Speaking of untreated severe mental illness, there was this patient of mine:
I first began treating him when he was in his mid 60s and he mercifully -for me- passed away in his mid 90s. He ran a very successful paper distribution business and had two sons, one who was diagnosed schizophrenic, and the other who was diagnosed schizotypal. His thoughts style was unlike anyone’s I’ve ever met before or since. The conversations I had with him were nearly indescribable because his frame of reference was so variable at any given instant that you never knew what sentence was going to come out of his mouth next.
What he would do routinely is take a supposition real or imagined, begin with a rational approach, and then diverge into what could be best described as fantastical, surrealistic, impossible to believe, but within the bounds of rationality, such that there was a finite chance that it might possibly have happened, but you sincerely doubted it. He would also segue from one subject to another with no intermediary, punctuation, or hesitation in his speech. I shall give you a virtually quoted rant, which he executed for me one time.
“You know, that woman, Hillary Clinton, the one in the White House? I really can’t stand her because she is not acting like a first lady should and takes way too much upon herself as though she’s speaking for the country, but nobody elected her. If I had a chance to talk to her, I would tell her this and then after I tell her this, she said to me that I was out of line and then I told her that she was the one who was out of line and what was she gonna do about it you know that filling you did for me last week bothered me for a couple days but I asked my son about it and he told me that it was probably OK. My wife wasn’t feeling well so I couldn’t ask her about it and anyway she wouldn’t wanna listen because she is having her own problems, including her back hurting and I told her it probably hurts because she hasn’t had sex with me for a while and all that muscle tension is all built up.and she needs to let it out or it’s going to kill her and when I asked the doctor about that, he told me that wasn’t true, but I know he’s lying because he wants to have sex with my wife and doesn’t want me to because I know I’m better at it than he is because his wife, who I met at the appliance store looks frustrated.”
This guy used to show up at 6 AM two out of three Saturdays and make me absolutely insane. The problem was that he was a 33rd° Mason and I treated all these people from the Masonic Temple who were both afraid of him and quietly hated his guts, but told me in no uncertain terms that it would be a bad idea to stop treating him and I am not to ask them why that would be . You think it’s easy being a healthcare practitioner don’t you?
So one day, I asked his delivery driver how he was able to maintain such a good business because he was crazy, so crazy, and the delivery driver said something really interesting. He said “OK, you own a pizzeria and the weekend is coming up and you are going to sell between 250 and 300 pies. If you don’t have the boxes, what are you going to do, put it on a napkin and tell them “good luck“? He always made sure that the deliveries were made whether it was to a diner with 30,000 napkins or a stadium that needed 5000 rolls of toilet paper. Unlike the big companies, he was never late and never needed to have excuses.“
My point all this is that he was a complete lunatic but functioned in business and society and yet by any measure, he needed severe psychiatric intervention, but in his case, to what end? As far as he was concerned, he was a success and “normal“.
The punch line for all of this was when he was in his 90s he really pissed me off one day, and I said to him “Aren’t you ever going to die?” And his reply, classic, was “not until all my enemies are dead… And that includes YOU!” I couldn’t stop laughing
But he was in my dental office, and this other lunatic is living on Pennsylvania Avenue, at least some of the time.
What a fucked-up world.
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