On Spirituality in Psychoanalysis

“Monday Musings” for Monday August 4, 2014

Volume IV. No. 30/180

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Spirituality in Treatment of 

Schizophrenia

By Assad Meymandi, MD, PhD, DLFAPA*

It was a hot day in Fayetteville, North Carolina. The August sun was beating down. You could fry an egg on the sidewalk by Cape Fear Valley Hospital. The thermometer at the Savings and Loan Bank registered 101. The climate on the street felt like something between a Turkish bath and a green house.

I had just gotten back from lunch and was seeing my first patient at 1:00 o’clock. My personal secretary buzzed me. We had a strict rule that my sessions with patients would not be interrupted unless it was an emergency, like life or death. So her interrupting me must have been very important. It was. I answered the phone. My secretary was very upset. All she said was that I ought to step out and see a patient who urgently needed help.

The patient was a young man, in his early twenties. He was gaunt, emaciated, a shell of a man, and a mere shadow of a person. He was tall, unshaved, with matted hair and sunken eyes. His clothes were torn and his bare feet were caked with dirt. There was a stench of body odor, old dried sweat and neglect surrounding his handsome frame. His parents said that he had not eaten any food in four days.They reported that he had refused all forms of liquids, even Mountain Dew, his favorite drink. He had not slept for four days. Earlier that morning they had found him in the barn behind the house with a large butcher knife trying to cut his throat. The family was a kind and gentle sort. They were farmers in a rural community near Fayetteville who grew tobacco, peanuts and soy beans. The family was well established and their farm dated back several generations to the Civil War.

I approached the young man and extended my hand to shake his. He ignored me. He was looking away, mumbling something to himself, something that his parents called “gibberish.” They said that he had been saying the same thing, like some kind of mantra, day and night for four days. We quickly ruled out the possibility of alcohol and substance induced psychosis, because his parents had been with him day and night during his illness, and he had no intake of food or water, much less drugs or alcohol. He was locked up in his own closed world.

I noticed that he was agitated with a fine tremor in his hands, yet there was a sense of peace and calm about him. There was no question that he was psychotic, hallucinating and delusional. He was completely disconnected from his environment and those who were in the room with him, including his sweet and distraught mother. I took the patient to one of the examining rooms in my office. I listened carefully to what he was mumbling, what his parents and the family were calling “gibberish”. After careful listening and paying attention to the faint movements of his lips, I heard scattered words in a staccato and dysrythmic manner. I heard “lamb of God…sacrifice…lamb of God…Jesus the Lord…”  I asked Bryan (not his real name) to tell me more about the Lord, Lamb of God. He ignored me. We just sat there patiently with my request repeated. Without pushing him, I made it known that I would listen if he wanted to tell me more about the Lord, Lamb of God.

He began to throw skulking glances in my direction. His hand furtively approached my hand resting on the arm chair and extended in his direction. He finally said that he was Jesus, Lamb of God and wanted to be sacrificed for the Lord. A thought occurred to me like a stroke of lightening. I said, “The Lord does not want such a skinny and nervous lamb to be sacrificed for Him. Why don’t you eat, fatten up, and take some medication to calm you down, so that you will be worthy of the sacrifice?” Somehow he connected with the promise of turning him into a more sacrifice-worthy lamb. He took a sip of water, and gradually ate some food. Then he accepted some intramuscular medication consisting of Thioridazine (Mellaril) and Benzodiazopine (Valium), state of the art medications in the 1960s. He took more food and drank some Mountain Dew before he was admitted to the hospital.

When I made rounds that evening, he greeted me with some degree of warmth.  His fulminating acute psychosis subsided. He gradually calmed down, rested and ate. In the following days, through psychotherapy, we explored the genesis of his psychotic breakdown. He continued to recover with full restoration to health. We never brought up the subject of his wanting to be a sacrificial lamb, because through therapy he learned how to become an “I” and stop being a “me”, a lamb-like subject who can be manipulated by people.

Several months ago, a fat packet came to me in the mail from Bryan. It was an invitation to the bicentennial anniversary of his farming village. Interestingly, my former patient, now in his early sixties, was listed in the program as the leading citizen of that community and the convener (master of ceremonies) of that day’s festivities.

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*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He serves as a Visiting Scholar and lecturer on Medicine, the Arts and Humanities at his alma mater the George Washington University School of Medicine and Health.

 

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