Bethesda Mental Health Clinic
Had first session with new patient. Always difficult to start a new series of treatments, this time slightly more difficult due to the presence of Secret Service personnel in session room. Very hard to get patient to focus on his current delusional self-image and do the hard work of seeing himself as real and human and flawed when he’s surrounded and protected by armed guards.
When asked to wait outside, the Secret Service detail complied, which allowed patient and doctor precious moments to connect. When queried as to the key issues that the patient feels need attention, he just shrugged. It’s all going well, no problems, all good, etc.
Patient is clearly delusional. Potential for malignant narcissism. Uphill climb. Medication not indicated as per 25th Amendment to the Constitution according to clinic’s in-house attorney.
Patient arrives in golf attire, which seems oddly cavalier. In an attempt to jumpstart transference, doctor asks about the round — patient proudly shows his card — and then doctor mentions, in passing, that doctor’s net worth has declined 65 percent since patient took office. Meant to rattle his cage a bit, did the opposite. Patient launches into a highly detailed rebuttal, suggesting that doctor’s net worth has actually increased in the past four years “if you look at it right.” Doctor remains unconvinced, and asks patient to engage in a thought experiment.
“What if you’re wrong?” doctor asks. “Just go with me here for a few moments. Just close your eyes and imagine that you’re wrong, that we’re on the wrong track, that what you’ve done isn’t working.”
Patient’s eyes remain open. He is frozen in place. Suggestive of cognitive brain lock.
Patient immovable for rest of session. Secret Service detail carries him to presidential limo.
Patient arrives unscheduled. He has just seen a series of poll results suggesting a dismal outcome in November. Patient is slightly unnerved by this “new” information.
Doctor painstakingly reviews the events of the past three years using the Internet. As he and patient review the information, patient becomes increasingly agitated. “Where did all this come from?” patient demands. Patient is dumbfounded to discover high unemployment, sluggish economic growth, discontented voters. Patient clicks through the Web in increasing rage. Directed, at first, at Patient J. Biden (see “BIDEN, J”: presents with Tourette’s; medication crucial for functioning affect) and then at all others, including (and especially) doctor.
This is of course normal. Patients often identify the doctor as the source of the problem. Blame-shifting is in fact a positive sign — it suggests that the delusional bubble is being burst; patient understands that there is, in fact, a problem.
Once the delusional and psychotic cognition is removed, patient’s natural malignant narcissism will reemerge. Probably next week.
Patient arrives early for scheduled session, accompanied by members of the press. Joe Klein (also a patient) serves as unofficial spokesman for the group, which includes several New York Times reporters, assorted bloggers, and the editorial staff of The New Republic. Patient refuses to engage, merely directing all questions and conversational gambits to his “entourage.”
Patient entirely confrontational. Refuses to engage doctor on any level. In fact, patient insists on sitting on several cushions to maintain his higher eye-level position vis-à-vis doctor. Entourage gathers around patient’s feet, staring adoringly.
In an attempt to break down patient’s reinforced narcissism, doctor begins asking about the economy and unemployment. Doctor is rebuffed by the journalists, who demand to inspect the doctor’s credentials. Further, they insinuate that the doctor is somehow “in the pay” of “Big Pharma” and “agitating” against what they accuse doctor of calling “Obamacare.” When doctor reminds them that he already works for the government, in a sense — Bethesda Clinic is a Navy-run organization — they scoff and suggest that it’s racism.
Doctor is on the one hand pleased — patient came to him delusional and out of touch, and is now returned to his static psychosis of malignant and reinforced narcissism.
On the other hand, patient is no closer to facing reality than he was before, and repeated suggestions for medication and/or more invasive therapies are totally ignored.
Patient arrives on time and looking good. Patient speaks in affable and pleasant tones, and convinces doctor that patient is, in fact, quite healthy both mentally and physically. Further, patient lays out a compelling vision for the future of America, as well as a thoughtful and sobering analysis of the problems that the patient inherited from his predecessors.
Doctor please help me recommends that patient please help me he’s watching me write this cease all treatment he’s watching me write this and making me say these things because he’s so amazingly healthy and well-balanced please help me.
Patient ceases all treatment.