GW Psychiatric Treatment: Letter 7/26/95

July 26, 1995

3801 Connecticut Ave., NW

#136

Washington, DC 20008-4530

D. Georgopoulos, M.D.
Dept. Psychiatry
GW Univ. Med. Ctr.
Washington, DC  20037

The following observations relate to comments and interpretations you offered at my consultation on July 24, 1995.

PSYCHIATRIST'S COMMENTS:

You mentioned in the past that at a previous place of employment there were two levels. That you got on well with your co-workers on a professional level, but that you were not included in social events.

ASSESSMENT:

These comments are a gross distortion of facts. Cf. Letter to Dr. Georgopoulos, dated July 17, 1995. In a previous session the patient had reported to the psychiatrist that at the law firm of Hogan & Hartson the patient had gotten on well with hos co-workers at a social level and was routinely invited to attend and did attend social functions but that his professional relations were very poor. The patient had explained that on one occasion fellow employees had acted so aggressively 1/ toward him at a staff meeting that both his supervisor (Sheryl Ferguson) and an attorney (Maree Sneed) felt a need to apologize to the patient.

There is an obvious relationship between the psychiatrist's gross factual distortion and the psychiatrist's comment from a prior session: “You want to be liked by everybody, you want to be a member of the in-group.” It would appear that the psychiatrist has a need to see the patient as lonely and isolated even when such an evaluation is not supported by the facts, and will proceed to alter the facts to suit this defensive need. The psychiatrist's statement, “You want to be liked by everybody, you want to be a member of the in-group” is an expression of the psychiatrist's fear of social isolation, projected onto the patient. The psychiatrist's projective fantasy that the patient wants to be a member of the "in-group” heightens the abreactive gratification of his parapraxis (false recollection) that the patient suffered social exclusion by peers; in other words, the psychiatrist derives pleasure out of imagining the patient's social needs being thwarted.

I suspect that the psychiatrists's fantasies and associated false recollections represent a wish fulfillment, and are the ideational predicate of shunning behaviors seen among group members who derive an abreactive  satisfaction by keeping an outsider in an isolated state. The psychiatrist's fantasies and false recollections relating to the patient's social isolation may have their origin in anality, as indicated by the following observations: “The anti-Semite is a regressed anal character, and for such characters only the organic insertion within an organized social system gives narcissistic importance to the individual and only this form of narcissistic integrity is capable of giving him a phallus. The Jew, lonely wanderer, castrated and miserable, is such as the anti-Semite would like to see his father, and is in a state in which he seeks to maintain the Jew.” Grunberger, B. “The Anti-Semite and the Oedipal Conflict.” Int'l J. Psychoanalysis (1964): 380-385, 384.

PATIENT'S REPORT:

I believe that I arouse a paranoid reaction in people, and that this is a recurring and important aspect of my interpersonal difficulties.

PSYCHIATRIST'S COMMENTS:

I am wondering whether your belief that you arouse paranoia in people is a result of a problem with people disagreeing with you. Maybe when people disagree with you, you feel that people are being paranoid.

ASSESSMENT:

When one reads this as a projection, we have an interesting insight: the psychiatrist will tend to recommend a neuroleptic to change the patient's ideation as a defense against the psychiatrist's anxiety state resulting from the patient's failure to agree with the therapist.

Such an interpretation is consistent with a body of evidence that the patient's unusual idea production arouses anxiety in the psychiatrist. See Letter to Dr. Georgopoulos, dated June 1, 1995. Cf. Letter to Dr. Georgopoulos, dated July 17, 1995 (discussing case study titled “Crimes against the State” in which a non-paranoid man in the Soviet Union was administered neuroleptics against his will after the authorities had discovered a book the man had written that was critical of the Soviet dictatorship: the authorities had found the man's ideas threatening to the Soviet social system.)

PATIENT'S REPORT:

Two employees at my previous place of employment said they were afraid that I would bring in a gun and shoot everybody.

PSYCHIATRIST'S COMMENTS:

You seem to have a problem with people thinking you are angry when you are not.

