From Psyche to Soma: Tales of Biopsychosocial Medicine
George Freeman Solomon, with Ping Ho (2000)
Norman [Cousins] had written 27 books ranging in topic from the pathology of power to the biology of hope. Perhaps I, too, should write a book. After all, my professional and personal life had been varied, interesting, and certainly controversial. (i-ii)
Perhaps you will find that there is an underlying theme to this book on varied topics, namely, the vicissitudes of aggression. . . . The lesson I have come away with is: Don't let others screw you over, don't screw others over, and don't let others convince you that it is acceptable to do so when you know that it isn't. It may have taken a professional lifetime and research in apparently utterly disparate areas of investigation to come to these simple, obvious truths. (iv)
An attractive, tall, slim, 30-year-old woman suffered from schizophrenia, catatonic type. Her response to the only effective neuroleptic available, Thorazine® (chlorpromazine), had been modest at best. . . .
"Do you like to knit?" Silence. Blank stare. Forty-five more minutes of her silence. Week after week for a couple of months. My supervisor advised, "Be patient." At this point, I must interrupt the narrative with a necessary personal note: During internship, I had fallen in love with a beautiful Danish postdoctoral fellow in hematology, who had come to the United States to study. We became engaged. She returned to Denmark. Our wedding in Copenhagen was scheduled three weeks hence when I got the "Dear John" letter. I had not sensed the premonitory signs (selective avoidance, no doubt). I was determined that no one would know how terribly upset I was, least of all my patients. The morning after having read the letter, I picked up Margot Johnson on the Women's Ward to accompany her, as usual, to my office on the Men's Ward. We were hardly out the door of the Women's Ward, when Margot turned to me and said, You're terribly depressed today, aren't you Doctor?" The first complete sentence she had ever said to me!
In shock, I managed to lead her to my office. I said, concerned about being too personally revealing. 'That could be. How did you know?"
"I really don't know how. 1 guess 1 just notice little things." (I thought, my God, that's what they mean by "schizophrenic's insight" in the textbook!) (10-11)
I was shipped off for six weeks of basic training at Ft. Sam Houston in San Antonio, Texas (1959). . . . I thought it was stupid to use nail polish remover to strip the lacquer off a perfectly shiny brass belt buckle only to begin polishing it again. So I only polished the front. I got caught by the drill sergeant and had to march the platoon of doctors back and forth for an hour in the noonday Texas sun for punishment. I learned an important lesson. If you give the appearance of conformity, you can get away with a lot. If you're labeled a rebel, forget it. I became a spit and polish officer with shiny boots, a snappy salute, and tailored fatiguesattributes that were to serve me well in the military and, analogously, later in academic life. My truly rebellious, unconventionaleven weirdnature would remain concealed. I learned to try to change systems from withinleaving the defiant approach as a very last resort. (15-16)
I had to sign a written pledge never to reveal secret information. Of course, those secrets are now history and important to disclose because of their threats to mankind. Nonetheless, I shall restrict myself to sharing information that has already (to the best of my knowledge) been revealed at some level. Physicians are forbidden by the Hippocratic Oath to use their professional knowledge in the service of harm; therefore, in its chemical and biological warfare programs, the Army cleverly utilized veterinarians, who have similar training but do not take the Oath. (There were, however, military physicians who disregarded it.) The incapacitating agents being studied and developed were largely psychotomimetic compounds, such as LSD, that lead to temporary confusion and mental aberrations. It was suggested to me that involvement with testing of these agents was compatible with the Hippocratic Oath because if one could incapacitate and capture an enemy soldier, one wouldn't have to kill him. These substances could thus be considered lifesaving. Full of curiosity, I bought the argument (which has some merit), but I now feel in retrospect that even my inconsequential involvement had been unethical. "Do no harm" is the first principal of medicine. . . .
I was ordered on temporary duty to Fort Lee, Virginia, just outside Washington, D.C., to observe the performance of high command officers who were to have LSD slipped into their coffee during an annual paper and pencil "war games" exercise. (LSD is tasteless, odorless, and potent in tiny amounts.) It had been decided that, in wartime, such agents would not likely be employed indiscriminately but, rather, in selective ways. I was to be disguised as an infantry colonel. No one of lower rank than a colonel participated in such games. It was mainly generals. (I thought I was a bit young, at 25, for such a disguise to work.) I refused to participate on the grounds that a military physician cannot be ordered to perform a medical procedure that he or she feels is inappropriate. I asserted that giving a potent psychotomimetic agent of unknown dose (some officers. no doubt. would drink more coffee than others) to uninformed subjects was highly dangerous and unethical. Thankfully, it was not done. (I heard a rumor that such an episode eventually took place.) My own refusal to obey orders in situations that I considered to be immoral made me more empathic in subsequent studies of Vietnam veterans.
