Magazine | March 8, 2010, Issue

Bethesda Mental-Health Clinic


Doctor’s Notes

Tuesday 1/19

Convened our first group session. Technically, we’re calling it “Dealing with Setbacks in Home and Career,” but I’ve decided to let the discussion encompass a wide range of responses. Of the twelve participants, nine are currently serving in Congress or in the administration.

The first meeting was rough — the group quickly broke into factions, with a great deal of anger coalescing around patients Nancy P. and Harry R., who responded with ego-defensive behavior until the group- breathing exercises. Then, doctor attempted to break group habit of “blame game” with some fun trust-building exercises. Slight setback in the “trust building” when patient Nancy P. allowed patient Arlen S. to fall onto his back as she responded to an e-mail on her BlackBerry, but it quickly turned into a teachable moment.

Meeting ended early when patient Keith O., who’d apparently broken free from his restraints in the psychotic ward, burst into the room, making incoherent demands and insults.

Further Action:

*Send memo to patient Keith O.’s attending team to increase his medication dosage.

*Double-check the insurance authorization of Keith O. and Chris M. and Markos M. — not sure they qualify as “government employees.”

*Patient Rahm E. is misdiagnosed and should be transferred immediately to the “Living with Delusion” group on Wednesdays.

Tuesday 1/26

Second meeting slightly better than the first. The group responded to the breathing and stretching stress-management techniques.

Doctor began the session with a negative-futurizing exercise, in which participants imagine the negative future events that seem to be causing the most discomfort in their lives. Participants seem to be suffering from the same basic phobia of losing their respective elections in November, so doctor chose that area to focus on.

Many really seemed to benefit from the “If I Weren’t a Member of Congress, I’d Still Be a Real Person Because . . .” thought experiment. However, patients Arlen S. and Barbara B. seemed stumped by that, even when the group chimed in with supportive suggestions such as “. . . I have hobbies” and “. . . I enjoy the outdoors” and “. . . I am rich.” Still, it was a success.

Further Action:

*Open each session with “If I Weren’t a Member of Congress . . .” thought experiment to allow each group member to explore this idea in detail, and to prepare them for November.

*Be vigilant about maintaining focus on what members can do, individually and as a group, in a proactive way. Conversation too often drifted into a general discussion of how awful and cruel the voters are, and daydreams and fantasies about a world with “no voters” isn’t useful for our purposes.

#page#*Consider antidepressant meds for patient Evan B. He seems listless.

Tuesday 2/2

Third meeting a total disaster. Allowed patient Rahm E. to address the group. Despite his week of intensive anti-delusional therapy, meeting erupted into physical abuse. Doctor suffered slight cut to bridge of nose. We’re not making much headway in “Dealing with Setbacks” portion of group mission. May need to recategorize group as “Connecting with the Real World.”

Further Action:

*Investigate possibility of security personnel posted outside, costs, etc.

*Possibly suggest to patients Nancy P. and Harry R. that they be treated on an individual basis? Their presence seems disruptive.

*Never allow patient Rahm E. back into session. Unproductive.

Tuesday 2/9

Fourth meeting attended by patient Evan B. only, because of snow and traffic conditions in the District. This was perhaps the most useful and effective session of the group. Patient is clearly not suffering from either depression or mild delusion but instead has a kind of clarity that doctor had not noticed before — perhaps the group is too large? Too diffuse? Patient and doctor explored possible outcomes for patient — we did some goal-clarifying and some outcome-projection exercises, and it was clear to the patient what his course of action must be. He seemed resigned and relieved and thanked doctor for his help. Meeting ended as both patient and doctor were distracted by the sight of patient Keith O., again free from his restraints (but not the ball gag), running naked into the snowbanks as he was pursued by orderlies. Patient Evan B. made a comment about that being some sort of metaphor.

Further Action:

*Suggest to patient Evan B. that he return to address the group. The others might benefit from his perspective.

*Late-night sobbing phone calls from several group members suggest that medications should be explored.

*Transfer patients Chris M. and Markos M. into “Managing Your Mania” groups. Really isn’t working having a mix in this group.

Tuesday 2/16

Fifth meeting not useful. The absence of patient Evan B. led many into non-productive blame-shifting, which ended with another round of factional disputes centered around Nancy P. and Harry R. In fact, doctor is considering shutting the group down as a discussion-therapy forum and restarting it as a medication-management drop-in service. Will recommend that all remaining group members begin taking anti-anxiety and antidepressant medication, with a goal of normalizing behavior and managing psychotic responses until November.

Further Action:

*Have meeting room repainted and sterilized after most recent Keith O. “decoration” attempt.

*Develop dosage plan for each remaining member, and organize outreach to entire Congress to invite any member who wishes to “coast” in “blissful detachment” to November’s midterm elections.

*Begin developing “Coping with Grandiose Self-Regard” group-therapy protocols, for the incoming new congressional majority.

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