Wednesday, February 29, 2012

GW Psychiatric Treatment: Letter 10/30/95

October 30, 1995 (rev'd 7/30/95)
3801 Connecticut Ave., NW 
#136
Washington, DC 20008-4530

D. Georgopoulos, M.D.
GW Med. Ctr.
Washington, DC 20037

Dear Dr. Georgopoulos:

This letter comments on the consultations on October 25, 1995 and October 27, 1995.

[Monday October 23, 1995 the patient forwards to the U.S. Department of Justice a computer disc that contains the texts of letters, dated May 5, 1995 to October 23, 1995, the patient had previously submitted to the psychiatrist.]

Consultation Wednesday October 25, 1995:

PATIENT'S REPORT:

I want to comment on the letter I sent to the FBI last October: the letter the FBI later forwarded to the U.S. Secret Service. I had previously mentioned that the incident—my meeting the Secret Service Agent—seemed uncanny to me.

BACKGROUND FACTS:

At a prior consultation, in February 1995, the patient had told the psychiatrist that his two meetings with a Secret Service agent had a quality of uncanniness: that the interaction seemed to involve the unfolding of certain events over which the patient had no control, but nonetheless helped shape an outcome that was peculiarly consistent with his pre-existing fantasies. The patient stated, concerning his meeting with the agent at a coffee shop in early February 1995, that the interaction recalled for the patient a brief creative piece the patient handwritten in July 1987; the creative piece concerned a man suspected of having Communist sympathies who sought to become an FBI agent and who had attempted to ingratiate himself socially with FBI agents. The patient obliquely alluded to the fact that the agent's request, in December 1994, that the patient provide to the U.S. Secret Service copies of the patient's previously written dream interpretations struck the patient as uncannily similar to the story of the biblical Joseph.

In that tale Joseph's skill as a dream interpreter came to the attention of Pharaoh seemingly by chance after Joseph, imprisoned on the false accusation of sexual impropriety made by Potiphar's wife, interprets the dreams of fellow prisoners who happen to be Pharaoh's servants. The biblical chronicler sees a divine plan at work: “Potiphar's wife had to tempt Joseph so that he would resist and be imprisoned [upon her false accusations]; the servants of Pharaoh had to be placed in prison with Joseph, so that he could interpret their dreams and rise to prominence as Pharaoh's interpreter.  Dreams and the recognition of their disguised meanings are critically linked to power and future possibilities.” Frieden, K. Freud's Dream of Interpretation, at 53 (Albany: State University of New York Press, 1990).

Oddly enough, there are parallels between, on the one hand, the biblical tale of Joseph's encounter with Pharaoh's servants upon his imprisonment on sexually-motivated false accusations, and, on the other, the patient's encounter with a Secret Service agent, a protector of the President. And while divine intervention as a mediating factor may be discounted in the case of the patient, the relevance of the repetition compulsion (with both active and passive aspects) seems plausible.

The patient had originally been assigned to work at the law firm of Akin, Gump, Strauss, Hauer & Feld by a temporary agency in early March 1988. The patient had not sought employment at Akin Gump, and, in fact, had been involuntarily terminated by his previous employer. Cf. Note 2, below. The patient was terminated by Akin Gump in late October 1991 following false accusations made by a female supervisor, who later told employees she feared the patient might return with a gun to kill her! 1/

During the subsequent period of unemployment the patient began, in January 1992, to prepare written analyses of his dreams. In late December 1992 the patient was apprised for the first time, in legal documents filed by Akin Gump in the patient's wrongful termination action, of certain false accusations made against him by the supervisor and others. And in early July 1993 the patient learned for the first time, in a conversations with a former coworker, that the supervisor had stated to employees, a brief time after the patient's termination, that the patient might be armed and homicidal.

By way of a letter dated October 8, 1994 to the FBI the patient detailed the supervisor's false accusations about the patient's supposed homicidal tendencies and listed certain of the patient's dream interpretations that mentioned President Clinton. In mid-December 1994 the U.S. Secret Service, which had been alerted by the FBI of the patient's letter, requested a meeting with the patient to resolve concerns that the patient might pose a risk of danger to the President. The U.S. Secret Service requested the patient to supply copies of the dream interpretations the patient had previously prepared, which the patient had mentioned in the letter to the FBI dated October 8, 1994. Thus, the patient's dreams found their way, following a series of fortuitous circumstances and active steps taken by the patient, to the U.S. Secret Service—the agency designated to protect the President of the United States.

