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TO BE OR NOT TO BE THAT IS THE QUESTION by Ralph B. Allison, M.D. (With thanks to W. Shakespeare) Submitted for Publication October 10, 1993 to Bulletin of Anomalous Experience David Gotlib, M.D., Editor 1365 Yonge Street, Suite 200 Toronto, Ontario, Canada M4& 2P7 Much of the debate about the stories told therapists of abduction by UFO's or Satanic Ritual Abuse in families may be the result of difficulties the therapists are having rather than the problems of the patient. Patients approach advertised professional therapists, expecting treatment for what ails them, and the therapists may have difficulty deciding what role to play. Their common choices are Shaman, forensic reporter, or detective. I suggest that it is impossible for one person to play all of these roles with one patient/client/suspect. Attempts to do so may have been responsible for much of the debate about whether the patient/client/suspect is telling "the truth." I should know, since I have tried to play all these roles myself, at one time or another, and I now realize the futility of such an unrealistic attempt to be so "flexible" in one's professional life. This is especially true when dealing with certain types of patients. Most individuals who come for therapy have a degree of inner anxiety that has risen to a level that they can no longer stand. They come for "diagnosis and treatment" to one who has publicly offered to play a helper role to the general public. What the patient needs is a Shaman, someone whom they invite to join them on their shamanic journey. Together, they can explore the world of ideas, emotions, fantasies, and physical discomfort in which the patient resides. Patients are very particular about whom they invite along on such journeys. They need someone who can share their experiences, who can accept what they experience as valid (in contrast to bad, evil, or worthless), and one who has taken sufficient previous similar journeys so that he/she can help the patient make sense out of the trip. I use the word Shaman as the ancient term to describe the healer the tribe recognized, but today that person may be called doctor, physician, psychotherapist, therapist, psychologist, healer, counselor, guide, support person, etc. When I attended medical school, no professor even mentioned the word "Shaman," and I did not become acquainted with the extensive history of this professional role until I met anthropologists who studied healing methods around the world. Some of them had learned to be Shamans, and they described the shamanic journeys they went on in the "other world" where animal spirits were seen as protectors of them and their patients. Only then did I realize that, during my years of psychotherapy practice with dissociating patients, I had "invented" a number of shamanic techniques. In discussions with these "anthropologists of consciousness," I learned that my "innovative" techniques had been in use for centuries in many cultures around the world. Since no one had never taught me any of these procedures in medical school or psychiatric residency, I thought I was being creative when I "invented" them and used them with dissociating patients. After my formal psychiatric training, I attended hypnosis classes and Mind Dynamics courses, and I watched rituals performed by a priest who had trained with a Native American medicine man. I also realized I needed to have "symbolic" techniques that transformed mental concepts of my patients into three dimensional reality. I "invented" techniques to assist my patients' progress through their torturous mental journeys. My overriding goal was to bring the patients to a state of improved mental health, so they could lead productive lives in our 20th century environment. That goal had been drilled into me during my medical and psychiatric training. While going through shamanic journeys, patients told me strange stories about their histories, past lives, family members and significant others. Once, a dissociating patient reported, in hypnosis, that she had killed her stepfather and his two friends after they had attempted to kill her. When she was awake, I informed her what she had told me while in trance. She picked up my phone to call the police and turn herself in. I asked what evidence she would give the police to demonstrate her guilt for three "murders," as she had described hiding the bodies in distant states and in Canada. After she decided she had nothing physical to prove her "memory" was accurate, she put down the phone. As her mother was her only financial and moral supporter at the time, I resisted the urge to play detective. If I asked the mother what had happened to her second husband, she would want to know why. If she thought her daughter had killed him, that could destroy my patient's support system. On the other hand, she might have met him for lunch the previous week, for all I knew. If that were true, what was I to tell the patient? Satisfaction of my curiosity was not worth the risk of either outcome. Other patients have ended up in the hands of police and courts, who looked to me, as the therapist, to explain what was going on. Then I was forced into the role of the forensic reporter, where my goal was different, but the patient/suspect