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Sunday, December 30, 2018

The Madness of King George - The Reluctant Psychoanalyst Observes Executive Function




I watched this film when it was released in theaters in 1994 and what I remember of it is that one of the friends that I watched it with, the chief psychiatry resident at the hospital where I worked, was able to remember that the obscure skin disease diagnosis that the film offers, porphyria, for King George’s madness was something that he somehow managed to remember from medical school based on its key identifying symptom – porphyria turns the patient’s urine blue – a symptom that King George manifested.  Now, many decades later, when the reluctant wife suggested that we watch it, I was intrigued, hoping that it would provide information about how King George’s madness was tied to our own revolution from the king, something that I had new interest in partly based on the musical Hamilton. 

Well, as a potentially historical film, this was a disappointment.  The events chronicled were at best loosely tied to historical moments.  This is a psychological study of a man – a character – who is perhaps the first of the kings whose job was less to govern than to reign – to serve as a figurehead who has a constitutional role, but a limited one.  This would become an art by the time Elizabeth II would ascend the throne.  But George (played by Nigel Hawthorne) was, unwittingly at times, creating the role of a non-interventionist but essential component of the governing structure of England – and his madness was a component of that.  The emphasis of the title clarifies that this is primarily a film about madness and only secondarily about History.

Madness is an interesting thing.  We are, and this is well portrayed in the film, not able to regulate ourselves when we are mad.  Antonio Damasio, in The Strange Order of Things, proposes that evolution has selected us to be able to regulate ourselves homeostatically.  From this perspective, our emotions are intended to give us information about internal and/or external states being out of whack.  When we are no longer able to use our feelings to exert the kind of controls that we would ordinarily assert – when, instead, those feelings propel us into being unbalanced, we are mad.  Thus, in this film, the king of England is suddenly taking his attendants – in their sleeping garments – for romps in meadows and, once assembled there, this deeply monogamous king is assaulting his wife’s lady in waiting openly trying to have sex with her with multiple onlookers present and in the light of day.

But madness, as portrayed by the author of the play the film is based on (Alan Bennett), does not divorce us from our essence.  As the king is returning to his senses his aid says, “Your Majesty seems more yourself.” And he responds, “Do I? Yes, I do. I've always been myself, even when I was ill. Only now I seem myself. And that's the important thing. I have remembered how to seem.”  This seeming – this appearing – is an important part of our “healthy” functioning.  We “appear” to be civilized – and in control – when actually there are all kinds of primitive and powerful thoughts and emotions roiling just under the surface of that seeming control.  When we are kings – or, in the current day and age, empowered in whatever way we may be, we may allow (or fail to control) our bestial selves – our uncontrolled and chaotic selves – to reign, imposing chaos on the world around us.

The remarkable thing about being king, then, is that we do exert control – that we function in the role of king on behalf of those we govern – that we don’t exert our will in selfish and immature ways but in ways that are in the better interests of those we are governing.  The subjects of a monarchy don’t choose who will govern them – the governors are born not elected.  So the Prince of Wales (also named George, played by Rupert Everett), the man next in line to be king, chooses to step in – he attempts to assert himself as regent – to take over for the unbalanced king.  He has a coterie of supporters who would emulate the United States and move further away from the rule of a king and move towards having those who are elected have greater power.  King George and his henchmen buy off the current representatives with titles and favors, ensuring their ability to exert monarchical rule in a nominal democracy.  Presumably his supporters see the younger George as more sympathetic to their cause – though they don’t seem to see that he has self-interest very much in mind and might become even more despotic than his father.

The prince states that “to be Prince of Wales is not a position - it is a predicament.”  Like the party that is not in power in our two party system – and like the Vice President – who is essentially a president in waiting without any true power in most administrations, the prince is simply waiting for the death of the king.  But this prince is not just making a comment on the position, but on his relationship with his father and his father’s consistent efforts to foil his activity – as if his father fears that his foppish and un-self-governed son would act madly if given the opportunity.  So it is with some trepidation that we see the son feeling that he must step in to restrain his father when his father is running amok – this becomes a family matter rather than a matter of government, he maintains.   The question that he raises is a very current one – both for those who are mentally disordered and for those who are governing in ways that others see as unbridled- is the man fit for office and if he is not, should he be removed?

OK, spoiler alert, in the film, King George, due to the cyclic nature of his disorder, returns, as referenced above, to “seeming” himself – and when he does this, there is no grounds for installing his son as regent.  Historically, this occurred a number of times, suggesting to me that the hypothesis that George suffered from Bipolar disorder in addition to or instead of porphyria.  Some have surmised that his blue urine may have been caused by some of the herbs that he was treated with rather than being a symptom.

