Monday, July 19, 2010

A Grand Rounds Hypothetical: Part 2

Grand rounds are a ritual of medical education, consisting of presenting the medical problems and treatment of a particular patient to an audience consisting of doctors, residents, and medical students.

The year is 1950. A man confined to a mental hospital tells his psychiatrist, "In July 1969, 19 years from now, an American will walk on the moon, drinking artificial orange juice." (Artificial orange juice? Why would anyone drink artificial orange juice? Who would manufacture artificial orange juice?) After questioning the patient the psychiatrist diagnoses the man with paranoid schizophrenia. The psychiatrist concludes that even if an American were to walk on the moon in 1969 (drinking artificial orange juice) there is no way the patient could know that. The man's beliefs are delusional and bizarre.


The year is 1990. A man tells his psychiatrist about a dream he had in which the psychiatrist was lounging in a swimming pool. In 1993 the man finds himself in out-patient psychotherapy at a major medical center; a psychiatrist at the facility has diagnosed him with psychotic mental illness. In 1991 the man's employer fired him when it learned, in consultation with a psychiatrist, that the man suffered from severe mental illness that rendered him potentially violent and not fit for employment. The man, who has a grandiose vision of himself as a latter day Sigmund Freud, presented to his treating psychiatrist a written interpretation of the dream he had had three years earlier concerning his former psychiatrist lounging in a swimming pool.

The man's dream interpretation suggests that one day in the future the U.S. Department of Justice and the Attorney General himself will become embroiled in a national scandal that has its origins in the man's employment problems from 1991.

The man's psychiatrist recommends that he take the potent anti-psychotic medication Haldol for delusional psychosis that centers on the man's belief that he was wronged by his former employer and that the employer has placed him under surveillance.

Needless to say, the man's seeming prediction that his employment problems would one day erupt into a national scandal involving the Attorney General of the United States is evidence of a severe thought disorder -- and nothing more. There is no way that any individual could predict the future by way of a dream interpretation.

Or is there?

1 comment:

Gary Freedman said...

I believe I can predict the future.

Good luck finding a jury that would say I wasn't insane!