The Ancient Scourge Revived: Part I
In Part I of this series I quoted Edward Rothstein's article, A Hatred That Resists Exorcism, and empathized two points.
… traditional reliance on conspiracy: the hidden plot.
Anti-Semitism never sees itself as a hatred; it views itself as a revelation. An attack on the Jew is never offensive; it is always defensive.
Anti-Semitism is the quintessential paranoid structure. It is an emergency procedure invoked by a deteriorating mind to serve a number of psychological purposes that protect the anti-Semite's mental apparatus from further decompensation. I will present a brief vignette from a patient's history and show how the paranoid structure works and then will attempt to find elements that can be illuminate aspects of anti-Semitism as a structure that is invoked in an emergency by a failing, deteriorating society to preserve its integrity.
I first met Mr. A during my Residency in Psychiatry at Bellevue Hospital in New York City. He was 18 years old at the time and we met in the emergency room of a large city hospital. He had been brought in by the New York City police because he was threatening passers-by on the street with a martial arts sword. He was in a violently agitated state, threatening to kill the staff, the police, myself; all of us were “in on it” and when queried he replied that we knew exactly what was going on and shouldn't play games with him. His agitation was so great that he needed to be heavily medicated to sedate him and prevent him from harming himself or anyone else in the emergency room. No further history or information was available. The list of potential diagnoses included drug related psychosis and blood was drawn for toxicology (which was negative.) By the next morning he had become calmer but was deeply suspicious and would not talk to anyone. He appeared to be responding to idiosyncratic perceptions and would occasionally be heard mumbling under his breath in a threatening tone. His family was contacted and his parents rushed to the hospital, relieved that they knew where their son was but worried that he was in the Psychiatric ward. They revealed that he had been having some evident difficulty in the preceding months. He had recently just barely graduated high school. During his senior year his behavior had changed. His grades deteriorated and he spent more and more time locked in his room. He stopped his karate training, something he had been involved in since he was 12. His parents were concerned but thought it was no more than a slightly exaggerated version of the teen angst that was so common in their community. He became increasingly sullen and could not be engaged in any but the most superficial conversation. They did wonder if he was getting into drugs but on the rare occasion he left the house they had looked through his belongings and could find no evidence of drugs or paraphernalia. In the week preceding the incident that led to his hospitalization, he had not left his room and could be hurt muttering and pacing in the middle of the night. The night of the hospitalization he had left home without a word sometime after midnight (while his parents were asleep) and his parents were alarmed to find that hie was gone and had taken his ceremonial katana with him.
For the next several days Mr. A was effectively mute. He could not be interviewed, was periodically agitated, often requiring multiple aides to assist in holding him down so he could be put into restraints and medicated. It was a harrowing time. On day 3 he was found in the “quiet room” in a rigid posture, unresponsive. He exhibited the classic “waxy flexibility” seen in Catatonic Schizophrenia. (If we This kind of Catatonia is rarely seen and is a dangerous development. Catatonic patients, while in that state, do not eat or drink readily, and they have a tendency to precipitously emerge from their apparent stupor in a state of intense excitement and aggression. The staff debated whether or not to continue with increasing doses of powerful anti-psychotic medicines or consider ECT (Electro-Convulsive Treatments) which are an established treatment for breaking the hold of a catatonic state. We decided to continue the more conservative course for a few more days but if his catatonia did not lift, we would start a course of ECT.
On day 4 his Catatonia lifted. He was able to begin to talk about his recent experiences. He revealed over the course of the next few weeks and months a not uncommon story of a Schizophrenic first break. Starting almost one year prior to his hospitalization Mr. A had begun to have periods of confusion and racing thoughts. He began to have increasing difficulty understanding passages in books he was reading and became convinced there were hidden messages in the text that he needed to decipher. At times he had the eerie feeling that newscasters on his TV were talking directly to him and trying to get him to understand that there was an important hidden text to what they were saying. On the streets when he saw numbers they began to take on greater meanings known only to him. He spent hours each night trying to make sense of the signals he was receiving. The signals increased in frequency such that he was seeing them everywhere. On one occasion he tried to share his evolving insight with a friend, but when his friend told him “that's nuts” he realized that only he could be privy to this new understanding. He withdrew from his friends and began to wonder if he was on the verge of uncovering something much greater than himself. His school work suffered, in part because his idiosyncratic reading of test questions were misunderstood by his teachers, who clearly could not comprehend his reasoning and were unaware of the momentous developments going on around him.
Two months prior to his hospitalization a change took place that shook Mr. A to his core; he began to hear voices telling him he was a failure, that he was gay, and that he should kill himself.
To be continued...
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