I was sent to a top secret three-day-long group briefing on chemical and biological warfare at the Army's Chemical Corps research center in Ft. Dietrick. Maryland. I believe that I was the first psychiatrist ever to attend such a briefing. We were observed by both identified monitors and "plants" lest we abscond with any notes. On reporting in, I was greeted by a physician-colonel who startled me by jumping out of the second story window, shrieking. "Oh, a psychiatrist, I'm going to kill myself!" As an ex-paratrooper, he knew how to fall. This commanding officer physician would routinely leave a new cap on a flagpole for a month to weather properly before he would wear it. What was really striking was that he carried a polished human femur (thigh bone) as a swagger stick. (Shades of Dr. Strangelove!) His eccentricities certainly did not do much for my insecurities about the development of lethal chemical and biological agents. (16-17)
In my father's work, I became aware of the importance of the intangible "human factor," particularly humor, in therapy. One evening, Dad was in his study at home seeing a patient who continually sought to elicit reactions in others. Unable to get a rise from Dad, he escalated the stakes by finally threatening. ''I'm going downstairs right now to rape your wife, and what are you going to do?"
Dad calmly replied, "I'm afraid I'm going to have to charge you for an extra visit." Laughter ensued, and insight was facilitated. (23)
I got a new lab at the Stanford affiliated Palo Alto Veterans Administration (VA) Hospital on campus and posted a sign next to the door: "Psychoimmunology Laboratory". Thus, began a new field. (32)
The other person with whom I had fruitful contact was Senga Whittingham. Senga (Agnesher mother's namespelled backwards) is a remarkable, quiet, attractive, brilliant, shy person. (36)
While Diana was staying with us, and after I found out that her ability to travel was because she was Mrs. Vartanian, I gingerly brought up the topic of the hospitalized dissidents, promising not to quote her publicly. She queried. "Is it not true that the content of delusions, in contrast to their presence is culturally determined?"
"Is it not true that many American grandiose paranoid schizophrenics believe they are Jesus Christ?"
"Well, not so many, but I have encountered a few Christs during my psychiatric career."
"The Soviet Union is an atheist, communist country and our paranoid schizophrenics have political delusions." Dr. Vartanian and associates later described so-called "sluggish schizophrenia," characterized by intact mental functions except for the presence of political delusions. Apparently, it only existed in the Soviet Union. (37-8)
We found that when stressed animals were housed in the same room with unstressed animals, they would all exhibit stress responses. Therefore, we housed experimental and control animals in separate quiet (non-stressful) rooms. Many years later, it was discovered that a stressed animal transmits pheromones through the air via the olfactory system to induce a stress response in an unstressed animal. (39)
By a stroke of luck, right to Sepulveda came from South Africa, one of the most outstanding gerontologists in the world, endocrinologist John Morley. Although John had been a terrible undergraduate student, in rebellion against his parents who had pressured him to get an education rather than becoming a tennis pro, he eventually wound up being a Type A+++ personality, producing prodigious amounts of work. When I commented to John that his driven nature combined with no exercise and obesity was a set-up for a heart attack, his reply was, "So what? I already have more than 200 articles in top peer-reviewed journals." (61)
"You mean I've created a feeling in you; you feel something because of me? [Now don't forget, this was "Jesus Christ". Grandiose delusions often represent a defense against feelings of nothingness and unimportance.] My mother never felt anything. She kept the house clean; she kept me clean. She dusted me off like the furniture. Once at a Christmas party she ventured to take a drink and actually laughed. I cried because I thought she was sick. When I was in the hospital after breaking my leg playing high school football, she never came to see me." He announced, "Now I'm going to tell you something. My mother bathed me until I was fourteen. One day I got a hard-on while in the bath and screamed, 'Get out of here! Get out of here!''' Russell pleaded, "I couldn't help those feelings, could I? I have two daughters, and if they were teenagers, I'd never think of bathing them. She shouldn't have been bathing me, should she? I couldn't help it, could I?"
"Of course not. Her behavior was most inappropriate, and those feelings were elicited by that inappropriate behavior." […]
"Doc, I believe I told you once that my father, whom I haven't seen in more than ten years and who had been an alcoholic but is now sober and long divorced from my mother, lives not far from herein Salinas. Could I have a weekend pass and go visit my father?" (Russell had never asked for a pass before.)