The psychiatrist refused, at the consultation in February 1995, to acknowledge the possibility that passive elements hay have led to the patient's meeting with the U.S. Secret Service—a meeting that struck the patient as uncanny—and asserted, instead, that the meeting was the sole product of active steps taken by the patient. In effect the psychiatrist denied that the patents meeting with the U.S. Secret Service was determined in part by a passive repetition compulsion. 2/

PATIENT'S REPORT (CONT'D):

When I mentioned to you months ago that I thought the encounter with the U.S. Secret Service was uncanny you said that the whole thing had been under my control—that I had brought about the meeting myself by sending a letter to the FBI. But I don't think so. I think there were strong elements of uncanniness in the meeting.

I thought of a metaphor that describes the mixture of active and passive elements in the experience. Let's say you're in the woods, that there's a river, and you want to cross the river. That's what you have in mind--that you actively want to cross the river. But let's say there's no way you can get to the other side. There's a rapids there, and it would be too dangerous to swim or wade across the rover. Then, all of a sudden, a giant tree falls and forms a natural bridge. You then cross the river by using the fallen tree as a bridge. In my mind, that metaphor encapsulates my experiences. The metaphor brings together both the active and passive elements of my experiences. There's an opportunistic element to my personality that gets overlooked in your simplistic interpretation. Yes, I wanted to cross the river and I did cross the rover, but originally there was no means to cross the river. Then, all of a sudden, something happens in the environment, something over which I had no active control, and I take advantage of the circumstances to further my pre-existing aims.  I wrote the letter to the FBI yes, but I didn't create the circumstances that led my supervisor to accuse me of being armed and homicidal.   And as for the dreams, I had begun to prepare written dream interpretations years before I ever wrote to the FBI or before I even knew of my supervisor's accusation that I might be armed and homicidal. I made opportunistic use of my supervisor's accusations. Your simplistic interpretation—that I made it all happen--overlooks the way I make use of my environment, the subtle interaction between my personality needs and other people in the environment.

PSYCHIATRIST'S RESPONSE:

The psychiatrist says absolutely nothing at the consultation other than to make a brief comment at the beginning of the hour relating to patient billing.

Consultation Friday October 27, 1995


PATIENT'S REPORT:

I had some additional comments to what I discussed at our last meeting. Last hour I compared my experiences with a person in a forest who wants to cross a rover, but there's no way he can get across. I said—imagine that a giant tree falls and forms a natural bridge that allows the person to cross to the other side. There's something I want to add to that. The metaphor leaves out an important element relating to my interpersonal experiences. Because in interpersonal relations we're not dealing with trees, we're dealing with people. In the metaphor, the tree is a passive facilitator. Whether the tree falls or not is outside the person's control. But in my interpersonal experiences, it's as if I am the one who makes the tree fall just by walking into the woods. 3/

[The psychiatrist winces at this statement.]

I really believe that I have this effect on people, that people react defensively to me when I interact with them, and that defensive reaction is analogous to the tree falling in the woods. I then make opportunistic use of that defensive reaction. When I say opportunistic, I don't necessarily mean for any salutary purpose. I may also use other persons' defensive reactions to serve my ego's regressive needs [to advance the repetition compulsion].

Just as the man in the metaphor made use of the fallen tree to advance his pre-existing goal, I made use of my supervisor's defensive reaction to me (her accusation that I might be armed and homicidal) to contact the FBI [which ultimately led to my meeting with the U.S. Secret Service].

I was thinking that there's a biological analogy to this. Its not something that actually happens, to the best of my knowledge, but maybe it could happen. Imagine a situation in which a virus was able to make adaptive use of a host's immune reaction. Imagine a situation in which an invading virus could translate the chemical structure of the host's antibodies for use in viral replication. Now that's a frightening thing if it could really happen. But that's essentially what I am saying. That I am able to take a person's defensive reaction to me and make adaptive use of it.

PSYCHIATRIST'S INTERPRETATION:

People are not actually reacting to you. They have their own issues, their own personalities. They may say certain things about you, but they are not reacting to you. It has nothing to do with you.