ASSESSMENT:

Observe how the psychiatrist transforms irrational fear of the patient, along with the accompanying implication of peers' retaliatory aggression, into a simple case of mistaken identity, thereby denuding peers of any aggressive drive or malice. 2/   The formulation “people are irrationally terrified of you and want to aggress on you” becomes ”people think you are angry when, in fact, you're not.” Using the psychiatrist's formulation, the Oedipally-charged character of the patient's interpersonal difficulties, and attendant peer reactions of jealousy and rumors of homosexuality, is obscured. See Spitzer, R.L. 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”).

Note also the double standard. Disturbing examples of paranoia in other persons that result in the patient losing his job and being certified by a government agency as severely disturbed, potentially violent and unemployable are casually dismissed as others' innocent and simple mistaken beliefs. The remarkable fact is that the patient, in the psychiatrist's valuation, never has any simple mistaken beliefs: all of his unsubstantiated ideas are examples of paranoia—severe psychopathology that must be removed with medication.

This is a dynamic typical in racial bigotry. A black customer is paranoid when he complains that a store clerk watches him while he shops. A white store owner makes a simple, innocent mistake when he wrongly accuses the black customer of theft.
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1/  It is significant that in the psychiatrist's reconstruction of events aggression directed at the patient by peers is denied, while the patient is depicted as isolated and lonely and, presumably, desirous of inclusion, or insertion, in the "in-group."  This confabulation is central to an understanding of the psychiatrist, and underlies many of his interpretations.  Once again, one is reminded of the defense attorney who denies the rapist's aggression, yet depicts the rape victim as the perpetrator lusting for penetration.  See Letter to Dr. Georgopoulos, dated July 17, 1995.

2/  There is an obvious symmetry between, on the one hand, the action of the small child who seeks to transiently project blame for wrongdoing onto an imaginary companion, sibling, or toy--thereby projecting his own aggression and liability for punishment onto a scapegoat--and, on the other, the action of the adult who routinely and inappropriately denies the aggression of third parties.  One suspects that the psychiatrist's interpretations are driven by a subtle ego boundary disturbance that involves the psychiatrist's absolute identification with or need to merge with an organized social system (i.e., "the in-group," perceived as the good object), which gives narcissistic importance to him and confers a narcissistic integrity capable of giving him a phallus.  As a consequence, any threat to the psychiatrist's social value system will arouse castration anxiety ("Everybody has to agree with me, nobody can disagree with me!") and will need to be defended against by preserving the image of the good object as absolutely non-aggressive, even at the expense of reality testing.  (It is significant that many of the psychiatrist's factual distortions relate to issues of aggression, rebellion, anger, malice, etc.)  Conversely, the patient's realistic contrary attribution of aggression to peers--defensively termed "paranoid" ("When people disagree with me, I feel that they are being paranoid")--is perceived by the psychiatrist as devaluing the idealized image of the social system, the good object, and is experienced by the psychiatrist as a narcissistic injury and a source of castration anxiety that must be defended against.

A revealing instance of the psychiatrist's distorted perception of aggression, and the relation of that distortion to the psychiatrist's object anxiety and fear of abandonment and isolation, is provided by the following anecdote.  In mid-November 1994 the patient reported a dream he had had that was prompted by the patient's concerns in connection with a pleading he was then preparing that was to be filed in a job discrimination action against his former employer.  The patient reported that he was experiencing considerable anxiety since it was important to him to come up with credible legal arguments, yet the appropriate legal arguments seemed to elude him.  The patient reported that he had a dream in which a judge castigated the patient for presenting "frivolous" arguments to the court.  (It is significant that the patient's anxieties disappeared at the moment he completed the pleading, indicating that the patient's anxieties centered on the issues of ego mastery and achievement.)  The psychiatrist stated: "Maybe the dream means that you are having thoughts that your action against your employer is frivolous." The psychiatrist had apparently transformed the patient's anxieties that centered on ego mastery and achievement in relation to the patient's own ideals into an issue relating to the patient's relations with the employer, suggesting that the patient's anxieties centered on his fear of punishment for having engaged in a "frivolous" act of rebellion and aggression against an authority figure.  In object relations terms the psychiatrist misinterpreted the patient's "self-shame" (experienced in relation to the patient's ego ideal) as an instance of "object anxiety" (in which the psychiatrist was expressing his own fears of the object being angry and abandoning him).