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  • The Spectacular Unraveling of Washington's Favorite Shrink Starring

    Washingtonian
    February 2014

    The Spectacular Unraveling of Washington's Favorite Shrink Starring
    Alen Salerian

    By Ariel Sabar


    About five years ago, C. Ray Foster, the sheriff of Buchanan County,
    Virginia, noticed the name of an unfamiliar doctor on the pill bottles
    turning up at drug busts, overdoses, and DUIs. OxyContin and other
    narcotic painkillers feed an epidemic of crime and addiction as
    insidious in this Appalachian outpost as the kudzu astride the Levisa
    Fork River. But this prescriber's name-Alen Salerian-was an enigma.

    The man wasn't a pain specialist but a psychiatrist, a doctor trained
    to treat mental illness. And his office was 400 miles north, in one of
    Washington's wealthiest neighborhoods.

    "I came out of there with 450 roxy 30s, 450 methadone 10s, Adderall
    and Xanax," someone calling himself "Crazy" wrote online about his
    first visit to Salerian, the popular subject of nearly 500 posts in a
    Buchanan County web forum. "My sister went the same day and got the
    same thing. . . . At one time 5 of us rode together and he made our
    appointments back to back . . . . I don't know how in the world we
    made it home we would be so messed up."

    The question Foster kept asking himself was why people in his
    impoverished county were driving up to eight hours each way-sometimes
    in caravans and carpools-to see a psychiatrist, one who didn't even
    take insurance.

    Salerian's colleagues back in Washington would have been just as
    bewildered. Salerian, now 66, was once chief psychiatrist to the FBI's
    employee-assistance program, traveling the world to minister to
    troubled agents. He taught at George Washington University, published
    in medical journals, wrote op-eds for theWashington Post.

    His private practice, steps from the Neiman Marcus in DC's Friendship
    Heights, was a world away from the troubles of Buchanan (pronounced
    "buck-cannon") County, a once-booming coalfield at Virginia's border
    with Kentucky and West Virginia that's now one of the poorest and most
    isolated places in the state.

    To get there from Washington this past September, I drove for hours
    down interstates 66 and 81, up through tunnels bored into mountains,
    and over the Trail of the Lonesome Pine. Finally, the road tucked into
    valleys so vertiginous that for much of the day the hills were
    shrouded in shadow.

    Sheriff Foster-a wry lawman with a silver mustache and a reputation
    for candor-was at his desk, picking at a breakfast of biscuits and
    gravy in a Styrofoam clamshell, when I entered. "I'm an old fat man,"
    he quipped when asked his age.

    But when I mentioned Salerian, Foster grew serious, turning off the
    air conditioner and dialing up his hearing aid. Buchanan County
    residents die of prescription-painkiller overdoses at more than five
    times the statewide rate, and Foster held the psychiatrist at least
    partly responsible. His pills had shown up at drug scenes across the
    county and in the homes of families so lost to addiction that the
    state had to take custody of children.

    "I've never met him, but I've met a lot of his work," Foster said.
    "His clientele has become my clientele"-by which he meant denizens of
    the county lockup.

    The giant doses Salerian was prescribing to young, seemingly healthy
    people in the county where Foster had grown up didn't make sense. "Why
    would a 20-year-old feller take five Oxys a day?" he asked. "Why would
    you prescribe that to a 20-year-old that has not got cancer, has not
    got no fatal disease, has got no chronic pain?"

    A visitor to Alen Salerian's office in the 1980s and '90s would have
    encountered one of the most glittering waiting rooms in Washington.
    Middle Eastern royals, Hollywood actors, and heiresses were all under
    his care, as were a general and a senator turned presidential
    candidate. Many patients felt he was the first doctor to really
    understand their suffering: "the one person I trusted," local author
    Gail Griffith said in a memoir.

