Franco Amati

Karen House

I was on internship at Karen House for a few months. It was a rough place. If only my grades were better in school, I might have gotten a better placement. I could’ve been working with schizophrenics or something. At least there are drugs for schizophrenia. There’s nothing for the Karens.

It was premature for Karen Syndrome to be added to the DSM-8. Such a poorly understood condition. The institution where I worked was pretty much a state-run halfway house for privileged white moms whose families couldn’t tolerate them anymore. Sometimes I wondered if we were doing more harm than good.

Since there was no official treatment guide for someone with acute Karen Syndrome (or the less commonly reported Kyle Syndrome), most of what we did was experimental. Half the attending clinicians were testing out some whack-job dissertation project, hoping to be the first to publish a finding demonstrating a successfully treated Karen.

As for me, I was just trying to get through my rotation. I had two more months until my qualifying exams. Then I’d be done with all the nonsense. I don’t think I’ll ever be done with the nightmares, though. I remember for weeks on end I dreamt of the Karens yelling at me, calling me the B-word, giving me the death stare from behind their designer sunglasses.

The one I was working with primarily—her real name was Susan, and she was forty-three. My main challenge in those early days was counseling her through her Empathic Simulation Therapy (EST). Realistic sim or not, EST was bullshit. If anything, from a Karen’s-eye view, it was just more practice at picking apart her adversary.

“And how did it feel to work as a retail manager for an hour?” I asked. “Did any of the customers cause problems?” I couldn’t stop looking at the razor-sharp blades of hair blasting out the back of her classic, asymmetrical Karen haircut.

“How did it feel? I’ll tell you how it felt,” she said, puffing out her chest, head gyrating, moving her fingers in that stereotypical gesture of entitlement—perhaps one of the most salient behavioral indicators of the condition. “For one, there’s no way I could stand doing that—that job—as an actual career. And only on—what—a paltry thirteen dollars an hour? Oh, hell no. I told those [expletive] customers, they better damn well apologize to me or get the hell out of my store.”

“Your store—okay. Did it help you to appreciate what it’s like being in their shoes? Like, for instance, were you able to reflect on a time when you might possibly have acted the same way those customers were acting towards you?”

Her eyes widened with mild confusion at first, and then every muscle in her face contorted into full-on bewilderment. “Appreciate it? I’ll tell you what I appreciated. Any person crazy enough to stay at a job like that doesn’t deserve my respect.”

I shook my head, trying to prevent myself from wincing. Then I remembered that it didn’t matter if I winced—this sorely afflicted monstrosity of a person was incapable of understanding even basic facial indicators of discomfort. “I was asking about your opinion of the customers, not your role as—you know what, never mind, Susan. That’s enough for today. I’ll come by tomorrow after your consultation with Doctor Ellison.”

Before I could stand up, she chirped, “W-w-wait a minute. Now, this Doctor Ellison—he’s an actual MD, right? A physician? Don’t tell me he’s one of those PhD, PsyD-whatchamacallit quacks who thinks they can cure me with their words.”

“She’s a DO, Susan. Still a medical doctor, though. She attended medical school.”

“Ha. Attended. Did she finish? I bet you dollars to donuts she’s not very good. I’ll tell you what—my father was an MD, and he worked with one of these OD-whateveryoucallems in his private practice, and—whew-wheee—you wouldn’t believe the stories he told me about how incompetent this person was.”

“I don’t see how that’s relevant. That’s a totally different person. And for your information, Kar—Susan, the PsyDs and PhDs who work here have also completed doctoral training. They’re just different kinds of doctors. They conduct research on disorders like the one you have. They publish findings in medical journals. They’re the ones trying to find a treatment for this—for folks like you.” I forced a smile and handed her a lollipop to distract her. She inspected the nutrition label, likely to make sure it was gluten-free.

While she scrutinized it, I jetted out of the room before she could say another word.

#

Karen House opened in 2040. It’s a murky story that few psych professionals like to talk about. The pathologizing of Karen Syndrome as a genuine psychological condition started decades ago. Initially, it was thought of as an amusing assortment of obnoxious behaviors. Eventually, it evolved into a more serious but still loosely-characterized personality disorder—kind of like narcissism, but weirder. It didn’t start receiving critical attention in academic circles until about 2030.

According to historical accounts, the earliest conceptualization of a “Karen” was in a widespread internet meme that reached peak popularity around 2019. I wasn’t even born yet, of course, but in my History and Systems class they taught us all about it. They even showed us the original archived Vines and Reddit threads that first poked fun at the disorder.

Right around the time I finished high school, psychiatric hospitals and family therapy clinics began seeing a rise in affluent, middle-aged individuals being committed by their loved ones. Many of them found it difficult dealing with the over-the-top Karen attitude, not to mention their wanton disregard for the less fortunate. Many wanted to lump Karens in with the narcissists and be done with it, but it was clear they were dealing with something different, something unique. In fact, I had an aunt who was a total Karen, and we knew right away. To this day, she’s holed up in some residential facility in Amherst. Haven’t spoken to her in years. 

