Compulsion: A Novel

Compulsion: A Novel

by Keith Russell Ablow MD

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Compulsion: A Novel by Keith Russell Ablow MD

Dr. Frank Clevenger, a brilliant forensic psychiatrist, is eager to leave the world of the criminally insane behind-until he receives a chilling phone call. Close friend and former colleague North Anderson, now the Chief of Police on the exclusive island of Nantucket, is desperate for help in solving a shocking case: One of the infant twin daughters of billionaire Darwin Bishop has been murdered in her crib at the family's estate. The suspected killer is her adopted brother Billy, and investigators believe that the fugitive teenager has targeted the surviving twin.

But as Clevenger maps the Bishop family's psychological layers he uncovers some disturbing revelations that lead him to believe Billy may be innocent. The Bishops are a deeply troubled family. As charming as he is ambitious and cruel, Darwin seems determined to protect his son-but is he actually trying to railroad him? Why does Garret, Bishop's other son, despise his father so intensely? Is beautiful Julia Bishop a mother grieving for her murdered child or a manipulative seductress with a dark secret to hide?

As Clevenger fights to protect the innocent and hunt down the guilty, aspects of the case begin to collide with demons from his own past. After a life-threatening attack the forensic psychiatrist knows he must penetrate the killer's psychosis in order to identify him before the Bishop family-and Clevenger himself-become the next victims. Using his mastery of psychiatry, Clevenger lays a trap to reveal the murderer in an unforgettable finale.

Product Details

ISBN-13: 9781429901109
Publisher: St. Martin's Press
Publication date: 06/16/2003
Series: Frank Clevenger , #3
Sold by: Macmillan
Format: NOOK Book
Pages: 320
Sales rank: 170,046
File size: 382 KB

About the Author

Keith Ablow received his medical degree from the Johns Hopkins School of Medicine and completed his psychiatric residence at New England Medical Center in Boston. A forensic psychiatrist, he serves as an expert witness in legal cases involving violence and has evaluated and treated murderers, gang members and sexual offenders for the Commonwealth of Massachusetts. His essays on psychiatry and society have appeared in The Baltimore Sun, the Boston Herald, Discover, USA Today, U.S. News&World Report and The Washington Post. He is the author of several works of nonfiction and of the novels Denial, Projection and Compulsion, and Psychopath. Ablow lives in the Boston area.
Keith Russell Ablow received his medical degree from the Johns Hopkins School of Medicine and completed his psychiatric residence at New England Medical Center in Boston. A forensic psychiatrist, he serves as an expert witness in legal cases involving violence and has evaluated and treated murderers, gang members and sexual offenders for the Commonwealth of Massachusetts. His essays on psychiatry and society have appeared in the Baltimore Sun, the Boston Herald, Discover, USA Today, U.S. News&World Report and the Washington Post. He is the author of several works of nonfiction, including Medical School: Getting In, Staying In, Staying Human, and of the novels Denial, Projection and Compulsion, and Psychopath. Ablow lives in the Boston area.

