3801 Connecticut Avenue, NW
Washington, DC 20008
Suzanne M. Pitts, MD
GW Univ. Medical Center
2150 Pennsylvania Ave., NW
Washington, DC 20037
Dear Dr. Pitts:
I offer the following thought problem to direct your attention to a paradox concerning ideas of reference/paranoid ideation versus reality-oriented, problem solving cognition.
Let us say that a playwright has written a political satire concerning a fictional wife of a President of the United States, Mrs. Preferred (a.k.a. Mrs. Copay-Preferred). The play contains no express references to any actual persons. The play centers on a task force, headed by Mrs. Preferred, that is appraising various plans to provide comprehensive government sponsored reimbursement for psychic readings. (Mrs. Preferred: “The President wants to insure that every American, regardless of age or economic means, has equal access to psychic readings.” Reporter: “Mrs. Preferred, what about critics who say that your plan does not include coverage for the Friends Psychic Network?”
A production of the play is performed at the Kennedy Center. In attendance are President and Mrs. Clinton. Both the president and his wife assume that they are being parodied, and are offended. Most persons in the audience also assume that the play satirizes Mrs. Clinton and her health care task force.
Problem: Both (1) the President and Mrs. Clinton and (2) member of the audience draw the same inferences. As to the president and Mrs. Clinton we must conclude that their inferences are paranoid ideas of reference since the play does not include any express references to them. Yet, paradoxically, members of the audience who draw the same inference would be called perceptive. Since, as you have emphasized, (a) ideas of reference and (b) inferences based on problem solving are not mutually exclusive it is possible that Mr. and Mrs. Clintons' inferences that it is they who are being parodied is the result of both paranoia and logical problem solving skills. In such a case, to administer a neuoleptic to Mr. and Mrs. Clinton might remove inferences derived from psychotic thought processes, but will leave the very same inferences derived from logical processes intact. Thus, even after successful treatment with a neuoleptic (assuming that in such a case one could determine the effects of the neuoleptic), Mr. and Mrs. Clinton will still maintain that they were being parodied--but the belief will be based exclusively on realty-oriented, problem solving cognition rather than on a paranoid process (which itself poses a problem in logic or semantics since any unsubstantiated inference that a reference relates to the self is by definition an idea of reference).
On a related issue, let us say that the playwright, when confronted, will not admit that he was parodying Mr. and Mrs. Clinton. Thus, we can never determine whether the inferences by Mr. and Mrs. Clinton and other members of the audience is correct. However, the number of pattern matches between the content of the play and the actual, real life actions of Mr. and Mrs. Clinton is such that one may logically infer that Mr. and Mrs. Clinton were being parodied. Thus, the issue is not the correspondence of the inferences that establishes the mental state of the Clintons, but rather the thought process they employed to arrive at the inference.
(Compare Hamlet, “The Mouse Trap:" Hamlet’s parody of the murder of a fictional king, performed before Hamlet’s stepfather, Claudius. Claudius’ rage upon viewing the play is attributable to an idea of reference--his assumption that it was he, Claudius, who was being parodied).
How would you resolve this paradox? I would maintain that any psychiatrist who cannot resolve this paradox should not be prescribing neuoleptic.