In addition to the threat to his monarchy that comes from his son, King George has to confront Francis Willis (Ian Holm), who is called in to treat his madness.  This man, a former clergyman who knows nothing of Shakespeare or, apparently, the soul, runs a farm where the mad are treated.  He knows how to use punishment – strapping the King into a chair when he won’t control himself – as a temporary means of reinstating the King's ability to exert some authority over himself.  Dr. Willis states, “If the King refuses food, He will be restrained. If He claims to have no appetite, He will be restrained. If He swears and indulges in MEANINGLESS DISCOURSE... He will be restrained. If He throws off his bed-clothes, tears away His bandages, scratches at His sores, and if He does not strive EVERY day and ALWAYS towards His OWN RECOVERY... then He must be restrained.”  To which, George responds, “I am the King of England.” And Willis rebuts, “NO, sir. You are the PATIENT.”  Eli Zaretsky, a historian of psychology, cites Willis and his treatment of George as an example of the enlightenment approach to treatment - based in Lockean principles of associationism, it is an attempt to appeal to the little rational part of the mind that is still present.

While Willis' approach affords some nominal level of control, it is the King’s wife, Queen Charlotte (Helen Mirren) who, despite being kept from him by Dr. Willis during the latter stages of his madness, maintains a sense of who the King is – not just what he seems but who she essentially knows him to be – someone whom she loves – despite his flaws – and someone she supports.  And when he is returned to “health” and is confronting his son, it is she who is able to guide the King through the homeostatic process of forgiveness and working from a position of love – helping to guide emotions that are now more clearly shakily in the King’s control – the way that all of us exert rather shaky control over our feelings when we are functioning at our best.






To access a narrative description of other posts on this site, link here.  For a subject based index, link here. 





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Saturday, December 22, 2018

In MY Lane: Gun Control, the NRA, and a Personal Psychoanalytic Response





The psychoanalysts depicted in New Yorker cartoons have almost certainly never shot a gun, and you may be wondering where it is that I, as a psychoanalyst, have the wherewithal to weigh in on something that is so completely out of my purview.  The NRA, in fact, has determined that ALL health and mental health professionals should not weigh in on gun control – they tweeted on November 7th (My father’s birthday) that "Someone should tell self-important anti-gun doctors to stay in their lane".  

So, first of all, let me state that I live in a flyover, red voting state – and that my family on both sides has hailed from the Midwest for generations (and has generally been dead red in their voting habits).  My Mother and Father went bird hunting together when they were dating – a sport each had learned and practiced with their parents.  Even when we lived in Florida for a time when I was growing up, I hunted ducks and mourning doves (yes, we hunted mourning doves – and ate them, too) in Lake Okeechobee and rice fields respectively.  I am the proud holder of what I think used to be called a Riflery merit badge (it is now called a Rifle Shooting  merit badge – if you scroll to the end of the linked BSA site, you will see an NRA banner) and learned to shoot a revolver as part of earning that badge.  I am also proud to say that I winged a bird – an actual bird called a snipe, not the fake kind you chase after on Boy Scout camping trips – the first time that I shot a shotgun, but more about that later.

The “stay in your lane” comment is one that the NRA made in response to a physician writing with concern about gun violence.  Within the psychology/psychoanalysis field there have been a number of professionally based responses.  Jane Tillman has written about this issue as a citizen and a suicide researcher and Todd Essig has charted in a Forbes magazine blog the ways in which the NRA and the politicians that they have supported have undermined our ability to use data to argue for gun control by preventing federal monies from supporting research on the relationship between guns and violence or suicide.  This post is more personal – coming from someone who has a long relationship with guns – including both the good and the very bad ways that they can affect a family (more about that later), but beyond that I would like to use my psychoanalytic mind to attempt to better understand some of our apparent irrationality about exploring the limits of our second amendment rights.  There are of course many reasons for the attitude that “we will only let them pry our guns out of our cold dead fingers” exists – I will not talk about all of them, but most of them are far from irrational.  But I do think that some of them– such things as profits that gun manufacturers make, while significant, are likely less important than what I am about to discuss.

My grandfather killed himself with a shotgun.  He did this shortly before my parents were to have married – they had to postpone their wedding in order to have the funeral.  There was some question about whether his death was a suicide.  He shot himself in the shoulder – he was dressed in formal wear (a tux, I think) in preparation for a celebratory dinner of some sort.  My father’s younger brother, my uncle Peter, found him and called for an ambulance.  There was an inquest because his life insurance policy would pay double the face value if it was an accidental death and nothing if it was a suicide.  Ultimately the insurance company split the difference and paid the face value of the insurance, but the record of the inquest remained and I was able to read it as an adult after my clinical training.

