Tuesday, June 22, 2010

My Day In Court: Psychoanalytic Associations

I wrote the following letter to my then-treating psychiatrist at the George Washington University Medical Center in 1996.  The letter summarizes two of my consultations in January 1996, and offers some psychoanalytical observations.  The letter also provides a contemporaneous report about my appearance before a judge of the D.C. Superior Court in connection with Freedman v. D.C. Department of Human Rights.

About two weeks later Dr. Georgopoulos diagnosed me with the debilitating psychotic disorder, paranoid schizophrenia.  I was not on any medication at the time I wrote the following letter. 

Additions to the letter as of this posting are highlighted in yellow.

January 31, 1996
3801 Connecticut Ave., NW
Washington, DC  200008-4530

D. Georgopoulos, M.D.
Dept. Psychiatry
GW Univ. Med. Ctr.
Washington, DC  20037

Dear Dr. Georgopoulos:

The following list of associations, which have emerged in the last few sessions, merit review as varied expressions of a single core of unconscious concerns.

Consultation Wednesday January 24, 1996:

[The patient is scheduled to appear in court two days later, on Friday January 26, 1996, in a matter relating to his former employer’s action in terminating his employment (resulting in his forced isolation, symbolic of castration).  The patient does not mention this fact to the psychiatrist during the session.

The psychiatrist begins the hour by informing the patient that the psychiatrist will be completing his residency program at the end of June, and that the patient’s relationship with this psychiatrist will end at that time.  The patient commences a series of associations instigated by the following thought::

“I have never felt comfortable with you as a psychiatrist.  That’s just the way I am.  I either take to somebody or I don’t.  If I don’t like somebody, I don’t come to like that person simply by interacting with him over a period of time.”]

[Note the similarity of this observation to a line from J.D. Salinger's short story Franny and Zooey: "'You either take to somebody or you don't. If you do, then you do all the talking and nobody can even get a word in edgewise. If you don't like somebody – which is most of the time – then you just sit around like death itself and let the person talk themself into a hole. I've seen you do it." ]

Association 1:

I feel I know people.  Like for example, that letter I wrote in June of ‘93 about the dream I called “Murder in the Lobby.”  The dream concerned the issue of rescue.  In the dream I placed myself in the role of a rescuer attempting to save someone in mortal danger.  The dream mentions the actor Mark Harmon.  What’s really strange is that recent incident in which Mark Harmon rescued two people from a burning vehicle in California.  Apparently I had unconsciously identified Mark Harmon as someone who had a rescuer personality, as evidenced by the letter I wrote way back in June 1993.  I think I really know people.  I think I respond to people based on that intuitive feeling I have about people.  That’s why I don’t like you.  Very early in our relationship I intuitively saw that you were not someone who I would want to deal with.


It is significant that the referenced “Dream of Murder in the Lobby” includes, as conjoined associations: rescue, law school, the practice of law (symbolically relating to performance anxiety and erective potency), and the disbarment of a castrating figure--this parallels many of the associations appearing in the present chain of associations.


[next thought]:

Association 2:

It’s like [Akin Gump founding partner and former U.S. Ambassador to Russia] Bob Strauss.  He has this self-concept as someone who really knows people.  It’s funny because the first time I saw him at Akin Gump--that was in March 1989, when I happened to see him walking toward me in the hallway of the firm--that’s the thing that struck me: that he seemed to have x-ray vision.  He has these piercing eyes.  It’s as if when he looks at you he’s reading what’s inside your head.  At least, he gives that impression.  When he was appointed Ambassador to the Soviet Union, he said--it was reported in the newspaper--”I don’t speak Russian, but I know people.”

[unconnected thought later in session, but related to issue of psychiatrist going away]:

Association 3:

I’ll tell you who I would like to do therapy with.  Dr. [Jeffrey] Akman or Dr. Wiener.  And Dr. [Joan] Barber.  They seem like strong people.  Dr. Barber, what I admire about her is that she entered the medical profession at a time when there were very few women.  Today, maybe 50% of medical students are women.  But, it’s not inconceivable that Dr. Barber might have been the only woman in her medical school class.  I’m sure she didn’t have an easy time of it--in medical school or after.  I’m sure there have been many environments she’s entered where other people simply wished she’d go away.  I admire that.  The ability to stay put in a hostile environment, to able to perform, and perform well, in a hostile environment.  To me, that’s a sign of strength. My feeling is that if Dr. Pitts were Dr. Barber’s age, if she had had to cope in that kind of environment, she never would have survived.