Read an Excerpt


A Novel

By Keith Ablow

St. Martin's Press

Copyright © 2003 Keith Ablow
All rights reserved.
ISBN: 978-1-4299-0110-9

1Saturday, June 22, 2002 
Lilly Cunningham looked up. I melted. She was twenty-nine years old, with pale blue eyes to get lost in. Her blond, curly hair would make any man want to touch it. Her strong forehead predicted intelligence and was perfectly balanced by the gentle slope of her nose. Then there were her full lips, dimples in her cheeks, her long, slender neck. A simple gold cross on a delicate chain pointed toward the curves of her chest and abdomen, rising and falling under a white sheet.Part of me wanted to let my attention linger on Lilly's beauty, but the bigger part of me loves truth, which is almost always about something ugly. My eyes moved to her exposed thigh.The flesh was inflamed from groin to knee. The skin had broken down in places, spreading like wet parchment, weeping pinkish fluid. Two serpentine black lines, in Magic Marker, each running twelve or fourteen inches through the muck, showed where her surgeon would make incisions to promote drainage.A war was being fought. Battle lines had been drawn."I don't believe we've met," Lilly said, her voice straining."Dr. Clevenger," I said, still focused on her thigh. Istayed several feet from the bed, which is my habit when first seeing patients."Hmm. Shaved head, jeans, cowboy boots. You don't look like any doctor I've ever seen. Certainly not at Mass General."I met her gaze. "What do I look like?"She worked at a smile. "I don't know. An artist, maybe ... or a bartender." She laughed, but weakly. "You have a first name?""Frank.""Okay, then, Dr. Frank Clevenger. What's your line? Surgery? Internal medicine? Infectious disease?""I'm a psychiatrist."She shook her head and turned toward the wall. "This is un-fucking believable."I stood there a few moments, staring through the tangle of IV tubing that dripped amphotericin and vancomycin into Lilly's subclavian vein. A window just beyond the hanging bottles looked onto Boston's Charles River at dusk, its waters blue-gray and utterly still. I tried again. "Do you mind if I ask a few questions?""You can do whatever you want. I don't care."I heard a fusion of anger and surrender in her voice. And I sensed something more in the way she half-whispered, half-swallowed the word care. A hint of seductiveness. Her tone made me imagine that I could, quite literally, do whatever I wanted to her. I took a mental note of that feeling, wondering whether she provoked it in others--and why. I stepped closer to the bed. "Do you know why your doctors asked me to see you?""Probably because they keep screwing up," she complained, shaking her head and exhaling in exasperation. "They can't figure out what's wrong with me, so they're calling me crazy."That was half right. Her doctors were calling her crazy, but they had figured out exactly what was wrong with her--at least, physically.Drake Slattery, chief of the internal medicine department,had filled me in. He is a lumberjack of a man who wrestled for Duke, and the muscles of his crossed arms had begun to ripple as he spoke. "She presented about four months ago, fresh from her honeymoon on St. Bart's. Mild fever, red blotch on her thigh. I'm figuring some tropical insect took a bite out of her, left her with a little cellulitis. Nothing to write home about. Like an idiot, though, I trash my whole schedule to get her worked up and started on antibiotics right away.""Is she that pretty?" I had asked.He looked offended. "Professional courtesy; she's a nurse over at Brigham & Women's.""Fair enough.""And she happens to be gorgeous."I smiled."So I dose her up on ampicillin, which seems to work," he said. "But then, two weeks later, she's back in the emergency room. The leg is puffed up twice normal size. She says she feels like someone's jamming a red-hot knife into her thigh. And she's running a fever of 103." His arms started rippling, again. "The ampicillin doesn't seem to cut it anymore, so I add a chaser of Rocephin. And the swelling goes down pretty quickly. All's well that ends well, right? Sometimes you have to go after the bugs with bigger guns."Slattery was an avid hunter, which made it hard for me to like him, despite his rare combination of genius and dry wit. "You're the shooter," I said.He winked. "Five days later, she's down in the ER again, bigger and redder than ever. Shaking like a leaf. Fever of 105. Now I'm worried. I don't know what to think. Lymphatic obstruction from a malignancy? Sarcoidosis? I even wondered about some weird presentation of AIDS. I never guessed what was really going on."Over the next few months, Slattery admitted Lilly to Mass General four times, treating her with a dozen different antifungal and antibiotic agents. Some seemed successful, dropping her white blood cell count and stopping the chills and sweats that plagued her. But, inevitably, she would returnto the emergency room within days, infected and feverish again.A CAT scan of her leg showed no tumor. A bone scan revealed no osteomyelitis. Repeated blood cultures failed to turn up any offending bacterium. So Slattery finally had a surgeon biopsy the semitendinous and biceps femoris muscles of Lilly's leg. He forwarded the tissue samples to the bacteriology laboratory of the National Institute of Infectious Disease in Bethesda, Maryland. The report came in a week later: Pseudomonas fluorescens, a pathogen generally found in soil."We gave her husband the news first," Slattery had told me. "He broke down and admitted he'd found a frigging syringe caked with mud at the back of one of her drawers. Wrapped in a pair of her panties."That image turned my skin to gooseflesh."Here we are busting our asses trying to keep this mental case from losing her leg," Slattery went on, "and it turns out she's been injecting herself with dirt.""That might say something about how she