That these three men had positive delusional referents is of theoretical importance in its own right, and points to an aspect which seems thus far to have been overlooked by those who have worked with psychotic persons. We have in mind here most particularly the important work of Norman Cameron, a psychiatrist who has written extensively on the nature of paranoid states. He describes the paranoid pseudo-community in the following way:
The paranoid pseudo-community is an imaginary organization, composed of real and imagined persons, whom the patient represents as united for the purpose of carrying out some action upon him.[8]
… The motivation he ascribes to [these] persons … is bound to be extremely hostile and destructive. To complete his conceptual organization of a paranoid conspiracy, the patient also introduces imaginary persons … helpers, dupes, stooges, go-betweens, and master-minds, of whose actual existence he becomes certain.[9]
The “presence” of positive authority figures was noted not only delusional systems of the three Christs but also in three paranoid female patients we studied for control purposes. (More will be said about this in Chapter XIX.) From all these observations it may be suggested that the paranoid pseudo-community also includes positive delusional referents. And we proposed in the second phase of research to enlist the aid of these delusional referents by initiating suggestions for change through them.
Cameron remarks that the patient “introduces imaginary persons … of whose actual existence he becomes certain.” The messages we were to send Leon and Joseph (but not Clyde) from their positive delusional referents were designed to explore the effect of such communications and also to ascertain whether Leon and Joseph actually believed in the existence of these referents.
Needless to say, I composed and sent all messages. In this connection, I would like to discuss some ethical matters to which I gave the gravest consideration before I finally decided to proceed.
Joseph and Leon did not invite us to come to Ypsilanti, and I did not seek their permission in advance for the experimental procedures we employed. To this day, neither Leon nor Joseph knows, as far as I am aware, that I was the author of the letters they received, supposedly from their delusional referents. Of even greater concern was the fact that I had no way of knowing in advance what would happen as a result of the messages they would receive. I was about to explore an obscure area of the human psyche by means of a method never before tried; I had to consider especially the possibility that these messages might be extremely upsetting to Leon and Joseph.
Obviously, serious ethical issues were involved. These issues are highly complex, and we can only comment on the considerations which guided us in employing these procedures. It should first be reiterated that it was on ethical grounds that we turned away from the study of identity in normal children, to work instead with psychotic subjects; with such people, we hoped there might be, therapeutically, little to lose and, hopefully, a good deal to gain. Second, we always proceeded cautiously with the men, assessed their emotional reactions at every step, and were ever ready to back off if we thought it advisable. Third, we always consulted the psychiatric staff at Ypsilanti State Hospital, particularly Dr. O. R. Yoder, Medical Superintendent, and Dr. Kenneth B. Moore, Assistant Medical Superintendent, before embarking on a new experimental procedure, thus obtaining independent checks on our ethical judgment. Fourth, the three men continued eagerly to attend our meetings despite the procedures employed. Had they refused, or had they refused to deal with one another or with us, that would have been the end of it. When Joseph, for example, objected to working in the vegetable room with Leon and Clyde, we changed his work assignment. Fifth, as we got to know the three men better, we were impressed by the fact that their defenses were powerful enough to counter any threat they could not cope with on a realistic level. Sixth, we were cognizant of Frieda Fromm-Reichmann’s observation: “… we no longer treat the patients with the utter caution of bygone days. They are sensitive but not frail.”[1]
Finally, the messages we were going to send Leon and Joseph from their delusional referents were to be composed in such a way as to be supportive and emotionally gratifying. Above all, they must contain suggestions designed to ameliorate the men’s unhappy condition.
[1]Theodore M. Newcomb: Personality and Social Change (New York: Dryden; 1943).
[2]Bruno Bettelheim: “Individual and Mass Behavior in Extreme Situations,” Journal of Abnormal and Social Psychology, Vol. 38 (1943), pp. 417–52.
[3]K. Lewin: Resolving Social Conflicts (New York: Harper; 1948); J. Adelson: “A Study of Minority Group Authoritarianism,” Journal of Abnormal and Social Psychology, Vol. 48 (1953), pp. 477–85.
[4]Lifton and Shein: op. cit.
[5]Lifton: ibid., p. 218.
[6]“The concept of transference is applied by Freud to schizophrenia in a negative way. According to him, all the libido in the schizophrenic is withdrawn from external objects, and therefore no transference, no attachment for the analyst, is possible. The result is that the patient is scarcely accessible to analytic treatment.” Sylvano Arieti: Interpretations of Schizophrenia (New York: Robert Brunner; 1955), p. 26.
[7]Strictly speaking, Leon’s “uncle” was not completely a figment of his imagination. Early in Leon’s stay at Ypsilanti there had been an aide by the name of George Bernard Brown, and this aide, from what Leon told us, had developed an unusually positive relationship with Leon before he left for another job. After his departure, Leon had apparently “canonized” him.
