Monday, April 09, 2012

GW Psychiatric Treatment: Object Constancy

May 31, 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:

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?


Gary Freedman

1/ The thought system comprises a complex of protective (negative paranoid) and persecutory ideations, stable over time.

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