I see here that you spent nearly a year in Switzerland studying issues of biochemistry with the esteemed Dr. Hans Gruber." He paused momentarily, glancing up to judge West's reaction. "In fact, you were present at the time of his death, weren't you?"

"I did not kill him," West said abruptly, his words clipped and succinct. "I tried to save him."

"But the Swiss authorities didn't seem to believe you." Cavanaugh made an obvious gesture of checking a notation within the folder in from of him. "They put you under psychiatric observation for several months, didn't they?" West didn't answer. "I expect that was a very upsetting experience."

"They didn't understand my work." West shrugged and sniffed haughtily.

Cavanaugh made a small, sympathetic noise. "I see."

West lapsed back into silence. Cavanaugh decided to change his approach.

"When you refer to your work, do you mean your work as a physician?"

"Of course not," West corrected him. "The research I was engaged in with Dr. Gruber was based almost exclusively in chemical reactions within the body. We weren't treating any patients."

"But you went on to become a licensed physician, didn't you Dr. West?" Cavanaugh asked, fascinated despite himself. "You graduated from Miskatonic Medical School and even went on to work within the hospital. But why do this if the work you were doing in Switzerland was focused in the field of biochemistry?"

"Clearly you have no understanding of how someone who wishes to observe how the body's chemistry affects and is affected by illness or injury would go about doing it." West lapsed into the droning tone of voice of a pedantic, and Cavanaugh speculated, with some amusement, that it was probably an affectation that was both comfortable and reassuring for the deposed doctor. "However, I admit that money was one of my chief concerns."

"Oh?"

"Obviously the extensive research I had hoped to undertake would be extremely expensive. And once I was shuffled out from under the wing of Dr. Gruber… well." West began to tap his fingers idly against the armrest. "I knew that I would be unable to secure adequate funding on my own through grants and so forth. And I didn't want to," he added emphatically. "In one breath, they all would have denounced me, called me a madman, and then stolen my work for their own purposes."

"So you felt you had to enter a profession that would allow you to be, ah, self-sufficient?" Cavanaugh prompted.

"In part. It was also convenient, since I had completed two years of medical college before going to Zurich. And Miskatonic had more than adequate funding and equipment that I could put to my own use." He shrugged and shifted slightly in his seat. "It's perfectly obvious when you think about it."

"I see, I see. But I have to ask you, Dr. West," Cavanaugh leaned forward over his desk, lacing his fingers together around his pen and slowly swiveling the seat of his chair from side to side, "Mostly because of my own curiosity… what exactly did your work and research entail?"

West gave him a paranoid glance.

"Well, you must know that what was printed in the newspaper and tabloids was incredibly vague and, ah, bordering on hysteria?" When West made no move to agree, disagree, or correct him, Cavanaugh tried again. "And you must want to correct some of the over-simplified misconceptions that spread during your trial, right?"

Still, West stayed silent; after a moment he turned his head to look out the tiny, barred window.

"Okay," Cavanaugh soon conceded defeat and turned back to the case file, searching for a new subject. "Then why don't we move on… and you can tell me a little bit about your partner, Dr. Daniel Cain?"

West's head jerked sharply back to look at Dr. Cavanaugh. "You have done your homework," he said without enthusiasm. Cavanaugh's smile broadened slightly.

"Oh, now I would hardly call it homework, Dr. West." He leaned forward in his seat and crossed his legs beneath the desk. "You've led a rather fascinating life."

"Perhaps. But I can't begin to imagine why you would want to hear about Dan from me."

"I was under the impression that he was a large part of your life for several years," Cavanaugh said pointedly. West sneered in return, hip upper lip lifting to reveal one sharp, pointed eyetooth.

"He may have been, at one time." West twitched one hand in a quick gesture that was reminiscent of someone brushing away an irritating insect. "But now… I'll probably never see him again, hmm? And I have no particular desire to."

Cavanaugh observed West's furrowed brow and clearly controlled frustration with some interest, making a note in the margin beside one of the mentions of Daniel Cain. "Are you angry with him?"

West's face suddenly became smooth, devoid of any expression other than faint boredom. "He made the choice he felt he had to make."

"His testimony was the primary reason for your conviction. I would think that would be very difficult to take, considering that he got a grant of immunity and you may be spending the next fifteen to twenty years here."

Again, West looked away from him and gave no sign of answering the question. Cavanaugh felt a spike of irritation and was unsurprised; it was always frustrating when patients opted to ignore questions, since even the most roundabout or irrelevant responses could offer clues that aided in diagnosis or therapy. He tried another question, half-hoping that he would be able to surprise or incite West to give him an answer that was more emotionally revealing. "What was Daniel Cain to you?"

"What?"

"Was he your partner? Your friend? Hired help, a lab assistant… any of those sound like accurate descriptions?" West pursed his lips and nodded slowly; he looked as if he was responding to a question he had asked himself, and not the one Dr. Cavanaugh had directed at him. "Well? Any one of those things in particular? Or all of them?"

West hesitated, and then shook his head once, very quickly. "I thought he cared about what we were doing." His voice became quiet. "I overestimated him."

"How do you feel about him now?"

West shook his head again and stared at Cavanaugh's desktop; his hands rested on his knees, palm-down and hooked into claws that strained the fabric of the clothing issued to him by the prison. "He deserves whatever he gets."