3801 Connecticut Ave., NW
#136
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:
A. FREEDMAN ASSESSMENT CHART prepared
by Dr. Cuenco
- 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)
- “intense but constricted affect”: ambiguous valuation used to establish existence of affective disorder
- intellectual functioning: glaringly incorrect devaluation
B. FREUD BIOGRAPHICAL ASSESSMENTS
- evidence of affective disorder: failure to characterize Freud's affective states as evidence of an affective disorder
- 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.
Sincerely,
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.
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