At this point, you might think that I would make a plea to prevent the sales of all guns so that catastrophes like the one that ended my grandfather’s life would never happen.  My intent here is different, though.  I would like to clarify two things – first that events like suicide and murder, have impacts across generations.  And second, to clarify, but this will take some time, what I think are some of the motives that lead gun advocates to be so rabid about avoiding what appear to be common sense limits to weapons proliferation – something that is relevant to my grandfather’s death – but likely not in the way you are thinking at this moment.

My father denied – in the court documents and throughout most of his life – that his father committed suicide.  He maintained that his father’s death was an accidental death - period.  And he did this quite vehemently.  Reading the court documents made it quite clear that, while the triggering of the weapon at the moment that it was triggered may not have been the moment that my grandfather intended to kill himself, he was quite likely intent on killing himself.  He may, for instance, have tripped on the way to killing himself or to storing the weapon for later use in killing himself, as my uncle Peter has surmised. 

My grandfather was the owner and proprietor of the family business – a department store that his father – my great grandfather – had started.  This business had survived the depression and was now, in the 1950s, a going concern that supported my grandfather and his family.  My father was employed at the store.  But a fire at the store about a month before my grandfather’s death had created a crisis for its continued viability.  For three weeks after the fire, my grandfather had been inconsolable – he blamed himself for the fire – fearing that he had not closed the grate on the furnace before going home on the night when the fire occurred.  For the last week of his life, he had returned to being himself and his mood seemed buoyant again. 

Reading the above account from the court documents as a clinician, I was struck by how frequently a positive change in mood occurs when people who are depressed have made a plan to kill themselves – they see a way out of their predicament and their mood lifts.  I became convinced that my grandfather had killed himself. I guessed that my grandfather felt something like, “I have gone from being the breadwinner for my family to having endangered them.  They would be better off if I weren’t here.” 

I am aware of having gone into more detail than I needed to in the story of my grandfather’s death.  I think I did this in part to give you context, but also because I needed to convince you that his death was somehow justified – or understandable.  I think that, though I never knew him, I am protective of him and that I want to prevent your negative judgment of him – and I think that betrays that I have judged him – I think I feel ashamed of having a grandfather who killed himself.  And if that is the case, I believe that it is even more the case that my father’s denial of his father’s suicide was, in large part, a way to avoid feeling the tremendous shame that I feel to a much smaller degree. 

I knew very little about my grandfather from my father.  He almost never spoke about him.  One little thing that I knew about him from Dad was that he wrote Dad a letter every week that Dad was in college.  I knew this in part because my father felt badly that he had not done the same with me.  But it was only when Dad was digging around trying to find evidence that he had been in the army because the records of his service had been lost in a St. Louis fire that I read the letters his father had written.  My father had letters that were written not only to him, but also to his mother and to another family member – in one case three letters from the same week.   Each of the letters was very warm and focused, despite being written in the same week, on very different events that had occurred in town.  Each letter was tailored to the interests of the reader – and my grandfather clearly had that reader in mind – weaving their interests into the stories that he told.  But it was not just that grandfather used content that was of interest to the reader, but he also clearly and warmly expressed his affection for the reader – talking about shared experiences and the way the reader had brought him joy at some point in his life.

It was very odd to discover that my grandfather – a person that I knew so little about other than the fact of his death – was such a warm and caring person.  I should have known that from the way that my family operated.  Despite his three sons having moved to very different parts of the country, we all regularly got together at Thanksgiving at one or the other brother’s homes.  Grandmother was always there as well as most all of the first cousins.  We generally had between 18 and 22 for dinner and the annual football game.  All was not peaches and roses – there were regular dust ups and a fair amount of bullying – especially at the football game – but there was also a lot of warmth.  And there was a contrast between the warmth of the family and the feelings between my father and his children.

My father, after he left the family business, became a travelling salesman, using the electronics skills he had learned in the military to sell electrical systems to engineers who were largely working to improve the functioning of automated factories.  This meant that he was generally on the road for two to three and sometimes four nights a week.  He was largely physically absent.  But he was also psychologically absent.  He had a hard time connecting with his children about their day to day lives – whether that was our sporting events or our homework and school achievements or our social lives.  At home he would frequently spend the weekends immersed in tasks that involved fixing things and our helping him frequently involved holding a flashlight so he could see his work better, but rarely involved interacting in a more give and take manner.

