Tuesday, November 10, 2009

GW's Psychiatric Assessment: Loose Associations

About loose associations. The term loose associations refers to thinking that is overgeneralized, diffuse, and vague with only a tenuous connection between one thought and the next.

Here is a verbatim transcript of a portion of the report of a schizophrenic patient. It's from Albert Rothenberg's book, "Creativity and Madness":

"I've never been confused as much as I have been recently. Confusion was nothing to me. It was fun. I loved art. I loved to have my hands in every single thing I could get them in. And when I'm here I don't have the facilities to dig in the garden and put my feet in the mud and I just can't stand that . . . feeling. I, I need to be free like most of us do, because I feel like a bird when I'm skiing, I feel like I could fly if I really tried but I wouldn't try because -- hee, hee -- it's beyond my power. Maybe someday they'll perfect it so that a person can fly without . . . walking. But they better hurry up! Because there's too many guys on the road right now."

Dr. Rothenberg comments: "There is no doubt about it: people suffering from schizophrenia say the darndest things. As a matter of fact, people suffering from schizophrenia often say or write things that are intriguing, ambiguous, even metaphorical; seemingly poetic, profound, and meaningful words and ideas virtually pour out at times."

Schizophrenics are less concerned with communication than normal individuals; they express their thoughts with indifference to their listeners' comprehension. Their speech is often unconventional in form, and appears to be striving to achieve a kind of unity between elements which are extremely disparate; in fact, any logical relationship between the elements is largely nonexistent. The speech of the schizophrenic is characterized by an absence of rhetoric or any need to convince. They seem to be exploring remote areas of experience which are intrapersonal or suprapersonal rather than interpersonal. That is, the schizophrenic is looking into the depths of his own psyche and is not very much concerned as to whether anyone else will follow him or understand him.

The order of the schizophrenic's ideas is markedly different from the logical psychological sequence of ideas as developed by the nonschizophrenic individual. This psychotic order is not easy to comprehend, because the ideas of the schizophrenic are not entirely realized, they are left incomplete -- they are a sequence of unexplained or unelaborated references, a veritable fugue-like series of ideas.

I can see why some people think I exhibit loose associations, but I'm not sure I do have them. Not all my psychiatrists think I do. Dr. Stanley R. Palombo, MD -- who I saw in 1990 -- didn't think I exhibited loose associations. He graduated from Columbia Medical School and had been accepted to Harvard Medical School. Dr. Lawrence C. Sack, MD -- who I saw in 1991 -- didn't think I exhibited loose associations. He did his undergraduate and medical studies at Harvard. He had graduated first in his class at a private prep school.

Why do some people think I exhibit loose associations? My explanation is that when I talk I use a lot of examples and metaphors. So in a brief span I might talk about a lot of different things. But really, I am making a single point.

Maybe you read the following blog post of mine from several days ago:

"Psychological testing differs from real life in that in the testing situation a subject is required to give a response. In real life a person can defer judgment. In other words, in the testing situation a person will necessarily expose his weaknesses. In real life a person can rely on his strengths and avoid his weaknesses.

That reminds me of something Elliott Mincberg, Esq. once said about his friend, Judge David Tatel who sits on the U.S. Court of Appeals for DC. Mr. Mincberg said: "You would never know he is blind. He functions so effectively in everything he does."

I don't drive. I never got a licence. I would probably make a terrible driver. My spatial intelligence is poor, a fact confirmed by the results of the Performance portion of the Wechsler intelligence test I took in May 1994. So I don't drive. I also don't play chess, another activity that requires spatial intelligence. You would never know how poor my spatial intelligence is.

The same principle holds true in the animal world. Sea lions have poor locomotion on land. But they are excellent swimmers. So they hunt for food in the sea. They don't bother trying to hunt for food on land.

Speaking metaphorically, I love swimming in the sea. -- But then, I always had a problem with metaphors!"

The post talks about a lot of things -- but there's one single point. A person can rely on his strengths and avoid his weaknesses.

I have a sense that people who say I suffer from loose associations don't have the intelligence or the motivation to process a lot of data that is fundamentally logical and cohesiveness. Instead, they would tend to interpret the above blog post as if I had said the following:

I once took a battery of psychological tests. You know in real life you don't have to answer questions. People can be so inquisitive. Do you ever defer judgment? I do. Judges sometimes defer giving opinions. Some people are weak. Some people are strong. What do you think I am? I used to work for a lawyer named Elliott Mincberg. He has a friend. There's a judge in Washington named David Tatel. Did you ever hear of the U.S. Court of Appeals for the DC Circuit? Blind people can be effective at what they do. I don't drive; I never got a license. I worry about being a terrible driver. Intelligence can be spatial and nonspatial. I don't play chess. In some ways my intelligence is poor. I love the animal world. Do you know anything about sea lions? They are excellent swimmers. I love swimming in the sea. I have a problem with metaphors.

It's a frightening thought, but apparently there are graduates of medical school who process a communication that includes examples and metaphors as if that communication comprised a series of loose associations. I think that people who can't process what I say have their own cognitive problems. But hey, that's me. And I have paranoid schizophrenia, -- or is it bipolar disorder, -- or maybe delusional disorder, -- or maybe even schizoaffective disorder?

There is no doubt about it: psychiatrists sometimes make the darndest diagnoses.


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