Albert H. Taub, M.D.: Psychoanalytic Thoughts

I was a patient of Albert H. Taub, M.D., a psychiatrist at the D.C. Department of Mental Health, from August 7, 1998 until the summer of 2001.  The following are some psychoanalytic thoughts I recorded about Dr. Taub.  Dr. Taub used to supervise psychiatry residents at St. Elizabeths Hospital;  psychiatrists at St. Elizabeths have testified in federal court that attempted presidential assassin John Hinckley should be granted extended leave from that institution.  The Justice Department should consider that absolutely frightening!

session with Dr. Taub: Friday August 7, 1998

1. Does writing these letters make you feel like a man, is that why you writes these letters?

possible interpretation: Taub felt emasculated by the receiver's office -- defends against that by the ego defenses of reversal/projection (a classic paranoid defense--just like Schreber). "It is not I who feel emasculated by his letters, it is he who feels unmasculine and who needs to puff himself up with the impression he's violent."

2. You have a need to get attention. Again, the use of reversal/projection (a paranoid defense). He transforms his shame about having been seen by the receiver's office into my need to be seen. "It is not I who feel ashamed by the receiver's attention being focused on me at the clinic, it is he who desperately needs attention.

3a. If you don't stop writing letters, you may end up confined at John Howard. The fantasy of confinement may be a reversal/projection of the shame of exposure. "Confinement from the world" is the polar opposite of "exposure to the world."

3. Medication. I say: "Dr. Singh said he and Dr. Quint decided that medication was not indicated for me." Taub: "That wasn't what was said. Dr. Quint said that it's simply not worth the battle."

Note that Taub (or Dr. Quint) creates a false dilemma, as if there are only two options of handling medical recommendations with a patient. Either you recommend and the patient takes the medication, or you recommend, the patient refuses, and you end up battling about medication. What about the third alternative: Doctor simply states that medication might be useful, and if patient says no, you drop the issue for the time being. Then every once in a while you simply raise the possibility again noncoercively. Raises question: Why did Taub put the issue in terms of battling over medication?

4. Interesting parallel. Symmetry between notion that repetitive bad action (patient sends out letters) will bring dire consequences (being sent off to St. Elizabeths). -- notion that increasing the frequency of good action (therapy sessions) will automatically help the patient (good consequences). Anal defensiveness. Transforming content into quantity.

what about the content of the letters? what about the nature of the interaction (the nature of the relationship) between therapist and patient? the content of the relationship between the patient and third parties?

Note the possible relationship between the doctor's statement to patient (on 8/7/98): "Does writing letters that refer to violence make you feel like a man?" and "Prescribing medication makes me feel like a doctor (a man)." Thus,

Patient is angry (psychiatric symptom remediable with medication) =

Patient writes letters (to compensate for gender-based shame) =

Patient exposes doctor to authorities thereby revealing inadequacies of doctor =

Doctor feels shame (feels like he's less than a doctor) =

Doctor prescribes medication to rehabilitate his gender-based esteem and eliminate his shame (Really, it is the doctor who is angry and it is he who seeks to discharge that anger by the act of writing a prescription).

At session on 8/13/98: possible symmetry. "If you write one more letter, it may be the straw that breaks the camel's back." (one more little bad thing, and you may be in big trouble). = "How about if I prescribe medication for you. There's a new drug. It's called Xyprexa. It has no side effects. (Blatant lie). I'll prescribe just a small dose." (just a little bit of medication (a little bit of a good thing) will help you a lot.)

"Identification with aggressor." Doctor identifies with the authorities against patient to ward off his own shame in the face of patient's behavior. Compare: Poles side with the Nazi invaders to defend against shame posed by the Jews.

The doctor's entire interaction with patient is about one thing: the doctor's own feelings of shame concerning the issue of his professional competence and how the doctor can moderate or eliminate his own feelings of shame, whether by medication, chastisement of patient, or identification with aggressor (federal law enforcement authorities.). Totally solipsistic -- has nothing to do with the patient.

Revealing comment at first consult (8/7/98): "You're a lawyer. How would you feel if a client of yours started writing letters to various persons." Basically saying, "this whole thing is about me, and the shame you have brought upon me. I will make you feel the way you have made me feel. He basically admits (unintentionally) that his aim is to transmute his shame to me. The aim of psychotherapy is not to make the patient "feel the doctor's pain."

