Douglas J. Feith, Esq. was a student in my graduating class at The Central High School of Philadelphia, 230th class, June 1971. Mr. Feith served as Deputy Secretary of Defense for Policy in the administration of George W. Bush. He was one of the architects of the Iraq War. Mr. Feith and I are not acquainted.
Ahmad Chalabi was in Washington, D.C., on Inauguration Day, 2001. He had chosen his favorite double-breasted Ermenegildo Zegna suit and a bright orange tie to celebrate opening day of the George W. Bush presidency. With his mischievous smile and aristocratic bearing, the fifty-six-year-old Iraqi-born Chalabi made his way from one inaugural bash to the next, gliding among the crowds of Bush partygoers. A Muslim who neither smokes nor drinks, he took it all in with the eye of an exile and the soul of a schemer. What would the Bush era mean for him? he wondered. How could he make the most of it?
The day after Bush's swearing in, Chalabi took a car to Chevy Chase, Maryland, just outside the nation's capital. He was invited to a meeting at the two-story home of Richard Perle, a leading figure in the neoconservative movement, which advocated using American military power to promote democracy abroad. Among those present, Chalabi said, were Paul Wolfowitz, Douglas J. Feith, Zalmay Khalilzad, and John P. Hannah. Within a few months, they all would hold influential positions in the new administration--with Wolfowitz and Feith landing the number two and number three positions at the Pentagon and Perle becoming a top adviser to Secretary of Defense Donald Rumsfeld, Khalilzad a special assistant to Bush and ambassador at large for Iraqi exiles, and Hannah a national security adviser to Vice President Dick Cheney. But on this brisk and sunny afternoon, January 21, 2001, they were just a handful of like-minded civilians who saw the charting of U.S. foreign policy as both their dominion and their duty.
Wednesday, February 22, 2012
GW Psychiatric Treatment: Letter October 2, 1995
October 2, 1995
3801 Connecticut Ave., NW
#136
Washington, DC 20008-4530
D. Georgopoulos, M.D.
Dept. Psychiatry
GW Univ. Med. Ctr.
Washington, DC 20037
Dear Dr. Georgopoulos:
This letter summarizes my refections on the consultation on Wednesday September 27, 1995.
PATIENT'S REPORT:
Today is the anniversary of my first day of college, 24 years ago, Monday September 27, 1971. I can still remember that day. My first class was introductory philosophy; it was at 2:00 PM. The teacher's name was Dr. Rieman—George Fred Rieman. I can remember that he took a picture of the class with an old Polaroid camera. You know, he had a seating chart, and he wanted to know people's names, he wanted to remember people; he coordinated the seating chart with the people in the picture. He counted down 'one alligator, two alligator'-- it was a Polaroid picture—he had to wait for the picture to develop.''
[I knew two of the students in the class: William DeVuono who was in my graduating class in high school and Gloria Goldsmith; she and I attended the same junior high school in Philadelphia, Wagner Junior High.]
Then late that afternoon I had my second class—introductory English with Dr. Smith. Then, the next day, Tuesday, I had French—that was with Dr. Smith. Actually it was a different Dr. Smith: Irma Jean Smith. She was from Kalamazoo, [Patient laughs.] She was the first person I ever knew from Kalamazoo. Actually, she's the only person I've ever known from Kalamazoo. You remember that telephone conversation I had with my sister? I gave you a copy of that tape.
[The referenced tape recorded a telephone conversation between my sister and me about my meeting earlier that day in August 1993 with GW Psychiatry Department Chairman, Jerry M. Wiener, M.D. I said on the recording, "Dr. Wiener said my paranoia has crippled my life."]
[Throughout the narrative, until this point, the psychiatrist had nodded and smiled at the patient, acknowledging the patient's pleasure in recounting his experiences. At the moment the patient mentions the tape recording of the telephone conversation with the patient's sister, the psychiatrist becomes stone-faced. The psychiatrist stares blankly at the patient and does not acknowledge that he recalls the cited telephone-recording.]
Don't you remember? The tape where I say to my sister that Dr. Wiener is not just some doctor from Kalamazoo.
PSYCHIATRIST'S RESPONSE:
It sounds like that was a happy time for you.
[Euphoric memories can mask past trauma: "The apparent reliving of a lost past in terms of grasping at the illusion of ecstasy can only represent a falsification of memory for the purpose of defence. And the dry, brittle memories of an emotionally arid childhood are as fearsome as those of more openly violent abuse. J. Moussaieff Masson and Terri C. Masson, "Buried Memories on the Acropolis: Freud’s Response to Mysticism and Anti-Semitism." International Journal of Psychoanalysis (1978).]
PATIENT: [Later in the session]
PATIENT: [Later in the session]
A few weeks ago I was talking about the Diabelli variations by Beethoven. I said it was the greatest piece of music ever written. Coincidentally, I got a recording of the Diabelli variations about a month before I started college, in August 1971. When I started college I had the Diabelli variations running through my head. 1/ That was what I was thinking about at that time. Sitting in philosophy class, I could hear the Diabelli variations. I don't mean a hallucination; you know, I mean I was imagining the music.
Yes, my recollection now is that it was a special time. But, I'm sophisticated enough to know that it is my present recollection of the events that gives me pleasure, not the events themselves. It reminds me of what Weissman said—that creative people as infants had the ability to withdraw their emotional investment in the mother, and hypercathect their imaginative recollection of the mother. That's the way I feel right now. That it's my present recollection of what I experienced then that is giving me pleasure now. I wouldn't necessarily want to go back to that time to re-experience those events. First of all, there are always new things to experience. But, also, I know that it's not the events themselves that were pleasurable, it's my recollection that is pleasurable. Well, this may sound like a devaluation, but I don't think you're sophisticated enough to see that distinction.
PATIENT: [Later in the session]
I'll tell you the impression I formed earlier in the session when you interrupted me, when you said: "That sounded like a happy time for you.” I thought it was a defensive reaction on your part. That my comments made you uncomfortable, that for you they were too unfocused, too non-directed. That that non-directed quality disturbs you. I had the feeling you were trying to get me to be more focused, trying to confer order on my rambling comments [comments that to you must have seemed like examples of circumstantiality].
PSYCHIATRIST:
What I was thinking was that your comments were very important. I appreciate the fact that you were able to talk about your feelings.
PATIENT:
See now, what I think about what you just said is that you're trying to placate me. I read your comments as mere words. They have no meaning. You're trying to placate me. My interpretation would be that you viewed my observation that my opening comments were too vague and unfocused as a hostile criticism, and that my hostility irritated you. You then tried to defuse my criticism by engaging in placating behavior, by saying, "I thought your comments were very important.”
[In fact, there is come confirmation of the patient's interpretation. In the fall of 1994 the patient had told the psychiatrist that he had concerns that he was not doing therapy correctly. The patient reported he had stated the same concern to a previous psychiatrist who responded: "You're doing fine.” The current psychiatrist proceeded to state, or mimic, the phrase “You're doing fine.” Only a few sessions later, the patient stated his concern that he was not making progress in therapy, which triggered an irritated and revealing response from the psychiatrist, at odds with the previous reassurance “You're doing fine.” The psychiatrist stated: “I am feeling frustrated here. I have recommended medication. You do not follow my recommendation to take medication." The earlier reassurance. “You're doing fine: struck the patient as hypocritical in the face of the psychiatrist's later statement: “I am feeling frustrated here.”]
INTERPRETATION:
Whether or not the psychiatrist was sincere in stating that he thought the patient's comments were “very important,” we can say with certainty that in fact the psychiatrist had no knowledge of the true importance of the patient's narrative. As with the latent content of a dream, the inner significance of a psychoanalytic narrative is “wrapped in disguises.” 2/ Linguistic analysis of psychoanalytic narratives confirms that the precise significance of a narrative may not be readily apparent to anyone. (An important corollary is that an attempt by a psychiatrist to confer meaning on superficial aspects of the patient's narrative may be ego destructive for the patient or will, at the very least, not advance the therapy and may, as in the patient case, derail the patient's train of associations.)
Janet Malcolm has reported ongoing work at the New York Psychoanalytic Institute by analyst Hartvig Dahl involving linguistic analyses of psychoanalytic narratives.
Through intensive linguistic and logical analysis of the verbatim transcript of a patient's hour, Dahl and Teller have attempted to lay bare the mental processes of analysis as they listen to tape recordings of an analysis with 'closely hovering attention' to a patient's utterances and find themselves forming hypotheses about their unconscious meaning. For embedded in the transcript, like a message written in invisible ink, are innumerable, unmistakable traces of the patient's unconscious motives. Invisible to the naked eye as such, they come into glaring view under the special linguistic and logical microscopy devised by Dahl and Teller from their singular demonstration of the existence of the unconscious. . . .Dahl proposed that I listen to Session Five as a preliminary to studying the annotated transcript. . . .
I remembered Freud's admonition in the first of his Introductory Lectures: “You cannot be present as an audience at a psychoanalytic treatment. You can only be told about it; and, in the strictest sense of the word, it is only by hearsay that you will get to know psychoanalysis. . . . The talk of which psychoanalytic treatment consisted brooks no listener.” I turned on the machine, and listened for fifty minutes to a young man's halting, rambling soliloquy describing ordinary trivial events and expressing commonplace thoughts and feelings. It was like listening to a boring, self-absorbed acquaintance. Freud had been right: an outsider eavesdropping on an analytic session gets almost nothing from it; he is like an eavesdropper on a conversation (or monologue) in a foreign language. Only later on reading the annotated transcription of the hour, did I laboriously decode the secret messages from the unconscious that the patient had wafted toward his analyst years before, and which Dahl, following Freud's instructions about loose, desireless, undirected listening, had “intuitively” grasped. Malcolm, J. Psychoanalysis: The Impossible Profession, 89-90 (New York: Vintage Books, 1982).
Instead of listening with “closely hovering attention" to the patient's utterances and forming hypotheses about the unconscious meaning as derived from the context of the patient's associations, this psychiatrist focuses on the most seemingly salient and /or recent component of the narrative, which procedure, consistently applied by this psychiatrist, betrays the psychiatrist's psychological naivete and, tragically, ignores the patient's underlying concerns.
Clues to the inner significance of the patient's narrative concerning his first day of college emerged only after the psychiatric consultation had concluded. The patient recalled the subject matter of the philosophy class to which he had referred at the consultation. The topic under discussion had been “Duty and Responsibility.”'
Issues pertinent to the problem of duty and responsibility were illustrated by the facts of the Kitty Genovese case.
On an evening in 1964, in New York City, a young woman named Kitty 3/ Genovese was brutally attacked and murdered outside her apartment building. Thirty-eight people witnessed the protracted, bloody attack and not one tried to help or even call the police from behind the safety of their window blinds. The victim's desperate screams for help were ignored; some of the neighbors were not disturbed by the criminal attack per se, but were simply irritated by the victim's screams, which disrupted an otherwise peaceful evening. See Letter to Dr. Georgopoulos, dated July 17, 1995 (discussing the psychiatrist's interpretation of the patient's communications with law enforcement authorities as a narcissistic attention-seeking ploy).
That the patient's narrative in some way concerned issues of victimization, duty and responsibility is indicated by the patient's express reference only sessions earlier, to the Calderon play The Mayor of Salamea. 4/ In that play a proud and prosperous man of humble birth, the farmer Pedro Crespo, has civil authority in a town though which the army is passing. When his daughter Isabel is ravished by an hidalgo captain, Don Alvaro, Crespo maintains that however loyal to his country a man may be, his honor is his own. He therefore arrests, then executes the captain. King Philip II, passing through, checks further trouble by commending the mayor's action.
(Coincidentally, the Secret Service Agent with whom the patient has been in communication is named Philip Leadroot.)