This last thought about Dr. Pitts parallels something I had said to Dr. Pitts about my sister, years earlier: “I think that if I had been in a Nazi concentration camp, I’m one of the people who would have survived.  I don’t think my sister would ever have survived.”


Association 4:

[next thought]:

I remember reading about that Supreme Court Justice--Sandra Day O’Connor.  When she graduated from law school and she started interviewing with different law firms, they actually told her her: “We don’t hire female lawyers.  We’d be happy to consider you for a secretarial position.  But, as far as practicing law at this firm, you can forget about that.  And now, she’s a Supreme Court Justice.”

Anyway, that’s something I admire about Dr. Barber.  It’s those types of characteristics, or indicia of personality characteristics, that seem to determine how I respond to people.  [And, a lot of that happens on an unconscious level.]

[At the time of this consult I knew that the Superior Court judge I would appear before on January 26, 1996 was a female.]

Association 5:

I’ll tell you what Dr. Barber reminds me of.  There’s this anecdote about Freud.  That in 1938, when the Nazis were closing in on Vienna, Freud’s daughter asked if it wouldn’t be better if they all killed themselves.  So, Freud said: “Why, because they’d like us to?”  Freud just wasn’t going to be bullied by other people.  He just wasn’t going to give into people who might have wanted him out of the picture.  It’s really the same thing that I’m saying about Dr. Barber.


Note that it was the U.S. Ambassador to the Soviet Union, William Bullitt, who in 1938 obtained exit visas for Freud and his family, which permitted Freud to gain safe haven in England.  Bullitt literally rescued Freud from a concentration camp oven.  See association 1, above, re: Mark Harmon’s rescue of two people from a burning vehicle (that is, rescue from a hostile environment in which the victim is absolutely helpless).

Compare the following statement the patient made at a prior consultation, on October 27, 1995: “What do you mean peoples’ reactions to me have nothing to do with me?  You mean a person can say, ‘We’re all afraid of you, we’re all afraid you’re going to bring in a gun and shoot everybody’  And that has nothing to do with me?  And that that can happen not once, but with two different people making the same accusation, and that has nothing to do with me?  Hitler sticks six million Jew in an oven, who is he reacting to--the Eskimos in Alaska?  If I were to say to you ‘I’m afraid you’re going to bring in a gun and shoot everybody,’ who am I reacting to--Dr. Wiener?  But cf. Letter to Dr. Pitts, dated June 4, 1993.”  See Letter to Dr. Georgopoulos, dated October 30, 1995. 1/

The referenced letter to Dr. Pitts, dated June 4, 1993, concerned the issue of peer jealousy in a professional environment headed by an all-powerful father figure, and referred to the patient’s performance as a law clerk: “While I was employed as a law clerk at the law firm of Sagot & Jennings in Philadelphia in the early 1980’s, one of the partners [Neil Sagot] confided in me about the senior partner: “Tom [Jennings] never has anything positive to say about anyone.  He criticizes everybody.  He praises you all the time.’  Thus, [psychoanalyst Otto] Rank’s interpersonal difficulties vis-à-vis Freud [in which peer jealousy played a prominent part] may have resembled a recurring feature of my interpersonal difficulties vis-à-vis authority figures.”

At the present consultation there re-emerge the recurring concerns regarding peer jealousy (in a professional environment) and (2) annihilatory retaliatory aggression by peers (in both personal and historical contexts).

One suspects that an additional, though unstated, issue pertinent to this complex of concerns are the patient's implied feelings of despair that center on his inability to locate an all-powerful protector. 2/  Cf. Letter to Dr. Georgopoulos, dated October 30, 1995: “Presumably, the Oedipally-charged nature of the patient’s interpersonal relations is related to an important aspect of the patient’s own Oedipal struggle: his apparent need for fusion with an all-powerful father representative, or omnipotent protector, such as symbolized by the President of the United States”--apparently, a figure the patient conceptualizes as a phallic-narcissistic rescuer, like Mark Harmon, Robert Strauss, and William Bullitt.

1/  According to Erikson, Hitler was not a father figure, but rather the leader of an Oedipally-charged (jealousy-driven) brother horde.

2/  “During the Middle Ages the secret brotherhoods (the corporations or early trade unions) excluded the Jews from nearly all trades, and if the Jews were sometimes protected it was always by certain isolated but powerful personalities, in a sense paternal figures, never by the brotherhoods themselves.” Grunberger, B. “The Anti-Semite and the Oedipal Conflict (emphasis added).”  Int’l J. Psychoanalysis, 45: 380-385, n. 6 at 383 (1964).

