Wednesday, December 22, 2010

GW Psychiatric Assessment 1992: That's What She Said!

In September 1992 I underwent a psychiatric assessment at the George Washington University Medical Center. The assessment was performed by a third-year psychiatry resident  named Napoleon Cuenco, M.D.  Dr. Cuenco diagnosed me with bipolar disorder with the mood congruent psychotic features of pressured, rapid speech; loose associations; and flight of ideas.

First off, the diagnosis itself was incorrect.  I did not then, nor have I ever suffered from bi-polar disorder.  The seeming presence of the above psychotic features may have resulted from a mislabeling by Dr. Cuenco of characteristics of creative persons, which might include verbal fluency, a capacity for remote associations, and the ability to extend effort in idea production.  See Guilford, J.P. The Nature of Intelligence (New York: McGraw-Hill, 1967); Mednick, S.A. "The Associative Basis of the Creative Process." Psychological Review 69: 220-232 (1962); Parnes, S.J. "Research on Developing Creative Behavior." In: Widening Horizons in Creativity. Edited by C.W. Taylor. (New York: John Wiley & Sons, 1964).

In addition, many  factual assertions contained in the assessment chart are gross distortions.

I suspect if you were to ask Dr. Cuenco how he could have come up with such a distorted view of me he would respond: "I simply wrote what Mr. Freedman told me.  I recorded and summarized Mr. Freedman's own statements."  Well, oddly enough, that's what she said!

The she in this case is the journalist Janet Malcolm.

Janet Malcolm is an author and a contributor to The New Yorker, a weekly magazine. She contacted the psychoanalyst Jeffrey Masson in 1982 regarding the possibility of an article on his relationship with the Sigmund Freud Archives -- and with Archives Directors Kurt Eissler, M.D. and Anna Freud. Masson agreed, and Jeffrey Masson and Janet Malcolm met in person and spoke by telephone in a series of interviews. Based on the interviews and other sources, Malcolm wrote a lengthy article. One of Malcolm's narrative devices consists of enclosing lengthy passages in quotation marks, reporting statements of Masson, Eissler, and her other subjects.

During the editorial process, Nancy Franklin, a member of the fact-checking department at The New Yorker, called Masson to confirm some of the facts underlying the article. According to Masson, he expressed alarm at the number of errors in the few passages Franklin discussed with him. Masson contends that he asked permission to review those portions of the article which attributed quotations or information to him, but was brushed off with a never-fulfilled promise to "get back to [him]."

The New Yorker published Malcolm's piece in December 1983, as a two-part series. In 1984, with knowledge of at least Masson's general allegation that the article contained defamatory material, the publisher Alfred A. Knopf, Inc., published the entire work as a book, entitled In the Freud Archives.

Malcolm's work received complimentary reviews. But this gave little joy to Masson, for the book portrays him in a most unflattering light. According to one reviewer, the psychiatrist Robert Coles, M.D. (who was a personal friend of Anna Freud's, by the way),

"Masson the promising psychoanalytic scholar emerges gradually, as a grandiose egotist -- mean-spirited, self-serving, full of braggadocio, impossibly arrogant and, in the end, a self-destructive fool. But it is not Janet Malcolm who calls him such: his own words reveal this psychological profile -- a self-portrait offered to us through the efforts of an observer and listener who is, surely, as wise as any in the psychoanalytic profession."

Jeffrey Masson wrote a letter to the New York Times Book Review calling the book "distorted." In response, Malcolm stated:

"Many of [the] things Mr. Masson told me (on tape) were discreditable to him, and I felt it best not to include them. Everything I do quote Mr. Masson as saying was said by him, almost word for word. (The 'almost' refers to changes made for the sake of correct syntax.) I would be glad to play the tapes of my conversation with Mr. Masson to the editors of The Book Review whenever they have 40 or 50 short hours to spare."  In effect, she said "I simply wrote what he told me."

Eventually, Jeffrey Masson sued Janet Malcolm and The New Yorker for defamation and the rest is history: a seemingly interminable exercise in litigatory warped passages styled Masson v. New Yorker Magazine, Inc. that ultimately wound its tortuous path to the U.S. Supreme Court, 501 U.S. 496 (1991).

Be that as it may.

The narrative summary of the statements of a person who is interviewed will always evidence the distortions of the interviewer.  First, the interviewer can control the content of what the interviewee says by the questions he chooses to ask.  I suppose there is no better example than what happens in the courtroom.  A witness examined by Attorney "A"  will tell one tale, while Attorney "B" on cross-examination of the same witness may extract a radically different version of events.  The interviewer can elicit -- by choice of questions asked -- what he likes from the interviewee.

Second, the interviewer can filter what the interviewee says.  The interviewer can pick and choose his subject's words and statements; in the end, only a fragment of what the subject actually says in the interview will make its way to a narrative summary.  I had a law professor named Claudio Grossman, now Dean of the School of Law at American University.  He used to say, "What you say is true, but it is not the truth."  That is an apt description of what happens when an interviewer filters his subject's statements to create an overall impression that does not match the gist of the subject's responses.

Third, in a psychiatric assessment, the psychiatrist can ask leading questions.  A good example of leading by Dr. Cuenco is the following.  Dr. Cuenco asked me, "Do you have racing thoughts?"  I said, "What are racing thoughts?"  He said, "Do you think of a lot of ideas at once."  I said, "yes."  He concluded I had racing thoughts, which is symptomatic of mania.  You will note that researchers in creativity maintain that a creative person can hold many ideas in his mind at once (a sign of ego strength, not ego weakness), which accounts for his ability to make a richer synthesis of ideas.  An example of creative thinking that allows a person to hold several ideas in his mind at once is "homospatial thinking," a term coined by Albert Rothenberg, M.D.

Did Dr. Cuenco simply write what I told him?  The answer is a qualified yes.  The question is -- what is it that he didn't ask?  What is it that he didn't elicit?  Also, what did I tell him that he didn't include in the written assessment?

You will also note that The Caliban Complex, a self-analysis I wrote without the intervention of an interviewer, presents a totally different picture of me than Dr. Cuenco's assessment chart.  I had provided a copy of that writing to Dr. Cuenco who acknowledged that he had read it.  GW's assessment chart states that my insight was poor, a conclusion that allowed Dr. Cuenco to ignore my self-report and substitute his faulty clinical observations.

1 comment:

Gary Freedman said...

Readers of biography will know that biographers relying on the same primary source materials can present a different portrait of a subject. Different biographers come to different conclusions.

Psychiatry needs to recruit more people with a background in the humanities.