The most common complaint is how frustratingly out of touch Karens tend to be, particularly how insensitive they are to people of lower socio-economic standing. They display an outright hostile disposition to members of the working class—especially wage workers and customer service staff. And, of course, who could overlook their borderline maniacal desire to “talk to the manager” whenever their needs aren’t met. I personally never thought I’d have to work with this population, but I guess internship placements can be a mixed bag.

A few days after we gave up on Susan’s Empathic Simulation Therapy, the staff decided to try an experimental treatment called Mirror Reintegration Therapy (MRT). The protocol was originally developed for patients with phantom limb syndrome. There are different variations, but the core concept involves the use of mirrors to help patients to re-identify with some aspect of themselves that has been lost or degraded. For instance, mirror therapy tends to be helpful in certain perceptual disorders, for instance with trauma patients reintegrating an artificial limb or brain-injured patients re-establishing self-awareness after a partial neural tissue transplant.

It turned out to be a difficult day, indeed, because with MRT you have to take all of the patient’s personal items away. We had to strip Susan of her essential Karen accoutrements, including her jewelry, designer shoes, makeup, etc. And, yes, we even gave her a haircut. Thankfully, the hairdressers were total saints. You can imagine how challenging it is to undo The Cut. Not an easy task. Sometimes the process is so traumatic, the hairdresser will just give up in frustration and buzz the whole patient’s head.

We managed to get Susan down to a sort of average looking pixie cut, far less dramatic than the thing she had going on before, which was something between late-era John and Kate Plus Eight and early-era Long Island Medium. See, that’s History and Systems paying off right there. Hit up the Wayback Machine if you don’t get the references.

When we washed off all her makeup, she flipped out. “Stop it,” she said. “Why are you rubbing so hard?! My eyebrows are tattooed on, you idiots. They don’t come off. Stop it!”

“Whoops, our mistake,” I said. “We’re just trying to cover all our bases before your treatment. We’re sorry. I didn’t realize your brows were inked.”

“You better be sorry,” she said, reaching for the Prada purse she somehow smuggled in under her chair. She dug into it, thinking she was being sneaky, and whipped out her backup pair of sunglasses, slapping them onto her face as a sort of shield.

“I know this is going to be hard, Susan, but I need to take those sunglasses away as well. What did I tell you about today’s session? No sunglasses.”

Her hand was convulsing as she held back her rage. I looked over my shoulder at the team of muscle-bound nurses behind me to remind them to be on the ready. We had seen far too many mirror sessions gone wrong. 

Reluctantly, she handed me the shades. “Those cost more than your rent, missy. If I see so much as a scratch—”

“What did we say about threats?” I folded up the glasses and placed them in a drawer. “Last thing I’m going to need before we go is for you to put this on.” I handed her an ordinary pair of white pajamas.

She tore them from me and grimaced. “Blegh. Don’t you people realize it’s after Labor Day?”

We brought her into the testing room and initiated the standard mirror procedure. First, we sat her in front of the looking glass and then asked what she thought of the person staring back at her.

As expected, she displayed a textbook lack of self-recognition. “Um, who does this basic-looking [expletive] think she’s staring at? What are you lookin’ at, honey? Why don’tcha take a picture, it’ll last longer,” she said, huffing and puffing, frantically addressing all of us and none of us at the same time. “I think this woman’s lost, guys. Did someone forget to bring her back to her room or something?” she asked, pointing over her shoulder with her thumb at her own reflection.

“Susan, what would you say if I told you the person over there staring back at you is actually you?”

Laughter. Just seconds of shrill, disoriented laughter. Cackling, almost. Then, as I expected, the tears came. Susan sat there on the cusp of a tantrum in complete, blubbering self-denial. You could tell, deep down, she knew. But she refused to verbally acknowledge that the unadorned reflection in the mirror was her own.

“Maybe this will help,” I said. I took her away from the mirror and placed a black mark on her forehead. This technique was for identifying rudimentary self-awareness—it’s what they do for chimpanzees and human infants to see if they possess basic metacognition. We wanted to see if she would reach for her forehead to wipe the smudge. This would indicate, with little doubt, that she perceived the face in the mirror as her own. “Okay, Susan. How ‘bout now?”

Sweaty, red-faced, and nearly hyperventilating, Susan gazed at the mirror as if staring into a black hole. After about forty seconds, she finally lifted her trembling hand and dabbed at the mark on her forehead with her index finger, rubbing the chalky ash into her oily skin.

Maybe there was hope for her after all, I thought. Half of acute Karens don’t reach for the mark, completely failing the self-recognition test. Susan would need rest, though. She was visibly distressed, so I brought her back to her room and gave all her stuff back. Fifteen minutes later, I had an orderly bring her food and tea.

When he returned, he told me Susan had fallen asleep. She had put all her makeup back on and then curled up in a fetal position, holding her sunglasses like a teddy bear.

#

The next day when I went to check on her, I was alarmed to find her bed empty. I checked all the common areas—the rec room, the cafeteria. Nowhere to be found. Fearing she had escaped, I panicked. I thought my life was over. They’re going to kick me out of my internship, I thought. And who knows what my professors would think. This was the first time I had a patient go MIA on me, and I had no idea what to do.

