Tuesday, April 10, 2012

GW Psychiatric Treatment: Misdiagnosis of Bipolar Disorder

June 20, 1994
3801 Connecticut Ave., NW
Washington, DC 20008

Suzanne M. Pitts, MD
Dept. of Psychiatry
GW Univ. Med. Ctr.
2150 Pennsylvania Ave., NW
Washington, DC 20037

Dear Dr. Pitts:

This communication offers some brief observations regarding a symmetry between the assessment chart prepared by Dr. Cuenco in my case, dated September 24, 1992, and biographical narratives concerning Sigmund Freud relating to the issue of affective disorder.

Concerning my presenting affective state Dr. Cuenco observed: “Patient's affect is intense but constricted.” Dr. Cuenco's observation regarding "tense but constructed affect” is apparently related, if not integral, to his diagnosis: Bi-Polar Disorder (an affective disorder). Dr. Cuenco makes an additional seemingly unrelated observation regarding my intellectual functioning: “insight poor, intelligence about average.”

Dr. Cuenco's assessment chart observations merit comparison with the following biographical assessment of Freud that focuses on Freud's “intense but constricted affect” and its relation to his intellectual functioning.

. . . Freud exploited the profound discrepancy between his emotions and his reason. Freud the future husband, was at odds with Freud the rational man who could objectively diagnose inconsistencies within society and within himself. As Jones observes: 'He was beyond doubt someone whose instincts were far more powerful [“intense”] than those of the average man, but whose repressions were even more potent [“but constricted”]. The combination brought about an inner intensity of a degree that is perhaps the essential feature of any great genius' (Jones, The Life and Works of Sigmund Freud, p. 136). It may be added that Freud's powers of reasoning drew on this very 'inner intensity' which resulted from the struggle between conflicting needs, a struggle he resolved with varying degrees of success over the years. Zanuso, B. The Young Freud, at 75 (Basil Blackwell: 1986) (the author is a practicing psychoanalyst in Milan).

There is, thus, a curious parallel or symmetry between Dr. Cuenco's assessment observations and biographers' assessments of Freud. In either case, the respective authors employ the seemingly clear-cut and unambiguous valuation”intense but constricted” to establish a single conclusion. In each case, however, the respective authors' conclusions are markedly different, if not in a certain sense diametrically opposed, thereby indicating just how ambiguous—and politically malleable—the diagnostic label “intense but constricted affect” really is.

Dr. Cuenco uses the valuation to establish the (possibly politically expedient 1/) diagnosis bi-polar disorder, and simultaneously devalues my intellectual abilities. Zanuso and Jones 2/ use the valuation “intense but constricted affect” to clarify the dynamics and source of Freud's unique intellectual gifts yet, like most Freud biographers 3/, simultaneously ignore evidence that Freud suffered from an affective disorder.

The symmetry may be diagrammed as follows:


  1. evidence of affective disorder: exaggerated in order to establish the diagnosis bi-polar disorder, a diagnosis of dubious merit (psychological testing performed in May 1994 failed to support the diagnosis Bi-Polar Disorder in my case)
  1. “intense but constricted affect”: ambiguous valuation used to establish existence of affective disorder
  1. intellectual functioning: glaringly incorrect devaluation

  1. evidence of affective disorder: failure to characterize Freud's affective states as evidence of an affective disorder
  1. intellectual functioning: almost universally acclaimed as hypernormal
The significance and implications of these observations merit further review and analysis.

I believe that Dr. Cuenco's assessment chart is not simply incorrect; that its inaccuracies do not simply reflect Dr. Cuenco's level of professional knowledge and competence. I believe, rather, that the chart is incorrect in a highly structured and organized fashion, and that its inaccuracies are an encoded, or encrypted, statement—or structured unconscious memoir—of Dr. Cuenco's psychological (defensive) reaction to me. As such, the true value of the chart lies not in its objective statements, but in the way in which it conceals who I am and reveals another person's defensive reaction to me. As a structured and organized misstatement, the chart is susceptible to a rational process of deconstruction that will reveal simultaneously who I am, the manner in which other persons react defensively to me, and the manner in which other persons are able to make their irrational, defensive reactions credible to the world.


Gary Freedman

1/ See my letter to Dr. Pitts dated June 4, 1993 discussing the possible politically-motivated and anti-Semitic aspects of the diagnosis Bi-Polar Disorder.

2/ Note that Ernest Jones' misapplication of ambiguous evidence relating affective instability in Otto Rank led to Jones' self-serving conclusion that Rank (a respected follower of Freud's – and Jones rival) suffered from a manic-depressive psychosis! In the view of GW clinical professor of psychiatry E. James Lieberman, MD, Ernest Jones was an anti-Semite. See Lieberman, E.J. Acts of Will (Free Press: 1985).

3/ Most biographical assessments of Freud eschew a psychiatric, or clinical, gloss of Freud's affective states. One notable exception is a paper co-authored by psychoanalyst and Freud scholar, J. Moussaieff Masson, “Buried Memories on the Acropolis: Freud's Reaction to Mysticism and Anti-Semitism,” International Journal of Psychoanalysis. Masson argues that feelings of euphoria may mask unconscious rage and that such euphoria/(rage), evidence of which Masson adduces in Freud, should properly be viewed as an affective disorder. Mason's implication, that there is evidence that Freud suffered from an affective disorder, is consistent with Ernest Jones' observation that Freud's affect was ”intense but constricted.” Why Jones chose to ignore persuasive evidence of an affective disturbance in Freud, yet misapplied ambiguous evidence of an affective disturbance in Rank, is, on purely clinical grounds, inexplicable.