Keith Russell Ablow

“A man like Kappler might become angriest, most detached, even sickest at those times his psychiatrist edges closest to the truths about his life. The rage and even the psychosis has to be seen for what it is: the flamethrower of a fortress under siege. Pleasantries, humor, and easy exchanges might be clues that no real work is being done. There can be no retreat on the psychiatrist's part. One patient with a psychotic illness has written: "the doctor has to feel sure he has the right to break into the illness, just as a parent knows he has the right to walk into a baby's room, no matter what the baby feels about it. The doctor has to know he's doing the right thing...some people go through life with vomit on their lips. You can feel their terrible hunger but they defy you to feed them.”

“For nearly a hundred years, psychiatry has been striving to apply medical model thinking to psychiatric disorders. In this model, the symptoms besieging patients are sorted into specific disease entities and the causes then identified and removed. For doctors of internal medicine, this works. In the case of diabetes mellitus, for example, the symptoms of urinary frequency, fatigue, and confusion often lead to suspicion of the underlying cause, which is confirmed by blood sugar monitoring and then treated by insulin replacement.But psychiatric symptoms are much harder to sort into diagnoses. People with depression sometimes become paranoid. People with schizophrenia sometimes become depressed. Some people who hear voices have no other symptoms whatsoever, and others who hear voices also fall victim to terrible mood swings. Thus far, the hope that psychiatry would be able to identify homogeneous disease states, uncover the biological underpinnings, and remedy them has been largely a barren one. Kappler's symptoms, however, evolved when the hope for psychiatry's becoming a true medical specialty was bright to the point of being blinding. Over the years he would collect over a dozen diagnoses and cavalierly take a myriad of medicines, but no one would be able to bring him close to confronting the past he had disowned, to stand a chance of making peace with it and, ultimately, overcoming it. (46)”