Friday, July 30, 2010

GW -- Psychotherapy -- Letter to Suzanne Pitts, M.D. 1992

I was terminated from my job as a paralegal at the law firm of Akin, Gump, Strauss, Hauer & Feld in late October 1991. In September 1992 I had a psychiatric assessment at the George Washington University Medical Center (Napoleon Cuenco, M.D.). Dr. Cuenco diagnosed me with bipolar disorder, a psychotic mental illness that, according to Dr. Cuenco, featured the mood congruent psychotic features of "loose associations" and "flights of ideas." In late October 1992 I started psychotherapy with Suzanne Pitts, M.D., a third-year psychiatry resident at GW. About a week and a half later I submitted the following letter to Dr. Pitts. I was not on any medication when I wrote the following letter.

My motivation in writing the following letter? First, I had a wealth of intellectual ideas that I wanted to work out at that time.   The creative individual "is almost insatiable for intellectual ordering and comprehension."

But the letter is also an example of "showing off." The chairman of the GW psychiatry department at that time was Jerry M. Wiener, M.D., a nationally-prominent psychiatrist who served as President of the American Psychoanalytical Association as well as the President of the American Psychiatric Association. I also believed that GW was in communication with my former employer, Akin Gump. I wanted to impress important people with the "brilliance" of my ideas. At this particular time Akin Gump founder Robert S. Strauss was ending up his service as
U.S. Ambassador to Russia. Strauss's father had aspired to be a concert pianist; the following letter is about the autobiography of renowned concert pianist Arthur Rubinstein.  Incidentally, Arthur Rubinstein's daughter, Alina Rubinstein, M.D. is a psychoanalyst who practices in Manhattan.

Of possible additional psychoanalytical interest is the fact that the Clinton-Bush Presidential election took place on Tuesday November 3, 1992, a few days before I wrote the following letter.

November 9, 1992
3801 Connecticut Avenue, NW
Apartment 136
Washington, DC 20008

Dr. Suzanne M. Pitts
Department of Psychiatry
George Washington University
Medical Center
2150 Pennsylvania Avenue, NW
Washington, DC 20037

Dear Dr. Pitts:

I have identified a case report in one of Freud’s papers, key elements of which parallel two key elements discussed in the opening pages of the autobiography of the pianist Arthur Rubinstein [Rubinstein, A., My Young Years (Knopf: 1973)].  Examination of the Freud case study (discussing clearly defensive processes) and comparison with the Rubinstein autobiography (discussing mixed defensive and adaptive processes in the context of a creative ego) raise several issues regarding the interaction of pathological (defensive) and creative (adaptive) ego processes in my case.  Further, the materials suggest the relation of seemingly unrelated psychological issues such as guilt, identity diffusion, the need for an omnipotent protector, or rescuer, among others.  Examination of the materials may help clarify the significance and relationship of these issues in my case.

In Part I. (“The ‘Exceptions’”) of “Some Character-Types Met With in Psychoanalytic Work” Freud discusses the case of a man who had developed the conviction that a special providence watched over him and protected him.  Freud traced the patient’s irrational conviction to an incident in the patient’s infancy. The patient who believed himself watched over by a special providence had been in infancy the victim of an accidental infection from his wet-nurse. The two key elements here are (1) the belief in a special protector and (2) traumatization from the wet nurse in infancy. (Freud does not explore the significance, if any, of the patient having suffered an oral disturbance, as opposed to having suffered some other “unjust injury.” That is to say, whether the issue of orality is material in this case is an open question. If the oral nature of the trauma were immaterial, the relation to the Rubinstein autobiography and to my own case is seriously diminished.)