[A few months earlier the patient had asked whether the psychiatrist was familiar with any literature concerning persons who arouse a paranoid, or defensive, reaction in others. The psychiatrist stated that he had read accounts of such persons, and, at the patient's request, said that he would provide the patient with citations to the literature—a promise yet to be fulfilled. The psychiatrist's statement at the current session “People are not actually reacting to you—it has nothing to do with you” is strikingly inconsistent with the psychiatrist's previous assertion that he had read of persons who arouse a defensive reaction others, an inconsistency that contributed to the patient's rage later in the hour.]

PATIENT'S RESPONSE:

In certain sense you're right. I mean, let's look at the immunology metaphor. The host has its own genetic make-up. Its response to a virus is based on its own genetically-determined immune response But that response is elicited by the virus. There's really two things going on simultaneously, the host's own internal capacities are there, yes. But also when the virus invades, it is the virus that triggers that response. So, actually the host is responding to the virus, despite the fact that the way it responds is pre-determined according to the host's own internal make-up.

[Further colloquy between the patient and psychiatrist concerning this issue leads to the patient becoming enraged.]

PATIENT [enraged, but maintaining his coherence and logic]:

What do you mean peoples' reactions to me have nothing to do with me? You mean a person can say, “We're all afraid of you, we're all afraid you're going to bring in a gun and shoot everybody” and that has nothing to do with me? And that that can happen not once, but with two different people making the same accusation, and that has nothing to do with me? 4/ When Hitler sticks six million Jews in an oven, who is he reacting to—the Eskimos in Alaska? If I were to say to you “I'm afraid you're going to bring in a gun and shoot everybody,” who am I reacting to—Dr. Wiener? (But cf. Letter to Dr. Pitts, dated June 4, 1993.)

INTERPRETATION:

The psychiatrist's comment that other person's behavior or statements, even when manifestly concerning or directed at the patient, are not related to the patient highlights once again the psychiatrist's inability to focus on the issue of mutuality in the patient's interpersonal difficulties and the Oedipally-charged nature of the patient's interpersonal conflicts.

The particular formulation employed by the psychiatrist at the current session to deny interpersonal mutuality, namely that other persons' behavior or statements have nothing to do with the patient, is a novel one for this psychiatrist, however. What is intriguing about the formulation is that the particular psychological context in which it does apply seems to serve as an identifier, a certificate of origin, as it were, of the very unconscious prohibitions that render the psychiatrist incapable of confronting issues relating to peer jealousy, fear and retaliatory aggression.

The psychiatrist's statement “Other peoples' reactions to you have nothing to do with you” carries an ironic ambiguity in that the statement may be interpreted to identify the cause of the psychiatrist's denial (or negation 5/) of aggression and, in addition, simultaneously affirm the Oedipally-charged nature of the patient's interpersonal difficulties with attendant peer reactions of jealousy and fear.

The small boy in the throes of the Oedipal struggle fears and envies the father whom he wishes to displace. Paradoxically, one might appropriately say, however, that the child's struggle over issues of fear and jealousy in relation to the father has nothing to do with the person of the father; in the child's Oedipal struggle, the father is a more-or-less mythological person who is absolutely fantasied. The child's struggle relates solely to the father's relationship with the mother, and is a product of the child's maturational stage.

The psychiatrist's statement to the patient “Other peoples' reactions to you have nothing to do with you” serves, as Nietzsche might say, as “the personal confession of its author and a kind of involuntary and unconscious memoir.” As a personal confession the statement reveals the nature of the psychiatrist's own Oedipal struggle and the relation of that struggle to the psychiatrist's apparent need to isolate or deny aggression and placate potential attackers.  It is as if the psychiatrist were saying to his own father: “My behavior, which seems to signify my rejection of you and which places me at risk of castration, has nothing to do with you. Do not punish me for my transgressions.” 6/

The particular character of the psychiatrist's Oedipal struggle carries important implications in regard to his work with a patient whose interpersonal conflicts are Oedipally-charged. 7/ The psychiatrist's defensive interpretations impair the therapy yet an analysis of those very defensive interpretations provides valuable insight into the nature of the patient's interpersonal relations generally. In his relations with the psychiatrist the patient re-experiences all his past toxic relationships in vivo via the counter-transference.