sees herself," I said."To you, maybe. To me, it says she has no business being in the hospital. She's stealing--my time, not to mention the hospital's resources.""I'd bet this case is all about stealing. But the key is to figure out what was stolen from her.""You're the poet," Slattery had said wryly. "That's why I called you in."I looked at Lilly lying in bed, still facing the wall. The technical term for her condition was Munchausen syndrome, intentionally creating physical symptoms in order to get attention from doctors. The name derives from Baron Karl Friedrich von Münchausen, a Paul Bunyan-like storyteller. Research studies have shown that a high percentage of patients with the disorder have, like Lilly, worked in the health care field.Many patients with Munchausen syndrome were also hospitalized when they were children. One theory is thatthey faced terrible abuse at home and were so relieved by the kindness shown them by doctors that they came to associate being sick with being safe. As adults they became dependent on using the sick role to numb their underlying emotional pain and keep distressing memories from surfacing--the same way drug addicts use heroin.To treat Munchausen's, a psychiatrist must coax the patient to confront the original psychological trauma he or she has repressed. If that sounds simple, it isn't. People with Munchausen's will generally flee treatment to avoid any exploration of their underlying problems.Trying to get Lilly to admit she had caused the infection would just make her shut down. The important thing was to let her know I understood that she was infected. Only one of the pathogens lived in dirt. The other--more toxic and invasive--lived in the remote recesses of her unconscious.I pulled an armchair to the edge of the bed and sat down. "No one doubts that you're ill," I said. "Dr. Slattery least of all. He told me the infection is very severe."Lilly didn't move.I decided to tempt her by bending the professional boundary between us, offering her a little of the physicianly warmth she craved. I reached out and touched one of the black lines her surgeon had drawn on her thigh. "Stress affects the immune system. That's a fact."Still no response.I moved my hand to Lilly's hip and let it linger. "As a nurse, I would think you'd agree."She rolled onto her back. If I hadn't moved my hand, it would have traveled to the lowest part of her abdomen. "Look, I'm sorry I jumped down your throat," she said, staring up at the ceiling. "I'm worn out. There's been one doctor in here after another. Medication after medication. I don't think I've been home five days in a row, between admissions." She let out a long breath. "Not exactly an extended honeymoon.""You're newly married," I said. "I read that in your chart.""I guess my life's just an open book," she said."I would guess you're as far from an open book as they come."She looked at me."How long ago did you marry?" I asked."Four months.""Is it everything you expected?"She stiffened, maybe because I sounded too remote, too analytic, too much the psychiatrist come to diagnose her.I offered up another bend in the doctor-patient boundary. "I've never tried the marriage thing myself.""No?""Engaged once. It didn't work out.""What happened?"I pictured Kathy the last time I had seen her, in her room on a locked psychiatric unit at Austin Grate Hospital. "She wasn't well," I said. "I tried to be her husband and her doctor. I made a mess of both.""I'm sorry," she said."Me, too."Lilly relaxed visibly. "Paul's been a dream. He's been so understanding about this whole thing. About everything.""Everything ..."She blushed like a schoolgirl. "We didn't have much time to be, you know ..."I shrugged and shook my head, even though I did know."Well, time to be"--she giggled--"newlyweds.""Did you have any time at all?""The problem with my leg started right after we left for St. Barth. We ended up flying home early.""But he understood.""He's never pressured me," she said. "He's a very patient man. He reminds me of my grandfather that way. I think that's the reason I fell in love with him."Sometimes a voice speaks at the back of my mind as Italk with patients. It is my voice, but it comes from a part of me over which I do not have complete control--a part that listens between the lines, even my own lines, then plays back what has gone unspoken. "Sex, pain, grandfather. When making love feels like being injected with dirt, you cut the honeymoon short and head for the hospital.""Tell me about him," I said, wanting to let her decide which man to talk about."Grandpa?"I just smiled."He's quiet and strong. Very religious." She paused. "My father died when I was six. My mother and I moved in with my grandparents.""Are they still living?""Thankfully," she said."Do they know about the trouble you're having?"She shook her head. "I haven't told anyone in my family.""Not even your mother?""No."I felt as though I had found a path into Lilly's psyche. I could speak of the infection in her leg as a metaphor for her childhood trauma. "Keeping a secret--especially a big one, like this--can add to your level of stress," I said."My grandparents are old now. And my mother's got her own problems to worry about. I don't want to burden them.""But they care about you, and you're in pain.""I can handle it," she said."After you've lost your father," the voice at the back of my mind said, "you don't risk losing your grandfather, no matter what it costs to keep him close. Even if it costs you your innocence. Or your leg."I kept speaking in metaphor. "It could be a long haul, getting to the bottom of this infection. You might want someone you can open up to. Someone outside your family." I glanced at the skin of her thigh where it stretched,tight and shiny, over the inflamed tissues below. "To release some of the pressure.""They do the incision and drainage tomorrow afternoon," she said."Otherwise the infection