[Updates at end}
During my Residency training I was in the Bellevue Hospital Psychiatric Emergency Room one night when the police brought in a 20 year old woman. She had been threatening to jump out of her third floor window; she was a student at a prestigious New York college and lived in an apartment shared with a number of other students. When I interviewed her she denied that she had been threatening suicide. In fact, she had merely been yelling at her landlord (who had called in the complaint) because he had been harassing her. She seemed perfectly rational, with no signs of agitation, no obvious thought disorder and denied any psychotic symptoms. (She denied hearing voices or seeing things; she denied feeling like people were against her.) She had a superficially logical explanation for her charge of harassment at her landlord. He wanted her out of the apartment so he could renovate her apartment and sell it as a co-op and was threatening his tenants so they would move out. She did not want to stay at the hospital and denied any suicidal thoughts. She had no history of psychiatric disturbance. On the other hand, my suspicions were raised because it was a Friday night and hanging out the window screaming at one's landlord raised questions about her judgment even in the absence of more overt psychiatric pathology. Further, the police statement said that her roommate (who did not accompany her to the hospital) denied that the landlord was harassing them. If she were with a family member I probably would have released her but they were unreachable. In my experience, Psychiatrists in New York were loathe to admit people to the hospital against their will unless the indications were quite clear, but because she was alone and her explanations for her behavior were questionable, I thought it better to err on the side of caution and admit her for the night. By keeping her in the hospital I could assure she wouldn't harm herself or anyone else and it would give the staff the opportunity to reach her family.
When I told her I had decided to admit her to insure her safety, there was an explosion:
"You f*ckin' Jew Doctors all are part of it. Get me a gynecologist. He stuck a machine in me and I want it out."
Her rant included that he, meaning the landlord, was actually a Jew Doctor in disguise, who had implanted an electronic device into her vagina in order to control her. This was part of a conspiracy of Jews, in league with the CIA and the FBI, to prevent her from exposing their plans to control the world. She was actively hearing voices (auditory hallucinations) which were telling her to beware of all the evil Jews who were the cause of all her troubles.
As luck would have it, I was in the unique position of being able to not only admit her but follow her progress on the ward where I was a Resident (though I was not the Resident assigned to treat her.) Once on the ward, over the next few weeks, we learned that her work at school had been gradually deteriorating and her behavior had been becoming more and more erratic. She had received A's and B's during her freshman year of college, but was missing classes and failing her courses in her sophomore year. Her parents had been growing concerned but had taken a long-planned vacation during which she had this episode, her first psychotic episode. Her treatment went well. She was given powerful anti-psychotic medications and her hallucinations and delusions began to resolve. She reported that she understood her ideas about Jewish Doctors had been false and no longer felt that way. When she was discharged she was fully recovered and her discharge diagnosis was of a Manic episode with paranoid psychotic features.
I next saw her six months later. She had stopped coming to see her therapist and had stopped her medications. She felt fine and didn't think she needed the medicine. She had become psychotic again and was admitted after attacking a policeman in the precinct house. She had gone there with hundreds of pages of documents, hand written notes and newspaper articles, which "proved" the existence of a spreading Jewish conspiracy to destroy her and control the world. She told the admitting Psychiatrist that when the policeman did not take her seriously she realized the policeman was part of the Jewish conspiracy, too, and was trying to use the machine to control her; to protect herself she had assaulted the policeman in an effort to make him stop him.
Her psychosis was, if anything, more virulent on this second admission. She took a longer time to recover but eventually was discharged in an improved state, though her cognitive functioning was somewhat impaired.
The last time I saw her was about three years later. I was an attending at NYU hospital by that time and learned from the admitting resident that this young woman had been living on the streets, estranged from her family and essentially non functional. She had a history of multiple hospitalizations and consistently refused follow up and medication.
I understand that the paranoid delusions of a psychotic patient are not an exact metaphor for a society and culture that have become infected with the virulent virus of anti-Semitism, yet there are some salient and compelling similarities.
I have described elsewhere The Reparative Function of Paranoid Delusions:
When a young patient develops Paranoid Schizophrenia, a most devastating Psychiatric disorder, there is a typical prodrome during which they become more and more dysfunctional over time. Their thinking becomes disordered. If they are in college, they begin to lag in their courses and eventually start to fail and typically drop out. They have more and more trouble making sense of their world until they experience a sudden moment of clarity, when their delusions crystallize: They are not sick and damaged, they are actually powerful and important. Some believe they are Jesus Christ returned to rescue mankind; others, with less grandiosity, believe they are being followed by the CIA or the FBI.
