How a Dangerous Patient Got That Way

April 30, 2013

Brave Merida

When I first saw “Mr. X” in my waiting room, I thought his head was on fire. Striking, spiked red hair aflame. My mistake. It was his heart.

Before long, he would be on the verge of doing harm. Or, as he saw it, putting things right; being something like an avenging angel on the side of all that he believed to be just and good; a kind of holy warrior.

This is the story of how he went from being depressed and disgruntled to someone who might kill. But it is also a story about what happens when hearts are inflamed with rage.

Until only a short time before the “X-Man” consulted me, he was the sort of guy who, when you saw him in a crowd, the crowd stood out. Hardly a mutant superhero. His physical stature and undistinguished facial features made him appear to be an average man in every way: average nose, average mouth, average height — you get the picture. Back then his hair was conservatively fashioned, not spiked, and my patient colored it a less startling shade.

Mr. X did not welcome attention, you see. Attention in his life had never signaled kindness.

His parents were unkind. His teachers had been unkind. His first wife was unkind. And his kids wanted no part of him other than financial support. They believed his first wife, who said that he was a scoundrel. Thus, we have a man who was abused and neglected, bullied by school mates, and badly treated by wife #1. The divorce had been financially ruinous and somehow that woman had managed to win his children’s favor.

The X-Person was reasonably bright and worked in a technical field of endeavor. He’d made a decent living, but watched as others surpassed him. Some of them were minorities, and rather than looking at possible short-comings in himself (his relatively clumsy social skills, for example), he thought that they were getting unfair promotion. In short, he became a bigot.

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Then the final blow: a financial downturn and the loss of his job. He came to me after several months of a futile job search. He was both depressed and embittered. My patient had tried to play by the rules and, it seemed to him, the referee was always penalizing him. Having no close friends, the only things he could count on were his second wife’s support and that of his religious faith, which he relied on more and more. It was not the religion of his parents, but one that he’d chosen some time after his divorce.

Therapy was aimed at keeping him afloat emotionally so that he could succeed in finding a proper job. To the extent that he opened himself to looking at his life of travail, the treatment attempted to help him grieve his losses. But, let’s just say that the goal of keeping him from curling into a ball was working, while relieving him of his back-pack of unresolved grief was not.

Several months in, however, it was clear that he was beginning to think about violence. Acting out. Targeting others. And he increasingly saw the religious texts that he faithfully read as indicating that wrong was being done in the world and that it was his job to right that wrong. Indeed, he felt that it would be irresponsible and sacrilegious not to.

Interestingly, Mr. X was untroubled by war and wished to have no part in supporting it or protesting it. Nor was he concerned with children who were abandoned or starving. No, his concern was for the unborn, but his anger was against those who conspired to prevent their birth. Specifically, physicians who performed abortions.

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This X-Man was uncomfortable after telling me this. He was more than smart enough to recognize that, if he talked about a plan of action or specified a target, I was required to report him to those authorities who might prevent the worst. When I questioned him about the inconsistency between valuing the lives of the unborn and the likelihood of destroying lives of innocent bystanders in addition to the “murderers” he hated, he brushed-off the thought. When I mentioned the commandment “Thou shalt not kill,” he was unfazed. Yet it came from the book he called “holy.”

To my patient, there was no problem in killing the MDs, and anyone else who might die in addition to the doctors would be “collateral damage,” worth the accomplishment of his goal. He did not expect to be punished by the god he worshipped and didn’t care what civil authorities might do to him.

It was clear to him and to me that my concern about potential carnage (he denied “yet” having a plan and claimed he hadn’t definitely decided to do anything) was getting in the way of his treatment. Within a few weeks he indicated that he could no longer trust me because I seemed too concerned about “the others” who, he believed, were beneath contempt. He wasn’t sure if he wanted another therapist when I offered to help him find one, because, he said, “They’d have to report me, too.” Assuming, of course, that he went further with his thinking and actually did come up with a plan and a specific target.

When he terminated therapy I was worried. I continued to try to keep phone contact, calling him every few weeks. And, before long, there was a change. The X-Man landed a job. He sounded buoyant, no longer angry, and free of the obsessive preoccupation with going out of this world in a glorious bloodbath, along with the evil soul or souls whose existence he wanted to erase. This frustrated man was frustrated no more, throwing himself into a job that felt fulfilling and interesting. And I breathed a sigh of relief.

As I look back on that man and that time, I sometimes think about what it takes to go over the line. Would this X-Man, lacking X-Men-like super powers that might have made him feel better about himself, have killed if he hadn’t found work just then? I think he might have. Would he have killed only because his religion saw his targets as sinning? No. With a different religion or no religion, he still could have justified his action. Righteous anger is always self-justifying.

Most, if not all religious documents are like a Rorschach Inkblot: one person looks at the picture and sees a butterfly, while another looks at the same picture and sees a vampire bat. The Bible recommends stoning as the punishment for adultery, but we haven’t heard of too many Jews or Christians taking that point seriously lately. In religion, interpretation is everything. No, this man could have been almost any isolated soul who had a sorry history of disappointment, heartbreak, and failed attempts to make his life better; and a bunch of anger ready to blossom into a mushroom cloud.

Nagasaki, 20 Minutes After the Atomic Bomb Explosion in 1945

Nagasaki, 20 Minutes After the Atomic Bomb Explosion in 1945

We humans look for justification for our actions, sometimes before we act, but always after. And we tend to find it. “They’ve got weapons of mass destruction,” said the government, “so let’s invade Iraq before they kill us.” “Slavery is in the Bible (and is not there rebuked) so God intended for us to keep slaves,” as the slave-holding Southern States used to argue. Even the god described in the first book of the Bible, the Book of Genesis, is the intelligent designer of the first-ever genocide, which we conveniently think of as the benign story of Noah and the Ark. God’s reasons?

The LORD saw that the wickedness of humankind was great in the earth, and that every inclination of the thoughts of their hearts was only evil continually.  And the LORD was sorry that he had made humankind on the earth, and it grieved him to his heart. (Genesis 6.5 and 6.6).

As Blaise Pascal said, “The heart has its reasons of which reason knows nothing.”

The top image comes from the movie Brave. Some details of this story have been changed to protect the identity of the patient.


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