Consultation Monday January 29, 1996:

[The patient reviews the previous consultation.  He discusses the relationship between the following associations, a symmetry that the patient detected only after the consultation had concluded.

Association 1:  Rescue from a hostile environment/Mark Harmon’s rescue of two persons from a burning vehicle;

Association 2:  Soviet Ambassador Robert Strauss;

Association 3:  Dr. Barber (doctor) in a professionally hostile environment;

Association 4:  Sandra Day O’Connor (lawyer) in a professionally hostile environment;

Association 5: Freud in a hostile environment/Soviet Ambassador Bullitt’s rescue of Freud from a burning oven

(Freud = Barber = O’Connor = Harmon’s victims / Ambassador Strauss = Ambassador Bullitt -= Mark Harmon).

The patient discusses feelings of insecurity and abandonment aroused by the prospect of GW terminating his therapy.  He states that this raises an existential concern for him: the fear of being a powerless individual at the mercy of powerful figures who act at their own whim and caprice, independent of whatever the patient does.  The patient recounts his employment experience in which he was demoted and then terminated despite the fact that he had excellent performance evaluations  The patient expresses a concern regarding what he perceives as a total lack of effectiveness in his environment, which situation he sees recurring both professionally and socially.  Near the end of the hour the patient discusses his court appearance, on Friday January 26, 1996].

Association 6:

I had a court appearance on Friday.  I had to appear in [D.C. Superior C]ourt in connection with this lawsuit I filed against Akin Gump.  It was just a routine thing.  It only lasted a few minutes.  The judge just had to take care of routine scheduling matters.  I felt all charged up by appearing in court.  It’s not a feeling that I would have anticipated, you know a pleasant feeling of excitement.  I was surprised that even with practicing attorneys, appearing in court, even in routine matters--maybe I’m projecting here--but I think even with these attorneys, there’s an air of tension.  They seemed sort of tense.  I was surprised by that.  I was sort of tense myself, but, like I say I was sort of charged up.

I’m thinking, maybe its like medical students.  Before a doctor has ever assisted in an operation, maybe he has no idea how he’ll react when he gets in  the operating room.  I suspect that for some medical students, the experience has no special meaning.  But with others, I imagine they experience a totally unexpected feeling of excitement--those are the ones who will become surgeons.


Note that the patient repeatedly links the issues of professional performance as between law and medicine.  At the previous consultation, the patient compared Dr. Barber, a physician, with Justice O’Connor, a lawyer.  (Incidentally, the actor Mark Harmon portrayed a surgeon on the television series Saint Elsewhere, a fact noted in the “Dream of Murder in the Lobby.”  See association 1, above).


I think maybe the judge thought I might be a lawyer because she said, “Mr. Freedman, are you an attorney?”  I said, “no, your honor.”  I didn’t want to get into the whole history, you know, how I’m licensed to practice, but never practiced.  I figured I’m not under oath, so that’s the difference.


The phrase “I’m not under oath” may be significant.  The themes of “the oath” and perjury (false swearing) were important in “The Dream of Murder in the Lobby.”  See Association 1, above.


Was that proper, to say you’re not an attorney?  Won’t that pose problems for you later on as you progress throughout the case?


You can always act as your own legal representative.  it’s not like medicine.  A non-physician can’t prescribe medication for himself.  But a doctor can prescribe to himself and others.  But in the law, a non-lawyer can always represent himself;  he just can’t act as another person’s legal representative.


The patient is able to conceptualize spontaneously a somewhat esoteric distinction between the practice of law as compared with the practice of medicine.  The patient’s observation may suggest his unusual sensitivity to performance issues.


I think maybe I impressed the judge as someone who actually looked like an attorney.  You know, when I was finished, and I turned around--they were all lawyers in back of me in the courtroom--I had the feeling that all their eyes were fixed on me, as if I had impressed them somehow.  You know I couldn’t see  the other lawyers in the courtroom while I was talking to the judge.  I mean, she’s up on the bench, you’re looking up at her, and the other lawyers are in back of you.

[Note the emergence of grandiosity in this session: "I had the feeling that all their eyes were fixed on me."  If anything, people in the courtroom may have been reacting to my statement to the judge: "There may be an ongoing criminal investigation in this matter."]


Oddly, the patient’s description of the configuration of parties in the courtroom is identical to the configuration of orchestral musicians performing a concerto in a concert hall.  See Letter to Dr. Georgopoulos, dated December 27, 1995, discussing the Beethoven violin concerto.  At a concert, the conductor stands on a podium (like a judge seated on a bench), while the soloist (like the appearing attorney) stands facing the conductor--the body of orchestral musicians (like a group of attorneys seated in a courtroom) are seated behind the soloist, unseen by the soloist, but watching the soloist and the conductor.

