Psychiatric Session Notes: Dr. SIngh

The following are notes I wrote about several of my sessions with Dr. Singh.  I saw Dr. Singh in psychotherapy from November 1996 to June 1998.  I generally write notes or letters about my mental health consults when I am experience a lot of confusion about my sessions.  The notes indicate that I take my psychiatric consults seriously, and that I do not simply view them as a way to keep the Social Security checks flowing:

need for praise & acknowledgement need for identity recogntion


expereinces comments as reproach disagrres with comments

capacity to intellectually represent feelings

teasing : people who are teased allow themseves to be teasedm

Dec 1996:

Introduce metaphor of the dolphin, relate this to identity and the issue of colonialism (family romance)

Doctor states that intellectualization (including metaphors) can pose difficulties for the ind. and his interpersonal relations

Jan.

Opens session stating that psychological testing at GW had a bias: the intern in a patterned and consistent way interpreted self-directed behaviors as other directed, that this relates to a conflict in internalized object development.

Mention that I disagreed with comments from previous session about intellectualization and metaphors. State importance of intellectualization and metaphors (Arlow) in psychoanalysis

Doctor lectures patient: You seem to interpret my (neutral) comments as chastisement, suggesting hypersensitivity.

(note: Why the emphasis on intent? The intent of the Nazis was to eradicate inferior peoples, not evil. Yet the effect for the victim was negative. Physician's treatment: may hurt but is beneficial--here intent, relevant. (But also Nazis) In terms of identity recognition, intent is irrelevant--Does the behavior confirm or disconfirm identity. Erikson, Identity and the Life Cycle--Individual seeks and needs environmental acceptance, not just praise.

(note: hypersensitivity and intellectualization are both anti-Semitic stereotypes)

Significant later comment: I'm not saying that you are not intelligent and not creative. Here, the psychiatrist attempts to soothe the patient's seemingly wounded ego. But that is irrelevant in terms of identity confirmation. The patient is not looking for praise of his intellectual productions, he is looking for an environment in which his intellectual tools may be utilized. To deny the importance of intellectualization for this patient is to deny him an important avenue of ego expression. The issue is not hurt, but identity confirmation.

teasing: people who are teased are people who allow themselves to be teased:

Brenman says that people who are teased may evoke the teasing behavior. They act like buffoons because of an array of ego defenses. But it is important to distinguish between the individual who objectively acts like a buffoon to evoke teasing behaviors, and a person who, because of a lack of identity equality with the community evokes teasing because he is simply different. In certain cases, such as my own, this disparity of identity can relate to the issue of disparity in the nature of object development. (As in anti-Semitism, the Jew is an unintended "buffoon"). Again, this may relate back to the issue of adaptation. The psychiatrist looks at my teasing in childhood as if it were a reaction to a innate negative characteristic, in fact it may have been the source of an adaptation. Because I was teased in the childhood situation, I may seek out or feel perversely comfortable in situations where I will be demeaned. Here, the doctor fails to integrate the "dolphin metaphor" from the session in December, Also, the act of evoking teasing may also relate to my place in the social system as a scapegoat.

Protects environment: own behaviors are viewed as patterned, while behaviors of others are depicted as willy-nilly. As with Heydt ("Well, that was just an individual reaction") Brother-in-law: people who are teased want to be teased, then -- how often was the contact?--possible anal defense aimed at denial (transforming content into quantity).

Asks questions about immediate affects ("How did that feel, was that painful, etc.). Fails to see affects as derivatives of impulses that may be ambivalently cathected. In mourning the loss of a loved object, the immediate conscious affect may be sadness, but the mourning reaction may be a derivative of an ambivalent cathexis that encompasses aggression and hatred as well as love.

In sum, assumes a lack of object development, fails to consider the role of underlying intrinsic characteristics in immediate affective state and interpersonal status.

Patient's view:

Intrinsic characteristics

(+ uncon. feelings) .

social reaction

patient's affect (product of intrinisic characteristics and subject to the distorting influence of the ego defenses, reactions from environment to patient, reaction to patient resulting from the environment's "own agenda.")

Psychiatrist recommends group therapy: relies predominantly on quantitative issues:

1. Group meets 2 hours per week

2. members range in age from 25-50

3. they may not have your verbal skills but they range in intellectual functioning from 1-100 (whatever that means?)

No empathy with the issue of frustration: that I might be intensely frustrated in a situation where group members cannot provide identity recognition.

No attempt to link qualitative aspects of my identity and consequent therapeutic needs with what the group has to offer.

Parallels Quint's observation when I mentioned that psychoanalysis is the treatment of choice for me: "Psychoanalysis is intense, group therapy is intense." (So is shock therapy!) Thereby linking the two forms of therapy on the basis of a quantitative issue, without regard to the nature of my ego functioning and ego needs.

May 1997 session:

Patient: I was thinking about your recommendation that I see you more often. I'm happy seeing you just once a month. I think the treatment of choice for me is psychoanalysis. Seeing you more often is not going to help me. It's like recommending more aspirin for a patient with an infection.

Doctor: Well, why are you here at all?

Patient: I'm so isolated. I think its important that I speak to someone at least once a month. Also, if I had some type of emergency, some type of psychological crisis, I think it's a good idea that I have someone available to talk to.

Doctor: It sounds as if you are saying you are lonely.

June 1997 session:

Patient : I want to review what we were talking about last time. I began the session by saying [here, patient repeats the material from May 1997 from memory.] I think your comment about being lonely was tangential. It's true but that was not the thrust of what I was saying. I was expressing an affirmative need for a certain type of relationship. That if I can't have that type of relationship, I would just rather not interact at all.

Doctor: You pick out the one thing I said about loneliness. That was just a small part of what I said. You interpreted that comment as a criticism, as if your feelings were hurt.

INTERPREATION: Again, the psychiatrist imputes to the patient feelings of narcisistic injury in response to the patient's criticism. Note also the transformation of content into quanity: the psychiatrist doesn't c omment on the content of the patient's statement, but transforms it into a quantity--"that was a small part of what I said.

Patient: [The patient enters into a lengthy discourse on intellectual processes and intellectulaization.]

Doctor: You are now commenting on something I said from about four sessions ago. Why do you continue to be concerned with this. You interpret my comment as a criticism.

Again, the psychiatrist transforms content into quantity ("four sessions ago"), and imputes narcissistic injury ("your feelings are hurt") when the patient criticizes the psychiatrist.

The psychiatrist is oblivious to the fact that the affect the patient feels is frustration--not hurt. As a general rule, we can say that this psychiatrist routinely interprets the patient's expeience of a thwarting of impulse as a narcissistic injury (with the implication of shame), rather than as a frustration of the patient's impulse with the patient retaining his sense of self-worth, or esteem.

Also, the doctor--in an apparent (misquided) effort to mollify the patient--begins to praise the patient's idea production and the letters he has written. But the patient, once again is not seeking parise, he simply desires to discuss the content of his ideas and not to have those ideas denuded of content, or defensively interpreted as a reaction to the patient's narcissistic injury. Also, inappropriately, the doctor states the possibility that the patient's preoccupation with ideas is a factor in the patient's interpersonal difficulties (probably a defensive [paranoid]) way for the psychiatrst to displace and rationalize his distress onto unidentified third parties in the patient's environment (In effect, "I suspect people in your environment have the same feelings I have in reaction to you.")

Contradiction: Doctor generalizes from his relationship with me onto my relations with third parties. When I complained about Mrs. Heydt, however, doctor said it was improper to generalize--it was an individual reaction.