Sullivan recognizes and describes triadic (Oedipally-charged) interpersonal relations in which peer jealousy of a fantasied individual has nothing to do with the individual himself, but everything to do with the fantasied individual's relations. Sullivan H.S. The Interpersonal Theory of Psychiatry, at 348 (New York: W.W. Norton, 1953).
Jealousy, [unlike envy], never concerns a two-group situation. [Somewhat as in the Oedipal triad or, even more remotely, as in the biblical tale of Joseph and his brothers it] is invariably a very complex, painful process involving a group of three or more persons, one or more of whom may be absolutely fantasied. Jealousy is much more poignant and devastating than envy; in contrast with envy, it does not concern itself with an attribute or an attachment, but, rather, involves a great complex field of interpersonal relations. While data are hard to get, apparently jealousy occurs frequently in adolescence, and frequently with real or fancied lustful involvement with someone else. In such cases, the jealous person has a deep conviction of his own inadequacy and unworthiness in participation in lustful involvement, along with the conviction that his partner and the third person could do much better.

Jealousy in malevolent situations often assumes delusional proportions, in which the person tends more less insidiously to become inaccessible to remedial experience by being secretive, and, later, by supplementary processes which make any factual data ineffective. Jealousy becomes properly termed paranoid when the sufferer “sees” that the second person in the threesome--the link--is doing things to make him jealous out of pure malice. Id.
In his psychoanalytic study of anti-Semitism Grunberger sees in the anti-semite's image of, and reaction to, the Jew a re-enactment of the Oedipal struggle with the father. In a certain sense, applying Grunberger, one might say that anti-semitism has nothing to do with the Jew 8/; the antisemite has his own issues, his own personality.
We have seen that the role played by the Jew in the anti-Semite's unconscious is a superego figure, a powerful father imago, and in a certain measure an identification project, especially since it is given at the same time, owing to the projection, a powerful anal sexuality. In other respects it is the decisive factor that the Jew, according to the anti-Semite's criteria . . . is an absolutely castrated being whom we may therefore attack without danger and without guilt. In the Jew we find combined the two contradictory characteristics which cannot anywhere else be found associated in such a way.

The father is both all-powerful and castrated, thus being, as Sartre said of a Jewish minister of State, 'at the same time His Excellency and an untouchable'. Grunberger, B. “The Anti-Semite and the Oedipal Conflict.” Intl. J. Psychoanalysis 45: 380-385, 384 (1964).
Sincerely,

Gary Freedman
________________________________

1/ Rumors and accusations that the patient was potentially violent or homicidal arose at various times during the patient's tenure at Akin Gump. That these rumors of a dangerous aggressiveness coexisted with rumors that the patient was homosexual indicates the Oedipally-charged (and possibly antisemitic) character of the patient's interpersonal difficulties, in which peer jealousy appears to have payed a prominent role. Cf. Spitzer, R. L. et al. DSM-III-R Diagnostic and Statistical Manual of Mental Disorders (Revised Edition) Case Book, at 197-198 (American Psychiatric Press: 1989) (case report titled “False Rumors”). The antisemite typically depicts the Jew inconsistently as a dangerous aggressor or weak and hypersensitive castrate. Grunberger, B. “The Anti-Semite and the Oedipal Conflict.” Intl. J. Psychoanalysis 45:380-385; 381, 384 (1964). “Paradoxes and contradictions have characterized anti-Semitic portrayals. Opposing traits clashing within the Jew, such as unbridled power vs. terrible cowardice, have underscored his alleged lack of humanity.” Encyclopedia of Jewish History: Events and Eras of the Jewish People at 119, Joseph Alpher, ed. (New York: Facts on File Publications). Curiously, the anti-Semite's conflicted depiction of the Jew parallels “contradictions to be found in the Bible in the characterization of Moses. He is often enough described as masterful, hot-tempered, even violent, and yet it is also said of him that he was the most patient and 'meek' of all men.” Freud, S. Moses and Monotheism at 49 (1939; reprint New York: Vintage Books, 1967). The parallel supports the inference that in either case—the anti-Semite's depiction of the Jew and the ancient Hebrews' depiction of the founder of their religion—we are dealing with a powerful father imago.