Also, significantly, in the letters dated July 17, 1995 the patient indicates his personal identification with a victim of rape:
The psychiatrist's gloss of the patient's letter to the FBI as a rebellious attention-seeking ploy transforms the patient into a perpetrator and simultaneously transforms the patient's victimizers into innocent victims. On a sexual level, the psychiatrist's reinterpretation of the facts is identical to the strategy of a defense attorney in a rape case who portrays the rapist as an innocent victim of the female's attention-seeking game of sexual seduction. Stated in general terms, the relationships (penetrated / victim) – (penetrator / perpetrator) are transformed into (penetrator / victim ) – (penetrated / perpetrator).
Regrettably, the innumerable, unmistakable traces of the patient's unconscious concerns—like the desperate cries of Kitty Genovese—go unheeded, lost in the psychiatrist's defensive and disruptive preoccupation with the patient's manifest utterances.
One wonders, incidentally, whether the psychiatrist's history of tangential responses to the patient's comments, noted in previous letters, may be related to a cognitive style that, in the psychotherapeutic milieu, reduces his ability to derive meaning from the context of the patient's associations and actually leads to anxiety in the face of the patient's unusual level of associational fluency. The psychiatrist's apparent difficulties with semantic integration, as indicated by his occasional tangential responding, may be related to his reluctance or diminished capacity to integrate the patient's associations over the long-term, and his tendency to focus on the most seemingly salient and/or recent component of information communicated to him, which necessarily impairs or precludes the analysis of latent or unconscious meaning in the patient's utterances. Cf. Silverstein, S. M. and Palumbo, D.R. “Nonverbal Perceptual Organization Output Disability and Schizophrenia Spectrum Symptomatology.” Psychiatry 58(1): 66-81, at 76, 77-78; 1995 (Stanley R. Palombo, editorial adviser).
The psychiatrist's therapeutic technique, which focuses on appraising mere surface appearances (“It sounds like that was a happy time for you”), may actually be a compromise with a cognitive style that reduces his ability to generate a framework or context from the patient's associations within each session and, even more so, from session to session. Unfortunately, when the psychiatrist interacts with a patient with unusual associational fluency, the psychiatrist experiences anxiety with which he proceeds to deal defensively. Thus, the psychiatrist will tend to view the patient's associational fluency (a need and ability to associate dissimilar, but fundamentally related, ideas) as a picaresque ideational fugue, or manic “flight of ideas,” and his highly-refined ability to infer latent meaning from context as “paranoia” (see no. 2, above) (really the need and ability to shape and reshape reality in search of it inner significance).
Confirmation for this speculation is provided by the psychiatrist's reaction to the patient in another context; the psychiatrist had mischaracterized the patient's unusual level of verbal fluency, objectively verified on the Wechsler Adult Intelligence Scales, as manic rapid speech (“You talk fast; I can give you medication for that.”) Thus, the psychiatrist had, by means of the ego defense of reversal (a key component in paranoia), transferred his own anxiety, in the face of the patient's verbal fluency, to the patient, attributing to the patient manic psychopathology in the form of “pressured, rapid speech,” which (projected anxiety might be remedied chemically with a major tranquilizer. (Compare the psychiatrist's express statement, or admission, at a previous session in which he indicated a desire to alter his own affective discomfort by prescribing medication to the patient: “I am feeling frustrated here. I have recommended medication. You do not follow my recommendation to take medication.”)
Sincerely,
Gary Freedman
________________________________
1/ There is a notable metaphoric, or poetic, quality to the patient's statement "I had the Diabelli variations running through my head" that symbolically communicates an important ego need of this patient, a need to synthesize remote ideas and to divine hidden meanings, which need to is frustrated by supportive (nonpsychoanalytic) therapy.
[According to Frank Barron, an expert in creativity, creative persons "become more aware of unconscious motives and fantasy life."]
The metaphoric quality of the patient's statement is laid bare by Maynard Solomon's eloquent description of the Diabelli variations. Solomon's description indicates the affinity of this musical work with psychoanalysis itself, a therapeutic technique that permits--indeed, requires--the patient to associate facially dissimilar but fundamentally related ideas, and to shape and reshape reality in search of its inner significance.
[Maynard Solomon has also published articles in applied psychoanalysis.]
Solomon writes: "Variation [psychoanalysis] is potentially the most "open" of musical procedures [psychotherapeutic techniques], one which gives the greatest freedom to the composer's [patient's] fantasy. It mirrors the unpredictability and chance nature of human experience and keeps alive the openness of human expectation. Fate cannot knock on the door in the variation form: such concepts as necessity and inevitability need a dialectical musical pattern within which to express their message, whereas the variation is discursive and peripatetic, in flight from all messages and ideologies. Its subject is the adventurer, the picaro, the quick-change artist, the impostor, the phoenix who ever rises from the ashes, the rebel who, defeated, continues on his quest, the thinker who doubts perception, who shapes and reshapes reality in search of its inner significance, the omnipotent child who plays with matter as God plays with the universe. Variation is the form of shifting moods, alternations of feeling, shades of meaning, dislocations of perspective. It shatters appearance into splinters of previously unperceived reality and, by an act of will, reassembles the fragments at the close. The sense of time is effaced--expanded, contracted--by changes in tempo; space and mass dissolve into the barest outline of the harmonic progressions and build up once again into baroque structures laden with richly ornamented patterns. The theme remains throughout as an anchor to prevent fantasy from losing contact with the outer world, but it too dissolves into the memories, images, and feelings which underlies it simple reality. In this the theme is like the manifest dream--a simple, condensed sequence of images masking an infinity of latent dream thoughts. The manifest dream is deceptively simple, wrapped in disguises of distortion, censorship, condensation, and displacement. Analysis (variation) pierces these veils; recollection fills the dream (the theme) with a significance that illuminates the past and points toward future possibilities of transcendence and fulfillment." Solomon, M. Beethoven, 303 (New York: Schirmer Books, 1979).
2/ At the very first session [with this psychiatrist in July 1994], the patient reported a dream the manifest content of which concerned a man's shirt. The patient reported the following dream thought: "Only a queer would smell another guy's shirt." At this, the psychiatrist interrupted the patient to deliver a little lecture: "You shouldn't say that. Homosexuals have an alternative lifestyle. They deserve to be respected. You shouldn't use words like 'queer.'" The patient felt like saying: "Hello, it's a dream!" In fact--uncannily, as this letter will later reveal--the latent content of the dream concerned a brutal double homicide in which one of the victims was a young woman. (It is significant that at the third session, the following week, the psychiatrist, after having read the patient's detailed written analysis of the subject dream, advised the patient (for the first time) that it was essential that the patient take anti-psychotic medication!)
3/ The name "Kitty" carries an association to Anne Frank, who addressed each of her diary entries to an imaginary friend named "Kitty." (The patient had read The Diary of Anne Frank in the fall of 1967 [in ninth-grade English]). Fortunately for posterity, Anne Frank had a "need to write things."
4/ The patient had first heard about the play in about 1983, and summarized the plot to the psychiatrist from present recollection. In the patient's confabulatory recollection Pedro Crespo was remembered as being an impoverished peasant without any political power. When his daughter is raped, Crespo's pleas for justice with the local authorities are ignored, and the perpetrator goes unpunished. Crespo vows to attain political power by becoming mayor, and avenge his daughter's disgrace himself. The patient's distorted recollection of the plot is revealing. The patient had likened the play to the attainment of political sovereignty by Jews in 1948 with the establishment of the state of Israel, which permitted the capture of Adolf Eichmann by Simon Wiesenthal as an agent of a sovereign Jewish state, thereby avenging the victimization and murder of politically powerless Jews under the Nazi regime.
Tuesday, February 21, 2012
GW Psychiatric Treatment: Letter 9/18/95
September 18, 1995 (rev'd 9/19/95)
3801 Connecticut Ave., NW
#136
Washington, DC 20008-4530
D. Georgopoulos, M.D.'
Dept. Psychiatry
GW Univ. Med Ctr.
Washington, DC 20008
Dear Dr. Georgopoulos:
This communication reports on several recent consultations.
By way of cover letter dated August 15, 1995 the patient submitted to the U.S. Secret Service an updated version of the letter to Dr Georgopoulos, dated July 26, 1995. The update comprised the following addition to footnote 3:
SESSION MONDAY AUGUST 21, 1995:
PSYCHIATRIST'S COMMENTS:
Psychiatrist says absolutely nothing.
______________________________________
SESSION MONDAY AUGUST 28, 1995:
PATIENT'S REPORT:
I notice that at this session you have made a few comments. I made a mental note of the fact that at our session last Monday (August 21, 1995) you said absolutely nothing.
PSYCHIATRIST'S COMMENTS:
You say you like it when I say nothing, but it seems that you want me to interact with you.
[At a prior session, in July 1995, the patient was silent for a lengthy period. The psychiatrist stated: "I am wondering whether your silence means that you have feelings of ambivalence about what you are supposed to be doing here." Note, incidentally, the coercive connotation of the psychiatrist's phrase, "what you are supposed to be doing here."]
PATIENT'S RESPONSE:
If you make comments like the ones you usually make, I would prefer that you say nothing But I do want you to react to me with worthwhile comments.
INTERPRETATION:
The psychiatrist's comment seems to focus on the patient's presumed ambivalence in relation to the psychiatrist. The psychiatrist's comment suggests that the patient cannot make up his mind whether or not he wants interaction with the psychiatrist.
There may be a parallel between the psychiatrist's attribution of ambivalence relating to the patient's interaction with the psychiatrist and the psychiatrist's attribution of ambivalence at a previous session relating to the patient's feelings about his former employer ("Maybe your dream means that you are having thoughts that your action against your employer is frivolous.")
The psychiatrist suggests at the current session that the patient is torn between a desire that the psychiatrist interact with the patient and the opposite, a desire for no interaction. At the previous session the psychiatrist interpreted the patient's dream to mean that the patient was torn between feelings of aggression against the employer and a feeling of fearful anxiety that the patient might suffer punishment for engaging in a "frivolous" legal action against his employer.
One suspects that the psychiatrist's attributions of ambivalence to the patient are in some way defensive, and represent the psychiatrist's need to ward off the anxiety engendered in the psychiatrist by the patient's aggression directed at the psychiatrist (as, for example, in the patient's statement to psychiatrist: "If you make comments like the ones you usually make, I would prefer that you say nothing") and aggression directed at the patient's employer (in the form of a job discrimination legal action).
The evidence suggests that one means employed by the psychiatrist to cope with the anxiety engendered by others' aggression is to imply that the aggression is not sincere. The psychiatrist seems to attribute, or misattribute, ambivalence as a defense against his own anxiety. 1/ When the psychiatrist attributes ambivalence to the patient he seems to assign primacy or genuineness to only one of the patient's feelings (and of course that feeling will be the one syntonic with the psychiatrist's own needs) and any contradictory feeling or impulse, which will necessarily be dystonic with the psychiatrist's needs and therefore anxiety-provoking, is depicted to some extent as artificial or illusory 2/ In sum, the psychiatrist seems to attribute ambivalence to another in the service of his own denial: to deny or diminish what is anxiety-provoking for the psychiatrist and to affirm what is need-satisfying.
In neither of the cited instances in which the psychiatrist seems to have attributed ambivalence to the patient is the attribution appropriate. With respect to the patient's anxious concern relating to ego mastery and achievement in connection with creating credible legal arguments in his action against his former employer, 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). In so doing, the psychiatrist attributed to the patient the unstable (ambivalent) feelings of aggression (ameliorated in the psychiatrist's gloss as "frivolous") and fear of retaliation 3/ in relation to only one object, the employer. This was an inappropriate attribution of ambivalent feelings to the patient vis-a-vis the employer since, in effect, the patient was expressing two different stable affects in relation to two distinct objects: 4/ aggression against his employer and simultaneous anxiety in relation to his own ego ideal. (According to Rothenberg we do not experience ambivalent feelings simultaneously, but in alternating sequence, Id.)
Likewise, the patient's seeming conflict over whether he does or does not want the psychiatrist to interact with the patient does not necessarily involve ambivalence. The following parable illustrates the patient's feelings:
The psychiatrist's recurring inappropriate attributions of ambivalence to the patient suggest the defensive nature of the psychiatrist's interpretations.
