Saturday, October 02, 2004

That Way Lies Madness

A long time ago, when I was just beginning to practice psychiatry, I had a young woman (17 years old) as a patient--I'll call her Chris. She was one of those extremely difficult patients who we suspected of having a Borderline personality disorder (BPD) (you really can't diagnose personality disorders before the age of 18 or so)--and if she didn't have BPD, she was well on her way to developing it. She used illegal drugs and claimed they "helped" her; she was impulsive and histrionic; she cut herself frequently; made suicide attempts regularly; and was so desperate for attention and love that she would lie, cheat, and do anything for attention. We had a particularly difficult session one day, and that night I was on call in the emergency room. I was awakened at 2:00 am by a call from a "friend" of Chris, who informed me that Chris's body had just been recovered from the ocean, where she had gone and killed herself because she was so angry at me.

I was devastated. I remember sobbing for some time after I hung up; overwhelmed with remorse and convinced that I had chosen the wrong career. Her death was all my fault and in my sorrow I considered leaving psychiatry, since I obviously was no good at it. I thought about what a sad, wasted life Chris had lived. If only I had paid more attention to her; listened more to her pain and not expected her to control her behavior. For three hours I was in a state of abject misery and hopelessness. I would have done ANYTHING to change the fact that she was dead.

At 6:00 am the page operator put through another call to me--from Chris. "Oh, " she told me, "the body they found on the beach wasn't mine"; her "friend made a mistake"; "sorry about that" and "could I see you a day early next week?"

It was amazing how quickly my remorse turned to anger. I had been incredibly, unmistakably HAD. My emotions had been played as if they were a song composed by my patient on an instrument of her choosing. My supervisor laughed (laughed!) and told me that this is what it felt like to be truly MANIPULATED by a pro. Such behavior, he pointed out, was pretty typical of the Borderline --why was I so shocked at what had been done to me? (I should point out that Borderline, Narcissistic, Antisocial and Histrionic Personalities overlap quite a bit, and are referred to as the "Cluster B" personality disorders).

I was reminded of Chris when I read this. I know exactly how the Italians are feeling right now.
Even I had posted my outrage at the rumors that these "innocent victims" had been ruthlessly murdered by their barbaric captors. Now it appears that there is a strong possibility that the two Simones were willing captives and were working with the terrorists to manipulate our emotions. If true, they also managed to manipulate $1 million from the Italian government (I think that is called "fraud"). I suppose it is possible that they really were kidnapped and scared out of their wits--if they had any to begin with. But their words today sound more like the second phone call from Chris.

And then there's this....

After I got over my angry feelings that early episode with Chris's fake suicide actually taught me a very valuable lesson as a psychiatrist and as a person. I could not take responsibility for other people's behavior. That Way Lies Madness.

Taking responsibility for their behavior is exactly what the blackmailers and terrorists of the world expect you to do. Their implicit message is that somehow YOU are the one responsible for THEIR murders. If YOU had behaved differently, then YOU would not have CAUSED THEM to behave the horrible way they did. THEY are the victims, and you are the perpetrators. That is of course the ultimate weapon of the Terrorist, isn't it? To make you feel that you cause their murderous behavior? That the beheadings would not have occurred IF NOT FOR YOU?

This is the reason why you don't negotiate with blackmailers. You must put the responsibility for their actions back on them and not permit yourself to be manipulated by their threats. If innocents suffer, it will not be because you don't pay the ransom or do what they want. They will suffer because the terrorists chose to make them suffer. And all the Simones and other useful idiots who enable terrorism are also responsible for the terrorist's behavior.

We know this, and yet the issue comes up over and over again, as we suffer the remorse and pain that Terrorism inflicts. It is helpful to remember that terrorists inflict this pain deliberately and exult at the idea of having so much power over us:

This does not seem to bother the hostage-takers. They began taunting Western governments over their efforts to seek their citizens’ release from captivity. Late on Friday a fresh message appeared on a website believed to be used by al-Zarqawi which read: “What is laughable is the insistence of the ministers of all infidel nationalities on the phrase ‘no negotiations’. As if there was any question of negotiation. Far from it - they must obey the demands of the Mujahadeen. If you refuse, we slaughter.”

Like the patients with Cluster B personalities, the terrorists try to make you feel inside as empty, worthless and dead as they themselves are. It is their only pleasure in Life. And that is true Madness.


Anonymous said...

This post is outstanding !!! I hope others pick it up and link to it. From a political perspective, President Bush's instincts are like this while Kerry's instinct is to enable. Now I keep thinking, if you could get five minutes of Bush's re-election team it would help the cause. Maybe call this "compasionate responsability."

Oak Leaf

Jerry said...

Having lived for a year with a woman who exhibited Every. Single. Damn. Symptom. of your "Cluster B" personalities.

She lied, she threatened suicide - when I was off TDY one year she called me up and said she'd cut her wrists - she wanted 'attention', she constantly said. But no amount of attention was good enough. She separated me from my friends, she screwed me over good - and I let her. It was actually a relief when she stole my car.

My therapist gave me the same advice - "I could not take responsibility for other people's behavior." It took a while to internalize that - but it made life a LOT easier.

The terrorists WANT us to believe their actions are our fault. That we are RESPONSIBLE when they kill. That they're blameless, because we're FORCING them to do these things.

When they're doing it because they can, and because they enjoy it...

Keep up the blogging. You're great.