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 the Washington 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: The Post 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 Times of 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.