PATIENT'S REPORT:
There seems to be an inconsistency in the way Yu-Ling Han treated my paranoia as opposed to the way she dealt with my manic depression. The tests failed to indicate that I suffer from either paranoia or bi-polar disorder. With respect to the paranoia, Yu-Ling Han claims I lied to conceal the paranoia.
Yet with the bi-polar disorder--and I was diagnosed as being bi-polar--even though the testing failed to pick up that illness, I wasn't accused of lying to conceal manic depression.
PSYCHIATRIST'S RESPONSE:
Sometimes a person's paranoia doesn't show up on psychological testing. Sometimes the way a person views things differs at different times. If you test a person a person at a certain time, you will find paranoia; if you test at another time, that same person may test differently.
INTERPRETATION:
First, the psychiatrist's comments are tangential and non-responsive. The gist of the patient's concern was the inconsistent nature of the accusation that he had lied on the testing not why the psychological testing failed to yield the diagnosis of paranoid. The psychiatrist does not respond to the question why the patient was accused of lying to conceal paranoia but was not accused of lying to conceal bi-polar disorder.
Also, the psychiatrist consistently refuses to come to terms with the systematic, enduring, and stable nature of the patient's ideas and the diagnostic significance of that ideational consistency. See Letter to Dr. Georgopoulos, dated September 6, 1995. The patient's belief that he has been under surveillance by his former employer has remained constant since the inception of the belief, in late October 1988. Indeed in August 1993 the chairman of the psychiatry department stated to the patient: "Nobody has ever been able to shake you of these ideas, have they?"
Further, paranoia has both cognitive/perceptual as well as dynamic features; paranoia involves not simply ideas but a style of perceiving, appraising, and responding to the environment. Even among paranoid patients whose beliefs change over time, it is highly unlikely that these patients' manner of thinking about, and responding to, the environment would change so drastically over time so as to leave no discernible traces of paranoid cognitive style on psychological testing. The Rorschach test for example, is highly sensitive to the distinctive dynamic, perceptual, and behavioral features of paranoia. "Rorschach indices of [the various identifying features of paranoid status appear in all three of the major dimensions of subjects' responses to the test situation: the structure of their answers, their response content, and their behavior in dealing with the inkblots (citations omitted)." Exner, J.E., Jr. and Weiner, I. The Rorschach: A Comprehensive System. Volume 3. An Assessment of Children and Adolescents, at 230 (New York: John Wiley & Sons, 1982) (from the chapter "Paranoid Status," at 230-234.
___________________________________________
At the session on Wednesday August 30, 1995 the patient reads to the psychiatrist the text of a letter, dated September 1, 1995, addressed to the office of U.S. Attorney that discusses the patient's psychiatric treatment history. See Letter to Dr. Georgopoulos, dated September 6, 1995.
On Thursday August 31, 1995 the patient hand delivers the letter to the Office of US. Attorney.
On Tuesday September 5, 1995 the patient hand delivers to the U.S. Secret Service a copy of the letter to the Office of U.S. Attorney dated September 1, 1995, and a copy of the Letter to Dr. Georgopoulos dated September 6, 1995, which discusses the psychiatric consultation on Wednesday August 30, 1995.
__________________________________________
SESSION WEDNESDAY SEPTEMBER 6, 1995:
PSYCHIATRIST'S RESPONSE:
Psychiatrist says absolutely nothing.
____________________________________________
SESSION MONDAY SEPTEMBER 11, 1995:
PSYCHIATRIST'S COMMENTS:
Psychiatrist says absolutely nothing.
____________________________________________
SESSION WEDNESDAY SEPTEMBER 13, 1995:
PSYCHIATRIST'S COMMENT:
The psychiatrist makes one comment during the session. During a lull in the patient's narrative, the psychiatrist says, "You're not saying anything."
Sincerely,
Gary Freedman
_______________________________________________
1/ There may be a symmetry between, one the one hand, the patient's own ready accommodation of opposites and his creative ego functioning and, on the other, the psychiatrist's apparent anxious response to the patient's creative idea production and his difficulty in coping with, and misapplication of, the concept of ambivalence See Rothenberg, A. "Janusian Thinking and Creativity." In: The Psychoanalytic Study of Society, vol. 7: 1-30, at 20. Gertrude R. Ticho, M.D., consulting ed. (New Haven: Yale University Press: 1976) (distinguishing ambivalence from the creative ego function of simultaneous defensive negation, and discussing the relation of ambivalence to creativity and schizophrenic processes).
2/ This interpretation is consistent with a previously observed response by the psychiatrist in another context. The psychiatrist will dismiss the patient's reports relating to unusual experiences by classifying the reports "improbable," or paranoid, that is, artificial or illusory.
3/ The psychiatrist's misattribution, or projection of aggression and fear of retaliation to the patient in this instance may be relevant to an understanding of why the patient had been misdiagnosed by the assessing psychiatrist as suffering from bipolar disorder. See Letter to Dr. Pitts, dated June 4, 1993: "A question for examination is whether the diagnosis 'cyclothymia (or mood disorder) may in fact have reflected a projection onto Rank of Jones's own hostility toward Rank. Jones, unable to resolve his own contradictory feelings of aggressiveness (and consequent fear of retaliation) toward Rank vis-a-vis Freud, may have projected these feelings (i.e., aggression and fear) onto Rank so that in the end Rank appeared to Jones as someone torn between timidity (melancholia) and homicidal aggression (mania)."
4/ The phrase "two different stable affects in relation to two distinct objects" suggests, by way of remote association, the key inspirational thought underlying Einstein's General Theory of Relativity: "'[F]or an observer in free fall from the roof of a house there exists during his fall, no gravitational field--at least not in his immediate vicinity. If the observer releases any objects, they will remain, relative to him, in a state of rest, or in a state of uniform motion, independent of their particular chemical and physical nature. The observer is therefore justified in considering his state as one of 'rest'." Rothenberg at 22, quoting Einstein, A. "The Fundamental Idea of General Relativity in its Original Form." According to Rothenberg Einstein's inspiration was the product of simultaneous defensive negation, not ambivalence.
5/ There is an intriguing and possibly significant shared dynamic between the parable which portrays the frustration of the patient's need for narcissistic nourishment, or identification--and the patient's dream about his legal action against his employer: both cases relate to the patient's handling of narcissistic needs and aggression, and suggest a symmetry between narcissism and aggression in the patient's psychic economy. (Note that the following two complexes are polar opposites, therefore susceptible of simultaneous defensive negation in conscious thinking. See Rothenberg at 5-9).
Sincerely,
Gary Freedman
3801 Connecticut Ave., NW
#136
Washington, DC 20008-4530
D. Georgopoulos, M.D.'
Dept. Psychiatry
GW Univ. Med Ctr.
Washington, DC 20008
Dear Dr. Georgopoulos:
This communication reports on several recent consultations.
By way of cover letter dated August 15, 1995 the patient submitted to the U.S. Secret Service an updated version of the letter to Dr Georgopoulos, dated July 26, 1995. The update comprised the following addition to footnote 3:
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).
SESSION MONDAY AUGUST 21, 1995:
PSYCHIATRIST'S COMMENTS:
Psychiatrist says absolutely nothing.
______________________________________
SESSION MONDAY AUGUST 28, 1995:
PATIENT'S REPORT:
I notice that at this session you have made a few comments. I made a mental note of the fact that at our session last Monday (August 21, 1995) you said absolutely nothing.
PSYCHIATRIST'S COMMENTS:
You say you like it when I say nothing, but it seems that you want me to interact with you.
[At a prior session, in July 1995, the patient was silent for a lengthy period. The psychiatrist stated: "I am wondering whether your silence means that you have feelings of ambivalence about what you are supposed to be doing here." Note, incidentally, the coercive connotation of the psychiatrist's phrase, "what you are supposed to be doing here."]
PATIENT'S RESPONSE:
If you make comments like the ones you usually make, I would prefer that you say nothing But I do want you to react to me with worthwhile comments.
INTERPRETATION:
The psychiatrist's comment seems to focus on the patient's presumed ambivalence in relation to the psychiatrist. The psychiatrist's comment suggests that the patient cannot make up his mind whether or not he wants interaction with the psychiatrist.
There may be a parallel between the psychiatrist's attribution of ambivalence relating to the patient's interaction with the psychiatrist and the psychiatrist's attribution of ambivalence at a previous session relating to the patient's feelings about his former employer ("Maybe your dream means that you are having thoughts that your action against your employer is frivolous.")
The psychiatrist suggests at the current session that the patient is torn between a desire that the psychiatrist interact with the patient and the opposite, a desire for no interaction. At the previous session the psychiatrist interpreted the patient's dream to mean that the patient was torn between feelings of aggression against the employer and a feeling of fearful anxiety that the patient might suffer punishment for engaging in a "frivolous" legal action against his employer.
One suspects that the psychiatrist's attributions of ambivalence to the patient are in some way defensive, and represent the psychiatrist's need to ward off the anxiety engendered in the psychiatrist by the patient's aggression directed at the psychiatrist (as, for example, in the patient's statement to psychiatrist: "If you make comments like the ones you usually make, I would prefer that you say nothing") and aggression directed at the patient's employer (in the form of a job discrimination legal action).
The evidence suggests that one means employed by the psychiatrist to cope with the anxiety engendered by others' aggression is to imply that the aggression is not sincere. The psychiatrist seems to attribute, or misattribute, ambivalence as a defense against his own anxiety. 1/ When the psychiatrist attributes ambivalence to the patient he seems to assign primacy or genuineness to only one of the patient's feelings (and of course that feeling will be the one syntonic with the psychiatrist's own needs) and any contradictory feeling or impulse, which will necessarily be dystonic with the psychiatrist's needs and therefore anxiety-provoking, is depicted to some extent as artificial or illusory 2/ In sum, the psychiatrist seems to attribute ambivalence to another in the service of his own denial: to deny or diminish what is anxiety-provoking for the psychiatrist and to affirm what is need-satisfying.
In neither of the cited instances in which the psychiatrist seems to have attributed ambivalence to the patient is the attribution appropriate. With respect to the patient's anxious concern relating to ego mastery and achievement in connection with creating credible legal arguments in his action against his former employer, 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). In so doing, the psychiatrist attributed to the patient the unstable (ambivalent) feelings of aggression (ameliorated in the psychiatrist's gloss as "frivolous") and fear of retaliation 3/ in relation to only one object, the employer. This was an inappropriate attribution of ambivalent feelings to the patient vis-a-vis the employer since, in effect, the patient was expressing two different stable affects in relation to two distinct objects: 4/ aggression against his employer and simultaneous anxiety in relation to his own ego ideal. (According to Rothenberg we do not experience ambivalent feelings simultaneously, but in alternating sequence, Id.)
Likewise, the patient's seeming conflict over whether he does or does not want the psychiatrist to interact with the patient does not necessarily involve ambivalence. The following parable illustrates the patient's feelings:
A starving Hindu makes his way to an encampment of Muslims where meat is being roasted for a feast. The Hindu is desperately hungry, but if only meat is available, he would rather continue to starve. The Hindu says to the host, "Masoud, I am starving. Please give me some food." Masoud replies: You are welcome to join in our feast. Here, take some meat." The devout Hindu says, "Masoud, you're not Hindu, Hindus don't eat meat!" 5/In psychoanalytic terms, the patient's need for narcissistic nourishment and the patient's reaction to the frustration of that need is mischaracterized by the psychiatrist as an example of ambivalence.
The psychiatrist's recurring inappropriate attributions of ambivalence to the patient suggest the defensive nature of the psychiatrist's interpretations.
PATIENT'S REPORT:
There seems to be an inconsistency in the way Yu-Ling Han treated my paranoia as opposed to the way she dealt with my manic depression. The tests failed to indicate that I suffer from either paranoia or bi-polar disorder. With respect to the paranoia, Yu-Ling Han claims I lied to conceal the paranoia.