"Of course you can."
When Russell came back from the visit, all delusions were gone and all symptoms of schizophrenia had disappeared. He reported, "I had a wonderful conversation with my father. He told me what a bitch my mother was." Russell was discharged within two weeks. (71)
Then a dramatic event occurred. Joel's father informed me by telephone that his middle-aged mother would be entering Stanford hospital for a risky open heart surgery. The message was transmitted to Joel. A second call from his father reported that his mother had died on the operating table. It was now my burden to relay this news to Joel, and I was afraid that he would regress from neat, clean aspiring janitor back to pig again. I told him.
Immediately, all symptoms disappeared. Joel became completely rational and apparently indistinguishable from his premorbid state. Everyone was amazed, myself included. In group therapy, he reflected, "I guess I had to get rid of her outside myself before I could get rid of her inside myself." (72)
Prior to assuming my official consultancy at Atascadero, I had arranged through the Superintendent to get a perspective on the institution from the patients' point of view, that is, to experience criminal hospitalization first hand. (This experience was enough to cure me of the idea of a mock incarceration in prison.) I wanted to be admitted as a mentally ill patient with the story that I had threatened to kill the president (actually having hostile feelings toward him for what was happening in Vietnam). I claimed to have been working as a laboratory assistant at Stanford, figuring that the closer the story came to my actual situation, the easier it would be to pull off. My true identity would be unknown to anyone but the superintendent. He insisted, however, that I be placed among the less psychotic inmates, namely, the sex offenders. He wanted me to pose as a child molester, about which I wasn't too pleased.
I was terrified going through the usual admission procedure, being stripped down and put into a deindividualizing khaki uniform. I fantasized saying, "But I'm really a doctor," and getting the reply, "Sure; lots of our patients are" as a response. It reminded me of a true story about my father's former boss at Johns Hopkins, the famous American psychiatrist Adolf Meyer, whom Queen Marie of Romania had requested to meet while on a diplomatic visit in 1937. On the day of the appointment, after keeping the Queen waiting for quite some time, Meyer finally emerged. The Queen greeted him saying. "How do you do, Professor Meyer, I'm Queen Marie of Romania," to which he psychiatrically remarked, "And how long has this been going on?" (87)
Subsequently, I went for my first consultant visit, the staff never having been informed of my experience as a "patient". I was greeted by the ward chief of a sex offender unit, a female Ph.D. psychologist clad in a khaki army blanket, out of which a hole had been cut for the neck, that draped over her dumpy figure, She inquired, "Do you want to meet the patients?" "I'd be glad to; whatever you think is best, Dr. Marigold." She proceeded to scream at the top of her lungs, "Hey you cock suckers and baby fuckers, come here and meet our new consultant!" Facetiously, I used to say that the only difference I could discern between the patients and staff of Atascadero at that time was that some of the patients got well. In that regard, it was the sickest "professional" environment I could ever have imagined with the most bizarre group of psychologists and psychiatrists I have ever encountered. (88)
The nature of the punishment is the question here. Was Leslie [van Houten] rehabilitated after the several years she had done in prison before her retrial? Yes. Did she represent an ongoing danger to society? No. Was she punished enough? This is the relevant question because every couple of years that Leslie has come up for parole, she has been routinely denied. I testified that, under the influence of this charismatic leader, Leslie had a diminished capacity to harbor malice and to form a premeditated intent to kill; therefore, the eight years that she had already served should have made her eligible for parole. If one views incarceration as punishment, she should never get out; however. if one wants her to lead a constructive life, then this intelligent and genuinely remorseful young woman should be given the opportunity to devote her life to the service of others. Should she be in prison or not? (My views about the others who were convicted are quite different.) (133)
This wealthy man had married a very attractive woman (Veda) of very low intelligence, whom I found to have an IQ of 70. (I had learned in the military that it takes an IQ of about 80 to get through basic training. In other words, she was borderline mentally retarded.) (135)
Wartime-related psychological syndromes, such as "survivor guilt", have been reported as long ago as the Civil War. Yet, the sorts of stresses unique to Vietnam could cause psychological traumas of an intensity greater than those witnessed in other wars. For example, American soldiers were not sent over in military units, but were rotated individually for a year's tour of duty, resulting in very little esprit de corps. Newly arrived soldiers were distrusted as "green" and undependable. Young, lower echelon, command officers were often not well-trained for the peculiar guerrilla war being fought in the villages and exhibited poor judgment, causing the troops to lose faith in their leadership. (143)
