Sunday, June 11, 2006

Psych Testing Hall of Shame

The following report was sent to us by McLean Hospital in Massachusetts. Affiliated with Harvard Medical, currently costing $2500/day, and considered to be one of if not the best psychiatrict hospital in the world.

The report was done in the 1990's - names of both patient, tester, and supervisor are left out. The report was generated on the basis of the following tests: Bender-Gestalt; Draw a Person; Rorschach; Thematic Apperception Test; and a WAIS-R. Conspicuously absent is the MMPI. Hmm.

Those of you who know these tests might well wonder how the psychologist discovered this deep insight into the patient from the above tests. I don't hold much with the Rorschach, but I admit that many of the psychologists I most respect use it. It seems to be at its best when there is a specific question, such as "is there an affective component to this presentation?" My own diagnosis is at the bottom.
Mr. S is struggling to overcome a deeply ingrained myth of his patriarchal lineage, which concerns the inheritance of the son from the father and the rivalry played out between them. While he believes that a child, and above all a son, inherently supports and redeems the father, validating and rewarding a father's traditional role, he also fears that a child may overpower or disappoint his father destructively, and that a child will inevitably undermine a parent's authority and autonomy by hindering their freedom. A father is latently a fallen leader. Mr. S tries to sustain the idealize image of his father as invincible, fearless, and forbidding, but he fears he will undermine his father. By acting out his ambivalence about subscribing to his father's modeling of the male role, by his passive surrender to instictual impulses, and by his valuation and admiration of his own children as more promising and resilient than himself, he feels he may endanger paternal authority.

Mr. S is chronically and helplessly depressed, caught in an unthinkable wish to kill the father already dead, and still haunts him intimidatingly and commands a meek and unquestioning reverence. He is painfully introspective and emotionally conflicted, without being able to focus an issue to his conflict, doubting and disgusted by his own life-solutions while faithful to the family ideology of presumptive masculine pride. His need to distance himself from an obsolete and inappropriate myth is internalized and becomes translated into a wish to do away with parts of himself he attempts to minimize and disown as flawed and faulty "outcroppings" like dead branches of a family tree useful only as firewood on the family hearth.

Frankly, I can't bear to type any more of this. If there is a groundswell of enthusiasm for wanting to see the rest, I will oblige. That was about 25% of the report. I think we know a great deal about the psychologist at this point, but precious little about the patient.

The patient was a depressed father with teenage sons. He drank a little too much, to "try and relax" so he could get to sleep, and had sleep apnea, which we discovered in the hospital. He elevated the head of his bed, reduced his drinking, and went off the energizing anti-depressant we put him on about three months after leaving the hospital. I ran into him a year later, a quiet but cheerful and pleasant man. In retrospect, he thought it was the sleep disorder that had overstressed him.


Anonymous said...

I once supervised a staff psychologist (Masters level) who turned in a report of some 3 single spaced typed pages based on only a Draw-A-Person. That was the last testing he supplied under my supervision.

In grad school, Charles Jennings, Ph.D was my mentor, professor and my friend. One of the things he made sure I and his other students learned was not to impose ourselves or our persona on our clients, in therapy, in test reporting or in treatment planning. Too bad the psychologist you refer to didn't have Dr. Jennings for a professor.

MaxedOutMama said...

I hurt myself laughing. Can I sue?