Yet with the bi-polar disorder--and I was diagnosed as being bi-polar--even though the testing failed to pick up that illness, I wasn't accused of lying to conceal manic depression.
PSYCHIATRIST'S RESPONSE:
Sometimes a person's paranoia doesn't show up on psychological testing. Sometimes the way a person views things differs at different times. If you test a person a person at a certain time, you will find paranoia; if you test at another time, that same person may test differently.
INTERPRETATION:
First, the psychiatrist's comments are tangential and non-responsive. The gist of the patient's concern was the inconsistent nature of the accusation that he had lied on the testing not why the psychological testing failed to yield the diagnosis of paranoid. The psychiatrist does not respond to the question why the patient was accused of lying to conceal paranoia but was not accused of lying to conceal bi-polar disorder.
Also, the psychiatrist consistently refuses to come to terms with the systematic, enduring, and stable nature of the patient's ideas and the diagnostic significance of that ideational consistency. See Letter to Dr. Georgopoulos, dated September 6, 1995. The patient's belief that he has been under surveillance by his former employer has remained constant since the inception of the belief, in late October 1988. Indeed in August 1993 the chairman of the psychiatry department stated to the patient: "Nobody has ever been able to shake you of these ideas, have they?"
Further, paranoia has both cognitive/perceptual as well as dynamic features; paranoia involves not simply ideas but a style of perceiving, appraising, and responding to the environment. Even among paranoid patients whose beliefs change over time, it is highly unlikely that these patients' manner of thinking about, and responding to, the environment would change so drastically over time so as to leave no discernible traces of paranoid cognitive style on psychological testing. The Rorschach test for example, is highly sensitive to the distinctive dynamic, perceptual, and behavioral features of paranoia. "Rorschach indices of [the various identifying features of paranoid status appear in all three of the major dimensions of subjects' responses to the test situation: the structure of their answers, their response content, and their behavior in dealing with the inkblots (citations omitted)." Exner, J.E., Jr. and Weiner, I. The Rorschach: A Comprehensive System. Volume 3. An Assessment of Children and Adolescents, at 230 (New York: John Wiley & Sons, 1982) (from the chapter "Paranoid Status," at 230-234.
___________________________________________
At the session on Wednesday August 30, 1995 the patient reads to the psychiatrist the text of a letter, dated September 1, 1995, addressed to the office of U.S. Attorney that discusses the patient's psychiatric treatment history. See Letter to Dr. Georgopoulos, dated September 6, 1995.
On Thursday August 31, 1995 the patient hand delivers the letter to the Office of US. Attorney.
On Tuesday September 5, 1995 the patient hand delivers to the U.S. Secret Service a copy of the letter to the Office of U.S. Attorney dated September 1, 1995, and a copy of the Letter to Dr. Georgopoulos dated September 6, 1995, which discusses the psychiatric consultation on Wednesday August 30, 1995.
__________________________________________
SESSION WEDNESDAY SEPTEMBER 6, 1995:
PSYCHIATRIST'S RESPONSE:
Psychiatrist says absolutely nothing.
____________________________________________
SESSION MONDAY SEPTEMBER 11, 1995:
PSYCHIATRIST'S COMMENTS:
Psychiatrist says absolutely nothing.
____________________________________________
SESSION WEDNESDAY SEPTEMBER 13, 1995:
PSYCHIATRIST'S COMMENT:
The psychiatrist makes one comment during the session. During a lull in the patient's narrative, the psychiatrist says, "You're not saying anything."
Sincerely,
Gary Freedman
_______________________________________________
1/ There may be a symmetry between, one the one hand, the patient's own ready accommodation of opposites and his creative ego functioning and, on the other, the psychiatrist's apparent anxious response to the patient's creative idea production and his difficulty in coping with, and misapplication of, the concept of ambivalence See Rothenberg, A. "Janusian Thinking and Creativity." In: The Psychoanalytic Study of Society, vol. 7: 1-30, at 20. Gertrude R. Ticho, M.D., consulting ed. (New Haven: Yale University Press: 1976) (distinguishing ambivalence from the creative ego function of simultaneous defensive negation, and discussing the relation of ambivalence to creativity and schizophrenic processes).
2/ This interpretation is consistent with a previously observed response by the psychiatrist in another context. The psychiatrist will dismiss the patient's reports relating to unusual experiences by classifying the reports "improbable," or paranoid, that is, artificial or illusory.
3/ The psychiatrist's misattribution, or projection of aggression and fear of retaliation to the patient in this instance may be relevant to an understanding of why the patient had been misdiagnosed by the assessing psychiatrist as suffering from bipolar disorder. See Letter to Dr. Pitts, dated June 4, 1993: "A question for examination is whether the diagnosis 'cyclothymia (or mood disorder) may in fact have reflected a projection onto Rank of Jones's own hostility toward Rank. Jones, unable to resolve his own contradictory feelings of aggressiveness (and consequent fear of retaliation) toward Rank vis-a-vis Freud, may have projected these feelings (i.e., aggression and fear) onto Rank so that in the end Rank appeared to Jones as someone torn between timidity (melancholia) and homicidal aggression (mania)."
4/ The phrase "two different stable affects in relation to two distinct objects" suggests, by way of remote association, the key inspirational thought underlying Einstein's General Theory of Relativity: "'[F]or an observer in free fall from the roof of a house there exists during his fall, no gravitational field--at least not in his immediate vicinity. If the observer releases any objects, they will remain, relative to him, in a state of rest, or in a state of uniform motion, independent of their particular chemical and physical nature. The observer is therefore justified in considering his state as one of 'rest'." Rothenberg at 22, quoting Einstein, A. "The Fundamental Idea of General Relativity in its Original Form." According to Rothenberg Einstein's inspiration was the product of simultaneous defensive negation, not ambivalence.
5/ There is an intriguing and possibly significant shared dynamic between the parable which portrays the frustration of the patient's need for narcissistic nourishment, or identification--and the patient's dream about his legal action against his employer: both cases relate to the patient's handling of narcissistic needs and aggression, and suggest a symmetry between narcissism and aggression in the patient's psychic economy. (Note that the following two complexes are polar opposites, therefore susceptible of simultaneous defensive negation in conscious thinking. See Rothenberg at 5-9).
The parable depicts feelings of despair resulting from the unavailability of an external idealized object suitable for narcissistic identification coupled with aggression turned against the self (in the form of self-starvation that provides masochistic pleasure and satisfies a need for mastery through repetition [repetition compulsion]).It is significant that these important distinctions relating to the patient's ego differentiation and affective economy, and the interplay of these variables with external objects, do not emerge if one applies the psychiatrist's simplistic "I love her, I love her not" ambivalence model.
The dream about the legal action against the employer depicts aggression against an external object (which aggression provides sadistic pleasure) and simultaneous anxiety centered on achieving narcissistic compliance with superego/ego-ideal (internal objects) commands (which compliance ultimately provides a sense of ego mastery).
Sincerely,
Gary Freedman
Sunday, February 19, 2012
Musical Nepotism: All in the Family!
Boris and Evelyne Berezovsky, father and daughter, perform the Mozart double piano concerto. Mozart wrote the piece to allow him to play duets with his sister, Maria Anna -- "Nannerl." Of course, when you play with a family member you make certain concessions, certain musical nuances to please one another.
Interview with Boris Berezovsky:
Boris Berezovsky on the piano, performing the Forellen Quintet. Yes, Forellen!!
Interview with Boris Berezovsky:
Boris Berezovsky on the piano, performing the Forellen Quintet. Yes, Forellen!!
Saturday, February 18, 2012
The Culmination of 26 Years of Work!!
Der Ring des Nibelungen ("The Ring of the Nibelung", "The Nibelung's Ring", or simply, "The Ring") consists of four musico-dramatic works. These four works constitute a whole, and were meant to be performed during a single week, something that is seldom done today due to the huge demands on operatic resources.
Wagner spent 26 years (from 1848 to 1874, from the time he was 35 years till he had become 61 years old) writing the text and composing the music for this all-encompassing work. Possibly, no other composer has probed deeper into the human mind than Wagner did here.
Wagner spent 26 years (from 1848 to 1874, from the time he was 35 years till he had become 61 years old) writing the text and composing the music for this all-encompassing work. Possibly, no other composer has probed deeper into the human mind than Wagner did here.
Friday, February 17, 2012
GW Psychiatric Treatment: Letter 9/6/95
September 6, 1995
3801 Connecticut Ave., NW
Washington, DC 20008-4530
D. Georgopoulos, M.D.
GW Univ. Med. Ctr.
Washington, DC 20037
Dear Dr. Georgopoulos:
This communication reviews and discusses issues raised at the consultation on Wednesday, August 20, 1995.
PATIENT'S REPORT:
[The patient reads the text of a letter, dated September 1, 1995, addressed to the U.S. Attorney for the District of Columbia, that summarizes the patient's psychiatric treatment history at the George Washington University Medical Center.
The letter 1/ includes the following summation:
PATIENT:
If we assume as a given that my delusions have been constant, stable and absolutely unchanged since 1988, then you have to assume one of two things—and you are limited, it seems to me, to one of these two things. First, assuming I suffer from bi-polar disorder, you have to assume that my delusions are sometimes mood incongruent: mood swings plus constant ideations means that sometimes the prevailing mood will fit the ideations and at other times the opposite mood will not fit the constant ideations. Or, once again, assuming I am bipolar and assuming constant delusions that are in fact exclusively mood congruent, then you have to assume that my mood has been stable since 1988—that my bipolar disorder involves extraordinarily slow cycling, with my current manic phase having lasted continuously since at least late October 1988.
[In effect, the patient is saying:
mania/depression – fixed delusions = occasional mood incongruent psychotic features (i.e., the fixed delusions might be congruent with either the mania or depression, but not both, or, alternatively,
fixed delusions – mood congruent psychotic features = constant mood (presumably manic) since inception of delusional system in 1988
It is at these particular comments that the psychiatrist seems to become agitated, cuts off the patient and in effect refuses to discuss the patient's reasonable and astute observations regarding an assessment chart that had been carefully reviewed by a staff of psychiatrists at a case assessment conference in September 1992. The patient has, in effect, called into question the conclusions of the Medical Center's psychiatry staff, or “social system,” an act that is, for this psychiatrist, forbidden. (“Everybody has to agree with me, nobody can disagree with me!”)
(It may also be that the abstract and unusual nature of the patient's comments aroused anxiety in the psychiatrist. See Letter to Dr. Georgopoulos, dated June 1, 1995.]
PSYCHIATRIST'S RESPONSE:
Why are you so concerned with what people say about you? We have talked about this before—that you are too concerned with what people say about you. 2/ The assessment chart was done three years ago; it relates to things that were done three years ago. What is said in the chart has nothing to do with your current treatment. When we started I said we would put the chart aside, and give everything a fresh look.
[A brief time later, the psychiatrist—despite having, only moments before, seemingly dispensed with the chart and having admonished the patient to move on and forget the chart—proceeds to retrieve the chart from atop his desk, scan the chart, and read the following comments, and only these comments, relating to the patient's social isolation.]
PSYCHIATRIST:
It says here that you feel people tend to be paranoid about you and trap you in double-binds; we've talked about that here. You feel lonely, isolated and hopeless.
INTERPRETATION:
With stunning regulatory the psychiatrist filters the patient's reports in such a way that the psychiatrist's interpretations repeat again and again, from session to session, the same fundamental theme, or progression, that seems to be of paramount existential concern to him.