[8] Norman Cameron: “Paranoid Conditions and Paranoia,” in S. Arieti (Ed.): American Handbook of Psychiatry (New York: Basic Books; 1959), pp. 518–19.
[9]Cameron: “The Paranoid Pseudo-Community Revisited,” American Journal of Sociology, Vol. 65 (1959), p. 56.
[1]Frieda Fromm-Reichmann: Psychoanalysis and Psychotherapy. Selected Papers, D. M. Bullard (Ed.) (Chicago: University of Chicago Press; 1959), p. 204.
CHAPTER XII
ENTER MADAME DUNG
ACTUALLY it was Leon who first brought up the subject. One day, back in April of 1960, he had asked: “How much is an 1898 two-dollar bill worth?” and had then gone on to explain that he was expecting a letter from his wife—with an 1898 two-dollar bill enclosed. A week later he announced that the letter was delayed because the mail had been tampered with.
What could these announcements possibly mean? In his classic work, Dementia Praecox, Blueler says that schizophrenics use a “double-entry bookkeeping” system, and that they know and can really distinguish reality from fantasy. In our dealings with Leon we sometimes had the impression that this was indeed the case, that although he had complex, difficult-to-understand psychological reasons for all the delusional things he said, he did not really mean them or believe in them himself. He wanted us to believe he believed when in fact he did not. On the other hand, it was extremely difficult for us to conceive that Leon, intelligent, shrewd, and sensitive as he was, could possibly make such utterly fantastic statements as, for example, that he was married, and that his wife’s name was Madame Yeti, unless he himself really believed these things were true.
Did Leon really believe in the existence of his wife? Did he really expect to hear from her? And what was the significance of his announcement of what he expected to find in the letter? Was he “inviting” us to send him money through such devious means, or was he only trying to tell us indirectly how much he needed, and yet despaired of obtaining, even cosmic—as he would say—companionship and care?
It was not until August 1, 1960, some four months later (after we had concluded that the first phase of the research had run its course), that we were able to pursue more systematically the questions raised by this behavior of Leon’s, and—at the same time —by the theoretical problem of the nature of reference or authority systems that was raised in the last chapter. In undertaking this new project, we had a twofold purpose: to find out empirically as best we could to what extent Leon really believed in the existence of his delusio
nal wife; and if he did believe, to find out whether changes in his delusions and behavior could be brought about through suggestions emanating from her rather than from us. The events relevant to this second purpose will be described in the next chapter. In the present chapter, I shall describe how we went about determining the psychological reality of Leon’s delusional wife.
The Reality of Delusion
August 1. A couple of hours before the daily meeting, an aide delivers a letter to Leon. It is addressed to Dr. R. I. Dung and has no return address. The aide explains that a lady approached him as he was walking down the main street of the hospital grounds and asked him to deliver it to Dr. Dung in Ward D-16. Leon, after thanking the aide, takes the letter and reads it.
The contents, which of course we knew, are as follows:
Dr. R. I. Dung
Ward D-16
Ypsilanti State Hospital
My dear husband,
I have been aware on Channel 1 that you have been waiting for me to visit for you a very long time. If the good Lord permits I will visit you at the Ypsilanti State Hospital on Ward D-16 on this Thursday at 1 o’clock.
Sincerely,
Madame Dr. R. I. Dung
Leon’s initial response is disbelief. Without divulging the contents of the letter, he tells the aide that although he has never seen his wife’s handwriting he knows that she didn’t write or sign this letter. He says further that he doesn’t like the idea of people imposing on his beliefs and that he is going to look into this.
A couple of hours later, during the daily meeting, we notice that Leon is extremely depressed and we ask him why. He evasively replies that he is meditating, but he does not mention the letter. This is the first time, as far as we know, that he has ever kept information from us.
August 4. This is the day Leon’s wife is supposed to visit him. He goes outdoors shortly before the appointed hour and does not return until it is well past.
In the next two weeks we made no further attempts either to send messages or to interview Leon about his attitudes or reactions to the letter. After all, we were not even supposed to know that he had received a letter. At all costs we wished to prevent him from becoming suspicious about our role.
Not much happened during this period, except that Leon seemed more depressed than usual and was more openly hostile to the female visitors (Friends Service Committee summer volunteers) who occasionally sat in on the daily meetings; he did not even respond to introductions in his usual polite and often gracious way. He complained that he was tired of having his time taken up with meetings and would rather be left alone to spend it in introspective prayer and silence.
To one of the Friends volunteers Leon explains the meaning of duping, saying that things would be different after the final shaking off, which was imminent. “Mr. Cassel will get what he’s asking for; that is, his transfer and discharge from the hospital. He wants to be himself and so do I.”
