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:
The following ideas regarding my
so-called delusional thought system, centering on my belief that I am
being surveilled by my employer, are offered to further clarify
aspects of my ego functioning and to suggest the diagnostic relevance
of the thought system.
The subject thought system had its
onset in the fall of 1988. The thought system features the belief
that my former employer is in communication with various individuals
including mental health professionals I have consulted, my sister,
current and former friends and acquaintances, etc. The thought
system includes the belief that the employer had regular and frequent
communications during a specific time period with the former manager
of my apartment building, who I believed, inspected my apartment
daily. 1/
One key aspect of the thought system,
then, is its duration and constancy. As Dr. Wiener stated to me in
August 1993: “No one has ever been able to shake you of these
ideas, have they?” Indeed, for five-and-one-half years now my
confidence in the thought system has never wavered. I have never
expressed any doubts, even transiently, that the subject thought
system is an accurate representation of reality.
Presumably, the ideational system has
its basis in my view of the world of objects, namely, my view of these
objects' nature, aims, and conduct as well as my affective investment
in these objects. Regardless of the pathological nature of the
belief system itself, the stability and constancy of the belief
system over a five-and-one-half year period indicates a high, if not
highly unusual, level of object constancy. A curious feature of the
subject thought system is that it has remained utterly unaffected by
changes in my real relations with the objects in question: thus, my
purportedly delusional thoughts about Malcolm Lassman have remained
constant (in content and intensity) despite my job termination in
which Mr. Lassman played a part; my purportedly delusional thoughts
about Craig have remained constant (in content and intensity)
despite changes in my real relations with him.
You will observe that lack of object
constancy is the signal feature of borderline disorder. Borderlines
are characteristically incapable of maintaining a constant investment
in objects. I assume that where paranoid ideation is present in the
borderline, that such ideation is subject to the same vicissitudes of
lack of object constancy characteristic of the borderlines' object
investments generally; specifically, I assume that the content and
intensity of the borderlines' paranoid ideations will track the
patients' characteristic vacillations between idealization and
devaluation. (Note that even among some persecutory psychotics, the
patients' confidence in the delusional system tends to waver over
time. Dr. Phillipa Garrety charted the fluctuating level of
confidence over time that one of her patients had in his delusional
system). The persecutory ideation of one of my co-workers at Akin
Gump, Stacey Schaar, was noticeably unstable: on occasion I was her
friend and others were her enemies, while at other times she viewed me
as potentially homicidal and her former enemies would be perceived as
friends.
I propose therefore that the unwavering
constancy and stability of my thought system, even if delusional,
indicates a high level of object constancy, and for that reason is a
virtual rule-out for borderline disorder. I further propose, that,
for the same reason, the thought system is a rule-out for any other
diagnosis in which lack of object constancy is a diagnostic
criterion.
Further, any diagnosis offered would
have to comprehend the stability and constancy of my thought system.
Thus, if one were to settle on the diagnosis bi-polar disorder
(indicating affective instability), what does it mean that the attendant
delusional (ideational) system is utterly unaffected by affective
shifts?
Sincerely,
Gary Freedman
_______________________________________
1/ The thought system comprises a
complex of protective (negative paranoid) and persecutory ideations,
stable over time.
No comments:
Post a Comment