  I stopped by the nurse’s station to ask if anyone had seen her. One of the nurses named Moriah calmed me down and suggested that maybe Susan had fled on over to Kyle House. Apparently, it wasn’t all that uncommon after mirror therapy. 

“You know, Lydia,” she said to me, “you’ll see, the more time you spend with them—it’s an ego killer, having them face the reality of what they look like under all that stuff. Sometimes I find them next door doin’ all sorts of wild things. They go there to hook up, you know. Makes them feel better. Picks up their self-esteem a bit to get some attention from their own kind.”

So without wasting another minute, I hurried over to Kyle House. Believe it or not, the incidence of Kyle Syndrome is estimated to be just as high as Karen. It’s just vastly underreported. See, for some reason, Kyles are rarely brought in by family members for treatment, and they hardly ever admit themselves. Unfortunately, there’s something about men behaving badly that doesn’t seem to prompt as much of a call for intervention. Most of the ones in Kyle House were forced under court-ordered mandates, you know, as part of custody trials or child-visitation agreements or as some kind of remedial work-place program.

In Kyle House, I paced up and down each wing, shouting Susan’s name, peering into the rooms, listening for her voice. I approached the last door in Wing B, and I heard a muffled, but definitely Karen-sounding monologue taking place. She was speaking in fits, like talking but also breathing heavily between sentences, with the occasional sort of moan punctuating each phrase.

Instead of barging in, I listened closely to figure out what she was saying. Through the door, I heard, “So my stepdaughter comes down the stairs, right—and she goes, ‘Ma, I’ll be back before two AM.’ [Expletive, expletive]. And I’m like, ‘Hold on, missy, where do you think you’re goin’ dressed like that?’ [Moan, moan, expletive, expletive]. And she goes, ‘I’m hanging out with Dina and Chad.’ And I’m like, ‘Not wearing that you’re not. No stepdaughter of mine is walking out the house looking like some kind of [expletive].’ So she puts her hand on her hip, like, giving me an attitude, and she goes, ‘Ma, respect the drip.’ [Expletive], I know, right? What the heck does that even mean? Respect the drip. Respect this spatula on your [expletive]. So I said, ‘Go back up to your room and change your outfit right now or I’m telling your father.’ [Moan, moan, expletive].”

I had heard enough. I was incensed that she had the nerve to leave the ward and get it on with one of the Kyles. I blasted through the door to find them naked on top of one another. They were both startled. Kyle leapt off the bed, and his left leg got caught in the blankets. He came crashing down headfirst. Susan screamed, covering herself with a sheet, not paying any attention to the Kyle who just slammed his head on the ground. 

“You stay right there, Susan,” I said. “I’ll deal with you in a second.” 

I approached Kyle to check if he was okay. He was unconscious. To me, it looked like he suffered a concussion. So I called Dr. Ellison. She arrived with Moriah and the other nurses, and they hauled him out. I took Susan by the hand and escorted her back to her room.

#

Kyle, whose real name was Kevin, underwent a functional MRI. The scan revealed brain trauma to his retrosplenial cortex (RSC). According to Dr. Ellison, this is a brain area thought to be involved in hierarchical category perception. But it had previously only been studied in the context of neurotypical individuals (mostly college undergrads) in psychology experiments where they’d been asked to distinguish simple categories, like shapes and colors.

Dr. Ellison and her team hypothesized that a malfunctioning RSC as seen in Karen Syndrome could be causing difficulty in higher-level category perception, specifically the processing of different groups of people. This would explain why Karens are so insensitive to how another person’s socio-economic standing in the world might differ from their own, causing an overly simplistic perception of the differences between individuals of various backgrounds.

She went on to explain to me, “The Karens and Kyles don’t seem to understand that every person has unique talents regardless of their role in society. But every person also has their own limitations. Karens have a fundamental misunderstanding of how another person’s struggle might differ from their own, and that’s why they act so brash all the time. With this finding, we’ve finally shed some light on the biological basis for why Karens seem so disconnected from the harsh realities of everyday people.”

You know, these academic doctors tend to be a little long-winded in their explanations. But what it boiled down to was that Dr. Ellison was able to kick-start a research program based on the finding from Kevin’s fMRI. The protocol they developed involved the use of a drug called Orontisol and weekly sessions of Transcranial Magnetic Stimulation (TMS) administered to the brain area in question. This proved to be effective in diminishing symptoms in early clinical trials. 

I never would have imagined that catching my Karen doing the nasty in Kyle House would have led to such a fortuitous discovery. In the following months, they implemented the treatment on Susan, and she showed substantial improvement. The results of her mirror test showed us that she was at least capable of basic self-insight, which turned out to be one of the biggest predictors of positive clinical outcomes for patients on the new treatment plan.

She’s now living a drama-free life with her family. And the coolest thing, for me at least, was that Dr. Ellison added me as a co-author on the paper she published. Because of that publication, I landed one of the best clinical psychology professorships in the country, all thanks to my wild stint at Karen House.

Franco Amati is a speculative fiction writer from New York. You can find more of his work at francoamatiwrites.com or subscribe to his poetry newsletter at francoamati.substack.com. You can also find him @FrancoAmati3.