August 18. Meeting. After the usual song, and aide comes in to say that Leon is wanted on the telephone. Joseph wonders aloud who could be calling him. Leon returns shortly and when asked who it was says it was a woman who accused him falsely of not being in the ward. He doesn’t go for falsehood, he says, but he isn’t sure whether it was his wife or not. “It will get straightened out,” he concludes.
After the meeting adjourns, we interview the aide who overheard the telephone conversation. After Leon hung up, the aide tells us, he asked Leon who it was. Leon replied that the phone call came from a special person and that if it was who he thought it was he would be happy to see her.
That afternoon Leon stays in his room meditating and praying for almost two hours. He then goes outdoors but, since curfew time is near, returns shortly.
August 19. Leon informs an aide that his wife’s maiden name is Ruth and that he is sorry he missed her on Thursday, when she had come to visit him.
August 20. At the meeting, Leon says that he misunderstood the woman on the telephone, which is why he claimed to be in the ward when in fact he wasn’t. He says that, since he had waited for his wife the “previous Thursday” instead of Thursday, August 4, she was speaking the truth. He adds that he is glad his wife is interested in him.
August 23. At the meeting, the research assistant tells Leon he would like to meet his wife. Would Leon let him know when she’s coming?
“No, I will not let you know. You’re the one that’s interfering with—Mr. Rokeach and the rest of the cohorts.”
—Will Joseph get to meet her?—
“He knows my wife. He sees her cosmic image.”
“I don’t know your wife,” Joseph says. “I’m not interested in you or your wife.”
Later, the aide notices Leon sitting quietly alone in his sitting room, smoking and meditating. When the aide asks if he has heard from his wife again, Leon replies that he has not, but that he expects to soon; he has asked Almighty God to let her appear to him in any form.
August 24. Leon receives another letter:
Dr. R. I. Dung
Ward D-16
Ypsilanti State Hospital
My dear husband,
I am very glad I had the opportunity to speak to you over the telephone last week.
Please accept the little gift I am enclosing since I know by observation of Channel 1 that you need a positive cigarette holder. I think you will enjoy this one since it also has a cosmic boupher.
Sincerely yours,
Madame Yeti Woman
At the meeting we say that the aide told us he had delivered a letter to Leon a few hours before. Leon comments that there might be an infringement on his emotional life, and that he has to wait to find out whether this was really his wife or whether the aide is only trying to amuse himself. He says he is disturbed because she hasn’t come right out and spoken to him; therefore, he has thrown away the cigarette holder.
But, apparently reconsidering the matter, he shortly afterwards retrieves the cigarette holder from the wastepaper basket.
August 26. Leon approaches the aide who delivered the letter and tells him that he saw his wife on the grounds today. He apologizes to the aide for having wrongly accused him of trying to dupe him, stating that it was definitely his wife that the aide had seen.
August 27. At the meeting, Leon says he saw his wife yesterday on the hospital grounds but did not speak to her because of interference. He tells us that she is in her fifties but looks to be in her forties. When we try to probe further into his reactions to the letters, he becomes reluctant and says it’s personal. He accuses me of using interference, and thus of being responsible for preventing him from speaking to his wife.
Leon goes on to say that he was killed on August 18 (the day he received the phone call) and that on this day he received a merciful gift: a body.
I ask Joseph what he thinks about all this, and Joseph replies: “If he says he’s got a wife, he’s got a wife.”
Turning once again to Leon, I remark that I have always believed that his wife is merely an invention of his imagination. But, I say, I am amazed and frankly at a loss to understand the phone call and the letters. May I see the letters as proof? Leon replies that he doesn’t have the letters, that he flushed them down the toilet so they could be “processed into truthful-idealed dung.”
Thus far, the results seemed inconclusive. We could not tell with any degree of certainty whether Leon believed or disbelieved, whether he accepted the messages as genuine or rejected them as a hoax. There appeared to be some ambivalence in his reactions. But after all, the messages themselves had not required Leon to do anything out of the ordinary, and this fact in itself might have been responsible for our inability to come to any firm conclusions about his attitude toward them. We therefore decided so to phrase the next message that it would require him to respond with behavior rather than with words. We recalled that Leon, who had no use for money, never went to the employees’ store, which was also open to the patients. Suppose his wife were to suggest they have a r
endezvous there?
August 31. Leon receives the following letter:
My dear husband,
I am very happy to say that I will be at the hospital today, August 31, and tomorrow, and I hope that you will come to see me in the Employees’ Store at 5:15 p.m. each day.
I am looking foward to seeing you after all this time and I hope that you will be able to recognize me.
Sincerely yours,
Madame Yeti Woman
After reading the letter, Leon tears it up into small pieces and throws it into the wastepaper basket. Later, at the meeting, he says that he received it today. He adds that he is going to take a bath, so that if he kisses his wife she won’t fall over. He says she is very understanding but that she can be very strict.
The Three Christs of Ypsilanti Page 22