was the same. What was I to do? In an ideal world, I could have stayed out of the legal arena and insisted that the legal authorities bring in an outside expert to advise them. Once, I was the Program Chief of the local mental health service and one of only two psychiatrists in the county. My office partner was the other one, and he had enough work to do without taking on my cases. Also the legal authorities often considered me the only one knowledgeable about the patient/client/suspect, and they expected me to tell them enough to solve the legal problem without harming the patient. They had no desire to convict a mentally ill patient of mine if I could give them valid reasons not to do so. A forensic reporter plays a completely different role with the client and is assigned to the case by a court or defense attorney. The reporter must quiz and examine the client to determine evidence of mental illness, as he would any patient, but his/her database is much larger than that used in a therapy situation. The reporter must review whatever documents are available that might enlighten him/her about the client's past behavior. Some of these documents have primary information, such as school or hospital records, but some have only secondary, and possibly unreliable, information, such as police interviews of witnesses and accomplices. Sometimes attorneys will hide important documents from him/her when they are trying to bias his/her report in a direction favorable to their clients. The forensic reporter is beholden to the legal authorities for payment, and those officials must understand his report. The authorities ask questions that are in the involved legal statute, and the report must address those questions or the case will be referred on to other experts for further evaluations. The reporter is not in the position of providing treatment to the client, who may now be under the care of a jail physician. When I was the only psychiatrist in a slum area mental health clinic, I treated many psychotic patients. One of my delusional patients invaded an elderly couple's home and accused them of stealing the house from his cousin. The police arrested him and took him in the county jail, where I conducted psychiatric sick call every Tuesday afternoon. I told the public defender this man was mentally ill, without giving details. He asked the court for a psychiatric examination regarding competency to stand trial. The judge appointed me to be the forensic reporter on the case. I responded that he was incompetent to stand trial. The law required a representative of the Director of Mental Health to recommend the proper place for treatment, and the director asked me to write that report, advising admission to the state hospital. When the hospital's staff recommended his return to court as competent, the judge asked me to write the report about his ability to stand trial. When the defendant pled insanity, I wrote the report on that issue also, with a recommendation that he had recovered his sanity and could return home. After release, he resumed treatment as my clinic patient. That is not the way these matters are supposed to be handled, as the chances for a conflict of interest on my part were rampant. But in that small county, where I had a number of assignments while working for the mental health service, the officials trusted me to be ethical and professional in telling them what I wanted to about my patient. After his arrest, I switched roles every time I saw him. Fortunately he was a chronic schizophrenic and not a dissociator. He did not appear to suffer from the changes in our relationship, as he was usually in his delusional world. That would not be true when the patient/client is someone who has a severe character disorder, especially someone who used dissociative defenses extensively. With those patients, severe transference and countertransference problems will inevitably arise. The third role we therapists are tempted to play is detective. That is the one I see as causing the trouble leading to the rhetoric surrounding the debate over true or false memories, be they Satanic Ritual Abuse or UFO survivor stories. To some degree, I blame TV for fostering the idea that anyone can be a good detective, that none of us need training or experience to solve crimes. Certainly, none of us therapists need be aware of the rules of evidence adopted by our criminal courts! Two of my favorite shows are "Murder She Wrote" and "Father Dowling Mysteries." Every week, I see examples of a writer, Jessica Fletcher, outwitting the local sheriff and identifying the killer each time. Where does she get the time and energy to track down the clues needed to find so many criminals in her small town, when she should be doing research and writing every day? Why doesn't the sheriff ever find the criminal with his own staff? In "Father Dowling Mysteries," I see a priest and nun, Sister Stephanie, totally neglecting the daily duties of the parish and traipsing all over town chasing down crooks before the police even know someone has committed a crime. Where do they find time to do all that investigative leg work, while they are locked in freezers and dressed up as bug exterminators, when the parish has a long list of activities they should attend to? What bishop would put