    Though just five-foot-seven, Salerian had a way of filling a room. He
    was garrulous, with an exotic accent and boisterous charm, and he
    loved the limelight. He had wrangled a gig as an on-air commentator
    for Channel 9, Washington's CBS affiliate, and was sought out for his
    expertise by TV programs such as 48 Hours.

    It was a remarkable ascent for a man who'd landed in the US from
    Istanbul in 1971 with no connections beyond a letter admitting him to
    a medical internship. Salerian's father, a successful engineer, and
    mother, a noted painter, had sent him and his identical-twin brother
    to America because they saw no future for Christian Armenians like
    them in Turkey. Alen's brother, Nansen Saleri, now a Houston oil
    executive, calls himself the ace student and "conformist one." Alen
    was more like his mother, a social butterfly with artistic impulses
    who sometimes skipped school to be with friends.

    No one was surprised when he declared an interest in psychiatry. "He
    wanted to be around people," Nansen says; among all the medical
    specialties, "it would allow him more of an emotional relationship
    with patients."

    Salerian's supervisors at George Washington University, where he
    completed his psychiatry training, named Salerian chief resident and
    hired him as an assistant clinical professor right after his training
    ended in 1976. He was no less a hit at Metropolitan Psychiatric Group,
    one of the nation's largest group mental-health practices. Salerian
    drew so much business to its DC and Rockville offices that the group
    made him partner after just two years.

    Soon after a Pennsylvania company acquired the group in 1994, Salerian
    took a $1.5-million payout and started his own practice on the ground
    floor of the Psychiatric Institute of Washington, a Wisconsin Avenue
    hospital that eventually named him associate medical director.

    It was a heady time. Pharmaceutical companies were so taken by the
    doctor's social dexterity that they paid him tens of thousands of
    dollars a year to host dinners introducing colleagues to new drugs.
    He'd also landed a glamorous five-year contract with the FBI's
    employee-assistance program, which wanted him to find help for agents
    wrestling with alcoholism, family strife, and other personal issues.

    Salerian, a married father of four, had always liked difficult cases:
    patients whose depression responded to none of the usual treatments,
    manic-depressives who'd sooner live on the streets than take their
    meds. At the FBI, he cracked his toughest case yet: getting hardened
    agents to confide in a shrink.

    Chuck McCormick, a former FBI agent who led the assistance program in
    the 1990s, says he could call day or night and Salerian would get on
    the next plane to anywhere in the world-domestic FBI offices, overseas
    embassies. "We saved lives, salvaged careers," McCormick says. "We
    kept families together. We prevented divorces. He was a godsend."

    A few years into the contract, however, Salerian had a falling-out
    with the agency over what he construed as a supervisor's racist remark
    about his olive-toned skin. "I used every F-word," Salerian recalls of
    his response. McCormick says he remembers no such incident. All the
    same, the bureau decided to shift its program in-house after
    Salerian's contract was up in 1997-a parting that would come to haunt
    the FBI and the doctor both.

    In February 2001, a veteran FBI spy catcher, Robert Hanssen, was
    arrested in the gravest security breach in the bureau's history: The
    mild-seeming Virginia man, it turned out, was a double agent who had
    been selling US secrets to the Russians for more than two decades.

    In his former employer's humiliation, Salerian glimpsed opportunity.
    He had been trying for years to write opinion pieces for major
    newspapers, with scant success (despite the help of publicists). Three
    weeks after Hanssen's arrest, Salerian got his big break: ThePost
    published his long op-ed flogging the FBI for not subjecting agents to
    routine mental-health checks.

    The piece read like a John Grisham thriller, with Salerian as its
    dashing lead, a troubleshooter who'd saved the agency from untold
    numbers of overstressed G-men who might well have become other
    Hanssens.

    He made no mention of his falling-out with the FBI. Nor did he
    disclose that he was just then auditioning for a starring role with
    Hanssen's defense team.

