Magazine | November 25, 2013, Issue

Bethesda Mental-Health Clinic

Doctor’s Notes

Tuesday: Spent a full session with Client BHO. Spent most of the session hearing how well the rollout has gone for one of his signature pieces of legislation — actually, his only signature piece of legislation.

Was experiencing transferred anxiety due to my own interaction with his health-care program — my self-employed son has been on the site for several days attempting to purchase health care — and so was in the awkward position of having to contradict Client BHO in his assessment, which of course violated the frame of therapy.

Luckily, Client BHO is currently suffering under a deluded — some might call “fugue” — state, and was unable to process my questions. I asked about the delays and unusable nature of the website and received blank stares. I asked about the “if you like your health plan, you can keep it” promises and received no response. Immobile, facially unexpressive, and without affect. Curious. Will also investigate possible medications for this psychotic non-acceptance of reality and simple cognition breakdown.

The traumatized brain often enters into a self-imposed “fugue” or protective immobility, where no new stimulus or thought can enter or exit, protecting its vital self-image functions and basic reptile-brain activity, and what we see here with Client BHO is precisely that.

At the end of the session, Client BHO asked me if we could continue our conversation — he calls them “conversations,” which is a familiar self-deluding term used by malignant narcissists, and extended-infancy adults, for critical therapy. I do not correct him, because I sense there is a small part of Client BHO’s consciousness that clearly perceives the world around him. It was this small part that I believe compelled him to ask for further unscheduled extra sessions. I agreed to see him the following day.

Wednesday: What I expected would have been a breakthrough day for Client BHO — a session that he asked for, coming on the heels of a fugue and immobile state during session in reaction to my simple questions about reality and the world around him — was instead derailed by the appearance during the session of Client BHO’s official spokesperson, who, ironically, is also a patient of mine.

When Client BHO walked into the room, I thought I detected the signs of a consciousness struggling — and barely succeeding — to grasp the true nature of his surroundings and personality. Throughout our troubled doctor–patient relationship, Client BHO has presented a self-identity of grandiose, almost messianic flavor. Some of this has been controlled through small doses of Latuda™ co-utilized with Klonopin™. But mostly, due to constitutional and legal requirements, we have relied on nicotine and controlled, targeted enemies list–making and political witch-hunting to keep the larger demons at bay.

#page#For the record, I counseled against this approach, despite its effectiveness during the recent general election.

Nevertheless, we have never actually had another real person in session with us. We have occasionally “role-played” another person — Client JBoehner and Client JBiden have often been “here” for fantasy “anger purging” sessions.

So when Client JayCarn entered the therapy space, I initially thought perhaps I had double-booked the session. I’ve been seeing Client JayCarn for several years in connection with his own cognition-acceptance issues, along with a very severe case of self-negation. (He tends to subsume his own needs/wants/selfhood/principles in the glow of a powerful patron, which has caused deep anxiety and unresolved sexual/personality issues, psychologically becoming a satellite — or “mind slave” — of his hero/self-replacement object.)

I was informed that Client BHO and Client JayCarn were attending the session together.

Client BHO took a seat, then turned to Client JayCarn and motioned for him to speak. For the next 30 minutes I was subjected to an exhaustive and (mostly) fantastical recitation of the benefits and successes of Client BHO’s health-care initiative. I was placed on the telephone with the six happy customers of said health-care initiative — one of whom, although it’s difficult to diagnose over the phone, was clearly mentally ill; another of whom, I’m fairly certain, was Client JBiden using a high-pitched female-sounding voice.

When this recitation was finished, I asked Client BHO to respond to my initial question about his many statements averring, simply, that “if you like your health-care plan, you can keep it, period.”

Before Client JayCarn could jump in, Client BHO insisted that he had been misquoted. “What I said was,” he said, “if you like your health-care plan you can keep it . . . for a period. The period of time between logging onto the site and typing in your name.”

Unfortunately, I then uttered a thoroughly unprofessional compound noun describing the feces of a bull calf. Frame, at that point, was broken irretrievably, and any glimpse of progress I had seen with Client BHO receded as the transference process came to an abrupt end.

Client BHO left the session, followed at a subservient distance by his Dom/Sub Object, Client JayCarn.

I blame myself for this failure. Recommend Client BHO seek treatment elsewhere.

Thursday: Sessions canceled, due to doctor unavailability. Have been called to the local IRS office for a “random audit.” Unknown when I’ll return. Am pleased that Client BHO is returning to his safer methods of grandiosity/messianic-behavior abatement. Whoever his new doctor may be, he’s clearly making progress.

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