has nowhere to go but deeper."She gazed down at her leg. "I guess it's going to look pretty ugly once they open it up.""I've seen ... and heard ... just about everything," I said.She studied the leg a few seconds longer, then looked at me."If it's okay with you, I'll stop by after the procedure." She nodded."Good." I squeezed her hand, stood up, then headed for the door.That's what a little victory in psychiatry looks like. You slip into the shadows, dodging the mind's defense mechanisms, glad enough to take a half-step toward the truth. Behind the next word or the next glance may lurk the demon you seek, all in flames, desperate to be held, but set to flee.As I left Lilly's room I caught the "-venger" part of my name being paged overhead. I stopped at the nurses' station, picked up the phone, and dialed the hospital operator. "Frank Clevenger," I said."Outside call, Doctor. Hold on."There was dead air, then a deep voice said, "Hello?"Even after two years I recognized North Anderson's baritone. He was a forty-two-year-old police officer from Baltimore, a black man as intimate with the dark city streets as with the veins coursing through his perfectly muscled, weight trainer's body. We had become fast friends working the forensic case I had sworn would be my last. Plumbing the minds of murderers had finally worn my own psyche paper-thin. "It's been too long," I said."I would have called sooner, but ..."But we reminded each other of carnage. We reminded one another of Trevor Lucas, a plastic surgeon gone madwho had taken over a locked psychiatric unit, performing grisly surgeries, including amputations, on select patients and staff. Before we could convince him to surrender, which only happened after I went onto that locked unit with him, he harvested a grotesque sampling of body parts that still floated through my nightmares. Anderson couldn't be sleeping any better himself. "You don't need to explain," I said.A few seconds passed. "You'll never guess where I'm working now."Anderson was as tough and streetwise a cop as I'd ever met. "Gang unit?""Not even close.""Vice Squad," I said."Nantucket," he said."Nantucket?""You remember how I like the ocean," he said. "They advertised for a chief of police; I sent in a résumé. Been here sixteen months. I actually sailed North's Star up here myself."North's Star was Anderson's thirty-two-foot Catalina sloop, one of the loves of his life. The only greater ones were his wife, Tina, and his daughter, Kristie."I figure I did my time on the front lines, you know?" he said.I knew. All too well. Anderson had retreated to an island. I had retreated to the halls of Harvard medicine. "You did more than your share," I said.He cleared his throat. "I could use your help."His tone made me wonder whether he was battling a depression of his own. "I'll do anything I can. What's up?""The Bishop family," he said, as if that would explain everything."Who are they?""Darwin Bishop.""Never heard of him," I said."The billionaire? Consolidated Minerals & Metals--CMM? It's publicly traded.""Hey, you may live in that world now, but I don't hang in Nantucket," I said. "And I don't play the market. I always liked the track better.""They made national news last night," he prompted."I try to stay away from the news, too."Anderson got to the point. "One of his little twin girls was found dead in her crib. Five months old."I closed my eyes and leaned against the wall. I had worked with other families stricken by SIDS, an unpredictable condition that cuts off breathing in infants, taking them in their sleep. "Sudden infant death syndrome," I said."Maybe ... We're not so sure. There are two older, adopted sons in the family--sixteen and seventeen years old. The younger one has a history of violence. Really ugly stuff, including strangling a few neighborhood cats."I knew where the discussion was headed. And I knew that Trevor Lucas had left me without the heart to go there. "I don't do forensic work anymore," I said."So I hear. The chief back in Baltimore said he tried you once or twice," he said."Four times.""Can't blame him. You have a gift.""That's one way to look at it," I said."I'm not expecting an investigation," he said, "just an evaluation.""The answer is still no.""I'll sign a purchase order for whatever you think is fair.""Christ, North, you know it's not about the money.""Look," he said, "the D.A. here is leaning on me. He wants the younger brother arrested and charged with murder. He'll try him as an adult and aim for life in prison, no parole."Few things outrage me more than a judicial system that bends chronology in service to vengeance, and Anderson knew it. I stayed silent."He's only sixteen," Anderson went on. "The Bishops adopted him from a Russian orphanage at six. Who knowswhat kind of hell he went through before that?""I've got my work cut out for me right here," I said, half to remind myself."I don't want to push you, but there's something that bothers me about this family--especially the way the father laid out a red carpet for me to question his son. You're the best I've ...""I'm trying to stay focused." I was also trying to stay sober, not to mention sane. "Why don't you call Ken Sklar or Bob Caggiano at North Shore Medical Center? They work with Judith David. You know the group. They're world class.""One interview with the boy," he pressed. "That's all I'm asking."I didn't want to let Anderson down. But I didn't know how far into darkness I could walk without losing my way forever. "If you want me to call Sklar myself and ask him the favor, I will.""I want you.""No," I said, "you want part of me I left behind two years ago, the part Trevor Lucas took." I didn't give him the chance to respond. "Listen, I got to finish up rounds.""Frank ...""I'll give you a call some time." I laid the receiver back in its cradle.Copyright © 1997 by Keith Ablow Excerpt from Psychopath copyright © 2003 by Keith Ablow

