Also by Louis B. Fierman, M.D.: "Shrink"
Psychotherapy evolved as a means of liberating the human spirit from the constraints of psychoneurosis. It was not meant to be simply a means of alleviating symptoms and improving social adjustment but was meant to promote the creativity and inborn aptitudes and talents of the patient. Now, managed care threatens the very existence of long-term, curative psychotherapy. Freeing the Human Spirit resists that threat to keep the flame of psychotherapy alive. This approach is based on the teachings of Hellmuth Kaiser and is nondirective, nonanalytic, communication-oriented, and similar to the person-centered approach advocated by Carl Rogers.
Freeing the Human Spirit consists primarily of twenty-one case vignettes intended for readers who are involved or interested in psychotherapy and psychiatric private practice. Psychotherapy is best understood in the context of actual clinical transactions between therapist and patient. There is also an essay on the development of nondirective therapy. This approach holds the promise of increasing the effectiveness of therapy and achieving results that are more meaningful than simple alleviation of symptoms, which leaves the patient vulnerable to relapse and recidivism.
"This volume of clinical vignettes reveals the mature capacities of a deeply thoughtful and humane physician after a lifetime of therapeutic work. The key to freeing the humanity of his patients lies in his fully present and authentic interactions with them. The connections between Fierman's personal qualities and his technical mastery are truly seamless." Eugene B. Brody, M.D., Professor and Chairman Emeritus of Psychiatry, University of Maryland, Visiting Professor of Psychiatry, Harvard Medical School, Editor-in-Chief, Journal of Nervous and Mental Disease
"Dr. Fierman has done an excellent job of explicating and extending Hellmuth Kaiser's insight that successful psychotherapy consists in 'whatever helps the client stand behind his words.' Although the obvious need for honesty and spontaneity by the therapist makes his/her role describable by what it is not, Fierman has found a way to impart the method. Using a typical Central-European device he tells us stories - cases he has had, what he did, and how they turned out. All this from an experienced and expert practitioner." Norman A. Polansky, Ph.D., Regents' Professor of Social Work Emeritus, University of Georgia
"Dr. Louis Fierman is a very experienced psychiatric clinician and esteemed teacher. Freeing the Human Spirit reflects his style and values and emphasizes honesty, straightforward communication, perseverance, and humor. The vignettes in the book bring these values to life by combining a discerning clinical eye with a direct and vivid prose." Malcolm Bowers, Jr., M.D., Professor of Psychiatry, Yale University
"A gripping testament to the healing power of honest, non-directive communication and the constant integrity and commitment to the patient's real liberation that it demands of the therapist. Dr. Fierman's writing speaks to the reader with a comparable blend of warmth, extraordinary honesty and integrity." Jacob Needleman, author of The American Soul
"Lou Fierman is a rare bird in the jungle of psychiatry: He actually listens to his patients - and he has meaningful conversations with them, too! Why is this so rare today? Because psychiatrists are taught to study brains and neuro-transmitters at the expense of understanding persons and the existential reasons for their behaviors. Dr. Fierman's candor frees the human spirit, and the conversations documented here could give disillusioned psychiatrists a new sense of purpose and meaning in their work. I recommend it." Jeffrey A. Schaler, Ph.D., author of Addiction Is a Choice
Table of Contents
Preface: The Magic Power of Communicative-Intimacy
Introduction: Case Vignettes
Case 1. You're Not Too Fat - You're Too Short
Case 2. I'm Al, Not Alexis
Case 3. Striptease
Case 4. The Seduction of Dr. North
Case 5. The Woman Who Killed Martin Luther King
Case 6. You'd Be Paranoid Too If Everyone Were Against You
Case 7. Catatonia
Case 8. The Reluctant Wife-Beater
Case 9. Go and Sin No More
Case 10. A Bond of Mutual Loathing
Case 11. An Unexpected Outcome
Case 12. The High-Profile Patient
Case 13. Gotcha!
Case 14. A Fatal Success
Case 15. The Dance
Case 16. Better Late Than Never
Case 17. Alice
Case 18. Facing Paranoid Rage
Case 19. If It Ain't Broke Don't Fix It
Case 20. An Exorcism
Case 21. The Shy Bachelor
The room was filled with friendly folk - talking, joking, laughing, introducing themselves to one another - drinking punch and munching on pretzels and potato chips. Fifteen psychiatrists from various Northern states were meeting that evening of April 4, 1968 in Montgomery, Alabama with a group of social workers from local community social service agencies. The psychiatrists were here as part of a government grant to learn about mental illness and mental health services in a Southern city.