    Salerian had recently offered his services to Plato Cacheris,
    Hanssen's court-appointed lawyer. Cacheris was the go-to attorney for
    defendants in the inner circles of Washington power: Aldrich Ames,
    Monica Lewinsky, and John Mitchell, of Watergate notoriety, had all
    been clients.

    Cacheris hadn't envisioned a psychiatric defense. "On the other hand,"
    he says, "if a psychiatrist could say something helpful, if not
    exonerating, we might need it.

    "I figured if the FBI used him, he must be okay."

    Over the course of seven jailhouse meetings, Salerian got Hanssen, a
    shy and socially awkward man, to confide his most humiliating personal
    secrets: his father's physical abuse, his sexual obsessions, the
    hidden camera Hanssen had installed in the bedroom he shared with his
    wife so a friend could watch their lovemaking.

    Privacy laws and professional ethics hold both lawyers and doctors to
    strict client/patient confidentiality. Federal rules for high-risk
    detainees like Hanssen set an even higher bar: Disclosures to possible
    witnesses or codefendants, such as a suspect's wife, are verboten. Yet
    despite Cacheris's explicit orders, Salerian went to Hanssen's wife,
    Bonnie, with details of her husband's betrayals, then lobbied her for
    permission to speak to the press.

    When she refused, Salerian did it anyway, telling BBC reporters about
    his jailhouse conversations with Hanssen. He even offered to take a
    photo of Hanssen to sell to the media.

    Shocked, Cacheris summoned Salerian to his office in May 2001 and
    fired him. He warned the doctor to say no more to anyone about the
    case. His client, after all, was facing the death penalty.

    But Salerian had other priorities.

    Over the next few months, he gave on-the-record interviews to CBS
    News, the Post, the Sunday Timesof London, and many others. He
    portrayed himself as a prophetic doctor who could have seen the
    warning signs the FBI and the Catholic Church had missed (Hanssen had
    confessed to a priest) and who owed America the truth.

    "His espionage was an escape from his sexual demons," Salerian told
    Lesley Stahl on 60 Minutes. "When he found himself in exciting and
    dangerous positions, such as espionage and spying, he found that his
    demons slowed down, they calmed down."

    Salerian sold the option rights to his story to author Norman Mailer
    and film producer Lawrence Schiller, who took him to a boozy dinner at
    Old Angler's Inn in Potomac. Though they never portrayed him in their
    book and TV movie about Hanssen, the voluble doctor appears to have
    held nothing back: Mailer's interview transcripts with Salerian span
    some 500 pages.

    When the rare reporter questioned whether Salerian's dismissal from
    the defense affected his credibility, the doctor suggested he answered
    to a higher code: He knew better than the lawyers or the guardians of
    medical ethics what was good for Hanssen and society. "I have
    100-percent moral and psychological authority," Salerian said.

    Others saw another motive. Cacheris had decided to seek a plea deal
    sparing Hanssen's life, and for Salerian that meant one thing: no
    chance to be the star expert in a trial with headlines the world over.
    "He told people he was hoping I wouldn't settle the case and deprive
    him of the opportunity" to testify, Cacheris says.

    Weeks after a plea deal was reached, Salerian argued that the
    opprobrium heaped on him by fellow psychiatrists proved that it was
    they-not he-who had failed the mentally ill. "The biases against
    psychiatric disorders and mental illnesses will only go away if we
    confront them," he wrote in USA Today. "So far, no one is brave enough
    to go up against them-not the church, not the FBI, not even the mental
    health profession itself."

    No one, that is, but him.

    Many colleagues struggled to square the brazenness of Salerian's
    conduct with the thoughtful physician they thought they knew. But
    clues to another side of the doctor-explosive, attention-craving,
    defiant-were hidden in plain sight.

    In his first year as a resident at GW, Salerian openly mocked a
    renowned expert on narcissism, who later bristled to the program
    director, "Where do you get your residents?"