Excerpted from Compulsion by Keith Ablow. Copyright © 2003 Keith Ablow. Excerpted by permission of St. Martin's Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

What People are Saying About This

Robert Parker

Compulsion is another really good book by Keith Ablow: compelling, graceful, and nearly impossible to put down. (Robert Parker, author of Widow's Walk)

Janet Evanovich

Fast-paced and frightening, COMPULSION is a novel that explores the very nature of evil itself. (Janet Evanovich, author of Hard Eight)

Harlan Coben

Keith Ablow's setting is the darkest of all-the twists and turns of the human mind...Great Psychological suspense. (Harlan Coben, author of Gone for Good)

Michael Palmer

This is a dark, taut, terrifying novel, driven by a talented psychiatrist's insights into the human condition. (Michael Palmer, author of Fatal)

Dennis Lehane

...Ablow writes like a man possessed - with a pace so blistering the pages will all but singe your hands. (Dennis Lehane, author of Mystic River)

James Hall

...mesmerizing...tense and sexy...With deft intelligence, Ablow maps the torturous terrain of the darkest regions of the human heart. (James Hall, author of Blackwater Sound)

Tess Gerritsen

It's a roller coaster of a mystery with hairpin twists and turns that shock and astonish. (Tess Gerritsen, author of The Surgeon)

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Compulsion 3.9 out of 5 based on 0 ratings. 16 reviews.
Jebbie74 on LibraryThing 11 days ago
I truly enjoyed this thriller, and plowed through the book pretty quickly. It led me to move on and read some of his other work that had been sitting on my shelf.
Anonymous More than 1 year ago
All the typos were distracting!! Just okay book.
Anonymous More than 1 year ago
Good story despite the horrendous editing.
Anonymous More than 1 year ago
I can't believe the positive reviews for this book! It was a totally unbelievable storyline, I mean really, falling in love with one of the suspects the first time he meets her? Plus the editing errors. I can't recommend it.
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AshleaJoy More than 1 year ago
This is one of my all time favorite books and I have actually read it 3 times. I own the hardback edition. It is great to read a book and not be able to know exactly how it will end, with the bad guy being obvious the whole time. The twists and turns of this psychological thriller are amazing. The main character is flawed and admits to this but is the heroine anyhow and you root for him the whole time. It is a great read and definitely inspired me to continue reading Ablow's other novels.
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Guest More than 1 year ago
Suspense is not enough to describe how intense this book is. This book is highly recommended for anyone who is majoring in criminal justice or any related fields. I know John Jay College in Manhattan has this book as a requirement for one of their literature courses. However, i bought it, read it, and could not put it down. If you are into criminal mysteries, this book is definitely something that should be read!!!
Guest More than 1 year ago
This is the first book of Dr. Ablow's that I've read, but it certainly won't be the last. I enjoyed the plot twists and the fact the 'hero' had his imperfections. This book gives a great look at an affluent but dysfunctional family during a murder investigation. It's easy to like the prime suspect, and there's doubts everywhere about who is and isn't involved. It's a great read, and I'd highly recommend it.
Guest More than 1 year ago
It is always a pleasure to read of a protagonist who is heroic but flawed and willing to admit it, which is certainly the case with life-scarred psychiatrist Frank Clevenger. He plunges, reluctantly at first, into a nasty brew of child murder, corrupt wealth, and family dysfunction in this crime tale set in Boston and Nantucket. Also appealing is Dr. Clevenger's sympathy towards even the most seemingly twisted personalities; he is always drawn to discover what has brought them to this point. I found only two faults with this well-written story. It seemed a little long; I felt a good editor could have cut it by about 50 pages. And it wasn't all that hard to figure out one of the "surprise" twists at the end....I guessed the situation about halfway through the book, and I think most readers who love psychological thrillers did the same.
harstan More than 1 year ago
Brooke and Tess are identical twin girls born to billionaire Darwin Bishop and his beautifully charismatic wife Julia. They also have two adopted sons, Graham the golden boy and sixteen year old Billy who has been in and out of psychiatric institutions all his life and is known to the local authorities for his violent behavior.

When Brooke unexpectedly dies, Darwin immediately thinks that his son murdered his sister. Nantucket police officer North Anderson isn¿t convinced that Billy is guilty and brings forensic psychologist Dr. Frank Clevenger on the case. Frank believes that everyone that was in the house except for baby Tess is a likely suspect and he risks his own life to uncover the truth.

The moment one starts reading this fascinating crime thriller one is compelled to finish it in one sitting. Like the protagonist, readers will find it hard, if not impossible, to figure out who killed the infant because all the suspects have motives, meaning and opportunity. Keith Ablow is a gifted storyteller who ha written an exceptional tale.

Harriet Klausner