The patient’s perception of the social matrix’s perception of him, polarized as it is between his self-concept as idealized performer, or artist, and, alternatively, as debased outsider, suggest the emergence into conscious thought of an unconscious conflict organized around the issues of narcissism and guilt.

A comparison in outline form of the essential features of the hero myth (in which narcissism plays a key role) with the essential features of the scapegoat myth (in which guilt plays a key role) highlights the polar opposite nature of these models, and suggests the patient’s probable use of negation as an offsetting mechanism.


COMPARE PATIENT’S REPORT:  “What do you mean peoples’ reactions to me have nothing to do with me?  You mean a person can say, ‘We’re all afraid of you, we’re all afraid you’re going to bring in a gun and shoot everybody’ and that has nothing to do with me?  And that that can happen not once, but with two different people making the same accusation, and that has nothing to do with me?  When Hitler sticks six million Jews in an oven, who is he reacting to -- the Eskimos in Alaska?”  See Letter to Dr. Georgopoulos, dated October 30, 1995.

[Note that it was the psychoanalyst Otto Rank who first analyzed and wrote about the myth of the birth of the hero.  See discussion above that mentions Otto Rank.]


--shuns scapegoat
--claims scapegoat acted alone in perpetrating the deed which certainly each member of the group contemplated or ventured upon
--represents deed as evil
--represents selves as guilt-free (pretense of mortal strength)
--projects blame onto scapegoat (GUILT) to expiate memory of harm or imagined harm
--deed is murder of primal father


-accepts blame
-possible oral fixation?; possible regression from phallic position?


COMPARE PATIENT’S REPORT:  “You know, when I was finished, and I turned around--they were all lawyers in back of me in the courtroom--I had the feeling that all their eyes were fixed on me, as if I had impressed them somehow.”


--moves to free himself from group (like a soloist performing a concerto with orchestra)
--claims to have acted alone in accomplishing the deed, which certainly only the group as a whole would have ventured upon
--represents deed as good
--represents self as brave (pretense of strength)
--related to group his hero’s deeds which he has invented (NARCISSISM) to expiate memory of harm or imagined harm
--deed is murder of primal father-possible phallic fixation?  (Note that a typical feature of the phallic type, according to Reich, is his potential transition, or regression, to the oral position.)


-identifies with HERO/ARTIST


It’s not unexpected that when someone does a good job that other people will take notice.


The psychiatrist acknowledges a connection between the patient’s actions (or personality) and other persons' positive, or admiring, response.  Yet, when  the patient cites instances in which another person exhibits a jealousy-inspired negative response to the patient, the psychiatrist will maintain with vehemence that other persons’ negative reactions “have nothing to do with” the patient.  It’s an odd contradiction in the psychiatrist’s thinking, possibly suggestive of both the defensive and disingenuous quality of the psychiatrist’s interpretations concerning the patient’s relations with the social matrix.


You know, I think all this has to do with the issue of identity.  It’s like I’m this person who’s pretending to be somebody else.  I’m really an attorney, and people suspect that about me.  My not practicing law is a kind of pretense, an act.  Dr. Palombo used to say I was just acting: that this negative identity I’ve taken on is just an act.

There’s a relationship between this and Hugo’s novel Les Miserables.  Jean Valjean is a criminal who takes on a false positive identity, and he’s stunned when people catch him out.  It’s like, with me, it's as if it’s a polar opposite thing.  I’ve taken on this negative identity, and am always surprised when people suspect I’m really a lawyer.


Uncannily, the patient’s final observation, concerning the Hugo character Jean Valjean--a guilt ridden figure who takes refuge in a false identity--brings the patient’s associations full circle back to an individual who, at great personal risk rescues two otherwise helpless persons in mortal danger.  See Association 1, above: “What’s really strange is that recent incident in which Mark Harmon rescued two people from a burning vehicle in California.”

Compare the following passage from Les Miserables.

But it seems that on the December evening when [Jean Valjean] unobtrusively entered the town, with a pack on his back and a thorn stick in his hand, a serious fire had broken out in the the Town Hall.  Plunging into the flames he had, at the risk of his life, rescued two children whose father as it turned out, was the Captain of Gendarmerie.  So no one had asked to see his identity papers.


Gary Freedman

1 comment:

Gary Freedman said...

Jeffrey Akman, M.D. is now the chairman of the psychiatry department at GW, having succeeded Jerry M. Wiener, M.D. (now deceased).