Rubinstein’s autobiography begins: “My life was saved by my Aunt Salomea. A seventh child, eight years after the last-born, I was utterly wanted by my parents, and if it had not been for the enthusiastic persuasion of Aunt Salomea Meyer, my intrusion into this valley of suffering might have been prevented.” The theme of a “special protector” was an important one for Rubinstein; Rubinstein chose to begin the story of his life with these very lines and, indeed, returns again throughout the two volumes of his autobiography to his belief in a “special providence” that saved him from disaster. On the second page of the book, Rubinstein discusses his wet nurse: “My physical care was entrusted to a wet nurse called Thecla who was devoted to me, but later on, I heard, she was caught thieving and was put in prison. I was frightened that possibly I had swallowed some of her vice along with her milk, though the future proved my apprehension unwarranted. I have never stolen -- yet!” 1/ Thus, within the span of the six opening paragraphs of Rubinstein’s autobiography we find the introduction of two important themes, namely, the belief in a special protector and the theme of oral “infection.” The two themes parallel those found in the Freud case study.

Note Rubinstein’s linking of what was presumably for him the symbolically equivalent issues of nursing and thieving, which is significant. By implicitly analogizing the act of nursing to thieving Rubinstein also implicitly raises the issue of depletion guilt. In the paper “Survivor Guilt in the Pathogenesis of Anorexia Nervosa,” [Friedman, M., Psychiatry, 48:25-39, February 1985], the author relates the infantile fear of depletion of the mother to the development of survivor guilt. Significantly--in view of Rubinstein’s discussion of infantile oral concerns and his implicit invocation of the issue of depletion guilt--Rubinstein later discusses, at pages 10-11 of his autobiography, an episode of apparent survivor guilt in early childhood that followed the death of a beloved female cousin. “Next morning, my father took me for a walk. At his first words, ‘You know, Arthur, .  . .,’ I cut him short, and said quickly, ‘Yes, I know, I know, Papa. She has left, but she will come back.’ My childhood was over; I was a boy now. Only years later could I talk about this and listen to the details of the abominable scarlet fever which took her away from me."

"My sweet little Nemutka--she is certainly an angel now if there are any! I went though a bad time. I became irritable and disobedient, refusing food [anorexia], avoiding people at home [a diagnostic criterion for adjustment disorder], and starting fights with boys at school. Nobody could persuade me to play the piano for pleasure [anhedonia]. I would just practice scales, but lazily, without conviction. The only thing I liked was to play cards with my sick grandfather, who distracted me by teaching me the most intricate games. I could not be reconciled to the loss of my little friend; there was a rage in me, a grudge, a resentment against something, or someone--I could not say what. One night, wide awake, I suddenly knew. Yes, it was God, this God of my grandfather [apparently a capricious God who plays cards] who prayed to Him so fervently, assuring me that God knows everything, is everywhere, perceives our most secret thoughts, protects us [note once again the theme of protector: but here, a capricious and failed protector], and is never wrong. Well, then, I thought  bitterly [possible oral reference: compare Rubinstein’s earlier fear in regard to his wet nurse, “I was frightened that possibly I had swallowed some of her vice along with her milk”], how could He do such an unjust and terrible thing as this? . . . Night after night I went through the same scene, which was very hard on my nerves [possible allusion to his concertizing as an adult, and possible implicit allusion to the protector/impresario, Sol Hurok]. In addition, I was unhappy at school, where we were made to absorb everything too mechanically [possible oral allusion], never putting our heart in our work. But I did succeed in learning Russian and German, which was spoken all around me. With my Polish [i.e., his native, or “mother,” tongue] it made three languages (emphases mine).”

Rubinstein’s discussion of his learning various foreign languages symbolically suggests identity diffusion. That the symbolic reference to identity diffusion occurs in the context of a discussion of Rubinstein’s survivor guilt seems important in view of Rubinstein’s earlier linking, at page 4 of the autobiography, of details concerning the spelling of his name in various languages and his difficulties with his wet nurse (survivor guilt and oral difficulties being parallel concerns).  See 1/

Also, the issue of “special protector” arises in both contexts.  On page 4, Rubinstein’s wet nurse (who simultaneously sustained and “infected” Rubinstein) and the impresario Sol Hurok (who ensured a livelihood for Rubinstein but who also “night after night made the pianist go through the same scene, which was very hard on Rubinstein’s nerves”] could both be interpreted as “protectors,” albeit ambivalently cathected ones. On page 11, the following individuals might be termed protectors: Rubinstein’s grandfather and God (omnipotent but capricious--like Rubinstein’s wet nurse). The possible symbolic reference to concertizing on page 11 (“Night after night I went through the same scene, which was very hard on my nerves”) may implicitly allude to the impresario/protector Sol Hurok.