    At the Metropolitan Psychiatric Group, Salerian needled what he called
    his "lily-white colleagues" by treating psychotics, schizophrenics,
    blacks, and the poor-people who deviated from the stock clientele of
    affluent women suffering what he dismissively dubbed "Bethesda Wife
    Syndrome."

    The board exams in psychiatry are a mark of professional distinction.
    But Salerian failed them and never tried again: "I began disagreeing
    with psychiatry," at least as currently practiced, he says. "It slowly
    began occurring to me how different my thinking was."

    Salerian saw his reputation for controversy as the calling card of an
    original mind. He sought patients whom other colleagues couldn't
    handle or wouldn't touch, then gave them treatments other doctors
    wouldn't. In the 1980s and early '90s, when most psychiatrists were
    still analyzing patients on couches, he began prescribing newly
    approved drugs in unorthodox combinations, in search of experimental,
    "off label" treatments, sometimes for conditions outside his field.

    His willingness, even eagerness, to prescribe exotic drug cocktails
    endeared him to many patients, particularly those in the grips of
    despair. A Chevy Chase woman whose brother is bipolar says they'd
    visited specialists in DC and New York before a doctor referred them
    to Salerian in 2000. For years, her brother refused pills that doctors
    said he needed to get better. Salerian was the first to break through.
    He patiently explained how the brain worked, never charging for the
    extra time, and drew sketches showing how pills helped. "From our
    family's perspective," she says, "Dr. Salerian saved a life."

    But his pharmaceutical cocktails made even his admirers nervous. "They
    were very unusual combinations of medications," says Carl Gray, a
    Rockville psychiatrist who sent Salerian some of his toughest
    patients.

    Laurence Greenwood, a psychiatrist in Prince George's County,
    remembers seeking out Salerian for advice about a relative with
    intractable schizophrenia. Salerian suggested the stimulant Ritalin,
    an ADHD drug traditionally thought to aggravate psychosis. The
    relative's doctor balked: He wasn't comfortable turning his patient
    into a test subject. "Nor would I have been as a doctor, because as a
    doctor I'm being cautious," Greenwood says. "But as a patient, a
    family member, where the quality of life of a whole family is being
    severely disturbed by the patient's suffering, it would be a very
    reasonable thing to try. In a sense, I wish I had Alen's courage."

    Bernard Vittone, who directs a prominent mental-health clinic in DC's
    Foggy Bottom and has known Salerian for decades, puts it another way:
    "He has some traits you could view as being admirable or very
    reckless."

    After the Hanssen affair, George Washington University cut Salerian
    loose and the Psychiatric Institute declined to renew his hospital
    privileges. He and the drug companies whose pills he promoted parted
    ways.

    The Maryland medical board issued an excoriating ruling that accused
    Salerian of "gross" ethics violations in the Hanssen case. The doctor,
    the board wrote, seemed to have "a perception of self so grandiose as
    to raise concerns about his judgment." Remarkably, the Maryland and DC
    medical boards let Salerian off with a reprimand and fines of just
    $8,500.

    The ruling barely broke his stride. Salerian remained a regular on
    Channel 9 and kept up a busy practice, where patients who remembered
    his TV appearances now felt they were in the hands of a highly
    sought-after psychiatrist.

    But things were getting strange. In 2003, Salerian self-published a
    glossy book of cartoons called Honest Moments With Dr. Shrink. Though
    pitched as a satire of psychiatry, the cartoons-pastel-crayon doodles
    that call to mind a grade-school art fair-were at best cryptic, at
    worst racially charged and sexually vulgar. "Doc, please help me find
    my G spot," a woman shaped like an eel says on the first page. "Who
    saw it last?" says Dr. Shrink, who's drawn in the shape of a
    refrigerator.

    Honest Moments was followed by a Salerian line of vitamins. Then came
    a deepening preoccupation with John F. Kennedy's assassination,
    research trips to Dealey Plaza, and a torrent of more than 200
    JFK-inspired paintings that he exhibited in Dallas and DC.