As is so typical the psychiatrist initially drains third parties' verbal reaction to the patient of any behavioral or aggressive component. That a previous psychiatrist subjected the patient to unnecessary blood tests for a needless lithium prescription for nonexistent bipolar disorder, as diagnosed by the assessment chart, is irrelevant. That the same previous psychiatrist repeatedly recommended in a coercive manner that the patient take anti-psychotic medication, which may have caused irreversible side effects, for a supposed paranoid illness that involved mere ideations with no significant behavioral or affective component, is irrelevant. The psychiatrist depicts the assessment chart as a collection of benign statements—mere words—rather than a guide, or rationalization for a questionable and needlessly intrusive treatment protocol, which ultimately may have been unconsciously determined by the assessing psychiatrist's defensive reaction to the patient (See attached letters to Dr. Pitts, dated June 4, 1993 and June 20, 1994). For the psychiatrist, others' statements about the patient are seen strictly as a verbal representation of ideas; having been denuded of any behavioral, aggressive, or affective component, the ideas carry no consequences. Whereas the patient's mere ideas at times seem, in some magical fashion for this psychiatrist, to carry a kind of danger as though the patient's ideas were tinged with a supra-ideational potency. A paraphrase of an allegation made by the patient's former employer indicates that this form of magical thinking may be a recurring feature of the patient's interpersonal difficulties: “Claimant's ideas rendered him potentially violent.”
The psychiatrist's statement “Why are you so concerned with what people say about you?” carries a subtext that indicates that the psychiatrist needs to preserve the image of the social system as absolutely non-aggressive, while simultaneously defensively implying that the patient's concerns are rooted in the patient's hypersensitivity or weakness.
The psychiatrist then proceeds, in a progression typical for him, to focus on the patient's social isolation: "It says here that you feel people tend to be paranoid about you and trap you in double-binds; we've talked about that here. 3/ You feel lonely, isolated, and hopeless.”
The psychiatrist's fundamental existential concern may be expressed in the following metaphoric formula, which encapsulates his anxieties with respect to questioning authority, defying the social system, and his fears of consequent social isolation. 4/ Like a priest rebuking a blasphemer, it is as if the psychiatrist were saying to the patient week after week, by means of psychiatric rationalizations:
It is because you question the community of Christ that you are cut off and isolated from the community of Christ, which provides succor and comfort to those who, like myself, do not question. This is why you suffer eternal torment in the form of loneliness, isolation and hopelessness. You question the community, therefore you suffer.
The metaphoric allusion to Christianity is particularly apt and elegant. The psychiatrist's absolute inability to appreciate the effects of defamation, whether in the form of rumors or accusations by peers that the patient is potentially violent or homicidal or, more subtly but no less spuriously, that he suffers from a grave mental illness that can only be remedied chemically – surely a form of psychiatric character assassination--points eerily to a chilling correspondence between the psychiatrist's thought process and the psychology of the anti-Semite. See Letter to Dr. Georgopoulos, dated August 8, 1995, regarding the psychiatrist's inability to cope with the concept of aggressive defamation.
The anti-Semite denies aggression directed at the Jew, and depicts the Jew as the dangerous aggressor (or weak and hypersensitive castrate). Grunberger, B. “The Anti-Semite and the Oedipal Conflict.” Int'l J. of Psychoanalysis 45: 380-385; 381, 384 (1964). So it is that the anti-Semitic message – and throughout the ages aggressive libel has been one of the preferred vehicles of anti-Semitic aggression—is protected, while the object of the libel, the Jew, is cast down by “The Word.” “Why, Jew, do you worry so much what people say about you?”
Why, indeed? Perhaps it is only fitting that the Jews – the so-called “People of the Book” – have, since antiquity, been the only people to have been consistently persecuted by means of a literary genre. “Thus, in 270 B.C. the Egyptian priest Manetho published, in Greek, a 'History of Egypt,' which [one scholar] calls 'the first written anti-Semitic piece to come down to us from antiquity.' It created an influential new genre, full of the most atrocious lies and the most absurd libels that formed the defamatory ideology of Jew hatred that became an idee fixe in the culture of Christendom.” Bernstein, R. “Spanish Model for a Final Solution.” The New York Times, August 23, 1995, p. C16.
PATIENT'S REPORT:
The chart says “rule out schizoaffective disorder.” Have you done that? Have you been able to rule out a schizoaffective disorder in my case?
PSYCHIATRIST'S RESPONSE:
Schizoaffective disorder is a possibility. We could look at that as a possibility. You are socially isolated, so that illness might apply. Also, schizoaffective disorder would include your delusions.''
INTERPRETATION:
Any experienced clinician, knowledgeable in psychiatric nomenclature, would find the psychiatrist's comments regarding the applicability of the diagnosis “schizoaffective disorder” incomprehensible and ludicrous.
It is observed at the outset that the results of psychological testing administered to the patient in May 1994 failed to yield either an Axis I or Axis II diagnosis. Further, the testing, which was deemed valid, failed to reveal any psychotic thought processes. If the patient is schizoaffective, we can therefore add that to the list of illnesses that the patient was able to conceal in the testing, a list that currently includes bipolar disorder, delusional (paranoid) disorder, and (if one assumes the appropriateness of a previous psychiatrist's diagnostic speculation) schizotypal disorder. Given the putative dearth of revealing test responses, one wonders how the patient's test report could amount to anything more than a single blank page!
It should not come as a surprise that of all the symptoms of schizoaffective disorder, the psychiatrist immediately focused once again on the patient's social isolation, coincidentally the one symptom the attribution of which may satisfy the psychiatrist's own projective need, namely, his own concerns regarding fear of social isolation. See Letter to Dr. Georgopoulos, dated July 26, 1995, discussing the psychiatrist's apparently defensive misattribution to the patient that the patient had complained of being isolated by coworkers at a previous place of employment, when in fact the patient had not been socially isolated.
An experienced clinician would observe that the patient's social isolation, unlike that of the patent suffering from schizoaffective disorder, does not stem from a pathologically-impoverished social sense. This patient, though isolated, is unusually socially sensitive, open to social interaction, has been characterized by peers and employers as “charismatic” or “inspiring,” possesses a keen sensitivity to verbal and nonverbal communication, does not experience debilitating social anxiety, and, oddly, maintains enduring and stable positive social feelings for persons from the past whom he has not seen in years. Indeed, a federal law enforcement agent told the patient in December 1994: “I don't understand why you are so socially isolated. You seem like a friendly guy.” (Apparently, the psychiatrist has blocked out any recollection of the agent's comments and the diagnostic significance of the patient's interaction with an unfamiliar person—in a stressful milieu, no less. See Letter to Dr. Georgopoulos, dated July 17, 1995, regarding the psychiatrist's inability to integrate the patient's experience with the Secret Service agent into the psychiatrist's overall concept of the patient.)
Applying the psychiatrist's simplistic rule of construction, namely, the interpretation “You are socially isolated, therefore possibly schizoaffective,” to a prison environment, we would have to conclude that a prisoner placed in isolation is a candidate for the diagnosis schizoaffective disorder,” regardless of demonstrated social interest or social sensitivity, simply because he is socially isolated. 5/ One is reminded of an aphorism of Nietzsche's: “Terrible experiences pose the riddle whether the person who has them is not terrible.”
The psychiatrist's statement “schizoaffective disorder would include your delusions” is manifestly incorrect, and raises a serious concern about the psychiatrist's knowledge of psychiatric nomenclature. A sine qua non of schizoaffective disorder is the existence of an accompanying major mood disorder. As discussed above, if we assume that the patient's delusions--which have been fixed and stable since October 1988--are a product of mania, we must conclude that the patient is now in the seventh year of an uninterrupted major manic episode!
So ridiculous is the psychiatrist's interpretation that one suspects that we are once again confronting the psychiatrist's desperate need to bolster the conclusions of a peer (a member of the social system) no matter how inconsistent with psychiatrist's personal experience with, and current knowledge of, the patient. And again, as is so often the case in the patient's interpersonal relations generally, the patient's identity is held hostage to the psychiatrist's fear of rejection the identity conferred on the patient by a third party, here, the assessing psychiatrist.
Further, the psychiatrist's act of bolstering what is now an obviously inapplicable differential diagnosis offered in the assessment chart (that the patient may suffer from schizoaffective disorder) demonstrates the hypocritical and purely defensive nature 6/ of the psychiatrist's earlier admonition to the patient: “Why are you so concerned with what people say about you? We have talked about this before--that you are too concerned with what people say about you. The assessment was done three years ago; it relates to things that were done three years ago. What is said in the chart has nothing to do with your current treatment. When we started I said we would put the chart aside and give everything a fresh look.”
_____________________
1/ The letter's central concern is inconsistencies in the treatment during the period 1992-1994, and reflects the patient's need to confer order on the contradictory and confusing attributions made about him by others. The patient's concern—a need to harmonize his experiences—became lost, as so often happens with the patient's concerns, in the psychiatrist's defensive response, which masked an internal and unacknowledged struggle over the psychiatrist's own conflicts and prohibitions. See Letter to Dr. Georgopoulos, dated July 17, 1995, discussing the psychiatrist's defensively tangential response to another of the patient's reports.
2/ The psychiatrist is here referring to his comment offered at the August 7, 1995 session in reaction to the patient's request that the therapist prepare a written statement certifying that the patient does not pose a risk of violence, as alleged by his former employer: “It's not important what I (or others) think. All that's important is what you think. All that's important is that you think you are not violent.” See Letter to Dr. Georgopoulos, dated August 8, 1995. The psychiatrist seems to appreciate intuitively some linkage between, on the one hand, statements made by the assessing psychiatrist in the deceptively-benign assessment chart, and, on the other, accusations by peers that the patient is potentially violent, which is uncanny in view of the Letter to Dr. Pitts, dated June 4, 1993 (attached), regarding the possible latent aggressive nature of the misdiagnosis bipolar disorder,
3/ Actually, the psychiatrist has done more than talk about double-binds. He has, on occasion, created them. See Letter to Dr. Georgopoulos, dated August 8, 1995: "Thus, the psychiatrist has created a curious double-bind. In complaining about others' defamatory accusations the patient will tend to face one of two consequences. Either the patient's report that he has been defamed will be interpreted as a paranoid perception or, if the report is accepted as accurate, the patient's reasonable concerns about the defamation will be cited as evidence of the patient's emotional dependency, weakness, and poorly developed sense of self (not merely coincidentally, attributes typically associated with homosexuals).”
4/ See Letter to Dr. Georgopoulos, dated July 26, 1995, n. 2, regarding the psychiatrist's object anxiety.
5/ I suspect that there is something significant and paradigmatic in the psychiatrist's action, in this one instance, of defining a person's intrinsic nature by reference to his manifest status or condition without regard to an examination of the individual's intrinsic qualities.
6/ The psychiatrist's consideration of the diagnosis schizoaffective disorder seems at odds with his attribution to the patient at a prior consultation, “You want to be liked by everybody, you want to be a member of the 'in-group.'” Schizoaffective disorder is typically characterized by a lack of social interest, not an overweening need for social acceptance.
Attachments:
(A.) Letter to Suzanne M. Pitts, M.D., June 4, 1993
(B.) Letter to Suzanne M. Pitts, M.D., June 20, 1994
3801 Connecticut Ave., NW
Washington, DC 20008-4530
D. Georgopoulos, M.D.
GW Univ. Med. Ctr.
Washington, DC 20037
Dear Dr. Georgopoulos:
This communication reviews and discusses issues raised at the consultation on Wednesday, August 20, 1995.
PATIENT'S REPORT:
[The patient reads the text of a letter, dated September 1, 1995, addressed to the U.S. Attorney for the District of Columbia, that summarizes the patient's psychiatric treatment history at the George Washington University Medical Center.