That Rubinstein was a creative individual suggests the likelihood that his ego functioning was more synthetic than that of the patient described by Freud. Accordingly, one might expect the far greater likelihood that Rubinstein’s fantasies regarding a “special protector” would be responded to, through a process of alloplastic adaptation, by real protectors. Thus, while the private fantasies of Freud’s patient and the private fantasies of Arthur Rubinstein might be identical, the role of the environment (including the political conflicts that might ensue from the actions of, or interaction with, a real protector) is of far greater interest and importance in the case of Rubinstein.  Certainly, analysis of Rubinstein, unlike analysis of the patient described by Freud, would have to comprehend both defensive processes and adaptive processes (including the possible negative political consequences of adaptive processes. The significance of this distinction may be illustrated by the following question:  Did my termination from Akin Gump result exclusively from my reliance on defensive processes (oral dependency, for example) or did the termination represent the negative political consequences of my need for a protector--stemming from an oral disturbance (defensive process)--that was in fact responded to by real protectors though an adaptive (alloplastic) process? In other words, when dealing with a certain type of alloplastic adaptation, what appears to be the result of, or is termed, a defensive (pathological) process may actually be a negative political response to, or characterization of, an adaptive (creative) process.)

In conclusion, the Rubinstein materials, to the extent that they combine in one personality a number of seemingly unrelated psychological issues related to my own case, may provide a clearer understanding of the significance and relation of these issues in my personality. (Note that the Rubinstein autobiography raises other issues, including the Family Romance fantasy, equally material in my case, which I have not discussed in this communication.) A comparison of the Freud paper with the Rubinstein materials may further define the relevant issues in my case. (One might note incidentally that the Freud paper also discusses the resistance and the effects of an overweening superego among “those wrecked by success” and among "criminals from a sense of guilt”--all seemingly material issues for my case. That the Freud paper in itself combines a wealth of seemingly unrelated issues that come into play in my own personality raises intriguing questions about additional possible linkages in my case, such as that between my belief in a special protector (as discussed in Part I. of the Freud paper) and my need to thwart success in life (as discussed in Part II. Of the Freud paper). Although the Freud paper uses the issue of resistance as an organizing thesis and adduces case material concerning unrelated character-types to support that thesis, one cannot help notice the uncanny resemblance between my case and the three unrelated character-types. It is as if in writing the paper Freud was motivated by another organizing thesis that remained unstated and unconscious.)

Thank you very much.


Gary Freedman

1/  Of possible significance with regard to the issues of (1) identity formation and (2) the relation of identity formation, or identity diffusion, to fantasies of oral disturbance, Rubinstein discusses, in the immediately preceding paragraphs of his autobiography, his parents’ choice of the name “Arthur.” “And so Arthur I was called. In Polish it is spelled Artur. In later years my manager [and protector] Sol Hurok used the h-less ‘Artur’ for my publicity, but I sign ‘Arthur’ in countries where it is common practice. ‘Arturo’ in Spain and Italy, and ‘Artur’ in the Slav countries.”  Rubinstein's discussion of his name and its divergent spellings in various languages may relate symbolically to the psychological issue of identity diffusion. That his discussion of a putative identity diffusion is linked, by juxtaposition to the immediately following paragraph, to a symbolic discussion of depletion guilt is intriguing, and is made all the more so by his linking, at page 11 of the autobiography, of a discussion of an episode of survivor guilt with his acquisition of various foreign languages.

1 comment:

Gary Freedman said...

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