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1. Does writing these letters that refer to violence make you feel like a man, is that why you writes these letters? (8/7/98) (doctor's paranoid discharge of castration anxiety)

2. You have a need to get attention. (8/7/98) (doctor's paranoid fear of being seen)

3. If you don't stop writing letters, you may end up confined at John Howard. (8/7/98) (doctor's paranoid fear of being seen)

4. "You're a lawyer. How would you feel if a client of yours started writing letters to various persons." (8/7/98) (identification with aggressor, unstable parent/child identification, like a child's game "Pretend you're the daddy and tell me how you would feel if your little boy did naughty things that brought shame on you," like a child struggling with the frustration and shame caused by emerging impulse control and the internalization of parental values). Note the failure of the doctor to assign the following role to the patient: A lawyer who is sending out letters on behalf of his client--A "Geoffrey Fieger type" aggressive, nut-case type lawyer.

5. Doctor recommends that patient see him once a week, and increase psychotherapy sessions from once a month to once a week. (8/7/98) (transforms content into quantity -- doctor views patient's letter writing (and the shame it brings the doctor) as inversely proportional to number of sessions at clinic (which moderate shame for the doctor-- note the doctor's admission, "Just what am I going to tell the receiver's office?" which suggests the doctor's need to appear (in the eyes of the receiver's office) to act "as if" he was actually doing something, so he increases the number of the patient's visits. Keep in mind: even five visits per week to a psychology student are still simply five visits per week to a psychology student.

Note the following symmetry: "The more letters you write, the worse it will be for you; the more often you come here, the better it will be for you." Note that the recommendation that the patient increase his frequency of clinic visits avoids confronting the fact that the specific type of therapy offered by the clinic (namely, supportive psychotherapy) may have little effect for a patient who requires psychoanalysis.

6. Doctor recommends a neuroleptic (Xyprexa) for the target symptom of anger; doctor states that he will prescribe a small dose of the drug, which the doctor asserts has "no side effects." (8/13/98)

(small dose of good thing will bring significant beneficial results-- and "Nothing bad")

7. "If you write one more letter, it may be the straw that breaks the camel's back." (8/13/98)

("small dose" of bad thing will bring significant bad results [--and "nothing good"]" -- i.e. 7 is symmetrical with 6)

8. Note the possible relationship between the doctor's statement to patient (on 8/7/98): (1) "Does writing letters that refer to violence make you feel like a man?" and (2) "Writing medical prescriptions makes me feel like a doctor (a man)." Thus,

Patient is angry (which anger the doctor depicts as a psychiatric symptom remediable with medication) =

Patient writes letters (which the doctor depicts as the patient's attempt to compensate for gender-based shame) =

The doctor feels that the patient's letters expose the doctor's inadequacies to the authorities, thereby emasculating the doctor =

Doctor feels shame (feels like he's less than a doctor, less than a man) =

For the doctor shame is experienced as anger =

Doctor recommends medication to rehabilitate his gender-based esteem and eliminate his shame (and anger). (Really, it is the doctor who is angry and it is he who seeks to discharge that anger by the act of writing a prescription).

TENTATIVE PROFILE: Castration anxiety that is the product of superego development at a stage of "identification with aggressor." ** Doctor identifies with parental values (i.e., the values of law enforcement and the receiver's office) in order to ward off shame of being seen by parent (receiver's office) and being punished. Accepts the value but projects the blame outward onto the patient. But the projection is carried out in a paranoid fashion, in which the doctor relies on not simply projection, but, rather, a combination of reversal/projection (as in classic paranoia). Thus, "You need attention" [translation: I don't like all this scrutiny from the receiver's office]; "Does writing letters make you feel like a man?" [translation: I feel emasculated by the receiver's office]; "If you don't stop writing letters, you may end up confined [i.e., hidden away] at John Howard" [translation: If I don't start writing prescriptions for this patient, I may be exposed [i.e., seen] as incompetent by the receiver's office].

The psychiatrist's failure to distinguish between (1) a mentally competent patient whose behavior, no matter how disturbing, is fundamentally a protest against authority (compare the Vietnam War protesters) and (2) a patient whose disturbing behavior is evidence of mental disturbance, may signify that the psychiatrist has an authoritarian personality. For example, in the Soviet Union, mentally competent dissidents were sent to mental hospitals and classified as insane, to ward off the shame to the state resulting from the protesters' complaints against authority (or the protesters' act of exposing the state).

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**"[C]astration anxiety progresses through a series of stages: fear of actual punishment by the external object, fear of potential punishment in relation to the introject (even when the parent is not present) "identification with the aggressor" (i.e., accepting the parent's values) but projection of the blame, and finally gradual acceptance of the critical attitude directed toward the self." Freeman, D.M. A. et al. "Superego Development and Psychopathology." In: The Psychoanalytic Study of Society. Vol. 7: 107-122 at 118. Gertrude R. Ticho, M.D., contributing editor (New Haven: Yale University Press, 1976).