I will show why i believe this. When the episode was done I said, “Flores, think about democracy for me, will you?”
He said, “Little doctor, you don’t catch old dogs quite that easily.”
“I am not catching you. Can you think about democracy or can’t you?”
“I think about it a good deal,” he said. And he shifted to right-brain activity, music. It was a chorus of the last part of the Ninth Symphony by Beethoven, I recognised it from the Arts term in high school. We sang it to some patriotic words. I yelled, “Don’t censor!” and he said, “Don’t shout, I can hear you.” Of course the room was perfectly silent, but the pickup on the audio was tremendous, like thousands of people singing together. He went on aloud, “I’m not censoring. I’m thinking about democracy. That is democracy. Hope, brotherhood, no walls. All the walls unbuilt. You, we, I make the universe! Can’t you hear it?” And it was the hilltop again, the short grass and the sense of being up high, and the wind, and the whole sky. The music was the sky.
When it was done and I released him from the crown I said, “Thank you.”
I do not see why the doctor cannot thank the patient for a revelation of beauty and meaning. Of course the doctor’s authority is important but it need not be domineering. I realise that in politics the authorities must lead and be followed but in psychological medicine it is a little different, a doctor cannot “cure” the patient, the patient “cures” himself with our help, this is not contradictory to Positive Thinking.
14 SEPTEMBER
I am upset after the long conversation with F.S. today and will try to clarify my thinking.
Because the rib injury prevents him from attending work therapy, he is restless. The Violent ward disturbed him deeply so I used my authority to have the V removed from his chart and have him moved into Men’s Ward B, three days ago. His bed is next to old Area’s, and when I came to get him for session they were talking, sitting on Area’s bed. F.S. said, “Dr. Sobel, do you know my neighbor, Professor Area of the Faculty of Arts and Letters of the University?” Of course I know the old man, he has been here for years, far longer than I, but F.S. spoke so courteously and gravely that I said, “Yes, how do you do, Professor Area?” and shook the old man’s hand. He greeted me politely as a stranger—he often does not know people from one day to the next. As we went to the scope room F.S. said, “Do you know how many electroshock treatments he had?” and when I said no he said, “Sixty. He tells me that every day. With pride.” Then he said, “Did you know that he was an internationally famous scholar? He wrote a book, The Idea of Liberty, about twentieth-century ideas of freedom in politics and the arts and sciences. I read it when I was in engineering school. It existed then. On bookshelves. It doesn’t exist any more. Anywhere. Ask Dr. Area. He never heard of it.”
“There is almost always some memory loss after electroconvulsive therapy,” I said, “but the material lost can be relearned, and is often spontaneously regained.”
“After sixty sessions?” he said.
F.S. is a tall man, rather stooped, even in the hospital pajamas he is an impressive figure. But I am also tall, and it is not because I am shorter than he that he calls me “little doctor.” He did it first when he was angry at me and so now he says it when he is bitter but does not want what he says to hurt me, the me he knows. He said, “Little doctor, quit faking. You know the man’s mind was deliberately destroyed.”
Now I will try to write down exactly what I said, because it is important.
“I do not approve of the use of electroconvulsive therapy as a general instrument. I would not recommend its use on my patients except perhaps in certain specific cases of senile melancholia. I went into psychoscopy because it is an integrative rather than a destructive instrument.”
That is all true, and yet I never said or consciously thought it before.
“What will you recommend for me?” he said.
I explained that once my diagnosis is complete my recommendation will be subject to the approval of the Head and Assistant Head of the Section. I said that so far nothing in his history or personality structure warranted the use of ECT but that after all we had not got very far yet.
"Let’s take a long time about it,” he said, shuffling along beside me with his shoulders hunched.
“Why? Do you like it?”
“No. Though I like you. But I’d like to delay the inevitable end.”
“Why do you insist that it’s inevitable, Flores? Can’t you see that your thinking on that one point is quite irrational?”
“Rosa,” he said, he has never used my first name before, “Rosa, you can’t be reasonable about pure evil. There are faces reason cannot see. Of course I’m irrational, faced with the imminent destruction of my memory—my self. But I’m not inaccurate. You know they’re not going to let me out of here un…” He hesitated a long time and finally said, “unchanged.”
“One psychotic episode—”
“I had no psychotic episode. You must know that by now.”
“Then why were you sent here?”
“I have some colleagues who prefer to consider themselves rivals, competitors. I gather they informed the TRTU that I was a subversive liberal.”
“What was their evidence?”
“Evidence?” We were in the scope room by now. He put his hands over his face for a moment and laughed in a bewildered way. “Evidence? Well, once at a meeting of my section I talked a long time with a visiting foreigner, a fellow in my field, a designer. And I have friends, you know, unproductive people, bohemians. And this summer I showed our section head why a design he’d got approved by the Government wouldn’t work. That was stupid. Maybe I’m here for, for imbecility. And I read. I’ve read Professor Area’s book.”
“But none of that matters, you think positively, you love your country, you’re not disaffected!”
He said, “I don’t know. I love the idea of democracy, the hope, yes, I love that. I couldn’t live without that. But the country? You mean the thing on the map, lines, everything inside the lines is good and nothing out-> side them matters? How can an adult love such a childish idea?”
“But you wouldn’t betray the nation to an outside enemy.”
He said, “Well, if it was a choice between the nation and humanity, or the nation and a friend, I might. If you call that betrayal. I call it morality.”
He is a liberal. It is exactly what Dr. Katin was talking about on Sunday.
It is classic psychopathy: the absence of normal affect. He said that quite unemotionally—“I might.”
No. That is not true. He said it with difficulty, with pain. It was I who was so shocked that I felt nothing—blank, cold.
How am I to treat this kind of psychosis, a political psychosis? I have read over De Cams’s book twice and I believe I do understand it now, but still there is this gap between the political and the psychological, so that the book shows me how to think but does not show me how to act positively. I see how F.S. should think and feel, and the difference between that and his present state of mind, but I do not know how to educate him so that he can think positively. De Cams says that disaffection is a negative condition which must be filled with positive ideas and emotions, but this does not fit F.S. The gap is not in him. In fact that gap in De Cams between the political and the psychological is exactly where his ideas apply. But if they are wrong ideas how can this be?