Now, we could just chalk his emotional distance up to his being a typically emotionally remote man of the mid twentieth century except that he could be remarkably interested in others and quite compassionate in his engagement with them.  This included both friends that he made through work and through his engagement at church, but also with our cousins.  At a recent family reunion, the spouse of one of my cousins talked about the importance of the letters that her husband frequently received from my father while my cousin was in college as helping to sustain him through difficult and lonely times, something I did not previously know about.  Additionally, there were things that my father could teach us – and teach us well and warmly.  One of these was skiing.  He was a good and patient teacher and truly enjoyed being with us and talking with us when we were riding up ski lifts together.  And I think it important that this activity was one that he learned on his own – this was not a family activity for him growing up.  It was also the case that, as the result of consistent efforts on my part, he and I became, as adults, quite close and were able to establish the kind of relationship that I had longed for as a child.

My hypothesis about the primary reason for my father’s physical and emotional distance when he was more actively parenting (or not parenting) my siblings and me is that this would have involved remembering his father and the interactions that he had with him as a son – and that this was too painful for him because he was, on some very deep level, profoundly ashamed of his action and, I think, he felt betrayed by his father’s choice to leave him through suicide. 

I have some support for my hypothesis.  As a result of my conversations with him, my father ultimately acknowledged that he had always believed that his father had committed suicide.  Unfortunately my father died before I talked through with him his reasons for denying his father’s death to be a suicide for as long as he did.  I tried out my hypothesis on my Uncle Peter recently, and he felt that it had some merit.  Even if it is “true”, there were certainly other factors that accounted for his emotional distance – I’m sure Freud would want us to work on the Oedipal elements, and personality theorists would talk about his being primarily introverted (though functioning, as a travelling salesman, as an extrovert).   I’m sure these and many other factors played into our relationship.  But I think his father’s suicide was a very important factor and one that was largely hidden from my – and likely from his – view.

So the point of this lengthy tale is that suicide has an impact to the third generation.  Indeed, I’m sure it is a factor in the relationship between my son and me.  And this in the context of a family that apparently recovered well from it.  The land the store was on was owned by the family and through a series of real estate deals, it became a consistent source of income for my grandmother who was able to live independently (and visit us regularly wherever we were in the US, and sometimes abroad) for the rest of her life.  For many families a suicide can have much greater and easier to track deleterious economic effects and these do not take the kind of psychoanalytic sleuthing I have engaged in to discover subtle impacts across time.  Neither suicide nor murder is good for the families in which they occur. 

So, to reiterate, this story is not that this suicide could have been prevented.  Suicides are as variable as the people who engage in them, and I think, for reasons I will spell out shortly, that my grandfather likely would have figured out how to kill himself without having access to guns.  But for many people, easy access to a means to kill oneself can be demonstrated by how suicide rates plummet when those easy means are not accessible – as a New York Times Sunday Magazine article articulated ten years ago.  All that said, I can’t help but wonder if my grandfather would not have taken his life if he did not have such an easy means to do it with.  But the point of the story is that suicide (and murder) are complex physical and psychological events that we should work to prevent with whatever means we have available to us.

Have you ever held a loaded weapon in your hand?  There is an awesome feeling of power that goes along with it.  There is also an awesome feeling – or should be – of responsibility.  This is related, in no small measure to fear – fear of what could go wrong if this thing fired unintentionally or hit and unintended target.  There is no going back from the impact of the bullet. 

If you have ever been trained in using a weapon – as I have – the first and most important part of the training is gun safety.  Recently I was talking with two men who first held guns in their hands in the military.  Both talked about how the rigidity of basic training became ramped up when gun training began.  Those in charge of the range laid down the law about when and where a weapon could be pointed.  In my own training the first and foremost rule was never ever point a weapon at another human being.  After that, there were many rules about keeping weapons unloaded except when prepared to fire them, etc.  As I later learned about the treatment of suicidal patients, the first three rules were safety, safety, safety and then, after that, other things could be introduced.

Weapons are very powerful tools.  Remember the snipe I injured the first time I shot a shotgun?  I found it on the ground flapping its one good wing and running in circles as its other wing dragged, broken, on the ground.  I felt terrible and wanted to put it out of its misery as quickly as possible.  I loaded my shotgun and shot it from point blank range, shooting its head clean off its body.  I was quickly told that this is not the way to humanely end the life of an injured bird – it is a waste of ammunition and can make the bird inedible as it is destroyed rather than killed.  The proper means to kill a wounded bird is to pick it up and beat its head against the butt of the gun until it is dead.

