Monday, July 19, 2010

A Grand Rounds Hypothetical: Part 3

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 2010. A man tells his psychiatrist that he has been under surveillance by his former employer, a large law firm, since late October 1988. He states that the employer had taken "a special" interest in him, for some unexplained reason. The patient believes that the employer spoke with internationally renowned scholars about the patient and his writings, including Fritz Stern of Columbia University, Peter Gay of Yale University, and Harold Bloom of Yale University. The patient states that the employer on one occasion gained access to his apartment and videotaped the apartment, sending a copy of the videotape to his sister.

A law enforcement investigation discloses that some of the patient's beliefs are accurate.

Despite the fact that the patient is shown to be correct in his beliefs, is he not nonetheless a delusional psychotic? There is no way the patient could possibly have "known" what he purported to know. Are the patient’s beliefs about his employer not evidence of delusional thinking that coincidentally matches reality?

Aside: I told a former treating psychiatrist, Suzanne M. Pitts, M.D., that I had "hypernormal reality testing," and explained that that was how I knew what I purported to know. She advised me that there was no such thing as "hypernormal reality testing."


Gary Freedman said...

I got the idea for this post from the movie "Twelve Monkeys." It's one of my favorite movies. Oddly enough, my former treating psychiatrist Rhoda Ruttenberg, M.D. told me it was one of her favorite movies too.

Gary Freedman said...

Title Card from Twelve Monkeys:...5 billion people will die from a deadly virus in 1997... /... The survivors will abandon the surface of he planet... /... Once again the animals will rule the world... / -

Excerpts from interview with clinically diagnosed paranoid schizophrenic, April 12, 1990 - Baltimore County Hospital.

Oddly enough, I can remember April 12, 1990. It was a Thursday. The next afternoon I saw my psychiatrist, Stanley R. Palombo. My supervisor had stopped up to my office before I left to see Dr. Palombo, and while talking to a paralegal she kept referring to the Bates stamping of documents. I inferred that she was referring to masturbation. See Brief of Appellee District of Columbia, Freedman v. D.C. Dept. Human Rights, 96-CV-961.

On Monday April 16, 1990 J.D. Neary, the legal assistant coordinator, had a clandestine meeting with Dr. Palombo. There's no way I could know these things.