    Salerian found another canvas for his creative impulses on the lawn
    outside his office. Pronouncing the landlord's landscaping "bland," he
    turned the empty sod into a statue garden, complete with a rooster
    figurine, a fountain ringed by 24 lion heads, and a giraffe he named
    after his son Justin. He told the Washington City Paper at the time
    that the installation was a whimsical welcome mat meant to "make
    neuropsychiatry accessible."

    Inside Salerian's office, however, some longtime patients felt
    unsettled. A Maryland woman recalled her unease when a large oil
    painting depicting a nude couple in the throes of coitus went up in
    the waiting room. Once-brisk appointments turned into drawn-out bull
    sessions about the doctor's art and his latest JFK findings. "When you
    went to see Dr. Salerian, you took the whole day off," one patient
    says.

    The most extraordinary shifts were inside the exam room. A growing
    number of patients were traveling great distances for another new
    sideline: addictive narcotic painkillers such as OxyContin, methadone,
    and Fentanyl.

    The doctor appears to have embraced the drugs soon after Cacheris
    fired him from the Hanssen case and just as the first major news
    stories about OxyContin's dark side broke. The pill, approved by the
    Food and Drug Administration in 1995, was the first made of pure
    oxycodone, a powerful derivative of the opium poppy. It was formulated
    to dissolve in the body over 12 hours, but people found they could
    ingest the oxycodone all at once by crushing the pill and then
    snorting or injecting it. The euphoria gave the drug street value and
    the nickname "hillbilly heroin."

    Narcotic painkillers, typically prescribed to cancer patients and
    others in severe physical pain, have no FDA-approved psychiatric uses.
    But Salerian wanted to blaze a new frontier. "I have prescribed
    OxyContin to more than 200 of my patients, and none of them has become
    addicted," he boasted in a 2002 op-ed in theIndianapolis Star. He said
    he'd used the drugs to treat not just physical pain but also
    depression.

    It had been at least a half century since doctors had tried anything
    of the kind. Though physicians in the 1800s had given opium
    derivatives such as morphine to people with "melancholia" and other
    ailments, by the 1950s scientists had produced the first class of
    modern antidepressants. They were more effective and had fewer side
    effects than opiates and were not addictive. To tout opiates for
    depression now would be somewhat like prescribing arsenic and mercury
    for syphilis, decades after the invention of penicillin.

    Salerian's faith in the power of painkillers springs from something he
    calls the Salerian Theory of Brain. This "new paradigm," he wrote in a
    non-peer-reviewed medical journal, would do to the foundations of
    modern psychiatry what Galileo did to "Ptolemaic assumptions about the
    celestial movements."

    The theory's narcotics bit goes something like this: Endorphins, our
    bodies' natural opiates, are necessary for healthy brain chemistry and
    good mood. People with too few endorphins-a group that in Salerian's
    view includes drug addicts-can get right, he believes, by taking
    super-sized doses of manmade opiates like OxyContin.

    As his colleague Bernard Vittone put it, Salerian was "operating in
    universes I've never even seen."

    Yet the doctor had nearly absolute faith in his patients. Though he
    often prescribed OxyContin at three times the recommended doses, he
    refused to subject patients to common safeguards against abuse and
    dealing. "Any doctor who creates these monkey, Mickey Mouse forms and
    forces you to give drug urines," he told an internet radio show, "is
    actually raping Hippocrates."

    The test subject for his opiate cure, Salerian says, was a severely
    depressed, drug-addicted railroad worker named Paul. Over a series of
    hospitalizations in the mid-1980s, Salerian used conventional methods
    to wean Paul off an addiction to Fiorinal, a non-opioid painkiller and
    muscle relaxant.