The letter 1/ includes the following summation:
Pt. presented in September 1992 with symptoms that fulfilled the criteria of a major affective disorder: bipolar disorder NOS (DSM-III-R 296.70) with mood congruent psychotic features, including “paranoid ideations which occasionally bordered on a delusional level.” Pt.'s manic-depressive symptoms, including unstable mood, pressured and rapid speech, flight of ideas, and looseness of associations, significantly affected his functioning in a pervasive manner. Medical therapy (lithium) was initiated in February 1993, 12 weeks (3 months) following commencement of out-patient care (on October 26, 1992), and continued during the period February 9, 1993 until about February 26, 1993, when pt. refused to continue the medication. Pt.'s delusional system was deemed largely irrelevant by his assessing and treating psychiatrists and his attempts to discuss his delusional system were dismissed by his treating psychiatrist as a “power play.” In August 1993, pt. filed a complaint against his psychiatrist with the D.C. Board of Medicine, at which time pt.'s paranoia, formerly deemed occasionally delusional, was termed “crippling” by the psychiatry department chairman. Within days of the Pt.'s filing the complaint, the treating psychiatrist recommended a course of the anti-psychotic Haldol. In May 1984 pt. was administered a battery of standard psychological tests, which failed to yield either an Axis I or Axis II diagnosis, including either bi-polar disorder (DSM-III-R 296.70) or delusional (paranoid) disorder (DSM-III-R 297.10). Pt. was not administered any tests specifically designed to assess psychosis or paranoia, such as the Wisconsin Scales of Psychosis Proneness. Pt. lied on the tests in order to conceal the nature and severity of his delusional (paranoid) disorder (DSM-III-R 297.10). The test report does not state that pt. lied to conceal the nature and severity of bi-polar disorder (DSM-III-R 296.70), the symptoms of which illness were determined by the assessing psychiatrist, in September 1992, to “have been significantly affecting his functioning in a pervasive manner.”The patient proceeds to discuss, at the consultation on August 30, 1995, inconsistencies in his psychiatric treatment history and infirmities in his assessment chart. The psychiatrist is silent throughout the reading of the letter and the patient's subsequent discussion. The patient begins to focus on a particular statement in the chart that characterizes the patient's symptoms as mood congruent psychotic features.]
PATIENT:
If we assume as a given that my delusions have been constant, stable and absolutely unchanged since 1988, then you have to assume one of two things—and you are limited, it seems to me, to one of these two things. First, assuming I suffer from bi-polar disorder, you have to assume that my delusions are sometimes mood incongruent: mood swings plus constant ideations means that sometimes the prevailing mood will fit the ideations and at other times the opposite mood will not fit the constant ideations. Or, once again, assuming I am bipolar and assuming constant delusions that are in fact exclusively mood congruent, then you have to assume that my mood has been stable since 1988—that my bipolar disorder involves extraordinarily slow cycling, with my current manic phase having lasted continuously since at least late October 1988.
[In effect, the patient is saying:
mania/depression – fixed delusions = occasional mood incongruent psychotic features (i.e., the fixed delusions might be congruent with either the mania or depression, but not both, or, alternatively,
fixed delusions – mood congruent psychotic features = constant mood (presumably manic) since inception of delusional system in 1988
It is at these particular comments that the psychiatrist seems to become agitated, cuts off the patient and in effect refuses to discuss the patient's reasonable and astute observations regarding an assessment chart that had been carefully reviewed by a staff of psychiatrists at a case assessment conference in September 1992. The patient has, in effect, called into question the conclusions of the Medical Center's psychiatry staff, or “social system,” an act that is, for this psychiatrist, forbidden. (“Everybody has to agree with me, nobody can disagree with me!”)
(It may also be that the abstract and unusual nature of the patient's comments aroused anxiety in the psychiatrist. See Letter to Dr. Georgopoulos, dated June 1, 1995.]
PSYCHIATRIST'S RESPONSE:
Why are you so concerned with what people say about you? We have talked about this before—that you are too concerned with what people say about you. 2/ The assessment chart was done three years ago; it relates to things that were done three years ago. What is said in the chart has nothing to do with your current treatment. When we started I said we would put the chart aside, and give everything a fresh look.
[A brief time later, the psychiatrist—despite having, only moments before, seemingly dispensed with the chart and having admonished the patient to move on and forget the chart—proceeds to retrieve the chart from atop his desk, scan the chart, and read the following comments, and only these comments, relating to the patient's social isolation.]
PSYCHIATRIST:
It says here that you feel people tend to be paranoid about you and trap you in double-binds; we've talked about that here. You feel lonely, isolated and hopeless.
INTERPRETATION:
With stunning regulatory the psychiatrist filters the patient's reports in such a way that the psychiatrist's interpretations repeat again and again, from session to session, the same fundamental theme, or progression, that seems to be of paramount existential concern to him.
As is so typical the psychiatrist initially drains third parties' verbal reaction to the patient of any behavioral or aggressive component. That a previous psychiatrist subjected the patient to unnecessary blood tests for a needless lithium prescription for nonexistent bipolar disorder, as diagnosed by the assessment chart, is irrelevant. That the same previous psychiatrist repeatedly recommended in a coercive manner that the patient take anti-psychotic medication, which may have caused irreversible side effects, for a supposed paranoid illness that involved mere ideations with no significant behavioral or affective component, is irrelevant. The psychiatrist depicts the assessment chart as a collection of benign statements—mere words—rather than a guide, or rationalization for a questionable and needlessly intrusive treatment protocol, which ultimately may have been unconsciously determined by the assessing psychiatrist's defensive reaction to the patient (See attached letters to Dr. Pitts, dated June 4, 1993 and June 20, 1994). For the psychiatrist, others' statements about the patient are seen strictly as a verbal representation of ideas; having been denuded of any behavioral, aggressive, or affective component, the ideas carry no consequences. Whereas the patient's mere ideas at times seem, in some magical fashion for this psychiatrist, to carry a kind of danger as though the patient's ideas were tinged with a supra-ideational potency. A paraphrase of an allegation made by the patient's former employer indicates that this form of magical thinking may be a recurring feature of the patient's interpersonal difficulties: “Claimant's ideas rendered him potentially violent.”
The psychiatrist's statement “Why are you so concerned with what people say about you?” carries a subtext that indicates that the psychiatrist needs to preserve the image of the social system as absolutely non-aggressive, while simultaneously defensively implying that the patient's concerns are rooted in the patient's hypersensitivity or weakness.
The psychiatrist then proceeds, in a progression typical for him, to focus on the patient's social isolation: "It says here that you feel people tend to be paranoid about you and trap you in double-binds; we've talked about that here. 3/ You feel lonely, isolated, and hopeless.”
The psychiatrist's fundamental existential concern may be expressed in the following metaphoric formula, which encapsulates his anxieties with respect to questioning authority, defying the social system, and his fears of consequent social isolation. 4/ Like a priest rebuking a blasphemer, it is as if the psychiatrist were saying to the patient week after week, by means of psychiatric rationalizations:
It is because you question the community of Christ that you are cut off and isolated from the community of Christ, which provides succor and comfort to those who, like myself, do not question. This is why you suffer eternal torment in the form of loneliness, isolation and hopelessness. You question the community, therefore you suffer.
The metaphoric allusion to Christianity is particularly apt and elegant. The psychiatrist's absolute inability to appreciate the effects of defamation, whether in the form of rumors or accusations by peers that the patient is potentially violent or homicidal or, more subtly but no less spuriously, that he suffers from a grave mental illness that can only be remedied chemically – surely a form of psychiatric character assassination--points eerily to a chilling correspondence between the psychiatrist's thought process and the psychology of the anti-Semite. See Letter to Dr. Georgopoulos, dated August 8, 1995, regarding the psychiatrist's inability to cope with the concept of aggressive defamation.
The anti-Semite denies aggression directed at the Jew, and depicts the Jew as the dangerous aggressor (or weak and hypersensitive castrate). Grunberger, B. “The Anti-Semite and the Oedipal Conflict.” Int'l J. of Psychoanalysis 45: 380-385; 381, 384 (1964). So it is that the anti-Semitic message – and throughout the ages aggressive libel has been one of the preferred vehicles of anti-Semitic aggression—is protected, while the object of the libel, the Jew, is cast down by “The Word.” “Why, Jew, do you worry so much what people say about you?”
Why, indeed? Perhaps it is only fitting that the Jews – the so-called “People of the Book” – have, since antiquity, been the only people to have been consistently persecuted by means of a literary genre. “Thus, in 270 B.C. the Egyptian priest Manetho published, in Greek, a 'History of Egypt,' which [one scholar] calls 'the first written anti-Semitic piece to come down to us from antiquity.' It created an influential new genre, full of the most atrocious lies and the most absurd libels that formed the defamatory ideology of Jew hatred that became an idee fixe in the culture of Christendom.” Bernstein, R. “Spanish Model for a Final Solution.” The New York Times, August 23, 1995, p. C16.
PATIENT'S REPORT:
The chart says “rule out schizoaffective disorder.” Have you done that? Have you been able to rule out a schizoaffective disorder in my case?
PSYCHIATRIST'S RESPONSE:
Schizoaffective disorder is a possibility. We could look at that as a possibility. You are socially isolated, so that illness might apply. Also, schizoaffective disorder would include your delusions.''
INTERPRETATION:
Any experienced clinician, knowledgeable in psychiatric nomenclature, would find the psychiatrist's comments regarding the applicability of the diagnosis “schizoaffective disorder” incomprehensible and ludicrous.
It is observed at the outset that the results of psychological testing administered to the patient in May 1994 failed to yield either an Axis I or Axis II diagnosis. Further, the testing, which was deemed valid, failed to reveal any psychotic thought processes. If the patient is schizoaffective, we can therefore add that to the list of illnesses that the patient was able to conceal in the testing, a list that currently includes bipolar disorder, delusional (paranoid) disorder, and (if one assumes the appropriateness of a previous psychiatrist's diagnostic speculation) schizotypal disorder. Given the putative dearth of revealing test responses, one wonders how the patient's test report could amount to anything more than a single blank page!
It should not come as a surprise that of all the symptoms of schizoaffective disorder, the psychiatrist immediately focused once again on the patient's social isolation, coincidentally the one symptom the attribution of which may satisfy the psychiatrist's own projective need, namely, his own concerns regarding fear of social isolation. See Letter to Dr. Georgopoulos, dated July 26, 1995, discussing the psychiatrist's apparently defensive misattribution to the patient that the patient had complained of being isolated by coworkers at a previous place of employment, when in fact the patient had not been socially isolated.
An experienced clinician would observe that the patient's social isolation, unlike that of the patent suffering from schizoaffective disorder, does not stem from a pathologically-impoverished social sense. This patient, though isolated, is unusually socially sensitive, open to social interaction, has been characterized by peers and employers as “charismatic” or “inspiring,” possesses a keen sensitivity to verbal and nonverbal communication, does not experience debilitating social anxiety, and, oddly, maintains enduring and stable positive social feelings for persons from the past whom he has not seen in years. Indeed, a federal law enforcement agent told the patient in December 1994: “I don't understand why you are so socially isolated. You seem like a friendly guy.” (Apparently, the psychiatrist has blocked out any recollection of the agent's comments and the diagnostic significance of the patient's interaction with an unfamiliar person—in a stressful milieu, no less. See Letter to Dr. Georgopoulos, dated July 17, 1995, regarding the psychiatrist's inability to integrate the patient's experience with the Secret Service agent into the psychiatrist's overall concept of the patient.)
Applying the psychiatrist's simplistic rule of construction, namely, the interpretation “You are socially isolated, therefore possibly schizoaffective,” to a prison environment, we would have to conclude that a prisoner placed in isolation is a candidate for the diagnosis schizoaffective disorder,” regardless of demonstrated social interest or social sensitivity, simply because he is socially isolated. 5/ One is reminded of an aphorism of Nietzsche's: “Terrible experiences pose the riddle whether the person who has them is not terrible.”
The psychiatrist's statement “schizoaffective disorder would include your delusions” is manifestly incorrect, and raises a serious concern about the psychiatrist's knowledge of psychiatric nomenclature. A sine qua non of schizoaffective disorder is the existence of an accompanying major mood disorder. As discussed above, if we assume that the patient's delusions--which have been fixed and stable since October 1988--are a product of mania, we must conclude that the patient is now in the seventh year of an uninterrupted major manic episode!