2/ See Freud, S. (1919) “The 'Uncanny'.” Standard Edition, 17:219-256 (London: Hogarth Press, 1955) (“whatever reminds us of the . . . inner 'compulsion to repeat' is perceived as uncanny”); See also Freud, S. (1920) Beyond the Pleasure Principle, 16 (New York: W.W. Norton, 1961) (discussing “cases where the subject appears to have a passive experience, over which he has no influence, but in which he meets with a repetition of the same fatality”). One might wish to speculate as to a possible insidious relationship, or symmetry, between the psychiatrist's denial of the applicability of the repetition compulsion in the stated fact pattern—a fact pattern that involves arguably anti-Semitic elements—and the psychiatrist's conviction that other persons' toxic reactions to the patient have nothing to do with him, a conviction that denies antisemitic animus.

Of possible relevance to this issue is Theodor Reik's application of the concept of the repetition compulsion to explain a recurring pattern in Jewish history, from antiquity to the present, concerning Jews' relations with the host population. “What is that repetitive core? In simplest terms it is the following: The Jews migrates into a new country (Egypt, Palestine, Greece, Germany), sometimes as welcome guests, where in a short time they become prominent in science, medicine, literature, commerce and finance. Some acquire high social position. The envy of the host people is then awakened and increases to hostility. A secret storm starts brewing. Often an insignificant incident has a triggering effect and unleashes the storm. There are accusations against the foreigners, and finally outbreaks of violence, riots pogroms and massacres. The end is always the same. The Jews are either exterminated or are forced to leave the country. . . The impression we get is that of a Schiksalsneurose (neurosis of destiny) of a whole group or nation[.]” Reik. T. Curiosities of the Self, at 140-141 (New York: Farrar, Straus & Giroux, 1965).

3/ Cf. Rose, G. “Creative Imagination in Terms of Ego 'Core' and Boundaries.” Intl. J. Psychoanalysis 45: 75-84 (1964).

4/ Cf. Prager, D., Telushkin, J. Why the Jews?, at 21 (New York: Simon & Schuster, 1983): “Nearly every study of antisemitism consists almost solely of historical narrative, thus seeming to indicate that no universal reason for antisemitism exists.  We reject this approach. To ignore or deny that there is an ultimate cause for antisemitism contradicts both common sense and history. Antisemitism has existed too long, and in too many disparate cultures, to ignore the problem of ultimate cause and/or to claim that new or indigenous factors are responsible every time it erupts. . . . The very consistency of the passions Jews have aroused demands a consistent explanation" (emphasis added).

5/ Freud pointed out that the process of saying that something was not so could be an effective means of sidestepping repression without overcoming it. Freud, S. (1925) “Negation.” Standard Edition, 19: 235-242 (London: Hogarth Press, 1961). “Negation is a way of taking account of what is repressed; indeed, it is actually a removal of the repression, though not, of course, an acceptance of what is repressed. It is to be seen how the intellectual function is here distinct from the affective process. Negation only assists in undoing one of the consequences of repression—namely, the fact that the subject matter of the image in question is unable to enter consciousness. The result is a kind of intellectual acceptance of what is repressed, though in all essentials the repression persists.” Id.

6/ Cf. Letter to Dr. Georgopoulos, dated September 6, 1995: “The psychiatrist's fundamental existential concern may be expressed in the following metaphoric formula, which encapsulates his anxieties with respect to questioning authority, defying the social system, and his fears of consequent social isolation. 4/ Like a priest rebuking a blasphemer, it is as if the psychiatrist were saying to the patient week after week, by means of psychiatric rationalizations:

It is because you question the community of Christ that you are cut off and isolated from the community of Christ, which provides succor and comfort to those who, like myself, do not question. This is why you suffer eternal torment in the form of loneliness, isolation and hopelessness. You question the community, therefore you suffer.”

7/ Presumably, the Oedipally-charged nature of the patient's interpersonal relations is related to an important aspect of the patient's own Oedipal struggle: his apparent need for fusion with an all-powerful father representative, or omnipotent protector, such as symbolized by the President of the United States.

8/ According to Grunberger, the Jewish concept of God as a superego figure—a pure father representative—makes the Jew a particularly suitable and susceptible object for the abreaction of the anti-semite's Oedipal conflict. See Grunberger at 382-3.

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