up with such negligence for long? Shows like these, plus many others, give the impression that detective work is suitable for the amateur, and it is not! I have had numerous patients tell me stories of incidents that I wish I could check out. For example, one dissociating patient went into a spontaneous trance and told me that her first born daughter, who had been taken from her by her grandmother and adopted out at birth, had just died in a car crash at a designated rural intersection in Fresno county. For the first time, I had a story I could check out, but I had no idea how to persuade the Highway Patrol let me see records of accidents in Fresno county on the day reported. Three days later, I learned from her Inner Self Helper that the imagery had been concocted by her inner therapists to give her a chance to grieve over the loss of that child. There was no accident! Fortunately, I had not contacted the Highway Patrol, so I avoided looking like a fool, had they had been cooperative enough to investigate my story and learn no such accident had occurred that day at that intersection. During my first year of providing psychiatric services in prison, an inmate with multiple personality disorder told me that, before his arrest for car theft, he had shot 11 motorists on the highways of our state. As an employee of the Department of Corrections with a responsibility to report crimes inmates admitted committing, I sent a report to the prison Security Squad. They forwarded the report to a department in the Central Office that investigates such stories. They checked every county this man had lived in, according to his police records, and found no reports of shot motorists on any highways anywhere in those counties. The Security Squad officer relayed this information back to me, but I never told the patient. Later, I discovered that the alter-personality that reported these "killings" was one that was there "to get the attention of the doctor." He only came out when he felt that I was not taking the patient seriously. Then he would say and do something that no one could ignore. He performed his mission very well! The other factor that therapists seem to be unaware of is the change in the Shaman-patient relationship that must occur when the Shaman tries to be a detective. The Shaman is privileged to be invited along on the mental journey with the patient, and, to stay invited, the Shaman must appreciate and accept the reality of the journey. This does not mean that the Shaman has to agree with or like everything the patient says or does, but he has to identify with the patient enough to be able to understand what the patient is experiencing. When one dons the uniform of the detective, one must consider all persons involved as possible suspects, and one must doubt the veracity of any suspect. A professional investigator also keeps secret what previous suspects and witnesses have told him, so that a subsequent suspect will not know what to confirm or deny to keep a fabricated story straight. During my involvement in a malpractice case, an investigator from the California Medical Board interrogated me regarding the actions of a misbehaving psychologist. The investigator was a former police officer who tried hard not to brag about how much he had learned from other witnesses. I tried my best to get him to tell me what he already knew so I could emphasize the points needed to counter what the psychologist had said that cast me in a bad light. We played cat and mouse with each other, since I wanted to make myself look as good as possible. Only by being the subject of an investigation did I come to appreciate the relationship that develops between the interrogator and the witness or suspect. The investigator must be suspicious of your every word, and he will not believe you unless you agree with other reliable sources. In my case, I used his personal pride to get him to tell me what the other witnesses had already told him, so I could be sure to include facts favorable to my position. When a therapist has had an accepting relationship with a patient and then turns into a detective, the patient will perceive the therapist as "not trusting me." This change can forever cause the patient/client/suspect to refuse to divulge any more secrets to that person. Therapy will cease immediately, and any new therapist who tries to gain the confidence of the patient will face doubt and mistrust in return. All therapists are curious people by nature, or we could not listen to so many tales of woe. But, if our goal is the improved health of the patient who came to us with pain and bewilderment, then we must stay in the role of Shaman. The patient has graciously invited us to share the journey so that we, as Shamans, can add our own experience, judgment and insight to that of the patient, so that together we can find meaning to and resolution of the patient's plight. When our patients are in legal trouble, someone else should be the forensic reporter, while we continue to support them through this part of their journey. We must let the professional detectives do the job they trained to do, to ferret out the "consensual truth" and determine who are the liars. Detectives cannot be therapists, and therapists cannot be detectives. 



  Copyright© 2017 - Ralph B. Allison