    But in the 1990s, after traditional depression treatments failed,
    Salerian says he ceded to Paul's request for Percocet, a narcotic
    painkiller. Salerian rhapsodized about the results. Though forced into
    a disability retirement, Paul discovered true pleasure in a new car
    and in vacations with his wife, Salerian insists. (Paul's wife
    disputes Salerian's account.) All the same, in the spring of 2001,
    Salerian added another pill to Paul's drug cocktail: OxyContin. The
    next year, another: Fiorinal, the very drug Salerian had detoxed Paul
    from a decade and a half earlier. Paul grew addicted again, this time
    to the active ingredient in OxyContin. In 2004, his wife filed a
    complaint with the DC medical board about Salerian's narcotics
    experiments, but it didn't do her any good. She became a widow in
    2005, when Paul bled to death from an undiagnosed intestinal ulcer.

    Four years later, in January 2009, the DC medical board said there
    wasn't sufficient evidence of misconduct and dismissed the case.
    Salerian, who spent $750,000 on an elaborate defense, says he took the
    ruling as both exoneration and endorsement. He changed the name of his
    practice to the Salerian Center for Neuroscience and Pain and felt
    that his scientific revolution was finally under way. "It was a
    dream," he said later. "My march began."

    By February 2010, another patient was dead.

    Patrick Kennedy-or Paddy, as his family called him-was a quiet but
    playful kid who began taking illegal drugs his sophomore year at
    Bethesda-Chevy Chase High School. In college he grew depressed and
    worried he might be succumbing, as had his mother, to schizophrenia.

    His elder brother took Paddy, then 20, to see Salerian, with whom
    their family had had good experiences in the past. Salerian gave Paddy
    an on-the-spot diagnosis of obsessive-compulsive disorder,
    attention-deficit disorder, and phobia-and a prescription for
    methadone, a narcotic approved only for chronic physical pain and for
    heroin maintenance and detox therapy.

    Because it can slow breathing, the medical rule of thumb for methadone
    is start low, go slow. Salerian wrote Paddy a dose above the
    manufacturer's guidelines, believing it would boost his dopamine, a
    neurotransmitter that helps regulate motivation and pleasure-seeking.

    The day he took his first pill, Paddy sent his family an effusive
    e-mail. "Dr. Salerian has given me new hope," he wrote.

    Two days later, his father, Steven Kennedy, an editorial consultant,
    cooked a dinner of beef-and-barley soup and settled onto the couch
    with his son for an episode of House, the TV drama about a drug-addled
    doctor with a genius for diagnosis. Before the show was over, Paddy
    complained about his vision. "My eyes feel out of focus, Dad," he said
    and went to bed.

    When Paddy was still in bed at 11 the next morning, his father went in
    and found his son's body pale and rigid. Blood had pooled in purple
    blotches under his skin, a sign he'd probably been dead for hours.
    Detectives counted the remaining methadone pills: There was no
    indication he'd taken more than prescribed. The Virginia medical
    examiner ruled the death an accidental overdose.

    On the morning of March 3, 2011, teams of gun-toting DEA agents in
    black jumpsuits raided Salerian's home. They handcuffed Salerian's
    wife and the two adult children at home. (His wife told me she was so
    traumatized that she soiled herself.) Salerian arrived at his practice
    to find it commandeered by agents, who spent the day searching his
    computers, files, and financial records. Under civil-forfeiture laws,
    which don't require criminal charges, the agents also seized three
    cars and the cash in three bank accounts.

    Salerian responded by appointing himself leader of a global movement
    to end discrimination against pain sufferers. The curtain raiser was
    to be a giant civil-rights-style demonstration-Festival Pain Brain-in
    the fall of 2011 at the Lincoln Memorial. Salerian hired an
    advertising firm to mount a publicity campaign and to e-mail
    invitations to 40,000 medical students. He promised a guest appearance
    by country star Blake Shelton, an onslaught of 20,000 protesters, and
    the freeing of thousands of butterflies. Actual turnout: perhaps two
    to three dozen. There was no Shelton (who'd never agreed to come).
    There weren't even butterflies.

