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Abel Elliott is the chief of staff at the West Haven Psychiatric Center and therefore in charge of all pharmacology, which explains Gus's questionable attemps to get in his good graces. Elliott agrees to cooperate with the SBPD's undercover operation to bust Bernie Bethel for faking his mental illness because he still owes his friend Henry a favor. He enlists Shawn as a patient and decides that the cover illness that would best suit his personality is Narcissistic Personality Disorder. Elliott is the only hospital employee privy to the operation and therefore the only one at the hospital who knows that Shawn is a spy and not a real patient.

After Shawn notices that Bernie's medication has been tampered with, the SBPD suspect Elliott is conspiring with Bernie's lawyer Phillip Zurn to keep Bernie insane and steal his fortune. Shawn then finds Elliott dead in his office, however, and starts suspecting head nurse Lavender McElroy of changing Bernie's medication behind Elliott's back and killing him when he confronted her about it. As it turns out when he pays Lavender a visit, though, it was in fact Bernie's brother Daniel who wanted to acquire Bernie's millions and had to kill Elliott to keep the scheme under wraps.

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