Thursday, July 29, 2010

Letters to Sister -- 1992

In the year 1992 I sent several letters per week to my sister, apprising her of ongoing issues concerning my job termination by Akin Gump in October 1991 and other matters.  I forwarded most of the letters to the U.S. Social Security Administration in June 1993 in support of my disability claim.  There were a few additional letters that I did not forward to Social Security because I had misplaced them and was not aware of their existence.  This is one of those letters.

I wrote the following letter in about September 1992 after I learned that I had been diagnosed with bipolar disorder by Napoleon Cuenco, M.D. at the George Washington University Medical Center.  I disagreed with the diagnosis at that time.

It was not until late December 1992 that I received in the mail a copy of Akin Gump's Response to Interrogatories and Document Request (dated May 22, 1992) in which the firm alleged that it had determined, in consultation with a psychiatrist, that I suffered from a severe psychiatric disorder that rendered me unfit for employment.

Note that the following document is adverse to my Social Security Disability claim, which I filed in April 1993.

transmittal for Mrs. Estelle Jacobson c/o Mr. Edward Jacobson

Dear Stell,

I don't mean to sound like a smart ass, and I appreciate how physicians feel about patients diagnosing their own illnesses, but I gravitate toward 309.90 (a residual category for disturbances that are not severe enough to meet the criteria for 309.89).  309.90 seems to comprehend in the broadest way my personality problems.

I choose 309.90 for the following reasons.

Dr. Spitzer states that 309.90 comprehends survivor guilt and, by implication, all that survivor guilt entails including anhedonia and disturbances of identity (and certain abnormal biological functioning: sympathetic nervous system functioning and possibly the neurochemical changes discovered by Dr. Charney at Yale) in an otherwise mature ego.  Since my symptoms are not currently sufficiently severe to warrant a diagnosis of 309.89, I would fall back to the more general 309.90.

With regard to 309.89, the following important factors should be noted, however.  There is exaggerated startle response, in my teens and early 20's I suffered from sleep disturbance (early morning awakening and screaming awakening), outbursts of anger that are more consistent with traumatization than narcissistic rage.  Note also Dr. Alikakos' prescription of an autonomic and the evaluation by Dr. Amsterdam at HOP that found anxiety and not depression to be a predominant symptom.

Also the depression I experience may be an exaggerated mourning reaction to the psychological loss of my mother in early adolescence, which itself is fully consistent with a diagnosis of 309.90 (Dr. Alikakos noted the presence of unresolved mourning in my personality); also significant is the numbing of emotional response to my mother's actual death  Note also the coincident emergence in early adolescence of (1) depression (increased social isolation, marked weight gain, suicidal thoughts) and (2) autonomic symptoms such as profuse sweating and outbursts of anger.  (I'm just a layman, but it seems to me that the coincident emergence of depression and autonomic symptoms is significant and, from a diagnostic point of view, telling).  But what do I know:  See the case designated "Nighttime Visitor" in DSM-III-R Case Book by Spitzer, R.L., et al. (American Psychiatric Press: 1989), at 342 (Dr. Palombo on a number of occasions remarked on the significance of "lack of protection by mother" in my case).


Diagnostic Code 309.90 is Adjustment Disorder Not Otherwise Specified

Diagnostic Code 309.89 is Post-Traumatic Stress Disorder  (It's interesting that PTSD is a recognized consequence of workplace mobbing.  But that diagnosis would have subjected my former employer Akin Gump to possible legal exposure.)

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