The plan that evening was for each psychiatrist to meet with an assigned Montgomery social worker and then to spend the following day with him or her observing the services being provided by that worker's agency. Most of the social workers were black and most were women. A party spirit prevailed and we psychiatrists basked in the warmth of Southern hospitality and interracial friendship. A black man suddenly entered the room, agitated and distraught. He sought out the leader of the gathering and whispered something in his ear. The leader looked stunned and then called out loudly: "Friends! Please! May I have your attention! I have just received terrible news! Martin Luther King has been assassinated in Memphis!"
Pandemonium broke out. Most of the psychiatrists were shocked and speechless. Many of the social workers screamed and wept. We tried to comfort one another. After several minutes had passed the leader again called out, "Friends, I think we should end our party now. You all know where to meet in the morning. Unless you hear otherwise we will carry out the program as planned." I headed out of the room into the hallway of the hotel where the party had been held. I happened to be the last to leave when suddenly the leader came out and rushed up to me: "Doctor! Please come with me! We have an emergency!"
He led me into a side room. There a few social workers were attempting to physically restrain a struggling weeping woman. I was told that she was Patricia Parsons, Ph.D., a divorced single mother of a three-year-old son, professor of social work at the local university, prominent in local politics and with no known history of past mental illness. She was a tall, beautiful, well dressed, black woman thrashing about trying to free herself from her colleagues. I intervened and signaled the others to release her. Once freed she began to pace feverishly about the room, wringing her hands, pulling at her hair, alternately sobbing and then crying out: "Oh God! Oh God all mighty! God all mighty! I've killed Martin Luther King! I've killed Martin Luther King!"
I paced alongside her. "No, no, Doctor Parsons. You did not kill Martin Luther King." I hoped my soft-spoken assurances would calm her but to no avail. Back and forth she paced and her weeping and repetitive protestations only seemed to increase in intensity the more I tried to comfort her. "This woman is having an acute reactive paranoid psychosis," I thought to myself. "I'm going to have to hospitalize her if her delusional disorder doesn't subside soon or if she becomes suicidal."
I asked one of the bystanders to take my place and to continue walking with her while I spoke to her worried friends. "She's obviously very upset over King's death," I said, "but I hope she will feel better in the morning." I advised that they take her home and arrange to have someone stay with her through the night. I prescribed some Valium and asked that I be called at my hotel if things got worse and to let me know in the morning how she was doing. I cautioned that if she did not recover overnight she would probably have to be hospitalized.
Doctor Parsons went along with her friends, weeping and moaning about killing Reverend King. I and my fellow psychiatrists returned to our hotel where we were cautioned not to leave the hotel that night. Soon the city erupted with rioting by blacks venting their anger and grief by burning buildings, shooting and assaulting whites, storming and looting white-run stores. We all feared for our own safety and spent a fitful night.
Early next morning I was phoned in my room and told that someone wanted to see me in the lobby. I went down and there was Doctor Parsons, smiling, alert, calm and composed and clearly not psychotic! "Thank you, Doctor Fierman, for trying to help me last night," she said. "I'm sure you must have thought I was insane!"
"Well, that did cross my mind," I said. We found a bench to sit and talk. "Let me explain," she said. "A black state congressman is running for governor of Alabama in the upcoming election. One month ago I organized a rally on his behalf to take place yesterday in Montgomery. Reverend King was then in Memphis to support the garbage men's strike for better working conditions there. I called Reverend King in Memphis to plead with him to come to Montgomery yesterday to speak at my rally and he agreed. Well, yesterday morning he called to say that negotiations in the Memphis strike had reached a critical point and, although he was willing to honor his commitment to speak at our rally here if we held him to it, he asked if I would please release him from his promise and cancel his appearance here so that he could continue his efforts to help the garbage men there in Memphis ... Don't you see? If only I had held him to his commitment to be here yesterday he would not have been killed!" She began to sob quietly as she finished her story. "No, Doctor Parsons," I said. "The only difference would have been that his assassin would have followed him here and he would have been shot in Montgomery instead of Memphis. You did not kill Martin Luther King!" Still sobbing she nodded her head in agreement.
* * * * *
The discerning therapist should never dismiss delusional statements of patients as being totally meaningless, but instead should search patiently for their hidden relevance. There is always a kernel of truth in the delusions of psychotic people just as there is always some measure of reality in our dreams, no matter how disguised or distorted. What seemed at first to be a bizarre distortion of reality in this historical instance became an understandable, albeit unjustified, misinterpretation of facts once the facts were known.
Blue Dolphin Publishing, 2002
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