    Convinced of sabotage, Salerian made a defiant trip three months later
    to southwestern Virginia, where he'd heard that his long-distance
    patients were being harassed by police. He had persuaded a Buchanan
    County newspaper, theVoice, to host a public forum to take on critics.
    The paper's publisher, Earl Cole, told me the issue was personal: His
    painkiller-addicted son had committed suicide in 2007, and his
    21-year-old grandson was high on pills a year later when he lost
    control of his car and died in a head-on crash with a tractor-trailer.

    "I said, 'You have a lot to do to convince me that you're not a drug
    dealer,' " Cole recalls. "But he did convince me. When he showed me a
    picture of the brain and how it all worked, I began getting an open
    mind about it."

    Cole remembers Salerian telling him, "I'm going to win a Nobel Prize for this."

    As the months passed, Salerian's waiting room saw fewer patients in
    Rolexes and designer suits and more who looked like extras in some
    modern Grapes of Wrath: coal dust under fingernails, hats bearing
    Confederate flags. According to court papers, other tenants were soon
    complaining to the landlord about "the traffic of dirty unkempt
    people."

    Veteran staff bolted, and his office became a kind of hall of mirrors.
    Salerian hired one of his sons as a clinical director and another as a
    medical technician. He rated patients on a Salerian Pain Score,
    Salerian Mood Score, and Salerian Attention Measure. Though people
    came to him for physical pain as well as emotional distress, "there
    wasn't a blood-pressure cuff or a stethoscope in the entire office," a
    former employee says.

    Salerian hired a bodyguard and, according to court records, ordered a
    strip search of a patient he thought was a police informant. By 2012,
    his fee for an initial "pain management" consultation had risen to
    $1,200, from $350 in 2010.

    The front-desk staff soon asked patients to sign a new form. "I am not
    an undercover agent," it began, before warning that anyone who tattled
    to authorities risked "serious consequences to [their] health."

    Seven hours to the south and west, Sheriff C. Ray Foster and Buchanan
    County's chief prosecutor, Tamara Neo-along with state and federal
    law-enforcement officials-were building what they hoped would be a
    bulletproof criminal case.

    A police informant showed up at Salerian's office with a healthy MRI
    and records from a previous doctor who thought he needed nothing more
    than over-the-counter painkillers and exercise; the informant walked
    out with a prescription for 210 tablets of oxycodone, 90 of methadone,
    and 90 of Adderall, a stimulant, according to court records. The next
    month, when he wanted refills, the informant didn't even have to come
    in. A request was phoned in to the office, and two days later UPS
    delivered the prescriptions to the informant's doorstep in
    southwestern Virginia, in an envelope bearing the slogan "The Art and
    Science of Healing."

    The DEA, meanwhile, heard from a Rockville pharmacist who'd stopped
    filling Salerian's prescriptions. The final straw for the pharmacist
    was the parade of patients with Tennessee ID cards who visited five
    minutes apart, each bearing a Salerian script written the same day.

    Investigators discovered that Salerian had been prescribing more than
    800 pills a month to four members of a major western Virginia
    drug-trafficking ring, according to court records. There was also a
    Buchanan County man, Brian Justice, who "was working with his mother,
    apparently, and his sister," a prosecutor said at a hearing. "Other
    people were engaged to go as girlfriends down to see the doctor, and
    they were actively recruiting-this was a thriving business, sort of
    like Mary Kay."

    Last April, a federal grand jury in southwestern Virginia indicted
    Salerian on 36 felony drug counts. Two months later, it added over 100
    more. The doctor now faces one count of conspiring to unlawfully
    distribute controlled substances and 143 for unlawful distribution-in
    many instances, to people in and around Buchanan County. If convicted
    at a trial set to begin February 10, Salerian could spend the rest of
    his life in prison.

