Remote Association: Abbas Jama, M.D. and King Edward VIII

I see a psychiatrist named Abbas Jama, M.D. He's a fourth year resident in psychiatry, affiliated with St. Elizabeths Hospital in Washington, DC.

My therapy with Dr. Jama is a huge disappointment for me. I like him a lot. But I can't tell you how many times he's cancelled appointments. In fact, I can't even remember the last time I saw him. Yes, he's cancelled that many appointments recently.

I've been seeing Dr. Jama since July. I should have known there was already something wrong when he cancelled my very first appointment!

I don't think he's very knowledgeable about psychodynamics. He doesn't seem in tune with what's going on with me intrapsychically. If he had to write up a case study, I don't know what he would say of any insight or value.

My relationship with Dr. Jama reminds me of a joke that Woody Allen tells at the beginning of the movie Annie Hall: "There's an old joke -- um . . . two elderly women are at a Catskill mountain resort, and one of 'em says, 'Boy, the food at this place is really terrible.' The other one says, 'Yeah, I know; and such small portions.' Well, that's essentially how I feel about life - full of loneliness, and misery, and suffering, and unhappiness, and it's all over much too quickly."

And that's essentially how I've come to feel about Dr. Jama: He's not very insightful, and he cancels most of my appointments.

Dr. Jama says that I need to understand that he's a psychiatric resident, that he has other duties, and sometimes he has to attend to those other duties.

My response? What is clear-cut for Dr. Jama is, in reality, a moral and ethical dilemma. And I'm disturbed that he doesn't see the dilemma that he faces. Dr. Jama is first and foremost a medical doctor who has ethical obligations as a medical doctor. His obligations as a resident-in-training are secondary to his ethical duties as a medical doctor. If he needs to cancel so many appointments with a patient, he needs to talk about this with his supervisor and St. Elizabeths' administration. He needs to have the balls to say to his supervisor: "Look, I'm a medical doctor, first and foremost. I have duties as a medical doctor. Those duties take precedence over my obligations as a resident." Why doesn't Dr. Jama see the moral dilemma that faces him? Why is his situation so clear-cut to him?

King Edward VIII was not much of a man, but I have to give him credit for telling the British people: "But you must believe me when I tell you that I have found it impossible to carry the heavy burden of responsibility and to discharge my duties as King as I would wish to do without the help and support of the woman I love." So he abdicated. He didn't try to have his royal cake and eat it too. He made a choice.

Another thing. In a sense, the Social Security Administration -- which pays me a monthly disability check -- is a third-party beneficiary of the relationship between me and St. Elizabeths. Social Security is counting on me getting appropriate treatment for my disability and moving on to gainful employment. Why is it that St. Elizabeths Hospital is oblivious to its quasi-legal obligation to my insurer (the U.S. Social Security Administration) to provide me with adequate psychiatric care?

And they say I am the one with grossly-impaired judgment?