I asked a young addict how he began to use heroin in Vietnam. The man openly described being part of a team that interrogated Viet Cong prisoners. They would take the prisoners up in helicopters and inform them that, if they didn't divulge information regarding Viet Cong activities, they'd be thrown out. The prisoners would, as expected, provide the informationand be thrown out of the helicopters anyway. "I simply found it easier to throw people out of helicopters when I was loaded on heroin," he confessed. (145)
Ironically, the VA was not legally permitted to treat heroin addicts! Alcoholism, however, had been a major condition treated at VA hospitals for some years. (Congress had always been supportive of alcohol treatment through the VA, not only because there was a moral judgment against the use of illegal substances but also because Congress has many recovering as well as active alcoholic members.) (146)
The vets were brought out and what ensued was an inevitable crossfire. At one point, the educated Marine and the Navy lieutenant got into a heavy entanglement over whether or not the war was worth fighting. None of the three vets that Mr. Cavett had invited was able to see each other's point of view, except that the violent one who sought out "Gooks" seemed to begin to question his own behavior as a result of the discussion. The exchange was so lively that Mr. Cavett deliberately ignored the "commercial break" sign as well as the producer's shaking fist. Finally, when the last commercial break rolled around, Mr. Cavett turned to me and asked, "We've certainly not exhausted the topic, have we?"
"We've barely scratched the surface."
"I think I'm not going to tape tomorrow night's scheduled program, and we'll go on again."
"What about your guests who are waiting to perform?"
"Screw that show business shit. I'll apologize and ask them to take a raincheck." (148-9)
The Vietnam vet whom I had brought out had never been to New York; so, after the taping I took him out for dinner and theater, culminating in an 11 PM "Dick Cavett party" thrown by an old friend of mine. After watching the show and discussing its implications, we didn't get back to the hotel until nearly 3 AM. We were immediately ushered to the front desk by the doorman of the Park Lane Hotel. The clerk at the desk seemed excited, blurting out. "Where in the world have you been? The White House has called several times."
'"I answered, innocently, "Well, we went out."
He handed me a slip of paper and instructed, "Promptly at nine o'clock you are to call this White House number."
I called, as I was told to do so, at nine o'clock. A voice informed me, "The President [Nixon] has seen last night's program and wishes you to know of his [exact quote] grave personal displeasure at your antiwar views. [l had not even, discussed the war per se or been directly antiwar!] The President also wishes you to know that, if you do not cancel your appearance on tonight's program, you will be required to sever all your connections with the U.S. government." The voice threatened explicitly, "This means you will be fired from the VA, and any VA or National Institute of Health grants you have will be canceled."
I made no effort to control my rage, "I am terribly sorry. The program has already been taped for broadcast. And the reason I am terribly sorry is that I have been robbed of the opportunity to tell the American people about this gross attempt at fascistic intimidation." Then I hung up, shaking. I had been pretty naive, not believing that this sort of thing could happen in the United States. I was also scared. Although my job was pretty secure as a Stanford faculty member (not yet tenured), the fact that my research was being jeopardized made me very nervous. Both Alfred Amkraut, my immunologist associate, and a lab assistant were being supported by federal grant money. (149-50)
Sometime thereafter, several months after the Cavett program, I was awakened from sleep at about 2 AM by a telephone call. "I am an investigator for a branch of the U.S. Government," the voice said quietly, "and I am calling you at some personal risk because it's possible that your phone is tapped. However, I happen to concur with what you have been saying and feel that you have the best interests of our vets at heart. I just wanted you to know that every aspect of your professional and personal life is being looked at by an agency of the United States government, possibly to be used against you for political purposes." The phone went "click". It was at that point that I developed acute galloping paranoia. (151)
Several months of nervousness went by. I heard nothing. At last, I got a call from Senator Cranston, who told me that he had had several meetings with White House staff and had made a quid pro quo deal on my behalf. The whole thing had been done by John Erlichman. I had indeed been placed on Nixon's notorious "enemies list"; however, Erlichman promised to call off the dogs. Nothing further would happen. I could relax. (Subsequent psychoanalyst associate Helen Stein used to say that the most difficult base human emotion to overcome is retribution. Although I don't think of myself as a particularly vindictive person, I must admit that I am not completely free of retributive qualities, I was quite gleeful when Erlichman went to prison.) (151-2)