So ridiculous is the psychiatrist's interpretation that one suspects that we are once again confronting the psychiatrist's desperate need to bolster the conclusions of a peer (a member of the social system) no matter how inconsistent with psychiatrist's personal experience with, and current knowledge of, the patient. And again, as is so often the case in the patient's interpersonal relations generally, the patient's identity is held hostage to the psychiatrist's fear of rejection the identity conferred on the patient by a third party, here, the assessing psychiatrist.
Further, the psychiatrist's act of bolstering what is now an obviously inapplicable differential diagnosis offered in the assessment chart (that the patient may suffer from schizoaffective disorder) demonstrates the hypocritical and purely defensive nature 6/ of the psychiatrist's earlier admonition to the patient: “Why are you so concerned with what people say about you? We have talked about this before--that you are too concerned with what people say about you. The assessment was done three years ago; it relates to things that were done three years ago. What is said in the chart has nothing to do with your current treatment. When we started I said we would put the chart aside and give everything a fresh look.”
_____________________
1/ The letter's central concern is inconsistencies in the treatment during the period 1992-1994, and reflects the patient's need to confer order on the contradictory and confusing attributions made about him by others. The patient's concern—a need to harmonize his experiences—became lost, as so often happens with the patient's concerns, in the psychiatrist's defensive response, which masked an internal and unacknowledged struggle over the psychiatrist's own conflicts and prohibitions. See Letter to Dr. Georgopoulos, dated July 17, 1995, discussing the psychiatrist's defensively tangential response to another of the patient's reports.
2/ The psychiatrist is here referring to his comment offered at the August 7, 1995 session in reaction to the patient's request that the therapist prepare a written statement certifying that the patient does not pose a risk of violence, as alleged by his former employer: “It's not important what I (or others) think. All that's important is what you think. All that's important is that you think you are not violent.” See Letter to Dr. Georgopoulos, dated August 8, 1995. The psychiatrist seems to appreciate intuitively some linkage between, on the one hand, statements made by the assessing psychiatrist in the deceptively-benign assessment chart, and, on the other, accusations by peers that the patient is potentially violent, which is uncanny in view of the Letter to Dr. Pitts, dated June 4, 1993 (attached), regarding the possible latent aggressive nature of the misdiagnosis bipolar disorder,
3/ Actually, the psychiatrist has done more than talk about double-binds. He has, on occasion, created them. See Letter to Dr. Georgopoulos, dated August 8, 1995: "Thus, the psychiatrist has created a curious double-bind. In complaining about others' defamatory accusations the patient will tend to face one of two consequences. Either the patient's report that he has been defamed will be interpreted as a paranoid perception or, if the report is accepted as accurate, the patient's reasonable concerns about the defamation will be cited as evidence of the patient's emotional dependency, weakness, and poorly developed sense of self (not merely coincidentally, attributes typically associated with homosexuals).”
4/ See Letter to Dr. Georgopoulos, dated July 26, 1995, n. 2, regarding the psychiatrist's object anxiety.
5/ I suspect that there is something significant and paradigmatic in the psychiatrist's action, in this one instance, of defining a person's intrinsic nature by reference to his manifest status or condition without regard to an examination of the individual's intrinsic qualities.
6/ The psychiatrist's consideration of the diagnosis schizoaffective disorder seems at odds with his attribution to the patient at a prior consultation, “You want to be liked by everybody, you want to be a member of the 'in-group.'” Schizoaffective disorder is typically characterized by a lack of social interest, not an overweening need for social acceptance.
Attachments:
(A.) Letter to Suzanne M. Pitts, M.D., June 4, 1993
(B.) Letter to Suzanne M. Pitts, M.D., June 20, 1994
Strauss Was Alone in his Praise: Even the Best Viennese Wanted to have him Certified Insane!
Performance in Berlin
In the middle of December 1901 Mahler went to the performance of the Fourth Symphony in Berlin, where he conducted all the rehearsals, as well as the concert, with the Strauss Orchestra. Fortunately, he was well satisfied with these players. The reception was warmer and more understanding than in Munich, though there was still some opposition. The greatest impression was made by the Adagio; but this time, the last movement, usually brilliantly successful, was less well received -- possibly because the singer was not equal to it. Richard Strauss, who felt closer to the work at each successive rehearsal, was finally swept off his feet by it, especially by the third movement. He declared that he could never write such an Adagio. They met afterwards at a rather large gathering, and he told Mahler that he had learnt a tremendous amount from him. 'I have studied your Second Symphony particularly thoroughly, and have appropriated a good deal from it for my own use.' As a sign of his high esteem, Strauss later sent him the scores of all his works.
But the Berlin critics, to a man, fell hysterically upon Mahler and his work, heaping their filthy abuse, mockery and scorn upon him and with less restraint than ever before. This embittered him profoundly.
Performance in Vienna
On 12 January 1902, Mahler conducted his Fourth at the Philharmonic concert in Vienna, in an admirable performance.
Its reception was about the same as that in Munich, if not worse (if that were possible), because of the conservative audience that attends these concerts. From the very beginning the most uncomprehending and hostile remarks were heard; it even seemed as if people had come only in order to make fun of the work. They even laughed out loud, showing their disapproval in their looks and behaviour. Afterwards they stood about in groups chattering. I heard some say: 'It starts just as if he were out to play a carnival joke on the public.' Others were disappointed that there had not been more hissing. A few callow youths found it 'ghastly', and not music at all.
Mahler, who was used to worse fiascoes, seemed depressed by this one. He said to Bruno Walter: 'They don't really know what to do with this one: which end should they start gobbling it up from?'
Walter, however, when I was with him and his wife afterwards, said: 'Why is it that even the best of them apply only their yardstick, consider only their verdict, refusing to understand that the sun does not revolve around the earth, but the earth around the sun!'
http://www.pep-web.org/document.php?id=ijp.053.0301a
In the middle of December 1901 Mahler went to the performance of the Fourth Symphony in Berlin, where he conducted all the rehearsals, as well as the concert, with the Strauss Orchestra. Fortunately, he was well satisfied with these players. The reception was warmer and more understanding than in Munich, though there was still some opposition. The greatest impression was made by the Adagio; but this time, the last movement, usually brilliantly successful, was less well received -- possibly because the singer was not equal to it. Richard Strauss, who felt closer to the work at each successive rehearsal, was finally swept off his feet by it, especially by the third movement. He declared that he could never write such an Adagio. They met afterwards at a rather large gathering, and he told Mahler that he had learnt a tremendous amount from him. 'I have studied your Second Symphony particularly thoroughly, and have appropriated a good deal from it for my own use.' As a sign of his high esteem, Strauss later sent him the scores of all his works.
But the Berlin critics, to a man, fell hysterically upon Mahler and his work, heaping their filthy abuse, mockery and scorn upon him and with less restraint than ever before. This embittered him profoundly.
Performance in Vienna
On 12 January 1902, Mahler conducted his Fourth at the Philharmonic concert in Vienna, in an admirable performance.
Its reception was about the same as that in Munich, if not worse (if that were possible), because of the conservative audience that attends these concerts. From the very beginning the most uncomprehending and hostile remarks were heard; it even seemed as if people had come only in order to make fun of the work. They even laughed out loud, showing their disapproval in their looks and behaviour. Afterwards they stood about in groups chattering. I heard some say: 'It starts just as if he were out to play a carnival joke on the public.' Others were disappointed that there had not been more hissing. A few callow youths found it 'ghastly', and not music at all.
Mahler, who was used to worse fiascoes, seemed depressed by this one. He said to Bruno Walter: 'They don't really know what to do with this one: which end should they start gobbling it up from?'
Walter, however, when I was with him and his wife afterwards, said: 'Why is it that even the best of them apply only their yardstick, consider only their verdict, refusing to understand that the sun does not revolve around the earth, but the earth around the sun!'
Fourth Symphony
http://www.pep-web.org/document.php?id=ijp.053.0301a
Thursday, February 16, 2012
GW Psychiatric Treatment: 8/21/95
TO: Dr. Georgopoulos
FROM: Gary Freedman
DATE: August 21, 1995
RE: Fictional Psychiatric Assessment
I have created a fictional narrative, such as might be offered by a patient at a psychiatric assessment. The narrative is based exclusively on my experiences, and is supported by documentary evidence in addition to normative facts drawn from the literature. Remarkably, despite the purely factual basis of the narrative, it is suggestive of a severely grandiose persecutory personality.
____________________
Why I'm not practicing law? I don't know. I think if I were interviewed by an attorney for a position, there's a possibility he wouldn't even know what I was talking about. My ideas are so different, the way I see things, the way I analyze things. I really believe an attorney interviewing me might not know what I was talking about. See Attachment A.
He'd probably think I was crazy. If I was talking to a hiring partner at one of those big-time law firms, I'd probably make him so uncomfortable, he'd think I was crazy. See Attachment P.
People are always making things up about me. Things like I'm crazy paranoid. People make up stories that I'm paranoid. They will actually fabricate evidence that I'm paranoid. See Attachment B.
Now, my interpersonal problems. There's a lot of jealousy there. I have the feeling that in different environments that I always have to cope with rumors. People spreading rumors about me because they're so jealous. See Attachment C.
The rumors are always sexual. You know, I'm homosexual. I'm gay. I'm steeped in gayness. Things along that line. Related things. Like I'm in love with this person or that person. Always rumors about my lustful involvement with people. See Attachment D.
I think people idealize me to a certain extent. It's as if they think I'm this mythical person. Larger than life. In a way people look up to me. But at the same time they think I'm unapproachable, because they have this fantastic view of who I am. See Attachment E.
I know a lot about people. It's almost as if I could read minds. I really think I can tell what other people are thinking and feeling when I'm around them. See Attachment F.
I'm very sensitive to hidden cues, I pick up on all kinds of implicit messages. Like I have these antennae, no, no. Radar. Its like I have this radar I can pick up things that nobody else sees. See Attachment G.
I was a victim of this incredible harassment at the last place I worked. It was a large law firm. The harassment. . . My impression of it was based on these subtle cues I pick up. The whole think was very subtle. It would take an expert to figure out what was going on in that place. See Attachment H.
Now, examples? Evidence? I could tell you things. But, again, like I say. You'd think I was crazy if I told you the things. Nobody else would think these are harassing things. But I knew what was going on. Nobody was going to tell me I didn't know. Because I knew. Like I say, I have this radar. It cues me in. Another thing. I can see patterns whereas other people just see random events. See Attachment I.
Like the time my supervisor was talking to another employee and asked if she was wet. You think I didn't know what she meant? These double entendres, you know. Wet. Come on, wet? You think I'm stupid? See Attachment I; See also Attachment J.
Or the time my supervisor offered me a piece of candy, chocolate. Again it was obvious. At least to me, it was obvious. See Attachment I; See also Attachment K.
Of course, I knew what she meant. Or the time I found a baby food jar in the trash can. I was on to the games she played. Can't you see it? I was being harassed. Sexual harassment. See Attachment I; See also Attachment L.
That racist bitch. What she put me through! See Attachment M.
People are scared to death of me. I mean, literally, scarred to death. They think I'm going to get a gun and go on a wild shooting spree. See Attachment N.
They think I'm this crazy person,paranoid, full of rage. See Attachment O.
It's hard for me to deal with people. They're all afraid of me. Did you ever try to dealing with people who were all afraid of you? It's really hard. See Attachment P.
Nobody would have anything to do with me where I was working. They shunned me. They all shunned me. They kept me isolated. I wanted to interact with people. But they kept me isolated. See Attachment Q.
I wanted to move on, you know, advancement, promotion. But they kept me doing this job that was way below my qualifications. I asked for a promotion. Then couple of days later, they fired me. Right after I asked for a the promotion, they fired me. See Attachment R.
If you ask me, the whole thing was unfair. I think they demoted me. They said they were transferring me, back in 1990, March of 1990. They called it a transfer. But if you ask me, it was a demotion. See Attachment S.
And, really, I was close to the perfect employee as it's possible to get. Perfect employee. Near total perfection. See Attachment T.