The delusion relieves them of responsibility for their troubles. Their failures are not their fault, they are caused by someone more powerful who singles them out for attention. (There is an element of grandiosity in every paranoid delusion; after all, the person is important enough to warrant vast arrays of powerful people focusing all their attentions on them.) For too many people living in dysfunctional societies, the Jews represent the ideal objects of fearful hatred. The Jews have traditionally been peaceful and peace loving, and even when they have achieved great power, have generally acted with restraint. They are also quite small in numbers while at the same time often successful and visible. Yet blaming the Jews for one's problems only works in the very short term.
The young woman I described used the Jews as her explanation for her emerging severe psychiatric disturbance. While it helped her preserve some false self-esteem for a time, it also made it impossible for her to accept the help that she so desperately needed. She identified all Doctors as part of the Jewish conspiracy and as a result could not accept their medication. She would even attack those who could help her (as with the policeman who brought her into the hospital for her second admission.) Without her needed medications, she suffered frequent and worsening psychotic episodes; her life deteriorated apace until she was finally left homeless, friendless, and estranged from those who loved her.
Contrast that with the behavior of the Arab legions who so hate Israel and the Jews. Rather than spend their energies trying to build their own societies, they devote their lives to destroying their imagined enemies. One of the great ironies has been that when the Israelis finally gave in to despair and began to build the fence to separate themselves from those who hate them so much, the Palestinians complained that the Israelis were preventing them from earning a living.
The Arabs have a choice of facing their own dysfunction and struggling to join the modern world or continuing to blame the Jews for all that ails them. One course leads to a chance of a better life; the other leaves them nearly friendless, homeless, and isolated.
As with a paranoid patient, the delusions, unless confronted (in a patient with medication), spreads and poisons all relationships; their delusions contaminate their own ability to think and adequately evaluate reality. The Muslim Jew-haters are becoming increasingly bizarre in their beliefs, unable to evaluate the impact of their own behavior, and more and more isolated. Their delusions spreads. They convince themselves the Americans are colluding with the Jews to threaten them. They convince themselves that they can destroy the Jews and the Americans. The misinterpret restraint as weakness and convince themselves that their own bravado represents strength. All who do not support them then become agents of the enemy, which causes them to attack those who might help them. As their house collapses around them, they voe to keep fighting, to use the most vile means to kill their enemies, even while their behavior discredits them and alienates their neighbors and friends.
Like the patient I described, they will end up homeless, in tatters, with no friends, no jobs, and no prospects, all in obeisance to their delusions of persecution and grandeur.
Once a person has been infected with paranoid anti-Semitism, the treatment is extremely difficult and often to no avail. Once a society has been infected with paranoid anti-Semitism, they may well be untreatable. Israel is offering the Arab a chance to repudiate their hatreds and begin to build their own society; if they cannot see their own responsibility for their plight, there is no hope for them and they will eventually be ground into dust.
Update: Gagdad Bob's post, Keep Your Thoughts out of My Brain, Abdul! should be on your "must read" list. HIs explication of projective identification is worth the price of admission and goes a long way toward clarifying this difficult concept. Here is a taste:
In reality, an enemy is someone who regards you as an enemy, whether or not you deserve the title. We clearly had an enemy for twenty or thirty or seven hundred years before 9-11, not because Islamists were our enemy, but because we were their enemy. We couldn't see it because it was a completely irrational process, based on projective identification. But with sufficient provocation, we have finally been enlisted into the Islamists’ psychodrama, taking on the role so vital to their psychological equilibrium. In other words, we are not their enemy because we are evil--because we have done anything in the real world, such as placing our soldiers on Saudi territory, or supporting Israel. Rather, as Harris points out, we are evil because we are their enemy.
Bob includes as a bonus a quote from Walter Sobchak, as well.
Dr. Sanity's post, FEELINGS, COUNTERTRANSFERENCE & REALITY, which Bob was kind enough to mention, is a reprise of an old post of hers which explores some of the mental functions a Psychiatrist uses to determine when projective identification and its close ally, counter-transference, are taking place.