If you are not a hunter, that last line may have come as a bit of a shock to you.  It may feel brutal and inhumane.  In fact, it is very quick and effective and becomes common place when hunting.  It is also something that is a common part of consuming meat of any kind – most domestic animals killed for consumption are killed with blows to the head.  We, in picking up already butchered meat at the grocery store, are protected from the course of events that has led to our being able to eat another animal.  But hunters are not.  They are engaged in the control of the life and death of other animals on a regular basis. 

How individuals respond to this – the ways that they differ from each other and the different ways that each of them responds to it – is something that is worth studying – and here I am asking you to consider the manifold responses in a psychological thought experiment as an important aspect of the psychology of our attachment to firearms.  There is a feeling of power, as I mentioned earlier, and control that is certainly part of the process of hunting (and I assume, though I have never served in the military, that this is true of being trained to use weapons to kill humans and actually using them to do that).  There is also a level of comfort with our basic biologic being and with – as we prosaically call it – the circle of life.  We live until we die.  And death is a part of our lived experience when we hunt in a way that it is not when the dead are only occasionally confronted on our grocery shelves and in funerals.

When Essig, in the blog cited above, wonders about the irrational position of the NRA that the answer to gun problems is more guns, I think it may help to understand the psychology behind the NRA’s huge funding, the tenacity and shrewdness of their lobbying, and the appeal of their message to a broad swath of the American people.  As Antonio Damasio has recently pointed out in The Strange Order of Things (following and updating Freud’s insightful but flawed analysis in Civilization and Its Discontents), we have only been “civilized” for the past 10-15,000 years.  We have millions of years of evolution that selected us before that – and Damasio maintains that evolution consistently favored those of us (he starts with bacteria) that could band together against a common enemy over those who did not.  We formed clans or family groups long before we began to build cities, much less states and countries.  The sense that we will prevail by banding together in order to have greater strength against a foe is deeply coded in our DNA. 

My position is not that there is a simple solution to the impasse about how to properly manage the second amendment, but that our search for something workable may be more fruitful when we acknowledge the roots of apparently irrational positions like some of those of the NRA.  The second amendment was put in place to protect our ability to protect ourselves against an imperial and corrupt power that would control us from without – as England controlled the colonies.  As we self-styled educated folks band together to attempt to eradicate a force that threatens us (the NRA and unregulated guns) and we use the power of the pen (and word processor) to fight that dangerous and corrupt force, it might help us to realize that we are functioning, in that banding together, just as they are and that we may be driven by the same primordial forces that have kept us “safe” for time immemorial.  If we can view the NRA and its adherents as people who are driven as we are to protect ourselves, and if we see them as being as committed to safety as we are, we might be able to find some common ground – some way to assure us all that we are all better off with limited but powerful safeguards – the kinds of safeguards that are woven into all sanctioned forms of weaponry training.  We – both the NRA and those of us who do not believe that unlimited proliferation of weapons will protect us – want to live in a world that is safe.

My grandfather came, I believe, to see himself as being a source of danger to his family rather than being a force for good.  I feel great sorrow that he felt that to be the case – or something like it, I cannot know what he was actually thinking.  I think that when we are able to see each other as allies rather than enemies – when we are able to envision the world as an organic whole that it is ours to preserve and protect (and I know of no greater advocates for the environment than most hunters), we, together, can figure out how to better protect ourselves.  If we can delay the action of suicide, we can work to help change the perspective of those who believe that it is a rational action.  Over time, the formerly suicidal person can come to realize the value of their contributions and can become generative – and support that generativity in their offspring.  We can help them move from a position of feeling isolated and alone to a position of feeling connected - the best way to prevent suicide - and war.  I’m not sure that the kind of help that my grandfather needed to make this transition was available to him – not just because his small town likely did not have a psych ward, but because he likely did not feel that he could confide the things that he was feeling in others.  I think he, himself, likely felt both shame, but also reassurance at the course of action that he mapped out - he had, on his own - worked out a solution.  If we fail to connect with each other, to see each other as allies against what is truly threatening us, we sow seeds of poison that can take generations to purify. 




To access a narrative description of other posts on this site, link here.  For a subject based index, link here. 





To subscribe to posts (which occur 2-3 times per month), if you are on a computer, hit the X button on the upper right of this screen and, on the subsequent screen, hover your cursor over the black line in the upper right area and choose the pop out box that says subscribe and then enter the information.  I'm sorry but I don't currently know how you can subscribe from a mobile device - hopefully you have a computer as well...     

       

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