    The end can't come soon enough for police in southwestern Virginia. In
    Sheriff Foster's office last summer, I asked two of his plainclothes
    drug investigators where Salerian had ranked among doctors writing
    scripts to county residents. "Number one," came the reply. "The
    majority of the medication coming into this county was written by
    him."

    Salerian denies any wrongdoing. His lawyers paint him as a pioneering
    pharmacologist whose clinic bore no signs of a profiteering pill mill.
    "Unlike other doctors actually convicted of similar charges," they
    wrote in a statement, "Dr. Salerian established a doctor-patient
    relationship with each of his patients. He did not receive kickbacks
    in exchange for prescribing medication. He never led an extravagant
    lifestyle. He never treated phantom patients."

    For Salerian, though, the ultimate indignity came in June of last
    year, when the DC medical board finally acted. The board, composed
    mostly of fellow doctors, voted unanimously to revoke Salerian's
    medical license. Salerian, trailed by his family, stormed out of the
    hearing room. One of his sons wiped away tears.

    I walked out with Paddy's father, Steven Kennedy. On the plaza outside
    the health department, Salerian, shaking with rage, pointed at
    Kennedy. "Child molester!" he bellowed. "Child molester!"

    As bystanders looked on stunned, Salerian's family tried to move him
    away. But he wouldn't back down. "Child molester is here!" Salerian
    sputtered. Finally, one of his sons managed to lead him up the steps
    to North Capitol Street.

    I caught up and asked Salerian for a response to his professional
    defrocking. "The Vatican was unanimous when they said the world was
    flat," Salerian said. "Remember Galileo."

    Alen Salerian lives with his wife on a wooded lot in Bethesda. I
    visited a week before he lost his license, and he answered the door
    unsmilingly, with the darting eyes of a hunted man.

    He's free on $100,000 bond until his trial. But a judge confiscated
    his passport and restricted his travel to Maryland and DC. Salerian
    has filed for personal bankruptcy and owes his twin brother at least
    $1.9 million, much of it for legal fees. In addition to preparing his
    defense, his lawyers are fighting to reinstate his medical license.
    Experts they've hired will argue that something other than methadone
    killed Paddy Kennedy.

    In the first minutes of our four-hour interview, I felt as if I were
    listening to the raw neural firings of a persecuted man, the ravings
    that jangle in our brains but that we dare not give voice for fear of
    being seen as unhinged. There were disjointed references to "the laws
    of the universe and the jungle," "computers and nuclear bombs," and
    "devastation with trickery." The shelves of a sunroom that had become
    his makeshift office were lined with conspiracy books: Plausible
    Denial, Rush to Judgment, Lessons in Disaster.

    Salerian told me that a former employee whose depression he'd treated
    with narcotics had family in Buchanan County, and that's how people
    there discovered his practice. Prosecutors, he said, were reading too
    much into the distance patients had traveled and the spike in his
    fees. He charged many people on a sliding scale. There was no mystery
    to his popularity: Southwestern Virginia is home to many "poor,
    uneducated" people in injury-prone jobs like mining and trucking.
    Overzealous DEA crackdowns, Salerian said, had deterred all but the
    noblest doctors from prescribing the painkillers patients desperately
    needed.

    Some of Salerian's friends and longtime patients told me they worried
    Salerian had himself succumbed to dangerously "narcissistic" and
    "grandiose" delusions. The doctor needed professional help, they said,
    not prison.

    When he and I spoke again last fall, I asked if it was possible he was ill.

    Salerian told me he'd been diagnosed in the 1980s with anxiety and
    ADHD, for which his psychiatrist still prescribes Prozac and Adderall.
    But he rejects the idea, proposed to him by colleagues over the years,
    that he also suffers from bipolar disorder, a more serious condition
    in which people sometimes feel possessed of a kind of superhuman
    invincibility. He said his colleagues, forgivably, had mistaken his
    prodigious work habits, theatrical personality, and wide-ranging
    artistic pursuits for a disorder.

    "Show me another psychiatrist who has had the record I have," he said.

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