I was seeing a psychiatrist. Lots of psychiatrists. They were all in communication with my employer. Again. Subtle cues. It's that radar I have. It cues me in. Can you imagine You can't find a single psychiatrist or psychologist who doesn't report everything back to your employer. See Attachment U.
You give me tests, psychological tests, psychiatric tests, whatever. I guarantee, you won't find a thing wrong with me. Not a thing. See Medical Records, George Washington University Medical Center, Results of Psychological Testing performed in May 1994.
I can guarantee you something, though. They'll say I lied. They'll say I lied on the tests. Like, you know, “this guy's gotta be nuts or something.” See Medical Records, George Washington University Medical Center, Results of Psychological Testing performed in May 1994.
Happy 16th!! "Send in the Next Jewish Concert Pianist!!"
Natan Brand (1944–1990) was an Israeli classical pianist.
Brand was the son of a doctor, Aron Brand, and his wife, Mala, who immigrated to Mandate Palestine in 1939. The family settled in Jerusalem. Brand began his studies as a child prodigy at the age of seven, with Haim Alexander at the Rubin Academy, where he later received an Artist's and Teacher's diploma. He made his orchestral debut at the age of 11, playing with the Israel Broadcasting Authority Symphony Orchestra.
Brand married Lori Hillman, with whom he had two sons, Jesse and Ari. He died in 1990 at the age of 46.
Geoffrey Dorfman: "... Brand ... was one of the few keyboard artists — perhaps the last — in the true tradition of Anton Rubinstein: a pianist who played in the Grand Style, fully free to interpret the masterworks as the spirit moved him, with a magnificent technique at his command. His premature death at the age of 46 robbed the music world of a man who was considered by many connoisseurs to be potentially one of the world’s greatest pianists. That he was not so recognized was due to his mercurial temperament (which did him little good in the world of concerts and bookings) and his early death."
Brand was the son of a doctor, Aron Brand, and his wife, Mala, who immigrated to Mandate Palestine in 1939. The family settled in Jerusalem. Brand began his studies as a child prodigy at the age of seven, with Haim Alexander at the Rubin Academy, where he later received an Artist's and Teacher's diploma. He made his orchestral debut at the age of 11, playing with the Israel Broadcasting Authority Symphony Orchestra.
Brand married Lori Hillman, with whom he had two sons, Jesse and Ari. He died in 1990 at the age of 46.
Geoffrey Dorfman: "... Brand ... was one of the few keyboard artists — perhaps the last — in the true tradition of Anton Rubinstein: a pianist who played in the Grand Style, fully free to interpret the masterworks as the spirit moved him, with a magnificent technique at his command. His premature death at the age of 46 robbed the music world of a man who was considered by many connoisseurs to be potentially one of the world’s greatest pianists. That he was not so recognized was due to his mercurial temperament (which did him little good in the world of concerts and bookings) and his early death."
Wednesday, February 15, 2012
For the Chapter: Oh, Really?
An array of state and federal anti-discrimination, privacy, and defamation laws limit the things employers can do to screen and/or terminate potentially violent applicants and employees.
GW Psychiatric Treatment: Letter 8/8/95
August 8, 1995
3801 Connecticut Ave., NW
#136
Washington, DC 20008-4530
D. Georgopoulos, M.D.
Dept. Psychiatry
GW Univ. Med. Ctr.
Washington, DC 20037
Dear Dr. Georgopoulos:
This letter comments on an interpretation that you offered at my consultation on Monday August 7, 1995.
PATIENT'S REPORT:
How are you able to certify that I am not potentially violent? I could be a psychopath. If I were a psychopath I might have committed crimes, but I would be very adept at concealing my propensity for violence. How can you say that I am not potentially violent? Have you ruled out the possibility that I am a psychopath?
PSYCHIATRIST'S INTERPRETATION:
It's not important what I (or others) think. All that's important is what you think. All that's important is that you think you are not violent.
PATIENT'S RESPONSE:
What I think is not the only issue. I can think I am not violent, but will I get my job back?
PSYCHIATRIST'S RESPONSE:
[silence].
ASSESSMENT:
Interpersonal Mutuality Versus Dependence
The psychiatrist transforms an issue of mutuality as between the patient and persons in his environment into an issue of the patient's dependence. Rumors or accusations that the patient is potentially violent are manifestations of a defensive reaction to the patient. The rumors or accusations involve others' defensive reaction of fear and jealousy and are a form of retaliatory aggression, which have had severe consequences for the patient. In the psychiatrist's interpretation the patient's report or concern relates solely to the patient's dependency needs and poorly developed sense of self. In the psychiatrist's view the patient's report or concern indicates the need of the psychiatrist to engage in supportive reassurance aimed at strengthening the patient's sense of self, independent of the psychiatrist's or others' possible view of him.
The psychiatrist's interpretation seems consistent with a world-view that holds that however other persons react to the patient is simply a willy-nilly happenstance, never the product of an unconsciously-determined, defensive reaction by others that involves mutuality between the patient's ego resources and the ego resources of the patient's peers. A corollary of such a world-view is that it can only be evidence of the patient's emotional dependence or paranoia that the patient attributes any meaning to others' view of him.
The essential psychotherapeutic dynamic expressed here, namely, the psychiatrist's transformation of an issue of mutuality into an issue relating to the patient's poor sense of self and dependence echoes throughout the psychiatrist's interpretations. A variation on this essential theme is discussed in the letter to Dr. Georgopoulos, dated June 1, 1995.
The final paragraph is of special relevance. The psychiatrist's statement on August 7, 1995 “It's not what I (or others) think about your potential for violence that is important, it is what you think that is important” once again shows the psychiatrist transforming the patient's concerns regarding peers' aggression into an issue of the patient's hypersensitivity and weakness.PATIENT'S REPORT:
I react so differently to stimuli than others. When I was in kindergarten all the other students participated in a class project, and I was the only student who declined to participate. I am troubled by this. I think: “How can a psychiatrist ever understand me if so many aspects of my personality are different from the personalities of the psychiatrist's other patients? What clinical experiences does the psychiatrist have to compare me with?”
PSYCHIATRIST'S INTERPRETATION:
It sounds like you have a need to be understood. What you seem to be describing is that you have a poor sense of identity, and a need to stand out—a need to do things differently so that you can assert an individual identity.
POSSIBLE DEFENSIVE ASPECTS OF PSYCHIATRIST'S INTERPRETATION:
DENIAL/(ANAL SADISM?)
The psychiatrist denies his own failure of empathy and lack of intellectual understanding of the patient, and places the burden of understanding exclusively on the patient's shoulders; in effect, the psychiatrist is saying “the fact I don't understand you is not my problem, the problem is that you have a need to be understood.”
A psychiatrist should respond affirmatively to the patient's need for identity confirmation, and should not interpret the patient's need for identity confirmation as an unreasonable demand on the psychiatrist or as a manifestation of psychopathology. Brenman-Gibson, discussing the importance of identity confirmation in adolescence, states: “According to Erikson, ' . . . it is of great relevance to the young individual's identity formation that he be responded to and be given function and status as a person whose gradual growth and transformation make sense to those who begin to make sense to him. . . . Such recognition provides an entirely indispensable support to the ego in the specific tasks of adolescing.'” Brenman-Gibson, M. Clifford Odets, at 631 n. 4.7 (New York: Atheneum, 1982), quoting Identity and the Life Cycle. Erikson's comments seem equally applicable to the psychotherapeutic relationship, and the salutary need of the patient for identity confirmation and the affirmative duty of the therapist to understand the patient and to communicate the fact that he does understand the patient.
There is a disquieting parallel between the psychiatrist's shifting of the burden onto the patient 1/ and the behavior of the sadistic bully who denies his own aggression and attributes his victim's complaint to the victim's hypersensitivity and weakness.
Denial of Aggressive Element in Defamation – Ego Differentiation
In the psychiatrist's interpretation, the defamatory statements of the patients's peers are denuded of any aggressive or destructive component. When the psychiatrist was confronted with the aggressive component or destructive consequences of peers' defamatory statements, he responded with silence.
Other possible applications of the psychiatrist's rule of construction highlight the absurd—indeed, sadistically inhumane—quality of the psychiatrist's world-view.
Imagine saying to a Gypsy who is being led to a Nazi gas chamber: “Remember, its not important what the Nazis think, all that is important is that you believe you are not sub-human.” Imagine saying to Alfred Dreyfus, rotting on Devil's Island: “It's not important that the French Government thinks you are a traitor, what's important is that you believe in your innocence.” In each of these examples, the aggressive element and the objective consequences of the defamation are denied; the focus is narrowed to a simple concern regarding a subjective narcissistic injury for the victim.
In effect, the psychiatrist is treating the patient as if the patient were a small child who had complained to the therapist: “Doctor, while I was playing in the school yard some kids came by and called me a name.”
Thus, the psychiatrist's interpretation, by ignoring the objective consequences of aggressive defamation, betrays the thought processes and psychological concerns of a small child. For the psychiatrist, aggressive defamation, and its consequences, has no meaning whatsoever. Like the small child, the psychiatrist can only empathize with the victim's feelings of hurt (narcissistic injury) but not the response of outrage 1/, which limitation suggests something about the psychiatrist's level of ego differentiation.
Inconsistencies with previous interpretations in analogous circumstances – Creation of Double Bind Situation
It is interesting to observe that the psychiatrist's handling of the patient's concerns regarding the defamatory accusation that the patient is potentially violent differs from his handling of the patient's so-called paranoid ideations.
In the case of the patient's so-called paranoid ideations, the psychiatrist did not say: "All that's important is that you think you are not paranoid. Whether or not I think you are paranoid is immaterial. I am a tolerant person who will permit you to think whatever you choose to think so long as you do not act on those ideas in a manner detrimental to yourself or others. Let us analyze your ideas.” To the contrary, the psychiatrist has never shown any reticence whatsoever in characterizing the patient's ideas as paranoid or in stating the absolute need to use medication to eliminate the ideas, despite the fact that the patient's ideations have no significant behavioral component.
Indeed, on one occasion the psychiatrist went out of his way to label as “improbable” (with the implication of paranoia) one of the patient's reports that was actually supported by documentary evidence, namely, that a senior partner at his previous place of employment had a government agency certify the patient insane on the basis of evidence the partner had fabricated.
Thus, the psychiatrist has created a curious double-bind. In complaining about others' defamatory accusations the patient will tend to face one of two consequences. Either the patient's report that he has been defamed will be interpreted as a paranoid perception or, if the report is accepted as accurate, the patient's reasonable concerns about the defamation will be cited as evidence of the patient's emotional dependency, weakness, and poorly developed sense of self (not merely coincidentally, attributes typically associated with homosexuals).
Sincerely,
Gary Freedman
__________________________________
1/ I suspect that the capacity to experience defamation or any mistreatment, or reports of same, as an “outrage” as opposed to a hurt (or narcissistic injury) relates to issues of ego differentiation—the development of a moral sense--as well as the individual's level of individuation and a capacity to tolerate disapproval or hostility (that of the other party or one's own) without fear of abandonment. Brenman-Gibson provides an exquisite example of the reaction of outrage by an ego-mature, identity-secure adult (in contradistinction to the hurt response of the identity-insecure child, emotionally dependent on his victimizer). Recounting an interaction with the aged father of playwright Clifford Odets, Brenman-Gibson states: "Once inside the car, there immediately ensued hostile, crude sexual advances of such magnitude that the sentence (often recorded by Odets in his diary as his own response to his father) 'How dare you!' kept running through my head. The total disregard of one's essence was the most outrageous part of the experience.” “My experience of outrage was not simply the repeated response of an 'underling' to the repeated affronts of an 'executive' of big business. It was his intrusive, narcissistic disregard of what I am that was so offensive.” Brenman-Gibson, M. Clifford Odets, n. 1.4 at 622, no. 13.7 at 645 (New York: Atheneum, 1982).
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